The evil meridian is the liver meridian, so the key to judge whether the prescription is true or false is to see whether it is aimed at the liver meridian.
Patients with different constitutions have different causes of vitiligo, so the treatment methods should be different. To sum up, the types of syndrome differentiation and treatment mainly include the following aspects.
Deficiency of both qi and blood, coupled with the invasion of cold, disharmony between camp and health: vitiligo is mostly in a stable period, mainly manifested as pale white spots, fatigue and sallow complexion. The tongue is pale and white, and the pulse is heavy and fine. Treatment should be invigorating qi and blood, expelling wind and promoting blood circulation. For example, Shang Jianjun and others used the self-made Xiaobai II prescription (Codonopsis pilosula 15g, Radix Astragali, Poria, Polygonum Multiflori, Radix Salviae Miltiorrhizae and Fructus Tribuli 20g each, Atractylodis Macrocephalae, Carthamus tinctorius, Radix Angelicae Sinensis, Radix Saposhnikoviae, Semen Lablab album and Rhizoma Dioscoreae 6g each) for decoction, once a day 1 dose, twice a day for children. If white spots appear on the face, Bupleurum chinense 10g or angelica dahurica10g should be added; Notopterygii Rhizoma 10g or Rhizoma Chuanxiong10g is added to the head; 20g Radix Puerariae is added to the nape, and Radix Dipsaci is added to the lumbosacral region10g; ; Turmeric10g; Used for upper limbs; Adding Achyranthes bidentata10g; To the lower limbs; Clematis chinensis10g; For people with extensive hair; At the later stage, ebony and Schisandra chinensis 10g were added. At the same time, use nitrogen mustard alcohol or psoralea tincture for external application, 2 ~ 3 times a day. * * * 84 cases of vitiligo were treated and 17 cases were cured, with a total effective rate of 78.57% [2].
Yin deficiency of liver and kidney, disharmony between qi and blood, and skin dystrophy: the patient has a long course of disease, local or systemic leukoplakia, white hair, dry skin, dizziness and tinnitus, soreness of waist and knees, pale red tongue with little coating, and weak pulse. Treatment should nourish liver and kidney and harmonize qi and blood. For example, Zou et al. used Ziyin Tongluo Pills (Radix Rehmanniae 250g, Eclipta prostrata, Radix Angelicae Sinensis, Semen Sesami Niger, Fructus Psoraleae, Semen Cuscutae, Fructus Lycii, Ootheca Mantidis each120g, Polygonum Multiflori Radix, Radix Rehmanniae Preparata and Mori Fructus each 50g, Radix Gentianae, Rhizoma Anemarrhenae, Radix Salviae Miltiorrhizae, Radix Paeoniae Rubra, Lignum Santali Alba, Flos Carthami and Fructus Lipuidambaris). * * * 124 patients with vitiligo were treated, and the total effective rate was 84.69% [3].
Rheumatic invasion, adverse meridians and collaterals, and skin dystrophy: it mostly occurs in the head or whole body, with acute onset and rapid spread, often local itching, thin and white fur and floating pulse. It is advisable to dispel wind and remove dampness, promote blood circulation and remove stasis. For example, the basic prescription used by Zhang Qin (tribulus terrestris 80g, Rhizoma Atractylodis 50g, Radix Sophorae Flavescentis 40g, Herba Ephedrae 50g, Cortex Dictamni Radicis 80g, Eclipta prostrata 100g, Fructus Gleditsiae Abnormalis 80g, Semen Persicae 80g, Flos Carthami 80g, Lignum Santali Albi 40g, Rhizoma Curcumae 80g, Radix Rehmanniae Preparata/kloc-0. * * * 1 13 cases of vitiligo were treated, of which 65 cases were reduced 1/2 or more, and 22 cases were reduced? Between ~ 1/2, its apparent efficiency is 58.3% [4].
Qi stagnation and blood stasis type: mainly manifested as spots or flakes with different sizes, clear and smooth edges, heavy pain in limbs, dark purple tongue, or petechiae and unsmooth pulse. Treatment should promote blood circulation and regulate qi. For example, Fang Min takes a self-made basic prescription (Fructus Psoraleae 15g, Radix Rehmanniae 30g, Radix Angelicae Sinensis, Rhizoma Chuanxiong, Radix Paeoniae Rubra, Semen Persicae, Flos Carthami, Radix Salviae Miltiorrhizae, Radix Platycodonis and Radix Achyranthis Bidentatae each 15g) in water, and the dosage is daily 1, which is increased or decreased according to symptoms. At the same time, traditional Chinese medicine infusion (Fructus Psoraleae, Polygoni Multiflori Radix, Rhizoma Zingiberis Recens 10g, Eclipta prostrata 15g, Ramulus Cinnamomi, Radix Angelicae Sinensis, Carthami Flos 5g, Radix Arnebiae 15g) is added. Soak in the dark with high-purity rice wine or high-quality brandy 1 month) for external application. * * * 40 cases of vitiligo were treated, 5 cases were cured, and the total effective rate was 80% [5].
Liver depression and qi stagnation type: leukoplakia has no fixed hair position, and its color is flickering, which is often aggravated with emotional changes. More common in women, often accompanied by chest tightness, belching, impatience and irritability, irregular menstruation, milk caking, white fur and thready pulse. Treatment should be soothing the liver and regulating qi. For example, Yin Ping's self-made basic prescription (fried Bupleurum, Radix Paeoniae Alba, Rhizoma Cyperi, Radix Angelicae Sinensis, Radix Stephaniae Tetrandrae, Fructus Xanthii each 65,438 05g, Rhizoma Chuanxiong 20g, Fructus Tribuli 45g, roasted Polygoni Multiflori Radix, Radix Astragali, Pyritum each 30g, Carthami Flos and Fructus Psoraleae each 65,438 00g) is decocted in water. Cimicifuga rhizome and angelica dahurica are added to the head and face; Trichosanthes kirilowii and Radix Curcumae for chest and abdomen hair; Hair in lower limbs and Achyranthes bidentata; Eclipta prostrata and Sesamum nigrum are added for patients with liver and kidney yin deficiency; Hirudo and Saviae Miltiorrhizae Radix are added for patients with obvious blood stasis. Each dose of medicine is decocted 4 times, twice a day, and a little medicine juice is left to be soaked in gauze and rubbed 4-5 times a day. * * * 56 cases of vitiligo were cured 14 cases, and the total effective rate was 88% [6].
Blood-heat type: white spots are pink or brown with blurred edges, which are more common in the face, aggravated in spring, summer or after sun exposure, with red tongue and yellow fur and thin pulse. Treatment should clear away heat and cool blood. For example, Liangxuehuangtang (Radix Rehmanniae 30g, Radix Paeoniae Rubra, Radix Salviae Miltiorrhizae, angelica tail, Rhizoma Chuanxiong, Semen Persicae, Scutellariae Radix, Sanguisorba officinalis, Herba Schizonepetae, Radix Saposhnikoviae, Radix et Rhizoma Rhei, Radix Angelicae Sinensis, angelica tail, angelica tail, angelica tail, angelica tail, angelica tail, angelica tail. Saxifraga 9g, Dictamni Radicis 9 g, Kochia scoparia 9 g, Zaocys 9 g, Glycyrrhiza 3g), 65,438+0 doses per day, decocted in water twice [7].
Yang deficiency of spleen and kidney: characterized by a long course of disease, chronic and recurrent leukoplakia lesions, aggravated in autumn and winter, accompanied by chills and cold limbs, clear stool, light and tender tongue, heavy and weak pulse, and the treatment should be mainly to warm and tonify the spleen. Xue Changlian and others take Kebailing No.2 (prepared from Radix Astragali, Folium Ginseng, Radix Rehmanniae Preparata, Radix Angelicae Sinensis, Rhizoma Chuanxiong, Cortex Cinnamomi, Caulis Spatholobi, Fructus Psoraleae, Herba Epimedii, etc. ) oral. Adults take 6-8 tablets each time, and take them with yellow wine or warm water. At the same time, Baike tincture (Psoralea corylifolia, Schizonepeta tenuifolia, safflower, etc. ) soaking in 60% alcohol for 65438+ moxibustion twice a day for 20 ~ 30 minutes on the unexposed part, * * * treated 800 patients with vitiligo of color island type, and the cure rate was 39.5% [8].
1.2 external treatment method
In recent years, there are many reports on the treatment of vitiligo by external treatment of traditional Chinese medicine. The main preparations are granules, powders and ointments. Because it directly acts on the focus, the curative effect is rapid and certain, especially for localized vitiligo. For example, Chen Jianzong et al. applied Danggui Wumei tincture (30g of Mume and Danggui respectively, soaked in 50 ml of 75% alcohol, and filtered after 2 weeks to remove residues) 3-4 times a day, and * * * cured 3 1 case, with 7 cases cured, with a total effective rate of 80.7% [9]. Wu Zhongan et al. reported that Radix Angelicae Dahuricae and Fructus Psoraleae were soaked in 95% alcohol for 65,438+0 weeks and then applied to the affected area twice a day, and 6 cases were treated with * * * [65,438+00]. Wang Chenghua et al. applied Qubai tincture (this product was percolated with ethanol and made into a tincture with a concentration of 20%, and each 65438±000ml contained 3g of Ginseng, 4g of Radix Astragali, Ligustrum lucidum, 4 g of Dictamni Radicis, 2g of Polygonum Multiflori Radix, 2g of Radix Rehmanniae Preparata and 2 g of Millennium Health) twice a day, and cured 65438±020g* * * to treat localized vitiligo 3/kloc-0. Zhao Xiurong et al. applied the self-made ebony tincture (ebony 100g, soaked in 75% alcohol 1000ml for 7 days and filtered) to the affected area, 1 ~ 3 times a day, * * * treated10/2 cases, and 44 cases were cured. Fan Cunwei used Kubai tincture (50g Sophora Flavescentis, 25g Salvia Miltiorrhiza angelica tail, 20g Chuanxiong rhizome 15g, 20g Saposhnikovia divaricata, grinded into 500ml 75% alcohol, sealed in a dark bottle 1 week and filtered) for external use, and treated 20 cases with * * * three times a day, all of which achieved good results [14]. Li Xiong grinds Fructus Tribuli 1 (20 g of Fructus Tribuli, 30 g of Fructus Psoraleae and 30 g of Mume) into powder, soaks it in 95% alcohol 100 ml, and then adds 50 ml of azone. 1 week and filter for later use. Apply it to the affected area 2-3 times a day and rub it on the affected area for 1 ~ 2 hours. Xu Aie and others used compound coal tar tincture (fig and salvia miltiorrhiza were extracted by ethanol reflux, safflower and tribulus terrestris were extracted by percolation, the extractive solutions were filtered and concentrated respectively, and the combined extractive solutions were filled with coal tar, propylene glycol and azone. ) Go to the affected area, 1, twice a day, sunbathe for 5 ~ 10 minutes, and gently massage, except for the limited type. Shi et al. applied Bufu Pill liniment (Psoralea corylifolia 30g, Radix Angelicae Dahuricae 20g, Radix Arnebiae 15g, 95% alcohol 100ml, sealed soaking 1 week, then filtered, leaving about 60ml of liquid medicine, mixing it with dexamethasone 20mg and indomethacin 250mg, and adding dimethyl sulfoxide 40ml) to the white spot.
1.3 acupuncture therapy
Acupuncture therapy is a traditional Chinese medicine method, which can achieve the purpose of treating vitiligo by adjusting the function of zang-fu organs, dredging meridians and harmonizing qi and blood. Through clinical verification, the effect is positive. For example, Che Jianli reported that 38 patients with vitiligo received acupuncture treatment and divided them into two groups. 1 group, selected from Cang Di, Tang Yin, Hegu, Baihui, Dazhui, Quchi, Zusanli, Yanglingquan and Yinlingquan. The second group selected Shangxing, Chache, Sanjian, Daoism, Shousanli, Shangjuxu, Hanging Bell and Sanyinjiao. The acupoints of the two groups were used alternately, every other day 1 time, and once a month 1 time was1course of treatment. After each acupuncture, apply edible white vinegar to local white spots, and then directly use moxa cone moxibustion. Moxibustion is very strong every time until the local skin turns red without leaving scars. Results 3 cases were cured, and the effective rate was 13 cases. The total effective rate was 8 1.6% [18]. Xilan Zhang used fire needle to acupuncture the affected area, and at the same time cooperated with fire needle to acupuncture Du meridian and Ren meridian points. Jiaji points should be added for those with yang deficiency and infirmity; For those with spleen and stomach deficiency and cold, add back Shu points and abdominal invitation points; For patients with liver-qi deficiency syndrome, acupuncture at Neiguan, Gongsun, Zusanli, Taichong and other points has cured 280 cases of vitiligo and 1 12 cases, with a total effective rate of 8 1% [19]. Dong Mingjiao used medicated thread moxibustion to treat 58 cases of localized vitiligo on the head and face. Acupoints such as Fengchi, Quchi, Shousanli, Xue Hai, Sanyinjiao and Guanyuan. No.2 drug line produced by Zhuang Medicine Clinic of Guangxi College of Traditional Chinese Medicine was selected. Moxibustion on white spots first, with plum blossom or sunflower moxibustion, then moxibustion on other points, each point 1 intensity, 15 ~ 20 days/course of treatment, after the course of treatment, rest 1 week before the next course of treatment. Results After 1 course of treatment, 2 1 case was cured and 26 cases were improved [20].
1.4 Other therapies
Foaming therapy: effective for local and small skin lesions. For example, in Liu Zhongshu, cantharidin tincture (50g of cantharidin, 95% alcohol 1000ml, soaked for 2 weeks, filtered to remove residue) was applied to the white spot, naturally dried, 2-3 times a day, and the drug was stopped after local foaming. 1 day later, puncture the blister with a sterile needle to make it naturally dry and scab. After recovery, depending on the pigment condition, it can be applied for the second time, and foaming for three times is 1 course of treatment, and the second course of treatment is feasible after 2 weeks' rest. * * * 87 cases of vitiligo were cured 14 cases, and the total effective rate was 70% [2 1].
Scraping therapy: By scraping the focus, the purpose of promoting blood circulation and qi circulation, improving circulation and curing leukoplakia can be achieved. For example, Kan Quanming uses 50 cents pangolin scales to scrape white spots with natural edges. If it is the front, it is from bottom to top, and the back is from top to bottom, from light to heavy 60 times. * * * 6 cases [22].
Water-light bath method: the trace elements and macro elements in mineral water are used to cure leukoplakia. According to Wang, bathing with cold mineral water for 3-4 times a day, 65,438+05-30 minutes each time, sunbathing for 20-30 minutes after bathing, drinking mineral water for 5-6 times a day, 300-500 ml each time, 40 cases were treated, 8 cases were cured, and the total effective rate was 90% [23].
Subcutaneous catgut embedding method: medical catgut is implanted subcutaneously. Specific methods: Under local anesthesia, the operator carries out aseptic operation. First, a suture needle is used to make a subcutaneous catgut embedding around the normal skin around the white spot, and the subcutaneous catgut embedding is carried out in the inner ring. After that, the skin was disinfected, covered with sterile gauze and pasted with adhesive tape. The next day, the gauze was taken off for infrared local irradiation for 20 minutes each time, 1 time per day, 15 times as 1 course of treatment [24].
In addition, other traditional Chinese medicine therapies, such as massage therapy, drug introduction therapy, qigong therapy, etc., can be used as an auxiliary treatment for vitiligo.
2 experimental research
In recent years, there are many reports of experimental studies, mainly by studying the activation or inhibition of tyrosinase, a key enzyme in the process of melanin biosynthesis, to provide reference for the clinical treatment of vitiligo in traditional Chinese medicine. For example, 48 kinds of traditional Chinese medicines were detected by colorimetry to determine their effects on tyrosinase. Results There are 13 kinds of Chinese medicines that can activate tyrosinase, which are Eclipta prostrata 49%, Ficus carica 38%, Cortex Moutan 34%, Tribulus terrestris 34%, Fructus Cnidii 33%, Fructus Psoraleae 3 1%, Kochia scoparia 25%, Semen Persicae 24% and Cortex Dictamni 23% in turn. In the same way as the above methods, Luo Shaohua and others found that the activation rate of Polygonatum odoratum to tyrosinase reached 29% at the level of 5mg (crude drug 10mg/ml) [27]. Xu Jianguo et al. used this experiment to prove that the activation rate of Psoralea corylifolia to tyrosinase at 20mg level was 26.44% [28].
3 abstract
To sum up, although the etiology of vitiligo is complicated and the treatment is difficult, many effective prescriptions can still be excavated in this great treasure house of traditional Chinese medicine. We should master the treatment methods flexibly in clinic. Generally speaking, for patients with limited types, stable period and small skin lesions, local external treatment can be used; However, those with systemic type, advanced stage and large skin lesions can choose oral administration or combination of internal and external, combination of traditional Chinese and western medicine and other comprehensive therapies. Judging from the prognosis, the course of disease is short, the scope is small, and the prognosis of facial skin lesions is good; However, the prognosis of long course, large category, late stage and segmental skin lesions is poor. At present, from the clinical reports, the research and treatment of vitiligo is still very limited, which is manifested in the following aspects: (1) In the aspect of internal treatment, most doctors treat diseases according to their own experience, one side is sick, and there is little dialectical treatment and lack of pertinence. It is necessary to gradually form a syndrome differentiation and treatment system for vitiligo according to people, time and place, and improve the cure rate. (2) In external therapy, the dosage form is not standardized, the standard is difficult to master, and it is inconvenient for patients to use. The principle of external treatment of TCM is the principle of internal treatment. Therefore, there are also problems of syndrome differentiation and treatment in external medicine and other external treatment methods. The author thinks that we should not only master the indications flexibly, but also improve the dosage form, which is convenient for patients and improves the curative effect. (3) In the aspect of experimental research, the screening experiment of traditional Chinese medicine is common, which is a good research approach. However, from various reports, the conclusions of different authors are not exactly the same, or even the opposite. Therefore, in order to further standardize the experimental standards and conditions in the future, it is necessary to do further in-depth pharmacological and pharmacodynamic research.
References:
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