基于伏气学说的犀角地黄汤用于寻常型银屑病血热证

张思文1，陈湘君1，刘靖 2

1.广州中医药大学第一临床医学院，广东 广州 510403；2.广州中医药大学第一附属医院，广东 广州 510120摘要：本文以“伏气学说”为指导，结合现代医学发病机制，探讨寻常型银屑病中医病因病机及血热证的治法方药；认为本病乃内生伏邪，郁于肌肤，日久化热所致；正气衰弱，外邪内扰，内外相合，蕴于血分，血热生风是其发病的根本原因；并据此确立以清热凉血为法，方选犀角地黄汤。关键词：伏气学说；寻常型银屑病；内生伏邪；犀角地黄汤

中图分类号：R275.986.3 文献标识码：A 文章编号：1005-5304(2020)03-0126-02

DOI：10.3969/j.issn.1005-5304.201810122 开放科学（资源服务）标识码（OSID）：

Application of Xijiao Dihuang Decoction in Blood-heat Syndrome of Psoriasis Vulgaris from the Perspective of Fuqi Theory

ZHANG Siwen1, CHEN Xiangjun1, LIU Jing2

1. First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510403, China;

2. First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China Abstract: Guided by “Fuqi theory” and combined with modern medical pathogenesis, this article explored the pathogenesis of TCM for psoriasis vulgaris and the treatment of blood-heat syndrome. It was believed that psoriasis vulgaris was caused by hidden pathogen stagnating on the skin to be transformed into blood heat syndrome with the passing of time. Positive qi became weak and made external pathogenic factors invade human bodies, and then the combination of internal and external pathogenic factors contained in blood generated blood-heat and pathogenic qi, which was the root cause of the onset of psoriasis vulgaris. Based on this point, a treatment method aiming at removing pathogenic heat from blood was established, and the prescription Xijiao Dihuang Decoction was selected. Keywords: Fuqi theory; psoriasis vulgaris; hidden pathogen; Xijiao Dihuang Decoction

临床上，对于寻常型银屑病血热证的发病理论可从伏气学说思想出发，并以犀角地黄汤加减论治。据此，笔者基于伏气学说思想，阐述犀角地黄汤加减论治寻常型银屑病血热证的理论基础。伏气学说《内经》有“冬伤于寒，春必温病”，“夫精者，身之本也。故藏于精者，春不病温”，此为后世学者视为伏气学说最初的理论基础。伏气温病的理论基本内容是指感邪之后，病邪伏留于体内，逾时而由里外发，或为新感引动，或为正虚自发，且病情较重的发病特点。伏气学说经历了从广义到狭义，再回归广义的过程。从《内经》所指的广义伏邪，如“春伤于风，邪气留连，乃为洞泄；夏伤于暑，秋为痎疟；秋伤于湿，上逆而咳，发为痿厥；冬伤于寒，春必温病”（《素问·生气通天论篇》）所言，四时之邪皆能伏于内而使机体致病。再到《伤寒论•平脉法》“伏气”之名确通讯作者：刘靖，E-mail：jinger1299@163.com

立，“伏气”一词变为专指一部分外感温热病的名词，伏寒化温逐渐成为主导思想。至明末清初，温病学说迅速发展，伏气学说不再是单一伏寒化温的思想。《温疫论》认为“天地间别有一种异气所感，伏于膜原，发为温疫”，可视为伏气温病的另一种阐述，也是伏邪再次向广义发展的开端。乃至后世所讲“六淫皆可伏气”，为伏气学说的应用拓宽了道路。银屑病与伏气学说的关系银屑病是与机体固有免疫系统、获得性免疫系统相关的特异性免疫性皮肤病，具有发病率较高、易复发、病程较长、季节性明显等特点。中医认为，寻常型银屑病主要由营血亏虚、血热内蕴、化燥生风，肌肤失养而成。从伏气学说而言，所伏邪气有外来邪气与内生邪气之分。从现代医学角度看，内生伏邪多与致炎因子、免疫介质等有着密不可分的关系。一般认

为，白细胞介素-23/T 辅助细胞 17免疫轴是发病机制

中的主要免疫途径[1]。这与内生邪气的观点不谋而合。《素问•阴阳应象大论篇》“壮火食气，少火生气”把