基于伏邪理论预防无先兆型偏头痛发作的临床疗效观察研究

发布时间：2018-03-19 15:14

本文选题：偏头痛　切入点：伏邪　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】：研究背景:偏头痛是神经内科常见的疾病,其发病率高,治愈率低,给患者及家人的日常生活带来极大影响,使患者困扰不已。由于偏头痛病机复杂,目前研究尚不能完全阐明疾病发作过程,且偏头痛发作具备鲜明的个体差异性,西药对偏头痛的疗效并不乐观。传统中医学对偏头痛的病因病机及治疗研究历史悠久,在缓解病情,减少发作次数,减轻头痛程度、改善生活质量等方面积累了丰富的临床经验。目前中医学者多从肝、肾、风、瘀、虚角度论治偏头痛。导师临床观察偏头痛的发病特点及症状表现,回顾《黄帝内经》伏邪理论,总结现代临床对其理论发展及应用,认为偏头痛反复发作,迁延不愈与伏邪有关,偏头痛治疗不当或失治误治,正气不能抗邪外出,邪气内伏(痰、瘀、寒)、甚者痰瘀交阻,或久病入络,成痰瘀互阻之势。偏头痛常因感受外邪(风、寒、湿)引动、或因情郁烦劳、饮食不节而发。伏邪(痰、瘀、寒)内伏、正气不足为偏头痛发病基础,外邪、忧思郁怒、劳累困顿、饮食失节为发病诱因,预防偏头痛发作重在扶正透邪。研究目的:对偏头痛的诊疗进行概述;从伏邪角度认识偏头痛的病因病机;观察透邪平肝止痛方预防无先兆型偏头痛急性发作的疗效;为结合伏邪致病理论预防偏头痛急性发作提供治疗方案。研究方法:本试验采用随机对照试验研究方法进行研究。治疗组服口服透邪平肝止痛方加减,每日1剂,早晚冲服。对照组口服盐酸氟桂利嗪胶囊5mg,qn。服药时间均为4周。研究期间患者记录头痛日记,重点记录头痛发作状况,包括头痛发作时间、程度、缓解方式、不良反应等,试验结束完善偏头痛CRF量表。研究结果:治疗组和对照组实际完成病例均为27例,试验前对两组受试者年龄、性别、病程、头痛程度比较均无明显差异,治疗后疗效评价结果如下:1.疗效比较:治疗组临床治愈1例(3.70%),显效12例(44.44%),有效10例(37.04%),无效4例(14.800%),总有效率85.1 8%;对照组临床治愈0例(00%),显效2例(7.40%),有效19例(70.37%),无效6例(22.222%),总有效率77.78%。治疗组总有效率优于对照组,两组间有差异。2.治疗后两组中医症候评分比较:治疗组治疗后评分为8.74±5.86分;对照组治疗后评分为13.15±6.99分。治疗后治疗组中医证候改善情况优于对照组。3.治疗后两组生活质量评分比较:治疗后治疗组评分为16.52± 10.44分;对照组评分为26.78±11.90分。试验结束后对照组生活质量评分高于对照组,说明治疗组在提高患者生活质量方面优于对照组。4.治疗过程中两组均未发生严重药物不良反应。研究结论:透邪平肝止痛方对肝阳上亢型无先兆型偏头痛的预防有效率高于盐酸西替利嗪胶囊;透邪平肝止痛方可在一定程度上降低肝阳上亢型无先兆型偏头痛患者的发作频次,减轻头痛程度,减少头痛发作持续时间,提高患者生活质量,尤其在改善患者中医症候方面,较西比灵有显著区别;透邪平肝止痛方预防无先兆型偏头痛发作有一定的疗效,且不存在明显不良反应,基于伏邪理论预防偏头痛值得进一步深入研究。
[Abstract]:Background: migraine is a common neurological disease, high incidence, low cure rate, brings great influence to the patients and the family's daily life, make the patient troubled. Due to migraine pathogenesis is complex, the current research is still not fully elucidated the onset of disease process, and migraine have distinct individual difference, efficacy of Western medicine the migraine is not optimistic. The traditional Chinese medicine on migraine pathogenesis and therapy study on etiology of disease has a long history, in the remission of the disease, reduce the number of attacks, alleviate headache degree, improve the quality of life and has accumulated rich clinical experience. At present, Chinese scholars from the liver, kidney, blood stasis, deficiency of wind, angle of migraine. Clinical characteristics and symptoms of tutor migraine clinical observation, Review < Neijing > Fuxie theory, summarizes the modern clinical development of its theory and application, that repeated attacks of migraine, delayed healing Related to migraine foxier, improper treatment or wrongly treated, could not resist the evil out of righteousness, evil in V (phlegm, blood stasis, cold), or phlegm blood stasis, or chronic illness into the network, from phlegm and blood stasis. Migraine often due to feelings of evils (wind, cold, wet) move, or trouble work because of feeling depressed, improper diet and hair. Fuxie (phlegm, blood stasis, cold) in volts, the deficiency of vital qi is the basic pathogenesis of migraine, evils, anxiety and rage, tired exhausted, improper diet as predisposing factors, prevention of migraine attacks on Fuzheng evil. Objective: summarizing the diagnosis and treatment of migraine; etiology and pathogenesis of migraine from the angle of Fuxie; observe pathogenic liver efficacy in the prevention of acute migraine without aura type pain; as a combination of Fuxie theory of disease prevention of acute migraine treatment. Methods: This study used a randomized controlled trial methods were studied. The treatment group take orally evil Calm the liver pain decoction, 1 dose daily morning and evening with. Control group was treated with Flunarizine Hydrochloride Capsules 5mg qn., taking time for 4 weeks. During the study of patients with headache diary, mainly recording the headache, including headache, degree, ease, adverse reaction, the end of the experiment to improve the migraine CRF scale. Results: the treatment group and control group, the actual completion of cases were 27 cases, before the test of two groups of subjects with age, gender, disease duration, severity of headache showed no obvious differences, the following clinical evaluation results after treatment: 1. comparison of efficacy: 1 cases of the treatment group were cured (3.70%), 12 cases (44.44%), effective in 10 cases (37.04%), invalid in 4 cases (14.800%), the total efficiency of 85.18%; control group 0 cases were cured, 2 cases were cured (00%) (7.40%), effective in 19 cases (70.37%), invalid in 6 cases (22.222%), the total efficiency of 77.78%. total effective rate in the treatment group than the control group between the two groups. Comparison of TCM syndrome score of the two groups after treatment: the differences of.2. scores of treatment group was 8.74 + 5.86; the control group after treatment score was 13.15 + 6.99. After treatment, the symptoms of the treatment group improved better than the control group.3. after treatment in two groups of quality of life score comparison: the treatment group score was 16.52 + 10.44; the control group score was 26.78 + 11.90. At the end of the experiment, the control group quality of life score higher than the control group, the treatment group in improving the quality of life of patients than the control group.4. during the treatment of the two groups were no serious adverse drug reactions occurred. Conclusion: prevention of pathogenic liver pain of migraine without aura liver yang hyperactivity type of efficiency is higher than that of Cetirizine Hydrochloride Capsules; evil can calm the liver pain frequency to a certain extent, reduce the hyperactivity of liver Yang in patients without migraine attacks, alleviate headache degree, reduce the head The duration of pain, improve the quality of life of patients, especially in the improvement of TCM symptoms, compared with flunarizine significantly different pathogenic liver pain; prevention of migraine without aura attack has certain curative effect, and has no obvious adverse reactions, Fuxie theory is worthy of further research on the prevention of migraine.

【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】：R277.7

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