基于数据挖掘的三承气汤证研究

【作者】 曾子芸；

【导师】 陈明；

【作者基本信息】 北京中医药大学 ， 中医临床基础， 2014， 博士

【摘要】 研究目的本论文主要包含三部分内容,上篇为文献综述、中篇三承气汤的应用轨迹研究、下篇为循证医学与系统评价。上篇主要是通过探讨中医下法的理论形成依据、张仲景对下法的运用、下法的禁忌、后世医家对三承气汤的运用与发展、笔者对三承气汤之见,在探讨中医八法中的“下法”。中篇是经由全面检索、收集、阅读、统计调胃承气汤、小承气汤、大承气汤的临床研究文献与个案(个人经验)文献,整理挖掘出三承气汤的运用轨迹。下篇则是对大承气汤、小承气汤、针灸疗法、西医基础疗法等中西医结合治疗肠梗阻的随机对照试验文献,在具有相同研究内容及目的基础进行分类,依据文献资料共分为11组。在使用Review Manager基础Meta-analysis(合并统计量)研究11组对肠梗阻的治疗疗效对比。最后,基于循证医学为每个疾病寻找出最佳治疗方案的精神与目的,就此统计研究结果对肠梗阻设计出一套建议治疗方案。研究对象1发表于1949-2014年之间的调胃承气汤、小承气汤、大承气汤的期刊文献,以及以针灸疗法治疗肠梗阻的期刊文献。2大承气汤、小承气汤、针灸疗法、西医基础疗法等中西医结合治疗肠梗阻的随机对照试验期刊文献。研究方法1文献检索：于CNKI、VIP、CBM等三大数据库中,分别设定检索词为：大承气汤、复方大承气汤、大承气汤加减；小承气汤、复方小承气汤、小承气汤加减；调胃承气汤、复方调胃承气汤、调胃承气汤加减；针灸疗法治疗肠梗阻。2文献整理：基于本论文研究内容,三承气汤的应用轨迹研究、治疗肠梗阻随机对照试验之RevMan Meta分析评价,文献整理方法与步骤如下：2.1全面阅读整理所有检索获得的调胃承气汤、小承气汤、大承气汤的期刊文献,再分别归纳分类出三承气汤的临床研究文献与个案文献。2.2全面阅读整理出调胃承气汤、小承气汤、大承气汤、针灸疗法用于治疗肠梗阻的随机对照试验临床研究文献。3文献录入：三承气汤的应用轨迹研究,依照疾病系统的分类逐篇统计其治疗疾病病名；将符合每篇文献按Cochrane文献质量评价系统中7项检测逐一做记录后,删除偏倚风险过高文献,最终获得较高质量的文献资料。最后,将分类好的11组对肠梗阻的治疗方案研究,分别在Review Manager Meta-analysis中设定研究题目及录入建档。4数据处理：三承气汤的应用轨迹研究,运用EXCEL表格及基本统计学方法处理相关数据；使用Review Manager基础Meta-analysis研究11组对肠梗阻的治疗疗效对比,包含OR、RR、RD、SMD等四方面。研究内容1将调胃承气汤、小承气汤、大承气汤期刊文献逐篇统计其治疗疾病病名,从中整理挖掘出三承气汤的运用轨迹。2使用Review Manager基础Meta-analysis研究下列11组对肠梗阻的治疗方案中的疗效对比：2.1大承气汤+西医基础疗法VS单纯西医基础疗法；2.2大承气汤+西医基础疗法VS西医基础疗法+生长抑素；2.3大承气汤+西医基础疗法VS西医基础疗法+二联法；2.4大承气汤+西医基础疗法VS西医基础疗法+三联法；2.5大承气汤+西医基础疗法VS西医基础疗法+盐水灌肠；2.6大承气汤+西医基础疗法VS西医基础疗法+肥皂水灌肠；2.7大承气汤+西医基础疗法VS西医基础疗法+石蜡油灌胃；2.8大承气汤+西医基础疗法VS西医基础疗法+阿托品；2.9小承气汤+西医基础疗法VS单纯西医基础疗法；2.10针灸+西医基础疗法VS西医基础疗法；2.11大承气汤+针灸+西医基础疗法VS西医基础疗法。研究结果1由统计结果发现,小承气汤、大承气汤两方大量用于治疗消化系统疾病。其中,无论是在临床经验或个人经验记载,小承气汤、大承气汤分别均以运用于治疗肠梗阻比例最高。2遵循循证医学及使用Review Manager基础Meta-analysis(合并统计量)研究大承气汤、小承气汤、针灸疗法、西医基础疗法等中西医结合治疗肠梗阻,统计研究结果发现其疗效：1大承气汤+西医基础疗法>单纯西医基础疗法；2大承气汤+西医基础疗法>西医基础疗法+生长抑素；3大承气汤+西医基础疗法>西医基础疗法+二联法；4大承气汤+西医基础疗法>西医基础疗法+三联法；5大承气汤+西医基础疗法>西医基础疗法+盐水灌肠；6大承气汤+西医基础疗法>西医基础疗法+肥皂水灌肠；7大承气汤+西医基础疗法>西医基础疗法+石蜡油灌胃；8大承气汤+西医基础疗法>西医基础疗法+阿托品；9小承气汤+西医基础疗法>单纯西医基础疗法；10针灸+西医基础疗法>西医基础疗法；11大承气汤+针灸+西医基础疗法>西医基础疗法。由以上11组统计研究结果来看,中医学加上西医学治疗肠梗阻的治疗疗效优于单纯西医学的个种治疗方案。研究成果与肠梗阻建议治疗方案结论基于循证医学为每个疾病寻找出最佳治疗方案的精神与目的,笔者与导师陈明教授就此统计研究结果对肠梗阻设计出一套建议治疗方案,方案如下：1中药处方：大承气汤(大黄、芒硝、枳实、厚朴)；2主要加减配伍：桃仁、炒莱菔子、赤芍；3兼证3.1兼瘀血重者加：桃仁、赤芍、丹参,以活血化瘀；3.2兼食积重者加：炒莱菔子、陈皮,以和胃消积；3.3兼腹胀痛重者加：木香、延胡索,以行气止痛；3.4兼气血虚重者加：黄芪、党参、当归,以益气补血；3.5兼湿热重者加：黄芩、金银花,以清热燥湿解毒。4针灸取穴：足三里、天枢、上巨墟、中脘、关元、下巨墟；5西医基础疗法：胃肠减压,纠正水、电解质紊乱和酸碱失衡,抗感染,其他治疗。更多还原

【Abstract】 ObjectivesThere are3parts in this thesis. Part1is the literature reviews. Part2is the3kinds of ChengQi Decoction application of the trajectory study. Part3is the evidence-based medicine and systematic reviews.The first part is mainly formed by exploring the basic theory of traditional Chinese medicine. Zhang Zhong Jing is a famous ancient medical practitioner who used8methods of treatment. Purgation is one of them. Further study on the used and development of3kinds of ChengQi Decoction as a method of purgation. The3kinds of ChengQi Decoction namely: TiaoweiChengQi Decoction, XiaoChengQi Decoction and DaChengQi Decoction.The second part is through comprehensive research, collection of datas, and study of statistics. Clinical research and case studies.The third part is the consolidation of successful clinical trials and theory, classification based on the same contents and purpose for treatment. Used of DaChengQi Decoction, XiaoChengQi Decoction, Acupuncture, Western-basis treatments and Integrative Medicine treatment for Intestinal Obstruction.Research Data1Published in1949-2014Journal literature, including TiaoweiChengQi Decoction, XiaoChengQi Decoction, DaChengQi Decoction and acupuncture treatments for Intestinal Obstruction.2Journal literature of randomized controlled trials of DaChengQi Decoction, XiaoChengQi Decoction, Acupuncture, Western medicine and Integrative Medicine treatments for Intestinal Obstruction. Research Methods1Literature search:In CNKI, VIP, CBM major databases, search data were set as follows:using DaChengQi Decoction, Compound DaChengQi Decoction, DaChengQi Decoction subtraction; XiaoChengQi Decoction, Compound XiaoChengQi Decoction, XiaoChengQi Decoction subtraction; TiaoweiChengQi Decoction, compound TiaoweiChengQi Decoction, TiaoweiChengQi Decoction subtraction; Acupuncture for Intestinal Obstruction.2Literature review, discussion contents, used of Decoction, as follows:2.1Studies obtained from the used of TiaoweiChengQi Decoction, XiaoChengQi Decoction, DaChengQi Decoction. Journal literature; categorized clinical research literature and case studies of the3kinds of ChengQi Decoction.2.2Studies on controlled trials clinical research literature for TiaoweiChengQi Decoction, XiaoChengQi Decoction, DaChengQi Decoction, acupuncture for the treatment of Intestinal Obstruction.3Document Input:Statistic on the3kinds of ChengQi Decoction treatment of Intestinal Obstruction Western disease name. Quality assessment using Cochrane seven test to obtain11groups of high quality literature.Finally, using Review Manager-base Meta-analysis to study and analyzed11groups of treatment for Intestinal Obstruction.4.Data processing through Excel and Review Manager-based Meta-analysis: Application trajectory studies of the3kinds of ChengQi Decoction and comparative study of the11groups treatment on Intestinal Obstruction, including OR, RR, RD&SMD.Research Content1Sorting out the application of the3kinds of ChengQi Decoction.2Using Review Manager-based Meta-analysis contrast the efficacy of the following11 groups of Intestinal Obstruction treatment as below:2.1DaChengQi Decoction+Western-basis treatments VS Western-basis treatments;2.2DaChengQi Decoction+Western-basis treatments VS Western-basis treatments+somatostatin;2.3DaChengQi Decoction+Western-basis treatments VS Western-basis treatments+bi-therapy;2.4DaChengQi Decoction+Western-basis treatments VS Western-basis treatments+tri-therapy;2.5DaChengQi Decoction+Western-basis treatments VS Western-basis treatments+saline enema;2.6DaChengQi Decoction+Western-basis treatments VS Western-basis treatments+soapy water enema;2.7DaChengQi Decoction+Western-basis treatments VS Western-basis treatments+paraffin oil gavages;2.8DaChengQi Decoction+Western-basis treatments VS Western-basis treatments+atropine;2.9XiaoChengQi Decoction+Western-basis treatments VS Western-basis treatments;2.10Acupuncture+Western-basis treatments VS Western-basis treatments;2.11DaChengQi Decoction+acupuncture+Western-basis treatments VS Western-basis treatments.Results1Based on statistics, clinical studies as well as personal experience records both showed that DaChengQi Decoction, XiaoChengQi Decoction, are being extensively used for the treatment of digestive diseases, especially in the treatment of Intestinal Obstruction.2On the basis of evidence-based medicine and using Review Meta-analysis, the results of statistical studies are found as follow:2.1DaChengQi Decoction+Western-basis treatments>Western-basis treatments;2.2DaChengQi Decoction+Western-basis treatments>Western-basis treatments+somatostatin;2.3DaChengQi Decoction+Western-basis treatments>Western-basis treatments+bi-therapy;2.4DaChengQi Decoction+Western-basis treatments>Western-basis treatments+tri-therapy;2.5DaChengQi Decoction+Western=basis treatments>Western=basis treatments+saline enema;2.6DaChengQi Decoction+Western-basis treatments>Western-basis treatments+soapy water enema;2.7DaChengQi Decoction+Western-basis treatments>Western-basis treatments+paraffin oil gavages;2.8DaChengQi Decoction+Western-basis treatments>Western-basis treatments+atropine;2.9XiaoChengQi Decoction+Western-basis treatments>Western-basis treatments;2.10Acupuncture+Western-basis treatments>Western-basis treatments;2.11DaChengQi Decoction+acupuncture+Western-basis treatments>Western-basis treatments.Based on the study and research on the11groups,results show that I ntegrative treatment of Intestinal Obstruction is better than Western-basis treatments.ConclusionsThe author and Mentor Professor Chen Ming recommended the following treatment:1Main Prescription:DaChengQi Decoction(Da Huang,Mang Xiao,Zhi Shi,Hou Po,(Rhubarb Root,Glaube r’s Salt,Citrus Aurantium,Magnolia Bark); 2Additional medicine:add Tao Ren, Chao Lai Fu Zi, Ci Shao,(Peach Kernel, Fried Radish Seed, Red Peony);3Secondary symptom with additional medicine3.1Severe Stasis:add Tao Ren, Chi Shao, Dang Shen (Peach Kernel, Red Peony, Radix Salvia Miltiorrhiza), promote blood circulation;3.2Severe stagnation:add Chao Lai Fu Zi, Chen Pi (Fried Radish Seed, Orange Peel), promote digestion;3.3Severe abdominal distension and pain:add Mu Xiang, Yan Hu Suo,(Radix Aucklandiae, Rhizoma Corydalis) eliminate pain;3.4Energy and blood deficiency:add Huang Qi, Dang Shen, Dang Gui,(Radix Astragali, Codonopsis, Radix Angelicae Sinensis), promote energy and blood;3.5Severe damp heat:add Huang Qin, Jin Ying Hua,(Skullcap, Lonicera Japonica), reduce heat, dampness and detoxification.4Acupuncture points:Zu San Li, Tian Shu, Shang Ju Xu, Zhong Wan, Guan Yuan, Xia Ju Xu;5Western-basis treatments: For gastrointestinal decompression, balance of water, electrolyte and acid-base disorders, anti-infective and other treatments.更多还原