基于玄府理论探讨脂溢性皮炎的病机与治法

Exploration of the Pathogenesis and Treatment of Seborrheic Dermatitis Based on Xuanfu Theory

摘要: 玄府理论肇始于《黄帝内经》，经刘完素发展为“玄府气液”学说，揭示了人体微观通道系统在气液流通与神机运转中的枢纽作用。本文基于玄府理论，提出脂溢性皮炎的核心病机为“玄府郁闭，湿热怫郁，肌肤失养”，其病机演化经历“外邪闭玄→热郁玄府→气液失渗→肌肤失荣”的动态过程。同时，将玄府理论与传统肺胃湿热、血虚风燥等理论进行比较，认为玄府理论在解释油腻、鳞屑、瘙痒、反复发作等核心症状方面，具有贯通微观通道、统一干湿两端、连接免疫微环境与皮肤屏障的解释优势，但需进一步操作化。本文试建“玄府郁闭”诊断要点，包括主症、核心表现、舌脉及兼夹证，并明确“开玄通府”中“开玄”指宣透开通玄府门户，“通府”指恢复玄府–络脉–腠理复合通道的气液渗灌、气血运行与神机运转。治疗上以“开玄通府”为总则，内治以风药开玄、清热透郁，兼以化湿、养阴、活血；外治以辛散轻清之品直达病所，佐以毫火针等通调经气。内外合治，恢复玄府通利之性，为脂溢性皮炎的中医辨治提供微观辨证新视角，具有临床拓展价值。验案部分附患者知情同意说明。

Abstract: The Xuanfu theory originated in the Huangdi Neijing (Yellow Emperor’s Inner Classic) and was developed by Liu Wansu into the “Xuanfu Qi and Fluid” theory, revealing the pivotal role of the human body’s micro-channel system in the circulation of Qi and fluids and the operation of Shenji. Based on Xuanfu theory, this paper proposes that the core pathogenesis of seborrheic dermatitis is “Xuanfu obstruction, damp-heat constraint, and skin malnutrition”. Its pathogenesis evolves through a dynamic process of “external pathogen obstructing Xuanfu → heat stagnating in Xuanfu → Qi and fluid percolation failure → skin losing nourishment”. At the same time, by comparing Xuanfu theory with traditional theories such as lung-stomach damp-heat and blood deficiency with wind-dryness, this paper holds that Xuanfu theory has explanatory advantages in accounting for core symptoms such as oiliness, scaling, pruritus, and recurrent attacks: it links microscopic channels, unifies the two extremes of dryness and dampness, and connects the immune microenvironment with the skin barrier; however, it still requires further operationalization. This paper tentatively establishes diagnostic key points for “Xuanfu stagnation and closure”, including main symptoms, core manifestations, tongue and pulse findings, and concomitant patterns. It also clarifies that in “opening Xuan and unblocking Fu”, “opening Xuan” refers to diffusing, penetrating, and opening the portals of Xuanfu, while “unblocking Fu” refers to restoring qi-fluid infiltration and perfusion, qi-blood circulation, and spirit-mechanism (shenji) activity within the composite Xuanfu-collateral-couli pathway. Therapeutically, “opening Xuan and unblocking Fu” is taken as the general principle. Internal treatment uses wind medicinals to open Xuan and clear heat to outthrust stagnation, supplemented by resolving dampness, nourishing yin, and activating blood; external treatment uses pungent-dispersing, light-clear agents to reach the affected site directly, supplemented by filiform fire needling and other methods to regulate meridian qi. Combining internal and external treatments restores the unobstructed nature of Xuanfu, providing a new perspective of micro-syndrome differentiation for the TCM diagnosis and treatment of seborrheic dermatitis, and holding value for clinical expansion. A case report section with a statement of the patient's informed consent is included.