To Observe The Therapeutic Effect Of "Chong Ren Theory" Combined With Acupuncture And Medicine In The Treatment Of Chloasma With Yin Deficiency Of Liver And Kidney And Its Influence On Sex Hormone Levels

Objective1.To observe the therapeutic effect of Liuwei Dihuang pill plus acupuncture on chloasma of liver-kidney yin deficiency type.2.To explore the effect of modified Liuwei Dihuang Pill combined with acupuncture on estrogen level in the treatment of melasma due to yin deficiency of liver and kidney,and further clarify the therapeutic mechanism of this method on melasma.3.To sort out the development and clinical significance of"Chongren Theory",and clarify its guiding significance for the treatment of chloasma.method:From December 2021 to July 2022,60 patients with chloasma（yin deficiency of liver and kidney）were collected from the Department of Dermatology of Jiangxi Provincial Hospital of Traditional Chinese Medicine,and a systematic study was carried out to explore the therapeutic effect.The subjects were randomly divided into two experimental groups,each with 30 people.The experimental group was treated with Liuwei Dihuang Pill plus or minus acupuncture（Zhongji,Guanyuan,Ganshu,Pishu,Shenshu,Sanyinjiao,Zusanli,Hegu,Gongsun,Xuehai,local acupoint selection）;Control group:take tranexamic acid orally.Within 6 and 12 weeks before and after treatment,the area and severity of chloasma were evaluated,and the scores of TCM symptoms,quality of life of skin diseases,serum estradiol,luteinizing hormone and follicle-stimulating hormone,as well as the clinical efficacy of treatment were recorded.Observe and analyze the adverse reactions in the trial,and follow up the patients who are cured and have obvious effect in the fourth week after the end of the treatment to analyze the recurrence rate.Result:1.Baseline comparison:Comparisons were made between the two groups in terms of age,course of disease,quality of life score,MASI score,TCM symptom score and sex hormone level（P>0.05）.2.Intra-group and inter-group comparison after 6 weeks of treatment:（1）DLQI score comparison:DLQI in the test group and control group decreased from（8.70±2.64）points and（8.73±3.21）points to（7.73±2.12）points and（7.63±2.71）points before treatment,with no statistically significant difference（P>0.05）;（2）Comparison of MASI scores:the MASI scores of the test group and the control group decreased from（15.78±4.40）points and（16.92±4.30）points to（12.71±4.46）points and（14.71±4.37）points before treatment,with no statistically significant difference（P>0.05）;（3）Comparison of TCM symptom score:before treatment,the TCM symptom score of the test group and the control group decreased from（6.53±1.61）points and（6.63±1.97）points to（4.20±1.37）points and（4.97±1.86）points,with no statistically significant difference（P>0.05）;（4）E₂level comparison:E₂level in the test group and the treatment group decreased from（117.90±21.88）pg/ml,（116.28±24.15）pg/ml to（101.58±16.02）pg/ml,（105.95±18.98）pg/ml before treatment,with no statistically significant difference（P>0.05）;（5）Comparison of LH level:the test group and control group decreased from（18.82±3.16）IU/l,（18.63±2.41）IU/l to（15.12±3.16）IU/l,（16.00±2.63）IU/l before treatment,with no statistically significant difference（P>0.05）;（6）Comparison of FSH level:FSH in the test group and control group decreased from（13.30±4.30）IU/l,（13.94±4.26）IU/l to（9.23±3.10）IU/l,（11.09±3.18）IU/l before treatment,with statistically significant difference（P<0.05）.（7）After 6 weeks,there were statistically significant differences in all parameters within the group（P<0.05）.3.Comparison between groups after 12 weeks of treatment:（1）The DLQI scores of the 12-week test group and the control group were（3.47±1.33）points and（3.73±1.31）points,which were not statistically significant compared with those before treatment（P>0.05）;（2）The MASI scores of the12-week test group and the control group were 3.15（1.75,8.62）and 8.25（2.40,14.00）;（3）The TCM symptom scores of the 12-week test group and the control group were（2.47±1.14）points and（3.43±1.13）points;（4）Comparison of E2 levels:E2 levels in the 12-week test group and the control group were（84.19±9.10）pg/ml,（95.38±13.33）pg/ml;（5）LH level comparison:the LH level of the 12-week test group and the control group was（10.82±1.76）IU/l,（13.70±2.59）IU/l;（6）Comparison of FSH levels:the FSH levels in the 12-week test group and the control group were（7.35±2.14）IU/l and（9.29±2.52）IU/l.The difference between the two groups in MASI score,TCM symptom score and sex hormone level was statistically significant（P<0.05）.4.After 12 weeks of treatment,in the experimental group,5 cases were cured,10 cases were markedly effective,6 cases were effective,and9 cases were ineffective,with an effective rate of 70.0%.In the control group,4 cases were cured,8 cases were markedly effective,8 cases were effective,and 10 cases were ineffective,with an effective rate of 66.7%.Because the T value of more than 20%cells was less than 5,Fisher’s exact probability method was used to analyze the effective rate of the two groups,and the result wasχ²=0.764,P=0.909,the difference was not statistically significant.5.Safety comparison:After the treatment,all the patients in the study group had no abnormalities in physical examination,liver and kidney function,and no adverse drug reactions.One patient in the test group suffered from dizziness.After taking the needle for rest,the patients were given psychological counseling,and the symptoms were relieved by themselves,and continued treatment.6.Four weeks after the end of the course of treatment,the two groups of cured and significantly effective patients were followed up,3 cases in the experimental group had recurrence,12 cases had no recurrence,the recurrence rate was 20.0%;In the control group,there were 5 cases of recurrence and 7 cases of no recurrence,with a recurrence rate of 41.7%.The recurrence rate of the two groups was statistically analyzed,and the difference was not statistically significant（P=0.398）by Fisher exact test because n<40.Conclusion:1.The clinical efficacy of Liuwei Dihuang Pill plus acupuncture in treating melasma due to yin deficiency of liver and kidney is better than that of the control group（oral tranexamic acid）,which can better relieve the symptoms of patients with traditional Chinese medicine,with low recurrence rate and small side effects,and is worthy of clinical promotion.2.Liuwei Dihuang pill combined with acupuncture in the treatment of chloasma has a certain effect on the levels of sex hormones（FSH,LH,E2）.3.The"Chong and Ren theory"has a long history of development.The Chong and Ren two meridians are part of the eight meridians of the strange meridians and belong to the meridian system;With the development of the times,an independent gynaecological special syndrome differentiation system centered on Chongren has gradually formed,and is gradually connected with the liver and kidney.4."Chong Ren Theory"can effectively guide the treatment of chloasma of yin deficiency of liver and kidney,which is worthy of further improvement.