【作者】 李敏；

【导师】 范瑞强；

【作者基本信息】 广州中医药大学 ， 中医外科学， 2009， 博士

【摘要】 一、研究目的探讨滋阴清肝消痤方配合耳穴在治疗女性痤疮中是否优于单用中药滋阴清肝消痤方治疗的疗效,为临床上联合用药、针药结合治疗女性痤疮提供临床依据。现代医学认为痤疮的发生与性激素异常有关,特别与睾酮升高关系密切。西医对本病的治疗多参照寻常痤疮治疗,使用抗生素、内分泌疗法、锌盐疗法、维生素、抑制皮脂腺分泌和抗角化药治疗,寻常型痤疮治疗往往不能取得满意的效果。而中医药治疗本病历史悠久,积累了丰富的临床经验,中医的临床疗效好、毒副作用少已得到医界的公认。进一步探讨女性青春期痤疮的发病机理,寻找更加有效的药物,已成为研究的重点。本研究运用中医学基本理论,结合现代免疫学实验技术,从临床和性激素水平两方面,观察滋阴清肝消痤方加耳针治疗女性痤疮的临床疗效,并与滋阴清肝消痤方作对照。通过检测患者治疗前后血清中睾酮(T),探讨滋阴清肝消痤方加耳针治疗女性痤疮与中医调理肝肾冲任法在治疗女性痤疮中的临床意义,为治疗该病提供科学理论依据。二、方法1.选取受试对象为60名女性痤疮患者,随机分为治疗组和对照组。最终完成实验59人。治疗组29名以内服滋阴清肝消痤方,外以耳针加上痤灵酊外擦、丹参注射液足三里穴位注射,配合液氮冷冻喷雾法。对照组30名以内服滋阴清肝消痤方,外以痤灵酊外擦、丹参注射注射液足三里穴位,配合液氮冷冻喷雾法,针对两种治疗机理及疗效进行了研究评估。2.选取受试对象为痤疮患者女性60名,运用无创性皮肤生理功能测试仪,测量受试者面部皮肤油脂,弹性和水分比较前后差异。3.探讨女性寻常痤疮患者在中药治疗和针药治疗后体内性激素水平的改变。4.以问卷方式对痤疮患者调查,调查内容包括痤疮病人的年龄、月经情况、经前加重与否、家族史、对患者生存质量调查及皮肤生理检测。三、结果1.从治疗前、治疗后症状积分和皮损改善情况来看,经治疗组和对照组治疗以后,患者临床症状和皮损方面均较治疗前得到较好改善,治疗前后相比,P＜0.05,两间的差异有统计学意义。2.从治疗的总疗效来看,治疗组(中药配合耳针)疗效与对照组(中药组)治疗疗效无显著性差异(P＞0.05)。3.生存质量改善方面:两组治疗前在临床发现除对容貌受损过分担心和焦虑,导致卑、抑郁和社交障碍,影响日常工作、生活质量外,精神心理因素与痤疮的发病、剧、复发具有密切关系。焦虑组与无焦虑组治疗前后其差异无统计意义(P＞0.05)可能治疗时间只有四周,治疗前改善不明显,一般痤疮患者的生存质量改善是需要时间的调适的。4.女性寻常痤疮患者体内性激素水平的改变,明显较治疗前得到改善,P＞0.05,两间的差异无统计学意义。四、结论本临床试验研究结果表明,耳穴配合滋阴清肝消痤方治疗组治疗痤疮总有效率稍高于滋阴清肝消痤方治疗组,但两组疗效差异无统计学意义。两组治疗都能明显改善患者皮损情况。在研究过程中还发现,通过中药治疗耳穴埋针,能改善皮损情况,平衡面部油脂、收缩毛孔、调整内分泌、改善睡眠且未发现任何副作用。同时患者的生存质量也得到不同程度的提高,尤其表现在心理领域、社会关系领域方面,证明在中药及配合耳针的治疗下,能提高患者的自信心。本研究客观的评价了滋阴清肝消痤疮汤及滋阴清肝消痤疮汤配合耳针的临床疗效,同时引入生存质量、皮肤生理检测来评估痤疮患者的变化情况,克服了传统治疗方法疗效评价体系只依赖生化指标等方面的缺陷,也为今后临床治疗痤疮多提供了一个有效手段。更多还原

【Abstract】 Background:Acne is a common chronic inflammatory skin disorder that is involved with the skin hair follicles,sebaceous glands and hair follicles on the face and neck,such as the thoracodorsal sebaceous glands.From a Chinese Medicine’ s point of view,ache is usually seen in specific "lung wind ache" areas that are characterized by a rich distribution of blackhead or whitehead ache, inflammatory papules,secondary pustules or nodules,cysts and scars.Ache can also be considered from a Western medicine’ s point of view.Many factors are involved with acne.Some factors include general changes in the level of sex hormones,sebaceous gland hyper function,follicular keratosis,sebaceous duct anomaly,microorganisms in follicle sebaceous units,inflammation,and genetic factors.There can also be psychological factors that are involved in the pathogenesis of acne by influencing the host immune response.The history of TCM practitioners investigates the etiology and pathogenesis of acne.Although there are many factors involved,the most common ones are heat accumulation in lungs and stomach,yin deficiency,blood heat, phlegm and blood stasis,disproportion of Chong and Ren Meridian,such as Spleen hypofunction and dampness accumulation.The TCM practitioners’ treatment is based on adjusting the balance between Liver-Kidney Chong and Ren Meridian.There are also treatments where enriching yin and draining fire, clearing lung and removing toxics,cooling and activating blood,conditioning Chong - Ren Meridian occurs.The methods of treatment should combine oral and external therapy together for good therapeutic effect.Ache vulgaris usually occurs in teenagers.It is a chronic disease in adult sebaceous glands.It often occurs on the face,chest and back of young men andwomen.Acne vulgaris causes the formation of comedones、papules、septic scars,node,cysts and so on.Left over scars are commonly seen in department of dermatology.This kind of ache is most often seen in teen girls.The picking exacerbates the acne and causes scars;the scarring leads to more ache and,ultimately, more picking.Anxiety,depression,and other emotional problems may accompany ache vulgaris.The psychological factors and live qualities of acne patients with nervous and nerveless symptoms.Methods we investigated social-psychological factors and life quality of ache patients by using questionnaire of social-psychological factors and living qualities,and identified whether patients have nervous symptoms by using self-rating nervous scale(SAS).According to statistic of SAS,patients were selected into nervous group and nerveless group,then Two groups were balanced in sex,age,occupation and severity of ache.The differences of affected frequency of some social psychological factors and somequality of life were statistically significant: the influenced frequency of some the social-psychological factors and life quality of acne patients who with nervous symptom are higher than those nerveless symptom.Conclusion Because some of social-psychological factors and life qualities of ache patients are impressionable to be affected, dermatologists should solving their nervous symptom and then treating their social-psychological factors so that their qualities of life will be improved while their Ache were treated.In western medicine the ache itself,is known as the common ache,or ache vulgaris,it is a very common skin condition caused by many factors.Treatments are aimed at these various factors.Some treatments include antibiotics, medications to increase skin turnover,and medications to decrease inflammation.In the case of ache vulgaris,the treatment should also address possible emotional problems.Birth control pills may significantly improve acne,and may be used specifically for the treatment of ache.It is also important to know that oral antibiotics may decrease the effectiveness of birth control pills.Otherwise,in cases of unresponsive or severe ache, isotretinoin may be used.Patients using isotretinoin must understand the side effects of this drug.Monitoring with frequent follow-up visits is necessary. The medication must be be prevented during pregnancy,since the drug causes birth defects.Women may also use female hormones or medications that decrease the effects of male hormones to help their acne and Photodynamic therapy using the blue wavelength of light can be helpful in treating acne as well.Methods:The liver and kidney have the same origin,the Yin deficiency of the kidney can cause Yin deficiency in the Liver.Professor Fan made a prescription of (Z.Y.Q.X.C.D.)ZiYinQinganXiaoCuo Decoction,with Auricular needle,which causes Yin to be enriched and the heat to be reduced as well as balance sexual hormone,and as a result treat female acne.From March 2008 to March 2009,we have observed 59 patients with F.A.V. (Female Ache Vulgaris).They were divided into two groups for a four week treatment in Guangdong Provincail Hospital of TCM.The 60 Patients who have symptom of Yin deficiency and internal heat were treated with oral (Z.Y.Q.X.C.D.) with auricular needle,Danshen acupoint injection and liquid nitrogen refrigeration treatment;this used for comparison with the comparing group which uses oral(Z.Y.Q.X.C.D.)with Danshen acupoint injection and liquid nitrogen refrigeration treatment.For external use,both groups used Cuolingding.Result:First stages,for four weeks studies,treatment group isn’t more effective than comparing group.The 59 patients treated with Auricular therapy received 4 weeks treatment depending on the severity of their acne and continue to use Auricular therapy.Side effects were limited to mild redness and painful that lasted for 48 hours,and the treatment was found to be safe even for patients.The treatment group to achieve complete treatment of ache for 4 weeks and a 59 percent clearance per treatment compare with compare group which achieved almost the same as comparing group.Second,according to data analysis,ache vulgaris has is related to male sex hormone.Aftering comparing the two groups,treatment group.isn’ t more effective than the other group.Treatment group have the same as the other group only has a 6%of improvement.The third step,is to do data analysis on the physiology of the skin on the face.According to our statistical data increasing seborrhea were recognized as risk factors for moderate to sever ache.This is because the skin on the patient’ face is more greasier than normal.Skin quality and certain nutrition habits may affect acne severity.Conclusion:Using a prescription of(Z.Y.Q.X.C.)ZiYinQinganXiaoCuo Decoction,with Auricular needle,can enrich Yin,reduce heat and balance sexual hormones, treating female’ s unbalanced sex hormone level.Treatment with oral (Z.Y.Q.X.C.) with auricular needle,Danshen acupoint injection and liquid nitrogen refrigeration have reliable effect,low recurrence rate and lower side effect on treatment of female acne vulgaris.更多还原