本文關(guān)鍵詞：王文友老師學(xué)術(shù)思想與臨床經(jīng)驗(yàn)總結(jié)及從少陽論治代謝綜合征的理論與臨床研究　出處：《北京中醫(yī)藥大學(xué)》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 柴胡三仁湯 代謝綜合征 方證研究 臨床觀察 少陽

【摘要】：本論文主要分為三個(gè)部分。第一部分追溯了王文友老師的學(xué)術(shù)淵源。王老自少年時(shí)代即立志從醫(yī),通過對《黃帝內(nèi)經(jīng)》等經(jīng)典著作的研究,奠定了深厚的中醫(yī)理論基礎(chǔ),并樹立了脾胃為后天之本、升降之樞,肝脾密切相關(guān),濕熱源自脾土等學(xué)術(shù)觀點(diǎn)。成年后王老至京行醫(yī)、學(xué)習(xí),師從傷寒大家,深受仲景學(xué)術(shù)思想的影響,注重方證對應(yīng),強(qiáng)調(diào)顧護(hù)脾胃,治肝兼顧體用,善用經(jīng)方苦辛藥法治療濕熱病證。此后王老又隨肝病名家工作,愈加重視治肝脾、調(diào)氣機(jī)、祛濕熱,闡釋諸病多從肝脾立論,常用柴胡劑施治,對肝膽脾胃疾患積累了豐富的治療經(jīng)驗(yàn)。通過博覽醫(yī)籍和積極實(shí)踐,王老在婦科、兒科、皮科等學(xué)科的診療中也形成了自身特色和專長,在臨床醫(yī)療、科研和師承教育等多個(gè)領(lǐng)域都取得了豐碩的成果。第二部分首先對王文友老師"保脾胃,調(diào)肝氣,祛濕熱"的學(xué)術(shù)思想進(jìn)行了概括闡述。王老認(rèn)為脾胃是化生氣血,調(diào)暢氣機(jī)的關(guān)鍵,易為飲食、勞倦、情志所傷,治療要點(diǎn)在于消除阻滯,恢復(fù)升降。對肝病的診治,王老則提出應(yīng)根據(jù)體、用矛盾的變化動(dòng)態(tài)調(diào)整治法,臨床常肝脾二臟同治。王老還指出濕熱致病日益廣泛,祛邪之法重在調(diào)理中焦氣機(jī),兼以疏利肝膽。在理論探討之后,對王老辨治脾陰虛證和其它9種病癥的經(jīng)驗(yàn)做了具體總結(jié)。脾陰虛證可致運(yùn)化失常、濡養(yǎng)不足和血失統(tǒng)攝,在面、唇、舌、脈等各方面有特征表現(xiàn),用藥多選甘平、甘涼,佐以健脾補(bǔ)氣之品。慢性胃炎以肝胃不和為基本病機(jī),王老通過觀苔、按腹辨其虛實(shí),治療以疏肝降逆,和胃消積為原則。肝囊腫的病機(jī)為肝郁脾虛,血瘀水停,治療當(dāng)疏肝健脾,活血利水,臨床隨機(jī)對照研究顯示驗(yàn)方王氏疏肝消囊湯可使肝囊腫縮小,癥狀改善,抑制囊腫生長,效果優(yōu)于西藥對癥治療。肝硬化腹水發(fā)生于肝病晚期,不但肝體受到損傷,且病變已累及于腎,故當(dāng)用一貫煎為基礎(chǔ)方滋水涵木,柔養(yǎng)肝腎。膽囊炎發(fā)病源于肝失疏泄,膽失通降,辨證可分虛實(shí)兩端,治實(shí)證用疏肝利膽之法,治虛證則疏補(bǔ)兼施,通過望診目睛可未病先防,對合并膽囊結(jié)石、膽囊息肉者亦有經(jīng)驗(yàn)用藥。失眠一病王老多從肝論治,以和解少陽,祛邪調(diào)氣,通降六腑為法,用小柴胡湯加減為基礎(chǔ)方。王老對心律失常的辨治取法《傷寒論》方證對應(yīng),藥物用量遵循經(jīng)典,對預(yù)后的判斷則參考脈診。月經(jīng)來源于腎中天癸,其正常來潮有賴于五臟功能的協(xié)調(diào),故治閉經(jīng)虛證用補(bǔ)腎健脾,調(diào)和五臟之法,治實(shí)證則活血疏肝,祛邪通經(jīng),對用疏肝藥物調(diào)整月經(jīng)周期亦有心得。小兒具有肺、脾、腎三臟不足的生理特點(diǎn),易因食積而患咳嗽,王老以葶藶丸化裁驗(yàn)方瀉肺消積,并總結(jié)了多個(gè)宿食積滯的望診要點(diǎn)。濕疹病由內(nèi)外合邪而發(fā),治療需辨別血熱、風(fēng)盛、濕淫為患孰輕孰重,王老多用藿樸夏苓湯為基本方以祛濕疏表。論文的第三部分從少陽角度對代謝綜合征治療進(jìn)行集中探討。內(nèi)容包括文獻(xiàn)綜述,少陽理論闡釋,少陽病驗(yàn)方柴胡三仁湯的方證研究及其治療代謝綜合征的臨床觀察。文獻(xiàn)綜述回顧了代謝綜合征的研究概況和近10年來的進(jìn)展,指出該病的現(xiàn)代醫(yī)學(xué)研究以對病因和發(fā)病機(jī)制的探討為熱點(diǎn),中醫(yī)學(xué)者則對臨床治療更為關(guān)注。中醫(yī)藥多途徑、多靶點(diǎn)的治療作用能同時(shí)糾正代謝綜合征的多種代謝紊亂,與西醫(yī)學(xué)針對各個(gè)組分的治療相比,具有一定的優(yōu)勢和發(fā)展前景。對少陽理論的闡釋涉及其內(nèi)涵意義、生理功能和病理特點(diǎn)。聯(lián)系代謝綜合征的病因、病機(jī)、病位,得出了該病可從少陽論治的結(jié)論并提出了該法的優(yōu)勢所在。對少陽病驗(yàn)方柴胡三仁湯的方證研究采用回顧性方法,將145例醫(yī)案納入統(tǒng)計(jì),分析癥狀、舌脈、柴胡劑量、加味藥物。結(jié)果顯示,該方證的主癥為小便短黃、大便粘滯、脅脹、脘痞、口苦、思涼、形體肥胖,兼癥為咽痰不利、納呆、頭暈、呃逆、多夢、耳鳴、身重、嗜睡。典型舌象為淡紅舌,薄黃膩苔。典型脈象為弦滑脈。常用柴胡劑量為20g,多以化濕藥、清熱藥、活血化瘀藥、消食藥、理氣藥、瀉下藥、補(bǔ)虛藥等加味。由此總結(jié)出柴胡三仁湯證的病機(jī)為少陽氣郁,濕熱蘊(yùn)結(jié)。臨床觀察通過隨機(jī)對照方式檢驗(yàn)了柴胡三仁湯對代謝綜合征的療效。選擇符合2005年IDF診斷標(biāo)準(zhǔn)和中醫(yī)濕熱困脾證辨證標(biāo)準(zhǔn)的代謝綜合征患者共70例,按隨機(jī)數(shù)字表法分為對照組、治療組各35例。在改善生活方式基礎(chǔ)上,對照組口服鹽酸吡格列酮片15mg,每日一次。治療組服用柴胡三仁湯中藥配方顆粒,每日1劑。共治療12周。觀察治療前后兩組在腹型肥胖、糖脂代謝、靜息心率和血壓、炎癥指標(biāo)和中醫(yī)癥狀分級量化積分等方面的改變。共66例患者完成治療,兩組患者的空腹血糖、空腹胰島素、胰島素抵抗指數(shù)、膽固醇、甘油三酯、低密度脂蛋白、C反應(yīng)蛋白、中醫(yī)癥狀積分都顯著降低。治療組在改善腹型肥胖、降低膽固醇、甘油三酯和低密度脂蛋白、提升高密度脂蛋白、控制靜息血壓和心率、改善證候等方面優(yōu)于對照組。中醫(yī)療效評價(jià)中,治療組顯效率72.7%,有效率27.3%,對照組有效率63.6%,兩組差異顯著。兩組治療依從性和不良事件無統(tǒng)計(jì)學(xué)差異。結(jié)果表明從少陽論治代謝綜合征理論確有臨床指導(dǎo)意義,提示其作用機(jī)制與抑制交感神經(jīng)的興奮性有關(guān),或涉及神經(jīng)反射、神經(jīng)內(nèi)分泌途徑。
[Abstract]:This thesis is mainly divided into three parts. The first part traces the academic origin of Wang Wenyou teacher. Wang Lao from the youth that wanted a doctor, through the study of "Huangdi Neijing classics > etc., laid a solid theoretical foundation of traditional Chinese medicine, and set up the spleen and stomach for the day after tomorrow, lifting the pivot and close the wet heat from the spleen, such academic point of view. The adult Wang Lao Beijing to practice, learn from typhoid everyone, deeply influenced by Zhang Zhongjing's academic thought, pay attention to that formula corresponding to syndromes, treatment of liver and spleen and stomach with both bitter medicine, use by law treatment of damp heat syndrome with liver disease. Then Wang Lao and famous work, pay more attention to treatment of liver and spleen, regulating qi, dispelling dampness and heat, the interpretation of disease from liver and spleen theory, common Bupleurum treatment, has accumulated rich experience in the treatment of liver and spleen diseases. The Expo medical books and actively practice, Wang Lao in the Department of Gynecology, pediatrics, dermatology, etc. The diagnosis and treatment, also formed its own characteristics and expertise in clinical care, many areas of scientific research and teacher education has made great achievements. The second part of teacher Wang Wenyou Paul regulating liver qi, spleen and stomach, dampness heat "academic thoughts are summarized. The old king that is the spleen and stomach qi and blood the key, regulating qi, easy for diet, overstrain, hurt by emotion, treatment is to eliminate the block, restore lift. Diagnosis and treatment of liver disease, Wang Laoze should be put forward according to body, with dynamic adjustment method of contradiction, clinical liver and spleen two dirty Tongzhi. Wang Lao also pointed out that damp heat pathogen widely, eliminating the by focusing on conditioning air focus, and to disperse the hepatobiliary. In theoretical study, on Wang Lao's treatment of spleen yin deficiency and other 9 kinds of illness experience specific summary. Spleen yin deficiency can cause the transport of disorders, nutrition deficiency and blood loss in the prostate, face, lips, tongue, pulse The medicine has the characteristics which gamping, Ganliang, accompanied by spleen Qi of chronic gastritis. In liver and stomach is the basic pathogenesis of Wang Lao, through the view of moss, to identify the actual situation in the treatment of abdominal, liver and stomach Jiangni, Xiaoji principle. The pathogenesis of hepatic cyst of liver stagnation and spleen deficiency stop, blood stasis and water treatment, when the liver and spleen, promoting blood circulation and diuresis, randomized clinical study showed that the prescription Shugan Wang xiaonang Tang can make liver cysts, improve symptoms, inhibition of cyst growth, better than western medicine treatment. Liver cirrhosis ascites occurred in patients with end-stage liver disease, not only liver damage, and has been involved in the renal lesion therefore, when using the Yiguanjian basic prescription for nourishing kidney and liver, liver and kidney. A soft cholecystitis from the liver and bile loss of Tongjiang, differentiation can be divided and ends with the method of empirical treatment of shuganlidan, treatment of deficiency is sparse supplementation, by which the eye can prevent disease before the merger, gallbladder Stones, gallbladder polyps are also experience insomnia medication. A disease more than the old king from the liver, in Shaoyang, Quxie gas regulation Tongjiang quickly for law, with Xiao Chaihu Tang based on arrhythmia. Wang Lao's method "Treatise on Febrile Diseases > prescription corresponding drug dosage, follow the classic. The prognostic reference pulse. Menstruation from the kidney meridian decanoate, coordinate the normal cramps depends on the function of internal organs, so the treatment of amenorrhea of deficiency of kidney and spleen, and the five internal organs, empirical treatment of Huoxue Shugan, eliminating menstrual flow, also experience to adjust the menstrual cycle. Liver drugs in children with lung and spleen. The physiological characteristics of the kidney three dirty insufficient, and easy to cough due to indigestion, Wang Lao cut prescription pill Tinglizi xiefei Xiaoji, and summarizes the inspection points places dyspepsia. Eczema by internal and external evil. The treatment needed to identify blood heat, wind Sheng, wet with the pros and cons, old king Using huopuxialing Decoction to eliminate dampness and sparse table. The third part of the thesis from the perspective of Shaoyang syndrome treatment focuses on metabolism. The content includes literature review, theoretical explanation of Shaoyang, research and clinical observation on the treatment of metabolic syndrome shaoyang disease prescription Bupleurum Sanren decoction. Review of research the metabolic syndrome and in the past 10 years, it is pointed out that modern medical research of this disease to explore the etiology and pathogenesis of traditional Chinese medicine for the hot spots, scholars pay more attention to the clinical treatment of traditional Chinese medicine. In many ways, the treatment effect of multiple targets at the same time can correct multiple metabolic disorders and metabolic syndrome, and the west medical treatment for each component compared, has certain advantages and development prospects. The connotation of Shaoyang relates to the explanation of the theory, the physiological and pathological characteristics of metabolic syndrome. Etiology, pathogenesis, disease A, the disease on the treatment results from the Shaoyang and puts forward the advantage. Research of shaoyang disease experience Fang Chaihu soup Sanren by a retrospective study, 145 cases were included in the statistical analysis, symptoms, tongue and pulse, bupleurum dose, added drugs. The results showed that the main symptoms of the syndrome to urinate short yellow, sticky stool, abdominal distension, abdominal distension, pain, thinking of cold, body fat, and disease for pharyngeal sputum negative, anorexia, dizziness, tinnitus, hiccup, dreaminess, body weight, sleepiness. Typical of the tongue is pale red tongue, thin yellow greasy fur. Typical pulse string slippery pulse. Bupleurum the dose of 20g, with the wet medicine, antipyretic, blood stasis, digestion medicine, Qi medicine, diarrhea medicine, tonic medicine etc.. It summed up the pathogenesis of modified Bupleurum Sanren Decoction syndrome for Shaoyang qi stagnation, damp heat accumulation. Clinical observation on the therapeutic effect of bupleurum root test Sanren Decoction on metabolic syndrome by with 200 random control. 5 years IDF diagnosis criteria and TCM damp spleen syndrome criteria of metabolic syndrome patients with a total of 70 cases were randomly divided into control group and treatment group with 35 cases in each group. In the improvement of life style on the basis of control group were treated with Pioglitazone Hydrochloride Tablets 15mg, once a day. The treatment group taking Bupleurum Sanren Decoction prescription of traditional Chinese medicine 1 particles, agent a day. The treatment lasted 12 weeks. To observe the two groups before and after treatment in abdominal obesity, lipid metabolism, resting heart rate and blood pressure, inflammation index and TCM symptom classification of quantitative points has changed. A total of 66 patients completed the treatment, two groups of patients with fasting blood glucose, fasting insulin, insulin resistance index, cholesterol, triglyceride, low density lipoprotein, C reactive protein, TCM symptom score were significantly decreased. The treatment group decreased cholesterol in improving abdominal obesity, triglyceride and low density lipoprotein, high density lipoprotein increase, resting blood pressure control And heart rate, improve syndrome than the control group. Clinical evaluation of Chinese medicine, the treatment group was 72.7%, efficiency was 27.3%, the effective rate of control group 63.6%, two groups had significant difference. No significant differences between the two groups of treatment compliance and adverse events. The results show that the treatment of metabolic syndrome theory has clinical significance from the theory of Shaoyang that, its mechanism and inhibition of sympathetic nerve excitability, or involving nerve reflex, neuroendocrine pathway.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R249;R259

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