Department of Immunology, Auckland City Hospital, and Department of Psychotherapy, Auckland University of Technology, 40 Grampian Rd, Auckland 1071, New Zealand.
Postgrad Med J. 2010 Jun;86(1016):365-70. doi: 10.1136/pgmj.2009.096446.
Chronic spontaneous urticaria (CSU) is a very common skin condition that causes considerable suffering and is often poorly responsive to drug treatment regimens. Most clinicians accept that multiple factors play a role in the aetiology of CSU, but there is a widespread reluctance to accept a significant role for 'mindbody' factors, despite a large number of clinical reports and studies over many decades suggesting their relevance. This reluctance has multiple origins. A primary influence is the flawed dualistic model of mind and body relatedness underpinning much of modern medical care. In this view, if a pathophysiological mechanism can be discerned, then 'mind' factors can be largely ignored. Recent evidence demonstrating intimate structural and functional relations between peripheral nerves and mast cells, and local skin secretion of mast cell-influencing neuropeptides by nerves, provides an argument for discarding old 'organic' and dualistic conceptualisations of CSU. A sound, integrative, multifactorial approach requires a unitive 'mindbody' model in which physical and subjective dimensions of personhood are seen as coexisting and equally deserving of exploration and management. Another influence is the tendency for 'psychosomatic' research studies in CSU to focus on patient experience using broad group-based diagnostic categories, such as anxiety and depressive disorders, and generic measures of stress. Two case examples are given, illustrating that CSU arises in relation to highly individual and relevant 'stories', which would not usually be picked up by these generic measures. It is suggested that an appropriate 'mindbody' management programme leading to good clinical outcomes for CSU is dependent on clinicians discerning unique patient 'stories'. Finally, a lack of formal studies comparing drug and 'mindbody' treatment outcomes will continue to negatively influence the adoption of 'mindbody' approaches in CSU. There is an urgent need for properly structured comparative studies, and the essential elements of a suitable 'mindbody' approach appropriate to such research are briefly outlined.
慢性自发性荨麻疹（CSU）是一种非常常见的皮肤疾病，会导致相当大的痛苦，而且通常对药物治疗方案反应不佳。大多数临床医生认为，多种因素在 CSU 的发病机制中起作用，但尽管几十年来有大量的临床报告和研究表明“身心”因素的相关性，但人们普遍不愿意接受其重要作用。这种不情愿有多种来源。一个主要的影响因素是现代医疗保健所基于的身心关系的有缺陷的二元论模式。在这种观点下，如果能够发现病理生理学机制，那么“心理”因素就可以在很大程度上被忽略。最近的证据表明，周围神经和肥大细胞之间存在密切的结构和功能关系，以及神经对肥大细胞影响的神经肽在局部皮肤中的分泌，这为摒弃CSU 的旧的“有机”和二元概念提供了依据。一个合理的、综合的、多因素的方法需要一个统一的“身心”模型，其中身体和主观的人格维度被视为共存的，同样值得探索和管理。另一个影响因素是 CSU 中的“身心”研究倾向于使用广泛的基于群体的诊断类别，如焦虑和抑郁障碍，以及一般性的压力衡量标准，来关注患者的体验。给出了两个案例示例，说明 CSU 是与高度个体化和相关的“故事”有关的，这些“故事”通常不会被这些通用措施所察觉。有人认为，一个适当的“身心”管理方案，对于 CSU 的良好临床结果，取决于临床医生辨别出独特的患者“故事”。最后，缺乏比较药物和“身心”治疗结果的正式研究将继续对 CSU 中“身心”方法的采用产生负面影响。迫切需要进行适当结构的比较研究，并简要概述了适合此类研究的适当“身心”方法的基本要素。
