| Vitiligo is a common depigmenting dermatosis.It is due to the reduction or disappearance of tyrosinase activity in melanocytes in the skin and hair follicles,resulting in the progressive reduction or disappearance of melanin granule production,resulting in limitations or pan Depigmented lesions.The skin lesions occur in a wide range and can spread over the whole body's skin.The onset age spans widely and can occur in both adults and children.Vitiligo can occur in any region and ethnicity.Recent studies have found that the onset age is characterized by a younger age.The disease has the characteristics of being easy to treat and intractable.It often occurs in the exposed part and affects the appearance of the skin.As a result,the patient has great mental stress and seriously affects the quality of life of the patient.Professor Cai Ruikang has been engaged in the clinical work of Chinese and Western medicine for 60 years.He has formed certain academic ideas for the treatment of vitiligo.Through the collection of Prof.Cai Ruikang's clinical trial cases,a prospective case database was formed.Using prescriptions as clues,based on data mining methods,human-machine integration,Professor Cai Ruikang's rule of syndrome differentiation and treatment of vitiligo was analyzed,and Professor Cai Ruikang's academic thought on the treatment of vitiligo was summarized.Clinical Experience.Objective(1)Construct a database using the clinical medical research information sharing system,analyze Professor Cai Ruikang's prescription medication rules for the treatment of vitiligo,and summarize the experience.(2)To collect clinical cases and observe the efficacy and safety of Professor Cai Ruikang in the treatment of vitiligo and the medication regimen.Method(1)Based on the Hospital Information System(HIS)Professor Cai Ruikang's diagnosis and treatment of vitiligo prescription database in the past 8 years,a retrospective case database was established using data mining techniques,combined with expert interviews and other research methods to analyze drug experience.(2)In this study,a series of cases were used to conduct prospective clinical observations,collect clinical cases,establish a database of clinical medical research information sharing systems,and verify the experience of Professor Cai Ruikang in the treatment of vitiligo after a preliminary review of the results of the research.Results(1)Professor Cai Ruikang's retrospective study on traditional Chinese medicine forvitiligo.For 2988 patients,4462 prescriptions were used for statistics.166 kinds of decoction pieces were used.20 kinds of statistical results were commonly used.Professor Cai Ruikang's most commonly used drugs were nourishing the liver and kidney,reinforcing qi and spleen,and promoting blood circulation.The major categories of traditional Chinese medicine analysis showed that the difference in frequency of use of antipyretic medicinal,digestion medicinal,qi medicinal,and rheumatoid medicinal was relatively small,and they were mostly used for cultivating pathogenic spirits,and the highest frequency of tonic medicines was formed to correct the pathogenic.It can be seen that Professor Cai Ruikang distinguished vitiligo for strengthening vital energy,strengthening spleen and dampness,replenishing kidney and astringent essence,and assisting wind-resolving therapy.At the same time,it is supplemented by heat-clearing,qi,and dehumidification,and based on this,clinical symptoms are added.Sub-category statistics are based on the categories of traditional Chinese medicines.Professor Cai Ruikang often uses tonics to correct vitality,and soothing the liver and activating qi to excrete water to dispel pathogenic.According to the analysis of the efficacy of traditional Chinese medicines,it can be seen that Professor Cai Ruikang treatment of vitiligo is mainly used to nourish the kidney,nourish the essence,strengthen the spleen and nourish the liver,and promote blood circulation and expel wind medicine.Most of them are tonic drugs more than drugs to eliminate pathogenic spirits.The four flavors and four flavors of the drug have the characteristics of peace of mind.With regard to drug conversion,Cai Ruikang believes that liver and kidney deficiency,dysfunction of the spleen in transport,and adverse cardiovascular and cardio-blood circulation can all lead to vitiligo.There are two major categories in the community analysis that are highly compatible with clinical medications.The syndrome of spleen and stomach and the syndrome of liver and kidney deficiency can be obtained by testing in squares.Spleen and stomach weak syndrome is full of deficiency spleen and stomach healthy transport disorders,accompanied by qi stagnation,blood stasis;liver and kidney deficiency syndrome is liver and kidney deficiency,accompanied by blood stasis.(2)Professor Cai Ruikang's prospective case series for treating vitiligoThe preliminary retrospective study summarized Professor Cai Ruikang's clinical experience in distinguishing and treating vitiligo,and later analyzed and summarized 39 prospective clinical medical cases.Through retrospective research results,he verified the results of prospective studies and improved Professor Cai Ruikang to treat vitiligo.The results showed that:Compared with the results of the traditional Chinese medicine study of retrospective case of 4462 medical examinations and with 154 medical examinations,The drug category,in the traditional Chinese medicine category,both with tonifying medicine,damp-draining diuretic,astringent medicine,Liver-pacifying wind-extinguishing medicinal,blood-activating and stasis-resolveing medicinal,exterior-relesaing,damp-resolving medicinal.It can be seen that Professor Cai Ruikang treats vitiligo to correct qi deficiency,invigorating the spleen and draining dampness,arresting seminal emission or morbid leukorrhea,and relieve wind-relief.Based on this,he adds and subtracts clinical symptoms.After sub-categories of each sub-category were specifically classified according to their functions,both were used at high frequency in qi supplements,replenishing yang drugs,yin drugs,and swelling drugs.Due to the slow efficacy of the disease,patients need long-term use of drugs,Cai in the treatment to based on tonic,according to the patient's condition is different yin and yang blood focus,multi-use tonic drugs righting,with soothing the to remove stagnancy of liver qi,moving qi to dredge meridians,promoting circulation of qi and blood.In the frequency of commonly used drugs,the first 20 Chinese herbs in the prospective and retrospective study have the same 17 drugs,which has the characteristics of strengthening vitality and eliminating pathogenic spirits.(3)Professor Cai Ruikang's academic characteristics in the treatment of vitiligo1 Adhere to the integration of Chinese and Western medicine1.1 Chinese and Western Drug System ApplicationProfessor Cai Ruikang adheres to the overall concept,pays attention to the whole while treating the local,and gives oral Chinese medicine to patients after clinical diagnosis,and focuses on improving the clinical symptoms of patients while using more traditional Chinese medicine with photosensitizing effects.Such as psoralen,white peony root,alone live,madder,Polygonum cuspidatum,Angelica,Atractylodes,etc.to increase the skin photosensitivity,irradiation black light and sunlight to the complex color.Based on his years of experience in clinical drug use,Professor Cai provided appropriate vitamin supplements,trace elements,and immunomodulators in patients with normal hepatic and renal function,and took oral drugs for 20 days and stopped for 10 days.According to this rule,he took drugs in a circular manner;Oral Chinese medicines were taken according to the above methods,and they were time-stamped with oral western medicines to prevent excessive oral administration of drugs that cause damage to the liver and kidney functions.They were still taking medication for two months after recovery.1.2 Chinese and Western drugs for external use with UV irradiationAccording to many years of clinical experience,Professor Cai often uses safe and light-sensitive traditional Chinese medicines for oral administration,and uses photosensitive drugs with different photosensitivity for different parts of the patient's skin.Professor Cai advocated night-night photochemotherapy,using daylight during the day,and UVA phototherapy at night to synergize.Prof.Cai actively improves the use of drugs for external use,and uses photosensitivity Chinese medicine preparations,western medicine photosensitizers,hormones,and traditional Chinese medicine solutions that have a blood circulation effect to make different mixtures to dilute the concentration of photosensitizing drugs,reduce phototoxic reactions,and improve microcirculation and resistance.Inflammation,antipruritic,and localized immunity to white spots.Professor Cai developed low-concentration photosensitizers for children aged 2-14.Household small black light,the affected area is rubbed with light medicine,wait until it penetrates into the skin,wait 30 minutes,then turn on the instrument local illumination,light distance is 5cm,once per night,initial exposure time is 30s,30s every 3d,continuous irradiation 2 months for a course of treatment,the longest cumulative exposure time is 30min.In the course of treatment,if there are obvious skin irritation reactions such as redness and blisters,irradiation may be stopped for a week.Avoid exposure to sunlight.2TCM syndrome differentiationPerform complex network analysis on important prescriptions in retrospective studies.The core prescription is to strengthen spleen and replenish vital energy and to nourish both the liver and kidney,taking into account blood circulation.In the forward-looking study,the two syndromes classified by community analysis are based on this core prescription.They focus on strengthening the spleen and benefiting the stomach,taking into account blood circulation and dampness,and focusing on nourishing the liver and kidney,taking into account blood circulation.Vitiligo has the characteristics of rapid onset,chronic and recurrent,and is based on the principle of slowing down the treatment of this disease.It mainly uses righting and tonic,and supplements qi,blood,dampness,and pathogenic.3Medication characteristics of traditional Chinese medicine3.1 medication slow,low toxicityAccording to the "Study on the disease of specimens and specimens," "The rule of urgency is to cure the disease,and the disease is to slow down the disease",so the basic rule of "restraining the disease" is followed because the disease is treated slowly and easily to recur.For a long time,clinical drugs are gentle,light doses,and toxic drugs are used less frequently to reduce the damage of liver and kidney function.3.2Taking analogy and black rule whiteProfessor Cai Ruikang used the idea of taking images and thought that the treatment of vitiligo should be "black with white",that is,the use of black,purple type with pigmentation drugs for the treatment of vitiligo,often used mulberry,such as Ligustrum lucidum,black sesame,ebony,wolfberry Substances,Danshen,such drugs into the liver and kidney two classics.It is used to nourish the liver and kidney,and to improve blood circulation and essence.Prof.Cai Ruikang applied for drug delivery based on clinical syndrome differentiation.In medication,based on the pharmacology and pharmacology of vitiligo,the traditional Chinese medicine with photosensitizing effects was selected to increase the skin photosensitivity to irradiate black light and sunlight.In a large number of traditional Chinese medicine such as psoralen,white peony root,unicorn,barnyardgrass,Polygonum cuspidatum,P.oleracea,Atractylodes,etc.have photosensitivity,Polygonum cuspidatum,Radix Paeoniae Alba,Radix Astragali and other drugs have hepatoprotective and anti-hepatic damage effects;Dodder seeds,Radix Astragali,Radix Astragali and other drugs can regulate immune function;Salvia Miltiorrhiza,Millettia,Angelica and other drugs have the effect of improving blood circulation.Modern research shows that it has photosensitivity and can be applied with fresh purslane juice before it is irradiated with black light and sunlight.It has certain photosensitivity and reduces phototoxic reactions.In the overall use of traditional Chinese medicine to strengthen the spleen and stomach,nourishing the liver and kidney,water and dampness,and promoting blood circulation,the use of the pharmacological effects of the drug to further play a role.Research conclusionThrough years of clinical practice,Professor Cai Ruikang has found a way to treat vitiligo with Chinese and Western medicine photochemotherapy.In the course of treatment,emphasis on the overall concept,not only to treat local leukoplakia,but also to proceed from the whole,pay attention to the combination of traditional Chinese medicine syndrome differentiation and the etiology and pathogenesis of Western medicine,systematic treatment of vitiligo.In the treatment of vitiligo,Professor Cai Ruikang emphasizes the combination of Western medicine and traditional Chinese medicine for syndrome differentiation.Therapeutic features such as the combination of oral and topical drugs,Western medicine combined with Chinese medicine,combination of drug therapy and phototherapy,and day and night treatment are all features.This study also has its own shortcomings.Due to the short follow-up time and the small number of cases,it cannot fully reflect Cai Lao's academic essence.It still needs to continue to study Cai Lao's profound academic ideas. |
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