运用扶正祛邪思想治疗难治性口腔溃疡一例

芮净 张惟郁 蔡浙毅

摘要：复发性口腔溃疡表现为不同程度的口腔灼痛，影响正常进食与生活质量。目前，尚无特效疗法，主要以促进溃疡面愈合、缓解症状为主，疗效不甚理想，复发率高。近年来，中医药在治疗口腔溃疡并预防复发中展现出一定优势。本文整理我老师张惟郁主任运用扶正祛邪思想临床成功治疗复发性口腔溃疡病案1例，针对正虚邪实型的口腔溃疡特殊的病因病机贯彻运用扶正祛邪大法，收到良好疗效，请同道探讨指正。

关键词：口腔溃疡;扶正祛邪;正虚邪实

Abstract：Recurrent oral ulcers are manifested by different degrees of mouth burning， which affects normal eating and quality of life. At present， there is no specific treatment， mainly to promote the healing of the ulcer surface and relieve the symptoms. The effect is not satisfactory and the recurrence rate is high. In recent years， traditional Chinese medicine has shown certain advantages in treating oral ulcers and preventing recurrence. This article records a case of my teacher’s director Zhang Weiyu’s successful clinical treatment of recurrent oral ulcers using the idea of strengthening the body and eliminating evils. The etiology and pathogenesis of oral ulcers of the type of deficiency and evil are discussed and analyzed， and some clinical TCM experience in preventing oral ulcers from recurrence is summarized. For clinical reference.

Keywords：Oral ulcers; strengthening the body resistance to eliminate pathogenic factors;body resistance weakened while pathogenic factors prevailing

【中圖分类号】R322.4+1  【文献标识码】A  【文章编号】1673-9026（2021）14--02

口腔溃疡的中医病名叫口疮，又名“口破”、“口糜”等，其病名首见于《黄帝内经》，以口腔内唇、舌、颊部、上颚及软腭等处黏膜发生溃疡、灼热疼痛为特征，好发于口腔黏膜角化程度较差的部位，病灶多呈圆形或椭圆形，伴有明显疼痛，少数患者可伴有发热等其他症状。病程呈自限性，发作持续时间一般为7-10天，周期反复发作。本病多因平素饮食不节、过食辛辣厚味、嗜好烟酒或情志内伤、劳倦过度而致病。

1临床治疗

口疮中医临床实践指南（2018）将此病中医辨证[1]分为5型：①心脾积热证：症见溃疡伴口干，心烦失眠，焦虑不安，便干尿赤，舌尖偏红，苔黄，脉数。治以清心泻脾，导热下行，用导赤散合泻黄散加减。②胃热炽盛证：溃疡周围充血发红，口中灼热疼痛，牙龈红肿出血，口臭，口干，渴思凉饮，大便干结，小便黄赤，舌质红，舌苔黄而干，脉滑或数。治以清胃降火，通腑泻热，用清胃散加减。……