基于“化腐生肌”理论探究玉黄膏治疗皮肤溃疡的临床疗效及机制

Exploring the Clinical Efficacy and Mechanism of Yuhuang Ointment in the Treatment of Skin Ulcer Based on the Theory of “Huafu Shengji”

摘要: 目的：基于中医“化腐生肌”理论，评价以藤黄单味中药加工而成的玉黄膏治疗皮肤溃疡的临床疗效并探讨其药效机制。方法：将2023年1月~2025年2月眉山市中医医院老年医学科收治的83例皮肤溃疡患者，以入院顺序按随机数字表法分为实验组40例、对照组43例。治疗组在创面清创的基础上外敷玉黄膏，对照组在创面清创的基础上外敷银离子敷料。观察两组创面愈合时间、腐肉脱落速度、肉芽生长情况、疼痛评分、不良反应及经济学指标。结合网络药理学分析藤黄活性成分的作用靶点。结果：治疗组创面愈合率显著高于对照组(P < 0.01)，腐肉脱落时间缩短(t = 4.28, P = 0.000)，肉芽组织评分及疼痛缓解程度优于对照组(P < 0.01)；两组均未见严重不良反应。网络药理学与分子对接分析显示，桑色素是藤黄的关键成分，其与靶点TNF、IL1B、MAPK3、EGFR结合能力均较强，藤黄通过PI3K-Akt、MAPK、TNF、IL-17等信号通路发挥治疗皮肤溃疡的作用。结论：玉黄膏通过多靶点协同实现“祛腐–抗炎–生肌”三重作用，为皮肤溃疡的治疗提供了新策略。

Abstract: Objective: Based on the theory of “Huafu Shengji” in traditional Chinese medicine, to evaluate the clinical efficacy of Yuhuang ointment processed from single Chinese medicine of gamboge in the treatment of skin ulcers and to explore its pharmacodynamic mechanism. Methods: 83 patients with skin ulcers admitted to the Department of Geriatrics of Traditional Chinese Medicine Hospital of Meishan from January 2023 to February 2025 were randomly divided into 40 cases in the experimental group and 43 cases in the control group according to the randomized numerical table method in the order of admission. The experimental group was treated with Yuhuang ointment on the basis of wound debridement, while the control group was treated with silver ion dressing on the basis of wound debridement. The wound healing time, carrion shedding rate, granulation growth, pain score, adverse reactions and economic indicators of the two groups were observed. Combined with network pharmacology, the targets of the active components of gamboge were analyzed. Results: The wound healing rate of the experimental group was significantly higher than that of the control group (P < 0.01), the time of carrion shedding was shortened (t = 4.28, P = 0.000), and the granulation tissue score and pain relief degree were better than those of the control group (P < 0.01). No serious adverse reactions were found in both groups. Network pharmacology and molecular docking analysis showed that morin was the key component of gamboge, which had strong binding ability with target TNF, IL1 B, MAPK3 and EGFR. Gamboge played a role in the treatment of skin ulcers through PI3 K-Akt, MAPK, TNF, IL-17 and other signaling pathways. Conclusion: Yuhuang ointment achieves the triple effect of “removing rot-anti-inflammatory-myogenic” through multi-target coordination, which provides a new strategy for the treatment of skin ulcer.