蔡瑞康教授治疗白癜风经验及艾灸疗法治疗肢端白癜风临床疗效观察

【作者】 张思；

【导师】 瞿幸；

【作者基本信息】 北京中医药大学 ， 中医外科学， 2010， 硕士

【摘要】 白癜风是一种常见的后天性色素障碍性皮肤病,症状为皮肤出现局限性或泛发性色素脱失,病理示皮损处黑色素细胞减少或消失,此病易于诊断,难于治疗,有碍容貌,影响患者身心健康。临床发病率呈上升趋势,病因复杂,尚未完全明了,通常认为是多种因素综合作用的结果。尽管治疗方法很多,但迄今尚未找到一个大家公认的理想治疗方案,中西医结合、内外兼治显示了强大的优势,光敏药、光源的改进,丰富了白癜风的光化学疗法,近代中医从补益肝肾、筛选具有激活酪氨酸酶活性、光敏性等中药入手,取得了较好的成绩。蔡瑞康教授在治疗白癜风方面有着丰富的临床经验,他经过长期临床实践总结出来的综合疗法,被认为是一种符合绝大多数患者,且行之有效的方法。论文包括文献综述和临床研究两部分。文献综述共两篇,第一篇综述白癜风的中医学研究进展；第二篇综述白癜风的现代医学研究进展。临床研究分为两部分,临床研究一：目的：观察蔡瑞康教授综合疗法治疗白癜风的临床疗效,总结蔡老治疗白癜风的经验。临床疗效：治疗6月后,总有效率66.6%,治愈率9.0%,其中头颈部疗效最好,总有效率82.5%,治愈率11.6%,躯干部次之,总有效率61.9%,治愈率5.3%,四肢部疗效最低,总有效率25.0%,治愈率12.5%。临床研究二：目的：观察艾灸治疗肢端白癜风的临床疗效。临床疗效：治疗6个月后,总有效率2.4%,说明艾灸治疗肢端白癜风收效不佳。总结讨论：蔡老认为白癜风病因病机可归为“两点”：肝肾不足、肺卫不固为本；风邪侵袭、气滞血瘀为标。治疗上采取中西医结合、内外兼治的综合疗法。中药主要辨证采取补益肝肾,养血活血祛风的白斑汤加减,另在组方用药时注意筛选具有激活酪氨酸酶活性、光敏性、免疫抑制性、富含微量元素功效的中药；西药主要通过免疫调节剂,补充微量元素及维生素起到辅助治疗作用；另局部外用家用小型黑光灯照射,除肢端白癜风收效不佳外,其它部位白癜风取得了良好的临床疗效,艾灸疗法治疗肢端白癜风收效不佳。更多还原

【Abstract】 Vitiligo is a common obstacle to acquired skin pigment. Its main symptoms are the limitations of skin pigment or generalized loss. Pathology shows the melanoma cells,in lesions department, reduction or disappearance. The disease is easy to diagnose, but difficult to treatment. It is not conducive to appearance, physical and mental health of affected patients. Clinical upward trend in the incidence, etiology complex, not yet fully understood, usually considered a variety of factors. Despite the treatment, but so far have not yet found a well-recognized treatment programs, combining Chinese and Western medicine, treatment with both within and outside shows the advantages of a powerful, photosensitive drug, the light source to improve and enrich photochemotherapy of vitiligo.The modern traditional Chinese medicine from the liver and kidney tonic, Screening of tyrosinase activity with the activated, photosensitive, such as traditional Chinese medicine approach, has achieved fairly good results. Professor Cai Ruikang in the treatment of vitiligo has extensive experience in clinical practice over a long period, he summed up the triple therapy, which is considered to be a way with the vast majority of patients, and effective.The thesis includes literature review and clinical study.Literature review includes two parts. The first part is about vitiligo progress of traditional chinese medical research,the second part is about vitiligo progress of modern medical research.The clinical study one:Purpose:Observe the clinical efficacy of combined treatment of Cai Ruikang for the treatment of vitiligo and sum up the experience of Mr. Cai’s treatment of vitiligo. Clinical efficacy:By the end of 6 months, the total effective rate has been up to 66.6%, cure rate up to 9%.Head and neck showed the best effect, whose total effective rate has reached up to 82.5%, cure rate up to 11.6%.The department of trunk are better than limbs,their cure rates were 61.9%, cure rate up to 5.3%. The limbs illustrated the worst effect, whose total effective rate has reached up to 25.0%, cure rate up to 12.5%.The clinical study two:Purpose:Investigate the clinical effecacy of moxibustion in treating acral vitiligo. Clinical effecacy:By the end of 6 months, the total effective rate has been up to 2.4%, which proves that the moxibustion does not have good response.Summar y and discussion:Professor Cai Ruikang summe up the etiology and pathogenesis of vitiligo to"two points":the root is insufficient liver and kidney, lung non-solid-based guardian,the branch is wind xie attack, qi and blood stasis. He adopt a treatment of traditional Chinese and western medicine, internal and external methods virtue, and pay much attention to the theory "wind first rule of blood, blood from the anti-style". The main benefit to take traditional Chinese medicine differentiation of liver and kidney, nourishing and activating-blood spot Qufeng decoction. In the other side, filter with activated tyrosinase activity, photosensitivity, immunosuppression, and rich in trace elements in the effectiveness of Chinese medicine. Western medicine through the immunomodulator, added trace elements and vitamins play a role in adjuvant therapy. Another small black household local external irradiation and achieved a good clinical efficacy except in acral vitiligo. The moxibustion treatment of acral vitiligo does not have good response.更多还原