| Objective:To explore the correlation among patient’s TCM diagnosis differentiation syndromes,severity of lesion,the level of anxiety,depression and stress in post-adolescence acne patients.The most common syndrome was treated by TCM herbal medicine combine with BoShi abdominal needle to intervene.To observe the effect of the treatment on patient’s severity of lesion,anxiety,depression and stress level in order to evaluate the efficacy.The possible mechanisms of the treatments were analyzed and discussed through the change of Sex hormone-binding globulin and Dehydroepiandrosterone sulfate.Method:1.Questionnaire:According to the diagnostic and enrollment criteria,randomly select 145 post-adolescence acne patients in Beijing DongZhiMen hospital dermatology department clinic.The dates collected were analyzed by TCM professionals.The test results were input into Excel database and analyzed by SPSS 19.0 software to process the correlation between patient’s TCM diagnosis syndromes with their severity of skin lesion,anxiety,stress and depression.2.Clinical study:60 patients were enrolled from December 2015 to December 2016 in Beijing DongZhiMen hospital dermatology clinic that fit the diagnostic criteria of post adolescence acne.60 patients randomly assigned into observation group(OB)and comparison group(CP);the OB group was given JiaWeiXiaoYao powder in combination of BoShi abdominal needle,and the CP group was given oral medication of JiaWeiXiaoYao powder.The treatment effects were accessed by DASS-21 chart through the comparison of the severity of acne lesion.3.Mechanism research:54 treatment effective cases(OB:27 CP:27)were taken 4cc of blood.The blood samples were stored under room temperature for 30 minutes and were centrifuged for 10mins(3000spins/min)after coagulated,.The supernatant liquid were collected and preserved in-80C coolant.The tests were done by the method of ELISA to test the level of DHEAS and SHBG.To study the relationship between the numbers of skin lesion,anxiety,stres,depression and their concentration changes.So then to explore the mechanisms of action,and to compare the efficacy of the two groups objective.Result:1.Questionnaire:6 questionnaires were neglected due to incompletion;among 139 cases,male 24 people and female 115 people.The occurrence of post-adolescence acne was 82.7%and significantly higher than male(17.27%).Persistent post-adolescence acne occupied 105 cases(75.54%of 139);male(20)and Female(85).Lateonset post-adolescence acne occupied 34 cases(24.64%of total patients);male(4)and female(30).The level of lesion severity was accessed and we discovered that level Ⅱpost-adolescence acne was the most common,takes up to 41%of total occurrence,followed by Level Ⅰ(29.50%)and Level Ⅲ(27.34%).Skin lesion from male patients dominated by level Ⅱ-Ⅲ(66.66%among male patients).Skin lesion from female patients dominated by-level Ⅰ-Ⅱ(65.18%among female patients).The acne skin lesion among male is more severe than female.Liver stagnation combine with blood heat type was the most common syndrome in post-adolescence acne patients(46.76%of 65),damp-heat in stomach and intestine syndrome was the second(44).Then,the syndrome of phlegm-dampness blocking collaterals(31.65%of 44),wind-heat of lung channel type(8.63%of 12)and the syndrome of yin deficiency of liver and kidne(6.47%of 12).Majority of the femal patients(48.2%)with post adolescent acne had the sympton of Chong-Ren disharmony.The average score of anxiety was higher than the normal range,indicated that up to 48.2%(67)of post adolescent acne patients had anxiety in different degrees.The average scores of depression and stress were both in the normal range.It showed that the average scores of depression,stress and anxiety were higer than that in male.We found a positive correlation between the scores of depression and stress,so as anxiety and stress.The scores of each subscale showed a direct proportion to the severity of acne.2.Clinical research:In clinical study,60 post-adolescence acne patients were enrolled,randomly assign 30 people into OB group and 30 into CP group;54 patients followed through the study(3 withdraw from OB and 3 withdraw from CP).The efficacy of each group were compared after 4 weeks into treatment,there’s no significant difference in the efficacy of the treatment(P>0.05).After the treatment is complete(8 weeks),the comparison between 2 groups shown that the total efficacy of OB is 85.19%,compare to that of 74.74%of CP,the difference have shown statistical significance(P<0.05),the result have indicated that OB group have shown better treatment result.During the follow up at 4 weeks into treatment,some patients have shown newly formed skin lesions;however,the OB group has efficacy of 81.48%,and CP group has efficacy of 51.85,indicate that OB group has better long-term result.Comparing the total area of lesion,OB and CP both shown noticeable efficacy(P<0.05),but OB have shown better result(P<0.05).In the comparison of DASS-21 chart,the level of anxiety in both group have shown reduction after the treatment,the anxiety level in OB group is lower than CP group after treatment(P<0.05);however,in the depression and stress level before-after treatment shows no significant change(P>0.05),emphasis the low efficacy for both treatment in lowering depress and stress level.In this research,we discovered that after treatment,most of patients who were diagnosed as Chong-Ren disharmony have feedback about improvement in menstruation pain and cycle disorder,suggesting acupuncture combine with herbal treatment is effective in treating Chon-Ren disharmony.3.Mechanism research:We have discovered that the level of DHEAS in blood serum from both groups have shown significant decrease(P<0.05),and OB has better effect that CP(P<0.05).The SHBG level in blood serum from both group have shown significant increase(P<0.05)after treatment,but there is no significant difference between the SHBG level between OB and CP(P>0.05).Through cross-comparison of SHBG/DHEAS level in blood serum,total lesion area and anxiety level,we discovered that both OB and CP group and lower DHEAS level and increase SHBG level to reduce skin lesion(P<0.05)as well as lowering anxiety(P<0.0.5).Conclusion:1.The most common TCM differentiation syndrome in post-adolescence acne patients is Liver stagnation combine with blood heat.The skin lesion on female patients often elevates before and during period and relieved after,which fits the description of Chong-Ren disharmony.This disease usually seen on adult female patients;compare to male patients,the level of severity in skin lesion is less among female patients,but the level of anxiety,depression and stress is significantly higher than that of male patients.The level of lesion severity is correlated with the level of emotional stress of patients.2.Both treatment strategies have satisfactory outcome;however,the combination of oral medication with acupuncture have better performance than using oral medication alone.3.JiaWeiXiaoYao powder in combine with BoShi abdominal needle’s long term treatment effect is better than deploying JiaWeiXiaoYao powder alone.4.Combination treatment not only can effectively improve acne skin lesion,but also harmonized Chong-Ren to reach better treatment effect.5.Both treatment could effectively lower the level of DHEAS and SHBG in patients’blood,thus could reduce the level of anxiety in patients. |
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