基于“胃强脾弱”论治儿童剥脱性角质松懈症

The Treatment of Children’s Keratolysis Exfoliativa Based on the Theory of “Stomach Exuberance and Spleen Deficiency”

摘要: “胃强脾弱”是在《伤寒明理论》中解释脾约丸时提出，历代医家对此理解各有不同，总结为两种，一为肠热脾约，二为胃热脾虚。文中主要根据胃热脾虚对剥脱性角质松懈症(Keratolysis Exfoliativa, KE)进行病机讨论。并总结王海教授运用“胃强脾弱”理论治疗儿童剥脱性角质松懈症经验，并附医案一则以资验证。王海教授根据儿童生理、病理特点并结合临床经验自拟消积凉血汤治疗本病，认为本病病机总属“胃强脾弱”，以胃热脾虚证为主证，治以健脾消积，清热凉血，并兼顾滋养阴津。临床效果明显，通过本文进一步加深对儿童KE的中医认识，为临床诊疗提供新思路。

Abstract: The concept of “stomach exuberance and spleen deficiency” was proposed in the Shang Han Ming Li Lun when explaining the Spleen Constriction Pill. Different generations of physicians have had varying interpretations of this concept, which can be summarized into two types: intestinal heat and spleen constriction, and stomach heat and spleen deficiency. This article mainly discusses the pathogenesis of keratolysis exfoliativa (KE) based on the theory of “stomach exuberance and spleen deficiency”, specifically focusing on the condition of stomach heat and spleen deficiency. It also summarizes Professor Wang Hai’s experience in treating KE in children using the theory of “stomach exuberance and spleen deficiency”, and includes a case study for verification. Professor Wang Hai, considering the physiological and pathological characteristics of children and his clinical experience, developed the Xiaojiliangxue Decoction to treat this disease. He believes that the pathogenesis of this disease is generally “stomach exuberance and spleen deficiency”, with the main syndrome being stomach heat and spleen deficiency. The treatment approach is to strengthen the spleen, eliminate accumulation, clear heat, cool the blood, and nourish yin and body fluids. The clinical effect is significant. Through this article, a deeper understanding of KE in children from a TCM perspective is achieved, providing new ideas for clinical diagnosis and treatment.