瘾疹是临床常见的瘙痒性、过敏性皮肤病.临床上易诊断,但因其反复发作,治疗上颇为棘手."瘾疹"一词最早出于《素问》"少阴有余,病皮痹隐疹",该病与"心"密切相关,通过结合《内经》脏腑理论,从心血、心火、心神等方面阐述瘾疹的病机及治疗.

患者男,66岁,接受卡瑞利珠单抗免疫治疗2个月后,全身散在出现化脓性肉芽肿样皮损并逐渐增多增大.皮损组织病理示:真皮层内可见分叶结节状增生毛细血管,血管内皮细胞形成管腔,其内可见红细胞,未见恶性增生.诊断:全身反应性皮肤毛细血管增生症.

Chronic spontaneous urticaria (CSU) is a common dermatologic disease that seriously affects patient quality of life. The choice of therapy to control the disease and prevent its recurrence has always presented a difficult clinical issue. Previous studies have shown that traditional Chinese medicine is a safe and effective treatment for CSU. Recently, the temporal rhythms of CSU, a disease characterized by intermittent flares of active disease and periods of little or no disease, have attracted the attention of traditional Chinese medicine researchers. We designed a multicenter, randomized, controlled study to evaluate the efficacy and safety of combining a Chinese herbal formulation with acupuncture using shu-stream acupoints applied on the corresponding time meridians during disease exacerbations. We plan to recruit 111 outpatients with CSU aged 18 to 65 years. Participants will be randomized to 1 of the 3 groups: group A, which will be given basic acupuncture and the herbal formulation dangui yinzi; group B, which will be given danggui yinzi and shu-stream acupuncture; and a control group, which will be given danggui yinzi alone. Patients will be treated for 4 weeks and followed for 8 additional weeks. Investigators will evaluate the following parameters: the symptoms and side effects of treatment, quality of life (using the chronic urticaria quality of life questionnaire), and overall patient condition. Each week, patients will also complete the measurement of 7-day urticarial activity score. This is the first use of a combination of shu-stream acupoints and Chinese herbal medicine in the treatment of CSU. If successful, it will prove to be a simple, inexpensive, treatment strategy for solving a difficult clinical problem.

临床资料 患者,男,63岁.额头结节6个月.患者6个月前无明显诱因于额头部出现淡红色的丘疹,患者未重视,皮疹逐渐增大为结节,无水疱、破溃,自觉轻度瘙痒,无疼痛,未于院外诊治.患者既往体健,无高血压、冠心病、肝炎、结核等病史,无手术、药物过敏史,家族史中无类似疾病史.体格检查:一般情况可,系统查体未见明显异常.皮肤科情况:额部可见类圆形结节,高出于皮面,直径约1.5 cm,质硬,无压痛,表面光滑,边界清楚,无破溃、渗出(图1).

A 26-year-old female had hair loss for 7 months,without any precipitating factors.She was diagnosed and treated as "androgenetic alopecia" or "alopecia areata" at local hospitals,with no improvement.The hair loss involved the whole head,and the hair-pulling test was positive.The laboratory and histopathological exams did not show any abnormalities.The diagnosis of acute telogen effluvium was made.The hair-pulling test became negative and hair regrew almost completely after the treatment with nicotinamide,zinc gluconate and folic acid.

Objective To study the influence of hydrocortisone sodium succinct by intravenous infusion or continuous intravenous micro pumping on the vital signs,shock duration,blood glucose and mortality in the patients with severe sepsis secondary shock.Methods Ninety patients with septic shock treated in our hospital from June 2014 to September 2016 were selected and divided into the control group and observasion group by using the random number table method,45 cases in each group.The control group was given hydrocortisone sodium succinct 200mg/d by slow intravenous drip for 2h,while the observasion group was given hydrocortisone sodium succinct 8.33mg/h by continuous intravenous micro pumping.The two groups were treated for continuous 5 d.The blood glucose,hemodynamics and prognosis were compared between the two groups.Results In the observasion group,the blood glucose indicators such as the time window of high blood glucose,LAGE,MBG and CV levels were lower than those in the control group,the difference had statistical significance (P<0.05).The hemodynamic indicators such as HR,CVP and MAP between the two groups before treatment and at 6,24 h and 5 d after treatment had no statistical difference between the two groups (P>0.05).The shock duration,ICU stay length,total hospital stay and 28 d mortality in the observasion group were lower than those in the control group,but the difference between the two groups had no statistical significance (P>0.05).Conclusion Continuous intravenous micro pumping of hydrocortisone sodium succinct can stabilize blood glucose fluctuation range in the patients with septic shock,but the hemodynamic indexes and prognosis have no obvious improvement.

患者,男,68岁,因左侧腹部疼痛10天,红斑水疱3天入院.患者10天前无明显诱因自觉左腹疼痛,呈阵发性跳痛,伴腹胀、肛门停止排气排便,偶觉恶心欲呕,无发热畏寒等不适,至当地医院就诊,诊断:不完全性肠梗阻,予禁食、灌肠等治疗后症状无明显缓解,后患者出现无法自行小便,予导尿处理.

播散性黄瘤是非朗格汉斯细胞组织细胞增生症的一种良性形式.本文报告1例播散性黄瘤,并就该病的临床表现及诊断,尤其是鉴别诊断等进行详细总结.

95例慢性荨麻疹随机分为两组,观察组54例采用自血疗法联合复方甘草酸苷及地氯雷他定治疗,对照组41例仅采用地氯雷他定治疗,比较观察两组的临床疗效和主要指标变化。结果观察组的总有效率明显高于对照组(P<0.05)。自血疗法联合复方甘草酸苷及地氯雷他定能够明显提高临床疗效,并能调节免疫功能,值得临床推广应用。

Objectives:To observe the therapeutic effects of the local application of Chinese herb Keyouling combined with microwave in the treatment for condyloma acuminatum.Methods:From January 2009 to January 2011,122 cases of female patients with condyloma acuminatum were selected as the research objects.According to their registration number,all patients were randomly divided into two groups.Sixty - one cases of patients in the observation group were given Chinese herb Keyouling and microwave treatment,and the other 61 patients in the control group were given simple microwave treatment.The clinical effects of the two groups were compared at one week and one month after the treatment.Results:With further treatment,the total significant efficiency of the observation group and the control group at one month after treatment were higher than that at one week after treatment,but the differences were of no statistically significance(P0.05).At 1 week after treatment,the total significant efficiency of the observation group was 81.97%,which was higher than that in the control group(57.38%).One month after the treatment,the total significant efficiency of the observation group was 95.08%,which was higher than that in the control group (65.57%).The comparative differences were statistically significant(P0.05).Conclusion:The combined treatment of Chinese herb Keyouling and microwave is practical for female condyloma acuminatum.The curative effect is significantly better than simply using microwave treatment.This suggests that the combined treatment is worthy of clinical promotion.

临床资料 患者,女,43岁,尼姑.主因头部脱屑伴瘙痒8年余加重半年,指趾甲灰白增厚1年余,于2007年9月1日来我院就诊.患者8年前发现头部脱屑增多,时有瘙痒,当地医院多次诊断为"脂溢性皮炎",治疗效果欠佳.近半年来,头皮屑明显增多伴头皮瘙痒,皮损继续扩大,遂来我院就诊.1年前患者发现右手拇指和左足拇趾指甲逐渐灰白、增厚.患者为庙宇修行僧人,既往体健,未婚,月经正常,否认动物接触史及家族遗传病史.患者自诉剃发时曾与他人共用1把剃刀,但同伴无类似病史.

报告1例隐翅虫皮炎诱发急性泛发性发疹性脓疱病.患者男,51岁,胸前接触隐翅虫毒素1～2天后,四肢、躯干出现与原发部位皮损不同的水肿性红斑,其上密集成群浅表脓疱,针帽至粟米大小.组织病理示:角层下脓疱,真皮浅层不等量炎性细胞浸润.诊断:急性泛发性发疹性脓疱病.糖皮质激素治疗敏感.

报告1例被误诊为带状疱疹的狼疮性脂膜炎.患者女,24岁.右肩胛部起皮疹伴痛疼5年.体检见右肩胛部有10.0cm×5.0cm大小呈条带状分布的疼痛性斑块,其上有多个淡红色的萎缩性瘢痕和溃疡,免疫及组织病理学符合狼疮性脂膜炎.

目的:探讨更年期痤疮发病机理及中医辨证分型论治。方法:常规西药一般治疗的基础上以自拟的疏肝泻肺汤为基本方辨证分型加减治疗更年期痤疮。结果:共治疗更年期痤疮32例,总有效率84.4%。结论:中医辨证分型配合西药常规治疗更年期痤疮,可明显提高疗效。

本文论述黄褐斑的病因病机及辨证分型论治,采用了经典方和验方,临床效果明显.并浅淡了作者的临床体会,给黄褐斑患者提供了治疗方法.