本文關(guān)鍵詞：溫膽湯加減治療脾虛濕熱型胃痞病的臨床觀察　出處：《廣州中醫(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： 溫膽湯 功能性消化不良 胃痞 脾虛濕熱 臨床觀察

【摘要】：背景祖國(guó)醫(yī)學(xué)對(duì)于胃痞的認(rèn)識(shí)始于《黃帝內(nèi)經(jīng)》,經(jīng)過(guò)千年的實(shí)踐,對(duì)于痞滿的明確的定義為:自覺(jué)心下痞塞,胸膈脹滿,觸之無(wú)形,按之柔軟,壓之無(wú)痛。按部位區(qū)分,則胃痞一病當(dāng)指心下痞�，F(xiàn)代醫(yī)學(xué)中的功能性消化不良則在祖國(guó)醫(yī)學(xué)中歸屬胃痞范疇。功能性消化不良是一種臨床上常見(jiàn)的消化系統(tǒng)疾病,其主要癥狀特點(diǎn)可表現(xiàn)為:上腹部疼痛或者不適,上腹部燒灼感,餐后飽脹感或者早飽。根據(jù)羅馬Ⅲ標(biāo)準(zhǔn),可將其分為兩類,一種是稱為餐后不適綜合征;另一種則是上腹痛綜合征。而且近年來(lái)FD的發(fā)病率呈上升趨勢(shì),根據(jù)研究報(bào)道顯示,歐美國(guó)家功能性消化不良人群發(fā)病率達(dá)19%-41%,平均32%;國(guó)內(nèi)為18%-45%,占消化門診的20%-40%。隨著功能性疾病出現(xiàn)身心合病的發(fā)病增長(zhǎng)趨勢(shì),部分患者的功能性消化不良癥狀甚至嚴(yán)重影響其生活質(zhì)量。據(jù)報(bào)道,每年癥狀可嚴(yán)重或持久,從有20-30%的人群有慢性或反復(fù)發(fā)作的消化不良癥狀,而很多臨床醫(yī)師將許多不同的消化道癥狀均視為"消化不良",從而混淆了對(duì)消化不良概念的理解。因此,現(xiàn)代醫(yī)學(xué)在治療功能性消化不良尤其是餐后不適綜合征上存在著臨床難以治愈,患者反復(fù)發(fā)作的難題。現(xiàn)代醫(yī)學(xué)對(duì)于功能性消化不良發(fā)病機(jī)制暫不能明確,且無(wú)特效療法,而中醫(yī)則在幾千年對(duì)胃痞病的辨證論治上積累了豐富的醫(yī)家經(jīng)驗(yàn)和大量醫(yī)書記載,形成了完善統(tǒng)一的理論體系。因此,中醫(yī)藥在治療功能性消化不良上有著自己的特色及優(yōu)勢(shì)。首先在提高臨床治愈率,尤其在緩解上腹疼痛不適、上腹飽脹及早飽等主要癥狀上優(yōu)勢(shì)明顯,其次辨證論治及飲食調(diào)理能明顯降低復(fù)發(fā)率,最后中醫(yī)藥治療功能性消化不良副作用小,且未出現(xiàn)嚴(yán)重的藥物不良反應(yīng)。目的本研究立足廣東嶺南地區(qū),因該地域氣候濕熱,且廣東人群偏愛(ài)"涼茶",濕熱為標(biāo),脾虛為本的體質(zhì)在廣東多見(jiàn),故導(dǎo)致胃痞病以脾虛濕熱型為主。本研究以臨床上治療脾虛濕熱型胃痞病的經(jīng)驗(yàn)方溫膽湯為基礎(chǔ)方進(jìn)行加減,以脾虛濕熱型胃痞病患者為研究對(duì)象,觀察溫膽湯治療脾虛濕熱型胃痞病患者的臨床療效,為臨床治療同類患者提供更好的借鑒思路。方法本研究采用采用隨機(jī)、單盲、對(duì)照的臨床設(shè)計(jì)方法,在廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院消化內(nèi)科鄺衛(wèi)紅教授門診患者中選取符合研究依據(jù)診斷、納入和排除標(biāo)準(zhǔn)的90例脾虛濕熱型胃痞病患者,隨機(jī)分為中藥組、西藥組及中西藥組。納入標(biāo)準(zhǔn):中醫(yī)診斷標(biāo)準(zhǔn)參考高等教育中醫(yī)藥類規(guī)劃教材第六版《中醫(yī)內(nèi)科學(xué)》);西醫(yī)診斷標(biāo)準(zhǔn)參考2006年5月正式發(fā)布的羅馬Ⅲ標(biāo)準(zhǔn)。中藥組治療方案:"溫膽湯加味"基本方:陳皮10g、半夏1Og、竹茹15g、黨參10g、白術(shù)15g、郁金10g、枳實(shí)10g、厚樸10g、紫蘇梗15g,中藥湯劑日1劑,每日150ml,早午飯后1小時(shí)溫服;西藥組:枸櫞酸莫沙必利分散片(新絡(luò)納):由成都康弘藥業(yè)集團(tuán)股份有限公司生產(chǎn),國(guó)藥準(zhǔn)字:H20031110,規(guī)格:5mg/片,一日三次,一次一片,餐前半小時(shí)服用;中西藥組:"溫膽湯"加減聯(lián)合莫沙必利分散片。療程為4周。觀察記錄試驗(yàn)對(duì)象治療前后的癥狀積分情況,以統(tǒng)計(jì)學(xué)方法進(jìn)行分析,評(píng)測(cè)溫膽湯對(duì)于脾虛濕熱型胃痞病患者的療效及安全性。結(jié)果1.本研究共納入符合研究病例90例,因不能堅(jiān)持或失訪脫落2例,無(wú)因藥物不良反應(yīng)退出試驗(yàn)者,共完成臨床觀察88例。2.臨床療效分析:中藥組治愈率24.14%,總有效率86.21%;西藥組治愈率10.34%,總有效率82.76%;中西藥組治愈率30.00%,總有效率96.67%。治愈率方面,中藥組明顯優(yōu)于西藥組,且存在統(tǒng)計(jì)學(xué)差異,而中西藥組則明顯優(yōu)于中藥組及西藥組,并具有統(tǒng)計(jì)學(xué)意義。有效率方面,中藥組同樣明顯優(yōu)于西藥組,且存在統(tǒng)計(jì)學(xué)差異,而中西藥組則明顯優(yōu)于中藥組及西藥組,并具有統(tǒng)計(jì)學(xué)意義。3.癥狀積分方面:對(duì)比治療前后總積分方面,中藥組及中西藥組明顯優(yōu)于西藥組,且具有統(tǒng)計(jì)學(xué)差異,中藥組及中西藥組之間無(wú)統(tǒng)計(jì)學(xué)差異;對(duì)比痞滿、小便短黃、大便稀溏三個(gè)癥狀前后積分,中藥組療效明顯優(yōu)于西藥組,且具有統(tǒng)計(jì)學(xué)差異,中藥組與中西藥組無(wú)明顯差異;對(duì)比噯氣反酸、疲乏無(wú)力、口干口苦、胸悶、喜太息等癥狀,中西藥組明顯優(yōu)于西藥組,且有統(tǒng)計(jì)學(xué)意義;對(duì)比胃痛、飲食減少、惡心嘔吐、胃中嘈雜、身困倦怠等癥狀,三組療效無(wú)明顯差異。結(jié)論1.溫膽湯對(duì)于脾虛濕熱型胃痞病療效確切,并對(duì)痞滿、小便短黃、大便稀溏等癥狀療效明顯,是臨床可行的有效方藥。2.溫膽湯聯(lián)合莫沙必利治療脾虛濕熱型胃痞病療效優(yōu)于單一服用溫膽湯或者單一使用莫沙必利。3.試驗(yàn)過(guò)程中無(wú)藥物不良反應(yīng)現(xiàn)象,溫膽湯加味治療脾虛濕熱型胃痞病安全性高,且能有效防止莫沙必利引起的大便稀溏等癥狀,值得臨床推廣。
[Abstract]:The background of Chinese medicine for the understanding of Weipi in < Neijing >, after thousands of years of practice, in the fullness of clear definition of consciousness: epigastric distention and fullness in chest, plug, touch the invisible pressure according to the soft, painless. According to the site to distinguish, is a disease of Weipi when referring to the heart PI. Functional dyspepsia in modern medicine is attributable to Weipi category in traditional Chinese medicine. Functional dyspepsia is a common clinical digestive system disease, the main symptoms can be expressed as: upper abdominal pain or discomfort, upper abdominal burning sensation, postprandial fullness or early full. According to the Rome criteria, which can be divided into two categories, one is called postprandial distress syndrome; another is epigastric pain syndrome. In recent years, and the incidence rate of FD is rising, according to reports, the European and American countries of functional dyspepsia incidence rate of 19%-41%, an average of 32%; China For 18%-45%, accounting for 20%-40%. with the function of digestive outpatient disease and disease growth trend, part of patients with functional dyspepsia symptoms or even seriously affect the quality of life. It is reported that every year the symptoms can be severe or persistent, 20-30% from people with chronic or recurrent symptoms of dyspepsia, and many clinicians many different gastrointestinal symptoms were regarded as "indigestion", thus confusing the concept of indigestion. Therefore, modern medicine in the treatment of functional dyspepsia postprandial distress syndrome has clinical difficult to cure recurrent problems. Modern medicine for patients with functional dyspepsia the mechanism can not clear, and no specific therapy, and TCM syndrome differentiation in the thousands of years of Weipi disease treatment has accumulated rich experience and a large number of doctors of medical records, formed the end The theoretical system of good unity. Therefore, traditional Chinese medicine in the treatment of functional dyspepsia with their own characteristics and advantages. Firstly, improve the clinical cure rate, especially discomfort in alleviating abdominal pain, abdominal distension and early satiety and other major symptoms of obvious advantages, followed by differentiation of signs and diet can significantly reduce the recurrence the rate of traditional Chinese medicine in the treatment of functional dyspepsia with little side effects, and no severe adverse drug reaction. The purpose of this study is based on Guangdong south of the Five Ridges region, because the region's hot and humid climate, and Guangdong people prefer "herbal tea", as the standard for the damp heat, spleen deficiency constitution is more common in Guangdong, resulting in Weipi disease in the spleen deficiency. The experience of Wendan Decoction based on the treatment of spleen deficiency Weipi disease is modified based, in patients with spleen deficiency Weipi disease as the research object, the observation of Wendan Decoction on spleen deficiency stomach The clinical curative effect of FD patients, to provide reference for the clinical treatment of similar patients better. Methods this study used a randomized, single blind, controlled clinical design method, in the Department of Gastroenterology professor Kuang Weihong outpatient clinic in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were selected in conformity with the study on the basis of diagnosis, inclusion and exclusion criteria, 90 cases of spleen deficiency stomach FD patients were randomly divided into Chinese medicine group, western medicine group and Western medicine group. Inclusion criteria: the diagnostic standard of Chinese medicine higher education reference TCM textbooks sixth edition of < >); Chinese medicine Western medicine diagnosis standard reference May 2006 officially released the Rome III standards. Traditional Chinese medicine treatment group: "Wendan Decoction" 10g 1Og: tangerine peel, pinellia, calamus 15g, dangshen 10g, Atractylodes 15g, Radix Curcumae 10g, orange 10g, Magnolia 10g, perilla 15g decoction, daily 1 agent, 150ml daily, 1 hours a day after breakfast and lunch; Western Medicine Mosapride Citrate Dispersible Tablets group (Xinluona): produced by Limited by Share Ltd Chengdu Kanghong Pharmaceutical Group, Zhunzi: H20031110 specifications: 5mg/ tablets, three times a day, one at a time, half an hour before a meal; western medicine group: "Wendan Decoction" combined with modified Mo will benefit dispersible tablets. The course was 4 weeks. Before and after the treatment of the test object to observe and record the symptom integral situation, analysis by the statistical method, the evaluation of Wendan Decoction for efficacy and safety in patients with spleen deficiency Weipi disease. Results 1. were included in the study of 90 cases, because they can not insist or lost off 2 cases, because no adverse drug reaction out of the test, completed the clinical observation of clinical analysis of 88 cases of.2. in Chinese medicine group, the cure rate was 24.14%, the total efficiency of 86.21%; western medicine group, the cure rate was 10.34%, the total efficiency of 82.76%; the western medicine group the cure rate was 30%, the total efficiency of 96.67%., the cure rate of Chinese medicine. Significantly better than the western medicine group, and there was significant difference, while in the western medicine group was significantly better than the traditional Chinese medicine group and Western medicine group, and has statistical significance. The efficiency of the traditional Chinese medicine group, also significantly better than western medicine group, and there was significant difference, while in the western medicine group was significantly better than the traditional Chinese medicine group and Western medicine group, and has statistical significance.3. symptoms: comparison of total score before and after treatment, traditional Chinese medicine group and Western medicine group was significantly better than the western medicine group, and has statistically significant difference, there was no difference between the traditional Chinese medicine group and Western medicine group; contrast fullness, short yellow urine, stool pond before and after the three symptoms, Chinese medicine group was better than western medicine group, and statistically, the Chinese medicine group and Western medicine group had no significant difference; comparison of fatigue, belching and acid reflux, dry mouth, chest tightness, heave a deep sigh and other symptoms, the western medicine group was significantly better than the western medicine group, and the difference was statistically significant; Comparison of stomach, eating less, nausea and vomiting, noisy stomach, sleepy body fatigue and other symptoms, no significant difference between the three groups. Conclusion 1. Wendan Decoction for spleen deficiency Weipi disease curative effect, and the fullness, short yellow urine, stool pond etc. effect symptoms, is clinically feasible and effective.2. medicine Wendan Decoction combined with Mosapride without adverse drug reaction and treatment of spleen deficiency stomach disease curative effect is better than single PI taking Wendan Decoction or single use of mosapride in the.3. tests, Wendan Decoction in treating spleen deficiency Weipi disease with high safety, and can effectively prevent the mosapride caused loose stool and other symptoms, it is worthy of clinical promotion.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R256.32

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