發(fā)布時間：2018-06-29 02:59

  本文選題：蔣小敏 + 學(xué)術(shù)思想�。� 參考：《南京中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：目的：總結(jié)蔣小敏教授學(xué)術(shù)思想及臨證經(jīng)驗,觀察消痛湯治療急性痛風(fēng)性關(guān)節(jié)炎的臨床療效,探討其可能的機制。方法：理論研究：通過跟隨導(dǎo)師臨床學(xué)習(xí)、記錄筆記,搜集整理導(dǎo)師相關(guān)文獻(xiàn)資料、臨證筆記及醫(yī)案,查閱相關(guān)文獻(xiàn)及著作等方式歸納、總結(jié)蔣教授的學(xué)術(shù)思想,并對蔣小敏教授辨治代謝性疾病的臨證經(jīng)驗進行總結(jié),分析其辨治規(guī)律。臨床研究：按照簡單隨機、對照、非盲的臨床試驗原則,入選80例符合西醫(yī)痛風(fēng)性關(guān)節(jié)炎診斷標(biāo)準(zhǔn)及中醫(yī)辨證符合濕熱蘊結(jié)證候的病人。將病人分為治療組和對照組各40例,治療組每日以消痛湯劑內(nèi)服治療,對照組以雙氯芬酸鈉片75mg/日進行治療,兩組療程均為2周并對治療前后關(guān)節(jié)功能、關(guān)節(jié)腫痛指數(shù)、中醫(yī)證候積分、炎癥指標(biāo)、血尿酸進行對照分析,并對安全性進行評價,簡要分析導(dǎo)師治療痛風(fēng)性關(guān)節(jié)炎的特色,進一步探討消痛湯治療痛風(fēng)性關(guān)節(jié)炎的相關(guān)機制。結(jié)果：提出雜病從脾腎論治,強調(diào)脾腎氣化理論對疾病的影響,在辨治過程中應(yīng)當(dāng)注重“三重”,即重脾腎、重氣化、重情志,臨證中重視診法,強調(diào)氣化,用藥平和,并系統(tǒng)介紹了導(dǎo)師對臨床常見代謝綜合證的理論認(rèn)識及臨證經(jīng)驗及遣方用藥特色。臨床研究：經(jīng)過對參與試驗的80例患者臨床結(jié)果進行統(tǒng)計學(xué)分析后顯示試驗組治療后總有效率92.5%,對照組總有效率80%,療效明顯優(yōu)于對照組,經(jīng)統(tǒng)計有統(tǒng)計學(xué)意義。中醫(yī)證候療效：治療組總有效率92.5%,對照組總有效率77.5%,治療組療效明顯優(yōu)于對照組,經(jīng)統(tǒng)計有統(tǒng)計學(xué)意義。治療后兩組患者主要癥狀比較,關(guān)節(jié)腫痛指數(shù)比較、關(guān)節(jié)功能比較方面治療組明顯優(yōu)于對照組,經(jīng)統(tǒng)計有統(tǒng)計學(xué)意義。實驗室指標(biāo)：兩組治療前后炎癥指標(biāo)均較治療前有明顯下降,治療組療效明顯優(yōu)于對照組,經(jīng)統(tǒng)計有統(tǒng)計學(xué)意義。結(jié)論：濕熱蘊結(jié)是痛風(fēng)性關(guān)節(jié)炎的中醫(yī)基本病機,應(yīng)用清熱解毒,除濕通絡(luò)法治療該病臨床確有療效,其安全性良好,且無明顯毒副作用。消痛湯治療組在改善濕熱蘊結(jié)型痛風(fēng)患者癥狀方面有確切有效,優(yōu)于西藥對照組：在控制疾病活動的各項實驗室檢測指標(biāo)WBC、UA、ESR、CRP方面,其療效明顯優(yōu)于對照組。
[Abstract]:Objective: to summarize Professor Jiang Xiaomin's academic thought and clinical experience, to observe the clinical effect of Xiaotong decoction on acute gouty arthritis and to explore its possible mechanism. Methods: theoretical study: by following the tutor's clinical study, taking notes, collecting and arranging the tutor's related documents, clinical evidence notes and medical records, consulting the relevant documents and works, summarizing the academic thoughts of Professor Jiang. Professor Jiang Xiaomin's experience in differentiation and treatment of metabolic diseases was summarized, and the law of differentiation and treatment was analyzed. Clinical study: according to the principle of simple randomized, controlled and non-blind clinical trial, 80 patients who met the diagnostic criteria of gouty arthritis in western medicine and syndrome differentiation of TCM in accordance with dampness and heat accumulation syndrome were selected. The patients were divided into treatment group (n = 40) and control group (n = 40). The treatment group was treated with Xiaotong decoction daily and the control group was treated with diclofenac sodium tablet 75mg/ day. TCM syndromes integral, inflammation index, blood uric acid were compared and analyzed, the safety was evaluated, the characteristics of tutor treating gouty arthritis were analyzed briefly, and the related mechanism of Xiaotong decoction in treating gouty arthritis was discussed. Results: treating miscellaneous diseases from spleen and kidney, emphasizing the influence of the theory of spleen and kidney gasification on disease, should pay attention to "triple" in the process of differentiation and treatment, that is, heavy spleen and kidney, heavy gasification, heavy emotion, paying attention to the method of diagnosis, emphasizing gasification, and using medicine peacefully in clinical syndrome. The theoretical understanding, clinical experience and medication characteristics of common metabolic syndromes were introduced systematically. Clinical study: after statistical analysis of the clinical results of 80 patients involved in the trial, it was shown that the total effective rate of the test group was 92.5, the total effective rate of the control group was 80, the curative effect was obviously better than that of the control group, and the statistical significance was statistically significant. The curative effect of TCM syndrome: the total effective rate of the treatment group was 92.5 and the total effective rate of the control group was 77.5.The curative effect of the treatment group was obviously better than that of the control group, which was statistically significant. After treatment, the main symptoms of the two groups, the index of joint swelling and pain, and the comparison of joint function were significantly better in the treatment group than in the control group, and there was statistically significant difference between the treatment group and the control group. Laboratory indicators: the two groups before and after treatment of inflammatory indicators were significantly lower than before treatment, the treatment group was significantly better than the control group, statistical significance. Conclusion: the damp-heat accumulation knot is the basic pathogenesis of gouty arthritis. The method of clearing away heat and detoxifying toxin and removing dampness and dredging collaterals is effective in treating this disease with good safety and no obvious side effects. The treatment group was more effective than the western medicine control group in improving the symptoms of the patients with dampness and heat accumulation, and the control group was superior to the control group in the control of disease activity.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R249;R259

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