胰腺癌辨证规律研究

发布时间：2019-05-10 12:21

【摘要】：辨证论治是中医学的精华,辨证是治疗的前提,辨证是否准确,是取得临床疗效的关键。目前中医药治疗胰腺癌尚无统一的诊断标准与疗效评判标准,缺乏循证医学依据的基础和临床研究,因此,我们认为有必要对胰腺癌辨治规律进行系统研究。目的：探析胰腺癌病位、病性证素特征,规范胰腺癌的病位、病性特征表现。将五脏辨证系统应用于胰腺癌的辨治,以期能够帮助提高胰腺癌病证辨治的准确率和临床疗效。方法：首先,通过文献研究,对胰腺癌病证的常见症状术语进行规范处理。应用临床流行病学调查方法,收集278例胰腺癌临床病例,应用SPSS18.0软件对常见症状进行聚类分析,归纳提示胰腺癌病位、病性相关系数较高的症状、体征和舌脉表现；再将一般症状、舌象、脉象分别进行主成分分析,找出各类的主成分及症状组成,归纳总结胰腺癌临床常见证型,构建“胰腺癌病证诊断信息表”,结合导师治疗经验,提出相应治则治法,以期提高中医治疗胰腺癌临证水准。结果：通过对病名规范的原则及胰腺癌的中医命名的探讨,把“伏梁”作为胰腺癌的中医病名；提出脾气虚弱为发病之本,癌毒留结为胰腺癌发病之根。脾胃虚弱、外感邪气、情志不畅、饮食不节等为胰腺癌发病的主要原因。278例胰腺癌临床病例显示胰腺癌主要病位为脾、肝、胃、胆、肾,分别占100%、58.6%、50.7%、27.3%、20.5%；主要病性为血瘀、气滞、气虚、湿、痰、热,分别占100%、74.1%、66.2%、59.7%、38.8%、34.5%。常见证型包括肝胆湿热证、肝脾不调证、痰瘀互结证、肝肾阴虚证、脾虚水停证。结论：胰腺癌的基础病位在脾,基础病性为痰、瘀,相兼病位胃、肝、胆、肾,相兼病性气滞、湿、热、水停,健脾助运、化痰逐瘀为治疗胰腺癌基本原则,对于相兼病位病性,辅以行气法、通腑法、利胆法、祛湿法、清热法治疗胰腺癌具有一定的临床指导意义。
[Abstract]:Syndrome differentiation and treatment is the essence of traditional Chinese medicine, syndrome differentiation is the premise of treatment, syndrome differentiation is accurate, is the key to achieve clinical efficacy. At present, there is no unified diagnosis standard and evaluation standard of curative effect in the treatment of pancreatic cancer by traditional Chinese medicine, and the basis of evidence-based medicine and clinical research are lacking. Therefore, we think it is necessary to study systematically the rule of differentiation and treatment of pancreatic cancer. Objective: to investigate the location and characteristics of pancreatic cancer, and to standardize the location and characteristics of pancreatic cancer. The system of differentiation of symptoms and signs of the five organs is applied to the differentiation and treatment of pancreatic cancer in order to help to improve the accuracy and clinical efficacy of the differentiation and treatment of the syndrome of pancreatic cancer. Methods: first of all, through literature research, the common symptom terms of pancreatic cancer syndrome were standardized. The clinical epidemiological investigation method was used to collect 278 clinical cases of pancreatic cancer. Cluster analysis of common symptoms was carried out with SPSS18.0 software, and the symptoms, signs and tongue-vein manifestations with high correlation coefficient of disease were summarized. Then the general symptoms, tongue images and pulse images were analyzed by principal component analysis, all kinds of principal components and symptom components were found out, the clinical common syndromes of pancreatic cancer were summarized, and the "diagnosis information table of pancreatic cancer syndrome" was constructed, combined with the experience of mentor in treatment. The corresponding treatment and treatment were put forward in order to improve the clinical level of traditional Chinese medicine in the treatment of pancreatic cancer. Results: through the discussion of the principle of disease name specification and the traditional Chinese medicine naming of pancreatic cancer, "Fuliang" was regarded as the TCM name of pancreatic cancer, and it was pointed out that the weakness of temper was the basis of the disease, and the cancer toxin was the root of pancreatic cancer. Weakness of spleen and stomach, ecstasy, lack of emotion and lack of diet were the main causes of pancreatic cancer. 278cases of pancreatic cancer showed that the main sites of pancreatic cancer were spleen, liver, stomach, gallbladder and kidney, accounting for 100%, 58.6% and 50.7%, respectively. 27.3%, 20.5%; The main diseases were blood stasis, qi stagnation, qi deficiency, dampness, phlegm and heat, accounting for 100%, 74.1%, 66.2%, 59.7%, 38.8%, 34.5% respectively. The common syndrome types include liver-gallbladder damp-heat syndrome, liver-spleen disorder syndrome, phlegm-stasis syndrome, liver-kidney yin deficiency syndrome, spleen deficiency and water stagnation syndrome. Conclusion: the basic diseases of pancreatic cancer are phlegm, blood stasis, stomach, liver, gallbladder, kidney, qi stagnation, dampness, heat, water stop, spleen invigorating and removing phlegm and removing blood stasis are the basic principles in the treatment of pancreatic cancer. In the treatment of pancreatic cancer, the methods of Qi, purging the Fu, clearing the gallbladder, removing dampness and clearing away heat have a certain clinical significance for the treatment of the disease.
【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】：R273

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