{"id":5449,"date":"2016-09-02T00:00:00","date_gmt":"2016-09-01T16:00:00","guid":{"rendered":"\/\/www.afterroberto.com\/?guid=8e966aef6396127fa2544351990bb035"},"modified":"2018-08-22T14:57:21","modified_gmt":"2018-08-22T06:57:21","slug":"%e9%86%ab%e5%be%b9%e4%b8%ad%e8%a5%bf%ef%bc%9a%e4%b8%ad%e9%86%ab%e9%86%ab%e5%be%97%e6%85%a2%e5%97%8e%ef%bc%9f","status":"publish","type":"post","link":"\/\/www.afterroberto.com\/%e9%86%ab%e5%be%b9%e4%b8%ad%e8%a5%bf%ef%bc%9a%e4%b8%ad%e9%86%ab%e9%86%ab%e5%be%97%e6%85%a2%e5%97%8e%ef%bc%9f\/","title":{"rendered":"\u3010\u4e2d\u91ab\u6cbb\u7642\u3011\u91ab\u5fb9\u4e2d\u897f\uff1a\u4e2d\u91ab\u91ab\u5f97\u6162\u55ce\uff1f"},"content":{"rendered":"

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\/\/www.afterroberto.com\/wp-content\/uploads\/2017\/07\/M70515q.jpg;<\/inline><\/p>\n","protected":false},"excerpt":{"rendered":"

【明報專訊】我不是皮膚科醫生，但有不少病人就奇難的皮膚病來就診。跟隨我的學生中醫，寫了以下的一個病例。<\/p>\n

皮膚乾硬、足冷 屢醫無效<\/p>\n

一名中年男子素來無病徵，自覺身體好。他三年前右小腿後側皮膚乾硬，其後其他皮膚出現紅點、小乾塊，主要見於身體下部，亦散見於臍周腰部。就診時，右腿部患處八寸皮膚乾燥、皮厚、脫屑，色黯偏黑。他曾接受數個中醫及西醫皮膚科醫生循濕疹方向治療，當中有的中醫以血熱證治之，皆未有改善。<\/p>\n

他體型健碩，不疲倦，腸胃好，脾氣佳，無痛處，下體亦無不適，整體無寒熱感覺異常，只是明顯覺得足冷。他不口乾，舌苔卻黃膩偏厚，舌腫，色偏紫，舌左邊中前方有凹摺紋，右舌邊細看偏光。唇黑。脈滑。右手指甲半月痕全失，左手還有一指甲有。<\/p>\n

通常，這些皮膚病用清熱除濕的方法就能見效，但病者之前卻屢治不效。唯有覆核。我斷證為體內痰濁多於濕（中醫認為水液積聚在身體而稠濁的就成痰）。當整體病徵表現甚少，就須在細微之處尋求病因。病者一向健碩，不是陽虛或血虛，亦不覺怕冷，但奇怪的是明顯感覺腳冷，可說是由陽氣分佈受阻所致。病者苔黃膩，細問下，吸煙多年，每日達1至2包，可說是肺熱導致痰熱阻絡。這結論足以制定治療方案，可是，還需思考為何身體徵狀表現有明顯的左右偏向。考慮到氣血的循環，以中醫「左肝右肺」的角度來作考慮。皮膚病患起於右邊下肢，以右邊及身體下部為主。肺主右降，肺熱則消耗陰血，至遠端時陰血更見不足，而肺主皮毛，病患常見於皮膚，恰恰與病者情况相符。病者右舌邊光苔，手指甲半月痕只餘左手有一隻，皆顯示右邊的氣血較為不足。病者舌凹摺紋只見於左邊，凹摺紋由舌下筋脈拘急收縮所引起，亦與左肝主筋相符。以左肝右肺的角度考慮之後，能更好地解釋病者左右不同的表現。肝肺氣血的循環營運不足亦可解釋遠端的足冷。所以最後決定先清熱化痰通絡，在皮膚常方中，特地加入了元參、桑白皮。目標是清肺熱則無痰熱阻絡，絡通則恢復氣血之運行。<\/p>\n

但預料皮膚厚實治療可能需時，擬定日後可從治療效果來檢討，待痰熱稍解再同時治以行氣活血。肺熱傷津方面，則當兼用養陰清熱以善其後，使身體各部位得到充分濡養。<\/p>\n

覆核細微處斷證 來診兩次大改善<\/p>\n

誰料來診兩次後，他不再覆診。再過了兩星期，找人問候他，他回來了。原來他那十數天單單口服清肺熱通絡藥物，皮膚就明顯改善，不再厚實，腳也不再冷了！回來診所只是看看還有什麼地方需要醫治。見他的厚舌苔也大部減退，於是以後也不需再覆診。<\/p>\n

中醫學是令人驚訝的醫學。有些人把中醫西醫配合簡化為西醫治病中醫治身體或治未病，又誤以為中醫治病會慢癒。其實中西醫各有所長，匹配有序才是發展方向。<\/p>\n

文：香港醫學專科學院院士、浸會大學中醫藥學院榮譽教授余秋良<\/p>\n

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