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疏肝清热健脾法治疗广泛性焦虑症的临床研究
【作者】 许静；
【导师】 唐启盛；
【作者基本信息】 北京中医药大学 ， 中医内科学， 2012， 硕士
【摘要】 目的本课题研究来源于北京市首发基金重大联合项目课题《广泛性焦虑症的中医证候规律研究》,该项目旨对广泛性焦虑症进行证候观察和临床评价,明确中医药治疗GAD的疗效、安全性以及其治疗的适应范围,对证候研究的结果进行临床验证,并为制订规范的GAD中医辨证治疗方案提供依据。方法研究对象来源于2009年10月至2011年12月北京中医药大学第三附属医院门诊及住院肝郁化火证型的GAD病人63例,男25例,女38例；年龄17～78岁；职业中办公室职员11人,退休人员21人,自由职业者7人,工人8人,农民9人和学生6人。将符合纳入标准同时不符合排除标准的患者,按随机化原则分别纳入相应的试验组或对照组,试验组32例,对照组31例。试验组采用丹栀逍遥散；对照组采用劳拉西泮进行药物干预,疗程均为6周,观察1周、2周、4周、6周的疗效,6周时停药。通过国际公认的疗效评价体系进行评价,分析治疗前后各组指标的变化,对调查结果采用统计描述的方法分析,对比试验组和对照组的疗效。结果(1)丹栀逍遥散组HAMA减分率在1、2、4、6周略优于相对照的劳拉西泮组。(2)丹栀逍遥散对肝郁脾虚型GAD中医证候指数率的总有效率在第1、2、4、6周明显优于劳拉西泮组。(3)治疗过程中,试验组个别患者在服药后出现胃脘不适、轻度腹泻的表现,经过减量、分多次或饭后服用,这些症状消失,无其他明显的副反应发生,对照组出现口干、出汗、震颤的不良反应。结论：1.疏肝清热健脾法治疗GAD具有较好的疗效,且无明显的毒副作用,提示了中医辨证治疗焦虑症具有一定的优势。2.丹栀逍遥散对脾虚辨证有特征意义的症状,如食欲下降、腹胀等的疗效明显优于劳拉西泮,对改善睡眠、口苦口干亦有明显疗效。
【Abstract】 ObjectiveThe research is supported by the city of Beijing the first fund major joint project 《generalized anxiety disorder symptoms of TCM》, this project aims to study the GAD and get clinical evaluation of TCM in the treatment of GAD. We can recognize the clear clinical effect, safety and the range of treatment.We can confirm the results and provide a basis for formulating the standard of GAD of TCM treatment plan.Medthod:The research collection period was from October2009to December2011. The data were collected from The Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine in63patients,25were male,38female; aged between from17to78years old; occupation of the office staff of11people, retiree21people, freedom of occupation in7people,8people of worker, farmer of9people and6students. On the basis of professor Tang Qisheng of basic research and clinical experience, the fire of liver qi stagnation is the most common GAD syndromes. By using a randomized, controlled, double-blind method of observation,through HAMA and the scale of TCM symptoms and to compare the curative effect of Chinese medicine dan zhi xiao yao san with the Deaxit on GAD with hotness and stagnancy of liver-qi.63GAD patients with the fire of liver qi stagnation were observed for6weeks in a randomized controlled clinical trail with dan zhi xiao yao san and HAMA and the scale of TCM symptoms were applied to measure the treatment effect.Results:We found that the score of HAMA of the total effective rate of both2groups after therapy decreased significantly (p<0.05) after1、2、4、6weeks. And the score of TCM symptoms scale of experimental group after therapy also decreased significantly (p<0.05)except the first week. There was no serious side effects in control group occurred. And there were fewer cases with side effects in control group occurred, there were dry mouth,sweating and fremitus of body.Conclusion:1. Method of soothing the liver and alleviating depression, strengthening the spleen and clearing away heat of generalized anxiety disorder has a better therapeutic effect, and no obvious toxic and side effect, prompting the Chinese medicine in the treatment of anxiety disorders has certain advantages.2. Dan zhi xiao yao san on spleen deficiency syndrome with features of significant symptoms, such as loss of appetite, abdominal distension, curative effect is obviously superior to lorazepam, to improve sleep, mouth xerostomia have obvious curative effect.