本文選題：王永炎 + 學術思想��； 參考：《中國中醫(yī)科學院》2017年博士論文

【摘要】：王永炎教授是我國著名的中醫(yī)內(nèi)科學、神經(jīng)內(nèi)科學專家,主要以運用中醫(yī)手段預防和診治心腦血管疾病為研究方向,先后承擔了國家的多項重大課題,作為中醫(yī)內(nèi)科的學術帶頭人,對中風、癡呆進行了更深入、更系統(tǒng)化地臨床與基礎研究,使我國的中醫(yī)藥腦病防治水平有了更大的提升。我有幸作為王永炎教授的學術繼承人跟師學習,對王永炎教授的學術思想尤其是其防治心血管疾病的經(jīng)驗進行了總結。本論文主要從以下四個方面對王永炎教授的學術思想以及臨證經(jīng)驗進行總結:1.王永炎教授學術淵源;2.王永炎教授學術思想;3.王永炎教授診治心血管病經(jīng)驗整理與總結;4.養(yǎng)陰熄風復脈湯治療心陰不足、風動心絡證室性早搏的臨床研究。1第一部分:探究王永炎教授的學術淵源。王永炎教授出生于中醫(yī)世家,幼承家訓,師從于中醫(yī)名家董建華老師,學術思想深得其真?zhèn)?繼承了董先生許多寶貴經(jīng)驗,并擅于發(fā)展創(chuàng)新,又熟讀經(jīng)典,勤于臨證,從醫(yī)數(shù)十年,積累了豐富的學術經(jīng)驗,不僅在以中風病為主的中醫(yī)腦病理論和臨床方面形成了自己的主要學術方向,并且在中醫(yī)藥標準化規(guī)范化、方劑組分配伍、臨床評價、中藥資源、臨床中藥學等方面培養(yǎng)了大量的人才。2第二部分:挖掘王永炎教授的學術思想。王永炎教授創(chuàng)立了較為完整的中風病的中醫(yī)診療體系,其中首推的便是“證候規(guī)范化”研究。導師多年來著力于中風病的診療發(fā)展,制定創(chuàng)立了“中風病中醫(yī)診斷、療效評定標準”,其中明確提出了中風病的名稱、病類以及證類的診斷標準、療效判定標準和其相應的治則治法,使中風病的臨床診療更加規(guī)范和系統(tǒng)化,為后來的眾多學者提供了清晰的臨床診療思路及易行有效的中醫(yī)藥治療方法,更是對我國臨床其他各科建立中醫(yī)藥的規(guī)范化系統(tǒng)化診療體系起到了一定啟示及模范帶頭作用。王永炎教授初次對病絡的涵義給出了明確定義:病絡是絡脈的病理過程和病機環(huán)節(jié),是病證產(chǎn)生的根源。強調(diào)通過深入分析病絡的發(fā)生機制,對尋求其共同的病機、制定治法方藥、評估預后均具有重要的意義。在此基礎上,發(fā)展創(chuàng)新,將其理論與實踐結合,用于心血管病的治療,提出心陰不足、風動心絡為室性早搏的病機之一,在臨床上根據(jù)本病的基本病機形成治療本病的經(jīng)驗方:養(yǎng)陰熄風復脈湯。3第三部分:王永炎教授診治心血管病經(jīng)驗整理與總結。本部分通過重點選取心血管病,包括高血壓、冠心病、房顫、室性早搏,系統(tǒng)整理分析王永炎教授防治此類心血管疾病的臨床經(jīng)驗和學術思想,以期為臨床醫(yī)師運用中醫(yī)藥預防和治診心血管疾病提供一定的學術經(jīng)驗。高血壓:王永炎教授認為高血壓病的治療應注重五臟一體,臟腑并重,其主要病因為:情志失調(diào)、飲食失節(jié)、內(nèi)傷虛損,主要的發(fā)病機理為:早期多標實,如肝陽上亢、瘀血內(nèi)停、外感風邪等;中期由于腎水不足,肝陽上亢,尤其是年邁精衰者,往往轉化為腎精虧虛或氣血不足之證,病機復雜,病情較重,變證叢生。辨證要點:西醫(yī)辨病與中醫(yī)辨證相結合,辨病是前提,辨證是核心,強調(diào)辨證論治。冠心病:王永炎教授認為冠心病總病機為“陽微陰弦”,病位在心及心絡。其發(fā)病機理本虛標實,其中,本為氣、血、陰、陽的虛損,標為痰、瘀、風冷、毒熱,中醫(yī)治療總原則為:急則治其標,緩則治其本。強調(diào)在冠心病的診治中應遵循“五臟六腑整體調(diào)節(jié)”,治療上分清疾病的輕重緩急,分證論治,標本兼顧。同時指出,冠心病的預防應放在首要位置,中醫(yī)藥應當發(fā)揮其應有的優(yōu)勢,注重針藥并施。房顫:在房顫的治療中,王永炎教授在多年的臨證中,總結出本病常見的方證及主治規(guī)律。總結發(fā)現(xiàn)炙甘草湯、桂枝加龍骨牡蠣湯、溫膽湯等為主要方證。導師認為腎虛是導致本病的重要病機,臨證時強調(diào)補腎。室性早搏:王永炎教授認為“心陰不足,風動心絡”是陰虛證室性早搏的基本病機,指出風邪致病具有起病急而變化快的特性,而心悸之“悸動”、“心中突兀不寧”、“時輕時重”、“時發(fā)時止”等癥類似于“風邪”為病的表現(xiàn)。在治療上也體現(xiàn)了“以風治風”的思想,風類藥質地輕清,可起到疏解宣透的作用,特點多為辛、散、竄、透、動等,一方面能發(fā)散祛邪、化濕、祛痰;另一方面其仍可發(fā)散開郁、溫通走竄、滋養(yǎng)血脈、行氣化瘀。養(yǎng)陰熄風復脈湯:王永炎教授在多年臨證實踐中,重視風邪在本病發(fā)病中的作用,強調(diào)風藥止悸對提高室性早搏陰虛證療效尤其重要。認為“心陰不足,風動心絡”是陰虛證室性早搏的基本病機,并在臨床上根據(jù)本病的基本病機形成治療本病的經(jīng)驗方:養(yǎng)陰熄風復脈湯。藥物組成為:北沙參、玄參、丹參、黃連、麩炒僵蠶、蟬蛻、全蟲、生龍骨、生牡蠣、酸棗仁、甘松等。方中北沙參、玄參二者相伍,養(yǎng)陰潤燥、滋陰降火、培元固本而共為君藥;僵蠶祛風定驚、化痰散結,蟬蛻疏散風熱、透邪外出,全蟲走竄,搜風通絡、攻毒散結,三藥相合,搜風通絡而共為臣藥;丹參活血化瘀、祛瘀生新,黃連苦寒,清熱解毒,生龍牡潛斂心神、安神定志,酸棗仁酸甘收斂,伍龍牡而共奏養(yǎng)心安神之效,五藥相合,兼顧標實,配合君臣以竟佐助之功;甘松味辛,其氣芳香,開郁醒脾,引導方中藥物直到病所,為使藥。諸藥相合,標本兼顧,完切病機,而共奏養(yǎng)陰熄風、安神復脈之功。4第四部分:養(yǎng)陰熄風復脈湯治療心陰不足風動心絡證室早的臨床研究。研究目的:觀察養(yǎng)陰熄風復脈湯治療心陰不足風動心絡證室早的臨床療效。研究方法:使用隨機對照設計方法,將符合納入標準的室性早搏(心陰不足、風動心絡證)患者隨機分為中藥治療組和西藥對照組,治療組與對照組各納入70例。中藥治療組給予“養(yǎng)陰熄風復脈湯”加減治療,西藥對照組給予美托洛爾25mg,2/日治療,療程均為28±2天。比較兩組患者治療前、后的臨床療效、中醫(yī)證候積分、24h動態(tài)心電圖室性早搏次數(shù)及心率變異性的變化差異。研究結果:入組的受試者中,治療組脫落1例,對照組脫落2例。1.中醫(yī)證候療效:兩組患者經(jīng)治療后,①中醫(yī)證候總療效分別為:治療組89.9%,對照組72.1%,治療組明顯優(yōu)于對照組,差異具有統(tǒng)計學意義(P0.05);②中醫(yī)證候總積分均有所減少,兩組治療前后自身比較,差異均具有統(tǒng)計學意義(P0.05);治療后組間比較,治療組明顯優(yōu)于對照組,差異具有統(tǒng)計學意義(P0.05);③中醫(yī)單項癥狀積分均有所改善,其中,心悸、易驚善恐、氣短乏力、心煩不安、失眠癥狀的改善,治療組明顯優(yōu)于對照組,差異具有統(tǒng)計學意義(P0.05)。2.室性早搏次數(shù)療效:兩組患者經(jīng)治療后,24h動態(tài)心電圖室性早搏次數(shù)均有所減少,兩組治療前后自身比較,差異均具有統(tǒng)計學意義(P0.05),組間比較,差異不具有統(tǒng)計學意義(P0.05);兩組24h動態(tài)心電圖有效率分別為,治療組73.9%,對照組67.6%,組間比較,差異不具有統(tǒng)計學意義(P0.05)。3.心率變異性HRV的影響:主要觀察指標有SDNN、SDANN、PNN50、RMSSD,兩組患者治療前后自身對比,治療后四項指標均有所升高,差異均具有統(tǒng)計學意義(P0.05);治療后組間比較,其中,SDNN、SDANN、RMSSD的變化,治療組優(yōu)于對照組,差異具有統(tǒng)計學意義(P0.05)。研究結論:1.本研究表明養(yǎng)陰熄風復脈湯能明顯改善心陰不足、風動心絡證室性早搏患者的臨床癥狀及體征,間接佐證了心陰不足、風動心絡是室性早搏的病機之一。2.養(yǎng)陰熄風復脈湯可減少患者動態(tài)心電圖的室性早搏總數(shù),通過其對心室變異率各項指標的影響,考慮室性早搏的發(fā)生可能與患者的交感神經(jīng)興奮有關,本方可能通過抑制交感神經(jīng)活性,提高迷走神經(jīng)張力,改善自主神經(jīng)功能,從而有效緩解患者癥狀。3.養(yǎng)陰熄風復脈湯對室性早搏患者最慢心率變化及肝腎功能均無明顯影響,無毒副作用,具有良好的安全性。本論文的創(chuàng)新點:1.系統(tǒng)歸納、總結王永炎教授治療心血管疾病的學術思想及臨床經(jīng)驗。2.首次提出“心陰不足,風動心絡”是陰虛證室性早搏的基本病機,立養(yǎng)陰熄風復脈法,并在臨床上根據(jù)本病的基本病機形成治療本病的經(jīng)驗方:養(yǎng)陰熄風復脈湯。3.進一步驗證王永炎教授經(jīng)驗方養(yǎng)陰熄風復脈湯加減治療室性早搏的臨床療效及安全性,探討其可能的作用機制,為中醫(yī)藥治療室性早搏提供新的治療方法和研究思路。
[Abstract]:Professor Wang Yongyan is a famous expert in internal medicine and neurology in China. It mainly takes the use of traditional Chinese medicine to prevent and treat cardiovascular and cerebrovascular diseases as the research direction. It has undertaken a number of major issues in the country. As the academic leader of the medical department of traditional Chinese medicine, it has carried out a deeper, more systematic clinical and basic research on stroke and dementia. In order to improve the level of cerebral disease prevention and cure of Chinese medicine, I have been lucky to learn from Professor Wang Yongyan's academic successor and teacher, and summarize the academic thought of Professor Wang Yongyan, especially his experience in preventing and controlling cardiovascular disease. This paper mainly discusses the academic thought and the experience of Professor Wang Yongyan from the following four aspects. Summary: 1. professor Wang Yongyan academic origin; 2. professor Wang Yongyan academic thought; 3. professor Wang Yongyan's diagnosis and treatment of cardiovascular disease experience collation and summary; 4. Yangyin Xifeng complex pulse soup treatment of yin deficiency, the clinical study of ventricular premature beat of wind and cardio collateral syndrome: Part 1: To explore the academic origin of Professor Wang Yong Yan. Professor Wang Yongyan was born in traditional Chinese medicine. Professor Wang Yongyan was born in traditional Chinese Medicine The family, the family training, the family training, the teacher from the famous Chinese traditional Chinese medicine Dong Jianhua, has a profound academic thought, inherits many valuable experiences of Mr. Dong, and is good at developing and innovating. He is also familiar with the classics. He has accumulated rich academic experience for decades, and has formed himself not only in the theory and clinical aspects of Chinese traditional Chinese medicine, but also on the theory and clinical aspects of Chinese traditional Chinese medicine. The main academic direction, and in the standardization of traditional Chinese medicine, prescription components and compatibility, clinical evaluation, traditional Chinese medicine resources, clinical pharmacy, and other aspects of training the second parts of.2: to excavate professor Wang Yongyan's academic ideas. Professor Wang Yongyan established a more complete system of TCM diagnosis and treatment of stroke, the first of which is " For years, the tutor focused on the development of diagnosis and treatment of apoplexy, established the establishment of a "TCM diagnosis of stroke, the standard of evaluation of curative effect", which explicitly proposed the name of the stroke, the diagnosis standard of the disease and the syndromes, the criterion of the curative effect and the corresponding treatment method, so that the clinical diagnosis and treatment of the stroke are more standardized and more standardized. Systematization has provided a clear idea of clinical diagnosis and treatment for many later scholars and effective treatment methods of traditional Chinese medicine. It also plays a certain inspiration and exemplary role in standardizing and systematized diagnosis and treatment system of Chinese medicine in other departments of our country. Professor Wang Yongyan gave a clear definition of the meaning of disease collaterals for the first time: disease Collaterals are the pathological process and pathogenesis of the collaterals, which are the root causes of the disease. It is emphasized that through the in-depth analysis of the pathogenesis of the disease and collaterals, it is of great significance to seek their common pathogenesis, formulate prescription drugs and evaluate the prognosis. Foot, wind dynamic heart and collaterals is one of the pathogenesis of ventricular premature beat. According to the basic pathogenesis of this disease, according to the basic pathogenesis of this disease, third parts of the treatment of this disease: Yin Yangfeng Fu Mai Decoction.3: Professor Wang Yongyan's experience in the diagnosis and treatment of cardiovascular diseases. This part focuses on cardiovascular disease, including hypertension, coronary heart disease, atrial fibrillation, ventricular premature beat, and system The clinical experience and academic thoughts of Professor Wang Yongyan in prevention and treatment of such cardiovascular diseases are analyzed and analyzed in order to provide a certain academic experience for clinicians to use traditional Chinese medicine to prevent and treat cardiovascular diseases. Hypertension: Professor Wang Yongyan believes that the treatment of hypertension should pay attention to the integration of the five Zang organs and the viscera, whose main disease is because of the loss of emotion. The main pathogenesis is: early multi - scale, such as liver yang hyperactivity, stagnation of blood stasis, exogenous wind evil and so on; in the middle period, the deficiency of kidney water, hyperactivity of liver Yang, especially the aged and senile, often converted to deficiency of kidney essence or deficiency of Qi and blood, the pathogenesis is complex, the condition is heavier, and the syndrome is clustered. Differentiation points of Western medicine: differentiation of disease and middle syndrome differentiation in Western Medicine Medical syndrome differentiation is the premise, differentiation is the premise, syndrome differentiation is the core, emphasis on syndrome differentiation and treatment. Coronary heart disease: Professor Wang Yongyan thinks that the total disease machine of coronary heart disease is "Yang micro Yin chord", the disease position is in the heart and heart collateral. The pathogenesis of the disease is true, which is the deficiency of Qi, blood, yin and Yang, the standard is phlegm, blood stasis, wind cold, toxic heat, the general principle of TCM treatment is to cure its standard by urgent rule, In the diagnosis and treatment of coronary heart disease, we should follow the "overall regulation of the five viscera and six organs" in the diagnosis and treatment of coronary heart disease. The treatment should distinguish the urgency of the disease, the syndrome differentiation and treatment and the consideration of the specimen. At the same time, it is pointed out that the prevention of coronary heart disease should be put in the first place, the traditional Chinese medicine should give full play to its due advantages, pay attention to the acupuncture and the application of the atrial fibrillation: in the treatment of atrial fibrillation, Wang Yongyan The professor summed up the common syndromes and rule of treatment of the disease in many years. It was found that the decoction of licorice, Guizhi, dragon bone and oyster soup, and Wendan soup were the main syndromes. The tutor thought that kidney deficiency was an important pathogenesis of this disease. The basic pathogenesis of ventricular premature beat indicates that the pathogenic pathogenic wind is characterized by rapid onset and rapid change, and the "throbbing" of palpitations, "sudden and unpleasant" in the heart, "time light weight", "time of hair time" are similar to the manifestation of "wind evil" for the disease. In the treatment, the idea of "wind treatment with wind" is also reflected, and the texture of wind like medicine is light and clear. On the one hand, it can diverge and dispel evil spirits, change dampness and dispel phlegm, on the other hand, it can still be diverged and dispel phlegm. On the other hand, it can be diverged and stagnated, nourishing blood circulation, nourishing blood stasis and removing blood stasis. In the practice of years, Professor Wang Yongyan attaches great importance to the effect of wind evil in the disease, and emphasizes the improvement of wind palpitation. The effect of the ventricular premature beat Yin deficiency syndrome is especially important. It is considered that "heart Yin deficiency, wind moving heart and blood" is the basic pathogenesis of premature ventricular beat of yin deficiency syndrome. According to the basic pathogenesis of this disease, it forms the experience of treating the disease according to the basic pathogenesis of this disease: Nourishing Yin and extinguishing the wind complex pulse soup. Oysters, Zizyphus jujube kernel, Gansu pine and so on. In the north and the north of Radix sastiais and Radix sasphanus, the two groups are compatible, nourishing yin and moistening dryness, nourishing yin and reducing fire, and making a total of monarch medicine; the silkworm dispelling wind and dispelling the wind, dispersing the wind, dispersing the wind and heat, passing the whole worm, searching the wind and dredging the collaterals, combining the three drugs and collecting the wind and collaterals, and removing blood stasis, removing stasis Sheng Xin, Huanglian Bitter cold, heat and detoxification, living dragon and hide the heart, calm the spirit, sour jujube benevolence and astringent, wu long and sour sweet and sour, Wu Long Mu together play the effect of heart and mind, five drugs coincide, give consideration to the subject matter, cooperate with the gentleman and minister to help it. The fourth part of nourishing yin and extinguishing the wind and restoring pulse work: the fourth part: the clinical study of Yangyin Xifeng Fu Mai Decoction in the treatment of Xinyin insufficiency wind dynamic heart and collateral syndrome. Objective: To observe the clinical effect of Yangyin Xifeng Fu Mai Decoction in the treatment of Xinyin insufficiency wind dynamic heart and collateral syndrome. The patients were randomly divided into the Chinese medicine treatment group and the western medicine control group. The treatment group and the control group were included in 70 cases. The Chinese medicine treatment group was given the treatment of "Yangyin quifeng Fu Mai Decoction", the western medicine control group was given metoprolol 25mg, 2/ day treatment, the course of treatment was 28 + 2 days. The clinical curative effect of the two groups before and after treatment was compared. Medical syndrome score, 24h dynamic electrocardiogram room sex early beat times and heart rate variability of variation. Results: in the group of subjects, the treatment group dropped 1 cases, the control group shedding 2 cases of.1. TCM syndrome effect: the two groups of patients after treatment, the total effect of TCM syndrome was 89.9%, the control group 72.1%, the treatment group was obviously better than the control group. Group, the difference was statistically significant (P0.05); the total scores of TCM syndromes were reduced, and the difference between the two groups before and after treatment was statistically significant (P0.05); the treatment group was significantly better than the control group after treatment, and the difference was statistically significant (P0.05); (3) the symptom scores of Chinese medicine were improved, palpitation, easy to be surprised. Good fear, shortness of breath, upset, insomnia symptoms improved, the treatment group was significantly better than the control group, the difference was statistically significant (P0.05).2. ventricular premature beat frequency effect: two groups of patients after treatment, the number of 24h dynamic electrocardiogram room sexual premature beat decreased, the two groups before and after treatment, the difference was statistically significant (P0.05). The difference was not statistically significant (P0.05); the two groups of 24h dynamic electrocardiogram were effective, 73.9% and 67.6% in the control group. The difference was not statistically significant (P0.05).3. heart rate variability HRV: the main observation indexes were SDNN, SDANN, PNN50, RMSSD, two groups of patients were compared before and after treatment, and four items after treatment. The difference was statistically significant (P0.05), and the changes of SDNN, SDANN and RMSSD after treatment, the treatment group was better than the control group, the difference was statistically significant (P0.05). The 1. studies showed that Yangyin Xifeng Fu Mai decoction could obviously improve the insufficiency of the heart and Yin, and the clinical symptoms of the patients with ventricular premature beat of the wind and the heart and the collateral syndrome. The form and sign indirectly confirm the insufficiency of the heart Yin, the wind moving heart and the collaterals is one of the pathogenesis of the ventricular premature beat..2. nourishing yin and extinguishing the pulse soup can reduce the total number of ventricular premature beat of the patient's dynamic electrocardiogram, and the occurrence of ventricular premature beat may be related to the sympathetic excitement of the patient. Making sympathetic nerve activity, improving vagus nerve tension, improving autonomic nerve function, thus effectively relieving the symptom.3. nourishing yin and extinguishing the wind complex pulse soup on the most slow heart rate change and liver and kidney function of patients with ventricular premature beat, non toxic side effect and good safety. The innovation of this paper: 1. systematic induction and summary of Professor Wang Yongyan The academic thought and clinical experience for the treatment of cardiovascular disease.2. first proposed that "the insufficiency of heart Yin, the wind and the heart and the collaterals" is the basic pathogenesis of the premature ventricular beat of yin deficiency syndrome, and the method of nourishing yin and extinguishing the wind to recover the pulse, and to form the experience in the treatment of the disease according to the basic pathogenesis of this disease in clinic: the nourishing Yin extinguishing vein soup.3. further verifies professor Wang Yongyan's experience. The clinical efficacy and safety of Yangyin Xifeng Fu Mai Decoction in the treatment of sexual premature beat in therapeutic room, the possible mechanism of action is discussed, and new treatment methods and research ideas are provided for the traditional Chinese medicine in the therapeutic room sex premature beat.
【學位授予單位】：中國中醫(yī)科學院
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R249;R259

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