柴芍四君子湯加味治療功能性便秘（氣虛兼氣滯型）的臨床觀察和實(shí)驗(yàn)研究
發(fā)布時(shí)間：2018-08-05 15:51
【摘要】：目的:功能性便秘是臨床上常見(jiàn)的胃腸道功能障礙性疾病,表現(xiàn)為大便秘結(jié)不通,或排便間隔時(shí)間延長(zhǎng),以及有便意而排出困難等癥。結(jié)合文獻(xiàn)研究和導(dǎo)師在臨床上治療便秘的多年經(jīng)驗(yàn)認(rèn)為慢性功能性便秘中氣虛兼氣滯型便秘常見(jiàn),主要是因?yàn)橐愿斡羝⑻摓楸?治療上以疏肝柔肝、健脾益氣、理氣通便為主要治法,擬"柴芍四君湯加味"治療"氣虛兼氣滯型"便秘。對(duì)功能性便秘進(jìn)行臨床觀察及實(shí)驗(yàn)研究,來(lái)探討"柴芍四君湯加味"對(duì)功能性便秘的治療作用,為臨床上治療功能性便秘提供科學(xué)依據(jù)。方法:1.文獻(xiàn)研究:關(guān)于慢性功能性便秘的中醫(yī)的病因、病機(jī)、辨證施治等,西藥的流行性學(xué)、發(fā)病機(jī)制、治療等,分析總結(jié)其研究規(guī)律。參考其他的試驗(yàn)及臨床研究,根據(jù)我們現(xiàn)在所具有的條件,制定出可以完成且科學(xué)的試驗(yàn)方法。2.臨床研究方法:采用隨機(jī)、對(duì)照方法,將符合功能性便秘的中西醫(yī)診斷標(biāo)準(zhǔn)的患者納入,分成兩組,治療組予以"柴芍四君湯加味"水煎服,對(duì)照組予以莫沙必利口服。觀察"柴芍四君湯加味"對(duì)功能性便秘的臨床療效、治療后癥狀改善療效、兩組治療后改善療效比較。3.實(shí)驗(yàn)研究方法:用饑飽失常、捆綁及過(guò)度的疲勞造出氣虛兼氣秘型小鼠,在其基礎(chǔ)上予以復(fù)方地芬諾酯造出便秘模型。分成正常組、莫沙必利組、模型組、高劑量組、中劑量組、低劑量組,觀察"柴芍四君湯加味"對(duì)小鼠排便功能的影響。結(jié)果:1.臨床研究結(jié)果:通過(guò)中藥組(柴芍四君湯加味)與西藥組(莫沙必利)臨床觀察,"柴芍四君湯加味"的中藥組總有效率為93.33%;"莫沙必利"的西藥組總有效率為86.67%,差異有顯著意義(P0.05)。中藥組及西藥組治療后,其糞便性質(zhì)、排便費(fèi)力、排便間隔時(shí)間、排便時(shí)間、腹脹、胸脅痞滿(mǎn)、噯氣、早飽、情志抑郁九個(gè)積分均比治療前明顯改善(P0.05)。中藥組、西藥組之間比較,在排便間隔時(shí)間、胸脅痞滿(mǎn)、噯氣、早飽、情志抑郁五個(gè)癥狀改善的情況,中藥組比西藥組明顯(P0.05),但糞便性質(zhì)、排便費(fèi)力、排便時(shí)間、腹脹四個(gè)癥狀中藥組與西藥組之間差異治療效果相當(dāng)(P0.05)。從結(jié)果看出,中藥組的療效較西藥組佳。所以對(duì)慢性功能性便秘的治療方面,中醫(yī)藥有較多的特色及優(yōu)勢(shì)。2.實(shí)驗(yàn)研究結(jié)果:(1)小鼠首粒排便時(shí)間來(lái)觀察小鼠的腸蠕動(dòng)情況。結(jié)果顯示:高劑量組、中劑量組、低劑量組、正常組、莫沙必利組灌胃后與模型組比較,均比模型組的首粒黑便排出時(shí)間縮短(P0.01)。而高劑量組與正常組比較,無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),則提示高劑量組可以對(duì)小鼠的腸蠕動(dòng)其到恢復(fù)正常作用。中劑量、低劑量組與正常組比較,具有統(tǒng)計(jì)學(xué)有意義(P0.05),提示中劑量組與低劑量組對(duì)小鼠腸蠕動(dòng)改善情況不如高劑量組。而莫沙必利組與正常組比較,有統(tǒng)計(jì)學(xué)意義(P05),其與中劑量組比較改善效果相當(dāng)。綜上可以得出柴芍四君湯治療便秘,有劑量的依賴(lài),且足夠劑量的中藥組比西藥組效果佳。(2)模型組的第一天、三天、五天分別與正常組比較,黑便粒數(shù)明顯減少,具有統(tǒng)計(jì)學(xué)意義(P0.001)。柴芍四君湯高、中、低劑量在第3-5天與模型組比較,均具有統(tǒng)計(jì)學(xué)意義(PP.01),(P0.05)。而高劑量組在第1天與模型組比較具有統(tǒng)計(jì)學(xué)意義(P0.05)。莫沙必利組與低劑量組對(duì)于小鼠黑便排出粒數(shù)相當(dāng)。綜上可以得出中藥劑量對(duì)小鼠排出的粒數(shù)有影響,且足夠劑量的中藥組比西藥組效果佳。(3)模型組的第一天、三天、五天分別與正常組比較,糞便重量明顯減輕,具有統(tǒng)計(jì)學(xué)意義(P0.01)。柴芍四君湯高、中、低劑量、莫沙必利組在第1、3、5天與模型組比較,均具有統(tǒng)計(jì)學(xué)意義(P0.01)。其高、中、低劑量及莫沙必利組與正常組比較,在第1天有統(tǒng)計(jì)學(xué)意義(P0.05),在第3、5天差異不明顯,無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。莫沙必利組與柴芍四君湯各個(gè)不同劑量組比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。綜上所述,柴芍四君湯及莫沙必利對(duì)小鼠排出糞便重量均有作用,但柴芍四君湯效果優(yōu)于莫沙必利。(4)通過(guò)觀察未排便小鼠數(shù)量顯示:除了正常組小鼠無(wú)未排便外,其他組在造模后均有不同數(shù)量的小鼠未排便。柴芍四君湯高、中、低劑量及莫沙必利組和模型組比較,均有統(tǒng)計(jì)學(xué)意義(P0.05)。從下表可以看出,柴芍四君湯各個(gè)劑量不排便小鼠數(shù)量較少,而且劑量高的明顯,且優(yōu)于莫沙必利組。綜上得出結(jié)論柴芍四君湯高劑量組對(duì)(氣虛兼氣滯型)便秘小鼠的腸蠕動(dòng)改善明顯、黑便粒數(shù)及重量增多、不排便動(dòng)物數(shù)減少。中藥組效果優(yōu)于西藥組。結(jié)論:"柴芍四君湯加味"治療功能性便秘的臨床療效顯著,特別對(duì)"氣虛兼氣秘型"便秘。對(duì)動(dòng)物便秘模型亦有顯著作用,促進(jìn)其排便。該方主要是以柴胡10g,白芍l0g,黨參15g,茯苓15g,白術(shù)15g,枳實(shí)10g,厚樸10g,甘草6g組成。
[Abstract]:Objective: functional constipation is a common gastrointestinal dysfunctional disease in clinic, which is characterized by incompatibility of stool, prolonged interval of defecation, and difficulty in excreting the bowel. Combined with literature study and mentors' years of clinical treatment of constipation, chronic functional constipation is common and common in chronic functional constipation. In the case of liver qi stagnation and spleen deficiency, the main treatment is to dredge the liver and soften the liver, strengthen the spleen and invigorate the Qi, and regulate the Qi Qi Decoction to treat the constipation of "Qi deficiency and qi stagnation". The clinical observation and experimental study of the functional constipation are carried out to explore the therapeutic effect of "Chai Peony four Jun Decoction" on functional constipation, and to treat the clinical work for the treatment of the constipation. Can provide scientific basis for sexual constipation. Methods: 1. literature research: the etiology, pathogenesis, syndrome differentiation and treatment of chronic functional constipation, the epidemic of Western medicine, pathogenesis, treatment and so on, analyze and summarize the research rules. Reference to other experimental and clinical research, according to the conditions we have now, it can be completed and scientific. The method of.2. clinical study: a randomized, controlled method was used to integrate the Chinese and Western medical diagnostic criteria of functional constipation into two groups. The treatment group was treated with the decoction of "Chai Shao four Jun Decoction plus flavour", and the control group was given mosapride. The clinical efficacy of "Chai Peony four Jun Decoction added" to functional constipation and post-treatment symptoms were observed. The curative effect of the two groups improved after treatment compared with the.3. experimental study method: the mice with hunger and satiety, binding and excessive fatigue were made out of qi deficiency and constipation model mice, and on the basis of the compound, the constipation model was made. It was divided into the normal group, the Mosapride group, the model group, the high dose group, the middle dose group, the low dose group, observation "Chai Peony four". The effect of "Jun Tang Jiawei" on the function of mouse defecation. Results: 1. clinical study results: through the clinical observation of Chinese medicine group (Chai Shaosi Jun Decoction plus flavour) and Western medicine group (mosapride), the total effective rate of "Chai Shao four Jun soup added" was 93.33%, and the total effective rate of "mosapride" was 86.67%, the difference was significant (P0.05). After the treatment, the nature of the excrement, defecation, defecation, defecation time, defecation time, abdominal distention, chest coerce full, belching, early satiety, depression nine points were significantly improved than before treatment (P0.05). The comparison between the Chinese medicine group and the western medicine group, in the interval of defecation, chest coerce full, belching, early full, emotion depression five symptoms improvement situation, Chinese traditional medicine, Chinese Medicine Group compared with western medicine group (P0.05), but the nature of feces, feces, defecation, defecation time, abdominal distention between the four symptoms of Chinese medicine group and Western medicine group difference treatment effect is equal (P0.05). From the results, the effect of Chinese medicine group is better than the western medicine group. Therefore, the treatment of chronic functional constipation, traditional Chinese medicine has more characteristics and advantages of.2. experimental research knot Fruit: (1) the time to observe the intestinal peristalsis in mice. The results showed that the high dose group, the middle dose group, the low dose group, the normal group and the mosapride group were compared with the model group, which were shorter than the model group (P0.01). The high dose group was not statistically significant compared with the normal group (P0.05), and the high dose group was higher than the normal group. In the dose group, the intestinal peristalsis could be restored to normal effect. The medium dose and low dose group had statistical significance compared with the normal group (P0.05), suggesting that the intestinal peristalsis in the middle dose group and the low dose group was not as good as the high dose group, but the mosapride group was compared with the normal group (P05), and the ratio was compared with the middle dose group. Compared with the improvement effect, we can conclude that Chai Shao four Jun decoction can treat constipation with a dose of dependence, and enough dose of Chinese medicine group is better than western medicine group. (2) the number of black urine grains decreased significantly on the first day of the model group, three days and five days, respectively, with the statistical significance (P0.001). The middle and low dose of Chai Peony four Jun decoction was in the 3-5 day. Compared with the model group, it was statistically significant (PP.01), (P0.05), while the high dose group had statistical significance with the model group at first days (P0.05). The number of murine excretion particles in the mosapride group and the low dose group was equivalent to the mice. The results showed that the dosage of Chinese medicine had an effect on the number of the mice discharged, and the sufficient dose of Chinese medicine group was more than the western medicine. (3) the first day, three days and five days of the model group were compared with the normal group, and the weight of the stool was significantly reduced, with statistical significance (P0.01). The high, middle, low dose, and the mosapride group were compared with the model group on day 1,3,5 (P0.01). The high, middle, low dose and Mosapride group were compared with the normal group. There was no significant difference between the first days (P0.05) and no significant difference in day 3,5 (P0.05). The difference was statistically significant (P0.05) compared with the different dosage groups of the mosapride group and Chai paehao Decoction (P0.05). In summary, the Chai Shao four Jun Decoction and the mosapride had the effect on the excretion weight of the rats, but the effect of Chai Shao four Tang was better than that of the Chai peony. (4) through the observation of the number of non defecation mice, the number of non defecation mice showed that in addition to the normal group without defecation, the other groups had different amounts of non defecation in the mice after making the model. The higher, middle, low dose, and the mosapride group and the model group were statistically significant (P0.05). From the table below, each dose of Chai Peony four Jun soup could be seen. The number of non defecated mice was less and the dose was higher than that of the mosapride group. The conclusion was that the intestinal peristalsis in the constipation mice (Qi deficiency and qi stagnation) was obviously improved, the number and weight of black stool increased and the number of non defecation decreased. The effect of the Chinese Medicine group was better than that of the western medicine group. Conclusion: the effect of the Chinese medicine group was better than that of the western medicine group. The curative effect of treating functional constipation is remarkable, especially for "Qi deficiency and gas constipation" constipation. It also has significant effect on the constipation model of animal constipation. It is mainly composed of Radix Bupleuri 10g, Paeonia lactiflora L0g, Codonopsis 15g, Poria 15g, Atractylodes macrocephala 15g, Fructus aurantii Immaturus 10g, Magnolia officinalis 10g, licorice 6G.
【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)】：R256.35
本文編號(hào)：2166263
[Abstract]:Objective: functional constipation is a common gastrointestinal dysfunctional disease in clinic, which is characterized by incompatibility of stool, prolonged interval of defecation, and difficulty in excreting the bowel. Combined with literature study and mentors' years of clinical treatment of constipation, chronic functional constipation is common and common in chronic functional constipation. In the case of liver qi stagnation and spleen deficiency, the main treatment is to dredge the liver and soften the liver, strengthen the spleen and invigorate the Qi, and regulate the Qi Qi Decoction to treat the constipation of "Qi deficiency and qi stagnation". The clinical observation and experimental study of the functional constipation are carried out to explore the therapeutic effect of "Chai Peony four Jun Decoction" on functional constipation, and to treat the clinical work for the treatment of the constipation. Can provide scientific basis for sexual constipation. Methods: 1. literature research: the etiology, pathogenesis, syndrome differentiation and treatment of chronic functional constipation, the epidemic of Western medicine, pathogenesis, treatment and so on, analyze and summarize the research rules. Reference to other experimental and clinical research, according to the conditions we have now, it can be completed and scientific. The method of.2. clinical study: a randomized, controlled method was used to integrate the Chinese and Western medical diagnostic criteria of functional constipation into two groups. The treatment group was treated with the decoction of "Chai Shao four Jun Decoction plus flavour", and the control group was given mosapride. The clinical efficacy of "Chai Peony four Jun Decoction added" to functional constipation and post-treatment symptoms were observed. The curative effect of the two groups improved after treatment compared with the.3. experimental study method: the mice with hunger and satiety, binding and excessive fatigue were made out of qi deficiency and constipation model mice, and on the basis of the compound, the constipation model was made. It was divided into the normal group, the Mosapride group, the model group, the high dose group, the middle dose group, the low dose group, observation "Chai Peony four". The effect of "Jun Tang Jiawei" on the function of mouse defecation. Results: 1. clinical study results: through the clinical observation of Chinese medicine group (Chai Shaosi Jun Decoction plus flavour) and Western medicine group (mosapride), the total effective rate of "Chai Shao four Jun soup added" was 93.33%, and the total effective rate of "mosapride" was 86.67%, the difference was significant (P0.05). After the treatment, the nature of the excrement, defecation, defecation, defecation time, defecation time, abdominal distention, chest coerce full, belching, early satiety, depression nine points were significantly improved than before treatment (P0.05). The comparison between the Chinese medicine group and the western medicine group, in the interval of defecation, chest coerce full, belching, early full, emotion depression five symptoms improvement situation, Chinese traditional medicine, Chinese Medicine Group compared with western medicine group (P0.05), but the nature of feces, feces, defecation, defecation time, abdominal distention between the four symptoms of Chinese medicine group and Western medicine group difference treatment effect is equal (P0.05). From the results, the effect of Chinese medicine group is better than the western medicine group. Therefore, the treatment of chronic functional constipation, traditional Chinese medicine has more characteristics and advantages of.2. experimental research knot Fruit: (1) the time to observe the intestinal peristalsis in mice. The results showed that the high dose group, the middle dose group, the low dose group, the normal group and the mosapride group were compared with the model group, which were shorter than the model group (P0.01). The high dose group was not statistically significant compared with the normal group (P0.05), and the high dose group was higher than the normal group. In the dose group, the intestinal peristalsis could be restored to normal effect. The medium dose and low dose group had statistical significance compared with the normal group (P0.05), suggesting that the intestinal peristalsis in the middle dose group and the low dose group was not as good as the high dose group, but the mosapride group was compared with the normal group (P05), and the ratio was compared with the middle dose group. Compared with the improvement effect, we can conclude that Chai Shao four Jun decoction can treat constipation with a dose of dependence, and enough dose of Chinese medicine group is better than western medicine group. (2) the number of black urine grains decreased significantly on the first day of the model group, three days and five days, respectively, with the statistical significance (P0.001). The middle and low dose of Chai Peony four Jun decoction was in the 3-5 day. Compared with the model group, it was statistically significant (PP.01), (P0.05), while the high dose group had statistical significance with the model group at first days (P0.05). The number of murine excretion particles in the mosapride group and the low dose group was equivalent to the mice. The results showed that the dosage of Chinese medicine had an effect on the number of the mice discharged, and the sufficient dose of Chinese medicine group was more than the western medicine. (3) the first day, three days and five days of the model group were compared with the normal group, and the weight of the stool was significantly reduced, with statistical significance (P0.01). The high, middle, low dose, and the mosapride group were compared with the model group on day 1,3,5 (P0.01). The high, middle, low dose and Mosapride group were compared with the normal group. There was no significant difference between the first days (P0.05) and no significant difference in day 3,5 (P0.05). The difference was statistically significant (P0.05) compared with the different dosage groups of the mosapride group and Chai paehao Decoction (P0.05). In summary, the Chai Shao four Jun Decoction and the mosapride had the effect on the excretion weight of the rats, but the effect of Chai Shao four Tang was better than that of the Chai peony. (4) through the observation of the number of non defecation mice, the number of non defecation mice showed that in addition to the normal group without defecation, the other groups had different amounts of non defecation in the mice after making the model. The higher, middle, low dose, and the mosapride group and the model group were statistically significant (P0.05). From the table below, each dose of Chai Peony four Jun soup could be seen. The number of non defecated mice was less and the dose was higher than that of the mosapride group. The conclusion was that the intestinal peristalsis in the constipation mice (Qi deficiency and qi stagnation) was obviously improved, the number and weight of black stool increased and the number of non defecation decreased. The effect of the Chinese Medicine group was better than that of the western medicine group. Conclusion: the effect of the Chinese medicine group was better than that of the western medicine group. The curative effect of treating functional constipation is remarkable, especially for "Qi deficiency and gas constipation" constipation. It also has significant effect on the constipation model of animal constipation. It is mainly composed of Radix Bupleuri 10g, Paeonia lactiflora L0g, Codonopsis 15g, Poria 15g, Atractylodes macrocephala 15g, Fructus aurantii Immaturus 10g, Magnolia officinalis 10g, licorice 6G.
【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)】：R256.35
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