温胆汤加减治疗脾虚湿热型胃痞病的临床观察

发布时间：2017-12-31 22:01

本文关键词：温胆汤加减治疗脾虚湿热型胃痞病的临床观察　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景祖国医学对于胃痞的认识始于《黄帝内经》,经过千年的实践,对于痞满的明确的定义为:自觉心下痞塞,胸膈胀满,触之无形,按之柔软,压之无痛。按部位区分,则胃痞一病当指心下痞。现代医学中的功能性消化不良则在祖国医学中归属胃痞范畴。功能性消化不良是一种临床上常见的消化系统疾病,其主要症状特点可表现为:上腹部疼痛或者不适,上腹部烧灼感,餐后饱胀感或者早饱。根据罗马Ⅲ标准,可将其分为两类,一种是称为餐后不适综合征;另一种则是上腹痛综合征。而且近年来FD的发病率呈上升趋势,根据研究报道显示,欧美国家功能性消化不良人群发病率达19%-41%,平均32%;国内为18%-45%,占消化门诊的20%-40%。随着功能性疾病出现身心合病的发病增长趋势,部分患者的功能性消化不良症状甚至严重影响其生活质量。据报道,每年症状可严重或持久,从有20-30%的人群有慢性或反复发作的消化不良症状,而很多临床医师将许多不同的消化道症状均视为"消化不良",从而混淆了对消化不良概念的理解。因此,现代医学在治疗功能性消化不良尤其是餐后不适综合征上存在着临床难以治愈,患者反复发作的难题。现代医学对于功能性消化不良发病机制暂不能明确,且无特效疗法,而中医则在几千年对胃痞病的辨证论治上积累了丰富的医家经验和大量医书记载,形成了完善统一的理论体系。因此,中医药在治疗功能性消化不良上有着自己的特色及优势。首先在提高临床治愈率,尤其在缓解上腹疼痛不适、上腹饱胀及早饱等主要症状上优势明显,其次辨证论治及饮食调理能明显降低复发率,最后中医药治疗功能性消化不良副作用小,且未出现严重的药物不良反应。目的本研究立足广东岭南地区,因该地域气候湿热,且广东人群偏爱"凉茶",湿热为标,脾虚为本的体质在广东多见,故导致胃痞病以脾虚湿热型为主。本研究以临床上治疗脾虚湿热型胃痞病的经验方温胆汤为基础方进行加减,以脾虚湿热型胃痞病患者为研究对象,观察温胆汤治疗脾虚湿热型胃痞病患者的临床疗效,为临床治疗同类患者提供更好的借鉴思路。方法本研究采用采用随机、单盲、对照的临床设计方法,在广州中医药大学第一附属医院消化内科邝卫红教授门诊患者中选取符合研究依据诊断、纳入和排除标准的90例脾虚湿热型胃痞病患者,随机分为中药组、西药组及中西药组。纳入标准:中医诊断标准参考高等教育中医药类规划教材第六版《中医内科学》);西医诊断标准参考2006年5月正式发布的罗马Ⅲ标准。中药组治疗方案:"温胆汤加味"基本方:陈皮10g、半夏1Og、竹茹15g、党参10g、白术15g、郁金10g、枳实10g、厚朴10g、紫苏梗15g,中药汤剂日1剂,每日150ml,早午饭后1小时温服;西药组:枸橼酸莫沙必利分散片(新络纳):由成都康弘药业集团股份有限公司生产,国药准字:H20031110,规格:5mg/片,一日三次,一次一片,餐前半小时服用;中西药组:"温胆汤"加减联合莫沙必利分散片。疗程为4周。观察记录试验对象治疗前后的症状积分情况,以统计学方法进行分析,评测温胆汤对于脾虚湿热型胃痞病患者的疗效及安全性。结果1.本研究共纳入符合研究病例90例,因不能坚持或失访脱落2例,无因药物不良反应退出试验者,共完成临床观察88例。2.临床疗效分析:中药组治愈率24.14%,总有效率86.21%;西药组治愈率10.34%,总有效率82.76%;中西药组治愈率30.00%,总有效率96.67%。治愈率方面,中药组明显优于西药组,且存在统计学差异,而中西药组则明显优于中药组及西药组,并具有统计学意义。有效率方面,中药组同样明显优于西药组,且存在统计学差异,而中西药组则明显优于中药组及西药组,并具有统计学意义。3.症状积分方面:对比治疗前后总积分方面,中药组及中西药组明显优于西药组,且具有统计学差异,中药组及中西药组之间无统计学差异;对比痞满、小便短黄、大便稀溏三个症状前后积分,中药组疗效明显优于西药组,且具有统计学差异,中药组与中西药组无明显差异;对比嗳气反酸、疲乏无力、口干口苦、胸闷、喜太息等症状,中西药组明显优于西药组,且有统计学意义;对比胃痛、饮食减少、恶心呕吐、胃中嘈杂、身困倦怠等症状,三组疗效无明显差异。结论1.温胆汤对于脾虚湿热型胃痞病疗效确切,并对痞满、小便短黄、大便稀溏等症状疗效明显,是临床可行的有效方药。2.温胆汤联合莫沙必利治疗脾虚湿热型胃痞病疗效优于单一服用温胆汤或者单一使用莫沙必利。3.试验过程中无药物不良反应现象,温胆汤加味治疗脾虚湿热型胃痞病安全性高,且能有效防止莫沙必利引起的大便稀溏等症状,值得临床推广。
[Abstract]:The background of Chinese medicine for the understanding of Weipi in < Neijing >, after thousands of years of practice, in the fullness of clear definition of consciousness: epigastric distention and fullness in chest, plug, touch the invisible pressure according to the soft, painless. According to the site to distinguish, is a disease of Weipi when referring to the heart PI. Functional dyspepsia in modern medicine is attributable to Weipi category in traditional Chinese medicine. Functional dyspepsia is a common clinical digestive system disease, the main symptoms can be expressed as: upper abdominal pain or discomfort, upper abdominal burning sensation, postprandial fullness or early full. According to the Rome criteria, which can be divided into two categories, one is called postprandial distress syndrome; another is epigastric pain syndrome. In recent years, and the incidence rate of FD is rising, according to reports, the European and American countries of functional dyspepsia incidence rate of 19%-41%, an average of 32%; China For 18%-45%, accounting for 20%-40%. with the function of digestive outpatient disease and disease growth trend, part of patients with functional dyspepsia symptoms or even seriously affect the quality of life. It is reported that every year the symptoms can be severe or persistent, 20-30% from people with chronic or recurrent symptoms of dyspepsia, and many clinicians many different gastrointestinal symptoms were regarded as "indigestion", thus confusing the concept of indigestion. Therefore, modern medicine in the treatment of functional dyspepsia postprandial distress syndrome has clinical difficult to cure recurrent problems. Modern medicine for patients with functional dyspepsia the mechanism can not clear, and no specific therapy, and TCM syndrome differentiation in the thousands of years of Weipi disease treatment has accumulated rich experience and a large number of doctors of medical records, formed the end The theoretical system of good unity. Therefore, traditional Chinese medicine in the treatment of functional dyspepsia with their own characteristics and advantages. Firstly, improve the clinical cure rate, especially discomfort in alleviating abdominal pain, abdominal distension and early satiety and other major symptoms of obvious advantages, followed by differentiation of signs and diet can significantly reduce the recurrence the rate of traditional Chinese medicine in the treatment of functional dyspepsia with little side effects, and no severe adverse drug reaction. The purpose of this study is based on Guangdong south of the Five Ridges region, because the region's hot and humid climate, and Guangdong people prefer "herbal tea", as the standard for the damp heat, spleen deficiency constitution is more common in Guangdong, resulting in Weipi disease in the spleen deficiency. The experience of Wendan Decoction based on the treatment of spleen deficiency Weipi disease is modified based, in patients with spleen deficiency Weipi disease as the research object, the observation of Wendan Decoction on spleen deficiency stomach The clinical curative effect of FD patients, to provide reference for the clinical treatment of similar patients better. Methods this study used a randomized, single blind, controlled clinical design method, in the Department of Gastroenterology professor Kuang Weihong outpatient clinic in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were selected in conformity with the study on the basis of diagnosis, inclusion and exclusion criteria, 90 cases of spleen deficiency stomach FD patients were randomly divided into Chinese medicine group, western medicine group and Western medicine group. Inclusion criteria: the diagnostic standard of Chinese medicine higher education reference TCM textbooks sixth edition of < >); Chinese medicine Western medicine diagnosis standard reference May 2006 officially released the Rome III standards. Traditional Chinese medicine treatment group: "Wendan Decoction" 10g 1Og: tangerine peel, pinellia, calamus 15g, dangshen 10g, Atractylodes 15g, Radix Curcumae 10g, orange 10g, Magnolia 10g, perilla 15g decoction, daily 1 agent, 150ml daily, 1 hours a day after breakfast and lunch; Western Medicine Mosapride Citrate Dispersible Tablets group (Xinluona): produced by Limited by Share Ltd Chengdu Kanghong Pharmaceutical Group, Zhunzi: H20031110 specifications: 5mg/ tablets, three times a day, one at a time, half an hour before a meal; western medicine group: "Wendan Decoction" combined with modified Mo will benefit dispersible tablets. The course was 4 weeks. Before and after the treatment of the test object to observe and record the symptom integral situation, analysis by the statistical method, the evaluation of Wendan Decoction for efficacy and safety in patients with spleen deficiency Weipi disease. Results 1. were included in the study of 90 cases, because they can not insist or lost off 2 cases, because no adverse drug reaction out of the test, completed the clinical observation of clinical analysis of 88 cases of.2. in Chinese medicine group, the cure rate was 24.14%, the total efficiency of 86.21%; western medicine group, the cure rate was 10.34%, the total efficiency of 82.76%; the western medicine group the cure rate was 30%, the total efficiency of 96.67%., the cure rate of Chinese medicine. Significantly better than the western medicine group, and there was significant difference, while in the western medicine group was significantly better than the traditional Chinese medicine group and Western medicine group, and has statistical significance. The efficiency of the traditional Chinese medicine group, also significantly better than western medicine group, and there was significant difference, while in the western medicine group was significantly better than the traditional Chinese medicine group and Western medicine group, and has statistical significance.3. symptoms: comparison of total score before and after treatment, traditional Chinese medicine group and Western medicine group was significantly better than the western medicine group, and has statistically significant difference, there was no difference between the traditional Chinese medicine group and Western medicine group; contrast fullness, short yellow urine, stool pond before and after the three symptoms, Chinese medicine group was better than western medicine group, and statistically, the Chinese medicine group and Western medicine group had no significant difference; comparison of fatigue, belching and acid reflux, dry mouth, chest tightness, heave a deep sigh and other symptoms, the western medicine group was significantly better than the western medicine group, and the difference was statistically significant; Comparison of stomach, eating less, nausea and vomiting, noisy stomach, sleepy body fatigue and other symptoms, no significant difference between the three groups. Conclusion 1. Wendan Decoction for spleen deficiency Weipi disease curative effect, and the fullness, short yellow urine, stool pond etc. effect symptoms, is clinically feasible and effective.2. medicine Wendan Decoction combined with Mosapride without adverse drug reaction and treatment of spleen deficiency stomach disease curative effect is better than single PI taking Wendan Decoction or single use of mosapride in the.3. tests, Wendan Decoction in treating spleen deficiency Weipi disease with high safety, and can effectively prevent the mosapride caused loose stool and other symptoms, it is worthy of clinical promotion.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R256.32

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