REVIEW doi: 10.12032/TMRIM202004003 TMR Integrative Medicine The use of traditional Chinese medicine internally and externally combined with auricular acupuncture point bloodletting in the treatment of vulvar leukoplakia Yan-Yin Ji1*, Shu-Ning Liu2, Xin Ping3, Shao-Kun Qin3 1School of Chinese Medicine, Hebei North University, Zhangjiakou 075000, China. 2School of Chinese Medicine, North China University of Science and Technology, Tangshan 063210, China. 3School of Chinese Medicine, Hebei University, Baoding 071002, China. *Corresponding to: Yan-Yin Ji. School of Chinese Medicine, Hebei North University, No. 11, South Diamond Road, Gaoxin District, Zhangjiakou 075000, China. E-mail: [email protected]. Highlights Vulvar leukoplakia is the chronic diseases of denaturation and hypopigmentation of vulvar skin and mucosa accompanied by unbearable itching, seriously affecting the quality of life in women. The article summarized the therapeutic methods of vulvar leukoplakia in traditional Chinese medicine (TCM), including TCM herbal decoction, external fumigation, and auricular acupuncture point bloodletting. Moreover, the authors recorded one patients with vulvar leukoplakia treated by the above TCM methods in detail, in order to provide the reference for clinicians. Traditionality The external treatments of TCM has a long history, and has significant effect on the treatment of vulvar leukoplakia. The external treatments of TCM mainly include Chinese medicine fumigation, auricular acupuncture point puncture and stick pressure, fire needle, acupuncture, warm acupuncture, acupoint injection, ion penetration of TCM, wet compress therapy of TCM, acupoint embedding therapy, and so on. These methods need to be used according to the syndrome differentiation of each patient and the effectiveness of each method. doi: 10.12032/TMRIM202004003 REVIEW Abstract Vulvar leukoplakia refers to the chronic disease of degeneration and hypopigmentation of the skin and mucous membrane of the vulva with unbearable itching in women, seriously affecting the quality of life. The main treatment of western medicine for vulvar leukoplakia is the external use of glucocorticoids or estrogen, resulting to the high recurrence rate and side effects. Traditional Chinese medicine (TCM) has the characteristics of the overall concept and dialectical treatment with a variety of ways. Literature review in recent years found that the treatment of TCM decoction combined with external therapies, such as external fumigation, acupuncture and other treatments, or the combination of TCM decoction and external western medicine hormone ointment, can obtain good effects in vulvar leukoplakia. During the clinical practice, we found that the use of TCM internally and externally combined with auricular acupuncture point bloodletting was highly effective with unique advantages in the treatment of vulvar leukoplakia, providing the ideas guidance for clinicians. Keywords: Vulvar leukoplakia, Traditional Chinese medicine (TCM), External therapy, Auricular acupuncture point bloodletting Abbreviations: TCM, Traditional Chinese medicine. Competing interests: The authors declare that there is no conflict of interest. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from the participant included in the study. Citation: Yan-Yin Ji, Shu-Ning Liu, Xin Ping, et al. The use of traditional Chinese medicine internally and externally combined with auricular acupuncture point bloodletting in the treatment of vulvar leukoplakia. TMR Integrative Medicine 2020, 4: e20003. Executive Editor: Rui-Wang Zhao. Submitted: 28 September 2019, Accepted: 26 November 2019. 2 Submit a manuscript: https://www.tmrjournals.com/im REVIEW doi: 10.12032/TMRIM202004003 distinguishing the etiology, nature, location, as well as Background the relationship between evil and good, determining the corresponding treatment methods can significantly Vulvar leukoplakia, namely white lesions of the vulva, improve the clinical symptoms and reduces the is a group of chronic diseases of denaturation and recurrence rate. It provides a new idea for clinical hypopigmentation of vulvar skin and mucosa. It can treatment of vulvar leukoplakia. TCM for internal oral cause vulvar skin mucous membrane to become white, use and external fumigation, combined with auricular coarse, chipped or chapped, and even atrophic, puncture is safe, easy to operate, having high accompanied by intense itching [1]. Vulvar leukoplakia compliance causing little pain, and bring a remarkable can occur at any age, particularly among middle-aged curative effect [8]. women [2], and seriously affects women's physical and mental health. Vulvar leukoplakia belongs to The understanding of vulvar leukoplakia in precancerous lesions and its cancer rate is about TCM 2%–5% [3]. The etiology of vulvar leukoplakia has not been clear to now, which may be associated with Vulvar leukoplakia belongs to the category of “Yin infection, autoimmunity, sex hormones, local itching”, “Yin sore”, “Yin epidemic” in TCM. stimulation and other factors [4]. Western medicine According to the summary of ancient Chinese treatment is mainly focus on hormone drug treatment, medicine, the occurrence of vulvar leukoplakia is which can greatly relieve the symptoms of itching, but caused by four pathological factors, namely cold, heat, no significant improvement in histology. What’s more, dryness and dampness, and the morbidity of vulvar its long-term application can lead to skin atrophy and leukoplakia are oftern related to liver, spleen, stomach, the patient's dependence on drugs of various degree [5]. kidney and lung. In the theory of TCM, liver diseases In addition, some therapies such as surgical treatment, are more involved in the vulva. Liver mainly plays the local closure injection, kinetics, placental injection, role of drainage and blood storage. Blood deficiency phototherapy, ultrasound, sacral block, hyperbaric will give birth to internal wind. The wind will cause oxygen, laser, liquid nitrogen freezing and others are the dry, resulting to rough skin, and chapped local also used. However, the disease recovery effect is poor, vulva. At the same time, liver depression for a long the course of treatment is long, and the long-term time turns heat, and damp evil are heavy and sticky. recurrence rate is high, so these measures has not been Heat and damp together tend to lower location of the widely applied in clinical practice, but used more as body, bringing about the occurrence of vulvar adjuvant therapies [6]. leukoplakia. If the ability of spleen and stomach to External treatment of Traditional Chinese medicine transport water and liquid decreases, the dampness and (TCM) has a long history. Furen Daquan Liangfang stasis will be aggravated in the body, and the dampness recorded TCM external treatment in the first time, and will gather air resistance, wet evil heavy turbidity proposed “cure women vulva itching with Dahuang under, causing vulva disease. Zhubing Yuanhou Lun powder (Chinese patent medicine) ”. Tian-shi Ye said that “kidney nutrition vulva; kidney Qi deficiency recorded that “a woman's vulva itch is unbearable... results the itches of skin, and scratching causes sores”. external use Shechuangzi (fructus cnidii) to washing, The kidney contains essence, and the kidney is mainly while internal use Classic ancient prescription Guilu in charge of reproduction, related to the vulva. If the Erxian ointment to take orally, then cured in four days”. kidney is deficient in Yang, its warm vernal function Auricular puncture has the functions of expelling heat will drop, aggravating the cold and wet stagnation, and dispelling evil, removing blood stasis and clearing promoting further development of the vulva disease. collaterals, and harmonizing Qi and blood [7]. TCM At the same time, the function of the growth and fall of treatment focuses on the holistic concept. The external lung is abate, together with the disorder of Qi activity. symptoms of a disease are the manifestations of its Meanwhile, lung is mainly responsible for skin and fur, internal pathological reactions. The rise and fall of evil and when the skin loses normal moisten embellish, and good in the body indicates the essence of the vulva disease will not be cured easily. Figure 1 shows disease and is the “origin” of the disease. In this case, the pathogenic mechanism of vulvar leukoplakia in the manifestations of the disease is treated by external TCM. therapy, and the “origin” of the disease is treated by oral Chinese medicine. Pathogenesis, both inside and External treatments of TCM outside, combined with the whole body, altogether plays curative effect. At the same time, under the In recent years, the number of physical therapy guidance of dialectical theory, TCM reveals the nature methods has increased gradually. At present, the of disease more profoundly, more comprehensively external treatment of vulvar leukoplakia includes and more correctly. Distinguishing Yin and Yang, infrared ray, photodynamic, bom light, liquid nitrogen knowing the cold and heat, distinguishing between freezing, microwave, electric heating needle, etc. Some inside and outside, knowing the actual situation, other physical therapy methods, such as focused Submit a manuscript: https://www.tmrjournals.com/im