男,20岁。

2017年6月30日初诊

初诊会面,患者是壮硕的年轻人,面色皮肤白里透红,手臂以及手掌,手背呈红疹发炎伴手指关节皲裂流水样汁半年。我问:“痛吗?”他答:“又痛又痒。”我好奇,心想怎么一个年轻人会患上皮肤炎。经过详细地问诊,了解到患者是一名面包厨师。工作流程就是每天8小时必须让双手与面粉,水,油接触。我又问: “其他同事有患上湿疹的吗?”他答:“没有。”

30-06-2017 dermatitis

这时候为了更了解患者的状况,继续号脉,脉象呈沉弦脉。这时,我想起了当季是炎热气候,“夏至”一周以后,理当脉滑数,表示血液流畅。这天脉怎么这么沉?(注:沉脉属于气血不能畅达,痰饮、湿浊、瘀血、食滞、火郁,皆可阻滞气机、气血不畅、脉道不利而脉沉。)通过近一步问诊,得知患者工作中揉搓面粉团后得把面粉团放进高温的烤炉,为了避免环境炎热高温,公司提供了一个舒适的环境给员工,把空调调得特寒冻的!加上患者开工时间是从夜晚到天亮,显然是生理时钟跟大自然不一致啊!

【病因关键】

我想病因关键就在这里了。他长期在又高温又寒冷的环境工作,高温导致体热内聚;工作到天亮说明了每天都在熬夜,身体虚火上炎。寒湿冷的空气又把手指关节附近的血液循环凝冻了。皮肤毛孔关闭了,热郁与湿浊留在体内,没有出路,所以热毒往四末端循行。一双手臂,手背,手掌,手指自然成了热毒循行之路,而发为皮肤炎。脉象正好诠释了所谓的湿浊与火郁阻滞导致气血不畅而显现沉脉。开了三天的科学中药粉吃。

 

2017年7月5日复诊

经过3日服药与治疗后,患处红疹明显消沉了下去。手指关节皲裂的伤口逐渐在修复中。皮肤瘙痒也改善了许多。建议患者暂时休息数日以让皮肤得以全面改善。继续服中药六日。

05-07-2017 Dermatitis

2017年7月12日

后来,患者发来照片。皮肤进展尚算满意,红疹患处尤其伤口皲裂处也开始结痂,不再流水样汁了,皮肤色素变浅。

12-07-2017 Dermatitis

让我比较担心的是患者的生活习惯依然没办法调整,每天继续在又热又寒的环境中持续劳作,恐怕皮肤问题会有重现的一天。祝福患者,希望他能在皮肤改善的同时,又能从容的从事他的行业。

【心得后语】

治疗皮肤病,短暂的改善可能会令一些患者暂时忘掉了疾病曾经带来的痛楚,而在生活中放纵了自己,最后导致病情复发。尤其对皮肤病患者,我们特别关注病人的饮食习惯,体育锻炼等等。服药期间他们会紧守禁忌,但是往往皮肤改善或痊愈之后,他们开始放纵自己,结果身体的阴阳偏性不调了,疾病又复发了。所以,这类患者可能觉得病情改善就好,反正现在好了;抱着侥幸的心态。身为医者,我们是真心希望患者的病能彻底连根拔除,标本兼治。

 

Dermatitis Case Study

Male,20- year old

30-06-2017 First visit

On the first day visit, the patient outlook given me an impression that he is fit and strong. His skin is fair with some pinky color despite the wound of the rashes and inflammation on the arm, the palm of hands and back of the palm. I asked: “Do you feel pain?” He answered: “Pain and Itchy.” My mind is curious, why the young man caught by this skin problem? After some details explanation, I come to understand that his career is pastry chef. Every day, he will soak his hand in the dough mixed with water and oil for eight hours.  I asked again: “Do your colleagues having the skin problems?” He said: “Nope.”

30-06-2017 dermatitis

At this point, I found that his pulse is like sinking deep. After some details enquiries made, it was found that his routine work is to put the dough into oven with high temperature setting, meaning he worked in a very cooling air conditioned environment with high temperature oven in front of him. In additional, the patient’s working hour started from night till the next day morning. Body cycle time is definitely contradict with natural cycle time.

I guess the reason is like this. The oven release heat to the body while he is exposed to cooling environment which caused the blood circulation indolence especially at the fingers and palm. When he worked in night shift, body temperature increased indirectly as well. Nevertheless, pores on the skin shrinking and the heat kept underneath skin, the dampness of dough, and mixture of oil and water was also kept underneath the skin. Due to no way of releasing the temperature, it was transmitted to the finger and caused rashes or inflammation, or so called dermatitis.  I decided to prescribe 3 days herbal medicine for him.

05-07-2017 Second visit

About a week later, the patient sent us some photos. The results seem good. We see no more rashes and the dermatitis problem is progressing well.

05-07-2017 Dermatitis

After 3 days oral prescription, the wounds started to sink and reduced gradually. Itchiness reduces too. I recommended him to rest for few days in order to get a thorough remedy. He continued the herbal medicine dosage for another 6 days.

12-07-2017 Dermatitis

I worried if the life style never changed, the problem might reoccur in the future. We make a blessed for him.

Notes:
Dermatitis is a tricky sickness, if we neglect the appropriate way of lifestyle, it could reoccur anytime. We always recommend patient to take good practice of a regular meal and a balance diet. After the recovery of skin problem, never forget to maintain healthy lifestyle in the future. When we really take effort to maintain a healthy lifestyle, the sickness could be treated thoroughly; otherwise the opportunity of re-occurrence is very high.

廖小慧中医师
Doctor TCM Liau Sheau Huey
愿景中医传统医疗中心
Visions TCM Healthcare Centre