本文選題：新制柴連湯　切入點：肝經(jīng)風(fēng)熱　出處：《浙江中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的前葡萄膜炎是眼科常見的急重病癥,也是主要的致盲疾病之一。根據(jù)對前葡萄膜炎病因病機的認識,針對臨床上常見的肝經(jīng)風(fēng)熱型前葡萄膜炎,治療應(yīng)以疏風(fēng)散邪、清肝瀉熱為主,選用經(jīng)典方新制柴連湯隨癥加減對癥治療。本課題通過對60例肝經(jīng)風(fēng)熱型前葡萄膜炎病人的臨床觀察研究,驗證新制柴連湯的臨床療效,探討了新制柴連湯的療效機理及降低復(fù)發(fā)的原因。方法臨床研究建立標(biāo)準(zhǔn)后,將入選的60例肝經(jīng)風(fēng)熱型前葡萄膜炎的病人,隨機分為治療組30例和對照組30例。對照組給予全身激素聯(lián)合局部點眼治療,治療組予新制柴連湯隨證加減及全身激素聯(lián)合局部點眼治療。對治療前后的主要癥狀及體征、實驗室檢查結(jié)果、治愈天數(shù)及復(fù)發(fā)率等指標(biāo)的變化進行觀察,并進行分析比較。結(jié)果通過觀察患者治療前后主要癥狀及體征、免疫類檢查結(jié)果及治愈天數(shù)、復(fù)發(fā)率的改變情況,發(fā)現(xiàn)無論是新制柴連湯聯(lián)合治療還是純粹的西醫(yī)治療均可改善患者的中醫(yī)癥候及臨床癥狀,降低患者的CRP、ESR水平,縮短病程及減少復(fù)發(fā)率。而中西醫(yī)聯(lián)合治療對改善患者主要癥狀與體征,降低炎癥介質(zhì)水平,縮短病程及減少復(fù)發(fā)率方面的優(yōu)勢更為明顯。同時,通過觀察患者經(jīng)兩種治療方法后的免疫球蛋白及補體水平的變化,盡管個別指標(biāo)在治療后變化不明顯,或者治療后治療組和對照組無顯著性差異,但總體來說,新制柴連湯聯(lián)合西醫(yī)藥綜合治療的方法使得患者的免疫球蛋白和補體水平大大降低,且降低效率明顯優(yōu)于對照組治療方案。結(jié)論第一,新制柴連湯隨證加減聯(lián)合西藥治療肝經(jīng)風(fēng)熱型前葡萄膜炎的臨床療效明確,患者的臨床癥狀、體征及各項檢查指標(biāo)均有明顯改善。第二,新制柴連湯聯(lián)合西藥治療可明顯降低肝經(jīng)風(fēng)熱型前葡萄膜炎患者的ESR、CRP、免疫球蛋白及補體的水平,提示新制柴連湯具有較好的抗炎和改善免疫功能的作用。第三,新制柴連湯聯(lián)合西藥治療在縮短肝經(jīng)風(fēng)熱型前葡萄膜炎病程方面優(yōu)于單純的西藥治療。第四,新制柴連湯聯(lián)合西藥治療在降低肝經(jīng)風(fēng)熱型前葡萄膜炎的復(fù)發(fā)率方面優(yōu)于單純的西藥治療。值得在臨床治療中廣泛應(yīng)用。
[Abstract]:Objective anterior uveitis is one of the most common acute and severe diseases in ophthalmology. According to the understanding of the etiology and pathogenesis of anterior uveitis, it is necessary to treat the common anterior uveitis of liver meridian with wind-heat type. In this study, 60 patients with anterior uveitis of the type of liver meridian and heat were observed and studied in order to verify the clinical effect of the new Chailian decoction, which was mainly used to clear the liver and reduce the heat, and to treat the disease with the addition or subtraction of the syndrome. This paper discussed the mechanism of curative effect and the reason of reducing recurrence of the new Chailian decoction. Methods after the establishment of clinical research standard, 60 patients with anterior uveitis of the type of liver passing through wind and heat were selected. The treatment group was randomly divided into treatment group (n = 30) and control group (n = 30). Results the changes of the main symptoms and signs before and after treatment, the results of immunological examination, the days of cure and the rate of recurrence were observed and compared. It was found that both the combined treatment of the new Cailian decoction and the pure western medicine treatment could improve the TCM symptoms and clinical symptoms of the patients, and lower the level of CRPN ESR in the patients. The combination of traditional Chinese and western medicine can improve the main symptoms and signs of the patients, reduce the level of inflammatory mediators, shorten the course of disease and reduce the recurrence rate. At the same time, By observing the changes of immunoglobulin and complement levels after two treatments, although the changes of individual indexes were not obvious after treatment, or there was no significant difference between the treatment group and the control group after treatment, generally speaking, there was no significant difference between the treatment group and the control group. The combined therapy of Xinzhen-Chailian decoction combined with western medicine can greatly reduce the level of immunoglobulin and complement, and the efficiency of the reduction is obviously better than that of the control group. The clinical curative effect of new Chailian decoction combined with western medicine in the treatment of anterior uveitis of the type of liver meridian and heat is clear, and the clinical symptoms, signs and various examination indexes of the patients have been obviously improved. Second, there is a significant improvement in the clinical symptoms, physical signs and various examination indexes of the patients. The level of ESR-CRP, immunoglobulin and complement in patients with anterior uveitis of the type of liver meridian and heat can be significantly reduced by the combination of Xinzhailian decoction and western medicine, indicating that the new decoction has better anti-inflammatory and improved immune function. Third, The treatment of new Chailian decoction combined with western medicine is superior to that of western medicine alone in shortening the course of anterior uveitis of the wind-heat type of liver meridian. Fourth, The treatment of new Chailian decoction combined with western medicine is superior to that of western medicine in reducing the recurrence rate of anterior uveitis of the type of liver meridian wind and heat and is worthy of wide application in clinical treatment.
【學(xué)位授予單位】：浙江中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R773.9

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