本文選題：學(xué)術(shù)經(jīng)驗 + 年齡相關(guān)性黃斑變性��； 參考：《成都中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：李宗智教授出生于中醫(yī)世家,從醫(yī)五十余載,在治療眼科疾病方面積累了豐富的經(jīng)驗,尤其是眼底疾病。李老一生努力鉆研祖國醫(yī)學(xué),精讀中醫(yī)經(jīng)典古籍,跟隨多位中醫(yī)名家從醫(yī),涉及內(nèi)科、婦科、兒科、眼科等,集眾家之所長,形成了自己獨特的診療疾病特色,成為享譽全省乃至全國的中醫(yī)眼科專家。他診治疾病不拘一格,整體與局部辨證相結(jié)合,辨病與辨證相結(jié)合等多種方法靈活運用。在治療眼科疾病當(dāng)中,認為目為清竅,需要氣血陰液、真血的濡養(yǎng),而神光的發(fā)越又容易耗傷陰血,故主張“陰常不足”,提出以滋養(yǎng)陰血為主治療眼科疾病的治療方法；同時,目為肝之外竅,肝中所藏之血為真血,肝氣的疏泄在神光的發(fā)越中起到非常重要的作用,常以疏肝平肝之法兼之。在治療許多眼底疾病上,認為疾病的發(fā)生發(fā)展涉及多臟腑、多因素,重視心中之陽在眼底疾病中的重要性。李老治療疾病還重視治未病,講究養(yǎng)生與治病相結(jié)合,提倡寡欲,形神俱養(yǎng)。認為許多眼科疾病,尤其是一些疑難性眼底疾病,與多思多欲有極大的關(guān)系。他喜好儒學(xué),講究中庸,處方用藥中正平和；臨證既立足于中醫(yī),也不排斥西醫(yī),把西醫(yī)先進的檢查運用到中醫(yī)的辯證論治中,使其成為四診的一個資料,合理運用。他長期堅持臨床,不斷學(xué)習(xí),學(xué)以致用,仁愛友善,善待每一個患者,不計較金錢名利,是患者心目中的“神醫(yī)”。其對近視力的重視程度大于對遠視力的重視,尤其在小兒弱視的治療中,認為近視力的恢復(fù)是視網(wǎng)膜黃斑功能恢復(fù)的重要體現(xiàn),提倡單頻視物,眼罩的制作必須是外黑內(nèi)紅,精細訓(xùn)練提倡穿針,不提倡穿珠子等,治療與訓(xùn)練堅持的時間長。而且貴州省第一個中醫(yī)眼科�？凭褪怯伤M建,培養(yǎng)出了一大批中醫(yī)眼科專門人才,為中醫(yī)眼科在貴州的發(fā)展打下了堅實的基礎(chǔ)。本論文主要分為四個部分,除上述第一部分主要介紹李宗智學(xué)術(shù)思想和臨證經(jīng)驗的整理與研究外,在第二部分則對目前中醫(yī)及西醫(yī)對于本病的認識及治療進行了綜述。其中,中醫(yī)對于本病的認識主要是肝脾腎虛損,痰瘀互結(jié)。治療上也主要是從補益肝脾腎,化痰散瘀等入手治療,未有在治療本病中重視心的功能的記錄,這正是導(dǎo)師治療本病的獨特之處。同時,還對從現(xiàn)代醫(yī)學(xué)對本病的認識做了簡單的回顧。現(xiàn)代醫(yī)學(xué)對于本病的研究雖然頗多,治療方法也齊全,從藥物治療到手術(shù)治療均有,但治療效果并不盡人意,且價格昂貴,副作用也較大,不是治療本病的首選。中醫(yī)藥治療本病有其價廉、無毒、效優(yōu)等特點,雖不能完全治愈本病,但能夠延緩疾病的發(fā)展,不失為治療本病的又一種選擇。隨著光學(xué)相干斷層成像術(shù)(OCT)的使用,目前對于本病的診斷及治療效果的觀察更加客觀。第三部分主要介紹李宗智教授治療年齡相關(guān)性黃斑變性的特色及優(yōu)勢。李老對于年齡相關(guān)性黃斑變性的病因病機的認識,主要認為脾腎虧虛是基礎(chǔ),精血不足是重點,痰濁與瘀血始終貫穿本病,在本病的形成及發(fā)展中有重要的促進作用。干性型者主要是由于年老體衰,腎氣虧損,脾氣虛弱,心陽不振引起；濕性型者主要是由于肝脾腎虧虛,營血虧滯,血熱內(nèi)生,水火不濟,心經(jīng)郁熱,脈絡(luò)津虧血少,因虛致瘀,運化失健,水濁內(nèi)停成痰,痰瘀互結(jié),導(dǎo)致本病的產(chǎn)生。同時還提出本病的發(fā)生發(fā)展是多臟腑受損的結(jié)果,不能簡單看待之。其對于本病病因病機,李老認為本病除了與肝脾腎有莫大的關(guān)系之外,還與心的關(guān)系密切。他認為心為君主之官,神明出焉,神光屬于神明。心為火藏,心之與其他臟腑猶如夜空之明燈,在老年人者主要是由于心陽不足,照耀、溫馨不夠,或心之陰血不足,血熱上蒸所致。心主血脈,一身之血莫不由心主控,而目得血能視,故心的功能正常,神光才有所依,發(fā)越方有基�？偨Y(jié)李老處方用藥規(guī)律,除了與傳統(tǒng)的認為本病主要與肝脾腎三臟有關(guān)的認識不同以外,他還提出干性者以實脾益腎平肝,溫振心陽,養(yǎng)心開竅為主,兼以化痰；濕性者以滋養(yǎng)精血,清營涼血解郁為主,兼以化痰逐瘀的治療方法。在第四部分臨床研究中,主要根據(jù)李老對年齡相關(guān)性黃斑變性的病因病機的認識,綜合自己三年跟師的心得,總結(jié)用藥規(guī)律,研討如何組方治療濕性年齡相關(guān)性黃斑變性。通過視力評分、視網(wǎng)膜神經(jīng)上皮層厚度(RNL)評分、脈絡(luò)膜毛細血管復(fù)合體(CBRC)的厚度評分以及中醫(yī)證候評分,評價療效。結(jié)果①治療組30例35眼中,顯效7只眼,有效13只眼,無效15只眼,總有效率57.14%,無效占42.86%；對照組30例30只眼,顯效3只眼,有效10只眼,無效17只眼,總有效率51.43%,無效48.57%,兩組比較,P0.05,有顯著差異性。②治療組與對照組治療前后視力均有變化,治療組視力提高明顯優(yōu)于對照組(P0.05)。③治療組治療前后RNL、CBRC厚度變化比較有顯著差異(P0.05),對照組治療前后RNL厚度比較(P0.05),差異無統(tǒng)計學(xué)意義,CBRC厚度比較有顯著性差異(P0.05)；兩組治療后RNL、CBRC厚度比較有顯著性差異(P0.05),治療組明顯優(yōu)于對照組。④兩組治療前后眼部癥狀比較有顯著性差異(P0.05),治療組明顯優(yōu)于對照組。通過以上研究,李宗智教授以補益脾腎為主,重視心的功能治療年齡相關(guān)性黃斑變性的學(xué)術(shù)思想簡要總結(jié)起來主要有以下三點：(1)病因病機是以脾腎虧虛是根本,精血不足是核心,血分郁熱與心陽不振是重點,注重“心火”在疾病形成中的重要性,痰濁與瘀血為其標；(2)提倡陰常不足,主張多臟腑治療,重視“心”的功能調(diào)解；(3)以此法組方治療濕性年齡相關(guān)性黃斑變性,能夠改善病人的視力,延緩疾病的發(fā)展,提高生存質(zhì)量,安全有效。
[Abstract]:Professor Li Zongzhi, born in the family of Chinese medicine, has accumulated a wealth of experience in the treatment of ophthalmological diseases, especially in the treatment of Ophthalmology, especially the fundus disease. Li Lao has worked hard to study the motherland medicine, read traditional Chinese classic books, followed the medical, gynecology, pediatrics and Ophthalmology, and formed his own independence. The special diagnosis and treatment of diseases has become an expert in ophthalmology of the whole province and even the whole country. Therefore, it advocates "Yin and yin deficiency", and puts forward the treatment method of nourishing yin and blood as the main treatment for ophthalmological diseases; at the same time, the eyes are outside the liver, the blood in the liver is true blood, and the drainage of the liver Qi plays a very important role in the development of the light. It is often used to dredge the liver and liver. In the treatment of many fundus diseases, the disease is considered the disease. The occurrence and development involved many Zang Fu organs and many factors, emphasizing the importance of the heart Yang in the fundus disease. Li Lao's treatment of disease also pays attention to the treatment of the disease, pays attention to the combination of health care and treatment, advocates the lack of desire and spirit, and believes that many ophthalmological diseases, especially some difficult fundus diseases, have a great relationship with the thought of dor. He likes Confucianism and is fastidious. Mediocre, prescription and prescription in Zheng Ping and the prescription, not only based on traditional Chinese medicine, but also do not exclude western medicine, and apply the advanced examination of Western medicine to the dialectical treatment of traditional Chinese medicine to make it a data of the four diagnosis and rational use. He persists in clinical, continuous learning, learning, kindness, kindness to every patient, and money, fame and wealth, is a patient. In the treatment of children's amblyopia, the restoration of near vision is an important manifestation of the restoration of retinal macular function. In Guizhou, the first ophthalmology department of traditional Chinese medicine was established by him, and a large number of specialists in the ophthalmology of traditional Chinese medicine were trained, which laid a solid foundation for the development of the ophthalmology of the Chinese medicine in Guizhou. This paper is divided into four parts. The first part of this paper mainly introduces Li Zongzhi's academic thought and experience. In the second part, the understanding and treatment of traditional Chinese medicine and Western medicine for this disease are reviewed in this paper. Among them, the knowledge of TCM for this disease is mainly liver and spleen kidney deficiency, phlegm and blood stasis, and the treatment is mainly from supplementing the liver and spleen and kidney, eliminating phlegm and dispersing stasis, and not recording the attention of the heart in the treatment of this disease. This is the unique point of the tutor's treatment of the disease. At the same time, a simple review of the knowledge of the disease is made from modern medicine. Although modern medicine has a lot of research on this disease, the treatment method is also complete, from drug treatment to surgical treatment, the treatment effect is not satisfactory, and the price is expensive and the side effects are large, not the treatment book. The treatment of this disease has its characteristics of low price, non-toxic and effective, which can not completely cure the disease, but can delay the development of the disease. It is another choice for the treatment of this disease. With the use of optical coherence tomography (OCT), the diagnosis and treatment effect of this disease are more objective. Third parts are main This paper introduces the characteristics and advantages of Professor Li Zongzhi in the treatment of age-related macular degeneration. Li Lao's understanding of the etiology and pathogenesis of age-related macular degeneration is mainly that the deficiency of the spleen and kidney is the basis, the insufficiency of the blood is the key point, phlegm and blood stasis always run through the disease, and it has an important promoting effect in the formation and development of the disease. If it is due to aging, deficiency of kidney qi, weak temper and inactive heart Yang, the wet type is mainly due to deficiency of liver and spleen and kidney, blood loss and deficiency, blood heat endogenous, water and fire, depression of heart meridian, lack of blood in choroid, loss of health, phlegm and stagnation of phlegm and stasis, resulting in the occurrence of this disease. The exhibition is the result of the damage of many viscera, which can not be seen simply. For the cause and pathogenesis of the disease, Li Lao believes that the disease is closely related to the heart except that it has a great relationship with the liver and spleen and kidney. He thinks that the heart is the official of the monarch, the God is out, the gods belong to the gods. The heart is a fire hiding, the heart and the other viscera are like the light of the night sky, in the old people The main reason is that the heart Yang is insufficient, the warmth is not enough, or the heart's Yin blood is insufficient, the blood heat is steamed. The blood of the heart is controlled by the heart, and the blood can be seen, so the function of the heart is normal, the gods and the light have the basis. The rule of the prescription medication of Li Lao is summed up in addition to the traditional thought that the three organs of the liver, spleen and kidney are mainly with the liver and the spleen. In addition to the different understanding, he also proposed that the dry person with the spleen and the kidney to smooth the liver, warm heart Yang, nourish the heart and open the orifices, and the phlegm in order to nourish the blood, the Qing Xue Xie Yu is the main treatment method. In the fourth part of the clinical study, the main root according to Li Lao's etiology and pathogenesis of age-related macular degeneration is recognized. Understanding, combining the experience of three years with the teacher, summarizing the rule of drug use, discussing how to treat the age-related macular degeneration of wet sex. Through the visual acuity score, the retinal nerve epithelial layer thickness (RNL) score, the thickness score of the choroidal capillary complex (CBRC) and the TCM syndrome score, to evaluate the curative effect. Results (1) 30 cases in the treatment group were 35 eyes, Effective 7 eyes, effective 13 eyes, 15 eyes ineffective, total effective 57.14%, invalid 42.86%, 30 cases in the control group 30 eyes, 3 eyes, effective 10 eyes, no effective 17 eyes, total effective 51.43%, invalid 48.57%, two group comparison, P0.05, significant difference. The treatment group and the control group before and after treatment visual changes, treatment group eyesight improved bright Compared with the control group (P0.05), there was a significant difference in the thickness of RNL and CBRC in the treatment group (P0.05) before and after treatment (P0.05). There was no significant difference in the thickness of RNL (P0.05) before and after treatment in the control group, and there was a significant difference in the thickness of CBRC (P0.05). The thickness of CBRC was significantly different in the two groups after treatment (P0.05), and the treatment group was significantly better than the treatment group. There was a significant difference between the two groups before and after treatment (P0.05), and the treatment group was obviously superior to the control group. Through the above study, Professor Li Zongzhi briefly summarized the following three points: (1) the pathogenesis of the spleen and kidney is the deficiency of the spleen and kidney. Deficiency is the core, blood deficiency is the core, blood heat and heart Yang is the key point, pay attention to the importance of "heart fire" in the formation of disease, phlegm and blood stasis as its standard; (2) advocate the deficiency of Yin, advocate multiple viscera treatment, pay attention to the function mediation of "heart"; (3) this method of treatment of wet age related macular degeneration, can improve disease People's vision, delay the development of disease, improve the quality of life, safe and effective.

【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R249;R276.7

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本文編號：1799466