【摘要】：糖尿病胃輕癱是糖尿病的常見并發(fā)癥之一,臨床表現(xiàn)主要為食欲下降、早飽、上腹部飽脹不適、慢性上腹痛、惡心、嘔吐等,目前國內(nèi)西醫(yī)治療糖尿病胃輕癱,主要是在調(diào)整飲食及生活方式、控制血糖的基礎(chǔ)上,以口服多潘立酮或莫沙必利促胃動(dòng)力為主,而這些西藥的應(yīng)用無疑會(huì)帶來一定的副作用�？梢奃GP的西醫(yī)治療方法十分有限。這便顯示出中醫(yī)的優(yōu)勢(shì)。而中醫(yī)雖無此病名,但根據(jù)其臨床表現(xiàn)可歸為"消渴病"繼發(fā)"痞滿"和(或)"嘔吐"的范疇,在治療上以辨證論治為主,然而由于辨證的多樣性及復(fù)雜性,目前仍缺乏統(tǒng)一的辨證選方的標(biāo)準(zhǔn),因此通過研究中醫(yī)文獻(xiàn)以探索前人治療糖尿病胃輕癱的組方用藥規(guī)律,為今后中醫(yī)治療提供一定的思路及方法,顯得尤為必要。目的:運(yùn)用數(shù)據(jù)挖掘技術(shù)對(duì)搜集到的符合納入標(biāo)準(zhǔn)的中醫(yī)治療糖尿病胃輕癱的文獻(xiàn)進(jìn)行全面深入地整理和分析,總結(jié)中醫(yī)治療糖尿病胃輕癱的組方用藥規(guī)律。方法:以CNKI相關(guān)期刊論文和萬方醫(yī)學(xué)網(wǎng)數(shù)據(jù)庫為檢索工具和文獻(xiàn)來源,檢索2007年1月至2017年1月間關(guān)于中醫(yī)治療糖尿病胃輕癱的文獻(xiàn),根據(jù)納入和排除標(biāo)準(zhǔn)獲得可納入文獻(xiàn),提取文獻(xiàn)中所記載的方劑及藥物組成并建立數(shù)據(jù)庫。運(yùn)用頻數(shù)及頻率分析找出治療糖尿病胃輕癱的高頻藥物及藥類,運(yùn)用聚類分析找出核心優(yōu)勢(shì)組合,進(jìn)而探討糖尿病胃輕癱的治療方法和藥物的配伍。結(jié)果:符合標(biāo)準(zhǔn)的文獻(xiàn)共有285篇,其中共應(yīng)用方劑181種,中藥共164味。應(yīng)用頻數(shù)在5次以上的方劑有9種(按使用頻數(shù)高低依次為:半夏瀉心湯、香砂六君子湯、六君子湯、四磨湯、補(bǔ)中益氣湯、枳實(shí)消痞湯、升陽益胃湯、旋覆代赭湯、枳術(shù)湯),共計(jì)90次,所占頻率為31.6%。而用于治療胃陰虧虛證的方劑只有6種(按使用頻數(shù)高低依次為:麥門冬湯、一貫煎、沙參麥冬湯、益胃湯、玉女煎),共出現(xiàn)11次,所占頻率為3.86%。中藥應(yīng)用總頻數(shù)為1928次,其中應(yīng)用頻數(shù)在10次以上的中藥38味,共計(jì)出現(xiàn)1026次,所占頻率為53.2%,對(duì)使用頻數(shù)在10次上的38味中藥進(jìn)行藥物歸類得出10種藥類,依據(jù)使用總頻數(shù)高低排列分別為:補(bǔ)氣藥、理氣藥、化濕藥、清熱藥、消食藥、化痰藥、補(bǔ)陰藥、活血藥、溫里藥及補(bǔ)血藥,用藥相對(duì)集中,最多的為補(bǔ)氣類藥物,按使用頻數(shù)高低依次為:白術(shù)、黨參、甘草、黃芪、山藥、太子參、人參,單此7味中藥便出現(xiàn)276次�？v觀近10年用于辨證治療DGP的藥物,滋陰藥有12種,而滋養(yǎng)胃陰類藥物只出現(xiàn)97次,所占頻率為5.03%(表4),共7種,分別為:麥冬、生地、石斛、沙參、葛根、玉竹、百合。結(jié)論:1.目前對(duì)糖尿病胃輕癱的辨證及方劑使用尚缺乏統(tǒng)一的標(biāo)準(zhǔn),不僅方劑種類分散,而且出現(xiàn)了較多自擬方及經(jīng)驗(yàn)方。但其中亦不乏較為公認(rèn)的方劑,如:半夏瀉心湯、香砂六君子湯及六君子湯。2.臨床醫(yī)家遣方用藥各有側(cè)重、各具特色,但多數(shù)現(xiàn)代中醫(yī)家均認(rèn)為其定位在胃,與脾、肝密切相關(guān),治療上以益氣健脾為主,佐以疏肝理氣、清熱化濕、消食導(dǎo)滯、滋陰益胃等。臨床用藥方面,主要藥類有補(bǔ)氣藥、理氣藥、化濕藥、清熱藥、消食藥、化痰藥、補(bǔ)陰藥、活血藥、溫里藥及補(bǔ)血藥。值得一提的是,不少醫(yī)家已關(guān)注DGP胃陰虧虛證繼而對(duì)此進(jìn)行臨床試驗(yàn)。3.通過對(duì)文獻(xiàn)數(shù)據(jù)的分析,得出頻數(shù)在40次以上的用于治療糖尿病胃輕癱的藥對(duì)10對(duì),多為補(bǔ)氣藥和化濕藥、化痰藥、理氣藥的組合,可見這些藥在治療DGP時(shí)占據(jù)主導(dǎo)作用。提示在臨床治療DGP時(shí),若不能完全把握患者的證型,使用這些藥物組合,雖不能完全符合患者的辨證論治,但能對(duì)改善患者癥狀有一定的作用。
[Abstract]:Diabetic gastroparesis is one of the common complications of diabetes mellitus. The clinical manifestations are appetite loss, early satiety, upper abdominal fullness discomfort, chronic upper abdominal pain, nausea, vomiting, etc. On the basis of controlling the blood sugar, it is the main way to promote the gastric motility by taking orally dopenone or Mosha, and the application of these western medicines will undoubtedly bring some side effects. It can be seen that the western medicine treatment method of DGP is very limited. This shows the advantages of traditional Chinese medicine. Traditional Chinese medicine has no disease name, but according to its clinical manifestation, it can be classified as" Crohn's disease "secondary" Richmond "and/ or" Vomiting "However, due to the diversity and complexity of syndrome differentiation, there is still a lack of the standard of unified syndrome differentiation, and therefore, by studying the traditional Chinese medicine literature to explore the prescription medication law of the predecessor to treat the gastroparesis of diabetic gastroparesis, It is especially necessary to provide some thought and method for the treatment of TCM in the future. Objective: To summarize and analyze the literatures of Chinese traditional Chinese medicine for treating diabetic gastroparesis by using data mining technology, and summarize the prescription medication rule of Chinese medicine for treating diabetic gastroparesis. Methods: Using CNKI Chinese Journal Full-text Database (CNKI) and Wanfang Medical Network Database as the retrieval tools and literature sources, the literature on the treatment of gastroparesis of diabetic gastroparesis from January 2007 to January 2017 was retrieved. According to the inclusion and exclusion criteria, the literature could be included. the composition and the medicine composition in the literature are extracted and a database is established. Frequency and frequency analysis were used to find out the high frequency drugs and drugs for treating gastroparesis of diabetic gastroparesis, and to find out the combination of core advantages by cluster analysis. Results: 285 articles were obtained according to the standard literatures, among which 181 kinds of prescriptions were applied, and 164 kinds of traditional Chinese medicine were used. The application frequency has 9 kinds of prescriptions (according to the frequency of use: Banxia Xiexin Decoction, Xiangsha Liujunzi Decoction, Liujunzi Tang, four-grinding soup, tonic tonic soup, syrup Xiaoyao Tang, Shengyang Yiwei Decoction, spin-coated decoction, and soup) for a total of 90 times. The frequency is 31.6%. The prescription used to treat the deficiency of stomach yin deficiency is only 6 (according to the frequency of use: wheat gate winter soup, persistent decoction, radix ophiope soup, prestomach soup and jade female decoction), and total occurrence of 11 times, accounting for 3.86%. The total frequency of the application of traditional Chinese medicine was 1928, among which, the application frequency of 38 Chinese medicines with frequency of more than 10 times appeared 1026 times, the frequency of which was 53.2%, and the 38 traditional Chinese medicines used in 10 times were classified into 10 kinds of drugs according to the total frequency. regulating qi, dispelling dampness, clearing heat, promoting digestion, eliminating phlegm, tonifying yin, activating blood, promoting blood circulation, warming the medicine, and tonifying blood. The medicine is relatively concentrated, and most of the medicines are qi invigorating medicine, and the use frequency is in sequence: Atractylodis Rhizoma, Radix Codonopsis, Glycyrrhrizae Radix, Radix Rehmanniae Preparata, Rhizoma Dioscoreae, Radix Rehmanniae Preparata, and Radix Ginseng; A single 7-flavored Chinese medicine appeared 276 times. In the last 10 years, there were 12 kinds of drugs used in the treatment of DGP, 12 kinds of nourishing yin medicine, 97 times of nourishing stomach yin medicine, and 5.03% of nourishing stomach yin medicine (Table 4). Conclusion: 1. At present, there is a lack of uniform standard for the syndrome differentiation and prescription use of diabetic gastroparesis, not only the prescription type is dispersed, but also has more self-confidence and experience side. But there are also more generally accepted prescriptions, such as Banxia Xiexin Decoction, Xiangsha Liujunzi Decoction and Liujunzi Decoction. Most modern Chinese medicine doctors believe that they are located in the stomach, which is closely related to the spleen and the liver, and is mainly used for treating the spleen and the liver of the spleen and the liver, so as to tonify qi and invigorate the spleen, so as to relieve the stagnation of the liver and regulate the flow of qi, clearing heat and eliminating dampness, promoting digestion, promoting digestion, nourishing yin and benefiting the stomach, and the like. In the aspect of clinical medication, the main medicine is tonic medicine, regulating qi, eliminating dampness, clearing heat, promoting digestion, eliminating phlegm, tonifying yin, promoting blood circulation, warming the medicine, and replenishing blood. It is worth mentioning that many doctors have paid attention to DGP's deficiency of stomach yin deficiency, which in turn carries on the clinical trial. Through the analysis of the literature data, it is concluded that more than 40 drugs for treating diabetes gastroparesis are more than 10 pairs, and the combination of the medicine for treating diabetes gastroparesis is more than 40 times, and the combination of phlegm-eliminating medicine and qi-regulating medicine can be seen, and the medicine can be seen to play a leading role in treating the DGP. It is suggested that in the clinical treatment of DGP, if the patient's syndrome cannot be fully grasped, the combination of these drugs can not be completely consistent with the differentiation and treatment of the patient, but it can play a role in improving the patient's symptoms.
【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)】：R259

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本文編號(hào)：2301067