芩連平胃散加減治療燥痹臨床觀察及理論初探
發(fā)布時間：2019-01-09 06:09
【摘要】：燥痹是由燥邪為主而導致的痹病,燥勝則干,其以孔竅干燥和關節(jié)疼痛為主要臨床特征,是中醫(yī)的難治性疾病,其臨床發(fā)病率近年呈上升趨勢。查閱現(xiàn)存古代醫(yī)籍并無燥痹病名的確切記載,“燥痹”病名為國醫(yī)大師路志正教授根據(jù)其病因病機并結合自己多年臨床經驗而提出。廣安門醫(yī)院風濕科基于路老對燥痹的理論及治療方案進行了大量的基礎與臨床的研究,導師曹煒主任在臨床應用路老理法方藥的實踐過程中發(fā)現(xiàn),燥痹雖多見氣陰不足證,然而隨著社會環(huán)境的變化,脾胃濕熱證多與其并見,芩連平胃散清熱燥濕,運脾和胃,為導師治療燥痹脾胃濕熱證的常用方。本文通過理論和臨床兩方面闡述芩連平胃散治療燥痹脾胃濕熱證的理論依據(jù)和臨床研究。運用中醫(yī)理論對燥痹脾胃濕熱證的發(fā)病機理進行分析,結合社會環(huán)境、生活方式討論燥痹脾胃濕熱證的成因,總結導師運用芩連平胃散治療燥痹脾胃濕熱證的臨床辨治要點及用藥經驗。文獻綜述：通過查閱參考相關文獻及相關書籍對燥痹的歷史源流、命名,歷代醫(yī)家對燥痹的認識加以梳理,以明確燥痹的定義及范疇。詳細論述脾胃在燥痹發(fā)病、病情轉歸及治療中的重要作用。芩連平胃散功可清熱燥濕,恢復脾胃氣機,運化布散精微,對組成芩連平胃散的六味中藥的現(xiàn)代藥理研究加以綜述,以現(xiàn)代藥理理闡釋芩連平胃散治療燥痹機制。臨床研究目的：觀察芩連平胃散治療32例燥痹脾胃濕熱證的臨床療效,對芩連平胃散治療燥痹脾胃濕熱證的理論機制進行初步探討,為今后的臨床應用提供依據(jù)。方法：2015年4月—2016年2月期間于中國中醫(yī)科學院廣安門醫(yī)院風濕科門診收集辨證屬燥痹脾胃濕熱證患者32例,予芩連平胃散加減治療。根據(jù)燥痹及脾胃濕熱證的診斷要點,以眼干、口鼻咽干,脘腹脹滿、皮疹,大便異常,關節(jié)痛,口腔潰瘍,納呆8個癥狀為主要癥狀,及消化系統(tǒng)、情緒、睡眠等27個次要癥狀。記錄首診、一月后復診、二月后復診、三月后復診總癥狀積分及各主癥積分,共計4次。運用SPASS22.0統(tǒng)計軟件統(tǒng)計數(shù)據(jù),采用t檢驗,秩和檢驗等統(tǒng)計方法,P0.05有統(tǒng)計學意義。結果：1、經3個月治療后,患者癥狀改善程度,顯效17例(53.13%),有效13例(40.63%),緩解1例(3.12%),無效1例(3.12%),總有效率為96.88%；2、治療過程中,4次評價,癥狀總積分呈遞減趨勢,差異有統(tǒng)計學意義P0.05；3、治療過程中,4次評價,各項主癥均有較明顯的改善,差異有統(tǒng)計學意義P0.05。結論：1、芩連平胃散能明顯改善燥痹脾胃濕熱證患者臨床癥狀。2、芩連平胃散治療燥痹脾胃濕熱證患者,能明顯降低其癥狀總積分及各主癥積分,3、芩連平胃散治療燥痹脾胃濕熱證,顯效53.13%,有效40.63%,緩解3.12%,總有效率為96.88%；
[Abstract]:Dryness arthralgia is a kind of arthralgia caused mainly by dryness and dryness. Dryness is mainly characterized by dryness of orifices and joint pain. It is a refractory disease of TCM. The clinical incidence of dryness is on the rise in recent years. The name of "dryness and arthralgia" is put forward by Professor Lu Zhizheng, the master of Chinese medicine, according to his etiology, pathogenesis and years of clinical experience. The Department of Rheumatology of Guang'an Men Hospital carried out a large number of basic and clinical studies based on the theory and treatment plan of Lu Lao Bi. Director Cao Wei, a tutor, found that although dryness is often seen as deficiency of qi and yin in the course of clinical application of Lu Lao Li's prescription of arthralgia, However, with the change of social environment, spleen and stomach dampness heat syndrome and its syndromes, Qinlianping stomach powder heat and dampness, spleen and stomach, as a tutor for the treatment of dryness, spleen and stomach dampness and heat syndrome commonly used prescription. In this paper, the theoretical basis and clinical study of Qinlianping Weishen Powder in treating dryness, spleen and stomach dampness and heat syndrome were expounded in both theory and clinic. Using the theory of traditional Chinese medicine to analyze the pathogenesis of damp-heat syndrome of spleen and stomach of dryness, and to discuss the causes of damp-heat syndrome of spleen and stomach in combination with social environment and life style. To sum up the main points of clinical differentiation and experience in treating dryness, spleen and stomach dampness and heat syndrome with Qinlianping Weishen Powder. Literature review: by referring to relevant literature and related books, the history of dryness arthralgia is named, and the understanding of dryness arthralgia is sorted out by physicians in past dynasties, in order to clarify the definition and category of dryness arthralgia. This paper discusses in detail the important role of spleen and stomach in the pathogenesis, prognosis and treatment of dryness. Qinlianping Weishan Powder can clear away heat and dampness, restore spleen and stomach Qi, and transfer Huazhuapu powder. The modern pharmacological studies of six kinds of traditional Chinese medicine composed of Qinlianping Weisan Powder are summarized, and the mechanism of Qinlianping Weishen Powder in treating dryness arthralgia is explained by modern pharmacology. Objective: to observe the clinical effect of Qinlianping Weishen Powder (QLianping Wei Powder) in treating 32 cases of dryness, spleen and stomach dampness and heat syndrome, and to explore the theoretical mechanism of Qinlianping Weishen Powder in treating dryness, spleen and stomach dampness heat syndrome, so as to provide the basis for clinical application in the future. Methods: from April 2015 to February 2016, 32 patients with syndrome differentiation of dryness, spleen and stomach damp-heat syndrome were collected from the Department of Rheumatology, Guanganmen Hospital, Chinese Academy of traditional Chinese Medicine. According to the main diagnosis points of dryness and damp-heat syndrome of spleen and stomach, the main symptoms were dry eye, dry mouth and nasopharynx, fullness of abdomen, rash, abnormal stool, arthralgia, oral ulcers, 8 symptoms of dysphoria, digestive system and mood. Sleep and other 27 secondary symptoms. The total symptom scores and main symptom scores were recorded after 1 month, 2 months, 3 months, respectively. Using SPASS22.0 statistical software statistical data, using t test, rank sum test and other statistical methods, P0.05 has statistical significance. Results: 1 after 3 months of treatment, the symptoms of the patients improved significantly in 17 cases (53.13%), effective in 13 cases (40.63%), remission in 1 case (3.12%), ineffective in 1 case (3.12%), the total effective rate was 96.88%; 2. In the course of treatment, the total score of symptoms decreased in 4 times, and the difference was statistically significant (P0.05 / 3). In the course of treatment, the main symptoms were obviously improved (P0.05), and the difference was statistically significant (P0.05). Conclusion: 1. Qinlianping Weishen Powder can obviously improve the clinical symptoms of patients with damp-heat syndrome of spleen and stomach. 2. In treating patients with damp-heat syndrome of spleen and stomach, Qinlianping Weisan Powder can obviously reduce the total score of symptoms and the scores of main symptoms, 3. Qinlianping Weisan treatment dryness, spleen and stomach dampness and heat syndrome, remarkable effect 53.13, effective 40.63, relief 3.12, the total effective rate is 96.88.
【學位授予單位】：中國中醫(yī)科學院
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R255.6
本文編號：2405232
[Abstract]:Dryness arthralgia is a kind of arthralgia caused mainly by dryness and dryness. Dryness is mainly characterized by dryness of orifices and joint pain. It is a refractory disease of TCM. The clinical incidence of dryness is on the rise in recent years. The name of "dryness and arthralgia" is put forward by Professor Lu Zhizheng, the master of Chinese medicine, according to his etiology, pathogenesis and years of clinical experience. The Department of Rheumatology of Guang'an Men Hospital carried out a large number of basic and clinical studies based on the theory and treatment plan of Lu Lao Bi. Director Cao Wei, a tutor, found that although dryness is often seen as deficiency of qi and yin in the course of clinical application of Lu Lao Li's prescription of arthralgia, However, with the change of social environment, spleen and stomach dampness heat syndrome and its syndromes, Qinlianping stomach powder heat and dampness, spleen and stomach, as a tutor for the treatment of dryness, spleen and stomach dampness and heat syndrome commonly used prescription. In this paper, the theoretical basis and clinical study of Qinlianping Weishen Powder in treating dryness, spleen and stomach dampness and heat syndrome were expounded in both theory and clinic. Using the theory of traditional Chinese medicine to analyze the pathogenesis of damp-heat syndrome of spleen and stomach of dryness, and to discuss the causes of damp-heat syndrome of spleen and stomach in combination with social environment and life style. To sum up the main points of clinical differentiation and experience in treating dryness, spleen and stomach dampness and heat syndrome with Qinlianping Weishen Powder. Literature review: by referring to relevant literature and related books, the history of dryness arthralgia is named, and the understanding of dryness arthralgia is sorted out by physicians in past dynasties, in order to clarify the definition and category of dryness arthralgia. This paper discusses in detail the important role of spleen and stomach in the pathogenesis, prognosis and treatment of dryness. Qinlianping Weishan Powder can clear away heat and dampness, restore spleen and stomach Qi, and transfer Huazhuapu powder. The modern pharmacological studies of six kinds of traditional Chinese medicine composed of Qinlianping Weisan Powder are summarized, and the mechanism of Qinlianping Weishen Powder in treating dryness arthralgia is explained by modern pharmacology. Objective: to observe the clinical effect of Qinlianping Weishen Powder (QLianping Wei Powder) in treating 32 cases of dryness, spleen and stomach dampness and heat syndrome, and to explore the theoretical mechanism of Qinlianping Weishen Powder in treating dryness, spleen and stomach dampness heat syndrome, so as to provide the basis for clinical application in the future. Methods: from April 2015 to February 2016, 32 patients with syndrome differentiation of dryness, spleen and stomach damp-heat syndrome were collected from the Department of Rheumatology, Guanganmen Hospital, Chinese Academy of traditional Chinese Medicine. According to the main diagnosis points of dryness and damp-heat syndrome of spleen and stomach, the main symptoms were dry eye, dry mouth and nasopharynx, fullness of abdomen, rash, abnormal stool, arthralgia, oral ulcers, 8 symptoms of dysphoria, digestive system and mood. Sleep and other 27 secondary symptoms. The total symptom scores and main symptom scores were recorded after 1 month, 2 months, 3 months, respectively. Using SPASS22.0 statistical software statistical data, using t test, rank sum test and other statistical methods, P0.05 has statistical significance. Results: 1 after 3 months of treatment, the symptoms of the patients improved significantly in 17 cases (53.13%), effective in 13 cases (40.63%), remission in 1 case (3.12%), ineffective in 1 case (3.12%), the total effective rate was 96.88%; 2. In the course of treatment, the total score of symptoms decreased in 4 times, and the difference was statistically significant (P0.05 / 3). In the course of treatment, the main symptoms were obviously improved (P0.05), and the difference was statistically significant (P0.05). Conclusion: 1. Qinlianping Weishen Powder can obviously improve the clinical symptoms of patients with damp-heat syndrome of spleen and stomach. 2. In treating patients with damp-heat syndrome of spleen and stomach, Qinlianping Weisan Powder can obviously reduce the total score of symptoms and the scores of main symptoms, 3. Qinlianping Weisan treatment dryness, spleen and stomach dampness and heat syndrome, remarkable effect 53.13, effective 40.63, relief 3.12, the total effective rate is 96.88.
【學位授予單位】：中國中醫(yī)科學院
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R255.6
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