崔德芝教授治疗老年2型糖尿病及其常见血管并发症的用药规律探讨

发布时间：2018-04-08 22:02

本文选题：老年2型糖尿病　切入点：糖尿病血管并发症　出处：《山东中医药大学》2016年硕士论文

【摘要】：目的:探索崔德芝教授治疗老年2型糖尿病及其血管并发症的处方用药规律,并总结探讨辨治思路,为糖尿病及其血管并发症的中医临床诊疗提供新的思路和方法。方法:以老年2型糖尿病及其常见的四种血管并发症——糖尿病合并脑血管病、糖尿病合并心脏病、糖尿病肾病和糖尿病足为切入点,以导师开立的中药复方为研究对象,共收集方剂394首(合并以上四种血管并发症的方剂分别为182首、106首、68首、38首),采用频数分析及关联规则分析数据挖掘方法,从核心药物、药对及药组方面探索处方用药规律。结果:治疗老年2型糖尿病及其四种血管并发症的方剂中,应用频次最多的药物为补虚药,其次为清热药、活血化瘀药、利水渗湿药等。从药物具体功效方面,补气药和活血止痛药应用最多。最常用的补气药为炙甘草、黄芪、白术、党参、太子参、山药,补血药为当归、白芍,补阴药为麦冬、枸杞子,补阳药常用杜仲、肉苁蓉。治疗老年2型糖尿病合并脑血管病的方剂中,补虚药、活血化瘀药、清热药、平肝息风药、化痰为导师治疗老年糖尿病合并脑血管病最常用的五类药物及药物组合。消食药、解表药、安神药、泻下药为治疗本病常配伍之品。天麻、葛根、川芎-地龙、黄芪-当归、半夏-白术-天麻、黄芪-赤芍-地龙-当归等为导师常用的具有代表性的药物及药物组合。治疗老年2型糖尿病合并心脏病的方剂中,补虚、清热、活血化瘀、理气和化痰药为最常用的药物及药物组合,常配以消食和养心安神药。甘草、丹参、瓜蒌、三七、桃仁-红花、酸枣仁-柏子仁、麦冬-五味子-太子参、黄芪-党参-当归、炙甘草-生地黄-黄芪、黄连-竹茹-荷叶-枳实为导师常用的有代表性的药物及药物组合。治疗老年2型糖尿病肾病的方剂中,补虚、清热、活血化瘀和利水渗湿药为最常用的药物和配伍组合,收敛固涩和止血宁血药也常在该病的治疗中配伍应用。熟地黄、金樱子、泽泻、生地黄-黄柏、山药-山茱萸、菟丝子为导师临床治疗本病常用的具有代表性的药物及药物组合。治疗老年2型糖尿病足的方剂中,清热、活血化瘀、补虚和利水渗湿药为最常用的药物和配伍组合。藤类药物、虫类药物在本病的治疗中得到了广泛的配伍应用。黄芪-当归、金银花、牛膝、土茯苓-薏苡仁、地龙-水蛭、鸡血藤-忍冬藤-海风藤-络石藤是导师常用的具有代表性的药物及药物组合。结论:导师临床治疗老年2型糖尿病总以健脾补气、生津止渴、益肾活血为主;邪实偏盛时则以活血化瘀、利水渗湿、清热解毒、化痰降浊等为治疗大法以祛其邪实,兼顾健脾益肾、补气生津以固其本,并认为顾护脾胃是贯穿老年2型糖尿病治疗始终的重要思想。总结核心方剂,由二黄(黄芪、黄连)、四君子汤、生脉散为基本药物、基本方加减组成,其组成为黄芪、黄连、山药、党参、白术、茯苓、炙甘草、太子参、麦冬、五味子、枸杞子、丹参、翻白草、葛根、荷叶、怀牛膝、当归。根据发病部位不同、相兼病证各异、具体邪正虚实的偏盛偏衰,结合急则治其本、缓则治其标的原则辨证施治。导师的以上方剂在临床中广泛应用并每获良效,其对于以上病证的辨治思路值得在临床中借鉴推广。为获得更多辨治思路精要还需更广泛地收集病例、更深入地挖掘其处方用药规律并进一步整理其临证经验,以在临床中进一步推广应用。
[Abstract]:Objective: To explore the rule of prescription of Professor Cui Dezhi in the treatment of elderly patients with type 2 diabetes and its vascular complications, and summarize the syndrome differentiation, clinical diagnosis and treatment for diabetes and its vascular complications and provide new ideas and methods. Methods: the elderly patients with type 2 diabetes and four common complications of diabetes, cerebrovascular disease, diabetes and heart disease, diabetic nephropathy and diabetic foot as the starting point, traditional Chinese medicine compound to a tutor as the research object, collected a total of 394 prescriptions (prescription combined with the above four kinds of vascular complications were 182, 106, 68, 38), using frequency analysis and Association analysis method of data mining, from the core drugs the law of prescription drugs, drug and drug group to explore. Results: the prescription treatment of elderly patients with type 2 diabetes mellitus and four vascular complications, drugs used most frequently for the tonic The medicine, followed by antipyretic, blood stasis and dampness medicine. From the specific drug efficacy, tonifying qi and activating blood circulation analgesia most. Qihm was most commonly used Zhigancao, astragalus, Atractylodes, Codonopsis, Radix Pseudostellariae, yam, hematonic for angelica, Radix Paeoniae Alba, yin tonic for Ophiopogon japonicus, Chinese wolfberry son, Chinese medicine commonly used eucommia, Cistanche. Prescription with cerebrovascular disease in elderly patients with type 2 diabetes, tonic, blood stasis, heat clearing drugs, Pinggan Xifeng drugs, and tutor in the treatment of elderly patients with diabetes mellitus cerebrovascular disease is the most commonly used five kinds of drugs and combinations of drugs. Drug digestion. Diaphoretic, sedative, diarrhea medicine for the treatment of this disease is often combined with the product. Tianma, kudzu root, Chuanxiong - earthworm, Astragalus - Angelica, pinellia Atractylodes - Tianma, Astragalus - Angelica for Radix Paeoniae Rubra - earthworm mentor commonly used representative drugs and combinations of drugs. The treatment of elderly type 2 diabetes with heart disease The prescription, tonic, heat, blood stasis, Qi and phlegm drugs and combinations of drugs most commonly used, often accompanied by digestion and Yangxinanshen pills. Licorice, salvia, Trichosanthes, 37, peach - safflower, Suanzaoren - arborvitae seed, Radix Ophiopogonis Schisandra - - heterophylla, Astragalus - Angelica dangshen. Licorice - Rehmannia - Radix Astragali, Rhizoma Coptidis and Zhuru - lotus leaf - commonly used as a mentor of Zhishi representative drugs and drug combinations. Prescription for treating elderly type 2 diabetic nephropathy, tonic, heat, blood stasis and dampness is the most commonly used drugs and drug combinations, astringent and hemostatic Ning the blood is used in the treatment of the disease. In the combined application of Shudihuang, Rosa, Alisma, Rehmannia - phellodendron, yam - dogwood, dodder, this disease commonly used representative drugs and combinations of drugs for clinical treatment. Mentor Qingre prescription in treatment of elderly type 2 diabetic foot, and blood stasis Tonic, and dampness medicine is the most commonly used drugs and combinations of drugs. The vine, the insect drugs are compatible is widely used in the treatment of this disease. Huang Qi - Angelica, honeysuckle, radix, tuckahoe - coix seed, earthworm and leech, Caulis Spatholobi Caulis Lonicerae haifengteng - - - Caulis trachelospermi commonly used is the mentor of representative drugs and combinations of drugs. Conclusion: the clinical instructor for elderly patients with type 2 diabetes with Spleen Qi, thirst, tonifying kidney and promoting blood circulation; evil flower is partial blood circulation, diuresis, detoxification, resolving phlegm and treatment method to remove the etc. evil, both spleen and kidney, nourishing fluid to the solid, and that the nursing care of the spleen and stomach is through the treatment of elderly patients with type 2 diabetes. The important thought always summed up the core prescription by Erhuang (Huang Qi, Coptis chinensis), four Sijunzi Decoction, Shengmai Powder as basic drugs, basic decoction, which is composed of Huang Qi yellow. Even, yam, Radix Codonopsis, Atractylodes, Poria, Radix Glycyrrhizae, Radix Pseudostellariae, ophiopogon root, Schisandra, medlar, radix salviae miltiorrhizae, radix puerariae, Potentilla discolor, lotus leaf, Achyranthes root, angelica. According to the incidence of different parts and different diseases, the evil is the actual piansheng partial failure, combined with the urgent then treat this. Slow is the principle for the mark of syndrome differentiation. The above prescription tutor used widely in clinical practice and received good effect, for the differentiation and treatment of diseases above is worthy of promotion in clinical practice. In order to obtain more dialectical thinking essentials should be more extensive collection of cases, dig deeper and further the law of prescription drugs finishing the clinical experience, to further clinical application.

【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R249;R259

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