A study on the treatment of chloasma with moxibustion based on the theory of“Yang transforming Qi,and Yin shaping”

Background:“Yang Transforming Qi and Yin shaping”comes from“Plain Question Yin and Yang should be like the theory”.Chinese medicine believes that the imbalance of yin and yang is the cause of human diseases.One of the strengths of TCM in treating diseases is holistic regulation.The theory of“Yang transforming Qi,and Yin shaping”implies a strong holistic view.Chloasma,one of the common skin diseases,seriously affects the physical and mental health of patients due to its unclear etiology,difficult treatment and easy recurrence.The occurrence and development of chloasma are closely related to internal organs.This paper is based on the theory of internal meridian,“Yang transforming Qi,and Yin shaping”which attaches importance to the concept of“Yang Qi”,from a new understanding of the pathogenesis etiology of chloasma.Methods:The author believes that the incidence of the disease is the deficiency of Yang Qi,which can’t promote the movement of Qi and blood to nourish the face,resulting in tangible material condensation,so proposes that this disease needs to be promoted by Yang transforming Qi and warm to dissipate.Moxibustion belongs to the fire,and its warming effect can dissipate the tangible evil.Results:Combined with clinical practice and the theory of internal meridian,the author elaborated that moxibustion is one of the effective methods for treating chloasma,which provides a new way of thinking for the treatment of chloasma.Conclusion:“Yang Transforming Qi and Yin shaping”can be used to guide the treatment of chloasma.

A Double-Blind, Placebo Controlled Clinical Trial Evaluating the Efficacy and Safety of a New Skin Whitening Combination in Patients with Chloasma

Melasma (or chloasma) is a hyperpigmentation disorder predominantly affecting sun-exposed skin in women, and is often refractory to treatment. The objective was to evaluate the efficacy and safety of a new whitening formula for the treatment of chloasma. This?single centre, double-blind, placebo controlled, bilateral (split-face) comparison, was conducted on 44 Chinese subjects with chloasma during the winter season. The test formula was applied twice a day, for 12 weeks on left side of the face and a placebo formula on the right side of the face. Assessments included the use of the hemi-MASI (split-face Melasma Area Severity Index), both ultraviolet and standard photography, together with clinical evaluations of efficacy and safety at T0, T6 and T12 weeks. A significant difference between the 2-hemi-MASI was noticed after 6 and 12 weeks of treatment. This result was confirmed by the clinical evaluation of the dermatologists who recorded a significant improvement in the half-face treated with the new whitening formula compared with that treated with placebo (p = 0.003). The tolerance of the new formula was recorded as excellent by 82% of subjects and found to be cosmetically appealing. In this study, the new whitening formula containing ferulic acid, Ginkgo Biloba, lipohydroxyacid (LHA), niacinamide and thermal spring water was safe and significantly improved chloasma after a 3-month-treatment period compared with placebo.

Fifty Cases of Chloasma Treated by Acupuncture plus Intensive Pulse Light Irradiation

Objective: To observe the clinical therapeutic effect of acupuncture plus intensive pulse light irradiation on chloasma. Methods: Ninety-six cases of chloasma were randomly divided into two groups, the control group of 46 cases treated by simple acupuncture and the treatment group of 50 cases treated by acupuncture and intensive pulse light irradiation. Results: The total effective rate was 89.1% and 98.0% in the control group and treatment group respectively, with a significant difference between the two groups (P<0.05). Conclusion: For chloasma, the effect of treatment with acupuncture plus intensive pulse light irradiation is superior to that with simple acupuncture.

CHLOASMA TREATED MAINLY WITH FACIAL ACUPUNCTURE

63 cases of chloasma were divided into two groups, observation group facial acupuncture combined with auricular-plaster therapy of 43 cases and control group auricular-plaster therapy only of 23 cases. The resuls show that marked effective rate in observation group is higher than in control group (P<0. 005). In observation group, there is no distinct relationship between the course of disease and curative effect (P>0. 5), while there is marked difference between the course of treatment and curative effect, the longer the course of treatment, the better the curative effect(P<0. 05).

Etiological analysis of chloasma from view of Western and Chinese traditional medicine

Chloasma is a common and refractory skin disease,which is a discosmetic dermatosis in which pigment is deposited on the face,cheeks,forehead and other parts due to the pigment metabolism disorder.It is manifested as facial yellow-brown patches,with different shades,different shapes,and often symmetrically distributed.The prevalence rate of chloasma is still increasing year by year,which reflects the physical and mental health of women.Because the cause of disease is unknown,and at present there is no uniform treatment.This paper discusses the etiology of chloasma from modern medicine and traditional Chinese medicine to provide reference for clinical therapy.

基于网络药理学和实验验证分析逍遥散治疗黄褐斑作用机制研究

目的基于网络药理学技术及实验验证分析逍遥散治疗黄褐斑的作用机制。方法应用TCMSP等数据库和相关的文献资料,检索逍遥散的生物活性成分及相关作用靶点,构建逍遥散的药物-有效成分-作用靶点网络。基于Drugbank和Genecards等数据库建立与黄褐斑相关的疾病靶点,与逍遥散的有效成分靶点匹配获得潜在治疗靶点。根据Metascape数据库和DAVID数据库对潜在的治疗靶点进行GO生物过程、KEGG信号通路和蛋白质-蛋白质相互作用(PPI)分析,PPI网络的拓扑分析用Cytoscape软件进行。并用实验验证上述结果。结果逍遥散中有效化学成分有928种,包括白芍85种,白术55种,柴胡349种,当归125种,茯苓34种,甘草280种,有效成分作用靶点基因155个。在药物-有效成分-靶点网络内重要性前10的有效成分中,来源自柴胡4种,白芍3种,白术1种,甘草2种。共收集到49个黄褐斑相关疾病靶点,其中有24个是逍遥散治疗黄褐斑的潜在靶点基因。KEGG富集分析表明,在全部的20调信号通路中得到10条较为靠前的信号通路。GO功能富集分析显示,前10个生物过程包括分子调节功能、磷酸化等;前10个分子功能包括细胞传递部分、生物膜等;前10个细胞定位包括核苷酸、嘌呤核苷酸等。PPI网络经提取后获得了包含36个节点的核心网络,其中HSP90AA1、HSP90AB1、NTRK1、CUL3、APP、EGFR、TP53、UBC、MCM2、PRKACA基因是核心靶点。实验验证表明,逍遥散可显著改善大鼠黄褐斑情况;能升高血清SOD水平,降低血清Tyr和MDA含量;改善黄褐斑处皮肤组织结构和皮肤HMB45表达情况。结论逍遥散可通过多成分、多靶点和多通路治疗黄褐斑,起治疗作用的有效成分主要来源自柴胡、白芍、白术和甘草,而核心靶点主要有HSP90AA1等基因。

芪参补气活血养颜汤联合Q开关Nd∶YAG激光治疗女性黄褐斑的美学效果观察

目的:探讨芪参补气活血养颜汤联合Q开关Nd∶YAG激光治疗女性黄褐斑的美学效果。方法:选取笔者医院2019年1月-2022年1月收治的80例黄褐斑女性作为研究对象,按照随机数字表法分为观察组42例(采用芪参补气活血养颜汤联合Q开关Nd∶YAG 1064 nm激光治疗)和对照组38例(采用Q开关Nd∶YAG 1064 nm激光治疗)。观察两组的临床疗效,中医症状积分,皮肤状况,黄褐斑面积及颜色,不良反应发生率。结果:治疗后,观察组患者的总有效率为97.62%,高于对照组患者的84.21%(P<0.05)。治疗后,观察组患者情绪低落、胸胁胀痛、经行乳胀、口苦咽干等上述中医症状积分均低于对照组患者(P<0.05)。治疗后,观察组黑素指数、红斑指数及皱纹指数均低于对照组(P<0.05)。治疗后,观察组黄褐斑面积及颜色评分均低于对照组(P<0.05)。治疗后,观察组患者的总不良反应发生率与对照组患者比较差异无统计学意义(P>0.05)。结论:芪参补气活血养颜汤联合Q开关Nd∶YAG1064 nm激光能够提高黄褐斑治疗的临床疗效,改善患者临床症状,改善皮肤状况,减少黄褐斑面积及颜色,安全性较高,值得临床推广。

Effect of Ear-Acupoint Pressing and Ear Apex(HX6,7)Bloodletting on Haemorheology in Chloasma Patients with Gan Depression Pattern

Objective： To explore the therapeutical effect of ear-acupoint pressing combined with Ear Apex （HX6,7） bloodletting on haemorheology in chloasma patients with Gan （Liver） depression pattern. Methods： A total of 180 chloasma patients were randomly assigned to three groups, 60 cases in each. Patients in the ear- acupuncture （EA） group were treated with ear-acupoint pressing combined with Ear Apex（HX6,7） bloodletting; vitamins C and E were put into practice in the Western medicine （WM） group together with 0.025% tretinoin cream for local external application; patients in the placebo group were treated with urea-cream by external use, while 30 healthy volunteers were in the control group. After a treatment course of 2 months, the changes of haemorheology, injury skin area, colour score and symptom score before and after the treatment were observed. Results： There was no significant difference on whole blood reduced viscosity （high shear, medium shear, and low shear）, erythrocyte aggregation index, hematocrit, plasma viscosity among the four groups （F=2.65, P〉0.05）. Compared with those before treatment, the whole blood viscosity （high shear） and whole blood reduced viscosity （high shear） after treatment in the EA group, the WM group and the placebo group were with no statistical significance （P〉0.05）. The injury skin area and colour score after treatment were significantly lower than those before treatment in the EA group and the WM group （P〈0.05）, while there was no significant difference in placebo group （P〉0.05）. Clinical symptoms of the EA group were obviously improved after the 2-month treatment, which was significantly different compared with those before treatment （P〈0.05）, there was significant difference compared with those of WM group and placebo group （P〈0.05）. Conclusion： There was no significant difference on haemorheology index between healthy people and chloasma patients without angionosis, cerebrovascular disease, hematopathy, metabolic disease or any other organic disease. Ear-acupoint pressing combined with Ear Apex （HX6,7） bloodletting can effectively improve concurrent symptoms, lighten chloasma and lower chloasma area in patients accompanied by Gan depression.

Clinical Observation on the Treatment of Chloasma by Chinese Herbs Combined with Acupuncture

Objective： To evaluate the clinical effect of Chinese herbs combined with acupuncture （CH-A） in treating chloasma. Methods： Sixty-one patients with chloasma were randomly assigned to two groups： 30 in the control group and 31 in the treated group. Both groups received conventional treatment with oral intake of vitamin C and E, and external application of Quban Powder （祛斑散）. Besides, the treated group also received CH-A, with the therapeutic course for both groups as 3 months. Results： The total effective rate in the treated group and the control group was 100.00% and 46.67% respectively, and the cure-effective rate was 74.19% and 13.33% respectively, all showing significant difference between the two groups （P〈0.01）. The scores of size and color of skin lesion and that of symptoms decreased in both groups, but the decrease in the treated group was more obvious, showing significant difference compared with those before treatment and also compared with those in the control group after treatment （P〈0.05 or P〈0.01）. A follow-up study in 1 year to 2 years and 4 months showed that the long-term effect in the treated group showed an increasing trend compared with the effect immediately after treatment, but it showed a decreasing trend in the control group, though with no any statistical significance （both P〉0.05）. Conclusion： On the basis of conventional treatment, combined use of Chinese herbal medicine and acupuncture in treating chloasma could markedly improve the accompanied symptoms, lighten the color and shrink the size of skin lesions.

Effect of Gan-Pi Regulatory Needling in Treating Chloasma

Objective： To study the effect of Gan （肝）-Pi （脾） regulatory needling （GPRN） in treating chloasma and its influences on female sex hormones, superoxide dismutase （SOD）, lipid peroxide （LPO） and melanocyte-stimulating hormone （MSH）. Methods： Ninety chloasma patients were equally randomized to three groups, the treatment group treated with GPRN, the control group treated with conventional Western medicine and the blank group untreated. Changes in the scores of skin lesion （area and color） and symptom, as well as blood levels of female sex hormones, MSH, SOD and LPO were Observed and compared after 3 months of treatment. Results： In the treatment group, the scores of skin lesion area and color were reduced from 2.76± 0.96 and 2.48 ± 0.78 before treatment to 1.42 ± 0.42 and 1.03± 0.41 after treatment, respectively, while in the control group they were from 2.78 ± 1.06 and 2.53 ± 0.88 to 1.58± 1.23 and 1.28 ± 0.96, respectively, all showing significant changes （P〈0.05）; the scores were insignificantly changed in the blank group （P〉0.05）. At the same time, the score of symptoms in the treatment group significantly improved after treatment （P〈0.05）, significantly different from that of the other two groups. Comparison of female sex hormones among groups showed no significant differences either before or after treatment. The level of LPO decreased and SOD increased in both the treatment group and the control group significantly （all P〈0.05）, but significant lowering of MSH was only seen in the treatment group （P〈0.05）. Conclusions： GPRN can effectively lessen the size and lighten the color of chloasma, improve the accompanying symptoms in patients and decrease LPO and MSH levels and increase the SOD level, but will not affect the level of the female sex hormones.

Clinical Observation on the Combined Use of Acupuncture and Herbal Medicine for Treatment of Chloasma

Objective:To observe the clinical effects of the combined use of acupuncture and herbal medicine for treatment of chloasma.Methods:Totally 60 patients were randomly divided into a treatment group of 30 cases,treated by acupuncture and herbal medicine,and a control group of 30 cases,administered Vitamin C and Vitamin E.The clinical effects were observed.Results:The total effective rate of the treatment group is 93.3%better than that of the control group(76.7%) ,the difference was significant(P<0.01) .Conclusion:Combined use of acupuncture and herbal medicine may yield definite therapeutic effects in treating chloasma patients.

基于数据挖掘探究黄青教授治疗黄褐斑的用药规律及经验

目的:利用数据挖掘方法分析和总结黄青教授治疗黄褐斑的用药经验和学术思想。方法:筛选整理2022年6月-2022年10月黄青教授门诊治疗黄褐斑首诊处方74首,统一录入中医传承辅助平台(V2.5)进行相关数据分析。结果:使用频率最高的药物依次为生地、川芎、续断、桑寄生、当归、合欢皮、赤芍、炒白术、白芍、茯苓等。使用频次最高的是温性药物,寒性及平性药物次之;药物五味以甘、苦、辛味最多。用药归经频次由高到低依次为肝、心、脾、肾经等;关联规则分析共得到36对常用药物组合和10个潜在新处方。结论:通过中医传承辅助平台对处方进行分析,整理出中医药治疗黄褐斑常用药对和潜在新处方,总结归纳出三补三消的黄褐斑治疗方法,三补即调补冲任、益气健脾、养心安神,三消即疏肝理气、活血化瘀、祛湿化痰。

Effects of Chinese Herbal Medicine Combined with He-Ne Laser on Lipoperoxide and Superoxide Dismutase in Chloasma Patients

Objective: To observe the effects of Chinese decoction and ligustrazin hydrochloride injection combined with He-Ne laser on lipoperoxide (LPO) and Superoxide dismutase (SOD) in patients with chloasma. Methods: 90 cases of chloasma were randomly divided into the following two groups: a treatment group (of 54 cases) treated by a self-prepared prescription for toning the kidneys and relieving the depressed liver to remove blood stasis, ligustrazin hydrochloricde injection and He-Ne laser therapy, and a control group (of 36 cases) treated with oral administration of Vitamin E and Vitamin C plus external application of 20% Azelaic acid cream. Results: The total effective rate in the treatment group was 79.6%, which was significantly higher than that of the control group (P<0.05). After treatment, the LPO level in the treatment group was significantly lowered (P<0.01), and the SOD level was significantly elevated (P<0.05). Conclusion: The therapeutic methods adopted in the treatment group may show the action of antioxidation, providing good clinical effects for treating chloasma.

Clinical observation on the effect of electroacupuncture treatment for chloasma in young and middle-aged women

Objective:To evaluate the clinical effect of electroacupuncture treatment for chloasma in young and middle-aged women.Methods:Sixty young and middle-aged female patients with chloasma were divided into treatment group(n=30)and control group(n=30)according to random number table.In the treatment group,the electroacupuncture was applied to the facial acupoints and"Vagus"in the cavity of concha in the ear.The selection of facial acupoints was relating to the running course of facial nerve trunk:Yifeng(翳风TE17),Shangguan(上关GB3)-Sizhukong(丝竹空TE 23)(Temporal branch),Xiaguan(下关ST7)-Sibai(四白ST2)(Zygomatic branch),Qianzheng(牵正Extra)-Quanliao(颧髎SI18)(Zygomatic branch),Jiache(颊车ST6)-Jiachengjiang(夹承浆Extra)(Buccal branch),Hegu(合谷LI 4).Electro-stimulation was adopted at"Vagus"in the cavity of concha in the ear(two distribution points of the vagus in the cavity of concha of each ear).The control group received conventional acupuncture(surrounding method of needling at the Ashi points in the facial lesion area and 15 acupoints which were selected in the highest frequency in the conventional acupuncture treatment).After 8 weeks of treatment,the clinical effects were compared.The total score of facial skin lesion,score of skin lesion color,score of lesion area,and effective rate of treatment for chloasma were used to evaluate the clinical effect of the two groups before and after treatment.Results:After treatment,the effective rate of the treatment group was 95.00%,that of the control group was 67.50%.The effect of the treatment group was better than that of the control group,and the difference was statistically signifiicant(x2=9.928,P=0.002).Before treatment,there was no difference in the area score,color score,and total score of skin lesions between the two groups(P>0.05).After treatment,the area score,color score,and total score of skin lesions in the treatment group were(1.05±0.64),(1.05±0.64),and(2.10±0.98)points respectively,while those in the control group were(1.38±0.63),(1.28±0.75),and(2.65±1.19)points respectively.The area score,color score,and total score of skin lesions in the treatment group were lower than those in the control group,with statistically significant differences(all P<0.05).Conclusion:electroacupuncture is more effective than conventional acupuncture in treating chloasma in young and middle-aged women.

基于Nrf-2/HO-1探究甘草锌对黄褐斑小鼠的治疗作用

目的探讨甘草锌对黄褐斑的治疗作用。方法将36只BALB/c小鼠平均分为空白组、模型组、甘草锌低剂量组、甘草锌中剂量组、甘草锌高剂量组和氨甲环酸组,用100 mJ/cm^(2) UVB照射联合15 mg/kg黄体酮注射进行黄褐斑造模,后对小鼠进行氨甲环酸(0.065 g/kg)与甘草锌低(0.65 g/kg)/中(1.3 g/kg)/高(2.6 g/kg)剂量连续治疗14 d。取皮肤进行HE、Masson-Fontana染色;并检测皮肤和外周血中SOD、MDA、GSP-Px、TNF-α、IL-1β及IL-6含量;皮肤组织中浆蛋白Nrf-2、核蛋白Nrf-2、HO-1表达水平。结果与模型组相比较,高剂量甘草锌组黑色素细胞形成、胶原细胞坏死与炎性浸润减少(P<0.01),MDA、IL-6、IL-1β与TNF-α表达和浆蛋白Nrf-2表达降低(P<0.01),GSP-Px、SOD表达和核蛋白Nrf-2、HO-1表达增加(P<0.01)。结论甘草锌激活Nrf-2/HO-1通路启动HO-1、SOD和GSP-Px高表达抗氧化应激,从而减少黑色素形成。

Electroacupuncture at facial acupoints combined with electrical stimulation on the auricular vagus nerve points for 60 cases of chloasma

Objective： To observe the clinical efficacy of electroacupuncture at facial acupoints combined with electrical stimulation on the auricular vagus nerve points for treatment of chloasma.Methods： Sixty patients with chloasma were selected. According to acupoint selection along facial nerve trunk initially created by professor Gao Wei-bin, Yifeng（翳风TE 17）, Shangguan（上关GB 3） Sizhukong（丝竹空 TE 23）,temporal branches, Xiaguan（下关 ST 7） Sibai（四白 ST 2）,zygomatic branches, Qianzheng（牵正）Quanliao（颧髎 SI 18）,zygomatic branches, Jiache（颊车 ST 6） Chengjiang（承浆 CV 24）,buccal branches, and Hegu（合谷 LI 4）. The auricular vagus nerve acupoints was added additionally（two distribution points in each cavity of auricular concha were selected）. Electroacupuncture was conducted for30 min/time, once a day, and 6 times/week. One day was free from treatment between 2 weeks. Treatment for 4 weeks was 1 course of treatment, and the effect was observed after 1 course.Results： Cured： 39 cases, markedly effective： 13 cases, effective： 6 cases, ineffective： 3 cases. The cure rate was 65%, and the total effective rate was up to 95.0%.Conclusion： The curative effect of electroacupuncture at facial acupoints combined with electrical stimulation on the auricular vagus nerve points for treatment of chloasma was satisfactory.

Treatment of Facial Chloasma by Auricular Pressure in41 Cases

According to differentiating syndrome and dividing patter, 41 cases of Facial Chloasma by Auricular Pressure in Shen (MA-AH), Fei (MA-IC 1), Neifenmi (MA-IC 3), Luanchao (MA-AT), Mianjia (MA-L) and Xia’erbei (MA-IC), the total effective rate was 87.8%. Key Words Skin Pigmentation, Chloasma - Auricular Point Sticking - Syndrome Differ Treatment Author: Liu Guang-xia (1954-), female, associate professorTranslator: Xiao Yuan-chun

唐志坤治疗黄褐斑经验介绍

介绍唐志坤教授治疗黄褐斑的临床经验。唐志坤教授认为,黄褐斑的核心病因病机为血瘀,贯穿于整个病程,病程分为进展期和稳定期,进展期以肝郁为主,稳定期则以阴虚或阳虚为主。故唐志坤教授将黄褐斑分为三个证型论治,以化斑饮加减用于治疗肝郁血瘀证;以滋阴活血汤加减用于治疗阴虚血瘀证;以温经汤加减用于治疗阳虚血瘀证。

针药结合治疗肝肾阴虚型黄褐斑临床观察

目的 观察针药结合治疗肝肾阴虚型黄褐斑的临床疗效。方法 随机将74例肝肾阴虚型黄褐斑患者分为观察组(37例)和对照组(37例)。对照组予以氨甲环酸片口服;观察组予以针刺与中药治疗。2组治疗时间均为8周。比较2组患者治疗前后皮损评分、中医证候积分、血清超氧化物歧化酶(SOD)、丙二醛(MDA)、促黑激素(MSH)指标水平和临床疗效。结果 治疗后2组患者皮损评分、中医证候积分、血清各项指标均优于对照组(P<0.05);观察组有效率高于对照组(P<0.05)。结论 针刺联合中药治疗可通过影响患者抗氧化能力、减少黑素细胞分泌,进而改善肝肾阴虚型黄褐斑患者的临床症状。

解郁合欢汤联合调Q激光治疗肝郁气滞型黄褐斑临床观察

目的:观察解郁合欢汤联合调Q Nd:YAG激光治疗肝郁气滞型黄褐斑的临床疗效和安全性。方法:选取符合纳入标准的黄褐斑患者60例,采用随机数字表法分为两组各30例。对照组予调Q Nd:YAG激光治疗,治疗组在对照组基础上予解郁合欢汤。治疗3个月,观察两组患者黄褐斑面积和严重指数(MASI)评分、黄褐斑皮损疗效及不良反应情况。结果:治疗后,治疗组黄褐斑皮损疗效指数为83.33%明显高于对照组的63.33%,差异具有统计学意义(P<0.05);两组患者MASI评分均较治疗前降低,且治疗组评分低于对照组,差异具有统计学意义(P<0.05)。结论:在调Q Nd:YAG激光治疗的基础上联合解郁合欢汤方治疗肝郁气滞型黄褐斑临床疗效较好。