帕金森病病证结合辨证规律研究
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摘要
目的：提取颤证与帕金森病的证候要素,厘清二者之异同；规范帕金森病辨证模式,揭示其辨证规律；探讨帕金森病证候演变规律,深化其病机理论。
方法：系统整理颤证的历代相关文献,研究其基本理论内容；收集帕金森病现代临床文献资料,按照“证候要素,应证组合”的思路,运用数据挖掘的方法,提取帕金森病证候要素及其相关内容,确定帕金森病中医证候诊断标准；本着“据病言证,病证结合”的理念,参考颤证研究结果,融汇西医病理,以深入探讨帕金森病病机。
结果：提取颤证的证候要素有：气虚、阴虚、内热及血虚,主要涉及脏腑为肝、脾；提取帕金森病的证候要素有：阴虚、内风、血瘀、气虚、痰和血虚,主要涉及脏腑为肝、肾。颤证和帕金森病均提取出了气虚、血虚、阴虚这3个证候要素,二者病机均以“本虚”为主,发病均与“肝”相关；但颤证和帕金森病在证候学上存在一定的差异：颤证以肝之阴血亏虚为基本病机,脾气虚为常见病机；帕金森病以肾中精气亏虚为基本病机,肝风内动为常见病机。帕金森病提取出的6个证候要素之间有机组合,共得到34种应证组合形式,所组成的证候类型的诊断即为帕金森病中医证候诊断标准。将证候要素提取结果、相关病机文献、西医病理结合起来,深入探讨帕金森病病机为：肾精亏虚为本,肝风内动为标,因虚而致瘀,并提出帕金森病病机新假说——以肾为中心、督脉为枢机的肝-肾-脑轴功能失调。
结论：颤证和帕金森病的基本症状大致相同,但在证候分型和证候要素以及病位等方面均有所不同。将病证结合应用于帕金森病辨证规律研究之中,使其证候演变规律更加易于把握,达到规范辨证体系,完善其中医证候诊断标准之目的。结合颤证,并以西医病理为佐证,确定肾虚为帕金森病基本病机。
Objective:To extract the pivotal syndrome factors of Parkinson disease(PD) and tremor while telling the difference between them; to standardize the syndrome differentiation of PD and explore the rules of syndrome differentiation; to deepen the pathogenesis of PD by exploring the developing rules of it's syndromes.
Method:The basic theory was studied by arranging the related ancient literatures systematically. After collecting modern clinical documents, the pivotal syndrome factors were extracted and the diagnostic criteria for PD were established using data mining. Referring to the research conclusion of tremor and integrating the modern pathology, the pathogenesis of PD was explored following the principle of discussing the syndrome according to the disease and combining the syndrome and the disease.
Result:The pivotal syndrome factors of tremor were qi deficiency, yin deficiency, internal heat and blood deficiency and the mainly involved organs were liver and spleen. The pivotal syndrome factors of PD were yin deficiency,internal wind, blood stasis, qi deficiency, phlegm and blood deficiency and the mainly involved organs were liver and kidney. They shared the common factors of qi deficiency, blood deficiency and yin deficiency. They were both characterized by deficiency of root aspect and related to liver. The difference was that tremor was deficiency of liver-yin and liver-blood as the basic pathogenesis, deficiency of splenic-qi as the common pathogenesis; PD was deficiency of kidney essence and disturbance of liver-wind. The six pivotal syndrome factors extracted from PD had obtained 34 types of combination and the diagnostic criteria of the syndromes composed of the combinations were the diagnostic criteria of PD. The pathogenesis of PD is characterized by kidney deficiency as the root aspect and liver wind as the branch aspect and blood stasis due to deficiency. To put forward a new the pathogenesis hypothesis of PD-the axle's function of Liver-Kidney-Brain is losing balance,which center is kidney and which pivot is the du meridian.
Conclusion:PD and tremor shared the similar sympotoms but differed in basic syndromes, pivotal syndrome factors and location. The method of combining the syndrome and the disease could be applied to the research of the syndrome differentiation rules of PD in order to standardize the syndrome differentiation system as well as enhance the uniformity of syndrome diagnosis.Referred to tremor and proved by western pathology, kidney deficiency was confirmed to be the basic pathogenesis of PD.
方法：系统整理颤证的历代相关文献,研究其基本理论内容；收集帕金森病现代临床文献资料,按照“证候要素,应证组合”的思路,运用数据挖掘的方法,提取帕金森病证候要素及其相关内容,确定帕金森病中医证候诊断标准；本着“据病言证,病证结合”的理念,参考颤证研究结果,融汇西医病理,以深入探讨帕金森病病机。
结果：提取颤证的证候要素有：气虚、阴虚、内热及血虚,主要涉及脏腑为肝、脾；提取帕金森病的证候要素有：阴虚、内风、血瘀、气虚、痰和血虚,主要涉及脏腑为肝、肾。颤证和帕金森病均提取出了气虚、血虚、阴虚这3个证候要素,二者病机均以“本虚”为主,发病均与“肝”相关；但颤证和帕金森病在证候学上存在一定的差异：颤证以肝之阴血亏虚为基本病机,脾气虚为常见病机；帕金森病以肾中精气亏虚为基本病机,肝风内动为常见病机。帕金森病提取出的6个证候要素之间有机组合,共得到34种应证组合形式,所组成的证候类型的诊断即为帕金森病中医证候诊断标准。将证候要素提取结果、相关病机文献、西医病理结合起来,深入探讨帕金森病病机为：肾精亏虚为本,肝风内动为标,因虚而致瘀,并提出帕金森病病机新假说——以肾为中心、督脉为枢机的肝-肾-脑轴功能失调。
结论：颤证和帕金森病的基本症状大致相同,但在证候分型和证候要素以及病位等方面均有所不同。将病证结合应用于帕金森病辨证规律研究之中,使其证候演变规律更加易于把握,达到规范辨证体系,完善其中医证候诊断标准之目的。结合颤证,并以西医病理为佐证,确定肾虚为帕金森病基本病机。
Objective:To extract the pivotal syndrome factors of Parkinson disease(PD) and tremor while telling the difference between them; to standardize the syndrome differentiation of PD and explore the rules of syndrome differentiation; to deepen the pathogenesis of PD by exploring the developing rules of it's syndromes.
Method:The basic theory was studied by arranging the related ancient literatures systematically. After collecting modern clinical documents, the pivotal syndrome factors were extracted and the diagnostic criteria for PD were established using data mining. Referring to the research conclusion of tremor and integrating the modern pathology, the pathogenesis of PD was explored following the principle of discussing the syndrome according to the disease and combining the syndrome and the disease.
Result:The pivotal syndrome factors of tremor were qi deficiency, yin deficiency, internal heat and blood deficiency and the mainly involved organs were liver and spleen. The pivotal syndrome factors of PD were yin deficiency,internal wind, blood stasis, qi deficiency, phlegm and blood deficiency and the mainly involved organs were liver and kidney. They shared the common factors of qi deficiency, blood deficiency and yin deficiency. They were both characterized by deficiency of root aspect and related to liver. The difference was that tremor was deficiency of liver-yin and liver-blood as the basic pathogenesis, deficiency of splenic-qi as the common pathogenesis; PD was deficiency of kidney essence and disturbance of liver-wind. The six pivotal syndrome factors extracted from PD had obtained 34 types of combination and the diagnostic criteria of the syndromes composed of the combinations were the diagnostic criteria of PD. The pathogenesis of PD is characterized by kidney deficiency as the root aspect and liver wind as the branch aspect and blood stasis due to deficiency. To put forward a new the pathogenesis hypothesis of PD-the axle's function of Liver-Kidney-Brain is losing balance,which center is kidney and which pivot is the du meridian.
Conclusion:PD and tremor shared the similar sympotoms but differed in basic syndromes, pivotal syndrome factors and location. The method of combining the syndrome and the disease could be applied to the research of the syndrome differentiation rules of PD in order to standardize the syndrome differentiation system as well as enhance the uniformity of syndrome diagnosis.Referred to tremor and proved by western pathology, kidney deficiency was confirmed to be the basic pathogenesis of PD.
引文
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[3]尤昭玲,李卫红,王若光,等.以“证候要素应证组合”构建功能失调性子宫出血的辨证体系新模式[J].湖南中医杂志,2008;24(3)：2.
[4]隆呈祥.中医老年颤证诊断和疗效评定标准(试行)[J].北京中医学院学报,1992：15(4)：39-40.
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[6]灵枢经[M].北京：人民卫生出版社,1993：67.
[7]汉·张仲景.伤寒论[M].上海：上海科学技术出版社,1986：56,61.
[8]汉·张仲景.金匮要略[M].上海：上海科学技术出版社,2000：223.
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