柴芍四君子汤加味治疗功能性便秘（气虚兼气滞型）的临床观察和实验研究
发布时间：2018-08-05 15:51
【摘要】：目的:功能性便秘是临床上常见的胃肠道功能障碍性疾病,表现为大便秘结不通,或排便间隔时间延长,以及有便意而排出困难等症。结合文献研究和导师在临床上治疗便秘的多年经验认为慢性功能性便秘中气虚兼气滞型便秘常见,主要是因为以肝郁脾虚为本,治疗上以疏肝柔肝、健脾益气、理气通便为主要治法,拟"柴芍四君汤加味"治疗"气虚兼气滞型"便秘。对功能性便秘进行临床观察及实验研究,来探讨"柴芍四君汤加味"对功能性便秘的治疗作用,为临床上治疗功能性便秘提供科学依据。方法:1.文献研究:关于慢性功能性便秘的中医的病因、病机、辨证施治等,西药的流行性学、发病机制、治疗等,分析总结其研究规律。参考其他的试验及临床研究,根据我们现在所具有的条件,制定出可以完成且科学的试验方法。2.临床研究方法:采用随机、对照方法,将符合功能性便秘的中西医诊断标准的患者纳入,分成两组,治疗组予以"柴芍四君汤加味"水煎服,对照组予以莫沙必利口服。观察"柴芍四君汤加味"对功能性便秘的临床疗效、治疗后症状改善疗效、两组治疗后改善疗效比较。3.实验研究方法:用饥饱失常、捆绑及过度的疲劳造出气虚兼气秘型小鼠,在其基础上予以复方地芬诺酯造出便秘模型。分成正常组、莫沙必利组、模型组、高剂量组、中剂量组、低剂量组,观察"柴芍四君汤加味"对小鼠排便功能的影响。结果:1.临床研究结果:通过中药组(柴芍四君汤加味)与西药组(莫沙必利)临床观察,"柴芍四君汤加味"的中药组总有效率为93.33%;"莫沙必利"的西药组总有效率为86.67%,差异有显著意义(P0.05)。中药组及西药组治疗后,其粪便性质、排便费力、排便间隔时间、排便时间、腹胀、胸胁痞满、嗳气、早饱、情志抑郁九个积分均比治疗前明显改善(P0.05)。中药组、西药组之间比较,在排便间隔时间、胸胁痞满、嗳气、早饱、情志抑郁五个症状改善的情况,中药组比西药组明显(P0.05),但粪便性质、排便费力、排便时间、腹胀四个症状中药组与西药组之间差异治疗效果相当(P0.05)。从结果看出,中药组的疗效较西药组佳。所以对慢性功能性便秘的治疗方面,中医药有较多的特色及优势。2.实验研究结果:(1)小鼠首粒排便时间来观察小鼠的肠蠕动情况。结果显示:高剂量组、中剂量组、低剂量组、正常组、莫沙必利组灌胃后与模型组比较,均比模型组的首粒黑便排出时间缩短(P0.01)。而高剂量组与正常组比较,无统计学意义(P0.05),则提示高剂量组可以对小鼠的肠蠕动其到恢复正常作用。中剂量、低剂量组与正常组比较,具有统计学有意义(P0.05),提示中剂量组与低剂量组对小鼠肠蠕动改善情况不如高剂量组。而莫沙必利组与正常组比较,有统计学意义(P05),其与中剂量组比较改善效果相当。综上可以得出柴芍四君汤治疗便秘,有剂量的依赖,且足够剂量的中药组比西药组效果佳。(2)模型组的第一天、三天、五天分别与正常组比较,黑便粒数明显减少,具有统计学意义(P0.001)。柴芍四君汤高、中、低剂量在第3-5天与模型组比较,均具有统计学意义(PP.01),(P0.05)。而高剂量组在第1天与模型组比较具有统计学意义(P0.05)。莫沙必利组与低剂量组对于小鼠黑便排出粒数相当。综上可以得出中药剂量对小鼠排出的粒数有影响,且足够剂量的中药组比西药组效果佳。(3)模型组的第一天、三天、五天分别与正常组比较,粪便重量明显减轻,具有统计学意义(P0.01)。柴芍四君汤高、中、低剂量、莫沙必利组在第1、3、5天与模型组比较,均具有统计学意义(P0.01)。其高、中、低剂量及莫沙必利组与正常组比较,在第1天有统计学意义(P0.05),在第3、5天差异不明显,无统计学意义(P0.05)。莫沙必利组与柴芍四君汤各个不同剂量组比较,差异有统计学意义(P0.05)。综上所述,柴芍四君汤及莫沙必利对小鼠排出粪便重量均有作用,但柴芍四君汤效果优于莫沙必利。(4)通过观察未排便小鼠数量显示:除了正常组小鼠无未排便外,其他组在造模后均有不同数量的小鼠未排便。柴芍四君汤高、中、低剂量及莫沙必利组和模型组比较,均有统计学意义(P0.05)。从下表可以看出,柴芍四君汤各个剂量不排便小鼠数量较少,而且剂量高的明显,且优于莫沙必利组。综上得出结论柴芍四君汤高剂量组对(气虚兼气滞型)便秘小鼠的肠蠕动改善明显、黑便粒数及重量增多、不排便动物数减少。中药组效果优于西药组。结论:"柴芍四君汤加味"治疗功能性便秘的临床疗效显著,特别对"气虚兼气秘型"便秘。对动物便秘模型亦有显著作用,促进其排便。该方主要是以柴胡10g,白芍l0g,党参15g,茯苓15g,白术15g,枳实10g,厚朴10g,甘草6g组成。
[Abstract]:Objective: functional constipation is a common gastrointestinal dysfunctional disease in clinic, which is characterized by incompatibility of stool, prolonged interval of defecation, and difficulty in excreting the bowel. Combined with literature study and mentors' years of clinical treatment of constipation, chronic functional constipation is common and common in chronic functional constipation. In the case of liver qi stagnation and spleen deficiency, the main treatment is to dredge the liver and soften the liver, strengthen the spleen and invigorate the Qi, and regulate the Qi Qi Decoction to treat the constipation of "Qi deficiency and qi stagnation". The clinical observation and experimental study of the functional constipation are carried out to explore the therapeutic effect of "Chai Peony four Jun Decoction" on functional constipation, and to treat the clinical work for the treatment of the constipation. Can provide scientific basis for sexual constipation. Methods: 1. literature research: the etiology, pathogenesis, syndrome differentiation and treatment of chronic functional constipation, the epidemic of Western medicine, pathogenesis, treatment and so on, analyze and summarize the research rules. Reference to other experimental and clinical research, according to the conditions we have now, it can be completed and scientific. The method of.2. clinical study: a randomized, controlled method was used to integrate the Chinese and Western medical diagnostic criteria of functional constipation into two groups. The treatment group was treated with the decoction of "Chai Shao four Jun Decoction plus flavour", and the control group was given mosapride. The clinical efficacy of "Chai Peony four Jun Decoction added" to functional constipation and post-treatment symptoms were observed. The curative effect of the two groups improved after treatment compared with the.3. experimental study method: the mice with hunger and satiety, binding and excessive fatigue were made out of qi deficiency and constipation model mice, and on the basis of the compound, the constipation model was made. It was divided into the normal group, the Mosapride group, the model group, the high dose group, the middle dose group, the low dose group, observation "Chai Peony four". The effect of "Jun Tang Jiawei" on the function of mouse defecation. Results: 1. clinical study results: through the clinical observation of Chinese medicine group (Chai Shaosi Jun Decoction plus flavour) and Western medicine group (mosapride), the total effective rate of "Chai Shao four Jun soup added" was 93.33%, and the total effective rate of "mosapride" was 86.67%, the difference was significant (P0.05). After the treatment, the nature of the excrement, defecation, defecation, defecation time, defecation time, abdominal distention, chest coerce full, belching, early satiety, depression nine points were significantly improved than before treatment (P0.05). The comparison between the Chinese medicine group and the western medicine group, in the interval of defecation, chest coerce full, belching, early full, emotion depression five symptoms improvement situation, Chinese traditional medicine, Chinese Medicine Group compared with western medicine group (P0.05), but the nature of feces, feces, defecation, defecation time, abdominal distention between the four symptoms of Chinese medicine group and Western medicine group difference treatment effect is equal (P0.05). From the results, the effect of Chinese medicine group is better than the western medicine group. Therefore, the treatment of chronic functional constipation, traditional Chinese medicine has more characteristics and advantages of.2. experimental research knot Fruit: (1) the time to observe the intestinal peristalsis in mice. The results showed that the high dose group, the middle dose group, the low dose group, the normal group and the mosapride group were compared with the model group, which were shorter than the model group (P0.01). The high dose group was not statistically significant compared with the normal group (P0.05), and the high dose group was higher than the normal group. In the dose group, the intestinal peristalsis could be restored to normal effect. The medium dose and low dose group had statistical significance compared with the normal group (P0.05), suggesting that the intestinal peristalsis in the middle dose group and the low dose group was not as good as the high dose group, but the mosapride group was compared with the normal group (P05), and the ratio was compared with the middle dose group. Compared with the improvement effect, we can conclude that Chai Shao four Jun decoction can treat constipation with a dose of dependence, and enough dose of Chinese medicine group is better than western medicine group. (2) the number of black urine grains decreased significantly on the first day of the model group, three days and five days, respectively, with the statistical significance (P0.001). The middle and low dose of Chai Peony four Jun decoction was in the 3-5 day. Compared with the model group, it was statistically significant (PP.01), (P0.05), while the high dose group had statistical significance with the model group at first days (P0.05). The number of murine excretion particles in the mosapride group and the low dose group was equivalent to the mice. The results showed that the dosage of Chinese medicine had an effect on the number of the mice discharged, and the sufficient dose of Chinese medicine group was more than the western medicine. (3) the first day, three days and five days of the model group were compared with the normal group, and the weight of the stool was significantly reduced, with statistical significance (P0.01). The high, middle, low dose, and the mosapride group were compared with the model group on day 1,3,5 (P0.01). The high, middle, low dose and Mosapride group were compared with the normal group. There was no significant difference between the first days (P0.05) and no significant difference in day 3,5 (P0.05). The difference was statistically significant (P0.05) compared with the different dosage groups of the mosapride group and Chai paehao Decoction (P0.05). In summary, the Chai Shao four Jun Decoction and the mosapride had the effect on the excretion weight of the rats, but the effect of Chai Shao four Tang was better than that of the Chai peony. (4) through the observation of the number of non defecation mice, the number of non defecation mice showed that in addition to the normal group without defecation, the other groups had different amounts of non defecation in the mice after making the model. The higher, middle, low dose, and the mosapride group and the model group were statistically significant (P0.05). From the table below, each dose of Chai Peony four Jun soup could be seen. The number of non defecated mice was less and the dose was higher than that of the mosapride group. The conclusion was that the intestinal peristalsis in the constipation mice (Qi deficiency and qi stagnation) was obviously improved, the number and weight of black stool increased and the number of non defecation decreased. The effect of the Chinese Medicine group was better than that of the western medicine group. Conclusion: the effect of the Chinese medicine group was better than that of the western medicine group. The curative effect of treating functional constipation is remarkable, especially for "Qi deficiency and gas constipation" constipation. It also has significant effect on the constipation model of animal constipation. It is mainly composed of Radix Bupleuri 10g, Paeonia lactiflora L0g, Codonopsis 15g, Poria 15g, Atractylodes macrocephala 15g, Fructus aurantii Immaturus 10g, Magnolia officinalis 10g, licorice 6G.
【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】：R256.35
本文编号：2166263
[Abstract]:Objective: functional constipation is a common gastrointestinal dysfunctional disease in clinic, which is characterized by incompatibility of stool, prolonged interval of defecation, and difficulty in excreting the bowel. Combined with literature study and mentors' years of clinical treatment of constipation, chronic functional constipation is common and common in chronic functional constipation. In the case of liver qi stagnation and spleen deficiency, the main treatment is to dredge the liver and soften the liver, strengthen the spleen and invigorate the Qi, and regulate the Qi Qi Decoction to treat the constipation of "Qi deficiency and qi stagnation". The clinical observation and experimental study of the functional constipation are carried out to explore the therapeutic effect of "Chai Peony four Jun Decoction" on functional constipation, and to treat the clinical work for the treatment of the constipation. Can provide scientific basis for sexual constipation. Methods: 1. literature research: the etiology, pathogenesis, syndrome differentiation and treatment of chronic functional constipation, the epidemic of Western medicine, pathogenesis, treatment and so on, analyze and summarize the research rules. Reference to other experimental and clinical research, according to the conditions we have now, it can be completed and scientific. The method of.2. clinical study: a randomized, controlled method was used to integrate the Chinese and Western medical diagnostic criteria of functional constipation into two groups. The treatment group was treated with the decoction of "Chai Shao four Jun Decoction plus flavour", and the control group was given mosapride. The clinical efficacy of "Chai Peony four Jun Decoction added" to functional constipation and post-treatment symptoms were observed. The curative effect of the two groups improved after treatment compared with the.3. experimental study method: the mice with hunger and satiety, binding and excessive fatigue were made out of qi deficiency and constipation model mice, and on the basis of the compound, the constipation model was made. It was divided into the normal group, the Mosapride group, the model group, the high dose group, the middle dose group, the low dose group, observation "Chai Peony four". The effect of "Jun Tang Jiawei" on the function of mouse defecation. Results: 1. clinical study results: through the clinical observation of Chinese medicine group (Chai Shaosi Jun Decoction plus flavour) and Western medicine group (mosapride), the total effective rate of "Chai Shao four Jun soup added" was 93.33%, and the total effective rate of "mosapride" was 86.67%, the difference was significant (P0.05). After the treatment, the nature of the excrement, defecation, defecation, defecation time, defecation time, abdominal distention, chest coerce full, belching, early satiety, depression nine points were significantly improved than before treatment (P0.05). The comparison between the Chinese medicine group and the western medicine group, in the interval of defecation, chest coerce full, belching, early full, emotion depression five symptoms improvement situation, Chinese traditional medicine, Chinese Medicine Group compared with western medicine group (P0.05), but the nature of feces, feces, defecation, defecation time, abdominal distention between the four symptoms of Chinese medicine group and Western medicine group difference treatment effect is equal (P0.05). From the results, the effect of Chinese medicine group is better than the western medicine group. Therefore, the treatment of chronic functional constipation, traditional Chinese medicine has more characteristics and advantages of.2. experimental research knot Fruit: (1) the time to observe the intestinal peristalsis in mice. The results showed that the high dose group, the middle dose group, the low dose group, the normal group and the mosapride group were compared with the model group, which were shorter than the model group (P0.01). The high dose group was not statistically significant compared with the normal group (P0.05), and the high dose group was higher than the normal group. In the dose group, the intestinal peristalsis could be restored to normal effect. The medium dose and low dose group had statistical significance compared with the normal group (P0.05), suggesting that the intestinal peristalsis in the middle dose group and the low dose group was not as good as the high dose group, but the mosapride group was compared with the normal group (P05), and the ratio was compared with the middle dose group. Compared with the improvement effect, we can conclude that Chai Shao four Jun decoction can treat constipation with a dose of dependence, and enough dose of Chinese medicine group is better than western medicine group. (2) the number of black urine grains decreased significantly on the first day of the model group, three days and five days, respectively, with the statistical significance (P0.001). The middle and low dose of Chai Peony four Jun decoction was in the 3-5 day. Compared with the model group, it was statistically significant (PP.01), (P0.05), while the high dose group had statistical significance with the model group at first days (P0.05). The number of murine excretion particles in the mosapride group and the low dose group was equivalent to the mice. The results showed that the dosage of Chinese medicine had an effect on the number of the mice discharged, and the sufficient dose of Chinese medicine group was more than the western medicine. (3) the first day, three days and five days of the model group were compared with the normal group, and the weight of the stool was significantly reduced, with statistical significance (P0.01). The high, middle, low dose, and the mosapride group were compared with the model group on day 1,3,5 (P0.01). The high, middle, low dose and Mosapride group were compared with the normal group. There was no significant difference between the first days (P0.05) and no significant difference in day 3,5 (P0.05). The difference was statistically significant (P0.05) compared with the different dosage groups of the mosapride group and Chai paehao Decoction (P0.05). In summary, the Chai Shao four Jun Decoction and the mosapride had the effect on the excretion weight of the rats, but the effect of Chai Shao four Tang was better than that of the Chai peony. (4) through the observation of the number of non defecation mice, the number of non defecation mice showed that in addition to the normal group without defecation, the other groups had different amounts of non defecation in the mice after making the model. The higher, middle, low dose, and the mosapride group and the model group were statistically significant (P0.05). From the table below, each dose of Chai Peony four Jun soup could be seen. The number of non defecated mice was less and the dose was higher than that of the mosapride group. The conclusion was that the intestinal peristalsis in the constipation mice (Qi deficiency and qi stagnation) was obviously improved, the number and weight of black stool increased and the number of non defecation decreased. The effect of the Chinese Medicine group was better than that of the western medicine group. Conclusion: the effect of the Chinese medicine group was better than that of the western medicine group. The curative effect of treating functional constipation is remarkable, especially for "Qi deficiency and gas constipation" constipation. It also has significant effect on the constipation model of animal constipation. It is mainly composed of Radix Bupleuri 10g, Paeonia lactiflora L0g, Codonopsis 15g, Poria 15g, Atractylodes macrocephala 15g, Fructus aurantii Immaturus 10g, Magnolia officinalis 10g, licorice 6G.
【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】：R256.35
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