中药治疗糖尿病胃轻瘫用药规律探讨及临床思考

发布时间：2018-10-30 20:19

【摘要】：糖尿病胃轻瘫是糖尿病的常见并发症之一,临床表现主要为食欲下降、早饱、上腹部饱胀不适、慢性上腹痛、恶心、呕吐等,目前国内西医治疗糖尿病胃轻瘫,主要是在调整饮食及生活方式、控制血糖的基础上,以口服多潘立酮或莫沙必利促胃动力为主,而这些西药的应用无疑会带来一定的副作用。可见DGP的西医治疗方法十分有限。这便显示出中医的优势。而中医虽无此病名,但根据其临床表现可归为"消渴病"继发"痞满"和(或)"呕吐"的范畴,在治疗上以辨证论治为主,然而由于辨证的多样性及复杂性,目前仍缺乏统一的辨证选方的标准,因此通过研究中医文献以探索前人治疗糖尿病胃轻瘫的组方用药规律,为今后中医治疗提供一定的思路及方法,显得尤为必要。目的:运用数据挖掘技术对搜集到的符合纳入标准的中医治疗糖尿病胃轻瘫的文献进行全面深入地整理和分析,总结中医治疗糖尿病胃轻瘫的组方用药规律。方法:以CNKI相关期刊论文和万方医学网数据库为检索工具和文献来源,检索2007年1月至2017年1月间关于中医治疗糖尿病胃轻瘫的文献,根据纳入和排除标准获得可纳入文献,提取文献中所记载的方剂及药物组成并建立数据库。运用频数及频率分析找出治疗糖尿病胃轻瘫的高频药物及药类,运用聚类分析找出核心优势组合,进而探讨糖尿病胃轻瘫的治疗方法和药物的配伍。结果:符合标准的文献共有285篇,其中共应用方剂181种,中药共164味。应用频数在5次以上的方剂有9种(按使用频数高低依次为:半夏泻心汤、香砂六君子汤、六君子汤、四磨汤、补中益气汤、枳实消痞汤、升阳益胃汤、旋覆代赭汤、枳术汤),共计90次,所占频率为31.6%。而用于治疗胃阴亏虚证的方剂只有6种(按使用频数高低依次为:麦门冬汤、一贯煎、沙参麦冬汤、益胃汤、玉女煎),共出现11次,所占频率为3.86%。中药应用总频数为1928次,其中应用频数在10次以上的中药38味,共计出现1026次,所占频率为53.2%,对使用频数在10次上的38味中药进行药物归类得出10种药类,依据使用总频数高低排列分别为:补气药、理气药、化湿药、清热药、消食药、化痰药、补阴药、活血药、温里药及补血药,用药相对集中,最多的为补气类药物,按使用频数高低依次为:白术、党参、甘草、黄芪、山药、太子参、人参,单此7味中药便出现276次。纵观近10年用于辨证治疗DGP的药物,滋阴药有12种,而滋养胃阴类药物只出现97次,所占频率为5.03%(表4),共7种,分别为:麦冬、生地、石斛、沙参、葛根、玉竹、百合。结论:1.目前对糖尿病胃轻瘫的辨证及方剂使用尚缺乏统一的标准,不仅方剂种类分散,而且出现了较多自拟方及经验方。但其中亦不乏较为公认的方剂,如:半夏泻心汤、香砂六君子汤及六君子汤。2.临床医家遣方用药各有侧重、各具特色,但多数现代中医家均认为其定位在胃,与脾、肝密切相关,治疗上以益气健脾为主,佐以疏肝理气、清热化湿、消食导滞、滋阴益胃等。临床用药方面,主要药类有补气药、理气药、化湿药、清热药、消食药、化痰药、补阴药、活血药、温里药及补血药。值得一提的是,不少医家已关注DGP胃阴亏虚证继而对此进行临床试验。3.通过对文献数据的分析,得出频数在40次以上的用于治疗糖尿病胃轻瘫的药对10对,多为补气药和化湿药、化痰药、理气药的组合,可见这些药在治疗DGP时占据主导作用。提示在临床治疗DGP时,若不能完全把握患者的证型,使用这些药物组合,虽不能完全符合患者的辨证论治,但能对改善患者症状有一定的作用。
[Abstract]:Diabetic gastroparesis is one of the common complications of diabetes mellitus. The clinical manifestations are appetite loss, early satiety, upper abdominal fullness discomfort, chronic upper abdominal pain, nausea, vomiting, etc. On the basis of controlling the blood sugar, it is the main way to promote the gastric motility by taking orally dopenone or Mosha, and the application of these western medicines will undoubtedly bring some side effects. It can be seen that the western medicine treatment method of DGP is very limited. This shows the advantages of traditional Chinese medicine. Traditional Chinese medicine has no disease name, but according to its clinical manifestation, it can be classified as" Crohn's disease "secondary" Richmond "and/ or" Vomiting "However, due to the diversity and complexity of syndrome differentiation, there is still a lack of the standard of unified syndrome differentiation, and therefore, by studying the traditional Chinese medicine literature to explore the prescription medication law of the predecessor to treat the gastroparesis of diabetic gastroparesis, It is especially necessary to provide some thought and method for the treatment of TCM in the future. Objective: To summarize and analyze the literatures of Chinese traditional Chinese medicine for treating diabetic gastroparesis by using data mining technology, and summarize the prescription medication rule of Chinese medicine for treating diabetic gastroparesis. Methods: Using CNKI Chinese Journal Full-text Database (CNKI) and Wanfang Medical Network Database as the retrieval tools and literature sources, the literature on the treatment of gastroparesis of diabetic gastroparesis from January 2007 to January 2017 was retrieved. According to the inclusion and exclusion criteria, the literature could be included. the composition and the medicine composition in the literature are extracted and a database is established. Frequency and frequency analysis were used to find out the high frequency drugs and drugs for treating gastroparesis of diabetic gastroparesis, and to find out the combination of core advantages by cluster analysis. Results: 285 articles were obtained according to the standard literatures, among which 181 kinds of prescriptions were applied, and 164 kinds of traditional Chinese medicine were used. The application frequency has 9 kinds of prescriptions (according to the frequency of use: Banxia Xiexin Decoction, Xiangsha Liujunzi Decoction, Liujunzi Tang, four-grinding soup, tonic tonic soup, syrup Xiaoyao Tang, Shengyang Yiwei Decoction, spin-coated decoction, and soup) for a total of 90 times. The frequency is 31.6%. The prescription used to treat the deficiency of stomach yin deficiency is only 6 (according to the frequency of use: wheat gate winter soup, persistent decoction, radix ophiope soup, prestomach soup and jade female decoction), and total occurrence of 11 times, accounting for 3.86%. The total frequency of the application of traditional Chinese medicine was 1928, among which, the application frequency of 38 Chinese medicines with frequency of more than 10 times appeared 1026 times, the frequency of which was 53.2%, and the 38 traditional Chinese medicines used in 10 times were classified into 10 kinds of drugs according to the total frequency. regulating qi, dispelling dampness, clearing heat, promoting digestion, eliminating phlegm, tonifying yin, activating blood, promoting blood circulation, warming the medicine, and tonifying blood. The medicine is relatively concentrated, and most of the medicines are qi invigorating medicine, and the use frequency is in sequence: Atractylodis Rhizoma, Radix Codonopsis, Glycyrrhrizae Radix, Radix Rehmanniae Preparata, Rhizoma Dioscoreae, Radix Rehmanniae Preparata, and Radix Ginseng; A single 7-flavored Chinese medicine appeared 276 times. In the last 10 years, there were 12 kinds of drugs used in the treatment of DGP, 12 kinds of nourishing yin medicine, 97 times of nourishing stomach yin medicine, and 5.03% of nourishing stomach yin medicine (Table 4). Conclusion: 1. At present, there is a lack of uniform standard for the syndrome differentiation and prescription use of diabetic gastroparesis, not only the prescription type is dispersed, but also has more self-confidence and experience side. But there are also more generally accepted prescriptions, such as Banxia Xiexin Decoction, Xiangsha Liujunzi Decoction and Liujunzi Decoction. Most modern Chinese medicine doctors believe that they are located in the stomach, which is closely related to the spleen and the liver, and is mainly used for treating the spleen and the liver of the spleen and the liver, so as to tonify qi and invigorate the spleen, so as to relieve the stagnation of the liver and regulate the flow of qi, clearing heat and eliminating dampness, promoting digestion, promoting digestion, nourishing yin and benefiting the stomach, and the like. In the aspect of clinical medication, the main medicine is tonic medicine, regulating qi, eliminating dampness, clearing heat, promoting digestion, eliminating phlegm, tonifying yin, promoting blood circulation, warming the medicine, and replenishing blood. It is worth mentioning that many doctors have paid attention to DGP's deficiency of stomach yin deficiency, which in turn carries on the clinical trial. Through the analysis of the literature data, it is concluded that more than 40 drugs for treating diabetes gastroparesis are more than 10 pairs, and the combination of the medicine for treating diabetes gastroparesis is more than 40 times, and the combination of phlegm-eliminating medicine and qi-regulating medicine can be seen, and the medicine can be seen to play a leading role in treating the DGP. It is suggested that in the clinical treatment of DGP, if the patient's syndrome cannot be fully grasped, the combination of these drugs can not be completely consistent with the differentiation and treatment of the patient, but it can play a role in improving the patient's symptoms.
【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

【参考文献】