【摘要】：目的:高胰島素血癥是能導(dǎo)致多代謝異常、代謝綜合征的共同病理,是導(dǎo)致糖尿病心腦血管疾病的危險(xiǎn)因素。這些疾病包括血脂異常、高血壓、高血糖、全身或腹部肥胖、高胰島素血癥伴胰島素抵抗等慢性疾病的危險(xiǎn)因素。高胰島素血癥可防可治,通過早期發(fā)現(xiàn),并積極防治危險(xiǎn)因素,能阻斷相關(guān)終點(diǎn)事件發(fā)生,符合中醫(yī)"治未病"的思想。李賽美教授長期從事內(nèi)分泌病及高胰島素血癥臨床研究,積累了不少臨床經(jīng)驗(yàn)。本研究通過臨床觀察,旨在探討李賽美教授治療高胰島素血癥的臨床運(yùn)用六經(jīng)辨證理法方藥的辨治經(jīng)驗(yàn)。方法:選擇從2014年1月至2016年12月在廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院內(nèi)分泌科南樓門診收集李賽美教授就診的高胰島素血癥的病歷,共105例。采用Office excel統(tǒng)計(jì)軟件建立個(gè)人資料、癥狀、證型、治法、方劑、藥味及藥效數(shù)據(jù)庫。采用SPSS統(tǒng)計(jì)軟件對(duì)收集的病歷資料的癥狀、舌苔脈象、證型、治法、方劑及藥味進(jìn)行頻數(shù)統(tǒng)計(jì)分析(Frequency Analysis),并初步歸納李賽美教授治療用藥規(guī)律的臨床經(jīng)驗(yàn)。結(jié)果:本研究收集李賽美教授門診的高胰島素血癥的病歷,共105例。其中,采用34個(gè)不同患者的病例,而另外71病例屬來復(fù)診的患者。女性27例,占79.41%,男性7例,占20.59%。六經(jīng)辨證分析為:太陽證67次(63.81%),陽明證7次(6.67%),少陽證34次(32.38%),太陰證51次(48.57%),少陰證50次(47.62%),厥陰證6次(5.71%)。從研究結(jié)果的病例分析數(shù)據(jù)庫顯示出李賽美教授治療高胰島素血癥的原則及思路,高胰島素血癥治法用補(bǔ)氣藥、清熱藥、利水滲濕藥、溫里藥、補(bǔ)陽藥、化濕藥、化痰藥為主,第二若患者感受風(fēng)寒或風(fēng)熱就用扶正祛邪治法,第三用補(bǔ)血藥、活血化淤藥、補(bǔ)陰藥、理氣藥、安神藥、平息肝風(fēng)藥、收斂藥為伴隨癥狀加減治療。治療高胰島素血癥先疏肝健脾,清熱除濕,利水滲濕,其次再以溫補(bǔ)脾陽,補(bǔ)益肝腎為主。對(duì)于李賽美教授用中藥治療高胰島素血癥患者,本研究結(jié)論如下:1.重視整體觀念;2.治療標(biāo)本結(jié)合;3.純中藥治療和中西醫(yī)結(jié)合;4.重視患者的心理問題;5.六經(jīng)辨證;6.臟腑辯證;7.癥狀用藥;8.常用藥對(duì)。結(jié)論:現(xiàn)代醫(yī)學(xué)治療高胰島素血癥的推薦方案基本上是注重預(yù)防和治療各種危險(xiǎn)因素。現(xiàn)代醫(yī)學(xué)研究、醫(yī)學(xué)實(shí)驗(yàn)對(duì)中醫(yī)治療糖代謝異常癥、胰島素抵抗、胰島素血癥及代謝綜合征等疾病具有明顯的效果。治療高胰島素血癥通過早期治療肥胖、眩暈(高血壓)、消渴(糖尿病),為了預(yù)防疾病趨勢發(fā)展中醫(yī)方面能共識(shí)為"治未病"。疾病越早發(fā)現(xiàn)治療越顯效。李賽美教授在臨床上運(yùn)用六經(jīng)辨證和傷寒論方治療高胰島素血癥獲得好療效。本研究初步探討李賽美教授治療的經(jīng)驗(yàn)和辨證用藥思路。
[Abstract]:Objective: hyperinsulinemia is a common pathology of metabolic syndrome and a risk factor for diabetic cardiovascular and cerebrovascular diseases. These include dyslipidemia, hypertension, hyperglycemia, systemic or abdominal obesity, hyperinsulinemia with insulin resistance and other chronic disease risk factors. Hyperinsulinemia can be prevented and treatable. By early detection and active prevention and treatment of risk factors, the occurrence of related endpoint events can be blocked, which is in line with the idea of "treating the disease before illness" in traditional Chinese medicine. Professor Li Sei-mei has long been engaged in the clinical research of endocrine disease and hyperinsulinemia, and has accumulated a lot of clinical experience. Through clinical observation, the purpose of this study was to explore the experience of professor Li Samei in the treatment of hyperinsulinemia. Methods: 105 cases of hyperinsulinemia were collected from the Department of Endocrinology, first affiliated Hospital of Guangzhou University of traditional Chinese Medicine from January 2014 to December 2016. The database of personal data, symptoms, syndromes, treatment, prescription, taste and efficacy were established by Office excel software. The symptoms, tongue coating pulse, syndromes, treatment methods, prescriptions and taste of the collected medical records were analyzed by SPSS software. The clinical experience of Professor Li Samei's treatment and medication was preliminarily summarized. Results: 105 cases of hyperinsulinemia were collected. Among them, 34 different cases were used, while the other 71 cases were returned patients. There were 27 females (79.41%) and 7 males (20.59%). The syndrome differentiation of six meridians was as follows: Yang syndrome 67 times (63.81%), Yang Ming syndrome 7 times (6.67%), Shaoyang syndrome 34 times (32.38%), Taiyin syndrome 51 times (48.57%), Shaoyin syndrome 50 times (47.62%), Jueyin syndrome 6 times (5.71%). From the case analysis database of the results of the study, the principles and ideas of Professor Li Samei's treatment of hyperinsulinemia are shown. The treatment of hyperinsulinemia is mainly composed of Qi tonifying drugs, heat clearing drugs, promoting water and infiltrating dampness medicine, warming medicine, tonifying yang medicine, dehumidifying medicine, resolving phlegm medicine. Second, if the patients feel the wind and cold or wind heat, they should be treated with the method of nourishing the qi and dispelling evil, and the third with the medicine of tonifying the blood, activating the blood and removing the stasis, tonifying the yin, regulating the qi, soothing the spirit, quelling the liver wind, and converging the medicine for the treatment of the accompanying symptoms. The treatment of hyperinsulinemia first soothes the liver and invigorates the spleen, clears the heat and dehumidifies the dampness, promotes water and seeps dampness, and then heats up the spleen and yang and invigorates the liver and kidney. For Professor Li Samei to treat hyperinsulinemia patients with traditional Chinese medicine, this study concluded as follows: 1. Attach importance to the concept of the whole. 3. Pure Chinese medicine treatment and integrated Chinese and western medicine 4. Pay attention to the psychological problems of patients. Six meridians differentiation of symptoms and signs. The zang-fu organs are dialectical. Symptom medication. The usual medicine is right. Conclusion: the recommended regimen for the treatment of hyperinsulinemia in modern medicine is to focus on the prevention and treatment of various risk factors. Modern medical research and medical experiment have obvious effect on the treatment of abnormal glucose metabolism, insulin resistance, insulinemia and metabolic syndrome. Treatment of hyperinsulinemia through early treatment of obesity, vertigo (hypertension), thirst (diabetes), in order to prevent the development of disease trends in traditional Chinese medicine can be agreed to "cure the disease." The earlier the disease is discovered, the more effective treatment is. Professor Li Samei used six meridians syndrome differentiation and febrile fever to treat hyperinsulinemia. This study preliminarily discusses the experience of Professor Li Samei's treatment and the thinking of syndrome differentiation and medication.
【學(xué)位授予單位】：廣州中醫(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)】：R249;R259
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本文編號(hào)：2261091