李宗智教授治疗年龄相关性黄斑变性的经验及学术思想整理

发布时间：2018-04-25 03:06

本文选题：学术经验 + 年龄相关性黄斑变性　；参考：《成都中医药大学》2016年博士论文

【摘要】：李宗智教授出生于中医世家,从医五十余载,在治疗眼科疾病方面积累了丰富的经验,尤其是眼底疾病。李老一生努力钻研祖国医学,精读中医经典古籍,跟随多位中医名家从医,涉及内科、妇科、儿科、眼科等,集众家之所长,形成了自己独特的诊疗疾病特色,成为享誉全省乃至全国的中医眼科专家。他诊治疾病不拘一格,整体与局部辨证相结合,辨病与辨证相结合等多种方法灵活运用。在治疗眼科疾病当中,认为目为清窍,需要气血阴液、真血的濡养,而神光的发越又容易耗伤阴血,故主张“阴常不足”,提出以滋养阴血为主治疗眼科疾病的治疗方法；同时,目为肝之外窍,肝中所藏之血为真血,肝气的疏泄在神光的发越中起到非常重要的作用,常以疏肝平肝之法兼之。在治疗许多眼底疾病上,认为疾病的发生发展涉及多脏腑、多因素,重视心中之阳在眼底疾病中的重要性。李老治疗疾病还重视治未病,讲究养生与治病相结合,提倡寡欲,形神俱养。认为许多眼科疾病,尤其是一些疑难性眼底疾病,与多思多欲有极大的关系。他喜好儒学,讲究中庸,处方用药中正平和；临证既立足于中医,也不排斥西医,把西医先进的检查运用到中医的辩证论治中,使其成为四诊的一个资料,合理运用。他长期坚持临床,不断学习,学以致用,仁爱友善,善待每一个患者,不计较金钱名利,是患者心目中的“神医”。其对近视力的重视程度大于对远视力的重视,尤其在小儿弱视的治疗中,认为近视力的恢复是视网膜黄斑功能恢复的重要体现,提倡单频视物,眼罩的制作必须是外黑内红,精细训练提倡穿针,不提倡穿珠子等,治疗与训练坚持的时间长。而且贵州省第一个中医眼科专科就是由他所组建,培养出了一大批中医眼科专门人才,为中医眼科在贵州的发展打下了坚实的基础。本论文主要分为四个部分,除上述第一部分主要介绍李宗智学术思想和临证经验的整理与研究外,在第二部分则对目前中医及西医对于本病的认识及治疗进行了综述。其中,中医对于本病的认识主要是肝脾肾虚损,痰瘀互结。治疗上也主要是从补益肝脾肾,化痰散瘀等入手治疗,未有在治疗本病中重视心的功能的记录,这正是导师治疗本病的独特之处。同时,还对从现代医学对本病的认识做了简单的回顾。现代医学对于本病的研究虽然颇多,治疗方法也齐全,从药物治疗到手术治疗均有,但治疗效果并不尽人意,且价格昂贵,副作用也较大,不是治疗本病的首选。中医药治疗本病有其价廉、无毒、效优等特点,虽不能完全治愈本病,但能够延缓疾病的发展,不失为治疗本病的又一种选择。随着光学相干断层成像术(OCT)的使用,目前对于本病的诊断及治疗效果的观察更加客观。第三部分主要介绍李宗智教授治疗年龄相关性黄斑变性的特色及优势。李老对于年龄相关性黄斑变性的病因病机的认识,主要认为脾肾亏虚是基础,精血不足是重点,痰浊与瘀血始终贯穿本病,在本病的形成及发展中有重要的促进作用。干性型者主要是由于年老体衰,肾气亏损,脾气虚弱,心阳不振引起；湿性型者主要是由于肝脾肾亏虚,营血亏滞,血热内生,水火不济,心经郁热,脉络津亏血少,因虚致瘀,运化失健,水浊内停成痰,痰瘀互结,导致本病的产生。同时还提出本病的发生发展是多脏腑受损的结果,不能简单看待之。其对于本病病因病机,李老认为本病除了与肝脾肾有莫大的关系之外,还与心的关系密切。他认为心为君主之官,神明出焉,神光属于神明。心为火藏,心之与其他脏腑犹如夜空之明灯,在老年人者主要是由于心阳不足,照耀、温馨不够,或心之阴血不足,血热上蒸所致。心主血脉,一身之血莫不由心主控,而目得血能视,故心的功能正常,神光才有所依,发越方有基。总结李老处方用药规律,除了与传统的认为本病主要与肝脾肾三脏有关的认识不同以外,他还提出干性者以实脾益肾平肝,温振心阳,养心开窍为主,兼以化痰；湿性者以滋养精血,清营凉血解郁为主,兼以化痰逐瘀的治疗方法。在第四部分临床研究中,主要根据李老对年龄相关性黄斑变性的病因病机的认识,综合自己三年跟师的心得,总结用药规律,研讨如何组方治疗湿性年龄相关性黄斑变性。通过视力评分、视网膜神经上皮层厚度(RNL)评分、脉络膜毛细血管复合体(CBRC)的厚度评分以及中医证候评分,评价疗效。结果①治疗组30例35眼中,显效7只眼,有效13只眼,无效15只眼,总有效率57.14%,无效占42.86%；对照组30例30只眼,显效3只眼,有效10只眼,无效17只眼,总有效率51.43%,无效48.57%,两组比较,P0.05,有显著差异性。②治疗组与对照组治疗前后视力均有变化,治疗组视力提高明显优于对照组(P0.05)。③治疗组治疗前后RNL、CBRC厚度变化比较有显著差异(P0.05),对照组治疗前后RNL厚度比较(P0.05),差异无统计学意义,CBRC厚度比较有显著性差异(P0.05)；两组治疗后RNL、CBRC厚度比较有显著性差异(P0.05),治疗组明显优于对照组。④两组治疗前后眼部症状比较有显著性差异(P0.05),治疗组明显优于对照组。通过以上研究,李宗智教授以补益脾肾为主,重视心的功能治疗年龄相关性黄斑变性的学术思想简要总结起来主要有以下三点：(1)病因病机是以脾肾亏虚是根本,精血不足是核心,血分郁热与心阳不振是重点,注重“心火”在疾病形成中的重要性,痰浊与瘀血为其标；(2)提倡阴常不足,主张多脏腑治疗,重视“心”的功能调解；(3)以此法组方治疗湿性年龄相关性黄斑变性,能够改善病人的视力,延缓疾病的发展,提高生存质量,安全有效。
[Abstract]:Professor Li Zongzhi, born in the family of Chinese medicine, has accumulated a wealth of experience in the treatment of ophthalmological diseases, especially in the treatment of Ophthalmology, especially the fundus disease. Li Lao has worked hard to study the motherland medicine, read traditional Chinese classic books, followed the medical, gynecology, pediatrics and Ophthalmology, and formed his own independence. The special diagnosis and treatment of diseases has become an expert in ophthalmology of the whole province and even the whole country. Therefore, it advocates "Yin and yin deficiency", and puts forward the treatment method of nourishing yin and blood as the main treatment for ophthalmological diseases; at the same time, the eyes are outside the liver, the blood in the liver is true blood, and the drainage of the liver Qi plays a very important role in the development of the light. It is often used to dredge the liver and liver. In the treatment of many fundus diseases, the disease is considered the disease. The occurrence and development involved many Zang Fu organs and many factors, emphasizing the importance of the heart Yang in the fundus disease. Li Lao's treatment of disease also pays attention to the treatment of the disease, pays attention to the combination of health care and treatment, advocates the lack of desire and spirit, and believes that many ophthalmological diseases, especially some difficult fundus diseases, have a great relationship with the thought of dor. He likes Confucianism and is fastidious. Mediocre, prescription and prescription in Zheng Ping and the prescription, not only based on traditional Chinese medicine, but also do not exclude western medicine, and apply the advanced examination of Western medicine to the dialectical treatment of traditional Chinese medicine to make it a data of the four diagnosis and rational use. He persists in clinical, continuous learning, learning, kindness, kindness to every patient, and money, fame and wealth, is a patient. In the treatment of children's amblyopia, the restoration of near vision is an important manifestation of the restoration of retinal macular function. In Guizhou, the first ophthalmology department of traditional Chinese medicine was established by him, and a large number of specialists in the ophthalmology of traditional Chinese medicine were trained, which laid a solid foundation for the development of the ophthalmology of the Chinese medicine in Guizhou. This paper is divided into four parts. The first part of this paper mainly introduces Li Zongzhi's academic thought and experience. In the second part, the understanding and treatment of traditional Chinese medicine and Western medicine for this disease are reviewed in this paper. Among them, the knowledge of TCM for this disease is mainly liver and spleen kidney deficiency, phlegm and blood stasis, and the treatment is mainly from supplementing the liver and spleen and kidney, eliminating phlegm and dispersing stasis, and not recording the attention of the heart in the treatment of this disease. This is the unique point of the tutor's treatment of the disease. At the same time, a simple review of the knowledge of the disease is made from modern medicine. Although modern medicine has a lot of research on this disease, the treatment method is also complete, from drug treatment to surgical treatment, the treatment effect is not satisfactory, and the price is expensive and the side effects are large, not the treatment book. The treatment of this disease has its characteristics of low price, non-toxic and effective, which can not completely cure the disease, but can delay the development of the disease. It is another choice for the treatment of this disease. With the use of optical coherence tomography (OCT), the diagnosis and treatment effect of this disease are more objective. Third parts are main This paper introduces the characteristics and advantages of Professor Li Zongzhi in the treatment of age-related macular degeneration. Li Lao's understanding of the etiology and pathogenesis of age-related macular degeneration is mainly that the deficiency of the spleen and kidney is the basis, the insufficiency of the blood is the key point, phlegm and blood stasis always run through the disease, and it has an important promoting effect in the formation and development of the disease. If it is due to aging, deficiency of kidney qi, weak temper and inactive heart Yang, the wet type is mainly due to deficiency of liver and spleen and kidney, blood loss and deficiency, blood heat endogenous, water and fire, depression of heart meridian, lack of blood in choroid, loss of health, phlegm and stagnation of phlegm and stasis, resulting in the occurrence of this disease. The exhibition is the result of the damage of many viscera, which can not be seen simply. For the cause and pathogenesis of the disease, Li Lao believes that the disease is closely related to the heart except that it has a great relationship with the liver and spleen and kidney. He thinks that the heart is the official of the monarch, the God is out, the gods belong to the gods. The heart is a fire hiding, the heart and the other viscera are like the light of the night sky, in the old people The main reason is that the heart Yang is insufficient, the warmth is not enough, or the heart's Yin blood is insufficient, the blood heat is steamed. The blood of the heart is controlled by the heart, and the blood can be seen, so the function of the heart is normal, the gods and the light have the basis. The rule of the prescription medication of Li Lao is summed up in addition to the traditional thought that the three organs of the liver, spleen and kidney are mainly with the liver and the spleen. In addition to the different understanding, he also proposed that the dry person with the spleen and the kidney to smooth the liver, warm heart Yang, nourish the heart and open the orifices, and the phlegm in order to nourish the blood, the Qing Xue Xie Yu is the main treatment method. In the fourth part of the clinical study, the main root according to Li Lao's etiology and pathogenesis of age-related macular degeneration is recognized. Understanding, combining the experience of three years with the teacher, summarizing the rule of drug use, discussing how to treat the age-related macular degeneration of wet sex. Through the visual acuity score, the retinal nerve epithelial layer thickness (RNL) score, the thickness score of the choroidal capillary complex (CBRC) and the TCM syndrome score, to evaluate the curative effect. Results (1) 30 cases in the treatment group were 35 eyes, Effective 7 eyes, effective 13 eyes, 15 eyes ineffective, total effective 57.14%, invalid 42.86%, 30 cases in the control group 30 eyes, 3 eyes, effective 10 eyes, no effective 17 eyes, total effective 51.43%, invalid 48.57%, two group comparison, P0.05, significant difference. The treatment group and the control group before and after treatment visual changes, treatment group eyesight improved bright Compared with the control group (P0.05), there was a significant difference in the thickness of RNL and CBRC in the treatment group (P0.05) before and after treatment (P0.05). There was no significant difference in the thickness of RNL (P0.05) before and after treatment in the control group, and there was a significant difference in the thickness of CBRC (P0.05). The thickness of CBRC was significantly different in the two groups after treatment (P0.05), and the treatment group was significantly better than the treatment group. There was a significant difference between the two groups before and after treatment (P0.05), and the treatment group was obviously superior to the control group. Through the above study, Professor Li Zongzhi briefly summarized the following three points: (1) the pathogenesis of the spleen and kidney is the deficiency of the spleen and kidney. Deficiency is the core, blood deficiency is the core, blood heat and heart Yang is the key point, pay attention to the importance of "heart fire" in the formation of disease, phlegm and blood stasis as its standard; (2) advocate the deficiency of Yin, advocate multiple viscera treatment, pay attention to the function mediation of "heart"; (3) this method of treatment of wet age related macular degeneration, can improve disease People's vision, delay the development of disease, improve the quality of life, safe and effective.

【学位授予单位】：成都中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R276.7

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