| World health organization(WHO)said that the mental illness would be oneof serious disease in 21 century. As one secondary depression, Post-strokedepression (PSD) have severely influenced on patients' life quality andfunctional recovery, even for life. PSD is an ever-present affective disorderafter stroke having characteristic manifestations of depressing emotion,activity decrease, and sluggish ideation, except for all idiosoma symptom. Atpresent, the antidepressants in western medicine have many defects includingslower effect,side-effect,expensive price and so on. By contrast, ChineseMedicine has evident advantages for PSD treatment and deferment. The TCMresearches of PSD symptom, pathogenesis and treatment have aroused commoninterest in many domestic and abroad academicians.This thesis concerns clinical cure of PSD with Chinese medicine, involvingin two parts: literature survey and clinical research.The survey part discussed progression of Chinese medicine and westernmedicine on etiology, pathogenesis and therapeutics of PSD, analyzed andconfirmed the curative effect on PSD of some western medicines; and some singleChinese herbs and complex prescriptions; summarized the characteristic andsuperiority of determination of treatment based on pathogenesis obtained throughsymptoms in Chinese medicine. Based on the systemic study of ancient papers andpresent articles about PSD, combining with the academic cognition and clinicalexperience of PSD on medication of my tutor professor TangQisheng, new viewpointwas put forward. Professor Tang thinks highly of body constitution in analysisof PSD etiopathogenisis and pathogenesis, upholds theory that deficiency ofzang-fu organs and insufficiency of both kidney and liver caused by stroke arebasic pathology of PSD. And then functional activity of Qi is not smooth and bodyfluid flow slowly, phlegm retention and blood stasis block the brain collateralsand the upper orifices, the marrow in the brain can not be nourished. The basicpathogenesis is insufficiency of kidney-Qi and deficiency of kidney-essence, theessential factors is qi stagnation and phlegm retention and blood stasis, andthe key factor is the stagnation of Qi. Since the single method of soothing livercan not get satisfied effect, the principle of PSD treatment should includesmoothing liver and invigorating the kidney, regulating vital energy andpromoting blood flow, improving depression and anchoring the mind.The clinical research was randomized, controlled clinical trial. Accordingto the diagnostic criteria, 121PSD outpatients and inpatients, from the DongfangHospital and the Dongzhimen Hospital affiliated to Beijing University of ChineseMedicine, the Hospital affiliated to Shandong University of Chinese Medicine,the First Hospital affiliated to Changchun University of Traditional ChineseMedicine, have been observed and been randomly divided into treatment and controlgroup at the ratio of 1:1. Sixty one cases in treatment groups were cured by YinaojieyuTang combining with Herba Leonuri; twenty eight cases in control groupswere cured by XiaoyaoSan combining with Herba Leonuri. We contrasted thequantification scores of symptoms in Chinese medicine and the scores of Hamiltondepression rating scale (HAMD),Social Disability Screening Schedule(SDSS)inorder to analyze the curative effect, thereby draw up a paradigmatic clinicalinvigorating the kidney and smoothing liver plan for PSD. Results:①Clinicaltreatment effect outcomes were assessed using HAMD(Hamilton depression ratingscale), 10 cases exhibited clinical remission (16.39％), 31 cases had greaterimprovements (50.82％), 8 cases had improvements (13.11％), 12 cases had no effect(19.67％) in treatment group. The total rate of effect is 80.33％; In control group5 cases exhibited clinical remission (8.33％), 17 cases had greater improvements(28.33％), 20 cases had improvements (33.33％), 18 cases had no effect (30％). Thetotal rate of effect is 70.00％. Treatment group is better than control group intotal effect rate (P＜0.05).②Curative effect were assessed using Chinesemedicine criteria, 11 cases exhibited clinical remission (18.03％), 31 cases hadgreater effects (50.82％), 10 cases had effects (16.39％), 9 case has no effect(14.75％) in treatment group. The total rate of effect is 85.25％; 6 cases exhibitedclinical remission (10.0％), 20 cases had greater effects (33.33％), 18 cases hadeffects (30.0％), 16 cases had no effect (26.67％) in control group. The total rateof effect is 73.33％. Treatment group is better than control group in total effectrate (P＜0.05).②With HAMD and SDSS, whether grouping or inter-grouping totalassessment, curative effect level before and after treatment have obviousimprovement, P＜0.01. By the way, after Treatment, the treatment group is betterthan control group in curative effect.④The clinical symptoms were improvedevidently in treatment group, especially for depressing emotion,fidget,fatigue,stagnancy,insomnia and so on. Statistics showed that sustaining therapy leadsto greater effect, P＜0.01. In control group, depressing emotion,pococurantism,lumbago,benumbed and insomnia symptoms were improved. No obvious improvementon other symptoms.⑤After one month and two month follow-up study on 40 patients,two groups have obvious difference on the quantification scores of symptoms inChinese medicine and the scores of HAMD,SDSS. Whole observation, there is nosevere bad reaction. To sum up in a word, YinaojieyuTang decoction obviouslyimproved the patients' clinical symptoms and is superior to XiaoyaoSan in clinicaleffect on treating PSD. This result validated further the predominance of therule of reinforcing kidney and regulating liver-Qi in treating PSD. |
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