本文選題：干眼 + 濁毒理論　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：第一部分中醫(yī)濁毒理論的探討從歷代文獻(xiàn)記載到現(xiàn)代醫(yī)家認(rèn)識,深入探討了濁毒產(chǎn)生的原因和致病特點。第二部分干眼的濁毒病機(jī)導(dǎo)師白世淼教授將濁毒理論應(yīng)用于干眼,闡述了臟腑功能失調(diào)導(dǎo)致濁毒內(nèi)生,與外感濁毒共同形成了干眼的病機(jī)。第三部分化濁解毒潤目法治療干眼的臨床研究目的:隨著現(xiàn)代社會的發(fā)展,人們生活方式與環(huán)境的變化,干眼(Dry Eye,DE)的患病率逐年增加。干眼嚴(yán)重影響著人們的工作與生活。濁毒理論是近年來對傳統(tǒng)中醫(yī)基礎(chǔ)理論的創(chuàng)新。該理論為現(xiàn)今很多疑難病的治療提供了新的指導(dǎo)思想。本研究旨在將濁毒理論應(yīng)用于眼科的干眼,以化濁、解毒、潤目為大法,綜合治療由濁毒引起的本病。通過觀察60例干眼患者的臨床療效,進(jìn)一步探討干眼的發(fā)病機(jī)制與治療方法。方法:嚴(yán)格按照由濁毒引起的干眼的診斷標(biāo)準(zhǔn)、納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),篩選、收集了2015年3月至2016年12月來河北省中醫(yī)院眼科就診的干眼患者60例,并將其隨機(jī)分為治療組30例和對照組30例。治療組男11例,女19例,年齡在20-80歲;對照組男13例,女17例,年齡在21-75歲。經(jīng)統(tǒng)計學(xué)分析,兩組在年齡、性別方面差異無顯著意義(P0.05),具有可比性。治療組采用自擬化濁解毒潤目湯口服(藥物組成:金銀花、黃芩、黃柏、陳皮、蒼術(shù)、薏苡仁、知母、麥冬、玄參、生地黃、牡丹皮、當(dāng)歸、防風(fēng)、蟬蛻、菊花、決明子、桔梗),針刺(取穴:攢竹、太陽、承泣、風(fēng)池、翳明、百會、中脘、天樞、太沖、氣海、三陰交、足三里、豐隆、陰陵泉),中藥熱奄包敷眼(藥物組成:黃柏、決明子、苦參、菊花、蒲公英、千里光)、人工淚液(玻璃酸鈉滴眼液)和非甾體類抗炎藥(普拉洛芬滴眼液)點眼;對照組給予人工淚液(玻璃酸鈉滴眼液)和非甾體類抗炎藥(普拉洛芬滴眼液)點眼。治療以15天為一療程,共2個療程。觀察并記錄兩組治療前后臨床癥狀積分、淚液分泌量(Schirmer I test,sit)、淚膜破裂時間(breakuptimeoftearfilm,but)、角膜熒光素鈉染色(cornealfluoresceinstaining,flt)積分的情況變化。結(jié)果:1治療前對兩組的臨床癥狀積分、sit、but、flt積分進(jìn)行比較,經(jīng)統(tǒng)計學(xué)分析,差異無統(tǒng)計學(xué)意義(p0.05),說明兩組之間的臨床癥狀積分、sit、but、flt積分具有可比性。2兩組治療前后臨床癥狀積分變化情況比較。對兩組各自治療前后積分進(jìn)行比較,差異有統(tǒng)計學(xué)意義(p0.05),說明兩組治療后臨床癥狀均好轉(zhuǎn)。對兩組治療后積分進(jìn)行比較,差異有統(tǒng)計學(xué)意義(p0.01),說明治療組療效明顯優(yōu)于對照組。3兩組治療前后sit、but、flt積分變化情況的比較。對兩組各自治療前后sit、but、flt積分進(jìn)行比較,差異均有統(tǒng)計學(xué)意義(p0.05),說明兩組治療前后的這三項指標(biāo)均有改善。對兩組治療后sit、but、flt積分進(jìn)行比較,差異均有統(tǒng)計學(xué)意義(p0.01),說明治療組療效明顯優(yōu)于對照組。4治療組顯效10例,有效18例,無效2例,總有效率93.33%;對照組顯效0例,有效23例,無效7例,總有效率76.67%。對兩組的有效率進(jìn)行比較,差異有統(tǒng)計學(xué)意義(p0.01),說明治療組以化濁、解毒、潤目為大法的綜合治療療效明顯優(yōu)于對照組。5本次研究發(fā)現(xiàn)濁毒引起的干眼患者在40-59歲最多,占43.33%。結(jié)論:1從濁毒理論出發(fā)提出現(xiàn)代社會干眼的中醫(yī)病機(jī)與治法,具有新的指導(dǎo)意義。2濁毒導(dǎo)致干眼的病機(jī)為:脾胃、肝、肺、腎功能失調(diào),濁毒內(nèi)生,與外感濁毒相合,蓄積體內(nèi),引起氣血凝滯,津液虧損,氣血津液在人體內(nèi)的輸布失常,目失潤養(yǎng)而致干眼。治法:以化濁、解毒、潤目為大法,采用自擬化濁解毒潤目方、針刺和中藥熱奄包,內(nèi)外兼治由濁毒引起的干眼。3基于濁毒理論指導(dǎo)的干眼的臨床研究顯示可以明顯改善干眼患者的臨床癥狀積分、增加sit、but、減少flt積分,療效顯著。4在治療期間,患者未發(fā)現(xiàn)與治療藥物及方法相關(guān)的不良反應(yīng)。說明本治療安全。
[Abstract]:The first part of the study of the theory of turbid poison in traditional Chinese medicine is recorded from the literature of the past dynasties to the understanding of modern doctors, and the causes and pathogeny characteristics of the turbid poison are discussed in depth. In the second part, Professor Bai Shimiao, the tutor of the Turbid Toxin machine in the dry eye, applied the theory of turbid poison to the dry eye. The clinical study of ophthalmic disease. Third part of the clinical study of treating dry eyes with the method of removing turbidity and detoxification and moistening the eye: with the development of modern society and the changes in people's life style and environment, the prevalence of dry eyes (Dry Eye, DE) has increased year by year. Dry eye seriously affects people's work and life. The theory of turbid toxicology is a new innovation in the basic theory of traditional Chinese medicine in recent years. The theory provides a new guiding ideology for the treatment of many difficult diseases in the present day. This study aims to apply turbid theory to dry eye in Ophthalmology, to treat turbid, detoxified, and moisten the eyes as a big method, and to treat the disease caused by turbid poison. By observing the clinical effect of 60 cases of dry eye, the pathogenesis and treatment of dry eyes are discussed step by step. Methods: strict According to the criteria for the diagnosis of dry eye caused by Turbid Toxin, 60 cases of dry eyes were collected from March 2015 to December 2016 in the ophthalmology department of Hebei traditional Chinese medicine hospital. They were randomly divided into 30 cases in the treatment group and 30 cases in the control group. The treatment group was 11 men, 19 women and 20-80 years old; 13 men in the control group and 17 women in the control group. The age was 21-75 years old. The statistical analysis showed that the two groups had no significant difference in age and sex (P0.05). The treatment group was taken orally by self-made turbid detoxification and moistening eye soup (medicinal composition: honeysuckle, Scutellaria, cypress, citrus, coix seed, Ophiopogon, Radix Ophiopogonis, Radix scaranae, radix rehmanniae, peony skin, Radix Angelicae, cicada, chrysanthemum, cassia seed. Acupuncture point: acupuncture (acupoint: acupoint: save bamboo, sun, sob, Yiming, Baihui, Zhong Wan, Tianshu, Taichi, Qi Hai, Sanyinjiao, Zusanli, Feng long, Yin Mausoleum), Chinese medicine hot pack eye (medicine composition: cypress, cassia seed, Sophora flavescens, chrysanthemum, dandelion, thousand li light), artificial tears (Sodium Hyaluronate Eye Drops) and non steroidal anti-inflammatory drugs (Pranoprofen Eye Drops) The control group was given eyes of artificial tears (Sodium Hyaluronate Eye Drops) and non steroidal anti-inflammatory drugs (Pranoprofen Eye Drops). The treatment was treated with 15 days as a course of treatment, with a total of 2 courses. The scores of clinical symptoms, Schirmer I test, sit, tear film rupture time (breakuptimeoftearfilm, but), corneal fluorescence, and corneal fluorescence were observed and recorded before and after treatment. The change of cornealfluoresceinstaining, FLT score. Results: 1 before treatment, the clinical symptom score of the two groups, sit, but, FLT integral were compared, the difference was not statistically significant (P0.05), indicating the score of the clinical symptoms between the two groups, sit, but, and FLT integral with the clinical symptoms before and after the treatment of group.2 two. The scores of the two groups were compared before and after the treatment of the two groups, the difference was statistically significant (P0.05), indicating that the clinical symptoms of the two groups were all better after treatment. The difference between the two groups after treatment was statistically significant (P0.01), indicating that the curative effect of the treatment group was better than the sit, but, FLT integral before and after the treatment of the control group.3. Comparing the sit, but, FLT scores of the two groups before and after treatment, the difference was statistically significant (P0.05), indicating that the three indexes of the two groups were improved before and after treatment. The difference of sit, but and FLT scores after the treatment of the two groups were statistically significant (P0.01), indicating that the curative effect of the treatment group was obviously better than the control group.4 treatment. The group showed 10 cases, 18 cases were effective, 2 cases were invalid, the total effective rate was 93.33%, 0 cases in the control group, 23 effective and 7 ineffective, the total effective rate 76.67%. was compared with the efficiency of two groups, the difference was statistically significant (P0.01), indicating that the treatment group with turbidity, detoxification, and moistening the eye as the big method was obviously superior to the control group.5. The dry eye patients were at the age of 40-59, which accounted for 43.33%. conclusion. 1 from the theory of Turbid Toxin, the TCM pathogenesis and treatment of modern social dry eyes were put forward, and the pathogenesis of dry eyes was new guiding significance: spleen and stomach, liver, lung, kidney function disorder, turbid and poisonous endogeny, combined with turbidity and turbidity, accumulation in the body, causing Qi and blood stagnation and loss of body fluid, Qi and blood body fluid in the body of the distribution of disorder, eyes lost and dry eyes. Treatment: with turbidity, detoxification, moistening the eyes as the big law, the use of self-made turbid and detoxification of the eye prescription, acupuncture and Chinese medicine hot dying bag, internal and external treatment of cloudy toxin induced dry eye.3 based on the theory of turbid toxicity theory of dry eyes can obviously improve the clinical symptoms of dry eye patients. Integral, increase sit, but, reduce FLT integral, the curative effect is significant.4 during the treatment, the patient has not found the adverse reactions related to the treatment of drugs and methods.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R276.7

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