發(fā)布時(shí)間：2018-05-21 17:56

  本文選題：大柴胡湯 + 理論探討��； 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:在對(duì)大柴胡湯方證相關(guān)條文理解歸納總結(jié)的基礎(chǔ)上,結(jié)合歷代醫(yī)家的論述,明確大柴胡湯證的病因病機(jī)及其方藥組成。并對(duì)近代醫(yī)案進(jìn)行統(tǒng)計(jì)分析,總結(jié)歸納大柴胡湯證的中西醫(yī)適應(yīng)疾病、癥狀、體征及藥物組成等內(nèi)容。最后運(yùn)用meta分析的方法對(duì)大柴胡湯及其加減方治療急性膽囊炎的臨床療效進(jìn)行系統(tǒng)評(píng)價(jià)。通過對(duì)大柴胡湯治療急性膽囊炎的臨床隨機(jī)對(duì)照實(shí)驗(yàn)進(jìn)行客觀系統(tǒng)的評(píng)價(jià),盡可能得出符合要求的結(jié)果,從而為臨床使用大柴胡湯治療急性膽囊炎提供循證學(xué)依據(jù)。方法:理論研究方面,首先在《傷寒論》和《金匱要略》所記載的本方證條文基礎(chǔ)上,通過解析方證條文、病因病機(jī)、病位、方藥、煎服法等內(nèi)容對(duì)大柴胡湯方證進(jìn)行深入探討,使得理法方藥一以貫之。其次,針對(duì)歷代醫(yī)家對(duì)于大柴胡湯證病位及是否方中有大黃的爭論進(jìn)行分析探討,客觀地認(rèn)識(shí)其病位與方藥組成。第三,以大柴胡湯為對(duì)象,進(jìn)行柴胡湯類方的異同比較,對(duì)大柴胡湯在柴胡類方劑中的位置與作用有一個(gè)系統(tǒng)明確的定位,最終達(dá)到為臨床恰當(dāng)使用大柴胡湯提供理論支持的作用。臨床醫(yī)案統(tǒng)計(jì)分析研究方面,總共收集現(xiàn)代臨床應(yīng)用大柴胡湯治療相關(guān)疾病的100例病案,從多個(gè)方面歸納整理本方治療的疾病種類、癥狀、藥物組成、藥物劑量、用藥劑數(shù)、患者性別年齡等情況,同時(shí)借助統(tǒng)計(jì)學(xué)方法的手段進(jìn)行研究,得出本方在臨床治療的適應(yīng)疾病范圍、適用癥等方面的優(yōu)勢(shì)。Meta分析方面,大柴胡湯及其加減方治療急性膽囊炎的系統(tǒng)評(píng)價(jià),由于缺乏大樣本多中心的隨機(jī)對(duì)照試驗(yàn),對(duì)大柴胡湯方證的研究多集中在小樣本量的臨床研究或者個(gè)案報(bào)道,為了更加系統(tǒng)客觀地評(píng)價(jià)大柴胡湯在治療具體疾病中所發(fā)揮的作用,筆者檢索數(shù)據(jù)庫:相關(guān)期刊論文(CNKI)、維普中文科技期刊全文數(shù)據(jù)庫(VIP)、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(CBM)1949年-2016年6月的相關(guān)文獻(xiàn),數(shù)據(jù)庫未檢索到的文獻(xiàn)通過手工檢索加以補(bǔ)充。檢索詞:為防止漏檢相同研究目的的文獻(xiàn)資料,設(shè)主題詞3個(gè):大柴胡湯、復(fù)方大柴胡湯、大柴胡湯加減。關(guān)鍵詞1個(gè):急性膽囊炎。通過計(jì)算機(jī)檢索出符合條件的文獻(xiàn)373篇,經(jīng)閱讀、整理、分類歸納之后,再將每篇文獻(xiàn)按Cochrane文獻(xiàn)質(zhì)量評(píng)價(jià)系統(tǒng)中7項(xiàng)檢測(cè)逐一做記錄,刪除偏倚風(fēng)險(xiǎn)過高文獻(xiàn),最終獲得26篇文獻(xiàn)資料,運(yùn)用Revman5.3軟件對(duì)已有的隨機(jī)對(duì)照實(shí)驗(yàn)研究進(jìn)行系統(tǒng)評(píng)價(jià)。結(jié)果:一、結(jié)合六經(jīng)、六經(jīng)病、六經(jīng)辨證等概念以及歷代醫(yī)家對(duì)于大柴胡湯證的理解,得出大柴胡湯病位在少陽陽明,病理層次涉及營血分。二、通過醫(yī)案統(tǒng)計(jì)研究得出大柴胡湯在應(yīng)用人群上具備特異性,多發(fā)病于中老年,但是臨床無論年齡大小,只要符合本方證侯,即可酌情使用。本方臨床廣泛應(yīng)用于肝膽脾胃消化系統(tǒng)疾病、肺系疾病等病癥中,應(yīng)用本方的主要指征為便秘、小便黃、腹脹痛、納呆、脅肋疼痛、發(fā)熱、煩躁、舌紅苔黃、脈弦數(shù)等癥狀,藥物組成主要包括柴胡、黃芩、大黃、枳實(shí)、法半夏、大棗、生姜、白芍等。療效確切可靠,值得廣泛推廣。三、二分類變量:大柴胡湯VS西醫(yī)常規(guī)治療:有效率:OR(total)= 5.15,95%CI[1.86,14.26],Z=3.16,P=0.002;RR(total)= 1.17,95%CI[1.07,1.29],Z=3.30,P=0.0010;RD(total)=0.14,95%CI[0.06,0.22],Z=3.51,P=0.0004 治愈率:OR(total)=2.55,95%CI[1.41,4.63],Z=3.09,P=0.002;RR(total)= 1.47,95%CI[1.15,1.88],Z=3.05,P=0.002;RD(total)= 0.19,95%CI[0.07,0.30],Z=3.24,P=0.001;大柴胡湯+西醫(yī)常規(guī)治療VS西醫(yī)常規(guī)治療:有效率:OR(total)= 4.95,95%CI[3.67,6.69],Z=10.43,P0.00001;RR(total)=1.20,95%CI[1.16,1.24],Z=10.68,P0.00001;RD(total)=0.16,95%CI[0.13,0.18],Z=11.56,P0.00001。治愈率:0R(total)=2.10,95%CI[1.77,2.51],Z=8.36,P0.00001;RR(total)= 1.40,95%CI[1.29,1.51],Z=8.19,P0.00001;RD(total)= 0.17,95%CI[0.13,0.21],Z=8.62,P0.00001。連續(xù)性變量:大柴胡湯VS西醫(yī)常規(guī)治療:腹痛消失時(shí)間:SMD(total)=-1.05,95%CI[-1.37,-0.72],Z=6.33,P0.00001;發(fā)熱消退時(shí)間:SMD(total)=-0.84,95%CI[-1.15,-0.52],Z=5.19,P0.00001;大柴胡湯+西醫(yī)常規(guī)治療 VS 西醫(yī)常規(guī)治療:腹痛消失時(shí)間:SMD(total)=-2.47,95%CI[-3.39,-1.56],Z=5.32,P0.00001;發(fā)熱消退時(shí)間:SMD(total)=-2.22,95%CI[-3.13,-1.31],Z=4.78,P0.00001;黃疸消失時(shí)間:SMD(total)=-0.47,95%CI[-0.80,-0.13],Z=2.73,P=0.006;惡心嘔吐消失時(shí)間:SMD(total)=-2.39,95%CI[-2.74,-2.04],Z=13.50,P0.00001。結(jié)論:大柴胡湯證病位當(dāng)為少陽陽明氣、血分,且有熱傷陰血的病理發(fā)展變化。大柴胡湯證的適應(yīng)疾病主要包含肝膽脾胃消化系統(tǒng)疾病、肺系疾病,其常見的癥狀體征為便秘、小便黃、腹脹痛、納呆、脅肋疼痛、發(fā)熱、煩躁、舌紅苔黃、脈弦數(shù)等癥狀,發(fā)病年齡主要集中在中老年。大柴胡湯加減治療急性膽囊炎有效率、治愈率優(yōu)于西醫(yī)常規(guī)治療,對(duì)改善腹痛、發(fā)熱時(shí)間、黃疸、惡心嘔吐等癥狀方面有不可比擬的優(yōu)勢(shì)。
[Abstract]:Objective: on the basis of the summary of the understanding of the relevant provisions of the prescription of Da Chaihu Decoction, the etiology and pathogenesis of Da Chaihu Decoction and the composition of its prescription were made clear, and the modern medical cases were statistically analyzed, and the symptoms, symptoms, signs and drug composition of the TCM and Western medicine were summarized and summarized. Finally, the met was used. The clinical efficacy of dchai Hu Decoction and its addition and subtraction prescription in the treatment of acute cholecystitis was systematically evaluated by a analysis. The objective and systematic evaluation of the clinical randomized controlled trial of Da Chaihu Decoction in the treatment of acute cholecystitis was carried out, and the results were obtained as much as possible, thus providing a basis for the clinical use of Dai Chai Hu Decoction in the treatment of acute cholecystitis. On the basis of the provisions of the prescriptions recorded in "Treatise on typhoid fever" and "synopsis of the Golden Chamber", through the analysis of the provisions of the prescription, the pathogenesis, the position of the disease, the prescription, the decoction and the decocting method, this paper makes an in-depth discussion on the prescription of the big Bupleurum soup. The argument of syndrome position and whether there are Rhubarb in all sides is analyzed and discussed objectively. Third, with daihuhu soup as the object, the similarities and differences of the decoction of Chaihu soup are compared, and the position and function of Dai Hu soup in the Bupleurum Decoction are clearly defined, and finally the proper use of radix Bupleurum for clinical use is achieved. The soup provides the role of theoretical support. In the field of statistical analysis of clinical medical cases, a total of 100 cases of modern clinical application of Dai Hu Tang in the treatment of related diseases were collected. From many aspects, the types of diseases, symptoms, drug composition, dosage of drugs, the number of drugs, the age and age of the patients were summed up and the statistical prescription was used. The method of the method is studied, and the systematic evaluation of the advantage.Meta analysis on the range of adaptation to the disease and the applicability of the clinical treatment, the systematic evaluation of the treatment of acute cholecystitis with Dai Hu Tang and its addition and subtraction prescription in the treatment of acute cholecystitis. Due to the lack of large sample and multi center randomized controlled trials, the research on the prescription of Dai Hu soup is mostly focused on the small sample size. In order to more systematically and objectively evaluate the role of Dai Hu soup in the treatment of specific diseases, the author retrieves the database: the Chinese journal full text database (CNKI), the full text database of VIP Chinese sci-tech periodicals (VIP), the relevant literature of the Chinese biomedical literature database (CBM) in June 1949, the database is not The retrieved literature was supplemented by manual retrieval. In order to prevent the missing examination of the same research purposes, 3 subjects were set up: Dacai Hu soup, compound Dacai Hu soup, Dacai Hu soup. The key words 1: acute cholecystitis. 373 articles were retrieved by computer, after reading, sorting, classification and induction. Each document was recorded one by one according to 7 tests in the Cochrane literature quality evaluation system. The literature was deleted from the high risk of bias, and 26 documents were obtained. The Revman5.3 software was used to systematically evaluate the existing randomized controlled experimental studies. The understanding of the syndrome of Chaihu soup is that the disease position of Dai Chai Hu soup is in Yangming of Shaoyang, and the pathological level involves the distribution of blood. Two, according to the statistical study of medical cases, it is concluded that Dai Chai Hu soup is specific in the application population and often occurs in the middle and old age, but the clinical age and size can be used as long as it is in accordance with this prescription. The clinical application of this prescription is widely used in the liver. Among the diseases such as the digestive system of the spleen and stomach, the disease of the lung system, the main indications of this prescription are constipation, urinating, abdominal distention and pain, the pain of the ribs, fever, irritability, the yellow tongue, the number of veins and so on. The medicine consists mainly of bupleurum, Scutellaria, rhubarb, Fructus aurantii, Rhizoma Ziziphi, ginger and Paeonia lactiflora. The curative effect is reliable and worthy of extensive popularization. Three, two classified variables: dchai Hu Decoction VS routine treatment: effective: OR (total) = 5.15,95%CI[1.86,14.26], Z=3.16, P=0.002; RR (total) = 1.17,95%CI[1.07,1.29], Z=3.30, P=0.0010; Z=3.05, P=0.002; RD (total) = 0.19,95%CI[0.07,0.30], Z=3.24, P=0.001; Da Chai Hu Soup + western medicine routine treatment of Western medicine routine treatment: effective: Efficiency: OR (total) = 4.95,95%CI[3.67,6.69], Z=10.43. 95%CI[1.77,2.51], Z=8.36, P0.00001; RR (total) = 1.40,95%CI[1.29,1.51], Z=8.19, P0.00001; RD (total) = 0.17,95%CI[0.13,0.21], Z=8.62. -0.52], Z=5.19, P0.00001; Dachai Hu Tang and conventional treatment of Western medicine for routine treatment of VS western medicine: SMD (total) =-2.47,95%CI[-3.39, -1.56], Z=5.32, P0.00001; SMD (total); The disappearance time: SMD (total) =-2.39,95%CI[-2.74, -2.04], Z=13.50, P0.00001. conclusion: the disease position of the big Bupleurum soup syndrome is the Yangming Qi, the blood, and the pathological changes of the hot injury and Yin blood. The adaptation diseases of the big Chaihu soup mainly include the liver and gallbladder, the spleen and stomach digestive system disease, the lung disease, and the common symptoms are constipation, urinating yellow, abdomen. Swell pain, nausea, flank pain, fever, irritability, tongue red moss yellow, pulse string number and other symptoms, age mainly concentrated in the elderly. Dachai Hu Decoction Treatment of acute cholecystitis is effective, the cure rate is better than the western medicine routine treatment, to improve abdominal pain, fever time, jaundice, nausea and vomiting and other symptoms have unparalleled advantages.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R289.5

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