| ObjectiveTo investigate the characteristic of eczema development and medication features of Wan-Shi Liquid in treatment of eczema,we analyzed eczema patients treated with Chinese medicine in Zeng’s dermatosis clinic,in order to searching for laws of symptoms/signs-Traditional Chinese Medicine(TCM)syndromes-medicine.Meanwhile,we explored whether Wan-Shi Liquid could be used to treat eczema of all kinds or not,so as to provide new ideas about clinical treatment of eczema.In addition,this study analyzed the correction between symptoms/signs and Chinese medicine,to explore the features of Chinese medicine for symptoms and signs.Methods1.Clinical cases320 case records of patients with eczema were selected from Zeng’s dermatosis clinic from January 2013 to December 2016,including 9 cases of subacute eczema and 311 cases of chronic eczema.These patients were treated effectively with Chinese medicine.Syndromes included exuberant dampness,yin deficiency,blood deficiency and wind dryness syndrome(EDYDBDWD);damp-heat,yin deficiency,blood deficiency and lung-heat syndrome(DHYDBDLH);exuberant dampness,qi deficiency,blood deficiency and wind-heat syndrome(EDQDBDWH);damp accumulating spleen,blood deficiency and wind-heat syndrome(DASBDWH);spleen deficiency,exuberant dampness,qi-blood stagnation syndrome(SDEDQXS);spleen deficiency with dampness encumbering,liver depression and blood deficiency syndrome(SDDELDBD).There were 57 patients with EDYDBDWD,26 patients with DHYDBDLH,197 patients with EDQDBDWH,19 patients with DASBDWH,19 patients with SDEDQXS,and 2 patients with SDDELDBD.2.Selection criteriaDiagnostic criteria: Diagnostic criteria is based on “the guide ofdiagnose and treatment of eczema(2011)”.Inclusion criteria: accord with diagnostic criteria;complete clinical materials;be treated with Chinese medicine and have significant effect(obvious remission of symptoms);the case record should be selected again when one’s symptoms changed during many visits;not to take other medicine due to other system diseases.Exclusion criteria:material is incomplete;not to take medicine following the doctor’s advice;suffering other skin diseases at the same time;suffering severe heart,liver,kidney,or blood system diseases.3.Medicine Component of Wan-Shi LiquidRadix rehmanniae(shengdi),Red peony root(chishao),Radix saposhnikoviae(fangfeng),Figwort root(xuanshen),Moutan cortex(danpi),Coix seed(yiyiren),Radix fici hirtae(beiqi),Baical skullcap root(huangqin),Herba violae(zihuadiding),Glabrous greenbrier rhizome(tufuling),Cortex dictamni(baixianpi),Fructus tribuli(baijili),Cicada slough(chanyi),Lonicerae flots(yinhua),and Licorice(gancao).4.Research methodsData were sorted out with excel software,and carried on the statistics with stata 11.0 software.The counting data was described by percentage and composition ratio,and made statistics with Chi-square test or fisher’s exact probability method.Non-parametric test was used for grade data.Medicines were analyzed through principal component analysis and system clustering analysis.Principal components were chosen if the characteristics of the root was greater than 1.The coefficient>0.6 was defined as significant correlation.Meanwhile,Correlation analysis was used to analyze the relationship between common symptoms/signs and common Chinese medicine,and btween subordinate symptoms/ signs and subordinate Chinese medicine.Absolute value of correlation coefficient less than 0.3 would be thought as no linear correlation.If absolute value of correlation coefficient is in the range of 0.3-0.5,it would be thought as low correlation.If absolute value of correlation coefficient is in the range of 0.5-0.8,it would be thought as medium correlation.And if absolute value of correlation coefficient is more than0.8,it would be thought as high correlation.The test level was 0.05,and P<0.05 was considered statistically significant.Results1.General Information(1)Distribution of gender,age,and courseThere were no significant differences among the pathological groups about distribution of gender,age,and course.(2)Distribution of onset ageThe number of patients whose onset age were less than 1 year-old was highest(46.87%).There were no significant difference among different-syndrome groups about distribution of onset age and between those onset age were less than1 year-old and those more than 1 year-old about distribution of syndromes.2.Clinical characteristic of eczema and TCM syndromes(1)Location of pathological changesThe most common location of pathological changes were upper and lower limbs.Next were neck,face,back,abdomen,head,waist,genitals and ears.The chest was the lowest.Compared with those with EDQDBDWH,the possibility that patients with DHYDBDLH had eczema at the waist was significantly higher(P=0.002).In contrast,compared to those with DHYDBDLH,the possibility that patients with EDQDBDWH had eczema at the neck and back were significantly higher(P=0.002 and 0.000).(2)Features of skin lesionsErythema appeared the highest proportion,followed by desquamation,rough,rash,pigmentation,scabby,pachyderma,erosionand seepage.The occurrence probability of red rash was significantly higher in patients with EDQDBDWH than those with DHYDBDLH(P=0.001),while the probability of occurring erosion was significantly lower(P<0.002).The probabilities of pachyderma in patients with EDYDBDWD,DASBDWH and SDEDQXS,were significantly higher than those with EDQDBDWH(P<0.002).(3)Degree of itching and burningAll of patients appeared itching,and 91.25% of patients felt strongly itchy.About 81.25% of eczema patients felt slightly scorching.However,there were no significant differences among different TCM syndromes group.3.Characteristics of tongue and pulse(1)Tongue body: red and crack tongue were common in these patients.There was no significant difference in distribution of tongue color among different TCM syndrome groups.For forms of tongue,the frequency of fat-soft tongue and indented tongue in the patients with EDQDBDWH was lower than that in the patients with EDYDBDWD(P=0.000).And the frequency of indented tongue in thepatients with DASBDWH was also lower than that in the patients with EDYDBDWD(P=0.001).There was only 1 patient with no crack tongue,and all the patients in the remaining groups showed crack tongue.(2)Tongue coating: the coating color of patients was mainly yellow,and yellowish coating was more common.Dryness was often seen for coating nature.And for coating thickness,the majority of patients showed medium coating.There was no statistical difference in the distribution of coating color and thickness among different TCM syndrome groups.In the case of coating nature,the frequency of dryness coating in the patients with EDYDBDWD was higher than that in patients with EDQDBDWH,and moister and greasy coating were relatively rare(P=0.002).(3)Pulse condition: the most common pulse was slippery pulse,followed by slippery-rapid pulse,slippery-slow pulse,wiry-rapid pulse,thread-rapid pulse,and soft pulse.In different TCM syndrome groups,there was significant difference in the distribution of pulse condition between patients with EDQDBDWH and those with DHYDBDLH(P=0003).The data indicated that compared with patients with DHYDBDLH,patients with EDQDBDWH more frequently showed slippery pulse,but slippery-rapid pulse,slippery-slow pulse,wiry-rapid pulse,and thread-rapid pulse were found more frequently in patients with DHYDBDLH.4.Concomitant symptomsWe found that most of patients felt distracted,thirsty,weary,insomnia and emaciated.Some patients showed dizziness,complexion deficiency,abdominal distension or breast swelling.For different TCM syndrome groups,the occurrence of abdominal distension in patients with EDQDBDWH were more frequent than that in patients with EDYDBDWD(P=0.003).There was no significant difference for concomitant symptoms among the remaining groups(P>0.05).5.Medication Features in TCM syndrome groups(1)EDYDBDWD group: on the basis of Wan-Shi liquid,this prescription medication added Agastachis rugosae(huoxiang),Eupatorium fortune(peilan),Fried jujube kernel(chaozaoren),Radix angelica sinensis(danggui),Polygonum multiflorum(heshouwu),Spatholobi caulis(jixueteng),Schisandra chinensis(wuweizi),Lophatherum gracile(danzhuye),Radix isatis(banlangen),Isatidis folium(daqingye),etc.The main medication included RadixRehmanniae,Red peony root(chishao),Radix saposhnikoviae(fangfeng),Polygonum multiflorum(heshouwu),Figwort root(xuanshen),Moutan cortex(danpi),Cortex dictamni(baixianpi),Herba violae(zihuadiding),Schisandra chinensis(wuweizi),Fried jujube kernel(chaozaoren),Cicada slough(chanyi),Agastachis rugosae(huoxiang),Eupatorium fortune(peilan),Lophatherum gracile(danzhuye),etc.The common medicine suits were Schisandra chinensis(wuweizi)with Fried jujube kernel(chaozaoren),Figwort root(xuanshen)and Moutan cortex(danpi)with Cortex dictamni(baixianpi),Lonicerae flots(yinhua)and Baical skullcap root(huangqin)with Glabrous greenbrier rhizome(tufuling),Isatidis folium(daqingye)with Radix isatis(banlangen),Agastachis rugosae(huoxiang)and Eupatorium fortune(peilan)with Lophatherum gracile(danzhuye),Cicada slough(chanyi)with Fructus tribuli(baijili).(2)DHYDBDLH group: on the basis of Wan-Shi liquid,this prescription medication added Radix isatis(banlangen),Isatidis folium(daqingye),Agastachis rugosae(huoxiang),White peony root(baishao),Bupleurum root(chaihu),Poria cocos(fuling),Cortex phellodendri(huangbai),Lophatherum gracile(danzhuye),Chrysanthemum(juhua),Portulaca oleracea(machixian),etc.The main medication included RadixRehmanniae,Figwort root(xuanshen),Moutan cortex(danpi),Isatidis folium(daqingye),Radix isatis(banlangen),Bupleurum root(chaihu),White peony root(baishao),Agastachis rugosae(huoxiang),Eupatorium fortune(peilan),Lophatherum gracile(danzhuye),Chrysanthemum(juhua),Poria cocos(fuling),Portulaca oleracea(machixian),Cortex phellodendri(huangbai)etc.The common medicine suits are Figwort root(xuanshen)and Moutan cortex(danpi)with Cortex dictamni(baixianpi),Isatidis folium(daqingye)with Radix isatis(banlangen),portulaca oleracea(machixian)with Cortex phellodendri(huangbai),Bupleurum root(chaihu)with White peony root(baishao),Agastachis rugosae(huoxiang)and Eupatorium fortune(peilan)with Lophatherum gracile(danzhuye),Cicada slough(chanyi)with Fructus tribuli(baijili).(3)EDQDBDWH group: on the basis of Wan-Shi liquid,this prescription medication got rid of Figwort root(xuanshen),Moutan cortex(danpi),Cortex dictamni(baixianpi),and added Agastachis rugosae(huoxiang),Eupatorium fortune(peilan),Lophatherum gracile(danzhuye),Chrysanthemum(juhua),etc.The main medication included Radix rehmanniae(shengdi),Radix saposhnikoviae(fangfeng),Coix seed(yiyiren),Chrysanthemum(juhua),Cicada slough(chanyi),Agastachis rugosae(huoxiang),Eupatorium fortune(peilan),Lophatherum gracile(danzhuye),Baical skullcap root(huangqin),Red peony root(chishao),Radix fici hirtae(beiqi),etc.The common medicine suits were Agastachis rugosae(huoxiang)with Eupatorium fortune(peilan),Cicada slough(chanyi)with Fructus tribuli(baijili).(4)DASBDWH group: this prescription medication got rid of Radix fici hirtae(Beiqi),and added Lophatherum gracile(danzhuye),Radix isatis(banlangen),Isatidis folium(daqingye),Agastachis rugosae(huoxiang),Eupatorium fortune(peilan),Cortex phellodendri(huangbai),Spatholobi caulis(jixueteng),Lonicerae japonicae caulis(rendongteng),Herba schizonepetae(jingjie),etc.on the basis of Wan-Shi liquid.The main medication included Radix rehmanniae(shengdi),Red peony root(chishao),Isatidis folium(daqingye),Radix isatis(banlangen),Agastachis rugosae(huoxiang),Eupatorium fortune(peilan),Herba schizonepetae(jingjie),Baical skullcap root(huangqin),Figwort root(xuanshen),Moutan cortex(danpi),Cortex dictamni(baixianpi),Herba violae(zihuadiding),Lophatherum gracile(danzhuye),etc.The common medicine suits were Spatholobi caulis(jixueteng)with Lonicerae japonicae caulis(rendongteng),Agastachis rugosae(huoxiang)with Eupatorium fortune(peilan),Figwort root(xuanshen)with Moutan cortex(danpi),Isatidis folium(daqingye)and Radix isatis(banlangen)with Cortex phellodendri(huangbai),Cicada slough(chanyi)with Fructus tribuli(baijili).(5)SDEDQXS group: this prescription medication added Radix isatis(banlangen),Isatidis folium(daqingye),Radix angelica sinensis(danggui),Spatholobi caulis(jixueteng),Taraxacum herb(pugongying),Lonicerae japonicae caulis(rendongteng),etc.The main medication included Radix rehmanniae(shengdi),Red peony root(chishao),Lonicerae flots(yinhua),Baical skullcap root(huangqin),Radix angelica sinensis(danggui),Radix fici hirtae(beiqi),Cicada slough(chanyi),Glabrous greenbrier rhizome(tufuling),Isatidis folium(daqingye),Radix isatis(banlangen),Fructus tribuli(baijili),Figwort root(xuanshen),Moutan cortex(danpi),Cortex dictamni(baixianpi),Coix seed(yiyiren),etc.The common medicine suits were Figwort root(xuanshen)and Moutan cortex(danpi)with Cortex dictamni(baixianpi),Spatholobi caulis(jixueteng)with Lonicerae japonicae caulis(rendongteng),Isatidis folium(daqingye)with Radix isatis(banlangen),Cicada slough(chanyi)with Fructus tribuli(baijili).(6)SDDELDBD group: because there were only two cases with this type of syndrome,principal component analysis and cluster analysis couldn’t be performed.However,according to the composition of the medication,this prescription mainly contained medication of Wan-Shi liquid and Xiao-Yao pill.6.The correction between symptoms/signs and Chinese medicine(1)The frequency of symptoms and signs: there were 51 kinds of symptoms and signs in this study.The results showed that those more than 90% were distraction,crack tongue,rash,erythema,weariness,thirst,insomnia,upper limbs areas,slippery pulse,red tongue,lower limbs areas,desquamation,dark yellowish coating and strong itchiness.Those symptoms/signs in range of50%-90% were emaciation,rough,burning,medium-thick coating,pigmentation,face areas,neck areas,dryness coating,indented tongue,back areas,and fat-soft tongue.Those in range of 10%-50% were abdomen areas,moister coating,dizziness,head area,thin coating,scabby,waist areas,complexion deficiency,breast swelling,and pachyderma.Those less than 10% were obvious itchiness,dark yellow coating,abdominal distension,pink tongue,greasy coating,erosion,slippery-rapid pulse,less seepage,genitals areas,ear areas,chest areas,blister,slippery-slow pulse,thick coating,wiry-rapid pulse,thread-rapid pulse,more seepage,and soft pulse.(2)The frequency of Chinese medicine: there were 72 kinds of medicine.Those whose frequency were more than 90% were radix rehmannia(shengdi),red peony root(chishao),radix saposhnikoviae(fangfeng),licorice(gancao),and lonicerae flots(yinhua).Those in range of 50%-90% were baical skullcap root(huangqin),radix fici hirtae(beiqi),fructus tribuli(baijili),glabrous greenbrier rhizome(tufuling),coix seed(yiyiren),cicada slough(chanyi),herba violae(zihuadiding),eupatorium fortune(peilan),agastachis rugosae(huoxiang),lophatherum gracile(danzhuye),and chrysanthemum(juhua).Those in range of 10%-50% were figwort root(xuanshen),moutan cortex(danpi),cortex dictamni(baixianpi),radix angelica sinensis(danggui),polygonum multiflorum(heshouwu),isatidis folium(daqingye),radix isatis(banlangen),schisandra chinensis(wuweizi),fried jujube kernel(chaozaoren),white peony root(baishao),and tangerine peel(chenpi).And those less than 10% were spatholobi caulis(jixueteng),cortex phellodendri(huangbai),bupleurum root(chaihu),portulaca oleracea(machixian),poria cocos(fuling),lonicerae japonicae caulis(rendongteng),herba schizonepetae(jingjie),pairs polyphylla smith(caoheche),taraxacum herb(pugongying),largehead atractylodes rhizome(baizhu),rhizoma imperatae(baimaogen),zaocys dhumnades(wushaoshe),common anemarrhena(zhimu),Chinese wolfberry(gouqi),radix lithospermi(zicao),alisma orientalis(zexie),Chinese rhubarb(dahuang),fructus kochiae(difuzi),sophora japonica.L(huaihua),Hedyotis diffusa(baihuasheshecao),prepared rehmannia root(shudi),Ligusticum wallichii(chuanxiong),Radix ophiopogonis(maidong),Sesame seed(humaren),Radix asparagi(tiandong),Tortoise plastron(guiban),salvia miltiorrhiz bunge(danshen),radix puerariae(gegen),capillary wormwood herb(yinchenhao),sophora flavescens ait(kushen),dioscorea opposita thunb(huaishan),almond(xingren),loquat leaf(pipaye),epimedium(xianlingpi),and magnolia officinalis(houpo).(3)Common and subordinate symptoms/signs and Chinese medicine: In this study,we difined symptoms/signs and Chinese medicine which were more than10% as common symptoms/signs and common Chinese medicine.At the same time,those symptoms/signs and Chinese medicine less than 10% were defined as subordinate symptoms/signs and subordinate Chinese medicine.Common and subordinate symptoms/signs were referenced in “the frequency of Symptoms/signs”.Moister tongue,pink tongue,and thin coating are the normal signs,so they were not factored into statistics.Common and subordinate Chinese medicine were referenced in “the frequency of Chinese medicine”.(1)common symptoms/signs and common Chinese medicinea)common pathological areas: some common Chinese medicine were statistically related with some common pathological areas,but absolute value of these correlation coefficient all were less than 0.3.b)common skin lesions: Among them,there were low positive correlation between pachyderma and figwort root(xuanshen),moutan cortex(danpi),cortex dictamni(baixianpi),and the correlation coefficient were 0.305,0.3056,0.3758,respectively.And there were low negative correlation between pachyderma and the use of Cicada slough(chanyi),agastachis rugosae(huoxiang),eupatorium fortune(peilan),lophatherum gracile(danzhuye),fructus tribuli(baijili),and the correlation coefficient were-0.3833,-0.4284,-0.4316,-0.3841,-0.3231,respectively.c)strong itchiness and burning symptoms: there was low negative correlation between radix rehmannia(shengdi)and burning of skin.The correlation coefficient was-0.405.d)common features of tongue and pulse: About tongue body,the results showed that there were low negative correlation between lophatherum gracile(danzhuye)and fat-soft tongue,and the correlation coefficient was-0.3512.There were low positive correlation between fat-soft tongue and figwort root(xuanshen),moutan cortex(danpi),cortex dictamni(baixianpi).Their correlation coeffient were 0.3372,0.3372,0.3646,respectively.Meanwhile,there was low negative correlation between lophatherum gracile(danzhuye)and indented tongue,and the correlation coefficient was-0.4088.Some common features of tongue coating and pulse were statistically correlated with some common Chinese medicine,but absolute value of correlation coefficient was less than 0.3.e)common concomitant symptoms: some common concomitant symptoms were statistically correlated with some common Chinese medicine,but absolute value of correlation coefficient was less than 0.3.(2)Subordinate symptoms/ signs and subordinate Chinese medicinea)subordinate pathological areas,skin lesions,obvious itchiness,tongue features,pulse characters and abdominal distension: there were low positive correlation between obvious itching and the use of Herba schizonepetae(jingjie),and the correlation coefficients was 0.4226.The remaining of them were statistically correlated with some subordinate Chinese medicine,but absolute value of correlation coefficient all was less than 0.3.b)subordinate pulse characters: in patients with eczema,there was low positive correlation between slippery-rapid pulse and the use of Chinese rhubarb(dahuang),and the correlation coefficient was 0.3083.There were low positive correlation between soft pulse and the use of Chinese wolfberry(gouqi)and alisma orientalis(zexie),and the correlation coefficients were 0.3117 and 0.405,respectively;there were medium positive correlation between this sign and the use of dioscorea opposita thunb(huaishan)and salvia miltiorrhiz bunge(danshen),and the correlation coefficients were 0.706 and 0.5755,respectively;there were high positive correlation between this sign and the use of radix aucklandiae(muxiang),aflatoxin(shenqu),and radix codonopsis(dangshen),and all of correlation coefficients were 1.In additon,there waslow positive correlation between the use of radix lithospermi(zicao)and this sign,and the correlation coefficient was 0.3744;there was medium positive correlation between the use of salvia miltiorrhiz bunge(danshen)and this sign,and the correlation coefficient was 0.5755;and the use of fructus mume(wumei)and uncaria(gouteng)were high-positively correlated with slippery-slow pulse,and all of correlation coefficients were 1.Besides,there were low positive correlation between the use of Chinese wolfberry(gouqi)and these two pulses.And both of correlation coefficients were 0.3117.Conclusion1.The development of eczema is closely related to gene.Limps are the predilection sites of this disease.In this study,skin lesions of eczema are commonly rash and erythema,and patients often feel itchy and scorching.Other common symptoms and signs includes red and crack tongue,dark yellowish and dry tongue coating,slippery pulse,distractedness,feeling thirsty,weary,insomnia and emaciation.2.Symptoms and signs of patients with different syndromes have certain characteristics.For patients with EDYDBDLH,their eczema location is common in the waist,and appears erosion.They have variety pulses,such as slippery-rapid pulse,wiry-rapid pulse,slippery-slow pulse,and thread-rapid pulse.For patients with EDQDBDWH,their neck and back are prone to eczema.The common symptoms and signs are rash,slippery pulse and abdominal distension.Common symptoms and signs of patients with EDYDBDWH include pachyderma skin,fat-soft tongue or/and indented tongue,dry tongue coating.Pachyderma skin is also common in patients with DASBDWH and SDDELDBD.3.Wan-Shi liquid could be used as the basic prescription for eczema patients with various syndromes.The common medicine suits are Schisandra chinensis(wuweizi)with Fried jujube kernel(chaozaoren),Figwort root(xuanshen)and Moutan cortex(danpi)with Cortex dictamni(baixianpi),Lonicerae flots(yinhua)and Baical skullcap root(huangqin)with Glabrous greenbrier rhizome(tufuling),Isatidis folium(daqingye)with Radix isatis(banlangen),Agastachis rugosae(huoxiang)with Eupatorium fortune(peilan),Cicada slough(chanyi)with Fructus tribuli(baijili),Spatholobi caulis(jixueteng)with Lonicerae japonicae caulis(rendongteng),Bupleurum root(chaihu)with White peony root(baishao).This will provide reference for clinical applications.4.For patients with blister,zaocys dhumnades(wushaoshe)is suitable.For patients with obvious itching,Herba schizonepetae(jingjie)is suitable.For patients with soft pulse,it is necessary to identify deficient syndrome and Dampness syndrome.Those patients with deficient syndrome can use radix codonopsis(dangshen),aflatoxin(shenqu),radix aucklandiae(muxiang),dioscorea opposita thunb(huaishan),salvia miltiorrhiz bunge(danshen)and Chinese wolfberry(gouqi).For patients with Dampness syndrome,alisma orientalis(zexie)is suitable.Fructus mume(wumei),uncaria(gouteng),salvia miltiorrhiz bunge(danshen),radix lithospermi(zicao)are suitable for patients with eczema and slippery-slow pulse.For patients with wiry-rapid and thread-rapid pulses,Chinese wolfberry(gouqi)is consideral.These are the characters of treatment in patients with eczema for signs.This needs more samples and prospective study to confirm and enrich these content. |
