基于焦树德教授治疗类风湿关节炎辨证分型学术经验的用药规律探讨

发布时间：2018-05-12 16:00

本文选题：类风湿关节炎 + 新方　；参考：《北京中医药大学》2017年硕士论文

【摘要】：目的:本研究以焦树德教授治疗类风湿关节炎辨证分型为基础,利用中医传承辅助平台进行数据挖掘,主要探讨中医药治疗类风湿关节炎各证型用药规律。为临床医师运用中药治疗类风湿关节炎提供新思路,为患者解除病痛。材料与方法:研究选取2014年4月至2016年4月中日友好医院中医风湿病科住院接受治疗的类风湿关节炎患者,采用回顾性调查方法,将符合纳入条件的病例,逐一记录患者的姓名、年龄、性别、关节肿痛情况、伴随症状、喜寒热情况、大小便、舌色、舌苔、脉象,辨证分型,口服中药具体用药。得出研究内容包括症状频次统计、药物频次统计、药物的四气五味和归经统计、药对分析、新方分析等。结果:(1)238例类风湿关节炎患者的中医证型分布频率如下:肾虚寒盛证占45%(107/238),肾虚标热轻证占24%(58/238),肾虚标热重证占4%(10/238),湿热伤肾证占27%(63/238)。(2)通过频率分析发现,类风湿关节炎患者症状整体以关节肿痛为主,症状出现频次区别在于,肾虚寒盛证患者晨僵、怕冷明显,肾虚标热证患者可见关节局部皮温升高,湿热伤肾证患者除关节局部皮温升高,还可见口干明显热象症状。治疗上,肾虚寒盛证用温性药较其他三证多,而寒性药使用为四证中最少,所用药物包含所有药物中仅有的两味热性药,湿热伤肾证及肾虚标热轻证使用寒性药较多,肾虚标热重证使用凉性药为四证中最多。治疗类风湿性关节炎中药总体多味苦、辛、甘,苦味药四证应用差别不大,肾虚寒盛证用辛味药最多,肾虚标热重证用辛味药最少。药物归经主要归肝、肾经(3)肾虚寒盛证药对:续断、桑寄生;续断、桑寄生、炙元胡;羌活、独活。新方:千年健、宧莶草、桂枝、赤芍、山药、竹茹;续断、骨碎补、羌活、炙元胡、芦根、浙贝母。肾虚标热轻证药对:续断、桑寄生、知母;桑寄生、片姜黄。新方:骨碎补、羌活、独活、怀牛膝、杜仲、黄柏;千年健、宧莶草、竹茹、桑枝、忍冬藤、山甲珠。湿热伤肾证药对:续断、补骨脂。新方:猪苓、炒白术、木瓜、桑枝、炙龟板、炙鳖甲;川牛膝、怀牛膝、海风藤、络石藤、知母、黄柏。结论:1、类风湿关节炎证型中以肾虚寒盛证最多见,符合焦老提出的(?)痹病因病机:"风寒湿三气杂至合而为痹",特点为肝肾亏虚为本。2、通过用药频次分析,发现四证均以温性药为主,药物归经主要归肝、肾经,四证中出现频次较高的药物均包含桑寄生、续断,除肾虚标热重证均包含桂枝,符合焦树德教授治疗旭痹善温补、从肝肾论治。3、四证用药频次较高的药物均包含炙元胡,说明活血理气止痛贯穿整个临床治疗。4、附子、淫羊藿出现频次低,虽临床以肾虚寒盛证最多见,但患者多处于疾病初期,寒邪为病因,但未及深入,故大热药物选用较少。5、分证论治类风湿关节炎,每个证型组合出对应新药对与新方,为临床医师提供诊疗新思路。
[Abstract]:Objective: this study is based on professor Jiaoshu de treatment of rheumatoid arthritis syndrome differentiation as the basis, using the Chinese medicine inheritance auxiliary platform for data mining, mainly to explore the Chinese medicine treatment of rheumatoid arthritis drug patterns. To provide a new way for clinicians to treat rheumatoid arthritis with traditional Chinese medicine, and to relieve the pain of the patients. Materials and methods: patients with rheumatoid arthritis who were hospitalized in rheumatology department of traditional Chinese medicine in China-Japan Friendship Hospital from April 2014 to April 2016 were investigated retrospectively. The patient's name, age, sex, joint swelling and pain, accompanying symptoms, cold and fever, defecation, tongue color, tongue coating, pulse, syndrome differentiation, oral Chinese medicine were recorded one by one. The contents of the study include symptom frequency statistics, statistics of four gases and five flavors of drugs, drug pair analysis, new prescription analysis and so on. Results the distribution frequency of TCM syndromes in 238 rheumatoid arthritis patients was as follows: kidney deficiency and cold syndrome accounted for 45 / 107 / 238N, kidney deficiency and heat light syndrome accounted for 24 / 58 / 238N, kidney deficiency / heat weight syndrome accounted for 4 / 10 / 238T / 238N, damp-heat injury syndrome accounted for 2763 / 238n / 2). The main symptoms of rheumatoid arthritis patients are mainly joint swelling and pain. The difference in frequency of symptoms is that the patients with kidney deficiency and cold syndrome have morning stiffness and obvious fear of cold, and the patients with kidney deficiency standard heat syndrome can see the increase of joint local skin temperature. In the patients with damp-heat injury, besides the elevation of the local skin temperature of the joint, they can also see the obvious symptoms of the dry mouth. In treatment, the use of warm drugs was more than that of the other three syndrome, while the use of cold drugs was the least in the four syndromes. The drugs used included only two kinds of hot drugs of all the drugs, the syndrome of damp-heat injury of the kidney and the light syndrome of kidney deficiency and heat deficiency, and the cold drugs were used more frequently. Kidney deficiency and heat-weight syndrome using cold medicine is the most of the four syndrome. The treatment of rheumatoid arthritis Chinese medicine in general multi-taste bitter, Xin, Gan, bitter medicine application difference is not significant, kidney deficiency cold Sheng syndrome with the most Xin Wei medicine, kidney deficiency standard heat weight syndrome with Xin Wei medicine is the least. Drug return to the liver, kidney meridian 3) kidney deficiency cold Sheng syndrome: Dipsacus, mulberry parasitism, Dipsacus, sunburn yuan Hu; Notopterygium, unique. New side: Millennium Jian, Siegesbeckiae, Cinnamomum, Radix Paeoniae Alba, Chinese yam, Bamboo Ru; Dipsacus, Rhizoma Corydalis, Notopterygium, Roots, Roots, Fritillaria thunbergii. Kidney deficiency standard heat light medicine: Dipsacus, mulberry parasitism, Anemarrhena; Mulberry parasitism, turmeric tablets. New side: shredded, Notopterygium, Rhizoma Notopterygii, Rhizoma Corydalis, Eucommia ulmoides, Phellodendron chinensis; Millennium Jian, Xiesbeckiao, Bamboo, Mulberry Branch, Lonicera Lonicera Rattan, Prunus Damp-heat injury of kidney medicine: Dipsacus, psoralen. New side: Polyporus, stir-fried Atractylodes macrocephala, papaya, mulberry branches, grilled tortoise, fried turtle beetle; Sichuan Achyranthes hyacinth, Achyranthes bidentata, Acanthophora asparagus, Anemarrhena chinensis, Huang Pai. Conclusion 1, the most common type of rheumatoid arthritis is kidney deficiency and cold, which is in accordance with Jiao Lao's proposal. The etiology and pathogenesis of arthralgia: "wind, cold, dampness, three qi are combined to be arthralgia", which is characterized by deficiency of liver and kidney. By analyzing the frequency of drug use, it is found that the four syndromes are mainly warm drugs, and the drugs are mainly attributed to liver and kidney meridian. The drugs with higher frequency in the four syndromes all contain mulberry parasitism, dipsacus, except kidney deficiency, heat and weight syndrome, all contain cinnamon branches, which accord with Professor Jiaoshu de to treat Xu Bi and good temperature tonic, from liver and kidney to treat .3. the drugs with higher frequency of use of the four syndromes all contain scorched yuan Hu. It shows that activating blood circulation and regulating qi to relieve pain runs through the whole clinical treatment. 4, aconite, Epimedium appear low frequency, although the most common clinical syndrome is kidney deficiency and cold, but most of the patients are in the early stage of the disease, cold evil is the cause, but it is not deep enough. Therefore, less. 5 drugs are used to treat rheumatoid arthritis, and each syndrome type combines the new medicine pair and the new prescription to provide a new way of diagnosis and treatment for clinicians.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R249;R259

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