三焦是体内脏腑气血津液代谢运行的通路，玄府是体表肌腠气机升降出入的通道。李惠林教授认为，痤疮多因三焦 功能失调，阳热怫郁，开阖失常，热毒蓄积肌腠而发病。运用中医药治疗痤疮尤需注重三焦-玄府的调畅，治疗以“通”为 要，以“通三焦-开玄府”为治则，临证需辨明上焦、中焦、下焦病证的不同。病在上焦者，多属火热，或因肺经风热，或 因心火亢盛，治当轻清疏泄，透邪开玄，可酌选麻黄连翘赤小豆汤、麻杏石甘汤、普济消毒饮等加减；病在中焦者，多属 气郁，或因胃热炽盛，或因脾胃湿热，或因肝郁气滞，或因脾虚湿蕴，治当调畅气机，发郁开玄，可酌选清胃散、三仁汤、 黄连温胆汤、柴胡疏肝散、荷芪散等加减；病在下焦者，多属正虚，或因肝肾阴虚，或因下焦虚寒，治当培元固本，补虚 开玄，可酌选六味地黄丸、阳和汤等加减。

The triple energizer is the pathway for the transportation and metabolism of qi，blood and body fluid in the body，and the xuanfu（sweat pores） is the way for the ascending，descending，exiting，and entering of qi movement in the muscular striae and the exterior. Professor Li Huilin believes that the pathogenesis of acne is usually due to the dysfunction of triple energizer and the stagnation of depressed yang-heat，which result into the abnormal opening and closing of the xuanfu and the accumulation of heat-toxin in the muscular striae. For the treatment of acne with traditional Chinese medicine， it is necessary to pay attention to the regulation of triple energizer-xuanfu. The treatment should be based on unblocking therapy， and the therapeutic principle of unblocking triple energizer and opening xuanfu should be taken into account. In clinical practice，it is necessary to identify the syndromes of upper energizer， middle energizer and lower energizer. The syndrome of the upper energizer is often due to fire-heat，which results from the wind-heat in lung meridian or the exuberance of heart fire. The upper-energizer syndrome can be treated by the therapy of relieving and clearing the pathogens with light and mild drugs， expelling fire-heat to open sweat pores， and through the modified use of Mahuang Lianqiao Chixiaodou Decoction， Ma Xing Shi Gan Decoction， or Puji Xiaodu Decoction. The syndrome of the middle energizer is usually due to the qi stagnation，which results from intense stomach-heat，damp-heat in the spleen and stomach，liver depression and qi stagnation，or spleen deficiency with dampness accumulation. The middleenergizer syndrome can be treated by the therapy of regulating qi movement to relieve stagnation and open sweat pores，and through the modified use of Qingwei san，Sanren Decoction，Huanglian Wendan Decoction，Chaihu Shugan Powder，or Heqi Powder. The syndrome of the lower energizer is often due to healthy-qi deficiency，which results from yin deficiency of liver and kidney， or deficiency-cold in lower energizer. The lower-energizer syndrome can be treated by the therapy of cultivating the vital essence and consolidating vital base，supplementing deficiency to open sweat pores，and through the modified use of Liuwei Dihuang Pills or Yanghe Decoction.

R275.9

国家自然科学基金青年项目（编号：82104759）；深圳市中医临床重点专科项目（编号：深卫健中医[2019]22号-2）