Discussion on treatment of cholestatic pruritus based on the theory that "inside diseases show signs outside"

MENG Linghan; TAO Jingna; WANG Xiufeng; XU Chunjun

doi:10.3969/j.issn.1006-2157.2023.11.016

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Discussion on treatment of cholestatic pruritus based on the theory that "inside diseases show signs outside"

Thought and Method | 更新时间：2023-12-08

- Discussion on treatment of cholestatic pruritus based on the theory that "inside diseases show signs outside"
- Journal of Beijing University of Traditional Chinese Medicine Vol. 46, Issue 11, Pages: 1599-1604(2023)
- 作者机构：
  
  1.首都医科大学附属北京中医医院肝病科　北京　100010
  2.北京中医药大学研究生院
  3.山西省肿瘤医院肝胆胰胃外科
- 作者简介：
  
  Prof. XU Chunjun, Chief Physician, Doctoral Supervisor. Department of Hepatology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23, Art gallery back street, Dongcheng District, Beijing 100010.E-mail: xu1409@sina.com
- 基金信息：
  
  National Science and Technology Major Project(2018ZX10725504)
- DOI：10.3969/j.issn.1006-2157.2023.11.016
  CLC： R273
- Received：21 May 2023，
  
  Online First：19 October 2023，
  
  Published：30 November 2023
- 稿件说明：
移动端阅览
MENG Linghan, TAO Jingna, WANG Xiufeng, et al. Discussion on treatment of cholestatic pruritus based on the theory that "inside diseases show signs outside"[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023, 46(11): 1599-1604.
DOI：

MENG Linghan, TAO Jingna, WANG Xiufeng, et al. Discussion on treatment of cholestatic pruritus based on the theory that "inside diseases show signs outside"[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023, 46(11): 1599-1604. DOI： 10.3969/j.issn.1006-2157.2023.11.016.

摘要

胆汁淤积性瘙痒是一种常见的肝系疾病，是由于肝内或肝外原因导致胆汁流动障碍、胆汁淤积造成的瘙痒，属中医学“痒风”范畴。本文基于中医学“有诸内者，必形诸外”理论，深入探讨胆汁淤积性瘙痒的病因病机及治疗。本文认为其病机包括湿热蕴结、蒸灼于外，血虚生风、燥伤腠理，以及瘀血阻络、肌肤不荣。治疗视疾病的外在表现以度其内在病机，治法包括清解湿热、凉血调神，方选龙胆泻肝汤、麻黄连轺赤小豆汤等；滋阴养血、祛风润燥，方选四物汤、当归饮子、滋燥养荣汤之类；以及活血通络、调和阴阳，方选桃红四物汤、大黄䗪虫丸之属。此外，患者的心理症状如焦虑、抑郁等不良情绪也需被重视，治疗时应清心凉血、安神定志。风药在瘙痒治疗中也发挥了重要作用，如荆芥、防风等。治疗当重视诸“内”与诸“外”之整体性，唯是始能解疾病之忧，轻患者之疾苦。

Abstract

Cholestatic pruritus is a common hepatobiliary disease caused by inhibited bile flow and bile stasis due to intrahepatic or extrahepatic causes. It is in the "

Yangfeng

" category in traditional Chinese medicine. This paper discusses the etiology

pathogenesis and treatment of cholestatic pruritus

based on the theory that "inside diseases show signs outside" in traditional Chinese medicine. The pathogenesis includes dampness-heat accumulation and steaming out

blood deficiency with wind intrusion and dryness damaging striae and interstices

and static blood blocking collaterals

resulting in pruritus and unsmooth skin. The treatment approach is based on the manifestation of the "external" disease to eliminate the internal pathogenesis

focusing on clearing heat and resolving dampness

cooling blood and regulating the mind

with formulas such as

Longdan Xiegan

Decoction and

Mahuang Lianyao Chixiaodou

Decoction; nourishing yin and enriching blood

dispelling wind and moisturizing dryness

using formulas like

Siwu

Decoction

Danggui Yinzi

and

Zizao Yangrong

Decoction; promoting blood circulation and dredging collaterals

harmonizing yin and yang

with formulas like

Taohong Siwu

Decoction and

Dahuang Zhechong

Pill being considered. Furthermore

psychological symptoms such as anxiety and depression need to be taken seriously and treated by clearing heart fire

cooling the blood and calming the mind. Wind drugs also play an essential role in the treatment of pruritus

such as Jingjie (schizonepetae herba)

Fangfeng(Saposhnikoviae Radix) and so on. The treatment should pay attention to the holistic nature of all "internal" and all "external"

only in this way can we solve the worries of the disease and alleviate the sufferings of patients.

关键词

Keywords

references

孟子 . 孟子 [M]. 长沙：岳麓书社， 2021 ： 189 .

朱震亨 . 丹溪心法 [M]. 北京：中国书店， 1986 .

王国忠 . 从“有诸内者，必形诸外”谈中西医优势互补 [J]. 浙江中医杂志， 2015 , 50 ( 8 )： 612 .

LANGEDIJK J , BEUERS UH , OUDE ELFERINK RPJ . Cholestasis-Associated Pruritus and Its Pruritogens [J/OL]. Front Med (Lausanne) , 2021 , 8 : 639674 [ 2023-06-01 ]. https://www.frontiersin.org/articles/10.3389/fmed.2021.639674/full .

RISHE E , AZARM A , BERGASA NV . Itch in primary biliary cirrhosis: a patients’ perspective [J]. Acta Derm Venereol , 2008 , 88 ( 1 )： 34 - 37 .

邵甲云 . 溶血磷脂酸通过非组胺依赖途径易化胆汁淤积性瘙痒的发生 [D]. 福州：福建医科大学， 2016 .

李奕卓，吴成利 . 胆汁淤积性瘙痒的发病机制 [J]. 肝脏， 2022 , 27 ( 9 )： 1045 - 1047 .

SIVAKUMAR T , KOWDLEY KV . Anxiety and Depression in Patients with Primary Biliary Cholangitis: Current Insights and Impact on Quality of Life [J]. Hepat Med , 2021 , 13 : 83 - 92 .

PATEL SP , VASAVDA C , HO B , et al . Cholestatic pruritus: Emerging mechanisms and therapeutics [J]. J Am Acad Dermatol , 2019 , 81 ( 6 )： 1371 - 1378 .

NEUBERGER J , JONES EA . Liver transplantation for intractable pruritus is contraindicated before an adequate trial of opiate antagonist therapy [J]. Eur J Gastroenterol Hepatol , 2001 , 13 ( 11 )： 1393 - 1394 .

MURRAY-BROWN FL . Naltrexone for cholestatic itch: a systematic review [J]. BMJ Support Palliat Care , 2021 , 11 ( 2 )： 217 - 225 .

许克昌，毕法 . 外科证治全书 [M]. 北京：人民卫生出版社 . 1987 : 134 .

李尚点 . 徐春军教授从血论治慢性肝病伴皮肤瘙痒临床观察 [D]. 北京：北京中医药大学， 2021 .

吴谦．医宗金鉴 [M]. 石学文，点校．沈阳：辽宁科学技术出版社 . 1997 .

余思邈，王亚超，朱云，等 . 从“诸痛痒疮，皆属于心”探讨胆汁淤积性肝病继发皮肤瘙痒的诊治 [J]. 中医杂志， 2019 , 60 ( 7 ): 622 - 624 .

赵献可 . 医贯 [M]. 北京：人民卫生出版社 . 1959 : 47 .

NEWTON JL , GIBSON GJ , TOMLINSON M , et al . Fatigue in primary biliary cirrhosis is associated with excessive daytime somnolence [J]. Hepatology , 2006 , 44 ( 1 )： 91 - 98 .

巢元方．诸病源候论 [M]. 黄作阵，点校 . 沈阳：辽宁科学技术出版社 . 1997 : 177 .

叶天士．临证指南医案 [M]. 华岫云，编订 . 北京：华夏出版社， 1995 .

马静毅，刘红权，徐征 . 缪希雍从脾阴论治“内虚暗风”探微 [J]. 四川中医， 2020 , 38 ( 8 )： 26 - 28 .

程杏轩 . 医述 [M]. 合肥：安徽科学技术出版社 . 1983 : 786 .

黎瑜，吴艳华 . 试谈中医对瘙痒夜间加重病因病机的认识 [J]. 中医药临床杂志， 2018 , 30 ( 4 )： 633 - 635 .

张璐 . 张氏医通 [M]. 上海：上海科学技术出版社 . 1963 : 480 .

吴以岭 . 络病病机探析 [J]. 中医杂志， 2005 , 46 ( 4 )： 243 - 245 .

赵仲雪，庞立健，滑振，等 . “络虚不荣”贯穿肺纤维化病程始终理论探析 [J]. 中医药导报， 2016 , 22 : 9 - 11 .

中华医学会肝病学分会 . 胆汁淤积性肝病管理指南(2021) [J]. 临床肝胆病杂志， 2022 , 38 ( 1 ): 62 - 69 .

沈初 . 中药冷敷治疗慢性胆汁淤积性肝病继发皮肤瘙痒的临床观察 [J]. 中国中医药科技， 2016 , 23 ( 3 )： 347 - 348 .

冯浩然 . 中药冷敷治疗慢性胆汁淤积性肝病继发皮肤瘙痒的疗效观察 [J]. 中国中医药科技， 2015 , 22 ( 4 )： 468 - 469 .

林洪萍，黄晋萍，黄淑兰，等 . 中药外洗在妊娠期肝内胆汁淤积症诱发皮肤瘙痒患者中的应用 [J]. 中国医学创新， 2022 , 19 ( 19 ): 96 - 99 .

王震 . 中药外洗配合拔罐治疗慢性胆汁淤积性肝病皮肤瘙痒的疗效分析 [J]. 黑龙江医学， 2013 , 37 ( 11 )： 1094 - 1095 .

孙思邈．银海精微 [M]. 北京：中国书店， 1986 : 35 .

李晶，张念志，汪诗清，等 . 张念志教授应用龙胆泻肝汤合升降散加减治疗皮肤瘙痒症验案举隅 [J]. 中国民族民间医药， 2022 , 31 ( 2 ): 89 - 91 .

秦琴，张毅，黄琼远，等 . 龙胆泻肝汤治疗皮肤科疾病医案6则 [J]. 新中医， 2022 , 54 ( 4 ): 32 - 36 .

尾台榕堂 . 类聚方广义 [M]. 北京：学苑出版社 . 2009 : 220 .

张锡纯 . 医学衷中参西录 [M]. 王云凯，杨医亚，李彬之，校点．石家庄：河北科学技术出版社 . 1985 : 116 .

钱潢．伤寒溯源集 [M]. 张喜奎，朱为坤，李灵辉，等，校注 . 上海：上海科学技术出版社 . 2021 : 229 .

侯真真，唐婷婷，吕佳，等 . 中药梓白皮基原考证 [J]. 中国中医药现代远程教育， 2022 , 20 ( 23 ): 49 - 52 .

张静远，赵娟，吴军，等 . 《伤寒论》麻黄连轺赤小豆汤之梓白皮考证 [J]. 长春中医药大学学报， 2015 , 31 ( 5 ): 1074 - 1076 .

孙思邈．千金翼方 [M]. 彭建中，魏嵩有，点校 . 沈阳：辽宁科学技术出版社 . 1997 : 94 .

刘渡舟名医工作室 . 伤寒论诠解 [M]. 北京：人民卫生出版社 . 2013 : 269 .

难经 [M]. 北京：中国医药科技出版社 . 1998 : 36 .

郭文娟，李俊莲，张红珍，等 . 试从“气主呴之，血主濡之”论气血之功能 [J]. 中华中医药杂志， 2022 , 37 ( 2 ): 968 - 970 .

刘邦民，张涓，高天文 . 浅谈从风论治瘙痒性皮肤病 [J]. 辽宁中医杂志， 2010 , 37 ( 5 )： 834 - 836 .

严用和．严氏济生方 [M]. 刘阳，校注 . 北京：中国医药科技出版社 . 2012 : 111 .

韩卫国 . 当归饮子联合西药治疗老年性皮肤瘙痒症患者的疗效 [J]. 黑龙江医药， 2021 , 34 ( 4 )： 896 - 898 .

侯定辉，陈红岭 . 当归饮子加减治疗血虚风燥型皮肤瘙痒症36例临床疗效观察 [J]. 辽宁医学杂志， 2020 , 34 ( 6 )： 34 - 35 .

丹波元坚．杂病广要 [M]. 李洪涛，主校 . 北京：中医古籍出版社 . 2002 : 1153 .

孙一奎 . 赤水玄珠全集 [M]. 凌天翼，点校 . 北京：人民卫生出版社 . 1936 : 98 .

黄丽丽，李明，闫超，等 . 加味滋燥养荣汤联合依巴斯汀治疗血虚风燥型腹膜透析尿毒症性皮肤瘙痒症疗效观察 [J]. 福建中医药， 2022 , 53 ( 7 ): 4 - 6 .

刘敏，李鸣，李娜 . 滋燥养荣汤熏洗对腹膜透析尿毒症病人皮肤瘙痒的临床应用 [J]. 全科护理， 2023 , 21 ( 2 ): 223 - 225 .

曹娟，沈明祎 . 从风论治瘙痒性皮肤病 [J]. 四川中医， 2007 , 25 ( 6 )： 30 - 31 .

曾晓，王亚琴，杨会军 . 周继刚运用风药治疗皮肤病经验 [J]. 湖北中医杂志， 2009 , 31 ( 5 )： 27 - 28 .

盛生宽，盛全成 . 四物汤佐风药治疗瘙痒性皮肤病验案举隅 [J]. 江苏中医药， 2005 , 26 ( 12 )： 44 - 45 .

张伟 . 祛风法在瘙痒性皮肤病中的应用规律探讨 [D]. 哈尔滨：黑龙江中医药大学， 2011 .

张介宾 . 景岳全书 [M]. 北京：中国中医药出版社， 1994 : 534 .

陈自明．妇人大全良方 [M]. 北京：中国中医药出版社， 2007 ： 57 .

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