颜面痤疮发病部位与五脏相应规律的理论与文献学研究

【作者】 刘澈；

【导师】 马淑然；

【作者基本信息】 北京中医药大学 ， 中医基础理论， 2011， 硕士

【摘要】 痤疮俗称“青春痘”,又名“粉刺”、“酒刺”、“暗疮”等,通常好发于面部、颈部、胸背部、肩膀和上臂。它是一种以毛囊皮脂腺为单位的慢性炎症性皮肤病,临床以白头粉刺、黑头粉刺、炎性丘疹、脓疱、结节、囊肿等为主要表现。这种疾病青春期多见,但也不完全受年龄阶段的限制,从儿童到成人,几乎所有年龄段的人都可以发病,以颜面痤疮最为常见,也以颜面痤疮对患者身心伤害最大,所以治疗和预防颜面痤疮具有重要意义。本课题通过有关痤疮文献的深入研究及对痤疮的100首方剂进行统计学处理,可见痤疮的方剂以清热类方剂最多,达58个,药物也以清热类药物最多,达54味,解表药29味,补虚药23味,祛湿化痰药19味,活血化瘀药17味,理气药10味,结合文献学研究结论,本文认为颜面痤疮发病最核心的病机为“火热之毒”,其概括了痤疮发病全过程的特点与规律,同时,“火热之毒”是贯穿痤疮发病不同阶段、不同证型的主线,风邪、气滞、血瘀、痰湿为兼夹致病因素,痤疮发病的根本病机是本虚标实,肺脏为主,五脏兼及,故痤疮的辨病治疗之关键应当是“五脏火热之毒”,兼以解表、行气、活血化瘀、补虚,这也对痤疮的临床辨治有着重要的指导意义。本课题对痤疮发病部位的颜面分区与五脏及经络相应规律进行研究,根据中医理论提供了几种不同的颜面部与脏腑经络对应的分区方法,不仅为临床防治颜面痤疮提供一定思路,而且也为中医临床辨证治疗颜面痤疮提供理论依据和新的途径。1目的：本课题主要是在先贤及近现代各医家学术经验的前提下,对颜面痤疮发病部位、核心病机与根本病机及与五脏的相关性规律进行系统的整理分析。我们从“整体观念”的角度来思考痤疮的病因病机,探索颜面部痤疮发病部位与“经络-脏腑相关”理论的相关性。本课题将分别从脏腑、经络、气血、辨证、立法、处方用药等多方面研究颜面痤疮与五脏的关系,总结规律,为从脏腑论治痤疮提供一套比较清晰系统的思路,提示五脏在痤疮的预防和治疗过程中的重要性,希望能为更好地诊断和治疗痤疮提供基础研究。2方法：2.1文献学研究方法本研究采用文献资料法、逻辑分析法和统计学方法,对历代文献关于痤疮发病的相关文献进行梳理,探索颜面部痤疮病因病机、发病规律、发病部位与“颜面-脏腑经络相关”理论的相关性。(1)分析梳理历代文献中有关于痤疮的文献记载。(2)研究颜面-脏腑相应的理论依据。(3)研究颜面痤疮发病的核心病机、兼夹致病因素与根本病机。(4)研究颜面痤疮发病部位与脏腑经络相关的机制与规律。(5)研究颜面痤疮发病部位与五脏-经络相应并进行对应面部分区以指导辨证。2.2统计学研究方法收集、整理、统计文献中治疗痤疮的100首方剂,重点研究治疗痤疮的方剂功效类别与治疗痤疮药物的功效与归经。3结果：3.1文献研究结果(1)颜面痤疮发病最核心的病机为“火热之毒”,风邪、气滞、血瘀、痰湿为兼夹致病因素,痤疮发病的根本病机是本虚标实,肺脏为主,五脏兼及。(2)五脏、经络与颜面痤疮的发病部位、病因病机、辨证分型具有密切相关性,即对应关系。(3)根据三焦理论并结合五脏解剖位置及功能,痤疮发病的部位与脏腑的对应为上部对应心肺；中部对应脾胃、肝胆；下部对应肾、膀胱、大小肠；全面部对应三焦。(4)根据《灵枢·五色》明堂脏腑色部,痤疮发病的部位与脏腑的对应关系为上部对应心肺；中部对应肝、脾胃、胆、大小肠；下部对应肾、膀胱、子处。(5)根据经络循行,痤疮发病的部位与脏腑的对应关系是上部(额、头角)对应肝、胃、膀胱、胆；中部(鼻、颧骨)对应胃、大小肠、胆；下部(颔、口唇)对应胃、肝、大肠；两侧(颊)对应大小肠,胃,胆；全面部对应胃。(6)根据面部的经络循行结合《素问·刺热》篇颜面五脏色部分区的论述,并结合导师临床辨证治疗痤疮的实践经验,将颜面痤疮发病部位与五脏进行对应分区,拟将颜面分为5个区,皮损在上,病位以心为主,并与胃经、膀胱经、肝经功能相关；皮损在中,病位以脾为主,并与胃经、大肠经功能相关；皮损在下,病位以肾为主,并与胃经、膀胱经、肝经功能相关；皮损在左右,病位以肝、肺为主,并与大肠经,小肠经,三焦经,胃经,胆经功能相关。3.2统计研究结果在对治疗痤疮的100首方剂的统计中,以清热类方剂最多达58首,占方剂总数的58%,其次是祛湿剂21首(21%),理血剂10首(10%),补益剂7首(7%),药物功效分类以清热药最多,为54(35%)味,其次是解表药29味(17%),补虚药23味(14%),祛湿化痰药19味(11%),活血化瘀药17味(10%),理气药10味(6%),说明清热解毒类药物和方剂最为常用治疗痤疮的方剂,认为颜面痤疮发病最核心的病机为“火热之毒”。4结论：4.1火热之毒是颜面痤疮的发生的核心病机(1)本研究通过文献资料法、逻辑分析法和统计学方法,认为颜面痤疮发病最核心的病机为“火热之毒”,其概括了痤疮发病全过程的特点与规律,同时,“火热之毒”是贯穿痤疮发病不同阶段、不同证型的主线,故痤疮的辨病治疗之关键应当是“五脏火热之毒”。(2)风邪、气滞、血瘀、痰湿为兼夹致病因素。(3)痤疮发病的根本病机是本虚标实,肺脏为主,五脏兼及。4.2痤疮发病的部位与脏腑、经络具有复杂的非线性关系(1)根据三焦理论并结合五脏解剖位置及功能,痤疮发病的部位与脏腑存在对应关系。(2)根据《灵枢·五色》明堂脏腑色部及相关文献研究,痤疮发病的部位与脏腑存在对应关系。(3)根据颜面经络循行,痤疮发病的部位与脏腑存在对应关系。(4)根据面部的经络循行结合《素问·刺热》篇颜面五脏色部分区的论述,并结合导师临床辨证治疗痤疮的临床经验,将颜面痤疮发病部位与五脏进行对应分区,将颜面分为5区。更多还原

【Abstract】 Acne, also known as "whelk", "dark sore", etc., usually occurs in the face, neck, chest back, shoulders and upper arm. It is a kind of chronic inflammation skin disease. Hoary acne and comedones, inflammatory papules, pustular, nodules, cyst are the main performances in clinical. This disease varies from ages, it can occur in both teenagers and adults. The most common acne is facial acne. Also, for patients with facial acne tend to have physical and mental trauma, the research of facial acne is of great significance. This study not only provide certain ideas for clinical prevention, but also for TCM and modern science and technology with the study of facial acne position and five zang correspondence relation to provide the theory basis and the new way.1 ObjectiveThis subject mainly in the sages and contemporary each academic experience necessary to the premise of facial acne, the correlation of position and five zang disease law system analysis. We discuss the mechanism of facial acne with the concept of wholism, explore the pathogenesis of facial acne position and "meridian-the correlation of zang-fu relative theory. In this article, we summerize regulation, and introduce modern science and technology means for research of facial acne position and five zang-organs provide scientific related laws, from viscera technique provide a relatively acne treatment, indicating the ideas clearly system in five the prevention and treatment of acne the importance, the hope can process better diagnosis and treatment of acne provide basic research.2 Methods2.1 Theoretical methodsThis study used the philology research and statistics methods of literature, the relative literatures about acne, explore face ministry acne pathogenesis regularity and "facial-the correlation of zang-fu organs and relevant theory".(1) Analysis of literature about acne is documented.(2) Study the correlation of facial-viscera corresponding law.(3) Study of facial acne mechanisms related position and viscera.(4) Research on and application of modern scientific and technological methods of exploring facial acne position and five zang-organs corresponding regulations.2.2 Analysis methodCollecting, sorting literature of herbal treating acne, focus on the drugs’ viscera orientations. 3 Results3.1 Results of theoretical studyThe onset, etiology and treatment of facial acne have viscera-relevance.3.2 Results of Statistical researchThe drugs used in facial acne are mainly going by the Lung-meridian, which is consistent with the classic understanding of the doctor in dynasties.4 ConclusionsThe occurrence of facial acne is closely related with the viscera.This study used the literature philology and statistical methods, collect the related literature, we find that the occurrence, pathogenesis, and treatment are closely related to the viscera theory. Modern science and technology can be used to study the pathogenesis and viscera correspondence of facial acne.更多还原