| ObjectiveMelasma is a common skin disease characterized by later acquired pigmentation.It is usually characterized by irregular brown spots and patches in the sunlit areas on both sides.Under the influence of climate,race and other conditions,melasma occurs frequently in Southeast Asia.In recent years,more and more attention has been paid to the emotion-related factors of melasma.Many researchers believe that the onset of melasma and emotional disorders interact and influence each other.Chinese medical treatment of chloasma has a long history,and its treatment methods are relatively diversified.Among them,fire needle therapy is widely respected for its direct effect.As one of the classic acupoint groups of Jin Sanpin of Lingnan School of acupuncture and moxibustion,Yu San Zhen is an important acupoint group for regulating depression-related diseases.In order to explore the relationship between the development of melasma and emotional depression in the North Sea area of Malaysia,as well as to explore the specific effects of fire needle combined with Yu SAN needle in the treatment of melasma,this study conducted a cross-sectional study related to melasma emotion and a clinical study on the factorial of fire needle combined with Yu SAN needle in the treatment of melasma.MethodsStudy 1(cross-sectional study):In this study,356 patients with melasma were collected from a clinic in Beihai Town,Beibu District,Penang,Malaysia,from October 2020 to August 2022 through a questionnaire survey.The diagnostic criteria of the cases were formulated according to the Diagnostic Criteria for Melasma and vitiligo(2010 Edition).The survey was conducted in a one-to-one interview manner.In the interview,each researcher was asked to use the same terms and order established by the training when filling in the questionnaire to collect data.The questionnaire mainly includes:A.Basic information;B.Current emotional state;C.Evaluation of melasma quality of life;D.Social fitness;E,chloasma area and severity score(MASI score);F.Hamilton Scale(HAMD scale).Among them,A,B,C and D are case self-evaluation,and E and F are researcher evaluation.After the investigation,statistical analysis was made on the distribution characteristics of all the data,the correlation between case self-rating and medical rating scale,and the comparison of depression in the severity of the disease.Study 2(Factorial clinical study):A total of 124 patients with melasma were enrolled in Yaishitang Clinic,Beihai Town,North District,Penang,Malaysia,from October 2020 to August 2022 using a randomized controlled trial protocol using 2×2 factorial analysis.The patients were randomly divided into 4 groups:basic treatment group,fire injection group,three injections for depression and three injections for combination of fire injection and depression.There were 31 cases in each group.The diagnostic criteria of the cases were formulated according to the Diagnostic Criteria for Melasma and vitiligo(2010 Edition).At the same time,relevant inclusion criteria,exclusion criteria,exclusion criteria,fall off criteria,etc.In this study,all the 4 groups were treated with the basic treatment regimen,namely oral vitamin C tablets and vitamin E soft capsules,for a total of two weeks.In addition,except for the basic treatment group,the other three groups were treated with the corresponding treatment regimen.Fire needle treatment:patients take supine position,routine disinfection,if the scope of the stain is wide,then local subcutaneous injection anesthesia.According to the size of the spot area,choose flat head fire pin.The surgeon first uses the alcohol lamp to heat the tip of the needle,thorn or scrape the spot,when the skin ADAPTS,the needle can gradually burn red,thorn or scrape out the pigmentation tissue.And the skin is flat spot,point thorns can;If the affected area is above the skin,hold the needle on the spot for a moment and cautery until it reaches skin level.The operation force is uniform,the acupuncture is accurate,the pigment layer can be removed,not too deep,so as to avoid leaving scars.Do not wet the needle within 24 hours to prevent infection.Do not pick the skin off after it becomes crazy.It should fall off by itself.If the stain is more,it can be treated in batches.After the first batch of knots falls off,the second batch is treated.Each stain is treated only once for a course of treatment.The treatment methods of three needles for depression are:four Shenshen needles,Neiguan and Sanyinjiao.Acupuncture point positioning refers to the textbooks of the 13th Five-Year Plan of China,Acupuncture Science and Clinical Experience Diagram of Jin SAN Acupuncture School.The method of four Shenshen acupuncture is flat acupuncture,the depth of acupuncture is 1 inch,and the direction of acupuncture is Baihui.Neiguan directly inserted the needle,the needle depth is 1 inch;Sanyinjiao straight into the needle,into the needle depth of 1.5 inches.After entering the needle,the four Shenshen needle to carry the conventional technique,the conventional lifting and inserting method at the remaining points,so that each point is Qi,and then the flat filling and purging method of operation for 10 seconds,leaving the needle for 30 minutes.The treatment was performed once a day for 7 days for a course of treatment,with a total of 2 courses of treatment.Outcome indicators included general condition,melasma area and severity score,Hamilton Scale,TCM syndrome Score scale,quality of life score of melasma patients,and efficacy evaluation.ResultsStudy 1(Cross-sectional study):(1)Demographic information:The mean age of the cases was 33.91±7.06 years.The age of the cases was graded according to the 10year span,and the proportion of cases between 18 and 28 years old was 69,accounting for 19.4%.There were 214 cases(60.1%)between 29 and 38 years old.There were 73 cases in the 39-49 age group,accounting for 20.5%.In the marital status survey,218 cases were married,accounting for 61.2%.Among all the cases,the highest educational level was high school or technical secondary school education,175 cases,accounting for 49.2%;This was followed by junior high school and associate’s/bachelor’s degree at 27.8%and 11.5%,respectively.(2)Conscious emotion score:85 cases of melasma had mild emotion score during the interview,accounting for 23.9%;141 cases,accounting for 39.6%,had moderate emotional scores.The emotion score was obvious in 115 cases,accounting for 32.3%;Emotional scores were severe in 15 cases,accounting for 4.2%.(3)Quality of life score of patients with melasma:135 cases had mild impact on quality of life score,accounting for 37.9%;213 cases(59.8%)were moderately affected by quality of life score.Eight patients(2.2%)had significant influence on quality of life score.The quality of life score was seriously affected in 0 cases,accounting for 0%.(4)Social adaptability score:74 cases with slight decline in social adaptability score,accounting for 20.8%;104 cases(29.2%)had moderate decline in social adaptability score.122 cases(34.3%)showed significant decline in social adaptability score.There were 56 cases(15.7%)with severe decline in social adaptability.(5)Score of chloasma area and severity:97 cases were mild,accounting for 27.2%;95 cases(26.7%)were moderate in MASI scale.There were 164 cases with severe MASI scale score,accounting for 46.1%.(6)Hamilton Depression Scale:There were 33 cases without depression,accounting for 9.3%;There were 188 cases with mild depression,accounting for 52.8%.120 cases(33.7%)were classified as obvious depression.15 cases(4.2%)were classified as severe depression.(7)Correlation between conscious score and MASI and HAMD:Emotional scores showed strong correlation with MASI and HAMD,Pearson correlation coefficients were 0.754 and 0.954(P<0.001),respectively,and quality of life scores showed moderate correlation with MASI and HAMD.Pearson correlation coefficients were 0.660 and 0.699(P<0.001),and the Pearson correlation coefficients of social adaptability scores and MASI and HAMD were 0.038 and 0.469(P>0.05),respectively.(8)Comparison of HAMD in different severity:The mean HAMD score of mild MASI cases was 10.25±3.14;Patients with moderate MASI score had an average HAMD score of 12.55±3.49,The mean HAMD score of patients with severe MASI score was 19.85±4.10.The difference among all groups was P<0.001.Study 2(factorial clinical study):(1)In the age baseline comparison in this study,the inter-group comparison of age,marital status,educational level,course of disease,quality of life score,MASI score,HAMD score and TCM syndrome score of patients with melasma were all P=0.484>0.05,indicating no statistical difference between groups.(2)After treatment,the four scores of each group before and after treatment were compared within the group.Wilcoxon paired rank sum test was used,and the results showed that all scores in each group were P<0.001 before and after comparison,indicating statistical differences before and after comparison.(3)Comparison between groups of quality of life evaluation of patients with melasma:the difference between scores before and after treatment was P<0.001,and the difference between groups was statistically significant.After pair-to-pair comparison,there was no statistical significance in the comparison between basic treatment group and Yu San Zhen group,Yu San Zhen group and fire acupuncture group,fire acupuncture group and combination group(P>0.05).P<0.001 was found between the basic treatment group and the fire acupuncture group,the basic treatment group and the combination group,and the three injections of Yu Qi and the combination group,and the difference was statistically significant.(4)Comparison between MASI groups:the difference of score before and after treatment was P<0.001,and the difference of score difference between groups was statistically significant.After pair-to-pair comparison,there was no statistical significance in the comparison between basic treatment group and Yu San Zhen group,Yu San Zhen group and fire acupuncture group,fire acupuncture group and combination group(P>0.05).P<0.001 was found between the basic treatment group and the fire acupuncture group,the basic treatment group and the combination group,and the three injections of Yu Qi and the combination group,and the difference was statistically significant.(5)Comparison between HAMD groups:the difference of score before and after treatment was P<0.001,and the difference of score difference between groups was statistically significant.After pair-to-pair comparison,there was no statistical significance in comparison between basic treatment group and fire acupuncture group,Yu San Zhen group and fire acupuncture group,fire acupuncture group and combined group,Yu San Zhen group and combined group(P>0.05).P<0.001 was found between the basic treatment group and the depression three injection group,and between the basic treatment group and the combination group,and the difference was statistically significant.(6)TCM syndrome score:the difference between the scores before and after treatment was P<0.001,and the difference between the scores was statistically significant.After pair-to-pair comparison,there were P>0.05 differences between Yu San Zhen group and fire acupuncture group,Yu San Zhen group and combination group,fire acupuncture group and combination group,and there was no statistical significance.P<0.001 was found between the basic treatment group and the depression three injection group,the basic treatment group and the fire injection group,and the basic treatment group and the combination group,and the difference was statistically significant.Conclusion(1)Melasma brings obvious changes in perceived mood and a decline in quality of life to patients,and these changes are positively correlated with the severity of melasma,and the depressive state of patients increases with the severity of the disease.(2)Fire acupuncture combined with Yu San Zhen in the treatment of melasma can effectively reduce facial symptoms of melasma,reduce depression,improve quality of life,and reduce TCM syndrome scores.By factorial analysis,the effect of fire needle therapy was more significant in reducing the facial symptoms of melasma,while Yu San Zhen was more effective in reducing the depressive state of patients.Although the combination of the two treatments did not show a statistical advantage,it is still recommended to use in the treatment of melasma. |
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