基于“玄府”理论浅谈外阴硬化性苔藓的中医微观病机及干预策略

A Brief Discussion on TCM Micro-Pathogenesis and Intervention Strategy of Vulvar Lichen Sclerosus Based on the “Xuanfu” Theory

摘要: 外阴硬化性苔藓(VLS)是一种以外阴皮肤黏膜萎缩、色素减退、剧烈瘙痒为主要特征的慢性炎症性疾病，现代医学治疗存在复发率高、不良反应明显等局限。中医虽无其明确病名，可归属于“阴痒”“阴蚀”等范畴，玄府理论作为中医微观病机的重要组成部分，为VLS的诊治提供了新视角。本文基于玄府“气液精血出入之门户”的核心内涵，结合VLS的西医病理特征，提出其核心病机为“玄府郁闭”，并呈现“肝郁血瘀→燥湿相兼→肾虚精亏”的递进演化规律。据此确立“开通玄府”为核心治疗原则，构建“辛味通玄、活血通络、补益肝肾、内外同治、情志调护”的多维度干预体系，为VLS的中医治疗提供新的思路与实践依据。

Abstract: Vulvar lichen sclerosus (VLS) is a chronic inflammatory disease characterized by atrophy of the vulvar skin and mucosa, hypopigmentation, and severe pruritus. Modern medical treatment has limitations such as high recurrence rates and significant adverse reactions. Although traditional Chinese medicine does not have a specific name for this disease, it can be classified under the categories of “yin itch” and “yin erosion”. The theory of xuanfu, as an important component of the micro-pathogenesis in traditional Chinese medicine, provides a new perspective for the diagnosis and treatment of VLS. Based on the core concept of xuanfu as “the gateway for the entry and exit of qi, fluid, essence and blood”, and in combination with the pathological features of VLS in Western medicine, this paper proposes that the core pathogenesis of VLS is “xuanfu obstruction”, and presents a progressive evolution pattern of “liver depression and blood stasis → concurrent dryness and dampness → kidney deficiency and essence deficiency”. According to this, the core treatment principle of “opening xuanfu” is established, and a multi-dimensional intervention system of “pungent flavor to open xuanfu, promoting blood circulation and unblocking meridians, tonifying liver and kidney, internal and external treatment, and emotional regulation” is constructed, providing new ideas and practical basis for the treatment of VLS with traditional Chinese medicine.