感染性慢性难愈合创面是临床常见的皮肤疾病，严重影响患者的生活质量，且发病率正逐年升高。其“热毒壅盛， 营卫不和，脏腑功能失衡”之病机与玄府气液理论具有相似之处，“玄府郁闭”是形成感染性慢性难愈合创面的病理基础。 该文以“开通玄府”为治疗原则，基于“以皮治皮”之皮类药善治皮肤疾病的特性，探讨皮类药在感染性慢性难愈合创面 的治疗中发挥的作用。提出治疗以火毒壅玄为病机特点之感染性慢性难愈合创面时，需清热散火以通玄，可选黄柏、白鲜 皮、秦皮等皮类药；治疗以瘀血滞玄为病机特点之感染性慢性难愈合创面时，需凉血活血以开玄，可选牡丹皮、地骨皮等 皮类药；治疗以风湿塞玄为病机特点之感染性慢性难愈合创面时，需祛风除湿以疏玄，可选五加皮、陈皮、茯苓皮等皮类 药；治疗以正虚闭玄为病机特点之感染性慢性难愈合创面时，需健脾补肾以荣玄，可选肉桂、杜仲、黑豆皮等皮类药。该 文基于玄府气液理论探析皮类药在感染性慢性难愈合创面治疗中的应用，可为皮类药治疗感染性慢性难愈合创面提供理论 依据，拓展了感染性慢性难愈合创面治疗的中医治疗理论，扩大了玄府理论的临床适用范围。

Infectious chronic refractory wounds are common in the department of dermatology，and have a great influence on the quality of life of patients. Their incidence is increasing year by year. The pathogensis of infectious chronic refractory wounds is due to the exuberance of pathogenic heat and toxin，disharmony between nutritive qi and defensive qi，and imbalance of zang-fu organs，which is related with the theory of qi-fluid and sweat pores. Therefore，it is proposed that stagnation and obstruction of sweat pores contribute to the pathological basis for the onset of infectious chronic refractory wounds，and therapeutic principle of opening sweat pores was presented. In the medication view of treating the skin diseases with the skin-related Chinese medicinals，skin-related Chinese medicinals are good at treating skin diseases，and consequently the application of skin-related Chinese medicinals to open sweat in treating infectious chronic refractory wounds was discussed. It is suggested that for the treatment of infectious chronic refractory wounds due to pathogenic fire-toxin accumulation in sweat pores，therapy of clearing heat and expelling fire to open sweat pores should be exployed， and skin-related Chinese medicinals such as Phellodendri Chinensis Cortex， Dictamni Cortex and Fraxini Cortex can be selected； for the treatment of infectious chronic refractory wounds due to blood-stasis stagnation in sweat pores， therapy of cooling and activating blood to open sweat pores should be exployed，and skin-related Chinese medicinals such as Moutan Cortex and Lycii Cortex can be selected；for the treatment of infectious chronic refractory wounds due to wind and dampness obstructing sweat pores， therapy of expelling wind and eliminating dampness to unblock sweat pores should be exployed， and skin-related Chinese medicinals such as Acanthopanacis Cortex， Citri Reticulatae Pericarpium，and Poriae Cutis can be selected；for the treatment of infectious chronic refractory wounds due to healthy qi deficiency resulting in the obstruction of sweat pores，therapy of invigorating spleen and tonifying kidney to nourish sweat pores should be exployed， and skin-related Chinese medicinals such as Cinnamomi Cortex， Eucommiae Cortex，and black soybean testa（Testa Glycinea Macids）can be chosen. Guided by the theory of qifluid and sweat pores， this paper explored the application of skin-related Chinese medicinals in the treating infectious chronic refractory wounds，which provides theoretical basis for such an approach，enriches the theory of traditional Chinese medicine for the treatment of infectious chronic refractory wounds，and expands the clinical application of the theory of sweat pores.

R269.41

广东省中医药局中医药科研项目（编号：20221381）；广东省佛山市卫生健康局医学科研项目（编号：20220443）