从“郁”论治神经性皮炎

Treating Neurodermatitis from the Perspective of “Yu” (Stagnation)

摘要: 神经性皮炎(慢性单纯性苔藓)，因其皮癣如牛项之皮，顽硬且坚的特征性表现，中医典籍将其归为“牛皮癣”“摄领疮”等范畴。中医将诱发神经性皮炎的因素分为内外两方面：内因多为情志不遂、抑郁烦闷或紧张劳累导致肝火郁滞、心火上炎，火郁肌肤，病程日久耗伤营阴，血虚津亏致生风化燥，肌肤失于濡养则反复发作。外因为风、湿、热邪侵袭皮肤后郁滞其中或机械反复刺激皮肤而诱发致病。在本病中，“郁”作为致病因素，贯穿疾病的发生发展。“郁”既可作为病因，也可作为病机。“郁”作为病因，涵盖了外感六淫、内生五邪和七情内伤等一切可导致人体气血失常的病理因素；作为病机，则有抑郁不发、不通之意。辨证治疗时，从“郁”论治，以疏风止痒、疏肝理气，清热泻火，养血润燥为主。

Abstract: Neurodermatitis (Lichen Simplex Chronicus), characterized by thickened, lichenified skin resembling cattlehide, is categorized in traditional Chinese medicine (TCM) as “Niu Pi Xian” (ox-hide lichen) or “She Ling Chuang” (collar-area sore). TCM attributes its etiology to both internal and external factors. “Internal factors” primarily involve emotional disturbances (e.g., depression, anxiety, or chronic stress) leading to liver fire stagnation and heart fire flaring, which result in pathological heat accumulation in the skin. Prolonged illness depletes “Ying-Yin” (nutritive and fluid components), causing blood deficiency, fluid depletion, wind-dryness generation, and recurrent skin lesions due to inadequate nourishment. “External factors” include invasion of wind, dampness, and heat pathogens that stagnate in the skin, or mechanical irritation triggering the disease. Central to its pathogenesis is the concept of “stagnation” (Yu). As an etiological factor, “Yu” encompasses all pathological influences—such as exogenous “Liu Yin” (six climatic pathogens), endogenous “Wu Xie” (five pathological factors), and emotional injuries—that disrupt Qi and blood circulation. “Yu” denotes blockage and failure of physiological flow. In syndrome differentiation treatment, the approach is based on addressing “stagnation”, primarily focusing on relieving wind and stopping itching, regulating the liver and qi, clearing heat and reducing fire, and nourishing the blood and moisturizing dryness.