糖尿病肾病的古今用药思维研究

发布时间：2017-12-27 16:57

本文关键词：糖尿病肾病的古今用药思维研究　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:糖尿病肾病是糖尿病的常见并发症,属于传统医学"肾消"的范畴,中药在其治疗上发挥着不可替代的作用。本文以糖尿病肾病为研究对象,系统收集古今方剂,统计分析古今治疗糖尿病肾病的用药特点和配伍规律,对比古今治疗原则及配伍用药的不同,以期对临床运用中药治疗糖尿病肾病提供参考。方法:以《中华医典》、中医世家网络数据库为检索途径,检索治疗糖尿病肾病的古代方剂;以中国知网、万方数据库、维普数据库、中国学术会议论文全文数据库、中国学位论文全文数据库作为检索库检索现代治疗糖尿病肾病的方剂。运用基本的统计方法统计各个时期药物的性味、功效类别使用频次、剂量及在总药物中的占比,统计各个时期使用频次较高的药物;分析归纳各个时期糖尿病肾病的治疗原则及用药规律。结果:从整体来看,明代以前治疗糖尿病肾病的药物以温性药居多,温性、寒性比例相差不大,平性药使用较少;明代至清及民国时期治疗糖尿病肾病使用寒性药超过温性药,平性药的使用较少;现代治疗糖尿病肾病使用寒性药与温性药的比例差距不大,平性药较少。从药味来讲,古代治疗糖尿病肾病以甘味药使用最多,在各朝代均远远超过其他各味药,甘寒药、甘温药、甘平药的使用频次占比均较多,且三者差距不明显;苦味药使用其次,其中苦寒药的占比最大,且整体呈增加趋势;辛味药和酸味药的使用占比较甘味药和苦味药小,清及民国时期酸温药物使用超过辛温药的比例;现代治疗糖尿病肾病以甘味药最多,其次为苦味药,其中甘平药、甘温药、苦寒药的频次及剂量较多,甘寒药占比较古代减少,辛味药和酸味药占比较甘味药和苦味药少。从药物功效角度讲,古代和现代均以补益药的使用最多,清热药其次,收涩药和去湿药的使用也占到一定比例。其中补益药的使用频次占比在清及民国时期使用最多;清热药的使用在明代以后增多,至现代使用频次占比又有所下降;收涩药的使用在宋金元时期占比最大,其他各个时期较均匀,祛湿药的使用在清及民国时期使用最少,现代使用较多;而活血药使用现代远远超过古代。总体来看,古代治疗糖尿病肾病注重滋补肾之元气、精血,清热养阴,兼以利水、固肾;而宋金元时期更加注重肾的阴阳双补,明清时期则注重补益气血。现代治疗糖尿病肾病以补益脾肾、清热化瘀,兼以利水、固肾为整体治疗思路。结论:古今治疗糖尿病肾病的思路相近,均以补气滋肾、养阴清热,兼以利水固肾为治疗思路,但具体用药上有差别。现代治疗糖尿病肾病在继承前人经验的基础上结合现代医学研究结果,对于古代治疗的用药思维在传承的基础上又有所发展。
[Abstract]:Objective: diabetic nephropathy is a common complication of diabetes, which belongs to the category of "kidney elimination" in traditional medicine, and Chinese medicine plays an irreplaceable role in its treatment. Taking diabetic nephropathy as the research object, this paper systematically collects ancient and modern prescriptions, and statistically analyzes the medication characteristics and compatibility rules of ancient and modern treatment of diabetic nephropathy, contrasts the difference between ancient and modern treatment principles and compatibility, so as to provide reference for clinical application of traditional Chinese medicine to treat diabetic nephropathy. Methods: the "Chinese medical classics", Chinese family network database retrieval, the retrieval of ancient prescription in the treatment of diabetic nephropathy; to Chinese CNKI, Wanfang database, VIP database, China academic conference papers database, China dissertations full text database as prescription retrieval database retrieval of modern treatment of diabetic nephropathy. The basic statistics method was used to analyze the sex odor, efficacy category, frequency and dosage of drugs in different periods and the proportion in total drugs. The drugs with high usage frequency in different periods were analyzed. The principles and rules of medication in different stages of diabetic nephropathy were analyzed and summarized. Results: Overall, the Ming Dynasty before drug treatment of diabetic nephropathy with warm medicine mostly, warm and cold sex ratio had little difference, peaceful property of drug use less; the Ming Dynasty to the Qing and the Republic of the treatment of diabetic nephropathy using cold medicine more than warm drugs, drug use less flat; little gap between the proportion of modern treatment diabetic nephropathy using cold drugs and warm drugs, even less medicine. From the formula, the ancient treatment of diabetic nephropathy with sweet medicine use most in all dynasties are far more than other drugs, cold medicine, sweet medicine, sweet medicine Ganping use frequency were accounted for more, and the gap between the three is not obvious; the use of bitter cold medicine secondly, which accounted for the largest, and the whole increased use of drugs and medicine; pungent sour and bitter sweet medicine accounted for a relatively small drug, Qing and the Republic of the acid temperature medication use over the proportion of modern medicine drugs; treatment of diabetic nephropathy with sweet medicine most, followed by bitter medicine, including medicine, sweet medicine, gamping cold medicine frequency and dose more, Gansu cold medicine accounted for relatively ancient reduction, pungent drugs and sour sweet herbs and bitter medicine accounted for relatively little medicine. From the perspective of drug efficacy, the use of tonifying drugs is the most used in ancient and modern times, followed by antipyretic drugs, and the use of astringent drugs and dehumidifiers also accounts for a certain proportion. One of the most frequently used tonic than that used in the Qing and the Republic of China; the use of heat clearing drugs increased in the Ming Dynasty, to the modern frequency of use and the proportion descended; use astringent drug in the Song Jinyuan era, the largest proportion of each period, the other is uniform, Qushi drug use in the Qing Dynasty and the Republic of China use at least, the use of more modern and modern medicine; blood use far more than the ancient. Overall, the ancient treatment of diabetic nephropathy, kidney nourishing Qi on blood, Yin heat, and water, solid kidney; and Song Jinyuan time pay more attention to kidney nourishing yin and Yang, Ming and Qing Dynasties focus on tonifying qi and blood. The modern treatment of diabetic nephropathy is to replenishing spleen and kidney, clearing heat and removing blood stasis, and Taking Lishui and kidney as a whole treatment. Conclusion: the thought of treating diabetic nephropathy in ancient and modern times is similar, and all of them are treated with nourishing qi and nourishing kidney, nourishing yin and clearing heat, and using Li Shui to fix the kidney as the treatment idea, but the specific drug use is different. The modern treatment of diabetic nephropathy is based on previous experience and modern medical research results.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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