济阴宣阳法治疗水肿病阴阳两型病例系列研究
发布时间：2018-07-29 19:32
【摘要】：背景:经过几千年的发展,中医在治疗水肿病方面有丰富的经验,临床治疗水肿时注重整体观,讲究追本溯源,辨证论治,常从肺、脾、肾、三焦论治。然而,随着社会环境的变化和现代医学技术的进步,水肿病的治疗亦变得复杂起来,水肿久治不愈或反复发作者,不仅有阳虚不能制水的病因,更因为治疗过程中应用利尿剂、激素、温热药等药物耗伤阴津,使其复加有阴虚原因。阴阳互根互用,阳损及阴,阴损及阳,针对阴阳两虚型的水肿,运用济阴宣阳法治疗符合病机,可以为水肿病的中医治疗打开新的思路。目的:针对阴阳两虚型水肿的患者,辨证应用济阴汤和宣阳汤加减作为干预措施,以验证济阴宣阳法治疗阴阳两虚型水肿的有效性和安全性,探索中医济阴宣阳法治疗水肿的新思路和新方法,为进一步的临床随机对照试验提供一定的立题依据。方法:本研究采用前瞻性病例系列研究的方法,根据诊断标准、纳入标准、排除标准,连续招募水肿病阴阳两虚型患者30例。本研究治疗水肿病采用济阴宣阳之法,通过中医辨证,予济阴汤和宣阳汤加减治疗,每日1剂,分早晚2次温服,并分别记录治疗前、治疗2周后,治疗4周后患者体重、水肿变化的记分情况和中医症状采集量表记分情况。在下肢水肿的测量时采用分段测量腿围的方法,使测量误差性相对减小。最终将30例阴阳两虚型水肿患者治疗前、治疗2周后、治疗4周后体重、水肿变化的记分情况以及中医症状采集量表记分情况进行统计学分析,并对其安全性进行评定,以验证济阴宣阳法治疗阴阳两虚型水肿的有效性和安全性。结果:济阴宣阳法在改善水肿病阴阳两虚型患者中医症状方面疗效确切,治疗后2周疗效指数在0～70%(不包括0)的有20例,占纳入病例的66.67%;治疗4周后疗效指数在0～70%(不包括0)的有26例,占纳入病例的86.67%,大于70%的有3例,占纳入患者的10%。各单项中医症状积分除"健忘"症状外,其余单项中医症状积分较治疗前均有改善,其差异具有统计学意义(P0.05)。纳入的30例水肿病阴阳两虚型患者治疗前与治疗后2周、治疗后4周体重、水肿恢复的时间及下肢分段周长的测定较前减轻,其差异有统计学意义(P0.05),提示济阴宣阳法对水肿的改善疗效明显,且未发现明显药物不良反应。结论:济阴宣阳法能够改善水肿病阴阳两虚型患者水肿严重程度,使水肿症状减轻,同时能够改善患者阴阳两虚的症状,提示济阴宣阳之法对治疗阴阳两虚型水肿有明显疗效,可以为中医临床辨证治疗水肿提供新的思路和方法。
[Abstract]:Background: after thousands of years of development, Chinese medicine has rich experience in the treatment of edema, clinical treatment of edema pay attention to the overall view, pay attention to tracing the source, differentiation treatment, often from the lung, spleen, kidney, tri-Jiao treatment. However, with the change of social environment and the progress of modern medical technology, the treatment of edema has become more complicated. Those who have not been cured for a long time or repeatedly have not only the cause of Yang deficiency but also the use of diuretics in the course of treatment. Hormones, warm-heat drugs and other drugs injure Yin-Jin, so that it adds Yin deficiency reasons. According to the edema of yin and yang deficiency type, the treatment of yin and yang deficiency is in line with the pathogenesis, which can open a new way for the traditional Chinese medicine treatment of edema disease. Objective: to investigate the efficacy and safety of Jiyin decoction and Xuanyang decoction in treating edema of yin and yang deficiency type by syndrome differentiation in order to verify the efficacy and safety of Jiyin Xuanyang method in treating edema of yin and yang deficiency type. To explore new ideas and methods of treating edema with traditional Chinese medicine method of Jiyin Xuanyang, and to provide some basis for further randomized controlled trials. Methods: according to diagnostic criteria, inclusion criteria and exclusion criteria, 30 cases of edema with deficiency of both yin and yang were recruited in this study. In this study, the treatment of edema by the method of Jiyin Xuanyang, through TCM syndrome differentiation, Jiyin decoction and Xuanyang decoction reduced treatment, 1 dose per day, divided into morning and evening, 2 times warm, and recorded before treatment, 2 weeks after treatment, 4 weeks after treatment of the patient's weight, The score of edema change and the score of TCM symptom acquisition scale. In the measurement of lower limb edema, the measurement error of leg circumference is relatively reduced by using the method of measuring leg circumference in sections. Finally, 30 cases of edema with deficiency of both yin and yang were statistically analyzed before treatment, 2 weeks after treatment, 4 weeks after treatment, the score of edema changes and the score of TCM symptom collection scale, and the safety of the patients was evaluated. To verify the efficacy and safety of Jiyin Xuanyang method in treating edema with deficiency of both yin and yang. Results: the curative effect of Jiyin Xuanyang method on improving the symptoms of traditional Chinese medicine in patients with deficiency of both yin and yang in edema was definite. The curative effect index of 20 cases was 0 ~ 70% (not including 0) in 2 weeks after treatment. After 4 weeks of treatment, the curative effect index was 0.70% (excluding 0) in 26 cases, accounting for 86.67% of the cases, and more than 70% in 3 cases, accounting for 10% of the patients. In addition to the "amnesia" symptoms, the other single TCM symptom scores were improved compared with before treatment, the difference was statistically significant (P0.05). The weight, recovery time of edema and segmental circumference of lower extremities in 30 patients with edema before and 2 weeks after treatment, 4 weeks after treatment and 4 weeks after treatment were reduced. The difference was statistically significant (P0.05), suggesting that Jiyin Xuanyang method was effective in improving edema, and no obvious adverse drug reactions were found. Conclusion: the method of invigorating yin and promoting yang can improve the severity of edema in patients with deficiency of both yin and yang, alleviate the symptoms of edema, and improve the symptoms of deficiency of both yin and yang, suggesting that the method of Jiyin and Xuanyang has obvious curative effect on edema of type of deficiency of yin and yang. It can provide new ideas and methods for TCM clinical treatment of edema.
【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】：R256.51
[Abstract]:Background: after thousands of years of development, Chinese medicine has rich experience in the treatment of edema, clinical treatment of edema pay attention to the overall view, pay attention to tracing the source, differentiation treatment, often from the lung, spleen, kidney, tri-Jiao treatment. However, with the change of social environment and the progress of modern medical technology, the treatment of edema has become more complicated. Those who have not been cured for a long time or repeatedly have not only the cause of Yang deficiency but also the use of diuretics in the course of treatment. Hormones, warm-heat drugs and other drugs injure Yin-Jin, so that it adds Yin deficiency reasons. According to the edema of yin and yang deficiency type, the treatment of yin and yang deficiency is in line with the pathogenesis, which can open a new way for the traditional Chinese medicine treatment of edema disease. Objective: to investigate the efficacy and safety of Jiyin decoction and Xuanyang decoction in treating edema of yin and yang deficiency type by syndrome differentiation in order to verify the efficacy and safety of Jiyin Xuanyang method in treating edema of yin and yang deficiency type. To explore new ideas and methods of treating edema with traditional Chinese medicine method of Jiyin Xuanyang, and to provide some basis for further randomized controlled trials. Methods: according to diagnostic criteria, inclusion criteria and exclusion criteria, 30 cases of edema with deficiency of both yin and yang were recruited in this study. In this study, the treatment of edema by the method of Jiyin Xuanyang, through TCM syndrome differentiation, Jiyin decoction and Xuanyang decoction reduced treatment, 1 dose per day, divided into morning and evening, 2 times warm, and recorded before treatment, 2 weeks after treatment, 4 weeks after treatment of the patient's weight, The score of edema change and the score of TCM symptom acquisition scale. In the measurement of lower limb edema, the measurement error of leg circumference is relatively reduced by using the method of measuring leg circumference in sections. Finally, 30 cases of edema with deficiency of both yin and yang were statistically analyzed before treatment, 2 weeks after treatment, 4 weeks after treatment, the score of edema changes and the score of TCM symptom collection scale, and the safety of the patients was evaluated. To verify the efficacy and safety of Jiyin Xuanyang method in treating edema with deficiency of both yin and yang. Results: the curative effect of Jiyin Xuanyang method on improving the symptoms of traditional Chinese medicine in patients with deficiency of both yin and yang in edema was definite. The curative effect index of 20 cases was 0 ~ 70% (not including 0) in 2 weeks after treatment. After 4 weeks of treatment, the curative effect index was 0.70% (excluding 0) in 26 cases, accounting for 86.67% of the cases, and more than 70% in 3 cases, accounting for 10% of the patients. In addition to the "amnesia" symptoms, the other single TCM symptom scores were improved compared with before treatment, the difference was statistically significant (P0.05). The weight, recovery time of edema and segmental circumference of lower extremities in 30 patients with edema before and 2 weeks after treatment, 4 weeks after treatment and 4 weeks after treatment were reduced. The difference was statistically significant (P0.05), suggesting that Jiyin Xuanyang method was effective in improving edema, and no obvious adverse drug reactions were found. Conclusion: the method of invigorating yin and promoting yang can improve the severity of edema in patients with deficiency of both yin and yang, alleviate the symptoms of edema, and improve the symptoms of deficiency of both yin and yang, suggesting that the method of Jiyin and Xuanyang has obvious curative effect on edema of type of deficiency of yin and yang. It can provide new ideas and methods for TCM clinical treatment of edema.
【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】：R256.51
【参考文献】
相关期刊论文 前10条
1 王筝;熊云昭;王萱;吴丽敏;陈立祥;王淼;梁丽娟;许庆友;;赵玉庸从肺论治肾性水肿经验[J];中华中医药杂志;2017年03期
2 陈佳静;叶小舟;张Z，
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