芩连平胃散加减治疗燥痹临床观察及理论初探

发布时间：2019-01-09 06:09

【摘要】：燥痹是由燥邪为主而导致的痹病,燥胜则干,其以孔窍干燥和关节疼痛为主要临床特征,是中医的难治性疾病,其临床发病率近年呈上升趋势。查阅现存古代医籍并无燥痹病名的确切记载,“燥痹”病名为国医大师路志正教授根据其病因病机并结合自己多年临床经验而提出。广安门医院风湿科基于路老对燥痹的理论及治疗方案进行了大量的基础与临床的研究,导师曹炜主任在临床应用路老理法方药的实践过程中发现,燥痹虽多见气阴不足证,然而随着社会环境的变化,脾胃湿热证多与其并见,芩连平胃散清热燥湿,运脾和胃,为导师治疗燥痹脾胃湿热证的常用方。本文通过理论和临床两方面阐述芩连平胃散治疗燥痹脾胃湿热证的理论依据和临床研究。运用中医理论对燥痹脾胃湿热证的发病机理进行分析,结合社会环境、生活方式讨论燥痹脾胃湿热证的成因,总结导师运用芩连平胃散治疗燥痹脾胃湿热证的临床辨治要点及用药经验。文献综述：通过查阅参考相关文献及相关书籍对燥痹的历史源流、命名,历代医家对燥痹的认识加以梳理,以明确燥痹的定义及范畴。详细论述脾胃在燥痹发病、病情转归及治疗中的重要作用。芩连平胃散功可清热燥湿,恢复脾胃气机,运化布散精微,对组成芩连平胃散的六味中药的现代药理研究加以综述,以现代药理理阐释芩连平胃散治疗燥痹机制。临床研究目的：观察芩连平胃散治疗32例燥痹脾胃湿热证的临床疗效,对芩连平胃散治疗燥痹脾胃湿热证的理论机制进行初步探讨,为今后的临床应用提供依据。方法：2015年4月—2016年2月期间于中国中医科学院广安门医院风湿科门诊收集辨证属燥痹脾胃湿热证患者32例,予芩连平胃散加减治疗。根据燥痹及脾胃湿热证的诊断要点,以眼干、口鼻咽干,脘腹胀满、皮疹,大便异常,关节痛,口腔溃疡,纳呆8个症状为主要症状,及消化系统、情绪、睡眠等27个次要症状。记录首诊、一月后复诊、二月后复诊、三月后复诊总症状积分及各主症积分,共计4次。运用SPASS22.0统计软件统计数据,采用t检验,秩和检验等统计方法,P0.05有统计学意义。结果：1、经3个月治疗后,患者症状改善程度,显效17例(53.13%),有效13例(40.63%),缓解1例(3.12%),无效1例(3.12%),总有效率为96.88%；2、治疗过程中,4次评价,症状总积分呈递减趋势,差异有统计学意义P0.05；3、治疗过程中,4次评价,各项主症均有较明显的改善,差异有统计学意义P0.05。结论：1、芩连平胃散能明显改善燥痹脾胃湿热证患者临床症状。2、芩连平胃散治疗燥痹脾胃湿热证患者,能明显降低其症状总积分及各主症积分,3、芩连平胃散治疗燥痹脾胃湿热证,显效53.13%,有效40.63%,缓解3.12%,总有效率为96.88%；
[Abstract]:Dryness arthralgia is a kind of arthralgia caused mainly by dryness and dryness. Dryness is mainly characterized by dryness of orifices and joint pain. It is a refractory disease of TCM. The clinical incidence of dryness is on the rise in recent years. The name of "dryness and arthralgia" is put forward by Professor Lu Zhizheng, the master of Chinese medicine, according to his etiology, pathogenesis and years of clinical experience. The Department of Rheumatology of Guang'an Men Hospital carried out a large number of basic and clinical studies based on the theory and treatment plan of Lu Lao Bi. Director Cao Wei, a tutor, found that although dryness is often seen as deficiency of qi and yin in the course of clinical application of Lu Lao Li's prescription of arthralgia, However, with the change of social environment, spleen and stomach dampness heat syndrome and its syndromes, Qinlianping stomach powder heat and dampness, spleen and stomach, as a tutor for the treatment of dryness, spleen and stomach dampness and heat syndrome commonly used prescription. In this paper, the theoretical basis and clinical study of Qinlianping Weishen Powder in treating dryness, spleen and stomach dampness and heat syndrome were expounded in both theory and clinic. Using the theory of traditional Chinese medicine to analyze the pathogenesis of damp-heat syndrome of spleen and stomach of dryness, and to discuss the causes of damp-heat syndrome of spleen and stomach in combination with social environment and life style. To sum up the main points of clinical differentiation and experience in treating dryness, spleen and stomach dampness and heat syndrome with Qinlianping Weishen Powder. Literature review: by referring to relevant literature and related books, the history of dryness arthralgia is named, and the understanding of dryness arthralgia is sorted out by physicians in past dynasties, in order to clarify the definition and category of dryness arthralgia. This paper discusses in detail the important role of spleen and stomach in the pathogenesis, prognosis and treatment of dryness. Qinlianping Weishan Powder can clear away heat and dampness, restore spleen and stomach Qi, and transfer Huazhuapu powder. The modern pharmacological studies of six kinds of traditional Chinese medicine composed of Qinlianping Weisan Powder are summarized, and the mechanism of Qinlianping Weishen Powder in treating dryness arthralgia is explained by modern pharmacology. Objective: to observe the clinical effect of Qinlianping Weishen Powder (QLianping Wei Powder) in treating 32 cases of dryness, spleen and stomach dampness and heat syndrome, and to explore the theoretical mechanism of Qinlianping Weishen Powder in treating dryness, spleen and stomach dampness heat syndrome, so as to provide the basis for clinical application in the future. Methods: from April 2015 to February 2016, 32 patients with syndrome differentiation of dryness, spleen and stomach damp-heat syndrome were collected from the Department of Rheumatology, Guanganmen Hospital, Chinese Academy of traditional Chinese Medicine. According to the main diagnosis points of dryness and damp-heat syndrome of spleen and stomach, the main symptoms were dry eye, dry mouth and nasopharynx, fullness of abdomen, rash, abnormal stool, arthralgia, oral ulcers, 8 symptoms of dysphoria, digestive system and mood. Sleep and other 27 secondary symptoms. The total symptom scores and main symptom scores were recorded after 1 month, 2 months, 3 months, respectively. Using SPASS22.0 statistical software statistical data, using t test, rank sum test and other statistical methods, P0.05 has statistical significance. Results: 1 after 3 months of treatment, the symptoms of the patients improved significantly in 17 cases (53.13%), effective in 13 cases (40.63%), remission in 1 case (3.12%), ineffective in 1 case (3.12%), the total effective rate was 96.88%; 2. In the course of treatment, the total score of symptoms decreased in 4 times, and the difference was statistically significant (P0.05 / 3). In the course of treatment, the main symptoms were obviously improved (P0.05), and the difference was statistically significant (P0.05). Conclusion: 1. Qinlianping Weishen Powder can obviously improve the clinical symptoms of patients with damp-heat syndrome of spleen and stomach. 2. In treating patients with damp-heat syndrome of spleen and stomach, Qinlianping Weisan Powder can obviously reduce the total score of symptoms and the scores of main symptoms, 3. Qinlianping Weisan treatment dryness, spleen and stomach dampness and heat syndrome, remarkable effect 53.13, effective 40.63, relief 3.12, the total effective rate is 96.88.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R255.6

【参考文献】