【作者】 韩奔；

【导师】 米建平；

【作者基本信息】 广州中医药大学 ， 针灸推拿， 2010， 硕士

【摘要】 背景：痤疮,又称粉刺,因其多发于青春期,又俗称“青春痘”,是一种皮脂腺的慢性炎症性皮肤病,是影响颜面美观的主要疾病之一。痤疮不仅是一种躯体疾病,其在社交、心理、情绪等方面对病人的影响亦不容小觑,不亚于严重的哮喘、癫痫、糖尿病、腰腿痛、关节炎等疾病。随着社会的发展以及生活水平的提升,人们对生活质量要求的层次也进入了更高的阶段,粉刺是一种常见病,虽不致命,但对青少年来说,其造成的精神和心理压力往往超过生理上的痛苦。患者易出现情绪低落,焦虑和愤怒,产生自卑感,导致性格孤僻。而不良的心态使到机体处于应激状态,经由炎症因子、激素水平紊乱而加重病情,从而形成恶性循环。西医方面,痤疮是一种多因素疾病,到目前为止,其发病机制尚未完全清楚。目前认为痤疮的发生主要与皮脂分泌过多、毛囊皮脂腺导管堵塞、细菌感染和炎症反应等诸多因素密切相关。治疗方面着重于进行痤疮的局部治疗,以及口服抗生素、异维A酸以及激素进行治疗。祖国医学中,历代医家对痤疮病因病机的认识虽各有不同,但大多从肺胃热、血热、血瘀痰结、冲任失调以及湿和虚等方面立论。根据临床报道,中医中药、针灸治疗本病具有一定疗效,且安全、副作用小,具有良好的前景。但临床治疗多局限于表面辨证,而忽略了结合患者年龄、身体特点、生活习惯来究其根本进行治疗。当今痤疮患者大多由于先天禀赋异常、学习工作以及生活压力过大、长期处于劳累、精神紧张状态,导致机体阴阳紊乱失衡,而肾为先天阴阳之本,肾之阴阳平衡失调,导致相火亢盛,天癸过旺,此为痤疮发病的根本原因,加之后天饮食生活失调,肺胃火热上蒸头面,血热郁滞而面生粉刺。肾阴不足,相火过旺,一方面虚火灼金,肺热上熏；另一方面水不涵木,肝气郁结,久而化热,发为痤疮。肝者,体阴不足,阳用不及,气郁化火,加之痰、湿、瘀等有形之邪,发为痤疮。因此在临床跟师过程中学习总结发现,粉刺病位虽在皮肤,却与肝肾二脏有密切关系。腹针调理肝肾法治疗各种类型痤疮,是米建平副主任医师在长期的治疗各种证型痤疮的经验中提出的,认为在所选取年龄范围内的痤疮患者除表现出其证型外都夹有肝肾失调之证。该法选取腹针中调理肝肾穴位为主,根据临床证型,结合少许对应证型穴位,在临床运用中,屡获良效。目的：通过随机对照研究探讨观察腹针调理肝肾法治疗粉刺的临床疗效。方法：从广东省中医院针灸门诊部,选择符合观察条件的100例粉刺患者。采取简单随机化方法,当合格病例进入试验时,按先后次序进入随机数字表中对应的组别。随机分为腹针治疗组(治疗组)和西药治疗组(对照组)。其中治疗组采用腹针疗法,治疗隔天一次,2周为一疗程,共治疗4个疗程；西药组采取口服口服异维A酸胶丸,第1月每天2次,每次10mg；第2月起每天1次,每次10mg。2月为一疗程,共治疗1个疗程。观察治疗前、治疗后第4周、治疗后第8周皮损评分情况和治疗结束总有效率。结果：治疗组46例,治疗结束,痊愈18例,显效12例,有效12例,无效4例,总有效率91.3%；药物组47例,治疗结束,痊愈23例,显效26例,有效5例,无效3例,总有效率93.6%。两组疗效比较,治疗结束,差异无显著性意义(P>0.05)。两组间皮损评分比较,治疗结束,差异无显著性意义(P>0.05)。结论：腹针调理肝肾法治疗痤疮对改善各种类型痤疮患者局部皮损有一定作用,近期疗效两者相当,但远期疗效针刺治疗明显优于药物治疗。更多还原

【Abstract】 Background:Acne, it is also known as "Pimple". It is commonly known as" Zit" by virtue of usually occurring during puberty. Acne is a sebaceous gland, chronic inflammatory skin disease, it is mainly a disease of affecting the facial appearance. Acne is not only a physical disease, its social, psychological, emotional etc. impact on patients can not be ignored. It is no less than severe asthma, epilepsy, diabetes, lumbocrural pain, arthritis etc diseases. With development of society and life quality, people have higher requirements of the quality of life. Acne is a kind of common disease, although not fatal, but for young people, the result of the mental and psychological troubles often exceeds the physical pain. The patients easily have depressed, anxiety & anger, inferiority complex and withdrawn. Abnormal Reaction makes the body in stress state, the disease is aggravated by inflammatory factor, hormone disorder. It leads up to a vicious circle of further trouble.In western medicine aspect, acne is a multifactor disease. So far, its pathogenesis has not yet entirely clear. Currently considered the occurrence of acne mainly related to excessive secretion of sebum, Pilosebaceous duct blockage, bacterial infections and inflammatory reactions etc factors. Treatment focuses on conduct topical therapy for acne, take by oral antibiotics, isotretinoin and hormone.In Chinese medicine aspect, ancient medical scholars have quite different understanding of etiology and pathogenesis of acne. But most of the argument on the heat excess of lung and stomach, blood-heat, sputum and blood stasis knot, Chong and Ren disorders, damp evil and deficiency of vital energy etc. According to clinical reports, traditional Chinese medical science and medicine, acupuncture have a certain effect with less adverse effect and safe. It has good prospects. However, most of clinical therapy focus on categorical identification in terms of surface. Ignore the combination of patient’s age, physical characteristics, habit to study its fundamental treatment.The current youth’s body Yin and Yang disturbances cause by innate deficiency, pressure of life and study, be overworked and psychentonia. However, the kidney is the origin of congenital constitution, the kidney Yin and Yang disorder causes hyperactivity of vital cate fire, excessive vigorous Tiangui when female at the age of 14, male at the age of 16. It is the main reason for acne. Moreover, acquired improper food and lifestyle.Therapy of abdominal acupuncture liver and kidney treats all types of acne. It is submitted by associate chief physician Jianping Mi, with his experiences of treatment of all types of acne in long-term. He thinks that all of acne patient liver and kidney disorder expect the normal appearance. The treatment mainly contains therapy of abdominal acupuncture liver and kidney in order to recuperate liver and kidney acupoints. According to clinlcal symptom, combine with the adjuvant therapy and achieve satisfying results.ObjectiveAccording to random control study, research the clinical effects of therapy of abdominal acupuncture liver and kidney treats all types of acne.MethodsChoose 100 acne patients from the acupuncture clinic of the Traditional Chinese Medicine Hospital, Guangdong. They are randomly divided into the abdominal acupuncture treatment group (treatment group) and western medicine treatment group (control group). Treatment group is treated with abdominal acupuncture treatment, treatment every other day,2 weeks is one period of treatment and altogether 4 courses; Control group is treated with capsule B containing isotretinoin, the 1st month, twice a day, 10mg/time; The 2nd month, once a day, 10mg/time,2months is one period of treatment and altogether 1 courses. The scores of skin lesion and total effective rate were compared between the two groups in the pretherapy, the 4th week post-treatment and the 8th week post-treatment. Acupuncture team with 46participants had an effective rate of 91.3% after two-month treatment (18 recovery cases,12 markedly cases,12 ffective cases and 4 invalid cases). Drug team with 47 participants had an effective rate of 93.6% after two-month treatment (23 recovery cases,16 markedly cases,5 effective cases and 3 invalid cases). In addition, the results indicated that both therapies were significant in four-month treatment (p<0.05), the evaluation of skin injury between two groups had a significant difference after four months treatment (p<0.05).ConclusionTherapy of abdominal acupuncture liver and kidney will be helpful to improve acne patient skin lesion. In the short time, the abdominal acupuncture treatment and western medicine treatment have the same effect. In the long-time, the abdominal acupuncture treatment is better than western medicine treatment.更多还原