歸脾湯加減內(nèi)外合治心脾兩虛型失眠的臨床研究
發(fā)布時間：2018-11-29 07:18
【摘要】：研究目的對歸脾湯加減內(nèi)外合治心脾兩虛型失眠進行臨床觀察,以期客觀評價其臨床療效,為今后尋找更易推廣的中醫(yī)內(nèi)外合治法提高失眠療效提供新的思路;創(chuàng)新性地觀察及比較中藥足浴與溫水足浴輔助治療失眠的臨床療效,進一步評估中藥足浴的療效并探討其作用機理,從而為中藥足浴法提高失眠療效提供臨床依據(jù)。研究方法選取北京中醫(yī)藥大學東直門醫(yī)院腦病科門診符合病例篩選標準的心脾兩虛型失眠癥患者,隨機分配至內(nèi)服湯藥組(A組)、內(nèi)服湯藥配合溫水足浴組(B組)、內(nèi)服湯藥配合中藥足浴組(C組)。A組予歸脾湯加減口服,日一劑,早晚分服。B組予歸脾湯加減口服的基礎上,同時配合溫水足浴,每晚一次。C組予歸脾湯加減口服的基礎上,同時將湯藥藥渣加水用于足浴,每晚一次。三組療程均為28天,療程結(jié)束后觀察三組中醫(yī)證候積分及PSQI評分的變化,并判定臨床療效。研究結(jié)果1.基線資料方面,本研究共入組病例60例,其中內(nèi)服湯藥組(A組)20例,內(nèi)服湯藥配合溫水足浴組(B組)20例,內(nèi)服湯藥配合中藥足浴組(C組)20例。三組病人入組當天的性別、年齡、病程、身高、體重、文化程度、職業(yè)分布、中醫(yī)證候積分及PSQI評分等基線資料比較均無統(tǒng)計學意義(P0.05),具有可比性。2.中醫(yī)證候積分方面,治療結(jié)束后,三組患者各癥狀積分及總分較治療前均有所下降,差異有統(tǒng)計學意義(P0.05)。其中在失眠、食少納呆、神疲乏力、氣短懶言、面色fD白、唇爪淡白、畏寒肢冷、舌質(zhì)舌苔及總分方面,三組有明顯差異(P0.05)。食少納呆、神疲乏力及畏寒肢冷方面,B組優(yōu)于A組(P0.05),C組明顯優(yōu)于A、B兩組(P0.05)。而在失眠、氣短懶言、面色fD白、唇爪淡白、舌質(zhì)舌苔及總分方面,A組與B組并無明顯異(P0.05),但C組仍明顯優(yōu)于A、B兩組(P0.05)。提示C組能有效緩解患者失眠癥狀及伴隨癥狀,且均優(yōu)于A、B兩組;而在食少納呆、神疲乏力及畏寒肢冷方面,B組優(yōu)于A組。3.PSQI評分方面,治療結(jié)束后,三組患者PSQI各單項評分及總分較治療前均有所下降,差異有統(tǒng)計學意義(P0.05)。其中睡眠質(zhì)量、入睡時間及總分方面,三組有明顯差異(P0.05)。入睡時間及日間功能障礙方面,B組優(yōu)于A組(P0.05),C組優(yōu)于A、B兩組(P0.05)。總分方面,C組優(yōu)于A、B組兩組(P0.05),A組與B組并無明顯差異(P0.05)。提示C組在降低PSQI評分及入睡時間、日間功能障礙兩項單項積分方面明顯優(yōu)于A、B兩組;而B組在入睡時間、日間功能障礙方面明顯優(yōu)于A組。4.失眠的中醫(yī)證候療效方面,治療結(jié)束后,A組總有效率為80.00%,B組總有效率為85%,C組總有效率為90%。且存在明顯差異(P0.05)。其中經(jīng)統(tǒng)計后A組與B組療效類似(P0.05);C組療效明顯優(yōu)于A組、B組(P0.05)。提示C組在中醫(yī)證候療效方面明顯優(yōu)于A組、B組,A組與B組中醫(yī)證候療效類似。5.失眠的綜合臨床療效方面,治療結(jié)束后,A組總有效率為80.00%,B組總有效率為85%,C組總有效率為95%。且存在明顯差異(P0.05)。其中經(jīng)統(tǒng)計后A組與B組療效類似(P0.05),C組療效明顯優(yōu)于A組及B組(P0.05)。提示C組在臨床療效方面明顯優(yōu)于A組、B組,A組與B組臨床療效類似。研究結(jié)論歸脾湯加減內(nèi)外合治的綜合療法在降低患者PSQI評分及改善中醫(yī)臨床癥狀方面明顯優(yōu)于單純內(nèi)服湯藥及配合溫水足浴的方案,配合溫水足浴在改善食少納呆、神疲乏力及畏寒肢冷等癥狀方面及入睡時間、日間功能障礙方面優(yōu)于單純內(nèi)服湯藥。總體來說,歸脾湯加減內(nèi)外合治的綜合療法有著較好的臨床療效,值得在基層推廣應用。
[Abstract]:The purpose of this study is to make a clinical observation on the deficiency type insomnia of the spleen and the spleen, which is combined with the addition and subtraction of the spleen and the stomach, in order to evaluate the clinical curative effect objectively, and to provide a new thought for the improvement of the curative effect of the internal and external combination of the traditional Chinese medicine for improving the curative effect of the insomnia in the future; The curative effect of the traditional Chinese medicine foot bath and the warm water foot bath in the treatment of insomnia is observed and compared, and the curative effect of the traditional Chinese medicine foot bath is further evaluated and the action mechanism of the traditional Chinese medicine foot bath is further evaluated, so that the clinical basis for improving the curative effect of the insomnia is provided for the traditional Chinese medicine foot bath method. The method of the study was to select the patients with two-deficiency type of heart and spleen in the outpatient department of Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine. The patients were randomly assigned to the oral decoction group (group A), and the oral decoction was combined with the warm water foot bath group (group B), and the oral decoction was used to match the traditional Chinese medicine foot bath group (group C). Group A is prepared by the following steps of: adding and adding the spleen and the decoction for oral administration, and taking the day and evening as an agent, and taking the decoction in the morning and the evening. The B group was given to the spleen and soup for oral administration, and the warm water foot bath was used for every night. Group C was taken as the basis of the addition and subtraction of the decoction of the spleen and the decoction, and the decoction dregs were added to the foot bath for once every night. The three-group treatment course was 28 days. After the course of treatment, three groups of TCM syndrome and the change of PSQI score were observed, and the clinical curative effect was determined. Study Results 1. On the basis of the baseline data, 60 cases were enrolled in the study, of which 20 cases were taken orally and 20 cases of the warm water foot bath group (group B) were matched with the oral decoction, and 20 cases were matched with the traditional Chinese medicine foot bath group (group C). The sex, age, course, height, body weight, degree of culture, occupational distribution, symptom score and PSQI score of the three groups were not statistically significant (P0.05). After the end of the treatment, the symptoms and total score of the three groups decreased and the difference was statistically significant (P0.05). Among them, there were significant differences in the three groups (P0.05). In group B, group B was superior to group A (P0.05), and group C was better than that of group A and B (P0.05). There was no significant difference between group A and group B in group A and group B (P <0.05), but group C was better than that in group A and B (P <0.05). in group B, group B was better than that of group A and group B in group A and B in group B, and in group B, group B was better than group A. The scores of PSQI and the total score of PSQI in three groups were decreased and the difference was statistically significant (P0.05). Among the three groups, the sleep quality, time of sleep and total score were significantly different (P0.05). In group B, group B was superior to group A (P0.05), and group C was superior to group A and group B (P0.05). In terms of total score, group C was superior to group A and group B (P0.05), and there was no significant difference between group A and group B (P0.05). The results showed that group C was better than that of group A and group B in the aspects of reducing PSQI score and falling asleep time and daytime dysfunction, while group B was significantly better than group A in time of sleep and daytime dysfunction. After the treatment, the total effective rate of group A was 80.00%, the total effective rate of group B was 85%, and the total effective rate of C group was 90%. and there was a significant difference (P0.05). The effect of group A and group B was similar to that of group B (P0.05). The curative effect of group C was better than that of group A and group B (P0.05). The results showed that group A and group B were better than group A and group B, and group A and group B were similar to those in group B. The total effective rate of group A was 80.00%, the total effective rate of group B was 85% and the total effective rate of C group was 95%. and there was a significant difference (P0.05). The effect of group A and group B was similar to that of group B (P0.05), and the curative effect of group C was better than that of group A and group B (P0.05). The clinical effect of group A and group B was similar to that of group A and group B. The result of the study is that the combined therapy of the external and external combination treatment of the spleen decoction is superior to that of the pure oral decoction and the warm water foot bath in the aspect of reducing the PSQI score of the patient and improving the clinical symptoms of the traditional Chinese medicine, The symptoms such as the fatigue force of God and the cold limbs cold and other symptoms and the time of falling asleep and the day dysfunction are superior to the pure oral decoction. In general, the combination therapy for both internal and external treatment of the spleen and the stomach has a good clinical curative effect, and is worthy of being popularized and applied at the grass-roots level.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R256.23
本文編號：2364302
[Abstract]:The purpose of this study is to make a clinical observation on the deficiency type insomnia of the spleen and the spleen, which is combined with the addition and subtraction of the spleen and the stomach, in order to evaluate the clinical curative effect objectively, and to provide a new thought for the improvement of the curative effect of the internal and external combination of the traditional Chinese medicine for improving the curative effect of the insomnia in the future; The curative effect of the traditional Chinese medicine foot bath and the warm water foot bath in the treatment of insomnia is observed and compared, and the curative effect of the traditional Chinese medicine foot bath is further evaluated and the action mechanism of the traditional Chinese medicine foot bath is further evaluated, so that the clinical basis for improving the curative effect of the insomnia is provided for the traditional Chinese medicine foot bath method. The method of the study was to select the patients with two-deficiency type of heart and spleen in the outpatient department of Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine. The patients were randomly assigned to the oral decoction group (group A), and the oral decoction was combined with the warm water foot bath group (group B), and the oral decoction was used to match the traditional Chinese medicine foot bath group (group C). Group A is prepared by the following steps of: adding and adding the spleen and the decoction for oral administration, and taking the day and evening as an agent, and taking the decoction in the morning and the evening. The B group was given to the spleen and soup for oral administration, and the warm water foot bath was used for every night. Group C was taken as the basis of the addition and subtraction of the decoction of the spleen and the decoction, and the decoction dregs were added to the foot bath for once every night. The three-group treatment course was 28 days. After the course of treatment, three groups of TCM syndrome and the change of PSQI score were observed, and the clinical curative effect was determined. Study Results 1. On the basis of the baseline data, 60 cases were enrolled in the study, of which 20 cases were taken orally and 20 cases of the warm water foot bath group (group B) were matched with the oral decoction, and 20 cases were matched with the traditional Chinese medicine foot bath group (group C). The sex, age, course, height, body weight, degree of culture, occupational distribution, symptom score and PSQI score of the three groups were not statistically significant (P0.05). After the end of the treatment, the symptoms and total score of the three groups decreased and the difference was statistically significant (P0.05). Among them, there were significant differences in the three groups (P0.05). In group B, group B was superior to group A (P0.05), and group C was better than that of group A and B (P0.05). There was no significant difference between group A and group B in group A and group B (P <0.05), but group C was better than that in group A and B (P <0.05). in group B, group B was better than that of group A and group B in group A and B in group B, and in group B, group B was better than group A. The scores of PSQI and the total score of PSQI in three groups were decreased and the difference was statistically significant (P0.05). Among the three groups, the sleep quality, time of sleep and total score were significantly different (P0.05). In group B, group B was superior to group A (P0.05), and group C was superior to group A and group B (P0.05). In terms of total score, group C was superior to group A and group B (P0.05), and there was no significant difference between group A and group B (P0.05). The results showed that group C was better than that of group A and group B in the aspects of reducing PSQI score and falling asleep time and daytime dysfunction, while group B was significantly better than group A in time of sleep and daytime dysfunction. After the treatment, the total effective rate of group A was 80.00%, the total effective rate of group B was 85%, and the total effective rate of C group was 90%. and there was a significant difference (P0.05). The effect of group A and group B was similar to that of group B (P0.05). The curative effect of group C was better than that of group A and group B (P0.05). The results showed that group A and group B were better than group A and group B, and group A and group B were similar to those in group B. The total effective rate of group A was 80.00%, the total effective rate of group B was 85% and the total effective rate of C group was 95%. and there was a significant difference (P0.05). The effect of group A and group B was similar to that of group B (P0.05), and the curative effect of group C was better than that of group A and group B (P0.05). The clinical effect of group A and group B was similar to that of group A and group B. The result of the study is that the combined therapy of the external and external combination treatment of the spleen decoction is superior to that of the pure oral decoction and the warm water foot bath in the aspect of reducing the PSQI score of the patient and improving the clinical symptoms of the traditional Chinese medicine, The symptoms such as the fatigue force of God and the cold limbs cold and other symptoms and the time of falling asleep and the day dysfunction are superior to the pure oral decoction. In general, the combination therapy for both internal and external treatment of the spleen and the stomach has a good clinical curative effect, and is worthy of being popularized and applied at the grass-roots level.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R256.23
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