Lean sores (Acne) are a common clinically common skin disease caused by chronic inflammatory lesions of the sebaceous units of hair follicles. The most common type is carcinosis vulgaris, which is characterized by staged, mixed lesions such as acne, inflammatory hilnolicity, pustules, nodules, cysts, and paralysis. Generally, the course of the disease is long, and although it is self-limited, it is prone to recurrent attacks.
At present, the rapid social and economic development, the quality of people's quality of life has gradually improved, the composition of diet has changed significantly, the pace of work and life has accelerated significantly, environmental pollution has become increasingly intensified, drug abuse and misuse, work and rest disorders, etc.
Under the influence of etiology and various triggers, the incidence of cancer ulcers is gradually increasing. A 2009 epidemiological survey of thin sores in college students in Guangzhou showed a prevalence of neoplasia of 36.4%], compared with 81.55% in 2020 [2].
Modern medical theoretical studies have shown that the causes of tumor sores are diverse and the pathogenesis is complex. In general, the following four processes are involved: colonization and proliferation of Propionibacterium paralyticus, androgen-induced seborrhea, hyperkeratosis of the sebaceous ducts of the hair follicles, and the body's immune response.
Propionibacterium lepionis metabolizes the release of non-acetated fatty acids, promotes the release of bioactive substances such as pro-inflammatory free short-chain fatty acids, and triggers an inflammatory response in host neoplasia[3].
Under the influence of androgens, sebum secretion increases, and 5-a reductase converts testosterone into stronger dihydrotestosterone, which binds to specific receptors in the sebaceous glands and increases sebum production.
Increased sebum leads to hyperplasia of the epidermis of hair follicles, so sebum is left in pigs. The inflated hair follicles rupture and release pro-inflammatory chemicals into the dermis, stimulating inflammation to occur and thus creating sores4].
Abnormal keratosis of the sebaceous ducts of the hair follicles leads to a smaller diameter of the sebaceous ducts of the hair follicles, and various metabolites accumulate in the inner mouth of the hair follicles, resulting in neoplasia [5].
The body's pro-inflammatory factors such as interleukin and tumor necrosis factor are released outside the cell under the stimulation of Propionibacterium carcinois, so that the inflammatory factors chemotaxis and the adaptive immune response are activated, resulting in the occurrence of tumor ulcers [6].
The understanding of tumor sores in Chinese medicine was first seen in the "Yellow Emperor's Internal Classic, Suwen, and the Theory of Vitality and Heaven": "Labor and sweat are the wind, cold is a drum, and Yu Nai tumor".
It is believed that the cause is when the wind is cold, qi and blood are not connected, Mao Yongyong Sai Song "Shengji General Record" said: "The face is also acne." The face is like a grain of rice, which is affected by the wind and evil by the skin and pancreas, and beats the qi of the jin vein. Because of the void, it is also evil into the virtual muscle to make it also", it is clear that "wrinkling" is "acne".
Later generations of physicians often used "acne" to refer to tumor sores. Ming "Authentic Surgery" has a saying: "Lung wind, acne, rosacea three of the same species, acne belongs to the lungs, slag belongs to the spleen, always blood heat stagnation."
For the first time, the classification of tumor sores was described, and it was believed that thin sores had the pathological process of blood heat stagnation and hair occlusion. And the Qing "Medical Sect Jinjian" said: "This certificate is formed by the blood heat of the lungs, each of which is broken and dug up on the face, nose, and crumbling, shaped like seasonal chips, red and painful, and breaking white powder juice."
The course of pathological changes in spasms is described in detail. This is basically consistent with the exposition of "Authentic Surgery", which believes that the etiology of thin sores is inseparable from "blood fever". From the above literature, it can be seen that Ming and Qing dynasty doctors associated tumor sores with internal organs, and believed that cancer sores came from the lungs through wind and heat, which is called "pulmonary wind acne", which is still used today.
On the basis of summarizing the theoretical research of predecessors and combining their own diagnosis and treatment experience, modern and modern medical practitioners have played a lot of role.
For example, Guowei believes that the onset of thin sores is not from the liver, heart, spleen and lungs, and its pathogenesis comes from the deficiency of the yin deficiency of the body, the imbalance of the yin and yang of the kidneys, and the hyperactivity of the phase fire, resulting in blood fever in the lungs and stomach, and paralytic sores on the upper head and face [7]. Liu Jingyuan explained the etiology and pathogenesis of cancer sores from wind, heat, phlegm and stasis.
Wind heat and yang evil, its sex is upward, wind and heat are attacking, and the body suffers, then cancer sores are more common on the face. Sputum and stasis are connotated, the qi machine is not smooth, the qi, blood and fluid cannot be infused normally, and the muscular surface is depressed, and acne and pus are present [8].
Cheng Yichun believes that the onset of tumor sores is mostly due to heat and evil, real or virtual. Those who are real, or feel external evil, or prefer spicy or vegetarian yang heat: those who are weak, or who have been ill for a long time consume fluid, or the five zhi are too extreme, or they are warm, hot and evil and inflamed skin, and they become tumors [9].
Modern medicine for the treatment of tumor sores includes: tretinoins, antibiotics, antiandrogen hormones, salicylic acids, chemical peels.
These drugs have greater side effects and are more irritating to the skin, while antibiotic resistance has increased in recent years, resulting in poor patient compliance.
Moreover, tretinoin has teratogenic effects on the fetus, and cancer sores are not only more common in female patients, but also most common in the childbearing age, resulting in the restriction of medication for women of childbearing age.
TCM adopts dialectical treatment to individualize the treatment of lean sores. "Guidelines for the Treatment of Thin Sores" (2019 Revised Edition)[10 will be divided into 4 types: lung meridian wind fever, spleen and intestine moist fever, stasis coagulation certificate, and rush and no adjustment certificate.
Commonly used internal prescriptions are Loquat Clear Lung Drink, Epsom Baisan, Yin Chen Artemisia Soup, Ephedra Forsythia Red Bean Soup, Cen Lianping Stomach Powder, Peach Four Things Soup, Xiaoyaosan, Erxian Tang Hezhi Baidi Huang Soup, etc. External treatments include Chinese herbal wet compresses, Chinese medicine masks, acupuncture, piercing cupping, ear point bean pressing, etc.
In the process of clinical diagnosis and treatment, the researchers found that the treatment effect of some patients with tumors, whether traditional Chinese medicine, western medicine or combination of traditional Chinese and western medicine, was not satisfactory, and some patients were prone to repeated attacks.
Early clinical observations have shown that some patients have a negative impact on life and work due to the disfiguration of tumor sores, resulting in anxiety and depression, and the effect can be improved by liver thinning and qi treatment: some favorites are humid and hot constitution, wet viscosity.
Not only is it easy to lead to the prolongation of the course of the disease, but also the humid heat and the body humid heat "seek the same qi", but also easy to cause the recurrence of cancer sores, after the use of ephedra forsythia red bean soup to clear heat and remove dampness, not only the treatment effect is improved, but also the recurrence of the benefit is reduced.
With the public's attention to health, the theory of constitution has gradually emerged, and many doctors have carried out research on the correlation between disease symptoms and individual constitution on the basis of clinical research.
The relevant research results of Wang Qi's team on constitution show that constitution plays an indispensable role in the whole process of disease occurrence, development and prognosis [11· 12].
In the process of clinical follow-up, the researchers found that the difference in constitution makes individuals different susceptibility to diseases and causes, so some constitutions will lead to individual susceptibility to tumor sores, and different constitutions will also cause tumor patients to show different symptoms.
Therefore, analyzing the correlation between physical constitution and TCM symptoms can formulate individualized treatment plans for patients with thin sores, which can improve the treatment efficiency of patients with paralytic sores, so as to highlight the characteristics and advantages of TCM differentiation and treatment compared with modern medicine in the treatment of cancer sores.
Previous studies have shown that the sex hormone disorder in female tumor sores is mainly manifested as increased androgens [1314], but the investigators found that the sex hormone disorders in patients were mainly decreased by follicle-stimulating hormone (FSH) and estradiol (E2), and the incidence of hyperandrogenemia decreased compared with the previous one, and the reasons for this change need to be further studied.
In clinical practice, researchers have also found that patients with tumor sores often have bad living habits, such as cravings for spicy and greasy, staying up late, and short sleep time. Therefore, poor diet and rest habits may be a risk factor for the development of lean sores.
This study intends to explore the pathogenesis of tumor disease vulgaris from various aspects such as TCM symptom type, TCM constitution, emotional state and related influencing factors, and analyze the distribution characteristics of medical symptom type, constitution and emotional state of patients with tumor vulgaris.
The relevant influencing factors were studied, and the relationship between the three and common tumor ulcers was explored, in order to open up a new idea of disease differentiation and body discrimination for clinical treatment of sores, so as to better guide individualized treatment and enrich the clinical prevention and treatment methods of cancer sores.