1 Ancient medical treatises on the etiology and pathogenesis of sores
As most of the seat sores are aesthetic hair follicle sebaceous gland diseases that occur on the face and upper body, they are not a major obstacle to life, and in ancient times, due to the historical conditions and standard of living at that time, the disease was not given much attention, so the ancient medical doctors had less discussion on the etiology and mechanism of the disease. Song Qunxian, Department of Dermatology, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
1.1 External evil depressing the surface
Due to the cold, heat and wind evil depressed in the muscle surface, closed obstruction meridians, fat condensation evil gathering and into the seat. As the Su Wen? Sang Qi Tong Qi Theory” cloud: “labor sweat when the wind, cold and thin for trembling, Yu is seat.” Wang Bing note day: “when the cold month, the form of labor sweat hair, bleak wind outside thin, skin shy living cold, lipids are condensed, convulsions in the house, according to the empty seepage dry, drum thorn long in the skin.” Chao Yuanfang “the source of all diseases? Facial body disease of the various symptoms” is pointed out: “and she is, said to have wind-heat gas on the face of her, the head as big as rice, also like Yi big, white is.” And also cloud: “This is from the skin shy by the wind evil, fighting in the fluid, fluid gas, because of the virtual made also.”
1.2 Dampness gathered as a problem
Dampness has internal dampness and external dampness. Internal wetness is mostly due to spleen deficiency in the main function of transporting water and dampness, or nourishing food fat, sweet and greasy products, so that dampness and heat are generated internally; external wetness is mainly due to living in wetlands for a long time, dampness, or rain and water, so that dampness invades the body and becomes a seat sore. Just like the Suwen? After sweating, the pores are empty and easily invaded by dampness, which can become localized and lead to sores.
1.3 Blood heat stagnation
Both external and internal causes can cause blood heat stagnation. Those caused by external causes are mostly caused by heat or wind heat or summer heat that invade the body and involve the blood, resulting in blood heat stagnation in the local area and the development of seat sores. The internal causes are mostly due to the heat of the blood, or to the spicy, fatty and sweet food, which helps to produce internal heat, and over time, the blood is involved, resulting in the stagnation of blood heat, which leads to the development of seat sores. In this case, the blood-heat stagnation is caused by the blood component. The “Pulmonary wind and acne with a wine nose” says: “Acne belongs to the lung, f nose belongs to the spleen, all are blood heat stagnation does not disperse, the so-called have within, the shape of the external.” Surgical Dacheng? Lung wind wine thorn” also cloud: “lung wind by the lung blood heat stagnation does not work and the birth of wine thorn.” Both of the above two famous monographs on Chinese medicine surgery particularly emphasize the significance of blood-heat stagnation in the pathogenesis of the seat sore.
2 Recent developments in the etiology and pathogenesis of the sore
The clinical reports on the treatment of this disease have been repeatedly published in magazines, and there have been some discussions and interpretations of its etiology and pathogenesis, which are summarized in the following aspects.
2.1 External attack of wind-heat
Most scholars believe that this disease is initially related to the external attack of wind-heat, which is the evil of the six sexes that invades the skin locally and closes the qi and blood, gradually becoming acne. This is also evidenced by the fact that wind-heat is a Yang evil, and its nature is good at inflaming the upper part of the body, so when wind-heat attacks the body, it mostly attacks the upper part first.
2.2 Heat in the lung meridian
Mostly due to heat invasion of the lung meridian, or addiction to spicy and oily products, breeding lung heat, the lung is the main table, external combined with the skin and hair, the lung meridian heat, the lung guard loss of publicity, the skin and hair is depressed, heat and toxicity within, so that the face and chest pimples, red bumps or pain or itch [‘].
2.3 Heat accumulation in the stomach and intestines (gastrointestinal damp heat)
Due to heat in the gastrointestinal tract, or summer heat invading the gastrointestinal tract, or poor diet, or excessive consumption of spicy, fatty, sweet and thick flavors, heat accumulation in the gastrointestinal tract or damp heat is embedded in the face, and the disease develops when it is concentrated in the pores. A large proportion of patients with constipation further prove the existence of heat accumulation in the stomach and intestines or damp-heat pathogenesis [‘].
2.4 Toxic-heat interconnection
When acne is prolonged, the evil of poison and heat invades directly, or the evil of heat or damp-heat becomes poisonous after a long time, and the evil of poison and heat intertwines with each other at the acne site, leading to pus, redness, swelling, and pain, which forms abscess-type and cyst-type acne [sl0
2.5 Blood traces and phlegm knots
Dampness condenses over time and turns into phlegm; dampness and heat or phlegm and heat stagnate for a long time and block the flow of qi and blood, so that the fatty blood stops inside, and then knots with phlegm and phlegm, so that phlegm and fatigue block the local area, forming nodules and palsy marks.
2.6 Blood-heat prevalent
Young people are vigorous, blood and vitality, but some people factor body yang heat, blood heat outside the kui, body surface ligament filling, qi and blood stagnation, thus the onset. This is the physical factor or related to heredity.
2.7 Dysregulation of the Punching Point
In some female patients, the onset or exacerbation of acromegaly often occurs around the time of menstruation; in others, it is accompanied by menstrual disorders and dysmenorrhea. Female patients are prone to anger, depression, irritability, and irritability, which leads to liver stagnation and fire, resulting in dysregulation of the flushing of the body and the fire of the liver, which is accompanied by blood heat from the flushing of the body and the flushing of the face.
From the above discussion of the etiology and pathogenesis of seat sores by recent medical scholars, there is a bias toward one or more aspects, and therefore some bias in treatment. For example, the treatment of those who emphasize the wind-heat caused by external sensation is more with the products of removing wind and clearing heat; those who emphasize the heat accumulation in the stomach and intestines are more with the products of clearing heat and diarrhea; those who emphasize the mutual junction of poison and heat are more with the products of clearing heat and detoxification; those who emphasize the blood-heat is more with the products of clearing heat and cooling blood, etc. Generally, it is advocated to differentiate and classify seat sores into several types, but often the typology is not uniform and difficult to learn to master. A large proportion of patients have only seat sores and no other symptoms, and their tongues and veins are generally normal, making it very difficult to identify the evidence, so it is necessary to discuss the etiology and pathogenesis of seat sores to guide clinical practice more effectively.
3 Re-exploration of the etiology and pathogenesis of the sore
In order to conduct an in-depth study of this disease, our group set up a specialist in seat sores at the first specialist outpatient clinic of Heilongjiang University of Traditional Chinese Medicine, and treated a total of 3121 patients with seat sores from June 2001 to May 2004, asking detailed questions about each patient’s family history, onset, and causative factors. Among them, 724 cases (23%) had a family history, a few had obvious causes, and 245 cases (7.85%) had a history of feeling wind, cold, and heat when complaining of the onset of the disease. There were 72 cases (2.30%) who were exposed to sunlight for a long time, 68 cases (2.18%) who lived in obvious humidity, 642 cases (20.50%) who were triggered by eating spicy food or drinking alcohol, 374 cases (11.98%) who were triggered by eating fatty and sweet food, 184 cases (5.90%) who had obvious mental factors (anger, depression, tension, etc.), some patients had two or more triggers, and most others had no obvious triggers (or complaints were unclear). There were 726 cases with sudden onset (a large number of cases within 1 week), while the others had a slow and gradual onset. Through systematic observation of more than 3,001] patients over the past 4 years, we believe that “dampness, heat, and toxicity fatigue” is the main etiologic mechanism of acrodynia, regardless of the type or degree of the patient, and although dampness, heat, and toxicity paralysis may manifest differently in a particular patient, most patients have both. The basis for this is as follows.
3.1 The majority of patients with zoster (about 70%) are of mixed type, with both pimples and papules, accompanied by pus bumps, and even cysts, nodules, and fatigue marks, i.e., the I I ul degree of the modified classification. In general, acne is dominated by dampness and phlegm, papules are dominated by dampness and heat, pustules and cysts are dominated by dampness and heat, while nodules and palsy marks are dominated by dampness and phlegm, and blood traces are obstructed by nodules and palsy marks, which are mostly mixed in a particular patient despite the different preference.
3.2 The various types of healed sores can transform into each other. Most patients first have pimples, then develop into papules and pustules, and in severe cases into cysts, nodules, and palsy marks; there are also patients who start with papules and pustules; or those who have pustules and cysts, but improve with treatment and turn into papules and pimples. The dampness and heat can be transformed into heat, and heat can become pus and poison. Conversely, poison 5, can also turn into heat, and if it involves the spleen and kidneys, it can also produce dampness and phlegm. In short, the etiology of seat sores is very complex and not due to a single factor.
3.3 The causes of “damp-heat disease and poison” are often the following, but they are often mixed with each other. More common is over-eating spicy, fatty, sweet and thick taste, spicy is most likely to heat, fatty, sweet and thick taste is easy to produce damp heat, damp heat is gathered in the poisonous traces; secondly, environmental factors, such as living, living, working environment, damp or hot, stimulating the skin of dust or smell, sunlight for a long time, etc. will lead to damp heat concentrated in the local; in addition, wind, cold, damp, dry and fire six evil can also directly invade the local, concentrated skin and hair disease; then is Mental factors, depression and anger hurt the liver, worry about the spleen, long-term mental tension, sleeplessness, etc., resulting in liver depression fire, spleen injury and dampness, damp-heat accumulation, the transformation of poison into
10, which can lead to sores.
3.4 Based on the above understanding of the etiology and pathogenesis, we established the treatment principle of clearing heat and dampness, invigorating blood and detoxifying the toxin, and used the main formula of Yin Chen Cun Tang and Mast Cyperus Bark Tang from the Treatise on Typhoid Fever, with the addition of invigorating blood and detoxifying products.
We have developed “Zha Sore Ying Granules”, which includes Yin Chen, Mast, Rhubarb, Phellodendron, Salvia, Radix Paeoniae Alba, Huang Dao, Peach kernel, and White Flower and Snake Tongue Herb. Over the past few years, we have treated 3,121 patients of various types and degrees with this formula, with a total efficiency of 97.5% and a significant efficiency of 85%, reaching a leading level in China.
This further proves that “damp-heat and fatty toxicity” is indeed the main etiological mechanism of seat sores.
4 Summary
In ancient times, the etiology and pathogenesis of seat sores were less discussed, and only external evil, dampness and blood heat were discussed; in recent times, there have been more discussions, such as wind heat, lung heat, gastrointestinal heat, toxic heat, blood paralysis, phlegm knots, blood heat, and imbalance of the flush, but most of them are biased. Through 4 years of observation of 3121 patients with seat sores, we proposed that “damp-heat trace toxicity” is the main etiological mechanism of seat sores, and that clearing heat and dampness, invigorating blood and detoxifying blood are the general treatment rules for seat sores.