基于浊毒理论指导的干眼的临床研究

发布时间：2018-06-22 21:33

本文选题：干眼 + 浊毒理论　；参考：《河北医科大学》2017年硕士论文

【摘要】：第一部分中医浊毒理论的探讨从历代文献记载到现代医家认识,深入探讨了浊毒产生的原因和致病特点。第二部分干眼的浊毒病机导师白世淼教授将浊毒理论应用于干眼,阐述了脏腑功能失调导致浊毒内生,与外感浊毒共同形成了干眼的病机。第三部分化浊解毒润目法治疗干眼的临床研究目的:随着现代社会的发展,人们生活方式与环境的变化,干眼(Dry Eye,DE)的患病率逐年增加。干眼严重影响着人们的工作与生活。浊毒理论是近年来对传统中医基础理论的创新。该理论为现今很多疑难病的治疗提供了新的指导思想。本研究旨在将浊毒理论应用于眼科的干眼,以化浊、解毒、润目为大法,综合治疗由浊毒引起的本病。通过观察60例干眼患者的临床疗效,进一步探讨干眼的发病机制与治疗方法。方法:严格按照由浊毒引起的干眼的诊断标准、纳入标准和排除标准,筛选、收集了2015年3月至2016年12月来河北省中医院眼科就诊的干眼患者60例,并将其随机分为治疗组30例和对照组30例。治疗组男11例,女19例,年龄在20-80岁;对照组男13例,女17例,年龄在21-75岁。经统计学分析,两组在年龄、性别方面差异无显著意义(P0.05),具有可比性。治疗组采用自拟化浊解毒润目汤口服(药物组成:金银花、黄芩、黄柏、陈皮、苍术、薏苡仁、知母、麦冬、玄参、生地黄、牡丹皮、当归、防风、蝉蜕、菊花、决明子、桔梗),针刺(取穴:攒竹、太阳、承泣、风池、翳明、百会、中脘、天枢、太冲、气海、三阴交、足三里、丰隆、阴陵泉),中药热奄包敷眼(药物组成:黄柏、决明子、苦参、菊花、蒲公英、千里光)、人工泪液(玻璃酸钠滴眼液)和非甾体类抗炎药(普拉洛芬滴眼液)点眼;对照组给予人工泪液(玻璃酸钠滴眼液)和非甾体类抗炎药(普拉洛芬滴眼液)点眼。治疗以15天为一疗程,共2个疗程。观察并记录两组治疗前后临床症状积分、泪液分泌量(Schirmer I test,sit)、泪膜破裂时间(breakuptimeoftearfilm,but)、角膜荧光素钠染色(cornealfluoresceinstaining,flt)积分的情况变化。结果:1治疗前对两组的临床症状积分、sit、but、flt积分进行比较,经统计学分析,差异无统计学意义(p0.05),说明两组之间的临床症状积分、sit、but、flt积分具有可比性。2两组治疗前后临床症状积分变化情况比较。对两组各自治疗前后积分进行比较,差异有统计学意义(p0.05),说明两组治疗后临床症状均好转。对两组治疗后积分进行比较,差异有统计学意义(p0.01),说明治疗组疗效明显优于对照组。3两组治疗前后sit、but、flt积分变化情况的比较。对两组各自治疗前后sit、but、flt积分进行比较,差异均有统计学意义(p0.05),说明两组治疗前后的这三项指标均有改善。对两组治疗后sit、but、flt积分进行比较,差异均有统计学意义(p0.01),说明治疗组疗效明显优于对照组。4治疗组显效10例,有效18例,无效2例,总有效率93.33%;对照组显效0例,有效23例,无效7例,总有效率76.67%。对两组的有效率进行比较,差异有统计学意义(p0.01),说明治疗组以化浊、解毒、润目为大法的综合治疗疗效明显优于对照组。5本次研究发现浊毒引起的干眼患者在40-59岁最多,占43.33%。结论:1从浊毒理论出发提出现代社会干眼的中医病机与治法,具有新的指导意义。2浊毒导致干眼的病机为:脾胃、肝、肺、肾功能失调,浊毒内生,与外感浊毒相合,蓄积体内,引起气血凝滞,津液亏损,气血津液在人体内的输布失常,目失润养而致干眼。治法:以化浊、解毒、润目为大法,采用自拟化浊解毒润目方、针刺和中药热奄包,内外兼治由浊毒引起的干眼。3基于浊毒理论指导的干眼的临床研究显示可以明显改善干眼患者的临床症状积分、增加sit、but、减少flt积分,疗效显著。4在治疗期间,患者未发现与治疗药物及方法相关的不良反应。说明本治疗安全。
[Abstract]:The first part of the study of the theory of turbid poison in traditional Chinese medicine is recorded from the literature of the past dynasties to the understanding of modern doctors, and the causes and pathogeny characteristics of the turbid poison are discussed in depth. In the second part, Professor Bai Shimiao, the tutor of the Turbid Toxin machine in the dry eye, applied the theory of turbid poison to the dry eye. The clinical study of ophthalmic disease. Third part of the clinical study of treating dry eyes with the method of removing turbidity and detoxification and moistening the eye: with the development of modern society and the changes in people's life style and environment, the prevalence of dry eyes (Dry Eye, DE) has increased year by year. Dry eye seriously affects people's work and life. The theory of turbid toxicology is a new innovation in the basic theory of traditional Chinese medicine in recent years. The theory provides a new guiding ideology for the treatment of many difficult diseases in the present day. This study aims to apply turbid theory to dry eye in Ophthalmology, to treat turbid, detoxified, and moisten the eyes as a big method, and to treat the disease caused by turbid poison. By observing the clinical effect of 60 cases of dry eye, the pathogenesis and treatment of dry eyes are discussed step by step. Methods: strict According to the criteria for the diagnosis of dry eye caused by Turbid Toxin, 60 cases of dry eyes were collected from March 2015 to December 2016 in the ophthalmology department of Hebei traditional Chinese medicine hospital. They were randomly divided into 30 cases in the treatment group and 30 cases in the control group. The treatment group was 11 men, 19 women and 20-80 years old; 13 men in the control group and 17 women in the control group. The age was 21-75 years old. The statistical analysis showed that the two groups had no significant difference in age and sex (P0.05). The treatment group was taken orally by self-made turbid detoxification and moistening eye soup (medicinal composition: honeysuckle, Scutellaria, cypress, citrus, coix seed, Ophiopogon, Radix Ophiopogonis, Radix scaranae, radix rehmanniae, peony skin, Radix Angelicae, cicada, chrysanthemum, cassia seed. Acupuncture point: acupuncture (acupoint: acupoint: save bamboo, sun, sob, Yiming, Baihui, Zhong Wan, Tianshu, Taichi, Qi Hai, Sanyinjiao, Zusanli, Feng long, Yin Mausoleum), Chinese medicine hot pack eye (medicine composition: cypress, cassia seed, Sophora flavescens, chrysanthemum, dandelion, thousand li light), artificial tears (Sodium Hyaluronate Eye Drops) and non steroidal anti-inflammatory drugs (Pranoprofen Eye Drops) The control group was given eyes of artificial tears (Sodium Hyaluronate Eye Drops) and non steroidal anti-inflammatory drugs (Pranoprofen Eye Drops). The treatment was treated with 15 days as a course of treatment, with a total of 2 courses. The scores of clinical symptoms, Schirmer I test, sit, tear film rupture time (breakuptimeoftearfilm, but), corneal fluorescence, and corneal fluorescence were observed and recorded before and after treatment. The change of cornealfluoresceinstaining, FLT score. Results: 1 before treatment, the clinical symptom score of the two groups, sit, but, FLT integral were compared, the difference was not statistically significant (P0.05), indicating the score of the clinical symptoms between the two groups, sit, but, and FLT integral with the clinical symptoms before and after the treatment of group.2 two. The scores of the two groups were compared before and after the treatment of the two groups, the difference was statistically significant (P0.05), indicating that the clinical symptoms of the two groups were all better after treatment. The difference between the two groups after treatment was statistically significant (P0.01), indicating that the curative effect of the treatment group was better than the sit, but, FLT integral before and after the treatment of the control group.3. Comparing the sit, but, FLT scores of the two groups before and after treatment, the difference was statistically significant (P0.05), indicating that the three indexes of the two groups were improved before and after treatment. The difference of sit, but and FLT scores after the treatment of the two groups were statistically significant (P0.01), indicating that the curative effect of the treatment group was obviously better than the control group.4 treatment. The group showed 10 cases, 18 cases were effective, 2 cases were invalid, the total effective rate was 93.33%, 0 cases in the control group, 23 effective and 7 ineffective, the total effective rate 76.67%. was compared with the efficiency of two groups, the difference was statistically significant (P0.01), indicating that the treatment group with turbidity, detoxification, and moistening the eye as the big method was obviously superior to the control group.5. The dry eye patients were at the age of 40-59, which accounted for 43.33%. conclusion. 1 from the theory of Turbid Toxin, the TCM pathogenesis and treatment of modern social dry eyes were put forward, and the pathogenesis of dry eyes was new guiding significance: spleen and stomach, liver, lung, kidney function disorder, turbid and poisonous endogeny, combined with turbidity and turbidity, accumulation in the body, causing Qi and blood stagnation and loss of body fluid, Qi and blood body fluid in the body of the distribution of disorder, eyes lost and dry eyes. Treatment: with turbidity, detoxification, moistening the eyes as the big law, the use of self-made turbid and detoxification of the eye prescription, acupuncture and Chinese medicine hot dying bag, internal and external treatment of cloudy toxin induced dry eye.3 based on the theory of turbid toxicity theory of dry eyes can obviously improve the clinical symptoms of dry eye patients. Integral, increase sit, but, reduce FLT integral, the curative effect is significant.4 during the treatment, the patient has not found the adverse reactions related to the treatment of drugs and methods.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R276.7

【参考文献】