【作者】 赖福顺；

【导师】 汪悦；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2010， 博士

【摘要】 目的：通过随机对照临床试验,观察健脾祛湿药膳治疗肥胖病证患者,中医证候、症状、身体质量指数(BMI)、体重、腰围、臀围、空腹血糖、血脂等指标的影响。方法：采用随机化对照的研究方法,将符合肥胖病、脾虚湿阻证诊断标准的患者,分为治疗组和对照组。对照组采用饮食控制,运动、均衡营养浓汤,每次250g,每日3次,疗程均为3个月。治疗组采用饮食控制、运动、荷叶药膳浓汤,每次250g,每日3次,疗程均为3个月。治疗前后两组分别观察临床症状、体征、舌象、脉象、BMI、体重、腰围、臀围、空腹血糖、血脂的变化。全部数据以SPSS13.0统计软件进行统计学分析。结果：1.文献研究：通过对肥胖病脾虚湿阻及相关药膳文献的研究,探讨了中西医对肥胖病的病因病机,治疗现状和荷叶药膳浓汤治疗肥胖病相关研究,揭示了药膳改善肥胖病,降低脂肪的机理,提出了健脾祛湿药膳是治疗该病的一个有效方法。2.肥胖病临床研究：通过随机对照的临床试验,确诊并最后纳入的肥胖病脾虚湿阻患者70例(治疗组35例,对照组35例),治疗前两组的性别、年龄、病程等基线数据经统计学处理无显著性差异(P>0.05)有可比性。治疗结果发现：①治疗组治疗后体重显著改善,与治疗前相比有显著差异(P<0.01),与对照组治疗后比较也有明显差异(P<0.01)；并且两组治疗前后比较,治疗组与治疗前有显著性差异(P<0.01)对照组身体质量指数(BMI)与治疗前有明显差异。说明加用药膳后,对体重、身体质量指数(BMI)均有明显改善作用。②治疗后,治疗组患者中医临床症状有明显改善,尤其腰膝酸软,浮肿尿少、倦怠乏力等症状较对照组有明显差别(P<0.01)说明本疗法可改善中医临床症状。③治疗组患者治疗后HDL水平升高,与治疗前比较有显著性差异(P<0.01)；对照组各项血脂指标与治疗前比较没有差异(P>0.05),说明本疗法有明显的升高HDL作用。④治疗组患者治疗后中医临床证候积分有明显改善,显效率为62.85%,有效率为28.57%,总有效率为91.42%提示健脾祛湿药膳对肥胖病脾虚湿阻证有明显的治疗作用。对照组中医证候疗效为显效率20%,有效率54.28%,总有效率74.28%。组间对比表明治疗组中医证候的改善明显优于对照组,经统计学处理,有显著性差别(P<0.01)。⑤治疗组总有效率为85.71%,对照组总有效率为62.85%,经卡方检验,有显著差异(P<0.01),说明健脾祛湿药膳对肥胖病脾虚湿阻具有较好的疗效。结论：从初步临床研究来看,健脾祛湿药膳对肥胖病肾脾虚湿阻具有较好的疗效。药膳营养浓汤结合,既可改善患者的临床症状、体征,又能降低体重,控制身体质量指数(BMI),并有调节HDL的作用,具有广泛的应用前景,值得进一步深入研究。更多还原

【Abstract】 Purpose:Via the randomized controlled clinic trials to observe the obese patients treated with the Chinese medicated diet of invigorating spleen Qi and dispelling dampness, and its influence on symptoms or manifestations of the disease (from the viewpoint of traditional Chinese medicine (TCM)), BMI, weight, waist,hip, fasting blood glucose,and blood lipid.Method:The random contrast research method was adopted, and the patients that accorded with the diagnosis standards of obesity and syndrome of internal dampness due to spleen deficiency were divided into the therapeutic group, which adopted diet control, exercise, and the Chinese medicated diet lotus leaf rich soup, and the control group, which adopted diet control, exercise, and balanced nutritious rich soup; the rich soup of both groups was offered 250g at a time and three times a day, and the period of treatment of both groups were three months. The variations of the two groups on clinical symptom, physical sign, tongue manifestation, pulse condition, BMI, weight, waist, hip, fasting blood glucose, and blood lipid before and after the treatment were observed respectively, and the entire data were analyzed by SPSS 13.0 statistical software.Results:1. Literature survey: Through the research of literature of obesity, internal dampness due to spleen deficiency, and related literature of Chinese medicated diet, the research of Chinese medicine’s and western medicine’s inference on cause of sickness of obesity, present condition of treatment, and the relevant research of utilizing the Chinese medicated diet lotus leaf rich soup to treat obesity were explored, the Chinese medicated diet lotus leaf rich soup’s mechanism of stimulating to improve obesity and reducing the fat was revealed, and the theory that the combination of Chinese medicine, western medicine, and the Chinese medicated diet of invigorating spleen Qi and dispelling dampness is an effective way of treating obesity was advanced. 2. Obesity clinical research:Via the randomized controlled clinical trials, seventy patients of obesity and internal dampness due to spleen deficiency were identified and included (35 patients in the therapeutic group, and 35 patients in the control group); before the treatment, the two groups’baseline data on gender, age, and period (of disease) were processed statistically, and there was no significant difference (P>0.05), yet there was comparability. The research findings are as follows:(1) After the treatment, the weight of the therapeutic group was obviously improved;the post-treatment weight of the therapeutic group had a significant difference from the pre-treatment weight of the same group (P<0.01); the post-treatment weight of the therapeutic group had a significant difference from that of the control group as well (P<0.01); moreover, comparing the two groups before and after the treatment, the weight of the therapeutic group and pre-treatment had significant difference (P<0.01), yet BMI of the control group and pre-treatment had significant difference. This explains that adding the Chinese medicated diet of lotus leaf has an apparent function of improvement on weight and BMI. (2) After the treatment, the therapeutic group patients’clinical symptoms of TCM were conspicuously improved, and they had a significant difference from those of the control group especially on soreness of the waist and knees, edema and oliguria, and tiredness and weakness (p<0.01); this explains that the therapy can better the clinical symptoms of TCM. (3) The therapeutic patients’ post-treatment HDL level boosted, and compared to the pre-treatment HDL level of the same group, there was a significant difference (P<0.01); each blood lipid index of the control group had no significant difference from that before the treatment (P>0.05). This shows that the therapy has a clear function of elevating HDL. (4) The therapeutic group patients’post-treatment TCM clinical integration of clinical symptoms was evidently improved, the markedly effective rate was 62.85%, the effective rate was 28.57%, and the total effective rate was 91.42%, pointing out that the combination of Chinese medicine, western medicine, and the Chinese medicated diet of invigorating spleen Qi and dispelling dampness has a strikingly therapeutic effect on obesity and syndrome of internal dampness due to spleen deficiency. The control group’s TCM symptom curative effect was:markedly effective rate:20%, effective rate:54.28%, and total effective rate:74.28%.The comparison between the groups manifested that the TCM symptom improvement of the therapeutic group was obviously better than that of the control group, and there was a significant difference after being processed statistically (P<0.01). (5) The total effective rate of the therapeutic group was 85.71%, of the control group was 62.85%, and there was a significant difference through Chi-square test (P<0.01), showing that the combination of Chinese medicine, western medicine, and the Chinese medicated diet of invigorating spleen Qi and dispelling dampness has a preferable curative effect for obesity and internal dampness due to spleen deficiency.Conclusion:From the preliminary clinical research, the combination of Chinese medicine, western medicine, and the Chinese medicated diet of invigorating spleen Qi and dispelling dampness has a better curative effect for obesity and syndrome of internal dampness due to spleen deficiency. The combination of the Chinese medicated diet of invigorating spleen Qi and dispelling dampness and the nutritious rich soup not only can improve the patients’clinical symptoms and physical signs, but also can lower the weight, control BMI, and adjust HDL. It has extensive prospect of application, and is worthwhile for further profound study.更多还原