周勇教授滋阴除湿法论治慢性湿疹的临床经验和学术思想研究

发布时间：2018-08-22 08:40

【摘要】：目的：本研究拟通过探讨慢性湿疹的发病原因和发病机理及导师治疗慢性湿疹的临床经验,归纳导师论治慢性湿疹的临床思路,总结其滋阴除湿法论治慢性湿疹的学术思想。并进一步提炼和升华,丰富中医辨证论治体系,为广大患者服务。方法：1.理论研究：结合古今文献对慢性湿疹的研究,整理、归纳周勇教授滋阴除湿法治疗慢性湿疹的临床经验,总结、研究其学术思想。2.临床研究：本研究通过观察、评价周勇教授采用滋阴除湿汤治疗血虚风燥型慢性湿疹的临床疗效,研究其滋阴除湿法论治慢性湿疹的临床经验。将96例血虚风燥型慢性湿疹患者随机分为2组,治疗组48例,对照组48例。治疗组口服中药滋阴除湿汤,对照组口服氯雷他定口腔崩解片(商品名：雷宁,四川新斯顿制药有限公司生产,10mg/片,批号：国药准字200800527)口服,两组疗程均为2周。观察两组患者在治疗前后的症状、体征、T淋巴细胞亚群CD4+、CD8+、CD4+、CDg+水平等指标的变化。同时观察豚鼠模型治疗前后耳片重量、病理变化、IL-2、IL-4水平的变化。结果：1.理论研究：周勇教授对慢性湿疹病因病机的认识有独到的见解,治疗手段有自身的特色：①主张对慢性湿疹的病因病机、治则治法的探讨应借鉴古代医家对湿疮病病因病机的认识,②认为阴血亏虚是慢性湿疹发病的基础,湿邪是慢性湿疹发病的条件,风邪对慢性湿疹发病有重要影响,瘀血是慢性湿疹的病理产物,以上因素相互胶着,相互影响。2.临床研究：周勇教授根据自身对慢性湿疹病因病机的认识,治疗手段上,采用滋阴除湿法治疗,同时兼顾祛风、活血,标本兼治。颇具特色。①.有效率的比较：治疗组的总有效率为89.58%；而对照组的总有效率为68.75%。通过比较,治疗组的疗效明显优于对照组。②.治疗前后CD4+水平的比较：治疗前两组CD4+水平明显低于健康体检组CD4+水平(P0.01),治疗后两组CD4+水平明显升高,与健康体检组相比无明显差异(P0.05),但治疗后治疗组与对照组相比,CD4+水平差异有显著性意义(P0.05)。③.治疗前后CD8+水平的比较：治疗前两组CD8+水平均高于健康体检组CD8+水平(P0.01),治疗后两组CD8+水平降低,与健康体检组CD8+水平相比无明显差异(P0.05),而治疗后治疗组与对照组相比CD8+水平无明显差异(P0.05)。④.治疗前后CD4+/CD8+水平的比较：治疗前两组CD4+/CD8+水平均明显低于健康体检组(P0.01),治疗后治疗组CD4+/CD8+水平与健康体检组相比无显著性差异(P0.05),而治疗后对照组CD4+/CD8+水平较治疗前有所升高(P0.01),但与健康体检组相比,仍有明显的差异(P0.01)。⑤.治疗前后豚鼠模型IL-2、IL-4水平比较：治疗前后与生理盐水组比较,中药组IL-2明显升高,IL-4明显降低,有极显著性差异(P0.01),与氯雷他定组比较,差异有显著性(P0.05)(见表11),皮肤病理、IL-2、IL-4水平均有变化。⑥.治疗前后豚鼠模型病理切片比较：模型组：棘层明显增厚,角化过度及角化不全,真皮浅层毛细血管壁增厚,胶原纤维变粗,呈慢性湿疹病理改变。生理盐水组：表皮角化过度,棘层肥厚,变化与模型组相似。氯雷他定组：正常少量角化过度,角化不全,棘层变薄。中药组：表皮基本恢复正常。结论：周勇教授滋阴除湿法论治慢性湿疹的临床经验和学术思想符合临床实际,切中病机,具有良好的滋阴养血、祛风除湿、活血化瘀作用,疗效确切,具有较高的临床价值。其滋阴除湿法法论治慢性湿疹的临床经验和学术思想,对于丰富和提高中医辨证论治体系,丰富中医治疗手段,拓宽中医皮肤病治疗范围,提高临床疗效,减轻患者痛苦均具有重要的理论和现实意义。
[Abstract]:Objective: To explore the etiology and pathogenesis of chronic eczema and the clinical experience of the tutor in the treatment of chronic eczema, summarize the clinical mentality of the tutor in the treatment of chronic eczema, and summarize the academic thought of the theory of nourishing yin and removing dampness in the treatment of chronic eczema. Methods: 1. Theoretical research: Combining ancient and modern literature on chronic eczema research, collate, summarize Professor Zhou Yong's clinical experience in the treatment of chronic eczema by Nourishing Yin and removing dampness, summarize, study its academic thinking. 2. Clinical research: This study through observation, evaluate Professor Zhou Yong's clinical treatment of chronic eczema by Nourishing Yin and removing dampness Decoction for blood deficiency and wind dryness. Ninety-six patients with chronic eczema of blood deficiency and wind dryness type were randomly divided into two groups: the treatment group (48 cases) and the control group (48 cases). The symptoms, signs, T lymphocyte subsets CD4 +, CD8 +, CD4 +, CDg + levels of the two groups were observed before and after treatment. Meanwhile, the weight of the guinea pig ear slices, pathological changes, IL-2, IL-4 levels were observed before and after treatment. Results: 1. Theoretical research: Professor Zhou Yong There are unique opinions on the etiology and pathogenesis of chronic eczema, and the treatment methods have their own characteristics: 1. Advocating the etiology and pathogenesis of chronic eczema, the discussion of treatment principles and methods should draw lessons from the ancient physicians'understanding of the etiology and pathogenesis of eczema; 2. Considering that deficiency of yin and blood is the basis of chronic eczema, eczema is the condition of chronic eczema, wind evil. Clinical research: Professor Zhou Yong, according to his own understanding of the etiology and pathogenesis of chronic eczema, uses the method of nourishing Yin and removing dampness to treat chronic eczema, and at the same time gives consideration to dispelling wind, activating blood circulation and treating both the root and the root. The total effective rate was 89.58% in the treatment group and 68.75% in the control group. By comparison, the curative effect of the treatment group was obviously better than that of the control group. There was no significant difference between the two groups (P 0.05), but there was significant difference between the treatment group and the control group in the level of CD4 + (P 0.05). The level of CD4 + / CD8 + in the treatment group was significantly lower than that in the health check-up group (P 0.01). There was no significant difference in the level of CD4 + / CD8 + between the treatment group and the control group (P 0.05). There was no significant difference in the level of CD4 + / CD8 + between the treatment group and the health check-up group (P 0.05). Compared with the normal saline group, the levels of IL-2 and IL-4 in the traditional Chinese medicine group were significantly higher and IL-4 was significantly lower (P 0.01). Compared with the loratadine group, the differences were significant (P 0.01). Significant (P 0.05) (see table 11), skin pathology, IL-2, IL-4 levels were changed. _. Before and after treatment, pathological sections of guinea pig model: model group: the spinous layer was significantly thickened, hyperkeratosis and incomplete keratosis, superficial dermal capillary wall thickened, collagen fibers thickened, showing chronic eczema pathological changes. Normal saline group: epidermal hyperkeratosis, spines. Conclusion: Professor Zhou Yong's clinical experience and academic thought in treating chronic eczema by Nourishing Yin and removing dampness accord with the clinical reality, cutting the pathogenesis, nourishing yin and nourishing blood, dispelling wind and removing dampness. Its theory of nourishing yin and eliminating dampness has important theoretical and academic value in enriching and improving the system of syndrome differentiation and treatment of TCM, enriching the means of TCM treatment, broadening the scope of TCM skin disease treatment, improving the clinical efficacy and alleviating the pain of patients. Practical significance.
【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R275.9

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