【作者】 李晋宏；

【导师】 曲竹秋；

【作者基本信息】 天津医科大学 ， 中西医结合临床， 2004， 硕士

【摘要】 痤疮(acne)是皮肤科的常见病、多发病，尤其在青春期男女发病率最高。它是毛囊皮脂腺的慢性炎症，主要发生于颜面及胸背等处，表现为黑头粉刺，炎性丘疹，继发脓疱或结节，囊肿等，个别患者甚至形成凹陷或增生性瘢痕，严重影响患者的生活质量。其发病机理一般认为涉及：(1)毛囊皮脂腺导管角化异常；(2)微生物作用，主要与痤疮丙酸杆菌有关；(3)雄激素对皮脂腺的调控；(4)炎症损害的发生。 对常见的寻常性痤疮(acne vulgaris)的治疗多采用外用抗角化药、抗生素，口服抗生素、抗雄激素药物，但可见局部红斑、脱屑、烧灼感和肝功能损害等不良反应。 本病属中医“肺风粉刺”范畴。中医认为其发病多因饮食不节，过食肥甘厚味，肺胃湿热，复感风邪而致。临床治疗有清肺胃湿热法、疏肝泻肝法、滋肾阴泻相火法和清湿热祛痰瘀法等。 导师曲竹秋教授，博采众长，在多年治疗寻常性痤疮的基础上，根据该病青春期发病率较高，且女性痤疮患者病情多在月经前加重的特点，提出本病乃相火亢盛为本，复因过食辛辣肥甘，酿成湿热，气血壅滞于皮肤经脉而发病为标。治疗用消痤煎，药用：黄柏、知母、生地、丹皮、茯苓、泽泻、丹参、连翘、地丁、白藓皮、地肤子、白芷等。全方以清泻相火为主，辅以利湿清热、凉血解毒之品，标本同治，外病内治，符合中医整体观念、辨证论治的原则。经临床观察治疗寻常性痤疮42例，显愈率80.9％，总有效率95.2％，且无明显的不良反应，疗效显著。 为了探讨消座煎的作用机理，我们进行了实验研究。首先，我们将大鼠去率九术后分为灌饲生理盐水对照组、皮下注射丙酸肇丸酮对照组和皮下注射丙酸皋丸酮十中药煎剂组，给药6天后观察各组大鼠的精囊和前列腺的重量。其次，我们用100%油酸涂于家兔耳管开口处，造成实验性粉刺模型并分组，对照组不处理，治疗组给予中药煎剂灌饲，2周后对比两组兔耳的粉刺样改变。第二，用消座煎的干浸膏对痊疮丙酸杆菌进行抑、杀实验。 实验结果证实，消痊煎有一定的抗雄激素作用，以木方209生药/kg体重灌胃给药，能对抗丙酸翠丸酮引起的去翠大鼠精囊和前列腺重量的增加，治疗组与丙酸肇丸酮对照组比较，去翠大鼠的精囊和前列腺重量明显降低，且有显著性差异(p<0.01，p<0.05);消座煎还有明显的抗炎和减轻角化过度作用，以木方309生药/kg体重灌胃给药，能明显减轻油酸引起的兔耳皮肤表皮层增厚、角化过度和毛囊壁增厚、毛囊口角质栓的形成以及炎症反应的程度，治疗组粉刺样改变较对照组明显减轻，且有显著性差异(p<0.05);同时消痊煎具有较好的抑、杀痊疮丙酸杆菌活性作用，在PH7时对痊疮丙酸杆菌的Mlc (最低有效浓度)范围、MICS。和MICg。分别为7.5一60、12.71、33.26mg生药zml;MBe(最低杀菌浓度)范围、MBes。和MBeg。分别为7.5一60、一6.54、46.5 mg生药/ml。 综__匕所述，消痊煎不仅组方合理，治疗寻常性痊疮临床疗效显著，同时无明显的不良反应，而且又有比较确切的作用途径，是一种安全有效治疗寻常性痊疮的中药配方，具有临床推广价值。同时中药抗雄激素作用的研究文献报道尚不多见，木实验对中药抗雄激素作用 的研究具有一定的创新性。更多还原

【Abstract】 Acne vulgaris is the most common disorder treated by dermatologists. It is a disease of the pijosebaceous unit characterized by the formation of open and closed comedones, papules, pustules, nodules, and cysts. It is primarily a disease of adolescence, which occurs usually on the face and to a lesser\extent on the back, chest and shoulders. The exact etiology of acne is unknown, but a complex process involving sebaceousgland secretion, sebaceous gland blockage, inflammatory response (related to bacteria, especially Propionibacterium acnes), genetic factors, and environmental factors seems to be responsible.The therapy includes anti-keratinization, antibiotics and antiandrogen. But the incidence of side-effect must be considered.In Traditional Chinese Medicine (TCM) acne belongs to Lung-Wind comedones. It is considered to be caused by Damp-Heat in the Lung and Stomach. Therapentic methods include clearing away damp-heat from the lung and stomach and clearing away heat and removing toxin.Advisor QuZhuqiu has been dedicated in treatment of ance for many years. She believes that the pathogenic factors include kidney-fire, excessive fat, damp-heat and Qi-Xue attacting skin.Advisor Qu uses the methods of clearing kidney-fire, cooling blood, clearing away dampness and removing toxin, which is the treatment of the Primary and Secondary Symptoms simultaneously. The prescription "Xiao Cuo Jian " deriving from " Zhi Bai Di Huang Tang " is Phellodendron bark, Rhizoma Anemarrhenae, dried Rehmannia root, Moutan bark, Poria, oriental water plantain rhizome, red Sage root, Forsythia fruit, Chinese Violet, Dittany bark, Broom Cypress fruit, Dahurian Angelica root, etc. The emphasis of the formular’s function is the concept of the Organism as a Whole and Diagnosis and Treatment Based n an overall Analysis of Signs and Symptoms. Its clinical effect is more efficient. So far no side-effect has been reported .In order to verify and explore the mechanism of the prescription, we carried out the study of this project. First, we did the bacteriostatic experiment with the powder. Second, an experimental model for acne to observe the anticomedone effect of the decoction is established. Third, an antiandrogen experiment is done.The conclusion shows that the prescription has bacteriostatic action, anti-keratinization action and antiandrogen action.更多还原