本文選題：臨床流行病學(xué)調(diào)查研究 + 肝�。� 參考：《南京中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：臨床工作中內(nèi)傷頭痛病因繁多,病機(jī)復(fù)雜,證候多端,其辨證診斷過(guò)程存在著許多不確定因素。中醫(yī)文化源遠(yuǎn)流長(zhǎng),傳統(tǒng)中醫(yī)理論對(duì)內(nèi)傷頭痛的病因病機(jī)的探討由來(lái)已久,雖眾說(shuō)紛紜,但大多從肝立論。本研究承接之前學(xué)術(shù)結(jié)果,調(diào)查統(tǒng)計(jì)內(nèi)傷頭痛九大病機(jī)證素的分布規(guī)律,找出病機(jī)證素相關(guān)因素,探尋肝經(jīng)病機(jī)證素在內(nèi)傷頭痛發(fā)病中的作用,為從肝論治內(nèi)傷頭痛提供循證醫(yī)學(xué)證據(jù)。方法：總結(jié)回顧古今醫(yī)家對(duì)內(nèi)傷頭痛和肝關(guān)系的闡釋,挖掘肝經(jīng)病機(jī)證素與內(nèi)傷頭痛發(fā)病關(guān)系密切之理論依據(jù)。利用《內(nèi)傷頭痛病機(jī)證素調(diào)查問(wèn)卷》收集患者臨床資料,利用《內(nèi)傷頭痛病機(jī)證素診斷量表》進(jìn)行辨證診斷,利用SPSS19.0數(shù)據(jù)庫(kù)進(jìn)行數(shù)據(jù)分析處理,從流行病學(xué)的角度證明肝經(jīng)病機(jī)證素在內(nèi)傷頭痛發(fā)病中的主要地位,并進(jìn)一步探究與這些病機(jī)證素有關(guān)系的影響因素。結(jié)果：(1)肝經(jīng)病機(jī)證素分布規(guī)律：從分布頻數(shù)上看,肝陽(yáng)、肝火的出現(xiàn)頻率明顯高于其他病機(jī)證素；血虛居第三位,是虛證中出現(xiàn)頻率最高的病機(jī)證素。(2)肝陽(yáng)、肝火、氣郁三者既可獨(dú)立導(dǎo)致內(nèi)傷頭痛,又常相互兼夾為復(fù)合病機(jī)導(dǎo)致內(nèi)傷頭痛的發(fā)生。內(nèi)傷頭痛發(fā)病中,肝陽(yáng)、肝火、氣郁可以單獨(dú)或組合引起相應(yīng)證候,也常常與其他病機(jī)證素兼夾引起的內(nèi)傷頭痛,形成復(fù)合病機(jī)證候。(3)肝經(jīng)病機(jī)證素影響內(nèi)傷頭痛指數(shù)：經(jīng)非參數(shù)檢驗(yàn)得出,肝陽(yáng)、肝火病機(jī)證素對(duì)頭痛評(píng)分有顯著影響,肝陽(yáng)、肝火病機(jī)證素者的頭痛評(píng)分明顯高于非肝陽(yáng)、非肝火者；寒凝和痰濁病機(jī)證素對(duì)內(nèi)傷頭痛的程度評(píng)分也有影響。(4)肝經(jīng)病機(jī)證素影響內(nèi)傷頭痛病程：經(jīng)非參數(shù)檢驗(yàn)得出,肝陽(yáng)、肝火、氣郁、血虛、陰虛病機(jī)證素對(duì)病程數(shù)有影響,肝經(jīng)病機(jī)證素患者病程數(shù)明顯長(zhǎng)于非肝經(jīng)病機(jī)證素的患者;血虛和陰虛病機(jī)證素患者病程數(shù)也較長(zhǎng)。(5)病機(jī)證素與年齡的相關(guān)性：肝火、氣郁、血瘀、陰虛病機(jī)證素在年齡構(gòu)成上存在差異。在肝火、瘀血、陰虛病機(jī)證素中,所占比例最高的都是老年組;在氣郁病機(jī)證素中,所占比例最大的是青年組。(6)病機(jī)證素與性別的相關(guān)性：肝陽(yáng)、肝火、氣郁、寒凝、氣虛病機(jī)證素在性別構(gòu)成上存在差異,其中肝陽(yáng)、肝火、寒凝病機(jī)證素中,女性所占比例大于男性；在氣虛病機(jī)證素中,男性陽(yáng)性者所占比例大于女性。(7)病機(jī)證素與影響因素的相關(guān)性：肝陽(yáng)病機(jī)證素的影響因素為急躁易怒、心煩；肝火病機(jī)證素的影響因素為急躁易怒、心煩、抑郁、失眠；氣郁病機(jī)證素的相關(guān)因素為月經(jīng)、急躁易怒、抑郁；寒凝病機(jī)證素的影響因素為吹風(fēng)受涼、抑郁；痰濁病機(jī)證素的影響因素為陰雨天氣；氣虛病機(jī)證素的影響因素為勞累、陰雨天氣；血虛病機(jī)證素的影響因素為月經(jīng)、抑郁、勞累：陰虛病機(jī)證素的影響因素為勞累;本研究暫未發(fā)現(xiàn)與瘀血病機(jī)證素相關(guān)的影響因素。結(jié)論：內(nèi)傷頭痛核心病機(jī)證素為肝陽(yáng)、肝火,肝經(jīng)病機(jī)證素是內(nèi)傷頭痛的主要病機(jī)證素。肝經(jīng)病機(jī)證素既可單獨(dú)致病,又會(huì)相互兼夾為復(fù)合病機(jī)證候,甚至與其他病機(jī)證素相互兼夾,形成復(fù)雜的病機(jī)證候。肝陽(yáng)、肝火病機(jī)證素者頭痛程度一般較重。肝經(jīng)病機(jī)證素和虛證病機(jī)證素患者病程較長(zhǎng)。在各病機(jī)證素構(gòu)成中,與年齡有關(guān)的是肝火、血瘀、陰虛、氣郁。肝火、陰虛、血瘀中老年人最多,氣郁中青年人最多；與性別有關(guān)的是肝陽(yáng)、肝火、氣郁、寒凝、氣虛,其中肝陽(yáng)、肝火、氣郁、寒凝中,女性比例大于男性,在氣虛病機(jī)證素中,男性比例大于女性。肝經(jīng)病機(jī)證素最常見(jiàn)的影響因素為急躁易怒。
[Abstract]:Objective: in clinical work, the causes of internal injuries and headaches are various, the pathogenesis is complicated and the syndrome is multiterminal. There are many uncertain factors in the diagnosis process of syndrome differentiation. The traditional Chinese medicine culture has a long history, and the traditional Chinese medicine theory has a long history on the etiology and pathogenesis of internal injury headache, although there are many opinions on the liver, but most of them are from the liver. In order to find out the factors related to the pathogenesis of the disease, find the factors related to the pathogenesis of the disease, find the role of the liver meridian syndrome in the internal injury and headache, and provide evidence-based medical evidence for the treatment of the headache and headache from the liver. Methods: To summarize and review the interpretation of the internal injuries and the relationship between the headache and the liver, and to dig out the pathogenesis of the liver disease and the internal injury. The theoretical basis of the headache is closely related. Using the questionnaire on the pathogenesis of internal injury and headache, the clinical data of the patients were collected, and the diagnosis was made by using the SPSS19.0 database. Status, and further explore the factors affecting the pathogenesis of these diseases. Results: (1) the distribution regularity of the liver meridian syndrome: from the frequency of distribution, the frequency of liver Yang and liver fire is obviously higher than that of other diseases; the blood deficiency is third, which is the most frequent occurrence rate of deficiency syndrome. (2) liver Yang, liver fire and qi depression are both three It can lead to internal injuries and headache independently, and often combined with each other to cause internal injury headache. In the onset of internal injury headache, liver Yang, liver fire, qi depression can cause the corresponding syndrome alone or combined with other diseases, and often with other diseases and syndromes caused by internal injury and headache, forming complex syndromes. (3) the liver meridian syndrome factor affects the internal injury headache index. Through non parameter test, it was found that liver Yang and liver fire syndrome factor had significant influence on the headache score, and the headache score of liver Yang and liver fire disease machine syndrome was significantly higher than that of non liver Yang, non liver fire person; cold coagulation and phlegm disease syndrome factor also had influence on the degree of internal injury headache. (4) liver meridian syndrome factor influenced the course of internal injury and headache: non parameter examination. It is found that the liver Yang, liver fire, qi depression, blood deficiency and yin deficiency syndrome factors have an influence on the course number, the course number of the patients with liver meridian syndrome is longer than that of the non hepatic meridian syndrome, and the course number of the patients with Yin deficiency and yin deficiency is longer. (5) the phase correlation of the disease factor and age: liver fire, qi depression, blood stasis and yin deficiency syndrome element in age composition Among the liver fire, blood stasis and yin deficiency syndrome, the highest proportion is the elderly group; in the qi depression machine syndrome, the largest proportion is the youth group. (6) the correlation between the pathogenesis factor and sex: Liver Yang, liver fire, qi depression, cold coagulation and Qi deficiency syndrome factors are different in sex composition, in which liver Yang, liver fire, cold coagulating machine Among the syndromes, the proportion of women is greater than that of men; the proportion of male positive in Qi deficiency syndrome is greater than that of women. (7) the correlation between pathogenesis and influencing factors: the factors affecting the pathogenesis of liver Yang disease are irritability, irritability, irritability, irritability, annoyance, depression, insomnia; Qi stagnation syndrome. The factors related to the hormone are menstruation, irritability, and depression; the factors affecting the syndrome factor of cold coagulation disease are the cooling of the wind and the depression; the factors affecting the pathogenesis of phlegm disease are cloudy and rainy weather; the factors affecting the Qi deficiency syndrome factor are tired, cloudy and rainy, and the factors affecting the pathogenesis of blood deficiency disease are menstruation, depression and tired: Yin deficiency pathogenesis syndrome element The influence factor is the influence factors. This study has not found the influencing factors related to the blood stasis syndrome. Conclusion: the main factors of internal injury and headache are liver Yang, liver fire, and liver meridian syndrome element is the main pathogenesis of internal injury headache. The degree of headache in liver Yang and liver fire disease machine is generally heavy. The patients with liver meridian syndrome and deficiency syndrome have a longer course of disease. In the constitution of the syndrome factors of each disease, the age related is liver fire, blood stasis, yin deficiency, qi depression, liver fire, yin deficiency, blood stasis, the most elderly people, the most young people in Qi Depression; Sex related to the liver Yang, liver fire, qi depression, cold coagulation, Qi deficiency, among which liver Yang, liver fire, qi depression, cold coagulation, the proportion of women more than men, in the Qi deficiency disease factor, the male proportion is greater than the female. The most common factor of the liver meridian pathogenesis is irritable and irritable.

【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R277.7

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