基于六经病欲解时理论运用《伤寒论》经方治疗失眠症的探索性研究

发布时间：2018-05-20 05:21

本文选题：失眠 + 伤寒论　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:基于六经病欲解时理论,运用经方对失眠患者辨证治疗,观察其临床效果;从而为失眠的中医临床辨治开拓新思路提供参考依据,初步探讨六经病经方辨治思路的实际价值,从而为失眠症的中医临床辨治开拓新思路提供参考依据。方法:本研究采用非对照临床观察性研究,根据纳入和排除标准,纳入就诊于2016年1月至2017年1月广东省中医院内科门诊的失眠患者61例,运用六经病欲解时辨证常规使用经方进行干预,观察治疗前后PSQI量表积分变化情况,并按《中药新药临床研究指导原则》评定其临床疗效。所有数据应用SPSS17.0统计软件进行统计分析。计量数据采用(均数士标准差)表示,符合正态性数据使用配对t检验,不符合正态分布的数据采用配对资料的化Wilcoxon符号秩和检验。确定P0.05为有显著性差异,P0.01为有非常显著性差异。根据检验结果评价六经病欲解时理论运用经方治疗失眠患者的临床疗效。结果:从2016年1月至2017年1月,共纳入研究病例79例,脱落18例,最后完成疗效观察纳入数据分析为61例。根据六经病欲解时辨证理论初诊诊断为少阳病患者5例,太阳病患者1例,阳明病患者2例,太阴病患者3例,少阴病患者5例,厥阴病患者28例,多经病患者17例。根据治疗前PSQI量表填写结果判断病情的轻重,共收集轻度患者18例,中度患者34例,重度患者9例。1.临床疗效:治疗4周结束后痊愈21例,显效15例,有效22例,无效3例,总有效率为95.1%。其中少阳病患者痊愈1例,显效2例,有效2例;太阳病患者痊愈1例;阳明病患者有效1例,无效1例;太阴病患者显效2例,有效1例;少阴病患者痊愈1例,显效2例,有效2例;厥阴病患者痊愈11例,显效7例,有效9例,无效1例;多经病患者痊愈6例,显效2例,有效8例,无效1例。其中轻度患者临床痊愈11例,显效1例,有效5例,无效1例,总有效率为94.4%;中度患者临床痊愈10例,显效9例,有效13例,无效2例,总有效率为94.1%;重度患者临床治愈0例,显效5例,有效4例,无效0例,总有效率为100%。2.P5Q1评分:61例患者治疗前总分(13.38±3.62),治疗后(8.79±3.71),治疗前后PSQI评分有显著性差别。3.PSQI主要睡眠指标的变化:治疗前后睡眠质量指标:(2.43±0.56),(1.59±0.78),P0.001,提示治疗前后差异具有统计学意义;治疗前后入睡时间指标:(2.00±1.08),(1.34±0.96),P0.001,提示治疗前后差异具有统计学意义;治疗前后睡眠时间指标:(2.44±0.74),(1.57±0.87),P0.001,提示治疗前后差异具有统计学意义;治疗前后睡眠效率指标:(2.21±1.05),(1.41±1.12),P0.001,提示治疗前后差异具有统计学意义;治疗前后睡眠障碍指标:(1.87±0.53),(1.33±0.57),P0.001,提示治疗前后差异具有统计学意义;治疗前后睡眠障碍指标:(1.87±0.53),(1.33±0.57),P0.000,提示治疗前后差异具有统计学意义;治疗前后催眠药物的使用指标:(0.66±1.15),(0.34±0.81),P0.005,提示治疗前后差异具有统计学意义;治疗前、后日间功能指标:(1.72±1.10),(1.13±0.96),P0.001,提示治疗前后差异具有统计学意义。结论:1.初步提示基于六经病欲解时理论的经方治疗对于轻、中、重度失眠患者均具有良好的疗效。2.六经病欲解时辨证理论对于失眠患者的睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、减少催眠药物的使用、日间功能均具有一定的作用。3.基于六经病欲解时辨证理论,临床应用《伤寒论》经方,治疗失眠病证是可行的。六经病欲解时辨证论治是当今辨证论治类型特别是六经辨证的一种补充。
[Abstract]:Objective: Based on the theory of six meridian disease, the clinical effect of syndrome differentiation of insomnia patients was observed and the clinical effect was observed, so as to provide reference for the clinical diagnosis and treatment of insomnia, and to explore the practical value of the thought of the treatment of six meridian diseases, so as to provide a reference for the clinical diagnosis and treatment of insomnia. Methods: in this study, 61 cases of insomnia patients in the Department of internal medicine of Guangdong Province Traditional Chinese Medical Hospital from January 2016 to January 2017 were treated with non controlled clinical observational studies and 61 cases of insomnia patients in the Guangdong Province Traditional Chinese Medical Hospital from January 2016 to January 2017. Clinical study guiding principle > evaluation of its clinical efficacy. All data are statistically analyzed with SPSS17.0 statistical software. The measurement data is represented by the standard deviation of the number of men, which conforms to normal data using paired t test, which does not conform to the normal distribution of data using the paired data of the Wilcoxon symbol rank sum test. The determination of P0.05 is significant. The difference, P0.01 has a very significant difference. According to the test results, the clinical efficacy of the theory used in the treatment of insomnia patients was evaluated. Results: from January 2016 to January 2017, 79 cases were included, 18 cases were dropped, and 61 cases were analyzed. The diagnosis was 5 cases of shaoyang disease, 1 cases of sun disease, 2 cases of Yangming disease, 3 cases of Taiyin disease, 5 cases of yin disease, 28 cases of yin disease, 28 cases of syncope, 17 cases of multiple diseases. According to the results of the PSQI scale before treatment, we collected 18 cases of mild patients, 34 moderate patients, and 9 cases of severe patients with.1.: treat 4 clinical efficacy: treat 4 with treatment: treatment 4 treatment effect: treat 4 treatment: treat 4 clinical curative effect: treat 4 treatment: treat 4 Effect: treat 4 clinical curative effect: treat 4 After the end of the week, 21 cases were cured, 15 cases were effective, 22 cases were effective and 3 cases were invalid. The total effective rate was 95.1%.. The total effective rate was 1 cases, 2 cases were markedly effective, 2 cases were effective, 1 cases were cured, 1 cases of Yang Ming disease were effective and 1 cases were invalid. 11 cases were cured, 7 cases were effective, 9 cases were effective, 1 cases were invalid, 6 cases were cured, 2 cases were markedly effective, 8 cases were effective, 1 cases were invalid, of which the mild patients were clinically cured, 1 cases, effective 5, invalid 1 cases, total effective rate was 94.4%; the moderate patients were clinically cured, effective cases, effective cases, invalid cases 0 cases were cured, 5 cases were effective, 4 cases were effective and 0 cases were ineffective. The total effective rate was 100%.2.P5Q1 score: the total score of 61 patients before treatment (13.38 + 3.62) and after treatment (8.79 + 3.71). The changes of.3.PSQI main sleep indexes were significantly different before and after treatment: the quality index of sleep and sleep before and after treatment: (2.43 + 0.56), (1.59 + 0.78), P0.001, suggesting the difference before and after treatment. The difference was statistically significant; the index of sleep time before and after treatment: (2 + 1.08), (1.34 + 0.96), P0.001, indicated that the difference between before and after treatment was statistically significant; the sleep time index before and after treatment: (2.44 + 0.74), (1.57 + 0.87), P0.001, indicating the difference between before and after treatment; (2.21 + 1.05), (2.21 + 1.05), (1.41 + 1.1) before and after treatment. 2), P0.001, the difference was statistically significant before and after treatment, and the index of sleep disorders before and after treatment: (1.87 + 0.53), (1.33 + 0.57), P0.001, indicating that the difference between before and after treatment was statistically significant; the index of sleep disorders before and after treatment: (1.87 + 0.53), (1.33 + 0.57), P0.000, suggesting that the difference between before and after treatment was statistically significant; and the hypnotic before and after treatment. The index of use: (0.66 + 1.15), (0.34 + 0.81), P0.005, indicated that the difference between before and after treatment was statistically significant; before and after treatment, the index of interdaily function: (1.72 + 1.10), (1.13 + 0.96), P0.001, suggested that the difference between before and after treatment was statistically significant. Conclusion: 1. preliminarily suggest that the meridian therapy based on the theory of six meridian disease is light, medium, and severe. The sleeping patients have good effect on the.2. six meridian disease. The theory of syndrome differentiation for the sleep quality, time of sleep, sleep time, sleep time, sleep efficiency, sleep disturbance, the use of hypnotic drugs, the function of daytime all have a certain effect on.3. based on the theory of syndrome differentiation of six meridian diseases, clinical application < typhoid > meridian, insomnia for insomnia. It is feasible to diagnose the disease. Differentiation of symptoms and signs is the supplement of syndrome differentiation and treatment.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R256.23

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