慢性萎缩性胃炎肠上皮化生证治规律研究

发布时间：2018-03-06 03:03

  本文选题：慢性萎缩性胃炎　切入点：肠上皮化生　出处：《河南中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：通过对近10年与慢性萎缩性胃炎(Chronic Atrophic Gastritis,以下简称CAG)肠上皮化生(Intestinal Metaplasia,以下简称IM)相关文献的研究,以及对导师治疗CAG伴IM经验的总结,归纳出CAG伴IM的证治规律。方法：检索相关期刊论文(CNKI).重庆维普(VIP)、万方等中文数据库中2006年1月-2016年1月收录的所有相关文献资料,以证候要素-靶位-应证组合规律理论为指导,对检索到的文献进行统计学分析,总结出CAG伴IM近10年相关文献中辨证论治文献中证候、证候要素、对应靶位出现的规律和证候要素之间、靶位与靶位之间以及证候要素与靶位之间的应证组合规律；对纳入的以固定方加减的文献进行统计学分析,得出各类药物的用药规律；结合临床实践,对导师论治CAG伴IM的经验进行归纳总结,对导师常用方药及验案进行剖析,进一步阐释本病的证治规律。结果：1)符合纳入标准的近10年文献中辨证治疗CAG伴IM的共63篇,规范后的证型36个,出现的证候频次为：胃阴亏虚证脾胃湿热证肝胃不和证脾胃气虚证瘀阻胃络证脾胃虚寒证气滞血瘀证气阴两虚证肝脾不和证寒热错杂证；2)频次大于10的证候要素分别为内热、气虚、阴虚、气郁、血瘀、内湿、阳虚、气滞,证候要素组合有单证、两证、三证和四证组合,其中两证组合出现频次最高,两证组合中又以“气郁+内热”和“内湿+内热”频次最高；对应的靶位为胃、脾、肝、心、胆,以胃、脾、肝为主,靶位-靶位组合中脾-胃,胃-胃,肝-胃组合最多；证素-靶位组合中胃-内热,脾-气虚,胃-阴虚,胃-血瘀,肝-气郁,胃-气虚,脾-内热,肝-内热,脾-内湿居前9位；3)以固定方加减治疗CAG伴IM的224篇文献中共出现198种药物,频数为2534次,补虚药、理气药、清热药、活血化瘀药、化湿药、消食药、化痰药出现频次居于前7位,使用频次居前10位的药物分别为甘草、白术、白芍、党参、黄芪、丹参、茯苓、半夏、白花蛇舌草、黄连。补虚药中补气药、补血药出现最多,补气药以甘草、白术、党参、黄芪为主；补血药以白芍、当归为主；理气药以陈皮、枳壳、柴胡、佛手、木香为首；清热药中清热解毒药、清热燥湿药最多,代表药为白花蛇舌草、黄连、蒲公英、黄芩；活血化瘀药以丹参、莪术、延胡索为主；化痰药中半夏出现最多。结论：1.通过基于证素-靶位-应证组合规律的CAG伴IM近10年中医文献的研究,可以得出CAG伴IM证候以胃阴亏虚证、脾胃湿热证、肝胃不和证、脾胃气虚证、瘀阻胃络证、脾胃虚寒证六个证型居多,辨证时可以上述六个证型为主,病位主要在胃,与脾、肝、心、胆等脏腑相关；2.固定方加减治疗CAG伴IM的224篇文献中补虚药、理气药、清热药、活血化瘀药、化湿药、消食药、化痰药出现频次居前七位,补虚药中补气药频次最高,其次为补血药、补阴药、补阳药,说明现代医家治疗CAG伴IM时以补虚为基础,尤以补气为重,且出现气郁(包括气滞)、内热、瘀血、内湿、食积、痰饮的可能性较大。根据用药规律可推出CAG伴IM的病机是以正虚为主、兼以邪实,正虚主要为脾胃气虚、脾胃阴虚、脾胃虚寒,邪实主要为气郁(包括气滞)、内热、瘀血、内湿、食积、痰浊等。3.根据聚类方,在辨证治疗时可将本病分为脾胃气虚证、脾胃虚寒证、胃阴亏虚证、寒热错杂证、瘀阻胃络证、肝气郁滞证、脾胃湿热证七个证型,分别运用类六君子汤；类小建中汤；类沙参麦冬汤；类半夏泻心汤；类丹参饮合百合乌药汤、类失笑散以及类桃红四物汤；类四逆散合金铃子散等方。
[Abstract]:Objective: through in the past 10 years with chronic atrophic gastritis (Chronic Atrophic Gastritis, hereinafter referred to as CAG) of intestinal metaplasia (Intestinal Metaplasia, hereinafter referred to as IM) the study of relevant literature, and a summary of CAG treatment with IM experience, summed up the law of CAG with IM syndrome. Methods: Chinese Retrieval Periodicals Full Text Database (CNKI). Chongqing VIP (VIP), Wanfang database Chinese January 2006 -2016 year in January included all the relevant literature on syndrome elements - target - theory combination rules as the guidance, the statistical analysis of the retrieved literature, summed up the CAG with the IM syndrome related literature 10 in the literature on the treatment of syndromes, syndrome elements, between the corresponding target occurrence rules and syndrome factors between the target and the target as well as between syndrome elements and target should permit the combination rule; the included fixed Decoction of the literature For statistical analysis, the drug laws of various drugs; combined with clinical practice, the tutor on the treatment of CAG with IM experience are summarized, the tutor of common prescriptions and case analysis, further explained the ill treatment of the law. Results: 1) met the inclusion criteria of the literature for nearly 10 years in the differentiation and treatment of CAG a total of 63 patients with IM syndrome type, specification after the 36, the frequency of syndrome: stomach yin deficiency syndrome of spleen stomach damp heat syndrome of disharmony between liver and stomach spleen qi deficiency and blood stasis syndrome of spleen deficiency syndrome of stomach qi stagnation and blood stasis syndrome of disharmony between liver and spleen yin two deficiency syndrome ofintermingled; 2) greater than the frequency of syndrome the 10 elements were heat, Qi, yin deficiency, qi stagnation, blood stasis, wet, Yang deficiency, qi stagnation, syndrome factor combination with documents, two cards, cards and the four card combination, the highest frequency of occurrence of two card combination, two card combination in "Qi + heat" and "wet + internal frequency 鏈，

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