【摘要】：辨證論治是中醫(yī)學的精華,辨證是治療的前提,辨證是否準確,是取得臨床療效的關(guān)鍵。目前中醫(yī)藥治療胰腺癌尚無統(tǒng)一的診斷標準與療效評判標準,缺乏循證醫(yī)學依據(jù)的基礎(chǔ)和臨床研究,因此,我們認為有必要對胰腺癌辨治規(guī)律進行系統(tǒng)研究。目的：探析胰腺癌病位、病性證素特征,規(guī)范胰腺癌的病位、病性特征表現(xiàn)。將五臟辨證系統(tǒng)應用于胰腺癌的辨治,以期能夠幫助提高胰腺癌病證辨治的準確率和臨床療效。方法：首先,通過文獻研究,對胰腺癌病證的常見癥狀術(shù)語進行規(guī)范處理。應用臨床流行病學調(diào)查方法,收集278例胰腺癌臨床病例,應用SPSS18.0軟件對常見癥狀進行聚類分析,歸納提示胰腺癌病位、病性相關(guān)系數(shù)較高的癥狀、體征和舌脈表現(xiàn)；再將一般癥狀、舌象、脈象分別進行主成分分析,找出各類的主成分及癥狀組成,歸納總結(jié)胰腺癌臨床常見證型,構(gòu)建“胰腺癌病證診斷信息表”,結(jié)合導師治療經(jīng)驗,提出相應治則治法,以期提高中醫(yī)治療胰腺癌臨證水準。結(jié)果：通過對病名規(guī)范的原則及胰腺癌的中醫(yī)命名的探討,把“伏梁”作為胰腺癌的中醫(yī)病名；提出脾氣虛弱為發(fā)病之本,癌毒留結(jié)為胰腺癌發(fā)病之根。脾胃虛弱、外感邪氣、情志不暢、飲食不節(jié)等為胰腺癌發(fā)病的主要原因。278例胰腺癌臨床病例顯示胰腺癌主要病位為脾、肝、胃、膽、腎,分別占100%、58.6%、50.7%、27.3%、20.5%；主要病性為血瘀、氣滯、氣虛、濕、痰、熱,分別占100%、74.1%、66.2%、59.7%、38.8%、34.5%。常見證型包括肝膽濕熱證、肝脾不調(diào)證、痰瘀互結(jié)證、肝腎陰虛證、脾虛水停證。結(jié)論： 胰腺癌的基礎(chǔ)病位在脾,基礎(chǔ)病性為痰、瘀,相兼病位胃、肝、膽、腎,相兼病性氣滯、濕、熱、水停,健脾助運、化痰逐瘀為治療胰腺癌基本原則,對于相兼病位病性,輔以行氣法、通腑法、利膽法、祛濕法、清熱法治療胰腺癌具有一定的臨床指導意義。
[Abstract]:Syndrome differentiation and treatment is the essence of traditional Chinese medicine, syndrome differentiation is the premise of treatment, syndrome differentiation is accurate, is the key to achieve clinical efficacy. At present, there is no unified diagnosis standard and evaluation standard of curative effect in the treatment of pancreatic cancer by traditional Chinese medicine, and the basis of evidence-based medicine and clinical research are lacking. Therefore, we think it is necessary to study systematically the rule of differentiation and treatment of pancreatic cancer. Objective: to investigate the location and characteristics of pancreatic cancer, and to standardize the location and characteristics of pancreatic cancer. The system of differentiation of symptoms and signs of the five organs is applied to the differentiation and treatment of pancreatic cancer in order to help to improve the accuracy and clinical efficacy of the differentiation and treatment of the syndrome of pancreatic cancer. Methods: first of all, through literature research, the common symptom terms of pancreatic cancer syndrome were standardized. The clinical epidemiological investigation method was used to collect 278 clinical cases of pancreatic cancer. Cluster analysis of common symptoms was carried out with SPSS18.0 software, and the symptoms, signs and tongue-vein manifestations with high correlation coefficient of disease were summarized. Then the general symptoms, tongue images and pulse images were analyzed by principal component analysis, all kinds of principal components and symptom components were found out, the clinical common syndromes of pancreatic cancer were summarized, and the "diagnosis information table of pancreatic cancer syndrome" was constructed, combined with the experience of mentor in treatment. The corresponding treatment and treatment were put forward in order to improve the clinical level of traditional Chinese medicine in the treatment of pancreatic cancer. Results: through the discussion of the principle of disease name specification and the traditional Chinese medicine naming of pancreatic cancer, "Fuliang" was regarded as the TCM name of pancreatic cancer, and it was pointed out that the weakness of temper was the basis of the disease, and the cancer toxin was the root of pancreatic cancer. Weakness of spleen and stomach, ecstasy, lack of emotion and lack of diet were the main causes of pancreatic cancer. 278cases of pancreatic cancer showed that the main sites of pancreatic cancer were spleen, liver, stomach, gallbladder and kidney, accounting for 100%, 58.6% and 50.7%, respectively. 27.3%, 20.5%; The main diseases were blood stasis, qi stagnation, qi deficiency, dampness, phlegm and heat, accounting for 100%, 74.1%, 66.2%, 59.7%, 38.8%, 34.5% respectively. The common syndrome types include liver-gallbladder damp-heat syndrome, liver-spleen disorder syndrome, phlegm-stasis syndrome, liver-kidney yin deficiency syndrome, spleen deficiency and water stagnation syndrome. Conclusion: the basic diseases of pancreatic cancer are phlegm, blood stasis, stomach, liver, gallbladder, kidney, qi stagnation, dampness, heat, water stop, spleen invigorating and removing phlegm and removing blood stasis are the basic principles in the treatment of pancreatic cancer. In the treatment of pancreatic cancer, the methods of Qi, purging the Fu, clearing the gallbladder, removing dampness and clearing away heat have a certain clinical significance for the treatment of the disease.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R273

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