【作者】 许前磊；

【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】 “治未病”理论是指导中医临床实践的基本原则之一,而现代医家多从理论层次把中医的“治未病”思想与现代疾病的防治进行了积极的整合,缺乏系统的整理、总结与提高,影响其成果的推广及应用。随着现代医学模式的转变和人们健康观的不断发展赋予了“治未病”更深刻的现实意义,人口老龄化与疾病医疗负担的不断加重给中医“治未病”理论的发展带来了新机遇和广阔的发展前景,以预防为主的医疗模式越来越得到人们的重视。艾滋病作为一种新发的传染病,近年来国内外医家们运用中医传统及药学理论对艾滋病的防治进行了积极地探索。根据其独特的发病规律,从整体出发,辨证论治,进行早期干预显示出了广阔的应用前景。因此,通过对传统中医“治未病”理论的探讨,针对无症状期这一临床治疗的黄金切入点,进行系统的研究,为更好的发挥中医药在治疗感染性疾病中的优势奠定基础。目的：通过对无症状期HIV感染者中医证侯流行病学研究,分析其内在病机,运用中医传统理论确立临床治疗大法,为中医药治疗感染性疾病提供一种治疗思路,以期提供一种可延缓其发病进程的有效药物。方法：本课题采用中医学、临床流行病学、生物统计学等方法,开展了大样本636例无症状感染者及778例对照人群中医证侯临床调查,根据症状体征、舌象、脉象及证侯分布规律分析其病因病机。针对病机拟以扶正排毒片进行早期干预治疗。结论：1.无症状HIV感染者的中医症状出现频率最高是乏力,共出现439例占69.0%。以全身症状和脾胃症状为主,存在全身症状和脾胃症状的集中趋势,肺系症状和心系症状居中,肾系症状次之,发生率在20%以上的症状中,肝系症状较少,且部分和心系症状重合,如心烦急躁等。2.共出现的40种中医证候,出现频率最高的证候为湿热内蕴脾气虚弱证105例,占全部证候16.5%。其次为湿热内蕴证52例,占全部证候的8.2%,再次为湿热内蕴肺脾气虚证43例,占全部证候的6.8%。从脏腑所涉及的证候分布来看,病变的初期主要以肺脾的证候为中心,随着疾病的发展,病变涉及五脏,存在着由实致虚,由浅入深发展演变的过程。3.通过对无症期HIV感染者临床症状、证侯表现分析其病邪性质兼夹湿、热、毒、疠,致病特点直接伤及元气；病机多由毒邪侵袭机体致本元之气渐虚而出现症状。针对病机予以“培元祛毒”之法,益肺脾之气,养肝肾之阴,祛湿热之邪,培元气之本。拟扶正排毒片(西洋参、黄芪、白术、防风、白花蛇舌草、女贞子、山茱萸、南沙参、紫草、连翘、甘草)进行早期干预治疗。4.临床研究结果表明,扶正排毒片对无症状HIV感染者能明显缓解或改善腹泻、恶寒、口渴、脱发等多个症状体征,并有控制其症状复发的作用；并有提高感染者免疫功能,降低病毒载量的作用。现有试验条件下扶正排毒片是安全的,临床上未见明显不良反应。通过运用中医传统理论确立的治疗大法进行临床干预,为中医药治疗感染性疾病提供一种治疗的思路,同时可提供一种可延缓无症状HIV感染者发病进程的中药,提高无症状HIV感染者的生存质量,具有重要的经济和社会价值,具有广阔的应用前景。更多还原

【Abstract】 The theory of preventive treatment is one of basic concepts for guiding TCM clinical practice. But many physicians positively integrate the theory with the method of preventing modern diseases only from theoretical aspect without systematic organization, summarization and improvement, then affect popularization and application of the achievements. With the transformation of the modern medical model and the constant development of people’s health attitude, they give it the in-depth practical significance. With the increasing ageing population and the burden of curing diseases bring the new chance and have broad developing prospect. The medical model of putting prevention first is becoming more and more attached importance to people.AIDS is a new occurring epidemic. In recent years, the domestic and foreign physicians use the traditional Chinese medicine and the pharmacological theory to actively probe the treatment and prevention of AIDS. According the special occurring rule of it, the physicians treat it based on syndrome differentiation to interfere in it at the early stage from wholeness, that approve the broad application aspect. Therefore, probe the TCM preventive treatment theory, and take on the systemic research at the clinical treatment golden stage of the no syndromes period, and lay the foundation for the further give play to advantages of TCM treating the infectious disease.ObjectiveResearch on HIV infected person’s Symptomless stage by TCM syndromes and signs epidemiologic study, analysis its internal pathogenesis, and use the TCM theory to establish clinical therapy method for TCM treat the infectious diseases providing a treatment thinking that look forward to provide a active drug to postpone its invasion process.MethodThe study adopts the methods of traditional Chinese medical science, clinical epidemiology and biodemography etc,. that carried out the TCM syndromes clinical research of the big samples 636 symptomless infection patients and 778 control people to analyses its etiopathogenisis and pathogenesis on the basis of symptoms, signs, tongue demonstration, pulse tracings and syndromes disposition regular pattern. Plan to use Strength Health Qi and Expelling of Toxin tablet undertaking the early intervention treatment to aim directly at pathogenesis. Conclusion1. Symptomless HIV infected persons who appear the TCM symptoms and signs of the max frequency of occurrence is debilitation that appears 439 samples and acount for 69 percent. Its relys mainly on general symptom and the spleen and stomach symptom, and has the central tendency of general symptoms and the spleen and stomach symptoms, pulmonary system symptoms and cardiac system symptoms in secondary,in the following is kidney system symptoms. Above 20 percent of symptoms incidence rate, the liver-connectors appear fewer and partly coincide with cardiac system symptoms such as dysphoria, impetuosity and so on.2. Totall 40 kinds TCM syndrome are appeared. The highest requency of occurrence syndrome is endoretention of damp heat and deficiency of spleen QI syndrome, that 105 samples acount for 16.5 percent in the total syndromes. The next is endoretention of damp heat syndrome,52 samples for 8.2 pecent, then last is endoretention of damp heat and deficiency of lung Qi syndrome,43 samples for 6.8 percent. From the syndrome disposition of Zang and Fu organs, in the initial stage of the disease is centered around the lung and spleen syndrome. With the developing of the disease, the pathological changes refer to five viscera and has the transition from sthenia syndrome to asthenia syndrome, and superficial to deep.3. From the clinical symptoms and syndrome manifestations of HIV infected patients at symptomless period, analysed pathogen nature that mixed damp, heat, toxin and pestilence, besides the pathopoiesis feature is hurt the vigour directly. Pathogenesis is most of posion factor which invaded body and cuase the gradually deficency of primordial qi and then appear the symptoms. In view of the pathogenesis, apply the cultivating primordial qi and expelling poison method, nourish liver and kidney yin, dispelling dampness and heat pathogen, cultivate the root of the primordial qi. Plan to use Strength Health Qi and Expelling of Toxin tablet (American ginseng, astragali, atractylodes macrocephala, divaricate saposhnikovia root, hedyotic diffusa, glossy privet fruit, red osier, fourleaf ladybell root, lithospermi, forsythia suspensa, glycyrrhiza uralensis) undertaking the early intervention treatment to aim directly at pathogenesis.4.Clinical research findings indicated that the tabelt can obviously realease and improve diarrhea, aversion to cold, hydrodipsia and so on multi-symptoms and signs for the HIV infected patients at symptomless period. And Its has the effects that control the symptoms recurring and enhance the patients immune function, degrade virus load. At present, in experimental condition the tablet is safe and have not any adverse effects.The treatment method that established by applying TCM theory to undertake the clinical intervention, providing a new treatment thought for TCM curing the infectious diseases, and can provide a new chinese medicine to delay the disease ocurracing process for the HIV patients at the symptomless stage too. It can improve the patients’living quality and has the significant ecnomic and social value with the broad application outlook.更多还原