Xu Mei-fang

Department of Acupuncture and Tuina, Jiangyin People’s Hospital, Jiangsu 214400, China

Therapeutic Observation on Acupuncture plus Auricular Point Sticking for Melasma

Xu Mei-fang

Department of Acupuncture and Tuina, Jiangyin People’s Hospital, Jiangsu 214400, China

Objective: To observe the clinical efficacy and safety of acupuncture plus auricular point sticking in treating melasma.

Methods: Forty-three eligible subjects with melasma were intervened by acupuncture plus auricular point sticking, 10 times as a treatment course, with an interval of 3-5 d between each two courses. The therapeutic efficacy was analyzed after 1, 2 and 3 treatment courses respectively.

Results: With the increase of treatment course, the markedly effective rate and total effective rate were also increasing. Of the 43 subjects after 3 treatment courses, the epidermal type had the highest markedly effective rate and total effective rate, then it’s the subtype Ⅳ of the mixed type and dermal type, and the subtype Ⅲof the mixed type had the lowest markedly effective rate and total effective rate.

Conclusion: Acupuncture plus auricular point sticking is effective and safe in treating melasma, but different types have different therapeutic efficacies.

Acupuncture Therapy; Auricular Points Sticking; Melanosis

Melasma, also named liver spots or dark patches in traditional Chinese medicine, or known as butterfly speckles, is a common acquired hypermelanosis. It’s often seen on the face in the middle-aged and young females, though males can also be affected. Its pathogenesis is closely associated with endocrine dysfunction, also involving psychological factors, over-fatigue, and sun-exposure. The author adopted acupuncture plus auricular point sticking in treating melasma. The report is now given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

The diagnostic criteria in theCriteria of Diagnosis and Therapeutic Efficacy of Melasma(modified in 2003) were adopted in this study[1]. Light-brown or dark-brown well-demarcated patches on the face, usually symmetrically, without inflammation or scales; no obvious subjective symptoms; having a predilection for women, mostly after adolescence; the disease condition can be seasonal, severe in summer and mild in winter; pigmentation caused by other diseases should be excluded.

According to the Wood’s lamp examination, melasma is classified into the following four types.

Epidermal type: It’s identified by the presence of excess melanin in the superficial layers of skin.

Dermal type: It’s distinguished by the presence of melanophages throughout the dermis.

Mixed type: This type includes both epidermal and dermal types.

Unnamed type: It’s often seen in dark-skin individuals, and cannot be detected by the Wood’s lamp.

1.2 Exclusion criteria[2]

Having a history of recent facial operation; having had radiotherapy or cryotherapy in the past six months; having active herpes simplex or viral warts on the face; having used tretinoin drugs orally or externally in the recent six months; patients with scar diathesis; patients with sunburn or without good protection from light; patients with immune dysfunction; patients with immunodeficiency diseases; women in pregnancy or lactation period.

1.3 General data

Fifty-three eligible subjects were women aged 25-50 years old, averaged at 35.5 years. The disease duration ranged from 2 months to 6 years. Diseases of other systems were excluded.

2 Treatment Methods

2.1 Acupuncture

Acupoints: Affected areas (Ashi points), Guanyuan (CV 4), Qihai (CV 6), Zigong (EX-CA 1), Zusanli (ST 36), Sanyinjiao (SP 6), Xingjian (LR 2), Taichong (LR 3), Pishu (BL 20), Shenshu (BL 23).

Operation: Cosmetic needles were punctured around lesions; Guanyuan (CV 4) and Qihai (CV 6) were tonified by lifting-thrusting manipulations; Xingjian (LR 2) and Taichong (LR 3) were reduced; even reinforcing-reducing manipulations were applied to Pishu (BL 20), Ganshu (BL 18), and Shenshu (BL 23) without retaining the needles. The acupuncture treatment was given once a day, and the needles were retained for 20-40 min, 10 times as a treatment course. The treatment should be discontinued during menstruation. There was a 3-5 d interval before next treatment course.

2.2 Auricular point sticking

Major points: Endocrine (CO18), Cheek (LO5,6i), Kidney (CO10), Liver (CO12).

Operation: After sterilization of auricle, use an auricular point detector to search the sensitive points and stickWang Bu Liu Xing(Semen Vaccariae) to the points. Ask the patients to press the stickers.

3 Observation on Therapeutic Efficacy

3.1 Criteria of therapeutic efficacy

It was referred to the criteria of therapeutic efficacy in theCriteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine[3].

Recovery: Lesions are gone, and the color is normal or almost normal.

Markedly effective: Lesions are reduced by over 70% or the color turns light obviously, and the color of skin is approaching to normal.

Effective: Lesions are reduced by 30% to 70%, and the color turns light.

Invalid: Lesions have no changes, or are reduced by less than 30%.

3.2 Treatment result

During the 3 treatment courses, with the increase of course, the markedly effective rate and total effective rate were increased. After 3 courses, of the 43 cases, 34 showed markedly effective, 7 showed effective, 2 were invalid, and the total effective rate was 95.3% (table 1).

Patients of different types had different markedly effective rate and total effective rate. Epidermal type had the highest markedly effective rate and total effective rate, next were skin type Ⅳ of the mixed type and dermal type, and the skin type Ⅲ of the mixed type had the lowest markedly effective rate and total effective rate (table 2).

3.3 Case study

A female patient, 42 years old, came to visit in May of 2010.

Chief complaints and present history: Her melasma had been 5 years, not responding well to various treatments. When visiting, the patients had dark-brown patches on bilateral cheeks. Her period usually came late, and the menstrual blood was dark purple with clots, accompanied by vexation and irritability.

Diagnosis: Melasma (due to liver and blood stagnation).

Table 1. Therapeutic observation after different courses (case)

Table 2. Comparison of therapeutic efficacies of different types (case)

Treatment: Following the above treatment for 1 course, the discolorations turned lighter, as well as the color of menstrual blood, and blood clots were also reduced. After 3 treatment courses, the melasma disappeared; the patient felt delighted and energetic; her menstruation became normal regarding its blood quantity, color, and quality. The melasma was not relapsed during the follow-up study for half a year.

4 Discussion

Melasma is a common hypermelanosis on face. Traditional Chinese medicine holds that it’s associated with liver-qi stagnation, spleen-stomach deficiency, and liver-kidney insufficiency, etc. Emotional disorders will induce liver-qi stagnation, resulting in failure of qi and blood to go up to nourish face and the occurrence of melasma; spleen-stomach deficiency can lead to insufficient production of qi and blood, resulting in the malnutrition of face and the happening of melasma; deficient liver and kidney, as well as insufficient essence and blood, will reflect the color of kidney onto the face and induce the development of melasma[4-6]. Modern medicine believes that the commonest pathogenic factor of melasma should be endocrine disorder. In acupuncture-moxibustion treatment for melasma, body acupuncture, auricular point, or the combining of both are majorly adopted[7-9]. It will be the focus in the future that how to use a simple acupuncture-moxibustion treatment protocol to achieve a content therapeutic efficacy. Acupuncture around the lesions can boost the topical blood circulation, and remove melasma. Acupuncture at Zigong (EX-CA 1) and Guanyuan (CV 4) works to promote the ovulation and stimulate the endometrium, and thus can regulate the estrogen level. With the assistance of auricular point sticking, it can restore normal menstruation and the balance of endocrine[10-12]. During the treatment, patients should avoid sun-exposure, and take more vegetables and fruits, supplement Vitamin C, keep their bowels open, and stay delighted.

[1] Hypermelanosis Group, Dermatovenereology Specialty Committee, Chinese Association of Integrative Medicine. The criteria of diagnosis and therapeutic efficacy of melasma (modified in 2003). Chin J Dermato Venerol Integ Trad W Med, 2004, 3(1): 66.

[2] Wu Y, Zhu XJ. Chemical peeling. Linchuang Pifu Ke Zazhi, 2001, 35(4): 262-263.

[3] State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine. Nanjing: Nanjing University Press, 1994: 156.

[4] Zhang XY. Acupuncture-moxibustion for 80 cases of melasma. Sichuan Zhongyi, 2008, 26(4): 122.

[5] Zheng XH, Hu W. Acupoint injection plus auricular point sticking for 60 cases of melasma. Shiyong Zhongyi Neike Zazhi, 2011, 25(2): 94.

[6] Du CY. Observations on the clinical curative effect of acupuncture on chloasma. Shanghai Zhenjiu Zazhi, 2007, 26(4): 14-15.

[7] Zhang BM, Xu SW, Zhang W. Clinical observation of auricular bloodletting therapy for chloasma in 30 cases. J Acupunct Tuina Sci, 2011, 9(3): 152-153.

[8] Ma XQ, Jiang SJ. Analysis of the efficacy of Back-Shu point pricking therapy and quick cupping for chloasma. Shanghai Zhenjiu Zazhi, 2007, 26(11): 20-21.

[9] Yu XS, Yan XQ, Shen YY. Ultrasonographic observation of ovulation facilitated with acupuncture plus Clomiphene in 36 patients. Shanghai Zhenjiu Zazhi, 2008, 27(5): 20-21.

[10] Liu YY, Zhuang SQ. Clinical study on hydro-acupuncture for hypomenorrhea. J Acupunct Tuina Sci, 2011, 9(5): 307-309.

[11] Zhang LJ, Xu JR. Acupuncture treatment of Clomipheneresistant anovulation. Shanghai Zhenjiu Zazhi, 2006, 25(9): 21-22.

[12] Zhao XQ, Li CD, Wen BP, Guo XY, Jiang F. Study progress of acupuncture-moxibustion for melasma. Xiandai Zhongxiyi Jiehe Zazhi, 2007, 16(14): 2014.

Translator: Hong Jue

R246.7

A

Date: April 20, 2013

Author: Xu Mei-fang, bachelor, attending physician.

E-mail: 1196428360@qq.com