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研究生:蔡佑杰
研究生(外文):Tsai, Yu-Chieh
論文名稱:過敏性鼻炎之中藥療效評估及其在脈波諧波頻譜分析儀的表現
論文名稱(外文):Allergic rhinitis study the efficacy of chinese herbs and the manifestation of pulse spectrum
指導教授:崔玖崔玖引用關係
指導教授(外文):Julia Tsuei
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:傳統醫藥學研究所
學門:醫藥衛生學門
學類:藥學學類
論文種類:學術論文
論文出版年:1997
畢業學年度:85
語文別:中文
論文頁數:120
中文關鍵詞:傳統醫學中國醫學中藥過敏性鼻炎
外文關鍵詞:TRADITIONAL-MEDICINECHINESE-MEDICINEHERB-MEDICINE
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在台灣,過敏性鼻炎是一常見的疾病,常造成病患生活與工作上的不便,而在現代醫學的治療中,仍有其瓶頸和副作用,因此本研究欲觀察以中醫辨證論治法來治療過敏性鼻炎,是否可提高療效?並初步觀察脈波諧波頻譜分析儀所測得之脈波強度在過敏性鼻炎病人中是否有其一致性及其與中醫證型的相關性。
我們首先依中醫望、聞、問、切四診所得之症狀與徵象將過敏性鼻炎病人分為肺虛表寒型35例、脾肺氣虛型14例、肺經鬱熱型12例和陰虛肝熱型13例,並分別給予小青龍湯、香砂六君子湯、辛夷清肺飲和龍膽瀉肝湯治療八週,並根據病患整體證候的表現而給予適當之加減。
在治療前,我們比較四種中醫證型與脈波諧波強度、血中總IGE值和周邊嗜伊紅性白血球值的相關性;在治療後,我們比較病患打噴嚏、流鼻涕和鼻塞的改善情況和血中總IGE值與周邊嗜伊紅性白血球值的變化。
結果發現,在脈波諧波頻譜分析儀的測量方面,6%過敏性鼻炎病人其脈波之第3或第4諧波強度不同於健康人,而在中醫藥療效方面,74例病人中,有27位完成8週療程,除脾肺氣虛型的病人,其鼻塞改善狀況較差外,其餘證型的病人,其打噴嚏、流鼻涕、鼻塞的症狀皆有明顯改善(P<0.0l),並只有5個病人有明顯之副作用,但病人在停止服藥後,仍會有復發的情形。此外,不論在脈波強度,血中總IGE和周邊嗜伊紅性白血球的值都與中醫證型無明顯相關。
所以我們認為本研究所使用之中藥在八週的治療中,只能暫時改善過敏性鼻炎病人打噴嚏、流鼻涕和鼻塞的症狀,至於脈波諧波頻譜分析儀在診斷過敏性鼻炎的臨床應用方面,則需要更進一步的研究。
Allergic rhinitis is a common disease m Taiwan. It can adversely effect both the life and work of those who have it. Conventional western treatments can be effective, but there are some limitations and side effects. In this study we observed the efficacy of Chinese herbs in the treatment of allergic rhinitis, with treatment based on the Chinese medicine principle that treatment should be based on symptoms present at the time of treatment, and be changed if symptoms change during the course of treatment.
We also observed changes in the intensity of many harmonics of the pulse spectrum. We compared the pulse spectrum of people with and without allergic rhinitis, and noted correlations between differences m intensity and the four types of allergic rhinitis patients, as classified according to Chinese medicine theory.
Seventy-four allergic rhinitis patients were grouped into 4 categories: 1)fei xu bicto han (lung qi vacuity and insecurity of exterior defense), 2) pi fei qi xu (spleen and lung qi vacuity), 3)feiJingyu re (lung meridian depressed heat), and 4) yin xu kan re (yin vacuity liver heat). Patients in each group were given one traditional herbal prescription for 8 weeks. Each prescription contained a combination of 3 to 11 different herbs. Patients in group 1 received hsian ching lung laung, patients in group2 received hstgan sha liu chun lzu long, patients in group 3 received hsin yi chingfei yin, and patients in group 4 received lung tan hsieh kan tang. During the treatment period, the doctor was allowed to modify the prescription according to the patient's symptoms.
Before treatment, we compared the correlation of the values of total lgE, peripheral eosinophil counts and pulse spectrum intensity for all four groups. After 8 weeks of treatment, we compared the improvement of sneezing, rhinorrhea and nasal congestion according to daily-recorded symptom scores and doctor's evaluations. We also did additional lab tests in order to compare the change of total lgE and peripheral eosinophil counts after treatment.
Before treatment, the intensity of pulse spectrum values, total lgE values and peripheral eosinophil counts were not different among the four groups of allergic rhinitis patients. For 64% of the allergic rhinitis patients, the third and fourth harmonics of the pulse spectrum were different from the mean values for healthy people.
Only 27 of 74 of the allergic rhinitis patients completed 8 weeks of treatment with Chinese herbs. For all 27, the severity scores for sneezing, and rhinorrhea decreased significantly (p<0.01). For all but the pifei qi xu group, nasal congestion scores also improved significantly (p<0.01). During the 3 months following treatment, allergic symptoms returned in all 27 patients. Side effects during treatment were noted in only 5 patients.
Our results suggest that the treatment protocol used in this study offers temporary improvement of symptoms of allergic rhinitis, such as sneezing, rhinorrhea and nasal congestion, with few side effects. Furthermore, clinical use of pulse spectrum in allergic rhinitis diagnosis shows great promise and deserves further study.



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