本文選題：柴胡加龍骨牡蠣湯　切入點：甘麥大棗湯　出處：《北京中醫(yī)藥大學》2016年博士論文

【摘要】：目的流行病學研究表明,失眠和抑郁癥之間的聯(lián)系是雙向的,由于失眠及抑郁有愈來愈嚴重的發(fā)病趨勢,且西醫(yī)用藥有成癮的副作用,基于中醫(yī)幾千年的用藥經(jīng)驗,特別是經(jīng)方在臨床的運用,且現(xiàn)代之失眠及抑郁在張仲景《傷寒雜病論》許多方證中能體現(xiàn)出來,本研究試圖挖掘更有效的用藥方式幫助患者,也讓西方了解中醫(yī)的特殊有效療法。方法第一,在這項回顧性人群研究輔助數(shù)據(jù)分析中,使用來自臺灣的縱向醫(yī)療保險數(shù)據(jù)庫(LHID)的數(shù)據(jù)進行分析,研究探討中草藥產(chǎn)品(CHPS)即(中成藥),以經(jīng)方稱之,對臺灣人失眠與抑郁癥的治療,探討中國草藥和西醫(yī)的處方模式于睡眠障礙和抑郁癥患者,此外,對單方(SH)和復方(HF)使用的頻率進行分析。第二,以常用經(jīng)方酸棗仁湯治療失眠,及治療抑郁癥之常用經(jīng)方甘麥大棗湯、柴胡加龍骨牡蠣湯進行了臨床隨機對照大樣本資料的meta分析,并再對酸棗仁湯證,甘麥大棗湯證,柴胡加龍骨牡蠣湯證進行理論研究,對此三方的病因病機及方藥特點深入探討。結果第一章,理論研究分兩大部分：1.有關失眠的條文,依據(jù)《傷寒論》六經(jīng)辨證系統(tǒng), 《金匱要略》臟腑經(jīng)絡理論辨證施治,從條文之病機、癥狀、治則、方藥及臨床運用現(xiàn)狀進行分析。2.有關抑郁癥的條文,依據(jù)《傷寒論》六經(jīng)辨證系統(tǒng),《金匱要略》臟腑經(jīng)絡理論辨證施治,從條文之病機、癥狀、治則、方藥及臨床運用現(xiàn)狀進行分析。第二章,基于數(shù)據(jù)庫挖掘的經(jīng)方治療臺灣人失眠與抑郁癥的研究,目的：中草藥產(chǎn)品(CHPS)是常用于睡眠障礙和抑郁癥(MDD)的處方。這項研究的目的是為有這些疾病在臺灣的患者調(diào)查其中草藥產(chǎn)品和西醫(yī)的處方模式,并分析使用單味草藥(SHS)和復方草藥配方(HFS)的頻率。材料方法：在這項回顧性人群研究輔助數(shù)據(jù)分析中,是2007年1月至2011年12月,使用來自臺灣的縱向醫(yī)療保險數(shù)據(jù)庫(LHID)的數(shù)據(jù)進行分析,從LHID百萬受益者,隨機從2010年的注冊表選定為全國的網(wǎng)絡健康保險研究數(shù)據(jù)庫。睡眠障礙和抑郁根據(jù)國際疾病分類,第九版,臨床修改代碼分別為307.40和311。第三章,經(jīng)方治療失眠、抑郁臨床隨機對照試驗之meta分析,酸棗仁湯治療失眠及甘麥大棗湯、柴胡加龍骨牡蠣湯治療抑郁癥臨床隨機對照試驗之meta分析。結論在這項回顧性人群研究輔助數(shù)據(jù)分析中,是2007年1月至2011年12月,使用來自臺灣的縱向醫(yī)療保險數(shù)據(jù)庫(LHID)的數(shù)據(jù)進行分析,總共有11030睡眠障礙患者,9619名使用西藥,1334名患者使用中國草藥產(chǎn)品,77名中西藥皆使用；總共有11157重度抑郁癥患者,11389名使用西藥,131名患者使用中國草藥產(chǎn)品,51名中西藥皆使用。無論睡眠障礙或重度抑郁癥(MDD),患者女性多于男性,年齡在22-44歲的人數(shù)最多,月收入在NT$17281-22800有大量的病人,1級2級城市有最大量的患者。中草藥使用,有1411人因睡眠障礙就診中醫(yī)5298次,有182人因重度抑郁癥疾患就診中醫(yī)755次,失眠合并抑郁癥最常用的前三名,用量比率最高的單味中藥(SHs)是酸棗仁,夜交藤及遠志,用量比率最高的復方(HFs)是加味逍遙散,酸棗仁湯及柴胡加龍骨牡蠣湯。結果：中藥復方及單方被廣泛用于睡眠障礙與抑郁癥。然而,中草藥對睡眠障礙和抑郁癥的安全性和有效性,需要進一步評估；基于數(shù)據(jù)庫的分析,對這些藥物用于治療睡眠障礙和抑郁癥的,劑量-反應關系和功效是未知的,故繼續(xù)深入了解經(jīng)方治療失眠與抑郁癥其療效的評估,本次Meta分析結果表明酸棗仁湯及其加減方治療失眠的效果優(yōu)于西藥,甘麥大棗湯及其加減方治療抑郁癥的效果優(yōu)于西藥,柴胡加龍骨牡蠣湯及其加減方在治療抑郁癥方面優(yōu)于西藥對照組,本研究得知經(jīng)方酸棗仁湯、甘麥大棗湯、柴胡加龍骨牡蠣湯之使用,對失眠及抑郁癥有很好療效,以臺灣衛(wèi)生健保部門的數(shù)據(jù)庫,得到的數(shù)據(jù),更證明中醫(yī)使用于失眠與抑郁癥及失眠伴發(fā)抑郁癥提供了參考數(shù)據(jù),使用臺灣全民健康保險研究數(shù)據(jù)庫得到的結果,證明中藥使用的安全性,希望有助失眠抑郁醫(yī)療質(zhì)量的提升,同時藉由期刊之發(fā)表,促進中醫(yī)藥的國際化。
[Abstract]:Objective epidemiological studies show that the relationship between insomnia and depression are bidirectional, insomnia and depression due to the incidence trend of more and more serious, and the side effects of Western medicine have addiction, Chinese medicine for thousands of years experience in medicine based on classical prescriptions in clinical application and modern insomnia and depression in Zhang Zhongjing < Shanghanzabinglun can be reflected in the many ", this study attempts to dig more effective drugs to help patients, also let the Western understanding of special effective therapy in traditional Chinese medicine. First, in the analysis of this retrospective cohort study using auxiliary data, from the Taiwan longitudinal health insurance database (LHID) data analysis, research on herbal products in the discussion of (CHPS) (Chinese), is known to classical, treatment of insomnia and depression of Taiwan, China herbal and Western medicine prescription pattern in sleep disorder and depression patients In addition, the unilateral (SH) and compound (HF) to analyze the frequency of use. In second, commonly used by Suanzaoren Decoction in the treatment of insomnia, depression and treatment of commonly used by ganmaidazao decoction, Chaihu Longgu Oyster Soup conducted a clinical randomized controlled large sample data of meta analysis, and then to semenziziphispinosae decoction, ganmaidazao decoction, bupleurum plus Longgu Oyster Soup syndrome theory research, this three party pathogenesis and prescription characteristics in depth. The first chapter, the theory research is divided into two parts: 1. the relevant provisions on the basis of insomnia, "Treatise on the six system >, < > jinkuiyaolue Meridians Theory from the provisions of syndrome differentiation, pathogenesis, symptoms, treatment, prescription and clinical application to analyze the current situation of.2. about depression according to provisions in < treatise on six > system > < jinkuiyaolue meridians syndrome differentiation theory, from the provisions of the pathogenesis, symptoms and treatment Then, prescription and clinical application status were analyzed. The second chapter, the purpose of database mining, insomnia and depression treatment by Taiwanese based on Chinese herbal medicine products (CHPS) is a common sleep disorder and depression (MDD) prescription. The purpose of this study is to investigate in Taiwan patients with these diseases which products and herbal medicine prescription pattern, and analysis of single herb use (SHS) and compound herbal formula (HFS) frequency. Materials and methods: in this retrospective cohort study of auxiliary data, from January 2007 to December 2011, used from Taiwan longitudinal health insurance database (LHID) data was analyzed. From LHID million beneficiaries from 2010, randomly selected for the National Registry of network health insurance research database. Sleep disorders and depression according to the international classification of diseases, Ninth Edition, Clinical Modification codes were 307.4 0 and 311. of the third chapter, the treatment of insomnia by analysis of depression, randomized clinical trials of meta, Suanzaoren Decoction in the treatment of insomnia and ganmaidazao decoction, analysis of Bupleurum plus Longgu Oyster Soup treatment of depression in randomized clinical trials of meta. Conclusion in this retrospective cohort study of auxiliary data analysis, from January 2007 to December 2011, the use of from the Taiwan longitudinal health insurance database (LHID) data analysis, a total of 11030 patients with sleep disorders, 9619 the use of Western medicine, 1334 patients with China herbal products, 77 in the western medicine are used; there are a total of 11157 patients with severe depression, 11389 the use of Western medicine, 131 patients with China herbal products, 51 in western medicine use. Regardless of sleep disorders or severe depression (MDD), with more women than men, at the age of 22-44 year olds, the monthly income in NT$17281-22800 has a large number of patients, grade 1 2 city the largest number of patients. Chinese herbal medicine use, there are 1411 people with sleep disorders clinic of traditional Chinese medicine 5298 times, 182 people with severe depression disease treatment of traditional Chinese medicine 755 times, insomnia and depression are most commonly used in the top three, the amount of the highest rate of single Chinese herb (SHs) is Suanzaoren, Caulis and Polygala. The amount of the highest rate of compound (HFs) is Jiaweixiaoyaosan, Suanzaoren Decoction and Bupleurum plus Longgu Oyster Soup. Results: the traditional Chinese medicine and is widely used for unilateral sleep disorders and depression. However, Chinese herbal medicine is safe and effective for sleep disorders and depression, the need for further evaluation of the database; based on the analysis of these. Drugs for the treatment of sleep disorders and depression, the dose-response relationship and the effect is unknown, so continue to in-depth understanding of the evaluation of insomnia and depression after treatment the curative effect, the Meta analysis results show that the Suanzaoren Decoction and its Decoction in the treatment of insomnia is better than western medicine, ganmaidazao Decoction in the treatment of depression is better than western medicine, Chaihu Longgu Oyster Soup Decoction in the treatment of depression and better than the control group, the prescription szrt, ganmaidazao decoction, using Bupleurum plus Longgu Oyster Soup, has a great effect on the insomnia and depression, the Taiwan health care department database, the data that Chinese medicine used in insomnia and depression and insomnia and provide reference data for depression, using the Taiwan national health insurance research database results prove the safety of using traditional Chinese medicine, to help insomnia depression medical quality, at the same time the journal is published, to promote the internationalization of Chinese medicine.

【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R256.23;R277.7
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本文編號：1689045