本文選題：脾胃病 + 健脾化瘀解毒方�。� 參考：《中國(guó)中醫(yī)科學(xué)院》2017年博士論文

【摘要】：[目的]張鳳武主任醫(yī)師為第五批全國(guó)老中醫(yī)藥專家學(xué)術(shù)經(jīng)驗(yàn)繼承指導(dǎo)老師,從醫(yī)40余年,治療脾胃病的經(jīng)驗(yàn)頗具特色。本人作為其學(xué)術(shù)經(jīng)驗(yàn)繼承人,有幸拜張老為師,通過(guò)臨床跟師學(xué)習(xí)、收集總結(jié)醫(yī)案、與老師訪談、檢索查閱相關(guān)論文書(shū)籍等方式,梳理張鳳武主任學(xué)術(shù)經(jīng)驗(yàn)淵源,總結(jié)其有關(guān)脾胃病治療的學(xué)術(shù)特色,從而繼承發(fā)揚(yáng)名老中醫(yī)的臨證經(jīng)驗(yàn)。張師尤其對(duì)慢性萎縮性胃炎的診治效果最佳,從“脾虛”、“血瘀”、“邪毒”論治慢性萎縮性胃炎,并以此為法創(chuàng)立“健脾化瘀解毒方”,通過(guò)臨床試驗(yàn)研究,探討張師健脾化瘀解毒方治療脾虛氣滯、挾瘀毒內(nèi)阻證型慢性萎縮性胃炎的臨床療效。[方法]從理論研究和臨床試驗(yàn)研究?jī)蓚�(gè)方面系統(tǒng)總結(jié)老師治療脾胃病學(xué)術(shù)經(jīng)驗(yàn)。1理論研究方面通過(guò)搜集文獻(xiàn),整理老師臨證醫(yī)案、醫(yī)話,精讀四部經(jīng)典和老師學(xué)術(shù)相關(guān)的書(shū)籍,導(dǎo)師授業(yè)與本人侍診,形成既符合臨床真實(shí)情況又反映導(dǎo)師脾胃病學(xué)術(shù)觀點(diǎn)的經(jīng)驗(yàn)總結(jié)、學(xué)術(shù)思想。2臨床試驗(yàn)研究方面對(duì)張鳳武主任治療慢性萎縮性胃炎的經(jīng)驗(yàn)方(健脾化瘀解毒方)進(jìn)行臨床研究。本研究病例來(lái)自于2014年6月-2015年10月期間至寧夏回族自治區(qū)中醫(yī)醫(yī)院國(guó)醫(yī)堂張鳳武主任門(mén)診的慢性萎縮性胃炎患者92例。所有患者均符合經(jīng)胃鏡及病理結(jié)果確診為慢性萎縮性胃炎,中醫(yī)證型為脾虛氣滯、挾瘀毒內(nèi)阻證。利用spss19.0軟件進(jìn)行隨機(jī)分組,分為治療組和對(duì)照組,每組46例。治療組:給予張氏“健脾化瘀解毒方”;對(duì)照組給予胃復(fù)春片。兩組均治療3個(gè)月后,比較對(duì)臨床綜合療效、中醫(yī)癥狀積分、胃鏡下黏膜評(píng)分、組織病理療效、幽門(mén)螺桿菌根除率等指標(biāo)變化的觀察,探討健脾化瘀解毒方治療脾虛氣滯、挾瘀毒內(nèi)阻證型慢性萎縮性胃炎的臨床療效。[結(jié)果]1理論研究方面1.1張鳳武主任脾胃病學(xué)術(shù)經(jīng)驗(yàn)的淵源張師的學(xué)術(shù)經(jīng)驗(yàn)淵源于中醫(yī)古籍經(jīng)典理論、歷代醫(yī)家及當(dāng)代名醫(yī)的臨床經(jīng)驗(yàn)。張師認(rèn)為《內(nèi)經(jīng)》中關(guān)于脾胃的理論是較為全面和系統(tǒng)的,是后世“脾胃乃后天之本”理論的淵源。張師在臨床治療各種疾病時(shí),除辨證施治外,總不忘以調(diào)理脾胃為根本,注意顧護(hù)胃氣,體現(xiàn)“脾胃為后天之本”的思想�！督饏T要略》中強(qiáng)調(diào)“四季脾旺不受邪”,脾胃健旺,后天氣血生化之源充足,則正氣充盛,體質(zhì)強(qiáng)健,能抵御外邪的入侵�！爸胃螌�(shí)脾”理論出自《金匱要略·臟腑經(jīng)絡(luò)先后病脈證第一》,云:“夫治未病者,見(jiàn)肝之病,知肝傳脾,當(dāng)先實(shí)脾”,本條所論,在臨床運(yùn)用上很有指導(dǎo)意義。張師遵循《傷寒論》中對(duì)脾胃病變病因病機(jī)的闡述及顧護(hù)脾胃是《傷寒論》治療六經(jīng)病關(guān)鍵的治療思想,在治療各經(jīng)疾病中均貫穿著養(yǎng)胃氣、存津液的學(xué)術(shù)思想�！秱摗穼�(duì)于寒熱錯(cuò)雜、陰陽(yáng)失調(diào)所引起的脾胃病用半夏瀉心湯、生姜瀉心湯、甘草瀉心湯、大黃黃連瀉心湯等治療,體現(xiàn)了仲景重視調(diào)理脾胃氣機(jī)升降的學(xué)術(shù)思想,現(xiàn)在用之臨床,仍每每獲效。《臨證指南醫(yī)案》書(shū)中首提胃陰學(xué)說(shuō),治療以甘涼柔潤(rùn),滋養(yǎng)胃陰為主。張師在臨床應(yīng)用中,對(duì)癥見(jiàn)胃陰虛證的患者,常用麥門(mén)冬湯、增液湯、沙參麥冬湯、玉女煎等方治療,取得良效。清代醫(yī)家吳鞠通在《溫病條辨》中治療三焦病證方面,提出了“治中焦如衡,非平不安”的著名論點(diǎn),張師認(rèn)為凡是以恢復(fù)中焦脾胃功能為最終目的的治則皆可謂吳鞠通所論及的“治中焦如衡,非平不安”。“治中焦如衡”,采用升降同調(diào)、寒熱并進(jìn)、燥濕相濟(jì)、補(bǔ)瀉兼施的方法,以使中焦如衡,恢復(fù)脾胃的功能。張師臨證許多辨治方法、經(jīng)驗(yàn)都根源于《脾胃論》的思想。1.2張鳳武主任治療脾胃病經(jīng)驗(yàn)總結(jié)導(dǎo)師對(duì)脾胃病的病因病機(jī)有獨(dú)到的見(jiàn)解,其認(rèn)識(shí)來(lái)源于《內(nèi)經(jīng)》、《金匱要略》、《傷寒論》、《臨證指南醫(yī)案》、《溫病條辨》、《脾胃論》等中醫(yī)經(jīng)典著作及當(dāng)代各位名家經(jīng)驗(yàn)。張氏認(rèn)為脾胃病的病因病機(jī)主要有四個(gè)方面:脾胃氣機(jī)升降失常,因滯而病;多種因素?fù)p傷,易致脾胃虛弱;久病入絡(luò),瘀血阻滯;內(nèi)外相引,濕邪致病。張師認(rèn)為準(zhǔn)確的把握治療原則,對(duì)治療脾胃病非常重要,臨床總結(jié)出張師治療脾胃病特色有:注重通降論,以“通”祛疾;脾胃合治;脾胃分治;注重氣血辨證論治;堅(jiān)持標(biāo)本論治:注意治胃病不忘健脾除濕熱;注重調(diào)和肝脾;從心治脾。張師結(jié)合40余年臨床經(jīng)驗(yàn),將六經(jīng)辨證、臟腑辨證、三焦辨證融會(huì)貫通,根據(jù)以上治則治法總結(jié)出辨治脾胃病十法,即散寒溫胃法、補(bǔ)氣健脾法、消積導(dǎo)滯法、清胃安中法、和中醒胃法、疏肝和胃法、升清益胃法、降逆調(diào)胃法、化瘀通絡(luò)法、滋陰潤(rùn)胃法。張鳳武主任對(duì)胃鏡下不同表現(xiàn)的7類胃炎,根據(jù)中醫(yī)學(xué)“胃痞、胃痛”等證記載,對(duì)其有明顯臨床表現(xiàn)者,采用辨病與辨證相結(jié)合的診療方法,取得了良好的療效。建立在治療脾胃病的認(rèn)識(shí)基礎(chǔ)上,張主任對(duì)腸炎的治療亦具特色。其辨治特點(diǎn)為:分清標(biāo)本虛實(shí);注重氣血兩調(diào);把握溫清并用;善以燥潤(rùn)相濟(jì);通澀結(jié)合、兩相其美。2臨床研究方面兩組患者性別、年齡、病程及Hp陽(yáng)性感染情況差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)。兩組臨床綜合療效比較,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn),兩組間差異有統(tǒng)計(jì)學(xué)意義(X2=11.03669,P＜0.05)。兩組中醫(yī)癥狀積分比較,治療前兩組患者癥狀積分無(wú)統(tǒng)計(jì)學(xué)差異(P＞0.05),治療后治療組和對(duì)照組癥狀積分均顯著下降(P＜0.05),其中治療組癥狀積分顯著低于對(duì)照組,差異有統(tǒng)計(jì)意義(P＜0.05)。治療前后胃鏡下黏膜評(píng)分比較,兩組患者治療后胃鏡下黏膜評(píng)分均較治療前有所改善,差異有統(tǒng)計(jì)學(xué)意義(P＜0.01),治療組治療后胃鏡下黏膜評(píng)分與對(duì)照組比較差異有統(tǒng)計(jì)學(xué)意義(P0.01)。治療前后病理療效比較,治療組和對(duì)照組治療前胃黏膜萎縮積分、腸上皮化生積分和異型增生積分差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05),治療后治療組和對(duì)照組上述各項(xiàng)病理積分均顯著改善(P＞0.01),其中治療組治療后萎縮程度積分顯著低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P＜0.01),但腸上皮化生積分和異型增生積分與對(duì)照組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)。兩組幽門(mén)螺桿菌根除率比較,治療前治療組Hp感染例數(shù)為30例(68.18%),對(duì)照組為27例(62.79%),兩組間的Hp感染率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)。治療后治療組Hp陽(yáng)性9例,根除率70.0%;對(duì)照組Hp陽(yáng)性14例,根除率48.15%,兩組根除率比較差異有統(tǒng)計(jì)學(xué)意義(X2=6.422723,＜0.05)。安全性評(píng)價(jià),治療組及對(duì)照組患者在服藥過(guò)程中均未出現(xiàn)發(fā)熱、皮疹等不良反應(yīng),治療前、后血常規(guī)、尿常規(guī)、肝腎功能、心電圖檢查未見(jiàn)異常。[結(jié)論]張鳳武主任熟讀各種中醫(yī)典籍,吸收各醫(yī)家學(xué)術(shù)精華,形成了其治療脾胃病的學(xué)術(shù)經(jīng)驗(yàn)特色。中藥健脾化瘀解毒方治療組與對(duì)照組治療后兩組癥狀及病理均有所改善。健脾化瘀解毒方治療后一方面可以明顯緩解患者胃痛、胃脹以及噯氣、納呆、疲倦和嘈雜等不適癥狀,并能改善胃鏡下胃黏膜局部循環(huán),另一方面還能促進(jìn)萎縮腺體恢復(fù),緩解胃黏膜炎癥狀態(tài),并有效提高Hp清除率。
[Abstract]:[Objective] director Zhang Fengwu, the director of the fifth batch of academic experience of Chinese traditional Chinese medicine, has been the successor to the academic experience of the Chinese traditional Chinese medicine. After 40 years of medical treatment, the experience in the treatment of spleen and stomach disease is quite distinctive. I have been the successor of his academic experience. I have been lucky to be the teacher of Zhang Lao, to collect and summarize the medical cases, interview with the teacher, and search and consult the related papers. And so on, combing the origin of Zhang Fengwu's academic experience, summarizing the academic characteristics of the treatment of spleen and stomach disease, so as to inherit the clinical experience of the famous old Chinese medicine. Zhang Shi especially has the best treatment effect on chronic atrophic gastritis, from "Spleen Deficiency", "blood stasis", "evil poison" on chronic atrophic gastritis, and in this way, "spleen invigorating the spleen" is established. To explore the clinical efficacy of Zhang Shi Jianpi Huayu Jiedu recipe in the treatment of spleen deficiency qi stagnation and stasis syndrome type chronic atrophic gastritis through clinical trial and study. [Methods] from the two aspects of theoretical research and clinical trial research, a systematic summary of the academic experience of the academic experience of the treatment of spleen and stomach disease in the.1 theory was collected and the literature was collected. The teacher is a medical case, a medical case, a medical language, a intensive reading of four classics and academic books related to teachers, tutors' teaching and personal consultation, which forms a summary of experience which is not only consistent with the clinical reality but also reflects the academic viewpoint of the spleen and stomach disease of the tutor. The experience of Zhang Fengwu's clinical trial and Research on the treatment of chronic atrophic gastritis (invigorating spleen and removing stasis) is an empirical prescription for Zhang Fengwu. 92 cases of chronic atrophic gastritis with chronic atrophic gastritis in the outpatient of Zhang Fengwu, state medical hall, the Ningxia Hui Autonomous Region Hospital of traditional Chinese medicine in the Ningxia Hui Autonomous Region, in October June 2014. All patients were diagnosed with chronic atrophic gastritis by gastroscopy and pathological results. The syndrome type of TCM was spleen deficiency qi stagnation and blood stasis poisoning. The internal resistance syndrome was divided into the treatment group and the control group by spss19.0 software. The treatment group was given 46 cases in each group. The treatment group was given Zhang's "Jianpi Huayu Jiedu recipe", and the control group was given Wei Fu Chun tablets. The two groups were treated for 3 months, compared with the clinical comprehensive effect, the TCM symptom score, the gastroscope mucosa score, the histopathological curative effect and Helicobacter pylori. The clinical curative effect of Jianpi Huayu Jiedu Recipe on spleen deficiency qi stagnation and stasis syndrome type chronic atrophic gastritis was observed. [results] the academic experience of 1.1 Zhang Fengwu's academic experience on the academic experience of Zhang Fengwu's spleen and stomach disease originated from the classical theory of ancient Chinese books, the immediate medical and Contemporary famous doctors. The theory of the spleen and stomach in the inner Sutra is more comprehensive and systematic, and it is the origin of the theory of "spleen and stomach in the future" in later generations. In the treatment of various diseases, Zhang Shi is always taking care of the stomach as the root of regulating the spleen and stomach, and reflecting the thought of "the spleen and stomach for the day of the day". The theory of "four seasons splenic flourish does not receive evil", the spleen and the stomach flourish, the natural Qi and blood biochemical source is sufficient, the positive gas is filled, the constitution is strong and strong, it can resist the invasion of the external evil. "The liver and the spleen" theory comes from the first of the golden chamber and the viscera meridian meridian syndrome first >, cloud: "the disease of the liver, the liver spleen, the first real spleen", is discussed in this article. The clinical application is of guiding significance. Zhang Shi follows the elaboration of the etiology and pathogenesis of the spleen and stomach diseases in the theory of typhoid fever and the key treatment idea of protecting spleen and stomach is the key to the treatment of six meridian diseases. In the treatment of various diseases, the academic thought of nourishing stomach Qi and storing body fluid is carried out in the treatment of various diseases. Banxia Xiexin Decoction, ginger Xiexin soup, liquorice diarrhea heart soup, Huanglian Xiexin Decoction and other treatment, embodies the academic thought of Zhongjing to regulate the lifting of the spleen and stomach qi, and is still used in clinical. The patients of yin deficiency syndrome, commonly used in the treatment of mamaendong soup, Zeng liquid soup, Sha Shen maidun soup and Jade Maiden decoction, have achieved good effects. The famous Qing Dynasty physician Wu Jutong put forward the famous argument of "treating the central coke as a balance and unpeace" in the treatment of the disease of the disease. It is called "treating middle Jiao like balance, unpeaceful and unpeaceful". "Treating middle coke like balance", using the method of lifting and regulating, cold and heat and entering, drying and damp, making up and reducing the function of the spleen and stomach, so as to restore the function of spleen and stomach, the experience is rooted in the experience of.1.2 Zhang Fengwu, director of the spleen and stomach theory, in the treatment of spleen and stomach disease experience. The knowledge of the etiology and pathogenesis of spleen and stomach disease was summed up by the tutor. Its knowledge came from the classic works of traditional Chinese medicine such as Neijing, "Golden Chamber", "Treatise on Febrile Disease >", "medical case guide", "Clinical Guide to syndrome", "spleen and stomach theory >" and other contemporary experience. The main causes of spleen and stomach disease are four aspects: the disorder of the spleen and stomach qi and the stagnation of the spleen and stomach qi. And the disease; a variety of factors injury, easy to cause weakness of the spleen and stomach; long illness into the collaterals, blood stasis block; internal and external lead, damp pathogenic pathogenic. Zhang Shi believes that accurate grasp the principle of treatment of the spleen and stomach disease is very important to treat the spleen and stomach disease characteristics: pay attention to the "Tong" theory, "Tong" and dispel disease; spleen and stomach treatment; spleen and stomach differentiation and treatment; pay attention to Qi and blood syndrome differentiation and treatment Adhere to the treatment of the specimens: pay attention to the treatment of stomach disease to improve the spleen and damp heat; pay attention to the harmony of the liver and spleen; treat the spleen from the heart. Zhang Shi combined with 40 years of clinical experience, the six meridian syndrome differentiation, the viscera syndrome differentiation, the three focal syndrome differentiation and integration, according to the above treatment method, summed up the differentiation and treatment of spleen and stomach disease ten methods, that is, the method of dispersing the spleen and stomach, invigorating the spleen and invigorating the spleen, eliminating the accumulation and guiding method, clearing stomach safety method, and the method of clearing the stomach in the stomach. The method of stomach and stomach, liver dredging and stomach, ascending and clearing stomach, lowering stomach and stomach regulating stomach, removing blood stasis and dredging collaterals, nourishing yin and moistening stomach. The 7 kinds of gastritis with different manifestations of gastroscope under the gastroscope of Zhang Fengwu were recorded according to the TCM "stomach ruffian, stomachache" and so on. Based on the understanding of the treatment of spleen and stomach disease, Mr. Zhang's treatment of enteritis is also characteristic. The characteristics of the treatment are as follows: distinguish the false and solid of the specimen; pay attention to the two tone of Qi and blood; grasp the temperature and the use; the good with the dryness and temper; the two groups of patients' sex, age, course of disease and positive infection of the two phases of the.2 clinical study Meaning (P > 0.05). Two groups of clinical comprehensive curative effect comparison, the difference between the two groups was statistically significant (X2=11.03669, P < 0.05). The two groups of TCM symptom scores were compared, the symptom scores of the two groups before the treatment were not statistically significant (P > 0.05), and the symptom scores of the treatment group and the control group were significantly decreased (P < 0.05), among them, the treatment group was symptomatic. The difference was significantly lower than that of the control group (P < 0.05). The mucosa scores of the two groups before and after the treatment were better than those before treatment, and the difference was statistically significant (P < 0.01). The difference of the mucous membrane score under the gastroscope of the treatment group was statistically significant (P0.01). Before and after treatment, the score of atrophy of gastric mucosa in the treatment group and the control group was not statistically significant (P > 0.05). All the pathological scores of the treatment group and the control group were significantly improved (P > 0.01) after treatment (P > 0.01), and the scores of the atrophy degree after treatment were significantly lower than those in the treatment group. The difference was statistically significant (P < 0.01), but there was no significant difference between the intestinal metaplasia score and the dysplasia score in the control group (P > 0.05). The number of Helicobacter pylori eradication in the two groups was 30 (68.18%) and 27 (62.79%) in the control group, and there was no statistical difference in the rate of Hp infection among the two groups. Learning significance (P > 0.05). After treatment, 9 cases were positive in the treatment group, the eradication rate was 70%, 14 cases with Hp positive in the control group and 48.15% of eradication rates. The difference of eradication rates in the two groups was statistically significant (X2=6.422723, < 0.05). The safety evaluation, the treatment group and the control group had no fever, rash and other adverse reactions, before and after the treatment. There was no abnormality in the routine urine, liver and kidney function and electrocardiogram. [Conclusion] director Zhang Fengwu was familiar with various classics of traditional Chinese medicine and absorbed the academic essence of various doctors, and formed its academic experience in the treatment of spleen and stomach disease. The symptoms and pathology of the two groups were improved after the treatment of the Chinese medicine Jianpi Huayu Jiedu Fang treatment group and the control group. On the other hand, it can obviously relieve the discomfort symptoms such as stomach pain, stomach distention, belching, tiredness, fatigue and noise, and can improve the local circulation of gastric mucosa under the gastroscope. On the other hand, it can also promote the recovery of atrophy glands, relieve the inflammatory state of the gastric mucosa and effectively improve the Hp clearance rate.
【學(xué)位授予單位】：中國(guó)中醫(yī)科學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259;R249

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