孙虹运用麻杏石甘汤治疗急性荨麻疹经验

Experience of Sun Hong in Treating Acute Urticaria with Mahuang Xingren Gancao Shigao Decoction

摘要: 急性荨麻疹属中医“瘾疹”范畴，是临床常见变态反应性皮肤病，现代医学对症治疗易反复且存在不良反应，经方化裁治疗本病疗效确切。孙虹教授深耕经方临床应用数十年，擅将《伤寒论》麻杏石甘汤移治急性荨麻疹风热犯表证，其核心病机归结为肺卫失固、风热郁表、血热生风，并以“火郁发之”为理论依据，秉持“宣肺泄热、凉血祛风、标本兼顾、脏腑同调”治疗原则。临床应用中，以麻杏石甘汤为基础方伍凉血祛风、活血利水之品形成核心化裁方，紧抓风热犯表核心证候并辨清痰湿阻滞、血热偏重等兼证，随症灵活加减；同时根据病程演变分为初发期、缓解期、恢复期三期论治，初治祛邪、中治扶正祛邪、后期调护脏腑；用药始终坚守顾护脾胃原则，谨防苦寒、走窜之品伤正，且注重饮食、情志、生活调护与药物治疗结合。孙教授运用麻杏石甘汤化裁治疗急性荨麻疹，辨证精准、方随证转，充分体现中医辨证论治精髓与经方应用的广泛性，临床疗效显著且能有效降低复发率，为经方治疗急性荨麻疹提供了宝贵的临床思路与实践参考。

Abstract: Acute urticaria, categorized as “Yinzhen” in traditional Chinese medicine (TCM), is a common clinical allergic skin disease. Symptomatic treatment in modern medicine is prone to recurrence and adverse reactions, while the modified application of classical TCM prescriptions has achieved definite curative effects in treating this disease. Professor Sun Hong has been engaged in the clinical application of classical TCM prescriptions for decades, and is skilled in adapting Mahuang Xingren Gancao Shigao Decoction from Treatise on Febrile and Miscellaneous Diseases for the treatment of acute urticaria with the syndrome of wind-heat invading the superficies. She summarizes the core pathogenesis as deficiency of lung and wei qi, stagnation of wind-heat in the superficies, and blood heat generating wind, and takes “releasing stagnant fire” as the theoretical basis, adhering to the therapeutic principles of dispersing lung qi to clear heat, cooling blood to dispel wind, treating both the principal and secondary aspects of the disease, and regulating zang-fu organs in a coordinated way. In clinical application, the core modified prescription is formed by taking Mahuang Xingren Gancao Shigao Decoction as the basic formula and combining it with herbs for cooling blood, dispelling wind, activating blood circulation and inducing diuresis. She firmly grasps the core symptoms of wind-heat invading the superficies and differentiates the concurrent syndromes such as phlegm-damp stagnation and excessive blood heat, with flexible medication modification according to symptoms. Meanwhile, the disease is treated in three stages according to the course evolution: the acute onset stage, the remission stage and the recovery stage, with pathogenic factors eliminated in the acute stage, both pathogenic factors eliminated and healthy qi strengthened in the remission stage, and zang-fu organs regulated in the recovery stage. In medication, the principle of nourishing the spleen and stomach is always adhered to, to prevent the damage of healthy qi by bitter-cold and wandering herbs. In addition, she attaches great importance to the combination of dietary, emotional and daily nursing with medication treatment. Professor Sun Hong’s modified application of Mahuang Xingren Gancao Shigao Decoction for acute urticaria features accurate syndrome differentiation and flexible prescription adjustment according to syndrome changes, which fully embodies the essence of TCM syndrome differentiation and treatment and the extensiveness of classical TCM prescription application. It has remarkable clinical curative effect and can effectively reduce the recurrence rate, providing valuable clinical ideas and practical references for the treatment of acute urticaria with classical TCM prescriptions.