基于“体病相关”理论运用“调气—调体—主

发布时间：2018-04-29 20:55

本文选题：体病相关 + 运气学说　；参考：《北京中医药大学》2017年博士论文

【摘要】：背景:世界卫生组织(WHO)在1996年指明21世纪的医学的发展方向将从"疾病医学"转向"健康医学",治疗上更加注重"个体治疗"的发展。在临床中如何建立个体化诊疗模式,识别个体的差异性、推测其发病倾向,做到"未病先防"、"已病防变"成为社会共同关注的问题。"因人制宜"要求中医学治病时以患者的体质情况作为处方用药的重要依据,这正是个体化诊疗的具体体现。王琦教授20世纪70年代创立中医体质学,该学说提出"体病相关"理论,建立了"辨体—辨病—辨证"诊疗模式。而五运六气是影响机体体质及体质状态的关键因素,基于此认识,能否建立"调气—调体—主病"的临床诊疗新模式值得探讨。目的:通过对银屑病患者中医体质、中医证型及患者出生时五运六气特点进行统计分析,挖掘其中的相关性,为"调气—调体—主病"提供理论基础;并以"调气—调体—主病"为指导思想对患者诊治与经普通辨证论治的患者,进行疗效评价比较,对该理论进行初步实践验证。方法:1、将纳入的银屑病患者分为运气组和非运气组,根据中华中医药学会2009年颁布的《中医体质分类与判定》进行体质辨别;参照《中药新药临床研究指导原则》进行常规银屑病的中医辨证;并对运气组患者出生日期(农历)运气进行推算分析,统计其岁运、主气、客气、司天在泉;应用Excel对上述结果进行描述性统计,采用统计学软件SPSS17.0进行相关性分析。2、运气组以"调气—调体—主病"为指导思想进行诊治,非运气组经辨证论治,对两组患者治疗前与治疗1个月、3个月、6个月时银屑病皮损面积与严重程度指数(PASI评分)、患者自评瘙痒程度评分(VAS评分)及皮肤病生活质量指数(DLQI得分)三个病情判定指标及治愈率情况进行统计比较分析。结果:1、运气组银屑病患者的体质类型以湿热质、气郁质、痰湿质为主;中医证型最多的为湿热证,其次是血热证;患者出生在土运太过之年,五之气阳明燥金所主时段,客气为太阴湿土,少阴君火司天,阳明燥金在泉,后天最容易罹患银屑病;出生在火运不及之年,三之气少阳相火所主时段,客气为厥阴风木或者阳明燥金,阳明燥金司天,少阴君火在泉或太阴湿土司天,太阳寒水在泉的人,患银屑病的可能最小;出生时三合局为土运太过、少阳相火司天、左间少阴君火及土运不及、少阳相火在泉、右间太阴湿土两类患者人数最多。然而经统计学分析银屑病患者出生日期在不同岁运、主气、客气及三合局的分布差异均无统计学意义(P0.05)。2、运气组银屑病患者中医体质类型与所患银屑病的中医证型存在相关性,辨证为湿热质及血热证的患者的体质类型最多的均为湿热质;多数银屑病患者体质类型倾向于湿热证,而气虚质患者倾向于血热证,阴虚质患者倾向于血虚证,气郁质患者倾向血瘀证。3、运气组银屑病患者出生日期的五运六气特点与患者体质及所患银屑病中医证型相关,银屑病患者体质最多的湿热质患者,多出生于土运太过之年者,主气为五之气阳明燥金所主时段,客气为太阴湿土,少阳相火司天,厥阴风木在泉,除主气分布差异无统计学意义(P0.05),其余均有统计学意义(P0.05);中医证型最多的湿热证患者多出生于木运太过或土运不及之年,四之气太阴湿土时段,客气为太阴湿土时段,出生当年以厥阴风木司天,少阳相火在泉或少阳相火司天,厥阴风木在泉最多,其中仅患者出生时的岁运分布差异有统计学意义(P0.05),其余均无。4、本研究对比分析了基于"调气—调体—主病"思路及普通辨证论治治疗银屑病患者治疗前、治疗1个月、3个月、6个月的各评分情况,治疗前两组患者各评分的组间差异无统计学意义(P0.05);经治疗两组患者3个观察节点的各评分均逐渐下降,但PASI评分、VAS评分自治疗1个月时组间差异有统计学意义(P0.05),DLQI得分在治疗6个月时,组间差异有统计学意义(P0.05),证明以"调气—调体—主病"理论为指导治疗银屑病相较于普通辨证论治,在治疗1个月后即在降低银屑病皮损面积与严重程度、及改善患者瘙痒程度方面显示优势,经治疗6个月可更有效的提高患者生活质量;从总体疗效上看基于"调气—调体—主病"思路治疗银屑病优于普通辨证论治治疗该病。结论:银屑病患者中医体质类型与所患银屑病的中医证型存在相关性;患者出生日期的五运六气特点与患者体质及所患银屑病中医证型相关;"调气—调体—主病"理论相较于普通辨证论治治疗银屑病,可更有效的降低银屑病皮损面积与严重程度、改善其瘙痒程度、提高患者生活质量,"调气—调体—主病"新临床诊疗模式具有可行性。
[Abstract]:Background: in 1996, the WHO (WHO) pointed out that the direction of the development of medicine in the twenty-first Century will turn from "disease medicine" to "health medicine", and the development of "individual treatment" will be paid more attention to. In clinical practice, how to establish individual diagnosis and treatment mode, identify individual differences, speculate the tendency of disease, and make "disease prevention first" and "disease prevention" It is an important basis for the prescription of the prescription to treat the patient's physique in the treatment of the disease in traditional Chinese medicine. This is the embodiment of the individualized diagnosis and treatment. Professor Wang Qi founded the constitution of traditional Chinese medicine in 1970s. This theory put forward the theory of "body disease related", and established the diagnosis and treatment mode of "differentiation and differentiation of disease and syndrome differentiation". And five transport and six gas is the key factor affecting the body's physique and physical condition. Based on this understanding, it is worth exploring the new mode of clinical diagnosis and treatment of "Regulating Qi - regulating body - main disease". Objective: to analyze the characteristics of the TCM Constitution, TCM syndrome type and the five transport and six gas characteristics at birth of patients with psoriasis. The theory of regulating Qi - regulating body - main disease "provides the theoretical basis, and with the guiding ideology of" Regulating Qi - regulating body - main disease "and comparing the patients with the general syndrome differentiation and treatment. The theory carries out a preliminary practice verification. Method: 1, the patients are divided into the luck group and the non luck group, according to the Chinese society of traditional Chinese Medicine 200 The constitution classification and judgment of Chinese medicine promulgated in 9 years was used to distinguish the constitution, and the traditional Chinese medicine based on the guiding principles of the clinical research of Chinese medicine and new medicine was used to carry out the traditional Chinese medicine syndrome differentiation of conventional psoriasis. The statistical software SPSS17.0 was used to carry out the correlation analysis.2. The lucky group was treated with the guidance of "Regulating Qi - adjusting body - main disease". The non lucky group was treated by syndrome differentiation, and the area of psoriasis and the severe range index (PASI score) of the two groups of patients before treatment and 1 months, 3 months and 6 months, and the self evaluation of pruritus degree score (VAS evaluation). The results were as follows: 1. The physical types of psoriasis in the group of luck were mainly wet heat, qi depression and phlegm wet quality, and the most of the TCM syndrome types were damp heat syndrome, and the second was the syndrome of blood heat; the patients were born in the year of soil transportation and five of Qi Yang. The main period of Ming dryness gold is too cloudy and wet soil, less Yin Jun fire, Yang Ming dryness gold in spring, and the most easy to suffer from psoriasis on the next day. Born in the year of fire, three of the Qi Shaoyang phase fire is the main time, the customer is the Jue Yin wood or Yangming dryness gold, Yangming dryness gold, Shaoyin monarch fire in spring or Taiyin wet soil, the sun cold water in spring people, The possibility of psoriasis was the smallest, the three in the birth time was too much, the Shaoyang phase fire, the left less Yin Jun fire and the soil transport, the Shaoyang phase fire in the spring, the right between the Tai Yin wet soil, the largest number of patients. However, the statistical analysis of the date of birth of psoriasis patients at different years of age, the distribution of the main gas, the passenger gas and the three parts were not statistically significant. Meaning (P0.05).2, the type of TCM Constitution of the patients with psoriasis in luck group is related to the TCM syndrome type of psoriasis. The physique types of patients with damp heat and blood heat syndrome are all damp heat, and most of the patients with psoriasis tend to damp heat syndrome, and the patients with Qi deficiency tend to be blood heat syndrome, and the patients with Yin deficiency tend to be inclined to the disease. Blood deficiency syndrome, qi depression patients tend to blood stasis syndrome.3, the five transport and six gas characteristics of the date of birth of the patients with psoriasis are related to the constitution of the patients and the type of TCM syndrome of psoriasis. The patients with the most physique of psoriasis are born in the years of excessive soil transport, and the main gas is five of the Qi Yang Ming dryness gold, and the passenger is too wet soil, There is no statistical significance (P0.05) in the distribution difference of the main gas in the spring of Shaoyang and Shaoyang, but the rest of the main gas distribution is statistically significant (P0.05). The phase fire is in the spring or Shaoyang phase fire, the Jue Yin wood is most in the spring, among which the difference of the age distribution of the patients at birth is statistically significant (P0.05), and the rest is not.4. This study contrasts and analyzes the 1 months, 3 months, 6 months of the treatment of patients with silver chip disease based on the thought of "Regulating Qi to adjust body - main disease" and the common syndrome differentiation treatment for patients with silver chip disease. There was no statistical difference between the two groups before treatment (P0.05); the scores of the 3 observation nodes in the two groups were decreased gradually, but the PASI score and the VAS score were statistically significant (P0.05) from the treatment group (P0.05), and the difference between the groups was statistically significant (P0.05) at 6 months of treatment (P0.05). According to the theory of "Regulating Qi - regulating body - main disease", the treatment of psoriasis was compared with ordinary syndrome differentiation. After 1 months of treatment, it showed the advantages of reducing the area and severity of psoriasis and improving the itching degree of patients. After 6 months of treatment, the quality of life of the patients could be improved more effectively, and the overall effect was based on "Qi adjustment". Conclusion: the physique type of the patients with psoriasis is related to the TCM syndrome type of psoriasis, the characteristics of the five transport and six gas of the patient's birth date are related to the constitution of the patients and the TCM syndrome type of psoriasis, and the theory of "Regulating Qi to adjust body to main disease" is compared to the general theory. The treatment of psoriasis by syndrome differentiation can be more effective in reducing the area and severity of psoriasis, improving the itching degree and improving the quality of life of the patients. The new clinical diagnosis and treatment model of "Qi regulating body - main disease" is feasible.

【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R275.9

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