本文選題：類風濕關(guān)節(jié)炎 + 新方　； 參考：《北京中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:本研究以焦樹德教授治療類風濕關(guān)節(jié)炎辨證分型為基礎(chǔ),利用中醫(yī)傳承輔助平臺進行數(shù)據(jù)挖掘,主要探討中醫(yī)藥治療類風濕關(guān)節(jié)炎各證型用藥規(guī)律。為臨床醫(yī)師運用中藥治療類風濕關(guān)節(jié)炎提供新思路,為患者解除病痛。材料與方法:研究選取2014年4月至2016年4月中日友好醫(yī)院中醫(yī)風濕病科住院接受治療的類風濕關(guān)節(jié)炎患者,采用回顧性調(diào)查方法,將符合納入條件的病例,逐一記錄患者的姓名、年齡、性別、關(guān)節(jié)腫痛情況、伴隨癥狀、喜寒熱情況、大小便、舌色、舌苔、脈象,辨證分型,口服中藥具體用藥。得出研究內(nèi)容包括癥狀頻次統(tǒng)計、藥物頻次統(tǒng)計、藥物的四氣五味和歸經(jīng)統(tǒng)計、藥對分析、新方分析等。結(jié)果:(1)238例類風濕關(guān)節(jié)炎患者的中醫(yī)證型分布頻率如下:腎虛寒盛證占45%(107/238),腎虛標熱輕證占24%(58/238),腎虛標熱重證占4%(10/238),濕熱傷腎證占27%(63/238)。(2)通過頻率分析發(fā)現(xiàn),類風濕關(guān)節(jié)炎患者癥狀整體以關(guān)節(jié)腫痛為主,癥狀出現(xiàn)頻次區(qū)別在于,腎虛寒盛證患者晨僵、怕冷明顯,腎虛標熱證患者可見關(guān)節(jié)局部皮溫升高,濕熱傷腎證患者除關(guān)節(jié)局部皮溫升高,還可見口干明顯熱象癥狀。治療上,腎虛寒盛證用溫性藥較其他三證多,而寒性藥使用為四證中最少,所用藥物包含所有藥物中僅有的兩味熱性藥,濕熱傷腎證及腎虛標熱輕證使用寒性藥較多,腎虛標熱重證使用涼性藥為四證中最多。治療類風濕性關(guān)節(jié)炎中藥總體多味苦、辛、甘,苦味藥四證應用差別不大,腎虛寒盛證用辛味藥最多,腎虛標熱重證用辛味藥最少。藥物歸經(jīng)主要歸肝、腎經(jīng)(3)腎虛寒盛證藥對:續(xù)斷、桑寄生;續(xù)斷、桑寄生、炙元胡;羌活、獨活。新方:千年健、宧薟草、桂枝、赤芍、山藥、竹茹;續(xù)斷、骨碎補、羌活、炙元胡、蘆根、浙貝母。腎虛標熱輕證藥對:續(xù)斷、桑寄生、知母;桑寄生、片姜黃。新方:骨碎補、羌活、獨活、懷牛膝、杜仲、黃柏;千年健、宧薟草、竹茹、桑枝、忍冬藤、山甲珠。濕熱傷腎證藥對:續(xù)斷、補骨脂。新方:豬苓、炒白術(shù)、木瓜、桑枝、炙龜板、炙鱉甲;川牛膝、懷牛膝、海風藤、絡(luò)石藤、知母、黃柏。結(jié)論:1、類風濕關(guān)節(jié)炎證型中以腎虛寒盛證最多見,符合焦老提出的(?)痹病因病機:"風寒濕三氣雜至合而為痹",特點為肝腎虧虛為本。2、通過用藥頻次分析,發(fā)現(xiàn)四證均以溫性藥為主,藥物歸經(jīng)主要歸肝、腎經(jīng),四證中出現(xiàn)頻次較高的藥物均包含桑寄生、續(xù)斷,除腎虛標熱重證均包含桂枝,符合焦樹德教授治療旭痹善溫補、從肝腎論治。3、四證用藥頻次較高的藥物均包含炙元胡,說明活血理氣止痛貫穿整個臨床治療。4、附子、淫羊藿出現(xiàn)頻次低,雖臨床以腎虛寒盛證最多見,但患者多處于疾病初期,寒邪為病因,但未及深入,故大熱藥物選用較少。5、分證論治類風濕關(guān)節(jié)炎,每個證型組合出對應新藥對與新方,為臨床醫(yī)師提供診療新思路。
[Abstract]:Objective: this study is based on professor Jiaoshu de treatment of rheumatoid arthritis syndrome differentiation as the basis, using the Chinese medicine inheritance auxiliary platform for data mining, mainly to explore the Chinese medicine treatment of rheumatoid arthritis drug patterns. To provide a new way for clinicians to treat rheumatoid arthritis with traditional Chinese medicine, and to relieve the pain of the patients. Materials and methods: patients with rheumatoid arthritis who were hospitalized in rheumatology department of traditional Chinese medicine in China-Japan Friendship Hospital from April 2014 to April 2016 were investigated retrospectively. The patient's name, age, sex, joint swelling and pain, accompanying symptoms, cold and fever, defecation, tongue color, tongue coating, pulse, syndrome differentiation, oral Chinese medicine were recorded one by one. The contents of the study include symptom frequency statistics, statistics of four gases and five flavors of drugs, drug pair analysis, new prescription analysis and so on. Results the distribution frequency of TCM syndromes in 238 rheumatoid arthritis patients was as follows: kidney deficiency and cold syndrome accounted for 45 / 107 / 238N, kidney deficiency and heat light syndrome accounted for 24 / 58 / 238N, kidney deficiency / heat weight syndrome accounted for 4 / 10 / 238T / 238N, damp-heat injury syndrome accounted for 2763 / 238n / 2). The main symptoms of rheumatoid arthritis patients are mainly joint swelling and pain. The difference in frequency of symptoms is that the patients with kidney deficiency and cold syndrome have morning stiffness and obvious fear of cold, and the patients with kidney deficiency standard heat syndrome can see the increase of joint local skin temperature. In the patients with damp-heat injury, besides the elevation of the local skin temperature of the joint, they can also see the obvious symptoms of the dry mouth. In treatment, the use of warm drugs was more than that of the other three syndrome, while the use of cold drugs was the least in the four syndromes. The drugs used included only two kinds of hot drugs of all the drugs, the syndrome of damp-heat injury of the kidney and the light syndrome of kidney deficiency and heat deficiency, and the cold drugs were used more frequently. Kidney deficiency and heat-weight syndrome using cold medicine is the most of the four syndrome. The treatment of rheumatoid arthritis Chinese medicine in general multi-taste bitter, Xin, Gan, bitter medicine application difference is not significant, kidney deficiency cold Sheng syndrome with the most Xin Wei medicine, kidney deficiency standard heat weight syndrome with Xin Wei medicine is the least. Drug return to the liver, kidney meridian 3) kidney deficiency cold Sheng syndrome: Dipsacus, mulberry parasitism, Dipsacus, sunburn yuan Hu; Notopterygium, unique. New side: Millennium Jian, Siegesbeckiae, Cinnamomum, Radix Paeoniae Alba, Chinese yam, Bamboo Ru; Dipsacus, Rhizoma Corydalis, Notopterygium, Roots, Roots, Fritillaria thunbergii. Kidney deficiency standard heat light medicine: Dipsacus, mulberry parasitism, Anemarrhena; Mulberry parasitism, turmeric tablets. New side: shredded, Notopterygium, Rhizoma Notopterygii, Rhizoma Corydalis, Eucommia ulmoides, Phellodendron chinensis; Millennium Jian, Xiesbeckiao, Bamboo, Mulberry Branch, Lonicera Lonicera Rattan, Prunus Damp-heat injury of kidney medicine: Dipsacus, psoralen. New side: Polyporus, stir-fried Atractylodes macrocephala, papaya, mulberry branches, grilled tortoise, fried turtle beetle; Sichuan Achyranthes hyacinth, Achyranthes bidentata, Acanthophora asparagus, Anemarrhena chinensis, Huang Pai. Conclusion 1, the most common type of rheumatoid arthritis is kidney deficiency and cold, which is in accordance with Jiao Lao's proposal. The etiology and pathogenesis of arthralgia: "wind, cold, dampness, three qi are combined to be arthralgia", which is characterized by deficiency of liver and kidney. By analyzing the frequency of drug use, it is found that the four syndromes are mainly warm drugs, and the drugs are mainly attributed to liver and kidney meridian. The drugs with higher frequency in the four syndromes all contain mulberry parasitism, dipsacus, except kidney deficiency, heat and weight syndrome, all contain cinnamon branches, which accord with Professor Jiaoshu de to treat Xu Bi and good temperature tonic, from liver and kidney to treat .3. the drugs with higher frequency of use of the four syndromes all contain scorched yuan Hu. It shows that activating blood circulation and regulating qi to relieve pain runs through the whole clinical treatment. 4, aconite, Epimedium appear low frequency, although the most common clinical syndrome is kidney deficiency and cold, but most of the patients are in the early stage of the disease, cold evil is the cause, but it is not deep enough. Therefore, less. 5 drugs are used to treat rheumatoid arthritis, and each syndrome type combines the new medicine pair and the new prescription to provide a new way of diagnosis and treatment for clinicians.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R249;R259

【參考文獻】

相關(guān)期刊論文 前10條

1 杜金萬;李良斌;袁劍波;胡春蓉;;中藥酒火療法治療類風濕關(guān)節(jié)炎(寒濕瘀阻證)臨床觀察[J];中國中醫(yī)急癥;2016年08期

2 駱鏡妃;胡宗科;鄧康;張瑤;彭莎莎;洪陳亮;王珍;楊麗;曾中三;秦旭平;;黑骨藤追風活絡(luò)膠囊抗類風濕性關(guān)節(jié)炎的藥理作用及機制[J];中南醫(yī)學科學雜志;2016年02期

3 管莉;;中藥濕熱敷配合云克治療風寒濕痹證型類風濕關(guān)節(jié)炎緩解關(guān)節(jié)疼痛的療效觀察[J];全科護理;2015年24期

4 王紅權(quán);詹杰;;白芍總苷治療類風濕關(guān)節(jié)炎藥理作用及機制[J];醫(yī)藥導報;2015年02期

5 車洪勇;車曉青;;通痹膠囊治療類風濕關(guān)節(jié)炎臨床研究[J];藥學研究;2014年08期

6 鄭文潔;曾小峰;;生物制劑在類風濕關(guān)節(jié)炎中的應用與進展[J];臨床藥物治療雜志;2014年04期

7 朱艷;;針刺療法治療類風濕關(guān)節(jié)炎療效觀察及生活質(zhì)量評價[J];中醫(yī)藥臨床雜志;2014年03期

8 孔伶俐;郭會卿;;郭會卿教授分期分型辨治類風濕關(guān)節(jié)炎經(jīng)驗[J];風濕病與關(guān)節(jié)炎;2014年01期

9 張立亭;婁俊東;;張鳴鶴教授治療類風濕關(guān)節(jié)炎的經(jīng)驗[J];風濕病與關(guān)節(jié)炎;2013年07期

10 蔡明明;馬寶東;;穴位注射丹參凍干粉針治療類風濕關(guān)節(jié)炎手關(guān)節(jié)腫痛43例[J];風濕病與關(guān)節(jié)炎;2013年05期

，

本文編號：1879238