加味寿胎丸治疗肝血亏虚型经行头痛临床研究

发布时间：2017-12-28 05:32

本文关键词：加味寿胎丸治疗肝血亏虚型经行头痛临床研究　出处：《广州中医药大学》2016年博士论文　论文类型：学位论文

【摘要】：经行头痛是一种对育龄期妇女困扰较大的妇科常见的一种临床疾病,表现为患者每逢经期或行经前后出现以头痛为主要症状,经后则自愈的一种病症,其发作与月经期有明显的相关性。本病在《张氏医通.卷十》有简要记载,属西医经前期紧张综合征的范畴,西医学一般按神经性头痛治疗,也称其为“月经性偏头痛”。随着社会的变迁,对女性的各项要求越来越多,所承受压力也越来越大,经行头痛的发病率也日益增高,由于本病反复发作,治疗方法单一,临床效果差,故日益受到临床工作者的重视。目的：观察加味寿胎丸治疗肝血亏虚型经行头痛临床疗效。实验设立寿胎丸组(实验组)和四物汤二组(对照组)。二组患者均治疗4个月经周期,治疗过程中详细的记录二组受试患者的临床资料,对比二组患者治疗前后及组间治疗后的头痛综合计分法评分、头痛指数、临床生物指标和总有效率和不良情绪评分情况,通过临床研究,期望能为治疗经行头痛探索出一种,疗效好、疗程短、副作用少的新方法,为老药新用提供新的可能性,为临床提供科学依据。方法：门诊收集肝血亏虚型经行头痛患者60例,以随机单盲为原则,以简单随机的方法,将患者分为两组。实验组30例,服用加味寿胎丸。对照组30例,服用四物汤治疗。运用头痛评分综合评分法、头痛指数法评价患者头痛程度和情况；运用焦虑自评量表(Self-Rating Anxiety Scale SAS)和抑郁自评量表(Self-rating depression scale, SDS)对患者进行评测；检测治疗前后患者血浆β-EP(人β内啡肽)、NO、 ET-1及血清PGF2 α、PGE2的含量变化。以判别两种方药对肝血亏虚型经行头前的治疗效果情况,并初步探索方药的作用机制。结果：1.加味寿胎丸实验组和四物汤对照组两组病人患病年龄、病程、头痛程度等一般情况在实验开始前比较没有统计学意义,即两组病人具有可比性。(表1)2.实验前两组患者头痛程度＼头痛综合评分数＼头痛指数比较均没有统计学差异,提示两组病人病情相当,具有可比性。(表2、表3)3.综合疗效(表4)显示加味寿胎丸组治愈18例；好转8例；未愈4例；总有效率达86.67%；四物汤组治愈10例；好转12例；未愈8例；总有效率达73.33%。4.加味寿胎丸实验组和四物汤对照组综合疗效总有效率比较经统计学分析P0.05,提示有统计学意义。提示加味寿胎丸组的总疗效优于四物汤。(表4)5.两组患者治疗后实验组严重头痛0例,中度头痛2例,轻度头痛18例,无头痛10例,对照组严重头痛2例,中度头痛12例,轻度头痛15例,无头痛1例,两组治疗后头痛程度比较经Ridit分析u=2.059,P=0.043。提示两组患者治疗后头痛程度有明显差异,实验组疗效优于对照组。(表5)6.实验组患者治疗前严重头痛9例,中度头痛18例,轻度头痛3例,无头痛0例,治疗后严重头痛0例,中度头痛2例,轻度头痛18例,无头痛10例,实验组治疗前后头痛程度比较经Ridit分析u=1.945,P=0.032。提示实验组患者治疗前后头痛程度有明显差异,治疗后头痛程度减轻。(表6)7.治疗前对照组严重头痛7例,中度头痛19例,轻度头痛4例,无头痛0例,治疗后严重头痛2例,中度头痛12例,轻度头痛15例,无头痛1例,对照组治疗前后头痛程度比较经Ridit分析u=3.172,P=0.0473。提示实验组患者治疗前后头痛程度有明显差异,治疗后头痛程度明显减轻。(表7)8.两组患者的头痛计分法综合评分比较经过统计学分析,提示加味寿胎丸实验组治疗前后评分有统计学差异((P0.05))；四物汤对照组治疗前后评分比较也有统计学差异((P0.05))。加味寿胎丸组和四物汤组治疗后评分均降低。两组评分组间比较治疗前无明显差异,治疗后两组评分有差异((P0.05))。提示治疗后实验组评分低于对照组评分,实验组效果更好。(表8)9.两组患者的头痛指数经过统计学分析,提示实验组治疗前后评分有显著性差异((P0.05))；对照组治疗前后评分比较也有显著性差异((P0.05))。两组治疗后头痛指数均降低。两组评分组间比较治疗前无明显差异,治疗后两组评分有差异((P0.05))。提示治疗后实验组评分低于对照组评分,实验组效果更好。(表9)10. 两组病人SDS量表评分(表10)两组病人SDS量表评分实验前比较结果无显著性差异(t=0.378,P=0.797),实验后两组比较结果有显著性差异(t=2.215,P=0.027)。两组病人SDS量表评分实验前、后比较,实验组实验前后比较(t=3.791,P0.001)有显著性差异；对照组实验前后(t=0.423,P=0.618)无统计学差异。提示加味寿胎丸对改善经行头痛患者抑郁症状有效。11.加味寿胎丸组和四物汤组两组病人SAS量表评分实验前比较结果无统计学差异。实验后比较有统计学差异。两组病人SAS量表评分实验前、后比较,实验组实验前后比较(t=3.985 P0.001)有统计学差异；对照组实验前后比较(t=1.052,P=0.376)无统计学差异。提示加味寿胎丸能缓解经行头痛患者焦虑症状。(表11)12.两组病人生化指标检测结果显示(表12、13、14、15、16、17),经过统计学分析,实验组治疗前后PGF2 α、PGE2、PGF2α/PGE2、β-E P、NO、ET-1有显著性差异((P0.05))；对照组治疗前后PGF2 α、PGE2、PGF2 α/PGE2、β-E P、NO、ET-1比较有显著性差异((P0.05))。两组PGF2 α、PGE2、PGF2 α/PGE2、β-E P、NO、ET-1组间比较治疗前无明显差异,治疗后两组PGF2 α、PGE2、PGF2 α/PGE2、β-E P、NO、 ET-1有差异((P0.05))。结论：1.实验中中药治疗肝血亏虚型经行头痛,加味寿胎丸组总有效率为86.67%,四物汤组总有效率为73.33%,经统计学分析两者有统计学差别。提示加味寿胎丸的总疗效优于四物汤。2.比较治疗前后肝血亏虚型经行头痛患者的头痛指数、头痛计分法综合计分,加味寿胎丸和四物汤都具有明显的降低作用,提示头痛相关症状的改善。而加味寿胎丸治疗效果更优。3.加味寿胎丸和四物汤对肝血亏虚型经行头痛患者焦虑、抑郁的影响,提示两方均有不同程度的改善患者焦虑、抑郁的作用,加味寿胎丸效果更明显。4.从两组患者生化指标检测结果来看,加味寿胎丸和四物汤两方服用4个月经周期后,两组患者血浆ET-1、血清PGF2 α含量及PGF2 α/PGE2比值均降低,血浆β-EP及血清PGE2、 NO含量均提高。说明两方均对肝血亏虚型经行头痛患者血浆β-EP、ET-1,血清PGF2、PGE2、NO的含量进行有益的调节,改善经行头痛患者体内异常的内分泌情况,同时还能调节患者体内神经激素和血管活性物质的水平,以达到恢复头部血管的舒缩平衡而缓解头痛。实验证明加味寿胎丸能更好调节患者体内神经内分泌系统。经行头痛是临床常见的一种妇科疾病,治疗类似于西医“月经性偏头痛”。目前其发病机制尚不完全明了,西医治疗本病常用的有性激素类药物、钙通道阻滞剂、镇静止痛剂等,多是对症治疗,虽然在短时间内有一定的疗效,但不良反应多,复发率也高,长期疗效不理想。中医药治疗经行头痛方法多样,中药、针灸及耳穴贴压、足疗等,均体现了中医传统疗法的特色,疗效确切。相反中医治疗本病极具特色,能达到减轻临床症状、缩短治疗时间、降低治疗经费等西药无法达到的效果,因此中医治疗经行头痛必然具有广泛前景。加味寿胎丸从名方寿胎丸加减而来,易为临床工作者掌握,且疗效明显,为名方新用开拓了思路。
[Abstract]:Menstrual headache is a common clinical disease of gynecologic women, which is more common in women of childbearing age. It is manifested by a headache which is the main symptom of menstruation or menstruation. It is a symptom of self-healing after menstruation, and its seizure is significantly correlated with menstrual period. This disease is recorded in Zhang Shi Tong Tong, volume ten. It belongs to the category of premenstrual tension syndrome in western medicine. Western medicine is usually treated by neuropathic headache, also known as "menstrual migraine". With the change of society, more and more women are required, and the pressure is increasing. The incidence of headache in menstrual cycle is also increasing. Due to the recurrent attack of this disease, the treatment method is single, and the clinical effect is poor. Therefore, it is receiving more and more attention from clinical workers. Objective: To observe the effect of modified Shoutai Pill in the treatment of liver blood deficiency of the headache clinical curative effect. The experiment set up the two groups (control group) of Shou Tai pill group (experimental group) and Siwu Decoction. Two groups of patients were treated for 4 menstrual cycles, detailed records of the two groups of subjects in the course of treatment in patients with clinical data, were compared between two groups before and after treatment and between group headache score method score after treatment, headache index, clinical and biological indicators of the total efficiency and adverse emotional score, by clinical study. Hope for the treatment of menstrual headache to explore a good curative effect, short course of treatment and less side effects of the new method for the new use of old drugs to provide new possibilities, to provide scientific basis for clinical. Methods: Outpatient collected liver blood deficiency menstrual headache in 60 patients, using random single blind principle, using simple random method, the patients were divided into two groups. In the experimental group, 30 cases were taken with Jiawei Shou Tai pill. 30 cases in the control group were treated with Siwu Decoction. By using the comprehensive score method, headache, headache score index of headache degree and condition; using the self rating Anxiety Scale (Self-Rating Anxiety Scale SAS) and self rating Depression Scale (Self-rating depression scale, SDS) for evaluation of patients; patients were detected before and after treatment of plasma beta -EP (human beta endorphin), change the contents of NO, ET-1 and serum PGF2, PGE2. In order to distinguish two kinds of prescription on liver blood deficiency by head treatment effect, mechanism of action and explore the prescription. Results: 1., there were no statistical differences in the age, course of disease and headache degree between the two groups of the Shou Tai pill experimental group and Siwu Decoction control group. There was no statistically significant difference between the two groups before the experiment. (Table 1) of 2. patients in the two groups before the experiment, the headache headache degree comprehensive evaluation scores and headache index were no statistically significant differences between the two groups of patients, suggesting that the disease is comparable. (Table 2, table 3) 3. (Table 4) shows the comprehensive curative effect of modified Shoutai Pill group 18 cases were cured; 8 cases improved; 4 cases failed; the total effective rate was 86.67%; Siwu Decoction group 10 cases were cured; 12 cases improved; 8 cases ineffective; the total effective rate was 73.33%. The total effective efficiency of the 4. Jiawei pill experimental group and the Siwu Decoction control group was statistically analyzed with statistical analysis of P0.05, suggesting a statistical significance. It is suggested that the total effect of Jiawei Shou Tai pill group is better than that of Siwu Decoction. 5. (4) 5.. Two groups of patients after treatment, severe headache in the experimental group 0 cases, moderate headache in 2 cases, mild headache in 18 cases, no headache in 10 cases, control group, severe headache in 2 cases, moderate headache in 12 cases, mild headache in 15 cases, no headache in 1 cases, and the headache degree after treatment in the 1 group was analyzed by Ridit u=2.059. It is suggested that there is a significant difference in the degree of headache after treatment in the two groups, and the effect of the experimental group is better than that of the control group. 6. (Table 5) 6.. In the experimental group, 9 cases had severe headache before treatment, 18 cases had moderate headache, 3 cases had mild headache, 0 cases had no headache, 0 cases had severe headache after treatment, 2 cases had moderate headache, 18 cases had mild headache, and 10 cases had no headache. The headache degree before and after treatment in the experimental group was analyzed by Ridit u=1.945. It was suggested that there was a significant difference in the degree of headache before and after treatment in the experimental group, and the degree of headache after treatment was reduced. (6) 7. before treatment, there were 7 cases of severe headache, 19 cases of moderate headache, 4 cases of mild headache, 0 cases without headache, 2 cases of severe headache after treatment, 12 cases of moderate headache, 15 cases of mild headache, and 1 cases without headache. The headache degree in control group was analyzed by Ridit analysis u=3.172, P= 0.0473. It was suggested that the degree of headache before and after treatment in the experimental group was significantly different, and the degree of headache after treatment was obviously reduced. (Table 7) 8.. The two groups of patients with headache score scoring system were statistically analyzed. The results showed that there was a significant difference in the scores before and after treatment in the experimental group (P0.05). There was also a significant difference in scores between Siwu Decoction group and control group (P0.05). The score of Jiawei Shou Tai pill group and Siwu Decoction group decreased after treatment. There was no significant difference between the two groups before treatment, and there was a difference between the two groups after treatment (P0.05). The score of the experimental group was lower than that of the control group after treatment, and the effect of the experimental group was better. (Table 8) 9.. The headache index of two groups was statistically analyzed, indicating that there was a significant difference in the score before and after treatment (P0.05), and there was a significant difference in the score before and after treatment in the control group (P0.05). The headache index decreased after treatment in the two groups. There was no significant difference between the two groups before treatment, and there was a difference between the two groups after treatment (P0.05). The score of the experimental group was lower than that of the control group after treatment, and the effect of the experimental group was better. (Table 9) 10., two groups of patients SDS scale score (table 10), two groups of patients SDS scale score before the experiment, there was no significant difference between the two groups (t=0.378, P=0.797). There was a significant difference between the two groups after the experiment (t=2.215, P=0.027). Two groups of patients SDS scale score before and after the experiment, compared with the experimental group before and after the experiment (t=3.791, P0.001), there was a significant difference; the control group before and after the experiment (t=0.423, P=0.618) had no statistical difference. It is suggested that Jiawei Shou Tai pill is effective in improving the depressive symptoms of the patients with menstrual headache. The results of the SAS scale score of the two groups of 11. modified Shou Tai pill group and Siwu Decoction group were not statistically significant before the experiment.
【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】：2016
【分类号】：R271.115

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