郭立中教授从扶阳论治风寒湿痹的临床经验研究

发布时间：2018-03-30 20:00

本文选题：风寒湿痹　切入点：寒湿凝滞　出处：《南京中医药大学》2017年硕士论文

【摘要】：[目的]通过对导师从扶阳论治风寒湿痹的临床病案资料进行回顾性研究,对导师从扶阳论治风寒湿痹的临证思路进行初步探讨,归纳总结导师的辨证方法及遣方用药特点,丰富中医对风寒湿痹的理论认识和临床思路,提高风寒湿痹的中医临床疗效。[方法]通过长期跟师门诊及查阅相关文献资料,按统一标准对导师2012年01月至2017年03月所有风寒湿痹的病案资料进行收集整理,运用频次频率分析、Wilcoxon符号秩检验等统计学方法对入选患者的基本信息、药物使用进行统计分析,并通过首末诊中医症候积分的变化情况进行统计,对临床疗效进行初步评价,从而分析导师从扶阳论治风寒湿痹的临证思路和立法用药规律。[结果]通过整理、筛查共获取符合条件要求的风寒湿痹病案总88例750诊次。其中男性23人,占26.1%,女性65人,占73.9%,男女比为1:2.8,女性多于男性。年龄主要分布在20-69之间,其中50-59年龄段最多,占33.00%。排除未经西医诊断的病例外,原发病以结缔组织和自身免疫性疾病为主,占23.86%,包括类风湿性关节炎16例,干燥综合征2例,强直性脊柱炎2例,系统性红斑狼疮1例;其次骨关节病10例,占比11.36%,其中包括膝盖痛2例,颈椎病2例,半月板损伤术后1例,骶管囊肿1例,腕管综合征1例,腰椎间盘突出症1例,足底跖筋膜炎1例,髋关节积液1例;代谢性疾病和其他疾病各占3.41%和5.68%。出现频率较高的临床症状依次为肢体疼痛81次,占92.05%,畏寒怕冷61次,占69.32%,肢体僵硬38次,占43.18%,夜寐不安38次,占43.18%,倦怠乏力35次,占39.77%,肢体酸胀33次,占37.5%,大便异常32次,占36.36%;舌象出现频率较高的为质淡红71次,占80.68%,苔厚腻67次,占76.14%,边齿痕34次,占38.64%,体胖大16次,占18.18%;脉象出现频率较多的是细脉66次,占75.00%,紧脉46次,占52.27%,滑脉39次,占44.32%,弱脉33次,占37.50%。病理因素主要包含阳虚66次,占75.00%,寒邪62次,占70.45%,湿邪48次,占54.55%,浊毒11次,占12.50%,其他类19次,占21.59%,其他类包含痰浊3例,虚火6例,风邪10例。主要病机则为阳气亏虚、寒湿凝滞、瘀血阻络、寒湿内盛为主,分别占比71.59%,60.23%,51.14%,21.59%,6.82%。治疗方法主要为温通宣痹和温阳除痹两大法门,使用温通法(通阳宣痹方22例和温通方7例)者29例,占32.6%;使用温阳建中法者9例,占10.23%,其中温降中土 2例,温运中土方7例;使用温阳建极法者47例,占53.41%,其中温阳除痹方34例,填精益髓方4例,温阳泻水方1例,补益心脾方2例,温潜方6例。其他包含葛根汤1例,麻黄附子细辛汤2例。遣方用药中其中使用频次较多(药物频次≥100)的类别分布由高到低分别为:补虚药、散寒药、祛风湿药、化湿药、养心安神药(前五位),其总使用频次分别达到2995次、2395次、1033次、912次、555次。其中核心使用药物有:炙甘草、仙灵脾、杜仲、白术、生黄芪、巴戟天、当归、附子、生姜、桂枝、小茴香、制川乌、细辛、油松节、威灵仙、石楠藤、木瓜、独活、羌活、路路通等(前20位)。在疗效评价方面,治疗前患者症候总积分为22.62±7.45,治疗后为8.91±5.19,经统计学处理(t=18.630,P0.01)有显著差异。总有效率为93.18%。[结论](1)导师从扶阳论治的风寒湿痹病人以中老年女性患者为主。(2)导师从扶阳论治风寒湿痹的常见症状有:肢体疼痛、畏寒怕冷、肢体僵硬;舌象以质淡红、苔厚腻、边齿痕最多;脉象以细脉、紧脉、滑脉、弱脉为主;涉及主要西医疾病包含类风湿性关节炎、骨关节病、强直性脊柱炎和干燥综合征等。(3)导师从扶阳论治风寒湿痹的基本病机为阳气亏虚、寒湿凝滞、瘀血阻络;以温化寒湿为主要治法,兼以祛风化痰祛瘀为辅;常用药物有炙甘草、仙灵脾、杜仲、白术、生黄芪、巴戟天、当归、附子、生姜、桂枝、小茴香、制川乌、细辛、油松节、威灵仙、石楠藤、木瓜、独活、羌活、路路通等(前20位)。(4)导师在治疗风寒湿痹时注重以温阳宣通和温补扶助两大基本治法为主,强调临证分次第论治的理念,善用辛温药化阳通阳,以通阳除痹法、温阳建中法、温阳建极法为主要次第用方,为风寒湿痹的治疗开拓新思路。
[Abstract]:In order to improve the clinical curative effect of traditional Chinese medicine in treating wind - cold - dampness arthralgia from January 2012 to March 2017 , the author makes a preliminary study on the clinical curative effect of the tutor from January 2012 to March 2017 according to the unified standard , and makes a preliminary evaluation on the clinical curative effect by means of statistical methods such as frequency analysis and Wilcoxon signed rank test . Among them , 23 were male 23 , 26.1 % , 65 were female , 73.9 % , male and female were 1 : 2.8 , female were more than men . The pathological factors mainly include 66 times of yang deficiency , 75.00 % of cold pathogen , 62 times of cold pathogen , 11 times of slippery pulse , 12 . 50 % of deficiency fire , and 10 cases of wind evil . In this study , there were 29 cases of warming and yang - removing herbs and 7 cases of warming yang , accounting for 32 . 6 % . Among them , there were 2 cases of warm - yang and 7 cases with warm - yang and 7 cases of warm - yang . Among them , there were 2 cases of warm - yang , 4 cases of warm - yang , 1 case of warm - yang diarrhea , 2 cases of tonifying heart - spleen and 6 cases of warm - submersible . The total effective rate was 93.18 % . ( 3 ) The basic pathogenesis of wind - cold - damp arthralgia is yang - qi deficiency , cold - dampness stagnation and blood stasis .

【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】：R249;R255.6

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