發(fā)布時間：2018-01-17 15:19

  本文關(guān)鍵詞：滋陰法的文獻整理及用藥規(guī)律探究　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 滋陰 內(nèi)科雜病 劉燕池 數(shù)據(jù)挖掘

【摘要】：三年的碩士研究生學(xué)習(xí)期間,有幸在劉燕池教授身側(cè)侍診。劉教授秉承燕京醫(yī)派的學(xué)術(shù)思想,在三因制宜思想的指導(dǎo)下,結(jié)合北京獨特的地理氣候和人文環(huán)境,在繼承古人、師承劉奉五及家學(xué)的基礎(chǔ)上,形成了自己一套診病、治病的特色和用藥規(guī)律。其在診療過程中,重視對于人體陰液的顧護,多取法滋陰降火,在臨床內(nèi)、外、婦、兒各科的治療過程中,其效果頗得患者認同。為了深入挖掘其滋陰思想,本文從以下幾個方面進行研究:第1部分,從哲學(xué)淵源和醫(yī)學(xué)淵源兩大方面,依次介紹了滋陰法的理論淵源。哲學(xué)淵源著重介紹了古有三易,即除了《周易》外其它兩易——《歸藏易》、《連山易》中的重陰思想,是滋陰法的最初淵源。另外,宋明理學(xué)尤其是其中的"理氣"思想也對后世醫(yī)學(xué)產(chǎn)生了很大影響。其"重天理"的觀點,直接促使朱丹溪自成滋陰一派。醫(yī)學(xué)淵源則大致從內(nèi)經(jīng)以降,按照年代依次進行了介紹,從仲景學(xué)說對滋陰法的發(fā)揮到金元時期滋陰思想的成熟,到后來明清時期的進一步深化,可以看出理論傳承的清晰脈絡(luò)。第2部分,滋陰法作為臨床診療過程中一種具體的治療方法,是各位醫(yī)家在一定的時代背景下,在其對于人體疾病的陰陽辨證的指導(dǎo)下的具體的治療方法。同是滋陰法,各醫(yī)家對于具體藥物的使用也各具特色。本文從仲景、河間、丹溪及張景岳各家、溫病派的吳鞠通、葉天士二家入手,逐次分析了他們的滋陰法的具體用藥特色。第3部分,劉燕池教授,國家級名老中醫(yī),其學(xué)術(shù)思想有家學(xué)肝病重清化的思想、師承劉奉五婦科"瓜石湯"等養(yǎng)陰涼血清熱的思想淵源,另外,劉老私淑丹溪、吳鞠通等。其父劉玉初公曾侍診北京四大名醫(yī)蕭龍友之側(cè),而劉奉五亦是京城御醫(yī)韓一齋之后。本章重點闡述了劉老師基于北京疾病譜系下傳承與發(fā)展的滋陰法的用藥規(guī)律和特色。第4部分,為探討劉燕池內(nèi)科門診的臨床用藥規(guī)律,以劉燕池教授2015年全年內(nèi)科門診病歷為基礎(chǔ),基于"中醫(yī)傳承輔助平臺系統(tǒng)(V2.5)構(gòu)建處方數(shù)據(jù)庫,采用軟件方劑統(tǒng)計等模塊,分析劉燕池教授處方用藥基本特點。除了對處方藥物的基本信息進行顯性信息的統(tǒng)計,還采用了基于改進互信息法、復(fù)雜系統(tǒng)熵聚類等算法數(shù)據(jù)挖掘方法,進行處方分析等隱性信息的挖掘。結(jié)果:劉老師2015年內(nèi)科門診病歷共361份,藥物頻次分析可得,降序排列前十位的依次為,石斛、麥冬、黃連、北沙參、生地黃、炒白術(shù)、茯苓、陳皮、黃芩、丹皮;就四氣而言,降序排列為:寒性(2944)、溫性(1629)、平性(920)、涼性(93)、熱性(19);就五味而言,苦味藥物頻次最多(3258),其次為甘味(3108)、辛味(1862)、咸味(527)、澀味(371)酸味(336);就歸經(jīng)而言,肝肺胃為主,分別為肝經(jīng)(2813)、肺經(jīng)(2257)、胃經(jīng)(2064),其次腎經(jīng)(1707)、脾經(jīng)(1669)、心經(jīng)(1665次)。另外,高頻藥物組合共20對,包括12味藥物;關(guān)聯(lián)規(guī)則分析得到58條藥物關(guān)聯(lián)規(guī)則,演化得到核心藥物組合22個,新處方11首。結(jié)論如下:(1)滋陰法的形成源于哲學(xué),始于《內(nèi)經(jīng)》。其形成與發(fā)展與特定的時代背景、地理、人文相應(yīng)。滋陰法的哲學(xué)淵源可以追溯到易經(jīng)和宋明理學(xué),《歸藏易》《連山易》中的重陰思想,是滋陰法的最初淵源。而醫(yī)學(xué)淵源,則始于《黃帝內(nèi)經(jīng)》,發(fā)揚于《傷寒論》和金元時期,并在明清進一步深入。(2)滋陰法作為臨床常用的治療方法,其用藥規(guī)律和特色隨時代而不斷完善:仲景根據(jù)"傷陰"的病因、病機,創(chuàng)立了許多滋陰生津的大法和名方。河間、丹溪開寒涼、滋陰一派,并創(chuàng)制知柏地黃丸等滋陰降火劑,開后世滋陰瀉火之濫觴,及至張景岳的左歸丸,戴思恭的"辛燥傷陰"說使養(yǎng)陰法進一步發(fā)展,清代溫病大家吳鞠通、葉天士不僅善于外感溫病的治療,亦創(chuàng)制了甘寒養(yǎng)陰法和復(fù)脈湯等系列方劑。(3)劉燕池教授的滋陰思想有家學(xué)、師承、私淑等相關(guān),并注重分層次分臟腑論治,提出陰虛多肝腎陰虛和肺胃津傷病機。劉燕池教授的滋陰思想有家學(xué)、師承和私淑的淵源,在繼承與發(fā)展的基礎(chǔ)上,因時、因地、因人地指出滋陰法對于京城疾病譜系的適用性,并提出陰虛多傷及肝腎肺和胃咽等,滋陰多分臟腑施治。肺胃陰虛喜用沙參、麥冬、生石斛,而肝腎陰虛多用生地、玄參、山茱萸等。具體而言,滋肺陰常用沙參、麥冬、百合、玉竹,養(yǎng)心陰多用麥冬、百合,養(yǎng)腎陰可用生地、元參、天冬、枸杞,肝陰虛多為血虛,治療以四物湯湯為基礎(chǔ)方。劉燕池教授學(xué)術(shù)思想有家學(xué)肝病重清化的思想、師承劉奉五婦科"瓜石湯"等養(yǎng)陰涼血清熱的思想淵源。另外,劉老私淑丹溪、吳鞠通等滋陰瀉火、甘寒養(yǎng)陰的思想,可以看出,劉老師基于北京疾病譜系下傳承與發(fā)展的滋陰法的用藥規(guī)律和特色是有學(xué)術(shù)淵源和理論依托的。(4)基于中醫(yī)傳承輔助平臺挖掘劉燕池滋陰用藥規(guī)律符合劉老師力主滋陰清熱、涼血生津法而取效,并且與其倡導(dǎo)的陰虛多肝腎肺胃虛損病機的用藥規(guī)律所吻合。以劉燕池教授2015年全年內(nèi)科門診病歷為基礎(chǔ),基于"中醫(yī)傳承輔助平臺系統(tǒng)(V2.5)構(gòu)建處方數(shù)據(jù)庫,采用軟件方劑統(tǒng)計等模塊,分析劉燕池教授處方用藥基本特點,結(jié)果如下:劉燕池處方用藥以寒性藥為主,即使溫補也多以溫性為主,少用熱性,五味則以苦、甘和辛味藥居多,符合甘寒養(yǎng)陰法和甘淡實脾的思想,與劉燕池教授滋陰清熱思想特點相吻合;藥物歸經(jīng)以肝經(jīng)和肺胃經(jīng)為主,其間脾胃經(jīng)尤為突出,體現(xiàn)出劉老師滋陰不忘顧護脾胃,及清熱藥多入胃經(jīng),及近些年在診療過程中對于脾胃的重視。
[Abstract]:During the three years of post-graduate master's degree study, Professor Liu Yanchi has been at the side of waitresses. Professor Liu Yanjing medical school uphold the academic thought of the three factors under the guidance of thinking, combined with Beijing unique geographical and cultural environments, inherited the ancient inheritance, based on the Fengwu and Liu family, formed a diagnosis, characteristics and medication rules for medical treatment. In the treatment process, pay attention to the body of Yin fluid nursing care, many of the method of Nourishing Yin, in clinical, and treatment process, all kinds of, the effect quite patient identity. In order to dig the Yin thought, this paper the research from the following aspects: the first part, from the origin of philosophy and medicine origin two aspects, introduces the theoretical origin of nourishing yin. Focuses on the philosophical origin of the ancient three, which in addition to the other two book < > - < < > Guizhang Yi, Caroline Yi > in the heavy overcast Thought is the origin of nourishing yin. In addition, the Neo Confucianism especially the "Qi" theory also has a great influence on later generations. The medical "justice" point of view, since the Zhu Danxi led directly to a medical sources of Yin. The roughly from down, according to the age are introduced and from Zhongjing theory play on Nourishing Yin to nourishing Yin in Jin and Yuan Dynasty, the maturity of the thought, to further deepen the later period of the Ming and Qing Dynasties, we can see clearly the theory of inheritance. In the second part, nourishing Yin as a clinical diagnosis and specific treatment method, all physicians in a certain historical background, specific in the treatment for human diseases under the guidance of yin and Yang syndrome. With nourishing Yin, the doctors for the use of specific drugs also have their own characteristics. This paper from Zhongjing, Hejian, Dan and Zhang Jingyue's disease, Wen sent Wu Jutong, leaves Two days, starting with the analysis of the specific characteristics of successive drug Ziyin them. In the third part, Professor Liu Yanchi, national famous doctors, the academic thoughts of home school of thought from the ill liver clearing, Liu Fengwu gynecological "GUASHITANG Decoction" Nourishing Yin blood heat the thought origin, in addition, Liu Lao thought Dan Xi, Wu Jutong. His father Liu Yuchu had male waitresses Beijing four doctors Xiao Longyou side, Liu Fengwu is also the capital of Korea. After his yizhai this chapter focuses on the teacher Liu drug law and characteristics of nourishing yin and development of the heritage of Beijing on the basis of the disease spectrum. In the fourth part, to discuss the rule of clinical medication Liu Yanchi medical clinic, by Professor Liu Yanchi in 2015 the year of outpatient medical records as the basis of TCM inheritance auxiliary system based on "(V2.5) to construct prescription database software using prescription statistics module, Professor Liu Yanchi analysis of prescription 鑽熀鏈壒鐐，

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