《伤寒论》解郁清气法治疗焦虑症的临床研究
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摘要
目的：《伤寒论》解郁清气法(小柴胡汤合栀子豉汤)治疗焦虑症的临床研究。
方法：本研究采用随机分组的原则将80例病例分为中药研究组(小柴胡汤合栀子豉汤的科学中药)与对照组口服阿普唑仑(alprazolam)，0.5mg，tid，治疗6周观察其结果。
结果：(1) 焦虑症患者经两组治疗前后Hamilton焦虑量表(HAMA)(x±s)比较，治疗后与治疗前比较，经t检验有显著差异*P＜0.05，**P＜0.01。两组总治疗后减分经x~2检验P＞0.05，两组无显著性差异。(2) 经两组治疗前后HAMA因子平分比较(x±S)，治疗后与治疗前比较，经t检验有显著差异*P＜0.05，**P＜0.01。两组总治疗后减分经x~2检验P＜0.05，有显著性差异。(3) 经两组治疗前后Zong焦虑自评量表(SAS)减分比较注治疗后与治疗前比较，经t检验有显著差异*P＜0.05，**P＜0.01。两组总治疗后减分经x~2检验P＞0.05，无显著性差异。(4) 经两组治疗前后临床疗效总量表(GGI)比较，治疗后与治疗前比较，两组总治疗后减分经x~2检验P＞0.05，无显著性差异。(5)两组治疗后，其副作用的发生如困倦、口干、口苦、便秘、头晕、头痛、恶心、无力、视力模糊，小柴胡汤合栀子豉汤明显少于alprazolam(P＜0.01)，有显著性差异。
结论：临床研究表明，该药毒副作用甚小，疗效相当，特别对伴有明显躯体性焦虑症状者疗效更佳。
Objective: To observe the clinical effect of the treating method of reliving depression and clearing
heat, which comes from Treatise on Exogenous Febrile Disease, on anxiety. Minor Decoction of Bupleurum in combination with Decoction of Gardeniae and Sojae Praeparatura was applied in the study.
Methods: 80 cases of anxiety were divided randomly into treatment group treated with Chinese herbs, which were made into scientific form, and control group treated with Alprazolam, 0.5mg each time, thrice daily. The therapeutic course lasted for 6 weeks.
Results: (1) According to HAMA, significant difference was observed in both groups before and after treatment (*P<0. 05, **P<0. 01 respectively, byt-test). As to the decreased value, There was no significant difference between 2 groups(P>0. 05, by x test). (2) According to HAMA factor grade, significant difference was observed in both groups before and after treatment (*P<0.05, **P<0.01 respectively). As to the decreased grade after treatment, There was no significant difference between 2 groups (P>0. 05, by X* test). (3) According to SAS, significant difference was observed in both groups before and after treatment (*P<0. 05, **P<0. 01 respectively, by t-test). As to the decreased value after treatment, There fas no significant difference between 2 groups(P>0. 05, by x test). (4) As to the decreased value of GGI after treatment, There was no significant difference between 2 groups(P>0.05, by X test). (5) After treatment, there were less side effects in the treatment group than in the control group (P<0. 01)
such side effects includes fatigue, dry mouth, bitter mouth, dry. stool, dizziness, headache, nausea, tiredness, blurred vision.
Conclusion: The effect of Chinese herbs of relieving anxiety and clearing heat is equal to that of alprazolam. This treating method is better for corporality anxiety.
方法：本研究采用随机分组的原则将80例病例分为中药研究组(小柴胡汤合栀子豉汤的科学中药)与对照组口服阿普唑仑(alprazolam)，0.5mg，tid，治疗6周观察其结果。
结果：(1) 焦虑症患者经两组治疗前后Hamilton焦虑量表(HAMA)(x±s)比较，治疗后与治疗前比较，经t检验有显著差异*P＜0.05，**P＜0.01。两组总治疗后减分经x~2检验P＞0.05，两组无显著性差异。(2) 经两组治疗前后HAMA因子平分比较(x±S)，治疗后与治疗前比较，经t检验有显著差异*P＜0.05，**P＜0.01。两组总治疗后减分经x~2检验P＜0.05，有显著性差异。(3) 经两组治疗前后Zong焦虑自评量表(SAS)减分比较注治疗后与治疗前比较，经t检验有显著差异*P＜0.05，**P＜0.01。两组总治疗后减分经x~2检验P＞0.05，无显著性差异。(4) 经两组治疗前后临床疗效总量表(GGI)比较，治疗后与治疗前比较，两组总治疗后减分经x~2检验P＞0.05，无显著性差异。(5)两组治疗后，其副作用的发生如困倦、口干、口苦、便秘、头晕、头痛、恶心、无力、视力模糊，小柴胡汤合栀子豉汤明显少于alprazolam(P＜0.01)，有显著性差异。
结论：临床研究表明，该药毒副作用甚小，疗效相当，特别对伴有明显躯体性焦虑症状者疗效更佳。
Objective: To observe the clinical effect of the treating method of reliving depression and clearing
heat, which comes from Treatise on Exogenous Febrile Disease, on anxiety. Minor Decoction of Bupleurum in combination with Decoction of Gardeniae and Sojae Praeparatura was applied in the study.
Methods: 80 cases of anxiety were divided randomly into treatment group treated with Chinese herbs, which were made into scientific form, and control group treated with Alprazolam, 0.5mg each time, thrice daily. The therapeutic course lasted for 6 weeks.
Results: (1) According to HAMA, significant difference was observed in both groups before and after treatment (*P<0. 05, **P<0. 01 respectively, byt-test). As to the decreased value, There was no significant difference between 2 groups(P>0. 05, by x test). (2) According to HAMA factor grade, significant difference was observed in both groups before and after treatment (*P<0.05, **P<0.01 respectively). As to the decreased grade after treatment, There was no significant difference between 2 groups (P>0. 05, by X* test). (3) According to SAS, significant difference was observed in both groups before and after treatment (*P<0. 05, **P<0. 01 respectively, by t-test). As to the decreased value after treatment, There fas no significant difference between 2 groups(P>0. 05, by x test). (4) As to the decreased value of GGI after treatment, There was no significant difference between 2 groups(P>0.05, by X test). (5) After treatment, there were less side effects in the treatment group than in the control group (P<0. 01)
such side effects includes fatigue, dry mouth, bitter mouth, dry. stool, dizziness, headache, nausea, tiredness, blurred vision.
Conclusion: The effect of Chinese herbs of relieving anxiety and clearing heat is equal to that of alprazolam. This treating method is better for corporality anxiety.
引文
1、陈学诗．《现代精神疾病治疗学》．济南：山东科学技术出版社，1997．
2、黄海．张仲景治疗精神疾病探析．中国医药学报，2003，9：568-569．
3、《新编精神医学》台湾教材
4、The New England Journal of Medicine, Dec 28, 2000
5、. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth edition. Washington, DC, American Psychiatric Association, 1994.
6、 Kaplan HI, Sadock BJ, Grebb JA: Kaplan and Sadock's Synopsis of Psychiatry: Behavioral sciences, Clinical psychiatry, 7th edition. Williams & Wilkins, 1994.
7、 World Health Organization: The ICD-10 classification of mental and behavioral disorders: Clinical descriptions and diagnostic guidelines. World Health Organization, 1992.
8、《精神医学新进展》台湾教材。
9、张亚林．《神经症理论与实践》．北京：人民卫生出版社，2000．
10、宁兴海，尹大力。抗焦虑药物研究进展。精细与专用化学品，2003，11，3-5
11 张朝卿．甘麦大枣汤治疗焦虑症．现代中两医结合杂志、1999，8(7)：1108-1109
12 古金光，古燕萍．养心益胆法治疗焦虑性神经官能症73例 山东中医杂志2000、19(7)：408-409
13 郭建新．于俊丽，孔德荣．血府逐瘀汤加减治疗焦感症40例。河南中医，1997，17(6)：354-355
14 黄敏．栀子龙牡汤治疗焦虑症16例临床小结．江苏中医 1995，16(11)：10-11
15 刘荔．刘启庭经方验案选．时珍国医国约，1999，10(10)778-779
16 于俊丽，孙俊玲．安神定志汤配合中西约治疗焦虑症100例．河南实用神经疾病杂志，1999，2(4)：58-59
17 张传儒．老年性焦虑症治疗经验．上海中医药杂志，1999(1)：24—25
18、李金瑚．老年期抑郁症从肾论治[J]．新中医．1990，22(5)：54．
19、刘宝录．解郁汤治疗隐匿性抑郁症31例体会[J]．天津中医，1999，8(1)：．
20、谷励．老年抑郁症诊治略识[J]．中医药学报，1992，21(2)：18．
21、李卫．《金匮》百合病篇方药治疗“抑郁症”临床体会．河南中医．1992，12(2)：74．
22、赵赢萍．露郁汤治疗抑郁症[J]．四川中医．1992．10(8)：35．
23、陈日亩．忧郁证从脾肾论治[J]．光明中医杂志，1995，10(6)：7．
24、李发明．小柴胡汤治疗抑郁症90例临床观察[J]．山西中医，1996，12(2)：10．
25、胡思荣．平心忘忧汤治疗抑郁症470例[J]．湖北中医杂志，1996，18(2)：4．
26、陈宗光．疏肝解郁活血化痰法治疗经前期跺狂抑郁症30例[J]，新中医，1996128[3]：．
27、邵文虎．解郁合欢汤治疗抑郁症举隅[J]．河北中医，1996118[5]：33．
28、方本荣．郁证主中焦说探折[J]．江苏中医．1996117[1]：37．
29、郝万由．柴桂温胆定志汤为主治疗精神抑部症[J]．北京中医约大学学报．1997，20(3)：64．
30、王丹莉．郁证概念及治则探折[63．浙江中医学院学报，1997．21[5]：10．
31、金光亮 有关抑郁症季节性发病机理的研究及启示U1．北京中医药大学学报，1997．20(1)：15．
32、武志平．自拟补源解郁汤治疗妇女抑郁症156例[JI，中国民间疗法．1998IfO(5)；48．
33、李僖如．神经精神疾病占今效方．北京：科学出版社，1998．638
34、中华医学会精神科学会，南京医科大学编．中国精神疾病分类方案和诊断标准(CCMD—2—R)．南京：东南大学出版社，1995：60
2、黄海．张仲景治疗精神疾病探析．中国医药学报，2003，9：568-569．
3、《新编精神医学》台湾教材
4、The New England Journal of Medicine, Dec 28, 2000
5、. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth edition. Washington, DC, American Psychiatric Association, 1994.
6、 Kaplan HI, Sadock BJ, Grebb JA: Kaplan and Sadock's Synopsis of Psychiatry: Behavioral sciences, Clinical psychiatry, 7th edition. Williams & Wilkins, 1994.
7、 World Health Organization: The ICD-10 classification of mental and behavioral disorders: Clinical descriptions and diagnostic guidelines. World Health Organization, 1992.
8、《精神医学新进展》台湾教材。
9、张亚林．《神经症理论与实践》．北京：人民卫生出版社，2000．
10、宁兴海，尹大力。抗焦虑药物研究进展。精细与专用化学品，2003，11，3-5
11 张朝卿．甘麦大枣汤治疗焦虑症．现代中两医结合杂志、1999，8(7)：1108-1109
12 古金光，古燕萍．养心益胆法治疗焦虑性神经官能症73例 山东中医杂志2000、19(7)：408-409
13 郭建新．于俊丽，孔德荣．血府逐瘀汤加减治疗焦感症40例。河南中医，1997，17(6)：354-355
14 黄敏．栀子龙牡汤治疗焦虑症16例临床小结．江苏中医 1995，16(11)：10-11
15 刘荔．刘启庭经方验案选．时珍国医国约，1999，10(10)778-779
16 于俊丽，孙俊玲．安神定志汤配合中西约治疗焦虑症100例．河南实用神经疾病杂志，1999，2(4)：58-59
17 张传儒．老年性焦虑症治疗经验．上海中医药杂志，1999(1)：24—25
18、李金瑚．老年期抑郁症从肾论治[J]．新中医．1990，22(5)：54．
19、刘宝录．解郁汤治疗隐匿性抑郁症31例体会[J]．天津中医，1999，8(1)：．
20、谷励．老年抑郁症诊治略识[J]．中医药学报，1992，21(2)：18．
21、李卫．《金匮》百合病篇方药治疗“抑郁症”临床体会．河南中医．1992，12(2)：74．
22、赵赢萍．露郁汤治疗抑郁症[J]．四川中医．1992．10(8)：35．
23、陈日亩．忧郁证从脾肾论治[J]．光明中医杂志，1995，10(6)：7．
24、李发明．小柴胡汤治疗抑郁症90例临床观察[J]．山西中医，1996，12(2)：10．
25、胡思荣．平心忘忧汤治疗抑郁症470例[J]．湖北中医杂志，1996，18(2)：4．
26、陈宗光．疏肝解郁活血化痰法治疗经前期跺狂抑郁症30例[J]，新中医，1996128[3]：．
27、邵文虎．解郁合欢汤治疗抑郁症举隅[J]．河北中医，1996118[5]：33．
28、方本荣．郁证主中焦说探折[J]．江苏中医．1996117[1]：37．
29、郝万由．柴桂温胆定志汤为主治疗精神抑部症[J]．北京中医约大学学报．1997，20(3)：64．
30、王丹莉．郁证概念及治则探折[63．浙江中医学院学报，1997．21[5]：10．
31、金光亮 有关抑郁症季节性发病机理的研究及启示U1．北京中医药大学学报，1997．20(1)：15．
32、武志平．自拟补源解郁汤治疗妇女抑郁症156例[JI，中国民间疗法．1998IfO(5)；48．
33、李僖如．神经精神疾病占今效方．北京：科学出版社，1998．638
34、中华医学会精神科学会，南京医科大学编．中国精神疾病分类方案和诊断标准(CCMD—2—R)．南京：东南大学出版社，1995：60