枇杷清肺饮加减治疗痤疮64例(中英对照专业论文).doc

枇杷清肺饮加减治疗痤疮64例（中英对照论文）顾炜 ( 辽宁中医学院 邮编：110032 )关键词: 枇杷清肺饮；痤疮；中医药治疗痤疮是指颜面、胸背肩等处发生炎症性丘疹、挤之有米粒碎样的白色粉质物质，初起为针尖大小位于毛囊口，有的呈黑头丘疹，若继续发展可产生脓疱、结节、囊肿、甚至疤痕。皮疹可散在分布，也可密集。病程缓慢，好发青春期的青年男女，所以又叫“青春痘”，属中医“粉刺”、“肺风粉刺”的范畴。临床较多见，本病虽有自愈倾向，但许多患者产生心理障碍，影响工作和学习。西医治疗通常采用对症处理以抗生素消炎为主，效果均不理想。近年来笔者采用枇杷清肺饮加减治疗痤疮64例，疗效满意，现报告如下。 The 64 cases of curing acne by taking the detergent lung with loquatAcne means that there are inflammatory papules on face, chest, back or shoulder, and there is white dusty substance like broken granule if you press it. At first, they are very little and at the edge of follicular pili, some of them are black papules, some days later, maybe become pustule, node, cyst, even scar. The rash sometimes are distributed separately, sometimes are dense. The time of this diseases progress is very long ,most of the patients are adolescent, so here is another name “pimple”, belongs to the “acne”, “lung feng acne” of Traditional Chinese Medicine .This is a common disease, and with the tendency of natural cure, but many sufferer result in psychogenic barrier and disturb their work and study. The method of western Medicine to treat the disease is using imipenem to reduce inflammation, but the effectiveness are not marked. Those years, the author had been mainly adapting the detergent lung with loquat to cure 64 cases of acne. This disease belongs to the acne of Traditional Chinese Medicine. Most because of the unreasonable food habit, eat bitter food too much, fall ill again because of infecting fentgxie, detergent and cure the disease which is caused by damp-heat of lung and stomach, and help to detoxify.1、 临床资料1.1一般资料 本组64例均选自门诊患者，其中男30例，女34例；年龄最小12岁，最大39岁；病程最短2个月，最长5年。皮疹部位：颜面64例，合并胸部10例，合并背部21例。1.2诊断标准 全部病例均按照中医病症诊断疗效标准粉刺的诊断依据进行诊断。2、治疗方法枇杷清肺饮组成：枇杷叶15g，北沙参10g，黄芩10g，黄连6g，栀子10g，桑白皮10g，金银花15g，连翘15g，升麻10g，皂刺5g，赤芍6g，芦根15g, 甘草5g。加减法：皮损色红明显者加生地10g，丹皮6g；结节囊肿者加浙贝母12g，夏枯草15g；脓疱加蒲公英15g，野菊花15g；皮脂溢出多者加山楂15g，白花蛇舌草15g；色素沉着加桃仁10g，丝瓜络6g；大便干者加大黄3g。水煎服，每日1剂。先用温水约200ml浸泡药物约30分钟，然后煎10分钟即可，重复再煎第二次，方法同前。将2次药水混匀分2次（早晚各1次）服用，两周为1疗程。每疗程间隔3天，治疗3个疗程统计结果。服药期忌食油腻辛辣食物。2、 疗效标准与治疗结果3.1疗效标准 依据中医病症诊断疗效标准分为治愈：皮损消退，自觉症状消失；好转：自觉症状明显减轻，皮损消退30%以上；未愈：皮损及症状均无变化或消退不足30%。3.1治疗结果 治愈46例，好转13例，未愈5例，总有效率92.2%。3、 讨论痤疮系毛囊皮脂腺单位的慢性疾病，西医认为痤疮的发病与雄性激素、游离脂肪酸刺激、毛囊漏斗部过度角化及病原微生物特别是痤疮丙酸杆菌引起的炎症作用有关。1其中，雄激素在痤疮的发病中起着重要作用，且这种作用是通过与雄激素受体（androgen receptor，AR）作用而发挥的。2本病属于祖国医学中粉刺的范畴，多因饮食不节，过食肥甘厚味，复感风邪而发病，治当清肺胃湿热、佐以解毒。正如医宗金鉴外科心法要诀载：“此证由肺经血热而成。每发于鼻，起碎疙瘩。宜服枇杷清肺饮”。枇杷清肺饮见于清代吴谦等编的医宗金鉴外科心法要诀，原方由人参、枇杷叶、甘草、黄连、桑白皮、黄柏六味药物组成，今昔对比去人参、黄柏，加入黄芩、金银花、连翘、栀子、赤芍、北沙参、升麻、皂刺。方中首选枇杷叶宣肺清热为主药，“保柔金而肃治节，香而不燥”（王孟英语），肺气降，一身之气皆降；肺与大肠相表里，肺气降，腑气通，积热因而得泄；肺乃娇脏，肺热叶枯，故配北沙参益肺气，清肺热，养胃生津；配黄芩、桑白皮清肺水；黄连清泄心胃之火；栀子清泄三焦；金银花、连翘清热解毒，且连翘泻火解毒，能消瘀散结，为疮家圣药；升麻升阳发表，透疹解毒，载药上行入肺胃二经，使脾升胃降，还其气化之常；佐以皂角刺托毒消肿，辛温反佐；赤芍凉血祛瘀，防止热与血结；芦根引热下行，使邪有出路；生甘草清热解毒，平调升降，调和