蒋小敏教授学术思想总结及治疗痛风性关节炎的临床研究

发布时间：2018-06-29 02:59

本文选题：蒋小敏 + 学术思想　；参考：《南京中医药大学》2016年博士论文

【摘要】：目的：总结蒋小敏教授学术思想及临证经验,观察消痛汤治疗急性痛风性关节炎的临床疗效,探讨其可能的机制。方法：理论研究：通过跟随导师临床学习、记录笔记,搜集整理导师相关文献资料、临证笔记及医案,查阅相关文献及著作等方式归纳、总结蒋教授的学术思想,并对蒋小敏教授辨治代谢性疾病的临证经验进行总结,分析其辨治规律。临床研究：按照简单随机、对照、非盲的临床试验原则,入选80例符合西医痛风性关节炎诊断标准及中医辨证符合湿热蕴结证候的病人。将病人分为治疗组和对照组各40例,治疗组每日以消痛汤剂内服治疗,对照组以双氯芬酸钠片75mg/日进行治疗,两组疗程均为2周并对治疗前后关节功能、关节肿痛指数、中医证候积分、炎症指标、血尿酸进行对照分析,并对安全性进行评价,简要分析导师治疗痛风性关节炎的特色,进一步探讨消痛汤治疗痛风性关节炎的相关机制。结果：提出杂病从脾肾论治,强调脾肾气化理论对疾病的影响,在辨治过程中应当注重“三重”,即重脾肾、重气化、重情志,临证中重视诊法,强调气化,用药平和,并系统介绍了导师对临床常见代谢综合证的理论认识及临证经验及遣方用药特色。临床研究：经过对参与试验的80例患者临床结果进行统计学分析后显示试验组治疗后总有效率92.5%,对照组总有效率80%,疗效明显优于对照组,经统计有统计学意义。中医证候疗效：治疗组总有效率92.5%,对照组总有效率77.5%,治疗组疗效明显优于对照组,经统计有统计学意义。治疗后两组患者主要症状比较,关节肿痛指数比较、关节功能比较方面治疗组明显优于对照组,经统计有统计学意义。实验室指标：两组治疗前后炎症指标均较治疗前有明显下降,治疗组疗效明显优于对照组,经统计有统计学意义。结论：湿热蕴结是痛风性关节炎的中医基本病机,应用清热解毒,除湿通络法治疗该病临床确有疗效,其安全性良好,且无明显毒副作用。消痛汤治疗组在改善湿热蕴结型痛风患者症状方面有确切有效,优于西药对照组：在控制疾病活动的各项实验室检测指标WBC、UA、ESR、CRP方面,其疗效明显优于对照组。
[Abstract]:Objective: to summarize Professor Jiang Xiaomin's academic thought and clinical experience, to observe the clinical effect of Xiaotong decoction on acute gouty arthritis and to explore its possible mechanism. Methods: theoretical study: by following the tutor's clinical study, taking notes, collecting and arranging the tutor's related documents, clinical evidence notes and medical records, consulting the relevant documents and works, summarizing the academic thoughts of Professor Jiang. Professor Jiang Xiaomin's experience in differentiation and treatment of metabolic diseases was summarized, and the law of differentiation and treatment was analyzed. Clinical study: according to the principle of simple randomized, controlled and non-blind clinical trial, 80 patients who met the diagnostic criteria of gouty arthritis in western medicine and syndrome differentiation of TCM in accordance with dampness and heat accumulation syndrome were selected. The patients were divided into treatment group (n = 40) and control group (n = 40). The treatment group was treated with Xiaotong decoction daily and the control group was treated with diclofenac sodium tablet 75mg/ day. TCM syndromes integral, inflammation index, blood uric acid were compared and analyzed, the safety was evaluated, the characteristics of tutor treating gouty arthritis were analyzed briefly, and the related mechanism of Xiaotong decoction in treating gouty arthritis was discussed. Results: treating miscellaneous diseases from spleen and kidney, emphasizing the influence of the theory of spleen and kidney gasification on disease, should pay attention to "triple" in the process of differentiation and treatment, that is, heavy spleen and kidney, heavy gasification, heavy emotion, paying attention to the method of diagnosis, emphasizing gasification, and using medicine peacefully in clinical syndrome. The theoretical understanding, clinical experience and medication characteristics of common metabolic syndromes were introduced systematically. Clinical study: after statistical analysis of the clinical results of 80 patients involved in the trial, it was shown that the total effective rate of the test group was 92.5, the total effective rate of the control group was 80, the curative effect was obviously better than that of the control group, and the statistical significance was statistically significant. The curative effect of TCM syndrome: the total effective rate of the treatment group was 92.5 and the total effective rate of the control group was 77.5.The curative effect of the treatment group was obviously better than that of the control group, which was statistically significant. After treatment, the main symptoms of the two groups, the index of joint swelling and pain, and the comparison of joint function were significantly better in the treatment group than in the control group, and there was statistically significant difference between the treatment group and the control group. Laboratory indicators: the two groups before and after treatment of inflammatory indicators were significantly lower than before treatment, the treatment group was significantly better than the control group, statistical significance. Conclusion: the damp-heat accumulation knot is the basic pathogenesis of gouty arthritis. The method of clearing away heat and detoxifying toxin and removing dampness and dredging collaterals is effective in treating this disease with good safety and no obvious side effects. The treatment group was more effective than the western medicine control group in improving the symptoms of the patients with dampness and heat accumulation, and the control group was superior to the control group in the control of disease activity.
【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R259

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