論蕁麻疹之診治與病例報告

A Case Report of Diagnosis and Treatment on Urticaria

蕁麻疹是一種常見皮膚病，俗稱風疹塊。據統計，人一生中至少發生過一次蕁麻疹者約佔20%之多。其發病機理可以是免疫性的（最常見的IgE介導的I型變態反應）和非免疫性的。唐‧孫思邈<<千金方>>中對本病作了具體描述「癢症不一，血虛皮膚乾燥癢乾，宜四物湯加防風…婦人血虛，或通身癢，或面癢，如蟲行皮中…有脾虛，本無疥癬，素非產褥，潔然一身，癢不可任，此乃胸虛所困」。經云：「諸痛為實，諸癢為虛」。中醫病因有外感和內生之異。總括病因病機「無風不作癢」，可概括為寒、熱、濕、虛、瘀， 並細分為十三型加以治療。但如能找出明確之過敏原而避免之，應是最有效之法。但因過敏原尋之不易，除了針對發病的現況給予適當的治療之外，如何藉由中醫藥調整體質使得體表的正氣充足，進而減低過敏現象的產生，當是預防蕁麻疹再發的重要方向。

Urticaria, also known as hives, is a common skin problem affecting up to 20 percent of the population at some point in their lives. Based on the pathogenesis, there are two types of urticarial - the immune (IgE-mediated type I allergic reaction) and the non-immune. According to the ancient textbook 'Qian Jin Fang' written by Sung Se-mial in Tang Dynasty, there are different syndromes of itching pruritus. Si Wu Tang with Fang Feng is for blood deficiency which is symptomatic with dry and itch skin. Blood deficiency may cause itching all over the body or only on face. The extremely itching suffered by a spleen deficient patient without puerperal disease or scabies is caused by chest deficiency. In an ancient textbook, it is said that pain is from excess and itching is from deficiency. In TCM, disease causes can be classified into evil-outside type and evil-inside type. The causes and mechanism include cold, heat, damp, deficiency and stasis. They also can be classified into thirteen types for treatment. The root solution is to find out the allergens and keep out of it. But, it is not easy. In addition to applying proper treatment aimed to the symptoms, the root way for recurrence prevention is to use TCM to regulate the physiological function and bring up enough vital Qi on the body surface in order to decrease the production of allergy.