【作者】 曲晓雪；

【导师】 蔡建伟；

【作者基本信息】 南京中医药大学 ， 中医康复学， 2010， 硕士

【摘要】 本研究以中医基础理论为指导,系统回顾了有关寻常性痤疮的相关文献,并结合导师多年研究,初步探讨了痤疮的发病机理和治疗方法。认为痤疮是一种多因素的疾病,病因病机相对复杂,涉及到多个脏腑,并与情志、环境等因素密切相关,其中又以肺胃热盛致病最为常见。就痤疮的治疗来讲,单一的药物或针灸治疗很难达到快速而又持久的疗效,而实践表明针药结合能明显提高效率和总有效率,并能有效降低药物的毒副作用。在此基础上,本实验将肺胃热盛型痤疮作为研究切入点,以清肺泄热、通腑利湿的消痤玉容方为代表方剂,结合针刺使用,力图从实验的角度进一步观察针药结合治疗寻常性痤疮的疗效,深入探讨针药结合的优越性及针药间的协同作用机制。实验研究目的观察针药结合治疗痤疮疗效的优越性,并探讨其作用机理,为临床治疗本病提供实验依据和新的思路方法。方法采用金黄地鼠侧背部皮脂腺斑作为实验动物模型。将32只金黄地鼠适应性饲养一周后,随机分为模型组、中药组、针刺组、针药结合组四组,每组8只。实验开始前,用电动剃须刀剃尽各组地鼠背部毛,暴露其背部双侧皮脂腺斑。后用乙醚将其麻醉,于强光照射下,用数码卡尺测量左右斑块的最大横径和最大纵径。实验开始后,每日观察各组金黄地鼠的饮食、饮水、大小便、精神状况及活动度,每7天测量一次体重。中药组以中药水煎剂每天灌胃1次,连续28天,生药量以人中等剂量为标准,折合成动物剂量,即9.583g/kg体重；针刺组针刺所选腧穴,每天1次,采用平补平泄手法,连续28天；针药组以中药水煎剂每天灌胃一次,每天针刺所选腧穴一次,剂量手法同上所述,连续28天；模型组实验过程只观测其皮脂腺斑,不做任何治疗,连续28天。于实验第30天采集标本,取材前禁食、自由饮水24h。腹腔注射麻醉各组地鼠,测量左右斑块的最大横径和最大纵径；并在每只地鼠背部双侧皮脂斑处取皮肤,放入装有10%甲醛固定液的小瓶中固定,送检,观察皮脂腺斑的组织学改变。采用眼球取血法,取血3ml,分离血清,检测睾酮(T)、雌二醇(E2)水平。结果(1)皮脂腺斑大小各治疗组皮脂腺斑大小均较模型组缩小,具有显著性差异(P<0.01)。其中针药组、针刺组皮脂腺斑较中药组缩小,但没有统计学意义(P>0.05)。(2)皮脂腺斑显微结构各治疗组皮脂腺厚度较模型组薄,具有显著性差异(P<0.05)。其中针药组又较针刺、中药组薄,具有显著性差异(P<0.05),后两者间差别无显著性意义(P>0.05)。各治疗组皮脂腺松散程度较模型组松散,具有显著性差异(P<0.05)。其中针药组又较针刺、中药组更为松散,具有显著性差异(P<0.05),后两者间差别无显著性意义(P>0.05)。各治疗组皮脂腺分布较模型组薄,排列稍松散,腺叶变小且数目较少,液化小囊较模型组多。其中针药组皮脂腺厚度明显变薄,排列松散度最大,腺叶散在分布,仅见个别腺叶重叠,液化囊形成数目多,并有较大的囊形成。(3)血清睾酮水平各治疗组地鼠血清睾酮水平较模型组降低,具有显著性差异(P<0.05)。其中针药组睾酮水平又较针刺、中药组低,具有显著性差异(P<0.05),后两者间差别无显著性意义(P>0.05)。(4)血清雌二醇水平针药组地鼠血清雌激素水平较模型组升高,具有显著性差异(P<0.05)。而针刺组、中药组雌二醇水平虽较模型组升高,但与其之间无显著性差异(P>0.05)。结论(1)针药结合疗法,在促进皮脂腺斑萎缩、松散、变薄方面优于单纯针刺、中药疗法,较以上两种疗法更能显著抑制皮脂腺斑增生及皮脂腺分泌。(2)针药结合疗法较单纯针刺、中药疗法更能显著降低血清睾酮水平,并能提高雌二醇水平。(3)推测针药结合疗法作用机制可能是通过降低血清睾酮水平、提高雌二醇水平,从而减轻皮脂腺增生状况来实现治疗痤疮的目的的。(4)单纯针刺、中药两种疗法疗效差别无显著意义,但均差于针药结合,提示针刺、中药具有协同性作用。更多还原

【Abstract】 Based on the TCM Basic Theory, systematically reviewing the literature of acne, combing with instructor s viewpoint, this article explores on the pathogenic mechanism and the therapeutic method of acne through theory and experimental study. That acne is a multi-factor disease, the pathogenesis of acne is relatively complex, involving multiple organs, in addition its occurrence related to emotional and environmental factors and other factors, among which the most common factor is wet and heat. In the treatment of acne, single drugs or acupuncture treatment is difficult to achieve quick and lasting effect. Practice shows that acupuncture combination with Chinese medicine can improve the efficiency and total efficiency, and can effectively reduce drug side effects. On this basis, the experiment takes wet and heat of acne as a research starting point, combing acupuncture with prescription of Xiaocuoyurong, further observation of its effect from the experimental point, investigating the superiority of acupuncture combination with Chinese medicine and its synergistic mechanism.Experimental research:Observed the effect of acupuncture combination with Chinese medicine, discussed its mechanism, provided experimental evidence and new thinking methods for the treatment of acne.Method:The sebaceous glands on the bilateral costal regions on the back of golden hamster were taken as the animal model. All 32 male golden hamsters were randomly divided into four groups:the model group(group I), the Chinese medicine group(groupⅡ),the acupuncture group(groupIII),the combination acupuncture with Chinese medicine group(groupIV). There were ten golden hamsters in each group. The father on the back of the hamsters had been cut completely with electric shaver on the beginning. After all hamsters were addicted, measured the right sebaceous glands by rule on the sunlight.The groupⅡare fed with Chinese medicine one time a day. The groupⅢare pinpricked one time a day. The groupIV are both fed with Chinese medicine and pinpricked one time a day. The group I has no treatment. After 30 days, anesthetized by intraperitoneal injection to hamsters in each group, then measured the right sebaceous glands by rule on the sunlight and took the sebaceous glands on the bilateral costal regions on the back of golden hamster for observing their miocrsturctures under light micscope.Picked off all hamsters’eyeballs and collected their blood samples. Then detected the serum concentrations of sex hormones of hamsters. Results:(1) The lever of testosterone(T)of group IV is significantly different from group I (P＜0.01). The level of T of group II and III is different from group I (P＜0.05). The level of T of group II and III have no difference from each other (P>0.05).(2) The lever of estrogen 2(E2) of group IV is different from group I (P<0.05). The levels of E2 of group II and III are higher than groupⅠ,but have no difference from group I (P>0.05).(3) Comparing with groupⅠ, groupⅡ,111 andⅣcan enable the sebaceous glands of hamsters become smaller(P＜0.01). GroupⅡandⅣcan enable the sebaceous glands of hamsters become smaller than groupIII,but have no difference from each other (P>0.05).(4) Comparing with group I, group II and III and IV can enable the sebaceous glands to become withered, sparse and thin(P<0.05). GroupIV can enable the sebaceous glands to become withered, sparse and thin, comparing with group II and III(P<0.05). Group II and III have no difference from each other (P>0.05).Conclusion:(1) Combination acupuncture with Chinese medicine is better than simple acupuncture and traditional Chinese medicine in promoting the sebaceous glands atrophy,oose, thinner.And it is better than the above two treatments significantly in inhibiting of proliferation and secretion of sebaceous glands. Combination acupuncture with Chinese medicine can obviously lower the blood serum testosterone level, and can raise the estrogen level comparing with acupuncture and Chinese medicine.(2) Combination acupuncture with Chinese medicine can remarkably decrease the level of androgen, improve the level of estrogen and influences proliferation of sebaceous glands and inhibits the sebaceous function, reduces the sebaceous glands by regulating the level of estrogen and androgen. Lt is maybe the mechanism and theory against acne.(3) Acupuncture therapy and traditional Chinese medicine therapy is no significant difference, but are poor in combination acupuncture with Chinese medicine. Acupuncture,Chinese medicine has a synergistic effect.更多还原