肝经失调在内伤头痛发病中的作用—附488例内伤头痛病机证素流行病学调查研究

发布时间：2018-04-24 00:23

本文选题：临床流行病学调查研究 + 肝　；参考：《南京中医药大学》2016年硕士论文

【摘要】：目的：临床工作中内伤头痛病因繁多,病机复杂,证候多端,其辨证诊断过程存在着许多不确定因素。中医文化源远流长,传统中医理论对内伤头痛的病因病机的探讨由来已久,虽众说纷纭,但大多从肝立论。本研究承接之前学术结果,调查统计内伤头痛九大病机证素的分布规律,找出病机证素相关因素,探寻肝经病机证素在内伤头痛发病中的作用,为从肝论治内伤头痛提供循证医学证据。方法：总结回顾古今医家对内伤头痛和肝关系的阐释,挖掘肝经病机证素与内伤头痛发病关系密切之理论依据。利用《内伤头痛病机证素调查问卷》收集患者临床资料,利用《内伤头痛病机证素诊断量表》进行辨证诊断,利用SPSS19.0数据库进行数据分析处理,从流行病学的角度证明肝经病机证素在内伤头痛发病中的主要地位,并进一步探究与这些病机证素有关系的影响因素。结果：(1)肝经病机证素分布规律：从分布频数上看,肝阳、肝火的出现频率明显高于其他病机证素；血虚居第三位,是虚证中出现频率最高的病机证素。(2)肝阳、肝火、气郁三者既可独立导致内伤头痛,又常相互兼夹为复合病机导致内伤头痛的发生。内伤头痛发病中,肝阳、肝火、气郁可以单独或组合引起相应证候,也常常与其他病机证素兼夹引起的内伤头痛,形成复合病机证候。(3)肝经病机证素影响内伤头痛指数：经非参数检验得出,肝阳、肝火病机证素对头痛评分有显著影响,肝阳、肝火病机证素者的头痛评分明显高于非肝阳、非肝火者；寒凝和痰浊病机证素对内伤头痛的程度评分也有影响。(4)肝经病机证素影响内伤头痛病程：经非参数检验得出,肝阳、肝火、气郁、血虚、阴虚病机证素对病程数有影响,肝经病机证素患者病程数明显长于非肝经病机证素的患者;血虚和阴虚病机证素患者病程数也较长。(5)病机证素与年龄的相关性：肝火、气郁、血瘀、阴虚病机证素在年龄构成上存在差异。在肝火、瘀血、阴虚病机证素中,所占比例最高的都是老年组;在气郁病机证素中,所占比例最大的是青年组。(6)病机证素与性别的相关性：肝阳、肝火、气郁、寒凝、气虚病机证素在性别构成上存在差异,其中肝阳、肝火、寒凝病机证素中,女性所占比例大于男性；在气虚病机证素中,男性阳性者所占比例大于女性。(7)病机证素与影响因素的相关性：肝阳病机证素的影响因素为急躁易怒、心烦；肝火病机证素的影响因素为急躁易怒、心烦、抑郁、失眠；气郁病机证素的相关因素为月经、急躁易怒、抑郁；寒凝病机证素的影响因素为吹风受凉、抑郁；痰浊病机证素的影响因素为阴雨天气；气虚病机证素的影响因素为劳累、阴雨天气；血虚病机证素的影响因素为月经、抑郁、劳累：阴虚病机证素的影响因素为劳累;本研究暂未发现与瘀血病机证素相关的影响因素。结论：内伤头痛核心病机证素为肝阳、肝火,肝经病机证素是内伤头痛的主要病机证素。肝经病机证素既可单独致病,又会相互兼夹为复合病机证候,甚至与其他病机证素相互兼夹,形成复杂的病机证候。肝阳、肝火病机证素者头痛程度一般较重。肝经病机证素和虚证病机证素患者病程较长。在各病机证素构成中,与年龄有关的是肝火、血瘀、阴虚、气郁。肝火、阴虚、血瘀中老年人最多,气郁中青年人最多；与性别有关的是肝阳、肝火、气郁、寒凝、气虚,其中肝阳、肝火、气郁、寒凝中,女性比例大于男性,在气虚病机证素中,男性比例大于女性。肝经病机证素最常见的影响因素为急躁易怒。
[Abstract]:Objective: in clinical work, the causes of internal injuries and headaches are various, the pathogenesis is complicated and the syndrome is multiterminal. There are many uncertain factors in the diagnosis process of syndrome differentiation. The traditional Chinese medicine culture has a long history, and the traditional Chinese medicine theory has a long history on the etiology and pathogenesis of internal injury headache, although there are many opinions on the liver, but most of them are from the liver. In order to find out the factors related to the pathogenesis of the disease, find the factors related to the pathogenesis of the disease, find the role of the liver meridian syndrome in the internal injury and headache, and provide evidence-based medical evidence for the treatment of the headache and headache from the liver. Methods: To summarize and review the interpretation of the internal injuries and the relationship between the headache and the liver, and to dig out the pathogenesis of the liver disease and the internal injury. The theoretical basis of the headache is closely related. Using the questionnaire on the pathogenesis of internal injury and headache, the clinical data of the patients were collected, and the diagnosis was made by using the SPSS19.0 database. Status, and further explore the factors affecting the pathogenesis of these diseases. Results: (1) the distribution regularity of the liver meridian syndrome: from the frequency of distribution, the frequency of liver Yang and liver fire is obviously higher than that of other diseases; the blood deficiency is third, which is the most frequent occurrence rate of deficiency syndrome. (2) liver Yang, liver fire and qi depression are both three It can lead to internal injuries and headache independently, and often combined with each other to cause internal injury headache. In the onset of internal injury headache, liver Yang, liver fire, qi depression can cause the corresponding syndrome alone or combined with other diseases, and often with other diseases and syndromes caused by internal injury and headache, forming complex syndromes. (3) the liver meridian syndrome factor affects the internal injury headache index. Through non parameter test, it was found that liver Yang and liver fire syndrome factor had significant influence on the headache score, and the headache score of liver Yang and liver fire disease machine syndrome was significantly higher than that of non liver Yang, non liver fire person; cold coagulation and phlegm disease syndrome factor also had influence on the degree of internal injury headache. (4) liver meridian syndrome factor influenced the course of internal injury and headache: non parameter examination. It is found that the liver Yang, liver fire, qi depression, blood deficiency and yin deficiency syndrome factors have an influence on the course number, the course number of the patients with liver meridian syndrome is longer than that of the non hepatic meridian syndrome, and the course number of the patients with Yin deficiency and yin deficiency is longer. (5) the phase correlation of the disease factor and age: liver fire, qi depression, blood stasis and yin deficiency syndrome element in age composition Among the liver fire, blood stasis and yin deficiency syndrome, the highest proportion is the elderly group; in the qi depression machine syndrome, the largest proportion is the youth group. (6) the correlation between the pathogenesis factor and sex: Liver Yang, liver fire, qi depression, cold coagulation and Qi deficiency syndrome factors are different in sex composition, in which liver Yang, liver fire, cold coagulating machine Among the syndromes, the proportion of women is greater than that of men; the proportion of male positive in Qi deficiency syndrome is greater than that of women. (7) the correlation between pathogenesis and influencing factors: the factors affecting the pathogenesis of liver Yang disease are irritability, irritability, irritability, irritability, annoyance, depression, insomnia; Qi stagnation syndrome. The factors related to the hormone are menstruation, irritability, and depression; the factors affecting the syndrome factor of cold coagulation disease are the cooling of the wind and the depression; the factors affecting the pathogenesis of phlegm disease are cloudy and rainy weather; the factors affecting the Qi deficiency syndrome factor are tired, cloudy and rainy, and the factors affecting the pathogenesis of blood deficiency disease are menstruation, depression and tired: Yin deficiency pathogenesis syndrome element The influence factor is the influence factors. This study has not found the influencing factors related to the blood stasis syndrome. Conclusion: the main factors of internal injury and headache are liver Yang, liver fire, and liver meridian syndrome element is the main pathogenesis of internal injury headache. The degree of headache in liver Yang and liver fire disease machine is generally heavy. The patients with liver meridian syndrome and deficiency syndrome have a longer course of disease. In the constitution of the syndrome factors of each disease, the age related is liver fire, blood stasis, yin deficiency, qi depression, liver fire, yin deficiency, blood stasis, the most elderly people, the most young people in Qi Depression; Sex related to the liver Yang, liver fire, qi depression, cold coagulation, Qi deficiency, among which liver Yang, liver fire, qi depression, cold coagulation, the proportion of women more than men, in the Qi deficiency disease factor, the male proportion is greater than the female. The most common factor of the liver meridian pathogenesis is irritable and irritable.

【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】：2016
【分类号】：R277.7

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