本文關(guān)鍵詞： 復(fù)發(fā)性口腔潰瘍 健脾清胃湯 脾虛胃熱證 臨床觀察　出處：《湖北中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過對(duì)健脾清胃湯治療復(fù)發(fā)性口腔潰瘍(脾虛胃熱證)患者的臨床觀察,評(píng)價(jià)健脾清胃湯的臨床療效及用藥安全性;運(yùn)用中醫(yī)學(xué)及現(xiàn)代醫(yī)學(xué)知識(shí)探討復(fù)發(fā)性口腔潰瘍的病因、病機(jī)、治法,討論健脾清胃湯的組方特點(diǎn)及健脾清胃湯治療復(fù)發(fā)性口腔潰瘍的現(xiàn)代藥學(xué)藥理特點(diǎn)。方法選擇2015年1月至2015年10月于湖北省中醫(yī)院花園山院區(qū)脾胃科甘愛萍教授專家門診符合西醫(yī)診斷為復(fù)發(fā)性口腔潰瘍,中醫(yī)辨證為脾虛胃熱證口瘡患者60例,隨機(jī)分組分為2組:治療組33例,予甘教授經(jīng)驗(yàn)方健脾清胃湯口服治療;對(duì)照組27例,予維生素B2、維生素C片口服治療;兩組均治療14天。治療前后觀察患者潰瘍面積、數(shù)目、充血、疼痛、燒灼感、大便情況、腹脹、口干口渴、舌脈等臨床癥狀、體征變化,對(duì)癥狀作出評(píng)分,并記錄其它不良反應(yīng);記錄第3天、5天、7天潰瘍局部疼痛情況。比較兩組用藥后局部病損療效、中醫(yī)證候療效及安全性。追蹤觀察療程結(jié)束后3個(gè)月患者復(fù)發(fā)情況,比較兩組的遠(yuǎn)期療效。數(shù)據(jù)統(tǒng)一采用SPSS19.0進(jìn)行統(tǒng)計(jì)學(xué)處理,計(jì)數(shù)資料采用χ2檢驗(yàn),計(jì)量資料及等級(jí)資料采用t檢驗(yàn)、秩和檢驗(yàn)。結(jié)果1.比較治療前后組內(nèi)主要癥狀及體征單項(xiàng)積分、總積分,兩組治療后主要癥狀及體征單項(xiàng)積分、總積分較治療前均有顯著改善(P0.05)。比較治療后兩組間的主要癥狀、體征單項(xiàng)積分和總積分,結(jié)果顯示兩組經(jīng)治療后總積分有顯著統(tǒng)計(jì)學(xué)差異(P0.05);其中在改善潰瘍面積、數(shù)目、充血、疼痛、口干口渴及大便異常、舌苔方面,治療組優(yōu)于對(duì)照組(P0.05);在改善潰瘍燒灼感、脈象方面,無顯著統(tǒng)計(jì)學(xué)差異(P0.05)。2.起效時(shí)間比較:治療組藥物起效時(shí)間短于對(duì)照組(P0.05),具有顯著統(tǒng)計(jì)學(xué)差異。3.兩組局部病損療效比較:治療組總有效率93.6%,對(duì)照組總有效率81.5%,兩組比較無顯著性差異(P0.05)。4.兩組中醫(yī)證候療效總有效率比較:治療組總有效率93.6%,對(duì)照組總有效率74.1%,兩組比較有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。5.兩組復(fù)發(fā)率比較:治療組復(fù)發(fā)率為40%,對(duì)照組復(fù)發(fā)率為77.8%,兩組復(fù)發(fā)率比較有顯著統(tǒng)計(jì)學(xué)差異(P0.05),可認(rèn)為治療組比對(duì)照組能更有效預(yù)防復(fù)發(fā)性口腔潰瘍復(fù)發(fā)。6.安全性比較:治療后兩組均未見明顯不良反應(yīng)。結(jié)論脾胃內(nèi)傷是復(fù)發(fā)性口腔潰瘍致病的基礎(chǔ),脾虛胃熱是其病機(jī),“熱”與“虛”、“瘀”三者膠著是本病反復(fù)發(fā)作及纏綿難愈的關(guān)鍵。健脾清胃湯具有清熱瀉火、健脾益胃、斂瘡生肌的功能,能明顯收斂潰瘍創(chuàng)面、減少潰瘍數(shù)目、緩解潰瘍灼痛、促進(jìn)潰瘍愈合、縮短潰瘍病程,同時(shí)改善全身不適、延長潰瘍間歇期、能有效防治潰瘍復(fù)發(fā),并具有起效快、安全性好的優(yōu)點(diǎn)。健脾清胃湯治療復(fù)發(fā)性口腔潰瘍(脾虛胃熱證)療效顯著,臨床安全有效,值得進(jìn)一步研究及推廣運(yùn)用。
[Abstract]:Objective to evaluate the clinical efficacy and safety of Jianpi Qingwei decoction in the treatment of recurrent oral ulcer (spleen deficiency and stomach heat syndrome). To explore the etiology, pathogenesis and treatment of recurrent oral ulcer with the knowledge of traditional Chinese medicine and modern medicine. To discuss the prescription characteristics of Jianpi Qingwei decoction and the modern pharmacological characteristics of Jianpi Qingwei decoction in the treatment of recurrent oral ulcers. Methods from January 2015 to October 2015, Professor Kogan Aiping of spleen and stomach of Huayuan Mountain Hospital of Hubei Province was selected. The expert outpatient clinic is in accordance with the western medicine diagnosis for recurrent oral ulcer, Sixty patients with oral ulcers due to spleen deficiency and stomach heat syndrome were randomly divided into two groups: treatment group (n = 33), treatment group (n = 33) treated by oral administration of Professor Gan's experience prescription Jianpi Qingwei decoction, control group (n = 27) treated with vitamin B2 and vitamin C tablets orally, and control group (n = 27). Before and after treatment, the area, number, hyperemia, pain, burning sensation, stool condition, abdominal distension, dry mouth thirst, tongue pulse and other clinical symptoms, signs and signs of the patients were observed, and the symptoms were evaluated. Other adverse reactions were recorded, the local pain of ulcer was recorded on the 3rd day, the 5th day and the 7th day. The curative effect of local lesion, the curative effect of TCM syndrome and the safety of the two groups were compared, and the recurrence of the ulcer was observed 3 months after the end of the course of treatment. The long-term effects of the two groups were compared. SPSS19.0 was used for statistical analysis, 蠂 2 test for counting data, t test for measurement data and grade data. The main symptoms and signs of the two groups were compared before and after treatment, the total scores of the main symptoms and signs after treatment, the total scores of the two groups were significantly improved compared with those before and after treatment, and the main symptoms between the two groups were compared after treatment. 2. The results showed that there was a significant difference between the two groups in the total score after treatment (P 0.05), especially in the improvement of ulcer area, number, congestion, pain, dry mouth, thirst and stool abnormality, tongue coating, etc. The treatment group was superior to the control group (P 0.05) in improving the burning sensation and pulse of ulcers. There was no significant statistical difference (P 0.05) .2.Comparison of effective time: the effective time of drugs in the treatment group was shorter than that in the control group (P 0.05), and there was significant statistical difference between the two groups. 3. Comparison between the two groups: the total effective rate of the treatment group was 93.6%, the total effective rate of the control group was 81.5%, and the total effective rate of the two groups was 81.5%. There was no significant difference between the two groups. The total effective rate of TCM syndromes in the two groups was 93.6 in the treatment group, 74.1 in the control group, and significantly different in the two groups. The recurrence rate of the two groups was compared: the recurrence rate in the treatment group was 40 beats, and the total effective rate in the control group was 74.1. The recurrence rate of the radiation group was 77.8. There was significant difference in the recurrence rate between the two groups. It can be concluded that the treatment group is more effective than the control group in preventing the recurrence of recurrent oral ulcer. 6. Comparison of safety: after treatment, there is no obvious adverse reaction between the two groups. Conclusion Internal injury of spleen and stomach is the basis of recurrent oral ulcer. Spleen deficiency and stomach heat are its pathogenesis, "heat" and "deficiency" and "blood stasis" are the key to the repeated attack of the disease and the difficulty of tangle healing. Jianpi Qingwei decoction has the function of clearing away heat and reducing fire, invigorating spleen and nourishing stomach, and astringent ulcers to produce muscle, which can obviously converge on ulcer wound. Reducing the number of ulcers, relieving the burning pain of ulcers, promoting the healing of ulcers, shortening the course of ulcerative diseases, improving the general discomfort, prolonging the interval period of ulcers, can effectively prevent and cure the recurrence of ulcers and have a quick effect. The efficacy of Jianpi Qingwei decoction in the treatment of recurrent oral ulcers (spleen deficiency and stomach heat syndrome) is significant, and the clinical efficacy is safe and effective, which is worthy of further study and application.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R276.8

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