本文選題：混合性焦慮抑郁障礙　切入點(diǎn)：中醫(yī)證候　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的和意義:探索分析混合性焦慮抑郁障礙(Mixed Anxiety and Depressive Disorder,簡稱MADD)患者的中醫(yī)證候特點(diǎn)及體質(zhì)類型,總結(jié)該病的常見證型及易感體質(zhì),進(jìn)一步探討分析MADD患者的中醫(yī)證候與體質(zhì)的相關(guān)性,把"辨病-辨體-辨證"這一診療模式有效地運(yùn)用到臨床中,以進(jìn)行個體化診療,從而更好地提高臨床療效。研究方法:本研究是在2016年北京中醫(yī)藥大學(xué)研究生自主課題的支持下進(jìn)行的。收集2016年8月至2017年1月北京中醫(yī)藥大學(xué)東方醫(yī)院腦病二科門診符合納入及診斷標(biāo)準(zhǔn)的MADD患者61人,以及北京中醫(yī)藥大學(xué)東方醫(yī)院體檢科健康人群30人作為研究對象,填寫中醫(yī)體質(zhì)分類與判定量表,對比二者之間體質(zhì)類型的異同,同時采集MADD患者的證候要素并分析其分布規(guī)律特點(diǎn),最后分析MADD患者的中醫(yī)證候與體質(zhì)的相關(guān)性。統(tǒng)計(jì)方法:使用Excel表格建立數(shù)據(jù)庫,用SPSS20.0統(tǒng)計(jì)處理分析。一般資料采用描述性分析,計(jì)數(shù)資料采用卡方檢驗(yàn),等級資料采取非參數(shù)檢驗(yàn),均以p0.05作為有統(tǒng)計(jì)學(xué)意義的標(biāo)準(zhǔn)。結(jié)合四診收集的臨床信息,運(yùn)用系統(tǒng)聚類分析提取證候要素,歸納總結(jié)證候要素分布、組合、演變特點(diǎn)。研究結(jié)果:(1)MADD的一般情況:本次研究共收集病例61例,其中女性多于男性;年齡段主要集中在青壯年;受教育程度以本科或大專為主;婚姻狀況以已婚為主;病程主要集中在1年之內(nèi);患者的焦慮抑郁狀況與性別、年齡沒有明顯差異。(2)中醫(yī)證候分布特點(diǎn):61例MADD患者的中醫(yī)證型分布出現(xiàn)的頻次由高到低依次為痰氣郁結(jié)證、肝氣郁結(jié)證、氣郁化火證、心脾兩虛證、心腎陰虛證及心神不養(yǎng)證,其中痰氣郁結(jié)證為主要證型。根據(jù)患者臨床的癥狀和體征以及運(yùn)用系統(tǒng)聚類分析的方法得出,MADD的病性證素多為氣滯、痰濁、血瘀、陰虛及陽虛,同時結(jié)合導(dǎo)師臨床經(jīng)驗(yàn)及相關(guān)研究進(jìn)展歸為三類:分別為類痰氣郁結(jié)證、類氣滯血瘀證及類陰陽兩虛證。此外,MADD的證候分布不受年齡、病程及焦慮抑郁狀況的影響。(3)中醫(yī)體質(zhì)分布特點(diǎn):61例MADD患者中氣郁質(zhì)最多,其次是氣虛質(zhì)、陽虛質(zhì)及濕熱質(zhì),陰虛質(zhì)、痰濕質(zhì)及血瘀質(zhì)在本病中少見;30例對照組健康人群以平和質(zhì)最多,其次是陽虛質(zhì)及濕熱質(zhì)多見,二者均有陽虛質(zhì)及濕熱質(zhì),但MADD患者以氣郁質(zhì)表現(xiàn)為主伴氣虛質(zhì),而對照組以平和質(zhì)最多。同時,本調(diào)查提示61例MADD患者中陰虛質(zhì)、痰濕質(zhì)、濕熱質(zhì)、血瘀質(zhì)以焦慮表現(xiàn)為主,陽虛質(zhì)、氣郁質(zhì)以抑郁表現(xiàn)為主,氣虛質(zhì)以焦慮抑郁表現(xiàn)差異相等為主。此外,據(jù)調(diào)查,MADD患者的中醫(yī)體質(zhì)與年齡的增長及病程的長短沒有明顯差異,提示個體體質(zhì)的分布不輕易改變,其本身固有的特性是相對恒定的。(4)中醫(yī)證候與體質(zhì)的相關(guān)性:61例MADD患者中,肝氣郁結(jié)證中氣郁質(zhì)(46.2%)最多;氣郁化火證中氣郁質(zhì)(36.4%)多見;痰氣郁結(jié)證中痰濕質(zhì)和氣郁質(zhì)多見(23.8%);心脾兩虛證中氣虛質(zhì)(44.4%)最多;心神不養(yǎng)證為血瘀質(zhì)最多(100.0%);心腎陰虛證中氣郁質(zhì)最多(50.0%)。同時,氣郁質(zhì)(18人)中肝氣郁結(jié)證出現(xiàn)的頻次最高(6人),氣虛質(zhì)(9人)中心脾兩虛證出現(xiàn)頻次最高(4人),陽虛質(zhì)(9人)中痰氣郁結(jié)證(4人)出現(xiàn)頻次最高,濕熱質(zhì)(9人)中以肝氣郁結(jié)證及氣郁化火證(3人)出現(xiàn)頻次最高,陰虛質(zhì)(7人)中以氣郁化火證及心腎陰虛證(2人)出現(xiàn)頻次最高,痰濕質(zhì)(6人)中痰氣郁結(jié)證出現(xiàn)頻次最高(5人),血瘀質(zhì)(3人)痰氣郁結(jié)證出現(xiàn)頻次最高(2人)。研究結(jié)論:(1)MADD的患病人群以女性、已婚者及受教育程度處于中等水平者較多,而文化水平偏低及偏高者較少,且MADD患者的發(fā)病年齡呈年輕化的趨勢。(2)氣滯、痰濁、血瘀、陰虛及陽虛與MADD的發(fā)病密切相關(guān)。由此可見,MADD中醫(yī)證素分布復(fù)雜多樣,證候類型虛實(shí)夾雜,導(dǎo)致病情反復(fù)發(fā)作,纏綿難愈。(3)MADD患病組與正常組相比,患病人群多為氣郁質(zhì),而正常人群多為平和質(zhì),二者均有陽虛質(zhì)及濕熱質(zhì)。陰虛質(zhì)、痰濕質(zhì)、濕熱質(zhì)、血瘀質(zhì)以焦慮表現(xiàn)為主,陽虛質(zhì)、氣郁質(zhì)以抑郁表現(xiàn)為主,氣虛質(zhì)以焦慮抑郁表現(xiàn)差異相等為主。因此,臨床中辨病與辨體相結(jié)合,及時糾正或改善偏頗質(zhì),可減少個體體質(zhì)對疾病的易感性,從而做到未病先防,既病防變。(4)以證候?yàn)橐靥接慚ADD的發(fā)病時,其與患者自身的體質(zhì)具有明顯相關(guān)性,而以體質(zhì)為要素求證MADD患者的證候時,患者的體質(zhì)與證候并不完全一致,但仍有一定的相關(guān)性。由此可見,臨床仍應(yīng)以辨證為基礎(chǔ),同時結(jié)合辨病與辨體,才能在診治疾病的過程中發(fā)揮更好的療效。
[Abstract]:The research purpose and significance: exploratory analysis of mixed anxiety and depressive disorder (Mixed Anxiety and Depressive Disorder, referred to as MADD) the characteristics of TCM syndrome and constitution of patients, summarize the common syndromes of this disease and predisposition, to further explore the correlation analysis between TCM syndromes and physical MADD patients, the disease - resolution body - differentiation "this treatment model effectively applied to clinical, for individualized treatment, which can effectively improve the clinical curative effect. Methods: This study was conducted in 2016 graduate of Beijing University of Chinese Medicine under the support of the independent subject. From August 2016 to January 2017 encephalopathy of Dongfang Hospital of Beijing University of Chinese Medicine two out-patient patients met the inclusion and MADD diagnosis the standard of 61 people, and the Department of physical examination of Oriental Hospital of Beijing University of Chinese Medicine 30 healthy people as the research object, fill in the Chinese constitution classification and determination of scale. Than the differences between the two types of constitution, and acquisition of syndrome elements in MADD patients and analysis the characteristics of distribution, correlation analysis between TCM syndrome and constitution in patients with MADD. The final statistical method: the use of Excel database, analyzed by SPSS20.0 statistical processing. The general data using descriptive analysis, chi square test with count data take, rank data non parametric test, with P0.05 as the significant standard. Combined with clinical information collected by the four diagnostic methods, using the cluster analysis to extract syndrome factors, summarized the distribution of syndrome elements, evolution characteristics. Results: (1) the general situation of MADD: This study collected a total of 61 cases, with more women than men; age mainly concentrated in young adults; education in university or college; marital status to married; duration in patients within 1 years; The anxiety and depression status and gender, no significant differences in age. (2): the distribution characteristics of TCM Syndromes of TCM Syndromes of 61 cases of MADD patients with the distribution of the frequency from high to low were sputum stagnation syndrome, liver qi stagnation, qi stagnation fire, deficiency of two heart and spleen, heart and kidney yin deficiency and heart of God without a permit among them, gas stagnation as the main syndromes. According to clinical symptoms and signs, obtained by cluster analysis method, MADD disease syndrome are qi stagnation, phlegm, blood stasis, yin and Yang, combined with my tutor's clinical experience and related research progress were classified into three classes: class Tanqi two kinds of qi stagnation syndrome, qi stagnation and blood stasis syndrome and the Yin and Yang syndrome. In addition, the distribution of MADD is not affected by the influence of age, course of disease and anxiety depression. (3) physical distribution characteristics of traditional Chinese medicine: 61 cases of MADD patients in stagnation most, followed by qi deficiency, Yang deficiency and dampness heat, yin deficiency Quality, phlegm and blood stasis in this rare disease; 30 cases of control group of healthy people with normal quality most, followed by the Yang deficiency and damp heat to see, the two were Yang deficiency and damp heat, but MADD patients with qi stagnation mainly manifested with Qi deficiency, while in the control group and quality most. At the same time, the survey showed 61 cases of patients with MADD Yin deficiency and phlegm dampness, dampness heat, blood stasis, mainly to anxiety Yang deficiency, Qi Stagnation with depression, anxiety and depression of qi deficiency to equal difference. In addition, according to the survey, there was no significant difference between the growth and the course of Chinese Constitution with the age of patients with MADD of the length distribution suggest that the individual constitution is not easily changed, the intrinsic characteristics is relatively constant. (4) the correlation of TCM syndrome and Constitution: 61 cases of MADD patients, syndrome of stagnation of liver Qi Qi Stagnation (46.2%); gas stagnation (qi stagnation fire more than 36.4%) 瑙，

本文編號：1635500