本文關(guān)鍵詞： 臨床經(jīng)驗(yàn) 脾虛濕熱證 痤瘡 健脾消痤方 臨床療效觀察　出處：《成都中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：痤瘡中醫(yī)學(xué)又稱肺風(fēng)粉刺、面皰、酒刺、青春痘等,是一種毛囊皮脂腺的慢性炎癥性疾病,多發(fā)生于青年面、胸、背部的毛囊、皮脂腺,因皮脂腺管與毛孔的堵塞,皮脂外泌不暢所致,出現(xiàn)丘刺、膿皰、結(jié)節(jié)、囊腫。由于社會對容貌的要求越來越高,痤瘡也受到更多關(guān)注。本文從病因、病位、病理產(chǎn)物、病機(jī)、病性、治法、方藥等方面,本論文總結(jié)導(dǎo)師岳仁宋教授從脾論治痤瘡的臨床經(jīng)驗(yàn),并觀察“健脾消痤方”治療脾虛濕熱證型痤瘡的臨床療效。第一,經(jīng)驗(yàn)總結(jié)。濕熱之地、飲食不節(jié)、不良作息習(xí)慣、情志不暢等病因,共傷脾胃,脾失鍵運(yùn),釀生內(nèi)濕,內(nèi)外濕邪侵襲,可隨體質(zhì)從寒從熱,或濕邪郁而化熱,濕熱侵淫肌腠,從肌腠發(fā)出皮膚,發(fā)為痤瘡。其病位主在脾,關(guān)乎肺、心、肝、肺、腎,病機(jī)為脾虛不化,濕熱浸淫,故導(dǎo)師自擬“健脾消痤方”,健脾化濕,解毒散結(jié),臨床實(shí)踐證明此方治療痤瘡療效顯著。第二,臨床療效觀察。目的：觀察“健脾消痤方”聯(lián)合外用克林霉素凝膠、姜黃搽劑治療脾虛濕熱型痤瘡的臨床療效,探討從脾論治痤瘡的機(jī)制,為痤瘡的治療提供更多思路。方法：觀察2014年1月-2015年12月成都中醫(yī)藥大學(xué)附屬醫(yī)院內(nèi)分泌科門診病人,依據(jù)納入標(biāo)準(zhǔn)、排除標(biāo)準(zhǔn)、評分原則選擇15-45歲的71例屬于脾虛濕熱證型的痤瘡患者,其臨床表現(xiàn)為皮膚油膩,面部痤瘡瘁或疼痛,以丘疹、膿皰為主,兼見神疲乏力,顏面色紅,大便不調(diào),溲赤,舌體胖大,齒痕舌,舌紅,苔黃/白膩,脈滑／脈緩濡。隨機(jī)將其分為兩組,試驗(yàn)組37例,對照組34例,試驗(yàn)組予以口服健脾消痤方,聯(lián)合外用藥,潔面后,有膿皰處使用適量克林霉素凝膠,其余部位蘸適量姜黃消痤搽劑,每日2次。對照組僅用外用藥,方法同試驗(yàn)組。健脾消痤方基本組成：人參、炒白術(shù)、茯苓、桑白皮、黃芩、連翹、浙貝母、皂角刺、陳皮各15g,白花蛇舌草、薏苡仁各20g,雞血藤30g,芥子、生甘草各l0g。諸藥煎煮,每付藥煎取300ml,每次100ml,每天3次,連用8周。觀察初診、4周、6周、8周的皮損評分、中醫(yī)癥候評分、總評分,根據(jù)尼莫地平公式計算判定療效。結(jié)果：1.試驗(yàn)組37例患者,痊愈12例,顯效15例,好轉(zhuǎn)7例,無效2例,痊愈率32.43%,總有效率94.59%,復(fù)發(fā)1例,復(fù)發(fā)率為8.32%；對照組34例患者,痊愈3例,顯效3例,好轉(zhuǎn)20例,無效8例,痊愈率8.82%,總有效率76.47%,復(fù)發(fā)2例,復(fù)發(fā)率66.67%。兩組痊愈率、總有效率比較P0.05,差異有統(tǒng)計學(xué)意義。2.試驗(yàn)組皮損情況及中醫(yī)癥狀有較好的改善作用,特別是對中醫(yī)癥狀神疲乏力、便溏、舌苔、脈象、舌形改善。3.試驗(yàn)組復(fù)發(fā)率為8.33%,對照組復(fù)發(fā)率為66.67%,試驗(yàn)組明顯低于對照組。結(jié)論：健脾消痤方聯(lián)合外用藥治療脾虛濕熱型痤瘡療效可靠,復(fù)發(fā)率低,可作為治療脾虛濕熱型痤瘡的有效方之一。健脾消痤方改善痤瘡患者癥狀明顯,尤其是對顏面色紅、神疲乏力、便溏、舌苔、脈象等癥狀的改善。導(dǎo)師從脾論治痤瘡有效可行,為治療痤瘡提供了新的辨證思路,值得傳承學(xué)習(xí)。
[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.
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R249;R275.9

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