【摘要】：目的:本課題從李濟仁教授治療痹病和痿病的臨床病案著手,使用TCMISS(V2.5)對符合納入標準的臨床病案進行統(tǒng)計分析和數據挖掘,結合中醫(yī)學理論知識,對痹病和痿病的癥狀-證候-治則治法-中藥進行比較研究,著重探討李濟仁教授治療痹病、痿病的用藥規(guī)律,進一步探討其“痹痿統(tǒng)一論”的學術思想。方法:收集2015年1月—2016年12月李濟仁教授診治的痹病、痿病患者完整病歷(門診),按照納入、排除標準進行篩選,將入選的痹病、痿病各50例病歷,包括相關患者基本情況、臨床癥狀、辨證分型、選方用藥等情況,在中醫(yī)傳承輔助系統(tǒng)中構建數據庫,通過頻數、關聯(lián)規(guī)則、卡方檢驗等分析方法,得到癥狀、證候、治則治法、中藥等方面的統(tǒng)計結果,比較分析痹病和痿病的用藥規(guī)律。結果:研究結果發(fā)現(xiàn),痹病和痿病同時出現(xiàn)的癥狀、證候、治則治法方面,大部分存在統(tǒng)計學差異。癥狀上,痹病和痿病患者在乏力、行走困難、肌肉萎縮以及腰痛等癥狀分布具有顯著統(tǒng)計學差異(P0.01);證候上,痹病和痿病患者中肝腎虧虛證、寒濕阻絡證、濕熱阻痹證、瘀血阻絡證等證候組比較存在統(tǒng)計學差異(P0.05),說明痹病和痿病患者在上述證候分布方面不完全相同,且痹病和痿病患者在寒濕阻絡證、瘀血阻絡證兩組證候分布比較具有顯著統(tǒng)計學差異(P0.01)。其中肝腎虧虛證在痹病和痿病患者證候中頻次最高;痹病和痿病患者中使用活血舒筋、溫補氣血、溫化寒濕等治則治法組存在統(tǒng)計學差異(P0.05),說明痹病和痿病的治則治法不完全相同,其中滋補肝腎、活血舒筋在痹病和痿病患者治則治法中頻次最高。痹病和痿病中同時出現(xiàn)的頻次較高的藥物有:黃芪、全蝎、當歸、千年健、雞血藤、活血藤、狗脊、補骨脂、五加皮、牛膝、生地黃、炒白術等,四氣均以溫、平藥物為主,溫藥出現(xiàn)頻次最多;五味以苦、辛、甘為主;歸經均以入肝、腎、脾、心、胃經藥物為主,其中肝經和腎經藥物出現(xiàn)頻次最多;同時挖掘出痹病新方4首,痿病新方6首。結論:痹病和痿病患者均可以出現(xiàn)以“乏力”、“行走困難”、“肌肉萎縮”等為主要表現(xiàn)的癥狀;“肝腎虧虛證”在痹病和痿病患者證候中出現(xiàn)頻次最高,是痹病和痿病的主要證候;“滋補肝腎”、“活血舒筋”是痹病和痿病患者出現(xiàn)頻次最高的治則治法;治療藥物多以肝經、腎經藥物為主。痹病和痿病在癥狀、證候、治則治法、中藥方面有著相似性和聯(lián)系性,為李濟仁教授“痹痿統(tǒng)一論”和“治痿專重肝腎”思想提供了一定意義上的臨床實例和參考。
[Abstract]:Objective: to start with Professor Li Jiren's clinical records of treating arthralgia and impotence, and use TCMISS (V2.5) to analyze and mine the clinical medical records according to the inclusive criteria, and combine with the theoretical knowledge of traditional Chinese medicine (TCM). This paper makes a comparative study on symptoms, syndromes, principles of treatment and traditional Chinese medicine of arthralgia and impotence, emphasizes on professor Li Jiren's treatment of arthralgia and impotence, and further probes into his academic thought of "unified theory of arthralgia and impotence". Methods: from January 2015 to December 2016, the complete medical records (outpatient) of the patients with arthralgia and impotence were collected and screened according to the inclusive and exclusion criteria. Each of the 50 cases of arthralgia and impotence was selected, including the basic information of the related patients. Clinical symptoms, syndrome differentiation and drug use, etc., to construct a database in the system of traditional Chinese medicine inheritance and assistance, through frequency, association rules, chi-square test and other analytical methods, to obtain symptoms, syndromes, and treatment methods. The statistical results of traditional Chinese medicine and other aspects, comparative analysis of arthralgia disease and impotence drug use law. Results: most of the symptoms, syndromes and treatments of arthralgia and impotence were statistically different. There were significant differences in the distribution of symptoms such as fatigue, difficulty in walking, muscular atrophy and low back pain between patients with arthralgia and arthralgia (P0.01); syndromes: deficiency of liver and kidney, cold and dampness, obstruction of collaterals, dampness and heat blocking arthralgia, syndrome of deficiency of liver and kidney, syndrome of dampness and dampness, and arthralgia of dampness and heat. There was a statistical difference between the syndrome groups of stagnation of blood and obstruction of collaterals (P0.05), which indicated that the distribution of the above syndromes was not identical in the patients with arthralgia and impotence, and the patients with arthralgia and impotence were in the syndrome of blocking collaterals with cold and dampness. There was significant difference in the distribution of syndrome between the two groups (P0.01). The syndrome of deficiency of liver and kidney is the highest in the syndrome of arthralgia and impotence. There was statistical difference between the two groups (P0.05), which indicated that the treatment principles of arthralgia and impotence were not the same, among which nourishing liver and kidney, activating blood circulation and Shujin were the highest in the treatment of arthralgia and impotence. The drugs with higher frequency in both arthralgia and impotence include astragalus, scorpion, angelica sinensis, healthy chicken, blood activating rattan, dog ridge, psoralen bone fat, Acanthopanax, Achyranthes bidentata, Rehmannia Rehmanniae, Atractylodes macrocephala, and so on. The most frequent appearance of warm drugs; the five flavors of bitter, Xin, Gan mainly; return to the liver, kidney, spleen, heart, stomach meridian drugs mainly, in which liver and kidney meridian drugs appear the most frequently; at the same time, excavated the disease of 4 new prescription, 6 new prescription of impotence. Conclusion: "fatigue", "walking difficulty" and "muscular atrophy" are the main symptoms in patients with arthralgia and impotence, and "liver-kidney deficiency syndrome" is the most frequent symptom in patients with arthralgia and impotence. It is the main syndromes of arthralgia and impotence; "nourishing liver and kidney" and "activating blood circulation and soothing muscle" are the most frequent treatment methods for patients with arthralgia and impotence; the main treatment drugs are liver meridian and kidney meridian drugs. Arthralgia and impotence have similarities and connections in symptoms, syndromes, principles of treatment and traditional Chinese medicine, which provide some clinical examples and references for Professor Li Jiren's thought of "unified theory of arthralgia and impotence" and "treating impotence with special emphasis on liver and kidney".
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R249;R255.6

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