糖尿病证候及柴胡疏肝散加减干预的临床研究

【作者】 段颖；

【导师】 刘铜华；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2007， 硕士

【摘要】 本论文分为文献综述和临床研究两部分。其中,文献综述包括糖尿病中医证候研究进展和从肝论治糖尿病的研究进展;临床研究包括糖尿病证候研究和柴胡疏肝散加减干预糖尿病的临床研究。糖尿病中医证候研究进展研究了近年来许多学者关于糖尿病中医证候分布的研究报道,分析总结了中医证型分布和临床辨治的证型分类,以及糖尿病中医证候演变的规律,糖尿病中医证候与相关指标的关系研究。从肝论治糖尿病的研究进展研究分析了古今关于肝郁致消的病因病机、从肝论治的辨证分型,分类总结了从肝论治糖尿病的治法。糖尿病证候研究统计了糖尿病常见症状的发生率,按照“以正虚定证型,以邪实定证候”的原则,归纳出糖尿病临床上常见的证型及证候,结果示:糖尿病证型以津伤燥热型、气阴两伤型、肺脾气虚型、脾肾阳虚型、阴阳两虚型为常见,兼夹证侯有血瘀、气滞、湿热、痰湿。肝郁气滞证存在于不同病程的糖尿病患者中,且在不同病程中其发生率大致相同。肝郁气滞证作为兼证在不同证型中均有分布,津伤燥热型、阴阳两虚型中气滞者所占比例较多,气阴两伤型所占比例接近均数,肺脾气虚型及脾肾阳虚型所占比例最少,故凡有津伤阴虚证者其肝郁气滞证的发生率较高。临床观察了柴胡疏肝散加减干预糖尿病的疗效。选择30例符合标准的有肝郁气滞兼证的糖尿病患者,在基础治疗和对症治疗的基础上,经中医辨证论治后服用中药汤剂,8周后观察疗效。结果示患者空腹血糖、餐后两小时血糖、糖化血红蛋白值均较前下降,差异显著(P<0.05)。症状积分中,除视物模糊外,其余症状的平均积分值治疗后均较治疗前下降,尤其是口干咽燥、神疲乏力、自汗、大便干结、急躁易怒五个症状治疗前后评分有显著差异,积分降低较多,说明柴胡疏肝散加减干预糖尿病在改善这些症状方面疗效显著。按本研究的评定标准,柴胡疏肝散加减干预糖尿病总有效率达90%。与目前采用疏肝理气法干预糖尿病的报道比较,有效率相似,表明采用疏肝理气法干预治疗糖尿病肝郁气滞证可改善中医症状,降低血糖,疗效确切。更多还原

【Abstract】 This thesis is made up of two parts: review on the research advancement of diabetic clinical manifestations and treating diabetes from treating the liver as well as clinical research on diabetic clinical manifestations and the intervention of Powder of Chinese thorowax root dispersing the depressed liver-energy on diabetes.In The Research Advancement of Diabetic clinical manifestations the distribution of clinical manifestations ,including survey of epidemic diseases and determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs are summarized,the research result of diabetic clinical manifestations is reviewed,and the reports on the relationship of diabetic clinical manifestations and the related index are summarized.In The Research Advancement of Treating Diabetes from Treating the Liver, the resent research reports of the etiological factors and pathogenesis of diabetes due to stagnation of liver-Qi are collected ,the results of grouping research of treating diabetes from treating the liver are reviewed,and the treatment method and current situation are summarized.In Clinical Research on Diabetic Clinical Manifestations, the incidence rate of the common diabetic clinical manifestations is added up according to the principle of“deciding the type of syndrome according to asthenia of healthy energy, and deciding syndrome and sign according to state of evil domination.Result: The most common patterns of syndrome are dryness-heat type, impairment of both QI and YIN,asthenia of pulmonosplenic qi,asdthenic splenonephro-yang,and deficiency of both yin and yang, accompanied with stagnation of blood or qi, humid heat, phlegmatic hygrosis.The syndrome of stagnation of QI due to depression of the liver is in different courses of diabetes, and the incidence rates in different courses of diabetes are approximately the same.As accompanied symptoms and signs ,the syndrome of stagnation of QI due to depression of the liver is in different types of syndrome,of which the most is dryness-heat, deficiency of both yin and yang,the lesser is impairment of qi and yin,and the least are asthenia of pulmonosplenic qi and asdthenic splenonephro-yang,so the higher chances of incident rate of stagnation of QI due to depression of the liver is those with impairment of YIN-fluid.In The Clinical Research of the Intervention of Powder of Chinese Thorowax Toot Dispersing the Depressed Liver-Energy on Diabetes,30 cases with the accompanied syndrome of stagnation of QI due to depression of the liver are chosen and treated with Chinese medicine ,after 8 weeks , fasting plasma gglucose-1-phosphate, 2-hours-after-lunch-blood glucose,and glycosylated hemoglobiaea decreased, and the distinction is noticeable(P<0.05)。In grading of syndrome and sign,the scores of the syndromes decreased except blurred vision,especially dry mouth and swallow, lassitude, spontaneous perspiration,dry stool, restlessness and irritability.The total effective rate is 90% which is similar compared with the effective rate in the report of Using the Method of Disperse the Depressed Liver-Energy and Qi to Intervene Diabetes .It indicates that using the method of disperse the depressed liver-energy and qi to intervene diabetes can improve the symptoms and lower the blood glucose,and the curative effect of which is certain.更多还原