病机与证候并重的阴阳分治法治疗心脾两虚型失眠的临床研究

【作者】 孙晨；

【导师】 张根明；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2011， 硕士

【摘要】 失眠是临床最常见的一种睡眠障碍性疾病,随着人类社会的发展,生活节奏的不断加快,失眠已成为影响人类健康的重要因素,严重干扰人们的正常工作和生活。本文系统回顾了古今中西文献对失眠的病因病机及治疗的论述,总结了近年来中西医对失眠治疗的研究进展,比较了失眠的中西医治疗方法,指出了中医治疗失眠的优势,并针对目前中医论治失眠有两个方向,即阴阳分治法和脏腑辨证治法,虽各有所长,但不够全面的问题,提出将两种治法相结合,即将辨病机论治和辨证论治相结合,旨在充分体现中医失眠理论,更有效提升临床治疗失眠疗效。研究目的通过临床对照研究,初步探讨阴阳分治法治疗失眠的临床疗效,以及对失眠患者“昼不精,夜不瞑”病理状态的改善情况。研究方法本次研究以心脾两虚型失眠患者为研究对象,进行随机对照临床研究,共纳入45例病例,采用随机数字表随机方法,将纳入病例分为试验组和对照组,试验组采用归脾汤配合益气维血颗粒和枣仁安神液分别于晨起和睡前服用,对照组仅服用归脾汤治疗,疗程为1周,分别于治疗前和治疗1周后观察其失眠症疗效、中医证候疗效以及PSQI、mESS量表评分等疗效指标。观察结果采用SPSS18.0统计软件进行统计分析,计量资料采用t检验或秩和检验,计数资料采用x2检验,等级资料采用R检验(Ridit分析),选择双侧检验,取95%置信区间,即a=0.05。研究结果两组患者治疗后参照《中药新药治疗失眠的临床研究指导原则》标准评价的临床疗效比较,结果显示试验组总有效率86.36%与对照组总有效率75.00%比较,差别无统计学意义(P>0.05)。提示试验组疗效与对照组类似。两组患者治疗后中医证候疗效比较,结果显示试验组总有效率77.27%与对照组总有效率85.00%比较,差别无统计学意义(P>0.05)。提示试验组疗效与对照组类似。两组患者治疗前后PSQI总分均有改善,试验组患者除因子6——催眠药物外,各因子治疗前后评分均有改善,而对照组患者因子1、2、5、8治疗前后评分有改善,因子3、4、6积分治疗前后无改善。两组患者治疗后PSQI总分差别虽无统计学差异(P>0.05),但两组治疗前后PSQI总分差值比较,差别有统计学意义(P<0.05),而试验组PSQI总分差值的均值为4.045,大于对照组的2.400,提示试验组整体睡眠质量的改善程度优于对照组。单项因子中,两组PSQI因子3——睡眠时间的治疗前后差值比较,差别也具有统计学意义(P<0.05),试验组差值的均值为0.3500,大于对照组的0.8636,提示试验组治疗后睡眠时间延长程度大于对照组。结论阴阳分治法治疗心脾两虚型失眠患者与单纯辨证论治相比,失眠症疗效、中医证候疗效和日间觉醒状态改善情况类似,但整体睡眠质量改善程度较好,能更有效地延长睡眠时间。更多还原

【Abstract】 Insomnia is one of the most common clinical sleep-disordered disease. With the development of human society and the accelerating pace of life, insomnia has become an important factor that affects people’s health, and seriously disturbs people’s normal work and life. This paper systematically reviewed the Chinese and western literature on ancient etiology, pathogenesis and treatment of in- somnia, and summed up the research progress of them in recent years. Then point- ed out the advantage of TCM therapy for insomnia by comparing it with western medicine insomnia treatments. The present Chinese medicine treatment of insomnia has two directions, named "Yin Yang Fen Zhi Fa" and "Organ Syndrome diffe- rentiation". Although each of them has its strong point, but are not compre- hensive. In order to further enhance the clinical curative effect of insomnia, and Fully embody insomnia theory of Chinese medicine, the "Yin Yang Fen Zhi Fa" had been combined with "Organ Syndrome differentiation".Objective:According to the clinical research, discussed the clinical curative effect of insomnia by the "Yin Yang Fen Zhi Fa" which lay equal stress on both the laws of pathogenesis and the syndrome, and see the improvement of "Zhou Bu Jing, Ye Bu Ming" pathological state of insomnia patients.Methods:The study set the insomnia patients with heart and spleen deficienct syndrome as the object of research. The sample size was 45 cases, using random digital meter to separate them into treatment group and control group. Treatment group took gui pi soup, coordinating with Yi Qi Wei Xue particles and Zao Yen An Shen liquid. Control group took only gui pi soup. The course of the treatment was a week. The clinical curative effects were observed before and after the treatment. The results were analysed by the SPSS18.0 statistical softwareResults:The total effectiveness of treatment group was 86.36%, and the control group’was 75.00% Difference of them was statistically significant(P>0.05). The totals of PSQI and factor 3 of PSQI of the two group had statistically significant difference.Conclusion:The clinical curative effect of "Yin Yang Fen Zhi Fa" of the insomnia patients with heart and spleen deficienct syndrome was similar with"Organ Syndrome differentiation", but could improve sleep quality better and prolonged sleep time more effectively.更多还原