姚春海教授认为黄褐斑的病机为"本虚标实",其中"脉络瘀阻"贯穿本病始终.姚春海教授结合皮损处血管参与情况,分三型外治黄褐斑:活动期色素合并血管型(血热证)、稳定期色素合并血管型(血瘀证)、稳定期单纯色素型(血虚证).将辨证论治与局部治疗相结合,重视"治络",运用中药面膜、面针围刺、穴位埋线、氨甲环酸溶液湿敷、水光针及光电治疗等手段制定了联合外治方案,形成独特"三二三外治法"理论,此治疗体系安全性高、疗效显著.

Objective:To explore the efficacy of external treatment of integrated traditional Chinese and Western medicine on melanized type complicated with vascularized type of chloasma.Methods:A total of 82 patients (aged 26-50 years, with an average age of 44.5 years) with melanized type complicated with vascularized type of chloasma were selected, and randomly divided into groups: 28 cases in the traditional Chinese medicine control group were treated with traditional Chinese medicine pourmask combined with surrounded facial acupuncture; 26 cases in Western medicine control group underwent wet compress with 0.5% tranexamic acid solution. In the integrated Chinese traditional and Western medicine treatment group, 28 cases were treated with 2 regimens. After 8 weeks, MASI score was carried out, and vascular hyperplasia in skin lesions was observed by polari-light skin scope.Results:After treatment, the MASI scores in the three groups were all decreased, and the decreasing rate of MASI scores from high to low was as follows: Integrated Chinese traditional and Western medicine treatment group (8.60±4.53) > TCM control group (6.26±3.20) > Western medicine control group (4.39±2.11). After treatment, the vascular hyperplasia scores in the three groups were all decreased, and the value of vascular hyperplasia in the integrated Chinese traditional and Western medicine treatment group (2.57±0.63) and Western medicine control group (1.55±0.51) was greater than that in TCM control group (0.96±0.51), but there was no significant difference between the integrated Chinese traditional and Western medicine treatment group and Western medicine control group.Conclusions:External treatment of integrated traditional Chinese and Western medicine is effective in the treatment of melanized type complicated with vascularized type of chloasma, and wet compress with tranexamic acid solution can inhibit vascular hyperplasia in patients with chloasma.

目的 探讨自拟方龙牡汤对特应性皮炎(AD)小鼠树突状细胞(BMDC)IgE高亲和力受体(high affinity IgE receptor,FcERI)γ亚基启动子甲基化水平以及对Th2型免疫反应的影响.方法 将30只BALB/c小鼠分成模型组、中药组、空白组,各10只.将模型组、中药组共20只小鼠制作AD模型,中药组给予龙牡汤灌胃,模型组、空白组给予浓度0.9％生理盐水灌胃,均1次/d,连续灌胃3周.将各组小鼠常规脱颈椎处死,取股骨和胫骨,分离并培养BMDC;中药组、模型组小鼠处死后,立刻经腹主动脉采血,分离血清,分别配成10％含龙牡汤血清和10％非含药血清.将BMDC随机分为对照组与给药组,对照组加入10％非含药血清,给药组加入10％含龙牡汤血清继续培养48 h.用流式细胞术检测BMDC的CD11c阳性率,用Western blotting法检测BMDC细胞FCER1γ蛋白表达,甲基化特异性PCR(MSP)检测,ELISA法检测BMDC细胞培养液上清中MCP-1、IL-12水平;流式细胞术检测BMDC细胞培养液CD4、IL-4双阳性率.结果 与对照组比较,中药组BMDC细胞FCER1γ蛋白表达低(P＜0.05);含药血清组FCER1γ亚基启动子甲基化水平高于对照组(P＜0.05);中药组比对照组MPC-1水平低,IL-12水平高(P＜0.05);与空白组比较,中药组的CD4和IL-4双阳性率差异无统计学意义(P＞0.05).结论 龙牡汤能够提高AD小鼠突状细胞FcERⅠ γ亚基基因调节序列甲基化水平,进而抑制FcER Ⅰ γ亚基与FcERⅠ在细胞表面过度表达,促进了Th1分化,抑制了Th2型免疫反应.

瘙痒性皮肤病是皮肤科最常见的的一类病症,其病因病机比较复杂,尤其是顽固性皮肤瘙痒病情容易反复,治疗棘手.黄尧洲教授临床善用纯中药治疗瘙痒性皮肤病,结合多年临证经验并总结古代医学典籍,认为皮肤瘙痒与心神不安、睡眠障碍密切相关,并可互为因果形成恶性循环.因此结合"诸痛痒疮,皆属于心",提出瘙痒性皮肤病的基本病机可统归为心神不宁,采用镇心安神法治疗,并创立龙牡汤为基础方加减治疗瘙痒性皮肤病及其相关病症,只要符合心神不宁这一病机,多可获得良好疗效.

房定亚教授提出尿道综合征以肝经湿热、气机不畅为核心病机,在疾病的发展过程中可以出现耗气伤阴、阴虚内热的症状;由于久病入络,病程较长的患者可以出现血行不畅、经脉瘀阻的症状;病久伤及中气,导致脾肾不足,出现膀胱失约的表现.治疗中房定亚教授选用四逆散合八正散化裁进行治疗,早期以清利湿热、理气止痛为主;阴虚内热辅以益气清热;对于血行不畅、经脉瘀阻的患者在治疗中辅以理气活血通络;对于疾病日久损伤中气的患者在治疗中注意温补脾肾以调畅气机贯穿治疗始终,取得良好的临床疗效.

SAPHO综合征是一组罕见的以皮肤和/或骨与关节炎性病变为主要临床表现的异质性疾病,其典型皮肤表现包括无菌性脓疱病及重度痤疮,此外还涉及化脓性汗腺炎、寻常型银屑病等,部分患者皮肤表现也可缺失.现代医学对本病的亚型分类尚未得到公认,各种亚型在治疗上是否应区别对待也未达成共识.既往中医药诊治SAPHO综合征的病例报道极少,尤其缺乏对痤疮型病例的治疗探讨.本文报道1例患者以"面部炎性丘疹、结节、囊肿3年,右臀区、右髋疼痛2周"为主诉于2017-04-27入住中国中医科学院西苑医院风湿病科,诊断为痤疮型SAPHO综合征,采用中医药治疗有效,揭示本型以湿热毒瘀为本,筋脉拘挛为标,临证应注意清热解毒药物、解痉止痛药物、入心经药物及藤类药物的使用,并结合文献研究探讨本病亚型分类的必要性与可行性.

房定亚教授善用三仁汤治疗湿热内蕴所致的各种疑难杂症.三仁汤是清代名医吴鞠通继承发扬叶天士经验而成的著名方剂,是治疗湿热内蕴证的经典方剂,具有宣畅气机、清热利湿之效,本方宣上、畅中、渗下,畅达三焦,对于各种疾病属于湿热内蕴证的均可使用.本文结合系统性红斑狼疮、不明原因发热、自汗、慢性便秘四个医案介绍了房教授使用三仁汤的经验,并介绍了三仁汤和二陈汤、小柴胡汤、枳术丸合方使用的方法.三仁汤与二陈汤合方适合湿热内蕴合并痰湿内阻证;三仁汤合小柴胡汤适合湿热内蕴合并少阳郁热证;三仁汤合枳术丸适合湿热内蕴合并脾虚便秘.

目的 通过检测特定性皮炎(AD)模型小鼠皮损中Toll样受体(TLR)-4和核转录因子(NF)-κB p65表达,探寻龙牡汤治疗AD的作用的可能机制.方法 取18只BALB/c小鼠,将其中12只制作成AD模型小鼠,并将其分为3组(中药组、模型组、空白组),通过对比3组小鼠的血清中白细胞介素(IL)-4、IgE、干扰素(IFN)-γ以及局部皮损中TLR-4、NF-κB p65的差异,分析其相关性,探讨龙牡汤发挥作用的机理.结果 ①)TLR-4、NF-κB p65在3组中表达差异有统计学意义,其中模型组最高,中药组其次,空白组最小(P＜0.05);②TLR-4和NF-κB p65的表达呈正相关(r=0.618,P＜0.05);③IL-4、IgE、IFN-γ与TLR-4/NF-κB p65通路相关性分析:IL-4与TLR-4、NF-κB p65呈正相关,相关系数分别是:0.485、0.569(P＜0.05);IgE与TLR-4、NF-κB p65呈正相关,相关系数分别是:0.651、0.721(P＜0.05);IFN-γ与TLR-4、NF-κB p65呈正相关,相关系数分别是:0.55、0.634 (P＜0.05).结论 龙牡汤有可能是通过影响TLR-4表达进而阻断NF-κB p65通路释放炎症因子,从而平衡Th1/Th2细胞亚群来发挥免疫调节作用.

目的:观察火针结合艾灸治疗稳定期局限性白癜风的临床疗效.方法:选择我院自2015年5月至2017年5月收治的57例稳定期局限性白癜风患者作为研究对象,将其随机分成对照组(28例)和研究组(29例),对照组采用卤米松乳膏治疗,研究组采用火针结合艾灸治疗,比较两组患者治疗前后的皮损面积、皮损色素分,治疗的总有效率以及不良反应发生率.结果:两组患者治疗前的皮损面积、皮损色素分对比无显著差异(P＞0.05),治疗后,研究组患者的皮损面积、皮损色素分、不良反应发生率明显低于对照组,研究组患者治疗的总有效率明显高于对照组,两组对比差异显著(P＜0.05).结论:对稳定期局限性白癜风患者采用火针结合艾灸治疗不仅能有效促进其皮肤恢复正常肤色,同时还能有效降低患者治疗期间的毒副反应发生率,因此其是一组安全、高效的中医组合疗法.

目的 观察420 nm脉冲激光联合化痰除瘀汤内服加中药面膜治疗囊肿结节型痤疮的临床疗效.方法 将2017年1-12月在中国中医科学院西苑医院痤疮专病门诊就诊的60例囊肿结节性痤疮患者随机分为试验组和对照组,各30例.试验组采用化痰除瘀汤内服、中药面膜外用联合420脉冲激光治疗;对照组仅给予化痰除瘀汤内服、中药面膜外用治疗.均治疗6周,分别于治疗4、6周对比2组临床疗效,比较治疗前后2组皮损变化,随访2个月观察复发情况.结果 治疗4、6周试验组总有效率均高于对照组(P＜0.05);试验组治疗后总皮损、炎性皮损、非炎性皮损均减少(P＜0.05);试验组复发率低于对照组(P＜0.05).结论 420 nm脉冲激光联合化痰除瘀汤加中药面膜外用的综合疗法对囊肿结节性痤疮患者起效快,复发率低,有较好的临床疗效.

时间重点:10点至16点宝宝在生长发育的高峰期,需要较多的钙和维生素D3,一定程度的日晒是补充维生素D3的有效途径,但宝宝皮肤比较娇嫩,很难抵御外界的刺激.在10点至16点期间,紫外线的强度比较高,宝宝要尤其注意防晒,其他时间相对好一些.

目的 研究中医药内外合治对痤疮患者皮脂分泌的影响.方法 用皮肤测试仪检测304例入组患者面部皮肤性状的改变;采用Lookingbill及Cunliffe改良测定法测定皮脂溢出率;酶联免疫吸附试验(ELISA)检测血清中睾酮及其受体的表达.结果 试验组治疗2,4,6周后,T型区皮脂量、U型区皮脂量和皮肤毛孔大小均明显减少(P＜0.05),而皮肤水分和皮肤弹性变化不明显(P＞0.05);治疗6周后皮肤水分仍然变化不明显(P＞0.05),而皮肤的弹性得到了明显改善(P＜0.05).皮脂溢出率(SER):试验组中60例患者治疗2,4周后SER均无明显变化(P＞0.05);治疗6周后SER显著减少(P＜0.05).血睾酮:试验组男性患者在治疗前后睾酮的变化不明显(P＞0.05),而对于女性患者明显降低了(P＜0.05).血清中睾酮受体:试验组患者治疗6周后血清中睾酮受体明显下降(P＜0.05).结论 中药内服可改善痤疮患者皮肤的性状,减少T型区及U型区皮脂量,缩小毛孔;可能通过降低SER、女性患者血睾酮的水平以及睾酮受体的水平来达到治疗作用.

通过对古典医籍以及近20年来发表文献的检索研究,采用Microsoft Office 2007 Excel电子表对文献进行信息的提取与整理,并对研究结果进行描述性分析,来阐述火针疗法治疗痤疮的研究进展.结果发现目前已有少数随机对照试验证实了火针疗法治疗痤疮的疗效,从已有研究可知火针治疗痤疮的安全性及患者的耐受性均已得到肯定.因此认为,火针疗法治疗痤疮,不仅能够减少皮损,缓解临床症状,且安全性高、复发率低.

目的:研究自拟除疣酊对传染性软疣的临床疗效.方法:将72例传染性软疣患者按照随机对照原则分为2组,治疗组36例给予自拟除疣酊外涂,对照组36例给予5％咪喹莫特乳膏外涂,每周复诊1次,共8周,观察疣体脱落情况.结果:两组疣体均明显脱落且治疗组疗效显著优于对照组,差异均有统计学意义(P＜0.05).结论:自拟除疣酊外涂治疗传染性软疣疗效确切,值得临床推广应用.

ObjectiveGeneral evaluate the clinical curative effect and security by performing the clinical study of Qingpeng ointment in treatment of Children with localized eczema.MethodDivide the children with localized eczema into two groups randomly. The treatment group includes 31 cases topically apply Qingpeng ointment twice a day. The control group includes 28 cases, topically apply Vaseline ointment twice a day.The treatment continues for 2 weeks. Evaluate the score of TSS before the treatment and after.ResultAfter 2 weeks of treatment, a statistical difference was observed in the response rate(70.97%vs28.57%), (P<0.01) and cure rate (9.68%vs3.57%),(P> 0.05) betweenthe treatment and control group. There was no significant difference in the incidence of adverse events betweenthe two groups (8.82%vs0%), (P>0.05).ConclusionQingpeng ointment displays a promisingefficacy for the treatment of Children with localized eczema with a rapid onset and high safety.

特应性皮炎（AD）又称遗传过敏性湿疹或异位性皮炎，是一种常见的慢性复发性、瘙痒性、炎症性皮肤病。一般自婴幼儿期起病，病情迁延反复，部分可持续至成年期，且80% AD儿童日后可发展成为过敏性鼻炎或哮喘。近年来，AD发病率呈逐年上升趋势，严重影响着患者的生活质量。由于其复发率高，需要长期反复治疗，给家庭和社会都带来了较大的经济负担。

ObjectiveTo evaluate the clinical curative effect and security by performing the clinical study ofYinggencao formula in treatment of psoriasis vulgaris with blood-heat TCM syndrome.MethodsA total of 75 patients, diagnosed with Psoriasis Vulgaris Blood-heat RCM syndrome, were randomizedly divided into the treatmeat group with 39 patients and the control group with 36. The treatment group tookYinggencao formula twice daily, while the control group tookQingdai capsules three times daily. All the patients were treated 12 weeks. PASI scores were used as the main outcome and to estimate the curative effect rates.ResultsThe PASI scores of patients in the treatment group (6.97 ± 2.02vs. 16.88 ± 2.91;t=14.380,P=0.009) and the control group (13.14 ± 3.18vs. 17.49 ± 2.32;t=7.780,P=0.013) after treatment showed significantly lower than the scores before. The PASI scores showed significant difference between the two groups after the treatment (P=0.027). The total effective rate of treatment group was significantly higher than the control group (76.9%vs. 61.1%;χ2=5.120, P<0.05).Conclusions TheYinggencao formula therapy showed better effect thanQingdai capsules therapy in treatment of psoriasis vulgaris with blood-heat TCM syndrome.

Objective To observe the clinical effect and safety of fire needle in the treatment of pa-tients with nodular prurigo. Methods A total of 98 patients with prurigo nodularis,were randomly divided into 2 groups. The 48 cases in the experimental group were given fire needle therapy. Another 50 cases in the control group received liquid nitrogen cryotherapy. Two groups both applied continuous treatment for 4 weeks, and the efficiency and the adverse reactions of all the patients after 8 weeks were observed and compared. The relapse rates of the two groups were also observed after 6 - month follow - up. Results The total effective rate in the fire needle group was 73. 91% ,which was significantly higher than that in the control group (46. 94% ,P ﹤ 0. 01). There were respectively 27 and 5 cases of mild adverse events in the control and fire needle groups. During the 6 - month follow - up,the relapse rates were 60%(3 / 5)and 25%(2 / 8)among the completely effective patients in the control and fire needle groups,respectively. Conclusion Compared with the conventional medicine,fire needle could be an alternative for the treatment of nodular prurigo with better clinical effect and safety.

Objective To observe the clinical curative effect Pudilanxiaoyan oral liquid for the treatment of acne vulgaris. Methods: 126 acne patients were randomly divided into the treatment group and the control group. The 64 cases in the treatment group were treated with Pudilanxiaoyan oral liquid and the 62 cases in the control group were treated with Salvia ketone capsule. The treatment cycle was 6 weeks. The clinical effects 3 weeks and 6 weeks after the treatment were evaluated,the alteration of the classification of acne improved levels were compared. Rusults The effective rate in treatment group and the control group 3 weeks after the treatment were 75. 0% and 75. 8% respectively,the difference was not significant( !2= 0. 50,P 0. 05); The total effective rates in treatment group was 93. 8%,significantly higher than the control group( 85. 5%),the difference was significant( !2= 8. 50, P 0. 05). The inflammatory lesions, noninflammatory lesions and the total lesions were significant different between the treatment group and control group before and after the treatment( P 0. 05); There were significant differences in classification of the two groups after the treatment,the difference was statistically significant( !2= 16. 8,P 0. 05). Conlusion The Pudilanxiaoyan oral liquid was effective in the treatment of the acne vulgaris,worthy of spreading therapeutic schedule.

Objective To determine the clinical efficacy of moisturizing itching relief capsules combined with Shidu paste in treating palmoplantar keratotic eczema.Methods The 40 patients in treatment group were orally given moisturizing itching relief capsules and treated with topical Shidu paste for 4 weeks.The 38 patients in control group were treated by topical Shidu paste alone for 4 weeks.Results After 4 weeks of treatment,the scores were significant different between the two groups(P0.05).The effective rates in treatment group(87.50%) were significantly higher than that in control group(60.53%),P0.05.Conclusion The moisturizing itching relief capsules combined with Shidu paste is a effective regimen for palmoplantar keratotic eczema.