王家悦 张丰川 蔡玲玲

摘要 白癜风属皮肤科易诊难治的损容性皮肤病，表现为多发的、局限性或泛发性的皮肤黏膜色素脱失，影响美观，给患者带来极大心理压力。此病发病机制不详，目前治疗效果并不理想，中医药治疗是一种新的希望。张丰川教授认为情志异常、肝气郁结是本病的发病诱因，劳损是其发病基础，外邪侵袭、毒邪郁结是发病关键，络脉瘀阻是其发病终点。辨病辨证相结合，司外揣内，由皮损推断体内脏腑气血变化。对症治疗，灵活辨证，精准用药，巧用外治，对于难复色特殊部位的治疗别具匠心。吾师从张丰川教授，学习总结其学术思想与临床经验，对白癜风的治疗具有一定的参考意义。

关键词 辨证思路;白癜风;临床经验; @ 张丰川

Abstract Vitiligo is a skin disease which is easy to be diagnosed，but difficult to be treated in dermatology.It is characterized by multiple，localized or generalized pigment loss of skin mucosa，which affects the appearance and brings great psychological pressure to patients.The pathogenesis of this disease is unknown，and the therapeutic effect is not ideal at present.Traditional Chinese medicine treatment is a new hope.According to Professor ZHANG Fengchuan believes that abnormal emotions and liver-qi stagnation are the causative factors of the disease，strain is the basis of the disease，exogenous pathogenic factors and toxic pathogenic factors are the key factors of the disease，and collaterals stasis is the terminal point of the disease.Prof.ZHANG uses the dialectic combination of disease differentiation，governing exterior to infer interior，and inferring internal viscera qi and blood changes by skin lesions.Symptomatic treatment，flexible syndrome differentiation，accurate medication，clever external treatment，and the treatment of special parts that are difficult to recolor show ingenuity.I learn from Professor ZHANG Fengchuan and summarize his academic thoughts and clinical experience，which has certain reference significance for the treatment of vitiligo.

Keywords Dialectical thinking; Vitiligo; Clinical experience; @ ZHANG Fengchuan

中图分类号：R289.5;R259;R758.4+1 文献标识码：B doi：10.3969/j.issn.1673-7202.2020.22.022

白癜风是皮肤科常见多发的、局限性或泛发性的皮肤黏膜色素脱失症，近年来发病率有增高趋势，发病率大约为1% ～2%[1]，属于易诊难治的损容性皮肤病。其发生是由于皮肤黑素细胞减少或缺失而引起，但具体机制不详。中医文献中关于此病的记载较多，病名有“白癜”“白点风”“白定”“白钩”“白毋奏”“龙舐”“癜风”“白驳风”“白驳”“白处”等，其认识多遵从《诸病源候论·白癜候》曰：“白癜者，面及颈项身体皮肉色变白，与肉色不同，亦不痒痛，谓之白癜。此亦是风邪搏于皮肤，血气不和所生也”。

1 白癜风的病因病机特点

中医学认为白癜风的发病总由风邪侵扰，气血失和、脉络瘀阻所致[2]。但我们根据其临床表现，还强调了情志异常、劳损、外邪蕴毒、络脉瘀阻在发病中的作用。……