常見皮膚病的西醫(yī)診斷和中醫(yī)治療

1、Western Diagnosis & TCM Managementfor Common Skin Diseases常見皮膚病的西醫(yī)診斷和中醫(yī)治療Yong Ming Li, MD, PhD李永明 博士 醫(yī)師,針灸醫(yī)生最常見的疾病是什么？ 答案不是經(jīng)常治療的疼痛或抑郁癥，而是皮膚病。 針灸醫(yī)生在“尋經(jīng)取穴”時(shí)可以“順便”檢查患者的皮膚病變，這是其它科醫(yī)生沒有的方便條件。 但是，很多針灸醫(yī)生沒有受過

2、皮膚病診斷的訓(xùn)練，只好視而不見。 美國是個(gè)移民國家，不同種族的病人皮膚病種類繁多，尤其是白種人皮膚癌發(fā)病率極高，不及時(shí)診斷，可能危及生命。 針灸師如果能夠掌握簡單皮膚病診斷技能，對患者和提高行醫(yī)水準(zhǔn)都會(huì)十分有益。 中醫(yī)中藥和針灸在治療一些炎癥皮膚病和某些疑難皮膚病有很多優(yōu)勢，每位中醫(yī)師和針灸師都應(yīng)該在臨床上探索使用。,Why an acupuncturist need to know skin diseases？

3、針灸醫(yī)生為什么需要皮膚疾??？,Why an acupuncturist need to know skin diseases？針灸醫(yī)生為什么需要皮膚疾?。?What is the most common condition encountered by an acupuncturist? The answer is not pain or depression but the skin problem. While l

4、ocating acupoints, an acupuncturist has the advantage to review most skin lesions, but other specialists do not have. Unfortunately, many practitioners who have insufficient dermatological training choose to ignore

5、 skin problems. Various complicated skin diseases might be seen in the USA and light skin individuals are special prone to skin cancer. An acupuncturist with basic dermatological expertise can be a great benefit

6、 to patients as well as to his/her own practice. Acupuncture and TCM herbs are known to be good alternative options for certain skin diseases.,1. 美國最常見皮膚病的分類2. 皮膚惡性腫瘤的臨床特征和鑒別診斷3. 常見炎癥皮膚病的分類和適合中醫(yī)治療的病癥4.

7、 “望聞問切”在皮膚病診斷和鑒別診斷中的應(yīng)用5. 中醫(yī)藥和針灸治療病例介紹,1. The classification of commonly seen skin diseases in the USA2. Clinical features and diagnosis of malignant skin tumorsCommonly seen inflammatory skin diseases and c

8、onditions may be managed by TCM therapiesApplication of TCM diagnostic principles in the examination and screening of skin diseases5. Case analysis on TCM management,Western Diagnosis & TCM Mana

9、gement for Common Skin Diseases常見皮膚病的西醫(yī)診斷和中醫(yī)治療,Classification of common skin conditions常見皮膚病分類,Seborrheic keratosis (SK) 脂溢性角化病Melanocytic nevus (mole) 黑色素痣Solar keratosis (actinic keratosis) 日光性角化病Fibroepit

10、helial polyp (skin tag) 纖維上皮息肉Epidermal cyst (sebaceous cyst） 表皮囊腫Verruca vulgaris, condyloma (wart) 尋常疣，濕疣Dermal scar (keloid) 皮膚疤痕，瘢痕疙瘩Dermatofibroma 皮膚纖維瘤Neurofibroma 纖維神經(jīng)瘤Hemangioma 血管瘤Basal ce

11、ll carcinoma (BCC) 基底細(xì)胞癌Squamous cell carcinoma (SCC) 鱗狀細(xì)胞癌Malignant melanoma (melanoma) 惡性黑素瘤,Common non-inflammatory skin conditions常見非炎癥皮膚病變,Clinical Features and Diagnosis of Malignant Skin Tumors皮膚惡性腫瘤的臨床

12、特征和鑒別診斷,Basal cell carcinoma (BCC) 基底細(xì)胞癌Squamous cell carcinoma (SCC) 鱗狀細(xì)胞癌Malignant melanoma (melanoma) 惡性黑素瘤Lymphoma, leukemia 淋巴瘤，白血病Soft tissue malignant tumor 軟組織惡性腫瘤Metastatic cancer 轉(zhuǎn)移癌,Clinical

13、Features of Malignant melanoma惡性黑素瘤的臨床特征,Eczema, atopic dermatitis 濕疹，特應(yīng)性皮炎（異位皮炎）Allergic and contact dermatitis 過敏性和接觸性皮炎Lichen simplex chronicus 神經(jīng)性皮炎Acne 痤瘡，粉刺Folliculitis 毛囊炎Herpes infection 皰

14、疹病毒感染Drug reaction 藥物皮炎Arthropod bite reaction 蚊蟲叮咬Dermatophysis 皮癬Psoriasis 銀屑癬，牛皮癬Lupus erythematosus 紅斑狼瘡Uticaria 蕁麻疹A(yù)lopecia areata 斑禿,Common inflammatory skin conditions常見炎癥皮膚病變,Eczema, atop

15、ic dermatitis 濕疹，特應(yīng)性皮炎Allergic dermatitis 過敏性性皮炎Urticaria reaction 蕁麻疹Zoster 帶狀皰疹Lichen simplex chronicus 神經(jīng)性皮炎Psoriasis 銀屑癬Auto immune dermatitis 自身免疫皮炎Alopecia 脫發(fā)Wart, verruca 疣Skin Itching, pain 皮膚瘙癢、疼痛,

16、Common Inflammatory Skin Diseases May Be Managed by TCM Therapies常見炎癥皮膚病的分類和適合中醫(yī)治療的病癥,Application of TCM Diagnostic Principles in the Examination and Screening of Skin Diseases“望聞問切”在皮膚病診斷和鑒別診斷中的應(yīng)用,望：Inspection聞：Lis

17、tening & smelling問：Inquiry切：Palpation,Tree Integrative Approaches in the Management of Eczema中西醫(yī)結(jié)合治療濕疹的三中方法,中藥 Herbs針灸 Acupuncture3. 生活和水土的改變 Life & Land Changes,Acupuncture Points for Eczema Manag

18、ement治療濕疹的常用針灸穴位,神庭 Shen Ting,曲池 Qu Chi,通里 Tong Li,合谷 He Gu,陽陵泉 Yang Ling Quan,隱白 Yin Bai,足三里 Zu San Li,太沖 Tai Chong,Acupuncture Shu Points for Eczema Management治療濕疹的常用針灸腧穴,風(fēng)門 Feng Men,肺腧 Fei Shu,心腧 Xin Shu,脾腧 Pi Shu,胃

19、腧 Wei Shu,三焦腧 San Jiao Shu,腎腧 Shen Shu,定喘 Ding Chuan,Local Acupuncture Area for Eczema Management治療濕疹的局部針灸治區(qū)域,重內(nèi)因病表治里，祥外治殊途同歸內(nèi)治：四型1. 濕熱：龍膽瀉肝湯龍膽草、 黃芩、 梔子、 澤瀉、 【木通】、 車前子、當(dāng)歸、 生地黃、 柴胡、 甘草膿皰：金銀花、連翹；便干：大青葉血熱：皮癬湯加減生地、

20、丹皮、赤芍、黃芩、苦參、地膚子、白鮮皮、丹參、生甘草,Dr Zhu Renkang’s Experience in Managing Eczema朱仁康治療濕疹經(jīng)驗(yàn),內(nèi)治：脾濕：胃苓湯加減蒼術(shù)、陳皮、茯苓、澤瀉、六一散、白鮮皮胃呆：藿香、佩蘭；腹脹：川樸、大腹皮陰傷：滋陰除濕法生地、元參、當(dāng)歸、丹參、茯苓、澤瀉、白鮮皮、蛇床子禁忌：重用燥濕和利濕之品,Dr Zhu Renkang’s Experience in Ma

21、naging Eczema朱仁康治療濕疹經(jīng)驗(yàn),外治：1. 濕敷：急性期滲出黃柏 或 馬齒莧 或 生地榆30克煎汁，用紗布浸透，外敷藥膏：各期均可以濕疹膏等粉劑：急性期藥粉加植物油：青黛、螵蛸、鍛石膏、冰片,Dr Zhu Renkang’s Experience in Managing Eczema朱仁康治療濕疹經(jīng)驗(yàn),辨濕疹，要在濕熱互結(jié)，治頑癥用“全蟲” 內(nèi)治：二型1. 熱盛型：龍膽草6、

22、黃芩9、 黃連6、 澤瀉9、 梔子6、 車前草15生地黃15、 連翹9、槐花9、 甘草3 【木通3】便干：川軍、枳殼；下焦?jié)駸幔狐S柏；滲液多：茵陳頭部：藁本；腰背：杜仲；上肢：姜黃；下肢：牛膝或木瓜；瘙癢：白鮮皮、地膚子、苦參2. 濕盛型：厚樸9、陳皮6、澤瀉9、黃柏9、茯苓9、豬苓9、枳殼9、薏米9白術(shù)9、車前子9 濕重：蒼術(shù) 頑癥方：全蟲（全蝎）6、皂角6、皂刺12、黃柏9、枳殼9、

23、 苦參6、白鮮皮15、威靈仙12、生槐花15,Dr Zhao Bingnan’s Experience in Managing Eczema趙炳南治療濕疹經(jīng)驗(yàn),濕熱血燥，脾虛濕停內(nèi)治：分三型濕熱互結(jié)，熱重于濕：清熱除濕：生石膏、山梔、黃芩、龍膽草涼血：生地、丹皮清熱利水：車前草、車前子、冬瓜皮、馬齒莧、六一散脾虛脾虛濕盛，濕蘊(yùn)肌膚健脾除濕：白術(shù)、蒼術(shù)、薏苡仁、枳殼、厚樸利水除濕：車前子、澤瀉、茯苓皮、

24、冬瓜皮、豬苓除濕止癢：馬齒莧、苦參養(yǎng)血潤膚：當(dāng)歸、丹參、赤芍陰虛血燥，氣血瘀滯育因滋燥：熟地、天麥冬、女貞子、旱蓮草、元參養(yǎng)血潤膚：當(dāng)歸、赤白芍、桃仁、紅花、丹參、首烏除濕止癢：白鮮皮、澤瀉、茯苓、苦參,Dr Zhang Zhili’s Experience in Managing Eczema張志禮治療濕疹經(jīng)驗(yàn),Dr. Gan Zhuwang’s Experience干祖望祛濕清熱經(jīng)驗(yàn)方,蒼術(shù)：燥濕Can

25、g Zhu: eliminating dampness黃柏：清熱Huang Bai: clearing heat忍冬藤：祛風(fēng)Ren Dong Teng: dispelling wind薄荷：宣表Be He: diffusing exterior牡丹皮：活血Mu Dan Pi: promoting blood circulation* A clinical trial of this formula w