【作者】 张永；

【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】 银屑病是一种常见的慢性炎症性皮肤病,病程长,易反复发作,银屑病是遗传背景下,多种因素综合作用所致的身心疾病。其致病机制复杂,至今尚未阐明,临床常反复发作而且缺乏有效的根治药物和手段。目前治疗银屑病尚无突破性进展。西医治疗近期疗效较好,但毒副作用大不能长期使用,停药后易复发加重,远期疗效差。中医药治疗银屑病采用中医整体观念、辨证论治和内治外治结合,坚持治疗疗效肯定而且副作用小,复发率低。因此采用中药内服加外用配合治疗银屑病是当前较好的一种治疗方法。全文包括文献综述和研究报告两部分。文献综述共两部分。第一部分综述了西医近年来对银屑病进行了大量的临床与实验研究,包括流行病学、病因及发病机制、治疗等不同方面的进展;第二部分综述了中医药治疗银屑病的临床与研究进展,包括银屑病的历史沿革,近代医家对银屑病病因病机的认识,以及中医内外治方法及近年的研究进展。研究报告包括银屑病的方证研究、临床研究和实验研究三部分。方证研究通过收集近二十年来治疗银屑病的110首方剂并整理统计分析,可以看出,中医治疗银屑病的分型论治,大多数医家主要从血分论治,分为血热型、血虚型、血瘀型三型。前三型所占总的比率共计89.1%。该统计也与临床实际所见相符。说明血分有热是银屑病发病的基本病因病机。而凉血解毒法是治疗银屑病基本方法。这和当代各皮肤科专家对银屑病血热型的病因病机的认识以及辨证施治是基本一致的。由于目前中医治疗银屑病的辨证分型太细,则与从血分论治大同小异,而且过于繁杂,不利于银屑病中医药治疗水平的总结和提高。所以有必要对银屑病的辨证分型论治以及常用中药进行规范统一,以有利于中医药治疗银屑病的进一步推广。临床研究通过凉血解毒汤治疗寻常型银屑病血热证来进行临床验证。对照组采用复方青黛胶囊口服配合加味黄芩油膏外用进行治疗;实验组内服凉血解毒汤配合加味黄芩油膏外用治疗。经两个月的治疗。临床疗效显示,治疗组30人中显效率76.7%(显效23人),有效率23.3%(有效7人),无效率0;对照组30人中显效率23.3%(显效7人),有效率66.7%(有效20人),无效10%(无效3人)。两组疗效有明显差异(p＜0.05)。实验研究包括两个实验部分。将50只BLBC小鼠分成五组,分别为空白组A,造模组B,对照组C(复方青黛胶囊配合加味黄芩油膏外用),实验一组D(凉血解毒汤配合加味黄芩油膏外用),和实验二组E(凉血解毒汤配合制克银灵软膏外用)。第一部分是采用金黄色葡萄球菌肠毒素(SEB)作为超抗原对小鼠进行腹腔注射。诱导小鼠血清肿瘤坏死因子(TNF)升高作为模型,来用中药内服加外用进行治疗。结果显示相对于空白组A,造模组B而言无论是治疗组还是对照组都能明显降低小鼠血清TNF水平,提示中药治疗有效。第二部分观察了各实验组对Jarrett和Spearman所提出的小鼠尾鳞片表皮模型的作用,结果显示相对于空白组A,造模组B而言对照组C、实验一组D和实验二组E均具有明显促进鼠尾鳞片表皮颗粒层形成的作用,能够使角化不全转变为正常角化。而对照组C和实验一组D相比无明显差异(P＞0.05),其中实验二组E有颗粒层的鳞片数增加更为明显,和对照组C实验一组D相比也有显著增加(P＜0.01)。通过临床与实验研究显示中药凉血解毒汤加减配合克银灵软膏外用对银屑病血热型疗效较好。更多还原

【Abstract】 Psoriasis is a common chronic ,recurrent, inflammatory disease of the skin. Psoriasis is a complex disease resulted from various etiological factors under the genetic background. It has comlex pathogenic mechanisms that cannot be explained by now. It tends to be recurrent attacks, but the effective radicular curative drugs and means are scarace . And there is no breakthrough in the therapy to Ps with both the TCM and the western medicine .Obviously the curative effect of the western medicine in the near future is effective ,but with the long-term toxicity and side-effect. Treatment for Ps with traditional Chinese medicines has many advantages: positive effect but little side effect. So treatment to Ps with the TCM and external use is a better means by now.This paper includes literature reviews and research reports.Two literature reviews are included. The first reviews modern clinic and research development on the Ps. It gains special concerns of the academic circles’ owing to its unknown etiological factors and pathogenesis. Besides, it is scarce of effective therapeutic tools. Considerable research has been performed on epidemiology, etiological factors, pathogenesis and therapy in recernt years. The second reviews Traditional Chinese clinic research and development on the Ps including its successive changes, the opinions of neoteric doctors on irs pathogenesis, medicial and surgical treatment.This research reports are consisted of three parts.First is the standardization of psoriasis about dieffrentiation - based treatment and the herbs. 110 prescriptions are collected to statistically analyzed. Most TCM doctors are likely to divide the Syndrome of Ps. to three kinds:blood heat, blood dryness and blood stasis .Accoridingly differently herbs are used to treat the three kinds Ps. above. Standardization of treatment to psoriasis with Chinese medicine is useful to improve levels of using Chinese medicine to treat Ps.The second is about the clinic research. We have performed clinicial verification on blood-heat syndrome applying with the Liangxuejiedutang(LXJDT) and external drug-the Jiaweihuangqinyougao(JWHQYG) to approach its effect. There are 60 cases with blood -heat syndrome who are all use the external drug-the JWHQYG included in the clinical verification, and 30 applied with the LXJDT and the other 30 cases applied with the Fufangqingdaijiaonang(FFQDJN) for control. After two months treatment, the PASI scores on lesions of the two groups are different significantly from those two months ago.The clinical effective rate is up to 76.7%, total effect rate is 100%in LXJDT group;While in control group is 23.3% and 90% respectively.There is remarkable difference between the two groups.The last one is about experimental research.The experiment consists of two texts.In text one ,we use the SEB as the superantigen to produce the TNF in the mouses’ blood. And then observed that different treatment to make TNF to reduced down to different levels. We concluded that all the treatment with Chinese herbs are remarkable reduced TNF levels.In the model text of Jarrett, all the groups with Chinese herbs including the group of FFQDJN with JWHQYG(groupC),the group of LXJDT with JWHQYG(groupD) ,the group of LXJDT with Keyinlingruangao(KYLRG)(group E) can significantly prompt the formation of the scale epidermis cells of the tail(P<0.05). But group E compared with group D and C is higher(P<0.01).All the researches indicated that applying LXJDT with KYLRG is the better way in treating blood-heat syndrome of Ps.更多还原