本文關(guān)鍵詞： 胸痹 病位特征 病性特征 辨證規(guī)范 辨證模型　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

【摘要】：研究目的:現(xiàn)如今,關(guān)于胸痹辨證分型的研究成果豐富。國家雖然出臺了胸痹心痛病證的診斷標(biāo)準(zhǔn)與證候分類(附錄1),但其所歸納的6個證型依然無法全面概括臨床中出現(xiàn)的復(fù)雜多變的證候,諸多醫(yī)家仍以其臨證經(jīng)驗加以辨證施治。故難以形成對胸痹辨證施治的統(tǒng)一認知,中醫(yī)對胸痹辨證的標(biāo)準(zhǔn)化尚存在諸多值得探討的地方。本研究在吳承玉教授所建立的藏象辨證理論體系的指導(dǎo)下,通過對胸痹的病名溯源、病因病機以及辨證分型等研究,結(jié)合胸痹患者的基本情況,運用流行病學(xué)調(diào)查等進行統(tǒng)計學(xué)分析,研究胸痹病證的辨證規(guī)律。研究意義:藏象辨證理論體系建立在準(zhǔn)確、規(guī)范的臨床信息的基礎(chǔ)之上,繼而提取病位與病性特征,將病位與病性有機結(jié)合,以形成相對規(guī)范的證。藏象辨證理論體系以"以象測臟,從證辨證"為原則,對臨床實踐中具有復(fù)雜性、善變性的證靈活把握,是對中醫(yī)學(xué)辨證原理與規(guī)律的應(yīng)用與體現(xiàn)。本研究通過對歷代文獻的整理與溯源,以及運用現(xiàn)代流行病學(xué)調(diào)查等方法,以"從癥辨證"、"辨病與辨證相結(jié)合"為原則,并結(jié)合現(xiàn)代中醫(yī)診斷思路辨病為先、辨證隨后的思想,將臟腑辨證體系與病位、病性組合規(guī)律應(yīng)用于胸痹病證,構(gòu)建胸痹辨證新模式。將胸痹病證的病位、病性特征用數(shù)學(xué)語言加以描述,以建立病位與病性組合的胸痹辨證數(shù)學(xué)模型,并結(jié)合案例分析其可行性與實用性。藏象辨證理論體系與辨證數(shù)學(xué)模型的結(jié)合,使胸痹辨證更加靈活準(zhǔn)確易于操作,有利于指導(dǎo)胸痹病證的診治。研究方法:本研究通過搜集查閱大量的中醫(yī)文獻資料,對歷代文獻中記載的胸痹心痛進行整理歸納。通過對比不同時期的文獻資料,對胸痹心痛的病名源流、病因與病機、病位與病性分別進行整理歸納。通過查閱現(xiàn)代絡(luò)病理論的文獻資料,探討其對胸痹心痛的認知與治療。歷代對胸痹的辨證分型與辨證方法繁多,加之現(xiàn)代中醫(yī)辨證各存已見尚不規(guī)范,故將簡便規(guī)范的藏象辨證理論體系與數(shù)學(xué)辨證模型相結(jié)合,使復(fù)雜的辨證過程簡單化,將胸痹的臨床信息層次化。通過回顧性的流行病學(xué)調(diào)查研究方法,臨床收集438例胸痹病例,在癥狀審核規(guī)范后進行數(shù)據(jù)統(tǒng)計,采用統(tǒng)計學(xué)分析研究方法如聚類分析、主成分分析等,分析胸痹病證的病位、病性、病位結(jié)合病性的分布規(guī)律,構(gòu)建"胸痹病證診斷信息表",總結(jié)胸痹的基本證與復(fù)合證的組合規(guī)律。應(yīng)用模糊數(shù)學(xué)原理,構(gòu)造模糊隸屬函數(shù),建立胸痹辨證的數(shù)學(xué)模型。應(yīng)用關(guān)聯(lián)分析,計算其置信度,最終進行辨證模型測試。研究結(jié)果:整理歸納歷代文獻資料與438例胸痹病例的調(diào)查結(jié)果,提出"痰瘀阻心"的基本證,并以此為基礎(chǔ)提出胸痹的病位與病性相兼的復(fù)合證,使胸痹的現(xiàn)代中醫(yī)辨證更加規(guī)范。建立胸痹辨證的數(shù)學(xué)模型,實現(xiàn)對辨證模型的初步探索。
[Abstract]:Research objective: nowadays, the research on syndrome differentiation and classification of chest arthralgia is rich. Although the country has issued the diagnosis standard and syndrome classification of chest arthralgia syndrome (appendix 1). However, the six syndrome types still can not fully summarize the complex and changeable syndromes that appear in the clinic, and many doctors still use their clinical experience to treat them, so it is difficult to form the unified cognition of syndrome differentiation and treatment of chest arthralgia. The standardization of syndrome differentiation of chest arthralgia in traditional Chinese medicine is still worth discussing. Under the guidance of the theory system of Tibetan syndrome differentiation established by Professor Wu Chengyu, the origin of chest arthralgia is traced to the source of the disease. Etiology and pathogenesis as well as syndrome differentiation and other studies combined with the basic situation of patients with chest arthralgia the use of epidemiological investigation to carry out statistical analysis. Study on the syndrome differentiation of chest arthralgia. Significance: the theoretical system of syndrome differentiation of Tibet image is based on accurate and standardized clinical information, and then extract the characteristics of disease and disease, and combine disease with disease. In order to form a relatively standardized syndrome, the theoretical system of syndrome differentiation of Tibet image is based on the principle of "using image to measure viscera, from syndrome differentiation of syndrome", which is flexible to grasp the complex and changeable syndrome in clinical practice. It is the application and embodiment of the principle and law of syndrome differentiation in traditional Chinese medicine. This study is based on the collation and tracing of the literature of the past dynasties, as well as the use of modern epidemiological investigation to "syndrome differentiation from symptoms". "differentiation of diseases and syndrome differentiation" as the principle, and combined with the modern Chinese medicine diagnosis thinking of disease differentiation first, then the thought of syndrome differentiation, Zang-fu organs syndrome differentiation system and disease position, disease combination law applied to chest arthralgia syndrome. To establish a new model of syndrome differentiation of chest arthralgia. The characteristics of disease of chest arthralgia syndrome are described by mathematical language, in order to establish a mathematical model of syndrome differentiation of chest arthralgia combined with disease position and disease. Combined with the case analysis of its feasibility and practicability, the combination of the theoretical system of syndrome differentiation and mathematical model of syndrome differentiation makes the syndrome differentiation of chest obstruction more flexible, accurate and easy to operate. This study is helpful to guide the diagnosis and treatment of chest arthralgia syndrome. Research methods: this study through the collection of a large number of traditional Chinese medicine literature materials. By comparing the literature of different periods, the origin, etiology and pathogenesis of chest arthralgia were analyzed. Through consulting the literature data of modern collateral disease theory, it discusses the cognition and treatment of chest arthralgia and heartache. There are many methods of syndrome differentiation and syndrome differentiation for chest arthralgia in past dynasties. In addition, the existence of modern TCM syndrome differentiation has not yet been standardized, so the simple and standardized Tibetan syndrome differentiation theory system and mathematical dialectical model are combined to simplify the complex syndrome differentiation process. The clinical information of chest arthralgia was stratified. 438 cases of chest obstruction were collected by retrospective epidemiological investigation and statistics were carried out after the symptoms were checked and standardized. Using statistical analysis methods, such as cluster analysis, principal component analysis, to analyze the disease location, disease, disease combined with disease distribution law, build "chest arthralgia syndrome diagnosis information table". The combination law of basic syndrome and compound syndrome of chest arthralgia is summarized. The fuzzy membership function is constructed by applying fuzzy mathematics principle, and the mathematical model of syndrome differentiation of chest arthralgia is established. The degree of confidence is calculated by using correlation analysis. Finally, the syndrome differentiation model test. Results: collate and summarize the literature and 438 cases of chest obstruction investigation results, put forward the basic syndrome of "phlegm stasis obstruction of the heart". On this basis, the author puts forward the combined syndrome of the disease position and disease of chest arthralgia, which makes the modern TCM syndrome differentiation of chest arthralgia more standardized, and establishes the mathematical model of the syndrome differentiation of chest arthralgia, and realizes the preliminary exploration of the syndrome differentiation model.
【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】：R256.22

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