本文選題：慢性胃炎 + 脾胃濕熱證��； 參考：《湖北中醫(yī)藥大學》2016年博士論文

【摘要】：目的:通過對現(xiàn)代文獻中慢性胃炎證型,慢性胃炎脾胃濕熱證臨床癥狀、舌象、脈象、方劑、藥物、藥物加減等資料的數(shù)據(jù)挖掘。研究慢性胃炎脾胃濕熱證的證候特點,并以藥測證、以方測證,探討病證結合模式下脾胃濕熱證的辨證規(guī)律。臨床上通過對全國6所醫(yī)院慢性胃炎流行病學(飲食偏好、誘發(fā)因素)、一般情況(病程、加重時間)和臨床證候(癥狀加重時間、癥狀、舌質、舌苔),胃鏡像、幽門螺旋桿菌等數(shù)據(jù)挖掘,為慢性胃炎脾胃濕熱證量化診斷標準的研究提供佐證依據(jù)。方法:慢性胃炎包括慢性萎縮性胃炎、慢性淺表性胃炎、慢性糜爛性胃炎、膽汁反流性胃炎、慢性胃炎(胃痞)、幽門桿菌相關性胃炎。收集以“慢性胃炎”為關鍵詞并包含“脾胃濕熱證”的所有文獻。收集文獻資料中慢性胃炎的病例來源省份、研究病例數(shù)、男女病例數(shù),辨證分型及相應的病例數(shù);慢性胃炎脾胃濕熱證的臨床癥狀、舌象、脈象、方劑、藥物、藥物加減進行統(tǒng)計,并對以上指標的稱謂進行統(tǒng)一。用Liquorice軟件對其以上資料進行頻次、節(jié)點度、緊密度統(tǒng)計,進行聚類分析、關聯(lián)分析。臨床上,采集2014年6月~2015年6月全國6所醫(yī)院(武漢、北京、廈門、鹽城、合肥、成都)消化內(nèi)科門診和住院的慢性胃炎患者600例。按照慢性胃炎西醫(yī)診斷標準,中醫(yī)脾胃濕熱證辨證標準及臨床納入標準,隨機選擇病例納入脾胃濕熱證組,其余病例均歸入非脾胃濕熱病組。首先用Epi Data軟件建立數(shù)據(jù)庫,進行數(shù)據(jù)處理,并轉換為SPSS數(shù)據(jù)庫文件。用SPSS20.0軟件對數(shù)據(jù)進行處理和分析,采用多重響應分析探究各數(shù)據(jù)間的頻次、交叉相互關系;用多項多元logistic回歸分析比較之間的擬合度,K均值聚類分析進行分類比較。結果:文獻數(shù)據(jù)挖掘中,慢性胃炎中脾胃虛寒證出現(xiàn)頻次最高,其次為肝胃郁熱證和脾胃濕熱證,明顯較其他證型高。各證型中發(fā)病病例數(shù),肝胃郁熱證最高,為23%,脾胃虛弱證為22%,脾胃濕熱證為16%,三證型總計61%。慢性胃炎脾胃濕熱證癥狀,出現(xiàn)頻次最高的為口苦。頻次在100以上的癥狀由高到低依次為:口苦、胃脘痞滿、尿黃、胃脘脹痛、口臭、惡心、胃脘灼熱、納呆、大便溏。頻次在50~100之間的癥狀由高到低依次為:胃脘疼痛、嘔吐、口渴少飲、口粘膩、肢體困重。慢性胃炎脾胃濕熱證脈象中,脈滑頻次最高,為97次,由高到低依次是脈滑數(shù)、脈濡數(shù)、脈弦、脈弦滑、脈濡緩、脈數(shù)。舌象上,總頻度最高的為舌質紅,為243次,舌苔黃膩為189次,舌苔黃厚為109次,舌苔膩為91次,舌邊尖深紅為63次。慢性胃炎脾胃濕熱證選用方劑由高到低依次為:連樸飲、半夏瀉心湯、黃連溫膽湯、三仁湯、藿樸夏苓湯、清化飲。藥物使用率最高的藥物為黃連,頻次為244次。頻次在100以上的藥物由高到低依次為半夏、厚樸、甘草、茯苓、黃芩、陳皮、蒲公英。頻次在50~100之間由高到低依次為:薏苡仁、藿香、蔻仁、蒼術、枳殼。清熱化濕類藥物在各慢性胃炎脾胃濕熱證中大量選用,黃連、半夏、厚樸、茯苓、甘草、蒲公英均有較高的使用。瓦楞子、厚樸、薏苡仁、竹茹、蛇舌草、蒼術、萊菔子、佩蘭、陳皮、莪術、砂仁、代赭石、枳實、蒲公英、白術等藥物在慢性胃炎脾胃濕熱證藥物加減上針對性強,使用率高,療效好。瓦楞子針對反酸癥狀使用率最高,配合烏賊骨;延胡索針對疼痛選用率最高,常與川楝子配合;大便秘結時大黃使用最高,惡心嘔吐竹茹、生姜配合;納呆麥芽、雞內(nèi)金、神曲、谷芽使用率高,厚樸對脹滿效果好。濕偏甚藿香、蒼術、佩蘭使用率高、熱偏甚蒲公英、黃芩使用率高。各慢性胃炎脾胃濕熱證發(fā)病率廣東、北京、江蘇、福建、山東高于全國其他地區(qū),其頻次均在35次以上。臨床上,病程在2~5年的患者中多以脾胃濕熱證為主,加重時間多在2周內(nèi)。慢性胃炎脾胃濕熱證的飲食偏好上,主要是以辛辣刺激食物最為常見,占74.4%,其次為油膩飲食、腌制食品,分別占73.4%和64.5%。飲酒、飯后癥狀明顯加重,個案占比分別為68.2%、64.2%。下午癥狀更為明顯,個案占比為61.7%。慢性胃炎脾胃濕熱證癥狀頻次中,脘腹脹滿占75.9%,肢體困重占65.0%,口苦為58.1%。慢性胃炎脾胃濕熱證舌色占比中,舌質紅62.6%,舌尖紅為49.8%;舌質形體上點刺舌為73.4%,舌體胖為37.4%,舌質老為30.0%。舌質紅、舌尖紅、點刺舌經(jīng)卡方檢驗有顯著的統(tǒng)計學意義(P0.05)。慢性胃炎脾胃濕熱證舌苔顏色上,黃苔占63.0%,白苔為26.1%。舌苔分布部位個案占比上,舌根部為86.2%,舌質紅為62.6%。舌苔的多項多元logistic回歸分析,參數(shù)估計P0.05的有舌苔黃、苔膩。慢性胃炎脾胃濕熱證組中熱重于濕的證候個案占比大于50%以上的主要有點刺舌為73.4%,舌苔黃63.5%,舌質紅62.6%,口苦為58.1%。慢性胃炎脾胃濕熱證組中濕重于熱的證候中,個案占比大于50%以上的主要有舌苔膩78.3%,點刺舌為73.4%,舌苔黃63.5%,肢體困重65.0%,便溏51.2%。慢性胃炎脾胃濕熱證組中濕熱并重的證候中,個案占比大于50%以上的主要有舌苔厚79.8%,舌苔膩78.3%,點刺舌為73.4%,舌苔黃63.0%,口苦58.1%。慢性胃炎脾胃濕熱證組中,慢性淺表性胃炎占86.2%,伴糜爛占71.9%,粘膜紅白相間,以紅為主占86.2%。在各慢性胃炎脾胃濕熱證,癥狀主要有口苦、胃脘痞滿、尿黃、胃脘脹痛、口臭、惡心、胃脘灼熱、納呆、大便溏;脈象上主要有脈滑數(shù)、脈滑、脈濡數(shù);舌象上表現(xiàn)為舌質紅或舌邊尖深紅,苔黃膩或黃厚或膩。結論:文獻研究中慢性胃炎各證型中肝胃不和證(肝郁氣滯證和肝胃郁熱證)脾胃虛弱證脾胃濕熱證,以上證型的發(fā)病病例數(shù)占慢性胃炎中醫(yī)證型的70%。慢性胃炎脾胃濕熱證的癥狀由高到低依次為:口苦、胃脘痞滿、尿黃、胃脘脹痛、口臭、惡心、胃脘灼熱、納呆、大便溏,胃脘疼痛、嘔吐、口渴少飲、口粘膩、肢體困重。脈象由高到低依次為:脈滑、脈滑數(shù)、脈濡數(shù)、脈弦、脈弦滑、脈濡緩、脈數(shù)。舌象由高到低依次為:舌質紅、舌苔黃膩、舌苔黃厚、舌苔膩、舌邊尖深紅。慢性胃炎脾胃濕熱證臨床常選用方劑由高到低依次為:連樸飲、半夏瀉心湯、黃連溫膽湯、三仁湯、藿樸夏苓湯、清化飲。藥物使用由高到低依次為:黃連、半夏、厚樸、甘草、茯苓、黃芩、陳皮、蒲公英、薏苡仁、藿香、蔻仁、蒼術、枳殼。藥物加減中由高到低依次為:竹茹、瓦楞子、大黃、蒼術、生姜、延胡索、佩蘭、旋覆花、蒲公英。各慢性胃炎脾胃濕熱證發(fā)病率廣東、北京、江蘇、福建、山東高于全國其他地區(qū)。臨床研究中病程在2~5年的患者中多以脾胃濕熱證為主,加重時間多在2周內(nèi)。慢性胃炎脾胃濕熱證的飲食偏好上主要是以辛辣刺激食物最為常見,其次為油膩飲食、腌制食品。飲酒、癥狀明顯加重,下午癥狀更為明顯。在慢性胃炎脾胃濕熱證主要癥狀中,慢性胃炎中頻次由高到低依次為:脘腹脹滿胃脘疼痛噯氣燒心感食少納呆便溏不爽肢體困重口苦睡眠差呃逆大便秘結反酸口臭口渴少飲胃中嘈雜惡心欲吐胸悶小便黃。最終篩選出百分率50%及具有統(tǒng)計學意義的條目作為慢性胃炎脾胃濕熱證診斷量表內(nèi)容,確定出:1脘腹脹滿、2肢體困重、3口苦、4口渴少飲、5口臭、6便溏不爽、7噯氣、8睡眠差,以上8項癥狀為慢性胃炎脾胃濕熱證的相關因素。綜合文獻和臨床研究,制定以下慢性胃炎脾胃濕熱證量化診斷內(nèi)容,主要包括慢性胃炎的特異癥狀、慢性胃炎臨床癥狀嚴重程度分級、脾胃濕熱證證候的輕重程度量化。確定主要證候依次為:1胃脘脹滿或胃脘脹痛或胃脘灼熱疼痛或胃脘隱痛(特異癥狀),2肢體困重,3口苦,4口渴少飲,5口臭,6便溏不爽,7納呆,8舌邊尖紅伴點刺、舌體胖;或舌邊尖紅伴點刺舌質老;9舌根部苔黃厚;或舌根部苔黃膩;或舌根部苔黃厚膩;或舌中后部苔黃厚;或舌中部、根部苔黃膩;或舌中后部苔黃厚膩10脈象上主要有脈滑數(shù),或脈滑,或脈濡數(shù)。具備18910,即慢性胃炎特異性癥狀一項加舌象、脈象可診斷慢性胃炎脾胃濕熱證。慢性胃炎臨床癥狀嚴重程度分級(參考表2-1)。脾胃濕熱證證候的輕重程度分級:1輕度為舌邊尖紅伴少許點刺,舌根部苔黃膩;2中度為舌邊尖紅伴點刺,舌根部苔黃厚膩,或舌中后部苔薄黃膩;或舌邊尖紅舌體胖,舌根部苔厚膩。3重度為舌邊尖紅絳伴明顯點刺,舌質老,舌中后部苔黃厚膩;或舌邊尖紅絳伴明顯點刺,舌質老,全舌苔燥厚膩;或舌邊尖紅,舌體胖,舌中后部苔厚膩;或舌邊尖暗紅,舌體胖,舌中后部苔厚膩。
[Abstract]:Objective: through the data mining of the clinical symptoms of chronic gastritis, chronic gastritis, spleen and stomach damp heat syndrome, tongue image, pulse image, prescription, medicine, drug addition and subtraction, the characteristics of syndrome of spleen and stomach damp heat syndrome of chronic gastritis were studied, and the syndrome differentiation law of spleen and stomach damp heat syndrome under the combination pattern of disease and syndrome was investigated by the drug test. On the basis of the epidemiology of chronic gastritis (diet preference, inducing factor), general condition (course of disease, aggravation time) and clinical syndrome (symptom aggravation time, symptom, tongue quality, tongue coating), gastric image, Helicobacter pylori and other data mining in 6 hospitals of the whole country, this paper provides evidence for the study of quantitative diagnosis standard for spleen and stomach damp heat syndrome of chronic gastritis. Chronic gastritis includes chronic atrophic gastritis, chronic superficial gastritis, chronic erosive gastritis, bile reflux gastritis, chronic gastritis (stomach ruffiffy), pylorus related gastritis. The collection of "chronic gastritis" as the key word and including "spleen and stomach damp heat syndrome". The number of cases, the number of men and women, the syndrome differentiation and the number of cases, the clinical symptoms of the spleen and stomach damp heat syndrome of the chronic gastritis, the tongue image, the pulse, the prescription, the medicine, the drug addition and subtraction are unified. The frequency, the node degree, the tightness statistics, the clustering analysis and the correlation of the above data are carried out by the Liquorice software. Analysis. Clinically, 600 cases of chronic gastritis in 6 hospitals (Wuhan, Beijing, Xiamen, Yancheng, Hefei, Chengdu) were collected from 6 hospitals of the whole country in June June 2014. According to the standard of Western medicine for chronic gastritis, the syndrome differentiation standard of spleen and stomach damp heat syndrome and the inclusion criteria were included, and the random selected cases were included in the spleen and stomach damp heat syndrome group. The remaining cases were all returned to the non spleen and stomach damp heat disease group. First, the database was established by Epi Data software, and the data were processed and converted into SPSS database files. The data were processed and analyzed with SPSS20.0 software. Multiple response analysis was used to explore the frequency of each data, intersecting with each other, and compared with a number of multiple logistic regression analysis. Results: in the literature data mining, the frequency of deficiency cold of spleen and stomach in chronic gastritis was the highest, followed by liver and stomach heat syndrome and spleen and stomach damp heat syndrome, which was higher than that of other syndromes. The number of cases in each type, the highest of liver and stomach heat syndrome, 22% of spleen and stomach weakness, 16% of spleen and stomach damp heat syndrome, 16%, three of spleen and stomach damp heat syndrome, were 16%, three. The symptoms of 61%. chronic gastritis with spleen and stomach damp heat syndrome were the most frequent. The symptoms from high to low were the following: stomachache, epigastric fullness, urine yellow, stomach distending pain, halitosis, nausea, heartburn, nausea and stool. The symptoms from high to low in 50~100 were as follows: stomachache, vomiting and thirst, and thirst. In the pulse image of the spleen and stomach damp heat syndrome of chronic gastritis, the frequency of pulse slipping is the highest, 97 times, from high to low is the number of veins, the number of veins, the veins, the veins, the veins and the veins. The highest frequency of the tongue is the red tongue, the 243 times, the yellow and greasy fur of the tongue 189 times, the tongue fur of 109 times, the tongue fur 91 times, and the deep red tongue edge of 63 times. The choice of prescription from high to low in chronic gastritis and spleen and stomach damp heat syndrome is: Lian Pu Yin, Banxia Xiexin soup, Huanglian Wendan soup, San Ren Tang, poupagari soup, Qinghua drink. The highest drug use rate is 244 times. The frequency of more than 100 of the drugs from high to low is the Pinellia ternata, Magnolia officinalis, licorice, Poria, Scutellaria, Chen peel, dandelion. 50~100 from high to low in turn: coix seed, patchouli, nutmeg, Atractylodes, Fructus aurantii, hot and humid drugs in the spleen and stomach of the chronic gastritis are widely used in the spleen and stomach damp and heat syndrome, and yellow Coptis, Pinellia ternata, Magnolia officinalis, licorice, dandelion all have high use. Ochre, ochre, ochre, Fructus aurantii trifoliate, dandelion, and Atractylodes on the spleen and stomach damp heat syndrome of chronic gastritis, the use rate is high, the curative effect is good. The use rate of corrugated on antiacid symptoms is the highest, with the cuttlefish bone; the Corydalis Corydalis has the highest selection rate for pain, often with the neem seed, and the use of the highest, nausea and vomiting and bamboo Ru when the constipation is conjecting. The use rate of malt, chicken inner gold, Divine Comedy and valley bud is high, and magnolia is good. The use rate of dampness is very high, the use rate of Perrin is high, the heat is dandelion, and the use rate of Scutellaria is high. The incidence of spleen and stomach damp heat syndrome in Guangdong, Beijing, Jiangsu, Fujian and Shandong is higher than the other regions of the country. The frequency of the syndrome is more than 35 times. In 2~5 years, most patients with spleen and stomach damp heat syndrome are mainly the spleen and stomach damp heat syndrome, and the time of aggravation is more than 2 weeks. The diet preference of chronic gastritis and spleen and stomach damp heat syndrome is the most common, accounting for 74.4%, followed by greasy food, pickled food, 73.4% and 64.5%. respectively, after meals, the symptoms are obviously aggravated, the case occupation ratio is 68.2% respectively. In the afternoon, the symptoms of 64.2%. were more obvious. The cases accounted for the frequency of spleen and stomach damp heat syndrome of 61.7%. chronic gastritis, the abdominal distention was 75.9%, the body weight was 65%, the oral pain was of 58.1%. chronic gastritis and spleen and stomach damp heat syndrome, the tongue color was 62.6%, the tongue tip red was 49.8%, the tongues were 73.4%, the tongue body fat was 37.4%, and the tongue was old 30.0%.. There are significant statistical significance (P0.05) in the tongue coating test of tongue quality red, tongue tip red and puncting tongue. The color of tongue coating of spleen and stomach damp heat syndrome of chronic gastritis, Huang Taizhan 63%, white moss for 26.1%. tongue fur distribution, 86.2% of tongue root, 62.6%. tongue fur with multiple multiple logistic regression analysis, parameter estimation of P0.05 with tongue coating yellow, In the group of spleen and stomach damp heat syndrome of chronic gastritis, the main points of hot and wet syndrome were 73.4%, 63.5% of tongue fur, 63.5% of tongue and 62.6% of tongue, and the pain in the group of 58.1%. chronic gastritis and spleen and stomach damp heat syndrome in the syndrome of damp and hot in the spleen and stomach damp heat syndrome, the cases accounted for 78.3% of the main tongue coating more than 50%, 73.4% of tongue tongue and tongue coating. Yellow 63.5%, limbs heavy 65%, loose stools of 51.2%. chronic gastritis and spleen and stomach damp heat syndrome in the syndrome of damp heat and weight, the proportion of cases accounted for more than 50% of the main tongue coating thickness 79.8%, tongue fur 78.3%, 73.4% tongue coating, tongue coating yellow 63%, chronic gastritis and spleen and stomach damp heat syndrome group, chronic superficial gastritis 86.2%, accompanied by erosion of 71.9%, mucous mucous membrane, 71.9%. Mucous mucosa is 71.9%, mucous mucous mucosa with 71.9%, mucous mucous mucosa with 71.9%, mucous mucous mucosa with 71.9%, mucous mucosa with 71.9%, mucous mucosa with 71.9%, mucous mucosa with erosion of 71.9%, mucosa of 71.9%, mucosa of 71.9%, mucosa of 71.9%, mucosa of 71.9%, mucosa of 71.9%, mucosa of 71.9%, mucosa of 71.9%, mucosa of 71.9%, mucous mucosa with 71.9% mucous mucous mucosa. Red and white, with red mainly 86.2%. in the spleen and stomach damp and hot syndrome of the chronic gastritis, the main symptoms are stomachache, epigastric fullness, urine yellow, stomachache distention and pain, bad breath, nausea, stomach burning, nausea and stool; the veins are mainly veins slippery, vein slippery, diulence and deep red, yellowish or yellow thick or greasy. Conclusion: literature research The syndromes of chronic gastritis in various syndromes (liver qi stagnation syndrome and liver and stomach depression) syndrome of spleen and stomach damp heat syndrome, the symptoms of the above syndrome type accounted for the symptoms of chronic gastritis 70%. chronic gastritis and spleen and stomach damp heat syndrome from high to low in turn: stomachache, stomach epigastric fullness, urine yellow, stomachache distention and pain, bad breath, nausea, heartburn heat. The pulse, the pulse number, the pulse number, the pulse string, the pulse string, the pulse and the pulse number. The tongue image is red, the tongue fur is yellow, the tongue fur is yellow, the tongue fur is yellow, the tongue fur is greasy, the tongue edge is deep red. The syndrome of chronic gastritis and spleen and stomach damp heat syndrome is often used clinically. The agent from high to low is: Lian Pu Yin, Banxia Xiexin soup, Huanglian Wendan soup, three kernel soup, huppu Xia Ling soup, Qinghua drink. The use of the medicine from high to low is yellow Coptis, Pinellia ternata, Radix Glycyrrhizae, Fuling, Scutellaria baicalensis, dandelion, dandelion, coix seed, patchouli, cardamom, Atractylodes, Fructus aurantii. From high to low, from high to low, the order of medicine is bamboo Ru, corrugated, rhubarb, and Cuba. The incidence of spleen and stomach damp heat syndrome in Guangdong, Beijing, Jiangsu, Fujian and Shandong is higher than the other regions in Guangdong, Beijing, Jiangsu, Fujian and Shandong. The majority of patients in the clinical study are spleen and stomach damp heat syndrome in 2 weeks. The diet preference of chronic gastritis and spleen and stomach damp heat syndrome is mainly based on the diet preference. Spicy food is the most common food, followed by greasy food, pickled food, drinking, the symptoms are obviously aggravated, the afternoon symptoms are more obvious. In the main symptoms of chronic gastritis, spleen and stomach damp heat syndrome, the middle frequency of chronic gastritis is from high to low in the following order: stomach distention, stomach, stomach, stomach, heart, heart, heart and loose stool A total of 50% and a statistically significant item were selected as a diagnostic scale for the spleen and stomach damp heat syndrome of chronic gastritis. It was determined that 1 abdominal distention, 2 limbs heavy, 3 stomachs, 4 thirst, 5 halitosis, 6 loose stools, 7 belching, 8 sleep poor, 8 poor sleep, 8 The symptom was the related factors of spleen and stomach damp heat syndrome of chronic gastritis. Comprehensive literature and clinical study were made to make quantitative diagnosis of spleen and stomach damp heat syndrome of chronic gastritis, including the specific symptoms of chronic gastritis, classification of the severity of chronic gastritis clinical symptoms, and the severity of spleen and stomach damp heat syndrome. The main syndromes were the 1 stomach in turn. Abdominal distention or stomachache pain or heartburn pain or epigastric pain (specific symptoms), 2 limbs heavy, 3 stomachs, 4 thirst little drink, 5 halitosis, 6 loose stools, 7 nausea, 8 tongue edge sharp red with prickly, fat tongue body, or tongue sharp red with tongues old; the root part of the tongue fur thick; or the tongue root moss yellow thick; or tongue in the thick and greasy fur; or the tongue of the thick and greasy fur; or the tongue of the thick and greasy fur; or the tongue of the thick and greasy fur; or the tongue of the thick and greasy fur; or the tongue of the thick and greasy fur; or the tongue of the thick and greasy fur; or the tongue of the thick and greasy fur; or the tongue of the thick and greasy fur; or the back tongue of the tongue. In the middle of the tongue, the root is yellow and greasy, or the thick and greasy tongue in the back of the tongue is thick and greasy 10 pulse, or pulse, or pulse. It has 18910, that is, a chronic gastritis with a special symptom of the tongue, the pulse can diagnose the spleen and stomach damp heat syndrome of chronic gastritis. The severity grade of chronic gastritis clinical symptom (reference table 2-1). Degree classification: 1 mild tongue edge sharp red with a little prick, the root of the tongue is yellow and greasy; 2 moderate tongue edge sharp red with prick, the root part of the tongue is thick and greasy, or the tongue is thin yellow and yellow fur; or the tongue edge sharp red tongue is fat, the tongue is thick and thick with the thick.3 for the tongue edge sharp red crimson, the tongue is old, the tongue in the back moss yellow thick greasy, or lingual sharp red and red crimson with obvious tongue side. Pricking, tongue old, full tongue coating dry thick and greasy; or tongue tip red, tongue fat, tongue in the back of the thick moss; or tongue tip dark red, tongue fat, tongue in the back of the moss thick and greasy.
【學位授予單位】：湖北中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R259

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