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1、治疗郁证学术思想及柴桂虑安汤治疗郁证有效性临床观察目录 录 一、摘要 中文摘要 . 1 Abstract . 3 二、正文 前言 . 5 焦富英教授治疗郁证学术思想及柴桂虑安汤治疗郁证有效性的临床视察. 9 材料与方法 . 10 试验结果 . 14 讨论 . 16 小结 . 18 三、本临床视察创新性的自我评价 . 19 四、参考文献 . 20 五、综述 . 21 个人简介 . 错误! 未定义书签。在学期间科研成果 . 25 致谢 . 错误! 未定义书签。一、1 摘要中文摘要目的：通过总结焦富英教授治疗郁证学术思想及柴桂虑安汤治疗郁证有效性的临床视察，提升中医中药对于临床上各种疾病诊治的效果。
2、材料与方法：所选患者均为 2018 年 11 月-2020 年 1 月期间，辽宁中医药高校附属其次医院门诊及病房的广泛焦虑状态患者，将辨证属于肝气郁结、心胆气虚型的 74 例患者按患者个人意愿随机分组原则分为视察组病例 44 例，比照组病例30 例。视察组患者自愿选用柴桂虑安汤加减治疗（组方：柴胡、黄芩、党参、半夏、生姜、大枣、桂枝、茯苓、大黄、龙骨、牡蛎、琥珀粉、贯叶金丝桃、酸枣仁、远志等，水煎，每次 100ml，分两次口服），比照组患者自愿选用其他中西医结合综合治疗，疗程 2 周。计算治疗前、治疗后 14 天患者中医证候及 HAMA 量表评分。运用 SPSS26.0 软件对临床信息和数据实
3、行统计学分析，同时结合医学理论，来探讨获得的统计结果。结果：1.视察组诊疗前与比照组诊疗前中医证候积分对比后可见 P0.05，说明两组无统计学意义，具有可比性；视察组和比照组诊疗后中医证候积分与自身诊疗前对比，P0.05，说明有统计学意义，诊疗后两组中医证候积分均低于诊疗前；视察组与比照组诊疗后中医证候积分对比可见 P0.05，具有统计学意义，表明视察组诊疗后积分比比照组诊疗后积分显著减低。视察组与比照组诊疗效果的中医证候积分对比可见 P0.05，具有统计学意义，表明从整体诊疗效果来说，视察组比比照组更优。2.视察组与比照组诊疗前 HAMA 量表积分对比后，P0.05，二组无显著差别，表明具有
4、可比性；视察组和比照组诊疗后 HAMA 量表积分与自身诊疗前相对比后，P0.05，有明显区分，表明诊疗后二组 HAMA 量表积分均低于诊疗前；视察组与比照组诊疗后 HAMA 量表积分相对比后，P0.05，有明显区分，表明诊疗后视察组积分显著低于比照组。比较视察组与比照组 HAMA 量表积分诊疗效果后，P0.05，有明显区分，表明从整体诊疗效果上说，视察组比比照组更满足。3.对比视察治疗组及比照组后，上述病人在服药过程中都没有发生不良反应，因2 此无由于严峻的不良结局而中止诊疗的案例。结论：1.应用柴桂虑安汤治疗、其他中西医结合综合治疗均能改善患者中医证候，但柴桂虑安汤要优于其他中西医结合综合治
5、疗的疗效。2.应用柴桂虑安汤治疗、其他中西医结合综合治疗均能改善患者的焦虑心情，但柴桂虑安汤要优于其他中西医结合综合治疗的疗效。3.柴桂虑安汤遵循中医学的整体观念，通过辨证论治从根本上治疗肝气郁结、心胆气虚型焦虑症，且平安有效，值得临床推广应用。 关键词：柴桂虑安汤；广泛性焦虑状态；郁证；肝气郁结、心胆气虚型；疗效视察3 Abstract tPurpose: By summarizing Professor Jiao Fuyings academic thoughts on the treatment of depression syndrome (generalized anxiety st
6、ate) and observing the clinical efficacy and safety of chaiguijiaan Decoction in the treatment of depression syndrome (generalized anxiety state), we can improve the clinical efficacy application of traditional Chinese medicine in disease treatment. Material and method: The selected patients were fr
7、om November 2018 to January 2020, outpatient department of the Second Affiliated Hospital of Liaoning University of traditional Chinese Medicine and ward patients with extensive anxiety. According to the principle of random grouping, 74 patients were divided into observation group (44 cases) and con
8、trol group (30 cases). The patients in the observation group were treated with chaiguijiaan Decoction (Group prescription: Chaihu, Scutellaria, dangshen, pinellia, ginger, jujube, Guizhi, Poria cocos, rhubarb, keel, oyster, amber powder, Hypericum perforatum, Zizyphus spinosa, Yuanzhi, etc.) by addi
9、ng and subtracting the decoction voluntarily. The patients in the control group were treated with other integrated Chinese and Western medicine for 2 weeks. The TCM syndromes and HAMA scale scores were calculated before and 14 days after treatment. Spss26.0 software was used to deal with the clinica
10、l information. At the same time, combining with medical theory, to discuss the statistical results. Results: 1. Comparison of TCM syndrome score between observation group and control group before treatment P gt; 0.05, there was no statistical significance between the two groups,indicating comparabil
11、ity; after treatment, the TCM syndrome score of the observation. There was significant difference between the treatment group and the control group before and after treatment. P lt; 0.05, indicating that the TCM syndrome score of the two groups after treatment is lower than that before treatment; af
12、ter treatment, the TCM syndrome score of the observation group is significantly different from that of the control group, P lt; 0.05, indicating the accumulation of the observation4 group after treatment Compared with the control group, the score decreased significantly. There was significant differ
13、ence between the observation group and the control group (P lt; 0.05). 2. Comparison of HAMA scale scores between observation group and control group before treatment There was no significant difference between the two groups (P gt; 0.05), indicating comparability; there was significant difference b
14、etween the observation and the control group after and before treatment (P lt; 0.05), indicating that the HAMA score of the two groups after treatment was lower than that before treatment; there was significant difference between the observation group and the control group after treatment (P lt; 0.0
15、5), indicating that the score of the observation group after treatment was not lower than the control group The control group decreased significantly. There was significant difference between the observation group and the control group (P lt; 0.05). 3. There was no adverse reaction in the treatment
16、group and the control group during the treatment period, so there was no case of treatment interruption due to serious adverse events. Conclusion: 1. The application of chaiguijiean Decoction and other integrated treatment of traditional Chinese and Western medicine can improve the TCM Syndromes of
17、patients, but chaiguijiean decoction is better than other integrated treatment of traditional Chinese and Western medicine. 2. Chaiguijiean Decoction and other integrated Chinese and Western medicine can improve the anxiety of patients, but chaiguijiean decoction is better than other integrated Chin
18、ese and Western medicine. 3. Chaiguijiean decoction, following the overall concept of traditional Chinese medicine, is safe and effective in treating anxiety of stagnation of liver qi and deficiency of heart and gall Qi through syndrome differentiation. Keyword: Chaiguijiaan Decoction; generalized a
19、nxiety state; depression syndrome; stagnation of liver qi and deficiency of heart and gallbladder Qi; curative effect5 observation 正文前言目前中医学探讨发觉，郁证与广泛性焦虑状态之间有剧烈的相关性。郁证病名最早见于明代医家虞抟的医学正传，是由于情志不舒、气机凝滞、肝功不良、脾失健运、心绪不宁、脏腑阴阳气血不足造成，把心情低落、心情担心、胸闷气短、腰肋胀痛，或易激惹，或咽中有异物感等为重要临床特点的一类病证。肝郁必以气郁为先，此乃病理生理的基础。肝郁特点是郁而静，即
20、胸胁闷，愁闷不乐善太息而脉弦。广泛性焦虑状态是现代人常见的一类心理性情感精神障碍，临床表现为长时间的心境低落，并且在长期的心境障碍下，渐渐失去对生活的信念，并且简单出现联想困难的状况。在中医学中，对肝脏的定义包括现代西医学中的肝脏器官，还包括人体的消化系统、神经内分泌系统、血液循环系统。肝气郁结、心胆气虚导致的病人身体欠佳，是临床上郁证的表现。患者在日常生活中长期受到肝脏气血不条达、气郁的状况，必定导致疏泄失畅、郁闷不欢的状况。意志消沉，善太息，胸胁苦满，纳少；血郁则胁刺痛肉削，月经失调。肝郁木不疏土，影响脾升降，脾升降失常，气机不畅为痞满1 。在广泛性焦虑状态的临床治疗中，西医治疗存在着赖药
21、性、副作用等缺陷，近年来，中医药治疗广泛性焦虑症得到了广泛实践，而大量患者临床疗效证明白其有不错的探讨和应用价值。焦富英教授，女，辽宁中医药高校附属其次医院脑病一科主任，辽宁中医药高校探讨生导师，辽宁省名中医。兼任辽宁省中医药学会脑病专业委员会主任委员、辽宁省中医药学会脑病专业委员会副主任委员、辽宁省中医药学会血栓病专业委员会副主任委员、中国中药协会脑病药物探讨专业委员会眩晕学组副组长、中国医药协会眩晕专业委员会常委、中国中医药探讨促进会脑病学分会常委等。先后师从闻名中医药专家白长川教授、顾植山教授、田宝国教授，从事临床、科研、教学工作 30 余年，早年曾于中国医科高校附属医院急诊内科、肾病内
22、科进修，后于北京天坛医院神经内科进修学习。曾主持省、市级课题及参加国家级、省级课题等10余项，横向参加国家中医药行业科研专项课题多项。所领导的科室于2005年被确定为国家中药新药探讨基地，作为主要探讨者主持及参加国内中药新药临床探讨项目近百项。焦富英教授在多年的临床工作中积累了大量阅历，加之多年6 跟师学习、对中医经典古籍的不断探究与探讨，形成了一套具有个人特色的诊疗体系。笔者有幸在探讨生三年跟随焦富英教授在临床学习，倾听训诲，受益颇多，对焦富英教授中医药治疗内科疾病方面有深刻体会，现将焦富英教授治疗郁证（广泛性焦虑状态）的学术思想及柴桂虑安汤治疗郁证的有效性进行总结，以供学术探讨和借鉴。7 焦富英 教授治疗郁证学术思想及柴桂虑安汤治疗郁证有效性的临床视察1 1 焦富英教授对郁证病名的相识中医对.