加减连朴饮治疗湿热中阻型反流性食管炎的理论与应用研究

发布时间：2017-12-28 18:09

本文关键词：加减连朴饮治疗湿热中阻型反流性食管炎的理论与应用研究　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的通过整理、挖掘古今反流性食管炎相关文献和临床随机对照研究,探析古代治疗吐酸、嘈杂与现代治疗湿热中阻型反流性食管炎方剂的用药规律,寻求加减连朴饮组方依据,并观察加减连朴饮治疗湿热中阻型反流性食管炎的临床疗效,探讨其可能作用机制。方法第一部分理论研究:通过搜集、整理、归纳相关文献,并对古代149首治疗吐酸、嘈杂与现代52首治疗湿热中阻型反流性食管炎的方剂用药进行频次、频率统计及关联规则分析。第二部分临床研究:将60例湿热中阻型反流性食管炎患者随机分为治疗组与对照组各30例。两组均以奥美拉唑为基础治疗,治疗组加用加减连朴饮,对照组加用莫沙必利分散片,疗程8周。观察治疗前后临床症状积分、内镜下食管炎症程度及胆汁反流情况、血浆胃动素及前列腺素E2水平等。结果(1)反流性食管炎宜归入中医学吐酸、嘈杂范畴,中医或中西医结合治疗均有较好效果。(2)古代149首方剂研究显示:补虚药频率最高(17.64%),其次为理气药(15.70%)、祛湿药(15.61%)、清热药(12.93%)、温里药(11.36%)、化痰止咳平喘药(8.86%),累计频率82.10%,是治疗"嘈杂""吐酸"的主要药类。使用频次大于8的常用31味药物中(大于30的药物可组成二术二陈汤和左金丸),频率最高的是陈皮(8.49%);药性中温性(51.49%)明显高于平性(19.46%)、寒性(12.78%);药味以辛(37.03%)、苦(31.09%)味居多,其次是甘(19.91%)味;归经以入脾经(27.97%)、胃经(21.90%)居多,其次是肺经(13.88%)、心经(10.72%);支持度最高的二联药对为茯苓-陈皮(30.87%),三联药对为半夏黄连-陈皮。(3)现代52首方剂研究显示:清热药频率最高(19.10%),其次为补虚药(15.45%)、化痰止咳平喘药(14.06%)、理气药(12.15%)、祛湿药(10.07%)、解表药(7.99%),累计频率78.82%,是治疗湿热中阻型反流性食管炎的主要药类。使用频次大于4的常用32味药物中(频次大于20的药物可组成左金丸和小柴胡加茯苓汤),频率最高的是黄连(6.60%);药性中以温性(29.14%)和寒性(28.04%)居多,其次是平性(16.34%)、微寒(12.28%);药味以苦味(40.30%)居多,其次是辛(26.27%)、甘(15.41%)味;归经以入脾经(21.78%)、胃经(20.80%)居多,其次是肺经(14.78%)、肝经(10.78%);支持度最高的二联药对为黄连-吴茱萸(48.08%),三联药对为吴茱萸半夏-黄连。(4)临床研究显示:治疗前后两组内镜积分比较均具有差异性(P0.05);两组内镜下食管炎症疗效比较治疗组优于对照组,具有差异性(P0.05);治疗前两组症状积分比较无差异性,治疗后两组症状积分比较具有差异性,治疗组优于对照组(P0.05);两组中医证候疗效比较治疗组优于对照组,具有差异性(P0.05);治疗组治疗后血浆胃动素和前列腺素E2水平明显升高优于对照组,具有显著差异性(P0.01);治疗组治疗后胃镜下胆汁消失率优于对照组,具有差异性(P0.05)。结论(1)古代治疗吐酸、嘈杂方剂主要以辛温、苦温,归脾、胃经,具理气化湿,健脾和胃功效的药味配伍组方,可体现"祛湿"兼以"补益"首要治法的应用;现代治疗湿热中阻型反流性食管炎方剂主要以苦温、苦寒,归脾、胃经,具清热泻火,燥湿化痰,调肝和胃功效的药味配伍组方,可体现"清热"兼以"调肝"首要治法的应用。(2)加减连朴饮组方有据,与古代治疗吐酸、嘈杂与现代治疗湿热中阻型反流性食管炎方剂用药规律基本一致,为临床治疗湿热中阻型反流性食管炎的有效方剂,其作用机制可能与增加胃动力、减少胆汁反流、调节胃肠激素等有关。
[Abstract]:By sorting, mining ancient literature of reflux esophagitis and randomized controlled clinical study, treatment of drug laws of ancient spit acid, noisy and modern treatment of damp heat type of reflux esophagitis and seek prescriptions, with lianpuyin prescription basis, and to observe the clinical effect of addition and subtraction with lianpuyin resistance type reflux esophagitis in the treatment of damp heat, to investigate its possible mechanism. Methods Part One: theoretical research: through collecting, sorting out and summarizing related literatures, we analyzed the frequency, frequency and association rules of 149 ancient prescriptions used for the treatment of vomiting, sour and modern 52 treatments for damp heat reflux esophagitis. The second part of the clinical study: 60 cases of dampness and heat resistance reflux esophagitis were randomly divided into 30 cases in the treatment group and the control group. Two groups were given omeprazole based therapy, the treatment group was treated with modified Lianpu decoction, the control group was treated with Mosapride, treatment for 8 weeks. The score of clinical symptoms, the degree of endoscopic esophagitis and bile reflux, plasma motilin and prostaglandin E2 were observed before and after treatment. Results (1) reflux esophagitis should be classified as acidity and noise in traditional Chinese medicine. The combination of traditional Chinese medicine or traditional Chinese and Western medicine has good effect. (2) 149 ancient prescriptions research shows that: the tonic the highest frequency (17.64%), followed by Qi medicine (15.70%), (15.61%), clearing heat and eliminating dampness medicine medicine (12.93%), warm in medicine (11.36%), Huatanzhike asthma drugs (8.86%), the cumulative frequency of 82.10%, is the treatment of "noisy" "the main drugs spit acid. The frequency of use is greater than 8 of the 31 drugs commonly used in (which can be composed of two of two Tang and Zuo Jinwan more than 30 drugs), is the highest frequency (8.49%) of temperature; peel resistance (51.49%) was significantly higher than that of the flat (19.46%), cold (12.78%); according to Xin (37.03%), bitter (31.09%) taste mostly, followed by sweet taste; (19.91%) go through to the spleen and stomach (27.97%) (21.90%) the majority, followed by lung (13.88%), heart (10.72%); the highest degree of support for the two drug - Fuling Chenpi (30.87%), the triple drug of Pinellia Rhizoma Coptidis tangerine peel. (3) 52 prescriptions of modern research shows that the highest frequency of heat clearing drugs (19.10%), followed by tonic medicine (15.45%), Huatanzhike asthma drugs (14.06%), Qi medicine (12.15%), (10.07%), Qushi medicine jiebiao drugs (7.99%), the cumulative frequency of 78.82%, is the main treatment of drug resistance type of reflux esophagitis in damp heat. The frequency of use is greater than 4 of the 32 drugs commonly used in (more than 20 times the drug can be composed of Zuojinwan and Xiao Chaihu plus Fuling decoction, Coptis chinensis) is the highest frequency (6.60%); resistance to temperature (29.14%) and cold (28.04%) majority, followed by flat (16.34%), cold (12.28%); (40.30%) the majority of bitter herbs, followed by Xin (26.27%), (15.41%) sweet taste; go through to the spleen and stomach (21.78%) (20.80%) the majority, followed by lung (14.78%), liver (10.78%); support the highest degree of the two drug for Coptis Wu Zhu: (48.08%), the triple drug for Evodia Pinellia Rhizoma coptidis. (4) clinical study showed: two groups before and after treatment were compared with endoscopic integral difference (P0.05); two groups of curative effect of endoscopic esophageal inflammation treatment group than the control group, with the difference (P0.05); the two groups before treatment symptom scores have no difference between the two groups after treatment, symptom scores compared with the differences, the treatment group than the control group (P0.05); two groups of TCM syndrome curative effect comparison of treatment group than the control group, with the difference (P0.05); the treatment group after treatment of plasma motilin and prostaglandin E2 levels were significantly higher than the control group, with significant difference (P0.01); after treatment, endoscopic bile disappearance rate better than the control group, with differences (P0.05). Conclusion (1) treatment of ancient prescription mainly to spit acid and noisy pungent and bitter temperature, spleen and stomach qi, with wet ingredients, compatibility of the spleen and stomach function, can reflect the "dampness" and "application to benefit" the main treatment method; resistance type reflux treatment of damp heat in the modern food hydrosalpinx2 prescription mainly to the bitter and warm, bitter cold, spleen and stomach, with clearing heat and dampness and phlegm, medicine prescription regulating liver and stomach function, can reflect the "heat" and "Application of regulating liver" primary treatment. (2) modified with lianpuyin prescription according to the treatment, and the ancient and modern treatment of spit acid, a damp heat type reflux esophageal inflammation prescription drug laws are basically consistent, effective prescriptions for the clinical treatment of damp heat in the resistance type of reflux esophagitis, its mechanism may be associated with increased gastric motility and reduce bile reflux flow, regulate gastrointestinal hormone and so on.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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