基于方证相关理论的苓桂术甘汤治疗过敏性鼻炎的研究

发布时间：2018-09-10 11:54

【摘要】：目的：通过文献整理研究、临床调研和动物实验探讨苓桂术甘汤与过敏性鼻炎的方证相关,并根据正交设计实验探讨苓桂术甘汤治疗过敏性鼻炎的中药剂量配伍的最佳组合。方法：第一部分是文献整理和研究。通过文献检索,探讨过敏性鼻炎的中西医诊治状况及方证相关方面的研究状况,重点分析近5年来苓桂术甘汤组成药物在治疗过敏性鼻炎中的运用情况,为苓桂术甘汤与过敏性鼻炎的方证相关提供理论依据和文献依据。第二部分是临床调查和研究。通过对150例过敏性鼻炎的病人的有关痰饮证的中医证候进行信息采集,探讨过敏性鼻炎与苓桂术甘汤证一痰饮证的相关关系；并用40例病人的疗效观察反证过敏性鼻炎与苓桂术甘汤的方证相关。第三部分是动物实验,分两次实验进行。第一次实验将40只大鼠分成正常组、模型组、苓桂术甘汤组、氯雷他定组,进行过敏性鼻炎的造模,并用对应的药物进行干预,探讨苓桂术甘汤与过敏性鼻炎的治疗效果和方证相关；第二次实验对40只大鼠根据正交设计表头对苓桂术甘汤4个的组成药物的药量分两个层面进行配伍分组干预,探讨苓桂术甘汤治疗过敏性鼻炎药量的最佳组合及药物对疗效的影响情况。结果：①在201卜2015年5年有关研究中医治疗过敏性鼻炎的文献中,得到符合要求的文献378篇,查到的治疗过敏性鼻炎的方剂为776条,总药物为270种,总药物出现频数为6958次,其中苓桂术甘汤四药出现的总频次为786次,约占总频次的11.3%,提示苓桂术甘汤四药在治疗过敏性鼻炎的药物中占有一定的份额。茯苓的用量是6—30克；桂枝的用量是3-20克；白术的用量3-30克,甘草的用量是3-15克。药对出现的频率要比单独药物出现的要高。②150例临床病人中医症状、体征和舌脉的条目经规范化整理后共有26个,其中出现频率大于10%的四诊信息共有24个,频率最高的是流清涕,其次是下鼻甲肿大、舌质淡、鼻塞、鼻流清涕、鼻痒、苔白,7个频数较高的信息的频率均大于80%。全身痰饮证的主要证候如咳嗽、咳痰、头身困重、体倦乏力、脉弦滑、气促等的频率虽然没有鼻部证候的比例大,但比例也超过了30%。40例病人用苓桂术甘汤治疗10天,用药前后的症状评分对比,差异有统计学意义,P0.05,治疗的有效率达到95%。③第一次动物实验,模型组、苓桂术甘汤组和氯雷他定组造模完成时,三组动物的症状评分比正常组明显升高,用药10天后,模型组的症状评分较用药前差异无统计学意义,P0.05,苓桂术甘汤、氯雷他定组动物的症状评分较用药前明显降低,P0.05；肥大细胞和嗜酸细胞计数的比较中,模型组较正常组明显增多,苓桂术甘汤组、氯雷他定组较模型组计数明显减少,P0.05；模型组的IL-2含量要比正常组要低,苓桂术甘汤、氯雷他定组的要比模型组的要高,模型组的IL-4含量要比正常组的要高,苓桂术甘汤、氯雷他定组的要比模型组的要低。④在根据正交设计的试验中,苓桂术甘汤8组动物用药前后的症状评分比较有显著性差异,P0.05；用药前,各组间症状评分比较无统计学差异,P0.05；用药后各组间症状评分比较有统计学差异,P0.05； 8组药物总效能比较中,最好的药物组合是第A组、其次是第G组和H组,其中A组、H组4个药物的配伍比例是4：3：3：2,A组的组合是茯苓20g、桂枝15g、白术15g、炙甘草10g。药物对疗效影响的结果显示：桂枝与白术相互作用、桂枝与茯苓的相互作用、甘草的不同水平对疗效影响显著。结论：苓桂术甘汤与过敏性鼻炎有一定的方证相关关系。过敏性鼻炎可以认为是鼻部的一种痰饮证,苓桂术甘汤治疗过敏性鼻炎有效。对于治疗过敏性鼻炎,苓桂术甘汤药量的最佳配伍为茯苓20g、桂枝15g、白术15g、炙甘草l0g。桂枝与白术相互作用、桂枝与茯苓的相互作用、甘草的不同水平对疗效影响显著。
[Abstract]:Objective: To explore the relationship between Linggui Zhugan Decoction and allergic rhinitis by literature research, clinical investigation and animal experiment, and to explore the best dose combination of Linggui Zhugan Decoction in treating allergic rhinitis by orthogonal design experiment. This paper mainly analyzes the application of Lingguizhugan Decoction in treating allergic rhinitis in the past five years, and provides theoretical basis and literature basis for the correlation between Lingguizhugan Decoction and allergic rhinitis. The second part is clinical investigation and research. The correlation between allergic rhinitis and Linggui Zhugan Decoction was studied by collecting information on the TCM syndrome of allergic rhinitis, and the correlation between allergic rhinitis and Linggui Zhugan Decoction was observed in 40 patients. 40 rats were divided into normal group, model group, Lingguizhugan Decoction group, loratadine group, to model allergic rhinitis, and with the corresponding drug intervention, to explore the Lingguizhugan Decoction and allergic rhinitis treatment effect and syndrome related; the second experiment on 40 rats according to the orthogonal design table four components of Lingguizhugan Decoction The dosage of the drug was divided into two levels, and the best combination of Linggui Zhugan Decoction and the effect of the drug on the curative effect were discussed. There are 776 prescriptions for inflammation, 270 kinds of drugs and 6958 times of occurrence of total drugs. Among them, 786 times of occurrence of Lingguizhugan decoction, accounting for 11.3% of the total frequency, suggest that Lingguizhugan Decoction occupies a certain share in the treatment of allergic rhinitis. The dosage of operation is 3-30 grams, and the dosage of liquorice is 3-15 grams. The frequency of occurrence of drug pairs is higher than that of single drug. 2 There are 26 items of TCM symptoms, signs and tongue veins in 150 clinical patients after standardization. Among them, 24 items of four diagnostic information appear more than 10%, the highest frequency is runny nose, followed by inferior turbinate enlargement. The frequencies of seven high frequency information were all more than 80%. The main symptoms of systemic phlegm drinks, such as cough, sputum, headache, fatigue, fatigue, pulse string smoothness, shortness of breath and so on, were more than 30%. 40 patients were treated with Linggui Zhugan Decoction for 10 days. Significant difference was found in the scores of symptoms before and after treatment, P 0.05, the effective rate of treatment reached 95%. (3) In the first animal experiment, when the model group, Lingguizhugan Decoction group and loratadine group were completed, the scores of symptoms in the three groups were significantly higher than those in the normal group, and there was no significant difference in the scores of symptoms between the model group and the control group 10 days after treatment. Significance, P 0.05, Lingguizhugan decoction, loratadine group animal symptom score significantly lower than before treatment, P 0.05; Mast cell and eosinophil count comparison, the model group than the normal group, Lingguizhugan Decoction group, loratadine group than the model group, significantly reduced the number of IL-2 content than the normal group, Lingguizhugan Decoction group, P 0.05; The content of IL-4 in the model group was higher than that in the normal group. The content of IL-4 in the model group was lower than that in the model group. There was no significant difference in symptom score between groups (P The results showed that the interaction between Cinnamon twig and Atractylodes macrocephala, Cinnamon twig and Poria cocos, and the different levels of Glycyrrhiza had a significant effect on the curative effect.Conclusion: Lingguizhugan Decoction and allergic rhinitis have a certain correlation.Allergic rhinitis can be regarded as a kind of phlegm drink syndrome in the nose, Lingguizhugan glycyrrhinitis. For allergic rhinitis, the best compatibility of Lingguizhugan decoction is Fuling 20g, Guizhi 15g, Baizhu 15g, Fried Glycyrrhiza uralensis l0g. Guizhi and Baizhu interact, Guizhi and Fuling interact, different levels of liquorice have a significant effect on the curative effect.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R276.1

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