【作者】 王欣；

【导师】 霍青；

【作者基本信息】 山东中医药大学 ， 中西医结合临床（专业学位）， 2022， 硕士

【摘要】 目的:根据中医经典古籍中所论三阴三阳开阖枢理论,使用柴胡加龙骨牡蛎汤治疗郁病(气郁化火型)的患者,与盐酸帕罗西汀对照组进行各方面的疗效对比,以说明开阖枢理论在郁病临床治疗中的应用价值,展现中医理论在疾病论治方面的实际意义。方法:筛选72名符合入组标准的郁病患者,按照随机原则分为试验组与对照组,每组36人,分别给予柴胡加龙骨牡蛎汤和盐酸帕罗西汀片,在入组前、用药4周后、用药8周后进行疗效测评,以汉密尔顿抑郁量表(HAMD-24)评分作为主要疗效观察指标,中医证候观察表和汉密尔顿焦虑量表(HAMA)作为次要疗效观察指标,使用EXCEl及SPSS 26.0对所得数据进行整理和统计,通过检验与计算对两类药物的各方面疗效进行比较,记录试验中的不良事件并处理。结果:1.基于HAMD-24评分进行分析比较,试验组和对照组有效率分别为82.35%、81.82%,显效率分别为64.71%、60.61%,经检验无统计学差异(P>0.05),二者临床效果相当。2.基于中医观察表评分进行分析比较,试验组和对照组有效率分别为85.29%、45.45%,显效率分别为44.12%、6.06%,经检验有统计学差异(P<0.05),试验组临床效果更好。3.研究过程中两组皆有患者出现不良反应,试验组和对照组发生率分别为2.94%、18.18%,试验组不良事件相对较少。结论:1.基于开阖枢理论,使用柴胡加龙骨牡蛎汤治疗郁病(气郁化火型)的患者临床效果显著,总体疗效与盐酸帕罗西汀片相当。2.柴胡加龙骨牡蛎汤不仅能减轻患者抑郁焦虑方面的症状,还可改善入睡困难或早醒、口苦咽干、神疲乏力等中医症状,整体疗效更好,盐酸帕罗西汀片对此则效果欠佳;本次试验中柴胡加龙骨牡蛎汤组的不良事件更少,用药相对更安全。3.基于开阖枢理论进行的郁病临床疗效观察取得了与预期一致的结果,展现了该理论的临床应用价值。更多还原

【Abstract】 Objective:According to the theory of Sanyin and Sanyang opening and closing pivot discussed in the classical ancient books of traditional Chinese medicine,Chaihu plus Longgu oyster decoction was used to treat patients with stagnation(Qi-stagnation-fire type),and the efficacy of paroxetine hydrochloride control group in various aspects was compared to verify the application value of opening and closing pivot theory in the clinical treatment of stagnation and reflect the practical significance of traditional Chinese medicine theory in disease treatment.Methods:Seventy-two patients with depression of qi stagnation and fire type who met the criteria were screened and divided into the control group according to the principle of randomization.They were given Chaihu plus Longgu oyster decoction and paroxetine hydrochloride tablets,respectively.The Hamilton Depression Rating Scale(HAMD-24)score was used as the main efficacy observation index,and the TCM score table and Hamilton Anxiety Rating Scale(HAMA)were used as the secondary efficacy observation indexes.The scores were performed before and after treatment.The obtained data were collated and statistically analyzed using EXCEl and SPSS 26.0.The efficacy of the two types of drugs in various aspects was objectively compared by test and calculation,and the adverse events during the trial were checked and controlled.Results: 1.Based on the HAMD-24 score,the effective rates of the experimental control group were 82.35% and 81.82%,respectively,and the significant rates were 64.71% and 60.61%,respectively,with no statistical difference(P > 0.05).The clinical effects of the two groups were equivalent.2.Based on the analysis and comparison of TCM score table,the effective rate of the experimental control group was 85.29% and 45.45%,respectively,and the significant rate was 44.12% and 6.06%,respectively,with statistical difference(P < 0.05).The clinical effect of the experimental group was better.3.Adverse events occurred in both groups.The incidence rate was 2.94% and 18.18% in the test control group,respectively.The test group had fewer adverse events.Conclusion:1.The clinical effect of Chaihu plus Longgu oyster decoction in the treatment of patients with stagnation of qi stagnation and fire type is significant and comparable to the clinical effect of paroxetine hydrochloride tablets.2.Chaihu plus Longgu oyster decoction not only reduces the symptoms of depression and anxiety in patients,but also improves the symptoms of difficulty falling asleep or waking up early,bitter taste and dry throat,fatigue and other TCM aspects,with better overall effect.Paroxetine Hydrochloride Tablets are not effective for these symptoms;during the treatment,Chaihu plus Longgu oyster decoction group has fewer adverse events and is relatively safer to use.3.The clinical curative effect observation of stagnation based on the theory of opening and closing pivot has obtained the results consistent with the expectation,which confirms the clinical application value of this theory.更多还原