發(fā)布時(shí)間：2018-07-26 13:30

【摘要】：目的:1.據(jù)世界衛(wèi)生組織估計(jì),2005年到2015年間我國20歲以上成年人的糖尿病患病率為9.7%,糖尿病前期的比例為15.5%,成人糖尿病總數(shù)已達(dá)9240多萬,有1.482億成人處于糖尿病前期。再次證實(shí)我國可能已成為世界上糖尿病患病人數(shù)最多的國家[1]。糖尿病可能為繼心腦血管疾病、腫瘤之后另一個(gè)嚴(yán)重違害人民健康的重要慢性非傳染性疾病。因此,在普通人群中預(yù)防、診斷和治療糖尿病是我們目前需緊急處理的問題。糖尿病是臨床常見病、多發(fā)病,嚴(yán)重危害著人們的健康,影響著人們的生活質(zhì)量。近年的多項(xiàng)調(diào)查表明,無論是歐美發(fā)達(dá)國家還雖發(fā)展中國家,糖尿病控制狀況均不容樂觀[1]。西醫(yī)治療糖尿病是對癥處理,不僅有嚴(yán)重的肝腎功能損害,且可導(dǎo)致低血糖,體重增加,胃腸道不良反應(yīng)及胰島素抵抗,療效并不理想,并可出現(xiàn)心腦腎等慢性嚴(yán)重并發(fā)癥。因此發(fā)掘中醫(yī)藥治療糖尿病的治療經(jīng)驗(yàn)迫在眉睫。2.根據(jù)糖尿病的臨床特征,類似于祖國醫(yī)學(xué)的“消渴”。歷代醫(yī)家不斷發(fā)展豐富“消渴”理論,創(chuàng)新療法,中醫(yī)藥治療糖尿病具有快速改善癥狀,延緩并發(fā)癥的進(jìn)展過程,提高生活質(zhì)量,減輕經(jīng)濟(jì)負(fù)擔(dān),無毒副作用等特點(diǎn),有獨(dú)特的療效和優(yōu)勢,得到醫(yī)學(xué)界普遍關(guān)注。因此梳理《內(nèi)經(jīng)》及有關(guān)文獻(xiàn)對消渴病的論述,認(rèn)識(shí)《內(nèi)經(jīng)》消渴病理論的原貌,學(xué)習(xí)重要醫(yī)家關(guān)于“消渴”病的治療,對“消渴”病進(jìn)行中醫(yī)藥創(chuàng)新治療的研究具有重要的學(xué)術(shù)價(jià)值和現(xiàn)實(shí)意義。3.唐宋教授在治療消渴病中積累了豐富的臨床經(jīng)驗(yàn)與學(xué)術(shù)思想,能重新理解經(jīng)典內(nèi)涵及創(chuàng)新消渴理論,擅長用新理論新觀點(diǎn)治療疾病。自《內(nèi)經(jīng)》提出“消渴病”以后,在病位方面,歷代醫(yī)家有不同看法,影響最大的是三消理論,在治療上也多以肺、胃、腎三臟為主進(jìn)行辨治,但與“五臟皆可發(fā)消癉”的理論不盡吻合,唐宋教授認(rèn)為,臨床實(shí)踐中,不乏五臟(腑)皆可發(fā)消渴的實(shí)例,應(yīng)該正確、深入、全面認(rèn)識(shí)“五臟皆可發(fā)消癉”的病機(jī),開辟新的治療途徑,提高療效。特別是對“消渴”病中消的診治有許多寶貴經(jīng)驗(yàn)未能及時(shí)整理歸納。通過對唐宋老師的門疹病例、講課課件、論文著作等資料及個(gè)人的臨床體會(huì)進(jìn)行系統(tǒng)歸納整理并探討其學(xué)術(shù)思想和臨床經(jīng)驗(yàn),望能對中醫(yī)藥事業(yè)的繼承與發(fā)展盡微薄之力。4.首次系統(tǒng)整理總結(jié)唐宋教授辨治消渴(中消)病的的經(jīng)驗(yàn)。方法:查閱文獻(xiàn),跟師臨床,總結(jié)唐宋教授臨床診治消渴的原始門診醫(yī)案和既往經(jīng)驗(yàn),進(jìn)一步探討診法特點(diǎn),臨床辨治規(guī)律及遣方用藥特色。收集病人療效及信息反饋;收集整理老師的診余談話、講課記錄和課件;通過臨床實(shí)踐,加深臨床感悟與理解,收集唐老師治療“消渴”病的處方,對其進(jìn)行統(tǒng)計(jì)分析,統(tǒng)計(jì)藥物使用頻次和頻率。觀察有關(guān)中藥的降低血糖和降低尿糖的效果,以期廣泛用于臨床和指導(dǎo)臨床,提高患者生活質(zhì)量。系統(tǒng)歸納老師治療“消渴”病中消的學(xué)術(shù)經(jīng)驗(yàn)和思想。成果與結(jié)論:三年來,整理唐老師的臨床病案和辨治思路,并加以探討、分析、歸納、總結(jié),查閱文獻(xiàn)結(jié)合唐老師的臨床經(jīng)驗(yàn)和個(gè)人的臨床體會(huì),對唐老師論治“消渴”病的學(xué)術(shù)思想有了初步的認(rèn)識(shí),唐老師根據(jù)“消渴”病的生理病理特點(diǎn),在臨床中形成了系統(tǒng)的“消渴”病學(xué)術(shù)思想。唐老師論治“消渴”病的主要學(xué)術(shù)思想有以下幾個(gè)方面。1.消渴病的發(fā)生與脾胃功能密切相關(guān)�！秲�(nèi)經(jīng)》“消渴”病理論明確指出五臟與“消渴”病皆有密切聯(lián)系。歷代醫(yī)家每論及消渴多認(rèn)為病因系素體陰虛,飲食不節(jié)所致,不能深刻闡明消渴病的基本病因�！秲�(nèi)經(jīng)》曰:“有所勞倦,形氣衰少,谷氣不盛�！奔礆馓搶�(dǎo)致谷氣留于胃中,郁而為熱,進(jìn)而發(fā)生中消;李東垣對消渴病的論治,體現(xiàn)其學(xué)術(shù)觀點(diǎn),即“內(nèi)傷脾胃,百病由生”、“陰火”病機(jī)理論及“甘溫除熱”的治療法則,遣方用藥均以“升發(fā)脾胃陽氣而瀉陰火”為基本原則;喻嘉言《寓意草》中云:“夫既癉成為消中,隨其或上或下,火熱熾盛之區(qū),以次傳入矣�！薄爸劣谖敢云錈嵊申P(guān)門下傳于腎,腎或以石藥耗其真、女色竭其精者,陽強(qiáng)于外,陰不內(nèi)守,而小溲混濁如膏,飲一溲一,腎消之證成矣”。均指出“消渴”病與脾的關(guān)系密切。2.中消與脾關(guān)系更為重要,中消者消谷善饑。脾為太陰濕土,胃為陽明燥土,兩者以膜相連,臟腑表里相合,同居中焦,燥潤相濟(jì),升降有序,納運(yùn)配合,脾為胃運(yùn)化水谷化生之精微,達(dá)于五臟六腑,四肢百骸,充養(yǎng)肌膚。若脾不能為胃行其津液,故消谷多食。四肢百骸亦不得稟水谷之氣,筋骨肌肉皆無以充養(yǎng),而形體日見消瘦,甚則肢體瘓廢不用。對此,漢代張仲景《金匱要略》消渴病篇似已有所論述,治療當(dāng)清胃熱兼滋脾陰,其理亦顯而易見。《丹溪心法》云“熱蓄主于中,脾虛受之,伏陽蒸胃,消谷善饑,飲食倍常,不生肌肉”�！蹲C治匯補(bǔ)》更明確指出:“中消消脾,脾氣熱燥,飲食倍常,皆消為小便”。3.消渴病的根本病理變化在于脾的傳輸功能失常及代謝紊亂,雖出現(xiàn)“消谷”癥狀,但不能化生精微物質(zhì)為人體正常利用,導(dǎo)致水津不足或失于濡養(yǎng),且伴有大量水谷精微丟失于體外。傳統(tǒng)的“陰虛燥熱”病理觀只能反映機(jī)體局部水津匱乏的病理改變,未能概括水谷精微大量丟失的病理變化,而舍去起根本病理作用的脾,僅從肺胃腎臟去論三消,不能揭示消渴病的病理實(shí)質(zhì)及把握其病機(jī)轉(zhuǎn)趨。且消渴渴飲無度,必內(nèi)潰于脾,單從“陰虛燥熱”病機(jī)出發(fā),濫用滋膩寒涼產(chǎn),愈滯脾運(yùn),使病情加重之教訓(xùn)亦不乏見。4.消渴病的辨證治療應(yīng)重視脾胃的功能。其發(fā)病基礎(chǔ)在于脾,渴飲無度傷于脾,治療更應(yīng)顧及脾�！秲�(nèi)經(jīng)》云:“治之以蘭,除陳氣也”,“蘭”者佩蘭之謂,原具化濕醒脾之功。有學(xué)者統(tǒng)計(jì)漢唐以來治消渴方,其中配用治脾之藥者達(dá)半數(shù)以上。如近代名醫(yī)張錫純消渴方玉液湯、滋伒飲中均重用黃芪�，F(xiàn)代藥理研究已經(jīng)證實(shí),許多治脾藥物如人參、黃芪、山藥、白術(shù)、蒼術(shù)、茯苓、玉竹等具有降血糖的作用,從而顯示了從脾探索消渴病的有效治療途徑是大有希望的。5.消渴病中脾之病變應(yīng)審因而治。消渴病患者起病隱匿,病因復(fù)雜,病程較長,癥候繁雜,提高辨證施治能力,規(guī)范辨證分型是關(guān)鍵問題。方藥是中醫(yī)治病的工具,方藥的功效要爛熟于心,臨床才能運(yùn)用自如,取得桴鼓療效。唐老師巧辨合方,擅施對藥,有主有次,升降配合,補(bǔ)泄兼施,寒熱并用,多臟兼顧而提高療效。善調(diào)脾胃,安定五臟�！�1瀉脾熱,脾有伏火,則蒸胃熏肺�！�2化脾濕,使?jié)癫焕⑦\(yùn)化自健�！�3益脾氣,脾氣旺而陰自升;○4健脾運(yùn),氣血化源充足而臟腑得養(yǎng);○5養(yǎng)脾陰,脾為太陰,太陰者二陰之長,脾陰足自能灌溉諸臟腑;○6溫脾陽,用于消渴病渴飲無度,脾土內(nèi)潰,或過用寒涼,克伐中陽者。治脾諸法,或可與滋脾益腎相兼,或與清胃同施,或?qū)Ｋ帾?dú)任,直培中宮,貴在使脾運(yùn)得健,水谷精微得轉(zhuǎn)輸與利用恢復(fù)正常為目的�？傊�,健運(yùn)脾胃,益氣養(yǎng)陰,溫清兼施,知常達(dá)變。6.現(xiàn)行“三消”理論經(jīng)肺、胃、腎對應(yīng)上、中、下三消在臟腑辨證上有失偏頗。臨床治療“消渴”病需要重視五臟均與“消渴”病有密切關(guān)系,尤其是脾、胃在“消渴”中的影響。
[Abstract]:Objective: 1. according to WHO, the WHO estimated that between 2005 and 2015, the prevalence of diabetes in adults aged 20 and over was 9.7%, the proportion of pre diabetes was 15.5%, the total number of adult diabetes reached about 92400000, and 148 million 200 thousand adults were in prediabetes. Again, it was confirmed that China can become the country with the largest number of diabetes in the world. [1]. diabetes in the family may be an important chronic non communicable disease following the cardiovascular and cerebrovascular diseases. After the tumor, it is a serious chronic non communicable disease which seriously violates the health of the people. Therefore, the prevention, diagnosis and treatment of diabetes in the general population are the urgent problems we need to deal with at present. In recent years, a number of investigations have shown that the control of diabetes in both developed and developing countries in Europe and America is not so optimistic that the treatment of diabetes in [1]. western medicine is a symptomatic treatment, not only has severe liver and kidney function damage, but also causes hypoglycemia, weight gain, gastrointestinal adverse reactions and insulin resistance. It is not ideal, and can have chronic serious complications such as heart, brain and kidney. Therefore, it is imminent to explore the therapeutic experience of Chinese medicine in the treatment of diabetes. According to the clinical characteristics of diabetes,.2. is similar to the "thirst" of the Chinese medicine. The doctors of the past generation have developed the theory of "thirst", innovative therapy, and Chinese medicine to treat diabetes with rapid improvement. Symptoms, delay the progress of the complications, improve the quality of life, reduce the economic burden, non toxic and side effects and other characteristics, have unique curative effect and advantages, and get the general attention of the medical community. Therefore, it combs the discussion of the internal classics and the related literature on the thirst disease, understands the original appearance of the pathology of "internal classics > thirst", and studies the treatment of the "thirst" disease of the important doctors. The research on the innovation and treatment of Chinese medicine for "thirst" disease has important academic value and practical significance.3. Tang and song professors have accumulated rich clinical experience and academic ideas in the treatment of thirst disease. They can re understand the classical connotation and the theory of innovation and thirst, and are good at treating disease with new theories and new ideas. After the disease, in the area of the disease, the doctors of the past dynasties have different views, and the greatest influence is the theory of "San Xiao". In the treatment, the three organs of the lungs, the stomach and the kidneys are mainly identified, but they are not consistent with the theory of "the five zang organs are all capable of eliminating them". In particular, there are many valuable experiences in the diagnosis and treatment of "Xiaoke" disease, in particular, there are many valuable experiences in the diagnosis and treatment of "Xiaoke" disease. To discuss his academic thought and clinical experience, we hope that the inheritance and development of the cause of Chinese medicine can be carried out with little strength.4. for the first time to systematically summarize and summarize the experience of Professor Tang and song in the discrimination and treatment of Xiaozhong (Zhong Xiao) disease. Methods: consult the literature, follow the clinical experience of the teacher, summarize the original outpatient medical case and experience of the clinical diagnosis and treatment of the thirst in the Tang and Song Dynasties, and further discuss the diagnosis of the doctor. Point, the rule of clinical discrimination and the characteristic of the prescription drug use. Collect the patient's curative effect and information feedback; collect and collate the teacher's talk, the lecture record and the courseware; through the clinical practice, deepen the clinical perception and understanding, collect the prescription of Tang's treatment of "thirst" disease, carry on the statistical analysis to it, statistics the frequency and frequency of the use of drugs. Observe the relation between the frequency and frequency of drug use. The effect of traditional Chinese medicine on reducing blood sugar and reducing urine sugar in order to be widely used in clinical and clinical guidance and to improve the quality of life of patients. The academic experience and ideas of teachers' treatment of "Xiaoke" were systematically summed up. Results and conclusions: in the past three years, the clinical case records and the thinking of discrimination and treatment were arranged and discussed, analyzed, summed up, and summed up, Cha Yuewen On the basis of the clinical experience and personal experience of Mr. Tang, Mr. Tang has a preliminary understanding of his academic thought on "Xiaoke" disease. According to the physiological and pathological characteristics of "Xiaoke" disease, Mr. Tang has formed a systematic academic thought of "Xiaoke" disease in clinical. In several aspects, the occurrence of.1. thirst is closely related to the function of the spleen and stomach. The theory of "inner Sutra > thirst" clearly points out that there is a close connection between the five zang organs and the "thirst" disease. The Qi deficiency causes the Qi deficiency to cause the valley Qi to stay in the stomach, and the depression is hot and then the medium and the elimination. The theory of Li Dong Yuan's treatment for the disease of thirst, that is, the theory of "internal injury to the spleen and the stomach, all kinds of diseases by birth", "Yin Fire" pathogenesis theory and the principle of "Gan Wen removing heat", which are used as the basis for "raising spleen and stomach Yang Qi and reducing Yin Fire" As for the heat from the door to the kidney, the kidney or the kidney, the kidney or the stone is consumed in the kidney, the kidney or the stone is consumed, the woman's color is exhausted, the sun is stronger than the outside, the Yin is not kept, and the small cloudy is like the ointment. The relationship between "Xiaoke" disease and the spleen is closely related to the relationship between the.2. medium and the spleen and the spleen and the spleen, the spleen is too wet soil, the spleen is too wet soil, the stomach is Yangming dryness soil, the two are connected by the membrane, the Zang Fu inner and the inside are conjoined, the central coke is cohabitation, the dryness is the same, the ascending and descending order, the transport coordination, the spleen as the metaplasia of the stomach and the valleys, which reach the five viscera, bones, and filling muscles. Skin. If the spleen can not make its body fluid for the stomach, so the valley can not be eaten by the valley. The muscles and muscles are not filled with water, the muscles and muscles are not filled, and the body is thinning, and the limb paralysis is not used. For this, the Han Dynasty Zhang Zhongjing "the Golden Chamber" and the thirst disease has been discussed. The treatment of the stomach heat and the spleen yin, the reason is also obvious. < Dan Xi Xin method > > < Dan Xi Xin method > > The basic pathological changes of.3. Xiaoke disease in the spleen are the abnormal transmission function and metabolic disorder of the spleen, though the symptoms of "eliminating the valley", but inability to change, are not changed. The traditional "Yin deficiency and hot" pathology view can only reflect the pathological changes of the local water and water deficiency, and can not generalize the pathological changes of the water and valley, but the spleen which has the fundamental pathological effect is removed only from the spleen. The kidney and kidney of the lung can not reveal the pathological essence of the disease and grasp the pathogenesis of the disease. And the thirst and thirst of the disease can not be grasped, and the thirst and thirst drink will be lost in the spleen. Starting from the disease machine of "Yin deficiency and heat", the abuse of the nourishing and cold and cold production, the more stagnant spleen, the syndrome differentiation treatment of.4. thirst should pay attention to the function of the spleen and stomach. Lies in the spleen, thirst drink without injury to the spleen, treatment should be more concerned with the spleen. < internal classics > > Yun: "cure to orchid, except Chen Qi", "blue" Perrin, the former has the work of reducing the damp and striking the spleen. Modern pharmacological studies have confirmed that many of the spleen drugs such as ginseng, astragalus, yam, Atractylodes, Atractylodes, Poria, and yyuzhu have the effect of hypoglycemic effect, which shows that the effective treatment way from the spleen to explore the thirst of thirst is the most promising.5. thirst disease in the spleen, the disease is hidden, the cause of the disease is complicated, and the course of disease is complicated. Long, symptomatic complex, improve the syndrome differentiation and treatment ability, standardize the differentiation and classification is the key problem. Prescription medicine is the tool of TCM treatment, the efficacy of prescription medicine should be well cooked in the heart. Good tune spleen and stomach, stability five zang organs. 1 diarrhea spleen heat, spleen has volt fire, steam stomach fumigating lung. 0 2 spleen damp, make wet spleen to transport and self health. 0 3 Spleen Qi, spleen transport, Qi and blood source abundant and viscera nourishing; 0 5 nourishing spleen yin, the spleen is Tai Yin two Yin long, spleen yin foot can irrigate Zhufu organs; 0 6 Wen splenic Yang, used for elimination Thirst and thirst drink no degree, spleen soil collapse, or the use of chill and cold, Kelling of Zhongyang. Treatment of spleen all methods, or with the nourishing spleen and kidney phase, or with the clearing of the stomach, or special medicine in the palace, the spleen is transported healthy, the water valley has to transfer and use recovery to normal for the purpose. In a word, healthy transportation of spleen and stomach, nourishing yin nourishing Yin, warming and cleaning, know often become.6. current " The theory of "three elimination" through the lungs, the stomach and the kidney corresponds to, the middle and the kidney, in the viscera syndrome differentiation. The clinical treatment of "Xiaoke" disease needs to pay attention to the close relationship between the five zang organs and the "thirst" disease, especially the influence of the spleen and the stomach in the "thirst".
【學(xué)位授予單位】：河南中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R249;R255.4

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7 張v瀞，

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