中醫對玫瑰痤瘡病因的認識

1.肺經熱盛:素肺經陽氣偏盛,或風熱外侵入肺,鬱久熱入血液,血熱再循經脈入肺竅,因肺開竅於鼻,故鼻漸漸發紅而生病。如明《古今醫統•鼻赤》中分析:“或因肺經素有風熱,雖不飲酒,亦自紅黑生齇也。”
2.脾胃積熱:長期嗜酒或食辛辣食物,生熱化火,使脾胃積熱。由於胃之經脈起於鼻翼旁,再沿鼻側上行,下循經口周,故脾胃積熱循經薰蒸,可使鼻部和口周潮紅、絡脈充盈而發病。《素問·刺熱論》最早指出:“脾熱病者,鼻先赤。”明《古今醫統•鼻赤》中說:“酒齇鼻多是飲酒之人。酒氣邪熱,薰蒸面鼻,血熱壅滯而成鼻齇,赤色者也。”《古今醫方》則指出:“若不絕酒而徒用藥,抱薪救火,何益於事?”強調了本病與飲食習慣、脾胃積熱的關係。
3.寒凝血瘀
面部、口鼻暴露于外易受風寒,若風寒客於皮膚,或冷水洗面,熱血遇寒則凝,以致血瘀凝結,鼻部先紅後紫,久則變為黯紅。如明代《外科啟玄》認為本病是 “因肺氣不清,受風而生,或以冷水洗面,以致熱血凝結於面所生”。明代《證治準繩》認為“酒齇乃熱血入面,為寒所拂,熱血得寒,污濁凝滯而然”。清《醫宗金鑒》指出本病“由胃火熏肺,更因風寒外束,血瘀凝結”。寒凝血瘀的病機,主要體現在病的後期,表現鼻贅增生,色暗紅或紫紅。
總之,本病外發於鼻,而內關肺、胃。肺胃積熱循經上蒸,入於肺竅,使鼻部潮紅;脾胃濕熱上蒸於肺,而使鼻紅腫脹、皮脂溢出。如果失治、誤治或調養失宜,使肺胃熱勢不減,致熱與血搏,則見紅色丘疹;熱鬱血分,脈絡充盈故血絲顯露;血熱壅聚化腐成膿,則見膿皰;若感受外寒,則致局部血瘀凝結、黯紅肥厚。

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