【作者】 毛颖；

【导师】 张剑；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2012， 硕士

【摘要】 [目的]通过对国医大师李辅仁治疗老年性便秘病历的收集整理分析,总结归纳出国医大师李辅仁在治疗老年性便秘中的用药特点。[方法]采用门诊病历收集、录入与系统分析结合的方法。1.门诊病历收集：通过北京医院门诊病历库,对李老诊治的门诊患者的诊疗记录进行拍照记录,采集有效门诊信息。2.数据标准化项目录入：通过《中医药防治重大疾病临床个体化诊疗信息采集系统》录入了73例国医大师李辅仁治疗便秘的病历,实现了对病历的临床信息多元化、准确、基本完整的结构化收集。将门诊诊疗过程中的望闻问切四诊摘要、中医诊断、西医诊断、辨证分型、治法方药等统一转换成可供分析的数据,便于分析国医大师李辅仁治疗老年性便秘的经验。通过人工分析和统计学软件互补,共同进行数据分析,参照后得出结论。3.结果分析：将人工数据分析与系统所得分析结果相对应,互相参考,得出最后的统计结果与结论,交与李老及其弟子,寻求他们的认可。[结果]数据分析与手工统计结合分析结果：73份门诊病历中中医证候最主要为阴虚便秘(34%),气滞便秘(27%),脾虚便秘(14%)和肾虚便秘(14%)。治疗便秘处方中最常用的药物：瓜蒌(52次),火麻仁(52次),肉苁蓉(28次),炒枳实(25次),生地黄(24次),苏梗(22次),白术(21次),茯神(21次),大黄炭(20次),厚朴(20次),木香(17次),炒决明子(16次),沙参(14次)及砂仁(13次)。阴虚便秘证型中最常用的药物前14味为火麻仁、瓜蒌、麦冬、甘草、枸杞子、生地黄、丹参、大黄炭、炒枳实、党参、黄芪、石斛、茯神、沙参。气滞便秘证型中最常用的药物为：瓜蒌、火麻仁、甘草、苏梗、炒枳实、厚朴、木香、肉苁蓉、丹参、枸杞子、焦神曲、砂仁大黄炭。脾虚便秘证型中最常用的药物为：瓜蒌、火麻仁、甘草、白术、党参、茯神、苏梗、炒枳实、麦冬、厚朴、黄芪、焦神曲、砂仁。肾虚便秘证型中最常用的药物为：火麻仁、瓜蒌、肉苁蓉、生地、猪苓、枸杞子、丹参、党参、麦冬、山药、甘草、熟地黄、桑寄生、石斛。所有药物均为常见药物,用量均在药典规定范围。分析李老治疗老年便秘的经验特点。[结论]将病历采集整理体会与系统分析结果互相验证,将两者相结合,请国医大师李辅仁弟子张剑主任医师核实,得出以下结论：国医大师李辅仁治疗老年便秘用药特点为以下4点：扶正固本为基本治则；滋补润下为基本治法；活血化瘀为辅,标本同治；用药平和,慎用峻猛攻伐之品。更多还原

【Abstract】 Objective:Summarized characteristics of State Hospital Master Li Furen medication in the treatment of constipation in the elderly, through collected the State Hospital Master Li Furen patient Outpatient medical records, and finishing,and analysis of medical records.Methods:Outpat ien t medical records by collecting, recording and integration of systems analysis methods.1. Outpatient medical record collection:diagnosis and treatment by Li Lao patients had out-patient medical records and related checks to take pictures, collect patient’s information.2. Standardized input data:a "pharmaceutical prevention of major diseases in clinical treatment of individual information gathering system" entry of73cases of State Hospital Master Li Furen medical treatment of elderly constipation. To achieve clinical information on cases, dynamic, diversified, and the basic structure of the complete collection. So that the process of out-patient clinics in the four diagnostic information, the Western diagnosis, TCM, therapy, prescription, doctor’s orders, nursing and so on, converted into a unified analysis of the data. To further tap the experience of State Hospital Master Li Furen. After the analysis required by the background data analysis, conclusion.3. Combinat ion of analysis:the experience and background analysis of medical records order results were compared with each other validation, add, draw final conclusions, for Li Lao recognition.Results:Combination of manual data analysis and statistical analysis:73cases of elderly patients with constipation medicine syndrome type declared major reduction of yin deficiency(34%), qi stagnation (27%), spleen deficiency (14%) and kidney deficiency (14%). The most common drug in the treatment of constipation prescription:Trichosanthes (52), hemp seed (52), Cistanche (28), fried citrus aurantium (25), Rehmanniae (24), the Soviet Union stems (22), Atractylodes (21), Fu Shen (21), rhubarb carbon (20), Magnolia (20), woody (17), fried cassia (16), Radix (14) and Amomum (13). Yin deficiency syndrome type most commonly used drugs before the14flavor of hemp seed, Trichosanthes, Radix,licorice root, wolfberry fruit, dried rehmannia root, red sage root, rhubarb charcoal, fried citrus aurantium, Codonopsis, Astragalus, Dendrobium, Fu Shen The, Shashen. Qi stagnation the constipation card type most commonly used drugs:Trichosanthes, hemp seed, licorice root, the Soviet Union stems, fried citrus aurantium, Magnolia, woody, Cistanche, red sage root, wolfberry fruit, coke Divine Comedy, Amomum, rhubarb charcoal. The most commonly used drugs in the spleen deficiency card type:Trichosanthes, hemp seed, licorice root, Atractylodes, Codonopsis, Fu Shen, the Soviet Union stems, fried citrus aurantium, Ophiopogon, Magnolia, Astragalus, coke Divine Comedy, Amomum. The most commonly used drugs in the kidney deficiency card type:hemp seed, Trichosanthes, Cistanche, habitat, Polyporus, wolfberry fruit, red sage root, Codonopsis, Radix, Chinese yam, licorice, rehmannia, mistletoe, Dendrobium. All the drugs are common drugs with a volumein the range of pharmacopoeia. Analyzed in the treatment of constipation in the elderly among all the drugs and the relationship between two corresponding frequency.Conclusion:medical records collected finishing to realize mutual authentication with the results of systems analysis, will be a combination of both, the State Hospital Master Li, Fu Ren Catholic disciple of Zhang Jian, director of physician to verify the following conclusions:State Medical Master Li Fu Ren Catholic treatment of senile constipation medication is characterized by the following four points:the basic principles is supporting healthy energy; the basic method of treatment is invigoration and purgation by drugs of lubricant nature; blood circulation, specimens of Tong zhi; Medication peaceful,caution Jun the onslaught cutting products.更多还原