中医辨证论治阿尔茨海默病研究进展  

Research Progress of the Treatment of Alzheimer′s Disease Based on Syndrome Differentiation of Chinese Medicine

作　　者：李一平[1] 谢宁[1] 王素[1] LI Yiping;XIE Ning;WANG Su(Heilongjiang University of Chinese Medicine,Harbin Heilongjiang China 150040)

机构地区：[1]黑龙江中医药大学,黑龙江哈尔滨150040

出　　处：《中医学报》2020年第3期559-563,共5页Acta Chinese Medicine

基　　金：国家自然科学基金项目(81573863,81774197)。

摘　　要：根据阿尔茨海默病(alzheimer disease,AD)的病因病机,可将此病辨证分为4型:髓海不足证、脾肾两虚证、痰浊蒙窍证、瘀血内阻证。中医辨证论治AD多以肾为本,髓海不足可补肾益髓,填精养神,选用补肾阳之淫羊藿、补骨脂、巴戟天、肉苁蓉、杜仲等加上益肾阴之女贞子、枸杞子等阴阳并补,添精益髓;脾肾两虚当补肾健脾,益气生精,用药需先后天并重,加入补气药人参、黄芪、白术等;痰浊蒙窍证治当豁痰开窍,健脾化浊,可加半夏、石菖蒲、茯苓、薏苡仁等;瘀血内阻证采用活血化瘀、开窍醒脑的治疗原则,可加入补血活血之熟地黄、当归、川芎、丹参、何首乌等。此外,针灸可不同程度地改善AD模型的行为学变化和认知记忆能力。目前中医治疗AD的研究仍然存在许多问题:①有关AD的医学研究疗效判定标准尚未统一,量表打分主观性较大;②病例观察样本量小,病例来源范围狭窄,一些临床观察未设置对照组,观察结果缺乏客观证据;③中医药治疗早期认知障碍的文献报道较少,研究不足。中医强调"三因制宜",由于患者遣方用药不同,需尽早建立科学统一的中医药相关研究标准;同时,适当延长观察周期,扩大样本量,设置空白组、对照组,采用更加严谨的统计学方法;将"见肝之病,知肝传脾"的中医治未病思想应用于临床,多收集并分析一些早期认知障碍方面的临床病例。According to the etiology and pathogenesis of alzheimer′s disease(AD),the syndrome differentiation can be divided into four types:syndrome of marrow sea insufficiency,syndrome of spleen and kidney deficiency,syndrome of orifices confused by phlegm,syndrome of internal blockade of static blood.The treatment of AD based on syndrome differentiation of Chinese medicine is mainly based on the kidney.Marrow sea insufficiency can be nourishd by invigorating kidney and marrow,tonifying the essence and nourishing the spirit.Yinyanghuo(Longspur epimedium),Buguzhi(Fructus Psoraleae),Bajitian(Morinda officinalis),Roucongrong(Herba Cistanches)and Duzhong(Eucommia ulmoides),etc.which can nourish the kidney yang,together with NYUzhenzi(Ligustrum lucidum)and Gouqizi(Lycium barbarum)which can nourish the kidney yin can be chosen to nourish the yin and yang,and tonifying the essence and marrow.The deficiency of spleen and kidney is to nourish kidney and strengthen spleen,nourishing qi and essence.When using the meidicine,pay attention to both strengthen spleen and nourish kidney,and add tonifying qi medicine,such as Renshen(ginseng),Huangqi(astragalus)and Baizhu(atractylodes).The syndrome of orifices confused by phlegm should be treated by clearing phlegm and opening orifices,strengthening the spleen and transforming turbid,and Banxia(Pinellia ternate),Shichangpu(Acorus tatarinowii),Fuling(Poria cocos)and Yiyiren(coix seed),etc.can be added.The principle of promoting blood circulation to remove blood stasis and resuscitate the brain can be applied to the syndrome of internal blockade of static blood,and Shudihuang(Prepared rehmannia),Danggui(angelica),Chuanqiong(Rhizoma Ligustici Chuanxiong),Danshen(Salvia miltiorrhiza),Heshouwu(Polygonum multiflorum),etc.can be added.In addition,acupuncture can improve the behavioral changes and cognitive memory ability of AD model.At present,there are still many problems in the research of Chinese medicine in the treatment of AD:①There is no unified standard for judging the curative effect o

关 键 词：阿尔茨海默病 辨证论治 髓海不足证 脾肾两虚证 痰浊蒙窍证 瘀血内阻证 

分 类 号：R277.7[医药卫生—中医学]