- 期刊
當歸飲子治療皮膚病的概況
Description on the Treatment of Skin Disease by Angelica Sinensis
摘要
自有人類以來即有皮膚疾病，古人認為那只是「皮毛之疾，不足為患」，而將之歸於外科學範疇。因此古籍中對皮膚病的相關記載雖多，卻較沒有系統的零散分載於古醫籍中。細究皮膚疾病的致病因素和致病機理，則是複雜而多樣的。皮膚疾病的外在表現如皮損、自覺症狀、舌象、脈象、全身症狀的變化等非常複雜，不同的皮膚病有著各自特殊的致病因素和病變機理。幸而中醫對皮膚病的致病原因和致病機理的認識，如同其他疾病一般從整體觀出發。認為皮膚病雖表現於皮表，其病因卻多是由於體內陰陽氣血的偏盛或偏衰，以及臟腑功能失調所致。雖然各式各樣的皮膚病，有著各自特殊不同的病因病機，但必定有其一定的規律性。中醫治療任何疾病都注重整體化，注重天人合一。治療皮膚疾病時也是一樣，一方面要針對皮膚損害做辨證，另一方面要從整體出發，明辨陰陽、寒熱、表裏、虛實、氣血、標本，和所有相關臟腑、經絡都要全面顧及。臨證之時只要能掌握住這樣的規律性，從整體觀，通過中醫辨證論治的法則分型治療。不論是多麼複雜變化的皮膚病，都可經由這些法則所立方藥達到滿意的療效。《外科理例》云：“然外科必本於內，知乎內以求乎外。”並提出了“治外必本諸內”的治療原則；《諸病源候論》云：“頭面生瘡係內熱外虛，風濕所乘。肺主氣，侯於皮毛。氣虛則膚腠開，為風濕所乘，脾主肌肉，內熱則脾氣溫，脾氣溫則肌肉生熱也，溼熱相搏身體皆生瘡。”《素問．至真要大論》云：“諸痛癢瘡，皆屬於心。”《外科啓玄》云：“瘡雖生於肌膚之外，而其根本源於臟腑之內。”又說“凡瘡瘍皆由五臟不和，六腑壅滯，則令經絡不通而所生焉。”這些論述反映出古人對瘡瘍的致病機理的基本觀。高錦庭《傷科臨證心得集》云：“夫外瘍之發也，不外乎陰陽、寒熱、表裏、虛實、氣血、標本，與內證異流而同源者也。其始或由六淫之氣所屬，或內被七情所傷。”《張氏醫通．諸血門》有云：“益氣與血，兩相維附，氣不得血則散而無統，血不得氣則凝而不流。”《瘍醫大全．癍疹門》云：“斑疹之發有外感風熱者，……也有陰虛血熱者，……此三焦無根之火，乘氣血之虛，而空發於上，怫鬱於皮毛血脈之中，內不得清，外不得散，遂發斑疹，乃陰虛屬里之證也。”足見氣、血的變化和盛衰與皮膚疾病有很大的關係；趙炳南也說：“皮膚瘡瘍雖形於外，而實於內。沒有內亂，不得有外患。”認為陰陽之平衡，衛氣營血之調和，臟腑經絡之通暢，與病損變化息息相關。總而言之，皮膚病的病因一如其他內科疾病般，不外內因：內傷七情。內發自臟腑，外形於肢體；外因：外感六淫，起於經絡，發於臟腑；不內外因：飲食饑飽不節，房勞損傷，虎狼蟲毒，金瘡壓溺等三種。臨證之時，掌握這樣的規律性的病因，謹守病機，審因用藥，不論是多麼複雜的中西醫病名，變化嚴重的皮損，必能立法處方而效驗。近代中醫採用當歸飲子加減治療各種不同的皮膚疾病，如濕疹、乾癬、疥瘡、蕁麻疹、銀屑病、異位性皮炎、皮膚搔癢症、白瘢風等，均獲得很好的療效，足見只要辨證分型準確，同病可以異治，異病亦可同治，選方用藥得當，都可達到滿意的治療效果。這是中醫辨證論治的獨到之處，也就是中醫的優勢。筆者在臨床亦常用當歸飲子加減治療各種不同的皮膚疾病，均能效驗。本文擬將這些相關臨床研究文獻略加整理，綜述於後。
並列摘要
Ther is skin disease since the existance of mankind. The ancestor thinks that it is ”only disease of skin, insufficient for suffer from”, so it is categoried to surgery scope. Though there are many records of the skin disease in ancient books, but it is not described systematically. It is complicated and various to study carefully causing the plain and pathogenic mechanism of the cause of skin disease in detailed. The symptoms of skin disease include the increase of external manifestation, subjective feelings, tongue symptom, pulse symptom, change of whole body etc., which is getting more complicated. Different skin diseases have each special cause, which can be explained by the pathological change mechanism. Fortunately, the understanding of pathogenic cause and pathogenic mechanism of the skin disease is generally conducted from whole view like other diseases in Chinese medicine. Think although the skin disease displays in the cover form, cause of disease but because internal negative and positive Chi and blood hold or decline simply, and internal organs function is sent to lack proper care. Though the skin disease of all kinds, each special different causes of disease are illness machine, but there must be its certain regularity. The doctor of traditional Chinese medicine treats any disease and pays attention to the harmony between man and nature. It is the same too while treating the skin disease, on one hand should damage and do dialectically to the skin, should be from set out wholly on the other hand, shrewd negative and positive fever and chills, outward show and inner thoughts, the actual situation, chi and blood, sample, take with all relevant internal organs, collateral channels into account in an all-round way. It can only know such regularity while facing the card, from the whole view, the rule dividing type managed through the dialectical theory of Chinese medicine is treated. No matter what skin disease of complicated change, can all reach satisfactory curative effect via these cubic medicine rules.