【摘要】：目的:通過(guò)文獻(xiàn)研究結(jié)果與導(dǎo)師運(yùn)用化痰通腑、活血利水法治療腦出血后腦水腫治驗(yàn)總結(jié)的對(duì)比,以文獻(xiàn)數(shù)據(jù)指導(dǎo)并驗(yàn)證臨床用藥,開(kāi)拓診療思路,提供中藥療效的循證醫(yī)學(xué)證據(jù)。材料與方法:收集近20年生物醫(yī)學(xué)期刊上(包括中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM)、中國(guó)學(xué)術(shù)期刊網(wǎng)(CNKI)、重慶維普(VIP)等中文數(shù)據(jù)庫(kù))刊登的所有有關(guān)中藥治療腦出血后腦水腫的臨床研究文獻(xiàn),對(duì)符合條件的文獻(xiàn)進(jìn)行綜合分析,針對(duì)常見(jiàn)病機(jī)、主要治法、常見(jiàn)中藥類別及中藥、藥性特點(diǎn)進(jìn)行歸納分類總結(jié);對(duì)導(dǎo)師應(yīng)用化痰通腑、活血利水法治療腦出血后腦水腫的治驗(yàn)進(jìn)行總結(jié)。結(jié)果:1.腦出血后腦水腫常見(jiàn)病機(jī)包括痰瘀化水、痰熱腑實(shí)、陰虛風(fēng)動(dòng)、氣虛血瘀。2.常見(jiàn)治法為活血法(84.42%)、通腑法(68.83%)、化痰法(36.36%)、利水法(27.27%)、熄風(fēng)法(25.97%)以及益氣法(9.09%)。3.治療腦出血后腦水腫常見(jiàn)中藥類別為活血化瘀類(26.65%)、瀉下類(10.54%)、熄風(fēng)類(10.54%)、化痰類(7.32%)、利水類(6.3%)、清熱涼血類(5.71%)、補(bǔ)氣類(5.13%)等。應(yīng)用頻次較多的中藥分別是:活血化瘀類-生水蛭38次、丹參30次;瀉下類-大黃66次;平肝熄風(fēng)類-地龍16次、天麻11次;化痰類-膽南星15次、瓜蔞13次;利水滲濕類-澤瀉19次、茯苓10次;清熱涼血類-赤芍14次、生地14次;補(bǔ)氣類-白術(shù)10次、黃芪9次;補(bǔ)血類-當(dāng)歸15次;止血類-三七37次,開(kāi)竅類-石菖蒲20次。清熱類中藥中以清熱涼血類最多見(jiàn);補(bǔ)益類中藥中以補(bǔ)氣類最多見(jiàn)。4.治療腦出血后腦水腫中藥藥性方面:寒涼性質(zhì)藥物較常用(49.14%);苦味藥最多見(jiàn)(40.17%);歸經(jīng)排在前2位的分別是肝(膽)經(jīng)(33.43%)、脾(胃)經(jīng)(27.54%)。結(jié)論:1.中醫(yī)病機(jī):文獻(xiàn)研究結(jié)果顯示痰瘀化水,停于腦府為本病主要病機(jī),導(dǎo)師臨證治驗(yàn)與該結(jié)論相吻合。2.中醫(yī)治法:文獻(xiàn)研究結(jié)果顯示活血、通腑、化痰、利水法為本病主要治法,而導(dǎo)師根據(jù)該病的分期提出:急性期以痰熱腑實(shí)為主,治療上以清熱化痰通腑為主,活血利水為輔;恢復(fù)期以痰瘀阻滯經(jīng)絡(luò)為主,治療上化痰通絡(luò)與活血利水并重。3.中藥規(guī)律:文獻(xiàn)研究結(jié)果顯示治療本病常見(jiàn)中藥類別為活血化瘀類、瀉下類、熄風(fēng)類、化痰類、利水類、清熱涼血類、補(bǔ)氣類;以苦寒性質(zhì)藥物最常用;以歸肝(膽)經(jīng)、脾(胃)經(jīng)藥物最常見(jiàn)。4.文獻(xiàn)研究結(jié)果與導(dǎo)師治驗(yàn)的結(jié)合在該病的診治中療效確切。
[Abstract]:Objective: to compare the results of literature research with that of tutor in treating cerebral edema after intracerebral hemorrhage by using the method of resolving phlegm and regulating fu-organs and activating blood circulation and promoting water, and to guide and verify the clinical use of drugs with literature data, and to develop the thinking of diagnosis and treatment. To provide evidence-based medical evidence for the efficacy of traditional Chinese medicine. Materials and methods: to collect all the Chinese medicine related to the treatment of cerebral water after intracerebral hemorrhage published in biomedical journals (including (CBM), China Biomedical Literature Database, (CNKI), Chongqing Weipu, (VIP), etc.) in the past 20 years. Literature on clinical studies of swelling, Comprehensive analysis of qualified literature, classification and summarization of common disease machines, main treatment methods, common types and characteristics of traditional Chinese medicine; application of Huatan to remove phlegm and entrails, The treatment of cerebral edema after cerebral hemorrhage by activating blood circulation and promoting water therapy was summarized. The result is 1: 1. The common pathogenesis of cerebral edema after intracerebral hemorrhage includes phlegm and stasis, phlegm and heat, Yin deficiency and wind movement, Qi deficiency and blood stasis. The common methods were promoting blood circulation (84.42%), clearing Fu organs (68.83%), resolving phlegm (36.36%), promoting water (27.27%), dispelling wind (25.97%) and benefiting qi (9.09%) .3. The common types of traditional Chinese medicine for cerebral edema after intracerebral hemorrhage were activating blood circulation and removing blood stasis (26.65%), diarrhea (10.54%), dispelling wind (10.54%), resolving phlegm (7.32%), promoting water (6.3%), clearing heat and cooling blood (5.71%), supplementing qi (5.13%) and so on. The frequently used Chinese medicines were 38 times of promoting blood circulation and removing blood stasis, 30 times of salvia miltiorrhiza, 66 times of diarrhea and rhubarb, 16 times of pinggan quilting-Dilong, 11 times of Gastrodia elata, 15 times of resolving phlegm, 15 times of Gentian Nanxing, 13 times of Trichosanthes; Rhizoma alisma 19 times, Poria cocos 10 times; Clearing heat and cooling blood type-red peony 14 times, raw land 14 times; tonifying qi-Atractylodes macrocephalae 10 times, Radix Astragali 9 times; Blood-tonifying type-Angelica sinensis 15 times; hemostasis-37 times-37 times, resuscitation-Acorus calamus 20 times. In Chinese medicine of clearing away heat and cooling blood, it is most common in Chinese medicine of clearing away heat and cooling blood, and that in Chinese medicine of tonifying and nourishing is mostly seen in the category of tonifying qi. 4. In the treatment of cerebral edema after intracerebral hemorrhage, Chinese medicine was more commonly used (49.14%), bitter drugs (40.17%), liver (gallbladder) (33.43%) and spleen (stomach) (27.54%). Conclusion 1. Pathogenesis of TCM: the results of literature study showed that phlegm and blood stasis were the main pathogenesis of the disease. TCM treatment: the results of literature study showed that promoting blood circulation, removing phlegm and promoting water were the main methods of treating the disease. According to the stages of the disease, the tutor put forward the following points: phlegm and heat in the acute stage, heat in the acute period, clearing heat, removing phlegm and removing the fu-organs in the treatment, activating blood and promoting water as the auxiliary; In convalescence stage, phlegm and blood stasis block meridian mainly, treatment of phlegm and circulation of collaterals and promoting blood circulation and promoting water equal emphasis. 3. Law of traditional Chinese Medicine: the results of literature study show that the common types of Chinese medicine for the treatment of this disease are promoting blood circulation and removing blood stasis, diarrhea, wind extinguishing, phlegm, promoting water, clearing away heat and cooling blood, replenishing qi; taking bitter and cold medicine as the most commonly used medicine; and returning the liver (gallbladder) to the meridian of liver (gallbladder). Spleen (stomach) meridian medicine is the most common. 4. The combination of literature research and tutors is effective in the diagnosis and treatment of the disease.
【學(xué)位授予單位】：遼寧中醫(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)】：R277.7

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