【作者】 梁卫；

【导师】 吴承玉；

【作者基本信息】 南京中医药大学 ， 中医诊断学， 2013， 博士

【摘要】 辨证是中医学的核心及精华,病位、病性是辨证的基本要素,基础证是由单一的病位与单一的病性构成的证。导师历经数十年的悉心探研,构建了具有系统性、发展性、特异性和稳定性的五脏系统辨证体系,本课题将导师五脏系统辨证新体系的辨证模式与组合规律应用于酒精性肝病。拟通过文献研究、临床病案流行病学调查的方法,规范酒精性肝病的病名、病位、病性、基础证及复合证,突出“从症辨证”与“辨病与辨证相结合”的原则,构建酒精性肝病辨证思维模式与辨证规律。在整体上揭示中医对酒精性肝病病证辨证的基本原理与普遍规律,同时又重视采用现代科学研究的方法,提出辨病与辨证相结合行之有效的思路与方法,保持了传统应用价值与临床紧密结合的中医病证结合的新思路,使酒精性肝病病证结合辨治更加灵活准确,易于掌握,更符合临床病证结合辨治思路,对提高临床诊治水平起到重要的指导作用。第一部分,理论研究。通过较为系统的文献整理,综述了古今医家对酒精性肝病的病名、病因病机、辨证分型、证候表现等文献研析。历代医家对病名的论述有“伤酒”、“酒病”、“伤饮”、“酒积”、“积聚、“酒癖”、“酒疸”、“酒臌”等,没有统一、明确的病名。其病因有湿热痰瘀毒邪,病位以肝系统为主,兼伤脾胃及肾系统。辨证分型各不相同。现代医学研究认为本病发生与乙醇及其代谢产物的毒性、细胞因子、铁、基因等因素有关。第二部分,酒精性肝病的病证辨证规律研究。通过对酒精性肝病中医病名研究,提出“酒积”作为酒精性肝病的中医病名。对酒精性肝病病因病机进行重新阐释,明确指出酒毒为主要病因；饮食劳倦、情志不调、邪毒留滞为酒精性肝病发生发展的重要因素,不可忽视体质因素导致酒精性肝病的重要意义。正虚邪蕴是该病发病的基础。基本病机特点是酒毒内侵、肝胆湿热。应用临床流行病学研究方法,收集713例酒精性肝病临床病例,采用SPSS统计软件,进行聚类分析和主成分分析,归纳酒精性肝病病证的症状、舌脉等诊断信息,探析病位、病性证素的分布；运用关联规则分析饮酒史、肝功能、血脂与病证的关联性。构建“酒精性肝病病证特征诊断信息表”,规范酒精性肝病的病位、病性证素及特征表现,探研了基础证与复合证的组合规律。研究发现,酒精性肝病病位在肝,与胆、脾、胃、肾相关；病性湿毒、火热为主,可兼有痰浊、瘀血、气滞、气虚、阴虚、阳虚、水停等。常见的基础证是肝湿证、肝热证、胆热证、肝郁证、脾气虚证、胃气滞证、脾湿证、肝瘀证、肝痰证、肝阴虚证、肾阴虚证、脾瘀证、脾阳虚证、肾阳虚证。复合证以肝胆湿热证、肝郁脾虚证、肝胃气滞证、肝脾血瘀证、痰瘀互结证、肝肾阴虚证、脾虚湿蕴证、脾肾阳虚证多见。此外,饮酒史、肝功能、血脂与证型有一定相关性。本研究对酒精性肝病的病证辨证规律进行了探讨,明确该病的病名、病位、病性证素及特征、基础证与复合证。遵循“从症辨证”的中医辨证思维原则,确定以“五脏系统辨证体系”为核心的辨证思路,体现了辨证的系统性和发展性、证的稳定性和特异性,符合临床酒精性肝病的辨证思路。更多还原

【Abstract】 Syndrome is the core and most important part of traditional Chinese medicine, disease-location and disease-character are essential to syndrome. When a syndrome is composed of single disease-location and disease-character, it is called basic syndrome. Having devoted to the study for tens of years, my tutor have constructed a systematic, developmental, dialectical, five viscera centered five-viscera syndrome system. This issue applied the syndrome pattern and combination law of her new five-viscera syndrome system to alcoholic liver disease. By the methods of literature research and epidemiology investigations on clinical case reports, this issue intended to regulate the name, location, characteristic, basic syndrome and compound syndrome of alcoholic liver disease, emphasized the principles of "from symptoms to syndromes" and "combination of disease and syndrome differentiation", constructed the syndrome thinking model and principle of alcoholic liver disease. The fundamental principle and general law of alcoholic liver disease in traditional Chinese medical was revealed on whole. Meanwhile modern scientific research methods are applied. The syndromes combined effective ideas and methods was proposed. The new idea was kept that the traditional value of TCM syndrome combination is closely integrated with clinical. Therefore the combination of disease and syndrome differentiation dialectical treatment of alcoholic liver disease was much more flexible, accurate, easier to grasp, and more in line with the clinical disease and syndrome differentiation thought. It would play an important guiding role in improving the level of clinical diagnosis and treatment.The first part is about theoretical research. By a systematic study on literatures, this part summed up researches by ancient and modern doctors on names, causes, mechanism, syndrome and classification, nature of syndrome of alcoholic liver disease. Ancient doctors classified alcoholic liver disease as for instance "alcoholic injury","drinking disease","disease with improper drink","alcoholic dyspepsia","accumulation","alcohol addiction","alcoholic jaundice","alcoholic tympanites", etc., there were no unified and definite disease-name. And they said that the cause was hot and humid phlegm the toxin, the location was liver system based and the spleen, stomach and renal system also hurt.They distinguish the patterns and syndromes quit different. Modern medicine deems that alcoholic liver disease relate to ethanol and its metabolite poison, cytokine, iron, gene etc.The second part is about research on syndrome regulation of alcoholic liver disease. Through researches on disease-names in TCM,"alcoholic dyspepsia" was proposed for the disease-name of alcoholic liver disease in TCM. The cause and mechanism was re-illuminated, it was specified that alcoholic toxicity is the major cause. Improper diet, disorder of emotions, poison perching are major factors of how alcoholic liver disease happened and developed, and physique is another very important factor. Healthy deficiency and poison excess is the foundation of the disease. The basic pathogenesis is alcohol poisoning intrusion, dampness and heat in liver and gallbladder.By the method of clinical epidemiologist research, we collected713clinical cases, and using SPSS to do cluster analysis and principal component analysis. We summed up the syndrome of diagnosis data, for instance, syndrome and tongue vein, explored the distribution of disease-position and disease syndrome factor, used the association rules to study relationship between the syndrome and drinking history, liver function, blood-fat. We constructed an "alcoholic liver disease Syndrome Diagnosis Information List", regulated disease-position, disease syndrome factor, and characteristic, researched into basic syndrome and compound syndrome combination laws.Researches have revealed that alcoholic liver disease is located in liver, relates to gall, spleen, stomach, kidney. Its main characteristic includes noxious dampness, fire heat, and also turbid phlegm, blood stasis, stagnation of qi, deficiency of qi, deficiency of yin, deficiency of yang, water retention etc.Its basic syndromes include liver heat syndrome, liver damp syndrome,, bile heat syndrome, live-depression syndrome, spleen-qi deficiency syndrome, gastric qi stagnation, spleen dampness, liver stagnation syndrome, liver sputum syndrome, liver yin deficiency syndrome,kidney yin deficiency syndrome, spleen stasis syndrome, spleen yang deficiency syndrome, kidney yang deficiency syndrome. Its compound syndromes are usually liver and gallbladder damp-heat syndrome, liver depression and spleen deficiency syndrome, incoordination between the liver and stomach, the liver and spleen blood stasis, intermingled phlegm and blood stasis, liver kidney yin deficiency, spleen deficiency wet accumulation syndromes, spleen kidney yang deficiency syndrome. It is also considered in pattern of syndrome that drinking history, liver function, blood-fat,syndromes.The thesis investigated the syndrome regulation of alcoholic liver disease, made it clear that the name, location, disease syndrome factor characteristics, basic syndrome and compound syndrome of the disease. The thesis followed the principle of "from symptoms to syndromes" in traditional Chinese medicine, and clarified the dialectical thought of "five viscera syndrome differentiation system "as the core, exposed dialectical systematicness and expansibility, stability and particularity of syndrome, thus in accordance with the dialectical thought of clinical alcoholic liver disease.更多还原