摘要
方显明教授是全国名老中医药专家学术经验继承工作指导老师,从事中医的教学、临床和科研工作三十多年,积累了丰富的临床经验,擅长治疗心系疾病、脾胃病,对时行病、疑难病等疾病的诊治也有独到见解和较高造诣,形成了其独特的学术思想。本课题归纳、总结方显明教授辨证论治冠心病的学术思想及临证经验。
冠心病(coronary heart disease, CHD),亦称缺血性心脏病,是冠状动脉粥样硬化性心脏病和冠状动脉痉挛的统称,是世界上最常见的死亡原因之一。如何防治和减少冠心病的发病率和病死率始终是心血管病研究领域的重点和热点之一。该病属于中医学“胸痹”范畴。本论文拟从以下几方面对方显明教授中医诊疗冠心病的研究进行了详细论述：
1.详细论述中医学对该病的病因、病机、诊治以及近年来的临床及实验研究进展等。
2.对方显明教授对于冠心病的病因、病机、诊断及治疗等经验方面进行了总结。
3.对方显明教授治疗冠心病经验进行临床研究。
目的：通过观察调脂颗粒对肝郁脾虚型冠心病易损斑块的治疗效果,并探讨易损斑块对冠心病的关系。
方法：通过观察氧化型低密度脂蛋白、血小板参数、纤维蛋白原、超敏C-反应蛋(hs-CRP)、颈动脉斑块厚度等常见理化指标在治疗前后的变化,了解易损斑块在冠心病心绞痛发病中的作用。
结果：1. LDL-C、Fg、CRP、IMT和冠心病心绞痛的发作有较强相关性。2.两组在LDL-C、Fg、CRP、IMT自身治疗前后比较有显著差异(P<0.05)。2.两组在治疗后LDL-C比较有显著差异(P<0.05),Fg、CRP、IMT在治疗后组间比较没有显著差异(P>0.05)。3.血小板参数两组在治疗前后比较没有显著差异(P>0.05),治疗后组间比较也没有显著差异性(P>0.05)。
结论：氧化型低密度脂蛋白、纤维蛋白原、超敏C-反应(hs-CRP)、颈动脉斑块厚度能较可以作为预测冠心病心绞痛严重程度的参考指标。调脂颗粒在治疗肝郁脾虚性冠心病时疗效确切,能有效地改善患者临床症状和患者的理化指标,预防冠心病。
Fang Xianming, one of National Instructors of Aceademic Experi-ence Inherit of Old Chinese Medieine ExPerts, has engaged in teaching, elinic and research work of "Chinese Medieine Physicians" more than30years and accumulated rich clinical experiences. He is expert intreating cardiovascular and digestive diseases, and has unique opinions in diagnosing and treating of seasonal and stubborn diseases as well, forming his own academic style. The Project sums up the academie thoughts and clinieal experiences of Professor Fang Xianming treating Coronary heart disease based in pathogennesis obtained through differentiation of symptoms and signs by collecting and analyzing his clinical cases and reading and sorting out the dissertations and works relatively.
Coronary Heart Disease(CHD) is a corramon cardiovaseular disease. The disease occurs following coronary atheroselerosis which causes lumen of blood vessel narrow, followed by such clinical symptoms as insuffieieney of blood supply from coronary artery, aeute myoeardial infaretion, transient isehemia, and anoxia. The disease belongs to the thoracic obstruetion in traditional Chinese medieine. This dissertation addresses some aspects indetails about coronary artery disease treated with Chinese medicine.
1. To discuss the etiology,pathogennesis, dialectical grouping, and treatment method of Coronary Heart Disease.
2. To sums up the academie thoughts and clinieal experiences of Professor Fang Xianming of the etiology, pathogennesis, dialectical grouping, and treatment method of Coronary Heart Disease.
3.Clinical symptom research
Objective:
To approach the relationship between Coronary Heart Disease and Vulnerable plaque of action of treating Coronary Heart Disease of Spleen deficiency due to stagnation of liver qi by observing therapeutic efficacy of Tiaozhi Granule.
Method:
Selection of patients based on proposed criterions. In the researeh,50Patients of Coronary Heart Disease are aceidenially chosen. Those are divided into2groups:Tiaozhi Granule and control one. Each consists of25patients. Clinieal symptom studies are implemented in inspecting:cardiogrma, the level of clinical symptom improvement, high-sensitive C-reactive Protein(hs-CRP), Fibrinogen (Fg), carotid intima-mediathiekness (IMT), platelet parameters and Oxidized low density lipoprotein before and after treatment. To study on relationship between change of LDL-C、Fg、CRP、IMT and Vulnerable plaque of coronary heart disease.
Result:
1. LDL-C、Fg、CRP、IMT may beassociated with CHD.2. Tiaozhi Granule group and control group have obvious difference of LDL-C、Fg、CRP、IMT before and after treatment, after treatment all were signifieantly lower, difference was statistieally signifieant (P<0.05).3.Two groups have obvious difference of LDL-C after treatment, Tiaozhi Granule group were signifieantly lower, difference was statistieally signifieant (P<0.05). Two groups have no obvious difference of Fg、CRP and IMT after treatment, difference was no statistieally signifieant (P>0.05).3. Two groups have no obvious difference of platelet parameters before and after treatment, and have no obvious difference after treatment (P>0.05).
Conclusion:
LDL-C、Fg、CRP、IMT may beassociated with CHD. There was obviously correlationin the level of seveirty of coronary artery disease. Using Tiaozhi Granule for Angina Pectoris treatment clearly helps improvement of clinieal symPtoms, speeds up Physicochemical index, forecasts relpase of nagina peetoris.
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