| Vascular dementia(VaD),occurring on the basis of cerebrovascular disease,is an acquired durative mental impairment disease characterized by functional impairment of memory and cognition,or accompanied by disorder of language,vision to space,emotion and personality.The incidence of VaD is only second to Alzheimer's Disease(AD) among the old dementia-stricken people,more and more becoming common disease and frequently-occurring disease of influencing middle-aged and aged people's health and quality of life.And with the development of Chinese aged population,it will bring heavy burden to society and family.For the treatment of VaD,there is not effective methods and medicine now.It is significant for adopting Chinese medicine to treat VaD.This study combined the collateral disease theory with my tutor's clinical experiences,the pathogenesis of modern medical knowledge and the TCM literature research in recent years about VaD.My tutor professor zhouwenquan put forward that the basic pathogenesis of early mild vascular dementia was result from kidney deficiency in the root, and the blockage of collaterals by blood stasis or phlegm on the basis of the TCM theory of syndrome differentiation.Objective:First, to observe the efficacy and security of Chinese Herb composition in treating the VaD through scientific clinical trial. Second, through analysing the influence of Chinese Herb composition on the activity of the central cholinergic system and modern pharmacological study to explore the probable mechanism.Method:Completely randomized controlled block trial was used.81 cases of VaD patients were divided into treatment group and control group with the ratio of 2:1 design. Then the treatment group was devided into deficiency of kidney and blood stasis syndrome, deficiency of kidney and phlegm obstruction in collaterals on the basis of TDS,which were then given Bushen and huoxue Granule,Bushen and huatan Granule. The control group was given aniracetam capsules. From the variation of clinical symptoms, simple Intelligence Scale, Clinical Dementia Scale, Daily life ability Scale,central cholinergic system of two group before and after treatment,to analyze clinical efficacy of Mild VaD patients,and to prove the feasibility of the collateral disease theory in guiding the treatment of Mild VaD patients.Result: The result showed that after treatment, the three groups could increase the scores of MMSE and ADL of early Mild VaD patients (P<0.01); as for the scores of NFDS, the effect of the therapentic group was superior to the control group. At the same time, the TCM treatment group had good effect in treating the symptoms, having a very prominent meaning to contrast before and after treating(P<0.01).The TCM syndrome scores was improved in TCM treatment group as compared with that in control group (P<0.01), except the facial expression. As to the impact on the central cholinergic system,the three groups also can stimulate the production of ACh?ChAT and inhibit the activity of AchE.The treatment group and the control group showed a similar efficacy in improving the function of ACh.For Ach,the comparison of the curative effect in the treatment group was better than the control group (P<0.05). After being observed, theTCM treatment groups had no adverse events.Conclusion:1 Aniracetam capsules does not show more effectiveness in treating VaD than Chinese Herb composition in my recearch. In improving the TCM syndrome and injusting the function of the central cholinergic system, Chinese Herb composition has more effective than aniracetam capsules.2 Kidney deficiency in the root, and the blockage of collaterals by blood stasis or phlegm is the basic pathogenesis of early mild vascular dementia.3 It is feasible to treat the VaD according to the collateral disease theory.4 Adjusting the central cholinergic system is the probable mechanism that the Chinese Herb composition works. |
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