本文選題：腸易激綜合征 + 證治��； 參考：《廣州中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：背景古代并無腸易激綜合征的病名,根據(jù)主要臨床表現(xiàn)目前多將其歸于"泄瀉"、"腹痛"、"便秘"、"痛瀉"、"腸郁"、"郁癥"。中醫(yī)在臨床的療效情況普遍理想,方藥中較多人選用為痛瀉要方,在其基礎(chǔ)上加減變化運用。中醫(yī)治療腹瀉型腸易激綜合征的主要方劑中,痛瀉要方、四逆散、逍遙散、柴胡疏肝散、附子理中丸、升陽益胃湯等較為有實驗基礎(chǔ)。一般認(rèn)為,腸易激綜合征的病因病機可概括為外邪犯肺、肝郁氣滯、脾胃虛弱、陽氣不足等等病機。由于病名眾多,以及隨著近年醫(yī)家對腸易激綜合征的研究更深入,現(xiàn)代醫(yī)家對腸易激綜合征有了很多不同的認(rèn)識,如周福生教授提出的心胃相關(guān)理論及蔡淦教授提出由氣機失調(diào)理論等。目前中醫(yī)辨證分型不統(tǒng)一的情況發(fā)生,少則2型,多則7型均有報道,以4或5型最常見。即使標(biāo)準(zhǔn)己逐準(zhǔn)建立起來,但各個標(biāo)準(zhǔn)間的辨證分型不統(tǒng)一,如《實用中醫(yī)消化病學(xué)》把腸易激綜合征分為7型;《中藥新藥臨床研究指導(dǎo)原則》按泄瀉把腸易激綜合征分為6型;《腸易激綜合征中西醫(yī)結(jié)合診治方案(草案)》把腸易激綜合征分為5型;《中醫(yī)消化病學(xué)診療指南》分為6型。導(dǎo)致臨床上較難有統(tǒng)一的認(rèn)識。同時,從文獻(xiàn)數(shù)據(jù)顯示,國外對中醫(yī)治療腸易激綜合征研究較少,亦缺乏相關(guān)的薈萃分析;在國內(nèi)對中醫(yī)治療腸易激綜合征具有一定的經(jīng)驗,但缺乏大規(guī)模的循證醫(yī)學(xué)證據(jù),以致療效尚不完全肯定�？偫ǘ�,中醫(yī)藥對該病有較好的療效,不良反應(yīng)少,透過對近代文獻(xiàn)中中醫(yī)對腸易激綜合征的中醫(yī)辨證用藥進(jìn)行系統(tǒng)的研究,分析其組合規(guī)律,總結(jié)現(xiàn)代醫(yī)家對治療腸易激綜合征的經(jīng)驗,可以簡化現(xiàn)代醫(yī)家對腸易激綜合征的認(rèn)識,便于推廣中醫(yī)藥,應(yīng)用于臨床。而整理中醫(yī)藥治療腸易激綜合征的相關(guān)文獻(xiàn)進(jìn)行綜合薈萃分析,則可探討現(xiàn)時在研究中醫(yī)藥治療腸易激綜合征的有效性及安全性,及發(fā)掘中醫(yī)治療腸易激綜合征的有效方案及其特點。目的:對中醫(yī)治療腸易激綜合征的證候要素組合、證候、用藥規(guī)律進(jìn)行總結(jié)。透過薈萃分析探討中醫(yī)藥治療腹瀉型腸易激綜合征、便秘型腸易激綜合征的臨床療效和安全性。方法:本課題分別針對醫(yī)家的經(jīng)驗及臨床對照研究進(jìn)行文獻(xiàn)研究2部分。1.以'腸易激'、'對照'為關(guān)鍵詞,檢索"相關(guān)期刊論文"、"中國優(yōu)秀碩士學(xué)位論文全文數(shù)據(jù)庫","相關(guān)博士學(xué)位論文",按照納入d}準(zhǔn)及排除標(biāo)準(zhǔn)進(jìn)行相關(guān)參考文獻(xiàn)篩選,把所得資料進(jìn)行頻數(shù)分析、類別主成分分析、聚類分析。2.以"腸易激"、"對照"為關(guān)鍵詞,檢索"相關(guān)期刊論文"、"中國優(yōu)秀碩士學(xué)位論文全文數(shù)據(jù)庫","相關(guān)博士學(xué)位論文",并按"腹瀉"、"便秘"分別納入腹瀉型及便秘型腸易激綜合征的研究。在納入排除標(biāo)準(zhǔn)上首次使用純中藥不加減原則篩選文獻(xiàn)。按照納入d}準(zhǔn)及排除標(biāo)準(zhǔn)進(jìn)行相關(guān)參考文獻(xiàn)篩選,按照其有否對照研究中患者有否辨證,分別納入辨病及辨證的薈萃研究。對納入的研究進(jìn)行數(shù)據(jù)的采集與評價,用Excel及Revman軟件進(jìn)行薈萃分析。結(jié)果:1.針對醫(yī)家的經(jīng)驗研究的文獻(xiàn)研究結(jié)果1.1納入61篇文獻(xiàn),在證素方面,頻數(shù)分析顯示提取的病性要素以氣滯、氣虛的頻次較高;病位要素為脾、肝的頻次較高;病性要素組合以二證組合頻數(shù)最高,氣虛氣滯為主要要素;病位要素組合以二證組合頻數(shù)最高,以脾肝的頻次最高,脾腎次之。證候要素的組合規(guī)律很可能為脾氣虛、肝氣郁滯、肝郁脾虛、脾虛夾濕。1.2在癥狀/體征方面,頻數(shù)分析顯示腹瀉、脘腹痛、便溏三個癥狀頻次較高,與腹瀉型腸易激綜合征癥狀相近,提示腹瀉型腸易激綜合征可能較為常見。類別主成分分析顯示癥狀/體征可分為屬于脾氣虛,肝經(jīng)郁滯,心陰不足,氣滯,陽虛的主要證候。聚類分析顯示癥狀/體征可分為屬于脾虛夾濕,肝郁脾虛,肝郁氣滯為主的證候。1.3在藥物成分方面,頻數(shù)分析顯示白g.或白芍使用頻次較高,與臨床上較多人使用痛瀉要方治療腸易激綜合征情況吻合。類別主成分分析顯示經(jīng)驗用藥主要可分為疏肝健脾、健脾溫脾、溫運脾陽及健脾埅濕類四類中藥,而聚類分析顯示經(jīng)驗用藥主要可分為疏肝健脾為主、健脾理氣、疏肝為主兼以化濕、及疏肝為主的中藥。2.針對醫(yī)家臨床對照研究的文獻(xiàn)研究結(jié)果2.1腹瀉型腸易激綜合征方面,薈萃分析顯示,中醫(yī)藥干預(yù)的有效率優(yōu)于單個西藥干預(yù),與匹維溴銨、洛呱丁胺、思密達(dá)、馬來酸曲美布汀及雙歧桿菌活菌膠囊比較均有優(yōu)勢。中藥在治療腹瀉癥狀上有優(yōu)勢,但在腹痛癥狀上與西藥無差異。在復(fù)發(fā)率上,上藥的復(fù)發(fā)率少于西藥干預(yù)組。且未發(fā)現(xiàn)嚴(yán)重不良反應(yīng)。在治療辨證后腹瀉型腸易激綜合征方面,薈萃分析顯示,中醫(yī)藥干預(yù)的有效率優(yōu)于單純西藥干預(yù),與匹維溴銨、思密達(dá)、馬來酸曲美布汀、及益生菌干預(yù)比較有優(yōu)勢。在與西藥比較,處理肝郁脾虛、脾胃虛弱、脾腎陽虛型患者有優(yōu)勢。在癥狀方面,中藥在處理腹脹及患者大便次數(shù)方面有優(yōu)勢,但在泄瀉及大便形狀方面與西藥無統(tǒng)計學(xué)上差異。納入研究中未發(fā)現(xiàn)嚴(yán)重不良反應(yīng)。2.2關(guān)于便秘型腸易激綜合征,薈萃分析顯示有效率顯著優(yōu)于單純西藥干預(yù),但與西沙必利比較無明顯差異。中醫(yī)藥干預(yù)未發(fā)現(xiàn)嚴(yán)重不良反應(yīng)。關(guān)于便秘型腸易激綜合征分型以后,對于氣秘型及肝郁氣滯型患者,薈萃分析顯示,中醫(yī)藥干預(yù)的有效率優(yōu)于單純西藥干預(yù)。中醫(yī)藥干預(yù)未發(fā)現(xiàn)嚴(yán)重不良反應(yīng)。2.3納入的73篇文獻(xiàn)中,41.0%(30/73)的文獻(xiàn)報告治療過程中治療組或者對照組的不良反應(yīng)(ADR)或不良事件(ADE),可以反映研究者關(guān)注到使用藥物的安全性。這些研究中,中藥治療組出現(xiàn)不良反應(yīng)的種類少于對照組,如口干,便秘、惡心、腹脹、腹瀉等,而大多數(shù)副作用報導(dǎo)數(shù)目出現(xiàn)少于對照組,可以看出中藥是安全使用。結(jié)論:1.從經(jīng)驗總結(jié)方面,可以看到(1)從證候要素方面,頻數(shù)分析顯示提取的病性要素以氣滯、氣虛是主要要素;病位要素為脾、肝為主。(2)癥狀/體征方面,頻數(shù)分析顯示腹瀉、脘腹痛、便溏三個癥狀頻次較高,與臨床常見的腹瀉型腸易激綜合征癥狀相近。類別主成分分析及聚類分析顯示癥狀/體征屬于肝郁脾虛為主的證候。(3)從藥物來說,頻數(shù)分析顯示白術(shù)、白芍頻次較高,與痛瀉要方相近。類別主成分分析及聚類分析顯示疏肝健脾,健脾溫脾類中藥是主要用藥。2.從薈萃分析方面,(1)結(jié)果顯示中醫(yī)干預(yù)腹瀉型腸易激綜合征上有優(yōu)勢,主要方劑有疏肝健脾方劑,如痛瀉要方。(2)分型后見肝郁脾虛證治療腹瀉型腸易激綜合征上有優(yōu)勢,選藥以白術(shù)、白芍、防風(fēng)、陳皮為主,與痛瀉要方用藥相近;(3)治療脾腎陽虛腹瀉型腸易激綜合征上有優(yōu)勢,選藥以炒白g.、茯苓、附子、炙甘草為主,與附子理中丸用藥相近,暫未搜尋到相關(guān)的薈萃分析。(4)從便秘型腸易激綜合征的薈萃分析顯示,辨證前后中藥在治療腸易激綜合征上有優(yōu)勢,治療方法主要有疏肝理氣潤腸等方劑,如六磨湯。綜上所述,肝郁脾虛證是在腸易激綜合征是常見的證型,本文首次對運用不含加減的藥物的臨床對照研究進(jìn)行薈萃分析,證實中藥治療肝郁脾虛證腹瀉型腸易激綜合征有效,痛瀉要方為主要方藥,這在臨床上值得重視辨證在治療腸易激激綜合征的階段性作用。透過病案的統(tǒng)計分析,醫(yī)家經(jīng)驗中脾腎陽虛型腹瀉型腸易激綜合征患者較為少見,而首次針對有脾腎陽虛型腹瀉型腸易激綜合征患者的臨床對照實驗,透過薈萃分析證實其有效性。白g.、茯苓、附子、甘草為主要藥物,與較多實驗研究提示附子理中丸在治療腸易激綜合征有作用的結(jié)果相符、提示陽氣在腸易激綜合征中的重要性,可加強對溫陽藥物的應(yīng)用。
[Abstract]:In the background, there is no name of irritable bowel syndrome in ancient times. According to the main clinical manifestations, it is often attributed to "diarrhea", "abdominal pain", "constipation", "pain diarrhea", "bowel depression" and "depression". The clinical effect of traditional Chinese medicine is generally ideal, many people in the prescription are used for pain and diarrhoea on the basis of it. The treatment of diarrhea type irritable bowel syndrome in Chinese Medicine Among the main prescriptions, the pain and diarrhea prescription, four inverse scatter, Xiaoyao Powder, bupleurum soothing liver, Fuzi Lizhong pill, Shengyang Yiwei soup, etc., are generally believed to be the etiology and pathogenesis of irritable bowel syndrome as external pathogenic, stagnation of liver qi, weakness of spleen and stomach, deficiency of Yang Qi and so on. The research of irritable syndrome is more in-depth. Modern doctors have many different views on irritable bowel syndrome, such as the theory of heart and stomach related to Professor Zhou Fusheng and Professor Cai Gan's theory of Qi disorder. At present, the syndrome differentiation of Chinese medicine is not unified, the 2 and the 7 are reported, which are the most common type of type 4 or 5. Even the standard is the most common. It must be set up, but the syndrome differentiation and classification of each standard is not unified, such as < practical TCM Digestive Disease > to divide irritable bowel syndrome into 7 types; < the guiding principle of clinical research for Chinese medicine new medicine > to divide irritable bowel syndrome into 6 types according to diarrhea; < middle intestinal irritable syndrome with Chinese and Western medicine treatment scheme (Draft) > to divide irritable bowel syndrome into 5 types; < The guide to diagnosis and treatment of medical and digestive diseases is divided into 6 types. It is difficult to have a unified understanding in clinic. At the same time, from the literature data, there are few studies on the treatment of irritable bowel syndrome in Chinese medicine and lack of related meta analysis. In general, traditional Chinese medicine has better curative effect and less adverse reaction. Through the systematic study of traditional Chinese medicine for irritable bowel syndrome in modern literature, it analyses the combination rule and summarizes the experience of modern doctors in treating irritable bowel syndrome, which can simplify the convenience of modern doctors. The understanding of irritable syndrome is convenient to popularize traditional Chinese medicine and apply to clinical practice. And colligate meta analysis of the relevant literature on the treatment of irritable bowel syndrome in Chinese medicine, we can explore the effectiveness and safety of TCM in the treatment of irritable bowel syndrome, and explore the effective scheme and characteristics of TCM Treatment of irritable bowel syndrome. To summarize the combination of TCM syndrome factors, syndrome, and the rule of drug use. Through meta-analysis, the clinical efficacy and safety of TCM in the treatment of diarrhea type irritable bowel syndrome and constipation irritable syndrome were discussed. Methods: the subjects were studied 2 parts of the medical experience and clinical comparative study respectively. .1. was divided into 'irritable bowel' and 'control' as the key words, retrieving "Chinese journal full text database", "full text database of Chinese excellent master's degree thesis", "full text database of Chinese doctoral dissertations", screening relevant reference documents in accordance with the standard and exclusion criteria of d}, and carrying out frequency analysis, category principal component analysis and cluster analysis of the obtained data. .2., with "irritable bowel" and "control" as the key word, retrieves "full text database of Chinese Periodicals", "full text database of Chinese excellent master's degree thesis", "full text database of Chinese doctoral dissertations" and "diarrhea" and "constipation" in the study of diarrhea and constipation irritable bowel syndrome respectively. The first use of pure Chinese medicine in the exclusion criteria is not. Screening the literature with the principle of addition and subtraction. According to the inclusion of d} quasi and exclusion criteria, the relevant reference literature was screened. According to whether or not the patients in the study were based on the syndrome differentiation, they were included in the meta analysis of disease discrimination and syndrome differentiation. Data collection and evaluation of the included studies were carried out with Excel and Revman soft parts. Results: 1. aimed at doctors' Classics The results of literature study 1.1 included 61 documents. In the aspect of syndrome factors, frequency analysis showed that the frequency of the disease factor was higher in Qi stagnation and Qi deficiency, the factor of the disease was spleen and the frequency of liver was higher; the combination of the disease elements was the highest in the combination of two syndrome, Qi deficiency and qi stagnation was the main factor, and the combination of the disease position elements was the highest in the combination of two syndrome. The frequency of spleen and liver is the highest and the spleen and kidney is the second. The combination of syndrome factors is likely to be spleen qi deficiency, stagnation of liver qi, liver qi stagnation, spleen deficiency, spleen deficiency and spleen deficiency. The frequency analysis shows that the three symptoms of diarrhea, abdominal pain and loose stool are higher, which are similar to diarrhea type irritable syndrome, suggesting the possibility of diarrhea type irritable bowel syndrome. Classification principal component analysis showed that symptoms / signs could be divided into main syndromes belonging to spleen qi deficiency, stagnation of liver meridian, deficiency of heart Yin, qi stagnation and yang deficiency. Cluster analysis showed that symptoms / signs could be divided into spleen deficiency, liver depression and spleen deficiency, liver depression and qi stagnation as the main syndrome.1.3 in the composition of drug substances, frequency analysis showed the frequency of white g. or paeony use frequency The classification principal component analysis showed that four kinds of traditional Chinese medicine were divided into liver and spleen, spleen warming, spleen yang, spleen yang and spleen invigorating dampness, and the cluster analysis showed that the master of drug use could be divided into liver and spleen, spleen and spleen, liver and liver. A meta analysis of the literature of Chinese herbal medicine.2., which is mainly based on chemical and liver dispersing, is more effective than single western medicine, compared with pippium bromide, roguaginamine, smecta, trimebutine maleic and Bifidobacterium living bacteria capsules. Traditional Chinese medicine has advantages in the treatment of diarrhea symptoms, but there is no difference in abdominal pain symptoms with western medicine. In the recurrence rate, the recurrence rate of the medicine is less than that in the western medicine intervention group. And there is no serious adverse reaction. In the treatment of syndrome differentiation after syndrome, the meta-analysis shows that the effective efficiency of Chinese medicine intervention is better than that of the western medicine intervention. Compared with the western medicine, the patients with liver depression and spleen deficiency, spleen and stomach weakness, spleen kidney yang deficiency have advantages. In terms of symptoms, Chinese medicine has advantages in dealing with abdominal distention and stool times, but it is not statistically different from western medicine in diarrhea and stool shape. No serious adverse reaction.2.2 was found in the study of constipation irritable bowel syndrome. The meta-analysis showed that the effective rate was significantly better than that of Western medicine, but there was no significant difference from cisapride. Traditional Chinese medicine intervention did not find serious adverse reactions. After the classification of constipation type irritable bowel syndrome, it was for gas constipation and liver depression. Meta-analysis showed that the effectiveness of traditional Chinese medicine intervention was better than that of pure western medicine. In the 73 literature which had not been found in.2.3, the adverse reactions (ADR) or adverse events (ADE) in the treatment group or the control group in the treatment process of 41% (30/73) could reflect the attention of the researchers. In these studies, the types of adverse reactions in the Chinese medicine treatment group were less than those of the control group, such as dry mouth, constipation, nausea, abdominal distention, diarrhea and so on, and the number of most side effects appeared less than the control group. It can be seen that the traditional Chinese Medicine is safe to use. Conclusion: 1. from the experience summary, we can see (1) frequency of syndrome factors. Analysis showed that the essential factors were qi stagnation and Qi deficiency, and the main factors were spleen and liver. (2) symptoms / signs, the frequency analysis showed that three symptoms of diarrhea, abdominal pain and loose stool were higher, which were close to the common symptoms of diarrhea type irritable bowel syndrome. Category principal component analysis and cluster analysis showed symptoms / signs. Syndrome of liver qi stagnation and spleen deficiency mainly. (3) from the drug, frequency analysis showed that the frequency of Atractylodes macrocephala was higher and similar to the prescription for pain and diarrhea. Category principal component analysis and cluster analysis showed that the liver and spleen, spleen warming and spleen are the main use of.2. from meta-analysis, (1) the results showed that TCM Intervention in diarrhea type irritable bowel syndrome has advantages, The main prescription has the prescription of soothing the liver and invigorating the spleen, such as the prescription of pain and diarrhea. (2) the liver qi stagnation and spleen deficiency syndrome has the advantage in the treatment of diarrhea type irritable bowel syndrome. The main choice is Baizhu, Paeoniae Paeoniae, wind proof and orange peel. (3) the treatment of spleen kidney yang deficiency diarrhea type irritable bowel syndrome has advantages, and the drugs are selected to stir fry white g., Poria cocos, aconite, licorice A meta analysis of the constipated irritable bowel syndrome showed that the traditional Chinese medicine has the advantage in the treatment of irritable bowel syndrome, and the treatment methods mainly include the prescription of moistening the liver and moistening the intestines, such as the six mill soup. In summary, the syndrome of liver depression and spleen deficiency is an irritable synthesis in the intestines. (4) The syndrome is a common syndrome type. In this paper, a meta-analysis of the clinical control study which is used without addition and subtraction is the first time to prove that the Chinese medicine is effective in the treatment of diarrhea type irritable bowel syndrome with liver depression and spleen deficiency, and the main prescription is the prescription of pain and diarrhea. It is worth paying attention to the stage effect of syndrome differentiation in the treatment of irritable irritable bowel syndrome. In the medical experience, the patients with diarrhea of spleen and kidney yang deficiency type irritable bowel syndrome are relatively rare, and the clinical control experiments for the patients with spleen kidney yang deficiency type irritable bowel syndrome for the first time prove its effectiveness through meta-analysis. White g., Poria cocos, Aconitum and Glycyrrhiza are the main drugs. The results of treatment for irritable bowel syndrome are consistent, indicating the importance of Yang Qi in irritable bowel syndrome, and can enhance the application of Warming Yang drugs.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R259

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