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疏肝理气活血法抗皮肤色素沉着的理论与实验研究
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摘要
皮肤色素沉着是皮肤科的疑难之症,例如黄褐斑、老年斑、雀斑、黑变病、颜面黑痣、胎斑等,严重影响着美容。现代生活中,随着人们生活水平的日益提高,美白祛斑渐渐变成了一个很热门的话题,很多人,不仅包括女士、甚至是男士,都在为美白皮肤而努力,特别是一些面颊长色斑的青年男女,脸上的雀斑、黄褐斑、黑变病严重影响了皮肤的美观。故而,祛斑则成为很多人的心头大事。皮肤色素沉着只是一个症状,他并不是疾病的诊断名词。许多皮肤病均可出现皮肤色素沉着,现代皮肤病学把以皮肤色素沉着为主要表现的疾病统称为皮肤色素沉着过度性疾病。皮肤色素沉着过度性疾病的病机为黑素小体细胞数目增多,或黑素小体活性提高。从病因上又可分为遗传性(雀斑)、代谢性(黑变病)、内分泌性(黄褐斑)、炎性(晒斑)、肿瘤性(色痣)、药物性(药疹)等。
     有关皮肤色素沉着类疾病,早在中医古籍中就有不少记载。隋巢元方在《诸病源候论·面皯候》指出:“人面皮上,或有如乌麻,或如雀卵上之色是也。此由风邪客于皮肤,痰饮渍于腑脏,故生皯 。”宋《太平圣惠方》中指出气血失和是导致皮肤色素沉着发生的病机:“夫面黧黑者,由脏腑有痰饮,或者皮肤受风邪,致令气血不调,则生黑。”而明代陈实功则于《外科正宗·雀斑》中提出:“雀斑乃肾水不会荣华于上,火滞结而为斑”;并于《外科正宗·女人面生黧黑斑》中阐明了黧黑斑发生的原因是由于“水亏不能制火,血弱不能华肉,以致火燥结成黑斑,色枯不泽。”清许克昌的《外科证治全书·面部证治》认为“面尘,面色如尘垢,日久煤黑,形枯不泽,或者起大小黑斑和面肤相平,由忧思抑郁,血弱不华”,不仅对皮肤色素沉着的症状体征进行了描述,而且还对其病机进行了探讨。清代吴谦等在《医宗金鉴·外科心法要诀》中对黧黑斑进行了更为全面更加深入的探讨,认为其因“忧思抑郁,血弱不华,火燥结滞而生”,且“妇女多有之”。
     中医药在治疗皮肤色素沉着的临床实践过程中积累了大量丰富的宝贵经验。疏肝理气活血法具有治疗和预防皮肤色素沉着的良好而可靠的效果。本研究从理论和实验方面对疏肝理气活血法治疗、预防皮肤色素沉着进行深入的研究,以期为治疗、预防皮肤色素沉着提供新的思路、方法和药物,为开发新药及新的化妆品打下基础。
     目的
     随着人们生活水平的日益提高,美白护肤自然成为人们关注的重要话题。人们在追求健康体魄的同时,也在追求肌肤健美,尤其是一些面生色斑的青年男女,脸上的色斑严重影响着皮肤的美观。因此,祛斑美白成为了很多人的热门追求。
     疏肝理气活血法之方药是导师邱明义教授运用中医的理论,结合数十年研究伤寒杂病论的心得,并吸取数十年临床经验之所得而创造的治疗皮肤色素沉着,如黄褐斑、雀斑、老年斑等极有效验的经验方,临床疗效满意,但尚缺少实验方面的研究。故特对该法治疗皮肤色素沉着进行较深入的实验研究,以阐明其防治皮肤色素沉着的机理,为进一步开发应用提供科学依据。
     方法
     1、用紫外线照射加捆绑以及注射黄体酮的方法制造大鼠皮肤色斑模型,造模后灌服疏肝理气活血法中药,对模型大鼠皮肤色斑进行治疗,并检测皮肤色斑中的黑色素细胞数量、黑色素小体数量、肝脏脂褐素含量的变化,以观察疏肝理气活血法中药治疗皮肤色斑的效果。
     2、用紫外线照射加捆绑以及注射黄体酮的方法制造大鼠皮肤色斑模型,在造模前灌服疏肝理气活血法中药,对模型大鼠皮肤色斑进行预防,并检测皮肤色斑中的黑色素细胞数量、黑色素小体数量、血清中SOD、MDA的变化,以观察疏肝理气活血法中药预防皮肤色斑的效果。
     3、通过体外黑素瘤细胞培养,在培养基中加入疏肝理气活血法中药,检测对黑素瘤细胞增殖、酪氨酸酶含量、黑素小体生成数量的影响,以探讨疏肝理气活血法中药防治皮肤色斑的机制。
     结果
     1、实验结果显示,和模型组比较,治疗组大鼠皮肤中的黑色素细胞数量、黑色素小体数量、肝脏脂褐素含量都显著减少(P<0.01或者P<0.05)。表明疏肝理气活血法中药对皮肤色素沉着有良好的治疗作用。
     2、实验结果显示,和模型组比较,预防组大鼠皮肤中的黑色素细胞数量、黑色素小体数量、血清中MDA含量都显著减少(P<0.01或者P<0.05),血清中SOD含量上升(P<0.01或者P<0.05)。表明疏肝理气活血法中药对皮肤色素沉着有较好的预防作用。
     3、疏肝理气活血法中药对黑素瘤细胞有显著抑制作用(P<0.01或者P<0.05),可抑制酪氨酸酶的表达(P<0.01或者P<0.05),使黑素小体生成数量减少(P<0.01或者P<0.05),且呈现剂量依赖关系,即疏肝理气活血法中药剂量越大、浓度越高,抑制黑色素的作用就越明显。
     结论
     疏肝理气活血法符合中医学之病因病机理论,组方合理。实验结果证实,疏肝理气活血法中药对皮肤色素沉着有较好的预防作用及治疗作用,该方不论是灌服还对体外培养的黑色素细胞、酪氨酸酶以及黑素都有抑制作用,并可以减少肝脏非正常的脂褐素、可以提高机体SOD的活力、可以降低体内MDA的含量,显示疏肝理气活血法中药有抗氧自由基损害、抗衰老、美白护肤的功效,具有广阔的开发应用前景。
Skin pigmentation related illness has always been challenging fordermatology treatments, such as macula retinae, senile plaque,freckle, melanosis, facial melasma, mongolian spots and so on.These skin pigmentation related illness has cause significantimpact on beauty. With the development of modern society andimproved living conditions, improving skin beauty and health hasbecome a popular topic. Lots of people, men and women are in pursuitof healthy looking skin, especially those young men and women withfacial freckle, macula retinae and melanosis. Those people have agreater desire to improve skin condition. Skin pigmentation is asymptom and not the diagnostic term for the illness. Pigmentationhas found to be related to many skin illnesses. In the theory ofdermatology, skin pigmentation related illnesses are categorizedas skin hyperpigmentation disorders. Pathogenesis of this disorder/disease in this category is nothing more than a small number ofmelanocyte cells increase or enhancing its activity. From theetiology point of view, it can be divided into the following categories, they are genetic (freckles), metabolic (rmelanosis),endocrine (macula retinae), Inflammation (sunburn), tumor(melasma) and drug-induced (fixed drug eruption).
     You can find lots of articles relating to skin pigmentationillnesses and their treatments in ancient and historicaltraditional Chinese medicine books. Sui Chao Yuan Fang pointed outin <>“If someone’ skin coloris as dark as deep brown, just like Ma Que, this is trigger by thefluid from lung and the repository deep down in the lung tissue.The lung issue shows up in the skin, therefore, the color of pigmentchanges.” In Song dynasty, it is pointed out in <> that the unbalance of blood flow and qi are the rootcauses of skin pigmentation related illnesses. Excessive amount ofmucus and fluid in the lung could cause the skin turning into darkercolor. And the disorder of blood flow and qi could lead to darkercolor in skin as well, sometimes, even in black color. In Mingdynasty, Chen Shi Gong pointed out in the <> that freckle is the symptom trigger by kidney issues. Theliquid in the kidneys does not balanced causing internal heat ofthe body trapped inside and qi is inot flowing freely. Therefore,skin pigmentation shows up on face. In addition, it was stated inthe <> melasmais caused by the lack of water fluid to balance the fire head insidethe body and lack of blood flow to support the nutrition requiredby the body. Therefore, the excessive heat and lack of nutritionwill cause the darker pigmentation appears in skin, eventually itturns to be melasma. Skin looks unhealthy and lack of nutrition. In Qing dynasty, Mr. Xu Ke Chang stated in the <> that some spots on the faces get darkerand darker, eventually, they are as black as coal color and becomemelasma. The skin looks really dry and lack of moisture andnutrition. These melasma regardless of small pieces or large pieceswhich cover large area of the skin are all triggered by the innerunbalanced caused by constant worrying, anxiousness and lack offree flowing blood flow to transport nutrition and circulate aroundthe body. In his article, Mr. Xu not only described the symptomsof skin pigmentation illnesses, but also presented his researchstudy conclusion regarding the root cause of the illnesses. In Qingdynasty, Mr. Wu Qian and his fellow colleagues did further studiesin the root cause of melasma. They stated in the <> that constant worrying in a prolong periodof time causes the blockage of qi flowing inside the body, lack ofblood flow to circulate nutrition around the body. All theseproblems trigger inner heat to be block in the pocket inside thebody. After a period of time, spots of discolored skins show up andlead to skin pigmentation illness. The skin pigmentation relatedillnesses are found more often among females.
     Using traditional Chinese medicine for skin pigmentation illnesstreatment has a long history. A wealth of accumulated experiencein both theory and clinical practice has been researched, developedand practiced. Using traditional Chinese medicine to regulatingliver qi and improving blood circulation for skin pigmentationrelated illnesses treatment have been proven to be effective andreliable. This research further study the method of using traditional Chinese medicine to regulating liver qi and improvingblood circulation for skin pigmentation related illnessestreatments and prevention from both theoretical and practicalperspectives. This leads to a more effective, extensively usedapproach for skin pigmentation treatment (such as freckle, senileplaque, melasma, etc.) and illnesses prevention. This research alsowill establish the foundation of the invention of new traditionalChinese medicine for both illnesses and anti-aging treatment, thedevelopment of new makeup&cosmetics and new raw material toproduce makeup&cosmetics which promote long lasting healthy skinand younger looking. Furthermore, this research also contributesto the development of treating and preventing depression andother related mental disorders in a long run.
     Purpose:
     With the development of modern society and improved livingconditions, improving skin beauty and health has become a populartopic. Lots of people, men and women are in pursuit of healthylooking skin, especially those young men and women with facialfreckle, macula retinae and melanosis. Those people have a greaterdesire to improve skin condition.
     Mentor professor Qiu Ming Yi put together a number of traditionalChinese herbs as a packaged traditional Chinese medicine toregulating liver qi and improving blood circulation for skinpigmentation related illnesses treatment. This invention are basedon core theory of using traditional Chinese medicine to treatmentskin pigmentation related illness; professor Qiu’s learning from decades of research and study of Shang Han diseases and professorQiu’s decades of clinical practices by using this invention totreat skin pigmentation related illnesses including macula retinae,senile plaque, freckle, melanosis, facial melasma, mongolian spotsand so on. This medicine has proven to be effective and treatmentresults are satisfactory via years of clinical practice in realworld. Currently, there is insufficient amount of laboratoryexperimental work to prove the effectiveness of this inventedmedicine from the theoretical perspective. This experimentalwork/proven can further expand the usage and adoption of thisinvented medicine, therefore, further promote the methodology ofusing traditional Chinese medicine to regulating liver qi andimproving blood circulation for skin pigmentation relatedillnesses treatment in clinical world.
     Methods:
     1. To verify the effectiveness and functionality of the packagedtraditional Chinese medicine to regulate liver qi and improveblood circulation for skin pigmentation related illnessestreatment. Form traditional Chinese medicine theory andherbal medicine mechanism perspective, bundled ultravioletirradiation was used on rats in conjunction with progesteroneinjection in the rats to create skin pigmentation relatedsymptoms. The number of melanocytes in the skin pigmentationwas measured. Then the same groups of rats were fed with thepackaged traditional Chinese medicine, afterwards, the numberof melanocytes in the skin pigmentation was measured again tocompare with the previous number collected. It was detected that the number of melanocytes in the skin pigmentationchanged and the content in liver lipofuscin melanin bodieswere also changed.
     2. To verify the effectiveness and functionality of the packagedtraditional Chinese medicine to regulate liver qi and improveblood circulation for skin pigmentation related illnessesprevention. Form traditional Chinese medicine theory andherbal medicine mechanism perspective, the rats were fed withthe packaged traditional Chinese medicine as a preventativemeasurement, bundled ultraviolet irradiation was used on ratsin conjunction with progesterone injection in the rats tosimulate the exposure to skin pigmentation illness. The numberof melanocytes in the skin pigmentation was measured tocompare the before and after situations. The changes of thenumber of melanocytes in the skin pigmentation and the changesin serum SOD, MDA's were detected.
     3. In addition, melanoma cells were produced in the lab, thepackaged traditional Chinese medicine to regulate liver qi andimprove blood circulation for skin pigmentation relatedillnesses treatment were added to the lab created melanomacells. Then melanoma cell proliferation, tyrosinase contentand melanosomes quantity of generation were measured andrecorded.
     Results:
     1. Laboratory results concluded that the rats were treated in the number of skin melanocytes, the number of melanosomes, liverlipofuscin was significantly reduced (P<0.01or P<0.05).This leads to the conclusion that this packaged traditionalChinese medicine to regulate liver qi and improve bloodcirculation can treat skin pigmentation related illnesseseffectively.
     2. Based on the laboratory experiment results, the number ofmelanosomes in the skin of those rats was reduced, the serumMDA levels of those rats were significantly reduced (P<0.01or P<0.05) and the serum SOD levels of those rats rise (P<0.01or P<0.05). This leads to the conclusion that thispackaged traditional Chinese medicine to regulate liver qi andimprove blood circulation can prevent skin pigmentationrelated illnesses effectively.
     3. Based on the laboratory experiment results, the melanoma cellscultured in vitro, joined with this packaged traditionalChinese medicine to regulate liver qi and improve bloodcirculation in the medium proved that this packagedtraditional Chinese medicine to regulate liver qi and improveblood circulation herbs is effective and functional as themelanoma cells were significantly inhibited (P<0.01or P<0.05); and the tyrosinase expression also were inhibited (P<0.01or P<0.05). So that the melanosomes generated toreduce the number (P<0.01or P<0.05), and the more dosesof this packaged traditional Chinese medicine to regulateliver qi and improve blood circulation were used, the more significant the results were (the more obvious showing theinhibition of melamin).
     Conclusion:
     This packaged traditional Chinese medicine to regulate liver qi andimprove blood circulation for skin pigmentation related illnessestreatment&prevention is in line with the theory of the etiologyand pathogenesis of traditional Chinese medicine. The assembly ofherbal components is reasonable, harmonizing, and compatibletogether to achieve the proposed functionality of this medicine andwork very effectively to regulate liver qi and improve bloodcirculation for skin pigmentation related illnesses treatment andprevention.
     Laboratory results from this research also proved that the packagedtraditional Chinese medicine to regulate liver qi and improve bloodcirculation for skin pigmentation related illnesses treatment&prevention works very effectively to regulate liver qi and improveblood circulation for skin pigmentation related illnessestreatment and prevention.
     whether it is fed decoction also cultured melanoma cells,tyrosinase and melanin are inhibited, can reduce abnormal liverlipofuscin, can improve the vitality of SOD and MDA levels in thebody can be reduced, indicating that this packaged traditionalChinese medicine works effective, the blood circulation of the bodyis smooth, meridians are clear; the liver qi is regulated as well.Therefore, stagnation of liver can be resolved, stasis be passed and the body can functional properly to fight off any diseases.
     This packaged traditional Chinese medicine to regulate liver qi andimprove blood circulation for skin pigmentation related illnessestreatment and prevention has laid a solid foundation to treat andprevent this type of illnesses.
     This packaged traditional Chinese medicine to regulate liver qi andimprove blood circulation not only used for skin pigmentationrelated illnesses treatment&prevention; but also can be usedfurther used for antioxidant free radical damage recovery,anti-aging, skin coloring enhancement and improveing theeffectiveness of physical Huangshou depression. There is abrilliant future and a promising progress in the field of in depthresearch and study in this field.
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