全身性濕疹的中醫診療病例報告

Generalized Eczema: A Case Treated with Chinese Medicine

這是一位47歲女性病患，素有異位性皮膚炎。一個月前在服用不明成分的高蛋白飲品後顏面、胸背與四肢皮膚出現紅斑與水皰，經高雄某醫學中心皮膚科診為全身性濕疹，使用類固醇藥物後病情未如預期改善，遂至本院中醫門診求治。來診時望之見兩頰皮膚發紅，後背、腹部與四肢皮膚呈大片紅色皮疹水皰、滲液，觸之灼熱。手掌與足心均出現大片膿皰，日夜搔癢。近一週來四肢及臉部水腫明顯，身體常覺有燥熱感，但不口渴。平素易腹脹、噯氣、打嗝，大便軟散排不淨已8-9年；苔少有裂舌淡紅體瘦，切之脈沉滑數關不足。中醫辨病為「浸淫瘡」，辨證屬熱毒熾盛，濕熱泛溢；治則主以健脾利濕，清熱解毒；處方用除濕胃苓湯加減清熱解毒藥物。服用二週後，顏面水腫已退，週身皮膚大片紅疹腫脹滲液較消，手掌水皰膿皰明顯消退許多。而後病情曾數度因病患貪食辛辣滋膩食物而復發，均以前方加減清熱解毒與涼血去風藥後獲得改善。前後將近三個月的治療，皮膚與腸胃症狀均明顯改善，病情控制穩定。

The female aged 47 years had suffered from widespread and itching skin rash over the face, chest wall, abdominal wall, back and extremities after taking an unlisted high protein drink 1 month before. Subsequently, generalized eczema was diagnosed by the dermatology department of medical center in Kaohsiung. But the illness showed no improvement after steroid treatment. Consequently, the patient visited our outpatient department of Chinese Medicine. On the first visit, the large erythematous patches and vesicles were spread over the face and the trunk, with exudates and palpable burning heat. Numerous itchy vesicles and pustules existed on the palms and soles. According to the statements of the patient, she had felt apparent edematous sensation on the face and extremities, frequently dry heat within the body but not thirsty in the recent one week. And the distended abdomen, hiccups, loose stool and incomplete rectal evacuation had persisted for 8-9 years. The tongue coating was little; the tongue body was pink and thin with cleft. The pulse was deep, slippery, and rapid with weak over the Guan portion. According to the Chinese medical differentiation system, the illness was diagnosed “generalized eczema” and the syndrome was classified as “heat toxin flourishing and damp heat invading”. The principle was arranged as “strengthening the spleen and draining the damp, clearing the heat and resolving the toxin”. The prescription was modified of “damp eliminating and stomach poria decoction”. After 2 weeks, the face edema disappeared; the hands and feet were less swollen; most vesicles and pustules over the body faded; the large patches of rash withered reasonably. Besides, edema and exudates of vesicle and pustula on the palm evanesced. After the treatment accomplished, eczema which recurred several times attributed to deep fried and nutrient-rich foods intake was amended by augmenting or removing the previously-prescribed medicines for “clearing heat and detoxicating; cooling blood and dispelling wind”. Owing to the recurrence therapy roughly 3 months, the illness of skin and gastrointestinal symptoms were improved apparently. Succeedingly, to consolidate the efficacy, focusing was on: “strengthening the spleen and regulating the qi; clearing the damp and disinhibiting the heat”.