桂枝茯苓丸证治规律研究及治疗40例黄褐斑的临床观察

【作者】 李思仪；

【导师】 王庆国；

【作者基本信息】 北京中医药大学 ， 中医临床基础， 2012， 硕士

【摘要】 目的：黄褐斑是临床较常见的一种损美性皮肤病,其病机多为本虚表实,本虚以肝、脾、肾三脏亏虚为主；标实多以血瘀、血热为主,近年来关于黄褐斑的临床应用研究取得了较大进展,但主要散在于个案病例报道和一般的临床观察之中,临床报道的多,纯经验性的内容多,带共性或规律性的内容少。桂枝茯苓丸为活血化瘀方剂之祖,而研究桂枝茯苓丸对黄褐斑治疗作用的文献却十分有限。本文拟从文献分析的角度出发,深入讨论近16年来临床医生对黄褐斑的应用经验,并通过临床上应用桂枝茯苓丸治疗40例女性黄褐斑患者,来观察桂枝茯苓丸的具体疗效和黄褐斑患者的改善情况。方法：本课题以中国知网(CNKI)数据库为依据,查阅数据库中近16年(1995-2011)的文献,收集有关黄褐斑、桂枝茯苓丸的临床资料,运用统计学研究的方法,分析了黄褐斑的辨证分型,以及治疗黄褐斑的临床常用方剂、中药,从统计学角度阐释了桂枝茯苓丸方治疗黄褐斑的可行性。运用统计学方法,分析了桂枝茯苓丸方治疗40例黄褐斑患者的疗效,部分阐明了桂枝茯苓丸治疗黄褐斑的一般规律。结果：本论文分析和比较了近16年来CNKI数据库中关于黄褐斑中医汤剂治疗方面的文献,总结为以下几点：1.辨证分型方面：黄褐斑的脏腑辨证分型以肝郁为主,占27.95%；而脾虚、肾虚次之,分别为18.28%、13.98%。而黄褐斑血分证分型以血瘀证为主,占23.66%；血虚证次之,占11.83%；血热证较少,占2.69%；而血寒证在统计文献中未有出现。这从侧面证实了黄褐斑发病的主要因素为郁、虚、瘀。2.方剂应用方面：临床上治疗黄褐斑的方剂多以活血剂为主,疏肝剂次之,兼用补肾健脾剂；而活血剂中,出现频次由高到低为：桃红四物汤、血府逐瘀汤、桂枝茯苓丸。3.方药应用方面：中药类别的应用频次由高到低的前5类为：活血药、补血药、补气药、健脾药、理气药。而常见中药的使用频次由高到低的前8味为：当归、柴胡、茯苓、红花、丹皮、川芎、桃仁、甘草。以上2、3点说明在临床上无论是方剂的应用还是中药的应用都十分重视黄褐斑发病因素中瘀的因素,倾向于使用活血化瘀法来治疗黄褐斑；另外这个结果反映出桂枝茯苓丸中的单味药物在治疗黄褐斑中出现频率高,从方药组成的角度为桂枝茯苓丸在黄褐斑的治疗中可能发挥的作用提供了重要依据。4.药理学方面：桂枝茯苓丸具有抑制酪氨酸酶活性,减少黑色素的形成,调节人体激素水平、改善血流变动力学、调节机体免疫功能的作用。这从药理学的角度为桂枝茯苓丸方治疗黄褐斑提供了依据。为了进一步验证桂枝茯苓丸对黄褐斑的作用,本课题通过临床上应用桂枝茯苓丸治疗40例女性黄褐斑患者,来观察桂枝茯苓丸的具体疗效和黄褐斑患者的改善情况。结果如下：1.以30-40为黄褐斑高发年龄段,40-50年龄段次之。2.黄褐斑患者皮损类型包括4种,分别为：蝶形型、面中部型、下颌型、泛发型,以蝶形型为主,面中部型次之,并且四种分型都是在30-40年龄段多见。3.黄褐斑患者多有瘀血表现,且以舌底静脉曲张为主,其次为斑色暗。4.桂枝茯苓丸疗效良好,总有效率为85%。无效的6例患者无明显瘀血表现,而40-50岁患者虚衰症状明显于瘀血,且无效比例较高。说明桂枝茯苓丸的适应症偏向于血瘀证。5.关于不同黄褐斑类型疗效的分析,以蝶形型疗效最为明显,总有效率达92.86%；以泛发型疗效最差,总有效率为60%。说明桂枝茯苓丸治疗蝶形型黄褐斑的疗效最为明显。结论：30-40为黄褐斑高发年龄段,40-50年龄段次之。黄褐斑患者皮损以蝶形型为主,面中部型次之,并且四种分型都是在30-40年龄段多见。黄褐斑发病的主要因素为郁、虚、瘀,脏腑辨证分型以肝郁为主,脾虚、肾虚次之,而黄褐斑血分证分型以血瘀证为主,血虚证次之。黄褐斑患者多有瘀血表现,且以舌底静脉曲张为主,其次为斑色暗。临床上治疗黄褐斑的方剂多以活血剂为主,常见中药的使用频次由高到低的前8味为：当归、柴胡、茯苓、红花、丹皮、川芎、桃仁、甘草。桂枝茯苓丸具有抑制酪氨酸酶活性,减少黑色素的形成,调节人体激素水平、改善血流变动力学、调节机体免疫功能的作用。并且桂枝茯苓丸中的单味药物在治疗黄褐斑中出现频率高。桂枝茯苓丸治疗黄褐斑疗效良好,总有效率为85%,并且其偏向于治疗蝶形型黄褐斑和血瘀证患者。更多还原

【Abstract】 Chloasma is a commonly seen capacitive skin disease, the pathogenesis of which is lowered body resistance and invasion by excessive pathogens.. The former is related to deficiency in the liver, spleen and kidney; while the latter to blood stasis and blood-heat. Recently, great progress has been made in the treatment of chloasma. However so many researches only focused on single case report and experience reviews, and there were few researches focusing on multiple case reports, which failed to sum up rules of treatment.. Guizhi, Fulin Pills (GFP) is the most famous formula used to promote blood circulation by removing blood stasis. There are few reports about the treatment of chloasma. The present study tries to focus on the clinical experience in the treatment of chloasma, while observe the effect of the GFP in the treatment of40cases of chloasma.Method:Based on the CNKI database, we accessed into the past16years (1995-2011) literature, collected clinical information about chloasma and the GFP. Statistical management was used to analyze the syndromes of chloasma, and the commonly used herbs and formulas for chloasma. We explored the feasibility of the GFP in the treatment of chloasma from a statistical point of view. By using statistical management, we analyzed the effect of the GFP in the treatment of40female patients with chloasma and. to some extent we have partly clarified the general rules in the treatment of chloasma with it.Result:This paper analyzed and compared the literature of the past16years from the CNKI database in the treatment of chloasma with herbal decoctions. Here is the summary:1.Differentiation of Syndromes:The main syndrome of chloasma was liver-qi stagnation,, accounting for27.95%; followed by spleen-deficiency, kidney-deficiency, respectively accounting for18.28%, and13.98%. Blood stasis was also the main reason of chloasma, accounting for23.66%; followed by blood-deficiency, accounting for11.83%; and blood-heat, accounting for2.69%. There was no record about blood-cold in literature. This was to confirme from one point that the main cause was stagnation and stasis..2. Formulas Used:: Stress was laid on activating blood circulation, and removing stagnated liver-qi., and,tonifying the kidney and spleen. The following is a list of the formulas used in order of frqquency:Taohong Siwu Decoction, Xuefu Zhuyu Decoction and the GFP.3. Herbs Prescribed in Order of Frequency:Danggui, Chaihu, Fulin, Honghua, Danpi, Chuangxiong, Taoren and Gancao, mainly for smooth blood and qi circulation, The most important method was to activate blood circulation and remove qi stagnation. Guizhi and Fulin played the main role in the treatment of chloasma, which provided an important basis for the possible role of the GFP in the treatment of chloasma.4. Pharmacology:The GFP inhibited tyrosinase activity, reduced the formation of melanin, regulated the body’s hormone level, improved blood rheology,and regulated the immune function. These provided a pharmacological basis for the GFP in the treatment of chloasma.To further validate the role of the GFP in the treatment of chloasma, we investigated its effect on chloasma in40female patients. The results are as follows:1. The incidence of chloasma was high between30-40years, and then40-50years.2. There were four kinds of skin lesions:butterfly type, central-face, jaw, and universal types. The butterfly type was mostly seen, then the central face type. These four types were more common between30-40years,3. Most chloasma patients suffered from bleeding, and varicose veins under the tongue.4. The effect of the GFP was excellent. The total effective rate of GFP was85%. Six patients failed to response, but they did not present significant bleeding manifestations. Patients between40-50years were easier to have symptoms caused by deficiency, and most of them had no response to the tretment.It indicated that the GFP was especially good to the syndrome of blood stasis.5. The butterfly type responsed mostly well to the GFP, and the total effective rate was92.86%. The universal type did not respond well, and the total effective rate was60%. Conclusion:High incidence of chloasma occurs in patients between30-40years, then between40-50years. The butterfly type is mostly seen and then the central face type. All of the four types are commonly seen in patients between30-40years.. The chief cause of the diseases is qi stagnation and blood stasis. In syndrome differentiation stress is laid on the liver, spleen and kidney. The blood type syndrome is caused by blood stasis and blood-deficiency. Most patients have bleeding manifestations,always accompanied by varicose veins under the tongue.. The herbal formulas aim at activating blood circulation. The majority of the prescribed medicinal herbs has already listed above. The GFP works to inhibit the tyrosinase activity and reduce the formation of melanin, regulate the hormone level, improve blood flow and blood rheology, and regulate the immune function. The effect of the GFP is excellent, having the total effective rate of85%. It is mostly indicated for the butterfly type and the blood stasis syndrome.更多还原