Aids-related Prurigo Tcm Syndromes And Clinical Research

Currently there is still no TCM syndrome identification and treatment research about pruritic papular eruption. This research is based on the national "Eleventh Five" major projects, and the State Key Basic Research Program of special funding. This study, through theoretical research, analyzes correlation between pruritic papular eruption and the syndrome of Chinese Medicine, investigate the present situation and problems of pruritic papular eruption at home and abroad. Through clinical research, it analyzes epidemic information of pruritic papular eruption patients, studies their symptoms, signs, patterns as well as relations among various factors, so as to identify pattern rule of pruritic papular eruption patients. Through clinical treatment research it explores TCM treating methods for pruritic papular eruption. ObjectiveThrough theoretical research, this study explores the causes, pathogenesis, as well as common patterns and symptoms of pruritic papular eruption;through epidemiological survey, it tries to summarize the characteristics of the pattern;through clinical treatment, it observes the curative effect of corresponding Chinese medicine prescription of each pattern to pruritic papular eruption.Methods1 Theoretical ResearchBased on the itch rash literature and pruritic papular eruption relevant literature at home and abroad from January 1980 to December 2011 as well as survey of common clinical manifestations of pruritic papular eruption, this study explores the causes, pathogenesis, as well as common patterns and symptoms, providing help for pattern standardization, as well as formulation of TCM syndrome questionnaires and clinical treatment of pruritic papular eruption. 2 Clinical Research(1)Statistical analysis is carried out about the symptoms, signs, patterns and epidemiological data of 364 standard pruritic papular eruption patients from Henan, Beijing, Yunnan, Guangzhou, Hubei, Shenzhen, Guangxi, etc., and the characteristics of the pattern are summarized.(2)Through multi-center, randomized and controlled study,358 standard pruritic papular eruption patients are randomly divided into Chinese medicine treatment group and Western medicine control group. The treatment lasted for 4 weeks. We observed the curative effect of corresponding Chinese medicine prescription of each pattern to pruritic papular eruption. Results1 Theoretical ResearchThe skin symptoms of pruritic papular eruption patients are similar to those of the patients of prurigo nodularis, including skin itching, having extensive skin lesions, showing red spotted papule, nodules, blisters, even water seepage erosion. Red tongue, yellow, thick greasy moss, slippery, small, string pulse, etc. The syndrome differentiation of TCM are mainly blood deficiency, wind-heat, damp-heat or blood-heat patterns. The diseases are chiefly in the spleen and liver, the pathological factors are chiefly wind-evil, wet-evil, blood deficiency, etc. It is a vacuity-repletion complex pattern. The virtual mainly is the deficiency of both qi and blood, the repletion mainly are the wet poison implication, the wind, the wind and heat, blood stasis coalescence in the skin.2 Clinical Research(1)Clinical epidemiology and TCM syndrome researchAmong the 364 pruritic papular eruption patients, the youngest is 18 while the oldest is 65. Most of them are 30 to 49 years old. The ratio of male and female is 1.33:1.The possible infection approaches are mainly sexual contact, blood transmission and intravenous drug use. Skin itching in patients is mainly moderate, accounting for 47.8% of the total number. Pimple is mainly mild, accounting for 64.6% of the total number.Among all the enrolled patients, there are 23 whose CD4≥500 cells/ul,129 whose CD4 is between 200 and 499 cells/ul,209 whose CD4<200 cells/ul,and 3 without measurement.Among 364 pruritic papular eruption patients, there are 173 cases of blood heat engendering wind pattern,104 cases of blood deficiency with wind dryness pattern,84 cases of spleen deficiency with dampness trapping pattern, and 3 cases of other pattern.Common skin symptoms whose onset frequency is beyond 50% include itchy skin, pimples, scratches, pigmentation, nodules, skin lesions, lesions located in the upper limbs.Common complicated symptoms whose onset frequency is more than 30% include fatigue, dry throat, insomnia, abnormal body, vexation, poor appetite, weakness of waist and knees, and dizziness.Research has found that patients whose CD4 is less than 200 cells/ul are susceptible to pattern of spleen deficiency with damp encumbrance, while those with CD4 between 200 to 499 cells/ul are susceptible to pattern of blood deficiency and wind dryness.Patients with blood-transmitted pruritic papular eruption are susceptible to pattern of spleen deficiency with damp encumbrance, sexually transmitted patients are susceptible to pattern of blood heat engendering wind, and intravenous drug infected patients are susceptible to pattern of blood deficiency and wind dryness. pruritic papular eruption patients without itching and papule are more likely to be sexually transmitted infections, patients with mild itching and pimples are more likely to be intravenous drug users, and patients with moderate and severe itching and pimples are more likely to be blood transmitted infections.The male witness more sexual contact and intravenous drug infections, while the female see more blood infections. As for the age, patients below 40 are more likely to be sexual contact and intravenous drug infections, while those beyond 40 are more likely to be blood transmitted infections. As for symptoms, moderate and severe itching and pimples are more likely to be blood transmitted infections.Those more aged with lower CD4 count and more serious pimples have more serious itching.Patients with mild and moderate itching see more pattern of blood deficiency and wind dryness, while those with severe itching see more pattern of spleen deficiency with damp encumbrance. Patients with mild pimples see more pattern of blood deficiency and wind dryness, while those with moderate and severe pimples see more pattern of spleen deficiency with damp encumbrance.With the age increasing, scale scores of TCM syndrome and PPE clinical performance gradually increase.From high to low, scores of TCM syndrome are pattern of spleen deficiency with damp encumbrance, pattern of blood heat engendering wind, and pattern of blood deficiency and wind dryness. It indicates that the more complicated the pattern is, the more severe symptoms are.From high to low, scale scores of PPE clinical performance and TCM syndrome are blood transmitted patients, sexual contact patients, and venous drug infected patients.There is a weak positive correlation between PPE clinical performance scale and Chinese Medicine syndromes scale, PPE clinical performance scale and skin life quality index scale, skin life quality index scale and Chinese Medicine syndromes scale. Patients with the more serious skin symptoms, as a whole.the more serious symptoms also are, the worse skin quality of life also are.(2)Clinical treatment research358 standardized patients with Pruritic papular eruption are selected and randomly divided into Chinese medicine treatment group and Western medicine control group. The treatment lasted for 4 weeks. We observed patients'CD4 count, TCM syndrome score, survival quality score, PPE clinical performance scale, skin life quality index scale, etc. The results show that Chinese medicine prescription of each pattern is safe and distinctly curative, not only relieving the rash and itching pain,but also adjusting the balance of yin and yang of the body, enhancing the resistance, and improving the quality of life of the patients.Conclusions1 Pruritic papular eruption patients are mainly young males. Infection are mainly through sexual contact, blood transmission and intravenous drug use. Most itches are moderate while pimples are mild. CD4 count is usually below 200 cells/ul.2 Pruritic papular eruption patients mainly suffer from three patterns, namely, pattern of blood heat engendering wind, blood deficiency and wind dryness, and spleen deficiency with damp encumbrance. There is different pattern distribution among different people.3 Pruritic papular eruption patients with CD4 count below 200 cells/ul have more severe skin symptoms, higher skin life quality index score, lower survival quality and higher TCM syndrome score. It indicates that Pruritic papular eruption may associated with immune function.4 There is a weak positive correlation between PPE clinical performance scale and Chinese Medicine syndromes scale, PPE clinical performance scale and skin life quality index scale, skin life quality index scale and Chinese Medicine syndromes scale.5 Chinese medicine prescription of each pattern is safe and distinctly curative, not only relieving the rash and itching pain, but also adjusting the balance of yin and yang of the body,enhancing the resistance, and improving the quality of life of the patients.