调肺法干预治疗肝郁脾虚型功能性消化不良的临床研究
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摘要
目的:通过观测功能性消化不良患者,运用调肺疏肝和胃法与疏肝和胃法治疗前后的临床疗效对比,观察研究宣降肺气在治疗功能性消化不良中的重要作用,客观评价调肺法干预治疗肝郁脾虚型功能性消化不良的临床疗效。同时根据抑郁自评量表(SDS)、焦虑自评量表(SAS)积分值变化,进一步证实FD患者与抑郁、焦虑的相关性,并客观评价调肺疏肝和胃法治疗肝郁脾虚型FD患者及伴抑郁、焦虑FD患者的疗效。
对象与方法:根据2006年罗马国际会议上达成的RomeⅢ诊断标准,并参照中华中医药学会2001年通过的《功能性消化不良(FD)中医诊治规范(草案)》,选择符合肝郁脾虚型FD患者60例,随机分为试验组和对照组各30例,对照组予柴芍六君子汤,试验组在柴芍六君子汤的基础上加用宣降肺气之品,以七天为1疗程,共服药四个疗程。均给予患者适当的病情解释,消除疑虑,但不做深层次的心理咨询和治疗。治疗前后分别对患者进行症状量表、SDS、SAS测评,并统计总积分、观察两组的疗效和消化不良症状与心理异常的变化以及药物不良反应情况。
结果:(1)60例FD患者中伴抑郁状态占48.33%,伴焦虑状态占28.33%,其中合并抑郁、焦虑状态者9名,经统计心理异常者总量达91.67%;(2)FD症状积分与SDS、SAS呈显著正相关(r=0.409～0.532、p＜0.05);(3)两组治疗前病情具可比性,治疗后症状改善明显(p＜0.01),各症状疗效相当,试验组总疗效与对照组比较虽无显著差异,但痊愈率较对照组占优(p＜0.05);(4)治疗后对照组症状积分、SDS、SAS下降(p＜0.01);试验组对症状积分、SDS、SAS的改善均获良效(p＜0.05)。(5)治疗好转后两组症状积分与SDS、SAS相关性均有所下降,以试验组更为明显,疗程结束两者无显著相关性(p＞0.05);(6)试验组对FD患者合并的心理异常缓解率高。
结论:(1)FD患者伴心理异常者比率较先前报导的FD为高,可能与研究选取的中医证型(肝郁脾虚型)有关;(2)肝郁脾虚型FD患者发病及病情程度与心理因素存在高度相关性,但药物治疗可显著影响两者的相关性;(3)加用调肺法可明显改善肝郁脾虚型FD患者伴随的心理异常;(4)柴芍六君子汤及加用调肺药治疗FD均无明显毒副作用和不良反应。
Objectives:Through observating before and after the use of adjusted lung liver and stomach and liver and stomach Law Act treatment the clinical effect of contrast in patients with functional dyspepsia,,I can observe and study drop Sun lung functional dyspepsia in the treatment of the important role.Of course,an objective assessment of lung transfer about treatment of functional dyspepsia clinical efficacy can be known.At the same time,according to integral value changeing about self-rating depression scale(SDS) and Self-rating anxiety scale(SAS),I can further confirmed that FD patients relevant with depression or anxiety,and objective evaluation of the lung liver and stomach tune treatment of patients with FD and FD with depressive patients.
Materials and Methods:
To base on RomeⅢdiagnostic standard that agreed in meeting Rome in 2006,and refer to《diagnostic and therapeutical criterion of dyskinetic functional dyspepsia(FD) of TCM (draft)》compassed by the China Institute of TCM in 2001,we choosed 60 patients with FD (Liver depression type),who were divided into two groups at random,the treated group(30 cases) received CLD orally;the control group received Tiaoxin Anshen FA which is on zhe base of CLD orally.One therapeutic course of both groups was one week.Given patients the relevant explain of state of an illness in order to eliminate the doubt,but didn't give them mental consultation and treatment deeply.Then graded scores of symptom scale、SDS、SAS.Before and after the course,analysed the statistics,observed the clinical effects、the changs between the dyspeptic symptom、gaster sensor and the psychological mental factors、ill-effects of the medicament and the rate of recrudescence four weeks after the treatment ended.
Results:(1)Among the 60 patients with FD,the rate with depression was 48.33%,that with anxiety was 28.33%,while 9 patients contained both depression and anxiety,the total psychological abnormity was 91.67%statistics show;(2)The symptomatic scores of dyspepsia were positively correlated to the leves of SDS、SAS(r=0.409～0.532、p＜0.05);(3) Before therapy,the state of illness between two groups could be compared with each other, the symptom of both groups alleviated obviously after treatment(p＜0.01),the therapeutic effects in every symptoms were similar except belch;the treated group was comparative with the control group in the total efficiency,but was superior in curable rate(p＜0.05);(4) After therapy,the scores of the control group in indigestive symptom、SDS、SAS were declining apparently(p＜0.01);While the treated group show excellent efficience for the scores of syptoms、SDS、SAS;(5)After therapy,the relationships between the scores in indigestive symptom and SDS、SAS were both declined in the two groups,especially for the control group;As the period of treatment ended,the relationships between them turned to insignificant(p＞0.05);(6)The relievable rate of psychological abnormality and gastric sensation thresholby in the treated group was higher than the control group for the patients with FD.
Conclusions:(1)The rate of patients with FD and psychological abnormity was higher than patients with FD reported before,perhaps it has certain connection with TCM symptomatology(Liver depression type);(2)To patients with FD(Liver depression type),the relationships between occurance of the diseases、the grade of illness and the psychological factors were explicit,while therapy could affect them evidently;(3) Liver-type FD using the tune depression lung liver and stomach can be improved the clinical efficacy of treatment; (4)TLD and Adjusted lung hasn't obvious side-effect and ill-effect.
对象与方法:根据2006年罗马国际会议上达成的RomeⅢ诊断标准,并参照中华中医药学会2001年通过的《功能性消化不良(FD)中医诊治规范(草案)》,选择符合肝郁脾虚型FD患者60例,随机分为试验组和对照组各30例,对照组予柴芍六君子汤,试验组在柴芍六君子汤的基础上加用宣降肺气之品,以七天为1疗程,共服药四个疗程。均给予患者适当的病情解释,消除疑虑,但不做深层次的心理咨询和治疗。治疗前后分别对患者进行症状量表、SDS、SAS测评,并统计总积分、观察两组的疗效和消化不良症状与心理异常的变化以及药物不良反应情况。
结果:(1)60例FD患者中伴抑郁状态占48.33%,伴焦虑状态占28.33%,其中合并抑郁、焦虑状态者9名,经统计心理异常者总量达91.67%;(2)FD症状积分与SDS、SAS呈显著正相关(r=0.409～0.532、p＜0.05);(3)两组治疗前病情具可比性,治疗后症状改善明显(p＜0.01),各症状疗效相当,试验组总疗效与对照组比较虽无显著差异,但痊愈率较对照组占优(p＜0.05);(4)治疗后对照组症状积分、SDS、SAS下降(p＜0.01);试验组对症状积分、SDS、SAS的改善均获良效(p＜0.05)。(5)治疗好转后两组症状积分与SDS、SAS相关性均有所下降,以试验组更为明显,疗程结束两者无显著相关性(p＞0.05);(6)试验组对FD患者合并的心理异常缓解率高。
结论:(1)FD患者伴心理异常者比率较先前报导的FD为高,可能与研究选取的中医证型(肝郁脾虚型)有关;(2)肝郁脾虚型FD患者发病及病情程度与心理因素存在高度相关性,但药物治疗可显著影响两者的相关性;(3)加用调肺法可明显改善肝郁脾虚型FD患者伴随的心理异常;(4)柴芍六君子汤及加用调肺药治疗FD均无明显毒副作用和不良反应。
Objectives:Through observating before and after the use of adjusted lung liver and stomach and liver and stomach Law Act treatment the clinical effect of contrast in patients with functional dyspepsia,,I can observe and study drop Sun lung functional dyspepsia in the treatment of the important role.Of course,an objective assessment of lung transfer about treatment of functional dyspepsia clinical efficacy can be known.At the same time,according to integral value changeing about self-rating depression scale(SDS) and Self-rating anxiety scale(SAS),I can further confirmed that FD patients relevant with depression or anxiety,and objective evaluation of the lung liver and stomach tune treatment of patients with FD and FD with depressive patients.
Materials and Methods:
To base on RomeⅢdiagnostic standard that agreed in meeting Rome in 2006,and refer to《diagnostic and therapeutical criterion of dyskinetic functional dyspepsia(FD) of TCM (draft)》compassed by the China Institute of TCM in 2001,we choosed 60 patients with FD (Liver depression type),who were divided into two groups at random,the treated group(30 cases) received CLD orally;the control group received Tiaoxin Anshen FA which is on zhe base of CLD orally.One therapeutic course of both groups was one week.Given patients the relevant explain of state of an illness in order to eliminate the doubt,but didn't give them mental consultation and treatment deeply.Then graded scores of symptom scale、SDS、SAS.Before and after the course,analysed the statistics,observed the clinical effects、the changs between the dyspeptic symptom、gaster sensor and the psychological mental factors、ill-effects of the medicament and the rate of recrudescence four weeks after the treatment ended.
Results:(1)Among the 60 patients with FD,the rate with depression was 48.33%,that with anxiety was 28.33%,while 9 patients contained both depression and anxiety,the total psychological abnormity was 91.67%statistics show;(2)The symptomatic scores of dyspepsia were positively correlated to the leves of SDS、SAS(r=0.409～0.532、p＜0.05);(3) Before therapy,the state of illness between two groups could be compared with each other, the symptom of both groups alleviated obviously after treatment(p＜0.01),the therapeutic effects in every symptoms were similar except belch;the treated group was comparative with the control group in the total efficiency,but was superior in curable rate(p＜0.05);(4) After therapy,the scores of the control group in indigestive symptom、SDS、SAS were declining apparently(p＜0.01);While the treated group show excellent efficience for the scores of syptoms、SDS、SAS;(5)After therapy,the relationships between the scores in indigestive symptom and SDS、SAS were both declined in the two groups,especially for the control group;As the period of treatment ended,the relationships between them turned to insignificant(p＞0.05);(6)The relievable rate of psychological abnormality and gastric sensation thresholby in the treated group was higher than the control group for the patients with FD.
Conclusions:(1)The rate of patients with FD and psychological abnormity was higher than patients with FD reported before,perhaps it has certain connection with TCM symptomatology(Liver depression type);(2)To patients with FD(Liver depression type),the relationships between occurance of the diseases、the grade of illness and the psychological factors were explicit,while therapy could affect them evidently;(3) Liver-type FD using the tune depression lung liver and stomach can be improved the clinical efficacy of treatment; (4)TLD and Adjusted lung hasn't obvious side-effect and ill-effect.
引文
[1]Douglas A.Drossman,Guest Editor.The Functional Gastrointestinal Disorders and the Rome ⅢProcess.Gastroenterology.2006,130:1377-1390.
[2]Tally NJ,Camilleri M.Epidemiological feature of funetional dyspepsia and arritable bowel syndtome.Clinician 1996,14:7-13.
[3]连传朋,功能性消化不良患者抑郁及焦虑状况进行调查.医学创新研究,2007,4(5):11-12.
[4]王国耀.半夏厚朴汤加减治疗功能性消化不良52例[J].中国中西医结合消化杂志,2004,12(6):368-369.
[5]陈雯湖,钟碧慧,李初俊等.广东城镇居民消化不良的流行病学调查.中华内科杂志,1998,11(5):21-22.
[6]中华中医药学会内科脾胃病专业委员会.功能性消化不良(FD)中医诊治规范(草案).中国中西医结合消化杂志,2002,10(4):封面二.
[7]韩晶杰,烟建华.从肺论治抑郁症的思路探讨.中华中医药杂志(原中国医药学报),2005,2(6):349-350.
[8]陈寿菲,黄可成.功能性消化不良2118例临床治疗特点分析.中国中西医结合脾胃杂志,2000,8(3):139-141.
[9]张志娣.功能性消化不良从肝论治.河北中医,2001,23(2),110-111.
[10]叶仁群,张光奇.疏肝调气法治疗功能性消化不良的探讨.吉林中医药,2003,23(1),1-2.
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1.Douglas A,Drossman.The Functional Gastrointestinal Disorders and the Rome ⅢProcess.Gastroenterology,2006;130:1377-1390.
2.王国耀.半夏厚朴汤加减治疗功能性消化不良52例[J].中国中西医结合消化杂志,2004,12(6):368-369.
3.单书健,陈子华.古今名医临证金鉴.胃痛痞满卷.中国中医药出版社,1999、8
4.石玉春.中药治疗功能性消化不良的临床观察.北京中医,2007,26(7):425-426
5.连传朋.功能性消化不良患者抑郁及焦虑状况进行调查.医学创新研究,2007.4(5).
6.潘腊梅,杨胜兰.逍遥散治疗功能性消化不良72例[J].中国中西医结合消化杂志,2002,9(6):371.
7.邓文.养阴化湿法治疗功能性消化不良52例体会.世界今日医学杂志(WOrld J Med Today)2007;8(2):114-115
8.刘永.自拟调中化饮汤治疗功能性消化不良临床观察.北京中医,2006,25(5):256
9.严光俊,桂壮.活血化瘀法治疗功能性消化不良临床观察.湖北中医杂志,2002,24(11):20-21
[2]Tally NJ,Camilleri M.Epidemiological feature of funetional dyspepsia and arritable bowel syndtome.Clinician 1996,14:7-13.
[3]连传朋,功能性消化不良患者抑郁及焦虑状况进行调查.医学创新研究,2007,4(5):11-12.
[4]王国耀.半夏厚朴汤加减治疗功能性消化不良52例[J].中国中西医结合消化杂志,2004,12(6):368-369.
[5]陈雯湖,钟碧慧,李初俊等.广东城镇居民消化不良的流行病学调查.中华内科杂志,1998,11(5):21-22.
[6]中华中医药学会内科脾胃病专业委员会.功能性消化不良(FD)中医诊治规范(草案).中国中西医结合消化杂志,2002,10(4):封面二.
[7]韩晶杰,烟建华.从肺论治抑郁症的思路探讨.中华中医药杂志(原中国医药学报),2005,2(6):349-350.
[8]陈寿菲,黄可成.功能性消化不良2118例临床治疗特点分析.中国中西医结合脾胃杂志,2000,8(3):139-141.
[9]张志娣.功能性消化不良从肝论治.河北中医,2001,23(2),110-111.
[10]叶仁群,张光奇.疏肝调气法治疗功能性消化不良的探讨.吉林中医药,2003,23(1),1-2.
[11]罗日永,等.485例功能性消化不良患者中医证型相关因素分析研究.新中医,1997,29(1):13.
[12]曹郑云.四逆散加味治疗功能性消化不良.光明中医,2006,8(21):46-47.
[13]张红照,常新华,赵杰.疏肝达肺运脾胃斡旋气机建中州.河南中医,2002,22(6):8-9.
[14]段庆银.清肺宣降法治疗慢性浅表性胃炎150例.国医论坛,2002,17(1):29-30.
[15]张锦坤,侯晓华.非溃疡性消化不良.临床内科杂志,1994,11:6.
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