濕疹診治醫案

Diagnosis and Treatment of an Eczema Case

黃瀞瑩(Chin-Ying Huang):楊中賢(Chung-Hsien Yang)

濕疹 ； 陽虛 ； 風邪濕熱 ； 四逆湯 ； 黃連解毒湯 ； Eczema ； Yang vacuity ； Wind ； Dampness and heat ； Sini decoction ； Huanglian Jiedu decoction

臺灣中醫醫學雜誌

13卷1期（2015 / 03 / 30）

43 - 58

繁體中文

患者為一45歲男性，工作壓力大，平時嗜食甜食且過去有菸酒習慣。在高中某次飲酒後，首次出現全身癢疹，之後每年反覆發作，已歷20餘年。本次就診3至4日前皮膚癢疹又作，範圍分布於臉、項、軀幹、四肢，疹色紅暗，撫之潮濕且溫熱。患者素習慣溫飲，指甲色淡紅，唇色淡暗，濕疹病灶淡紅紫，舌質暗紅，苔白膩稍厚夾黃，裂紋，少津，有明顯朱點；脈浮弦滑數有力。證以陽虛為本，風邪濕熱，氣滯血瘀，內蘊肌膚為標，治以溫補陽氣，清熱瀉火，祛風利溼，調氣行血為主，處方用加味四逆湯合黃連解毒湯，症狀漸獲改善。

A forty five-year-old male experienced diffuse itching rashes after drinking alcohol when he was a senior in high school. After the first episode, the rashes occurred frequently during the following twenty years. He is a rigorous businessman under a huge amount of pressure due to his work. He has a habit of eating sweet foods, smoking cigarettes and drinking alcohol. During this onset, he noticed that there were multiple rashes appearing on the face, neck, trunk and four extremities, which have persisted for three to four days. The lesions are wet and warm, and the itchy parts are not always the same. He preferred warm food and drinks. His lips were pale and nails were pale and dark. The rashes were pale and purple. He has a dark tongue, and the tongue fur is white slimy with slight yellow and thick. The tongue body was dry with red speckles. The pulse was floating, string-like, slippery and rapid with power. After diagnosis using the four examinations, Yang vacuity was the root while dampness and heat with wind brewed in skin, liver qi stagnation and blood stasis were the tip of the disease. The treating methods of warming Yang and clearing heat, coursing wind and dispelling dampness, rectifying Qi and blood were applied. The modified Sini decoction and Huanglian Jiedu decoction were prescribed with noticeable effect.

1. （金）李東垣(2010).脾胃論.北京:人民衛生出版社.
2. 王沛,李曰慶,張燕生(1997).中醫外科治療大成.河北科學科技出版社.
3. 王彥暉(1997).中醫濕病學.人民衛生出版社.
4. 王敬義(2009).脈論.中醫古籍出版社.
5. 朱士宗,朱樺,陳光偉(2008).中醫外科講義.:中國醫藥大學.
6. 朱家瑜,張俊祥(2005).臨床皮膚科學圖譜.合記圖書出版社.
7. 何丹,李麗瓊,謝薇,楊莉,郝小枝(2013)。基於中醫體質學說優化濕疹辨證論治品質的一點思考。雲南中醫中藥雜誌，34(5)，13-15。
8. 徐金枝,龔麗萍(2012)。中醫藥治療濕疹臨床研究進展。江西中醫藥雜誌，7(43)，68-71。
9. 高建忠(2012).讀方思考與用方體會.中國中醫藥出版社.
10. 高書豔(2013)。中醫內科法治療濕疹60例。中國中醫藥現代遠程教育，18(11)，18-19。
11. 陳兆極(1983).中醫外科學釋義.文光圖書有限公司.
12. 陳書悅,宋為民(2007)。濕疹的中醫辨證論治進展。浙江中醫藥大學學報，31(4)，528-529。
13. 陳達灿(2005).皮膚性病科專病中醫臨床診治.人民衛生出版社.
14. 彭主榮,謝慶良,唐娜櫻(2005).方劑學.:中國醫藥大學.
15. 楊陽,馬淑然,楊楨,肖遙(2013)。濕疹辨治經驗之處方方法學辨析。中醫雜誌，54(12)，1010-1013。
16. 賈敏,鄒克揚(2002).中醫皮膚科臨床實踐.貴州科技出版社.
17. 蔣森(1989).濕熱論.南天書局.
18. 戴新民(1987).簡明中醫皮膚病學.啟業書局.

1. 陳香霓,呂琇蓉,王育才(2021)。中醫治療異位性皮膚炎之病例報告。中醫內科醫學雜誌，19(2)，81-91。