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研究生:羅淑方
研究生(外文):Shu-Fang Luo
論文名稱:消化性潰瘍患者舌象分析與治療前後舌象變化之研究
論文名稱(外文):The Analysis of the Tongue Inspection for Peptic Ulcer Patient and the Change of the Tongue manifestation Before and After Treatment)
指導教授:高尚德高尚德引用關係
學位類別:碩士
校院名稱:中國醫藥大學
系所名稱:中西醫結合研究所碩士班
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:34
中文關鍵詞:舌診舌象消化性潰瘍上消化道內視鏡
外文關鍵詞:tongue inspection.tongue diagnosistongue manifestationpeptic ulcerupper gastrointestinal endoscopy
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消化性潰瘍是消化道常見的疾患,與胃幽門螺旋桿菌感染有密切的關係;古籍有言:「舌為胃之鏡」,故可知消化性潰瘍與舌象關係密切。本研究的目的,除了比較健康成人與消化性潰瘍患者舌象的差異外,一方面要探討胃潰瘍與十二指腸潰瘍舌象的異同,一方面也可比較消化性潰瘍患者在治療前後舌象的變化,及胃幽門桿菌根除與否的舌苔變化。對照組50位健康成人,實驗組148名患者,皆經由門診上消化道內視鏡檢查,確定有胃潰瘍或十二指腸潰瘍疾病,且排除有全身系統性的疾患、潰瘍活動性出血、消化道的惡性病變及嚴重染苔者,安排舌診攝影紀錄舌象;統計結果顯示148名消化性潰瘍患者中有108名感染胃幽門螺旋桿菌,40名則無,分析舌象以黃膩苔(38.51﹪)與黯紅舌(45.27﹪)較多,舌下絡脈多有怒張與瘀象;在108例皆接受胃幽門桿菌根除治療,只有49例於3個月後再接受第二次上消化道內視鏡檢查及第二次舌象攝影,排除仍有胃幽門螺旋桿菌感染患者8例,總計有41例潰瘍癒合且胃幽門螺旋桿菌根除。本研究針對此41例病患比較其治療前後之舌象變化,發現治療前後舌質並無明顯差異(P=0.075),但舌苔與舌下絡脈則有明顯差異,舌苔由黃轉白、膩轉薄(P=0.0145),舌下絡脈怒張減輕(P=0.0463)及瘀象減少(P<0.0001)。說明患者治療後病勢向癒,印證了舌診的臨床意義,可進一步應用在推測病狀之進退。本研究結果證實中醫的舌診觀察,可以提供臨床醫師在診斷消化性潰瘍疾病與治療預後之判斷,有客觀性及科學性的依據。
The peptic ulcer disease is the common situation in digestive tract. It is concerned with Helicobacter Pylori. And there is an old saying that the tongue is the mirror of the stomach. So it tells there is a close relationship between the tongue inspection and the peptic ulcer disease. In the study, the differences between the healthy and the patients with the peptic ulcer disease are compared in the tongue manifestation. And then, the study can compare and contrast the tongue manifestations between the patients with the gastric ulcer and those with the duodenal ulcer. And the tongue manifestations can be compared before and after the treatment. Moreover, the changes of the tongue fur, with or without Helicobacter Pylori, can also be studied. By observing the tongue manifestations, it can be applied to evaluate the prognosis and the curative effects of the patients with the peptic ulcer disease.
In the study, there are 50 healthy adults in the control group and 148 patients in the experimental group. The patients were arranged to have the upper gastrointestinal endoscopy in clinic to make sure they were with the peptic ulcer disease. Besides, it has to be sure that they were without the systemic disease, active ulcer bleeding, malignancy of gastrointestinal tract and severe stained fur. Then, they were taken a photo to record their tongue manifestations. The result was that 108, out of the 148 patients with the peptic ulcer disease, had the Helicobacter Pylori, which means the other 40 were not. Their tongue manifestations were mostly with yellow slimy fur and red dark tongue, and the sublingual collateral vessels are with engorgement and blood stasis. In the 49 of 108 patient that accepted triple treatment took the second upper gastrointestinal endoscopy and the second photo for the tongue manifestations after three months. This time was to exclude 8 patients still with Helicobacter Pylori infection. That means the other 41, who got well on the ulcer and were not with Helicobacter Pylori, were treated to be compared the changes of their tongue manifestations. The result showed the color of tongue had no differences, but the fur obviously changed from yellow to white, and from thick to thin (P=0.0145). The sublingual collateral vessels with engorgement (P=0.0463) and blood stasis (P< 0.0001) both got improved obviously. It told the patients were getting well. That proves the tongue inspection has the clinical meaning. It can be applied in figuring out the symptoms is good or not. The study is to show the tongue inspection in Chinese Medicine can sharply reflect the qi, blood, cold and heat of the patients with peptic ulcer disease. And it is objective and it is also science to apply the tongue inspection in clinic diagnosis, treatment and prognosis.
圖目錄………………………………………………………………….v
表目錄………………………………………………………………….vi
中文摘要……………………………………………………………….1
第一章 前言………………………………………………………….2
第二章 文獻探討…………………………………………………….4
2.1 舌診的源流……………………………………………………..4
2.2 舌與經絡的關係………………………………………………..6
2.3 舌與臟腑的關係………………………………………………..6
2.4 舌下絡脈………………………………………………………..8
2.5 舌的現代解剖生理學…………………………………………..8
第三章 材料與方法…………………………………………………12
3.1 研究對象……………………………………………………….12
3.2 內視鏡檢查…………………………………………………….12
3.3 舌診電腦化攝影檢查………………………………………….13
3.4 影像處理……………………………………………………….13
3.5 舌象判讀……………………………………………………….14
3.6 實驗流程……………………………………………………….16
3.7 統計分析方法………………………………………………….16
第四章 結果……………………………………………………...….17
4.1 基本資料分析……………………………………………….....17
4.2 健康成人舌象……………………………………………….....17
4.3 實驗組患者的舌象變化……………………………….….…...18
4.4 消化性潰瘍的類別與舌苔的關聯………………………..…...21
4.5 治療前後舌象變化…………………………………….………22
第五章 討論…………………………………………..……………..24
第六章 結論…………………………………………………..……..27
參考文獻……………………………………………..………………..28
英文摘要………………………………………………..……………..33
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