發(fā)布時(shí)間：2018-06-22 09:41

  本文選題：澎湖 + 李賽美�。� 參考：《廣州中醫(yī)藥大學(xué)》2017年博士論文

【摘要】：目的:本研究通過(guò)收集臺(tái)灣澎湖地區(qū)慢性乙型病毒性肝炎患者的資料,從性別、年齡、職業(yè)、家族史等幾方面對(duì)臺(tái)灣澎湖地區(qū)乙肝患者進(jìn)行初步的流行病學(xué)分析;利用屬性偏序結(jié)構(gòu)圖,對(duì)臺(tái)灣澎湖地區(qū)慢性乙型病毒性肝炎患者的中醫(yī)證型進(jìn)行數(shù)據(jù)挖掘,以探討澎湖地區(qū)乙肝的流行病學(xué)和證型分布特點(diǎn)。其次,通過(guò)門(mén)診收集李賽美教授治療慢性乙肝病例103例,結(jié)合李賽美教授相關(guān)論文,以及跟師學(xué)習(xí)體會(huì),對(duì)李賽美教授門(mén)診治療慢性乙型病毒性肝炎的經(jīng)驗(yàn)進(jìn)行總結(jié),為臨床中醫(yī)辨治慢性乙型病毒性肝炎提供參考。方法:1.利用簡(jiǎn)單的統(tǒng)計(jì)學(xué)方法,對(duì)澎湖地區(qū)慢性乙肝患者進(jìn)行流行病學(xué)分析。采集澎湖地區(qū)慢性乙型病毒性肝炎患者資料,包括年齡、性別、確診年齡、就診時(shí)年齡、病史、職業(yè)、家族史等,制定病例資料采集卡,對(duì)采集卡的信息進(jìn)行整理分類(lèi),得到原始病例資料整理表,并進(jìn)行簡(jiǎn)單的統(tǒng)計(jì)學(xué)處理,根據(jù)相關(guān)結(jié)果,對(duì)臺(tái)灣澎湖地區(qū)慢性乙型病毒性肝炎患者流行病學(xué)信息進(jìn)行初步總結(jié)。2.利用屬性偏序結(jié)構(gòu)圖,總結(jié)臺(tái)灣澎湖地區(qū)慢性乙型病毒性肝炎中醫(yī)證型。收集2016年至2017年就診于周?chē)?guó)雄診所,符合本次研究的診斷標(biāo)準(zhǔn)、納入標(biāo)準(zhǔn)的慢性乙肝患者資料,包括姓名、年齡、性別、職業(yè)、籍貫、現(xiàn)病史、既往史、家族史等以及中醫(yī)四診資料,設(shè)計(jì)資料采集卡,由松安堂中醫(yī)診所林志堅(jiān)醫(yī)師進(jìn)行慢性乙型病毒性肝炎患者資料收集及整理。原始資料采集完成后,由兩名研究員分別按人民衛(wèi)生出版社《傷寒論講義(第二版)》六經(jīng)辨證標(biāo)準(zhǔn)對(duì)患者進(jìn)行六經(jīng)辨證。如有出入,請(qǐng)第三方人員進(jìn)行仲裁。然后進(jìn)行數(shù)據(jù)規(guī)范化,建立數(shù)據(jù)庫(kù)并構(gòu)建澎湖地區(qū)慢性乙肝患者-證型形勢(shì)背景。進(jìn)行形式背景優(yōu)化后,由專(zhuān)人利用MATLAB程序加載至Microsoft Office Excel 2007,把數(shù)據(jù)生成屬性偏序結(jié)構(gòu)圖,達(dá)到知識(shí)可視化的效果。3.利用經(jīng)驗(yàn)總結(jié)法,總結(jié)李賽美教授治療慢性乙肝經(jīng)驗(yàn)。收集符合標(biāo)準(zhǔn)的李賽美教授治療慢性乙型病毒性肝炎驗(yàn)案,以及李賽美教授闡述的有關(guān)慢性乙型病毒性肝炎治療經(jīng)驗(yàn)的講座、論文,結(jié)合個(gè)人跟師學(xué)習(xí)心得,利用經(jīng)驗(yàn)總結(jié)法,對(duì)李賽美教授治療慢性乙肝經(jīng)驗(yàn)進(jìn)行總結(jié)。結(jié)果:本論文研究?jī)?nèi)容主要分為三部分,分別的研究成果如下:1.臺(tái)灣澎湖地區(qū)乙型病毒性肝炎的流行病學(xué)研究。1.1共收集病例125例,最終納入研究120例。1.2生成澎湖地區(qū)乙型肝炎患者性別組成、就診年齡、發(fā)病年齡、病史長(zhǎng)度、職業(yè)、家族史相關(guān)表格。2.利用屬性偏序結(jié)構(gòu)圖,總結(jié)臺(tái)灣澎湖地區(qū)慢性乙型病毒性肝炎中醫(yī)證型。2.1共收集病例125例,最終納入研究120例。2.2建立澎湖地區(qū)乙型肝炎患者中醫(yī)證候數(shù)據(jù)庫(kù):經(jīng)處理后,共得到臺(tái)灣澎湖地區(qū)慢性乙型病毒性肝炎患者的48個(gè)癥狀。2.3生成澎湖地區(qū)乙型肝炎患者中醫(yī)證候?qū)傩云蚪Y(jié)構(gòu)圖。3.李賽美教授治療慢性乙型病毒性肝炎經(jīng)驗(yàn)總結(jié)。3.1收集整理李賽美教授治療慢性乙肝驗(yàn)案103例,最終納入研究100例。3.2結(jié)合李賽美教授治療乙肝有關(guān)的講座、論文,以及本人跟師學(xué)習(xí)體會(huì),對(duì)李賽美教授治療慢性乙型病毒性肝炎經(jīng)驗(yàn)作一總結(jié)。結(jié)論:1.臺(tái)灣澎湖地區(qū)乙型病毒性肝炎的流行病學(xué)研究。對(duì)于臺(tái)灣澎湖地區(qū)乙型病毒性肝炎的流行病學(xué)研究表明:性別方面,男性患者占有更大比例,男女比例約2:1,這可能與男性吸煙飲酒較多,濕熱之邪蘊(yùn)結(jié),毒邪內(nèi)蘊(yùn),遷延難愈有關(guān),以及社會(huì)壓力較大,肝氣疏泄條達(dá)失職有關(guān)。就診年齡方面,主要集中在40-69歲之間,可能與病程達(dá)到一定時(shí)間后出現(xiàn)相應(yīng)癥狀,以及年老正氣不足有關(guān)。發(fā)病年齡方面,分布相對(duì)平均,各個(gè)年齡段基本均有涉及,有明確發(fā)病年齡的患者中,20-29歲這一年齡段所占比例最高,與升學(xué)體檢、產(chǎn)檢、捐血時(shí)體檢有關(guān)。這表明了常規(guī)體檢檢查肝炎病毒,對(duì)于及早發(fā)現(xiàn)乙型病毒性肝炎有著積極的意義,早發(fā)現(xiàn)早治療,對(duì)比晚發(fā)現(xiàn)晚治療,可以有效提高治療效果,減輕疾病危害,節(jié)約醫(yī)療資源,減輕患者經(jīng)濟(jì)負(fù)擔(dān)。病史長(zhǎng)度方面,有長(zhǎng)有短,分布相對(duì)平均,各個(gè)年齡段基本均有涉及。結(jié)合發(fā)病年齡等,乙型病毒性肝炎患者年齡分布主要集中在40-69歲之間,而大部分患者在40歲以前查出患有乙型病毒性肝炎。這表明感染乙型肝炎病毒人口存在老齡化的趨勢(shì),乙型病毒性肝炎的疫苗接種預(yù)防措施是有效的。職業(yè)分布方面,以家管最多,其次為工業(yè)、自由業(yè)者。這提醒食品衛(wèi)生部門(mén)應(yīng)注重食品衛(wèi)生安全的管理,努力從源頭遏制乙型病毒性肝炎的傳播。此外,漁業(yè)、商業(yè)、軍隊(duì)、公職中也占有不小的比例。家族史方面:74例患者的父母或兄弟姐妹患有慢性乙型病毒性肝炎,占61.67%。45例患者無(wú)家族史,占37.50%,1例患者家族史不詳。表明澎湖地區(qū)乙型病毒性肝炎的發(fā)病呈現(xiàn)出一定的家族聚集性,可能與家族成員之間密切接觸有關(guān)。衛(wèi)生部門(mén)應(yīng)加強(qiáng)對(duì)乙型病毒性肝炎的宣教科普,提高民眾的認(rèn)識(shí)度;對(duì)于患有乙肝的孕婦,分娩時(shí)應(yīng)做好對(duì)應(yīng)措施,盡可能減少母嬰垂直傳播的幾率;對(duì)于無(wú)抗體的人群,尤其是高危人群,應(yīng)及早進(jìn)行乙肝疫苗的接種;對(duì)于已經(jīng)患有乙肝的患者,爭(zhēng)取做到早期、積極治療,降低病毒復(fù)制程度,一方面可以降低傳染給他人的幾率,另一方面也有助于延緩病程進(jìn)展,降低乙肝后肝硬化、肝癌的可能。2.利用屬性偏序結(jié)構(gòu)圖,總結(jié)臺(tái)灣澎湖地區(qū)慢性乙型病毒性肝炎中醫(yī)證型。根據(jù)屬性偏序結(jié)構(gòu)圖,總結(jié)出以下幾個(gè)證型:1)少陽(yáng)證,肝火上炎、肝氣郁結(jié)證,或有心火,或有血瘀。2)少陽(yáng)證合并厥陰證。3)少陰證,脾腎陽(yáng)虛,陽(yáng)虛寒凝血瘀證,中焦樞機(jī)不利,水濕內(nèi)停。4)少陽(yáng)證,肝膽火旺證,橫犯脾胃。5)陽(yáng)明熱盛證。除了典型的少陽(yáng)熱證以外,還出現(xiàn)了少陽(yáng)病合并厥陰病、少陰病與陽(yáng)明病等。3.李賽美教授治療慢性乙型病毒性肝炎經(jīng)驗(yàn)總結(jié)。李賽美教授治療的慢性乙型病毒性肝炎的患者,辨證主要以少陽(yáng)病為主,在少陽(yáng)病的基礎(chǔ)上常見(jiàn)肝郁氣滯、肝膽不和、肝郁犯脾、肝膽郁熱、肝腎不足、脾陽(yáng)不足等證。治療方面,以疏肝理氣,健脾益氣為主要治療思路,遵循先治標(biāo)后治本的原則進(jìn)行治療。如患者合并有感冒、嚴(yán)重甲亢或其他疾病時(shí),先治療其它疾病,待癥狀緩解后,再治療慢性乙型病毒性肝炎。常以四逆散合四君子湯作為治療乙型病毒性肝炎的基礎(chǔ)方。在這個(gè)合方的基礎(chǔ)上,針對(duì)患者的證型特點(diǎn)做出加減調(diào)整。具體如下:3.1 辨病辨證綜合分析李賽美教授門(mén)診慢性乙型病毒性肝炎患者辨證,發(fā)現(xiàn)李賽美教授治療慢性乙型病毒性肝炎多從少陽(yáng)證入手,認(rèn)為可分為實(shí)證與虛證兩大類(lèi)。實(shí)證常見(jiàn)肝郁氣滯、肝膽不和、肝郁犯脾、肝膽郁熱。虛證常見(jiàn)肝腎不足、脾陽(yáng)不足。3.2 治法治則李賽美教授治療慢性肝病常用的治法有:疏肝理氣,養(yǎng)血柔肝,活血化瘀,補(bǔ)氣健脾,清熱祛濕,涼血瀉火,溫經(jīng)散寒。3.3 常用處方李賽美教授治療慢性乙肝的常用處方有:小柴胡湯,四逆散,四君子湯,四逆湯,葛根芩連湯,理中丸,桂枝湯,腎四味,半夏瀉心湯,左金丸。3.4 常用中藥及藥對(duì)李賽美教授治療慢性乙肝的常用中藥及藥對(duì)有:柴胡配黃芩,枳實(shí)/枳殼,當(dāng)歸配川芎,茯苓配白術(shù),淫羊藿配仙茅,生地黃配玄參,麥芽配綿茵陳,紅曲配決明子,五味子配田基黃/垂盆草/半枝蓮/半邊蓮,茵陳配澤蘭,白芍配赤芍,防風(fēng)配紫蘇葉。3.5 辨治特色3.5.1 依病情分期論治,主張分清標(biāo)本緩急3.5.2 臟腑同治,強(qiáng)調(diào)治肝不離利膽3.5.3 肝脾腎同治,強(qiáng)調(diào)治肝不忘實(shí)脾補(bǔ)腎3.5.4 疏肝健脾為主,擅用四逆散與四君子湯合方3.5.5 靈活選方,隨癥加減3.5.6 注重心理疏導(dǎo)及病后調(diào)護(hù)3.5.7 動(dòng)靜結(jié)合,護(hù)肝為要,忌濫用藥物本研究對(duì)上述患者的相關(guān)資料進(jìn)行了流行病學(xué)資料探討;基于數(shù)學(xué)屬性偏序結(jié)構(gòu)圖,對(duì)臺(tái)灣澎湖地區(qū)慢性乙型病毒性肝炎患者的證型規(guī)律進(jìn)行了數(shù)據(jù)挖掘;同時(shí),總結(jié)了李賽美教授治療慢性乙型病毒性肝炎的經(jīng)驗(yàn),嘗試對(duì)李賽美教授治療慢性乙肝經(jīng)驗(yàn)做一總結(jié)。研究結(jié)果可為慢性肝病的辨治提供參考,有助于提高慢性肝病的中醫(yī)療效,延緩病程進(jìn)展,提高患者生活質(zhì)量,減輕社會(huì)公共衛(wèi)生負(fù)擔(dān)。
[Abstract]:Objective: through collecting the data of chronic hepatitis B patients in Penghu area of Taiwan, this study carried out preliminary epidemiological analysis on hepatitis B patients in Penghu area of Taiwan from the aspects of sex, age, occupation and family history, and the TCM syndrome type of chronic hepatitis B patients in Penghu area of Taiwan by using the attribute partial sequence diagram. Data mining is carried out to explore the epidemiological and syndrome distribution characteristics of hepatitis B in Penghu area. Secondly, 103 cases of chronic hepatitis B were collected by Professor Li Saimei in the outpatient department, combined with Professor Li Saimei's related papers and the experience of the teacher, summarizing the experience of the treatment of chronic hepatitis B in Professor Li Saimei's outpatient clinic. Treatment of chronic hepatitis B hepatitis by traditional Chinese medicine. Methods: 1. the epidemiological analysis of chronic hepatitis B patients in Penghu area was carried out by simple statistical methods. The data of chronic hepatitis B patients in Penghu area were collected, including age, sex, age of diagnosis, age, history, occupation, family history and so on. Data collection card, collect the information of the collection card, get the original case data sorting table, and carry out simple statistical processing, according to the relevant results, the epidemiological information of chronic hepatitis B patients in Penghu area of Taiwan, Taiwan, is preliminarily summarized, and the chronical structure map of the genus is used to summarize the chronic B in Penghu, Taiwan. Type of TCM syndrome type of viral hepatitis, collected from 2016 to 2017 at the Zhou Guoxiong clinic, accords with the diagnostic criteria of this study, and included the standard data of chronic hepatitis B patients, including name, age, sex, occupation, native place, current history, history, family history and other four medical data, design data collection card, and the pine an Tang traditional Chinese medicine clinic Dr. Lin Zhijian carried out the data collection and arrangement of the patients with chronic hepatitis B. After the original data collection was completed, two researchers were divided into six meridians according to the people's Health Publishing House (Second Edition) and the six meridian syndrome differentiation standard. If there were any discrepancy, third parties were asked to arbitrate. Then the data were standardized, Setting up a database and constructing the background of chronic hepatitis B patients in Penghu area. After optimizing the form background, the MATLAB program is used by special people to load the Microsoft Office Excel 2007, and the data is generated by generating attribute partial sequence structure map to achieve the effect of knowledge visualization..3. is used to summarize the treatment of chronic hepatitis B by Professor Li Saimei. Experience. Collect the standard of Professor Li Saimei for the treatment of chronic hepatitis B, and Professor Li Saimei's lecture on the treatment experience of chronic hepatitis B, this paper, combined with personal experience and experience, summarizes the experience of the treatment of chronic hepatitis B by Li Si Mei teaching. The research content is divided into three parts, the results are as follows: 1. the epidemiological study of viral hepatitis B in Penghu, Taiwan,.1.1 collected 125 cases, and finally included the study of sex composition, age, age, length of disease history, occupation, family history related table.2. in 120 cases of hepatitis B in Penghu region. Using the attribute partial sequence diagram, 125 cases of chronic viral hepatitis B in Penghu area of Taiwan were collected and 125 cases were collected, and the database of TCM syndrome of the patients with hepatitis B in Penghu area was established by 120 cases of.2.2. After treatment, the 48 symptoms of.2.3 in the patients with chronic hepatitis B in the Penghu area of Taiwan were obtained. Partial sequence structure map of TCM syndrome properties of hepatitis B patients in Penghu area.3. professor Li Saimei's experience in the treatment of chronic hepatitis B,.3.1 collects and collects 103 cases of Professor Li Saimei for the treatment of chronic hepatitis B, and finally includes the lectures, papers, and the study of Professor Li Saimei in the treatment of hepatitis B related to Professor Li Saimei. Experience of Professor Li Saimei's experience in the treatment of chronic viral hepatitis B is summarized. Conclusion: 1. epidemiological studies on hepatitis B in Penghu, Taiwan. Epidemiological studies on hepatitis B in Penghu, Taiwan show that male patients occupy a larger proportion of sex, male and female ratio is about 2:1, which may be with men. Sex smoking and drinking more alcohol, damp and hot evil implication, toxic evil connotation, deferred healing, and social pressure is larger, the liver Qi relief bar related to dereliction of duty. The age of medical treatment is mainly concentrated between 40-69 years old, may be related to the period of time after the onset of the corresponding symptoms, as well as the lack of aging. The age of the disease is relatively flat. All age groups are basically involved. Among the patients with a clear age, the age of 20-29 is the highest proportion, which is related to physical examination, examination, and blood donation. This shows that the routine examination of the hepatitis virus has a positive significance for the early detection of hepatitis B virus, early detection and early detection. Late treatment can effectively improve the effect of the treatment, reduce the harm of the disease, save the medical resources and reduce the economic burden of the patients. The length of the medical history is short, the distribution is relative average, all ages are basically involved. The age distribution of the patients with hepatitis B is mainly concentrated between 40-69 years and most of the patients. The detection of hepatitis B hepatitis before the age of 40 shows that the population of hepatitis B virus has an aging trend and that the vaccination of hepatitis B virus is effective. The occupational distribution, the most housekeeping, industry, free industry, reminds the food and health department to pay attention to the management of food hygiene and safety. Besides, the family history: 74 cases of parents or siblings with chronic hepatitis B, accounted for 61.67%.45 patients without family history, accounted for 37.50%, and the family history of 1 patients was unknown. It showed that Penghu region B The incidence of viral hepatitis has a certain familial aggregation, which may be related to close contact with family members. The health department should strengthen the propaganda and popularization of viral hepatitis B and raise the awareness of the people; for the pregnant women suffering from hepatitis B, the corresponding measures should be done to reduce the probability of the vertical transmission of mother and child as far as possible; People with no antibody, especially high risk people, should be inoculated with hepatitis B vaccine as early as possible. For patients who have been suffering from hepatitis B, it is possible to reduce the probability of infection to others by early, active treatment and reduction of the degree of virus replication. On the other hand, it can also help to delay the progress of the course of the disease, reduce the possibility of liver cirrhosis and liver cancer. 2. to summarize the TCM syndrome type of chronic viral hepatitis B in Penghu area of Taiwan by using the attribute partial sequence structure map. According to the structure map of the attribute partial sequence, the following syndrome types are summed up: 1) Shaoyang syndrome, liver fire inflammation, liver qi stagnation syndrome, or heart fire, or blood stasis.2), Shaoyang syndrome, Yang deficiency of spleen and kidney, Yang deficiency cold coagulation and blood stasis syndrome, middle Jiao In addition to the typical Shaoyang heat syndrome, there are also a total of.3. Li SEI's experience in treating chronic viral hepatitis B, such as shaoyang disease combined with Jue yin disease, Shaoyin disease and Yangming disease, etc., in addition to typical Shaoyang heat syndrome. Professor Li seim's treatment of chronic viral hepatitis B in the treatment of.4. Patients are mainly treated with shaoyang disease. On the basis of shaoyang disease, the syndrome of stagnation of liver qi and qi stagnation, liver and gallbladder disharmony, liver depression to make spleen, liver and gallbladder depression, deficiency of liver and kidney, deficiency of Spleen Yang and so on. In the case of other diseases, the treatment of other diseases first, after the symptoms are relieved, and then the treatment of chronic hepatitis B. It is often used as the basis for the treatment of hepatitis B by the four inverse powder and four gentlemen soup. On the basis of this combination, the syndrome characteristics of the patients are added and adjusted. The following: 3.1 syndrome differentiation and syndrome differentiation and comprehensive analysis of Li Saimei Professor Li Saimei's treatment of chronic viral hepatitis B in the outpatient clinic shows that Professor Li Saimei's treatment of chronic hepatitis B mostly from Shaoyang syndrome can be divided into two categories: positive stagnation, liver and gallbladder stagnation, liver and gallbladder disharmony, liver Qi invading the spleen, liver and gallbladder depression, deficiency syndrome common liver and kidney deficiency, and spleen yang deficiency.3.2 treatment of Li Si Mei Teaching The commonly used treatment methods for treating chronic liver disease include: Soothing the liver and nourishing the liver, nourishing blood and removing blood stasis, replenishing qi and invigorating the spleen, clearing away heat and dampness, cooling blood and reducing fire, the commonly used prescription of Professor Li Saimei in the treatment of chronic hepatitis B commonly used by professor Li Saimei, the prescription for treating chronic hepatitis B, are: small Bupleurum soup, four inverse scatter, four gentleman soup, four inverse soup, Gegen Qinlian soup, Lizhong pill, Guizhi soup, four flavors of kidney, Banxia. Xiexin Decoction and Zuo Jin pill.3.4 commonly used traditional Chinese medicine and medicine on Professor Li Saimei's traditional Chinese medicine and medicine for treating chronic hepatitis B: Radix Bupleuri with Scutellaria baicalensis, Fructus aurantii Immaturus / Fructus aurantii Immaturus, Rhizoma Chuanxiong, tuckahoe with white art, Herba Epimedium with cassia root, Radix Rehmanniae with Radix scabra, malt with miosolia, red koji and Ming Zi, and Schisandra chinensis with field base yellow / tub grass / Lusa / Scutellaria / half lotus Chen Peizelan, Radix Paeoniae Alba, Radix Paeoniae Alba and Radix Paeoniae Radix Paeoniae,.3.5 differentiation and treatment of anti wind and perilla leaf treatment characteristic 3.5.1 according to the stage of disease treatment, advocating the separation of specimens and treating the 3.5.2 viscera with the same treatment, emphasizing the treatment of liver, 3.5.3 liver spleen and kidney treatment, emphasizing the treatment of liver and strengthening the spleen, 3.5.4 liver, liver and spleen, and using the four converse powder and the four gentleman decoction combined prescription 3.5.5 flexibly selected prescription 3.5.6 attention was paid to the psychological guidance and the combination of 3.5.7 dynamic and static care after the disease, the liver protection and the abuse of drugs in the study of the related data of the above patients were investigated by epidemiological data. Based on the mathematical attribute partial sequence diagram, data mining of the chronic hepatitis B patients in Penghu area of Taiwan was excavated; meanwhile, This paper summarizes professor Li Saimei's experience in treating chronic hepatitis B and tries to sum up professor Li Saimei's experience in the treatment of chronic hepatitis B. The results can provide reference for the diagnosis and treatment of chronic liver disease, help to improve the curative effect of chronic liver disease, delay the progress of the course of the disease, raise the quality of life of the patients and reduce the burden of social public health.
【學(xué)位授予單位】：廣州中醫(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)】：R249;R259

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