祛湿健发汤对脾虚湿滞型脂溢性脱发患者代谢指标及心理状态的影响

陈彩飞; 邱础; 朱晓燕; 王晖; 蔡路炜

doi:10.16766/j.cnki.issn.1674-4152.004345

祛湿健发汤对脾虚湿滞型脂溢性脱发患者代谢指标及心理状态的影响

doi: 10.16766/j.cnki.issn.1674-4152.004345

1.
绍兴市中医院皮肤科, 浙江绍兴 312000
2.
绍兴市中医院检验科

基金项目:

浙江省中医药科技计划项目 2025ZL579

详细信息

通讯作者:
邱础, E-mail: 253002714@qq.com

中图分类号: R289.57 R758.732
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出版历程
- 收稿日期: 2025-04-19
- 网络出版日期: 2026-04-01

The influence of Qushi Jianfa Decoction on metabolic indicators and psychological status in patients with seborrheic alopecia of spleen deficiency and dampness stagnation type

1.
Department of Dermatology, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的脂溢性脱发是临床常见毛发疾病，脾虚湿滞是其重要证型之一，主要表现为脱发、糖脂代谢紊乱及焦虑、抑郁等，西医尚缺乏特异性治疗手段，仅进行对症治疗，为此本研究通过祛湿健发汤治疗脂溢性脱发(脾虚湿滞型)，并探讨其对患者代谢与心理状态的影响。方法回顾性纳入2023年6月—2024年6月绍兴市中医院收治的96例男性脂溢性脱发(脾虚湿滞型)患者，根据不同的治疗方案将患者分为西医组(48例)与结合组(48例)。西医组予以米诺地尔外用，结合组在西医组的基础上给予祛湿健发汤治疗；比较2组临床疗效、中医证候评分、血脂代谢指标及心理状态。采用Spearman相关系数分析疾病严重程度与代谢水平、心理状态的相关性。结果结合组总有效率(91.67%，44/48)显著高于西医组[72.92%(35/48), χ²=5.790，P＜0.05]。治疗后，2组患者瘙痒、鳞屑、油腻评分均下降，且结合组低于西医组(P＜0.05)。治疗6个月后，结合组总胆固醇(TC)、甘油三酯(TG)及低密度脂蛋白胆固醇(LDL-C)水平均下降，但西医组水平无显著变化(P>0.05)，且结合组低于西医组(P < 0.05)。治疗6个月后结合组抑郁、焦虑、压力及抑郁-焦虑-压力量表(DASS-21)评分均低于西医组(P＜0.05)。Spearman相关分析显示，疾病严重程度与TG、TC、LDL-C、压力评分及DASS-21评分呈正相关关系(P＜0.05)，与HDL-C呈负相关关系(P＜0.05)。结论祛湿健发汤用于脂溢性脱发(脾虚湿滞型)患者，临床疗效显著，可降低中医证候评分，改善代谢水平及心理状态。
- 脂溢性脱发 /
- 祛湿健发汤 /
- 皮炎 /
- 代谢 /
- 抑郁 /
- 焦虑
Abstract: Objective Seborrheic alopecia is a common clinical hair disease, and spleen deficiency with dampness stagnation is one of its important syndromes, mainly manifested as alopecia, glycolipid metabolism disorder, anxiety, depression. Western medicine still lacks specific treatment methods and only conducts symptomatic treatment. Therefore, this study aims to evaluate the efficacy of Qushi Jianfa Decoction in treating seborrheic alopecia (spleen deficiency with dampness stagnation type) and explores its impact on patients ' metabolism and psychological state. Methods A total of 96 male patients with seborrheic alopecia (of the spleen deficiency and dampness stagnation type) admitted to Shaoxing Hospital of Traditional Chinese Medicine from June 2023 to June 2024 were conducted. The patients were randomly divided into a western medicine group (n=48) and a combined group (n=48) using a different treatment options. The western medicine group was given topical minoxidil, while the combined group was supplemented with Qushi Jianfa Decoction on the basis of the treatment for the western medicine group. The clinical efficacy, TCM syndrome scores, blood lipid metabolism indicators, and psychological status were compared between the two groups. Spearman correlation coefficient was used to analyze the correlation between disease severity and metabolic level as well as psychological status. Results The clinical total effective rate of the combined group (91.67%, 44/48) was significantly higher than that of the western medicine group (72.92%, 35/48, χ²=5.790, P < 0.05). After treatment, the scores of pruritus, scales and greasiness in both groups decreased, and those in the combined group were lower than those in the western medicine group (P < 0.05). After 6 months of treatment, the levels of total cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) in the combined group decreased, while there was no significant change in the western medicine group (P>0.05), and the levels in the combined group were lower than those in the western medicine group (P < 0.05). After 6 months of treatment, the scores of depression, anxiety, stress and depression-anxiety-stress scale (DASS-21) in the combined group were lower than those in the western medicine group (P < 0.05). Spearman correlation coefficient analysis showed that the severity of the disease was positively correlated with TG, TC, LDL-C, stress score and DASS-21 score (P < 0.05), and negatively correlated with HDL-C (P < 0.05). Conclusion Qushi Jianfa Decoction is effective in treating seborrheic alopecia (spleen deficiency and dampness stagnation), which can reduce TCM syndrome score and improve metabolic level and psychological state.
- Seborrheic alopecia /
- Qushi Jianfa Decoction /
- Dermatitis /
- Metabolism /
- Depression /
- Anxiety

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表 1 2组脂溢性脱发患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with seborrheic alopecia

组别	例数	年龄(x±s，岁)	病程(x±s，年)	脱发分级[例(%)]			BMI (x±s)
组别	例数	年龄(x±s，岁)	病程(x±s，年)	Ⅲ	Ⅳ	Ⅴ	BMI (x±s)
西医组	48	40.12±8.75	2.45±0.89	25(52.08)	16(33.33)	7(14.58)	24.48±3.96
结合组	48	39.25±9.47	2.51±0.96	22(45.83)	18(37.50)	8(16.67)	24.75±4.09
统计量		0.467^a	0.318^a	0.376^b			0.329^a
P值		0.641	0.752	0.829			0.743
注：^a为t值，^b为Z值。

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表 2 2组脂溢性脱发患者临床疗效比较[例(%)]

Table 2. Comparison of clinical efficacy between the two groups of patients with seborrheic alopecia[cases(%)]

组别	例数	痊愈	显效	有效	无效	总有效
西医组	48	14(29.17)	11(22.92)	10(20.83)	13(27.08)	35(72.92)
结合组	48	20(41.67)	16(33.33)	8(16.67)	4(8.33)	44(91.67)
统计量		-2.244^a				5.790^b
P值		0.025				0.016
注：^a为Z值，^b为χ²值。

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表 3 2组脂溢性脱发患者治疗前后中医证候评分比较(x±s，分)

Table 3. Comparison of TCM syndrome scores before and after treatment between the two groups of patients with seborrheic alopecia(x±s, points)

组别	例数	瘙痒		鳞屑		油腻
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
西医组	48	4.28±0.69	2.25±0.57^b	3.76±0.68	2.06±0.51^b	4.09±0.79	2.06±0.68^b
结合组	48	4.25±0.76	1.15±0.34^b	3.79±0.70	1.03±0.26^b	4.12±0.88	0.95±0.28^b
统计量		0.202^a	2.811^c	0.213^a	3.848^c	0.176^a	5.898^c
P值		0.840	0.001	0.832	< 0.001	0.861	< 0.001
注：^a为t值，^c为F值。与同组治疗前比较，^bP < 0.05。

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表 4 2组脂溢性脱发患者治疗前后代谢指标比较(x±s，mmol/L)

Table 4. Comparison of metabolic indicators before and after treatment between the two groups of patients with seborrheic alopecia(x±s, mmol/L)

组别	例数	TG		HDL-C		TC		LDL-C
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
西医组	48	2.17±0.60	2.18±0.64	1.13±0.29	1.15±0.33	5.91±1.06	5.93±0.97	3.23±0.85	3.20±0.94
结合组	48	2.19±0.63	1.62±0.39^b	1.12±0.31	1.24±0.32	5.93±1.08	5.32±0.66^b	3.25±0.87	2.76±0.62^b
统计量		0.159^a	2.693^c	0.163^a	1.063^c	0.092^a	2.160^c	0.114^a	2.299^c
P值		0.874	0.001	0.871	0.834	0.927	0.001	0.910	0.005
注：^a为t值，^c为F值。与同组治疗前比较，^bP < 0.05。

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表 5 2组脂溢性脱发患者治疗前后心理状态比较(x±s，分)

Table 5. Comparison of psychological status before and after treatment between the two groups of patients with seborrheic alopecia(x±s, points)

组别	例数	抑郁评分		焦虑评分		压力评分		DASS-21评分
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
西医组	48	9.36±2.13	6.14±1.78^b	13.25±3.76	7.12±1.45^b	18.72±4.13	12.62±3.05^b	41.33±10.20	25.88±7.72^b
结合组	48	9.32±2.09	5.02±1.13^b	13.36±3.80	5.03±1.07^b	18.55±4.26	10.13±2.26^b	41.23±9.96	20.18±6.35^b
统计量		0.093^a	2.481^c	0.143^a	1.836^c	0.199^a	1.821^c	0.049^a	2.082^c
P值		0.926	0.002	0.887	0.040	0.843	0.042	0.961	0.013
注：^a为t值，^c为F值。与同组治疗前比较，^bP < 0.05。

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表 6 脂溢性脱发严重程度与代谢水平、心理状态的相关性

Table 6. Correlation between the severity of seborrheic alopecia and metabolic levels, psychological status

项目	P值	r值	95% CI
TG(mmol/L)	＜0.001	0.406	0.218~0.565
HDL-C(mmol/L)	＜0.001	-0.352	-0.520~-0.157
TC(mmol/L)	＜0.001	0.394	0.204~0.555
LDL-C(mmol/L)	＜0.001	0.545	0.381~0.675
抑郁评分(分)	0.957	0.006	-0.201~0.212
焦虑评分(分)	0.059	0.193	-0.014~0.384
压力评分(分)	＜0.001	0.351	0.156~0.520
DASS-21评分(分)	0.024	0.231	0.026~0.417

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参考文献(28)

[1]	李景春, 刘凤, 陈丽蓉. 梅花针叩刺、针灸联合米诺地尔搽剂治疗男性脂溢性脱发疗效观察[J]. 中国美容医学, 2024, 33(6): 93-96. LI J C, LIU F, CHEN L R. Observation on the efficacy of plum-blossom needle tapping, acupuncture combined with minoxidil liniment in the treatment of male seborrheic alopecia[J]. Chinese Journal of Aesthetic Medicine, 2024, 33(6): 93-96.
[2]	OIWOH S O, ENITAN A O, ADEGBOSIN O T, et al. Androgenetic alopecia: a review[J]. Niger Postgrad Med J, 2024, 31(2): 85-92. doi: 10.4103/npmj.npmj_47_24
[3]	彭涛, 李艳伟, 李东娜, 等. 二至丸治疗脂溢性脱发的生物信息学研究[J]. 云南民族大学学报(自然科学版), 2024, 33(3): 335-344. PENG T, LI Y W, LI D N, et al. Bioinformatics study on Erzhi Pills in the treatment of seborrheic alopecia[J]. Journal of Yunnan Minzu University (Natural Sciences Edition), 2024, 33(3): 335-344.
[4]	夏继宁, 项晶. 透骨草-侧柏叶煎剂治疗雄激素性秃发的疗效及对患者焦虑与抑郁水平的影响[J]. 中华全科医学, 2023, 21(1): 123-126. XIA J N, XIANG J. Efficacy of Tougucao-Cebaiye Decoction in the treatment of androgenetic alopecia and its influence on patients' anxiety and depression levels[J]. Chinese Journal of General Practice, 2023, 21(1): 123-126.
[5]	欧阳欢, 王雪茜, 程发峰, 等. 国医大师王庆国辨治脂溢性脱发[J]. 中国皮肤性病学杂志, 2024, 38(2): 168-170, 176. OUYANG H, WANG X Q, CHENG F F, et al. Differentiation and treatment of seborrheic alopecia by national TCM master WANG Qingguo[J]. The Chinese Journal of Dermatovenereology, 2024, 38(2): 168-170, 176.
[6]	沈博, 付涛, 赵英, 等. 电动微针导入"祛湿健发汤"结合CGF技术穴位注射治疗雄激素性脱发的疗效评价[J]. 家庭药师, 2024, 17(3): 52-54. SHEN B, FU T, ZHAO Y, et al. Efficacy evaluation of electric microneedle delivery of "Qushi Jianfa Decoction" combined with CGF technology acupoint injection in the treatment of androgenetic alopecia[J]. Family Pharmacist, 2024, 17(3): 52-54.
[7]	任裕. 首乌合剂外洗联合口服中药治疗脂溢性脱发(脾胃湿热证)的疗效观察[D]. 咸阳: 陕西中医药大学, 2023. REN Y. Observation on the efficacy of external washing with Shouwu Mixture combined with oral Chinese medicine in the treatment of seborrheic alopecia (spleen-stomach dampness-heat syndrome)[D]. Xianyang: Shaanxi University of Chinese Medicine, 2023.
[8]	闵祥博, 李丽娜, 余萍, 等. 黑枸杞本草酵素缓解小鼠脂溢性脱发作用[J]. 食品与发酵工业, 2024, 50(15): 41-47. MIN X B, LI L N, YU P, et al. Alleviation of black wolfberry ferment on seborrheic alopecia in mice[J]. Food and Fermentation Industries, 2024, 50(15): 41-47.
[9]	BATAN T, ACER E, KAYA ERDOǦAN H, et al. The relationship between nutrition habits, BMI, anxiety, and seborrheic dermatitis[J]. J Cosmet Dermatol, 2025, 24(1): e16737. DOI: 10.1111/jocd.16737.
[10]	CHOI S, ZHANG B, MA S, et al. Corticosterone inhibits GAS6 to govern hair follicle stem-cell quiescence[J]. Nature, 2021, 592(7854): 428-432. doi: 10.1038/s41586-021-03417-2
[11]	CHEONG W K, YEUNG C K, TORSEKAR R G, et al. Treatment of seborrhoeic dermatitis in Asia: a consensus guide[J]. Skin Appendage Disord, 2016, 1(4): 187-196.
[12]	国家卫生健康委毛发质控项目专家委员会, 国家中西医结合医学中心毛发专病医联体, 中国整形美容协会中医美容分会, 等. 脂溢性皮炎的中西医诊疗专家共识(2024版)[J]. 中国皮肤性病学杂志, 2025, 39(1): 1-9. Expert Committee of Hair Quality Control Project of National Health Commission, Hair Specialty Medical Consortium of National Center for Integrative Medicine, TCM Cosmetology Branch of Chinese Association of Plastics and Aesthetics, et al. Expert consensus on integrated traditional Chinese and Western medicine diagnosis and treatment of seborrheic dermatitis (2024 edition)[J]. The Chinese Journal of Dermatovenereology, 2025, 39(1): 1-9.
[13]	郑筱萸. 中药新药临床研究指导原则(试行)[M]. 北京: 中国医药科技出版社, 2002: 121. ZHENG X Y. State Drug Administration. Guidelines for Clinical Research of New Chinese Medicines (Trial Implementation)[M]. Beijing: China Medical Science Press, 2002: 121.
[14]	CHEN I H, CHEN C Y, LIAO X L, et al. Psychometric properties of the depression, anxiety, and stress scale (DASS-21) among different Chinese populations: a cross-sectional and longitudinal analysis[J]. Acta Psychol (Amst), 2023, 240(1): 104042. DOI: 10.1016/j.actpsy.2023.104042.
[15]	LOVIBOND P F, LOVIBOND S H. The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories[J]. Behav Res Ther, 1995, 33(3): 335-343. doi: 10.1016/0005-7967(94)00075-U
[16]	PENHA M A, MIOT H A, KASPRZAK M, et al. Oral Minoxidil vs Topical Minoxidil for male androgenetic alopecia: a randomized clinical trial[J]. JAMA Dermatol, 2024, 160(6): 600-605. doi: 10.1001/jamadermatol.2024.0284
[17]	尹俊芳, 郭丽, 杨琴, 等. 除湿养发汤联合参柏洗剂治疗脂溢性脱发[J]. 长春中医药大学学报, 2024, 40(10): 1126-1129. YIN J F, GUO L, YANG Q, et al. Treatment of seborrheic alopecia with Chushi Yangfa Decoction combined with Shenbai Lotion[J]. Journal of Changchun University of Chinese Medicine, 2024, 40(10): 1126-1129.
[18]	王月萍, 陆晶, 顾银银, 等. 凉血消风汤联合米诺地尔治疗血热风燥型脂溢性脱发患者的临床观察[J]. 世界中西医结合杂志, 2024, 19(5): 1016-1020. WANG Y P, LU J, GU Y Y, et al. Clinical observation on Liangxue Xiaofeng Decoction combined with minoxidil in the treatment of seborrheic alopecia of blood-heat and wind-dryness type[J]. World Journal of Integrated Traditional and Western Medicine, 2024, 19(5): 1016-1020.
[19]	GUPTA A K, BAMIMORE M A, WANG T, et al. The impact of monotherapies for male androgenetic alopecia: a network meta-analysis study[J]. J Cosmet Dermatol, 2024, 23(9): 2964-2972. doi: 10.1111/jocd.16362
[20]	杨伟金, 王婷婷, 朱燕舞, 等. 基于数据挖掘研究含白术-茯苓药对方剂的组方规律[J]. 中国现代应用药学, 2024, 41(14): 1980-1988. YANG W J, WANG T T, ZHU Y W, et al. Study on the prescription regularity of prescriptions containing Atractylodes macrocephala-Poria cocos herb pair based on data mining[J]. Chinese Journal of Modern Applied Pharmacy, 2024, 41(14): 1980-1988.
[21]	CHOI D G, SHIN W C. Botanical extract-infused shampoo and hair tonic for hair loss in androgenetic alopecia: a trend-compliant, prospective single-arm preexperimental study[J]. J Cosmet Dermatol, 2025, 24(6): e70273. DOI: 10.1111/jocd.70273.
[22]	李泽璠, 胡韵, 何小蝶, 等. 5α-还原酶植物抑制剂的筛选及其对小鼠毛发生长的影响[J]. 湖北大学学报(自然科学版), 2025, 47(1): 91-98. LI Z F, HU Y, HE X D, et al. Screening of plant-derived 5α-reductase inhibitors and their effects on hair growth in mice[J]. Journal of Hubei University (Natural Science Edition), 2025, 47(1): 91-98.
[23]	WANG S, XU S, WANG S, et al. Risk factors and lipid metabolism characteristics of early-onset male androgenetic alopecia: a pilot study[J]. J Cosmet Dermatol, 2024, 23(9): 3038-3044. doi: 10.1111/jocd.16371
[24]	李德品, 孙欣, 卞晓洁, 等. 减重代谢术后维生素水平变化与脱发的相关性研究[J]. 药学与临床研究, 2023, 31(4): 326-331. LI D P, SUN X, BIAN X J, et al. Study on the correlation between changes of vitamin levels and alopecia after bariatric metabolic surgery[J]. Pharmaceutical and Clinical Research, 2023, 31(4): 326-331.
[25]	林少琴, 王成澄, 徐清, 等. 茯苓泽泻汤联合生活方式干预湿证代谢综合征的临床试验[J]. 中药新药与临床药理, 2024, 35(10): 1453-1461. LIN S Q, WANG C C, XU Q, et al. Clinical trial of Fuling Zexie Decoction combined with lifestyle intervention in the treatment of dampness syndrome metabolic syndrome[J]. Traditional Chinese Drug Research and Clinical Pharmacology, 2024, 35(10): 1453-1461.
[26]	张敏, 王凤云, 唐旭东, 等. 麸炒白术水提液对实验性功能性腹泻脾虚证大鼠结肠上皮Cl^-、K⁺转运的影响[J]. 中华中医药杂志, 2023, 38(2): 593-597. ZHANG M, WANG F Y, TANG X D, et al. Effect of water extract of bran-fried Atractylodes macrocephala on colonic epithelial Cl^-, K⁺ transport in rats with experimental functional diarrhea of spleen deficiency syndrome[J]. China Journal of Chinese Materia Medica, 2023, 38(2): 593-597.
[27]	KHARE S, BEHERA B, DING D D, et al. Dermoscopy of hair and scalp disorders (trichoscopy) in skin of color-a systematic review by the international dermoscopy society "imaging in skin of color" task force[J]. Dermatol Pract Concept, 2023, 13(4 S1): e2023310S. DOI: 10.5826/dpc.1304S1a310S.
[28]	LANCAR R, MISSY P, DUPUY A, et al. Risk factors for seborrhoeic dermatitis flares: case-control and case-crossover study[J]. Acta Derm Venereol, 2020, 100(17): adv00292. DOI: 10.2340/00015555-3661.