【作者】 陈美荣；

【导师】 王静波；

【作者基本信息】 山东中医药大学 ， 中医五官科学， 2012， 博士

【摘要】 目的：从文献、动物实验及理论多个角度探讨中医肾-脑-目系统的实质及其在弱视发病及治疗过程中的作用，为临床研究及弱视治疗提供新的思路和方法。方法：1、现代文献研究：以“弱视”为主题词，检索自1994年至2011年期间正式发表的中医药治疗弱视文献资料74篇，对弱视的证型、中药出现频次进行统计，分析弱视的发病机制及用药规律。2、实验研究：通过电镜下观察用药前后斜视性弱视猫视皮质的超微结构变化和采用RT-PCR方法检测视皮质NMDAR1基因表达，观察视明宝颗粒对弱视的作用，并以此为切入点探讨补益肝肾、健脾益气养血法治疗弱视的作用机制。3、在上述研究的基础上，探讨中医“肾-脑-目系统”的实质及其在弱视发病及治疗过程的作用。结果：1、现代文献研究：治疗弱视的药物以补益药为主，其中又以补阴药、补血药和补气药居多，弱视的病因病机以肝肾亏虚为主，脾虚气弱次之。2、实验研究：电镜下发现，中剂量和高剂量组可以明显改善斜视所致的视皮质损害，效果依次为高剂量组＞中剂量组＞低剂量组＞生理盐水组和模型组，横向比较各区各部位之间没有明显差异。RT-PCR显示：模型组的视皮质双侧17区和21a区均可见NMDAR1的表达减少。应用视明宝颗粒治疗后，中剂量组和高剂量组视皮质各区NMDAR1表达均较模型组有不同程度提高。3、理论研究：视觉过程包括对外界光信息接收、分析、识别几方面。肾之精是脑和目的生成、发育的物质基础，是目接收光信息并正确传递给大脑的保障。脑分析和识别能力又是视觉形成的关键，所以，在视觉形成的过程中，肾、脑、目之间存在密切联系，我们称之为肾-脑-目系统。在任何一个环节出现问题都会导致弱视的发生。肾精不足，目失所养，神光发越无源可以出现弱视，脑分析、识别即神识功能不足也会出现弱视。结论：1、肾-脑-目系统的实质为：肾为脑和目提供物质基础，目的结构功能正常，脑的神识功能正常，接受三光的刺激而形成正常的视觉过程。2、肾-脑-目系统共同参与弱视的形成，弱视的发病机理应为：由于先天禀赋不足或后天摄养失宜，肾气不足而导致肝肾阴精亏损，精气不能上承，髓海空虚，神识不足，目失所养，神光发生无源，发越无能，视力欠缺而成。在今后的弱视研究和治疗中应侧重于脑的研究和填精生髓的治疗方法，使弱视的中医中药治疗效果更上一个台阶。更多还原

【Abstract】 Objective: To explore the essence of renal-brain-eye system in traditional Chinesemedicine, and to find its importance in pathogenesis, therapy processes of amblyopia fromthe documental, animal experimental and theoretical aspects. Providing new thoughts andmethods for clinical research and treatment of amblyopia.Methods:1.modern documental research:74articles published formally on literaturematerials from1984to2011were searched taking the amblyopia as keywords. Types ofsyndromes of amblyopia and the occurrence of traditional Chinese medicine werecalculated to analysis the pathogenesis of amblyopia and regularity of medicine application.2. experimental research: Ultrastructural changes of visual cortex and NMDAR1geneexpression tested by RT-PCR methods of amblyopic cat were observed before and afterapplying ShiMingBao granule through electron microscopy. Function of ShiMingBaogranule on amblyopia were tested. Treatment principles of tonifing kidney and liver,strengthening spleen and qi, nourishing blood on treating amblyopia were discussed.3.Theessence of "kidney-brain-eye system” in traditional Chinese medicine and its role in theprocess of treating amblyopia were explored.Results:1. modern documental research: Reinforcing drugs were found mostcommonly used in treating amblyopia. Medicine of nourishing yin and blood werefollowed. Liver and kidney deficiency, spleen qi deficiency was thought as the mainpathogenesis of amblyopia.2.experimental study: Strabismus caused by visual impairmentwere found being improved in middle dose and high dose groups through morphologicalobservation. The effect sequence were high dose group, middle dose group, low dosegroup, saline group and model group. Differences were not found by horizontal comparison between various parts of the district. NMDAR1expression in17th district and21a district on visual cortex were found decreased in model group. NMDAR1expressionin17th district in middle and high dose groups were found increased compared with modelgroup after the application ShiMingBao granule treatment.3Theoretical research：Humanvisual process includes external light receiving information, analysis, recognition and so on.The congenital essence is the fundamental substance of formation and development ofbrain and eye which is guarantee for the eyes receiving optical information and transfer tothe brain.Brain. Analysis and recognition ability is the key to the formation of visual.kidney, brain and eye has a close relationship in the process of formation of the vision. It iscalled kidney brain eye system. Problems on any link will lead to the occurrence ofamblyopia. Kidney essence deficiency, eyes losing nutrients will lead to amblyopia，brainanalysis, recognition (conscious function) inadequacy may lead to amblyopia.Conclusions:1.Essence of kidney-brain-eye system is that kidney providingmaterial foundation for the brain and eye and normal structure and the function of brainproviding guarantee for accepting lights stimulation of eye.2.Kidney, brain and eye worktogether in amblyopia formation. the pathogenesis of amblyopia are as followed,congenital weakness or postnatal malnutrition cause kidney deficiency which will lead toliver and kidney Yin essence insufficiency. Then essence can’t go up and nourish brain.And mental deficiency will cause eyes losing nutrients. So the eye lose the fundamentalresources of visual function and amblyopia forms. In the future research and treatment ofamblyopia, study on brain and treatment principle of nourishing essence should be focusedon which will improve the treatment of amblyopia by applying traditional Chinesemedicine.更多还原