Diagnostic and efficacy criteria for dermatological diseases in Chinese medicine
1. Main content and scope of application
This standard specifies the names, diagnostic basis, classification of symptoms and assessment of efficacy of 42 diseases in the Department of Dermatology of Traditional Chinese Medicine. Feng Jianqing, Department of Dermatology, Taicang City Hospital of Traditional Chinese Medicine
This standard is applicable to clinical medical quality assessment of TCM, and TCM scientific research and teaching can also be used for reference.
2. Diagnostic basis, classification of symptoms, and assessment of efficacy of yellow sores
Yellow water sores are a kind of infectious skin disease characterized by yellow water and immersion in patches due to poisonous heat in the skin and hair. It is comparable to impetigo.
2.1 Diagnostic basis
2.1.1 The skin lesions are shallow in-between blisters and pustules, surrounded by a red halo, easily broken, eroded and crusted. After debridement, pale brown pigmentation remains and no scarring is left.
2.1.2 Most often occurs on exposed areas such as the face and extremities. It is easily infected by contact and has the characteristic of self-inoculation.
2.1.3 Prevalent in children, adults can also be infected. It is common in summer and autumn.
2.1.4 Slightly itchy and may be accompanied by enlarged lymph nodes nearby.
2.2 Classification of symptoms
2.2.1 Summer heat and dampness: dense pustules with yellow color surrounded by a red halo, bright red erosion surface, dry mouth, dry stool, yellow urine. The tongue is red, the coating is yellow and greasy, and the pulse is moist and slippery.
2.2.2 Spleen deficiency with dampness: pustules are sparse, grayish white or yellowish, and the erosion surface is light red. There is mostly yellow face, little food and loose stools. The tongue is pale, the coating is thin and slightly greasy, and the pulse is moist and thin.
2.3 Assessment of curative effect
2.3.1 Cured: all rashes subsided.
2.3.2 Improved: no new pustules or blisters, rash dried up and crusted, and more than 50% of skin lesions receded.
2.3.3 Not healed: no reduction of skin lesions or less than 30% remission.
3 Diagnostic basis, classification of symptoms and assessment of efficacy of runny skin
It is a skin disease with dark red infiltrated patches with brownish-red nodules on the surface and atrophic scar formation after healing. It is equivalent to common lupus.
3.1 Diagnostic basis
3.1.1 The skin lesions start as pinpoint to soybean-sized, bright red or maroon infiltrative nodules, which gradually expand and fuse into patches, with a non-fading applesauce-colored nodule visible on the slide.
3.1.2 The onset is often unilateral and can occur anywhere in the body, especially in the nose, mouth, cheeks and ears of the face.
3.1.3 The course of the disease is slow and the spontaneous symptoms are not obvious.
3.1.4 It can occur at any age, with children and youth being the most common.
3.1.5 Pathological examination shows tuberculous nodular changes, with caseous necrosis in the center.
3.2 Classification of symptoms
3.2.1 Damp-heat stagnation: Soybean-sized maroon nodules on the face, surrounded by infiltration and fusion, or with ulcers. Accompanied by poor appetite, irritability and irritability. The tongue is light red or red at the edges, the coating is greasy or yellowish, and the pulse is stringent and slippery.
3.2.2 Qi and blood deficiency: dark red or pale red patches on the face, nodular infiltration, thin pus, depression of old scars, dark new ulcers, accompanied by fatigue, low fever and night sweating, and poor appetite. The tongue is pale, the coating is thin and white, and the pulse is thin and slow.
3.3 Evaluation of curative effect
3.3.1 Cured: The skin lesion is completely receded, the wound surface is healed, and no new rash appears.
3.3.2 Improved: the skin lesions are healed by more than 50%.
3.3.3 Not healed: lesions as before, there is still a new rash constantly appearing or less than 30% of the healed lesions.
4 Diagnostic basis, classification of symptoms, assessment of efficacy of gangrene
Gangrene is a sore that occurs in the lower leg and is characterized by a dark red hard nodule that can ulcerate and does not close for a long time, similar to a hard red spot.
4.1 Diagnostic basis
4.1.1 The lesion begins as a tough, mobile subcutaneous nodule the size of a pea, gradually increasing in size and adhering to the skin in a dark red or greenish-purple color. It may break down and form ulcers, which are not easy to heal and leave atrophic scars after healing. Self-perceived slight tenderness.
4.1.2 Symmetrically distributed in the lower and middle flexors of the calf. It passes slowly and occurs in spring and autumn.
4.1.3 Most often seen in young women.
4.1.4 Previous history of tuberculosis or concomitant visceral tuberculosis.
4.1.5 Strongly positive tuberculin test.
4.1.6 Histopathological examination: epidermal atrophy and sloughing, mainly infiltrating the deep dermis, composed of mostly epithelioid cells, lymphocytes and containing a few Langan giant cells.
4.1.7 It should be differentiated from gourd vine tangle.
4.2 Classification of symptoms
4.2.1 Damp-heat stasis: dark red nodules with obvious pressure pain, mostly with low fever, aching calves, poor appetite and dry stool. Red tongue, thin white coating, thin or counted pulse.
4.2.2 Deficiency of qi and blood: nodule ulceration, thin pus, long-standing failure to close, accompanied by fatigue, poor appetite and loose stools. The tongue is pale, the coating is thin, and the pulse is sunken and weak.
4.3 Assessment of curative effect
4.3.1 Cure: All skin lesions fade away and self-conscious symptoms disappear. -4.3.1 Cured
4.3.2 Improvement: the nodules become smaller and the symptoms are reduced by about 50%.
4.3.3 Not cured: lesions remain the same or less than 30% of the nodules disappear. No change in symptoms.
5 Diagnostic basis, classification of symptoms, and assessment of efficacy of fatty sores
Fat sores are a kind of ringworm that occurs mostly on the head, characterized by yellow crusts and balding hair. It is comparable to ringworm.
5.1 Basis for diagnosis
5.1.1 The scalp is covered with a thick yellow scab in the shape of a dish with the odor of rat urine, the center of which is sticky and has hair passing through it, and the hair becomes yellow and bent, easy to pull out but not broken. At first, it is the size of a penny, but for a long time it can spread to the whole scalp and finally form an atrophic scar, leaving permanent baldness with only a circle of hairs left along the hairline of 1cm. Itching is often secondary to infection, and abscesses can be formed.
5.1.2 The course of the disease is slow and can be prolonged for decades.
5.1.3 Onset is mostly in childhood, with a history of close contact with the same patient.
5.1.4 Fungal examination: dark green fluorescence under filtered UV lamp. Fungal culture of the causative organism was S. xanthus. Microscopic examination shows intra-hair spores and antler-like mycelium and air sulcus bubbles.
5.2 Classification of symptoms
5.2.1 Feng damp poisonous gathering: yellow scab and filthy, hair withered and easy to fall, itchy and endless, roaming and diffuse. Tongue red, coating thin, pulse floating or slippery.
5.2.2 Damp-heat poisonous gathering: yellow scab sticking, flushed scalp, painful when pressed, vesicles overflowing pus. With cold, heat, headache, thirst and dry throat. Red tongue, yellow or greasy coating, slippery pulse.
5.3 Assessment of curative effect
5.3.1 Cured: Clinical symptoms and signs disappear. The fungal examination is negative for three consecutive times or negative under filtered ultraviolet light.
5.3.2 Improvement: Pruritus and other symptoms are obviously reduced, more than 50% of the scabs are shed, and the fungal examination is still positive, or dark green fluorescence is still seen under the filtered UV lamp.
5.3.3 Failure to heal: no change in symptoms, less than 30% relief of signs, and still positive on fungal examination.
6 Diagnostic basis, classification of symptoms, and assessment of efficacy of white baldness
White baldness is a kind of ringworm that occurs mostly on the head and is characterized by white flakes and broken hairs over time. It is comparable to ringworm.
6.1 Basis of diagnosis
6.1.1 The lesions are mostly on the top of the head and appear as round white scaly patches as large as coins or beans with clear boundaries. The hair in the lesion is lusterless and breaks at 2-5 mm from the scalp, leaving no scar after the disease. Self-perceived pruritus.
6.1.2 Prevalent in school-age children, more males than females, often prevalent in collective units. There is a history of close contact with the same patient or with sick cats or dogs.
6.1.3 Fungal examination: bright green fluorescence under filtered UV lamp, fungal culture with pathogenic bacteria such as Microsporum spp. and Trichophyton spp.
6.2 Classification of symptoms.
6.2.1 Blood deficiency and wind dryness: the lesions are grayish-white patches, itching, dry hair, easy to break, and dull yellow face. Light red tongue, thin white coating, moist and thin pulse.
6.2.2 Damp-heat poisonous gathering: lesions are erythematous and swollen, with papular pustules and yellow scabs, mostly with fever and body pain. The tongue is red, the coating is thin and yellow, and the pulse is smooth.
6.3 Assessment of curative effect
6.3.1 Cured: symptoms and signs disappear, hair growth is normal. Re-examination of the fungus is negative for three consecutive times, or filtered UV lamp check negative pieces.
6.3.2 Improvement: symptoms are obviously reduced, scaly spots are reduced by more than 50%, fungus is still positive in the re-examination, or bright green fluorescence is still visible under the filtered UV lamp.
6.3.3 Failure to heal: no remission of symptoms and signs or less than 30% reduction of scaly patches.
7 Diagnostic basis, classification of symptoms, and assessment of efficacy of ringworm
Tinea versicolor is a type of ringworm that occurs on smooth skin and is characterized by an itchy, coin-like rash with a curved outline. It is equivalent to tinea corporis.
7.1 Diagnostic basis
7.1.1 The lesions are round or shapeless, with inflammatory papules on the edges that gradually expand outward and may also be concentric or polycyclic in shape, and adjacent lesions may also fuse with each other in a wreath-like pattern. The surface is covered with fine scales, often with a central tendency to heal itself, and itching is obvious.
7.1.2 Prevalent on the face, neck, axilla and other sweaty and humid areas, mostly seen in obese body shape, often occurring in the summer rainy season.
7.1.3 Fungal culture or microscopic examination, commonly Microsporum spp, Trichophyton spp and S. epidermidis are the causative agents.
7.2 Classification of symptoms
7.2,1 Wind-damp skin: rash like coins, gradually expanding, itching without rest. The tongue is light red, the coating is white and greasy, and the pulse is slippery.
7.2.2 Damp-heat toxic aggregation: skin lesions appear as wreaths of red spots with pustules, mild pain, erosion and crusting, or discomfort with low fever. Red tongue, thin coating, and number of pulse.
7.3 Assessment of curative effect
7.3.1 Cured: symptoms and signs disappear. The second consecutive negative fungal recheck.
7.3.2 Improvement: Itching is obviously reduced, the rash subsides more than 30%, and the fungal results are still positive.
7.3.3 Not healed: no relief of symptoms and signs or less than 30% remission of rash.
8 Goose palm wind diagnosis, classification of symptoms, efficacy assessment
Goose palm wind is a skin disease that occurs on the palm of the hand, characterized by rough, thickened and cracked skin. It is comparable to tinea cruris.
8.1 Diagnostic basis
8.1.1 Localized erythematous flaking of the palms with distinct boundaries, dry and cracked skin, or even the entire palm skin is thickened, rough, cracked, and flaky, or blisters or vesicles may appear. Self-perceived itching or itching is not obvious.
8.1.2 Mostly starts at the tip of one finger or the interphalangeal area. Often secondary to foot dampness.
8.1.3 Fungal culture or microscopic examination is mostly positive, often with S. epidermidis and Trichophyton spp. as the causative agents.
8.2 Classification of symptoms
8.2.1 Rheumatic skin: blisters on the palms or between the fingers are like crystals, dry and flaky, with obvious boundaries and gradual expansion. Or the fingers are red, wet and rotten. Red tongue, white or greasy coating, smooth pulse.
8.2.2 Blood deficiency and wind dryness: palm skin is thick, rough, dry and cracked. Or blisters do not appear, dry and flaky. Pale red tongue, thin coating, thin pulse.
8.3 Assessment of curative effect
8.3.1 Cured: clinical symptoms and signs disappear, and the skin returns to normal. The fungus is negative for two consecutive times.
8.3.2 Improvement: symptoms are significantly reduced, skin lesions fade in more than 50%. Re-examination of fungus negative or positive.
8.3.3 Not healed: no change in clinical symptoms and signs.
9 Diagnostic basis, classification of symptoms and assessment of efficacy of foot dampness
Dampness of the feet is a skin disease that occurs on the feet and is characterized by white spots on the feet or blisters between the plantars and toes. It is equivalent to tinea pedis.
9.1 Diagnostic basis
9.1.1 Interdigital maceration, covered with white skin, often with malodor. Or clusters of blisters on the plantar and foot edges, dry and flaky. Or heel, foot edge or even the entire foot-plantar skin hypertrophy, dry, cracked. Self-perceived severe itching, especially in summer.
9.1.2 People with sweaty feet are susceptible to this disease.
9.1.3 Fungal culture and microscopic examination is mostly positive.
9.2 Classification of symptoms.
9.2.1 Damp-heat injection: dense blisters, erosion and flowing water, immersion in patches, itching and pain or fever. Thin yellow tongue coating and slippery pulse.
9.2.2 Blood-deficiency and wind-dryness: thickened skin, rough and cracked, itching without flowing water. Tongue red, thin coating, thin pulse.
9.3 Assessment of curative effect
9.3.1 Cured: symptoms and signs disappear and the skin returns to normal.
9.3.2 Improvement: symptoms are obviously reduced, and the skin lesions fade above 50%. Re-examination of the fungus is still positive.
9.3.3 Not healed: no change in symptoms and signs.
10 Gray finger (toe) nail diagnosis, evidence classification, efficacy assessment
Gray finger (toe) nail is mostly due to goose palm wind or foot dampness that extends to the claw nail over time, characterized by thickened finger (toe) nail with gray color and loss of luster. It is equivalent to nail fungus.
10.1 Diagnostic basis
10.1.1 Yellowish white spots are seen on the distal end or both sides of the nail, gradually extending to the whole nail and under the nail. The nail plate is thickened, brittle, uneven, and not gloriously gray or brown in color; or the nail plate is thinned, buckled, and hollowed out underneath; or the nail plate is partially thickened and the nail edge is honeycombed with decay.
10.1.2 Common in adults. It starts from 1 to 2 nail plates on one side, gradually to the adjacent nail, and long to all nail. Mostly secondary to goosefoot and foot moisture.
10.1.3 Fungal culture and microscopic examination are mostly positive.
10.2 Classification of symptoms
10.2.1 Blood dryness and loss of nourishment: the nail plate is not glorious in color, thickened or buckled, or cavities in the form of honeycomb. Pale tongue, little coating, thin pulse.
10.2.2 Dampness and heat accumulation: red nail plate, red and swollen nail grooves, or pustules, itching and stinging. The tongue is red, the coating is thin and greasy, and the pulse is slippery.
10.3 Assessment of curative effect
10.3.1 Cure: all diseased nails fall off, new nail color is normal, fungal microscopy is negative.
10.3.2 Improvement: 30% or more of the diseased nails are shed.
10.3.3 Not cured: The diseased nail is not shed or less than 30% is shed. Positive fungal reexamination.