《内经》“风淫于内”视域下白癜风的病机与治疗探析

Exploration on the Pathogenesis and Treatment of Vitiligo from the Perspective of “Wind Flourishing in the Interior” in Huangdi Neijing

摘要: 以《内经》“风淫于内”理论为指导，认为风邪是贯穿白癜风始终的重要病理因素，风邪内生是发病之基础，风邪外侵是发病之诱因，风邪伏藏是复发之根源，提出以“治风、通络”为基本治疗原则。临证将该病分为初发期、进展期、稳定期进行分期辨治，初发期外风侵袭引动内风，治以散外风为主，阻遏白斑扩散；进展期外风入里、内风妄动，治以息内风为主，平复病情进展；稳定期伏风内潜，兼见肝郁、脾虚、痰湿、血瘀多端夹杂、虚实互见之复杂病机，治以搜伏风为主，固本防止复发。遵“风淫于内，治以辛凉，佐以苦甘”之旨，临证以自拟辛凉苦甘汤为基础方加减治疗。

Abstract: Guided by the theory of “Wind Flourishing in the Interior” in Huangdi Neijing, wind pathogen is regarded as a core pathological factor running through the whole course of vitiligo. Endogenous wind serves as the fundamental cause of the disease onset, external wind invasion acts as the inducing factor, and latent wind pathogen is the root of disease recurrence. The therapeutic principle of “calming wind and unblocking collaterals” is therefore proposed. Clinically, vitiligo is treated by stage differentiation including the initial stage, progressive stage and stable stage. In the initial stage, external wind invades the body and stirs endogenous wind, so the treatment focuses on dispelling external wind to restrain the spread of leukoplakia. In the progressive stage, external wind penetrates inward and endogenous wind becomes hyperactive, thus the therapy prioritizes tranquilizing endogenous wind to stabilize disease progression. In the stable stage, latent wind lurks internally, accompanied by complicated pathogenesis such as liver depression, spleen deficiency, phlegm-dampness and blood stasis with intermingled excess and deficiency. The treatment centers on eliminating latent wind to consolidate healthy foundation and prevent recurrence. Following the classical tenet that “when wind is excessive in the interior, treat with pungent-cool medicinals assisted by bitter-sweet herbs”, the self-formulated Xinqiang Kugan Decoction is adopted as the basic prescription with modified adjustments for clinical treatment of vitiligo.