本文選題：體病相關(guān) + 運(yùn)氣學(xué)說(shuō)�。� 參考：《北京中醫(yī)藥大學(xué)》2017年博士論文

【摘要】：背景:世界衛(wèi)生組織(WHO)在1996年指明21世紀(jì)的醫(yī)學(xué)的發(fā)展方向?qū)?疾病醫(yī)學(xué)"轉(zhuǎn)向"健康醫(yī)學(xué)",治療上更加注重"個(gè)體治療"的發(fā)展。在臨床中如何建立個(gè)體化診療模式,識(shí)別個(gè)體的差異性、推測(cè)其發(fā)病傾向,做到"未病先防"、"已病防變"成為社會(huì)共同關(guān)注的問(wèn)題。"因人制宜"要求中醫(yī)學(xué)治病時(shí)以患者的體質(zhì)情況作為處方用藥的重要依據(jù),這正是個(gè)體化診療的具體體現(xiàn)。王琦教授20世紀(jì)70年代創(chuàng)立中醫(yī)體質(zhì)學(xué),該學(xué)說(shuō)提出"體病相關(guān)"理論,建立了"辨體—辨病—辨證"診療模式。而五運(yùn)六氣是影響機(jī)體體質(zhì)及體質(zhì)狀態(tài)的關(guān)鍵因素,基于此認(rèn)識(shí),能否建立"調(diào)氣—調(diào)體—主病"的臨床診療新模式值得探討。目的:通過(guò)對(duì)銀屑病患者中醫(yī)體質(zhì)、中醫(yī)證型及患者出生時(shí)五運(yùn)六氣特點(diǎn)進(jìn)行統(tǒng)計(jì)分析,挖掘其中的相關(guān)性,為"調(diào)氣—調(diào)體—主病"提供理論基礎(chǔ);并以"調(diào)氣—調(diào)體—主病"為指導(dǎo)思想對(duì)患者診治與經(jīng)普通辨證論治的患者,進(jìn)行療效評(píng)價(jià)比較,對(duì)該理論進(jìn)行初步實(shí)踐驗(yàn)證。方法:1、將納入的銀屑病患者分為運(yùn)氣組和非運(yùn)氣組,根據(jù)中華中醫(yī)藥學(xué)會(huì)2009年頒布的《中醫(yī)體質(zhì)分類(lèi)與判定》進(jìn)行體質(zhì)辨別;參照《中藥新藥臨床研究指導(dǎo)原則》進(jìn)行常規(guī)銀屑病的中醫(yī)辨證;并對(duì)運(yùn)氣組患者出生日期(農(nóng)歷)運(yùn)氣進(jìn)行推算分析,統(tǒng)計(jì)其歲運(yùn)、主氣、客氣、司天在泉;應(yīng)用Excel對(duì)上述結(jié)果進(jìn)行描述性統(tǒng)計(jì),采用統(tǒng)計(jì)學(xué)軟件SPSS17.0進(jìn)行相關(guān)性分析。2、運(yùn)氣組以"調(diào)氣—調(diào)體—主病"為指導(dǎo)思想進(jìn)行診治,非運(yùn)氣組經(jīng)辨證論治,對(duì)兩組患者治療前與治療1個(gè)月、3個(gè)月、6個(gè)月時(shí)銀屑病皮損面積與嚴(yán)重程度指數(shù)(PASI評(píng)分)、患者自評(píng)瘙癢程度評(píng)分(VAS評(píng)分)及皮膚病生活質(zhì)量指數(shù)(DLQI得分)三個(gè)病情判定指標(biāo)及治愈率情況進(jìn)行統(tǒng)計(jì)比較分析。結(jié)果:1、運(yùn)氣組銀屑病患者的體質(zhì)類(lèi)型以濕熱質(zhì)、氣郁質(zhì)、痰濕質(zhì)為主;中醫(yī)證型最多的為濕熱證,其次是血熱證;患者出生在土運(yùn)太過(guò)之年,五之氣陽(yáng)明燥金所主時(shí)段,客氣為太陰濕土,少陰君火司天,陽(yáng)明燥金在泉,后天最容易罹患銀屑病;出生在火運(yùn)不及之年,三之氣少陽(yáng)相火所主時(shí)段,客氣為厥陰風(fēng)木或者陽(yáng)明燥金,陽(yáng)明燥金司天,少陰君火在泉或太陰濕土司天,太陽(yáng)寒水在泉的人,患銀屑病的可能最小;出生時(shí)三合局為土運(yùn)太過(guò)、少陽(yáng)相火司天、左間少陰君火及土運(yùn)不及、少陽(yáng)相火在泉、右間太陰濕土兩類(lèi)患者人數(shù)最多。然而經(jīng)統(tǒng)計(jì)學(xué)分析銀屑病患者出生日期在不同歲運(yùn)、主氣、客氣及三合局的分布差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2、運(yùn)氣組銀屑病患者中醫(yī)體質(zhì)類(lèi)型與所患銀屑病的中醫(yī)證型存在相關(guān)性,辨證為濕熱質(zhì)及血熱證的患者的體質(zhì)類(lèi)型最多的均為濕熱質(zhì);多數(shù)銀屑病患者體質(zhì)類(lèi)型傾向于濕熱證,而氣虛質(zhì)患者傾向于血熱證,陰虛質(zhì)患者傾向于血虛證,氣郁質(zhì)患者傾向血瘀證。3、運(yùn)氣組銀屑病患者出生日期的五運(yùn)六氣特點(diǎn)與患者體質(zhì)及所患銀屑病中醫(yī)證型相關(guān),銀屑病患者體質(zhì)最多的濕熱質(zhì)患者,多出生于土運(yùn)太過(guò)之年者,主氣為五之氣陽(yáng)明燥金所主時(shí)段,客氣為太陰濕土,少陽(yáng)相火司天,厥陰風(fēng)木在泉,除主氣分布差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),其余均有統(tǒng)計(jì)學(xué)意義(P0.05);中醫(yī)證型最多的濕熱證患者多出生于木運(yùn)太過(guò)或土運(yùn)不及之年,四之氣太陰濕土?xí)r段,客氣為太陰濕土?xí)r段,出生當(dāng)年以厥陰風(fēng)木司天,少陽(yáng)相火在泉或少陽(yáng)相火司天,厥陰風(fēng)木在泉最多,其中僅患者出生時(shí)的歲運(yùn)分布差異有統(tǒng)計(jì)學(xué)意義(P0.05),其余均無(wú)。4、本研究對(duì)比分析了基于"調(diào)氣—調(diào)體—主病"思路及普通辨證論治治療銀屑病患者治療前、治療1個(gè)月、3個(gè)月、6個(gè)月的各評(píng)分情況,治療前兩組患者各評(píng)分的組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);經(jīng)治療兩組患者3個(gè)觀察節(jié)點(diǎn)的各評(píng)分均逐漸下降,但PASI評(píng)分、VAS評(píng)分自治療1個(gè)月時(shí)組間差異有統(tǒng)計(jì)學(xué)意義(P0.05),DLQI得分在治療6個(gè)月時(shí),組間差異有統(tǒng)計(jì)學(xué)意義(P0.05),證明以"調(diào)氣—調(diào)體—主病"理論為指導(dǎo)治療銀屑病相較于普通辨證論治,在治療1個(gè)月后即在降低銀屑病皮損面積與嚴(yán)重程度、及改善患者瘙癢程度方面顯示優(yōu)勢(shì),經(jīng)治療6個(gè)月可更有效的提高患者生活質(zhì)量;從總體療效上看基于"調(diào)氣—調(diào)體—主病"思路治療銀屑病優(yōu)于普通辨證論治治療該病。結(jié)論:銀屑病患者中醫(yī)體質(zhì)類(lèi)型與所患銀屑病的中醫(yī)證型存在相關(guān)性;患者出生日期的五運(yùn)六氣特點(diǎn)與患者體質(zhì)及所患銀屑病中醫(yī)證型相關(guān);"調(diào)氣—調(diào)體—主病"理論相較于普通辨證論治治療銀屑病,可更有效的降低銀屑病皮損面積與嚴(yán)重程度、改善其瘙癢程度、提高患者生活質(zhì)量,"調(diào)氣—調(diào)體—主病"新臨床診療模式具有可行性。
[Abstract]:Background: in 1996, the WHO (WHO) pointed out that the direction of the development of medicine in the twenty-first Century will turn from "disease medicine" to "health medicine", and the development of "individual treatment" will be paid more attention to. In clinical practice, how to establish individual diagnosis and treatment mode, identify individual differences, speculate the tendency of disease, and make "disease prevention first" and "disease prevention" It is an important basis for the prescription of the prescription to treat the patient's physique in the treatment of the disease in traditional Chinese medicine. This is the embodiment of the individualized diagnosis and treatment. Professor Wang Qi founded the constitution of traditional Chinese medicine in 1970s. This theory put forward the theory of "body disease related", and established the diagnosis and treatment mode of "differentiation and differentiation of disease and syndrome differentiation". And five transport and six gas is the key factor affecting the body's physique and physical condition. Based on this understanding, it is worth exploring the new mode of clinical diagnosis and treatment of "Regulating Qi - regulating body - main disease". Objective: to analyze the characteristics of the TCM Constitution, TCM syndrome type and the five transport and six gas characteristics at birth of patients with psoriasis. The theory of regulating Qi - regulating body - main disease "provides the theoretical basis, and with the guiding ideology of" Regulating Qi - regulating body - main disease "and comparing the patients with the general syndrome differentiation and treatment. The theory carries out a preliminary practice verification. Method: 1, the patients are divided into the luck group and the non luck group, according to the Chinese society of traditional Chinese Medicine 200 The constitution classification and judgment of Chinese medicine promulgated in 9 years was used to distinguish the constitution, and the traditional Chinese medicine based on the guiding principles of the clinical research of Chinese medicine and new medicine was used to carry out the traditional Chinese medicine syndrome differentiation of conventional psoriasis. The statistical software SPSS17.0 was used to carry out the correlation analysis.2. The lucky group was treated with the guidance of "Regulating Qi - adjusting body - main disease". The non lucky group was treated by syndrome differentiation, and the area of psoriasis and the severe range index (PASI score) of the two groups of patients before treatment and 1 months, 3 months and 6 months, and the self evaluation of pruritus degree score (VAS evaluation). The results were as follows: 1. The physical types of psoriasis in the group of luck were mainly wet heat, qi depression and phlegm wet quality, and the most of the TCM syndrome types were damp heat syndrome, and the second was the syndrome of blood heat; the patients were born in the year of soil transportation and five of Qi Yang. The main period of Ming dryness gold is too cloudy and wet soil, less Yin Jun fire, Yang Ming dryness gold in spring, and the most easy to suffer from psoriasis on the next day. Born in the year of fire, three of the Qi Shaoyang phase fire is the main time, the customer is the Jue Yin wood or Yangming dryness gold, Yangming dryness gold, Shaoyin monarch fire in spring or Taiyin wet soil, the sun cold water in spring people, The possibility of psoriasis was the smallest, the three in the birth time was too much, the Shaoyang phase fire, the left less Yin Jun fire and the soil transport, the Shaoyang phase fire in the spring, the right between the Tai Yin wet soil, the largest number of patients. However, the statistical analysis of the date of birth of psoriasis patients at different years of age, the distribution of the main gas, the passenger gas and the three parts were not statistically significant. Meaning (P0.05).2, the type of TCM Constitution of the patients with psoriasis in luck group is related to the TCM syndrome type of psoriasis. The physique types of patients with damp heat and blood heat syndrome are all damp heat, and most of the patients with psoriasis tend to damp heat syndrome, and the patients with Qi deficiency tend to be blood heat syndrome, and the patients with Yin deficiency tend to be inclined to the disease. Blood deficiency syndrome, qi depression patients tend to blood stasis syndrome.3, the five transport and six gas characteristics of the date of birth of the patients with psoriasis are related to the constitution of the patients and the type of TCM syndrome of psoriasis. The patients with the most physique of psoriasis are born in the years of excessive soil transport, and the main gas is five of the Qi Yang Ming dryness gold, and the passenger is too wet soil, There is no statistical significance (P0.05) in the distribution difference of the main gas in the spring of Shaoyang and Shaoyang, but the rest of the main gas distribution is statistically significant (P0.05). The phase fire is in the spring or Shaoyang phase fire, the Jue Yin wood is most in the spring, among which the difference of the age distribution of the patients at birth is statistically significant (P0.05), and the rest is not.4. This study contrasts and analyzes the 1 months, 3 months, 6 months of the treatment of patients with silver chip disease based on the thought of "Regulating Qi to adjust body - main disease" and the common syndrome differentiation treatment for patients with silver chip disease. There was no statistical difference between the two groups before treatment (P0.05); the scores of the 3 observation nodes in the two groups were decreased gradually, but the PASI score and the VAS score were statistically significant (P0.05) from the treatment group (P0.05), and the difference between the groups was statistically significant (P0.05) at 6 months of treatment (P0.05). According to the theory of "Regulating Qi - regulating body - main disease", the treatment of psoriasis was compared with ordinary syndrome differentiation. After 1 months of treatment, it showed the advantages of reducing the area and severity of psoriasis and improving the itching degree of patients. After 6 months of treatment, the quality of life of the patients could be improved more effectively, and the overall effect was based on "Qi adjustment". Conclusion: the physique type of the patients with psoriasis is related to the TCM syndrome type of psoriasis, the characteristics of the five transport and six gas of the patient's birth date are related to the constitution of the patients and the TCM syndrome type of psoriasis, and the theory of "Regulating Qi to adjust body to main disease" is compared to the general theory. The treatment of psoriasis by syndrome differentiation can be more effective in reducing the area and severity of psoriasis, improving the itching degree and improving the quality of life of the patients. The new clinical diagnosis and treatment model of "Qi regulating body - main disease" is feasible.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R275.9

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