Efficacy And Mechanism Of Sichuan Wen's Dermatology In The Treatment Of Chronic Eczema

Aims: The study aims to summarize the clinical experiences of Sichuan Wen's dermatology school;to assess the efficacy of these cipher prescriptions combined with Shehuang Ointment in the treatment of chronic eczema;to explore the mechanism of the combination treatment to chronic eczema.Methods: 1.Master works and relative articles of Sichuan Wen's dermatology school were extensively reviewed to summarize their thoughts.These experiences were formulated into cipher prescriptions by the author with the help of the current school head and doctoral supervisor.2.Patients received by the outpatient clinics of Department of Dermatology,Sichuan Provincial Hospital of Traditional Chinese Medicine during December 2016 to May 2018,who were diagnosed as chronic eczema were included into the study.Data of patient's general condition were collected to analyze the distribution of chronic eczema abased on different syndromes.3.Patients with damp heat storage in skin(DHSS)syndrome,spleen deficiency & damp storage(SDDS)syndrome and blood deficiency & wind dryness(BDWD)syndrome were prescribed with Modified Machixian Decoction,Modified Spleen Tonifying & Damp Eliminating Decoction and Moistening Dryness & Relieving Pruritus Decoction respectively,combined with topical application of Shehuang Ointment.4.All patients were assessed by EASI scores and pruritis scores both before treatment and 4 weeks after treatment,to obtain an objective evaluation of Sichuan Wen's dermatological cipher prescriptions combined with Shehuang Ointment in the treatment of chronic eczema.5.Some patients and healthy controls volunteered to receive a test on serum IFN-?,IL-4,IL-22 and IgE.These indicators of immunological disorders in patients with chronic eczema were determined,as an evidence for exploring the possible mechanism of these cipher prescriptions.Results: 1.Distribution of common syndromes: A total of 277 patients with chronic eczema were included in the study,including 250 patients in sichuan province.DHSS syndrome predominated in the study patients with chronic eczema(n=145,52%),followed by SDDS syndrome(n=107,39%)and then BDWD syndrome(n=25,9%).2.Evaluation of clinical efficacy:(1)Patients with all symptoms were found with a decrease in size of lesion,EASI scores and pruritus scores after treatment.Paired-sample T test was applied and result to P<0.01(P<0.0001)in all patients,suggesting the differences are statistically significant.(2)Among the 277 treated patients,49(17.7%)had full response,125(45.1%)had good response,93(33.6%)had partial response and 10(3.6%)had no response.To compare the efficacy in all syndrome groups,P>0.05(P=0.188)revealed no statistical significance.(3)A follow-up to patients with full and good response 6 months after the treatment found that the number of patient with full response increased to 101.To compare the numbers of full response and recurrence among all syndrome groups,P>0.05(P=0.514)was found,indicating no statistical significance.3.Comparison of immunological indicators between patients and healthy adults:(1)Before treatment,the serum IFN-? was significantly lower in patients than in healthy controls with P less than 0.01 in all groups(DHSS group P=0.0069,SDDS group P < 0.0001,BDWD group P < 0.0001),indicating statistical significance.(2)Serum IL-4 and IL-22 were only found significantly higher in DHSS syndrome group than in healthy controls with both P<0.05(P=0.0246 and 0.035)but not in patients with SDDS symptom or BDWD(both P>0.05).(3)Serum IgE was higher in all the 3 syndrome groups than in healthy controls,which was of statistical significance in DHSS syndrome with P<0.01(P<0.0001)and SDDS syndrome with P<0.05(P=0.0219),but not in BDWD syndrome with P>0.05(P=0.1952),compared with that in healthy control group.4.Comparison of immunological indicators before and after treatment in all groups:(1)In DHSS group,serum IL-4,IL-22 and IgE all reduced significantly after treatment with P<0.01(P=0.0098,0.0040 and 0.0007 respectively);IFN-? increased insignificantly after treatment with P>0.05(P=0.0710).(2)In SDDS group,IgE was significantly lower after treatment with P<0.01(P=0.0011);IFN-? increase and IL-4 decrease were found with P<0.05(P=0.0161 and 0.0440 respectively),suggesting statistical significance;IL-22 was not significantly changed with P>0.05(P=0.6203).(3)In BDWD group,IFN-? significantly increased after treatment with P<0.05(P=0.0428);IL-4,IL-22 and IgE were not significantly changed after treatment with P>0.05(P= 0.8836,0.2927 and 0.5527,respectively).Conclusions: 1.DHSS symptom predominated in study patients with chronic eczema,followed by SDDS syndrome and then BDWD syndrome.2.Sichuan Wen's dermatological cipher prescriptions combined with Shehuang Ointment were able to significantly decrease patient's lesion size,EASI scores and pruritus scores,and thereby relieve symptoms.Efficacy could be further enhanced by expanding the length of treatment time.3.Immunological disorders of patients with chronic eczema mainly manifested as IFN-? reduce and IgE improvement.Besides that,patients with DHSS syndrome will also present increased IL-4 and IL-22.4.Wen's Machixian Decoction has effect on patients of DHSS syndrome by down-regulating IL-4,IL-22 and IgE.5.Wen's Spleen Tonifying and Damp Eliminating Decoction has effect on patients of SDDS symptom by up-regulating serum IFN-? and down-regulating IL-4 and IgE.6.Wen's Moistening Dryness and Relieving Pruritis Decoction may have effect on patients of BDWD syndrome by regulating IFN-?.