中药配合面针治疗痤疮的临床观察及对痤疮患者生活质量影响的研究
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摘要
一、研究背景与目的
寻常痤疮是皮肤科常见病、多发病,好发于青春期的男女面部、胸部、肩背部等处,是一种毛囊皮脂腺的慢性炎症性皮肤病,以粉刺、丘疹、结节、囊肿、脓疱和瘢痕为其特征,易反复发作。本病常发生在暴露部位,若未及时处理或治疗不当,易遗留萎缩性疤痕和瘢痕疙瘩,不仅影响了患者的容貌,而且使患者日常活动、工作、社交等方面都受到不同程度的困扰,可能因此产生自卑感和社交恐惧等问题,患者的生存质量明显地受到影响。
目前西医认为痤疮是多因素的综合作用所致的一种皮肤附属器疾病,其发病因素主要与雄性激素刺激皮脂腺增生和分泌过盛,毛囊皮脂腺导管角化异常、毛囊漏斗部堵塞及毛囊内微生物感染有关。现代医学多对其采取对症治疗,主要用抗雄性激素药、抑制皮脂腺分泌、抗角化药、抗生素等药物治疗。
寻常痤疮在祖国医学中属于“肺风粉刺”、“面疱”等范畴。中医文献很早就有记载。近几十年来,中医对痤疮的认识有了很大的发展和提高,除了古人提出的湿热、血热、肺热、痰瘀互结、冲任不调之外,导师范瑞强教授在多年的临床实践中总结出,痤疮的发病除与肺胃血热等病因有关外,认为肾阴不足,水不涵木,相火妄动,上蒸头面而发;另一方面肝肾同源,肾阴不足亦可导致肝阴不足,日久郁而化热。因此总结出经验方滋阴清肝消痤汤(女贞子、旱莲草、柴胡、郁金、鱼腥草等),临床上治疗阴虚内热型痤疮屡治屡效,本研究在此基础上配合面部针灸作为局部治疗,二法合用,标本兼治,相得益彰。
近几年已有学者从不同层面对滋阴清肝消痤汤机理及疗效进行了研究,这为本次研究奠定了一定的基础。但较少引用世界卫生组织生存质量测定简表(WHOQOL-BREF)对痤疮进行生存质量的评估,因此,本研究以此为切入点,探讨滋阴清肝消痤汤配合面针治疗阴虚内热型痤疮的疗效观察及引入生存质量量表(WHOQOL-BREF)来观察患者的生存质量改善情况。
二、研究方法
我们于2004年11月—2006年2月在广东省中医院皮肤科门诊观察了以阴虚内热型为主要表现的且符合纳入标准的寻常痤疮患者64例,随机分为治疗组32例,对照组32例,治疗组服用滋阴清肝消痤汤并配合面针治疗(主要以面部局部围刺为主),对照组单服用滋阴清肝消痤汤治疗,两组同时外搽三黄洗剂,疗程4周。试验期间,
Investigation' s background and objects: Acne is a very common dermatological disease. Mostly seen in teenagers. It appears on the face, chest, shoulder and back. Acne is a chronic disease which affects the hair follicle sebaceous glands. It is characterized by the carbuncle, papular eruption, node, cyst, pus-pocket and scar. Easily repeated attack. Currently, acne' s incidence is rising. Its development is tend to the young and advanced ages. Acne appears in the obvious part of the body. Without proper treatment, atrophy scar, cicatrix and pimple could be remained. As consequence, obviously, it affects in addition to the patient' s appearance, the daily activities, social life could also be disturbed. Therefore, it also effect patient' s psychology.Presently, due to modern medicine, acne is caused by synthesized factors, among which the androgen is the most common. In which irritates the hyperplasia of sebaceous glands. Exceed congestion of the funnel of the hair follicle, the infection of the microorganism inside the hair follicle. All above are the factors which cause acne. Currently, treatment like using the medicine pf androgen, restraining of the secretion of the sebaceous gland, anti-cornification and antibiotics are commonly used.According to TCM, acne is called lung-wind acne. In the last decade, Chinese medicine doctors had learned more about acne. In ancient times, acne referred to the disease caused by dampness-heat, heat in blood or in lung,
the complexion of the phlegm and the blood stasis, the imbalance of the Flush and Conception Vessel. Professor Fan Rui Qiang had made a conclusion base on many years of clinical experiences. He concluded that beside of the heat blood in lung and stomach, he considers that it also includes the deficiency of kidney' s Yin which affects the liver), hyperactivity of ministerial fire, all above factors affect the face. In the other side, the liver and kidney have the same origin, the Yin deficiency of kidney can also result the liver' s Yin deficiency. As the time passes by, it brings the heat. Thus, Prof. Fan created a herbal soup based on his experiences, the nourishing Yin and heat-cleaning acne -removing herbal soup. It is very efficient, for the deficiency of Yin and the inner heat type in particular.In the last years, researches have made many investigations of this soup and finally formed a stable foundation. But rarely used WHOQOLJ3REF to make evaluation f its quality. Therefore, this report is an evaluation of the nourishing Yin and heat-cleaning acne -removing herbal soup, using the WHOQOL_BREF, it also reveals the enhancement or the transformation after using this herbal soup.Investigation' s method: From November 2004 to February 2006, we have been observing and making researches of 64 cases of patients who suffer from the acne of Yin Deficiency and inner heat type. We divided into 2 groups in random. 32 cases compared with 32cases. The 32 cases are called treatment group, they had tried the nourishing Yin and Heat-cleaning acne -removing herbal soup. Also use the facial acupuncture treatment (principally using the surrounding style). While the compared group using only the herbal soup. Both groups used the SanHuang ointment. The treatment routine was totally 4 weeks. During the experiment, each week in between we assessed the damage and the enhancement of the skin. Use the WHOQOL-BREF evaluation. After the experiment was done, we divided the WHOQOL-BREF table into PHYS, PSYCH, SOCIL, ENVIR, and 24 points. After experiment was finished, we arranged all ye clinical researches. Insert them into the computer, set the database with
SPSS 11.0 software.The investigation' s result: 1. After the treatment, both groups patient' s damaged skin is enhanced. P=4%, P<0. 05, while the treatment group efficiency ranked 90. 63%. P=3. 9%, P<0. 05 based on the statistics. There revealed the comparison between 2 groups. No side-effects have been discovered. 2. Both groups have improved. Before taking treatment, both groups ranked P>0. 05 physically, psychologically, socially and the environment aspect were not obvious. After the treatment, P=0. 000. Comparing with the psychologically, P<0.05. Therefore, it is very obvious the enhancement of the treatment group is much more efficient than the compared group. The physical, environment aspects and the comparison of the compared group are not obvious P>0. 05, nonsense in Statistics.Conclusion: Integrating all the clinical experiments. It reveals the following: Using only the herbal soup is efficient, it enhances patient' s damaged skin. But we consider that the treatment is more efficient when using the facial acupuncture at the same time. And the time of treatment last shorter. During the experiment, we also discovered by surprise that the facial acupuncture could balance the facial' s grease, hair follicle-constriction, no side effect at all. It also brings a better life for the patients, psychologically, socially in particular. This report provides an extra new treatment, worth promoting.
寻常痤疮是皮肤科常见病、多发病,好发于青春期的男女面部、胸部、肩背部等处,是一种毛囊皮脂腺的慢性炎症性皮肤病,以粉刺、丘疹、结节、囊肿、脓疱和瘢痕为其特征,易反复发作。本病常发生在暴露部位,若未及时处理或治疗不当,易遗留萎缩性疤痕和瘢痕疙瘩,不仅影响了患者的容貌,而且使患者日常活动、工作、社交等方面都受到不同程度的困扰,可能因此产生自卑感和社交恐惧等问题,患者的生存质量明显地受到影响。
目前西医认为痤疮是多因素的综合作用所致的一种皮肤附属器疾病,其发病因素主要与雄性激素刺激皮脂腺增生和分泌过盛,毛囊皮脂腺导管角化异常、毛囊漏斗部堵塞及毛囊内微生物感染有关。现代医学多对其采取对症治疗,主要用抗雄性激素药、抑制皮脂腺分泌、抗角化药、抗生素等药物治疗。
寻常痤疮在祖国医学中属于“肺风粉刺”、“面疱”等范畴。中医文献很早就有记载。近几十年来,中医对痤疮的认识有了很大的发展和提高,除了古人提出的湿热、血热、肺热、痰瘀互结、冲任不调之外,导师范瑞强教授在多年的临床实践中总结出,痤疮的发病除与肺胃血热等病因有关外,认为肾阴不足,水不涵木,相火妄动,上蒸头面而发;另一方面肝肾同源,肾阴不足亦可导致肝阴不足,日久郁而化热。因此总结出经验方滋阴清肝消痤汤(女贞子、旱莲草、柴胡、郁金、鱼腥草等),临床上治疗阴虚内热型痤疮屡治屡效,本研究在此基础上配合面部针灸作为局部治疗,二法合用,标本兼治,相得益彰。
近几年已有学者从不同层面对滋阴清肝消痤汤机理及疗效进行了研究,这为本次研究奠定了一定的基础。但较少引用世界卫生组织生存质量测定简表(WHOQOL-BREF)对痤疮进行生存质量的评估,因此,本研究以此为切入点,探讨滋阴清肝消痤汤配合面针治疗阴虚内热型痤疮的疗效观察及引入生存质量量表(WHOQOL-BREF)来观察患者的生存质量改善情况。
二、研究方法
我们于2004年11月—2006年2月在广东省中医院皮肤科门诊观察了以阴虚内热型为主要表现的且符合纳入标准的寻常痤疮患者64例,随机分为治疗组32例,对照组32例,治疗组服用滋阴清肝消痤汤并配合面针治疗(主要以面部局部围刺为主),对照组单服用滋阴清肝消痤汤治疗,两组同时外搽三黄洗剂,疗程4周。试验期间,
Investigation' s background and objects: Acne is a very common dermatological disease. Mostly seen in teenagers. It appears on the face, chest, shoulder and back. Acne is a chronic disease which affects the hair follicle sebaceous glands. It is characterized by the carbuncle, papular eruption, node, cyst, pus-pocket and scar. Easily repeated attack. Currently, acne' s incidence is rising. Its development is tend to the young and advanced ages. Acne appears in the obvious part of the body. Without proper treatment, atrophy scar, cicatrix and pimple could be remained. As consequence, obviously, it affects in addition to the patient' s appearance, the daily activities, social life could also be disturbed. Therefore, it also effect patient' s psychology.Presently, due to modern medicine, acne is caused by synthesized factors, among which the androgen is the most common. In which irritates the hyperplasia of sebaceous glands. Exceed congestion of the funnel of the hair follicle, the infection of the microorganism inside the hair follicle. All above are the factors which cause acne. Currently, treatment like using the medicine pf androgen, restraining of the secretion of the sebaceous gland, anti-cornification and antibiotics are commonly used.According to TCM, acne is called lung-wind acne. In the last decade, Chinese medicine doctors had learned more about acne. In ancient times, acne referred to the disease caused by dampness-heat, heat in blood or in lung,
the complexion of the phlegm and the blood stasis, the imbalance of the Flush and Conception Vessel. Professor Fan Rui Qiang had made a conclusion base on many years of clinical experiences. He concluded that beside of the heat blood in lung and stomach, he considers that it also includes the deficiency of kidney' s Yin which affects the liver), hyperactivity of ministerial fire, all above factors affect the face. In the other side, the liver and kidney have the same origin, the Yin deficiency of kidney can also result the liver' s Yin deficiency. As the time passes by, it brings the heat. Thus, Prof. Fan created a herbal soup based on his experiences, the nourishing Yin and heat-cleaning acne -removing herbal soup. It is very efficient, for the deficiency of Yin and the inner heat type in particular.In the last years, researches have made many investigations of this soup and finally formed a stable foundation. But rarely used WHOQOLJ3REF to make evaluation f its quality. Therefore, this report is an evaluation of the nourishing Yin and heat-cleaning acne -removing herbal soup, using the WHOQOL_BREF, it also reveals the enhancement or the transformation after using this herbal soup.Investigation' s method: From November 2004 to February 2006, we have been observing and making researches of 64 cases of patients who suffer from the acne of Yin Deficiency and inner heat type. We divided into 2 groups in random. 32 cases compared with 32cases. The 32 cases are called treatment group, they had tried the nourishing Yin and Heat-cleaning acne -removing herbal soup. Also use the facial acupuncture treatment (principally using the surrounding style). While the compared group using only the herbal soup. Both groups used the SanHuang ointment. The treatment routine was totally 4 weeks. During the experiment, each week in between we assessed the damage and the enhancement of the skin. Use the WHOQOL-BREF evaluation. After the experiment was done, we divided the WHOQOL-BREF table into PHYS, PSYCH, SOCIL, ENVIR, and 24 points. After experiment was finished, we arranged all ye clinical researches. Insert them into the computer, set the database with
SPSS 11.0 software.The investigation' s result: 1. After the treatment, both groups patient' s damaged skin is enhanced. P=4%, P<0. 05, while the treatment group efficiency ranked 90. 63%. P=3. 9%, P<0. 05 based on the statistics. There revealed the comparison between 2 groups. No side-effects have been discovered. 2. Both groups have improved. Before taking treatment, both groups ranked P>0. 05 physically, psychologically, socially and the environment aspect were not obvious. After the treatment, P=0. 000. Comparing with the psychologically, P<0.05. Therefore, it is very obvious the enhancement of the treatment group is much more efficient than the compared group. The physical, environment aspects and the comparison of the compared group are not obvious P>0. 05, nonsense in Statistics.Conclusion: Integrating all the clinical experiments. It reveals the following: Using only the herbal soup is efficient, it enhances patient' s damaged skin. But we consider that the treatment is more efficient when using the facial acupuncture at the same time. And the time of treatment last shorter. During the experiment, we also discovered by surprise that the facial acupuncture could balance the facial' s grease, hair follicle-constriction, no side effect at all. It also brings a better life for the patients, psychologically, socially in particular. This report provides an extra new treatment, worth promoting.
引文
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[2] Chi Keung Yeung, Lynn Hwee Ying. A Commnity-based Epidemiological Study of Acne Vulgaris in HongKong Adolescents. Acta Dermato-Venereologica. 2002;82(2):104-107
[3] 巢和安,张宏,吴赤蓬.澳门青少年寻常痤疮的现患情况和有关因素分析.暨南大学学报自然科学与医学版,2003;24(2):104-106
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[5] 邱玉芬,李仁贵,孙建国.1365名高一学生痤疮调查.社区医学杂志,2004;2(6):60-61.
[6] Thiboutot D, Knaggs H, Gilliland K, Lin G. Activity of 5-alpha-reductase and 17-beta-hydroxysteroed dehydrogenates in the infrainfundibulum of subjects with and without acne vulgaris. Dermatology. 1998;196(1):38-42.
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[2] Chi Keung Yeung, Lynn Hwee Ying. A Commnity-based Epidemiological Study of Acne Vulgaris in HongKong Adolescents. Acta Dermato-Venereologica. 2002;82(2):104-107
[3] 巢和安,张宏,吴赤蓬.澳门青少年寻常痤疮的现患情况和有关因素分析.暨南大学学报自然科学与医学版,2003;24(2):104-106
[4] Cordain L, Lindeberg S. Ache vulgaris: a disease of Western civilization. Arch Dermatol. 2002 Dec;138(12):1584-90.
[5] 邱玉芬,李仁贵,孙建国.1365名高一学生痤疮调查.社区医学杂志,2004;2(6):60-61.
[6] Thiboutot D, Knaggs H, Gilliland K, Lin G. Activity of 5-alpha-reductase and 17-beta-hydroxysteroed dehydrogenates in the infrainfundibulum of subjects with and without acne vulgaris. Dermatology. 1998;196(1):38-42.
[7] 李元文,张丰川.专科专病名医临证经验丛书.人民卫生出版社,2002,(1).519～521
[8] 范瑞强,禤国维.中西医结合治疗皮肤病性病.广东人民出版社,1996,384～385
[9] 龚景林.肺风粉刺辨证施治200例.河北中医,1986,8(6):19～20
[10] 中国中医研究院广安门医院.朱仁康临床经验集.人民卫生出版社,1979.
[11] 秦万章.现代中医药应用与研究大系第十二卷皮肤科,上海中医药大学出版社1994,(1).244～245
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