哮喘发作期152例用药特点的回顾分析

【作者】 陈华琼；

【导师】 周平安；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2005， 硕士

【摘要】 本课题在继承导师周平安教授治疗哮喘发作期多年临床经验的基础上,结合现代医学和中国医学文献,提出以五脏为核心辨证论治哮喘发作期的辨证论治体系,并且回顾总结了152例临床住院患者的病历,根据此理论体系统计出主要证型及具体遣方用药,分析其用药特点,从临床角度加以阐述证实此理论体系的可行性和科学性。 论文包括以下几个部分:支气管哮喘的现代医学认识部分、哮喘的中国医学文献综述部分、哮喘辨证论治方法及体系探讨部分、临床病例统计分析部分和导师经验举例部分。 支气管哮喘的现代医学认识部分通过简介现代医学对于支气管哮喘的机制的认识及主要进展,加深对于支气管哮喘这一疾病的认识及其机理的理解。而哮喘中国医学文献综述包括两大部分。第一部分在列举历代主要医书和医家对于哮喘认识的基础上,阐述了对哮喘认识不断深入的过程,提示了本课题的理论基础:根据临床需要,以五脏为核心理论体系对发作期哮喘进行辨证论治。第二部分结合本课题,综述了哮喘辨证论治方法和体系的发展及应用,在此基础上提出五脏辨治急性期哮喘的五脏辨治体系。 临床病例统计分析部分是在东直门医院病案室收集既往的急性期哮喘患者住院病历共152例,以统一的电子表格进行记录。以患者主要临床症状和具体方药为主要观察点,以导师周平安教授的五脏辨治急性期哮喘理论体系进行重新辨证分型,并总结分析其用药特点。结果:1.出现的主要临床症状包括:哮喘,咯痰,咳嗽,胸闷气短,口干口苦口粘,纳差恶心呕吐,不能平卧,大便异常,咽部症状,汗出,小便异常,喉中痰鸣,心悸怔忡心烦,头晕头胀头痛,寒热,胃脘胀痛,腹胀痛,呼吸困难,精神倦怠,紧张抑郁,鼻部症状,四肢症状,胁胀痛,张口抬肩,腰酸痛,耳鸣,唇干,鼻翼煽动,唇甲紫绀等等。这些症状大多通过治疗后得以改善。2.五脏辨证分型的统计:599次辨证中属于肺型的占58.10%,脾型占10.35%,肾型占7.51%,肝型占15.69%,心型占1.84%,其他占6.51%。3.主要用药包括:杏仁,甘草,苏叶子梗,黄芩,麻黄,半夏,地龙,茯苓,瓜蒌,五味子,桑叶皮,石膏,柴胡,赤白芍,乌梅,防风,桃仁,紫菀,地黄,葶苈子,桔梗,白果,陈皮,贝母,冬花,莱菔子,厚朴,川芎,麦冬,全蝎,当归,钩藤,沉香,沙参,枳壳,前胡,苍白术,苡仁,蝉衣,僵蚕,芦茅根,大黄,鱼腥草,党(人)参,细辛,炙杷叶,连翘,射干,丹参,丹皮,大枣,黛蛤散,石韦,旋复花,泽泻,炙百部,桂枝,生姜,知母,藿佩,紫石英,补骨脂,郁金,黄芪,化橘红,橘红,山萸肉,黄连,地骨皮,牛蒡子,白芥子,冬瓜子,玄参,干姜,太子参,全虫,车前子,仙灵脾,枳实,栀子,石决明,胆南星,焦三仙,荆芥,砂仁,黄精,紫河车,远志,枸杞子,海蛤壳,银花,槟榔,等等。证实了五脏辨证论治体系治疗急性期哮喘的可行性和科学性,其用药为临床治疗急性期哮喘提供了一定的参考价值,对临床具有一定指导意义。讨论部分分析了五脏辨证论治急性期哮喘的理论体系的延伸以及用药特点。最后一部分为导师周平安教授的用药经验举例,指出运用该理论体系治疗急性期哮喘还应注重选方用更多还原

【Abstract】 Based on the clinical experiences supervisor Pro. Zhou Ping’ an, combinated modern and traditional Chinese medical documents, a theory system of treatment based on the differential diagnosis which regard five Zang-organs as the core(TS of 5Z) to treat paroxysmal asthma(PA) is put out of in this dissertation . At the same time, based on the 152 clinical cases, the main syndromes and particular formulas and herbs can be statisticed, and the characteristics of using herbs can be analyzed. As the result, the possibility and scientific nature can be verified from the aspect of clinic.This dissertation includes several parts as below: The first part is the summary of modern mechanism about bronchus asthma .The second part is the overview of the TCM about asthma. The third part is the approach of the theory systems of treatment based on the differential diagnosis(TS) about PA.The fourth part is the clinical research report. The last part is the discussion.The part one is about the present understanding and progress of asthma, aiming to deepen the comprehension of bronchus asthma and its mechanism .In part two, based on the understanding in literal documents of various dynasties and doctors, through the expound of the continuously deep-going process of the knowing about asthma, the TS of 5Z to treat PA was put forward to.In part three, based on the development and application of theory system about how to treat asthma based on the differential diagnosis(TS), the TS of 5Z to treat PA was put forward to.In part four, past 152 PA cases in Dong Zhi Men hospital were collected and were recorded in spreadsheet. With observing the main symptom and particular herbs, reclassify these cases on the TS of 5Z to treat PA. As the result, the main herbs in every class can be summarized, and the characte- ristics of using herbs can be analyzed.The result shows that the main symptom includes: asthma, cough, expec- toration, stuffiness in the chest, shortness of breath, thirsty, bitter taste in the mouth, sticky taste in the mouth, anorexia, nausea, vomiting, lie- lessness, abnormity of stool, abnormity of throat, perspiration, abnormity of pee, sputum in the larynx, palpitation, swirl, headache, aversion to cold and fever, abdominal flatulence, decompensation, accidie, tension, blahs, symptom of nose, symptom of extremity, distending pain over hypochondrium, dehisce and uplift the shoulders, lumbago, tinnitus,dryness of lip, fomenty of nosewing,purplish lips and nails, etc. Most of these symptoms can be meliorated after therapy.In all cases ,lung disorder occupy 58.10% of all Differential diagnosis, spleen disorder occupy 10.35%,kidney disorder occupy 7.51 %, liver disorder occupy 15.69%,heart disorder occupy 1.84%,and others occupy 6.51 %.The main herbs include: Bitter Apricot Kernel (Semen Armeniacae Amarum) (XingRen) , Liquorice (Radix Glycyrrhizae) (Gan Cao) , Scutellaria Root (Radix Scutellariae) (Huang qin), Ephedra (Herba Ephedrae) (Ma huang), Pinellia Tuber (Rhizoma Pinelliae) (Ban Xia) , Perilla Fruit (Fructus Perillae) (Su Zi), Earthworm (Lumbricus) (Di Long), Poria (Poria) (Fu ling), Trichosanthes Fruit (Fructus Trichosanthis) ( Gua Lou), Schisandra Fruit (Fructus Schisandrae) (Wu Wei Zi), Gypsum (Gypsum Pibrosum) (Shi gao), Bupleurum Root (Radix Bupleuri) (Chai hu), Mulberry Bark (Cortex Mori Radicis) (Sang bai pi), Purple Perilla Leaf (Folium Perillae) (Zi su ye), Black Plum (Fructus Mume) (Wu Mei) , Ledebouriella Root (Radix Ledebouriellae) (Fang feng), Peach Kernel (Semen Persicae) (Tao Ren), Aster Root (Radix Stemonae) (Zi Wan) , Lepidium Seed (Semen Lepidii Seu Descurainiae) (Ting Li Zi) , Platycodon Root (Radix Platycodi) (Jie Geng) , Ginko Nut (Semen Ginkgo) (Bai Guo), Tangerine Peel (Pericarpium Citri Reticulatae) (Ju pi), Flos Farfarae(kuan dong hua), Radish Seed (Semen Raphani) (Lai fu zi), Magnolia Bark (Cortex Magnoliae Officinalis) (Hou po), Red Peony Root (Radix Paeoniae Rubra) (Chi shao), Chuanxiong Rhizome (Rhizoma Ligustici Chuangxiong) (Chuan Xiong), Radix Ophiopogonis(mai dong), Scorpion (Scorpion) (Quan Xie),更多还原