中藥方劑之臨床實證研究

Clinical Evidence Based Research of Traditional Chinese Medicine Prescription

吳宗修(Tsung-Hsiu Wu)

指導教授 ： 楊玲玲

臺北醫學大學/藥學院/藥學研究所/博士(2007年)

摘要

Wenger早在1943年就利用幾項生理指標來衡量人體自主神經功能的平衡狀態。而在1979年北京醫學院梁月華教授乃利用修改Wenger自主神經平衡因子分析法而制定的綜合指標測定其體質的平衡狀態。本實驗乃利用梁氏之體質分析法配合臨床實驗室檢驗數值觀察，以期對中醫體質學說有更進一步的認識。
傳統中藥方劑具有雙向調節作用，已為人們所証實。尤其是中藥方劑中的補氣與補血方劑治療氣虛及血虛患者有不錯的療效。本研究以福嚴佛學院之學員為對象來探討長期素食者體質之變化，進而用中藥方劑針對不同證型之學員來評估對體質的影響。另外本實驗對於高尿酸血症及肝炎帶原者之體質亦做了相關的探討。我們除了以中藥方劑來評估對體質的平衡狀態外，另外我們以 Fordtran 之“人工胃模式(Artificial stomach model)mes New Roman"建立中藥方劑體外制酸的作用。在中藥方劑的臨床運用方面，我們以口述數字評分法（Verbal Numerical Scale）來評估台大緩和醫療病房的癌末病人止痛作用。
依本研究結果，發現長期素食者自主神經功能異常以副交感神經功能增強為主，而在臨床實驗室檢驗數值方面，長期素食者中除尿酸偏高外，其血糖、血脂、血液內容物皆有偏低現象，而在肝炎帶原者之肝功能檢測方面: GOT、GPT、Alk-P與對照組比較；在統計學上有顯著差異。經中藥方劑調養4週後，中藥方劑對長期素食者的自主神經功能，特別是副交感神經功能有顯著的調節作用。而血尿酸治療前後在統計學上有顯著差異，在肝炎帶原者之GOT、GPT、Alk-P治療前後在統計學上亦有顯著差異。在體外制酸方面：補氣之中藥方劑呈現不同程度之制酸作用，且在胃的保護機制上佔有非常重要的角色。對癌末病人的止痛評估方面，結果發現芍藥甘草為基礎調製之藥膳對病人疼痛症狀有明顯改善。綜合以上本論文的相關研究結果，除探討中藥方劑對體質平衡狀態之影響及臨床意義外，並將進以提供臨床治療應用評估之參考。

關鍵字

體質 ； Wenger自主神經平衡因子 ； 中藥方劑 ； 人工胃模式 ； 口述數字評分法

並列摘要

Wenger makes use of physiological index of several items to measure the balance state of the human autonomic nerve function as far back as 1943. Beijing medical college Liang Yue-hua professor revised “Wenger’s equilibrium factor autonomic system analysis” in 1979, in order to measure the balance state of its body constitution. This experiment is to utilize Liang Yue-hua professor's body constitution analysis to cooperate with clinical laboratory blood serum chemistry test to observe, expect that there is further understanding to the body constitution theory of Chinese medicine.
The traditional Chinese medicine prescription has two-way regulating action, have already been verified by people. Especially the medicine to enrich the qi and blood has good curative effect to treat the patient with insufficient qi and blood in the traditional Chinese medicine prescription. This research regards student of Fu Yen Buddhist College as the target, to probe into the change of the long-term vegetarian's body constitution, and then assess the impact on body constitution with the traditional Chinese medicine prescription. In addition, have also done the relevant discussion to the body constitution of Hyperuricemic and HBV carrier in this experiment. Except that assess the balance state to the body constitution with the traditional Chinese medicine prescription, we are also with "Artificial stomach model" of Fordtran, have set up traditional Chinese medicine prescription on in vitro function of antacid effect. Using the respect in the clinic of the traditional Chinese medicine prescription, we assess the pain of the terminal cancer patients with Verbal Numerical Scale.
Depend on a result of study; find that the long-term vegetarian's autonomic nerve function unusually relies mainly on the fact that the parasympathetic nerve function is strengthened. In clinical laboratory blood serum chemistry test, except that the uric acid is higher in the long-term vegetarian, blood sugar, blood lipid, blood composition of it are all relatively low. In measuring in liver function of HBV carrier: GOT, GPT, Alk-P is compared with control group; there is difference of showing in statistics. After the traditional Chinese medicine prescription is taken for 4 weeks, to the long-term vegetarian's autonomic nerve function, especially the parasympathetic nerve function has apparent regulating action. And there is difference of showing in statistics before and after the uric acid is treated in the blood, also there is difference of showing in statistics before and after GOT, GPT, Alk-P of HBV carrier are treated. In antacid effect of in vitro: Tonic Chinese medicinal prescriptions present antacid effect in various degrees, and occupy very important role on the protection mechanism of the stomach. Assess the respect to the pain of terminal cancer patients, found finally that the pain symptom to the patient of herbal diet modulated based on the peony root and licorice root was obviously improved. Integrate the relevant result of study of this thesis, except probing into the influence that the traditional Chinese medicine prescription balances the state to the body constitution and clinical meaning; expect to offer the reference of clinical practice.

並列關鍵字

Body constitution ； Wenger’s equilibrium factor autonomic system analysis ； traditional Chinese medicine prescription ； artificial stomach model ； verbal numerical scale

參考文獻

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