【作者】 张荣坤；

【导师】 樊巧玲；

【作者基本信息】 南京中医药大学 ， 方剂学， 2009， 博士

【摘要】 痛风(Gout)是由于嘌呤代谢紊乱导致血尿酸水平增高和/或尿酸排泄减少而导致尿酸盐在组织沉积的疾病。其临床表现为由高尿酸血症、尿酸盐沉积所导致的反复发作的急、慢性关节炎和软组织损伤,尿酸性肾结石所导致的痛风性肾病,是一种严重危害人类健康的代谢性疾病,其发作与肥胖症、高脂血症、糖尿病、高血压病及心脑血管病等成正相关。随着社会经济的发展和人们生活方式的改变,痛风的患病率逐年上升,且因其病情顽固,迁延难愈,已引起国内外医学界的广泛重视。人们在经历长期化学药物治疗该病的过程中,逐渐发现化学药物虽然能够在较短时间内改善患者的临床症状,但其毒副作用却限制了该类药物的广泛和长期应用,而且迄今为止尚未发现用于痛风缓解期以及痛风伴肾功能不全患者的安全有效的化学治疗药物。因此,从祖国医学中寻找既能促进尿酸排泄,抑制尿酸合成,又能消肿止痛,安全有效,服用方便的中药制剂逐渐成为目前的研究热点与趋势之一。中医治疗痛风有着悠久的历史,在长期的临床实践过程中积累了极为丰富的治疗经验。本研究阅读了台湾中国医药大学期刊室1985-1996年的相关期刊和1994-2008年间“中国知网”中的相关论文,以及《中华医典》系列光盘中所收录记载的大量与“痛风”证候治疗有关的文献资料,通过对历代医家治疗痛风的论述、方药、医案等文献的分析、整理,对于痛风的病因病机、治疗方法、常用药物、方剂配伍等进行了较为全面系统的归纳与总结,在文献研究的基础上对33例痛风患者进行了中医临床治疗观察。本研究结果表明,痛风起因于人体正气不足,继而导致营卫失和,气血不足,阴阳失调,脏腑亏虚,或兼以七情伤人等多种因素共同作用,复加风、寒、暑、湿等邪之侵袭,痹阻经脉,使气血失畅,生痰致瘀,胶结留连,化热成毒,以致病情反复发作,难以痊愈。治疗痛风的基本原则在于清热利湿治其标,化浊逐瘀通经络,调补脾肾培其本。与此同时,通过建立数据库系统,运用数理统计、分析归纳等方法,对245首大致符合现代医学中痛风临床表现的“痹证”、“历节”、“脚气”的古方、以及105首治疗痛风的现代方剂进行了多变量统计处理与分析,探讨治疗痛风常用药物的性味归经、功效类别、高频药物、配伍规律,及其化学成分、药效作用等。发现治疗痛风最常用的28味中药:其药性以温、平为主,药味以辛、甘、苦为多,归经以肝、脾、肾为常,配伍以辛温、辛甘、苦辛、甘温、甘平等组合为特征,进而证实了滋补肝肾、健脾化浊、清热活血以及温经通络法在痛风治疗中的重要意义及其广泛应用。笔者在临床的观察上,领会以扶正化瘀法来治疗痛风。在33例痛风患者中,治疗组17例予以扶正化瘀通络复方,对照组16例予以奥贝。结果治疗组对于痛风风湿瘀热型总有效率88.2%,对照组的总有效率为68.8%,比较之下,有20%的显著差异;治疗组的血尿酸值以及血沉均较治疗前明显降低(P＜0.05)与对照组治疗后的差异亦具有显著性(P＜0.05);治疗组平均白细胞值较治疗前明显降低(P＜0.01),与对照组治疗的差异亦具有极为显著性(P＜0.01),表明扶正化瘀法是治疗痛风的有效方法之一,具有研究与推广价值,并为临床治疗痛风提供了新的思路与方法。更多还原

【Abstract】 Gout is an illness by the abnormal metabolism of the high rate of uric acid. Gout is a serious metabolism problem and the clinical manifestation shows it causes several illness, such as acute and chronic gouty arthritis and the impair of soft tissue. The uric acid kidney stones also bring about the gouty nephropathy.People who are obesity, high lipemia, diabetes, high blood pressure and cardiovascular will be easy to have gout. Along with economic development and lifestyle changes, the prevalence rate to increase gradually the medical profession has call attention both at home and abroad. There is no such safe and efficient medical treatment for gout patients because the chemical treatments would cause the side effect to patents who take western medicine for a long time period. Therefore, it is a hot research topic in finding out a good Chinese herb medicine that is easy for patients to take and to help them to deal with their uric acid in their body.The Chinese herb medical treatment has a long-age historical experiences and records in dealing with gout patients. This research paper is according to the journals (1985-1996) of China Medical University in Taiwan, between 1994-2007 of HowNet and the "Chinese Medical Code" series of CD-ROM included in the records of the Cuban side, prescription finishing systems to analyze and summed up the treatment of the most commonly used herbs prescriptions and then give the observation to the 33 gout patients and gathering data from them.The research has shown that due to the human body healthy is inefficient then subsequently causes the inefficient in food, the insufficiency of vitality, masculine and feminine elements being out of balance, the internal organs were ill and offends the body and so on. Due to many kinds of factor combined with wind, cold, hot weather and wet; therefore, it is not easy to recover from gout. The basic element to deal with gout is to clean through its meridian and taking care of the spleen and kidney.Meanwhile, the database systems has been set up and applicative the mathematical statistical methods and the inductive method of analysis, and also the analysis the modern medical of the 245 uarthritis clinical manifestation "Arthralgia", "Adventure Day", "the beriberi " of the ancient medical prescription and with another 105 modern medical treatments to gout. The results shows that the most commonly used 28 taste traditional Chinese medicine: Its property by warm, even primarily, taste take Xin, Gansu, painstakingly as many, turns over to after take the liver, the spleen, the kidney as often, blends take Xin Wen, Xin Gan, the hardship, Gan Wen, the Gansu equality combination as the characteristic, then it proves that it is meaningful and important that giving a good nourish to liver and kidney and the refrigeration blood circulation are the elements to fight with gout.The 33 example of gout patient, divided into the treatment group of 17 examples were given removing extraverted blood to pass through the compound prescription and the control group of 16 examples were given Aobei. The results show that the treatment group has a better result of 88.2% in treating gout, whereas the control group has the total of 68.8% in treating gout.Under the comparison, there is a 20% remarkable difference. It is obviously to show it reduces (p<0.05) before the treatment group’s hematuria acid value as well as the erythrocyte sedimentation rate treat, and the control group also has the significance difference of (P<0.05) after treatment. Before the treatment group average white blood cell value treats, it is obviously reduced (P<0.01) and the difference which treats with the control group also has extremely significance difference (P<0.01). To indicate that makes up the spleen profit kidney, removing extraverted blood passes through treats is one of gout’s efficacious devices, it has a big research and the promoted value, and it provides the new ways of thinking and method in clinical care of gout patients.更多还原