【作者】 李军艳；

【导师】 赵冠英；

【作者基本信息】 中国人民解放军军医进修学院 ， 中西医结合临床， 2009， 博士

【摘要】 赵冠英教授在老年病的诊断、治疗、预防等方面积累了丰富的经验。认为老年发病特点是:“虚”和“滞”,以虚为主,积损成疾,由虚生滞,气郁痰瘀并现。因正虚邪留,患病易而去病难,常累及多脏,易生突变。临证时强调病证合参,融贯中西,辨证与辨病、宏观与微观相结合,疾病、分期、证候“三位一体”的科学辨证思路,深化了对疾病及证候的本质认识。治疗上强调以调和为主,平衡阴阳,调理气血,补偏救弊;宜补虚通滞并举,动静结合,补而不留邪,通而不伤正;五脏之中尤重脾肾,提出治疗老年病以固肾之本和顾护脾胃为重点。养生调摄中强调治未病思想,提出顺应自然,节制饮食,调神怡志,身心并治,防微杜渐,消病邪于萌芽。帕金森病(Parkinson’s Disease,PD)是老年神经系统退行性病变之一。导师结合PD的中西医发病机理,从发病年龄、症状、病位、病程、分子生物学机制等方面深入分析肾虚血瘀与PD发病的相关性,提出肾虚髓空是PD发生的内在条件,血瘀是发病的必然因素,PD的基本病机是肾虚血瘀,治疗当以补肾活血立法。通过补肾活血饮治疗PD临床研究发现:补肾活血饮联合西药治疗PD,其疗效明显优于单用西药治疗者:不仅能改善患者的运动功能,而且在改善患者的非运动症状和减少运动波动症方面更体现出明显的优势。中西医结合组患者的睡眠、情感障碍、肢体不适、认知障碍等明显减轻,“开-关”现象、剂末恶化减轻或消失,开期明显延长,显示出良好的增效减毒作用。研究发现:中药的作用较持久,稳定性强,中西医结合组治疗各时点相比,病情程度呈递减趋势。单用西药组则不能有效延缓疾病的进程,虽治疗1月后PD患者病情有所减轻,但随着疗程延长,改善减少,UPDRS评分又有上升趋势。疗效与病情方面,中西医结合组对H-Y2.5～3级的患者疗效较单用西药组显著,提示:对于病情较重的PD患者,应用中西医结合治疗是很有临床意义的。补肾活血饮对强直明显者疗效较震颤者显著,说明其能明显缓解肌强直,从根本上改善患者的运动功能和日常生活能力。通过对神经递质的研究发现,补肾活血饮改善情感障碍和认知障碍的机制与提高脑内5-羟色胺(5-HT)、去甲肾上腺素(NE)的含量有关。本研究还表明:PD的发病是多因素的,因而仅用左旋多巴对症治疗,许多症状不能有效缓解。中医整体调节的特点、中药的神经保护作用都提示中西医结合治疗可取长补短,是治疗PD的最佳形式。更多还原

【Abstract】 Professor Zhao Guanying has accumulated rich experience in diagnosis, treatment and prevention of senile diseases.He thinks the pathogenetic characteristics of the aged can be summarized as "deficiency" and "stagnation", and "deficiency" is the basis and leads to "stagnation",including qi-stagnation, phlegm-blockage and blood-stasis.Because of deficient vital-qi and stagnated pathogenic qi,the senile diseases are difficult to be cured,multi-viscera is usually involved,and mutation is prone to happen.Combining traditional chinese medicine with west medicine,syndrome differentiation with disease differentiation,macrocosm with microcosm,professor Zhao raised a mode called the trinity of syndrome differentiation,which emphasizes the combination of disease,stage and syndrome.He emphasizes regulation and harmony in treatment, combines reinforcing deficiency with removing stagnation.Among the five viscera,he especially emphasizes protecting kidney and spleen.He also underlines health preservation and eliminating pathogenic factors physically and mentally in the beginning.Parkinson’s disease(PD) is a kind of degenerative disease of the central nervous system in the aged.The professor analyzed the associativity between renal-deficiency blood-stasis and the pathology of PD from such aspects as age of onset,symptoms,location,duration of disease and molecular biologic mechanism, etc.He proposed that in the pathogenesis,deficiency of kidney and debility of marrow is the internal condition,and blood stasis is the necessary factor.Renal deficiency and blood stasis is the fundamental pathogenesis of PD.Strengthening kidney and activating circulation is the therapeutic principle of PD.The clinical research on Bushen Huoxue Yin(BHY) indicated that the PD curative effect in integrated traditional and western medicine group(ITWG) was significantly better than that in single western medicine group(SWG),especially on improving non-motor symptoms,motor fluctuation,such as sleep,mood,physical discomfort, cognition,on-off phenomenon,deterioration at the end of dose,etc.It showed satisfactory synergy and attenuation.It was found that the curative effect of the decoction(BHY) was more permanent and stable.Compared at each time point,the severity was relieved gradually in ITWG,as in SWG it relieved after one-month treatment but rose as time going on,UPDRS score showed an upward trend.For H&Y 2.5～3 stage, the curative effect in ITWG was significantly better than in SWG,which indicated that treatment with combined traditional Chinese medicine and western medicine had important clinical significance for the higher stage of PD.The decoction (BHY) relieved muscle rigidity more effectively than tremor.It could improve hypokinesia and quality of life fundamentally.The study on neurotransmitter suggested that the mechanism of improving affective disorder and cognitive handicap was relevant to elevating 5-HT and NE.It was also indicated that the pathogenic factors of PD was multiple,many symptoms couldn’t be relieved effectively only by symptomatic treatment with L-dopa.The whole adjustment of Chinese medicine and the neuroprotective effect of decoction indicated that treatment combined traditional Chinese medicine and western medicine,which could make up for each other,may be the best modality of PD system treatment.更多还原