【作者】 范宏元；

【导师】 罗才贵；

【作者基本信息】 成都中医药大学 ， 针灸推拿学， 2010， 博士

【摘要】 本文从理论上探讨大骨节病的中医辨证分型；根据辨证分型结果从临床上采用不同治疗方法对寒湿阻络型大骨节病进行临床疗效观察和验证。目的：通过开展大骨节病的中医证候群的临床大样本流行病学调查,运用现代统计学软件分析大骨节病人群中医证候分布的一般规律,经专家论证,规范大骨节病的辨证分型。在此基础上客观评价循膀胱经背俞穴弹拨法合针灸与中药制剂大骨节Ⅰ号分别对寒湿阻络型大骨节病的临床治疗效果,为临床治疗大骨节病提供新的思路和方法。方法：采用区组随机、单盲、阳性对照试验,对符合纳入标准的132例寒湿阻络型大骨节病患者分为A组(循膀胱经背俞穴弹拨法合针灸),B组(口服中成药大骨节Ⅰ号),C组(口服西药布洛芬缓释胶囊),共治疗30天,于治疗结束后第1月、2个月各随访1次。以中医证侯积分、症状体征、实验室指标ALP、LDH及生活质量指数为主要评价指标。结果：1.对患者临床疗效和中医证侯积分改善循膀胱经背俞穴弹拨法合针灸组和中成药大骨节Ⅰ号组效果较好。2.对寒湿阻络型大骨节病对患者疼痛指数、压痛指数及晨僵时间的改善A组较C组效果明显。A组虽然对患者晨僵时间缩短上没有明显疗效,但是在肿胀指数,平均握力的提高有较好的临床疗效。B组对寒湿阻络型大骨节病的肿胀指数、晨僵时间的缩短及平均握力的提高与C组比较有较好疗效。3.A组对寒湿阻络型大骨节病患者的血清碱性磷酸酶(ALP)的降低较C组明显,对乳酸脱氢酶(LDH)的降低较C组明显。4.三组患者治疗前后生活质量指数均有明显升高,与治疗前比较,差异均有统计学意义,治疗后组间比较无统计学意义。结论：综合聚类分析、方差分析、判别分析及专家评议,首次对大骨节病的中医辨证分型进行了规范化研究,初步制定了大骨节病的三个基本证型：寒湿阻络型、肝肾亏虚型、痰瘀互结型。循膀胱经背俞穴弹拨法合针灸治疗寒湿阻络型大骨节病能够有效地改善患者中医证侯、症状体征,并且对患者血清碱性磷酸酶、乳酸脱氢酶的降低均有较好效果,且该方法临床使用简便,值得在病区大力推广应用。中药制剂大骨节Ⅰ号对寒湿阻络型大骨节病的中医症候积分,关节肿胀数目减少、晨僵时间的缩短及平均握力的提高均有较好的临床疗效。更多还原

【Abstract】 This article discussed the differentiation of Kaschin-Beck disease in TCM. The therapeutic effect of different treatments for Kaschin-Beck disease with the syndrome of Cold-dampness blocking channels had been observed and compared.Objective:This research was based on the design measurement and evaluation investigation on TCM syndrome of Kaschin-Beck disease in a large sample. The modern statistics analysis software had been applied to analyze the syndrome discipline in Kaschin-Beck diseases. The result must been demonstrated by experts, and eventrually standard the differentiation and syndrome of Kaschin-Beck diseases. Our study had compared the threautic effect of plectrum on back-shu points following the bladder meridian and acupuncture with the Number 1 Traditional Chinese Medicine for Kaschin-Beck disease in the syndrome of Cold-dampness blocking channels. This study provided a new method of clinical therapy for Kaschin-Beck disease eventrually.Method:According to the block randomized, single blind, positive controlled trialing principle,132 cases of Kaschin-Beck diseases in the syndrome of cold-dampness blocking the channel had been divided into three groups stochastically. The group A applied plectrum on back-shu points following the bladder meridian combined with acupuncture. The group B used the Number 1 Traditional Chinese Medicine for Kaschin-Beck disease orally and the group C applied the ibuprofen sustained release capsule. All the treatment had been continued 30 days. They were compared at the end of 1 month,2 months after the treatments.Results:.1.The treatment of plectrum on back-shu points following the bladder meridian combined with acupunture, and the Number 1 Traditional Chinese Medicine can improve the syndrome score in TCM and have a good therapeutic effect.2. For the patients of Kaschin-Beck disease with the syndrome of Cold-dampness, the group A could more obviously improve the score of the pain, the tenderness index and the early morning stiff time than the group C. The group A didn’t shorten the early morning stiff time but provide a good therapeutic effect in improving the tenderness index and the average grip strength. Compared with the group C, the group B provided a better curative effect to improve the swelling index, shorten the early morning stiff time and strengthen the average power of gripping.3. Compared with the group C, the group A can lower down the ALP and LDH for the patient of Kaschin-Beck disease with the syndrome of Cold-dampnessblocking channels more significantly.4. The treatments in three groups could improve the quality of life index significantly. Compared with the index before treatments, there were significant differences. Bue the differences among three groups did not have statistic meaning.Conclusion:It was the first time to standard the differentionation and syndrome of Kaschin-Beck disease in TCM according to the cluster analysis, analysis of variance, discriminant analysis and expert comments. This reseach initially formulated three syndromes for Kaschin-Beck disease:cold-dampness blocking channels, the deficiency of spleen and stomach and the stagnation of phlegm and blood stasis.For Kaschin-Beck disease with the syndrome of Cold-dampness, the treatment of plectrum on back-shu points following the bladder meridian combined with acupunture can significantly release the TCM syndrome, symptoms and low down the LDH ans LDP. It was easy to operate in clinic and should be worth to promote and app ly.For Kaschin-Beck disease with the syndrome of Cold-dampness blocking the channels, the Number 1 Traditional Chinese Medicine had a good curative effect to improve the record of TCM symptoms, the number of swelling joints, shorten the early morning stiff time and promote the average power of gripping.更多还原