| Eczema is an allergic inflammatory skin disease,known in Chinese medicine as "wet sores(shichuang)".According to the different clinical manifestations,etiology and pathogenesis,the ancients name eczema such as "steeped sore(qinyinchuang)","blood wind sores(xuefengchuang)","fire leather sores(huogechuang)",etc.Perianal eczema is a common form of eczema that occurs on the skin around the anus,which belongs to eczema of anus in traditional Chinese medicine(TCM).Ancient Chinese medicine practitioners have accumulated rich experience in the treatment of Perianal eczema.Shiyangning recipe is an gradually perfected prescription treating perianal eczema,prescribed by Professor Jia Xiaoqiang under the guidance of the theory of TCM and combined with more than thirty years of Prof.Jia's clinical experience.The purpose of this study is to summarize the clinical experience of Prof.Jia Xiaoqiang,with a view to forming a more comprehensive theory,also it aims to verify the clinical efficacy and safety of Shiyangning recipe and to initially reveal its mechanism of treatment,which can provide scientific evidence for its clinical application and promotion.1.Summarize the clinical experience of Prof.Jia Xiaoqiang in treating perianal eczemaObjective:Summarize the experience of Prof.Jia Xiaoqiang in treating perianal eczema based on the study during the internship.Methods:Based on clinical experience of Prof.Jia Xiaoqiang,the incidence,development and characteristic of perianal eczema were analyzed to summarize Professor Jia Xiaoqiang's experience in perianal eczema.Results:Prof.Jia Xiaoqiang believed that the disease was particularly closely correlated to wind-dampness-heat.The main pathogenesis were retention of wind,dampness,heat and disharmony between qi and blood.In order to achieve good effect,four methods,expelling wind,removing dampness,clearing heat and activating blood should be used.Among them,expelling wind was the primary treatment;removing dampness and clearing heat was the core;activating blood was the key to improve the curative effect.Conclusion:Prof.Jia Xiaoqiang believed that "disturbance of qi and blood caused by wind-dampness-heat" was the core pathogenesis of perianal eczema.The clinical therapy should be expelling wind,removing dampness,clearing heat and activating blood.2.Randomized controlled trials of Shiyangning recipe on treating perianal eczema Objective:Evaluate the clinical efficacy of Shiyangning recipe on treating perianal eczema through randomized controlled clinical trial.Meanwhile,preliminary explore the mechanism of Shiyangning recipe on treatment of perianal eczema through observing the changes of the cytokines IFN-y,IL-2 and IL-4 levels before and after treatment of patients with perianal eczema.Methods:Patients with perianal eczema who were treated in the anorectal clinic of Xiyuan Hospital of China Academy of Chinese Medical Sciences from May 2018 to December 2019 were included.56 patients who agreed to participate in the trial were randomly divided into the test group(Shiyangning recipe)and the control group(Pifu Kang)with 28 cases respectively.The treatment course of both groups was 2 weeks.The efficacy of the patients after treatment was evaluated by observing the signs,eczema area and severity index(EASI),perianal symptom score and anal moist symptom score of the two groups of patients before and after treatment.At the same time,serum IFN-y,IL-2 and IL-4 level were also compared.Follow-up to 3 months after the end of treatment was performed to evaluate the recurrence of patients.Results:During the trial,2 patients in the test group discontinued medication due to menstrual period,and 1 patient discontinued medication due to business trip,which were all judged as dropped-off cases;in the control group,1 patient discontinued medication due to business trip,which was judged as dropped-off case,and 2 patients lost follow-up.After tests,there were no statistically significant differences in baseline(P>0.05)on age,duration of disease,gender,EASI score,perianal sensation,anal dampness symptom score and cytokine levels in the two groups.The EASI score,perianal itching symptom and anal moist symptom score of the two groups of patients were significantly improved after the treatment(P<0.05).Compared two groups,it was better in the test group than that of the control group in the total effective rate?improving the anal itching symptom score and anal moist symptom score of the patients(P<0.05);but the advantage in EASI score was not statistically significant(P>0.05).After the treatment,the levels of IFN-? increased and the levels of IL-4 decreased showed statistical significance(P<0.05)and there was no statistical significance in the level of IL-2 increased(P>0.05)in the test group.The IFN-y level increased showed statistical significance(P<0.05)and the levels of IL-2 increased and IL-4 decreased showed no statistical significance(P>0.05)in the control group after treatment.There was no statistical difference in the levels of IFN-? increased,IL-2 increased and IL-4 decreased after treatment between the two groups(P>0.05).There was no statistical difference in the recurrence rate between the test group(21.43%)and the control group(33.33%)during the follow-up period(P>0.05).Conclusion:Shiyangning recipe could significantly improve the symptoms of perianal itching,anal moistness and skin lesion EASI in patients with perianal eczema.Shiyangning recipe showed better effect than Pifu Kang in improving the symptoms of perianal itching and moist anus.The mechanism of Shiyangning recipe for treating perianal eczema may achieve by improvement the immune and inflammation response of patients by increasing the level of IFN-y and reducing the level of IL-4. |
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