基于卫气营血理论分阶段探讨寻常型银屑病证治规律

Exploring the Syndrome Differentiation and Treatment Patterns of Plaque Psoriasis in Stages Based on the Theory of Wei, Qi, Ying, and Xue

摘要: 寻常型银屑病以红斑鳞屑为特征，病势缠绵、易于复燃，其由表入里、自浅而深的病位迁移与叶天士卫气营血辨证的层次划分具有内在呼应。文章以此为切入点，将卫气营血之层次辨证与寻常型银屑病之临床分期相整合，提出进行期重在卫分、气分，静止期以营分伏热为核心，退行期属血分燥瘀互结的分期认识，各阶段各有其主导病机与相应治则，并据此构建“分阶段、辨浅深、动态论治”的辨治框架。文中系统阐释了各阶段的证候特征、病机实质及治法方药，并就本思路与既有“从血论治”体系的关系、适用范围及理论局限进行讨论，以期为银屑病中医诊疗提供动态辨证的参考路径。

Abstract: Psoriasis vulgaris is characterized by erythema and scales, with a protracted course and a tendency to relapse. The pathogenic process of this disease, which progresses from the surface to the interior and from the superficial to the deep, is in harmony with the hierarchical division of the syndrome differentiation based on Wei, Qi, Ying, and Xue by Ye Tianshi. Taking this as the starting point, this article integrates the hierarchical differentiation of wei, qi, ying, and xue with the clinical staging of psoriasis vulgaris. A phased understanding is proposed, where the active stage focuses on the Wei layer and the Qi layer, the static stage centers on the Ying layer with latent heat, and the regression stage belongs to the blood layer with dry and stagnant blood intermingled. Each stage has its dominant pathogenesis and corresponding treatment principles, and this is used to construct a “staging, distinguishing depth, and dynamic treatment” diagnostic and therapeutic framework. The article systematically explains the syndrome characteristics, pathogenesis essence, and treatment methods and prescriptions of each stage, and discusses the relationship, application scope, and theoretical limitations of this approach with the existing “treatment based on blood theory” system, with the aim of providing a dynamic diagnostic and therapeutic reference path for the diagnosis and treatment of psoriasis using traditional Chinese medicine.