【作者】 韩立民；

【导师】 朱文锋；

【作者基本信息】 湖南中医药大学 ， 中医诊断学， 2006， 博士

【摘要】 目的:探讨胃脘痛中医辨证规律及其与相关实验指标的关系。方法:1、文献研究:对胃脘痛的相关文献和论文进行综合性研究和统计学分析,了解胃脘痛名称演化、病因病机、辨证分型及其研究进展,确定其较统一的辨证分型及相关实验指标的关系。2、临床流行病学研究:采用回顾性调查方法,对江西省南昌市900例主诉为胃脘痛的上消化道疾病患者进行统计学调查,探讨其辨证规律、辨证分型及对诊断有统计意义的重要症状。3、通过对胃脘痛患者HP感染,胃窦粘膜生长抑素含量变化的测定,胃肠运动障碍的胃阻抗运动测试,胃动素放免实验和胃泌酸功能的测定等实验分析,以图探讨其与胃脘痛各证型的关系。结果:1、文献研究:综合古今胃脘痛的相关文献,发现古人早就对胃脘痛现象进行过研究,但常常“心痛”与“胃痛”不分,从而使后世对胃脘痛产生分歧,金元医家将其作为独立的名称提出,明清时代对其证治渐趋完善;辨证分型亦多不一致,多建立在临床报道和个人经验基础上,胃脘痛辨证分型方法和辨证思路对临床和科研有一定指导意义,但忽视了证候学的客观性;文献研究以分为胃气壅滞、肝胃气滞、胃中蕴热、肝胃郁热、瘀血阻滞、胃阴不足、脾胃虚寒型为多见,与有关教材分型较一致。2、流行病学研究:根据变量聚类结果,可将胃脘痛患者症状分为七个证候群;根据多元logistic回归分析和主成分分析结果,可知每一个中医证型诊断上有统计意义的主要症状,并探讨了胃脘痛辨证与辨病的对应关系。3、实验结果显示:胃脘痛病人感染HP的可能性大于正常对照组;以实证为主的胃脘痛患者胃窦粘膜生长抑素的分泌量显著高于虚证患者及正常对照组;胃泌素分泌与胃的运动关系密切;胃酸分泌量的变化直接影响到食物的消化和吸收。结论:1、文献研究,特别是古代文献、现代文献和文献综合系统的评价是中医科研工作的重要任务和方法之一。2、流行病学回顾性调查是对中医证的规范性进行科学研究的重要手段。3、聚类分析、多元logistic回归分析和主成分分析,可对中医基本证型的分类研究提供科学依据。4、现代实验方法有助于对中医证本质的认识。更多还原

【Abstract】 Objective: To approach the diagnosis based on overall analysis of epigastralgia of traditional Chinese medicine and the relevant experimental index.Methods:1. Investigation of literature: general study and statistics analysis on epigastralgia-related literature and essays to keep abreast of the change of the name, pathogenesis, diagnostic pattern and the progress of study for the determination of more unified diagnostic pattern and its relation with relevant experimental index.2. Clinical epidemiological study: through retrospective study on the 900 cases with chief complaint of epigastralgia in upper alimentary tract in Nanchang to approach the diagnosis and pattern, and the chief symptoms with statistic significance for diagnosis.3. to study the interrelationship of the syndromes through the measurement and analysis of HP infection, content of gastric mucosa inhibition change, the functional gastrotestinel disorder, the function of motilin and gastric acid. Results:1. investigation of literature: Through general study on the ancient and present literature, we found that our forefathers did the research on the epigastralgia early in history. However, they mixed up "cardiac pain" and "stomachache", which leads to disagreement on epigastralgia in later ages. Doctors in Jin and Yuan Dynasties used it as an independent name, the diagnosis and treatment was progressively improved in Ming and Qing Dynasties. The patters were in disagreement, mostly based on clinical reports and personal experience. The patterns and approaches have guiding significance in clinical and scientific research. But the objectivity of diagnosis was neglected. The investigation of literature can be classified as wei qi yong zhi, gan wei qi zhi, wei zhong yun re, gan wei yun re, yu xue zhu zhi, wei yin bu zhu, pi wei xu han, much the same as the classification in relevant textbooks.2. Epidemiological study: according to the results of clustering analysis, the symptoms can be divided into 7 syndromes. According to the results of multi-logistic analysis and principal components analysis, we know that there are chief symptoms with statistic significance in diagnosing a syndrome pattern, with the study of differentiation of symptoms and signs of epigastralgia.3. The result of experiment: The patients with epigastralgia is more likely to have HP infection than the normal control group. The secretion of gastric antrum mucosa growth inhibition is significantly more in the cases with sthenia-syndrome than in the cases with asthenia-syndrome and the control group. The gastrin secretion has much to do with the movement of stomach. The change of quantity of the secretion of gastric acid has direct influence on the digestion and absorption of food.Conclusion:1. The investigation of literature, especially the general study of ancient and modern literature, is one of the important tasks and approaches in the scientific research of traditional Chinese medicine.2. The retrospective approach to the clinical epidemiological study has certain scientific significance in standardizing research of syndromes of traditional Chinese medicine.3. Clustering analysis, multi logistic analysis and principal components analysis are helpful in the differentiation of symptoms and signs of epigastralgia.4. Modern experimental approaches are helpful for the acknowledgment of the nature of the syndrome.更多还原