从厥阴病寒热错杂证论治稽延性戒断症状  

Treating for Protracted Withdrawal Symptoms from Perspective of Cold-heat Syndrome of Jueyin Disease

作　　者：李巨奇[1] 方亚明[2] 白宇乾 张横柳[4] 万晓刚[4] 沈创鹏[4] 方志辉[4] 徐广伟 杨烤纯 崔韶阳 LI Juqi;FANG Yaming;BAI Yuqian;ZHANG Hengliu;WAN Xiaogang;SHEN Chuanpeng;FANG Zhihui;XU Guanwei;YANG Kaoehun;GUI Shaoyang(Luohu Hospital Affiliated to Shenzhen university/The fifth Hospital of Shenzhen City,Shenzhen Guangdong China 518001;Kangning Hospital of Shenzhen City,Shenzhen Guangdong China 518020;Shenzhen Occupational Disease Prevention and Treatment Institute,Shenzhen Guangdong China 518001;The First Affiliated Hospital to Guangzhou University of Chinese Medicine,Shenzhen Guangdong China 510005;Luohu Detention Center of Shenzhen,Shenzhen Guangdong China 518022;Shenzhen Hospital Affiliated to Guangzhou University of Chinese Medicine/Futian TCM Hospital,Guangdong Shenzhen China 518033)

机构地区：[1]深圳大学附属罗湖医院/深圳市第五人民医院,广东深圳518001 [2]深圳市康宁医院,广东深圳518020 [3]深圳市职业病防治院,广东深圳518001 [4]广州中医药大学第一附属医院,广东深圳510005 [5]深圳市罗湖看守所,广东深圳518022 [6]广州中医药大学深圳医院/福田中医院,广东深圳518033

出　　处：《中医学报》2018年第12期2427-2431,共5页Acta Chinese Medicine

基　　金：2012年广东省中医药局资助项目(20121042)

摘　　要：目的:从伤寒六经厥阴病寒热错杂证论治思路出发,探讨稽延性戒断症状的六经病机特点、证候特征及临床疗效。方法:将稽延性戒断症状(protracted withdrawal syndromes,PWS)患者随机分为两组,治疗组给予乌梅戒断颗粒,对照组给予盐酸曲唑酮片。采用稽延性戒断症状评定量表(protracted withdrawal syndromes assessing table,PWST)、Hamilton焦虑量表(Hamilton anxiety scale,HAMA)、Hamilton抑郁量表(Hamilton Depression Scale,HAMD)、匹兹堡睡眠质量指数(ppittsburgh sleep quality Index,PSQI)、不良反应症状量表(treatment emergent symptom scale,TESS)、中医证候疗效评价指标(TCM syndrome efficacy index,TCMI)及治疗前后神经递质5-羟色胺(5-hydroxytryptamine,5-HT)、多巴胺(dopamine,DA),神经-免疫介质β内啡肽(β-endorphins,β-EP)、促肾上腺皮质激素(adrenocorticotropic hormone,ACTH),性激素雌二醇(estradiol,E2)、睾酮(testosterone,T)监测,评价乌梅戒断颗粒治疗PWS的临床疗效和不良反应。结果:从厥阴病寒热错杂证论治PWS,对不寐、周身烦疼、恶寒厥逆、大便结利交替症状改善程度明显优于对照组,对烦躁症状改善疗效与盐酸曲唑酮相当,对抑郁症状改善较差;对神经递质(DA)、神经-免疫介质(β-EP、ACTH)的动态平衡均有较好调节作用。结论:从厥阴病寒热错杂证思路论治,运用乌梅丸加减治疗PWS,在稳定患者神经-内分泌-免疫系统内环境、调节正负反馈失衡方面具有良好优势。Objective: To explore the pathogenesis characteristics of typhoid Liujing disease,syndrome characteristics and clinical efficacy the typhoid Liujing Jueyin disease with Cold-heat syndrome treatment from perspective of Heat-cold syndrome of typhoid fever. Methods: PWS cases were enrolled and randomly divided into groups. By using the protracted withdrawal syndromes assessment table( PWST),the Hamilton anxiety scale( HAMA),and the Hamilton Depression Scale( HAMD),Pittsburgh sleep quality index( PSQI),adverse reaction symptom scale( TESS),TCM syndrome efficacy index( TCMI) and neurotransmitter serotonin before and after treatment( 5-Hydroxytryptamine,5-HT),dopamine( DA),neuro-immune mediators beta-endorphins( β-EP),adrenocorticotropic hormone( ACTH),sex hormone estradiol( estradiol,E2),testosterone( T),neuro-immune medium( β-EP,ACTH),sex hormone( E2,T) monitoring,the clinical efficacy and adverse reactions of Wumei Pills in the treatment of PWS were evaluated. Results: From the treatment of PWS from phlegm and blood stasis syndrome,the improvement of the symptoms of convulsions and dysentery was better than that of the trazodone group. Quite,the improvement of depressive symptoms is poor; the dynamic balance of neurotransmitters( DA) and neuro-immune mediators( β-EP,ACTH) is well regulated. Conclusion: Treatment of PWS from perspective of Heat-cold syndrome,the clinical efficacy of Wumei Pill was significantly better in improving the symptoms of insomnia,body pain,feeling cold greatly,alternation of constipation and diarrhea than that of Trazodone. The improvement effect on irritability is similar to that of Trazodone,and the improvement of depressive symptoms is poor. The dynamic balance of neurotransmitter( DA) and neuro-immune medium( β-EP,ACTH) is well regulated. Conclusion:,Wumei Pills in treatment of longterm disease PWS from perspective of Heat-cold syndrome of typhoid fever is significantly effective in stabilizing the patient’s neuro-endocrine-immune system environment and regulating the positive and

关 键 词：稽延性戒断症状 阿片药物依赖 厥阴病 寒热错杂证 中医药疗法 

分 类 号：R259.496[医药卫生—中西医结合]