台湾澎湖乙肝中医证型研究及李赛美教授经验总结

发布时间：2018-06-22 09:41

本文选题：澎湖 + 李赛美　；参考：《广州中医药大学》2017年博士论文

【摘要】：目的:本研究通过收集台湾澎湖地区慢性乙型病毒性肝炎患者的资料,从性别、年龄、职业、家族史等几方面对台湾澎湖地区乙肝患者进行初步的流行病学分析;利用属性偏序结构图,对台湾澎湖地区慢性乙型病毒性肝炎患者的中医证型进行数据挖掘,以探讨澎湖地区乙肝的流行病学和证型分布特点。其次,通过门诊收集李赛美教授治疗慢性乙肝病例103例,结合李赛美教授相关论文,以及跟师学习体会,对李赛美教授门诊治疗慢性乙型病毒性肝炎的经验进行总结,为临床中医辨治慢性乙型病毒性肝炎提供参考。方法:1.利用简单的统计学方法,对澎湖地区慢性乙肝患者进行流行病学分析。采集澎湖地区慢性乙型病毒性肝炎患者资料,包括年龄、性别、确诊年龄、就诊时年龄、病史、职业、家族史等,制定病例资料采集卡,对采集卡的信息进行整理分类,得到原始病例资料整理表,并进行简单的统计学处理,根据相关结果,对台湾澎湖地区慢性乙型病毒性肝炎患者流行病学信息进行初步总结。2.利用属性偏序结构图,总结台湾澎湖地区慢性乙型病毒性肝炎中医证型。收集2016年至2017年就诊于周国雄诊所,符合本次研究的诊断标准、纳入标准的慢性乙肝患者资料,包括姓名、年龄、性别、职业、籍贯、现病史、既往史、家族史等以及中医四诊资料,设计资料采集卡,由松安堂中医诊所林志坚医师进行慢性乙型病毒性肝炎患者资料收集及整理。原始资料采集完成后,由两名研究员分别按人民卫生出版社《伤寒论讲义(第二版)》六经辨证标准对患者进行六经辨证。如有出入,请第三方人员进行仲裁。然后进行数据规范化,建立数据库并构建澎湖地区慢性乙肝患者-证型形势背景。进行形式背景优化后,由专人利用MATLAB程序加载至Microsoft Office Excel 2007,把数据生成属性偏序结构图,达到知识可视化的效果。3.利用经验总结法,总结李赛美教授治疗慢性乙肝经验。收集符合标准的李赛美教授治疗慢性乙型病毒性肝炎验案,以及李赛美教授阐述的有关慢性乙型病毒性肝炎治疗经验的讲座、论文,结合个人跟师学习心得,利用经验总结法,对李赛美教授治疗慢性乙肝经验进行总结。结果:本论文研究内容主要分为三部分,分别的研究成果如下:1.台湾澎湖地区乙型病毒性肝炎的流行病学研究。1.1共收集病例125例,最终纳入研究120例。1.2生成澎湖地区乙型肝炎患者性别组成、就诊年龄、发病年龄、病史长度、职业、家族史相关表格。2.利用属性偏序结构图,总结台湾澎湖地区慢性乙型病毒性肝炎中医证型。2.1共收集病例125例,最终纳入研究120例。2.2建立澎湖地区乙型肝炎患者中医证候数据库:经处理后,共得到台湾澎湖地区慢性乙型病毒性肝炎患者的48个症状。2.3生成澎湖地区乙型肝炎患者中医证候属性偏序结构图。3.李赛美教授治疗慢性乙型病毒性肝炎经验总结。3.1收集整理李赛美教授治疗慢性乙肝验案103例,最终纳入研究100例。3.2结合李赛美教授治疗乙肝有关的讲座、论文,以及本人跟师学习体会,对李赛美教授治疗慢性乙型病毒性肝炎经验作一总结。结论:1.台湾澎湖地区乙型病毒性肝炎的流行病学研究。对于台湾澎湖地区乙型病毒性肝炎的流行病学研究表明:性别方面,男性患者占有更大比例,男女比例约2:1,这可能与男性吸烟饮酒较多,湿热之邪蕴结,毒邪内蕴,迁延难愈有关,以及社会压力较大,肝气疏泄条达失职有关。就诊年龄方面,主要集中在40-69岁之间,可能与病程达到一定时间后出现相应症状,以及年老正气不足有关。发病年龄方面,分布相对平均,各个年龄段基本均有涉及,有明确发病年龄的患者中,20-29岁这一年龄段所占比例最高,与升学体检、产检、捐血时体检有关。这表明了常规体检检查肝炎病毒,对于及早发现乙型病毒性肝炎有着积极的意义,早发现早治疗,对比晚发现晚治疗,可以有效提高治疗效果,减轻疾病危害,节约医疗资源,减轻患者经济负担。病史长度方面,有长有短,分布相对平均,各个年龄段基本均有涉及。结合发病年龄等,乙型病毒性肝炎患者年龄分布主要集中在40-69岁之间,而大部分患者在40岁以前查出患有乙型病毒性肝炎。这表明感染乙型肝炎病毒人口存在老龄化的趋势,乙型病毒性肝炎的疫苗接种预防措施是有效的。职业分布方面,以家管最多,其次为工业、自由业者。这提醒食品卫生部门应注重食品卫生安全的管理,努力从源头遏制乙型病毒性肝炎的传播。此外,渔业、商业、军队、公职中也占有不小的比例。家族史方面:74例患者的父母或兄弟姐妹患有慢性乙型病毒性肝炎,占61.67%。45例患者无家族史,占37.50%,1例患者家族史不详。表明澎湖地区乙型病毒性肝炎的发病呈现出一定的家族聚集性,可能与家族成员之间密切接触有关。卫生部门应加强对乙型病毒性肝炎的宣教科普,提高民众的认识度;对于患有乙肝的孕妇,分娩时应做好对应措施,尽可能减少母婴垂直传播的几率;对于无抗体的人群,尤其是高危人群,应及早进行乙肝疫苗的接种;对于已经患有乙肝的患者,争取做到早期、积极治疗,降低病毒复制程度,一方面可以降低传染给他人的几率,另一方面也有助于延缓病程进展,降低乙肝后肝硬化、肝癌的可能。2.利用属性偏序结构图,总结台湾澎湖地区慢性乙型病毒性肝炎中医证型。根据属性偏序结构图,总结出以下几个证型:1)少阳证,肝火上炎、肝气郁结证,或有心火,或有血瘀。2)少阳证合并厥阴证。3)少阴证,脾肾阳虚,阳虚寒凝血瘀证,中焦枢机不利,水湿内停。4)少阳证,肝胆火旺证,横犯脾胃。5)阳明热盛证。除了典型的少阳热证以外,还出现了少阳病合并厥阴病、少阴病与阳明病等。3.李赛美教授治疗慢性乙型病毒性肝炎经验总结。李赛美教授治疗的慢性乙型病毒性肝炎的患者,辨证主要以少阳病为主,在少阳病的基础上常见肝郁气滞、肝胆不和、肝郁犯脾、肝胆郁热、肝肾不足、脾阳不足等证。治疗方面,以疏肝理气,健脾益气为主要治疗思路,遵循先治标后治本的原则进行治疗。如患者合并有感冒、严重甲亢或其他疾病时,先治疗其它疾病,待症状缓解后,再治疗慢性乙型病毒性肝炎。常以四逆散合四君子汤作为治疗乙型病毒性肝炎的基础方。在这个合方的基础上,针对患者的证型特点做出加减调整。具体如下:3.1 辨病辨证综合分析李赛美教授门诊慢性乙型病毒性肝炎患者辨证,发现李赛美教授治疗慢性乙型病毒性肝炎多从少阳证入手,认为可分为实证与虚证两大类。实证常见肝郁气滞、肝胆不和、肝郁犯脾、肝胆郁热。虚证常见肝肾不足、脾阳不足。3.2 治法治则李赛美教授治疗慢性肝病常用的治法有:疏肝理气,养血柔肝,活血化瘀,补气健脾,清热祛湿,凉血泻火,温经散寒。3.3 常用处方李赛美教授治疗慢性乙肝的常用处方有:小柴胡汤,四逆散,四君子汤,四逆汤,葛根芩连汤,理中丸,桂枝汤,肾四味,半夏泻心汤,左金丸。3.4 常用中药及药对李赛美教授治疗慢性乙肝的常用中药及药对有:柴胡配黄芩,枳实/枳壳,当归配川芎,茯苓配白术,淫羊藿配仙茅,生地黄配玄参,麦芽配绵茵陈,红曲配决明子,五味子配田基黄/垂盆草/半枝莲/半边莲,茵陈配泽兰,白芍配赤芍,防风配紫苏叶。3.5 辨治特色3.5.1 依病情分期论治,主张分清标本缓急3.5.2 脏腑同治,强调治肝不离利胆3.5.3 肝脾肾同治,强调治肝不忘实脾补肾3.5.4 疏肝健脾为主,擅用四逆散与四君子汤合方3.5.5 灵活选方,随症加减3.5.6 注重心理疏导及病后调护3.5.7 动静结合,护肝为要,忌滥用药物本研究对上述患者的相关资料进行了流行病学资料探讨;基于数学属性偏序结构图,对台湾澎湖地区慢性乙型病毒性肝炎患者的证型规律进行了数据挖掘;同时,总结了李赛美教授治疗慢性乙型病毒性肝炎的经验,尝试对李赛美教授治疗慢性乙肝经验做一总结。研究结果可为慢性肝病的辨治提供参考,有助于提高慢性肝病的中医疗效,延缓病程进展,提高患者生活质量,减轻社会公共卫生负担。
[Abstract]:Objective: through collecting the data of chronic hepatitis B patients in Penghu area of Taiwan, this study carried out preliminary epidemiological analysis on hepatitis B patients in Penghu area of Taiwan from the aspects of sex, age, occupation and family history, and the TCM syndrome type of chronic hepatitis B patients in Penghu area of Taiwan by using the attribute partial sequence diagram. Data mining is carried out to explore the epidemiological and syndrome distribution characteristics of hepatitis B in Penghu area. Secondly, 103 cases of chronic hepatitis B were collected by Professor Li Saimei in the outpatient department, combined with Professor Li Saimei's related papers and the experience of the teacher, summarizing the experience of the treatment of chronic hepatitis B in Professor Li Saimei's outpatient clinic. Treatment of chronic hepatitis B hepatitis by traditional Chinese medicine. Methods: 1. the epidemiological analysis of chronic hepatitis B patients in Penghu area was carried out by simple statistical methods. The data of chronic hepatitis B patients in Penghu area were collected, including age, sex, age of diagnosis, age, history, occupation, family history and so on. Data collection card, collect the information of the collection card, get the original case data sorting table, and carry out simple statistical processing, according to the relevant results, the epidemiological information of chronic hepatitis B patients in Penghu area of Taiwan, Taiwan, is preliminarily summarized, and the chronical structure map of the genus is used to summarize the chronic B in Penghu, Taiwan. Type of TCM syndrome type of viral hepatitis, collected from 2016 to 2017 at the Zhou Guoxiong clinic, accords with the diagnostic criteria of this study, and included the standard data of chronic hepatitis B patients, including name, age, sex, occupation, native place, current history, history, family history and other four medical data, design data collection card, and the pine an Tang traditional Chinese medicine clinic Dr. Lin Zhijian carried out the data collection and arrangement of the patients with chronic hepatitis B. After the original data collection was completed, two researchers were divided into six meridians according to the people's Health Publishing House (Second Edition) and the six meridian syndrome differentiation standard. If there were any discrepancy, third parties were asked to arbitrate. Then the data were standardized, Setting up a database and constructing the background of chronic hepatitis B patients in Penghu area. After optimizing the form background, the MATLAB program is used by special people to load the Microsoft Office Excel 2007, and the data is generated by generating attribute partial sequence structure map to achieve the effect of knowledge visualization..3. is used to summarize the treatment of chronic hepatitis B by Professor Li Saimei. Experience. Collect the standard of Professor Li Saimei for the treatment of chronic hepatitis B, and Professor Li Saimei's lecture on the treatment experience of chronic hepatitis B, this paper, combined with personal experience and experience, summarizes the experience of the treatment of chronic hepatitis B by Li Si Mei teaching. The research content is divided into three parts, the results are as follows: 1. the epidemiological study of viral hepatitis B in Penghu, Taiwan,.1.1 collected 125 cases, and finally included the study of sex composition, age, age, length of disease history, occupation, family history related table.2. in 120 cases of hepatitis B in Penghu region. Using the attribute partial sequence diagram, 125 cases of chronic viral hepatitis B in Penghu area of Taiwan were collected and 125 cases were collected, and the database of TCM syndrome of the patients with hepatitis B in Penghu area was established by 120 cases of.2.2. After treatment, the 48 symptoms of.2.3 in the patients with chronic hepatitis B in the Penghu area of Taiwan were obtained. Partial sequence structure map of TCM syndrome properties of hepatitis B patients in Penghu area.3. professor Li Saimei's experience in the treatment of chronic hepatitis B,.3.1 collects and collects 103 cases of Professor Li Saimei for the treatment of chronic hepatitis B, and finally includes the lectures, papers, and the study of Professor Li Saimei in the treatment of hepatitis B related to Professor Li Saimei. Experience of Professor Li Saimei's experience in the treatment of chronic viral hepatitis B is summarized. Conclusion: 1. epidemiological studies on hepatitis B in Penghu, Taiwan. Epidemiological studies on hepatitis B in Penghu, Taiwan show that male patients occupy a larger proportion of sex, male and female ratio is about 2:1, which may be with men. Sex smoking and drinking more alcohol, damp and hot evil implication, toxic evil connotation, deferred healing, and social pressure is larger, the liver Qi relief bar related to dereliction of duty. The age of medical treatment is mainly concentrated between 40-69 years old, may be related to the period of time after the onset of the corresponding symptoms, as well as the lack of aging. The age of the disease is relatively flat. All age groups are basically involved. Among the patients with a clear age, the age of 20-29 is the highest proportion, which is related to physical examination, examination, and blood donation. This shows that the routine examination of the hepatitis virus has a positive significance for the early detection of hepatitis B virus, early detection and early detection. Late treatment can effectively improve the effect of the treatment, reduce the harm of the disease, save the medical resources and reduce the economic burden of the patients. The length of the medical history is short, the distribution is relative average, all ages are basically involved. The age distribution of the patients with hepatitis B is mainly concentrated between 40-69 years and most of the patients. The detection of hepatitis B hepatitis before the age of 40 shows that the population of hepatitis B virus has an aging trend and that the vaccination of hepatitis B virus is effective. The occupational distribution, the most housekeeping, industry, free industry, reminds the food and health department to pay attention to the management of food hygiene and safety. Besides, the family history: 74 cases of parents or siblings with chronic hepatitis B, accounted for 61.67%.45 patients without family history, accounted for 37.50%, and the family history of 1 patients was unknown. It showed that Penghu region B The incidence of viral hepatitis has a certain familial aggregation, which may be related to close contact with family members. The health department should strengthen the propaganda and popularization of viral hepatitis B and raise the awareness of the people; for the pregnant women suffering from hepatitis B, the corresponding measures should be done to reduce the probability of the vertical transmission of mother and child as far as possible; People with no antibody, especially high risk people, should be inoculated with hepatitis B vaccine as early as possible. For patients who have been suffering from hepatitis B, it is possible to reduce the probability of infection to others by early, active treatment and reduction of the degree of virus replication. On the other hand, it can also help to delay the progress of the course of the disease, reduce the possibility of liver cirrhosis and liver cancer. 2. to summarize the TCM syndrome type of chronic viral hepatitis B in Penghu area of Taiwan by using the attribute partial sequence structure map. According to the structure map of the attribute partial sequence, the following syndrome types are summed up: 1) Shaoyang syndrome, liver fire inflammation, liver qi stagnation syndrome, or heart fire, or blood stasis.2), Shaoyang syndrome, Yang deficiency of spleen and kidney, Yang deficiency cold coagulation and blood stasis syndrome, middle Jiao In addition to the typical Shaoyang heat syndrome, there are also a total of.3. Li SEI's experience in treating chronic viral hepatitis B, such as shaoyang disease combined with Jue yin disease, Shaoyin disease and Yangming disease, etc., in addition to typical Shaoyang heat syndrome. Professor Li seim's treatment of chronic viral hepatitis B in the treatment of.4. Patients are mainly treated with shaoyang disease. On the basis of shaoyang disease, the syndrome of stagnation of liver qi and qi stagnation, liver and gallbladder disharmony, liver depression to make spleen, liver and gallbladder depression, deficiency of liver and kidney, deficiency of Spleen Yang and so on. In the case of other diseases, the treatment of other diseases first, after the symptoms are relieved, and then the treatment of chronic hepatitis B. It is often used as the basis for the treatment of hepatitis B by the four inverse powder and four gentlemen soup. On the basis of this combination, the syndrome characteristics of the patients are added and adjusted. The following: 3.1 syndrome differentiation and syndrome differentiation and comprehensive analysis of Li Saimei Professor Li Saimei's treatment of chronic viral hepatitis B in the outpatient clinic shows that Professor Li Saimei's treatment of chronic hepatitis B mostly from Shaoyang syndrome can be divided into two categories: positive stagnation, liver and gallbladder stagnation, liver and gallbladder disharmony, liver Qi invading the spleen, liver and gallbladder depression, deficiency syndrome common liver and kidney deficiency, and spleen yang deficiency.3.2 treatment of Li Si Mei Teaching The commonly used treatment methods for treating chronic liver disease include: Soothing the liver and nourishing the liver, nourishing blood and removing blood stasis, replenishing qi and invigorating the spleen, clearing away heat and dampness, cooling blood and reducing fire, the commonly used prescription of Professor Li Saimei in the treatment of chronic hepatitis B commonly used by professor Li Saimei, the prescription for treating chronic hepatitis B, are: small Bupleurum soup, four inverse scatter, four gentleman soup, four inverse soup, Gegen Qinlian soup, Lizhong pill, Guizhi soup, four flavors of kidney, Banxia. Xiexin Decoction and Zuo Jin pill.3.4 commonly used traditional Chinese medicine and medicine on Professor Li Saimei's traditional Chinese medicine and medicine for treating chronic hepatitis B: Radix Bupleuri with Scutellaria baicalensis, Fructus aurantii Immaturus / Fructus aurantii Immaturus, Rhizoma Chuanxiong, tuckahoe with white art, Herba Epimedium with cassia root, Radix Rehmanniae with Radix scabra, malt with miosolia, red koji and Ming Zi, and Schisandra chinensis with field base yellow / tub grass / Lusa / Scutellaria / half lotus Chen Peizelan, Radix Paeoniae Alba, Radix Paeoniae Alba and Radix Paeoniae Radix Paeoniae,.3.5 differentiation and treatment of anti wind and perilla leaf treatment characteristic 3.5.1 according to the stage of disease treatment, advocating the separation of specimens and treating the 3.5.2 viscera with the same treatment, emphasizing the treatment of liver, 3.5.3 liver spleen and kidney treatment, emphasizing the treatment of liver and strengthening the spleen, 3.5.4 liver, liver and spleen, and using the four converse powder and the four gentleman decoction combined prescription 3.5.5 flexibly selected prescription 3.5.6 attention was paid to the psychological guidance and the combination of 3.5.7 dynamic and static care after the disease, the liver protection and the abuse of drugs in the study of the related data of the above patients were investigated by epidemiological data. Based on the mathematical attribute partial sequence diagram, data mining of the chronic hepatitis B patients in Penghu area of Taiwan was excavated; meanwhile, This paper summarizes professor Li Saimei's experience in treating chronic hepatitis B and tries to sum up professor Li Saimei's experience in the treatment of chronic hepatitis B. The results can provide reference for the diagnosis and treatment of chronic liver disease, help to improve the curative effect of chronic liver disease, delay the progress of the course of the disease, raise the quality of life of the patients and reduce the burden of social public health.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R249;R259

【参考文献】