【作者】 陈国仁；

【导师】 薛博瑜；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2010， 博士

【摘要】 论文以中医学理论为基础,通过对慢性病毒性丙型肝炎的古代文献研究,现代中医药学对慢性病毒性丙型肝炎的研究、总结出慢性病毒性丙型肝炎的基本病因病机,近十五年中医药对慢性病毒性丙型肝炎辨证论治的文献研究,总结出慢性病毒性丙型肝炎的临床证型分布规律及治法分布规律,并对5年江苏省中医院门诊及病房和台湾地区收治的慢性病毒性丙型肝炎的辨证论治病例80例,了解江苏省和台湾地区慢性病毒性丙型肝炎的临床常见证型,并与文献研究结果相对比.全文共分为三个部分.第一部分：回顾了历代中医文献对慢性病毒性丙型肝炎病名的认识.慢性病毒性丙型肝炎为现代医学病名,根据其病程的长短、受邪脏腑部位、病情演变过程及临床表现属中医学“黄疸”、“胁痛”、“症积”、“鼓胀”、“疫毒”、“肝瘟”等范畴.认为湿热疫毒是丙型病毒性肝炎发生的主要病因,饮食不洁、七情所伤、劳倦过度为加重因素,疫毒是慢性病毒性丙型肝炎的主要致病因素,湿热疫毒是发病之始因,肝血瘀滞是病变之核心,正气亏虚是疾病缠绵难愈的关键.病位在肝、脾、肾,病变过程中具有气滞、血瘀、致虚早等病机特点并创制了茵陈蒿汤、大黄庶虫丸、鳖甲煎丸、小柴胡汤、大柴胡汤、茵陈术附汤等临床行之有效的方剂.第二部分：通过对近15年中医文献对慢性病毒性丙型肝炎辨证和治法的归纳.总结出慢性病毒性丙型肝炎的辨证论治规律及目前存在的问题,临床分型种类繁多,辨证分型方案缺少量化指标,辨治原则尚缺核心主干,制定量化微观辨证分型标准和治疗总则乃当务之急,我们通过对近15年对于慢性病毒性丙型肝炎中医辨证论治相关文献研究,临床常见证型按构成比的高低,排除兼夹证,化繁为简,血瘀证和肝郁脾虚证、湿热内蕴证为慢性病毒性丙型肝炎患者最为常见证型,而治法亦是以清热解毒,凉血化瘀为最常见.旨在为中医药治疗慢性病毒性丙型肝炎提供新的思路和方法.第三部分：通过对80例临床慢性病毒性丙型肝炎病例的辨证分型,治法和常用药物的归纳,并与文献研究结果相比较,找出异同之处,探讨目前慢性病毒性丙型肝炎的辨证论治规律.考虑以五种基本证型为主,同时根据临床基本症状进行加减辨证论治,客观辨证与微观辨病研究相结合,对于无证可辨者,可以清热解毒,凉血化瘀这一最常见之法为基本大法论治.更多还原

【Abstract】 The study of traditional chinese medicine differential diagnosis pattern in Chronic hepatitis C, modern traditional Chinese medicine on chronic viral hepatitis C research, summed up the basic chronic viral hepatitis C pathogenesis, nearly fifteen years Traditional Chinese Medicine Syndrome Differentiation and Treatment of the chronic viral hepatitis C, the literature summarized chronic viral hepatitis C, distribution of clinical syndromes, and treatment distribution, and collected the clincal case fromJiangsu Provincial Hospital out-patient and ward and taiwan treated for chronic toxicity Differential Treatment of hepatitis 80 cases from past 5 years and Understanding of Jiangsu province and Taiwan, chronic viral hepatitis C common clinical syndrome, and results were compared with the literature.Text is divided into threePartⅠ:Review of the ancient Chinese medical literature on the chronic toxicity of awareness of hepatitis C disease name. Chronic viral hepatitis C disease name for modern medicine, according to the length of its course, by the evil parts of organs, evolution and clinical manifestations of disease are in the medical "jaundice " " hypochondriac pain, " " stasis "," bulging "," epidemic toxin, " "liver plague "and other areas.that the heat epidemic toxin is a major cause of hepatitis C occurred, eating unclean and injured seven emotions,weary over the contributing factors, epidemic toxin is the major chronic viral hepatitis C risk factors, the incidence of heat epidemic toxin is due to start, hepatic blood stasis is a disease of the heart, Righteousness deficiency is the key to the disease hard to be cured. Disease located in the liver, spleen, kidney, disease process with qi stagnation, blood stasis, caused by diseases such as virtual machine features of early and create their YinChenHaoTang, Da Huang Zhe Chong Wan,Biejiajian pill, Xiao Chai Hu Tang, Tai Chai Hu Tang, YinChenZhuFu decoction and other clinical effective prescription.parts.PartⅡ:Through the past 15 years, literature on the chronic toxicity of TCM Syndrome Differentiation and Therapeutic Methods of hepatitis C induction. Concluded Differential Treatment of chronic viral hepatitis C, the law and the current problems in a wide range of clinical classification, classification type program lack of quantitative indicators, the principle of treating the core of the trunk is still missing, to develop quantitative standards for micro syndrome differentiation and treatment of general principles is a priority, we have adopted in recent 15 years for chronic viral hepatitis C related to traditional Chinese medicine, literature research, clinical syndromes according to component ratio the level of exclusion and folders permit to simplify, Blood stasis and stagnation and spleen deficiency, dampness evidence for chronic toxicity in patients with hepatitis C is the most common syndrome, but therapies are based on heat toxin, cooling blood as the most common. To a Chinese medicine treatment of chronic diseases toxic hepatitis C to provide new ideas and methods.PartⅢ:The toxicity of 80 patients with chronic hepatitis C cases in syndrome differentiation, treatment method and the commonly used drugs, induction, and the results are compared with the literature, to identify similarities and differences and discussing the current chronic viral hepatitis C Differential Treatment rules.to consider the main five basic card types, while the basic symptoms of addition and subtraction based on clinical diagnosis and treatment, objective differentiation and disease differentiation of micro-combination can be identified for the undocumented who can heat toxin, cooling blood, the most common law as the basic law of governance.更多还原