迁延日久化热,热势轻,选用桂枝芍药知母汤;湿热并重,下肢浮肿,选用当归拈痛汤;痹证日久内舍肝肾,选用独活寄生汤;寒热不明显,风邪偏胜,全身症状明显,选用五皮五藤饮加减。“用成方,不拘其法不泥其量,贵在权变”是吾师学术特点,在痹证的治疗中有几类药的应用很有特色:第一,使用虫蛇类药,如全蝎、蜈蚣、白花蛇等,虫蛇药善搜剔诸邪,通经窜络,刮剔瘀血。全蝎长于止痛,蜈蚣长于解痉,两药为祛风止痉的要药,吾师根据拘挛疼痛配伍应用,一般全蝎3~9g,蜈蚣3~6条,白花蛇在7剂药中用2~3条另煎兑服。第二,治痹常合用大量黄芪,多则100g以上,据王清任补阳还五汤之意,痹证的发生主要是由于正气不足,感受风、寒、湿、热之邪。收稿日期:2012-05-28作者简介:周宝宽(1955-),男,辽宁沈阳人,主任医师,博士,研究方向:中医药防治皮肤病。“生芪之妙不在补气而在通阳”,阳气一通,则气血通畅,阴寒易除。第三,治疗麻木大胆用药。早晨手胀麻拘紧,选用麻黄配伍白芥子,这是吾师学习名老中医王大经以阳和汤治疗寒痹的绝招。麻黄辛温达卫,宣通经络,引阳气,开寒结;白芥子祛皮里膜外之痰,二味合用宣通气血。吾师一般用麻黄10~12g,配白芥子10~15g;若全身麻选用马钱子0.3~0.6g,马钱子有毒他医畏之,吾师50年临床实践未见不良反应。第四,合理选用引经药,四肢症状重吾师选用五皮五藤饮中的药物,既治病又引经,两全其美,背痛用络石藤,上肢痛,加桂枝,羌活,下肢痛加牛膝,独活,足跟痛加桑寄生,痹症日久加地龙、水蛭等虫蚁药,效果卓著。第五,痛重合用活血止痛药,多用血竭4~6g,三七3g,制乳香10g,制没药10g。参考文献[1]张炳厚.神医怪杰张炳厚[M].北京:中国中医药出版社,2007:119.辨证论治银屑病验案周宝宽(沈阳皇姑协和中医门诊部,辽宁沈阳110036)摘要:目的:总结周宝宽主任医师辨治银屑病经验。方法:以医案的形式阐述银屑病的病因病机、证型、治法、方药。结果:银屑病的病因病机复杂,主要为血热、血虚、风燥、气滞、血瘀、湿毒、火毒及脏腑功能失调导致肌肤失养。治疗原则为凉血消斑,养血润燥,化瘀通络,清热利湿,泻火解毒。自拟清热解毒汤,养血润燥汤,化瘀通络汤,化湿解毒汤,泻火解毒汤。结论:辨证论治银屑病有较好疗效。关键词:银屑病;辨证论治;周宝宽;临床经验;医案中图分类号:R758.63文献标识码:A文章编号:1000-1719(2012)10-2279-03SyndromeDifferentiationandTreatmentExperienceofPsoriasisZHOUBao-kuan(ShenyangHuangguXieheOutpatientDepartmentofTraditionalChineseMedicine,Shenyang110036,Liaoning,China)Abstract:Objective:Tosummarizesyndromedifferentiationandtreatmentexperienceofpsoriasisinclinic.Methods:Discussetiopathogenisis,pathogenesis,patternofsyndrome,methodoftreatment,formulaeandmedicinalsbasedonmedicalrecords.Re-sults:Theetiopathogenisisandpathogenesisarecomplicated,causesofpsoriasisincludebloodheat,blooddeficiency,wind-dry-ness,qistagnation,bloodstasis,dampnesstoxin,firetoxin,anddisharmonyofZangFufunction,andresultinnutritionaldisorderofskin.treatmentprinciplesofpsoriasisarecoolingbloodtoclearmacula,nourishingbloodtomoistendryness,dispersingbloodstasisanddredgecollateral,clearingawayheatevilandpromotingdiuresis,purgingfireforremovingtoxin.Formulaeforpsoriasisaredecoctionofheat-clearinganddetoxicating,decoctionofmoisturizedrynessbynourishingblood,decoctionofdispersebloodstasisanddredgecollateral,decoctionofdissipatingdampnessforremovingtoxin,decoctionofpurgingfireforremovingtoxin.Conclusion:Syndromedifferentiationandtreatmentshowabettertherapeuticeffectforpsoriasis.Keywords:psoriasis;syndromedifferentiationandtreatment;ZHOUBao-kuan;clinicalexperience;medicalrecord银屑病又称牛皮癣,是一种常见的慢性复发性炎症性皮肤病,典型皮损为鳞屑性红斑,属于中医“白疕”的范畴。白...