【作者】 林宝华；

【导师】 石岩；

【作者基本信息】 辽宁中医药大学 ， 中医内科学， 2007， 硕士

【副题名】黄连解毒汤加方治疗实热型302例的分析

【摘要】 一百多年来，妥瑞氏症仍是现代脑神经医学的难题。此病表征包括不自主的动作、不自主的声音、或兼有不自主的动作和声音；但是病人的意识清楚。本临床研究采用清热解毒疗法，以黄连解毒汤为主方，随症加药。自2004年8月至2007年2月底，在两年七个月的临床经验，曾诊治524个妥瑞氏症病人。本临床统计排除有舞蹈症、肝豆状核变性、癫痫肌阵挛、脑肿瘤及其它锥体外系等中枢神经疾病引起抽动者11人；排除伴有明显强迫症、自闭症、忧郁症等精神障碍者24人；排除只看诊一次和服中药不足30天难以认定为中医疗效者180人；也排除非以清热解毒疗法治疗者7人。扣除上列，本临床研究用黄连解毒汤加方治疗之病人共302人，男性264人(87％)，女性38人(13％)。其中完全缓解68例(22.52％)、显效178例(占58.94％)、有效40例(占13.25％)、无效16例(占5.30％)。总有效率为94.70％。将302例患者分开为中药组或中西药并服组，分别做疗效分析。第一组，中药组，共257人。完全缓解59人(22.96％)、显效157人(61.09％)、有效29人(11.28％)、无效12人(4.67％)，总有效率为95.33％。第二组，中西药并服组，病人尽快戒断西药，共45人。完全缓解9人(20.00％)、显效21人(46.67％)、有效11人(24.44％)、无效4人(8.89％)，总有效率为91.11％。两组间以卡方检定(The Chi-square Test)分析，无明显区别(P＞0.05)，说明中药组与中西药并服组疗效一致。1、前言怪动作频繁，怪声音烦人，都不是小孩顽皮。这是妥瑞氏症(Tourette’s syndrome)，又称抽动秽语综合症、多发性抽动症、进行性抽搐、冲动性肌痉挛等。西医发现于1885年，我国古代早有论述，属中医的“惊风”、“瘛疭”、“筋惕肉润”、“痉风”等范畴。台湾民间闽南话称为「着猴症」。妥瑞氏症病人经现代医学的核磁共振(MRI)、脑电图检查，部分发现异常，病人的脑基底核协调功能异常、多巴胺反应过度、联系额叶的功能异常，或是有个人的基因问题。虽然统计上，有些人可能在长大后自己减轻或痊愈，但是困扰的问题是，许多病童的求学过程受到病情的影响；并且忧心是否会遗传。美国妥瑞氏症协会曾经统计，父母亲有一人是妥瑞氏症基因带原者，有50％的机会，其子女也有tic。如果采实验室设计，用中药治疗仿真为妥瑞氏症的小动物，恐怕不切实际。因为此病的症状太多、变化太大、病情差异也大。如果临床用中药治疗妥瑞氏症病人，而依常规以三个月为疗程统计，也缺乏说服力。因为西医的治疗经验，此病常在症状消失一、二个月后又突然发作或改变症状。更多还原

【Abstract】 For well over 100 years now since the condition was first documented, the Tourette syndromeremains a difficult problem of modern cranial nerve medical science. The symptoms of this diseaseinclude involuntary movements and abnormal vocalizations, or both, while the patients are fullyconscious of their surroundings.This clinical research adopts the treatment of releasing heat and resolving toxins. Patients wereadministered "Huang Lian Jie Du Decoction," adding other herbs based on the individual’spresenting signs and symptoms.Five-hundred twenty-four (524) Tourette syndrome patients were treated from August of 2004to February of 2007. These clinical statistics excluded 11 patients with central nervous systemdisorders, such as Huntington’s disease, Wilson’s disease, epilepsy, and brain tumors; 24 patientswith mental disorders, such as obsessive-compulsive disorder, autism, and melancholia; and 180patients who were non-compliant in taking an adequate 30-day treatment dosage.; and 7 patientswho were treated with a traditional Chinese medicine (TCM) method other than releasing heat andresolving toxins.Accounting for the forementioned exclusions, 302 patients were administered the "Huang LianJie Du Decoction," exhibiting an efficacy ratio of 94.70% while 5.30% laeked treatment efficacy.We separately analyzed two groups: one that solely received TCM treatment and another thatreceived a Chinese-Western integrated medicine approach:The first group, the TCM group, accounts for 257 patients. Complete recovery occurred in 59patients (22.96%), significant treatment efficacy in 157 patients (61.09%), some treatment efficacyin 29 patients (11.28%), and no treatment efficacy in 12 patients (4.67%). The total treatmentefficacy ratio is 95.33%.The second group, the Chinese-Western integrated medicine approach, accounted for 45patients. Complete recovery occurred in 9 people (20.00%), significant treatment efficacy in 21patients (46.67%), some treatment efficacy in 11 patients (24.44%), and no treatment efficacy in 4 patients (8.89%). The total treatment efficacy ratio is 91.11%.According to the analysis of the "Chi-Square Test," there is no significant difference betweenthese two groups (P＞0.05). It reveals that the treatment efficacy of the TCM group and theChinese-Western integrated medicine group is the same.更多还原