基于面部不同埋线方法的综合针灸疗法治疗女性青春期后痤疮的疗效及其作用机制
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摘要
背景痤疮是青春期常见的毛囊皮脂腺的慢性炎症性疾病,青春期后女性患者较多,皮疹持续时间较长,严重影响患者容貌美观和身心健康。常规埋线对女性青春期后痤疮有较好疗效,而平滑线埋线是基于浅筋膜理论的一种埋线方法,目前临床尚无两种埋线方法的疗效比较研究。目的探讨基于面部不同埋线方法的综合针灸疗法治疗女性青春期后痤疮的疗效及其作用机制。方法选取2015年7月—2017年7月连云港市第一人民医院针灸科门诊收治的女性青春期后痤疮患者61例,分为平滑线组31例和常规埋线组30例。两组均接受综合针灸疗法,在此基础上平滑线组于2次体穴埋线后第2周予平滑线埋线;常规埋线组于2次体穴埋线后第2、8周予常规埋线。两组均干预8周(1个疗程),12周后评定两组痤疮皮损疗效、痤疮皮损评分、伴随症状疗效、伴随症状评分及不良反应发生情况。结果平滑线组痤疮皮损疗效、伴随症状疗效优于常规埋线组(P<0.05)。治疗前、后两组痤疮皮损、伴随症状评分比较,差异无统计学意义(P>0.05)。两组治疗后痤疮皮损、伴随症状评分均低于本组治疗前(P<0.05)。两组均未发生明显不良反应。结论基于面部不同埋线方法的综合针灸疗法对女性青春期后痤疮皮损和伴随症状均有较好的临床疗效;面部埋线作用机制主要与经络、浅筋膜、卫气等理论密切相关;平滑线埋线较常规埋线患者痛苦小,且有较好的改善皱纹效果,因此平滑线埋线优于常规埋线,值得临床推广应用。
Background Acne is a chronic inflammatory disease of the hair follicle sebaceous glands that is common in adolescence.There are many female patients after puberty,and the rash lasts for a long time,which seriously affects the appearance and health of the patient.Conventional catgut embedding has a good effect on postpubertal acne in women,and smooth catgut embedding is a method of catgut embedding based on the theory of superficial fascia.At present,there is no comparison of the efficacy of two methods of catgut embedding.Objective To explore the efficacy and mechanism of different facial catgut embedding methods combined with comprehensive acupuncture therapy on adult female acne.Methods Sixty-one female patients with adult acne were enrolled from acupuncture clinics of the First People's Hospital of Lianyungang from July 2015 to July 2017.They were divided into smooth catgut embedding group(31 cases) and conventional catgut embedding group(30 cases).Both groups had comprehensive acupuncture therapy.In smooth catgut embedding group,smooth catgut was embedded in face one week after two times of body acupoints embedment.In conventional catgut embedding group,catgut was embedded in face one and seven weeks after two times of body acupoints embedment.Both groups were intervened for 8 weeks as one course.After 12 weeks,the efficacy for acne skin lesions and accompanying symptoms,scores of acne skin lesions and accompanying symptoms and adverse effects were assessed in both groups.Results The efficacy for acne skin lesions and accompanying symptoms in smooth catgut embedding group was significantly better than that of conventional catgut embedding group(P<0.05).There were no significant differences in acne lesion score and accompanying symptom score between two groups before and after treatment(P>0.05).The acne lesion score and accompanying symptom score after treatment were lower than those before treatment in the two groups(P<0.05).There were no obvious adverse effects in both groups.Conclusion Different facial catgut embedding methods combined with comprehensive acupuncture therapy has better clinical efficacy on acne lesions and accompanying symptoms in adult female acnes.The mechanism of facial catgut embedding is closely related to the theories of meridians,superficial fascia and defensive Qi.Smooth catgut embedding has less painful than routine catgut embedding and has better wrinkle improvement effect.Therefore,smooth catgut embedding is superior to routine catgut embedding,which is worthy of clinical popularization and application.
Background Acne is a chronic inflammatory disease of the hair follicle sebaceous glands that is common in adolescence.There are many female patients after puberty,and the rash lasts for a long time,which seriously affects the appearance and health of the patient.Conventional catgut embedding has a good effect on postpubertal acne in women,and smooth catgut embedding is a method of catgut embedding based on the theory of superficial fascia.At present,there is no comparison of the efficacy of two methods of catgut embedding.Objective To explore the efficacy and mechanism of different facial catgut embedding methods combined with comprehensive acupuncture therapy on adult female acne.Methods Sixty-one female patients with adult acne were enrolled from acupuncture clinics of the First People's Hospital of Lianyungang from July 2015 to July 2017.They were divided into smooth catgut embedding group(31 cases) and conventional catgut embedding group(30 cases).Both groups had comprehensive acupuncture therapy.In smooth catgut embedding group,smooth catgut was embedded in face one week after two times of body acupoints embedment.In conventional catgut embedding group,catgut was embedded in face one and seven weeks after two times of body acupoints embedment.Both groups were intervened for 8 weeks as one course.After 12 weeks,the efficacy for acne skin lesions and accompanying symptoms,scores of acne skin lesions and accompanying symptoms and adverse effects were assessed in both groups.Results The efficacy for acne skin lesions and accompanying symptoms in smooth catgut embedding group was significantly better than that of conventional catgut embedding group(P<0.05).There were no significant differences in acne lesion score and accompanying symptom score between two groups before and after treatment(P>0.05).The acne lesion score and accompanying symptom score after treatment were lower than those before treatment in the two groups(P<0.05).There were no obvious adverse effects in both groups.Conclusion Different facial catgut embedding methods combined with comprehensive acupuncture therapy has better clinical efficacy on acne lesions and accompanying symptoms in adult female acnes.The mechanism of facial catgut embedding is closely related to the theories of meridians,superficial fascia and defensive Qi.Smooth catgut embedding has less painful than routine catgut embedding and has better wrinkle improvement effect.Therefore,smooth catgut embedding is superior to routine catgut embedding,which is worthy of clinical popularization and application.
引文
[1]余婷婷,顾小平.青春期后女性痤疮患者卵泡期性激素水平的检测[J].中国皮肤性病学杂志,2015,29(6):572-574.YUTT,GUXP.Sexhormonelevelsinfollicularphaseof females with post-adolescent acne[J].The Chinese Journal of Dermatovenereology,2015,29(6):572-574.
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[4]顾春英,卢文,任虹.埋线、火针、耳针综合疗法治疗寻常痤疮136例[J].南京中医药大学学报,2009,25(6):476-477.GU C Y,LU W,REN H.Treatment of 136 cases of acne vulgaris by embedding thread,fire needle and acupuncture combined therapy[J].JournalofNanjingUniversityofTraditional Chinese Medicine,2009,25(6):476-477.
[5]卢文,斯维特娜·曼恩.埋线为主治疗黄褐斑临床观察[J].中国针灸,2006,26(10):713-715.LU W,MANEN S.Clinical observation on treatment of chloasma with point embedding thread[J].Chinese Acupuncture&Moxibustion,2006,26(10):713-715.
[6]陈然,黎波,杜元灏,等.针灸治疗寻常痤疮的疗效综合判定[J].辽宁中医杂志,2012,39(2):331-333.DOI:10.13192/j.ljtcm.2012.02.144.chenr.047.CHEN R,LI B,DU Y H,et al.Comprehensive evaluation of acupuncture and moxibustion therapy for acne vulgaris[J].Liaoning Journal of Traditional Chinese Medicine,2012,39(2):331-333.DOI:10.13192/j.ljtcm.2012.02.144.chenr.047.
[7]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.Chinese Acne Treatment Guide Expert Group.Chinese Acne Treatment Guide(Revised 2014)[J].Journal of Clinical Dermatology,2015,44(1):52-57.
[8]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.ZHENG X Y.Guiding principles for clinical research of new drugs in traditional Chinese medicine[M].Beijing:The Medicine Science and Technology Press of China,2002:292-295.
[9]薛筑云,杜承权,刘国红,等.阿达帕林凝胶个体化治疗寻常痤疮的临床研究[J].中华皮肤科杂志,2003,36(4):198-200.DOI:10.3760/j.issn:0412-4030.2003.04.006.XUE Z Y,DU C Q,LIU G H,et al.Chinical efficacy and safety of adapalene 0.1%gel with individualized treatment regimen for acne vulgaris[J].Chinese Journal of Dermatology,2003,36(4):198-200.DOI:10.3760/j.issn:0412-4030.2003.04.006.
[10]陈福如.祛痤汤治疗寻常型痤疮40例临床观察[J].中医药导报,2008,14(5):69.DOI:10.3969/j.issn.1672-951X.2008.05.040.CHEN F R.Clinical observation on 40 cases of acne vulgaris treated by dispel acne soup[J].Guiding Journal of Traditional Chinese Medicine and Pharmacy,2008,14(5):69.DOI:10.3969/j.issn.1672-951X.2008.05.040.
[11]孙兵,车晓明.视觉模拟评分法(VAS)[J].中华神经外科杂志,2012,28(6):645.SUN B,CHE X M.Visual analog scoring(VAS)[J].Chinese Journal of Neurosurgery,2012,28(6):645.
[12]HOLZMANNR,SHAKERYK.Postadolescentacnein females[J].Skin Pharmacol Physiol,2014,27 Suppl 1:3-8.DOI:10.1159/000354887.
[13]卢文,周源,房忠女.埋线、电针治疗单纯性肥胖症对照研究[J].针灸临床杂志,2005,21(9):4-6.DOI:10.3969/j.issn.1005-0779.2005.09.003.LU W,ZHOU Y,FANG Z N.A comparative study of embedding and electroacupuncture in the treatment of simple obesity[J].Journal of Clinical Acupuncture and Moxibustion,2005,21(9):4-6.DOI:10.3969/j.issn.1005-0779.2005.09.003.
[14]姜敏,曾宪玉,王玮蓁.火针治疗中重度寻常型痤疮疗效观察[J].中国针灸,2014,34(7):663-666.JIANG M,ZENG X Y,WANG W Q.Efficacy observation on fire needling therapy for moderate to severe acne vulgaris[J].Chinese Acupuncture&Moxibustion,2014,34(7):663-666.
[15]原林.筋膜学[M].北京:清华大学出版社,2011:67.YUAN L.Fasciology[M].BeiJing:Tsinghua University Press,2011:67.
[16]刘农虞.“筋针”的作用机制探析[J].中国针灸,2015,35(12):1293-1296.DOI:10.13703/j.0255-2930.2015.12.028.LIU N Y.Exploration and analysis on the mechanism of sinew acupuncture[J].Chinese Acupuncture&Moxibustion,2015,35(12):1293-1296.DOI:10.13703/j.0255-2930.2015.12.028.
[17]陈若雨,窦鹏.浅析卫气与痤疮[J].河南中医,2015,35(2):224-226.DOI:10.16367/j.issn.1003-5028.2015.02.0095.CHEN R Y,DOU P.The analysis of relationship between Weiqi and acne[J].Henan Traditional Chinese Medicine,2015,35(2):224-226.DOI:10.16367/j.issn.1003-5028.2015.02.0095.
[18]周峰峰,顾庆华.顾庆华教授从卫气论治痤疮经验探微[J].中医药通报,2013,12(3):26-28.ZHOU F F,GU Q H.Professor Gu Qinghua's experience in treating hemorrhoids from Wei-energy[J].Traditional Chinese Medicine Journal,2013,12(3):26-28.
[19]吴姗姗,刘翔,麦跃,等.锯齿线结合平滑蛋白线皮下埋置提升紧致的疗效观察[J].中国美容医学,2017,26(1):48-50.WU S S,LIU X,MAI Y,et al.Clinical observation of the lift effect of the protein line combination the zigzag suture in the subcutaneous tissue[J].Chinese Journal of Aesthetic Medicine,2017,26(1):48-50.
[2]GOULDEN V,CLARK S M,CUNLIFE W J.Postadolescent acne:a review of clinical features[J].Br J Dermatol,1997,136(1):66-70.
[3]卢文,解春桃,朱礼刚.穴位埋线与刺血治疗寻常痤疮临床对照观察[J].上海针灸杂志,2009,28(12):700-702.LU W,XIE C T,ZHU L G.Clinical observations on comparing the efficacy of catgut embedding with pricking bloodletting in treating acne vulgaris[J].Shanghai Journal of Acupuncture and Moxibustion,2009,28(12):700-702.
[4]顾春英,卢文,任虹.埋线、火针、耳针综合疗法治疗寻常痤疮136例[J].南京中医药大学学报,2009,25(6):476-477.GU C Y,LU W,REN H.Treatment of 136 cases of acne vulgaris by embedding thread,fire needle and acupuncture combined therapy[J].JournalofNanjingUniversityofTraditional Chinese Medicine,2009,25(6):476-477.
[5]卢文,斯维特娜·曼恩.埋线为主治疗黄褐斑临床观察[J].中国针灸,2006,26(10):713-715.LU W,MANEN S.Clinical observation on treatment of chloasma with point embedding thread[J].Chinese Acupuncture&Moxibustion,2006,26(10):713-715.
[6]陈然,黎波,杜元灏,等.针灸治疗寻常痤疮的疗效综合判定[J].辽宁中医杂志,2012,39(2):331-333.DOI:10.13192/j.ljtcm.2012.02.144.chenr.047.CHEN R,LI B,DU Y H,et al.Comprehensive evaluation of acupuncture and moxibustion therapy for acne vulgaris[J].Liaoning Journal of Traditional Chinese Medicine,2012,39(2):331-333.DOI:10.13192/j.ljtcm.2012.02.144.chenr.047.
[7]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.Chinese Acne Treatment Guide Expert Group.Chinese Acne Treatment Guide(Revised 2014)[J].Journal of Clinical Dermatology,2015,44(1):52-57.
[8]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.ZHENG X Y.Guiding principles for clinical research of new drugs in traditional Chinese medicine[M].Beijing:The Medicine Science and Technology Press of China,2002:292-295.
[9]薛筑云,杜承权,刘国红,等.阿达帕林凝胶个体化治疗寻常痤疮的临床研究[J].中华皮肤科杂志,2003,36(4):198-200.DOI:10.3760/j.issn:0412-4030.2003.04.006.XUE Z Y,DU C Q,LIU G H,et al.Chinical efficacy and safety of adapalene 0.1%gel with individualized treatment regimen for acne vulgaris[J].Chinese Journal of Dermatology,2003,36(4):198-200.DOI:10.3760/j.issn:0412-4030.2003.04.006.
[10]陈福如.祛痤汤治疗寻常型痤疮40例临床观察[J].中医药导报,2008,14(5):69.DOI:10.3969/j.issn.1672-951X.2008.05.040.CHEN F R.Clinical observation on 40 cases of acne vulgaris treated by dispel acne soup[J].Guiding Journal of Traditional Chinese Medicine and Pharmacy,2008,14(5):69.DOI:10.3969/j.issn.1672-951X.2008.05.040.
[11]孙兵,车晓明.视觉模拟评分法(VAS)[J].中华神经外科杂志,2012,28(6):645.SUN B,CHE X M.Visual analog scoring(VAS)[J].Chinese Journal of Neurosurgery,2012,28(6):645.
[12]HOLZMANNR,SHAKERYK.Postadolescentacnein females[J].Skin Pharmacol Physiol,2014,27 Suppl 1:3-8.DOI:10.1159/000354887.
[13]卢文,周源,房忠女.埋线、电针治疗单纯性肥胖症对照研究[J].针灸临床杂志,2005,21(9):4-6.DOI:10.3969/j.issn.1005-0779.2005.09.003.LU W,ZHOU Y,FANG Z N.A comparative study of embedding and electroacupuncture in the treatment of simple obesity[J].Journal of Clinical Acupuncture and Moxibustion,2005,21(9):4-6.DOI:10.3969/j.issn.1005-0779.2005.09.003.
[14]姜敏,曾宪玉,王玮蓁.火针治疗中重度寻常型痤疮疗效观察[J].中国针灸,2014,34(7):663-666.JIANG M,ZENG X Y,WANG W Q.Efficacy observation on fire needling therapy for moderate to severe acne vulgaris[J].Chinese Acupuncture&Moxibustion,2014,34(7):663-666.
[15]原林.筋膜学[M].北京:清华大学出版社,2011:67.YUAN L.Fasciology[M].BeiJing:Tsinghua University Press,2011:67.
[16]刘农虞.“筋针”的作用机制探析[J].中国针灸,2015,35(12):1293-1296.DOI:10.13703/j.0255-2930.2015.12.028.LIU N Y.Exploration and analysis on the mechanism of sinew acupuncture[J].Chinese Acupuncture&Moxibustion,2015,35(12):1293-1296.DOI:10.13703/j.0255-2930.2015.12.028.
[17]陈若雨,窦鹏.浅析卫气与痤疮[J].河南中医,2015,35(2):224-226.DOI:10.16367/j.issn.1003-5028.2015.02.0095.CHEN R Y,DOU P.The analysis of relationship between Weiqi and acne[J].Henan Traditional Chinese Medicine,2015,35(2):224-226.DOI:10.16367/j.issn.1003-5028.2015.02.0095.
[18]周峰峰,顾庆华.顾庆华教授从卫气论治痤疮经验探微[J].中医药通报,2013,12(3):26-28.ZHOU F F,GU Q H.Professor Gu Qinghua's experience in treating hemorrhoids from Wei-energy[J].Traditional Chinese Medicine Journal,2013,12(3):26-28.
[19]吴姗姗,刘翔,麦跃,等.锯齿线结合平滑蛋白线皮下埋置提升紧致的疗效观察[J].中国美容医学,2017,26(1):48-50.WU S S,LIU X,MAI Y,et al.Clinical observation of the lift effect of the protein line combination the zigzag suture in the subcutaneous tissue[J].Chinese Journal of Aesthetic Medicine,2017,26(1):48-50.