放血疗法治疗女性痤疮?(?肺胃湿热?)?随机平行对照研究
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摘要
[目的]观察放血疗法治疗女性痤疮(肺胃湿热)疗效。[方法]使用随机平行对照方法,将60例门诊患者按就诊顺序号方法随机分为两组。对照组30例枇杷清肺饮(枇杷叶、桑白皮各10g,柴胡12g,连翘、银花各10g,黄芩12g,白芷30g,川楝子15g,苦参9g,淫羊藿、夏枯草各10g,甘草6g,薏苡仁20g,莱菔子15g),水煎400mL,1剂/d,早晚分服。治疗组30例放血疗法,患者俯卧位,充分暴露背部,取肺俞、胃俞,耳尖:在耳区,外耳轮的最高点,局部0.5%碘伏常规消毒,采用华佗牌一次性无菌七星皮肤针、三棱针,3号、4号玻璃罐;皮肤针叩刺:针头对准叩击穴位进行叩击,运用腕部弹力,针尖叩击皮肤后,立即弹起,反复叩击,叩击时针尖与皮肤垂直,弹刺准确,强度均匀,以局部皮肤明显潮红、充血,患者有明显疼痛感觉为度,也可见出血为度,各穴出血量3～5mL,用闪火法将玻璃罐吸拔于叩刺部位,留罐10min后取下;三棱针点刺耳尖:点刺前,推、挤耳尖部,使其充血,点刺时,一手固定被刺部位,另一手持针,露出针尖3～5mm,对准所刺部位快速刺入并迅速出针,进针时针体应保持在同一轴线上,点刺放出少量血,可以辅以挤法以增加出血量,两耳交替;术后消毒干棉球擦拭干净,碘伏擦拭,保持清洁,治疗后6h后方可洗澡,第一个疗程,第一周,1次/d,第2周隔天1次;第二个疗程隔天1次。连续治疗10d为1疗程。观测临床表现、皮损消退率、痤疮综合分级系统(GAGS)评分、面部痤疮特异性生活质量调查问卷(Qol-acne)评分、不良反应。连续治疗2疗程(20d),判定疗效。[结果]治疗组临床痊愈20例,显效6例,有效2例,无效2例,总有效率93.33%;对照组临床痊愈15例,显效4例,有效2例,无效9例,总有效率70.00%;治疗组疗效优于对照组(P<0.05)。痤疮综合分级系统(GAGS)评分、面部痤疮特异性生活质量调查问卷(Qolacne)评分,治疗组改善优于对照组(P<0.05)。[结论]放血疗法治疗女性痤疮(肺胃湿热),疗效满意,无严重不良反应,值得推广。
[Objective] To observe the effect of bloodletting therapy on female acne(Feiwei Shire). [Method] 60 outpatients were randomly divided into two groups according to the order number of visits by randomized parallel control method. The control group consisted of 30 cases of loquat Qingfei Yin(Pipaye, Sangbaipi each 10 g, Chaihu 12 g, Lianqiao, Yinhua each 10 g, Huangqian 12 g, Baizhi 30 g, Chuanlianzi 15 g, Kushen9 g, Yinyanghuo, Xiakucao each 10 g, Gancao 6 g, Yiyiren 20 g, Laifuzi 15 g), water decoction mL, 1 dose per day, evening. In the treatment group, 30 cases were treated with bloodletting therapy. The patients were in prone position, fully exposed their back, Feishu and Weishu were taken, and the ear tips were: in the ear area, the highest point of the outer ear wheel, routine local disinfection with 0.5% iodophor, using Huatuo brand disposable aseptic seven-star skin needle, three-edged needle, glass jar No.3 and 4; skin needle tapping: needle tapping at the point. Strike, use wrist elasticity, pinpoint tapping skin, immediately pop up,repeated tapping, tapping pinpoint and skin vertical, accurate, uniform intensity, local skin obvious flushing,congestion, patients have obvious pain, bleeding can also be seen as a degree, the amount of bleeding at each point is 3-5 mL, glass can be sucked by flashing fire method. Push and squeeze the ear tips before pricking.When pricking, fix the pricked part with one hand and expose the needle tips with the other hand for 3～5 mm.Push the needle into and out quickly at the point where it is pricked. When needling, the needle body should be kept on the same axis and the point should be put out. A small amount of blood can be supplemented by squeezing method to increase the amount of bleeding, alternating ears; after the operation, disinfection cotton ball wipe clean, iodophor wipe, keep clean, after treatment 6 hours can be bathed, the first course of treatment,the first week, once a day, the second week, once every other day; the second course of treatment every other day. Continuous treatment for 10 days is a course of treatment. Clinical manifestations, skin lesion subsidence rate, acne comprehensive grading system(GAGS) score, acne specific quality of life questionnaire(Qol-acne)score and adverse reactions were observed. Continuous treatment for 2 courses(20 days) to determine the efficacy. [Result] In the treatment group, 20 cases were cured, 6 cases were markedly effective, 2 cases were effective and 2 cases were ineffective, the total effective rate was 93.33%. In the control group, 15 cases were cured, 4 cases were markedly effective, 2 cases were effective and 9 cases were ineffective, the total effective rate was 70.00%. The curative effect of the treatment group was better than that of the control group(P<0.05).Acne Comprehensive Grading System(GAGS) score and Face Acne Specific Quality of Life Questionnaire(Qol-acne) score. [Conclusion] Qiangxin Prescription combined with western medicine has satisfactory curative effect on chronic heart failure of Qi deficiency and blood stasis stagnation type, and has no serious adverse reactions. It is worth popularizing.
[Objective] To observe the effect of bloodletting therapy on female acne(Feiwei Shire). [Method] 60 outpatients were randomly divided into two groups according to the order number of visits by randomized parallel control method. The control group consisted of 30 cases of loquat Qingfei Yin(Pipaye, Sangbaipi each 10 g, Chaihu 12 g, Lianqiao, Yinhua each 10 g, Huangqian 12 g, Baizhi 30 g, Chuanlianzi 15 g, Kushen9 g, Yinyanghuo, Xiakucao each 10 g, Gancao 6 g, Yiyiren 20 g, Laifuzi 15 g), water decoction mL, 1 dose per day, evening. In the treatment group, 30 cases were treated with bloodletting therapy. The patients were in prone position, fully exposed their back, Feishu and Weishu were taken, and the ear tips were: in the ear area, the highest point of the outer ear wheel, routine local disinfection with 0.5% iodophor, using Huatuo brand disposable aseptic seven-star skin needle, three-edged needle, glass jar No.3 and 4; skin needle tapping: needle tapping at the point. Strike, use wrist elasticity, pinpoint tapping skin, immediately pop up,repeated tapping, tapping pinpoint and skin vertical, accurate, uniform intensity, local skin obvious flushing,congestion, patients have obvious pain, bleeding can also be seen as a degree, the amount of bleeding at each point is 3-5 mL, glass can be sucked by flashing fire method. Push and squeeze the ear tips before pricking.When pricking, fix the pricked part with one hand and expose the needle tips with the other hand for 3～5 mm.Push the needle into and out quickly at the point where it is pricked. When needling, the needle body should be kept on the same axis and the point should be put out. A small amount of blood can be supplemented by squeezing method to increase the amount of bleeding, alternating ears; after the operation, disinfection cotton ball wipe clean, iodophor wipe, keep clean, after treatment 6 hours can be bathed, the first course of treatment,the first week, once a day, the second week, once every other day; the second course of treatment every other day. Continuous treatment for 10 days is a course of treatment. Clinical manifestations, skin lesion subsidence rate, acne comprehensive grading system(GAGS) score, acne specific quality of life questionnaire(Qol-acne)score and adverse reactions were observed. Continuous treatment for 2 courses(20 days) to determine the efficacy. [Result] In the treatment group, 20 cases were cured, 6 cases were markedly effective, 2 cases were effective and 2 cases were ineffective, the total effective rate was 93.33%. In the control group, 15 cases were cured, 4 cases were markedly effective, 2 cases were effective and 9 cases were ineffective, the total effective rate was 70.00%. The curative effect of the treatment group was better than that of the control group(P<0.05).Acne Comprehensive Grading System(GAGS) score and Face Acne Specific Quality of Life Questionnaire(Qol-acne) score. [Conclusion] Qiangxin Prescription combined with western medicine has satisfactory curative effect on chronic heart failure of Qi deficiency and blood stasis stagnation type, and has no serious adverse reactions. It is worth popularizing.
引文
[1]中国医师协会皮肤科医师分会《中国痤疮治疗指南》专家组.中国痤疮治疗指南(讨论稿)[J].临床皮肤科杂志,2008,37(5):339-342.
[2]翁鹤,曹毅.柴胡疏肝散加味治疗寻常痤疮疗效观察[J].山西中医,2013,29(3):18.
[3]Dréno,B.Recent data on epidemiology of acne[J].Annales de Dermatologie et de Vénéréologie,2010,137(12):3-5.
[4]Kaur S,Verma P,Sangwan A,et al.Etiopathogenesis and Therapeutic Approach to Adult Onset Acne[J].Indian Journal of Dermatology,2016,61(4):403-407.
[5]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2016-05-01].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[6]赵辨.中国临床皮肤病学[M].南京:江苏科学技术出版社,2009:1165-1168.
[7]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:292-295.
[8]中国痤疮治疗指南专家组.中国痤疮治疗指南(2014修订版)[J].临床皮肤科杂志,2015,44(1):52-57.
[9]Harald Gollnick MD,Willian Cunliffe MD,FRCP.Correction management of acne:a report from a global alliance to improve outcomes in acne-Journal of the American Academy of Dermatology[J].Retour Au Numéro,2003,49(2):254.
[10]屠军波,姚天华,杨壮群,等.激素在毛囊皮脂腺单位发育中的作用(中)[J].中国美容医学杂志,2002,11(4):188-191.
[11]李晓庆.5α-还原酶I型基因多态性与痤疮相关性的研究[D].哈尔滨:哈尔滨医科大学,2011.
[12]吴波,邵晓珊,吴文锦.青少年痤疮患者雄激素受体水平、雄激素受体基因CAG多态性的研究[J].贵州医药,2014,38(7):583-586.
[13]韩婷梅.郭晓光.女性痤疮与性激素关系分析[J].中国麻风皮肤病杂志,2013,29(12):773-777.
[14]裴文元.异维A酸联合维生素B6克林霉素甲硝唑治疗重度痤疮的疗效观察[J].实用医技杂志,2012,19(6):638-639.
[15]邓芳,周岐新.抗生素治疗痤疮的临床应用进展[J].中国药业,2008,17(1):59-60.
[16]李洁思,陈雷宁,苏惜香,等.抗雄激素药物联合应用治疗女性中重度迟发型痤疮的临床疗效评价[J].中国美容医学杂志,2011,20(1):95-97.
[17]冯素英,林麟,靳培英.维A酸类药的临床应用、不良反应及对策[J].中华皮肤科杂志,2003,36(8):485-486.
[18]魏南军.痤疮切莫滥用药[J].健康问答,2005(2):45.
[19]谢培煜.红蓝光治疗痤疮[J].医学信息旬刊,2012,25(6):266.
[20]刘根起,陈树民.痤疮综合分级系统和皮损计数法的一致性评价[J].中华皮肤科杂志,2004,37(7):403-405.
[21]李沂轩,贺雪文,侯爱华,等.面部痤疮患者两种生活质量量表的考评[J].中国中西医结合皮肤性病学杂志,2016,15(2):108-110.
[22]李文圣,刘晋洪.寻常型痤疮患者性激素水平与发病的相关性研究[J].皮肤病与性病,2012,16(4):189-190.
[23]毛文姣.痤疮古代文献整理及研究[D].南京:南京中医药大学,2009.
[24]佚名.黄帝内经[M].北京:人民卫生出版社,2009.
[25]潘纯,戴慎.痤疮源流探析[J].现代中西医结合杂志,2011,20(30):3845-3846.
[26]周宝宽.辨证论治酒糟鼻经验[J].广西中医药大学学报,2011,14(4):15-16.
[27]黄宇平.痤疮的中医药治疗辨证分型及用药规律临床文献分析[D].武汉:湖北中医药大学,2010.
[28]高学敏.中药学[M].北京:中国中医药出版社,2009.
[29]李佩芸.从《内经》、《儒门事亲》、《针灸大成》探讨刺络放血疗法的应用[D].广州:广州中医药大学,2013.
[30]姜桂美,袁旺贵,林谋德,等.《内经》放血疗法的应用探讨[J].河北中医,2014,30(6):903-906.
[31]王占慧,刘凌.刺络疗法治疗疖肿28例[J].上海针灸杂志,2006,25(10):20.
[32]陈波,高芩,李冲,等.放血疗法适宜病初探[J].中国针灸,2009,5(29):397-399.
[33]Aloe L,Bricci-Laudiero-L,Bonin S,et al.The expanding role of nerve growth factor from neuro trophic activity to immunologic diseases[J].Allergy,1997,52(9):8.
[34]王本正.放血疗法[M].哈尔滨:哈尔滨出版社,2003.
[35]杜玉茱,贾春生,王建岭,等.基于数据挖掘的刺络放血疗法治疗痤疮规律与特点研究[J].针刺研究,2015,3(40):251-257.
[36]李丽璇.放血结合针刺治疗肺胃积热型痤疮30例[J].光明中医,2016,11(31):1617-1618.
[2]翁鹤,曹毅.柴胡疏肝散加味治疗寻常痤疮疗效观察[J].山西中医,2013,29(3):18.
[3]Dréno,B.Recent data on epidemiology of acne[J].Annales de Dermatologie et de Vénéréologie,2010,137(12):3-5.
[4]Kaur S,Verma P,Sangwan A,et al.Etiopathogenesis and Therapeutic Approach to Adult Onset Acne[J].Indian Journal of Dermatology,2016,61(4):403-407.
[5]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2016-05-01].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[6]赵辨.中国临床皮肤病学[M].南京:江苏科学技术出版社,2009:1165-1168.
[7]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:292-295.
[8]中国痤疮治疗指南专家组.中国痤疮治疗指南(2014修订版)[J].临床皮肤科杂志,2015,44(1):52-57.
[9]Harald Gollnick MD,Willian Cunliffe MD,FRCP.Correction management of acne:a report from a global alliance to improve outcomes in acne-Journal of the American Academy of Dermatology[J].Retour Au Numéro,2003,49(2):254.
[10]屠军波,姚天华,杨壮群,等.激素在毛囊皮脂腺单位发育中的作用(中)[J].中国美容医学杂志,2002,11(4):188-191.
[11]李晓庆.5α-还原酶I型基因多态性与痤疮相关性的研究[D].哈尔滨:哈尔滨医科大学,2011.
[12]吴波,邵晓珊,吴文锦.青少年痤疮患者雄激素受体水平、雄激素受体基因CAG多态性的研究[J].贵州医药,2014,38(7):583-586.
[13]韩婷梅.郭晓光.女性痤疮与性激素关系分析[J].中国麻风皮肤病杂志,2013,29(12):773-777.
[14]裴文元.异维A酸联合维生素B6克林霉素甲硝唑治疗重度痤疮的疗效观察[J].实用医技杂志,2012,19(6):638-639.
[15]邓芳,周岐新.抗生素治疗痤疮的临床应用进展[J].中国药业,2008,17(1):59-60.
[16]李洁思,陈雷宁,苏惜香,等.抗雄激素药物联合应用治疗女性中重度迟发型痤疮的临床疗效评价[J].中国美容医学杂志,2011,20(1):95-97.
[17]冯素英,林麟,靳培英.维A酸类药的临床应用、不良反应及对策[J].中华皮肤科杂志,2003,36(8):485-486.
[18]魏南军.痤疮切莫滥用药[J].健康问答,2005(2):45.
[19]谢培煜.红蓝光治疗痤疮[J].医学信息旬刊,2012,25(6):266.
[20]刘根起,陈树民.痤疮综合分级系统和皮损计数法的一致性评价[J].中华皮肤科杂志,2004,37(7):403-405.
[21]李沂轩,贺雪文,侯爱华,等.面部痤疮患者两种生活质量量表的考评[J].中国中西医结合皮肤性病学杂志,2016,15(2):108-110.
[22]李文圣,刘晋洪.寻常型痤疮患者性激素水平与发病的相关性研究[J].皮肤病与性病,2012,16(4):189-190.
[23]毛文姣.痤疮古代文献整理及研究[D].南京:南京中医药大学,2009.
[24]佚名.黄帝内经[M].北京:人民卫生出版社,2009.
[25]潘纯,戴慎.痤疮源流探析[J].现代中西医结合杂志,2011,20(30):3845-3846.
[26]周宝宽.辨证论治酒糟鼻经验[J].广西中医药大学学报,2011,14(4):15-16.
[27]黄宇平.痤疮的中医药治疗辨证分型及用药规律临床文献分析[D].武汉:湖北中医药大学,2010.
[28]高学敏.中药学[M].北京:中国中医药出版社,2009.
[29]李佩芸.从《内经》、《儒门事亲》、《针灸大成》探讨刺络放血疗法的应用[D].广州:广州中医药大学,2013.
[30]姜桂美,袁旺贵,林谋德,等.《内经》放血疗法的应用探讨[J].河北中医,2014,30(6):903-906.
[31]王占慧,刘凌.刺络疗法治疗疖肿28例[J].上海针灸杂志,2006,25(10):20.
[32]陈波,高芩,李冲,等.放血疗法适宜病初探[J].中国针灸,2009,5(29):397-399.
[33]Aloe L,Bricci-Laudiero-L,Bonin S,et al.The expanding role of nerve growth factor from neuro trophic activity to immunologic diseases[J].Allergy,1997,52(9):8.
[34]王本正.放血疗法[M].哈尔滨:哈尔滨出版社,2003.
[35]杜玉茱,贾春生,王建岭,等.基于数据挖掘的刺络放血疗法治疗痤疮规律与特点研究[J].针刺研究,2015,3(40):251-257.
[36]李丽璇.放血结合针刺治疗肺胃积热型痤疮30例[J].光明中医,2016,11(31):1617-1618.