基于数据挖掘的大柴胡汤证研究

发布时间：2018-05-21 17:56

本文选题：大柴胡汤 + 理论探讨　；参考：《北京中医药大学》2017年硕士论文

【摘要】：目的:在对大柴胡汤方证相关条文理解归纳总结的基础上,结合历代医家的论述,明确大柴胡汤证的病因病机及其方药组成。并对近代医案进行统计分析,总结归纳大柴胡汤证的中西医适应疾病、症状、体征及药物组成等内容。最后运用meta分析的方法对大柴胡汤及其加减方治疗急性胆囊炎的临床疗效进行系统评价。通过对大柴胡汤治疗急性胆囊炎的临床随机对照实验进行客观系统的评价,尽可能得出符合要求的结果,从而为临床使用大柴胡汤治疗急性胆囊炎提供循证学依据。方法:理论研究方面,首先在《伤寒论》和《金匮要略》所记载的本方证条文基础上,通过解析方证条文、病因病机、病位、方药、煎服法等内容对大柴胡汤方证进行深入探讨,使得理法方药一以贯之。其次,针对历代医家对于大柴胡汤证病位及是否方中有大黄的争论进行分析探讨,客观地认识其病位与方药组成。第三,以大柴胡汤为对象,进行柴胡汤类方的异同比较,对大柴胡汤在柴胡类方剂中的位置与作用有一个系统明确的定位,最终达到为临床恰当使用大柴胡汤提供理论支持的作用。临床医案统计分析研究方面,总共收集现代临床应用大柴胡汤治疗相关疾病的100例病案,从多个方面归纳整理本方治疗的疾病种类、症状、药物组成、药物剂量、用药剂数、患者性别年龄等情况,同时借助统计学方法的手段进行研究,得出本方在临床治疗的适应疾病范围、适用症等方面的优势。Meta分析方面,大柴胡汤及其加减方治疗急性胆囊炎的系统评价,由于缺乏大样本多中心的随机对照试验,对大柴胡汤方证的研究多集中在小样本量的临床研究或者个案报道,为了更加系统客观地评价大柴胡汤在治疗具体疾病中所发挥的作用,笔者检索数据库:相关期刊论文(CNKI)、维普中文科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)1949年-2016年6月的相关文献,数据库未检索到的文献通过手工检索加以补充。检索词:为防止漏检相同研究目的的文献资料,设主题词3个:大柴胡汤、复方大柴胡汤、大柴胡汤加减。关键词1个:急性胆囊炎。通过计算机检索出符合条件的文献373篇,经阅读、整理、分类归纳之后,再将每篇文献按Cochrane文献质量评价系统中7项检测逐一做记录,删除偏倚风险过高文献,最终获得26篇文献资料,运用Revman5.3软件对已有的随机对照实验研究进行系统评价。结果:一、结合六经、六经病、六经辨证等概念以及历代医家对于大柴胡汤证的理解,得出大柴胡汤病位在少阳阳明,病理层次涉及营血分。二、通过医案统计研究得出大柴胡汤在应用人群上具备特异性,多发病于中老年,但是临床无论年龄大小,只要符合本方证侯,即可酌情使用。本方临床广泛应用于肝胆脾胃消化系统疾病、肺系疾病等病症中,应用本方的主要指征为便秘、小便黄、腹胀痛、纳呆、胁肋疼痛、发热、烦躁、舌红苔黄、脉弦数等症状,药物组成主要包括柴胡、黄芩、大黄、枳实、法半夏、大枣、生姜、白芍等。疗效确切可靠,值得广泛推广。三、二分类变量:大柴胡汤VS西医常规治疗:有效率:OR(total)= 5.15,95%CI[1.86,14.26],Z=3.16,P=0.002;RR(total)= 1.17,95%CI[1.07,1.29],Z=3.30,P=0.0010;RD(total)=0.14,95%CI[0.06,0.22],Z=3.51,P=0.0004 治愈率:OR(total)=2.55,95%CI[1.41,4.63],Z=3.09,P=0.002;RR(total)= 1.47,95%CI[1.15,1.88],Z=3.05,P=0.002;RD(total)= 0.19,95%CI[0.07,0.30],Z=3.24,P=0.001;大柴胡汤+西医常规治疗VS西医常规治疗:有效率:OR(total)= 4.95,95%CI[3.67,6.69],Z=10.43,P0.00001;RR(total)=1.20,95%CI[1.16,1.24],Z=10.68,P0.00001;RD(total)=0.16,95%CI[0.13,0.18],Z=11.56,P0.00001。治愈率:0R(total)=2.10,95%CI[1.77,2.51],Z=8.36,P0.00001;RR(total)= 1.40,95%CI[1.29,1.51],Z=8.19,P0.00001;RD(total)= 0.17,95%CI[0.13,0.21],Z=8.62,P0.00001。连续性变量:大柴胡汤VS西医常规治疗:腹痛消失时间:SMD(total)=-1.05,95%CI[-1.37,-0.72],Z=6.33,P0.00001;发热消退时间:SMD(total)=-0.84,95%CI[-1.15,-0.52],Z=5.19,P0.00001;大柴胡汤+西医常规治疗 VS 西医常规治疗:腹痛消失时间:SMD(total)=-2.47,95%CI[-3.39,-1.56],Z=5.32,P0.00001;发热消退时间:SMD(total)=-2.22,95%CI[-3.13,-1.31],Z=4.78,P0.00001;黄疸消失时间:SMD(total)=-0.47,95%CI[-0.80,-0.13],Z=2.73,P=0.006;恶心呕吐消失时间:SMD(total)=-2.39,95%CI[-2.74,-2.04],Z=13.50,P0.00001。结论:大柴胡汤证病位当为少阳阳明气、血分,且有热伤阴血的病理发展变化。大柴胡汤证的适应疾病主要包含肝胆脾胃消化系统疾病、肺系疾病,其常见的症状体征为便秘、小便黄、腹胀痛、纳呆、胁肋疼痛、发热、烦躁、舌红苔黄、脉弦数等症状,发病年龄主要集中在中老年。大柴胡汤加减治疗急性胆囊炎有效率、治愈率优于西医常规治疗,对改善腹痛、发热时间、黄疸、恶心呕吐等症状方面有不可比拟的优势。
[Abstract]:Objective: on the basis of the summary of the understanding of the relevant provisions of the prescription of Da Chaihu Decoction, the etiology and pathogenesis of Da Chaihu Decoction and the composition of its prescription were made clear, and the modern medical cases were statistically analyzed, and the symptoms, symptoms, signs and drug composition of the TCM and Western medicine were summarized and summarized. Finally, the met was used. The clinical efficacy of dchai Hu Decoction and its addition and subtraction prescription in the treatment of acute cholecystitis was systematically evaluated by a analysis. The objective and systematic evaluation of the clinical randomized controlled trial of Da Chaihu Decoction in the treatment of acute cholecystitis was carried out, and the results were obtained as much as possible, thus providing a basis for the clinical use of Dai Chai Hu Decoction in the treatment of acute cholecystitis. On the basis of the provisions of the prescriptions recorded in "Treatise on typhoid fever" and "synopsis of the Golden Chamber", through the analysis of the provisions of the prescription, the pathogenesis, the position of the disease, the prescription, the decoction and the decocting method, this paper makes an in-depth discussion on the prescription of the big Bupleurum soup. The argument of syndrome position and whether there are Rhubarb in all sides is analyzed and discussed objectively. Third, with daihuhu soup as the object, the similarities and differences of the decoction of Chaihu soup are compared, and the position and function of Dai Hu soup in the Bupleurum Decoction are clearly defined, and finally the proper use of radix Bupleurum for clinical use is achieved. The soup provides the role of theoretical support. In the field of statistical analysis of clinical medical cases, a total of 100 cases of modern clinical application of Dai Hu Tang in the treatment of related diseases were collected. From many aspects, the types of diseases, symptoms, drug composition, dosage of drugs, the number of drugs, the age and age of the patients were summed up and the statistical prescription was used. The method of the method is studied, and the systematic evaluation of the advantage.Meta analysis on the range of adaptation to the disease and the applicability of the clinical treatment, the systematic evaluation of the treatment of acute cholecystitis with Dai Hu Tang and its addition and subtraction prescription in the treatment of acute cholecystitis. Due to the lack of large sample and multi center randomized controlled trials, the research on the prescription of Dai Hu soup is mostly focused on the small sample size. In order to more systematically and objectively evaluate the role of Dai Hu soup in the treatment of specific diseases, the author retrieves the database: the Chinese journal full text database (CNKI), the full text database of VIP Chinese sci-tech periodicals (VIP), the relevant literature of the Chinese biomedical literature database (CBM) in June 1949, the database is not The retrieved literature was supplemented by manual retrieval. In order to prevent the missing examination of the same research purposes, 3 subjects were set up: Dacai Hu soup, compound Dacai Hu soup, Dacai Hu soup. The key words 1: acute cholecystitis. 373 articles were retrieved by computer, after reading, sorting, classification and induction. Each document was recorded one by one according to 7 tests in the Cochrane literature quality evaluation system. The literature was deleted from the high risk of bias, and 26 documents were obtained. The Revman5.3 software was used to systematically evaluate the existing randomized controlled experimental studies. The understanding of the syndrome of Chaihu soup is that the disease position of Dai Chai Hu soup is in Yangming of Shaoyang, and the pathological level involves the distribution of blood. Two, according to the statistical study of medical cases, it is concluded that Dai Chai Hu soup is specific in the application population and often occurs in the middle and old age, but the clinical age and size can be used as long as it is in accordance with this prescription. The clinical application of this prescription is widely used in the liver. Among the diseases such as the digestive system of the spleen and stomach, the disease of the lung system, the main indications of this prescription are constipation, urinating, abdominal distention and pain, the pain of the ribs, fever, irritability, the yellow tongue, the number of veins and so on. The medicine consists mainly of bupleurum, Scutellaria, rhubarb, Fructus aurantii, Rhizoma Ziziphi, ginger and Paeonia lactiflora. The curative effect is reliable and worthy of extensive popularization. Three, two classified variables: dchai Hu Decoction VS routine treatment: effective: OR (total) = 5.15,95%CI[1.86,14.26], Z=3.16, P=0.002; RR (total) = 1.17,95%CI[1.07,1.29], Z=3.30, P=0.0010; Z=3.05, P=0.002; RD (total) = 0.19,95%CI[0.07,0.30], Z=3.24, P=0.001; Da Chai Hu Soup + western medicine routine treatment of Western medicine routine treatment: effective: Efficiency: OR (total) = 4.95,95%CI[3.67,6.69], Z=10.43. 95%CI[1.77,2.51], Z=8.36, P0.00001; RR (total) = 1.40,95%CI[1.29,1.51], Z=8.19, P0.00001; RD (total) = 0.17,95%CI[0.13,0.21], Z=8.62. -0.52], Z=5.19, P0.00001; Dachai Hu Tang and conventional treatment of Western medicine for routine treatment of VS western medicine: SMD (total) =-2.47,95%CI[-3.39, -1.56], Z=5.32, P0.00001; SMD (total); The disappearance time: SMD (total) =-2.39,95%CI[-2.74, -2.04], Z=13.50, P0.00001. conclusion: the disease position of the big Bupleurum soup syndrome is the Yangming Qi, the blood, and the pathological changes of the hot injury and Yin blood. The adaptation diseases of the big Chaihu soup mainly include the liver and gallbladder, the spleen and stomach digestive system disease, the lung disease, and the common symptoms are constipation, urinating yellow, abdomen. Swell pain, nausea, flank pain, fever, irritability, tongue red moss yellow, pulse string number and other symptoms, age mainly concentrated in the elderly. Dachai Hu Decoction Treatment of acute cholecystitis is effective, the cure rate is better than the western medicine routine treatment, to improve abdominal pain, fever time, jaundice, nausea and vomiting and other symptoms have unparalleled advantages.
【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】：R289.5

【参考文献】