本文選題：寒熱錯雜證 + 連夏芪麥湯��； 參考：《北京中醫(yī)藥大學》2017年博士論文

【摘要】：栗德林教授,主任醫(yī)師,博士生導(dǎo)師,國家級名老中醫(yī)。自幼因父親和自己患病立下醫(yī)學夢,考入黑龍江中醫(yī)學院,秉承龍江醫(yī)派學術(shù)教育,研讀古籍,深受《黃帝內(nèi)經(jīng)》、《傷寒論》、《脾胃論》、《丹溪心法》、《醫(yī)宗金鑒》、《溫熱論》、《醫(yī)林改錯》等影響,從師于馬驥教授,聆聽名師教誨,夯實了中醫(yī)基礎(chǔ),積累了臨床經(jīng)驗,逐漸形成了自己獨具特色的學術(shù)思想�？偨Y(jié)栗德林教授學術(shù)思想如下:1固本求源,注重脾腎:在內(nèi)傷雜病論治中,要固護脾腎正常的生理功能,充分重視脾、腎二臟在疾病發(fā)生、發(fā)展和防治衍變中的作用,采取針對性治療策略。2寒熱多態(tài),順逆平調(diào):寒熱錯雜證具有多態(tài)性,對其治療除寒熱并用、調(diào)和陰陽方法,還要根據(jù)內(nèi)在病機,采用或因勢利導(dǎo)或逆勢而行的治療方法。3病證結(jié)合,主抓病理:針對傳統(tǒng)中醫(yī)無證可辨的情況,只有抓住西醫(yī)病理特點,探究中醫(yī)病機本質(zhì),辨病與辨證相結(jié)合,摸索規(guī)律,才能確立治療法則,遣方用藥。4中西并舉,注重藥理:在中醫(yī)辨證論治原則基礎(chǔ)上,結(jié)合現(xiàn)代西醫(yī)藥理研究成果,從臨床療效、藥效機理等方面開展中西并舉的研究,是時代發(fā)展的需要。總結(jié)栗德林教授具有代表性的臨床診療經(jīng)驗,并附典型醫(yī)案。1慢性萎縮性胃炎:多屬中醫(yī)"痞滿",病因有脾胃素虛、飲食失宜、情志所傷、久病勞倦等,病機為脾胃虧虛、氣機壅塞、升降不利,主要證型為寒熱錯雜證,研制延參健胃膠囊,湯藥用半夏瀉心湯合扶正驅(qū)邪之品。提出固定方藥是治療的發(fā)展趨勢,注重脾胃養(yǎng)護。2糖尿病及其并發(fā)癥:"消渴"相當于西醫(yī)糖尿病,病因病機為"五臟柔弱、內(nèi)熱熏蒸、傷津耗氣、血稠液濃","氣陰兩虛和血滯不暢是貫穿糖尿病全過程的基本病理變化",立"益氣養(yǎng)陰、清熱生津、活血化瘀"基本治法,研制芪黃消渴膠囊,湯藥用自擬芪連葛參湯。"瘀阻痰凝"并發(fā)冠心病,研制芪玄益心膠囊。"蓄濁失精"并發(fā)糖尿病腎病,研制麥地參腎消膠囊。"瘀塞毒壅"并發(fā)糖尿病足,研制降糖解毒膠囊。并發(fā)周圍神經(jīng)病變,按五體痹辨治。并發(fā)胃輕癱表現(xiàn)痞滿者,合半夏瀉心湯加減治療等。3類風濕關(guān)節(jié)炎:總屬"痹證",日久屬"歷節(jié)"。病因病機早期因營衛(wèi)失和,腠理不密,風寒濕熱等邪氣乘虛而入,病久則邪入臟腑、痰瘀交結(jié)、正氣受損。治療早期宜驅(qū)邪通絡(luò)、調(diào)和營衛(wèi)并重。病久則以扶助正氣為主,驅(qū)邪通絡(luò)為輔�；痉接米詳M二龍蠲痹湯。4外傷后癲癇:屬"癇證"范疇,致病因素有瘀血阻竅、痰濁蒙竅,肝風內(nèi)動易引發(fā)作。常合并肢體不遂,初期為血瘀氣滯,病久則氣虛血瘀。以活血化瘀通竅、逐痰豁痰開竅、平熄內(nèi)動肝風為基本法,輔以益氣活血通絡(luò)。治療常用通竅活血湯、礞石滾痰丸、黃芪桂枝五物湯,善加治肝平木熄風之品。5溫熱病:衛(wèi)氣營血辨證最重要的是氣分階段,此"氣"指的是宗氣,氣分證是宗氣生理功能失常所造成的一系列病理變化。把握氣分證,及時甚至提前施藥,"清氣"不使邪氣傳營入血,是治療溫熱病提高療效、縮短病程的關(guān)鍵。栗德林教授善治脾胃病,近年來治療CNAG,除采用辛開苦降、調(diào)理脾胃法,常加益氣養(yǎng)陰、活血化瘀之品,臨床療效較好。為了客觀評價栗教授治療慢性非萎縮性胃炎寒熱錯雜證的臨床療效,本課題將栗教授常用方劑整理總結(jié),進行了臨床研究。首先整理文獻綜述如下:西醫(yī)尚未闡明CNAG發(fā)病機制,治療以對癥為主。對CNAG→CAG→PLGC→胃癌演變模式達成共識,但無有效治療手段。中醫(yī)對CNAG病因認識一致,病機和辨證分型未統(tǒng)一,治療總體效果優(yōu)于西藥。開始重視CNAG→胃癌演變模式的研究,但尚未達成共識。目前治療多局限于CNAG階段的隨證辨治,對CNAG→胃癌預(yù)防治療應(yīng)用很少。其次總結(jié)匯報自擬連夏芪麥湯治療慢性非萎縮性胃炎寒熱錯雜證的臨床研究。目的:觀察栗德林教授常用自擬方劑連夏芪麥湯治療慢性非萎縮性胃炎寒熱錯雜證的臨床療效,以及深入挖掘其學術(shù)思想。方法:按照1:1隨機分組原則,將88例患者分為治療組、對照組各44例。試驗結(jié)束每組各有4例脫落,每組各完成40例。治療組:予栗德林教授臨床常用基本方連夏芪麥湯治療。對照組:口服六味安消膠囊。兩組均治療8周。觀察指標為兩組治療前、后痞滿等癥狀、胃鏡檢查分級情況、Hp感染情況。結(jié)果:治療組中醫(yī)證候療效總有效率92.5%,對照組75%,有統(tǒng)計學意義。兩組治療后證候積分均較前明顯下降,有顯著統(tǒng)計學意義,但治療組明顯優(yōu)于對照組。治療組CNAG疾病療效總有效率80%,對照組62.5%,有統(tǒng)計學意義。兩組治療后胃鏡檢查分級情況,有統(tǒng)計學意義,治療組優(yōu)于對照組。兩組治療后Hp陽性率,無統(tǒng)計學意義。結(jié)論:栗德林教授連夏芪麥湯不僅能夠明顯改善CNAG寒熱錯雜證的癥狀,獲得很好的中醫(yī)證候療效,而且能夠改善胃鏡下胃黏膜病變,使其痊愈或好轉(zhuǎn)。但本課題未顯示連夏芪麥湯對Hp有殺滅作用。本課題挖掘了栗教授治療CNAG寒熱錯雜證的學術(shù)思想,提出CNAG發(fā)生發(fā)展的根本原因是脾胃氣陰兩虛,且貫穿始終,造成寒熱錯雜多見,最終導(dǎo)致陰虛加重、瘀血內(nèi)阻、甚至惡變。CNAG核心病機為"氣陰兩虛、寒熱錯雜",確立"辛開苦降、益氣養(yǎng)陰"為主、"活血化瘀"為輔的治法,為臨床治療CNAG提供了新的思路,也可能為防治CNAG→胃癌發(fā)展演變提供了新的思路。通過本課題證實了栗德林教授寒熱并用治療脾胃病學術(shù)思想和"治未病"學術(shù)思想的有效性和實際應(yīng)用價值。創(chuàng)新觀點:首次挖掘提煉栗德林教授治療CNAG寒熱錯雜證的學術(shù)思想:將"治未病"思想應(yīng)用于CNAG,提出脾胃氣陰兩虛是發(fā)生、發(fā)展的根本原因,是貫穿始終的病理變化,逐漸加重可導(dǎo)致陰液大虧、瘀血內(nèi)阻、蘊毒惡變。寒熱錯雜證是脾胃氣陰兩虛引發(fā)的表現(xiàn)形式,臨床最為常見。提出核心病機為"氣陰兩虛、寒熱錯雜",制定了 "辛開苦降、益氣養(yǎng)陰"為主針對CNAG、"活血化瘀"為輔防止進展的治療方法和預(yù)防策略,分析了連夏芪麥湯的組方特點。提出CNAG寒熱錯雜證的治療應(yīng)重視CNAG發(fā)生、發(fā)展、演變的全過程,辛開苦降和益氣養(yǎng)陰、活血化瘀法同用。本課題為臨床治療CNAG提供了新的思路,也可能為防治CNAG →胃癌發(fā)展演變提供了新的思路。
[Abstract]:Professor Li Delin, chief physician, doctorate tutor, national famous old Chinese medicine. Since his father and his own illness, he was admitted to the Heilongjiang College of traditional Chinese medicine, accepted the academic education of Longjiang medical school, studied the ancient books, was deeply influenced by the Huangdi Neijing, the theory of typhoid, the theory of spleen and stomach, the heart law of Dan Xi, the thermo heat theory, the medical forest error, and so on. Professor Ma Ji, Professor Ma Ji, listened to the teachings of the famous teacher, rammed the foundation of traditional Chinese medicine, accumulated the clinical experience, and gradually formed his own unique academic thought. The academic thought of Professor chestin was summarized as follows: 1 solid source and spleen and kidney: in the treatment of internal injuries, the normal physiological function of the spleen and kidney should be fixed, the spleen and the two organs of the kidney were paid full attention to the disease. The function of birth, development and prevention and control evolution, adopt the targeted treatment strategy.2 cold and heat polymorphism, smooth and reverse adjustment: the syndrome of cold and heat confusion is polymorphic, the treatment of cold and heat, the use of cold and heat, the method of regulating yin and Yang, and the combination of the internal disease machine, the combination of the treatment method of.3 disease, or the use of the potential guidance or the adverse potential, and the pathology of the traditional Chinese Medicine To distinguish the situation, only by grasping the pathological features of Western medicine, exploring the essence of the pathogenesis of traditional Chinese medicine, combining disease identification with syndrome differentiation, and exploring the law, can we establish the rule of treatment, take the medicine of.4 and pay attention to pharmacology: on the basis of the principle of TCM syndrome differentiation and treatment, combined with the pharmacological research results of modern western medicine, to carry out the Chinese and Western medicine from the clinical effect and the mechanism of drug effect. The research in the same way is the need of the development of the times. It is a summary of the representative clinical diagnosis and treatment experience of Professor chestin and the typical medical case.1 chronic atrophic gastritis. Many of them belong to the "ruffian" of traditional Chinese medicine. The cause is the deficiency of the spleen and stomach, the discomfort of the diet, the injury of the mood, the long illness, the deficiency of the spleen and stomach, the congestion of the Qi and the detrimental rise and fall, the main syndrome type is the cold and heat error. The development trend of the treatment is fixed prescription medicine, which pays attention to the maintenance of.2 diabetes and its complications: "Xiaoke" is equivalent to western medicine diabetes. The etiology and pathogenesis are "five dirty weak, internal heat fumigation, injury of Qi consumption, thick blood liquid", "Qi Yin deficiency and blood stagnation" Through the basic pathological changes of the whole process of diabetes, the basic treatment of Qi and nourishing Yin, clearing heat and nourishing blood, promoting blood circulation and removing stasis is the basic treatment, the Qi Huang Xiaoke Capsule is developed, the decoction of Qi Lian Ge Shen decoction is prepared with the stasis of stagnation of phlegm coagulating with coronary heart disease, and the Qi Xuan Yixin Capsule is developed. Diabetic foot, the development of Jiangtang detoxification capsule. Complicated peripheral neuropathy, according to the five body syndrome differentiation and treatment. Complicated with gastric hemiplegia, combined with Banxia Xiexin Decoction and the treatment of.3 rheumatoid arthritis: the general genus "Bi syndrome", a long term "calendar". In the early period of treatment, it is advisable to drive evil to collaterals and coordinate with the camp and Wei. For a long time, it is mainly to help the Zheng Qi, and to exorcise the collaterals and collaterals for the auxiliary. The basic prescription is to draw up the epilepsy of.4 after the two dragon Juan Bi soup. It belongs to the category of "epileptic syndrome", the pathogenic factors include blood stasis, phlegm and the orifices and the internal movement of the liver. Qi stagnation, Qi deficiency and blood stasis for a long time. The basic law is to promote blood circulation and dissipate blood stasis, make phlegm and open the phlegm to open the orifices, adjust the internal movement of the liver wind as the basic law, supplemented by qi activating blood circulation and dredging collaterals. It is used to treat the commonly used Tongqiao activating blood circulation soup, the stone rolling phlegm pills, the Astragalus cinnamon branch five substances soup and the good treatment of the liver flat wood extinguishing wind: the most important phase of the Qi Qi camp blood syndrome differentiation is the Qi "Qi" refers to Zong Qi and Qi syndrome are a series of pathological changes caused by the abnormal function of Zong Qi. It is the key to treat the disease of spleen and stomach to cure the spleen and stomach disease. In recent years, Professor chestin is good at treating the spleen and stomach disease and treating CNAG. In order to objectively evaluate the clinical efficacy of Professor chestnut in the treatment of chronic non atrophic gastritis, the clinical study of Professor Chestnut's common prescription is summarized and the clinical study is carried out. First, the literature review is summarized as follows: Western medicine has not yet elucidated the pathogenesis of CNAG and the treatment is mainly symptomatic. To C NAG - CAG - PLGC - gastric cancer evolution model reached consensus, but there was no effective treatment. Traditional Chinese medicine was unanimous to the etiology of CNAG, the pathogenesis and syndrome differentiation were not unified, the overall effect of the treatment was better than western medicine. It began to pay attention to the study of CNAG to gastric cancer evolution mode, but no consensus had been reached. At present, the treatment and treatment are mostly limited to the identification and treatment of the CNAG stage, and CNAG The application of the prevention and treatment of gastric cancer is very few. Secondly, we summarize the clinical study of Lian Xia Qi Mai Decoction in the treatment of chronic non atrophic gastritis. Objective: To observe the clinical effect of Professor chestlin in the treatment of chronic non atrophic gastritis with cold and heat syndrome in the treatment of chronic non atrophic gastritis, and to dig out its academic ideas. According to the principle of random grouping of 1:1, 88 patients were divided into treatment group and 44 cases in control group. 4 cases in each group were separated and 40 cases were completed in each group. The treatment group was treated by Professor Li dlin's clinical commonly used basic prescription Lian Xia Qi Mai decoction. The control group was treated with six taste Anxiao capsules. The two groups were treated for 8 weeks. The observation indexes were two groups before treatment, and after the fullness of the posterior ruffian. Symptoms, gastroscopy classification and Hp infection. Results: the total effective rate of TCM syndrome in the treatment group was 92.5%, and the control group was 75%. The scores of the two groups were significantly lower than those in the former, but the treatment group was significantly better than the control group. The total effective rate of CNAG disease in the treatment group was 80%, and the control group was 62.5%. There were 62.5% of the control group. Statistical significance. The classification of gastroscopy after treatment in the two groups was statistically significant. The treatment group was better than the control group. The positive rate of Hp in the two groups was not statistically significant. Conclusion: Li dlin Lian Xia Qi Mai decoction can not only improve the symptoms of CNAG cold and heat syndrome obviously, get good TCM syndrome effect, but also can improve the gastroscope under the gastroscope. But this topic did not show the effect of Lian Xia Qi Mai Decoction on Hp. This subject excavated the academic thought of Professor Chestnut's treatment of CNAG cold and heat syndrome, and put forward that the basic reason for the development of CNAG was the deficiency of spleen and stomach, and through all the time, it resulted in the confusion of cold and heat, which eventually led to the aggravation of yin deficiency and blood stasis. Resistance, even malignant transformation of.CNAG core disease machine is "Qi Yin deficiency, cold and heat and mixed", the establishment of "Xin Kai bitterness, nourishing yin nourishing Yin", "activating blood and removing blood stasis" as the supplement, provides a new way of thinking for clinical treatment of CNAG, and may also provide new ideas for the prevention and control of the development and evolution of CNAG and gastric cancer. The academic thought of spleen and stomach disease and the practical value of the academic thought of "treating the disease without disease". Innovative viewpoint: the first time to excavate the academic thought of refining Professor Chestnut's treatment of CNAG cold and heat syndrome: applying the idea of "treating the disease without disease" to the CNAG, and putting forward that the spleen and Stomach Qi Yin deficiency is the root cause of the development, and the gradual addition of the pathological changes. The syndrome of cold and heat disorder is the manifestation of spleen and stomach qi and yin deficiency, and the most common clinic. The core disease machine is "Qi Yin deficiency, cold and hot mixed", and the treatment method and prevention strategy of "Xin Kai bitterness, nourishing yin and nourishing Yin" for CNAG and "activating blood and removing stasis" as supplemented to prevent progress. The characteristics of Lian Xia Qi Mai soup was analyzed. It was suggested that the treatment of CNAG cold and heat syndrome should pay attention to the whole process of CNAG occurrence, development and evolution. It is a new way of thinking for clinical treatment of CNAG, and a new idea for the prevention and control of the development and evolution of CNAG to gastric cancer.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R249;R259

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