赵静 杨志波 李兆晟

〔摘要〕 杨志波教授认为脂溢性脱发是由于胃肠湿热向上熏蒸头面部，侵及发根致发落，湿热为因，与脾胃关系密切。治疗上以清热利湿、健脾祛风为法，辅以凉血活血，采用枇杷清肺饮合茵陈煎剂加减治疗，结合患者体质对证施治，善用膏方，注重内服外洗，联合治疗，临床疗效显著。

〔关键词〕 脂溢性脱发;湿热;清热利湿;健脾祛风;凉血活血;枇杷清肺饮;杨志波

〔中图分类号〕R275.9       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2020.07.019

〔Abstract〕 Professor YANG Zhibo thinks that seborrheic alopecia is caused by the stomach and intestine dampness heat upward fumigating the head and face， invading the hair root and causing the hair to fall. The damp heat is the cause of disease， which is closely related to the spleen and stomach. The treatment is based on the methods of clearing heat and removing dampness， strengthening the spleen and expelling wind， supplemented by cooling blood and promoting blood circulation. It is treated with modified Pipa Qingfei Decoction and Yinchen Decoction. It is emphasized that the syndrome differentiation is accurate， and the syndrome differentiation is treated with the combination of the patient's constitution. The cream formula is made good use， and attention is paid to internal and external washing， as well as combined treatment. The clinical effect is significant.

〔Keywords〕 seborrheic alopecia; damp heat; clearing heat and removing dampness; strengthening the spleen and expelling wind; cooling blood and promoting blood circulation; Pipa Qingfei Decoction; YANG Zhibo

脂溢性脫发相当于西医雄激素源性脱发[1]，属于皮肤科难治性疾病，具有常见、多发的特点。现代研究表明其发病机制多与遗传、局部炎症、细胞因子、激素合成代谢、维生素D缺乏、血脂异常等有关[2-4]。脂溢性脱发易诊难治，常随年龄增长而加重。临床表现为头皮易出油、多油腻性鳞屑，头发逐渐变得细软，额颞部发际线后移，大多数呈M型，女性多是头顶部毛发弥漫性稀疏，额颞部较少累及，伴有瘙痒或无自觉症状[5]。

杨志波教授是中华中医药学会皮肤分会主任委员，多年来潜心钻研，累积了丰富经验，临床功底深厚，对脂溢性脱发的病因病机、治疗方法等有独到见解和经验，现将其治疗脂溢性脱发经验阐述如下。

1 病因病机分析

脂溢性脱发属中医学“发蛀脱发”“蛀发癣”等范畴，其病名首见于清代王洪绪的《外科证治全生集》：“头毒，皮红光亮，初起微痒，于发内为油风，为蛀发癣”[6]，简明的叙述了脂溢性脱发的症状，指出了其临床表现有头皮易油，初期常伴有轻微瘙痒的特征。……