刮痧配合外敷蜂胶治疗黄褐斑的临床研究
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摘要
黄褐斑也叫“肝斑”,属于中医“黧黑斑”、“面尘”、“黑皯”、“皯黯”等范畴,是临床较常见的一种面部色素代谢障碍性皮肤病,多见于中青年女性,临床表现为面部淡褐色到深褐色界线清楚的斑片,形状不规则,大小不等,对称分布,小者如蝴蝶或钱币状,大者满布颜面如地图,轮廓清晰,无鳞屑及炎症表现,压之不褪色。随着社会的发展,人民的生活、社会压力不断增加,加之各种环境因素的变化等因素的影响,黄褐斑在我国的发病率呈逐年增多的趋势。而黄褐斑尽管不引起较大的局部疼痛、瘙痒等局灶性炎性症状,但是却能够给患者的植物神经系统带来不同程度的影响：如多汗、潮热、烦躁易怒等等。继而影响更多脏器的功能。另一方面,面容的改变,也使较多女性患者在心理层面缺乏自信,甚至抑郁焦虑,给患者生活及精神方面带来诸多烦恼和痛苦,严重影响患者的身心健康。
现代医学认为,本病的发病机制十分复杂,其发病可能与内分泌、遗传、紫外线、局部微生态、氧自由基、药物及化妆品的使用等因素有关,但仍未找到-个比较确切的病因。而对于黄褐斑尚未有一个比较特异有效的根治方法。临床上多采用一些激光、冷冻等外部治疗手段,而基于这些手段的原理,或多或少地给患者带来了一定的隐患。如：久用毒副作用大,风险较大,易产生外源性黄褐斑、皮肤萎缩、永久性脱色造成的点斑样变化、色素反弹等,而且远期疗效欠佳。
中医外治法也是从古至今运用于临床治疗,刮痧疗法作为其中一种疗法,具有疗效好、安全、无副作用、复发率低及费用少等优点；而且蜂胶具有美白作用、抗皮肤老化、抗自由基氧化和抑制酪氨酸酶活性的功能,能减少皮肤黑色素的生成,又能吸收紫外线,有消除黄褐斑的作用,两者结合,疗效确切。目前中医对黄褐斑的治疗研究较多,但在临床上仍存在一些不足之处,最突出表现为疗效评价标准不一或评价标准以主观观察为主,缺乏客观的评价标准,从而导致治疗效果不易进行相互比较,不利于广泛交流与研究。
研究目的：
通过古今文献研究及临床研究,总结黄褐斑发病病因及表现规律,探讨刮痧配合外敷蜂胶治疗黄褐斑的临床疗效及安全性,为临床治疗黄褐斑提供新的治疗思路。
研究方法：
采用随机对照临床试验研究的方法,参照2003年中国中西医结合学会皮肤性病专业委员会色素病学组制订的《黄褐斑的诊断和疗效标准(2003年修订稿)》中对黄褐斑的临床诊断标准,将符合纳入标准的60例黄褐斑患者随机分为治疗组(刮痧配合外敷蜂胶治疗)与对照组(常规针刺治疗)各30例。
治疗组采用刮痧配合外敷蜂胶治疗,先采用平刮法轻沿面部肌肉纹理走向与骨骼形态由内向外,由上而下按面部额头区、眼周区、面颊区、口唇区、鼻区、下颌区的刮痧顺序和手法要求缓慢刮拭。每个部位做3-5遍。刮痧力度：以患者面部能耐受,刮痧后面部皮肤轻微发热或潮红为度。全部刮完为1次,共刮4次。清洁面部后,将贴膜按黄褐斑大小剪切,以能够覆盖所有面部黄褐斑部位为度,然后挤出蜂胶均匀附于贴膜上,蜂胶厚度为0.5-1mm,敷贴于面部黄褐斑部位及其周围,每次敷贴时间为30min,敷贴后用清水洗净面部。
对照组主穴选：足三里、三阴交、曲池、血海,皮损局部。配穴：肝郁配太冲、合谷；脾虚配脾俞、气海；肾虚配肾俞、关元；血瘀配膈俞。使用30-32号,Φ0.32×25mm-50mm华佗牌不锈钢一次性针灸针,75%酒精皮肤常规消毒后进针。各穴均采用快速常规进针。皮损局部采用围刺法,连接上海产的G6805型电针治疗仪,选用连续波,频率为80次/分钟,刺激量以患者能耐受为度,留针30分钟后出针
两组患者均为每周治疗3次,12次为一个疗程,两个疗程后观察疗效。
采用《黄褐斑的临床诊断和疗效标准(2003年修订稿)》的黄褐斑疗效标准、皮损面积、皮损颜色、中医兼证评分、世界卫生组织生活质量测定量表简表、自评焦虑量表、自评抑郁量表、Bech-Rafaelsen躁狂量表及药物副反应量表对黄褐斑患者在治疗前及治疗结束后各临床疗效进行评定。
研究结果：
1.黄褐斑患者以30-50岁的已婚女性脑力患者居多,接受过大学以下教育水平的中高收入者更容易患病。
2.黄褐斑患者以肝郁型患者最多,其次依次为血瘀型、肾虚型和脾虚型,大多数为继发性患者,且以上面部型患者多见。
3.刮痧配合外敷蜂胶治疗黄褐斑疗效显著,总有效率为90%,明显优于对照组(P<0.05)。
4.刮痧配合外敷蜂胶治疗肝郁型和血瘀型黄褐斑总有效率为100%,明显优于脾虚型和肾虚型患者(P<0.05)
5.刮痧配合外敷蜂胶治疗黄褐斑不仅可明显改善患者皮损面积、颜色,而且对月经失调、烦躁易怒等兼证也有改善,明显优于单纯针刺治疗(P<0.05)。
6.刮痧配合外敷蜂胶治疗对改善患者的生活质量、抑郁、焦虑状况有明显优势,疗效优于对照组(P<0.05)
7.刮痧配合外敷蜂胶治疗黄褐斑安全无任何副作用。
结论：
黄褐斑的发生与肝、脾、肾相关,尤其与肝的关系最为密切。刮痧配合外敷蜂胶治疗黄褐斑可明显改善症状,提高治疗效果,安全无副作用,患者容易接受,值得在临床推广应用。黄褐斑患者存在不同程度的抑郁与焦虑,临床治疗时应重视患者心理因素的影响,适当进行心理疏导可促进疾病的康复。
Melasma is also called "melasma hepaticum", which, in Chinese medicine, belongs to "blackish facial patch","dusty complexion" etal. It is a quite common Facial pigment metabolism disorder of skin, which is more often seen in young and middle-aged women. The clinical manifestations are light-brown to dark-brown stains with clear boundaries in the face. The shape is irregular, and they are unequal in size and distributed symmetrically. The small ones look like butterflies or coins, while the big ones are like maps overspread the face. The boundaries are clear, and there is no scale or inflammation. If you press the stain, it won't fade. With the development of the society, the stress from daily life and society grows. Together with the influence of some environmental facts, the morbidity of melasma is growing from year to year. Although this disease doesn't bring much sensory symptoms to patients, and only a few of them feel slightly uncomfortable, but many patients have endocrine and autonomic nervous system function disorder symptoms like restlessness of the mind and irascibility, menoxenia and so on. While at the same time many patients lose their confidence, or even have anxiety-depression because of the disease, which brings a lot of pain to patients'life and spirit, severely affect patients'physical and mental life.
Modern medical science considers that the nosogenesis of this disease is very complex, probably has something to do with incretion, heredity, ultraviolet rays, local microenvironment, oxyradical, and the use of pills and maquillage. There is no specific treatment for melasma. The mainstream method is external treatment in use of destructive ways to abrase the stains (like freezing, laser, etc.), which is fastm but may have some bad effects potentially. If this method is over used, the risk rises, which will easily cause exogenous melasma, adermotrophia, stains of permanent decolorization, Pigment rebound, etc. furthermore, the long-term effect is not good enough.
External treatment of traditional Chinese Medicine is used in all ages, and scrapping is one of them. Scrapping is effective, safe, in expensive and has no side-effect. And the recurrence rate is low. Whi le propolis has functions of whitening, Anti-aging-skin, Anti-free-r adical-oxidation and Inhibition of tyrosinase activity. It can also r educe the production of Skin melanin and absorb ultraviolet rays. Whe n we combine scrapping and propolis, the curative effects are outstan ding. Now there are many studies about using traditional Chinese Medi cine to treat melasma, but there are still some deficiencies in clini cal practice, which is underscored by no unified standard in evaluati ng the curative effect, or subjective standards. This will make it ha rd to compare the curative effects, and it is also not good for Exten sive exchanges and research.
Objective:
Through the study of ancient and modern literature and clinical research, summarize the pathogenesis and manifestation of melasma, investigate the clinical efficacy and safety of scrapping combined with propolis in treating melasma, and provide a new therapeutic approach for clinical treatment of melasma.
Methods:
We use the method of randomized controlled clinical study. We randomly divide60patients who are in accordance with the inclusion criteria, into a regular needling group (30cases) and a scrapping-propolis group(30cases), according to "Diagnosis and curative effect standard of melasma (2003Revision)"
The patients in scrapping-propolis group first get a scrapping in the order of The forehead area, the eye area, cheeks, lips, nose area, mandibular area. The technique requires are scrapping slowly, each area scrap3-5times. The stress must be tolerable, and cause slight skin fever of flush. And the process will be practiced4times in all. And secondly, after cleaning the face, put stain-shaped masks with propolis on the stains, which can totally cover the stains. The propolis is thinly and evenly applied on the masks, and the thickness of propolis is0.5-1mm. 30minutes later, remove the masks, clean the face again with clear water.
In the regular needling group, the main acupoints are Zusanli (ST36), Sanyinjiao(SP6), Quchi(LI11), Xuehai(SP10), and the stain area. The matching acupoints:with stagnation of liver-Qi, use Taichong(LR3) and Hegu(LI4); with spleen-Qi efficiency, use Piyu(BL20) and Qihai (RN6); with kidney efficiency, use Shenyu(BL23) and Guanyuan(RN4); with blood stagnation, use Geshu(BL17). Use30-32, Φ0.32X25mm-50mm Hua Tuo brand stainless steel disposable acupuncture needle, after routine disinfection by75%alcohol, insert the needle fast(in the stain area, use encircling needling). After inserting all the needles, connect them to Shanghai G6805type electric acupuncture therapeutic instrument, using continuous wave, frequency is80times/min, the amount of stimulation to patients must be tolerate. Withdraw the needles30minutes later.
Both groups of patients were treated3times a week,12times for a course of treatment. We evaluate the curative effect after two courses.
"Diagnosis and curative effect standard of melasma (2003Revision)", area of skin lesion, color of skin lesion, TCM syndrome score,"WHO Determination of quality of life scale","Self-Rating Anxiety Scale"," Self-Rating Depression Scale"," Bech-Rafaelsen Mania Rating Scale" and "Adverse drug reaction scale" are all used in the evaluations both before and after the treatments.
Results:
1. Among patients with melasma, the majority are married female brainworker between30-50years old. And middle and high income earners who received lower than university education level are more likely to have this disease.
2. most of the patients with melasma are liver-Qi stagnation type, followed by blood stagnation type, kidney efficiency type and spleen efficiency type. Most of them are Secondary patients, and more of which are upper face type.
3. The curative effect of scrapping combined with external application of propolis is significant with a total effective rate of90%, remarkably higher than regular needling group (P<0.05).
4. The total effective rate of scrapping combined with external application of propolis used in treating melasma of liver-Qi stagnation type and blood stagnation type is100%, significantly higher than kidney efficiency type and spleen efficiency type (P<0.05).
5. scrapping combined with external application of propolis can not only remarkably improve the area and color of the skin lesion, but also improve the symptom of restlessness of the mind and irascibility and menoxenia, which is significantly better than acupuncture treatment (P<0.05).
6. scrapping combined with external application of propolis is significantly better than needling group in improving patients'quality of life and the state of anxiety and depression (P<0.05).
7. scrapping combined with external application of propolis is safe and has no side-effect in treating melasma.
Conclusions:
The occurrence of melasma is related with liver, spleen and kidney, especially liver. Scrapping combined with external application of propolis can significantly improve the symptoms and raise the curative effect. Furthermore, it is safe with no side-effect, which is more receptible for the patients. So it worth spreading clinically. Patients with melasma have depression and anxiety in different degrees, so we should pay enough attention to patients'mental problems, appropriate psychological counseling can promote the rehabilitation of the disease.
现代医学认为,本病的发病机制十分复杂,其发病可能与内分泌、遗传、紫外线、局部微生态、氧自由基、药物及化妆品的使用等因素有关,但仍未找到-个比较确切的病因。而对于黄褐斑尚未有一个比较特异有效的根治方法。临床上多采用一些激光、冷冻等外部治疗手段,而基于这些手段的原理,或多或少地给患者带来了一定的隐患。如：久用毒副作用大,风险较大,易产生外源性黄褐斑、皮肤萎缩、永久性脱色造成的点斑样变化、色素反弹等,而且远期疗效欠佳。
中医外治法也是从古至今运用于临床治疗,刮痧疗法作为其中一种疗法,具有疗效好、安全、无副作用、复发率低及费用少等优点；而且蜂胶具有美白作用、抗皮肤老化、抗自由基氧化和抑制酪氨酸酶活性的功能,能减少皮肤黑色素的生成,又能吸收紫外线,有消除黄褐斑的作用,两者结合,疗效确切。目前中医对黄褐斑的治疗研究较多,但在临床上仍存在一些不足之处,最突出表现为疗效评价标准不一或评价标准以主观观察为主,缺乏客观的评价标准,从而导致治疗效果不易进行相互比较,不利于广泛交流与研究。
研究目的：
通过古今文献研究及临床研究,总结黄褐斑发病病因及表现规律,探讨刮痧配合外敷蜂胶治疗黄褐斑的临床疗效及安全性,为临床治疗黄褐斑提供新的治疗思路。
研究方法：
采用随机对照临床试验研究的方法,参照2003年中国中西医结合学会皮肤性病专业委员会色素病学组制订的《黄褐斑的诊断和疗效标准(2003年修订稿)》中对黄褐斑的临床诊断标准,将符合纳入标准的60例黄褐斑患者随机分为治疗组(刮痧配合外敷蜂胶治疗)与对照组(常规针刺治疗)各30例。
治疗组采用刮痧配合外敷蜂胶治疗,先采用平刮法轻沿面部肌肉纹理走向与骨骼形态由内向外,由上而下按面部额头区、眼周区、面颊区、口唇区、鼻区、下颌区的刮痧顺序和手法要求缓慢刮拭。每个部位做3-5遍。刮痧力度：以患者面部能耐受,刮痧后面部皮肤轻微发热或潮红为度。全部刮完为1次,共刮4次。清洁面部后,将贴膜按黄褐斑大小剪切,以能够覆盖所有面部黄褐斑部位为度,然后挤出蜂胶均匀附于贴膜上,蜂胶厚度为0.5-1mm,敷贴于面部黄褐斑部位及其周围,每次敷贴时间为30min,敷贴后用清水洗净面部。
对照组主穴选：足三里、三阴交、曲池、血海,皮损局部。配穴：肝郁配太冲、合谷；脾虚配脾俞、气海；肾虚配肾俞、关元；血瘀配膈俞。使用30-32号,Φ0.32×25mm-50mm华佗牌不锈钢一次性针灸针,75%酒精皮肤常规消毒后进针。各穴均采用快速常规进针。皮损局部采用围刺法,连接上海产的G6805型电针治疗仪,选用连续波,频率为80次/分钟,刺激量以患者能耐受为度,留针30分钟后出针
两组患者均为每周治疗3次,12次为一个疗程,两个疗程后观察疗效。
采用《黄褐斑的临床诊断和疗效标准(2003年修订稿)》的黄褐斑疗效标准、皮损面积、皮损颜色、中医兼证评分、世界卫生组织生活质量测定量表简表、自评焦虑量表、自评抑郁量表、Bech-Rafaelsen躁狂量表及药物副反应量表对黄褐斑患者在治疗前及治疗结束后各临床疗效进行评定。
研究结果：
1.黄褐斑患者以30-50岁的已婚女性脑力患者居多,接受过大学以下教育水平的中高收入者更容易患病。
2.黄褐斑患者以肝郁型患者最多,其次依次为血瘀型、肾虚型和脾虚型,大多数为继发性患者,且以上面部型患者多见。
3.刮痧配合外敷蜂胶治疗黄褐斑疗效显著,总有效率为90%,明显优于对照组(P<0.05)。
4.刮痧配合外敷蜂胶治疗肝郁型和血瘀型黄褐斑总有效率为100%,明显优于脾虚型和肾虚型患者(P<0.05)
5.刮痧配合外敷蜂胶治疗黄褐斑不仅可明显改善患者皮损面积、颜色,而且对月经失调、烦躁易怒等兼证也有改善,明显优于单纯针刺治疗(P<0.05)。
6.刮痧配合外敷蜂胶治疗对改善患者的生活质量、抑郁、焦虑状况有明显优势,疗效优于对照组(P<0.05)
7.刮痧配合外敷蜂胶治疗黄褐斑安全无任何副作用。
结论：
黄褐斑的发生与肝、脾、肾相关,尤其与肝的关系最为密切。刮痧配合外敷蜂胶治疗黄褐斑可明显改善症状,提高治疗效果,安全无副作用,患者容易接受,值得在临床推广应用。黄褐斑患者存在不同程度的抑郁与焦虑,临床治疗时应重视患者心理因素的影响,适当进行心理疏导可促进疾病的康复。
Melasma is also called "melasma hepaticum", which, in Chinese medicine, belongs to "blackish facial patch","dusty complexion" etal. It is a quite common Facial pigment metabolism disorder of skin, which is more often seen in young and middle-aged women. The clinical manifestations are light-brown to dark-brown stains with clear boundaries in the face. The shape is irregular, and they are unequal in size and distributed symmetrically. The small ones look like butterflies or coins, while the big ones are like maps overspread the face. The boundaries are clear, and there is no scale or inflammation. If you press the stain, it won't fade. With the development of the society, the stress from daily life and society grows. Together with the influence of some environmental facts, the morbidity of melasma is growing from year to year. Although this disease doesn't bring much sensory symptoms to patients, and only a few of them feel slightly uncomfortable, but many patients have endocrine and autonomic nervous system function disorder symptoms like restlessness of the mind and irascibility, menoxenia and so on. While at the same time many patients lose their confidence, or even have anxiety-depression because of the disease, which brings a lot of pain to patients'life and spirit, severely affect patients'physical and mental life.
Modern medical science considers that the nosogenesis of this disease is very complex, probably has something to do with incretion, heredity, ultraviolet rays, local microenvironment, oxyradical, and the use of pills and maquillage. There is no specific treatment for melasma. The mainstream method is external treatment in use of destructive ways to abrase the stains (like freezing, laser, etc.), which is fastm but may have some bad effects potentially. If this method is over used, the risk rises, which will easily cause exogenous melasma, adermotrophia, stains of permanent decolorization, Pigment rebound, etc. furthermore, the long-term effect is not good enough.
External treatment of traditional Chinese Medicine is used in all ages, and scrapping is one of them. Scrapping is effective, safe, in expensive and has no side-effect. And the recurrence rate is low. Whi le propolis has functions of whitening, Anti-aging-skin, Anti-free-r adical-oxidation and Inhibition of tyrosinase activity. It can also r educe the production of Skin melanin and absorb ultraviolet rays. Whe n we combine scrapping and propolis, the curative effects are outstan ding. Now there are many studies about using traditional Chinese Medi cine to treat melasma, but there are still some deficiencies in clini cal practice, which is underscored by no unified standard in evaluati ng the curative effect, or subjective standards. This will make it ha rd to compare the curative effects, and it is also not good for Exten sive exchanges and research.
Objective:
Through the study of ancient and modern literature and clinical research, summarize the pathogenesis and manifestation of melasma, investigate the clinical efficacy and safety of scrapping combined with propolis in treating melasma, and provide a new therapeutic approach for clinical treatment of melasma.
Methods:
We use the method of randomized controlled clinical study. We randomly divide60patients who are in accordance with the inclusion criteria, into a regular needling group (30cases) and a scrapping-propolis group(30cases), according to "Diagnosis and curative effect standard of melasma (2003Revision)"
The patients in scrapping-propolis group first get a scrapping in the order of The forehead area, the eye area, cheeks, lips, nose area, mandibular area. The technique requires are scrapping slowly, each area scrap3-5times. The stress must be tolerable, and cause slight skin fever of flush. And the process will be practiced4times in all. And secondly, after cleaning the face, put stain-shaped masks with propolis on the stains, which can totally cover the stains. The propolis is thinly and evenly applied on the masks, and the thickness of propolis is0.5-1mm. 30minutes later, remove the masks, clean the face again with clear water.
In the regular needling group, the main acupoints are Zusanli (ST36), Sanyinjiao(SP6), Quchi(LI11), Xuehai(SP10), and the stain area. The matching acupoints:with stagnation of liver-Qi, use Taichong(LR3) and Hegu(LI4); with spleen-Qi efficiency, use Piyu(BL20) and Qihai (RN6); with kidney efficiency, use Shenyu(BL23) and Guanyuan(RN4); with blood stagnation, use Geshu(BL17). Use30-32, Φ0.32X25mm-50mm Hua Tuo brand stainless steel disposable acupuncture needle, after routine disinfection by75%alcohol, insert the needle fast(in the stain area, use encircling needling). After inserting all the needles, connect them to Shanghai G6805type electric acupuncture therapeutic instrument, using continuous wave, frequency is80times/min, the amount of stimulation to patients must be tolerate. Withdraw the needles30minutes later.
Both groups of patients were treated3times a week,12times for a course of treatment. We evaluate the curative effect after two courses.
"Diagnosis and curative effect standard of melasma (2003Revision)", area of skin lesion, color of skin lesion, TCM syndrome score,"WHO Determination of quality of life scale","Self-Rating Anxiety Scale"," Self-Rating Depression Scale"," Bech-Rafaelsen Mania Rating Scale" and "Adverse drug reaction scale" are all used in the evaluations both before and after the treatments.
Results:
1. Among patients with melasma, the majority are married female brainworker between30-50years old. And middle and high income earners who received lower than university education level are more likely to have this disease.
2. most of the patients with melasma are liver-Qi stagnation type, followed by blood stagnation type, kidney efficiency type and spleen efficiency type. Most of them are Secondary patients, and more of which are upper face type.
3. The curative effect of scrapping combined with external application of propolis is significant with a total effective rate of90%, remarkably higher than regular needling group (P<0.05).
4. The total effective rate of scrapping combined with external application of propolis used in treating melasma of liver-Qi stagnation type and blood stagnation type is100%, significantly higher than kidney efficiency type and spleen efficiency type (P<0.05).
5. scrapping combined with external application of propolis can not only remarkably improve the area and color of the skin lesion, but also improve the symptom of restlessness of the mind and irascibility and menoxenia, which is significantly better than acupuncture treatment (P<0.05).
6. scrapping combined with external application of propolis is significantly better than needling group in improving patients'quality of life and the state of anxiety and depression (P<0.05).
7. scrapping combined with external application of propolis is safe and has no side-effect in treating melasma.
Conclusions:
The occurrence of melasma is related with liver, spleen and kidney, especially liver. Scrapping combined with external application of propolis can significantly improve the symptoms and raise the curative effect. Furthermore, it is safe with no side-effect, which is more receptible for the patients. So it worth spreading clinically. Patients with melasma have depression and anxiety in different degrees, so we should pay enough attention to patients'mental problems, appropriate psychological counseling can promote the rehabilitation of the disease.
引文
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