本文選題：老年2型糖尿病　切入點：糖尿病血管并發(fā)癥　出處：《山東中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:探索崔德芝教授治療老年2型糖尿病及其血管并發(fā)癥的處方用藥規(guī)律,并總結(jié)探討辨治思路,為糖尿病及其血管并發(fā)癥的中醫(yī)臨床診療提供新的思路和方法。方法:以老年2型糖尿病及其常見的四種血管并發(fā)癥——糖尿病合并腦血管病、糖尿病合并心臟病、糖尿病腎病和糖尿病足為切入點,以導(dǎo)師開立的中藥復(fù)方為研究對象,共收集方劑394首(合并以上四種血管并發(fā)癥的方劑分別為182首、106首、68首、38首),采用頻數(shù)分析及關(guān)聯(lián)規(guī)則分析數(shù)據(jù)挖掘方法,從核心藥物、藥對及藥組方面探索處方用藥規(guī)律。結(jié)果:治療老年2型糖尿病及其四種血管并發(fā)癥的方劑中,應(yīng)用頻次最多的藥物為補虛藥,其次為清熱藥、活血化瘀藥、利水滲濕藥等。從藥物具體功效方面,補氣藥和活血止痛藥應(yīng)用最多。最常用的補氣藥為炙甘草、黃芪、白術(shù)、黨參、太子參、山藥,補血藥為當歸、白芍,補陰藥為麥冬、枸杞子,補陽藥常用杜仲、肉蓯蓉。治療老年2型糖尿病合并腦血管病的方劑中,補虛藥、活血化瘀藥、清熱藥、平肝息風(fēng)藥、化痰為導(dǎo)師治療老年糖尿病合并腦血管病最常用的五類藥物及藥物組合。消食藥、解表藥、安神藥、瀉下藥為治療本病常配伍之品。天麻、葛根、川芎-地龍、黃芪-當歸、半夏-白術(shù)-天麻、黃芪-赤芍-地龍-當歸等為導(dǎo)師常用的具有代表性的藥物及藥物組合。治療老年2型糖尿病合并心臟病的方劑中,補虛、清熱、活血化瘀、理氣和化痰藥為最常用的藥物及藥物組合,常配以消食和養(yǎng)心安神藥。甘草、丹參、瓜蔞、三七、桃仁-紅花、酸棗仁-柏子仁、麥冬-五味子-太子參、黃芪-黨參-當歸、炙甘草-生地黃-黃芪、黃連-竹茹-荷葉-枳實為導(dǎo)師常用的有代表性的藥物及藥物組合。治療老年2型糖尿病腎病的方劑中,補虛、清熱、活血化瘀和利水滲濕藥為最常用的藥物和配伍組合,收斂固澀和止血寧血藥也常在該病的治療中配伍應(yīng)用。熟地黃、金櫻子、澤瀉、生地黃-黃柏、山藥-山茱萸、菟絲子為導(dǎo)師臨床治療本病常用的具有代表性的藥物及藥物組合。治療老年2型糖尿病足的方劑中,清熱、活血化瘀、補虛和利水滲濕藥為最常用的藥物和配伍組合。藤類藥物、蟲類藥物在本病的治療中得到了廣泛的配伍應(yīng)用。黃芪-當歸、金銀花、牛膝、土茯苓-薏苡仁、地龍-水蛭、雞血藤-忍冬藤-海風(fēng)藤-絡(luò)石藤是導(dǎo)師常用的具有代表性的藥物及藥物組合。結(jié)論:導(dǎo)師臨床治療老年2型糖尿病總以健脾補氣、生津止渴、益腎活血為主;邪實偏盛時則以活血化瘀、利水滲濕、清熱解毒、化痰降濁等為治療大法以祛其邪實,兼顧健脾益腎、補氣生津以固其本,并認為顧護脾胃是貫穿老年2型糖尿病治療始終的重要思想�？偨Y(jié)核心方劑,由二黃(黃芪、黃連)、四君子湯、生脈散為基本藥物、基本方加減組成,其組成為黃芪、黃連、山藥、黨參、白術(shù)、茯苓、炙甘草、太子參、麥冬、五味子、枸杞子、丹參、翻白草、葛根、荷葉、懷牛膝、當歸。根據(jù)發(fā)病部位不同、相兼病證各異、具體邪正虛實的偏盛偏衰,結(jié)合急則治其本、緩則治其標的原則辨證施治。導(dǎo)師的以上方劑在臨床中廣泛應(yīng)用并每獲良效,其對于以上病證的辨治思路值得在臨床中借鑒推廣。為獲得更多辨治思路精要還需更廣泛地收集病例、更深入地挖掘其處方用藥規(guī)律并進一步整理其臨證經(jīng)驗,以在臨床中進一步推廣應(yīng)用。
[Abstract]:Objective: To explore the rule of prescription of Professor Cui Dezhi in the treatment of elderly patients with type 2 diabetes and its vascular complications, and summarize the syndrome differentiation, clinical diagnosis and treatment for diabetes and its vascular complications and provide new ideas and methods. Methods: the elderly patients with type 2 diabetes and four common complications of diabetes, cerebrovascular disease, diabetes and heart disease, diabetic nephropathy and diabetic foot as the starting point, traditional Chinese medicine compound to a tutor as the research object, collected a total of 394 prescriptions (prescription combined with the above four kinds of vascular complications were 182, 106, 68, 38), using frequency analysis and Association analysis method of data mining, from the core drugs the law of prescription drugs, drug and drug group to explore. Results: the prescription treatment of elderly patients with type 2 diabetes mellitus and four vascular complications, drugs used most frequently for the tonic The medicine, followed by antipyretic, blood stasis and dampness medicine. From the specific drug efficacy, tonifying qi and activating blood circulation analgesia most. Qihm was most commonly used Zhigancao, astragalus, Atractylodes, Codonopsis, Radix Pseudostellariae, yam, hematonic for angelica, Radix Paeoniae Alba, yin tonic for Ophiopogon japonicus, Chinese wolfberry son, Chinese medicine commonly used eucommia, Cistanche. Prescription with cerebrovascular disease in elderly patients with type 2 diabetes, tonic, blood stasis, heat clearing drugs, Pinggan Xifeng drugs, and tutor in the treatment of elderly patients with diabetes mellitus cerebrovascular disease is the most commonly used five kinds of drugs and combinations of drugs. Drug digestion. Diaphoretic, sedative, diarrhea medicine for the treatment of this disease is often combined with the product. Tianma, kudzu root, Chuanxiong - earthworm, Astragalus - Angelica, pinellia Atractylodes - Tianma, Astragalus - Angelica for Radix Paeoniae Rubra - earthworm mentor commonly used representative drugs and combinations of drugs. The treatment of elderly type 2 diabetes with heart disease The prescription, tonic, heat, blood stasis, Qi and phlegm drugs and combinations of drugs most commonly used, often accompanied by digestion and Yangxinanshen pills. Licorice, salvia, Trichosanthes, 37, peach - safflower, Suanzaoren - arborvitae seed, Radix Ophiopogonis Schisandra - - heterophylla, Astragalus - Angelica dangshen. Licorice - Rehmannia - Radix Astragali, Rhizoma Coptidis and Zhuru - lotus leaf - commonly used as a mentor of Zhishi representative drugs and drug combinations. Prescription for treating elderly type 2 diabetic nephropathy, tonic, heat, blood stasis and dampness is the most commonly used drugs and drug combinations, astringent and hemostatic Ning the blood is used in the treatment of the disease. In the combined application of Shudihuang, Rosa, Alisma, Rehmannia - phellodendron, yam - dogwood, dodder, this disease commonly used representative drugs and combinations of drugs for clinical treatment. Mentor Qingre prescription in treatment of elderly type 2 diabetic foot, and blood stasis Tonic, and dampness medicine is the most commonly used drugs and combinations of drugs. The vine, the insect drugs are compatible is widely used in the treatment of this disease. Huang Qi - Angelica, honeysuckle, radix, tuckahoe - coix seed, earthworm and leech, Caulis Spatholobi Caulis Lonicerae haifengteng - - - Caulis trachelospermi commonly used is the mentor of representative drugs and combinations of drugs. Conclusion: the clinical instructor for elderly patients with type 2 diabetes with Spleen Qi, thirst, tonifying kidney and promoting blood circulation; evil flower is partial blood circulation, diuresis, detoxification, resolving phlegm and treatment method to remove the etc. evil, both spleen and kidney, nourishing fluid to the solid, and that the nursing care of the spleen and stomach is through the treatment of elderly patients with type 2 diabetes. The important thought always summed up the core prescription by Erhuang (Huang Qi, Coptis chinensis), four Sijunzi Decoction, Shengmai Powder as basic drugs, basic decoction, which is composed of Huang Qi yellow. Even, yam, Radix Codonopsis, Atractylodes, Poria, Radix Glycyrrhizae, Radix Pseudostellariae, ophiopogon root, Schisandra, medlar, radix salviae miltiorrhizae, radix puerariae, Potentilla discolor, lotus leaf, Achyranthes root, angelica. According to the incidence of different parts and different diseases, the evil is the actual piansheng partial failure, combined with the urgent then treat this. Slow is the principle for the mark of syndrome differentiation. The above prescription tutor used widely in clinical practice and received good effect, for the differentiation and treatment of diseases above is worthy of promotion in clinical practice. In order to obtain more dialectical thinking essentials should be more extensive collection of cases, dig deeper and further the law of prescription drugs finishing the clinical experience, to further clinical application.

【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R249;R259

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