| 引用本文: |
田艺璨, 陶方泽, 周小敏, 曾庆琪.“病-证-症”视角下四物清疹汤辨治瘙痒性皮肤病的思路与方法[J].湖南中医药大学学报,2026,46(2):329-334[点击复制] |
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| “病-证-症”视角下四物清疹汤辨治瘙痒性皮肤病的思路与方法 |
| 田艺璨,陶方泽,周小敏,曾庆琪 |
| (南京中医药大学附属南京中医院, 江苏 南京 210022;南京市红十字医院, 江苏 南京 210001;江苏卫生健康职业学院, 江苏 南京 210029) |
| 摘要: |
| 四物清疹汤为山西名医张子琳治疗瘙痒性皮肤病的经验方，由四物汤化裁而来，以赤芍易白芍、生地黄代熟地黄，并加入苦参、白鲜皮、地肤子、蛇床子，共奏养血润燥、清热除湿、杀虫止痒之效。本文系统梳理该方在瘙痒性皮肤病治疗中的方药配伍特点，提出“血虚湿热，燥湿相混”为此类疾病的核心病机，并以“开阖枢”理论阐释其“内燥外湿”交织的复杂病理。在辨治策略上，从“痒疹”切入，构建“由症辨病，以病为纲，据证立法，随症加减”的辨治体系。临证强调在明确疾病诊断的基础上，紧扣证机，审因论治，并通过随症加减与合方应用拓展其治疗范围，适用于湿疹、荨麻疹等多种瘙痒性皮肤病。并附验案佐证，体现四物清疹汤调和气血、燮理阴阳之效，为临床活用该方治疗瘙痒性皮肤病提供理论与实践参考。 |
| 关键词: 瘙痒性皮肤病 病-证-症 血虚湿热 燥湿相混 开阖枢 四物清疹汤 张子琳 |
| DOI：10.3969/j.issn.1674-070X.2026.02.015 |
| 投稿时间：2025-10-17 |
| 基金项目:第七批全国老中医药专家学术经验继承工作(国中医药人教函[2022]76号);第五批江苏省中医临床优秀人才研修项目(苏中医科教[2025]9号);南京市“十四五”中医药青年人才培养计划项目(宁卫中医[2020]4号,ZYQ20041);南京市(赵薇)名中医工作室建设项目(宁卫中医[2023]9号)。 |
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| Differentiation and treatment of pruritic dermatoses with Siwu Qingzhen Decoction: An integrated disease-pattern-symptom perspective |
| TIAN Yican, TAO Fangze, ZHOU Xiaomin, ZENG Qingqi |
| (Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210001, China;Nanjing Red Cross Hospital, Nanjing, Jiangsu 210022, China;Jiangsu Health Vocational College, Nanjing, Jiangsu 210029, China) |
| Abstract: |
| Siwu Qingzhen Decoction is an empirical formula developed by ZHANG Zilin, a renowned doctor in Shanxi Province, for treating pruritic dermatoses. Evolving from the classical Siwu Decoction, it incorporates thoughtful modifications:Chishao (Paeoniae Radix Rubra) substitutes Baishao (Paeoniae Radix Alba) and Shengdihuang (Rehmanniae Radix) is used in place of Shudihuang (Rehmanniae Radix Praeparata). The formula is further enhanced with addition such as Kushen (Sophorae Flavescentis Radix), Baixianpi (Dictamni Cortex), Difuzi (Kochiae Fructus), and Shechuangzi (Cnidii Fructus). These ingredients collectively function to nourish blood, moisturize dryness, clear heat, eliminate dampness, kill parasites, and relieve itching. This article systematically reviews the characteristics of herbal formula compatibility in the treatment of pruritic dermatoses, proposing "blood deficiency with damp-heat, coexistence of dryness and dampness" as the core pathogenesis of such diseases. It explains the complex pathology of "internal dryness and external dampness" intertwined with the "opening, closing, and pivoting" theory. In terms of differentiation and treatment strategies, starting from "prurigo", a differentiation and treatment system is constructed based on "differentiating the disease from the symptoms, taking the disease as the outline, formulating treatment according to the pattern, and making adjustments according to the symptoms". In clinical practice, it emphasizes closely following the pathogenesis and mechanismand differentiating and treating according to the cause on the basis of a clear diagnosis of the disease. By making adjustments according to the symptoms and combining formulas, the treatment scope is expanded, applicable to various pruritic dermatoses such as eczema and urticaria. Supported by a verified medical record, this study illustrates the formula's capacity to harmonize qi and blood and balance yin and yang, providing both theoretical foundation and practical reference for its clinical applications in treating pruritic dermatoses. |
| Key words: pruritic dermatoses disease-pattern-symptom blood deficiency with damp-heat coexistence of dryness and dampness opening, closing, and pivoting Siwu Qingzhen Decoction ZHANG Zilin |
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