严光俊教授治疗功能性便秘的临床经验总结和数据研究

发布时间：2018-06-17 07:42

本文选题：功能性便秘 + 通降　；参考：《湖北中医药大学》2016年硕士论文

【摘要】：目的运用“中医经验采集/数据挖掘系统软件”对严光俊教授诊治功能性便秘的临床病例资料进行数据挖掘,分析并总结其辨治功能性便秘的用药经验,探讨其“治肠通降六法”的临床运用规律,从而推动和指导功能性便秘的诊治。方法收集并整理严光俊教授2014年3月至2015年10月诊治功能性便秘的病例资料,经纳入和排除标准的筛选,对符合研究标准的198位患者进行疗效评估和随访,将治疗有效的189位患者的病例资料进行统一规范化处理,并将病例信息录入至经验采集系统,制定功能性便秘的专病模板,建立临床资料数据库,采用数据挖掘获得一般资料频数分布、各治法频次、总体用药频次、各治法用药频次、药物关联分布等。从而分析和探讨严光俊教授运用“治肠通降六法”治疗功能性便秘的用药特色,并总结规律和经验。结果(1)总体分析结果:(1)临床常见症状:大便干结,排出困难(41.27%);大便干结(34.39%);腹中胀满或痛(33.33%);大便不干,有便意而排不出(24.34%);肠鸣矢气(23.81%);乏力(21.69%);用力努挣则汗出短气(18.52%);心悸气短(15.34%);(2)临床常见舌苔:舌淡苔白、舌红少津、舌红苔黄燥、舌红苔腻、舌淡苔白边有齿痕、舌淡苔白腻、舌红苔黄厚;(3)共计脉象7种,脉弱、脉细、脉滑数、脉弦、脉弦细、脉沉迟、脉沉;(4)共录入中药106种,用药2982频次,治疗功能性便秘的常用药物有:紫苏梗、茯苓、陈皮、枳壳、桃仁、柏子仁、火麻仁、郁李仁、白术、党参、厚朴、大腹皮、木香、黄芪、香附、泽泻、山药、白扁豆、苍术、黄连、柴胡、玄参、麦冬、玉竹。以理气药、泻下药、健脾祛湿药、滋阴药多见。(2)“治肠通降六法”各治法频次:益气通降法49次(25.93%)润肠通降法46次(24.34%)清化通降法30次(15.87%)理气通降法27次(14.29%)温阳通降法20次(10.58%)清热通降法17次(8.99%),以益气通降、润肠通降法多见。结论(1)严光俊教授治疗功能性便秘用药以理气药、泻下药、健脾祛湿药、滋阴药多见,并施以“治肠通降六法”进行治疗,疗效肯定;(2)通过数据挖掘各治法用药频数以及药物关联规则挖掘分析,可得出各治法核心组方用药,用药特色以及配伍规律;(3)严光俊教授认为,便秘病因病机复杂,但不离各脏腑气血阴阳的调节作用,并在治疗上提出“治肠通降六法”,抓“通降”,以脾胃“通降理论”为根,契合“六腑以通为用,以降为顺”,不忘整体调节,辨证论治,通降为线,寓通于补,通补合治,将通降之法应用于便秘的诊治,以恢复大肠传导功能。(4)借助中医传承辅助软件进行数据挖掘临证经验科学有效,有助于各医者中医理论的丰富和经验传承,使之更为科学有效的指导疾病的治疗。
[Abstract]:Objective to analyze and summarize the clinical experience of Professor Yan Guangjun in the diagnosis and treatment of functional constipation by using the software of experience acquisition / data Mining system of TCM (TCM experience acquisition / data Mining system), and to analyze and summarize the clinical data of Professor Yan Guangjun in the diagnosis and treatment of functional constipation. To explore the clinical application rule of "treating Changtong and descending six methods", thus promoting and guiding the diagnosis and treatment of functional constipation. Methods the data of Professor Yan Guangjun's diagnosis and treatment of functional constipation from March 2014 to October 2015 were collected, and 198 patients who met the criteria were evaluated and followed up. The data of 189 patients with effective treatment were standardized, and the case information was input into the experience collection system, and the special disease template of functional constipation was established, and the clinical data database was established. The data mining was used to obtain the frequency distribution of general data, the frequency of each treatment method, the total frequency of drug use, the frequency of each treatment method, the distribution of drug association, etc. This paper analyzes and discusses the characteristics of the treatment of functional constipation by Professor Yan Guangjun, and sums up the law and experience in the treatment of functional constipation. Results 1) the results of general analysis were as follows: common clinical symptoms: dry stool knot, difficult to discharge 41.27%, stool dry knot 34.39%; abdominal distention or pain 33.33%; stool not dry, no dry stool, dry stool and dry stool. If you have a stool intention, you will not be able to get rid of it. (2) the common clinical tongue coating is: pale tongue coating, white tongue coating, little red tongue, yellow tongue coating, greasy tongue coating, white tongue coating, tooth mark on white side of tongue coating, white tongue coating, and white and greasy tongue coating. A total of 7 kinds of pulse were recorded in red tongue (Huang Hou), including weak pulse, fine pulse, pulse slip number, fine pulse string, late pulse sinking, pulse sinking and pulse sinking. 2982 times were used to treat functional constipation: Perilla perilla, Poria cocos, Chen Pei, and so on, the main drugs used in the treatment of functional constipation were: Perilla pedicle, Poria cocos, Chen Pei. Fructus Aurantii, peach kernel, cypress kernel, fire hemp kernel, tulip kernel, Atractylodes macrocephala, Codonopsis, Magnolia officinalis, Amur, Astragalus, Alismatis, yam, White lentil, Atractylodes, Coptis chinensis, Radix Bupleurum, Radix Ophiopogonis, Radix Ophiopogonis. Medicine for regulating qi, medicine for diarrhea, medicine for invigorating spleen and dispelling dampness, The frequency of each method is 49 times (25. 93) moisturizing the intestines and lowering the energy (46 times) clearing up and lowering 30 times (15. 87) regulating qi and lowering 27 times (14. 29) warming yang, opening and lowering 20 times (10. 58) clearing heat and lowering heat 17 times. The method of Runchang Tong descending is more common. Conclusion (1) Professor Yan Guangjun used to treat functional constipation by regulating qi medicine, catharsis medicine, invigorating spleen and removing dampness medicine, nourishing yin medicine. (2) through data mining and analysis of the frequency of drug use and drug association rules of each treatment method, we can draw the conclusion that the core prescriptions, characteristics and compatibility rules of each treatment method can be obtained. Professor Yan Guangjun believes that the etiology and pathogenesis of constipation are complex. However, the regulating effect of Qi and blood yin and yang in various viscera organs is not separated, and in the treatment, it is put forward that "treating the intestines and regulating and descending the six methods", grasping "opening up and descending", taking the theory of spleen and stomach "opening down and descending" as the root, consonant with "the six fu-organs are used for the purpose of using", and not forgetting the whole regulation. Differentiation of symptoms and treatment, Tongjiang as a line, linking to complement, Tongbu combined treatment, will be used in the diagnosis and treatment of constipation, in order to restore the function of large intestine conduction. 4) with the help of traditional Chinese medicine inheritance assistant software for data mining clinical experience scientific and effective, It is helpful to enrich and inherit the TCM theory and make it more scientific and effective to guide the treatment of diseases.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R249;R256.35

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