李赛美教授治疗高胰岛素血症临床经验探讨

发布时间：2018-10-10 07:05

【摘要】：目的:高胰岛素血症是能导致多代谢异常、代谢综合征的共同病理,是导致糖尿病心脑血管疾病的危险因素。这些疾病包括血脂异常、高血压、高血糖、全身或腹部肥胖、高胰岛素血症伴胰岛素抵抗等慢性疾病的危险因素。高胰岛素血症可防可治,通过早期发现,并积极防治危险因素,能阻断相关终点事件发生,符合中医"治未病"的思想。李赛美教授长期从事内分泌病及高胰岛素血症临床研究,积累了不少临床经验。本研究通过临床观察,旨在探讨李赛美教授治疗高胰岛素血症的临床运用六经辨证理法方药的辨治经验。方法:选择从2014年1月至2016年12月在广州中医药大学第一附属医院内分泌科南楼门诊收集李赛美教授就诊的高胰岛素血症的病历,共105例。采用Office excel统计软件建立个人资料、症状、证型、治法、方剂、药味及药效数据库。采用SPSS统计软件对收集的病历资料的症状、舌苔脉象、证型、治法、方剂及药味进行频数统计分析(Frequency Analysis),并初步归纳李赛美教授治疗用药规律的临床经验。结果:本研究收集李赛美教授门诊的高胰岛素血症的病历,共105例。其中,采用34个不同患者的病例,而另外71病例属来复诊的患者。女性27例,占79.41%,男性7例,占20.59%。六经辨证分析为:太阳证67次(63.81%),阳明证7次(6.67%),少阳证34次(32.38%),太阴证51次(48.57%),少阴证50次(47.62%),厥阴证6次(5.71%)。从研究结果的病例分析数据库显示出李赛美教授治疗高胰岛素血症的原则及思路,高胰岛素血症治法用补气药、清热药、利水渗湿药、温里药、补阳药、化湿药、化痰药为主,第二若患者感受风寒或风热就用扶正祛邪治法,第三用补血药、活血化淤药、补阴药、理气药、安神药、平息肝风药、收敛药为伴随症状加减治疗。治疗高胰岛素血症先疏肝健脾,清热除湿,利水渗湿,其次再以温补脾阳,补益肝肾为主。对于李赛美教授用中药治疗高胰岛素血症患者,本研究结论如下:1.重视整体观念;2.治疗标本结合;3.纯中药治疗和中西医结合;4.重视患者的心理问题;5.六经辨证;6.脏腑辩证;7.症状用药;8.常用药对。结论:现代医学治疗高胰岛素血症的推荐方案基本上是注重预防和治疗各种危险因素。现代医学研究、医学实验对中医治疗糖代谢异常症、胰岛素抵抗、胰岛素血症及代谢综合征等疾病具有明显的效果。治疗高胰岛素血症通过早期治疗肥胖、眩晕(高血压)、消渴(糖尿病),为了预防疾病趋势发展中医方面能共识为"治未病"。疾病越早发现治疗越显效。李赛美教授在临床上运用六经辨证和伤寒论方治疗高胰岛素血症获得好疗效。本研究初步探讨李赛美教授治疗的经验和辨证用药思路。
[Abstract]:Objective: hyperinsulinemia is a common pathology of metabolic syndrome and a risk factor for diabetic cardiovascular and cerebrovascular diseases. These include dyslipidemia, hypertension, hyperglycemia, systemic or abdominal obesity, hyperinsulinemia with insulin resistance and other chronic disease risk factors. Hyperinsulinemia can be prevented and treatable. By early detection and active prevention and treatment of risk factors, the occurrence of related endpoint events can be blocked, which is in line with the idea of "treating the disease before illness" in traditional Chinese medicine. Professor Li Sei-mei has long been engaged in the clinical research of endocrine disease and hyperinsulinemia, and has accumulated a lot of clinical experience. Through clinical observation, the purpose of this study was to explore the experience of professor Li Samei in the treatment of hyperinsulinemia. Methods: 105 cases of hyperinsulinemia were collected from the Department of Endocrinology, first affiliated Hospital of Guangzhou University of traditional Chinese Medicine from January 2014 to December 2016. The database of personal data, symptoms, syndromes, treatment, prescription, taste and efficacy were established by Office excel software. The symptoms, tongue coating pulse, syndromes, treatment methods, prescriptions and taste of the collected medical records were analyzed by SPSS software. The clinical experience of Professor Li Samei's treatment and medication was preliminarily summarized. Results: 105 cases of hyperinsulinemia were collected. Among them, 34 different cases were used, while the other 71 cases were returned patients. There were 27 females (79.41%) and 7 males (20.59%). The syndrome differentiation of six meridians was as follows: Yang syndrome 67 times (63.81%), Yang Ming syndrome 7 times (6.67%), Shaoyang syndrome 34 times (32.38%), Taiyin syndrome 51 times (48.57%), Shaoyin syndrome 50 times (47.62%), Jueyin syndrome 6 times (5.71%). From the case analysis database of the results of the study, the principles and ideas of Professor Li Samei's treatment of hyperinsulinemia are shown. The treatment of hyperinsulinemia is mainly composed of Qi tonifying drugs, heat clearing drugs, promoting water and infiltrating dampness medicine, warming medicine, tonifying yang medicine, dehumidifying medicine, resolving phlegm medicine. Second, if the patients feel the wind and cold or wind heat, they should be treated with the method of nourishing the qi and dispelling evil, and the third with the medicine of tonifying the blood, activating the blood and removing the stasis, tonifying the yin, regulating the qi, soothing the spirit, quelling the liver wind, and converging the medicine for the treatment of the accompanying symptoms. The treatment of hyperinsulinemia first soothes the liver and invigorates the spleen, clears the heat and dehumidifies the dampness, promotes water and seeps dampness, and then heats up the spleen and yang and invigorates the liver and kidney. For Professor Li Samei to treat hyperinsulinemia patients with traditional Chinese medicine, this study concluded as follows: 1. Attach importance to the concept of the whole. 3. Pure Chinese medicine treatment and integrated Chinese and western medicine 4. Pay attention to the psychological problems of patients. Six meridians differentiation of symptoms and signs. The zang-fu organs are dialectical. Symptom medication. The usual medicine is right. Conclusion: the recommended regimen for the treatment of hyperinsulinemia in modern medicine is to focus on the prevention and treatment of various risk factors. Modern medical research and medical experiment have obvious effect on the treatment of abnormal glucose metabolism, insulin resistance, insulinemia and metabolic syndrome. Treatment of hyperinsulinemia through early treatment of obesity, vertigo (hypertension), thirst (diabetes), in order to prevent the development of disease trends in traditional Chinese medicine can be agreed to "cure the disease." The earlier the disease is discovered, the more effective treatment is. Professor Li Samei used six meridians syndrome differentiation and febrile fever to treat hyperinsulinemia. This study preliminarily discusses the experience of Professor Li Samei's treatment and the thinking of syndrome differentiation and medication.
【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】：R249;R259
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本文编号：2261091