岳仁宋教授从脾论治痤疮经验总结及临床疗效观察

发布时间：2018-02-27 23:56

本文关键词： 临床经验脾虚湿热证痤疮健脾消痤方临床疗效观察　出处：《成都中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：痤疮中医学又称肺风粉刺、面疱、酒刺、青春痘等,是一种毛囊皮脂腺的慢性炎症性疾病,多发生于青年面、胸、背部的毛囊、皮脂腺,因皮脂腺管与毛孔的堵塞,皮脂外泌不畅所致,出现丘刺、脓疱、结节、囊肿。由于社会对容貌的要求越来越高,痤疮也受到更多关注。本文从病因、病位、病理产物、病机、病性、治法、方药等方面,本论文总结导师岳仁宋教授从脾论治痤疮的临床经验,并观察“健脾消痤方”治疗脾虚湿热证型痤疮的临床疗效。第一,经验总结。湿热之地、饮食不节、不良作息习惯、情志不畅等病因,共伤脾胃,脾失键运,酿生内湿,内外湿邪侵袭,可随体质从寒从热,或湿邪郁而化热,湿热侵淫肌腠,从肌腠发出皮肤,发为痤疮。其病位主在脾,关乎肺、心、肝、肺、肾,病机为脾虚不化,湿热浸淫,故导师自拟“健脾消痤方”,健脾化湿,解毒散结,临床实践证明此方治疗痤疮疗效显著。第二,临床疗效观察。目的：观察“健脾消痤方”联合外用克林霉素凝胶、姜黄搽剂治疗脾虚湿热型痤疮的临床疗效,探讨从脾论治痤疮的机制,为痤疮的治疗提供更多思路。方法：观察2014年1月-2015年12月成都中医药大学附属医院内分泌科门诊病人,依据纳入标准、排除标准、评分原则选择15-45岁的71例属于脾虚湿热证型的痤疮患者,其临床表现为皮肤油腻,面部痤疮瘁或疼痛,以丘疹、脓疱为主,兼见神疲乏力,颜面色红,大便不调,溲赤,舌体胖大,齿痕舌,舌红,苔黄/白腻,脉滑／脉缓濡。随机将其分为两组,试验组37例,对照组34例,试验组予以口服健脾消痤方,联合外用药,洁面后,有脓疱处使用适量克林霉素凝胶,其余部位蘸适量姜黄消痤搽剂,每日2次。对照组仅用外用药,方法同试验组。健脾消痤方基本组成：人参、炒白术、茯苓、桑白皮、黄芩、连翘、浙贝母、皂角刺、陈皮各15g,白花蛇舌草、薏苡仁各20g,鸡血藤30g,芥子、生甘草各l0g。诸药煎煮,每付药煎取300ml,每次100ml,每天3次,连用8周。观察初诊、4周、6周、8周的皮损评分、中医症候评分、总评分,根据尼莫地平公式计算判定疗效。结果：1.试验组37例患者,痊愈12例,显效15例,好转7例,无效2例,痊愈率32.43%,总有效率94.59%,复发1例,复发率为8.32%；对照组34例患者,痊愈3例,显效3例,好转20例,无效8例,痊愈率8.82%,总有效率76.47%,复发2例,复发率66.67%。两组痊愈率、总有效率比较P0.05,差异有统计学意义。2.试验组皮损情况及中医症状有较好的改善作用,特别是对中医症状神疲乏力、便溏、舌苔、脉象、舌形改善。3.试验组复发率为8.33%,对照组复发率为66.67%,试验组明显低于对照组。结论：健脾消痤方联合外用药治疗脾虚湿热型痤疮疗效可靠,复发率低,可作为治疗脾虚湿热型痤疮的有效方之一。健脾消痤方改善痤疮患者症状明显,尤其是对颜面色红、神疲乏力、便溏、舌苔、脉象等症状的改善。导师从脾论治痤疮有效可行,为治疗痤疮提供了新的辨证思路,值得传承学习。
[Abstract]:Acne TCM, also known as pulmonary wind acne, facial blister, wine thorn, acne, etc., is a chronic inflammatory disease of hair follicle sebaceous gland, mostly occurs in young people's face, chest, back hair follicle, sebaceous gland, because sebaceous gland tube and pore block, As a result of the obstruction of sebum secretion, there are prickles, pustules, nodules and cysts. Because of the increasingly high social demands for appearance, acne has also received more attention. This article focuses on the etiology, location, pathological products, pathogenesis, disease, disease, treatment, prescription, and so on. This paper summarizes the clinical experience of professor Yue Ren Song, a tutor, in treating acne from the point of view of spleen, and observes the clinical efficacy of "Jianpi Xiaocuo recipe" in the treatment of acne with spleen deficiency and dampness heat syndrome. Causes such as unobstructed mood, total injury of spleen and stomach, loss of key transportation of spleen, internal dampness of brewed blood, invasion of internal and external dampness evil, can change heat from cold or dampness to heat, dampness and heat invade muscle, skin from muscle is sent out from muscle to produce acne, and the main position of the disease is in spleen, Related to lung, heart, liver, lung, kidney, pathogenesis for spleen deficiency, dampness and heat immersion, so the tutor of "Jianpi Xiaocuo recipe", invigorating spleen to remove dampness, detoxification and scattered knot, clinical practice proved that this prescription has a significant effect on acne. Second, Objective: to observe the clinical efficacy of "Jianpi Xiaocuo recipe" combined with clindamycin gel and turmeric liniment in the treatment of acne with spleen deficiency, dampness and heat, and to explore the mechanism of treating acne from spleen theory. Methods: from January 2014 to December 2015, the outpatients in Endocrinology Department, affiliated Hospital of Chengdu University of traditional Chinese Medicine, were observed. According to the scoring principle, 71 acne patients aged 15-45 years with spleen deficiency and dampness heat syndrome were selected. Their clinical manifestations were greasy skin, sudden or painful acne on the face, papules, pustules, fatigue, red face, irregular stool, and Deutzia. It was randomly divided into two groups: experimental group (n = 37) and control group (n = 34). The pustules were treated with appropriate amount of clindamycin gel, and the rest with curcumin Xiaocuo liniment, twice a day. The control group was treated externally only, the same as the experimental group. The basic composition of Jianpi xiaocuo recipe: ginseng, fried Atractylodes macrocephala, Poria cocos, mulberry white skin, Scutellaria baicalensis, Forsythia forsythia, Fritillaria thunbergii, Sapenopsis sinensis, Old peel 15g each, Hedysarum chinensis 20g each, Coix seed 20g, Chicken-blood rattan 30g, mustard seed, raw liquorice l0g.Fry 300 ml for each drug, 100ml per time, 3 times a day, After 8 weeks of continuous use, the skin lesion score, TCM symptom score and total score were observed for 4 weeks, 6 weeks and 8 weeks. The curative effect was evaluated according to nimodipine formula. Results 1. In the trial group, 37 patients were cured, 12 were cured, 15 were markedly effective, and 7 were improved. The total effective rate was 94.599.59%, and the recurrence rate was 8.32. In the control group, 3 cases were cured, 3 cases were improved, 20 cases were improved, 8 cases were ineffective, the cure rate was 8.82%, the total effective rate was 76.4747%, the recurrence rate was 2 cases, and the recurrence rate was 66.67.The cure rate of the two groups was 76.477,2 and 66.67.The total effective rate was 76.47m, the recurrence rate was 2, and the recurrence rate was 8.32. The total effective rate was higher than that of P0.05, and the difference was statistically significant. 2. The skin lesions and TCM symptoms in the experimental group were improved, especially for the symptoms of fatigue, loose stools, tongue coating and pulse, The recurrence rate of the experimental group was 8.33 and that of the control group was 66.67, which was significantly lower than that of the control group. Conclusion: the combination of Jianpixiaocuo prescription and external medicine is effective and low in the treatment of acne with deficiency of spleen, dampness and heat. It can be used as an effective treatment for acne due to spleen deficiency, dampness and heat. 1. Jianpi xiaocuo prescription can improve the symptoms of acne patients obviously, especially the improvement of facial color, fatigue, loose stool, tongue coating, pulse and so on. It is effective and feasible to treat acne from the point of view of spleen. For the treatment of acne provides a new dialectical thinking, worthy of heritage and learning.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R249;R275.9

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