痿证辨证论治规律的临床研究

【作者】 刘子志；

【导师】 李任先；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2001， 博士

【摘要】 本课题旨在通过对痿证的临床观察分析，试图发现更为客观的痿证病机演变规律，以便确立其辨证论治规律，进而寻求治疗本病的较好方法。 痿证因其病变范围广，临床上呈现多态性，因此其主导病机并非一种，或可谓复杂难辨，所以必须对痿证进行分类研究。通过比较，我们认为从西医学以肌无力为主要症状的疾病入手，依据中医学“同病异治”、“异病同治”的原则，对这些疾病进行多中心、大样本的随机对照分析研究，是目前发现痿证辨证论治规律的较理想方法。鉴于时间和工作条件所限，我们只能选择其中一种疾病——肌萎缩侧索硬化症（ALS）进行重点研究。 通过对古代文献及痿证目前研究现状的分析，我们发现诸医家、学者尽管对于痿证的病因病机及治法方药作了较为详细的论述，但他们的认识并不相同，大多据自己的临床经验而偏执一说，难免有片面之嫌，又未能用令人信服的科研方法进行求证，使人们对于痿证的辨证论治规律仍然莫衷一是。我们正是在他们的认识基础之上，取其精华，补其不足，从而开展本课题研究工作的。 通过对120例ALS患者全面临床资料分析，我们认为ALS的病机演变规律为：脾气亏虚——肝肾阴亏、虚风内动——痰湿瘀等病理产物的形成——死亡。据此可将脾气亏虚、肝肾阴虚视作ALS的两个基本证 瘦怔辩怔铂伯舰镣的 究型，因此拟健脾补肾方治疗ALS。 通过健脾补肾方治疗ALS 32例患者的临床观察，结果表明健脾补肾方能够改善ALS患者的临床症状、舌脉的病理象、肌力等，减少ALS患者脑脊液谷氨酸含量，加快神经元的运动传导速度，降低束颤电位出现的概率。一方面证明了我们关于ALS病机演变规律及辨证论治规律的假说，另一方面也表明健脾补肾方为治疗ALS的安全、有效方剂。从而对于ALS的治疗及瘦证辨证论治规律的揭示有一定的指导意义。 也正是由于屡证病机的复杂性，ALS发病机制不明确及治疗的疑难性，本课题的研究工作尚存在许多问题有待解决。更多还原

【Abstract】 The article aim at trying to find the pathology rule of atrophydisease by the clinic observation analysis，moreover to find apreferably ways to treat the disease． Because the atrophy disease related to many pathlogical changes，having varies manifesting in clinic, so its dominant pathologymechansims not one kind；we must study it by sorts． By comparing，we think the ideal ways of questing for the ruleof TCM treating by differenttations，is starting with the diseaseof which manifested the main syndromes of muscle atony, and haverandom comparison with enough cases，but with the limit of time andresearch conditions，we have to choose one kind disease -Amyotrophic lateral sclerosis(ALS)to study． Through the analysis of ancient article andthe present studyof atrophy disease，we found thoughvarles doctors or scholars havequite detail theory about the etlology＼pathology＼treating law andrecipes，but they are not agree with each other，nobody can makeothers believe him by enough science proof．So all we do was basedon the knowledge． by the complete analysis of 120 ALS clinic data, we thoughtthe rules of pathology change is spleen qi deficiency - liver andkidney yin deficiency-phlegm, dampness and blood stasis formed-die. The clinic observation of 32ALScases treated by recipe ofstrengthen the spleen and kidney showthat the recipe can improvethe syndromes andtough and pulsepathologychanges，flesh于orce；decreasethe contain of glutamlc acid In brain and spine fluid，improve the nerve movement passingveloClty，decreasetheappearingratio of bundle quivering electricity digit, The study prove ourtheory of the pathology changes rules and treating discipline is 4correct on one hand，and on the other hand It prove our recipe ofstrengthening the spleen and kidney is effective and safe, whichcontribute to the treatment of the atrophy disease. Because of the complexity of its pathology and the difficultyof curing it , there are many proiblems about research work to besolved.更多还原