本文選題：中藥 + 針灸　； 參考：《南京中醫(yī)藥大學》2017年碩士論文

【摘要】：本研究以中醫(yī)對胃食管反流病肝胃不和證的患者為研究對象,觀察患者使用單純中藥和針藥結(jié)合組(中藥合針灸)的治療療效,對比兩個治療方案的臨床優(yōu)勢。分別從患者之工作、家庭、個性、飲食與針灸與中藥療效分析,探討相關(guān)因素對患者癥狀改善之療效影響。研究方法:本研究采用結(jié)構(gòu)方程模式(structural equation modeling,SEM)提出研究架構(gòu),以最小偏微分法(PLS)和SPSS17.0進行數(shù)據(jù)分析及架構(gòu)驗證。臨床研究共收集50例患者連續(xù)8周時間序列數(shù)據(jù),因其中13例患者未能在本調(diào)查研究過程中持續(xù)觀察8周,因此有效觀察樣本計37例患者。全部病患均給予胃食管反流病教育、合理飲食等基礎治療。單純中藥組的方藥為左金丸合半夏厚樸湯加減。方藥:黃連3g吳茱萸1g姜半夏10g厚樸10g茯苓10蘇梗10g白芍10g炒白術(shù)10g柴胡5g炙甘草5g。每日1劑,水煎2次至300ml,分早、晚2次溫服,4周為1個療程,總共2個療程。針藥結(jié)合組的中藥和單純中藥組的方藥組成相同,其中針灸取穴以鳩尾、上脘、中脘、足三里、三陰交、內(nèi)關(guān)、太沖為主穴治療,針刺為常規(guī)瀉法。留針30分鐘,每周3次(隔日1次),比較兩組之間的療效差異。結(jié)果:(1)中藥組與針藥組均能有效治療肝胃不和型胃食管反流病(2)中藥組與針藥組治療前后主要癥狀以及伴隨癥狀經(jīng)配對以治療前與第8周的差值進行成對T檢定,中藥組治療前后主要癥狀都有明顯改善,而中藥組除了慢性咳嗽和大便不調(diào)無明顯改善以外,其余伴隨癥狀都有明顯改善。(3)中藥組與針藥組患者治療后,計算療效指數(shù),按照療效評判標準統(tǒng)計顯示,中藥組臨床痊愈1例,顯效8例,有效5例,無效3例,總有效率為82.35%。針藥組臨床痊愈1例,顯效11例,有效7例,無效1例,總有效率為90.00%。經(jīng)統(tǒng)計分析,P=0.150.05,說明針藥組在主要癥狀及伴隨癥狀的改善方面明顯優(yōu)于中藥組。(4)工作與飲食因子構(gòu)面對患者有正向顯著影響,改善工作壓力與調(diào)整飲食習慣對患者主要與伴隨癥狀有顯著改善。家庭因子與個性因子構(gòu)面對患者短期內(nèi)多數(shù)未有明顯改善,顯示短期內(nèi)患者不易改變家庭與個性因素的影響力。(5)實證結(jié)果顯示治療因素子構(gòu)面治療時間是對治療患者具有正向顯著影響,本研究顯示治療8周后對改善患者癥狀產(chǎn)生顯著影響的改善;治療時間越長患者改善程度越高。(6)主要癥狀在針藥組與中藥組分別跑PLS模型時因為樣本數(shù)減少,導致因素負荷量會下降并出現(xiàn)部分參數(shù)低于0.5;未來研究需要擴大樣本數(shù)即可修正此一問題。
[Abstract]:The aim of this study was to observe the therapeutic effect of traditional Chinese medicine (TCM) combined with acupuncture and moxibustion on the patients with gastroesophageal reflux syndrome of liver-stomach disharmony, and to compare the clinical advantages of the two treatment schemes. The effects of related factors on the improvement of patients' symptoms were analyzed from work, family, personality, diet, acupuncture and traditional Chinese medicine. Methods: in this study, the structural equation model (structural equation) was used to propose the research framework, and the minimum partial differential method (PLs) and SPSS 17.0 were used to analyze the data and verify the architecture. A total of 50 patients with 8 weeks of time series data were collected in the clinical study. Among them, 13 patients failed to observe for 8 weeks in the course of the investigation, so 37 patients were observed effectively. All patients were given gastroesophageal reflux disease education, reasonable diet and other basic treatment. The prescription of simple Chinese medicine group is Zuo Jin Wan and Banxia Houpu decoction. Prescription: Rhizoma Coptidis 3 g, Evodia rutaecarpa 1 g, ginger, Pinellia ternata 10g, Magnolia officinalis 10g, Poria cocos 10g, Radix Paeoniae Alba 10g, Atractylodes macrocephala 10g. 1 dose per day, 2 times to 300 ml water, early, 2 times in the evening for 4 weeks as a course of treatment, a total of 2 courses. The composition of traditional Chinese medicine in acupuncture and medicine combination group is the same as that in traditional Chinese medicine group, in which acupuncture and moxibustion are treated with Jiu tail, Shangwan, Zhongwan, Zusanli, Sanyinjiao, Neiguan, Taichong as main points, acupuncture as routine method of diarrhea. The therapeutic effects were compared between the two groups 3 times a week (3 times a week) for 30 minutes. Results: (1) both Chinese medicine group and acupuncture and medicine group could effectively treat gastroesophageal reflux disease of hepatogastric disharmony. (2) before and after treatment, the main symptoms and associated symptoms in the Chinese medicine group and the acupuncture and medicine group were matched to determine the difference between before and after treatment and at the 8th week. The main symptoms of the Chinese medicine group were obviously improved before and after treatment, while the Chinese medicine group had no obvious improvement except for chronic cough and defecation disorder. (3) after treatment, the curative effect index was calculated in the traditional Chinese medicine group and the acupuncture and medicine group. According to the statistics of curative effect criterion, 1 case of clinical cure, 8 cases of remarkable effect, 5 cases of effective and 3 cases of ineffective were found in TCM group. The total effective rate was 82.35. In the acupuncture and medicine group, 1 case was cured, 11 cases were effective, 7 cases were effective, and 1 case was ineffective. The total effective rate was 90.005%. The statistical analysis showed that the improvement of main symptoms and associated symptoms in acupuncture and medicine group was obviously superior to that in traditional Chinese medicine group. (4) work and dietary factors had positive and significant effects on the patients. Improvement of work stress and adjustment of eating habits significantly improved the main and accompanying symptoms of patients. Family factors and personality factors were not significantly improved in the short term. The results showed that the influence of family and personality factors was not easy to change in the short term. (5) the empirical results showed that the treatment time of treatment factors had a positive and significant effect on the patients. This study showed that the improvement of symptoms after 8 weeks of treatment had a significant effect on the improvement of symptoms, and the longer the treatment time, the higher the degree of improvement. (6) the number of samples decreased when the main symptoms were in the pls model of acupuncture and medicine group and traditional Chinese medicine group, respectively. The factor load will decrease and some parameters will be lower than 0.5. In the future research we need to expand the sample number to correct this problem.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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