本文關(guān)鍵詞：許銑教授學術(shù)思想及從肝肺論治銀屑病傳承研究　出處：《中國中醫(yī)科學院》2016年博士論文　論文類型：學位論文

  更多相關(guān)文章： 許銑 經(jīng)驗傳承 皮膚病 銀屑病 核心病機 肝肺失調(diào)

【摘要】：許銑教授,中國中醫(yī)科學院廣安門醫(yī)院皮膚性病科研究員、主任醫(yī)師,博士生導師,享受國務(wù)院政府特殊津貼,兼任中國中醫(yī)科學院專家委員會委員,中央保健委員會會診專家,第五批全國老中醫(yī)藥專家學術(shù)經(jīng)驗繼承工作指導老師。許老對中西醫(yī)都有過系統(tǒng)的學習經(jīng)歷,西醫(yī)方面曾蒙受老一代著名醫(yī)學家胡傳葵、王光超、陳集舟、王雙元等教授的教誨,中醫(yī)方面師從20世紀七十年代西北地區(qū)名老中醫(yī)張漢祥、于己柏、尚坦芝等,后又得到北京名醫(yī)朱仁康的指導,繼承了諸位前輩的寶貴經(jīng)驗,博采眾長。從醫(yī)近60年,勤奮努力,勇于創(chuàng)新,加之曾在多地工作涉及城市與農(nóng)村、國內(nèi)與國外,逐漸形成了其中醫(yī)西醫(yī)并重、經(jīng)典理論與民間經(jīng)驗相結(jié)合的學術(shù)特色。臨床方面診治皮膚性病領(lǐng)域中諸多種疾病均有十分確切的療效,尤擅治療濕疹皮炎類、銀屑病、痤瘡、各種疣類皮膚病、結(jié)締組織病等。我有幸作為許老學術(shù)繼承人,通過跟師臨證、聽講、整理醫(yī)案、復習文獻等對許老學術(shù)思想與臨床經(jīng)驗進行較全面的總結(jié),并在許老診治銀屑病經(jīng)驗基礎(chǔ)上進一步研究探索,大膽提出“從肝肺論治銀屑病”的新觀點。本論文主要包括中醫(yī)典籍學術(shù)思想在皮膚科的體現(xiàn)及應(yīng)用、銀屑病中西醫(yī)研究概況及微觀辨證研究現(xiàn)狀、許老學術(shù)淵源與特色、許老治療皮膚病臨床經(jīng)驗總結(jié)、從肝肺論治銀屑病的理論研究以及調(diào)肝理肺、活血解毒法聯(lián)合小劑量阿維A治療斑塊狀銀屑病的臨床研究六個方面。1中醫(yī)典籍學術(shù)思想在皮膚科的體現(xiàn)及應(yīng)用深入學習和挖掘中醫(yī)經(jīng)典著作中的理論要素,從中醫(yī)皮膚科臨床實際出發(fā),探討皮膚病辨證治療的思路與方法。重點研讀了《諸病源候論》、《黃帝內(nèi)經(jīng)》、《傷寒論》、《溫病條辨》、《醫(yī)林改錯》、《醫(yī)宗金鑒·外科心法要訣》等典籍,繼承吸收其中的理論精髓,并在皮膚病之臟腑辨證、厥陰病診治思路在皮膚科的應(yīng)用、皮膚病之養(yǎng)陰護陰、活血化瘀以及皮膚科外治法等方面提出自己的觀點與體會。2銀屑病中西醫(yī)研究概況及微觀辨證研究現(xiàn)狀通過文獻研究,綜述銀屑病的流行概況及中西醫(yī)治療現(xiàn)狀,指出中醫(yī)藥治療銀屑病的優(yōu)勢及存在的問題,著重分析斑塊狀銀屑病的中西醫(yī)治療現(xiàn)狀與研究意義。從皮膚組織病理及相關(guān)分子機制研究兩方面整理分析銀屑病的微觀辨證研究現(xiàn)狀,拓寬銀屑病辨證治療的思路與視野。3許銑教授學術(shù)淵源與特色許銑教授1958年畢業(yè)于北京醫(yī)學院(現(xiàn)北京大學醫(yī)學部),打下了堅實的西醫(yī)理論基礎(chǔ),上世紀七十年代在甘肅支邊階段又脫產(chǎn)系統(tǒng)學習中醫(yī)理論,并與基層、民間中醫(yī)進行了深入交流,進一步吸納了中醫(yī)的文化和理念。因此,“實踐中醫(yī),同時不離西醫(yī)”是許銑教授臨床一直奉行的原則。其學術(shù)特色概括如下。3.1中西并舉,結(jié)合辨病與辨證：診斷主張以西醫(yī)辨病,以中醫(yī)辨證。治療用藥主張以中藥為主,全面調(diào)理、內(nèi)外兼治；以西藥為輔,盡量用最小劑量的西藥達到針對病因治療的目的。這樣既可以緩解癥狀、改善證候,使患者體質(zhì)達到平和狀態(tài),又可以去除病因,同時將西藥的副作用和風險降到最低,實現(xiàn)“減毒增效”。致力于將中醫(yī)、西醫(yī)從診斷到治療相結(jié)合、相借鑒,在長期臨床實踐中已取得了比單純中醫(yī)或單純西醫(yī)更好的臨床療效。3.2辨證求本,兼顧局部與整體：傳承了朱仁康教授的學術(shù)思想,既關(guān)注局部皮損辨證,同時也關(guān)注整體臟腑、氣血的失調(diào),力求兼顧局部與整體。同時,還重視從組織病理角度進行微觀辨證。皮損辨證方面,主要以六淫辨證為主；整體辨證方面,注重臟腑經(jīng)絡(luò)辨證、衛(wèi)氣營血辨證；微觀辨證方面,關(guān)注“濕邪”與“毒邪”。3.3內(nèi)外兼治,重視中藥外用：始終重視中藥外治療法,在許多皮膚病的中藥外治方面積累了寶貴的經(jīng)驗。認為“古方中以及民間確有一些現(xiàn)代醫(yī)者意想不到療效的驗方,應(yīng)當細心地尋求”。3.4慢病難病,強調(diào)心身調(diào)節(jié)：認識到許多慢性、難治性皮膚病都屬于心身疾病,如銀屑病、白癜風、痤瘡等。在臨證時十分重視與患者的心理、精神上的交流,包括耐心告知患者疾病的轉(zhuǎn)歸預后等情況,給予必要的心理安慰；在藥物治療方面,酌情應(yīng)用疏肝解郁、養(yǎng)心安神、重鎮(zhèn)安神等方藥,并密切觀察患者的睡眠及情緒變化。4許銑教授治療皮膚病臨床經(jīng)驗總結(jié)4.1銀屑病治療經(jīng)驗：主張中西醫(yī)結(jié)合,以西醫(yī)的微觀觀念探尋本病之根源,以中醫(yī)臟腑、氣血之辨證理解本病不同階段、不同表象之證候,分別又協(xié)同施以中西藥物或其他科學治法(如光療、藥浴等),始能取得最圓滿的療效。具體分兩期(急性期、慢性期)三型(血熱、血虛、血瘀)論治,重視對慢性期患者的長期治療監(jiān)測；提倡中西藥聯(lián)合,力求增效減毒；擅長外治療法,積極攻克頑固皮損；重視預防調(diào)護,爭取逐年減輕。4.2痤瘡治療經(jīng)驗：重視病因病機,根據(jù)痤瘡發(fā)病的四個環(huán)節(jié)采取針對性治療,選擇相應(yīng)的中西藥物；根據(jù)痤瘡皮疹形態(tài)的四個階段確定中醫(yī)的理法方藥,具體分肺經(jīng)風熱、胃腸濕熱、痰凝血瘀三型論治：擅長應(yīng)用中藥液體面膜(經(jīng)驗方“四季湯”)濕敷患處,效佳價廉；適時補充維生素B、維生素C等,全面改善癥狀。4.3濕疹治療經(jīng)驗：診斷方面,既強調(diào)經(jīng)典濕疹與其他皮炎的區(qū)別,也重視濕疹可能合并感染或其他皮膚病等復雜情況;辨證方面,宏觀與微觀相結(jié)合,強調(diào)濕、熱、風、瘀是濕疹辨證的要點；治療方面,中西并重,標本兼顧,重視止癢及清“虛熱”。4.4白癜風治療經(jīng)驗：辨病為主,治療重在活血化瘀、補腎益氣,同時根據(jù)不同患者的臟腑失調(diào)情況,或疏肝、或理脾等有針對性地進行調(diào)治；注重心身調(diào)節(jié)及言語疏導；外用藥復色與遮蓋相結(jié)合。認為中西醫(yī)結(jié)合治療白癜風優(yōu)勢明顯。4.5病毒性疣治療經(jīng)驗：認為頑固性疣應(yīng)使用內(nèi)外兼治、中西藥聯(lián)合的綜合療法。內(nèi)服中藥強調(diào)分證施治,扁平疣重在解表祛濕；尋常疣(包括跖疣)重在活血解毒。外治法運用中藥泡洗配合封包療法,強調(diào)重用香加皮(北五加皮)。4.6慢性蕁麻疹治療經(jīng)驗：以臟腑辨證為主,認為脾虛是根本。治療原則以補虛扶正為主,始終以健脾益氣為核心,兼顧調(diào)理其他臟腑,根據(jù)患者的具體表現(xiàn)常輔以疏肝氣、清心火、清肺熱、補腎陰等。酌情聯(lián)合西藥抗組胺、調(diào)節(jié)免疫、抗感染等治療。重視患者教育,幫助養(yǎng)成良好的生活習慣。4.7斑禿治療經(jīng)驗：中西醫(yī)并重,內(nèi)外治結(jié)合,多角度出擊(酌情應(yīng)用免疫調(diào)節(jié)劑、維生素、微量元素及鎮(zhèn)靜安眠藥物等),盡可能使患者得到全面而系統(tǒng)的治療;中醫(yī)辨證論治方面,重視從肝腎論治,與傳統(tǒng)理論相比許老更重視對肝郁、肝火的治理。4.8常用經(jīng)驗方總結(jié)：列舉了許銑教授治療皮膚病常用經(jīng)驗方劑5首,包括內(nèi)服方4首(丹參散結(jié)方、丹蛇解毒方、龍芩除濕方及消痤方),外敷方1首(四季湯),詳細分析其方劑組成、功效主治及臨床加減應(yīng)用法則,并附典型病案。5從肝肺論治銀屑病的理論研究立足臟腑辨證,整理銀屑病中醫(yī)辨證的各種理論與觀點,結(jié)合中醫(yī)藏象理論及對銀屑病臨床觀察體會,提出“肝肺失調(diào)、外感毒邪、皮絡(luò)損傷”是銀屑病的核心病機。結(jié)合許銑老師治療銀屑病分急慢二期等思想及文獻研究,提出急性期多以治肺為主,清熱解毒、涼血平肝；慢性期多以調(diào)肝為主,活血解毒、養(yǎng)陰潤肺。同時,在銀屑病治療全過程始終重視治療“外感毒邪”,重視活血化瘀“通絡(luò)”,并適當聯(lián)合小劑量西藥或物理療法(如光療等),形成有特色、較完整的銀屑病治療方案。6調(diào)肝理肺、活血解毒法聯(lián)合小劑量阿維A治療斑塊狀銀屑病的臨床研究基于“肝肺失調(diào)、外感毒邪、皮絡(luò)損傷”是銀屑病的核心病機這一創(chuàng)新觀點,在繼承許銑老師中西醫(yī)結(jié)合學術(shù)思想以及治療慢性期銀屑病活血解毒搜風等臨床經(jīng)驗基礎(chǔ)上,確立調(diào)肝理肺、活血解毒法聯(lián)合小劑量阿維A治療斑塊狀銀屑病的方案并開展臨床研究。臨床研究目的：客觀評價調(diào)肝理肺、活血解毒法聯(lián)合小劑量阿維A治療斑塊狀銀屑病的臨床療效。方法：采用隨機、對照的方法,選擇符合斑塊狀銀屑病診斷的患者60例,分為聯(lián)合治療組和單純中藥組各30例。聯(lián)合治療組采用調(diào)肝肺活血解毒方聯(lián)合小劑量阿維A口服(10mg/d),單純中藥組僅內(nèi)服調(diào)肝肺活血解毒方。連續(xù)治療8周,每2周復診1次。觀察并記錄治療前及治療后第2、4、8周時皮損面積和嚴重程度指數(shù)(PASI)評分、瘙癢程度評分以及靶皮損不同癥狀(紅斑、鱗屑、浸潤)評分變化。結(jié)果：①聯(lián)合治療組痊愈6例,顯效18例,總有效率為80.0%,單純中藥組痊愈3例,顯效14例,總有效率為56.7%,聯(lián)合治療組總有效率高于單純中藥組,但差異無統(tǒng)計學意義(P=0.253);②兩組患者療后2周、4周、8周時與治療前比較,除單純中藥組治療2周時瘙瘁評分差異無統(tǒng)計學意義外,其余各時點皮損PASI評分、瘙癢程度評分差異均有統(tǒng)計學意義(P0.01)。治療2周、4周、8周時,兩組間同期比較,皮損PASI評分、瘙癢程度評分差異均無統(tǒng)計學意義(P0.05)；③兩組患者療后2周、4周、8周時與治療前比較,靶皮損紅斑、鱗屑、浸潤評分差異均有統(tǒng)計學意義(P0.01或P0.05)；兩組間治療后靶皮損紅斑、鱗屑、浸潤評分同期比較,除治療8周時兩組靶皮損浸潤評分差異有統(tǒng)計學意義(P0.05),其余各項差異均無統(tǒng)計學意義(P0.05)。結(jié)論：①調(diào)肝理肺、活血解毒法治療斑塊狀銀屑病臨床療效確切,能夠有效地改善斑塊狀銀屑病患者皮損的紅斑、浸潤、鱗屑及瘙癢癥狀,能夠降低皮損局部的PASI評分；②聯(lián)合治療組治愈率和總有效率高于單純中藥組,在改善皮損浸潤方面優(yōu)于單純中藥組而總體PASI評分下降幅度也更大,且無明顯副作用,說明中西藥聯(lián)合治療銀屑病能起到優(yōu)勢互補、增強療效的作用,方向是正確的。
[Abstract]:Xu China milling Professor, Guanganmen Hospital of Chinese Academy of Sciences Department of Dermatology Professor, chief physician, tutor of doctoral students, enjoy special government allowances of the State Council, who is also a member of the Chinese Academy of Sciences China expert committee, the Central Committee on health care expert consultation, the fifth batch of the old Chinese medicine experts academic experience inheritance to guide the work of teachers. The traditional Chinese medicine and Western medicine are old Xu the system's learning experience, western medicine have been subject to the old generation of the famous physician Hu Chuankui, Wang Guangchao, Chen Jizhou, Wang Shuangyuan, Professor of education, Chinese medicine from twentieth Century 70s in the northwest of old Chinese Zhang Hanxiang, to Bo, is Tanzhi, then get the Beijing doctors Zhu Renkang, inherited the precious experience, you senior doctor. Learn widely from others'strong points for nearly 60 years, hard work, innovation, and had much work involved in city and countryside, domestic and foreign, gradually formed The medicine of Western medicine and academic characteristics, classical theory and folk experience combined. The clinical treatment of Dermatology fields are in various diseases and very effective, especially the treatment of eczema dermatitis, psoriasis, acne, warts, various skin diseases, connective tissue disease. I am fortunate as Xu old academic heir. With the teacher in class, finishing clinical, medical records, review of the literature on the old Xu conducted a comprehensive summary of academic thought and clinical experience in diagnosis and treatment of psoriasis and many old experience further study, put forward a new viewpoint of treating psoriasis "from the liver and lung. This paper mainly includes the academic thought in TCM Classics reflection and application of Department of Dermatology, western medicine research survey and research status of micro differentiation in psoriasis, academic origin and characteristics of the old Xu, Xu old treatment of skin disease clinical experience on the treatment of psoriasis, from the theory of liver and lung Study of Tiaoganlifei, huoxuejiedu method combined with small dose of acitretin A in the treatment of plaque psoriasis clinical research thought six.1 classics of Chinese medicine academic reflection and application in Department of Dermatology for further study and mining theory of traditional Chinese Medicine Classics of Chinese medicine from the Department of Dermatology, clinical practice, to explore the ideas and methods of treatment of skin diseases read the source key. < >, > < < Huangdi Neijing, treatise on differentiation and treatment of Epidemic Febrile Diseases > >, < < >, < yilingaicuo, golden mirror of Medicine & surgery to heart > and other books, which inherited and absorbed the theory essence, and differentiation in the organs of skin disease, Jueyin disease diagnosis and treatment in the Department of Dermatology application, skin disease of Yin protectscloudyly, put forward their views and experience of Western Medicine on.2 in psoriasis and microcosmic research status through literature research and Department of Dermatology external therapy of promoting blood circulation and removing blood stasis, review of psoriasis The treatment of traditional Chinese medicine and Western medicine and epidemic situation, points out that the traditional Chinese medicine treatment of psoriasis advantages and existing problems, focuses on the analysis of plaque psoriasis of traditional Chinese medicine and Western medicine treatment status and significance of the research. From two aspects of research and the related molecular mechanism of skin pathology and analysed the current research situation of micro differentiation of psoriasis, psoriasis and broaden the view of.3 treatment and differentiation Xu Xian s academic origin and characteristics of Xu Xian s 1958 graduated from Beijing Medical College (now Peking University Health Science Center), western medicine laid a solid theoretical foundation, in 70s the last century learning Chinese medicine theory in Gansu local stage full-time system, and with the grass-roots folk medicine, conducted in-depth exchanges, further absorb the Chinese culture and philosophy. Therefore, the practice of Chinese medicine, western medicine is not at the same time from "Xu has been pursuing a clinical professor of milling principle. Its characteristics are as follows.3.1 Chinese Simultaneously, combination of disease and syndrome differentiation diagnosis advocated by western medicine, TCM treatment. That is dominated by traditional Chinese medicine, comprehensive conditioning, internal and external; western medicine as a supplement, try to use the minimum dose of Western medicine to achieve the purpose of treatment for the cause. It can relieve the symptoms and improve the symptom of patients, make the physical reach peace, and can remove the cause, while the side effects of Western medicine and the risk to a minimum, to achieve "synergistic". Committed to the traditional Chinese medicine and Western medicine from diagnosis to treatment by combining phase reference, in the long-term clinical practice has achieved a better clinical effect than.3.2 differentiation of pure Chinese medicine or western medicine alone. For this, both local and global inheritance the academic thoughts of Professor Zhu Renkang, both concerned with local skin syndrome, also pay attention to the whole viscera, Qi and blood disorders, to both local and global. At the same time, but also from tissue disease Physical view of microcosmic syndrome differentiation. Differentiation of lesions, mainly in six with syndrome differentiation; integral syndrome differentiation, focusing on viscera meridian syndrome differentiation, weiqiyingxue syndrome differentiation; microcosmic syndrome differentiation, pay attention to "wet evil" and "evil".3.3 internal and external treatment, attention: Chinese traditional medicine has always attached importance to the external treatment of traditional Chinese medicine therapy in traditional Chinese medicine many of the external treatment of skin diseases has accumulated valuable experience. That "the ancient folk prescription and some modern medical treatment should be carefully unexpected, for" chronic disease.3.4 difficult disease, psychosomatic adjustment: recognizing that many stressed that chronic, intractable skin diseases are psychosomatic diseases, such as psoriasis, vitiligo acne. In clinical, and attaches great importance to the patient's psychological, spiritual communication, and patient prognosis including inform patients of the disease, to provide the necessary psychological comfort; in the treatment aspect, appropriate application Soothing, calming, soothing the nerves and other drugs, and close observation of sleep and mood changes in patients with.4 Xu Xian s treatment of skin disease to summarize the clinical experience of 4.1 psoriasis treatment experience: the idea of combining traditional Chinese and Western medicine, western medicine in micro concept explore the root causes of the disease, in TCM, Qi and blood dialectical understanding of different stages of the the appearance of disease, different syndromes, respectively with Chinese and Western medicine collaborative or other scientific treatment (such as phototherapy, bath, etc.) was the most satisfactory curative effect can be acquired. The two phases (acute, chronic) type three (blood heat, blood deficiency, blood stasis) on the treatment of attention to the long-term treatment of chronic phase monitoring with the combination of Chinese and Western medicine; advocate, and strive to synergistic; good therapy, actively overcome stubborn skin; the importance of preventive nursing for the treatment of acne, decrease year by year.4.2 experience: the importance of etiology and pathogenesis, according to the four aspects of the pathogenesis of acne take For the treatment, choose the corresponding Chinese and Western medicine; according to four stages of acne rash form the prescription of traditional Chinese medicine, the lung by wind heat, gastrointestinal damp heat, phlegm and blood stasis on the treatment of type three: at the application of traditional Chinese medicine liquid mask (the experience of "four soup") wet dressing effect is good, cheap; timely vitamin B, vitamin C, improve symptoms of.4.3: the experience in the treatment of eczema diagnosis, not only emphasizes the difference between classical and other eczema dermatitis, eczema may also pay attention to infection or other skin disease complex; syndrome differentiation, emphasizing the combination of macro and micro, wet, heat, wind, and blood stasis is the main points of syndrome differentiation eczema; treatment, both Chinese and western, both attention, antipruritic and clear "hot.4.4" treatment of vitiligo disease: experience, focusing on the treatment of blood stasis, kidney qi, and according to the different organs of patients with disorders, or Liver, spleen or other targeted treatment; pay attention to psychosomatic adjustment and verbal guidance; external medicine combined with complex color cover. That the treatment of vitiligo have obvious advantages.4.5 viral warts treatment experience of combining traditional Chinese and Western medicine: think of recalcitrant warts should be used for both internal and external treatment, comprehensive therapy of traditional Chinese and Western Medicine Combined Traditional Chinese medicine. Emphasize the syndrome treatment, flat wart on relieving dampness; verruca vulgaris (including warts) on blood detoxification. External treatment with traditional Chinese medicine bath with packet therapy, emphasize the reuse of cortex Periplocae (Bei Wujiapi) experience in the treatment of chronic urticaria with.4.6: viscera syndrome, spleen deficiency is the fundamental principle that buxufuzheng treatment. As always with Spleen Qi as the core, taking into account the conditioning of other organs, according to the specific performance of patients often with sparse liver qi, clearing heart fire, Qingfei heat, tonifying kidney yin. Appropriate combined with western medicine antihistamine, regulating immunity, anti sense Dyeing treatment. Pay attention to patient education, help the living habits of.4.7 good experience in the treatment of alopecia areata: both traditional Chinese medicine and Western medicine, and treatment with multi angle of attack (use of immunomodulator, vitamins, trace elements and sedative hypnotic drugs), as far as possible so that patients get a comprehensive and systematic treatment; TCM. Pay attention to treatment from the liver and kidney, compared with the traditional theory of Xu old pays more attention to the liver,.4.8 governance experience summary: common anger cited Xu Xian s prescription for treating skin disease commonly used experience of 5 songs, including oral 4 prescriptions (Dan Shen Sanjie, Dan Antidotarium snake, dragon and Xiaocuo Qin dehumidification 1 the first party), external party (four soup), a detailed analysis of the composition of the prescription, indications and clinical application of modified rules, with typical cases of.5 from lung and liver theory study of treatment of psoriasis based on TCM syndrome differentiation of Zang Fu, a variety of finishing psoriasis treatment The theory and view, combined with TCM theory and experience of psoriasis clinical observation, put forward the "lung and liver disorders, exogenous toxin, skin injury collaterals" is the core pathogenesis of psoriasis. Combining the treatment of psoriasis is divided into acute and chronic milling teacher thought and literature research phase two, put forward the acute stage to cure lung, clearing heat detoxification, cooling blood and liver; chronic phase in regulating liver, detoxification, nourishing yin and moistening lung. At the same time, the whole process in the treatment of psoriasis treatment has always attached importance to the "exogenous toxin", pay attention to blood circulation meridians, and appropriately combined with small dose of Western medicine and physical therapy (such as phototherapy, etc.) to form a distinctive, relatively complete the treatment of psoriasis.6 Tiaoganlifei, clinical study of Yiqihuoxuejiedu method combined with small dose A acitretin in treating plaque psoriasis on liver and lung disorders, exogenous toxin, skin injury collaterals "is the core pathogenesis of psoriasis is the innovation point of view, in the succession of Xu Combination of traditional Chinese and Western medicine based teacher milling academic thought and treatment of chronic psoriasis huoxuejiedu soufeng clinical experience, the establishment of Tiaoganlifei, huoxuejiedu method combined with small dose of acitretin A in the treatment of plaque psoriasis and carry out clinical research. Clinical research objective: To evaluate the clinical curative effect of Tiaoganlifei, huoxuejiedu method combined with small dose of acitretin A in the treatment of plaque psoriasis. Methods: a randomized, controlled method, 60 patients with plaque psoriasis patients, divided into treatment group and control group with 30 cases in each group. Combination therapy by regulating liver and lung Huoxue Jiedu recipe combined with low-dose oral acitretin A (10mg/d). The Chinese herbal medicine group only oral pulmonary tiaogan Huoxue Jiedu recipe. 8 weeks of continuous treatment, every 2 weeks for 1 times. Observed and recorded before and after treatment 2,4,8 weeks of lesions area and severity index (PASI) score, pruritus The target lesion score and different symptoms (erythema, scaling, infiltration) score changes. Results: the combined treatment group 6 cases were cured, 18 cases markedly effective, the total efficiency of 80%, the Chinese herbal medicine group 3 cases were cured, 14 cases markedly effective, the total effective rate was 56.7%, and the total effective rate of treatment group is higher than the pure traditional Chinese medicine group, but the difference was not statistically significant (P=0.253); the two groups of patients after treatment for 2 weeks, 4 weeks, 8 weeks compared with before treatment, except the Chinese medicine treatment group was not statistically significant at 2 weeks, pruritus score differences, the rest of the time the lesions PASI score, pruritus score differences were statistically significant (P0.01). For 2 weeks, 4 weeks, 8 weeks, two groups were compared, lesions PASI score, pruritus score showed no significant difference (P0.05); the two groups of patients after treatment for 2 weeks, 4 weeks, 8 weeks compared with before treatment, the target of erythema, scaling, infiltration score the differences were statistically significant (P0.01 or P0.05); between the two groups after treatment target of erythema, scaling, infiltration score comparison over the same period, except for 8 weeks when the two target lesions group infiltration score difference was statistically significant (P0.05), the differences were not statistically significant (P0.05). Conclusion: Tiaoganlifei, clinical curative effect of Huoxue Jiedu therapy for plaque psoriasis is effective, can effectively improve the plaque psoriatic erythema, infiltration, scaling and itching, can reduce the local lesions of the PASI score; the combined treatment group cure rate and the total efficiency is higher than that of pure traditional Chinese medicine group, improve skin lesions infiltration is better than pure Chinese medicine group and the overall rating of PASI

【學位授予單位】：中國中醫(yī)科學院
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R249;R275.9

【相似文獻】

相關(guān)期刊論文 前10條

1 吳京海,金嵐,吳惠t ,秦立模,朱麗芬,吳文媛,秦萬章;可溶性細胞粘附分子表達與銀屑病疾病活動的相關(guān)性[J];中國皮膚性病學雜志;2000年04期

2 張曉紅,瞿幸,周志強,牛福林,張建中;消銀解毒飲對銀屑病患者鱗屑白介素8的影響[J];中華皮膚科雜志;2000年02期

3 劉濤峰,張學軍,楊森,王福喜,魏生才,陳珊宇;銀屑病誘發(fā)因素的病例對照研究[J];中華皮膚科雜志;2000年05期

4 張力軍,楊雪琴,樊建勇,劉秀清;銀屑病患者血漿血管緊張素Ⅱ水平檢測[J];中華皮膚科雜志;2000年06期

5 馮素英,靳培英;飲酒和銀屑病[J];國外醫(yī)學.皮膚性病學分冊;2000年04期

6 孫軍紅,方躍明,鄭茂榮;銀屑病與中性粒細胞趨化因子[J];國外醫(yī)學.皮膚性病學分冊;2000年05期

7 李占國,秦社玲,張素紅,張長軍;整體綜合思維在銀屑病診治中的應(yīng)用[J];皮膚病與性病;2000年02期

8 曹序浦;老藥新用治療銀屑病[J];天津藥學;2000年03期

9 陳英,智強,朱年春;重組人白細胞介素-10對銀屑病患者外周血單個核細胞的作用[J];中國臨床藥理學與治療學;2000年04期

10 霍秀琪;銀屑病治療的進展[J];醫(yī)學文選;2000年05期

相關(guān)會議論文 前10條

1 范斌;李斌;;銀屑病與肥胖新進展[A];2009全國中西醫(yī)結(jié)合皮膚性病學術(shù)會議論文匯編[C];2009年

2 范平;張禁;黎超;;127例長期緩解的銀屑病共同點調(diào)查分析[A];2009全國中西醫(yī)結(jié)合皮膚性病學術(shù)會議論文匯編[C];2009年

3 鄭厚峰;;根據(jù)三個基因分類的銀屑病臨床特征比較[A];中華醫(yī)學會第十五次全國皮膚性病學術(shù)會議論文集[C];2009年

4 涂彩霞;齊曉怡;;銀屑病治療的整體觀——生活方式和飲食[A];2010全國中西醫(yī)結(jié)合皮膚性病學術(shù)會議論文匯編[C];2010年

5 楊雪琴;;對銀屑病30年的研究和認識[A];中華醫(yī)學會第16次全國皮膚性病學術(shù)年會摘要集[C];2010年

6 付翔宇;陳宏;;銀屑病的危險因素(摘要)[A];第五屆全國中西醫(yī)結(jié)合變態(tài)反應(yīng)學術(shù)會議論文集[C];2011年

7 王剛;;特殊類型銀屑病的治療[A];2011全國中西醫(yī)結(jié)合皮膚性病學術(shù)會議論文匯編[C];2011年

8 沙海松;;陳凱教授對銀屑病的中西醫(yī)治療經(jīng)驗[A];中華中醫(yī)藥學會學術(shù)會議、國家中醫(yī)藥管理局繼續(xù)教育項目——銀屑病中醫(yī)藥防治交流會暨趙炳南學術(shù)思想高級研修班論文集[C];2011年

9 樊建勇;楊雪琴;張力軍;劉秀清;;銀屑病患者血中糖皮質(zhì)激素及其受體mRNA的測定及其意義[A];2001年中國中西醫(yī)結(jié)合皮膚性病學術(shù)會議論文匯編[C];2001年

10 潘德海;張曉艷;鄭占財;劉永生;;染發(fā)劑過敏誘發(fā)銀屑病8例[A];第一屆全國變態(tài)反應(yīng)學術(shù)研討會論文匯編[C];2001年

相關(guān)重要報紙文章 前10條

1 蒲成學;煙酒與銀屑病[N];中藥報;2000年

2 牧童;銀屑病怎樣防[N];中國中醫(yī)藥報;2007年

3 記者嚴少衛(wèi);銀屑病診治應(yīng)重視心理疏導[N];健康報;2009年

4 本報記者 海霞　吳大衛(wèi) 夏廈;關(guān)愛銀屑病患者[N];中國中醫(yī)藥報;2009年

5 郭艷麗;引起銀屑病的4大因素[N];農(nóng)村醫(yī)藥報（漢）;2009年

6 本報記者 徐亞靜;銀屑病寧可不治莫亂治[N];中國醫(yī)藥報;2009年

7 山西省晉中市第三人民醫(yī)院 張英棟;治銀屑病當重療心[N];中國中醫(yī)藥報;2010年

8 記者 顧泳;上海銀屑病發(fā)病率約0.2%[N];解放日報;2010年

9 山西中醫(yī)學院中西醫(yī)結(jié)合醫(yī)院 張英棟;從系統(tǒng)理論解讀汗對銀屑病防治的重要性[N];中國中醫(yī)藥報;2012年

10 記者 田雅婷;我國銀屑病患者僅15%接受正規(guī)治療[N];光明日報;2012年

相關(guān)博士學位論文 前10條

1 楊海平;銀屑病激發(fā)因素的調(diào)查與防治對策的研究[D];中國協(xié)和醫(yī)科大學;1999年

2 李龍年;漢族人群與歐美人群銀屑病易感基因的遺傳異質(zhì)性研究[D];安徽醫(yī)科大學;2015年

3 金海蓉;白藜蘆醇脂質(zhì)體凝膠對小鼠銀屑病模型的治療及經(jīng)皮給藥藥代動力學研究[D];第二軍醫(yī)大學;2015年

4 吳文中;Th17細胞在銀屑病發(fā)病機制中的作用及復方甘草酸苷對HaCaT細胞增殖和相關(guān)因子表達的研究[D];山東大學;2015年

5 陳曦;JAK/STAT信號通路與銀屑病辨證分型的關(guān)聯(lián)機制研究[D];北京中醫(yī)藥大學;2016年

6 姚鳳鳴;插入/缺失變異與漢族人群銀屑病關(guān)聯(lián)研究[D];安徽醫(yī)科大學;2015年

7 欒超;NRIP1在銀屑病發(fā)病機制中的作用初步研究[D];北京協(xié)和醫(yī)學院;2016年

8 丁旭;許銑教授學術(shù)思想及從肝肺論治銀屑病傳承研究[D];中國中醫(yī)科學院;2016年

9 張心瑜;皮膚鏡在尋常型銀屑病皮損嚴重程度評估研究[D];北京協(xié)和醫(yī)學院;2016年

10 徐麗敏;銀屑病細胞因子異常表達及相關(guān)藥物的研究[D];天津大學;2007年

相關(guān)碩士學位論文 前10條

1 李懷軍;銀屑病臨床相關(guān)因素的回顧性分析[D];黑龍江中醫(yī)藥大學;2009年

2 羅慶;銀屑病社會心理因素調(diào)查研究[D];湖北中醫(yī)學院;2009年

3 吉莉;銀屑病患者的疾病感知和應(yīng)激、應(yīng)對[D];華東師范大學;2009年

4 任為;IL23R基因多態(tài)性與漢族人銀屑病易感性關(guān)聯(lián)分析研究[D];安徽醫(yī)科大學;2009年

5 田雅;527例銀屑病住院患者臨床分析[D];新疆醫(yī)科大學;2009年

6 趙艷霞;銀屑病的發(fā)病與治療的回顧性分析[D];成都中醫(yī)藥大學;2003年

7 劉愛花;銀屑病危險因素研究[D];天津醫(yī)科大學;2007年

8 梁興龍;62例銀屑病住院患者回顧性臨床分析[D];汕頭大學;2011年

9 李俊麗;銀屑病治療現(xiàn)狀及進展[D];重慶醫(yī)科大學;2013年

10 呂艷;阿維A對銀屑病患者血脂影響的回顧性分析[D];鄭州大學;2015年

，

本文編號：1413851