本文關(guān)鍵詞：麻柔主任醫(yī)師經(jīng)驗(yàn)總結(jié)及中西醫(yī)分型治療再生障礙性貧血臨床研究　出處：《中國(guó)中醫(yī)科學(xué)院》2012年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的：本研究通過對(duì)麻柔主任醫(yī)師學(xué)術(shù)思想形成淵源及臨床經(jīng)驗(yàn)的整理與總結(jié),分析提煉他獨(dú)到的用中醫(yī)理論闡釋疾病發(fā)生發(fā)展規(guī)律的方法及在診病過程中體現(xiàn)的獨(dú)特診病經(jīng)驗(yàn)；通過典型醫(yī)案的搜集總結(jié),結(jié)合中醫(yī)古典醫(yī)籍,使他的學(xué)術(shù)思想得到進(jìn)一步的理論升華。本研究還重點(diǎn)對(duì)麻柔主任醫(yī)師中西醫(yī)結(jié)合分型治療再生障礙性貧血經(jīng)驗(yàn)進(jìn)行了總結(jié)與臨床研究,通過臨床客觀數(shù)據(jù)證實(shí)他診治再障的臨床療效并分析其診病用藥特點(diǎn)。本研究人群為筆者師承臨證學(xué)習(xí)期間,麻柔主任醫(yī)師所治療的再生障礙性貧血患者,結(jié)合既往基礎(chǔ)研究結(jié)果,進(jìn)一步總結(jié)和研究他對(duì)不同分型(急性或慢性)及中醫(yī)不同證型(腎陰虛或腎陽虛)再生障礙性貧血(aplastic anemia, AA)患者的臨床療效及證候療效,探討對(duì)AA不同分型及證型患者的中醫(yī)及中西醫(yī)結(jié)合診治規(guī)律,探尋中醫(yī)或中醫(yī)與適當(dāng)西藥聯(lián)合的規(guī)范化治療方法,以克服過度治療,提高臨床療效及充分發(fā)揮中醫(yī)藥治療再障的優(yōu)勢(shì)。另外通過對(duì)麻柔主任醫(yī)師補(bǔ)腎為核心的中醫(yī)辨證分型治療再障病例的總結(jié),掌握其辨證及用藥規(guī)律,以利于進(jìn)一步傳承與推廣。 方法：前瞻性納入并系統(tǒng)隨訪總結(jié)麻柔主任醫(yī)師診治的60例AA患者。據(jù)其臨床經(jīng)驗(yàn)結(jié)合西醫(yī)分型及中醫(yī)證型分為三組行中西醫(yī)結(jié)合分型治療：1.單純補(bǔ)腎中藥治療組,病例為慢性再障輕型、小兒患者以及西藥無效或不能耐受患者；2.補(bǔ)腎中藥+免疫抑制治療組,病例以免疫抑制導(dǎo)致骨髓衰竭為主要病理機(jī)制的急重型再障患者；3.補(bǔ)腎中藥+雄激素治療組,病例以骨髓造血功能衰竭為主要病理機(jī)制,診斷為慢性再生障礙性貧血或免疫抑制劑無效或療效不完全以及慢性重型再生障礙性貧血Ⅱ型患者。其中對(duì)病史長(zhǎng)于20年以上的重型再障Ⅱ型患者嘗試補(bǔ)腎兼化瘀聯(lián)合雄性激素治療。 從中醫(yī)辨證(腎陽虛/腎陰虛)、西醫(yī)診斷(急重性再障/慢性再障)、療效(緩解/進(jìn)步/無效)和治療方法(雄激素有效/無效和免疫抑制劑有效/無效)四個(gè)角度,對(duì)AA患者進(jìn)行不同組別、不同中醫(yī)證型治療前后療效及癥狀積分進(jìn)行總結(jié)分析,闡釋麻柔主任醫(yī)師診治本病的分型療效、證候療效及用藥特點(diǎn)和規(guī)律。 結(jié)果：1.總結(jié)60例AA患者,至少接受6-12個(gè)月的治療進(jìn)入療效總結(jié)�？傆行�93.00%。 2.分型治療及療效：?jiǎn)渭冄a(bǔ)腎中藥治療組10例,基本治愈4例,緩解6例,其中6例為小兒患者；雄性激素聯(lián)合補(bǔ)腎中藥組24例,基本治愈4例,緩解10例,明顯進(jìn)步8例,無效2例；免疫抑制劑環(huán)孢菌素A和/或ATG聯(lián)合雄性激素及補(bǔ)腎中藥組26例,基本治愈4例,緩解12例,明顯進(jìn)步8例,無效2例。 3.中醫(yī)分型特點(diǎn)分析：腎陽虛組主要為慢性再障患者(58.8%,20/34),腎陰虛組主要為急重型再障患者(57.6%,15/26)。這說明中西醫(yī)分型標(biāo)準(zhǔn)雖不具備精確對(duì)應(yīng)關(guān)系,但存有一定的關(guān)聯(lián)性。其中4例為病程長(zhǎng)于20年的重型再障Ⅱ型患者,辨證屬腎陽虛兼血瘀,探索性采用具溫陽化瘀功效的雄黃聯(lián)合雄性激素及補(bǔ)腎中藥治療,1例基本治愈,2例有效。 4.中醫(yī)分型與西醫(yī)分型治療相關(guān)性及結(jié)果：①腎陽虛組和慢性再障組使用單純中藥(80.0%,8/10)或雄激素(66.7%,16/24)患者比例較高；腎陰虛組和急重型再障組使用免疫抑制劑的患者比例較高(61.6%,16/26；76.9%,20/26)。單純中藥治療組小兒比例高(6/10)且療效顯著。表明中醫(yī)分型與選擇用藥(雄激素或免疫抑制劑)有相關(guān)性,中醫(yī)分型有助于臨床用藥的選擇；②腎陽虛型和腎陰虛型總有效率分別為100.0%和83.3%,急重型和慢性再障的總有效率分別為84.6%和100.0%。單純中藥治療組小兒比例高(6/10)且療效顯著。說明通過中西醫(yī)分型原則的綜合運(yùn)用有助于提高臨床療效。③腎陽虛和腎陰虛組治療前的白細(xì)胞、血紅蛋白、血小板均低于正常值,治療后腎陽虛組和腎陰虛組外周血白細(xì)胞、血紅蛋白、血小板均顯著上升(P0.01),但治療后腎陽虛型患者白細(xì)胞、血紅蛋白、血小板達(dá)正常水平均顯著高于治療后腎陰虛型患者(P0.01),說明治療后腎陽虛組外周血象恢復(fù)快且完全。 5.中醫(yī)證候特點(diǎn)分析：腎陰虛和腎陽虛組腰膝酸痛出現(xiàn)頻率均較多,說明腰膝酸痛是再障腎虛辨證的主要癥狀。治療前腎陽虛組以畏寒、耳鳴及水腫為主要見癥,經(jīng)補(bǔ)腎中藥治療后,癥狀較易改善恢復(fù)。腎陰虛組以五心煩熱、午后潮熱、咽干、便結(jié)而尿短赤和盜汗等癥狀為主,治療后癥狀減輕；腎陰虛組出血癥狀較腎陽虛組多見,但經(jīng)中藥治療后大多得以改善。舌苔舌質(zhì)基本能作為區(qū)分腎陰虛、腎陽虛的關(guān)鍵性客觀指標(biāo)。 6.中醫(yī)證候療效判定特點(diǎn)：治療后臨床痊愈的癥狀是便結(jié)而尿短赤；顯效的癥狀是腰膝酸痛、畏寒肢涼、耳鳴或耳聾、盜汗；有效的癥狀是發(fā)脫或齒搖、水腫、尿后余瀝或失禁、五心煩熱及舌質(zhì)舌苔；無效的癥狀是性功能減退和咽干口燥。說明中醫(yī)辨證腎陽虛型患者的臨床癥狀輕,預(yù)后好；腎陰虛型患者臨床表現(xiàn)重,預(yù)后相對(duì)較差,舌質(zhì)苔的改善也相對(duì)較慢。 結(jié)論： 1.麻柔主任醫(yī)師治療急重型再障和慢性再障的有效率分別為84.6%和100.0%,總有效率93.0%。與國(guó)內(nèi)報(bào)道的中西醫(yī)結(jié)合治療從有效率70.0%～80.0%比較,證實(shí)采用中西醫(yī)結(jié)合分型治療再障的方法具有一定的療效優(yōu)勢(shì)； 2.進(jìn)一步證實(shí)慢性再障以腎陽虛型為主,重型再障以腎陰虛型為主； 3.單純補(bǔ)腎中藥在輕型患者、小兒患者及西藥療效不佳或不能耐受患者確能發(fā)揮中醫(yī)藥優(yōu)勢(shì)； 4.對(duì)各種類型再障,合理使用雄性激素及免疫抑制劑聯(lián)合補(bǔ)腎中藥治療均能獲得較好療效,既提高了療效又避免過度治療所導(dǎo)致的毒副作用； 5.探索性應(yīng)用具溫陽化瘀功效的雄黃聯(lián)合雄性激素及補(bǔ)腎中藥治療病史長(zhǎng)于20年的重型再障Ⅱ型患者,取得1例基本治愈,2例有效,1例無效(因觀察時(shí)間較短),初步顯現(xiàn)出較好的苗頭； 6.麻柔主任醫(yī)師臨床應(yīng)用補(bǔ)腎中藥與不同西藥聯(lián)合治療,認(rèn)為只要找準(zhǔn)切入點(diǎn)就能取得良好療效,避免了不必要的過度治療。提出并證明再障的發(fā)病大致可分為以異常免疫為主和以骨髓衰竭為主2個(gè)階段,前一階段以免疫抑制劑+補(bǔ)腎中藥為主治療；后一階段應(yīng)以雄性激素+補(bǔ)腎中藥為主治療,兩者之間可能存在過渡階段；適時(shí)減量或停用免疫抑制劑或雄性激素,較好貫徹了能中不西的原則。 7.中醫(yī)證型特點(diǎn)： 腎陰虛組和腎陽虛組腰膝酸痛出現(xiàn)的頻次均較多,說明腰膝酸痛是再障腎虛辨證的主要癥狀,中醫(yī)癥狀判定標(biāo)準(zhǔn)對(duì)腎陰虛陽虛的判定區(qū)分有意義,舌質(zhì)舌苔基本能作為區(qū)分腎陰虛、腎陽虛的關(guān)鍵性客觀指標(biāo)；中醫(yī)辨證腎陽虛型再障的臨床癥狀的改善優(yōu)于腎陰虛型；慢性再障或病程長(zhǎng)的重型再障患者多表現(xiàn)為腎陽虛型,適宜于溫腎填精中藥為主或聯(lián)用雄激素治療,而急重型再生障礙性貧血多為腎陰虛型,多適于滋腎填精中藥為主聯(lián)用免疫抑制劑治療。按中醫(yī)證候療效判定標(biāo)準(zhǔn)說明中醫(yī)辨證腎陽虛型患者的臨床癥狀輕,預(yù)后好；腎陰虛型患者臨床表現(xiàn)重,預(yù)后相對(duì)較差。還發(fā)現(xiàn)舌質(zhì)苔的改善也相對(duì)較慢。 8.麻柔主任醫(yī)師診治再生障礙性貧血臨床用藥特點(diǎn)：補(bǔ)腎調(diào)陰陽為主,兼顧脾胃,陰中求陽,陽中求陰,陰陽雙補(bǔ)；堅(jiān)持守方治療,他認(rèn)為慢性疾病如證型未變,則應(yīng)堅(jiān)持主方不變,僅據(jù)陰陽寒熱偏衰及脾胃盛衰做加減化裁。 麻柔主任醫(yī)師認(rèn)為,首先要正確把握中醫(yī)對(duì)疾病發(fā)生發(fā)展規(guī)律的認(rèn)識(shí),必須從中醫(yī)理論淵源水平找到綱領(lǐng)。因此,他以其獨(dú)到的“發(fā)病觀”、“治病觀”和“防病觀”統(tǒng)領(lǐng)中醫(yī)疾病的發(fā)生及防治。首先從陰陽角度認(rèn)識(shí)疾病的發(fā)生,陰陽平衡即健康,陰陽失衡即患��；從正邪關(guān)系概括疾病的發(fā)生無非正虛與邪盛。他認(rèn)為中醫(yī)藥治療疾病就是通過陰陽自和的能力燮理機(jī)體陰陽、正邪等矛盾關(guān)系,把“失和”調(diào)為“和”,把“偏”調(diào)為“平”,從而達(dá)到治療疾病的目的,醫(yī)生的作用僅僅是順勢(shì)利導(dǎo),糾偏,調(diào)整陰陽偏勝而已。還認(rèn)為順應(yīng)天地自然才能更好的防病治病,辨證論治才卓有成效。其健脾調(diào)胃扶正以祛邪及祛邪不忘兼顧脾胃的組方用藥處處體現(xiàn)出老師以“脾胃為本”的“未病先防”的防病觀。 他認(rèn)為中醫(yī)治病是從整體、系統(tǒng)角度看問題,強(qiáng)調(diào)因人、因時(shí)、因地制宜,因勢(shì)利導(dǎo)。中醫(yī)的治療體系應(yīng)以辨證論治為核心,以病人表現(xiàn)出的“證”為靶點(diǎn),針對(duì)動(dòng)態(tài)過程,認(rèn)知的是在時(shí)間過程中病人整體變化的本質(zhì)和規(guī)律。體現(xiàn)在治療再生障礙性貧血、骨髓增生異常綜合征等疾病,針對(duì)腎陰陽虧虛的根本病機(jī),辨治以補(bǔ)腎調(diào)陰陽為主；針對(duì)慢性免疫性血小板減少癥等出血性疾病,認(rèn)為以氣虛兼血瘀為根本病機(jī),采用益氣通陽,調(diào)和氣血治療,明顯提高了療效。還探索性采用具解毒散瘀功效的古方青黃散治療骨髓增生異常綜合征的各型取得了良好療效,他認(rèn)為本病病機(jī)為正氣虛損,復(fù)感邪毒,因毒致瘀,毒瘀互阻。并擴(kuò)大應(yīng)用于慢性骨髓增殖性疾病及部分類型的急性非淋巴細(xì)胞白血病,認(rèn)為因毒致瘀,毒瘀互結(jié)為其根本病因病機(jī),運(yùn)用解毒散瘀功效的青黃散泄其實(shí),緊緊圍繞毒瘀這個(gè)根本病機(jī)。近年還探索性用含砷中藥治療病程較長(zhǎng)的慢性重型再生障礙性貧血患者,認(rèn)為其病機(jī)為“久病入絡(luò)”、“因虛致瘀”,而非“因毒致瘀”,故治療上單用性溫散瘀之雄黃,其溫?zé)嶂幮钥芍柹?化瘀功效針對(duì)“瘀血”病機(jī),取得初步療效。麻柔主任醫(yī)師認(rèn)為探索中醫(yī)藥治療疑難性血液病的關(guān)鍵在于對(duì)疾病病機(jī)的準(zhǔn)確認(rèn)識(shí),與中醫(yī)“治病求本”、“謹(jǐn)守病機(jī)”的理論異曲同工。 麻柔主任醫(yī)師在臨床立法、組方、用藥上時(shí)刻不忘顧護(hù)脾胃,認(rèn)為血液系統(tǒng)疾病一般病程較長(zhǎng),素體脾胃虧虛,長(zhǎng)期服藥易傷脾胃,故臨證為補(bǔ)而不壅滯、瀉而不傷中,常合用四君子湯等補(bǔ)氣健脾,防治脾虛影響到藥物療效。其健脾調(diào)胃扶正以祛邪及祛邪不傷脾胃的組方用藥,處處體現(xiàn)出其以“脾胃為本”的學(xué)術(shù)思想。 他獨(dú)到采用經(jīng)方桂枝湯為主治療慢性和難治性免疫性血小板減少癥(cITP和rITP),認(rèn)為經(jīng)方具有組方精簡(jiǎn)、配伍嚴(yán)謹(jǐn)、方證相應(yīng)、療效確切等特點(diǎn)。對(duì)cITP和rITP辨證以脾虛氣弱,陰陽失和為主者,擬桂枝湯治療,取其“內(nèi)調(diào)陰陽”之特性,取得良好療效。 他認(rèn)為多種慢性血液系統(tǒng)疾病的發(fā)生根本原因是“正氣虧虛”,在診病中處處體現(xiàn)扶正即祛邪的學(xué)術(shù)思想。具體體現(xiàn)在治療白血病緩解期表現(xiàn)為正虛邪戀階段,注重健脾補(bǔ)腎調(diào)陰陽扶正治療,少用清熱解毒抗癌祛邪之品。還體現(xiàn)在治療自身免疫性溶血性貧血等自身免疫性疾病,認(rèn)為本病的根本病機(jī)為“正虛”與“血瘀”,通過以扶正為主及扶正固本“防患于未然”的治療策略取得良好療效。他認(rèn)為與自身免疫相關(guān)的病證中醫(yī)藥調(diào)理應(yīng)以扶正為主,所謂扶正即可祛邪。 病證結(jié)合是目前中西醫(yī)結(jié)合的重要手段之一。麻柔主任醫(yī)師在多年的臨床實(shí)踐中一方面堅(jiān)持以中醫(yī)辨證論治思想探索中醫(yī)藥治療血液系統(tǒng)疑難性疾病的方法,其臨床實(shí)踐中同病異治,異病同治還是專驗(yàn)方的應(yīng)用均是體現(xiàn)中醫(yī)辨證論治思想,另一方面重視辨“病”,血液病盡量基于細(xì)胞學(xué)、免疫學(xué)、細(xì)胞遺傳學(xué)及基因等疾病診斷,從宏觀到微觀、從整體到局部、從一個(gè)階段到整個(gè)病程全面認(rèn)識(shí)疾病后,客觀制定出中醫(yī)或中西醫(yī)結(jié)合治療策略,一以貫之,收效明顯。還致力于通過臨床實(shí)踐發(fā)現(xiàn)苗頭,總結(jié)規(guī)律,回到實(shí)驗(yàn)研究達(dá)到理論升華,再回到臨床普遍實(shí)踐,這是中醫(yī)及中西醫(yī)結(jié)合臨床及研究方向,也是辨證與辨病結(jié)合優(yōu)化研究模式的具體體現(xiàn)。 總之,麻柔主任醫(yī)師在臨證實(shí)踐中,堅(jiān)持以中醫(yī)理論為指導(dǎo),時(shí)時(shí)貫徹天人相應(yīng)的整體觀、治病求本的治病觀、陰陽平調(diào)的平衡觀、血液病的扶正治療觀、注重顧護(hù)脾胃、獨(dú)到使用經(jīng)方、探索性運(yùn)用古驗(yàn)方、辨病與辨證相結(jié)合等學(xué)術(shù)思想,經(jīng)過多年的歷練形成了自己獨(dú)特的診治血液病臨床經(jīng)驗(yàn)。
[Abstract]:Objective: This study of Ma Rou director academic thought origin and clinical experience summary, analysis and refine his method of using law of the development of TCM theory and interpretation of disease occurred in the process of diagnosis is reflected in the unique experience of diagnosis by collecting original; summarize the typical cases, combined with traditional Chinese medical classics, his academic thought to be sublimated further theory. This research also focuses on the combination of traditional Chinese and Western Medicine Director Ma Rou typing experience in treating aplastic anemia were summarized by clinical and clinical research, clinical diagnosis and treatment of objective data confirmed he aplastic anemia and analyze the diagnosis of drug characteristics. The study population for the clinical teachers during the study, Ma soft physician patients with aplastic anemia, combined with previous research results, summarized and further his research on different types of acute (or Chronic) and different syndromes (deficiency of kidney or kidney yang) of aplastic anemia (aplastic anemia, AA) the clinical curative effect and curative effect in patients with the syndrome, to explore the regularity of TCM and Western medicine combined with the treatment of AA of different types and syndromes of patients, to explore the treatment method combined with the appropriate specification Chinese or western medicine traditional Chinese medicine, in order to overcome the excessive treatment, improve the clinical efficacy and give full play to the advantages of Chinese medicine treatment of aplastic anemia. In addition to the TCM Ma Rou director as the core of the kidney type treatment of aplastic anemia were summarized, the differentiation and medication rule, in order to further inheritance and promotion.
Methods: We prospectively enrolled 60 patients with AA system and follow up the diagnosis and treatment of director Ma rou. According to the clinical experience with western medicine and TCM syndrome type divided into three groups with western medicine treatment: 1. types of the Chinese herb treatment group, cases of chronic aplastic anemia in children patients with light, and Western medicine or invalid intolerant patients; 2. kidney tonifying herbs + immunosuppressive treatment group, patients with immune suppression leads to bone marrow failure is the main pathological mechanism of acute severe aplastic anemia patients; 3. kidney tonifying herbs + androgen treatment group, patients with bone marrow failure is the main pathological mechanism, diagnosis of chronic aplastic anemia or immunosuppressive effect is invalid or incomplete chronic and severe aplastic anemia patients with type II. The history of severe aplastic anemia patients with type II is longer than 20 years to try and male hormone therapy combined with Bushen Huayu.
From the TCM (kidney yang deficiency and kidney yin deficiency / diagnosis of Western Medicine), (acute / chronic aplastic anemia, aplastic anemia) effect (remission / progress / invalid) and treatment (androgen and immunosuppressant valid / invalid valid / invalid) four angles of different groups of AA patients, summarize and analyze the curative effect and symptom score before and after the TCM syndrome of different types of treatment, curative effect of Ma Rou interpretation of physician diagnosis and treatment of this disease, symptoms and medication characteristics and principles.
Results: 1. a total of 60 patients with AA were summed up for at least 6-12 months of treatment. The total effective rate was 93.00%.
2. typing and therapy: the Chinese herb treatment group of 10 cases, 4 cases were cured, remission in 6 cases, including 6 cases of pediatric patients; male hormone combined with Tonifying Kidney Chinese medicine group of 24 cases, 4 cases were cured, 10 cases were relieved, 8 cases improved, 2 cases ineffective; immunosuppressant cyclosporin A and / or ATG with male hormone and Bushen Chinese medicine group of 26 cases, 4 cases were cured, 12 cases were relieved, 8 cases improved, 2 cases were invalid.
Analysis of characteristics of 3. TCM syndrome: kidney yang deficiency group were mainly chronic aplastic anemia patients (58.8%, 20/34), kidney yin deficiency group were mainly severe aplastic anemia patients (57.6%, 15/26). This shows that Chinese and Western Medicine classification criteria do not have precise correspondence, but there is a certain correlation. Including 4 cases of course more than 20 years of severe aplastic anemia in type II patients, syndrome of kidney yang deficiency and blood stasis, explore realgar male hormone and kidney tonifying herbs combined with Wenyang Huayu with effect, 1 cases were basically cured, 2 cases were effective.
The 4. type of traditional Chinese medicine and Western medicine treatment of type and correlation results: kidney yang deficiency group and chronic aplastic anemia group using Chinese traditional medicine (80%, 8/10) or androgen (66.7%, 16/24) a higher proportion of patients; kidney yin deficiency group and severe AA group using immunosuppressant higher proportion of patients (61.6%, 16/26; 76.9%, 20/26) the TCM treatment group. A high proportion of children (6/10) and significant effect. That TCM type and choice of drugs (androgen or immunosuppressant) the relationship between TCM type is helpful for the selection of clinical medicine; the kidney yang deficiency of kidney yin and total effective rate were 100% and 83.3%, severe acute and chronic aplastic anemia the total effective rate was 84.6% and 100.0%. pure Chinese medicine treatment group in high proportion (6/10) and significant effect. Through the integrated use of traditional Chinese medicine and Western Medicine classification principle is helpful to improve the curative effect. The kidney yang deficiency and kidney yin deficiency group before treatment White blood cells, hemoglobin, platelets were lower than normal, after the treatment of kidney yang deficiency group and kidney yin deficiency group of peripheral white blood cells, hemoglobin, platelet were significantly increased (P0.01), but after the treatment of patients with kidney yang deficiency of white blood cells, hemoglobin, platelet to normal level were significantly higher than that after the treatment of kidney yin deficiency patients (P0.01), after treatment of kidney yang deficiency group peripheral blood recovery quickly and completely.
Analysis of 5. TCM syndrome characteristics: Yin deficiency and kidney yang deficiency group were more frequently waist and knee pain, waist and knee pain is the main symptom of aplastic anemia that syndrome differentiation of kidney deficiency and kidney yang deficiency group. Before treatment with chills, tinnitus and edema are the main symptoms, with kidney tonifying herbs, are easy to improve symptoms of kidney yin deficiency group in five. Fanre, afternoon fever, throat, and constipation symptoms such as sweating and short red urine, alleviated after treatment; kidney yin deficiency and kidney yang deficiency group bleeding symptom is rare, but after traditional Chinese medicine treatment to improve. Many big tongue and fur can be used to distinguish kidney yin deficiency, a key objective index of kidney yang deficiency.
6. TCM syndrome curative characteristics: after treatment, clinical cure symptoms and urine short red knots; effective symptoms of waist and knee pain, aversion to cold sweats, tinnitus or deafness; effective symptoms of hair off or tooth shake, edema, urinary incontinence or after heeltap, Fanre and tongue fur invalid; the symptoms of hypogonadism and dry throat. The clinical symptoms of TCM syndrome of kidney yang deficiency in patients with mild, the prognosis is good; the clinical manifestations of kidney yin deficiency patients, the prognosis is relatively poor, improve the quality of tongue coating is relatively slow.
Conclusion:
1. Ma Rou chief physician for treatment of acute severe aplastic anemia and chronic aplastic anemia rates were 84.6% and 100%, the total effective rate of treatment from 70% to 80% with the efficiency of 93.0%. and domestic reports of traditional Chinese medicine and Western medicine, confirmed by typing method in treating aplastic anemia has some advantages in efficacy with traditional Chinese medicine and Western medicine;
2. further confirmed with chronic aplastic anemia of kidney yang deficiency, kidney yin deficiency type in severe aplastic anemia;
3. the traditional Chinese medicine for tonifying the kidney in light patients, children and Western medicine have poor curative effect or intolerance of the patients can give full play to the advantages of traditional Chinese medicine.
4. various types of aplastic anemia, reasonable use of male hormone and immunosuppressant combined with kidney tonifying herbs can obtain better curative effect, the curative effect is improve and avoid excessive treatment of side effects caused by;
5. to explore the male hormone and tonifying kidney combined with realgar treatment history of Wenyang Huayu effect more than 20 years of severe aplastic anemia patients with type II, 1 cases were basically cured, 2 cases effective, 1 cases were invalid (because of the shorter observation time), initially showing good signs;
6. Ma Rou director of clinical application of Bushen Chinese medicine and Western medicine combined with different treatment, as long as the starting points can achieve good effect and avoid unnecessary over treatment. We put forward and prove the incidence of aplastic anemia can be divided into the abnormal immune and bone marrow failure mainly in 2 stages, the Chinese Medicine + immunosuppressant after the treatment of Tonifying the kidney; a stage should take Chinese medicine of tonifying kidney + male hormone therapy, there may be a transitional phase between the two; timely reduction or withdrawal of immunosuppression or male hormone, can not carry out better in the West principle.
7. characteristics of TCM Syndrome Type:
Kidney yin deficiency and kidney yang deficiency group appear more ache of waist, waist and knee pain is the main symptom of aplastic anemia that symptoms of TCM syndrome differentiation of kidney deficiency, deficiency of kidney yang deficiency criteria distinguish meaningful, tongue fur can basically distinguish Yin deficiency, a key objective index of kidney yang deficiency syndrome of kidney yang deficiency anemia; the clinical symptoms improved better than kidney yin deficiency; chronic aplastic anemia or long duration of severe aplastic anemia patients with multiple manifestations of kidney yang deficiency, kidney essence is suitable for traditional Chinese medicine or treatment with androgen, and acute severe aplastic anemia for kidney yin deficiency, more suitable for replenishing kidney essence combined with traditional Chinese medicine immunosuppressive therapy. According to TCM syndrome efficacy criteria of clinical symptoms of TCM syndrome differentiation of kidney yang deficiency in patients with mild, the prognosis is good; the clinical manifestations of kidney yin deficiency patients, the prognosis is relatively poor. It is also found that the tongue The moss are also relatively slow.
8. Ma Rou chief physician for diagnosis and treatment of aplastic anemia clinical features: Invigorating the kidney and regulating yin and Yang, both spleen and stomach, yin and Yang, Yang and Yin, nourishing yin and Yang; adhere to the treatment, he believes that chronic diseases such as type has not changed, should adhere to the main square unchanged, only partial failure and cold heat according to Yin and Yang the spleen and stomach and do chmical process.
Ma Rou director believes that the first to correctly grasp the Chinese understanding of disease occurrence and development rule, must find the program from the Chinese medicine theory origin level. Therefore, with his unique "view of pathogenesis", "the occurrence and prevention of disease" and "prevention concept" to guide the TCM diseases. Firstly, from the angle of yin and yang to understand the disease occurs, the balance of yin and Yang is healthy, the imbalance of yin and Yang is sick; summarize the disease from the good relationship between the occurrence of it is false and evil Sheng. He believed that traditional Chinese medicine treatment of the disease is the imbalance of Yin and Yang the ability of regulating yin and Yang, and contradictory relationship, "and" notes "and", "partial" to "flat", so as to achieve the purpose of treating disease, the doctor's role is merely naturltopography homeopathy, correction, adjustment of yin and Yang. Too much also believes that nature can better conform to the disease prevention and cure, treatment based on syndrome differentiation only effective the health. In the course of spleen stomach regulating Fuzheng and Quxie prescription and not forgetting both embody the teacher with "spleen and stomach" and "disease prevention prevention first" concept.
He believes that Chinese medicine is from the whole system perspective, emphasizing the human, because, according to local conditions, the treatment of Chinese medicine. In the light of its general trend system should be based on syndrome differentiation as the core, to show the patient's "card" as the target, the dynamic process of cognition is the essence and rule of the whole change of patients in the course of time reflected in the treatment of aplastic anemia, myelodysplastic syndrome and other diseases, the basic pathogenesis for kidney deficiency of yin and Yang, yin and Yang in treating the kidney; for chronic immune thrombocytopenia and hemorrhagic diseases, recognize the fundamental pathogenesis of qi deficiency and blood stasis, Qi and Yang, Qi and blood the treatment, can significantly improve the curative effect. The type of the most also explore the detoxification effect of Stasis Formula Qinghuang powder in the treatment of myelodysplastic syndrome has good curative effect, he believed that the pathogenesis of this disease is Qi, complex sense of toxin Because, poison and blood stasis, toxin and blood stasis. And expand the application of acute non lymphocytic leukemia in chronic myeloproliferative disease and some types of thought because of poison and blood stasis, toxin and blood stasis is the basic pathogenesis, the detoxification effect of stasis Qinghuang powder relief in fact, focus on the fundamental disease toxin and blood stasis the machine is also exploring. In recent years, with longer duration of arsenic containing Chinese medicine for the treatment of patients with chronic severe aplastic anemia, its pathogenesis is "long into the network", "due to Qi Deficiency", rather than "poisoned blood stasis", the treatment with realgar warm Sanyu, its warm resistance blood stasis can help Yang, the efficacy of "blood stasis" disease and achieved preliminary curative effect. Ma Rou director believes that the key to explore the Chinese medicine treatment of difficult blood disease lies in the accurate understanding of disease pathogenesis, and the traditional Chinese medicine "cure for this", "so

【學(xué)位授予單位】：中國(guó)中醫(yī)科學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R556.5

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9 楊玉良;;刁本恕主任醫(yī)師治療小兒慢性腸炎經(jīng)驗(yàn)[A];第28次全國(guó)中醫(yī)兒科學(xué)術(shù)大會(huì)暨2011年名老中醫(yī)治療（兒科）疑難病臨床經(jīng)驗(yàn)高級(jí)專修班論文匯編[C];2011年

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