中醫治療情緒性脫髮之醫案報告

現代人更重視外表，因掉髮造成的外觀不雅更令患者感到困擾。脫髮的原因有因造髮營養不足供應，有因遺傳性體質，有因內分泌甲狀腺功能低下，有因自體免疫系統攻擊毛囊，更多的因素是因皮膚相關疾病致頭髮難以生長。中醫對脫髮描述從古籍中可得一瞥，秦漢時期對脫髮的病因已有初步認識；隋代對脫髮的病因病機闡述則包含內因及外因，主要是因自身體虛及風邪侵襲；治療方式則在唐代發展以祛風、清熱、養陰等法治療脫髮；後續醫家更闡述因外科癬病、血瘀的關聯性，本篇醫案希冀經由臨床的治療經驗與文獻探討，提供臨床中醫師有效的案例分享。本病例為一64歲女性，二個月持續掉髮，自述發病初始洗髮後即產生掉髮現象，數量約為每日一撮髮，初步檢視頭皮髮量稀疏；經檢視頭皮無明顯異樣。症狀起先始發生於二個多月前兒子輕生自殺，情緒低落每天哭泣，後續出現掉髮及眠差症狀，轉而尋求中醫治療。以中醫病因病機分析，研判因年老體衰、飲食過度控制、情志失調病因，造成化源不足、耗傷太過、臟腑受損、肝失疏泄病機發展，最後形成心氣陰虛、肝鬱氣滯、腎氣虛弱、氣血不足的證型。近程治療方向以心氣陰虛、肝鬱氣滯為主。治以養心益陰，疏肝解鬱，寧神安躁之法，一個月內顯著改善脫髮及眠差易醒的症狀。

關鍵字

脫髮；病因病機分析

並列摘要

The alopecia embarrass human being much more than before. Causes of alopecia included the lack of nutrition supplies, congenital abnormalities, hypothyroidism, and autoimmune system attacking hair follicles. Skin-related diseases inhibiting the growth of hair follicle is the most common cause. Tracing back, Chinese ancient books already had some description about alopecia. In the Qin and Han Dynasties, scholars had a preliminary understanding of the pathogen of alopecia. The pathogenesis and pathology in the Sui Dynasty included internal and external factors, mainly because of their own body and wind invasion. Traditional Chinese medicine in the Tang Dynasty developed expelling wind, heat clearing, nourishing yin and other methods of treatments. After that, surgical ringworm disease and blood stasis are believed to have correlation by following scholars with alopecia. This case aims to illustrate the clinical experiences, literatures, and to provide effective case-sharing to clinical Chinese medicine practitioners. This 64-year-old female had continuous alopecia for two months. Though the scalp hair was sparse, physical examination revealed no obvious scalp abnormalities. Symptoms right after her son committed suicide 2 months ago, the time she kept crying and underwent depression mood every day. Due to progressive hair loss and sleep disorders, she look for Chinese medicine treatment. According to pathogenesis and pathology analysis, we considered the pathogens due to old and exhausted, excessive diet control and emotional disorders, and the pathogenesis due to yield insufficiency, further exhaustion, liver failing to course freely. And finally bring out heart qi and yin formation deficiency, liver depression and qi stagnation, kidney deficiency, qi and blood deficiency syndrome types. We developed an effective treatment to those syndrome types; and nourishing the heart to calm the mind, dispersing stagnated liver qi for relieving, mind tranquilizing. We improve the alopecia and sleep difficulty symptoms within one month.