| Objective:In order to investigate the distribution of vitiligo patients’ clinical characteristics,TCM syndrome types and constitutions,to explore the connection between their TCM syndrome types and constitutions,and to investigate the correlation between their clinical characteristics and TCM syndrome types and constitutions,aiming to provide some reference significance for clinical vitiligo diagnosis and treatment.Methods:In this investigation,156 vitiligo patients who attended the outpatient clinic of the Department of Dermatology of Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital and met the case ranking criteria from October 2020 to February 2022 were selected,and the clinical data including the distribution of vitiligo patients’ clinical characteristics,TCM syndrome types and constitutions were obtained through detailed questionnaires,which were entered into EXCEL tables for data management and imported into SPSS26.0 software for statistical description and analysis,with P < 0.05 indicating that the difference was statistically significant.Result:1 General and clinical characteristicsA total of 156 cases were included in this investigation,with a male to female ratio of1.2:1.The presentation age of vitiligo patients was 32.5(26,41)years,with a concentration of18-37 years.Their age of first onset was 28(19,37.8)years,with a concentration of 16-35 years,with a peak of 16-35 years for males and 26-35 years for females,and there was a statistically difference between the genders and age of first onset.The season of first onset was summer > spring > autumn and winter,41.7% of the patients had seasonal exacerbations,with the majority being male,and there was a statistically difference between the genders as to whether seasonal exacerbations were present.22.4% of the patients had a family history,with first degree relatives > second degree relatives > third degree relatives.The disease duration of vitiligo patients varied,with 66.0% of the patients having a disease duration for more than 1 year,of which 22.4% had a disease duration for more than 10 years.30.1% of the patients had their first onset,48.7% of them had recurrent disease,and 21.2% of them had stable disease;21.8% of them were untreated,51.3% of them had been treated intermittently,16.0% of them had been treated regularly,and 10.9% of them had been treated for recoloration and then discontinued the drug,and they visited the doctor again after the recurrence.Most of the patients with first onset were women,while the majority of patients with recurrence were men,and the majority of patients with intermittent treatment were men,and there was a statistically difference between the genders and the condition of attendance and treatment respectively.The head,trunk,back of the hand,palm and fingers were the preferred site which were first and currently been affected,and vulvar mucosal sites was less been affected.The non-segmental type accounted for 75%,the segmental type accounted for7.1%,the mixed type accounted for 1.9%,and the undetermined type accounted for 16%.78.8% of the patients were in the progression period,and 21.2% of them were in the stabilisation period.The severity of vitiligo was mostly mild,followed by moderate and moderate to severe,no severe cases were included this time.24.4% of the patients were accompanied by one or more other diseases,and the frequency of the accompanying diseases from highest to lowest were: thyroid nodule > hypothyroidism > halo nevus,white hair disease > hyperthyroidism > rheumatoid arthritis,psoriasis > dermatomyositis,chronic HBV carriers,endometrial cancer.Most of the vitiligo triggers or exacerbations were caused by the interaction of multiple factors,and the frequency of the influencing factors from highest to lowest were: emotion > exhaustion > trauma or invasive > sun exposure > chemical stimulation > pregnancy.The majority of those with isomorphic responses were males,and there was a statistically difference between the genders and isomorphic responses.33.3% of patients had different degrees of anxiety,of which 30.1% were mild,2.6% were moderate and0.6% were severe.In addition,35.3% of patients had different degrees of depression,of which28.8% were mild,5.8% were moderate and 0.6% were severe.2 TCM syndrome types and constitutionsIn this investigation,liver stagnation and qi stagnation syndrome and qi-blood disharmony syndrome accounted for more,followed by liver-kidney deficiency syndrome,meridian blood stasis syndrome,while a small number of patients belonged to the syndrome of spleen-stomach weakness syndrome,and a small number of patients had other syndrome differentiation.The constitutions of vitiligo patients were mixed,among the 156 patients,only9 cases were of pure peaceful constitution,42 cases were basically of peaceful constitution and had one or more biased constitution tendencies,and the remaining 105 patients had one or more biased constitutions and may have one or more biased constitution tendencies.The frequency of "yes" constitution from highest to lowest were: qi-depression constitution >qi-deficiency constitution > yang-deficiency constitution,phlegm-dampness constitution >yin-deficiency constitution,damp-heat constitution,blood-stasis constitution > peaceful constitution > idiosyncratic constitution,while the frequency of "basic yes or tendency yes" constitution from highest to lowest were: qi-deficiency constitution tendency >yang-deficiency constitution tendency > basically peaceful constitution > qi-depression constitution tendency > blood-stasis constitution tendency > yin-deficiency constitution tendency > damp-heat constitution tendency > phlegm-dampness constitution tendency >idiosyncratic constitution tendency.Those with peaceful constitution mostly had other syndrome;for those with qi-depression constitution,the syndrome was mainly for liver stagnation and qi stagnation syndrome;for those with qi-deficiency constitution,the syndrome was mainly for qi-blood disharmony syndrome;for those with yang-deficiency constitution and yin-deficiency constitution,the syndrome was mainly for liver-kidney deficiency syndrome;for those with phlegm-dampness constitution and damp-heat constitution,the syndrome were mainly for qi-blood disharmony syndrome,followed by spleen-stomach weakness syndrome;for those with blood-stasis constitution,the syndrome were mainly for meridian blood stasis syndrome,followed by liver stagnation and qi stagnation syndrome;for those with idiosyncratic constitution,the syndrome was mainly for liver stagnation and qi stagnation syndrome;there was a statistically difference between the "yes" constitution and TCM syndrome types.For those with basically peaceful constitution and qi-deficiency constitution tendency and yang-deficiency constitution tendency and yin-deficiency constitution tendency,the syndrome were mainly for qi-blood disharmony syndrome and liver stagnation and qi stagnation syndrome;for those with qi-depression constitution tendency and phlegm-dampness constitution tendency and damp-heat constitution tendency and blood-stasis constitution tendency and idiosyncratic constitution tendency,the syndrome were mainly for liver stagnation and qi stagnation syndrome,followed by qi-blood disharmony syndrome;there was no statistically difference between the "basic yes or tendency yes" constitution and TCM syndrome types.3 clinical characteristic and TCM syndrome typeMost of the patients with qi-blood disharmony syndrome had a disease duration of less than 3 months,those with liver stagnation and qi stagnation syndrome and meridian blood stasis syndrome had a disease duration of 1 to 5 years,and those with liver-kidney deficiency syndrome had a disease duration of more than 1 year.There was no obvious regularity in the disease duration of those with spleen-stomach weakness syndrome and those with unclear syndrome differentiation;there was a statistically difference between TCM syndrome types and disease duration.The classification of those with qi-blood disharmony syndrome,liver stagnation and qi stagnation syndrome,spleen-stomach weakness syndrome,meridian blood stasis syndrome,liver-kidney deficiency syndrome and unclear syndrome differentiation,were mainly non-segmental type,and there was no significant difference.The period of those with qi-blood disharmony syndrome,liver stagnation and qi stagnation syndrome,spleen-stomach weakness syndrome and unclear syndrome differentiation,were mainly progressive period,while the period of those with meridian blood stasis syndrome,liver-kidney deficiency syndrome,were mainly stable period.There was no statistically difference between the TCM syndrome types and classification,while there was a statistically difference between the TCM syndrome types and period.Patients with qi-blood disharmony syndrome were mostly affected by the factors such as exhaustion,sun exposure,trauma or invasive;those with liver stagnation and qi stagnation syndrome were mostly affected by emotion,followed by exhaustion,trauma or invasive;those with spleen-stomach weakness syndrome were affected by sun exposure slightly higher than other factors;those with meridian blood stasis syndrome can be affected by the factors such as emotion,exhaustion,sun exposure,trauma or invasive,chemical stimulation;those with liver-kidney deficiency syndrome were affected by the factors such as emotion,exhaustion,sun exposure,trauma or invasive;those with unclear syndrome differentiation were slightly affected by factors such as exhaustion,trauma or invasive,and chemical stimulation;there was a statistically difference between the TCM syndrome types and predisposing or aggravating factors.66.1% of the patients with liver stagnation and qi stagnation syndrome had different degrees of anxiety,among which 37 cases were mild and 4 cases were moderate.Only a few patients with qi-blood disharmony syndrome,liver-kidney deficiency syndrome,and meridian blood stasis syndrom had mild anxiety,and very few patients with qi-blood disharmony syndrome had severe anxiety.71.0% of patients with liver stagnation and qi stagnationliver stagnation and qi stagnation syndrome had different degrees of depression,among which 36 cases were mild,7cases were moderate and 1 case was severe.Only a few patients with qi-blood disharmony syndrome,liver-kidney deficiency syndrome,and meridian blood stasis syndrom had mild anxiety,and very few patients with qi-blood disharmony syndrome had severe anxiety.A few patients with qi-blood disharmony syndrome had mild to moderate depression,and a few patients with meridian blood stasis syndrome and liver-kidney deficiency syndrome,had mild depression;there was a statistically difference between the TCM syndrome types and anxiety level or depression level.4 clinical characteristic and constitutionMost of the patients with qi-depression constitution,yang-deficiency constitution and yin-deficiency constitution had a disease duration of more than 1 year,those with qi-deficiency constitution,phlegm-dampness constitution and damp-heat constitution had a disease duration of less than 3 months,and those with blood-stasis constitution had a disease duration of 1 to 5 years;there was a statistically difference between the "yes" constitution and disease duration.The classification of patients with nine different constitutions were mainly non-segmental type,with no significant difference.The period of those with yang-deficiency constitution,yin-deficiency constitution and blood-stasis constitution,were mainly stable period,while those with the remaining constitution were mainly progressive period.There was no statistically difference between the "yes" constitution and classification,while there was a statistically difference between the "yes" constitution and period.Patients with qi-depression constitution were mostly affected by emotion,followed by exhaustion,trauma or invasive;those with qi-deficiency constitution,yang-deficiency constitution and yin-deficiency constitution,were affected by the factors such as emotion,exhaustion,trauma or invasive and sun exposure;there was a statistically difference between the "yes" constitution and predisposing or aggravating factors.69.4% of the patients with qi-depression constitution had mild to moderate anxiety,and a few of the rest had mild anxiety;83.4% of the patients with qi-depression constitution had mild to severe depression,and a few of the rest had mild to moderate depression;there was a statistically difference between the "yes" constitution and anxiety level or depression level.Conclusion:1.The peak age of vitiligo patients’ s first onset was 16-35 years old,with a peak of16-35 years for males and 26-35 years for females.2.The males with vitiligo were more prone to seasonal exacerbations and isomorphism.3.The disease duration of vitiligo patients varied,and about half of the patients had recurrent disease.Most of the patients who seek treatment for the first onset were males,while most of the patients who receive intermittent treatment and those who relapse were females.4.The co-morbidity rate of vitiligo was 24.4%,of which thyroid-related diseases accounted for the largest proportion.5.Most of the vitiligo triggers or exacerbations were caused by the interaction of multiple factors,among which emotional factor was the main factor,while anxiety,depression and other negative emotions were common in patients with vitiligo.6.Vitiligo patients mostly had liver stagnation and qi stagnation syndrome and qi-blood disharmony syndrome,followed by liver-kidney deficiency syndrome,meridian blood stasis syndrome,and a few syndromes of spleen-stomach weakness.7.Most of the vitiligo patients had mixed constitutions,only a few were pure peaceful constitution,while biased-constitution was the most part of them,among which qi-depression constitution was more common.8.There was a correlation between TCM syndrome types and constitution in vitiligo patients,and constitution determined the occurrence of TCM syndrome types.9.There were correlations between some clinical characteristics of vitiligo patients(such as disease duration,period,predisposing or aggravating factors,anxiety level,depression level)and TCM syndrome types and constitutions,while no correlation was found between other clinical characteristics(such as classification)and TCM syndrome types and constitutions. |
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