劉擁軍 于澤宇 于海潮

扁平疣，中醫(yī)稱之為 “扁瘊”，是一種表皮良性贅生物，表面光滑，質硬，數(shù)目較多，長期存在可融合成片［1］。扁平疣在疣類皮膚病中發(fā)病率較高，且病程漫長，易反復發(fā)作，因影響美觀，給患者造成了一定的心理負擔?；疳樖菍⑻囟ㄡ樉邿裏岷蟠倘胩囟ú课坏囊环N傳統(tǒng)中醫(yī)療法，其在皮膚病的治療中效果突出。濕潤燒傷膏是一種具有清熱解毒、斂瘡生肌作用的中藥制劑，常用于燒傷及潰瘍創(chuàng)面的治療，對熱毒型瘡癰亦有顯著療效。因此，筆者采用火針聯(lián)合濕潤燒傷膏對30例風熱毒蘊型扁平疣患者進行了治療，以期尋找一種較為理想的扁平疣治療方法，現(xiàn)報告如下。

Flat warts， also known as “verruca plana” in Chinese medicine，are benign neoplasms with smooth surface，hard in texture and large in number，and can connect with each other to form a big piece if they exist on patients’ skin for a long time［1］.Flat warts have a higher incidence among various warts and are characterized by long course of disease and frequent relapse.They may have impact on the physical appearance to cause psychological burden on patients.Fire needle therapy is a traditional Chinese medical therapy that uses customized and heated needles to puncture a certain body part，presenting good effect in treating skin diseases.MEBO is a traditional Chinese medical preparation with the effect of clearing heat and detoxifying，healing sore and promoting granulation tissues，which is often used for the treatment of burns and ulcerative wounds，and also has significant curative effect on heat-toxic ulcerative carbuncle.Therefore， in this study， fire needle and MEBO was combined to treat 30 patients with flat warts of wind-heat and toxic type，in hopes of finding a better way of treating flat warts.

1 臨床資料

1.Clinical data

1.1 一般資料

本組患者共60例，均為2017年12月至2018年12月黑龍江中醫(yī)藥大學附屬第二醫(yī)院皮膚科收治的風熱毒蘊型扁平疣患者，按照隨機數(shù)表法將其隨機分為治療組 （30例）和對照組 （30例），其中治療組男性16例、女性14例，年齡 （24.07±6.33）歲，病程（12.90±7.63）個月；對照組男性18例、女性12例，年齡 （24.10±5.09）歲，病程（14.07±5.09）個月。兩組患者性別分布情況、年齡及病程對比，P均＞0.05，差異無統(tǒng)計學意義，具有可比性 （表1）。本研究經(jīng)黑龍江中醫(yī)藥大學附屬第二醫(yī)院倫理委員會批準，且所有患者均簽署了知情同意書。

1.1.General data

Sixty patients with flat warts admitted to the Dermatology Department of The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine， were divided， according to the random number table，into a treatment group （30 cases） and a control group （30 cases）.In the treatment group， there were 16 males and 14 females， aged（24.07±6.33） years old，with the course of disease（12.90±7.63）months， while in the control group， there were 18 males and 12 females，aged（24.10±5.09） years old，and with the course of disease（14.07±5.09） months.The gender distribution， age and course of disease were respectively compared between the two groups，and the results showed no statistically significant difference（all P＞0.05），presenting comparability （Table 1）.The study was approved by the Ethics Committee of The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine and all patients signed the informed consent.

1.2 納入標準

（1）符合 《中醫(yī)皮膚科常見病診療指南》［2］中風熱毒蘊型扁平疣的診斷標準者；（2）年齡在18～65歲之間，且具有獨立行為能力者；（3）依從性良好，能夠配合醫(yī)務人員完成規(guī)定療程治療者；（4）對本研究知情，并自愿簽署知情同意書者。

1.2.Inclusion criteria

（1） Those who meet the diagnostic criteria for flat warts of windheat and toxic type in the“Guidelines for Diagnosis and Treatment of Common Diseases in TCM Dermatology”［2］； （2） those who aged between 18 and 65 years old， with good independent behavior capability；（3） patients with good compliance and are willing to follow medical staff’s advice to complete the prescribed course of treatment； （4） those who are well informed of this study and can voluntarily sign the informed consent.

1.3 排除標準

（1）入選前4周內進行過與此疾病相關治療者； （2）對本研究所用藥物成分過敏者；（3）合并有嚴重免疫力低下、肝腎功能不全、高血壓、糖尿病、惡性腫瘤、心腦血管疾病者；（4）哺乳期或妊娠期婦女； （5）同時參加其他藥物臨床試驗者；（6）患有傳染性疾病者；（7）屬于瘢痕體質，不宜進行火針治療者；（8）對火針治療有恐懼心理或暈針者；（9）皮損位于眼周等薄弱處，不宜進行火針治療者。

1.3.Exclusion criteria

（1） Those who had been treated with drugs related to the disease within 4 weeks prior to enrollment； （2） those who are allergic to theingredients used in this study； （3） patients with severe hypoimmunity，liver and renal insufficiency， hypertension， diabetes mellitus， malignant tumor， cardiovascular and cerebrovascular diseases； （4） women in gestation or pregnancy； （5） Those who are also taking part in clinical trials of other drugs； （6） patients with infectious diseases； （7） those who have scar diathesis and are not suitable for fire needle therapy； （8）those who fear fire needle therapy or suffer needle sickness； （9） those with skin damage at delicate areas， such as around the eyes， and therefore not suitable for fire needle therapy.

表1 兩組患者一般資料對比Table 1 Comparison of general data between the two groups

2 方法

2.Methods

2.1 治療方法

對照組：患者取合適體位，醫(yī)務人員將常規(guī)消毒后的26號1寸針灸針于酒精燈火焰上由針身到針尖燒至發(fā)白，隨后迅速對準疣體頂部進行垂直點刺 （深度不宜超過皮損基底部），并迅速拔出 （若皮損融合成片，可用梅花針密集點刺，間距0.3～0.5 cm），每3～5 d治療1次，連續(xù)治療4周。

2.1.Treatment

Control group：patients were placed in an appropriate body position.Medical staff put disinfected acupuncture needle （No.26，1-inch needle）on the flame of alcohol lamp to burn it to the point where the needle turned white from the body to the tip，and then quickly punctured vertically at the top of warts（do not exceed the base of the injured part in depth） and then pulled it out in a swift manner（If the injured parts are connected into a whole piece，use a plum-blossom needle to prick in dense manner， with an interval of 0.3 to 0.5 cm）.Such treatment was performed every 3-5 days for 4 consecutive weeks.

治療組：按照對照組的治療方法進行火針點刺后，皮損部位均勻涂抹濕潤燒傷膏（汕頭市美寶制藥有限公司生產(chǎn)，國藥準字Z20000004），厚約1.0 mm，每4～6 h換藥1次，每次換藥時將殘留藥膏拭凈后再涂抹新鮮藥膏，連續(xù)治療4周。

Treatment group：After the fire needle therapy as did in the control group，a layer of MEBO about 1.0 mm in thickness was evenly applied on the injured parts（manufactured by Shantou MEBO Pharmaceutical Co.， Ltd.， SFDA approval number Z20000004）.The fire needle therapy was performed once every 3-5 days and the dressing change with MEBO was conducted every 4-6 hours.Residual ointment should be wiped away before applying new one each time.The treatment lasted for 4 weeks.

注意事項：火針治療前為患者講解火針治療的操作方法，消除其緊張情緒和恐懼心理，防止暈針；針刺時應迅速淺刺，迅速拔出，不留針；點刺過程中若有出血，待血液自然流出后用無菌干棉球拭凈；針刺后24 h以內不宜沾水，以防感染；治療期間囑患者勿用酒精、肥皂等刺激物擦洗患處，針刺處結痂后避免搔抓。

Note：Explain the procedure of fire needle therapy to patients before the therapy to relieve their tension and fear and avoid needle sickness.Perform shallow puncture in a swift manner-prick and pull out the needle quickly.If bleeding is observed during the puncturing，clean the pinhole with sterile dry cotton ball after bleeding.To prevent infection，make sure to keep the pinhole out of contact with water within 24 h after puncturing；warn patients not to scrub or wash the affected area with stimulants such as alcohol or soap during the treatment.

2.2 觀察指標及療效判定標準

治療4周后，參照 《中醫(yī)病證診斷療效標準》［3］判定兩組患者的臨床療效：痊愈，皮損全部消退，僅留或不留色素沉著，且無新皮損出現(xiàn)；顯效，皮損消退70%以上，僅有極少量新皮損出現(xiàn)；有效，皮損消退30%～70%，有少量新皮損出現(xiàn)；無效，皮損消退30%以下或增多；總有效率=（痊愈例數(shù)+顯效例數(shù)+有效例數(shù)） ／總例數(shù)×100%。

2.2.Observational indexes and assessment criteria of curative effect

After 4 weeks of treatment，the curative effect of the two groups was evaluated by referring to the“Standards for Diagnosis and Curative Effect of TCM Syndromes”［3］.Cured： all skin lesions subsided and only some pigmentation or no pigmentation can be observed，and no new skin lesions appear； markedly effective： skin lesions subsided by more than 70%，only few new skin lesions can be observed；effective：skin lesions subsided by 30%to 70%and a few new skin lesions appeared；ineffective： skin lesions subsided by less than 30%or increased in area； Total effective rate= （number of cured cases+number of markedly effective cases+number of effective cases） ／total number of cases×100%.

2.3 統(tǒng)計學處理

采用SPSS 22.0統(tǒng)計軟件對所得數(shù)據(jù)進行統(tǒng)計學分析，其中計數(shù)資料以頻數(shù)或百分比表示，采用卡方檢驗或秩和檢驗；計量資料以均數(shù) ±標準差 （±s） 表示， 采用t檢驗或t＇檢驗；均以P＜0.05為差異具有統(tǒng)計學意義。

2.3.Statistical analysis

The SPSS 22.0 software was adopted to analyze the study data，in which the chi-square test or the rank sum test were applied to manage the count data expressed with frequency or percentage while thettest ort＇test was used to manage the measurement data expressed with （±s）.P＜0.05 was considered as statistically significant difference.

3 結果

治療4周后，治療組患者中痊愈7例，顯效16例，有效5例，無效2例，總有效率為93.33%；對照組患者中痊愈3例，顯效8例，有效 13例，無效 6例，總有效率為80.00%。兩組患者臨床療效對比，P＜0.05，差異具有統(tǒng)計學意義 （表2）。

3.Results

After 4 weeks of treatment，the total effective rate in the treatment group was 93.33%，with 7 cases cured，16 cases markedly effective，5 cases effective and 2 cases ineffective，while that in the control group was 80.00%，with 3 cases cured，8 cases markedly effective，13 cases effective and 6 cases ineffective.The comparison of curative effect between the two groups showed significant statistic difference （P＜0.05） （Table 2）.

表2 兩組患者臨床療效對比 （例，%）Table 2 Comparison of curative effect between the two groups（n，%）

4 討論

4.Discussion

中醫(yī)學認為，扁平疣多為氣血失和，肌膚不密，風熱毒邪侵襲，蘊阻于肌膚所致［4］，治宜清熱解毒，活血通絡?，F(xiàn)代醫(yī)學認為，扁平疣是人乳頭瘤病毒感染所致［5-6］，其發(fā)生、發(fā)展及消退與機體免疫功能密切相關［7-8］。

火針是將針法和灸法相結合，借助針體將灼熱導入人體，焯烙病處，激發(fā)經(jīng)氣，鼓舞氣血運行［9］，溫壯臟腑之氣，通經(jīng)活絡，扶固正氣；現(xiàn)代醫(yī)學研究表明，火針可提高相應細胞及因子的免疫活性，增強機體的抗病毒能力［10-11］，有效治療扁平疣等病毒感染所致的免疫功能紊亂型皮膚?。?2］。此外，火針的灼熱之性還可化解有形之物，進而達到腐蝕贅疣的目的［13］，顯著改善扁平疣的癥狀，加速疣體消退。同時，火針作用于皮膚，使針孔周圍皮膚組織炭化，延長針孔閉合時間，有利于風熱毒邪的排出［14］。因此，需囑患者在針刺24 h內避免患處沾水，以防感染。濕潤燒傷膏是一種具有清熱解毒、消癰斂瘡功效的中藥制劑，其內含有的黃連、黃芩及黃柏具有清熱燥濕、瀉火解毒之功，罌粟殼及地龍具有活血化瘀、生肌收斂之效，可有效防治創(chuàng)面的經(jīng)絡阻塞及氣血凝滯［15］?，F(xiàn)代醫(yī)學研究表明，濕潤燒傷膏含有的黃芩甙、小檗堿等成分可破壞病原菌的生長環(huán)境，抑制其活性及毒性，提高機體的非特異性免疫功能［16］；可改善局部血液循環(huán)，減輕因組織缺氧對神經(jīng)末梢刺激引發(fā)的瘙癢，從而減少因搔抓造成的疣體自身接種［17］。

筆者于本研究中將火針與濕潤燒傷膏聯(lián)合應用于風熱毒蘊型扁平疣的治療。結果顯示，治療4周后，火針聯(lián)合濕潤燒傷膏治療組患者中痊愈7例，顯效16例，有效5例，無效2例，總有效率為93.33%，明顯優(yōu)于單純應用火針治療組患者的痊愈3例，顯效8例，有效 13例，無效 6例，總有效率80.00%，兩組對比，P＜0.05，差異具有統(tǒng)計學意義。可見火針聯(lián)合濕潤燒傷膏可明顯促進風熱毒蘊型扁平疣的消退，效果明顯優(yōu)于單純應用火針治療。其原因可能為：濕潤燒傷膏與火針聯(lián)合應用，可使藥物通過火針針孔滲入疣體內部，進而發(fā)揮更大的作用。

綜上所述，火針與濕潤燒傷膏聯(lián)合應用具有疏風清熱、解毒散結之效，可明顯促進風熱毒蘊型扁平疣的消退，療效顯著，值得臨床推廣應用。

From the point of view of traditional Chinese medicine，flat warts are mostly caused by disharmony between Qi and blood，wind heat invasion， and toxin congestion in skin［4］.Clearing away heat and toxic materials and promoting blood circulation to remove meridian obstruction shouldbe the treatment focus.Modern medicine believes that flat warts are caused by infection of human papilloma virus［5-6］， and their occurrence， development and regression are closely related to patients’ immune function［7-8］.

Fire needle therapy， combines needling and acupuncture， can introduce the burning heat of needle into human body， burn injured parts，stimulate qi-blood circulation， warm qi of zang-fu organs（internal organs）， unblock the meridians and strengthens the vital-Qi［9］.Modern medical research shows that fire needle can improve the immunological competence of cells and their factors， and enhance body’s antiviral ability［10-11］.Such a therapy is effective in treating flat warts and other skin diseases of immune dysfunction type caused by viral infection［12］.In addition，the scorching heat of the fire needle can also dissolve warts and other forms of neoplasm［13］， significantly reducing the symptoms and accelerating the regression of flat warts.Moreover，fire needle can carbonize the skin tissues around the pinholes to prolong the closure time of pinholes， thereby promoting the discharge of wind heat and toxin［14］.Therefore，patients should be warned not to get the injured part wet within 24 hours after the acupuncture to prevent infection.MEBO is a Chinese medical preparation with the effect of clearing heat and detoxifying，healing sore and promoting granulation tissues［15］.Modern medical research shows that the ingredients of MEBO，such as baicalin and berberine， can destroy the growth environment of pathogenic bacteria， inhibit their activity and toxicity，and improve the non-specific immune function of patients’ body［16］； it can also improve local blood circulation and relieve itching caused by stimulation of nerve endings resulting from hypoxia，thereby avoiding autoinoculation of flat warts induced by scratching［17］.

In this study，the authors combined fire needle therapy with MEBO in treating flat warts of wind-heat and toxic type.After 4 weeks of treatment，the results showed that the total effective rate in the treatment group was 93.33%，with 7 cases cured，16 cases markedly effective，5 cases effective and 2 cases ineffective，while that in the control group was 80.00%，with 3 cases cured，8 cases markedly effective，13 cases effective and 6 cases ineffective.The comparison of the curative effect between the two groups showed statistically significant difference（P＜0.05）.It can be concluded that fire needle combined with MEBO can significantly promote the regression of flat warts of wind-heat and toxic type，presenting superior curative effect to that of the simple application of fire needle.The mechanism might be that the combination of MEBO and fire needle allows the ointment to penetrate into warts through pinholes，thereby exerting a greater effect.

To sum up， fire needle combined with MEBO， with the effects of dispelling wind and clearing heat， resolving toxin and dissipating stasis，can promote the regression of flat warts of wind-heat and toxic type.This approach deserves to be promoted in clinical practice given its remarkable curative effect.

（收稿日期：2019-03-09）