【作者】 黄文李；

【导师】 陈蔚文；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2002， 博士

【摘要】 研究目的 结合文献资料研究和导师临床治疗便秘的经验，以补肾益气养血润肠通便为主要治法，自拟“温补润下方”组方，对慢性功能性便秘患者和动物模型进行研究，以探讨补肾益气养血法与“温补润下方”对慢性功能性便秘的治疗作用，为该方临床用于治疗慢性功能性便秘，特别是老年人便秘，提供科学依据。 研究方法 1 临床研究方法：采用随机、对照方法，将临床符合慢性功能性便秘诊断标准的患者，分为两组，治疗组服用“温补润下方”水煎液，同时以便秘通口服液为对照。观察“温补润下方”对慢性功能性便秘的临床疗效、治疗后症状改善疗效、两组治疗后症状改善疗效的比较以及临床副作用。 2 实验研究方法：选择正常小鼠、燥结便秘模型小鼠、复方地芬诺酯便秘模型小鼠为观察对象，分别灌胃“温补润下方”不同剂量。同时以秘通口服液为阳性药对照和蒸馏水为空白对照，观察“温补润下方”对上述各种小鼠排便功能的影响。并且采用均匀设计方法对“温补润下方”中各味药物最佳剂量配伍进行筛选以找出该方最佳组方。 研究结果 1 临床研究结果：“温补润下方”组总有效率为92.7％、与便秘通口服液组对比，差异无显著性意义(P＞0.05)，两组不同年龄段患者分析，年龄等于、大于50岁患者中，治疗组疗效明显优于对照组(P＜0.05)。两组治疗后主要症状均有显著好转(P＜0.05)，在减少排便费力症状，治疗组疗效优于对照组(P＜0.05)。治疗过程中，有个别患者出现轻度腹痛、头晕，症状可自行消失。 2 实验研究结果：结果表明“温补润下方”水煎液能使正常小鼠、燥结便秘模型小鼠第一次排黑便时间缩短，粪便总粒数、黑便粒数增加；使复方地芬诺酯便秘模型小鼠干粪总粒数、稀粪点数 黄文李：补肾益气养血店治疗慢性功能性便秘的临床观察和实验研究明显增加（Pq．of），不排便动物数明显减少；sg｝w＝lxx－－－－－－正常小鼠小肠推进率。拆方实蛾果表明该杆蹦中，肉众蓉、黄蔑、何首乌、白芍等四味对促边由F腕明显作用，其中肉从蓉贡献最大，是为本方的君药，其次分别为黄蔑、日芍、何首乌，是为本方的臣、佐、使药，而棒湘p、莱葩子起作用不明显。结0，＿b左该方最佳剂量配比是以肉灰蓉、黄蔑、何首乌、白芍等四味药组成，剂量分别为259、209、15g、10g。实验验证结果与fNWg结果相粕。结论 “温补润下方”临床治疗慢性功能牲便秘，疗效显著，特别适用于 性便秘。Bop费力症状重便秘患者，其副作用小。对g型有明显的E便作用c该方以肉从蓉259、黄蔑209。白芍匕、何首乌10g组成，S日色最佳疗效。更多还原

【Abstract】 AIM: To observe the therapeutic effects and safety of "WenBuRunXiaFang", which based on therapeutic principle of reinforcing kidney; strengthening Qi, nourishing blood and lubricating bowels to purgation, for treatment of CFC, specially for older age of CFC Ihrough clinical and experimental study, screen out the best dose-matched manner of all the drugs in "WenBuRunXiaFang" , and therefore provided scientific evident for "WenBuRunXiaFang" in clinical treatment of CFC.METHODS1 Clinical research method: CFC examples were randomly divided in to two group: treat group (treated with WenBu RunXiaFang )and control group(treated with "BianBiTong oral solution"), aiming to observe the purgation effect and symptom improvement effect of "WenBuRunXiaFang" on treatment of CFC, and compare the curative effect of two groups and find out its side effect2 Experiment research method: Normal mice ,constipation mice and DC constipation mice randomly divided into groups, separate given orally administrated with "WenBuRunXiaFang" decoction in different dosage(30> 15 > 7.5g/kg), "BianBiTong oral solution" and distilled water respectively. Aiming to observe the purgation effect of "WenBuR.unXiaFang" on those mice. Furthermore ,used uniform design method and regression analysis method, aiming screened out41 WenBuRunXiaFang" the best dose-matched manner of all the drugs.RESULTS1 Clinical research resuhs: The results showed that there were not distinct difierence between the two groups (P>0.05), However, as analyzed the patients in different age stages, the effect of treat group was obviously better than that of control group in the patients older than fifty years. The prime symptoms of two groups after treatment were both vastly improved(P<0.05), and treat group was superior than control group in easeing defecation efforts(P<0.05)=2 Experiment research results: results showed that ’WenBuRunXiaFang’’ could made the first time of passing black stools of normal mice ,constipation mice shorter: the total number of excrement drop, the total number of black stools, and the weight of excrement increased; could made total number of dry and wet faeces of DC constipation mice increased too. The Experiment results was also suggested "WenBuRunXiaFang" has the function of advancing small intestinal movement, and appears a dose-dependent manner. Combination study results indicated that four dru^Cistanche salsa , Astragalus membranaceus , Paeonia lactiflora Pall and Polygonum multiflonan Thunb ) of "WenBuRunXiaFang" play a major role in purgation action., Furthermore, among the four drugs, Cistanche salsa takes the most important role, which considered as the principle of "WenBuRunXiaFang". Astragalus membranaceus , Paeonia lactiflora Pall and Polygonum mdtiflojian Thunb ,then ,are thinked as the associate , adjuvant and messenger of the prescription respectively. Areca cathecu and Raphamis sativus exert little effect The study also screened out the best dose-matched manner of all the drugs : Cistanche salsa 25g, Astragalus membranaceus 20g. Paeonia lactiflora Pall 15g and Polygonum multiflorum Thunb lOg. Areca cathecu and Raphamis sativus were excludedConclusion "WenBuRunXiaFang" has distinctive purgation effect, clinical treatment of CFC, effect is obviously, especially fit to older age of CFC or take great efforts to move bowels of CFC patient Can successfully improve the primary symptoms of the patients and induce little side effect. Prescrption which composed of Cistanche salsa 25g, Astragalus membranaceus 20g, Paeonia lactiflora Pall 15gand Pofygonum multiflorum Thunb 1 Og can exert the best eflfect.更多还原