| BackgroundWith30years of clinical, teaching, research practice in Surgery of TCM, the tutor Professor Yang Liu, has gained rich experience by srudying and exploiting the available achievements in skin diseases, that is Traumatic Diseases such as Acne and Alopecia, Pigment Diseases such as Vitiligo and Chloasma, Infections Diseases such as Furuncles, Itch Dermatoses such as Urticaria and Eczema, having some unique understandings. Professor Yang is good at the treatment of integrated traditional Chinese and western medicine therapy and combined with internal and external treatment by Vitiligo stage, especially the theory of herbal medicine color-effect phenomenon based on clinical practice and further probing into the influence of herbal medicine color on the pigment metabolism, that has significant therapeutic effect in clinical.Vitiligo is a kind of common, intractable depigmentation diseases. The incidence is around1%-2%of the general population. Despite of numerous therapies in use, most of them are slow in effectiveness, long in treatment course, low in recovery rate. Vitiligo is deemed to be one of the most difficult dermatological disease to cure. Many theories and the study of TCM in the treatment of Vitiligo are reported, but it’s difficult to evaluate or improve the effect because of lack of the optimization treatment scheme.For understanding the treatment of domestic medical field of Vitiligo, we evaluated the clinical study of TCM treatment of by evidence-based medicine, and we should know the clinical curative effect of objective evaluation and provide evidence for clinical treatment scheme.In this research, the evidence-based medicine based randomized controlled methodology has been applied in the evaluation of clinic effect of integrated traditional Chinese and western medicine in the treatment of Active Vitiligo Vulgaris.Object1To summarize Yang Liu’s academic origin, treatment characteristics, clinical experiences and inductive principle and prescriptions on Pigment Diseases, especially on Vitiligo, through learning with him, recording medical cases, and literature reviewing.2To analyze types of TCM treatment to Vtiligo clinic literature and the features of randomized controlled literature, find problems in the current situation for the evaluation of TCM effectiveness based on evidence-based medicine.3Various1theatments compared with the commonly recognized controlled treatment in the clinic trials to detect the actual effectiveness of integrated traditional Chinese and western medicine in the treatment of Active Vitiligo Vulgaris.Method1Experience summaryThe teacher’s academic origin and characteristics and treatment characteristics were summarized through clinical recording, analysis medical records, and treatment characteristics were summarized through clinical recording, analysis medical records, and reviewing the ancient and modern literature.2Evidence-based MedicineAccording to the analysis to all the literatures on TCM treatment for Vitiligo retrieved from2001to2010from CNKI, the literatures can be classified as randomized controlled trial, controlled trial, case series study and experts’ experiences conferences. Of all the randomized controlled trial literatures, the ones chich fit the Evidence-based Medicine standards are further reviewed on meta-analysis for efficacy and safety for integrated traditional Chinese and western medicine in the treatment of Vitiligo.3Clinical researchFrom August,2010to July,2009,94participants had been selected in the Traditional-Integrated Hospital and Nafang Hospital of outpatient departments. The participants were divided into two groups,47for integrated traditional Chinese and western medicine,47for western medicine. Before and after the treatment, the participants have been evaluated by main outcome measures of white spot subsided area percentage, and secondary endpoints of pigment integral. After treatment for6months, the participants were reviewed according for efficacy and safety for integrated traditional Chinese and western medicine.Results1Experience summaryTreatment characteristics, clinical experiences and inductive principle and prescriptioms on Vitiligo, the treatment system should be established by vitiligo stage based on herbal medicine color-effect phenomennon theory.2Evidence-based Medicine2.1Bibliometric analysis In the pst10years, it’s a large number on Vitiligo clinical studies that many literatures was published, and the number was increasing, almost the largest in2005, but enstable after2006. The number of literature was the most in China Journal of Leprosy and Skin Disease,25which weighs8.6%;70are controlled trials24.1%in core journals, less than quarter of the total. The literatures of clinical research on vitiligo were concentrated in the Department of Dermatology in the past10years. The institution was the3rd People’s Hospital of Hangzhou which had the most research, secondly was Huashan Hospital of Fudan University and Guangzhou University of TCM, which explained the research in the field of these academic institutions were more active. The focus of domestic relevant Vitiligo were on prevention and treatment, that were difficult, and the treatment of various ways were much, secondly were study on diagnosis standard and clinical type, thirdly were the study on the prognosis and quality of life of Vitiligo, which were on the rise recently.2.2The evaluation on Evidence-based medicineWithin the total291litertures,238are disagreement to the requirements, because of the treatment of western medicine, experimental research, case reports, reviews and repetitive literatures. Finally, there were8literatures are included in the study from53articles, study of non randomized controlled trials being excluded. It’s showed that the treatment effect of optimization was better than TCM group or western medicine group, and Chinese medicine treatment had small side effects, stable curative effect, low recurrence rate.3Two groups of clinical curative effect comparison3.1The analysis showed that4cases were cured,17cases were effective,15cases were improved,11cases were ineffective, and effectiveness for group combined traditional Chinese and Western medicine are76.6%, of47patients, then nobody was cured,5cases were effective,21cases were improved,21cases were ineffective, and effectiveness for that are55.3%, both of which are significant different (X2=4.738, p=0.030)3.2The analysis of therapeutic effect index showed significant statistical difference(t=5.039,p=0.000) between two groups of white spot subsided percentage comparison, and no differences (t=-0.426,p=0.670) of leukoplakia pigment ratios compatison, before and after treatment, then the clinical efficacy of combined group was better than western medicine group on white spot subsided percentage comparison.3.3There were1case who had mild gastronintestinal reaction, recovered after3days of pause, then continue the treat, no obvious adverse reactions again, in group combined traditional Chinese and Western medicine. There were3cases who had moderate gastronintestinal reaction, including1nausea, and2stomach pain, recovered after7days of pause and symptomatic treatment, then continue the treat. There5cases who had a transient itching, then continue to treat after symptomatic treatment,3cases of combined group,2cases of western group.3.4Follow-up78of94patients were followed up, and35of which were treating. It showed that one part of the patients had a relapse.5cases were in combined group,1been occurred in the first half of the year, the other after the first half of the year.6cases were in western group,4cases been in the first half of the year,2cases after then.Conclusion1Academic Thoughts on VitiligoBaidianfeng is a Chinese name of disease, pathogenesis features have relied on stage treatment of Vitiligo. Dispelling Wind is the one of best treatment. Dispelling Wind and Reliving Depression in the earlys days, Nourishing Kidney and Nourishing Blood for the long days; The method of Regulating Qi and Blood is realized by Dispelling Wind and Reliving Depression, Activating Blood and Resoving Stasis, and Nourishing Liver and Kidney; Construction the treatment system by Vitilugo stage based on herbal medicine color-effect phenomennon theory; The theory of herbal medicine color-effect phenomenon based on clinical practice and further probing into the influence of herbal medicine color on the pigment metabolism.2Evidence-based MedicineCurrently the qualities of literature for the clinical study of TCM are quite low which no unified standard of diagnosis and no uniform curative effect judgment standard, low selected test methodology, most of that only mention randomly, without a specific description of random method, hide on more random scheme; only one case mentioned single blind, others no using blind method, that have led to the bias.Then, it is suggertested important to establish the evidence-based medicine evaluation for the TCM according to its feature, because of the limited function of evidence-based medicine due to the differences between TCM and Western medicine.3Clinical research3.1Effectiveness of treatment combined traditional Chinese and Western medicine are better than that of Westetn medicine.3.2The efficiency of No.1combined therapy for active vitiligo is significantly better than that of western medicine.3.3The effect of No.1combined therapy was better than western medicine, which in the main indicators the effect of the white spot area subsided. |
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