本文關(guān)鍵詞：加減連樸飲治療濕熱中阻型反流性食管炎的理論與應(yīng)用研究　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 反流性食管炎 濕熱中阻型 加減連樸飲 用藥規(guī)律 理論研究 臨床研究

【摘要】：目的通過整理、挖掘古今反流性食管炎相關(guān)文獻(xiàn)和臨床隨機(jī)對照研究,探析古代治療吐酸、嘈雜與現(xiàn)代治療濕熱中阻型反流性食管炎方劑的用藥規(guī)律,尋求加減連樸飲組方依據(jù),并觀察加減連樸飲治療濕熱中阻型反流性食管炎的臨床療效,探討其可能作用機(jī)制。方法第一部分理論研究:通過搜集、整理、歸納相關(guān)文獻(xiàn),并對古代149首治療吐酸、嘈雜與現(xiàn)代52首治療濕熱中阻型反流性食管炎的方劑用藥進(jìn)行頻次、頻率統(tǒng)計及關(guān)聯(lián)規(guī)則分析。第二部分臨床研究:將60例濕熱中阻型反流性食管炎患者隨機(jī)分為治療組與對照組各30例。兩組均以奧美拉唑為基礎(chǔ)治療,治療組加用加減連樸飲,對照組加用莫沙必利分散片,療程8周。觀察治療前后臨床癥狀積分、內(nèi)鏡下食管炎癥程度及膽汁反流情況、血漿胃動素及前列腺素E2水平等。結(jié)果(1)反流性食管炎宜歸入中醫(yī)學(xué)吐酸、嘈雜范疇,中醫(yī)或中西醫(yī)結(jié)合治療均有較好效果。(2)古代149首方劑研究顯示:補虛藥頻率最高(17.64%),其次為理氣藥(15.70%)、祛濕藥(15.61%)、清熱藥(12.93%)、溫里藥(11.36%)、化痰止咳平喘藥(8.86%),累計頻率82.10%,是治療"嘈雜""吐酸"的主要藥類。使用頻次大于8的常用31味藥物中(大于30的藥物可組成二術(shù)二陳湯和左金丸),頻率最高的是陳皮(8.49%);藥性中溫性(51.49%)明顯高于平性(19.46%)、寒性(12.78%);藥味以辛(37.03%)、苦(31.09%)味居多,其次是甘(19.91%)味;歸經(jīng)以入脾經(jīng)(27.97%)、胃經(jīng)(21.90%)居多,其次是肺經(jīng)(13.88%)、心經(jīng)(10.72%);支持度最高的二聯(lián)藥對為茯苓-陳皮(30.87%),三聯(lián)藥對為半夏黃連-陳皮。(3)現(xiàn)代52首方劑研究顯示:清熱藥頻率最高(19.10%),其次為補虛藥(15.45%)、化痰止咳平喘藥(14.06%)、理氣藥(12.15%)、祛濕藥(10.07%)、解表藥(7.99%),累計頻率78.82%,是治療濕熱中阻型反流性食管炎的主要藥類。使用頻次大于4的常用32味藥物中(頻次大于20的藥物可組成左金丸和小柴胡加茯苓湯),頻率最高的是黃連(6.60%);藥性中以溫性(29.14%)和寒性(28.04%)居多,其次是平性(16.34%)、微寒(12.28%);藥味以苦味(40.30%)居多,其次是辛(26.27%)、甘(15.41%)味;歸經(jīng)以入脾經(jīng)(21.78%)、胃經(jīng)(20.80%)居多,其次是肺經(jīng)(14.78%)、肝經(jīng)(10.78%);支持度最高的二聯(lián)藥對為黃連-吳茱萸(48.08%),三聯(lián)藥對為吳茱萸半夏-黃連。(4)臨床研究顯示:治療前后兩組內(nèi)鏡積分比較均具有差異性(P0.05);兩組內(nèi)鏡下食管炎癥療效比較治療組優(yōu)于對照組,具有差異性(P0.05);治療前兩組癥狀積分比較無差異性,治療后兩組癥狀積分比較具有差異性,治療組優(yōu)于對照組(P0.05);兩組中醫(yī)證候療效比較治療組優(yōu)于對照組,具有差異性(P0.05);治療組治療后血漿胃動素和前列腺素E2水平明顯升高優(yōu)于對照組,具有顯著差異性(P0.01);治療組治療后胃鏡下膽汁消失率優(yōu)于對照組,具有差異性(P0.05)。結(jié)論(1)古代治療吐酸、嘈雜方劑主要以辛溫、苦溫,歸脾、胃經(jīng),具理氣化濕,健脾和胃功效的藥味配伍組方,可體現(xiàn)"祛濕"兼以"補益"首要治法的應(yīng)用;現(xiàn)代治療濕熱中阻型反流性食管炎方劑主要以苦溫、苦寒,歸脾、胃經(jīng),具清熱瀉火,燥濕化痰,調(diào)肝和胃功效的藥味配伍組方,可體現(xiàn)"清熱"兼以"調(diào)肝"首要治法的應(yīng)用。(2)加減連樸飲組方有據(jù),與古代治療吐酸、嘈雜與現(xiàn)代治療濕熱中阻型反流性食管炎方劑用藥規(guī)律基本一致,為臨床治療濕熱中阻型反流性食管炎的有效方劑,其作用機(jī)制可能與增加胃動力、減少膽汁反流、調(diào)節(jié)胃腸激素等有關(guān)。
[Abstract]:By sorting, mining ancient literature of reflux esophagitis and randomized controlled clinical study, treatment of drug laws of ancient spit acid, noisy and modern treatment of damp heat type of reflux esophagitis and seek prescriptions, with lianpuyin prescription basis, and to observe the clinical effect of addition and subtraction with lianpuyin resistance type reflux esophagitis in the treatment of damp heat, to investigate its possible mechanism. Methods Part One: theoretical research: through collecting, sorting out and summarizing related literatures, we analyzed the frequency, frequency and association rules of 149 ancient prescriptions used for the treatment of vomiting, sour and modern 52 treatments for damp heat reflux esophagitis. The second part of the clinical study: 60 cases of dampness and heat resistance reflux esophagitis were randomly divided into 30 cases in the treatment group and the control group. Two groups were given omeprazole based therapy, the treatment group was treated with modified Lianpu decoction, the control group was treated with Mosapride, treatment for 8 weeks. The score of clinical symptoms, the degree of endoscopic esophagitis and bile reflux, plasma motilin and prostaglandin E2 were observed before and after treatment. Results (1) reflux esophagitis should be classified as acidity and noise in traditional Chinese medicine. The combination of traditional Chinese medicine or traditional Chinese and Western medicine has good effect. (2) 149 ancient prescriptions research shows that: the tonic the highest frequency (17.64%), followed by Qi medicine (15.70%), (15.61%), clearing heat and eliminating dampness medicine medicine (12.93%), warm in medicine (11.36%), Huatanzhike asthma drugs (8.86%), the cumulative frequency of 82.10%, is the treatment of "noisy" "the main drugs spit acid. The frequency of use is greater than 8 of the 31 drugs commonly used in (which can be composed of two of two Tang and Zuo Jinwan more than 30 drugs), is the highest frequency (8.49%) of temperature; peel resistance (51.49%) was significantly higher than that of the flat (19.46%), cold (12.78%); according to Xin (37.03%), bitter (31.09%) taste mostly, followed by sweet taste; (19.91%) go through to the spleen and stomach (27.97%) (21.90%) the majority, followed by lung (13.88%), heart (10.72%); the highest degree of support for the two drug - Fuling Chenpi (30.87%), the triple drug of Pinellia Rhizoma Coptidis tangerine peel. (3) 52 prescriptions of modern research shows that the highest frequency of heat clearing drugs (19.10%), followed by tonic medicine (15.45%), Huatanzhike asthma drugs (14.06%), Qi medicine (12.15%), (10.07%), Qushi medicine jiebiao drugs (7.99%), the cumulative frequency of 78.82%, is the main treatment of drug resistance type of reflux esophagitis in damp heat. The frequency of use is greater than 4 of the 32 drugs commonly used in (more than 20 times the drug can be composed of Zuojinwan and Xiao Chaihu plus Fuling decoction, Coptis chinensis) is the highest frequency (6.60%); resistance to temperature (29.14%) and cold (28.04%) majority, followed by flat (16.34%), cold (12.28%); (40.30%) the majority of bitter herbs, followed by Xin (26.27%), (15.41%) sweet taste; go through to the spleen and stomach (21.78%) (20.80%) the majority, followed by lung (14.78%), liver (10.78%); support the highest degree of the two drug for Coptis Wu Zhu: (48.08%), the triple drug for Evodia Pinellia Rhizoma coptidis. (4) clinical study showed: two groups before and after treatment were compared with endoscopic integral difference (P0.05); two groups of curative effect of endoscopic esophageal inflammation treatment group than the control group, with the difference (P0.05); the two groups before treatment symptom scores have no difference between the two groups after treatment, symptom scores compared with the differences, the treatment group than the control group (P0.05); two groups of TCM syndrome curative effect comparison of treatment group than the control group, with the difference (P0.05); the treatment group after treatment of plasma motilin and prostaglandin E2 levels were significantly higher than the control group, with significant difference (P0.01); after treatment, endoscopic bile disappearance rate better than the control group, with differences (P0.05). Conclusion (1) treatment of ancient prescription mainly to spit acid and noisy pungent and bitter temperature, spleen and stomach qi, with wet ingredients, compatibility of the spleen and stomach function, can reflect the "dampness" and "application to benefit" the main treatment method; resistance type reflux treatment of damp heat in the modern food hydrosalpinx2 prescription mainly to the bitter and warm, bitter cold, spleen and stomach, with clearing heat and dampness and phlegm, medicine prescription regulating liver and stomach function, can reflect the "heat" and "Application of regulating liver" primary treatment. (2) modified with lianpuyin prescription according to the treatment, and the ancient and modern treatment of spit acid, a damp heat type reflux esophageal inflammation prescription drug laws are basically consistent, effective prescriptions for the clinical treatment of damp heat in the resistance type of reflux esophagitis, its mechanism may be associated with increased gastric motility and reduce bile reflux flow, regulate gastrointestinal hormone and so on.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 周玉蘭,王尚勇;消渴病(糖尿病)濕熱中阻型治療研究[J];北京中醫(yī);2002年02期

2 郭勇;江海松;;陳意治療濕熱中阻的經(jīng)驗[J];世界中醫(yī)藥;2007年04期

3 覃光地;毛德文;龍富立;周陽紅;邱華;張榮臻;黃鴻娜;;解毒飲治療濕熱中阻型慢性乙型肝炎療效觀察[J];遼寧中醫(yī)藥大學(xué)學(xué)報;2009年11期

4 呂安定;;自擬藿佩湯治療濕熱中阻型糖尿病30例臨床觀察[J];北京中醫(yī)藥;2012年10期

5 王成德;濕熱中阻臨床辨證論治體會[J];陜西中醫(yī);1985年03期

6 陳曉蓉;陸云飛;王江蓉;陳建杰;;序貫療法治療濕熱中阻型慢性乙型肝炎臨床觀察[J];肝臟;2006年05期

7 陳旭;;枳術(shù)顆粒治療濕熱中阻型胃潰瘍隨機(jī)平行對照研究[J];實用中醫(yī)內(nèi)科雜志;2014年04期

8 于大猛;孫成棟;路文軍;任福軍;司國英;;夏連薏英湯逆轉(zhuǎn)慢性萎縮性胃炎癌前病變濕熱中阻型臨床研究[J];中華中醫(yī)藥學(xué)刊;2008年12期

9 蘇玲;李春穎;尚曉玲;;從三焦論治胃痛(濕熱中阻型)臨床驗案探析[J];北京中醫(yī)藥大學(xué)學(xué)報(中醫(yī)臨床版);2006年03期

10 管小江,田米娜,葉航,邊東達(dá);藏茵陳片治療濕熱中阻型慢性肝炎54例[J];中西醫(yī)結(jié)合肝病雜志;1999年02期

相關(guān)重要報紙文章 前2條

1 ;濕熱中阻致胃寒[N];中國中醫(yī)藥報;2013年

2 崔軍;口膩分型治[N];醫(yī)藥養(yǎng)生保健報;2008年

相關(guān)碩士學(xué)位論文 前6條

1 顧瑋;加減連樸飲治療濕熱中阻型反流性食管炎的理論與應(yīng)用研究[D];南京中醫(yī)藥大學(xué);2017年

2 吳麗;梔葜湯治療濕熱中阻型慢性乙型肝炎的臨床研究[D];福建中醫(yī)學(xué)院;2005年

3 顧玲;膽胃寧顆粒對濕熱中阻型胃潰瘍的治療作用及EGF、PGE_2含量的影響[D];南京中醫(yī)藥大學(xué);2014年

4 郭芳宏;慢性乙肝中醫(yī)濕熱中阻、肝郁脾虛、瘀血阻絡(luò)證蛋白質(zhì)組學(xué)初步研究[D];瀘州醫(yī)學(xué)院;2010年

5 張艷彬;清化調(diào)胃飲治療幽門螺桿菌相關(guān)淺表性胃炎（濕熱中阻型）臨床研究[D];山東中醫(yī)藥大學(xué);2011年

6 李金菊;HBeAg陰性慢性乙肝證型分布及與HBVDNA定量的關(guān)系[D];廣州中醫(yī)藥大學(xué);2007年

，

本文編號：1346864