Effects of CT Combined with Modified Qinfan Decoction on Improving Sores and Promoting Angiogenesis.

In order to explore the clinical treatment of severe acne, this paper proposed the effect of CT technology combined with modified qinfan decoction on improving sores and promoting angiogenesis. From October 2016 to November 2017, 69 patients with severe acne treated in the first traditional Chinese medicine hospital of a city were selected for retrospective analysis. The 69 patients were randomly divided into control group and treatment group. There were 34 patients in the control group and 35 patients in the treatment group. Patients in the control group were treated with VSD. Patients in the treatment group were treated with qinfan decoction combined with VSD. Then, the total effective rate, the time of clinical symptom improvement, the time when the new granulation began to grow, and the time when the sore surface area was reduced by 1/2 were compared between the two groups. The results showed that after treatment, the total effective rate of the treatment group was higher than that of the control group. The time for the improvement of clinical symptoms, the time for the growth of new granulation, and the time for the reduction of the sore surface area by 1/2 were shorter than those of the control group, and the healing rate of the sore surface was higher than that of the control group (P < 0.05). Qinfan decoction combined with negative pressure sealing drainage technology has a significant effect on the treatment of severe acne and can promote its rehabilitation.

1. Introduction

At present, the incidence rate of LVU is increasing year-by-year. The incidence rate in China is about 0.4%–3%, and the incidence rate in European and American countries is close to 1%. Consulting a large number of relevant theories and references, it is found that there are more and more relevant studies on the treatment of acne. The commonly used methods of Western medicine include intravenous infusion of anti-inflammatory and intravenous active drugs, debridement and dressing change of the affected area, and surgical treatment for the cause, but due to internal venous hypertension and congestion, it is difficult to heal, and it is easy to relapse after healing [1]. The treatment of acne with traditional Chinese medicine is based on syndrome differentiation and treatment. Compared with western medicine, it has its own unique advantages. Many doctors use traditional Chinese medicine methods, such as oral administration, fumigation, external application and binding, and obtain certain curative effects. More and more doctors have used the method of combining traditional Chinese and Western medicine to treat acne and achieved good results. Among them, the treatment of severe acne is less mentioned, but it often attracts the attention of doctors because of its poor prognosis. Tutor Wang Yulin, director of traditional Chinese medicine, has been engaged in clinical research on peripheral vascular diseases for many years. Considering the pathogenesis of acne, according to the external treatment of acne in “traditional Chinese medicine surgery,” combined with drugs that clear heat and detoxify, activate blood circulation and remove stasis, and dissolve putrefactive muscles, and drawing on the medication experience of Chen Shiduo, a famous surgeon in the Ming and Qing Dynasties, a single drug “uses a large amount of drugs” to directly break the focus and form qinfan decoction [2]. Severe acne is a long-term disease that consumes blood and injures yin. Yin deficiency is easy to produce internal heat, which forces blood circulation. Blood overflows outside the veins, which aggravates blood stasis. Yin deficiency is easy to cause blood deficiency. Blood deficiency leads to the loss of nourishment of muscles and veins, and there is no metaplasia. Therefore, the modified qinfan decoction is composed of yin nourishing drugs. When combined with the method of soaking, it can directly act on the lesion and increase the targeting effect of drugs. The warm medicine liquid can expand the local blood vessels and promote blood circulation.

2. Literature Review

Zhixiong et al. proposed that the internal treatment of acne should first distinguish between deficiency and excess and believed that the syndrome differentiation of acne can be divided into dampness and heat infusion type, vein dampness and stasis type, and qi and blood weakness type. Dampness, stasis, and deficiency coexist throughout the disease [3]. Zhou et al. believed that the basic pathogenesis of acne is dampness, stasis, and deficiency, which runs through the whole process of the disease. Stasis refers to the transverse release of the muscles and veins of the lower limbs and the accumulation of blood vessels; deficiency refers to the weakness of vital qi, which is called venous valve insufficiency in modern medicine [4]. Qin et al. proposed that the treatment of acne should be divided from deficiency and excess in the clinical research of peripheral vascular diseases. It is concluded that the onset of acne is mainly caused by summer heat injury and excess heart fire at the beginning. The location of the disease is superficial, which is empirical; at the beginning, the deficiency of the heart and spleen, involving the liver and kidney, resulting in acne, is a deficiency syndrome. The location of the disease is deep. This deficiency is marked by excess, and this deficiency is the deficiency of the liver and kidney. The marked excess can also be divided into the evil of clearing dryness and dampness [5]. Based on the theory of “removing corruption and generating muscles,” Zeng et al. combined with their own clinical experience accumulated for many years, believed that the pathogenesis of acne was mainly “deficiency and blood stasis” and put forward the academic theory of “removing blood stasis, tonifying deficiency, and generating muscles”. Professor Tang believes that the onset of acne is not only a local symptom, but also an external manifestation of physical weakness of the body. The occurrence of ulcer must have the existence of “deficiency and stasis.” The main cause is “corruption stasis deficiency.” The main cause of the disease is long-term illness, physical deficiency, blood stasis, poor blood circulation, skin failure to nourish, and repeated invasion by evil drugs. Moreover, the weakness of the spleen and stomach is lost in the transportation of water and humidity, and the humidity tends to decline, accumulating heat and fumigating the skin, which is manifested as the image of heat toxicity. Based on “deficiency and blood stasis,” the “rot” is the standard, “blood stasis due to deficiency and deficiency due to blood stasis,” so that the development of ulcer is prolonged, difficult to heal, and even easy to recur after healing [6]. Zhou, et al. summed up their own clinical experience for many years and believed that the syndrome differentiation of acne belongs to the deficiency syndrome, yin syndrome and cold syndrome. The main cause of its occurrence is that dampness and heat are injected into the meridians and collaterals, resulting in blood blockage, blood stasis, yin consumption and gas injury, imbalance of camp and health, skin loss, and ulceration. Qi stagnation, cold coagulation, and blood stasis are the main causes of lingering and refractory acne [4]. Liao et al. used Sihuang decoction to treat 30 patients with acne. The specific method: mainly for those with clean sore surface and no obvious systemic infection, routine cleaning, and disinfection, Sihuang decoction (honeysuckle, astragalus, Phellodendron, Coptis, rhubarb, dandelion, angelica, isatis root, and other drugs), saute with water and mix with white powder, and soak the affected part in the liquid or warm compress with gauze dipped in the liquid after the temperature is appropriate. Among them, 22 cases were cured, 7 cases were improved, and 1 case was not cured. The total effective rate was 96.67%, of which the shortest healing time was 10 days, the longest healing time was 49 days, and the average healing time was 28 days [7]. Piccialli et al. treated 30 cases of acne vulgaris with putrescence and muscle cream. Specific methods: routine skin disinfection and debridement. According to the size of the sore surface, the gauze of putrescence and muscle cream (shikonin, Angelica sinensis, dragon's blood, red powder, astragalus, Angelica dahurica, sesame oil, pearl powder, light powder, and licorice) was applied externally, and then covered with sterile dry dressing for binding and fixation. Among 30 patients, 20 were cured, 7 were effective, and 3 were ineffective. The total effective rate was as high as 90%. The healing time of the sore surface was 18.14 ± 4.47 days [8]. Charisiou and others used Xian-Fang-Huo-Ming-Yinto treat 116 cases of acne vulgaris. The prescription: Phellodendron amurense, Coptis chinensis, rhubarb, frankincense, angelica, cinnamon twig, saponin thorn, licorice, pangolin, honeysuckle, Fritillaria thunbergii, red peony, tangerine peel, Achyranthes bidentata, and other drugs. Decoct the juice in water, and scrub the sore surface and its surrounding with sterile gauze dipped in medicine juice. 107 cases were cured, 6 cases were improved, and 3 cases were not cured. The total effective rate was 97.41% [9]. Figure 1 shows the negative pressure sealing drainage technology.

Figure 1

Negative pressure sealing drainage technology.

In order to explore the clinical effect of qinfan decoction combined with negative pressure sealing drainage (VSD) in the treatment of severe acne, the author studied the clinical data of 69 patients with severe acne treated in the first hospital of traditional Chinese medicine.

3. Research Methods

3.1. CT Technology

X-CT system has been widely used in the field of medical and industrial nondestructive testing. It can be divided into parallel beam CT, fan beam CT, and cone beam CT. The typical X-CT system mainly includes X-ray source, X-ray detector, mechanical scanning device, and computer operating system. The existing X-CT system generally uses three kinds of ray sources, which are X-ray tube (including electron linear accelerator), synchrotron radiation source, and isotope radiation source. Among them, X-ray tube is the most commonly used X-ray source, which produces X-ray photons when high-speed electrons bombard objects. The detector of the traditional X-CT system mainly adopts the integrated detection mode of X-ray photons, that is, it receives X-ray photons of different energies as a whole. The common ones are inflatable ionization detector and scintillation counting detector. In terms of detector integration mode, X-ray detectors can be divided into linear array detectors (one-dimensional) and area array detectors (two-dimensional). The mechanical scanning device of the X-CT system is used to control the relative motion of ray source, detector, and detection object. At present, mechanical scanning device mainly adopts two modes: fixed ray source and detector, rotating scanning mode of detection object; fixed detection object, ray source, and detector rotate scanning mode at the same time. The computer operating system of X-CT is used to analyze and process detection data, reconstruct, and display sectional images.

3.2. General Information

From October 2016 to November 2017, 69 patients with severe acne treated in the first hospital of traditional Chinese medicine were taken as the research objects. The 69 patients were randomly divided into control group and treatment group. There were 34 patients in the control group and 35 patients in the treatment group. In the control group, there were 18 males and 16 females; their age ranged from 40 to 79 years, with an average age of (59.4 ± 6.1) years; the course of disease ranged from 2.3 to 4.4 years, with an average of (2.5 ± 3.7) years; the area of acne was (32.51 ± 7.68) cm2. In the treatment group, there were 19 males and 16 females; their age ranged from 41 to 79 years, with an average age of (59.3 ± 6.2) years; the course of disease ranged from 1.7 to 4.5 years, with an average of (2.3 ± 3.9) years; the area of acne was (32.37 ± 7.56) cm2. The general data of the two groups were comparable (P > 0.05).

3.3. Inclusion Criteria and Exclusion Criteria

The inclusion criteria of these 69 patients are as follows: (1) their condition meets the clinical diagnostic criteria of acne. (2) Its sore area is ≥ 30 cm2, and its sore secretion is more [10, 11]. The exclusion criteria are as follows: (1) those combined with bedsore. (2) Leprous ulcer, tuberculous ulcer, radioactive ulcer, syphilitic ulcer, or cancerous ulcer were associated. (3) Those combined with cardiovascular and cerebrovascular diseases. (4) Complicated with liver, kidney, and hematopoietic system and other serious primary or secondary diseases. (5) Those complicated with serious mental illness. (6) Those complicated with diabetes or unstable blood glucose level. (7) Those combined with dystrophic polyneuropathy. (8) There was severe infection. (9) Those whose condition was critical. (10) In pregnancy and lactation. (11) Those allergic to the drugs used in this study.

The clinical diagnostic criteria for acne in the “diagnostic efficacy standard of traditional Chinese medicine” issued by the State Administration of traditional Chinese medicine are as follows: (1) most of the patients are located in the medial side of the leg. (2) The skin of the patient's affected area is itchy first, then painful, red, and erosive, and then ulcers occur rapidly. The sore surface of the affected part of the patient varies in size, and its sore surface is gray or dark red [12]. The sore surface of the patient's affected area is covered with yellow pus moss, pus can be seen and filthy odor can be smelled. The skin around the sore surface of the affected part of the patient becomes thick, convex, and swollen, and the color is black, which can be accompanied by eczema. (3) The affected area of the patient did not close for a long time, and the area of the sore surface of the affected area gradually expanded. (4) Patients with this disease are prone to recurrent attacks.

3.4. Treatment Methods

Patients in the control group were treated with VSD. The specific treatment method is disinfect the patient's sore surface and the skin around the sore surface with Sihuan brand iodophor with a concentration of 0.1%, and cut off the carrion and necrotic tissue on the sore surface [13]. Rinse the sore surface of the patient with sterile normal saline. Keep the affected skin dry and clean, adjust the polyethylene ethanol hydrated seaweed salt foam dressing to a suitable size according to the size and shape of the sore surface, and fix it on the sore surface. Connect the negative pressure drainage material to the negative pressure drainage bottle. After checking that the negative pressure drainage bottle does not leak, drain the patient for 7 days as a course of treatment. Patients in the treatment group were treated with qinfan decoction and VSD. The main pharmaceutical components of qinfan decoction are 50g alum, 25g Scutellaria baicalensis, 25g Cortex Phellodendri, 30g dandelion, 25g frankincense, 25g myrrh, 12g safflower, 12g Sparganium, 12g zedoary, and 9g Achyranthes bidentata. Add the above traditional Chinese medicine to 2500 ml of clear water, decoct for 30 min, remove the residue, take 2000 ml of the liquid medicine, and cool the liquid medicine to 37°C–39°C [14]. After cleaning the sore surface of the affected area for the patient, immerse the leg in the liquid medicine for about 10 ∼ 15 min, cover the sore surface with sterile gauze, and let it soak 3–5 times a day. Continuous treatment for 7 days. After the pus on the sore surface of the affected area was drained, the blood supply was improved, fresh granulation grew, and the condition was stable, the patient was treated with VSD. The method of treatment with VSD was the same as that of the control group. The patients in both the groups were treated continuously for 3 months.

3.5. Observation Indicators

After receiving the treatment, the total effective rate of the two groups of patients, the improvement time of clinical symptoms, the time when the new granulation began to grow, and the time when the sore surface area decreased by 1/2 [15]. Healing rate of sore surface = (original sore surface area - unhealed sore surface area)/original sore surface area × 100%.

3.6. Efficacy Criteria

According to the improvement of the 69 patients' condition, the clinical efficacy was divided into three levels: significantly effective, effective, and ineffective. Remarkable effect: after treatment, the area of the sore surface of the patient's affected area is significantly smaller than that before treatment, and the new granulation tissue on the sore surface grows well. Effective: the area of the wound surface of the patient is smaller than that before treatment, and the new granulation tissue on the wound surface grows better. Invalid: the area of the sore surface of the patient's affected area has not been reduced, and there is no new granulation tissue growth on the sore surface.

3.7. Efficacy Evaluation Criteria

3.7.1. Efficacy Evaluation Criteria

The healing rate of sore surface = (sore surface area before treatment - sore surface area after treatment)/sore surface area before treatment × 100%

Total effective rate = cure rate + significant efficiency + effective rate.

Cure: the sore surface is completely healed;

Remarkable effect: the healing rate of sore surface is more than 85%;

Effective: the healing rate of sore surface is 50%–85%;

Ineffective: the healing rate of the sore surface is less than 50%, even expanded.

Grade I: the sore surface is completely healed;

Grade II: there is no erosion around the sore surface and the base, and the new granulation tissue grows well;

Grade III: there is no erosion, ulcer, yellow pyoderma, or putrefaction around the sore surface and the base, and the surrounding skin is red and swollen;

Grade IV: no significant improvement in sore surface symptoms.

3.7.3. Safety Evaluation Criteria

Grade I: safe, no adverse reactions;

Grade II: basically safe, the patient only has slight discomfort, does not need to be treated, and does not affect the continued treatment;

Grade III: in case of safety problems, patients have moderate adverse reactions, and routine treatment will not affect the follow-up treatment;

Grade IV: in case of serious adverse reactions, the test must be terminated.

3.7.4. Skin Irritation Scoring Criteria

No edema and erythema on the skin after medication;

Edema and erythema can be barely seen on the skin;

The skin has edema and moderate erythema, and the edge is higher than the surrounding skin;

Severe erythema and edema appear on the skin, the skin bulges about 1 mm, and the outline is clear;

There are purplish red spots and eschar formation on the skin, with edema and swelling of more than 1 mm, and the scope expands to all sides.

3.8. Statistical Methods

The data in this study were processed by SPSS 19.0 statistical software. The measurement data were expressed by mean ± standard deviation (x ± s), t-test was used, and the counting data were expressed by percentage (%), χ2-test was used. P < 0.05 indicates that the difference is statistically significant [16].

The mathematical definition formula of factor correlation analysis using the test is as follows (1):where r is the number of rows in the contingency table; c is the number of columns in the contingency table; f0 is the observation frequency; and f is the expected frequency [17].

f the formula for calculating the expected frequency is as follows (2):where RT is the total of line observation frequencies; and CT is the total of column observation frequencies.

From the chi square statistics obtained from the above formula, it can be seen that if the expected frequency and the observed frequency are the same, the χ2 statistics is the smallest, which is 0. It can be inferred that these two variables are completely independent and have no correlation. The greater the difference between the expected frequency and the observed frequency, the larger the statistics χ2 can be obtained and the higher the degree of correlation [18].

4. Result Analysis

4.1. Comparison of Treatment Effects between the Two Groups

After receiving treatment, the total effective rate of the treatment group was 94.29%, and that of the control group was 78.26%. The total effective rate of the treatment group was higher than that of the control group (P < 0.05), see Table 1 and Figure 2 for details [19].

Table 1

Number of cases in the two groups.

Groups	The number of cases
The treatment group	35
The control group	34

Figure 2

Comparison of treatment effects between the two groups.

The comparison of the healing degree is shown in Table 2 [20].

Table 2

Comparison of the healing degree.

Group	n	Level 1	Level 2	Level 3	Level 4
The treatment group	33	8 (24.2%)	17 (51.5%)	8 (24.2%)	0 (0%)
The control group	31	0 (0%)	9 (29.0%)	22 (71.0%)	0 (0%)

Note.P < 0.05, was statistically significant by the chi-square test.

See Table 3 for comparison of healing time of sore surface [21].

Table 3

Comparison of healing time of sore surface.

Groups	n	Median (interquartile range)
The treatment group	33	97 (81–112)
The control group	31	123 (109–146)

4.2. Recovery of Patients in the Two Groups after Treatment

After receiving treatment, the time for the improvement of clinical symptoms, the time for the growth of new granulation, and the time for the reduction of the sore surface area by 1/2 in the treatment group were shorter than those in the control group, and the healing rate of the sore surface was higher than that in the control group (P < 0.05) [22], see Table 4 for details [23].

Table 4

Recovery of patients in the two groups after treatment(x ± s).

Groups	The number of cases	Clinical symptom improvement time (H)	New granulation begins to grow (H)	The area of sore surface is reduced by 1/2 (d)	Healing time (d)	Healing rate of sore surface (%)
The treatment group	35	67.03±14.47	339.38±39.11∗	4.51±2.11∗	76.64±24.49	93.02
The control group	34	80.11±18.91	461.23±57.88	2.28±1.03	93.22±20.81	80.97

4.3. Comparison of Blood Routine, Liver and Kidney Function, Blood Glucose, and C-Reactive Protein before and after Treatment

As shown in Table 5, during the treatment, there were no adverse reactions and other serious complications in both the groups. There was no significant difference in blood pressure, electrocardiogram, chest X-ray, routine blood and urine, and liver and kidney function before and after treatment, and it was within the controllable range [24].

Table 5

Comparison of blood routine, liver and kidney function, blood glucose, and C-reactive protein before and after treatment (x ± s).

Safety index	Groups	n	Before treatment	After treatment	t	P
White blood cell (10^9/L)	The treatment group	33	11.05±12.71	7.07±1.53	7.332	<0.001
	The control group	31	11.45±2.56	7.28±1.74	7.492	<0.001
Red blood cell (10^12/L)	The treatment group	33	4.25±1.04	4.40±0.83	-0.617	0.539
	The control group	31	3.99±0.59	4.12±0.89	-0.650	0.518
Hemoglobin (g/L)	The treatment group	33	145.46±19.08	147.44±20.09	-0.412	0.682
	The control group	31	139.21±14.15	140.42±6.51	-0.433	0.667
Aspartate aminotransferase (U/L)	The treatment group	33	24.27±14.14	21.03±8.11	1.142	0.258
	The control group	31	23.52±10.84	23.77±7.48	-0.109	0.914
Alanine aminotransferase (U/L)	The treatment group	33	24.54±10.79	20.97±6.75	1.613	0.112
	The control group	31	22.51±7.86	20.80±7.15	0.895	0.374
Muscle matching (umol/L)	The treatment group	33	68.30±15.86	66.84±12.30	0.416	0.679
	The control group	31	69.45±16.17	63.86±14.03	1.452	0.152
Uric acid (mg/Dl)	The treatment group	33	267.09±73.77	264.00±62.87	0.183	0.855
	The control group	31	273.68±102.00	241.84±68.32	1.444	0.154
Blood sugar (mmol/L)	The treatment group	33	6.68±2.22	5.94±0.95	1.760	0.083
	The control group	31	7.78±2.90	6.79±1.93	1.590	0.117
C-reactive protein (mg/L)	The treatment group	33	23.74±23.13	3.25±2.28	5.061	<0.001
	The control group	31	29.29±36.27	3.40±2.39	3.967	<0.001

Note. After t-test, the white blood cells and C-reactive protein of the two groups were compared before and after treatment, P < 0.05, which was statistically significant; Red blood cells, hemoglobin, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, creatinine, uric acid, and blood glucose in the two groups were compared before and after treatment, P > 0.05, with no statistical significance.

5. Conclusion

Acne refers to a chronic ulcer that occurs between the skin on both sides of the lower 1/3 tibial ridge of the patient's lower leg. The pathogenic factors of the disease include standing for a long time, weight-bearing travel, overwork, poor blood circulation of the lower limbs, and being bitten by mosquitoes. Traditional Chinese medicine believes that acne is caused by the skin ulceration of patients who are seized by the evil of dampness and heat. The Ming Dynasty's “surgery opens the mystery” called acne as “pants mouth poison, skirt sores, and old rotten legs.” In patients with severe acne, ulceration, erosion, exudation, and pus can be seen on the sore surface of the affected area, and the skin around the sore surface of the affected area can be seen red, swollen, and necrotic, and is still accompanied by pigmentation after the swelling subsides. Patients with severe acne with a long course of disease have sunken sore surface and are prone to bleeding. The steps of using negative pressure closed drainage and suction technology to treat patients with VSD are as follows: first, apply polyethylene ethanol-hydrated seaweed salt foam dressing to cover or fill the skin and soft tissue of the affected part of the patient, and then connect the dressing to the negative pressure suction device to conduct continuous drainage on the sore surface. VSD is often used to treat various types of acute or chronic sore surface infections in the clinic. Treating patients with severe acne with VSD can promote their local blood circulation, reduce the incidence of infection, and promote the growth of fresh granulation tissues. Using VSD to treat patients with severe acne can also reduce the number of dressing changes, reduce their pain, and shorten their hospital stay. Achyranthes bidentata has the function of activating blood circulation and removing blood stasis and inducing medicine downward. The combination of various drugs in qinfan decoction can play the effects of drying dampness and killing insects, activating blood circulation and removing blood stasis, clearing away heat and toxins, and transforming putrefaction and generating muscles. Qinfan decoction can be used to wash and wet compress the sore surface of patients with severe acne, so that the liquid can act on the affected area for a long time. Modern pharmacology has proved that alum, dandelion, Viola, Scutellaria baicalensis, and Phellodendron amurense have broad-spectrum antibacterial effects, which can inhibit the proliferation of a variety of Gram-positive bacteria, Gram-negative bacteria, some anaerobic bacteria, and other bacteria; Alum and Phellodendron amurense can promote the healing of the sore surface of the affected part of the patient; Sparganium, zedoary turmeric, safflower, and Angelica can inhibit platelet aggregation, promote local blood circulation in the affected area, and inhibit the formation of intravascular thrombosis in the affected area; frankincense can accelerate the excretion of inflammatory exudates on the sore surface of patients and promote the healing of their wounds; myrrh can reduce lipid and inhibit the formation of atherosclerotic plaque in the intima of arteries; Achyranthes bidentata has the effects of analgesia, anti-inflammatory, and improving patients' body immunity. The combination of the above drugs can play the effects of anti-inflammatory, bacteriostasis, microcirculation improvement, pain relief, and muscle regeneration. In conclusion, qinfan decoction combined with negative pressure sealing drainage technology has a significant effect on the treatment of severe acne, which can promote the rehabilitation.