刺血拔罐-火针-埋线-雷火灸-中药内服“五联法”辨证分型治疗痤疮随机平行对照研究

The Bleeding and Cupping-Needle-Catgut-Thunder Fire Moxibustion-Chinese Medicine "Five" Syndrome Differentiation in the Treatment of Acne Randomized Controlled Study

[目的]观察刺血拔罐-火针-埋线-雷火灸-中药内服“五联法”辨证分型治疗痤疮疗效。[方法]使用随机平行对照方法,将118例门诊患者按就诊顺序号方法简单随机分为两组。对照组59例口服红霉素肠溶片（0.5g/次,2次/d）,异维A酸软胶囊（20mg/次,2次/d）;外用涂患处,维A酸软膏,1次/d,过氧苯甲酰凝胶,2次/d。治疗组59例五联疗法,刺血（心俞、肺俞、膈俞、脾俞穴及双侧耳尖穴,热重加大椎、十二井穴;便秘加大肠俞）,一次性无菌注射器针头腧穴直径1.0cm范围点刺5~7针,拔玻璃火罐10min,吸出少量血液后消毒局部皮肤;火针：痤疮局部消毒,火针置于酒精灯外焰烧至通红发白后迅速垂直刺入痤疮皮损顶部,深达痤疮基底部,拔针后挤压出皮脂、脓血等,刺血和火针1次/5d,3~5次1疗程,连续治疗2个疗程;穴位埋线（胸一至腰四旁开0.5~3寸之间的阳性反应点-局部暗红按之不褪色）,无菌穴位埋线包将0~3#胶原蛋白羊肠线,以穴位为中心8~10cm,左手拇食指撑开穴区皮肤,右手持无菌持针器从穴位十字印下0.5cm处以30°斜向上刺入1.5~2cm,达肌层后埋入肠线,肠线不露出皮肤,埋线后用无菌纱布覆盖针孔,1天后可淋浴,每星期1次,3次1疗程,连续治疗2~3个疗程;雷火灸（灸药点燃置于单孔灸具）,面部痘疮生长部位广泛熏灸,旋转、横向、纵向温灸,面部发红、深部组织发热为度;散在痘疮,数量少只在痘疮处温灸;痤疮硬结处可雀啄灸3壮,每雀啄7次为1壮;肺经风热、脾胃湿热泻双合谷5壮,每雀啄7次为1壮,距离皮肤2~3cm,每壮之间用手按一下施灸处;冲任不调温灸双耳部和足三里,2~3㎝距离,上下移动或旋转法灸耳前部与后部,至耳部和足三里发红,同时在下腹部摆雷火灸阵盒温灸;中药内服：肺经风热,疏风清肺,枇杷清肺饮或半夏泻心汤（党参20g,清半夏、枇杷叶各15g,生甘草、黄连各10g,桑白皮、黄柏、蒲公英各15g,紫花地丁10g）;脾胃湿热,热除湿解毒,茵陈蒿汤和龙胆泻肝丸（龙胆草15g,茵陈25g,知母10g,黄柏15g,黄芩、柴胡、生地、泽泻各10g,当归15g,栀子10g,大黄5g）;冲任不调,滋肾阴,调冲任,黑逍遥丸和六味地黄汤（熟地30g,山药20g,山萸肉、当归各15g,白芍20g,柴胡15g,茯苓10g,白术15g,甘草10g,生地、益母草各15g,泽兰10g）;外治,大黄、硫磺1：1比例研粉茶调涂患处,每晚涂1次,次日清晨除去;脓肿、囊肿、结节较甚三黄洗剂（黄连、黄芩、黄柏、苦参）清洗后,外敷四黄膏（黄连、黄芩、黄柏、大黄、乳香、没药）,2次/d。连续治疗20d为1疗程。观测临床症状、不良反应。连续治疗2疗程,判定疗效。[结果]治疗组痊愈35例,显效20例,有效3例,无效1例,总有效率96.60%。对照组痊愈5例,显效13例,有效23例,无效18例,总有效率69.49%。治疗组疗效优于对照组（P〈0.01）。[结论]刺血拔罐-火针-埋线-雷火灸-中药内服“五联法”辨证分型治疗痤疮,疗效满意,无严重不良反应,值得推广。

[Objective] Observation of blood letting puncture and cupping acupuncture catgut thunder fire moxibustion of traditional Chinese medicine ＂Five＂ syndrome differentiation type for the treatment of acne. [Method] Using the random parallel control method, 18 outpatients were randomly divided into two groups according to the order number. The control group （59 cases） take oral erythromycin enteric coated tablets （0.5g/ time,2 times daily）,isotretinoin limp capsule （20rag, twice daily）; Topical coated surface of the skin, vitamin a acid ointment,1 times /d, benzoyl peroxide gel,2/d.The treatment group of 59 cases take pentalogy therapy, pricking blood （Xinshu, Feishu,Pishu, Geshu and bilateral ear tip,Dazhui, Shierjing and Dachangshu are given if needed）,disposable sterile syringe needle acupoint 5-7 times 1.Ocm diameter range of circle,pulling cupping for 10min, skin disinfection after a little amont of blood released;needle：disinfect ache place,alcohol lamp flame burned needle to white piercing vertical acne top quickly,deep into the basal of acne,squeeze out sebum after needling,blood pricking needle once a day,3 to 5 times for a period of treatment, continuous treatment for 2 courses;catgut embedding （thoracic vertebra and lumbar vertebral 0.5-3 inchs positive point for dark red around that nat faded when press down）,sterile catgut embedding package contain 0-3# collagen catgut,set the point as the center with the radius of 8-10cm, use the left hand thumb and index finger distraction acupoint skin, right hand holding a sterile needle 30 degrees oblique pierce 1.5-2cm from the point of a cross under 0.5cm,embedding catgut after reach the muscle layer without exposing the skin,use sterile gauze to cover the pinhole,ahower available after 1 day,once per week,3 times the 1 period of treatment, continuous treatment for 2 to 3 courses;thunder fire moxibustion （moxibustion medicine lit in single hole tool） face moxibustion, rotation, horizontal and vertical moxibustion,until facial redness,deep tissue heated by the heat;a small number of scattered,moxibustiona few place;pecking moxibustion 3 zhuangs for acne scleroma, every 7 times for 1 zhuang; lung and stomach illness heat double Hegu 5 zhuangs,every 7 times for 1 zhuang, 2-3cm above the skin,press the mixibustioned place between each zhuang;Jingluo disharmonius,give moxibustion to each ear and Zusanli,2-3 cm distance, move up and down or the front and rotating for ear front moxibustion,until Zusanli and the ear become redness,and placedmoxibustion moxibustion box array in the lower abdomen;Chinese medicine： loquat decoction or Pinellia ternata decoction （Dansghen 20g, Qingbanxia, Pipaye 15g, Shenggancao, Huanglianl0g, Sangbaipi,Huangbai, Pugongying 15g, Zihuadiding 10g）; Wormwood decoction and Gentianae decoction（Longd ancaolSg,Yinchen25g, Zhimul0g,Huangbai 15g, Huangcen, Chaihu,Shengdi, Zexiel0g, DangguilSg,Zhizi 10g, Dahuang 5g）;Black Xiaoyao Pill and Six Ingredient Rehmannia decoction（Shudi30g, Shanyao20g, Shanyurou, DangguilSg,ChaihulSg, Fulingl0g, Baizhu15g, Gancaol0g, Shengdi, YimucaolSg, Zelanl0g）; external treatment, rhubarb, sulfur 1：1 proportion tea powder coated surface of the skin, twice a day, once every night and clean up the next morning, abscess, cyst, nodule is heavy, use Sanhuang lotion （Huanglian, Huangcen, Huangbai, Kushen） ,after cleaning and external use Sihuang paste （Huanglian, Huangcen, Huangbai,Dahuang, Ruxiang, Moyao）. Continuous treatment for 1 courses of 20d.Observation of clinical symptoms and adverse reactions. Continuous treatment for 2 courses of treatment, determine the efficacy.[Result] In the treatment group,35 cases were cured,20 cases were markedly effective, 3 cases were effective, 1 cases were ineffective, the total effective rate was 96.60%.In the control group,5 cases were cured, 13 cases were markedly effective, 23 cases were effective,18 cases were ineffective, the total effective rate was 69.49%. The curative effect of the treatment group was better than that of the control group （P〈0.01）.[Conclusion] Pentalogy therapy （blood letting cupping-needle- catgut embedding-thunder fire moxibustion-Chinese medicine） on the treatment of acne divided by syndrome differentiation has a satisfactory curative effect and no serious adverse reaction, it is worth promoting.