基于数据库挖掘的经方治疗台湾人失眠与抑郁症的研究

发布时间：2018-03-31 04:04

  本文选题：柴胡加龙骨牡蛎汤　切入点：甘麦大枣汤　出处：《北京中医药大学》2016年博士论文

【摘要】：目的流行病学研究表明,失眠和抑郁症之间的联系是双向的,由于失眠及抑郁有愈来愈严重的发病趋势,且西医用药有成瘾的副作用,基于中医几千年的用药经验,特别是经方在临床的运用,且现代之失眠及抑郁在张仲景《伤寒杂病论》许多方证中能体现出来,本研究试图挖掘更有效的用药方式帮助患者,也让西方了解中医的特殊有效疗法。方法第一,在这项回顾性人群研究辅助数据分析中,使用来自台湾的纵向医疗保险数据库(LHID)的数据进行分析,研究探讨中草药产品(CHPS)即(中成药),以经方称之,对台湾人失眠与抑郁症的治疗,探讨中国草药和西医的处方模式于睡眠障碍和抑郁症患者,此外,对单方(SH)和复方(HF)使用的频率进行分析。第二,以常用经方酸枣仁汤治疗失眠,及治疗抑郁症之常用经方甘麦大枣汤、柴胡加龙骨牡蛎汤进行了临床随机对照大样本资料的meta分析,并再对酸枣仁汤证,甘麦大枣汤证,柴胡加龙骨牡蛎汤证进行理论研究,对此三方的病因病机及方药特点深入探讨。结果第一章,理论研究分两大部分：1.有关失眠的条文,依据《伤寒论》六经辨证系统, 《金匮要略》脏腑经络理论辨证施治,从条文之病机、症状、治则、方药及临床运用现状进行分析。2.有关抑郁症的条文,依据《伤寒论》六经辨证系统,《金匮要略》脏腑经络理论辨证施治,从条文之病机、症状、治则、方药及临床运用现状进行分析。第二章,基于数据库挖掘的经方治疗台湾人失眠与抑郁症的研究,目的：中草药产品(CHPS)是常用于睡眠障碍和抑郁症(MDD)的处方。这项研究的目的是为有这些疾病在台湾的患者调查其中草药产品和西医的处方模式,并分析使用单味草药(SHS)和复方草药配方(HFS)的频率。材料方法：在这项回顾性人群研究辅助数据分析中,是2007年1月至2011年12月,使用来自台湾的纵向医疗保险数据库(LHID)的数据进行分析,从LHID百万受益者,随机从2010年的注册表选定为全国的网络健康保险研究数据库。睡眠障碍和抑郁根据国际疾病分类,第九版,临床修改代码分别为307.40和311。第三章,经方治疗失眠、抑郁临床随机对照试验之meta分析,酸枣仁汤治疗失眠及甘麦大枣汤、柴胡加龙骨牡蛎汤治疗抑郁症临床随机对照试验之meta分析。结论在这项回顾性人群研究辅助数据分析中,是2007年1月至2011年12月,使用来自台湾的纵向医疗保险数据库(LHID)的数据进行分析,总共有11030睡眠障碍患者,9619名使用西药,1334名患者使用中国草药产品,77名中西药皆使用；总共有11157重度抑郁症患者,11389名使用西药,131名患者使用中国草药产品,51名中西药皆使用。无论睡眠障碍或重度抑郁症(MDD),患者女性多于男性,年龄在22-44岁的人数最多,月收入在NT$17281-22800有大量的病人,1级2级城市有最大量的患者。中草药使用,有1411人因睡眠障碍就诊中医5298次,有182人因重度抑郁症疾患就诊中医755次,失眠合并抑郁症最常用的前三名,用量比率最高的单味中药(SHs)是酸枣仁,夜交藤及远志,用量比率最高的复方(HFs)是加味逍遥散,酸枣仁汤及柴胡加龙骨牡蛎汤。结果：中药复方及单方被广泛用于睡眠障碍与抑郁症。然而,中草药对睡眠障碍和抑郁症的安全性和有效性,需要进一步评估；基于数据库的分析,对这些药物用于治疗睡眠障碍和抑郁症的,剂量-反应关系和功效是未知的,故继续深入了解经方治疗失眠与抑郁症其疗效的评估,本次Meta分析结果表明酸枣仁汤及其加减方治疗失眠的效果优于西药,甘麦大枣汤及其加减方治疗抑郁症的效果优于西药,柴胡加龙骨牡蛎汤及其加减方在治疗抑郁症方面优于西药对照组,本研究得知经方酸枣仁汤、甘麦大枣汤、柴胡加龙骨牡蛎汤之使用,对失眠及抑郁症有很好疗效,以台湾卫生健保部门的数据库,得到的数据,更证明中医使用于失眠与抑郁症及失眠伴发抑郁症提供了参考数据,使用台湾全民健康保险研究数据库得到的结果,证明中药使用的安全性,希望有助失眠抑郁医疗质量的提升,同时藉由期刊之发表,促进中医药的国际化。
[Abstract]:Objective epidemiological studies show that the relationship between insomnia and depression are bidirectional, insomnia and depression due to the incidence trend of more and more serious, and the side effects of Western medicine have addiction, Chinese medicine for thousands of years experience in medicine based on classical prescriptions in clinical application and modern insomnia and depression in Zhang Zhongjing < Shanghanzabinglun can be reflected in the many ", this study attempts to dig more effective drugs to help patients, also let the Western understanding of special effective therapy in traditional Chinese medicine. First, in the analysis of this retrospective cohort study using auxiliary data, from the Taiwan longitudinal health insurance database (LHID) data analysis, research on herbal products in the discussion of (CHPS) (Chinese), is known to classical, treatment of insomnia and depression of Taiwan, China herbal and Western medicine prescription pattern in sleep disorder and depression patients In addition, the unilateral (SH) and compound (HF) to analyze the frequency of use. In second, commonly used by Suanzaoren Decoction in the treatment of insomnia, depression and treatment of commonly used by ganmaidazao decoction, Chaihu Longgu Oyster Soup conducted a clinical randomized controlled large sample data of meta analysis, and then to semenziziphispinosae decoction, ganmaidazao decoction, bupleurum plus Longgu Oyster Soup syndrome theory research, this three party pathogenesis and prescription characteristics in depth. The first chapter, the theory research is divided into two parts: 1. the relevant provisions on the basis of insomnia, "Treatise on the six system >, < > jinkuiyaolue Meridians Theory from the provisions of syndrome differentiation, pathogenesis, symptoms, treatment, prescription and clinical application to analyze the current situation of.2. about depression according to provisions in < treatise on six > system > < jinkuiyaolue meridians syndrome differentiation theory, from the provisions of the pathogenesis, symptoms and treatment Then, prescription and clinical application status were analyzed. The second chapter, the purpose of database mining, insomnia and depression treatment by Taiwanese based on Chinese herbal medicine products (CHPS) is a common sleep disorder and depression (MDD) prescription. The purpose of this study is to investigate in Taiwan patients with these diseases which products and herbal medicine prescription pattern, and analysis of single herb use (SHS) and compound herbal formula (HFS) frequency. Materials and methods: in this retrospective cohort study of auxiliary data, from January 2007 to December 2011, used from Taiwan longitudinal health insurance database (LHID) data was analyzed. From LHID million beneficiaries from 2010, randomly selected for the National Registry of network health insurance research database. Sleep disorders and depression according to the international classification of diseases, Ninth Edition, Clinical Modification codes were 307.4 0 and 311. of the third chapter, the treatment of insomnia by analysis of depression, randomized clinical trials of meta, Suanzaoren Decoction in the treatment of insomnia and ganmaidazao decoction, analysis of Bupleurum plus Longgu Oyster Soup treatment of depression in randomized clinical trials of meta. Conclusion in this retrospective cohort study of auxiliary data analysis, from January 2007 to December 2011, the use of from the Taiwan longitudinal health insurance database (LHID) data analysis, a total of 11030 patients with sleep disorders, 9619 the use of Western medicine, 1334 patients with China herbal products, 77 in the western medicine are used; there are a total of 11157 patients with severe depression, 11389 the use of Western medicine, 131 patients with China herbal products, 51 in western medicine use. Regardless of sleep disorders or severe depression (MDD), with more women than men, at the age of 22-44 year olds, the monthly income in NT$17281-22800 has a large number of patients, grade 1 2 city the largest number of patients. Chinese herbal medicine use, there are 1411 people with sleep disorders clinic of traditional Chinese medicine 5298 times, 182 people with severe depression disease treatment of traditional Chinese medicine 755 times, insomnia and depression are most commonly used in the top three, the amount of the highest rate of single Chinese herb (SHs) is Suanzaoren, Caulis and Polygala. The amount of the highest rate of compound (HFs) is Jiaweixiaoyaosan, Suanzaoren Decoction and Bupleurum plus Longgu Oyster Soup. Results: the traditional Chinese medicine and is widely used for unilateral sleep disorders and depression. However, Chinese herbal medicine is safe and effective for sleep disorders and depression, the need for further evaluation of the database; based on the analysis of these. Drugs for the treatment of sleep disorders and depression, the dose-response relationship and the effect is unknown, so continue to in-depth understanding of the evaluation of insomnia and depression after treatment the curative effect, the Meta analysis results show that the Suanzaoren Decoction and its Decoction in the treatment of insomnia is better than western medicine, ganmaidazao Decoction in the treatment of depression is better than western medicine, Chaihu Longgu Oyster Soup Decoction in the treatment of depression and better than the control group, the prescription szrt, ganmaidazao decoction, using Bupleurum plus Longgu Oyster Soup, has a great effect on the insomnia and depression, the Taiwan health care department database, the data that Chinese medicine used in insomnia and depression and insomnia and provide reference data for depression, using the Taiwan national health insurance research database results prove the safety of using traditional Chinese medicine, to help insomnia depression medical quality, at the same time the journal is published, to promote the internationalization of Chinese medicine.

【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R256.23;R277.7
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本文编号：1689045