【作者】 王江淮；

【导师】 左俊岭；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2008， 硕士

【摘要】 神经衰弱(Neurasthenia)是神经症性障碍七个类别中的一种,于1869年由美国神经学家Geroge Beard创其名,是一种长期过度紧张与压抑使大脑皮质失衡,内分泌失调,自律神经功能紊乱之神经官能症。女性远多于男性。本文以中医肝胆郁结痰热扰神脑的观点加以探讨其相关性,以复方四逆温胆汤作临床疗效的解析。目的:探索复方四逆温胆汤对初期实证情志所伤之肝胆郁结痰热型神经衰弱症的疗效,以专证专治方法,防治肝郁致病的精神官能症。截断后期缠绵之虚实掺杂之后遗症。以达已病防变,防病复发之目标,帮助病人走出不良心境,可望为精神科患者提供另一有效的途径。方法:按照制定的纳人标准收集肝胆郁结痰热型患者40例。采随机,服药前后之疗效比较的方法,进行体征病状及遗传体质因素作初步相关性分析,客观评价复方四逆温胆汤对神经衰弱的临床效果。结果:1、神经衰弱以职塲35-45岁女性为主,家族性遗传与本身个性占极重要因素,且多发作于秋冬两季,主症的倦怠,紧张焦虑与睡眠障碍,次症的胸闷,胃肠障碍为显着,而睡眠障碍几占神经衰弱100%。家族性遗传基因所形成的个别差异,造成后天抗应激力低下,加上生理—心理—社会三向互为影响,使病情复杂化。临床观察性格内向紧张烦恼型病患致病高,疗效低,复发机会高,反之外向乐观型病患致病低,疗效高,复发低。2、使用复方四逆温胆汤在神经衰弱主症的倦困乏力,紧张烦恼与睡眠障碍,次症的胸闷胃肠障碍等,在一个月疗程为基准下,均有显着性的改善。其总有效率为87.5%。其机转系透过疏肝解郁,镇静安神,提升免疫及内分泌功能,以达稳定气血流畅,协调脏腑之功能。3、随时代变迁,神经衰弱在紧张焦郁的背景下,发病率逐年升高且易再复发,除药物治疗外,改善环境及减轻病患的经济负担及放松心身以提升心理免疫力,才可达到预期效果。结论:复方四逆温胆汤治疗初期神经衰弱效果明显,是通过疏肝清胆解郁,化痰开郁及重镇宁心安神以安定神脑。与西药抗焦抗郁安眠的方法以降低脑神经递质的代谢率,在初步研究上,其相关性是吻合的,对初期神经衰弱症应是种安全稳定性的治疗方法。更多还原

【Abstract】 Neurasthenia is in one of the seven neurotic disorder categories,was named by the USA neurologist Geroge Beard in 1869.It is the neurosis that is caused by imbalance between the cerebral cortex result of a long-term excessive tension and oppression,endocrine disorders and self-discipline nerve function Disorders.Women are far more than men.The article is based on the view of hepatocholic depression stagnated phlegm to trouble cerebullar of the TCM and to approach their relevance,and with the complex prescription of cold limbs Decoction for Clearing Away Gallbladder Heat for the analysis of clinical.Objective:To explore the curative effect of the complex prescription of cold limbs Decoction for Clearing Away Gallbladder Heat to cure the neuroasthenia of the liver and gallbladder Yu-neurasthenia which is caused by sentiment in initial stage.To cut off last aftermath of the inseparable asthenia and sthenia situation.And to increase the goal to prevent the diseased to change and prevent recurrence and help patients to go out the bad mood.It is expected to provide another effective way for the psychiatric patients.Method:Collect patients with 40 cases which is developed in accordance with the standards were satisfied that the collection of hepatobiliary Yu Tanreqing. With the random method,comparate the effects of before and after medication. To do the rudiment dependablity analysis of the condition of illness,objective sign andgeno-body constitution factor.To evaluate objectively the clinical effect of the complex prescription of cold limbs Decoction for Clearing Away Gallbladder Heat. Conclusion:Neurasthenia is dominated to 35-45 years old of female occupation,family history of genetic and personality of its own are very important factors,it is used to break out in the autumn and winter season,the main symptoms of lassitude,anxiety,tension and sleep disorders,secondary symptoms of chest distress and digestive tract function disorders are significant,and sleep disorders account for almost 100%of neurasthenia,family history of genetic formed by individual differences to result in acquired anti-stress caused by low capacity,besides,with physical,psychological,social impact with each other so that the condition complicated.Clinical observations:to the character,introrse and strenuous patients with high incidence,low efficacy and high relapse,exoscopic and optimistic patients with low incidence,high efficacy and low relapse.Complex prescription of cold limbs Decoction for Clearing Away Gallbladder Heat used in the treatment of the main symptoms of lassitude,anxiety,tension and sleep disorders,secondary symptoms of chest distress and digestive tract function disorders,and in the course of a month as the base,there was significant improvement.The total effective rate was 87.5 percent.The mechanism is disperse the depressed liver-energy and anti-Yu,tranquilizing and allaying excitement to stabilize the central nervous,immune and endocrine function upgrade,to achieve smooth qi and blood,entrails of the coordination function.With the changes of the time,with neurasthenia in the background of anxious and tensive,the incidence rate increases year by year,and is easy to relapse, besides the drug treatment,to improve the environment,reduce the financial burden on patients and relax the physically and mentally,in order to enhance the psychological immunity,only in this way can achieve the desired results.Discussion:The effection of the Complex prescription of cold limbs Decoction for Clearing Away Gallbladder Heat the early neurasthenia is Obvious,through the disperse the depressed liver-energy cleaning courage,anti- gloomy, dissipating phlegm and expelling stagnation,calming the heart to calm the nerves and brain stability.Anti-Western medicine and anti-Coke Yu sleep ways to reduce the metabolic rate of brain neurotransmitters,in the preliminary study,its relevance is identical to the early neurasthenia should be the kind of security and stability of the treatment.更多还原