本文關(guān)鍵詞：加味壽胎丸治療肝血虧虛型經(jīng)行頭痛臨床研究　出處：《廣州中醫(yī)藥大學(xué)》2016年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 肝血虧虛 經(jīng)行頭痛 加味壽胎丸 四物湯 臨床研究

【摘要】：經(jīng)行頭痛是一種對(duì)育齡期婦女困擾較大的婦科常見(jiàn)的一種臨床疾病,表現(xiàn)為患者每逢經(jīng)期或行經(jīng)前后出現(xiàn)以頭痛為主要癥狀,經(jīng)后則自愈的一種病癥,其發(fā)作與月經(jīng)期有明顯的相關(guān)性。本病在《張氏醫(yī)通.卷十》有簡(jiǎn)要記載,屬西醫(yī)經(jīng)前期緊張綜合征的范疇,西醫(yī)學(xué)一般按神經(jīng)性頭痛治療,也稱其為“月經(jīng)性偏頭痛”。隨著社會(huì)的變遷,對(duì)女性的各項(xiàng)要求越來(lái)越多,所承受壓力也越來(lái)越大,經(jīng)行頭痛的發(fā)病率也日益增高,由于本病反復(fù)發(fā)作,治療方法單一,臨床效果差,故日益受到臨床工作者的重視。目的：觀察加味壽胎丸治療肝血虧虛型經(jīng)行頭痛臨床療效。實(shí)驗(yàn)設(shè)立壽胎丸組(實(shí)驗(yàn)組)和四物湯二組(對(duì)照組)。二組患者均治療4個(gè)月經(jīng)周期,治療過(guò)程中詳細(xì)的記錄二組受試患者的臨床資料,對(duì)比二組患者治療前后及組間治療后的頭痛綜合計(jì)分法評(píng)分、頭痛指數(shù)、臨床生物指標(biāo)和總有效率和不良情緒評(píng)分情況,通過(guò)臨床研究,期望能為治療經(jīng)行頭痛探索出一種,療效好、療程短、副作用少的新方法,為老藥新用提供新的可能性,為臨床提供科學(xué)依據(jù)。方法：門診收集肝血虧虛型經(jīng)行頭痛患者60例,以隨機(jī)單盲為原則,以簡(jiǎn)單隨機(jī)的方法,將患者分為兩組。實(shí)驗(yàn)組30例,服用加味壽胎丸。對(duì)照組30例,服用四物湯治療。運(yùn)用頭痛評(píng)分綜合評(píng)分法、頭痛指數(shù)法評(píng)價(jià)患者頭痛程度和情況；運(yùn)用焦慮自評(píng)量表(Self-Rating Anxiety Scale SAS)和抑郁自評(píng)量表(Self-rating depression scale, SDS)對(duì)患者進(jìn)行評(píng)測(cè)；檢測(cè)治療前后患者血漿β-EP(人β內(nèi)啡肽)、NO、 ET-1及血清PGF2 α、PGE2的含量變化。以判別兩種方藥對(duì)肝血虧虛型經(jīng)行頭前的治療效果情況,并初步探索方藥的作用機(jī)制。結(jié)果：1.加味壽胎丸實(shí)驗(yàn)組和四物湯對(duì)照組兩組病人患病年齡、病程、頭痛程度等一般情況在實(shí)驗(yàn)開始前比較沒(méi)有統(tǒng)計(jì)學(xué)意義,即兩組病人具有可比性。(表1)2.實(shí)驗(yàn)前兩組患者頭痛程度＼頭痛綜合評(píng)分?jǐn)?shù)＼頭痛指數(shù)比較均沒(méi)有統(tǒng)計(jì)學(xué)差異,提示兩組病人病情相當(dāng),具有可比性。(表2、表3)3.綜合療效(表4)顯示加味壽胎丸組治愈18例；好轉(zhuǎn)8例；未愈4例；總有效率達(dá)86.67%；四物湯組治愈10例；好轉(zhuǎn)12例；未愈8例；總有效率達(dá)73.33%。4.加味壽胎丸實(shí)驗(yàn)組和四物湯對(duì)照組綜合療效總有效率比較經(jīng)統(tǒng)計(jì)學(xué)分析P0.05,提示有統(tǒng)計(jì)學(xué)意義。提示加味壽胎丸組的總療效優(yōu)于四物湯。(表4)5.兩組患者治療后實(shí)驗(yàn)組嚴(yán)重頭痛0例,中度頭痛2例,輕度頭痛18例,無(wú)頭痛10例,對(duì)照組嚴(yán)重頭痛2例,中度頭痛12例,輕度頭痛15例,無(wú)頭痛1例,兩組治療后頭痛程度比較經(jīng)Ridit分析u=2.059,P=0.043。提示兩組患者治療后頭痛程度有明顯差異,實(shí)驗(yàn)組療效優(yōu)于對(duì)照組。(表5)6.實(shí)驗(yàn)組患者治療前嚴(yán)重頭痛9例,中度頭痛18例,輕度頭痛3例,無(wú)頭痛0例,治療后嚴(yán)重頭痛0例,中度頭痛2例,輕度頭痛18例,無(wú)頭痛10例,實(shí)驗(yàn)組治療前后頭痛程度比較經(jīng)Ridit分析u=1.945,P=0.032。提示實(shí)驗(yàn)組患者治療前后頭痛程度有明顯差異,治療后頭痛程度減輕。(表6)7.治療前對(duì)照組嚴(yán)重頭痛7例,中度頭痛19例,輕度頭痛4例,無(wú)頭痛0例,治療后嚴(yán)重頭痛2例,中度頭痛12例,輕度頭痛15例,無(wú)頭痛1例,對(duì)照組治療前后頭痛程度比較經(jīng)Ridit分析u=3.172,P=0.0473。提示實(shí)驗(yàn)組患者治療前后頭痛程度有明顯差異,治療后頭痛程度明顯減輕。(表7)8.兩組患者的頭痛計(jì)分法綜合評(píng)分比較經(jīng)過(guò)統(tǒng)計(jì)學(xué)分析,提示加味壽胎丸實(shí)驗(yàn)組治療前后評(píng)分有統(tǒng)計(jì)學(xué)差異((P0.05))；四物湯對(duì)照組治療前后評(píng)分比較也有統(tǒng)計(jì)學(xué)差異((P0.05))。加味壽胎丸組和四物湯組治療后評(píng)分均降低。兩組評(píng)分組間比較治療前無(wú)明顯差異,治療后兩組評(píng)分有差異((P0.05))。提示治療后實(shí)驗(yàn)組評(píng)分低于對(duì)照組評(píng)分,實(shí)驗(yàn)組效果更好。(表8)9.兩組患者的頭痛指數(shù)經(jīng)過(guò)統(tǒng)計(jì)學(xué)分析,提示實(shí)驗(yàn)組治療前后評(píng)分有顯著性差異((P0.05))；對(duì)照組治療前后評(píng)分比較也有顯著性差異((P0.05))。兩組治療后頭痛指數(shù)均降低。兩組評(píng)分組間比較治療前無(wú)明顯差異,治療后兩組評(píng)分有差異((P0.05))。提示治療后實(shí)驗(yàn)組評(píng)分低于對(duì)照組評(píng)分,實(shí)驗(yàn)組效果更好。(表9)10. 兩組病人SDS量表評(píng)分(表10)兩組病人SDS量表評(píng)分實(shí)驗(yàn)前比較結(jié)果無(wú)顯著性差異(t=0.378,P=0.797),實(shí)驗(yàn)后兩組比較結(jié)果有顯著性差異(t=2.215,P=0.027)。兩組病人SDS量表評(píng)分實(shí)驗(yàn)前、后比較,實(shí)驗(yàn)組實(shí)驗(yàn)前后比較(t=3.791,P0.001)有顯著性差異；對(duì)照組實(shí)驗(yàn)前后(t=0.423,P=0.618)無(wú)統(tǒng)計(jì)學(xué)差異。提示加味壽胎丸對(duì)改善經(jīng)行頭痛患者抑郁癥狀有效。11.加味壽胎丸組和四物湯組兩組病人SAS量表評(píng)分實(shí)驗(yàn)前比較結(jié)果無(wú)統(tǒng)計(jì)學(xué)差異。實(shí)驗(yàn)后比較有統(tǒng)計(jì)學(xué)差異。兩組病人SAS量表評(píng)分實(shí)驗(yàn)前、后比較,實(shí)驗(yàn)組實(shí)驗(yàn)前后比較(t=3.985 P0.001)有統(tǒng)計(jì)學(xué)差異；對(duì)照組實(shí)驗(yàn)前后比較(t=1.052,P=0.376)無(wú)統(tǒng)計(jì)學(xué)差異。提示加味壽胎丸能緩解經(jīng)行頭痛患者焦慮癥狀。(表11)12.兩組病人生化指標(biāo)檢測(cè)結(jié)果顯示(表12、13、14、15、16、17),經(jīng)過(guò)統(tǒng)計(jì)學(xué)分析,實(shí)驗(yàn)組治療前后PGF2 α、PGE2、PGF2α/PGE2、β-E P、NO、ET-1有顯著性差異((P0.05))；對(duì)照組治療前后PGF2 α、PGE2、PGF2 α/PGE2、β-E P、NO、ET-1比較有顯著性差異((P0.05))。兩組PGF2 α、PGE2、PGF2 α/PGE2、β-E P、NO、ET-1組間比較治療前無(wú)明顯差異,治療后兩組PGF2 α、PGE2、PGF2 α/PGE2、β-E P、NO、 ET-1有差異((P0.05))。結(jié)論：1.實(shí)驗(yàn)中中藥治療肝血虧虛型經(jīng)行頭痛,加味壽胎丸組總有效率為86.67%,四物湯組總有效率為73.33%,經(jīng)統(tǒng)計(jì)學(xué)分析兩者有統(tǒng)計(jì)學(xué)差別。提示加味壽胎丸的總療效優(yōu)于四物湯。2.比較治療前后肝血虧虛型經(jīng)行頭痛患者的頭痛指數(shù)、頭痛計(jì)分法綜合計(jì)分,加味壽胎丸和四物湯都具有明顯的降低作用,提示頭痛相關(guān)癥狀的改善。而加味壽胎丸治療效果更優(yōu)。3.加味壽胎丸和四物湯對(duì)肝血虧虛型經(jīng)行頭痛患者焦慮、抑郁的影響,提示兩方均有不同程度的改善患者焦慮、抑郁的作用,加味壽胎丸效果更明顯。4.從兩組患者生化指標(biāo)檢測(cè)結(jié)果來(lái)看,加味壽胎丸和四物湯兩方服用4個(gè)月經(jīng)周期后,兩組患者血漿ET-1、血清PGF2 α含量及PGF2 α/PGE2比值均降低,血漿β-EP及血清PGE2、 NO含量均提高。說(shuō)明兩方均對(duì)肝血虧虛型經(jīng)行頭痛患者血漿β-EP、ET-1,血清PGF2、PGE2、NO的含量進(jìn)行有益的調(diào)節(jié),改善經(jīng)行頭痛患者體內(nèi)異常的內(nèi)分泌情況,同時(shí)還能調(diào)節(jié)患者體內(nèi)神經(jīng)激素和血管活性物質(zhì)的水平,以達(dá)到恢復(fù)頭部血管的舒縮平衡而緩解頭痛。實(shí)驗(yàn)證明加味壽胎丸能更好調(diào)節(jié)患者體內(nèi)神經(jīng)內(nèi)分泌系統(tǒng)。經(jīng)行頭痛是臨床常見(jiàn)的一種婦科疾病,治療類似于西醫(yī)“月經(jīng)性偏頭痛”。目前其發(fā)病機(jī)制尚不完全明了,西醫(yī)治療本病常用的有性激素類藥物、鈣通道阻滯劑、鎮(zhèn)靜止痛劑等,多是對(duì)癥治療,雖然在短時(shí)間內(nèi)有一定的療效,但不良反應(yīng)多,復(fù)發(fā)率也高,長(zhǎng)期療效不理想。中醫(yī)藥治療經(jīng)行頭痛方法多樣,中藥、針灸及耳穴貼壓、足療等,均體現(xiàn)了中醫(yī)傳統(tǒng)療法的特色,療效確切。相反中醫(yī)治療本病極具特色,能達(dá)到減輕臨床癥狀、縮短治療時(shí)間、降低治療經(jīng)費(fèi)等西藥無(wú)法達(dá)到的效果,因此中醫(yī)治療經(jīng)行頭痛必然具有廣泛前景。加味壽胎丸從名方壽胎丸加減而來(lái),易為臨床工作者掌握,且療效明顯,為名方新用開拓了思路。
[Abstract]:Menstrual headache is a common clinical disease of gynecologic women, which is more common in women of childbearing age. It is manifested by a headache which is the main symptom of menstruation or menstruation. It is a symptom of self-healing after menstruation, and its seizure is significantly correlated with menstrual period. This disease is recorded in Zhang Shi Tong Tong, volume ten. It belongs to the category of premenstrual tension syndrome in western medicine. Western medicine is usually treated by neuropathic headache, also known as "menstrual migraine". With the change of society, more and more women are required, and the pressure is increasing. The incidence of headache in menstrual cycle is also increasing. Due to the recurrent attack of this disease, the treatment method is single, and the clinical effect is poor. Therefore, it is receiving more and more attention from clinical workers. Objective: To observe the effect of modified Shoutai Pill in the treatment of liver blood deficiency of the headache clinical curative effect. The experiment set up the two groups (control group) of Shou Tai pill group (experimental group) and Siwu Decoction. Two groups of patients were treated for 4 menstrual cycles, detailed records of the two groups of subjects in the course of treatment in patients with clinical data, were compared between two groups before and after treatment and between group headache score method score after treatment, headache index, clinical and biological indicators of the total efficiency and adverse emotional score, by clinical study. Hope for the treatment of menstrual headache to explore a good curative effect, short course of treatment and less side effects of the new method for the new use of old drugs to provide new possibilities, to provide scientific basis for clinical. Methods: Outpatient collected liver blood deficiency menstrual headache in 60 patients, using random single blind principle, using simple random method, the patients were divided into two groups. In the experimental group, 30 cases were taken with Jiawei Shou Tai pill. 30 cases in the control group were treated with Siwu Decoction. By using the comprehensive score method, headache, headache score index of headache degree and condition; using the self rating Anxiety Scale (Self-Rating Anxiety Scale SAS) and self rating Depression Scale (Self-rating depression scale, SDS) for evaluation of patients; patients were detected before and after treatment of plasma beta -EP (human beta endorphin), change the contents of NO, ET-1 and serum PGF2, PGE2. In order to distinguish two kinds of prescription on liver blood deficiency by head treatment effect, mechanism of action and explore the prescription. Results: 1., there were no statistical differences in the age, course of disease and headache degree between the two groups of the Shou Tai pill experimental group and Siwu Decoction control group. There was no statistically significant difference between the two groups before the experiment. (Table 1) of 2. patients in the two groups before the experiment, the headache headache degree comprehensive evaluation scores and headache index were no statistically significant differences between the two groups of patients, suggesting that the disease is comparable. (Table 2, table 3) 3. (Table 4) shows the comprehensive curative effect of modified Shoutai Pill group 18 cases were cured; 8 cases improved; 4 cases failed; the total effective rate was 86.67%; Siwu Decoction group 10 cases were cured; 12 cases improved; 8 cases ineffective; the total effective rate was 73.33%. The total effective efficiency of the 4. Jiawei pill experimental group and the Siwu Decoction control group was statistically analyzed with statistical analysis of P0.05, suggesting a statistical significance. It is suggested that the total effect of Jiawei Shou Tai pill group is better than that of Siwu Decoction. 5. (4) 5.. Two groups of patients after treatment, severe headache in the experimental group 0 cases, moderate headache in 2 cases, mild headache in 18 cases, no headache in 10 cases, control group, severe headache in 2 cases, moderate headache in 12 cases, mild headache in 15 cases, no headache in 1 cases, and the headache degree after treatment in the 1 group was analyzed by Ridit u=2.059. It is suggested that there is a significant difference in the degree of headache after treatment in the two groups, and the effect of the experimental group is better than that of the control group. 6. (Table 5) 6.. In the experimental group, 9 cases had severe headache before treatment, 18 cases had moderate headache, 3 cases had mild headache, 0 cases had no headache, 0 cases had severe headache after treatment, 2 cases had moderate headache, 18 cases had mild headache, and 10 cases had no headache. The headache degree before and after treatment in the experimental group was analyzed by Ridit u=1.945. It was suggested that there was a significant difference in the degree of headache before and after treatment in the experimental group, and the degree of headache after treatment was reduced. (6) 7. before treatment, there were 7 cases of severe headache, 19 cases of moderate headache, 4 cases of mild headache, 0 cases without headache, 2 cases of severe headache after treatment, 12 cases of moderate headache, 15 cases of mild headache, and 1 cases without headache. The headache degree in control group was analyzed by Ridit analysis u=3.172, P= 0.0473. It was suggested that the degree of headache before and after treatment in the experimental group was significantly different, and the degree of headache after treatment was obviously reduced. (Table 7) 8.. The two groups of patients with headache score scoring system were statistically analyzed. The results showed that there was a significant difference in the scores before and after treatment in the experimental group (P0.05). There was also a significant difference in scores between Siwu Decoction group and control group (P0.05). The score of Jiawei Shou Tai pill group and Siwu Decoction group decreased after treatment. There was no significant difference between the two groups before treatment, and there was a difference between the two groups after treatment (P0.05). The score of the experimental group was lower than that of the control group after treatment, and the effect of the experimental group was better. (Table 8) 9.. The headache index of two groups was statistically analyzed, indicating that there was a significant difference in the score before and after treatment (P0.05), and there was a significant difference in the score before and after treatment in the control group (P0.05). The headache index decreased after treatment in the two groups. There was no significant difference between the two groups before treatment, and there was a difference between the two groups after treatment (P0.05). The score of the experimental group was lower than that of the control group after treatment, and the effect of the experimental group was better. (Table 9) 10., two groups of patients SDS scale score (table 10), two groups of patients SDS scale score before the experiment, there was no significant difference between the two groups (t=0.378, P=0.797). There was a significant difference between the two groups after the experiment (t=2.215, P=0.027). Two groups of patients SDS scale score before and after the experiment, compared with the experimental group before and after the experiment (t=3.791, P0.001), there was a significant difference; the control group before and after the experiment (t=0.423, P=0.618) had no statistical difference. It is suggested that Jiawei Shou Tai pill is effective in improving the depressive symptoms of the patients with menstrual headache. The results of the SAS scale score of the two groups of 11. modified Shou Tai pill group and Siwu Decoction group were not statistically significant before the experiment.
【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】：2016
【分類號(hào)】：R271.115

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