【作者】 秦文广；

【导师】 黄仲委；

【作者基本信息】 广州中医药大学 ， 中医五官科学， 2008， 硕士

【摘要】 岭南医学是研究岭南地区自然气候、地理环境、人群体质对该地区疾病发生发展的影响和防治规律的一个学术流派,包括岭南温病、岭南内科、岭南儿科、岭南疫病、岭南瘴疟等。至今,我国还没有南北地域中医眼科的辨证论治差异的研究,本课题选择三种眼科常见疾病:病毒性角膜炎(HSK)、葡萄膜炎、中心性浆液性视网膜脉络膜炎(CSC)为研究对象。目的:通过统计分析病毒性角膜炎、葡萄膜炎、中心性浆液性视网膜脉络膜炎的相关论文资料及病例资料,对比此三种常见眼病的南北辨证论治的差异,来了解、分析岭南地域中医眼科的辩证论治特色。方法:采用回顾性分析,收集资料包括1980年至今的南北方的论文资料271篇,以及1980年后从广州中医药大学第一附属医院病案室及眼科门诊激光室的病例资料325例,将收集的资料按北方(北京、天津、河北、河南、山西、安徽、山东、江苏、上海)及南方(广东、广西、海南)分为南北两组,比较此三种常见病的南北辨证论治用药的差异。结果:1.证型分析:①病毒性角膜炎前组湿热蕴伏证南方较北方为多,肝胆火炽证、正虚邪留证北方较南方多;后组肝经风热、湿热蕴伏证南方较北方为多,正虚邪留证、肝胆火炽证北方较南方多,后组南方论文和北方论文证型对比无统计学意义;南方前后组证型对比无统计学意义。②葡萄膜炎前组阴虚火旺证北方较南方多,后组南北方证型对比无统计学意义;南方后组阴虚火旺证较前组多,前组脾肾阳虚较后组多。③中浆湿浊上泛证南方较北方为多,肝肾阴虚证北方较南方为多;南方前后组证型对比无统计学意义。2.治疗用药分析:①HSK药物比较:南北方用药前十名药物比较,P＜0.05,有统计学意义。②葡萄膜炎药物比较:南北方用药前十名药物比较,P＜0.05,有统计学意义。③CSC药物比较:南北方用药前十名药物比较,P＜0.05,有统计学意义。结论:1.证型差异:①岭南地域多见湿热痰湿证候。②病毒性角膜炎的病因病机与肝经风热密切相关。③葡萄膜炎的病因病机与肝胆湿热密切相关。④北方地区病毒性角膜炎肝胆火炽证较多,葡萄膜炎阴虚火旺证较多,中浆肝肾阴虚证较多。2.论治特点:①南方用药多使用祛瘀凉血之品。②南方用药多用轻省之品,缓和之剂。③南方多顾护脾胃。④南方重视疏肝理气,宣畅气机。⑤北方多用力量相对较峻之药。⑥北方用通阳化气,利水渗湿之品。⑦北方重益阴滋阴之品。3.南方辨证论治的特点与岭南的气候特点、人的体质特点密切相关,而与时间推移、网络发展等相关性不大。更多还原

【Abstract】 Medical science in South China is an academic school by studying the occurrence and development of the disease in the influence of the natural climate, the circumstances and the group constitution, and by studying the rule of prevention and cure.It includes seasonal febrile disease, internal medicine, pediatrics, plague, malignant malaria and so on. To this day, there is no the study on the difference of treatment by differentiation of syndromes (TDS) in ophthalmology between in South China and North China. We select 3 ophthalmocaces as the research objects, It includes herpes simplex keratitis(HSK), uveitis and central serous chorioretinopathy(CSC).Objective:By statistical analyzing the data of thesis and cases of HSK, uveitis and CSC, by contrasting the difference of TDS in ophthalmology between in South China and North China, to understand the special feature of TDS in ophthalmology.Method:Using retrospective analysis , collecting 271 thesis in the library of Guanghzou University of TCM and 325 cases in the medical record library and the laser-room in the first of affiliated hospital of Guangzhou University of TCM after 1980, we divided these data into two groups:the north group (Beijing, Tianjin, Hebei, Henan, Shanxi, Anhui, Shandong, Jiangsu, Shanghai) and the south group (Guangdong, Guangxi, Hainan) , to contrast TDS between in the South and North group, to conclude the difference between in the South North group. Result:1. Analysis of type of syndrome:①There are more ratio of syndrome of accumulated damp-heat in south than north, more syndrome of excessive fire of liver-gallbladder and remaining of pathogens due to deficiency of vital QI in north than south in front group of HSK. There are more ratio of syndrome of accumulated damp-heat and wind-heat of liver channel in south than north, more syndrome of excessive fire of liver-gallbladder and remaining of pathogens due to deficiency of vital QI in North than South in post group of HSK. There is the same ratio of type of syndrome in thesis in South as North, the same ratio of type of syndrome in the front group as the post group in South.②There are more ratio of syndrome of hyperactivity of fire due to deficiency of YIN in north than south in the front group of uveitis. There is the same ratio of type of syndrome in South as North. There are more ratio of syndrome of hyperactivity of fire due to deficiency of YIN in the post group than front , more syndrome of asdthenic splenonephro-yang in the front group than post. ?There are more ratio of syndrome of damp stagnancy in the South group of CSC than North, more hepatic and renal yin deficiency in north than south. There is the same ratio of type of syndrome in the front group as the post group in south. 2. Analysis of determination of treatment:①Contrast of medicine of HSK: Contrast ing the top of ten medicine in the South and North group , it has statistical significance. (P<0.05)②Contrast of medicine of uveitis: Contrasting the top of ten medicine in the South and North group , it has statistical significance. (P<0. 05)③Contrast of medicine of CSC Contrasting the top of ten medicine in the South and North group , it has statistical significance. (P<0.05)Conclusion:1. Difference of type of syndrome:①There is more ratio of syndrome of damp-heat or damp in South China.②The cause and pathogenesis of HSK are closely correlated with syndrome of wind-heat of liver channel.③The cause and pathogenesis of uveitis are closely correlated with syndrome of hepatochlic hygropyrexia.④There are more ratio of syndrome of excessive fire of liver-gallbladder of HSK, more ratio of syndrome of hyperactivity of fire due to deficiency of YIN of uveitis, more ratio of syndrome of hepatic and renal yin deficiency of CSC in North China. 2. Characteristic of treatment:①Medication in South China is more medicine of removing blood stasis and cooling the blood.②Medication in South China is more slight and bland medicine.③Medication of protecting the spleen and stomach is more applied in South China.④Medication of dispersing stagnated liver-qi for relieving qi stagnation is more applied in South China.⑤Drastic relatively medicine is more applied in North China.⑥Medication of activating yang and removing dampness and promoting diuresis is more applied in North China.⑦Medication of tonifying YIN is more applied in North China. 3.The feature of TDS is closely correlated with climate and body constitution in South China, but not much closely correlated with time-lapse and development of network.更多还原