张兰教授以温阳法治疗消渴合并痤疮的经验总结(1)
摘要：由消渴病引起的并发症屡见不鲜，其中消渴合并痤疮日益增多，中医称之为肺风粉刺、暗疮等，临床上常好发于面部、胸背部，以白头粉刺、脓包、囊肿、结节多见，目前西医主要从血糖、皮肤及体内激素水平异常来分析此病病因，在治疗上多采用西药对症治疗。中医对消渴合并痤疮多采取西药降糖、中医辨证治疗的方法，疗效显著。对消渴合并痤疮的病因病机，多数医者认为主要由于肺经风热、脾胃湿热、肾虚所致，治疗过程中除控制血糖外，主要从肺、脾胃、肾进行辨证论治，配合一定的心理疗法临床疗效更为显著。吾师张兰教授认为消渴合并痤疮多由肺胃或脾胃湿热，或肝胃郁热引起，但不乏阳虚引起者，对阳虚引起的痤疮，从温补脾肾兼以化瘀解毒入手进行治疗，疗效显著。本人随导师出诊，根据自己临床所见所闻，对导师以阳虚为切入点治疗本病，体会颇深，从辨证及用药特点总结点滴经验供大家借鉴。
关键词：导师；消渴病合并痤疮；阳虚
中图分类号：R255.4 文献标识码：A 文章编号：1006-1959(2017)18-0119-02
, 百拇医药
Abstract：Suffering from diarrhea caused by complications are common，including diabetes combined with increasing acne，Chinese medicine called the lungs acne，acne，etc.，clinically common in the face，chest and back，with whitehead acne，pustules，cysts，nodules more common，the current Western medicine mainly from the blood sugar，skin and hormone levels in the body to analyze the etiology of the disease，the treatment of Western medicine symptomatic treatment.Traditional Chinese medicine for diabetes combined with acne，taking western medicine hypoglycemic，Chinese medicine dialectical treatment method，the curative effect is remarkable.The etiology and pathogenesis of diabetes complicated with acne，most doctors think that is mainly due to the lung by wind heat，spleen，kidney deficiency，in the course of treatment in addition to blood glucose control，mainly from the lung， spleen，kidney of TCM mental therapy combined with certain clinical curative effect is more significant.My teacher Professor Zhang Lan believes that diabetes combined with acne and more by the stomach or spleen and stomach，or liver and stomach caused by heat，but there are many caused by yang deficiency，caused by yang deficiency acne，from the warmth of the spleen and kidney to poisoning treatment，significant effect.I visit with my tutor， according to my own clinical experience，I think of the teacher's yang deficiency as the starting point for the treatment of this disease，I have a deep understanding of the characteristics of syndrome differentiation and medication，sum up some experience for your reference.
, 百拇医药
Key words：Tutor；Diarrhea with acne；Yang deficiency
1臨床资料
患者李某某，女，46岁，以“面部散在性痤疮2～3年，加重半年”为主诉于2013年4月10日来门诊就诊。患者患有2型糖尿病5年，现应用诺和灵30R早15 U晚18 U餐前30 min皮下注射以控制血糖，血糖控制欠佳，空腹血糖一般控制在9 mmol/L左右，餐后2 h血糖控制在13～14 mmol/L，患者2～3年前于面部反复出现痤疮，色暗红，此消彼长，月经前加重。现症见：面部痤疮反复发作，尤以脸颊及额头多见，色暗红，无脓头，口渴多饮，乏力，畏寒肢冷，喜温，腰膝酸软，易怒，纳欠佳，夜尿多，便溏，舌淡苔白，脉沉细无力，尺脉尤弱。否认其他疾病史。月经史：经期正常，经前及经期小腹冷痛，得温痛减，经色暗红有血块，经量较少。家族史：母亲患有2型糖尿病。辅助检查：空腹血糖9.8 mmol/L。根据患者症状及病史，考虑患者由于长期血糖控制不佳，导致痤疮的反复发作，因此诊断：消渴病合并痤疮，又根据患者症状及舌脉，考虑患者属于脾肾阳虚证，治疗应中西医结合治疗，西医继续调整胰岛素用量以控制血糖，务必使血糖达标，中医以温肾健脾，活血化瘀为主，具体药用：巴戟天15 g，淫羊藿15 g，仙茅15 g，菟丝子15 g，党参20 g，当归15 g，白芷15 g，益母草10 g，半夏5 g，皂角刺10 g，柴胡15 g，茯苓15 g，白术15 g，白花蛇舌草10 g，甘草10 g，7付，水煎服，2 次/d。4月19日复诊，患者脸颊及额头痤疮明显变浅，且基本无新痤疮出现，手脚怕凉及腰酸症状缓解，血糖控制基本达标，空腹血糖控制在7 mmol/L左右，餐后血糖控制在10 mmol/L左右，故继续服用此方7付，7付之后定期复诊，嘱患者控制血糖，适量运动，保持心情愉悦，病情变化随诊。2月后患者再次复诊，血糖控制平稳，面部痤疮基本消退，仍有少量色素沉着，其余症状均明显改善, http://www.100md.com(吴聪 闵希瑞)
关键词：导师；消渴病合并痤疮；阳虚
中图分类号：R255.4 文献标识码：A 文章编号：1006-1959(2017)18-0119-02
, 百拇医药
Abstract：Suffering from diarrhea caused by complications are common，including diabetes combined with increasing acne，Chinese medicine called the lungs acne，acne，etc.，clinically common in the face，chest and back，with whitehead acne，pustules，cysts，nodules more common，the current Western medicine mainly from the blood sugar，skin and hormone levels in the body to analyze the etiology of the disease，the treatment of Western medicine symptomatic treatment.Traditional Chinese medicine for diabetes combined with acne，taking western medicine hypoglycemic，Chinese medicine dialectical treatment method，the curative effect is remarkable.The etiology and pathogenesis of diabetes complicated with acne，most doctors think that is mainly due to the lung by wind heat，spleen，kidney deficiency，in the course of treatment in addition to blood glucose control，mainly from the lung， spleen，kidney of TCM mental therapy combined with certain clinical curative effect is more significant.My teacher Professor Zhang Lan believes that diabetes combined with acne and more by the stomach or spleen and stomach，or liver and stomach caused by heat，but there are many caused by yang deficiency，caused by yang deficiency acne，from the warmth of the spleen and kidney to poisoning treatment，significant effect.I visit with my tutor， according to my own clinical experience，I think of the teacher's yang deficiency as the starting point for the treatment of this disease，I have a deep understanding of the characteristics of syndrome differentiation and medication，sum up some experience for your reference.
, 百拇医药
Key words：Tutor；Diarrhea with acne；Yang deficiency
1臨床资料
患者李某某，女，46岁，以“面部散在性痤疮2～3年，加重半年”为主诉于2013年4月10日来门诊就诊。患者患有2型糖尿病5年，现应用诺和灵30R早15 U晚18 U餐前30 min皮下注射以控制血糖，血糖控制欠佳，空腹血糖一般控制在9 mmol/L左右，餐后2 h血糖控制在13～14 mmol/L，患者2～3年前于面部反复出现痤疮，色暗红，此消彼长，月经前加重。现症见：面部痤疮反复发作，尤以脸颊及额头多见，色暗红，无脓头，口渴多饮，乏力，畏寒肢冷，喜温，腰膝酸软，易怒，纳欠佳，夜尿多，便溏，舌淡苔白，脉沉细无力，尺脉尤弱。否认其他疾病史。月经史：经期正常，经前及经期小腹冷痛，得温痛减，经色暗红有血块，经量较少。家族史：母亲患有2型糖尿病。辅助检查：空腹血糖9.8 mmol/L。根据患者症状及病史，考虑患者由于长期血糖控制不佳，导致痤疮的反复发作，因此诊断：消渴病合并痤疮，又根据患者症状及舌脉，考虑患者属于脾肾阳虚证，治疗应中西医结合治疗，西医继续调整胰岛素用量以控制血糖，务必使血糖达标，中医以温肾健脾，活血化瘀为主，具体药用：巴戟天15 g，淫羊藿15 g，仙茅15 g，菟丝子15 g，党参20 g，当归15 g，白芷15 g，益母草10 g，半夏5 g，皂角刺10 g，柴胡15 g，茯苓15 g，白术15 g，白花蛇舌草10 g，甘草10 g，7付，水煎服，2 次/d。4月19日复诊，患者脸颊及额头痤疮明显变浅，且基本无新痤疮出现，手脚怕凉及腰酸症状缓解，血糖控制基本达标，空腹血糖控制在7 mmol/L左右，餐后血糖控制在10 mmol/L左右，故继续服用此方7付，7付之后定期复诊，嘱患者控制血糖，适量运动，保持心情愉悦，病情变化随诊。2月后患者再次复诊，血糖控制平稳，面部痤疮基本消退，仍有少量色素沉着，其余症状均明显改善, http://www.100md.com(吴聪 闵希瑞)
参见：首页 > 医疗版 > 疾病专题 > 皮肤科 > 皮肤附属器官疾病 > 痤疮(青春痘)