清利濕熱法治療泛發性濕疹病例檢討

The case review of treating general eczema with dampness draining and heat clearing

這是一位52歲的男性患者，於一年前開始從背部散發紅癢丘疹，之後逐漸擴散到全身，退休後症狀不減反劇，使用西藥塗抹效果不佳。來診時，背部、腹側、上肢散布紫黑色丘疹塊、丘疹，足部滲液糜爛龜裂，唇周紅疹膚裂，舌軟齒痕胖大淡紅，苔白膩，右脈滑帶數，左脈弦數，診為濕毒泛溢，予其胃苓湯加甘露飲以燥濕健脾化氣利水，並使用黃連膏以及苦參黃柏水煎液塗擦，但在服藥之後，病情反而加重，故在胃苓湯基礎上改加龍膽瀉肝湯利下焦濕熱，外擦中藥水煎液則加重苦參以燥濕，治療後患者病情獲得改善，而後續用處方兩個月。目前則持續以清利濕熱的原則給予治療，病情穩定。

This 52-year-old male patient denied any systemic disease but diabetes mellitus. He had been suffered from itching papules since one year ago. The papules was spread from his back to whole body. The symptoms got severe after his retirement and topical therapy was in vain. The purple-black papules and plaques with scales over his back, flank and upper extremities, erosion over feet, fissure and reddish papules around his lips. His tongue was enlarged, pale red with teeth-marked. White, slimy fur was over his tongue. His pulse condition showed slippery with rapid in right hand and string-like with slippery in left hand. The holistic differential diagnosis was pattern of dampness –heat. Wei-Ling Decoction was combined with Gan-Lu Yin for drying dampness to fortify the spleen. Huang-Lian ointment and decoction of kushan(?Radix Sophorae) and huangbo(?Cortex Phellodendri) were topical use. After the treatment, the condition became worse. We shift Gan-Lu Yin to?Long-Dan-Xie-Gan Tang , and dosage of kushan(?Radix Sophorae) was added in topical use for dry dampness. The skin lesion was improved after the treatment. We kept using the principle of drying dampness and clear heat for two months. The condition of his skin lesion was stable.