濕疹診治醫案

Diagnosis and Treatment of an Eczema Case

患者為一45歲男性，工作壓力大，平時嗜食甜食且過去有菸酒習慣。在高中某次飲酒後，首次出現全身癢疹，之後每年反覆發作，已歷20餘年。本次就診3至4日前皮膚癢疹又作，範圍分布於臉、項、軀幹、四肢，疹色紅暗，撫之潮濕且溫熱。患者素習慣溫飲，指甲色淡紅，唇色淡暗，濕疹病灶淡紅紫，舌質暗紅，苔白膩稍厚夾黃，裂紋，少津，有明顯朱點；脈浮弦滑數有力。證以陽虛為本，風邪濕熱，氣滯血瘀，內蘊肌膚為標，治以溫補陽氣，清熱瀉火，祛風利溼，調氣行血為主，處方用加味四逆湯合黃連解毒湯，症狀漸獲改善。

A forty five-year-old male experienced diffuse itching rashes after drinking alcohol when he was a senior in high school. After the first episode, the rashes occurred frequently during the following twenty years. He is a rigorous businessman under a huge amount of pressure due to his work. He has a habit of eating sweet foods, smoking cigarettes and drinking alcohol. During this onset, he noticed that there were multiple rashes appearing on the face, neck, trunk and four extremities, which have persisted for three to four days. The lesions are wet and warm, and the itchy parts are not always the same. He preferred warm food and drinks. His lips were pale and nails were pale and dark. The rashes were pale and purple. He has a dark tongue, and the tongue fur is white slimy with slight yellow and thick. The tongue body was dry with red speckles. The pulse was floating, string-like, slippery and rapid with power. After diagnosis using the four examinations, Yang vacuity was the root while dampness and heat with wind brewed in skin, liver qi stagnation and blood stasis were the tip of the disease. The treating methods of warming Yang and clearing heat, coursing wind and dispelling dampness, rectifying Qi and blood were applied. The modified Sini decoction and Huanglian Jiedu decoction were prescribed with noticeable effect.