本文選題：從肝論治 + 椎動(dòng)脈型頸椎病��； 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:觀察從肝論治椎動(dòng)脈型頸椎病的治療效果,為治療椎動(dòng)脈型頸椎病的中醫(yī)治療提供新的思路。方法:選取自2013年4月至2015年12月在湖北省中醫(yī)院花園山院區(qū)就診的椎動(dòng)脈型頸椎病患者,將所選患者從中醫(yī)肝的角度出發(fā)進(jìn)行辨證,并分為肝陽上亢證、肝腎陰虛證、肝郁氣滯證及風(fēng)痰上擾證4個(gè)證型,并在以上每個(gè)證型中設(shè)觀察組及對(duì)照組各25例患者,各組病例在性別、年齡、病程上無統(tǒng)計(jì)學(xué)差異(P0.05),可以進(jìn)行比較。其中觀察組患者根據(jù)辨證后的分型,肝陽上亢證組服用天麻鉤藤飲、肝腎陰虛證組服用一貫煎合六味地黃丸、肝郁氣滯證組予以柴胡疏肝散、風(fēng)痰上擾證組則予以半夏白術(shù)天麻湯。并在所有患者的藥物中加入葛根30g及川芎9g,在方中當(dāng)作引經(jīng)藥,假如原方中有葛根及川芎兩味藥物便不重復(fù)加入。觀察組患者單純予以以上中藥方口服進(jìn)行治療,藥物統(tǒng)一由湖北省中醫(yī)院花園山院區(qū)提供并統(tǒng)一煎制,每日早晚各服一次。對(duì)照組患者則僅予以鹽酸氟桂利嗪膠囊口服治療,每日晚臨睡前口服1粒。以上所有觀察組及對(duì)照組患者均以2個(gè)星期為治療周期,并在后期對(duì)所有患者進(jìn)行為期3個(gè)月的隨訪監(jiān)測(cè),囑所有患者避免長期低頭、過度旋轉(zhuǎn)等有害頸椎的動(dòng)作,指導(dǎo)患者行相同的頸椎保健操。比較各證型的治療效果、不良反應(yīng)及復(fù)發(fā)率三個(gè)方面。統(tǒng)計(jì)學(xué)分析使用SPSS18.0,計(jì)量資料以(x?±s)表示,計(jì)數(shù)資料采用X2檢驗(yàn),組間比較選擇t檢驗(yàn),以P0.05作為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:本次觀察經(jīng)過為期2周的治療周期以及后續(xù)3個(gè)月隨訪,所有患者共計(jì)200人有197例獲得完整隨訪。肝陽上亢證組中觀察組與對(duì)照組的總有效率分別為92.0%、68.0%,肝腎陰虛證組中觀察組與對(duì)照組的總有效率分別為87.0%、76.0%,肝郁氣滯證組中觀察組與對(duì)照組的總有效率分別為91.0%、68.0%,風(fēng)痰上擾證組中觀察組與對(duì)照組的總有效率分別為84.0%、80.0%。中藥組的總不良反應(yīng)率為2.0%,西藥組總不良反應(yīng)率為9.0%,P0.05,差別具有統(tǒng)計(jì)學(xué)意義。中藥組的復(fù)發(fā)率為1.0%,西藥組復(fù)發(fā)率為7.0%,P0.05,差別具有統(tǒng)計(jì)學(xué)意義。結(jié)論:由從肝論治的理論出發(fā),對(duì)椎動(dòng)脈型頸椎病進(jìn)行辨證分型,并針對(duì)個(gè)各證型分別予以相應(yīng)的中藥方劑,可使大部分患者的臨床癥狀明顯減輕,起到了優(yōu)于西藥的臨床效果�？梢哉f從肝論治椎動(dòng)脈型頸椎病辨證合理,療效確切。并且相對(duì)于服用鹽酸氟桂利嗪膠囊而言,通過中藥治療還具有不良反應(yīng)發(fā)生率低及復(fù)發(fā)率低的優(yōu)點(diǎn)。本理論及治療方法值得在臨床上進(jìn)一步深入研究及推廣。
[Abstract]:Objective: to observe the therapeutic effect of treating cervical spondylosis of vertebral artery type from liver theory, and to provide a new idea for the treatment of cervical spondylosis of vertebral artery type. Methods: from April 2013 to December 2015, patients with cervical spondylopathy of vertebral artery type were selected from Huayuan Mountain Hospital, Hubei traditional Chinese Medicine Hospital. The selected patients were divided into liver yang hyperactivity syndrome, liver kidney yin deficiency syndrome and liver yang hyperactivity syndrome. There were 4 syndromes of stagnation of liver qi and disturbance of wind and phlegm, and 25 patients in observation group and control group in each syndrome type above. There was no statistical difference in sex, age and course of disease in each group (P0.05). According to the type of syndrome differentiation, the observation group took Tianma Gouteng decoction, the liver and kidney yin deficiency group took the consistent decoction combined with Liuwei Dihuang pills, the liver stagnation syndrome group was treated with Chaihu Shugan San, Wind and phlegm disturbance syndrome group was given Pinellia macrocephala Gastrodia decoction. 30 g and 9 g of kudzu root and 9 g of Chuanxiong were added to all patients' drugs. If the original prescription had Radix Puerariae root and Chuanxiong drugs, they would not be added repeatedly. The patients in the observation group were treated by oral administration of the above traditional Chinese medicine prescriptions. The drugs were provided by the Huayuan Mountain Hospital of Hubei Provincial Hospital of traditional Chinese Medicine and the decoction was made once a day and once a day in the morning and evening. The patients in the control group were treated with flunarizine hydrochloride capsule orally and 1 tablet before bedtime every day. All the patients in the observation group and the control group were treated for 2 weeks, and all the patients were followed up for 3 months at the later stage, and all the patients were told to avoid the harmful cervical movement, such as long-term bow, excessive rotation and so on. Instruct the patient to do the same exercises as the cervical vertebrae. The therapeutic effect, adverse reaction and recurrence rate of each syndrome type were compared. SPSS 18.0 was used for statistical analysis, and (x? 鹵s) for metrological data, X2 test was used for counting data, t test was chosen for comparison between groups, and P0.05 was used as statistical significance. Results: 197 out of 200 patients were followed up for 2 weeks and followed up for 3 months. The total effective rates of observation group and control group were 92.00.The total effective rates of observation group and control group were 87.0 and 76.0, respectively. The total effective rates of observation group and control group were 91.0 and 68.0, respectively. The total effective rates of observation group and control group were 84.0 and 80.0 respectively. The total adverse reaction rate of the traditional Chinese medicine group was 2.0 and that of the western medicine group was 9. 0 and P 0. 05. The difference was statistically significant. The recurrence rate was 1.0 in Chinese medicine group and 7.0 in western medicine group, the difference was statistically significant. Conclusion: based on the theory of liver treatment, the syndrome differentiation and classification of cervical spondylosis of vertebral artery type and the corresponding traditional Chinese medicine prescriptions for each syndrome type can obviously alleviate the clinical symptoms of most patients. It has better clinical effect than western medicine. It can be said that treating cervical spondylosis of vertebral artery type from liver is reasonable and effective. Compared with flunarizine hydrochloride capsule, traditional Chinese medicine treatment also has the advantages of low incidence of adverse reactions and low recurrence rate. This theory and therapy are worthy of further study and popularization in clinic.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R274.9

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