李世增學術(shù)思想與臨床經(jīng)驗總結(jié)及李氏和降湯治療胃食管反流病脾虛肝郁證的療效觀察
發(fā)布時間：2018-07-15 21:32
【摘要】：導師李世增,男,1940年出生于北京一個中醫(yī)世家,畢業(yè)于北京中醫(yī)學院,首都醫(yī)科大學教授,主任醫(yī)師,國家級名老中醫(yī)。李世增教授從事臨床工作近50年,溫病學教學工作30余年,具有扎實的中西醫(yī)理論功底和豐富的臨床實踐經(jīng)驗,善治內(nèi)科雜病及婦科、皮科疾病。尤其在溫病學理論方面造詣頗深,擅用中醫(yī)溫病學理論指導臨床實踐,療效顯著。本論文主要從追尋李世增教授學術(shù)淵源,整理挖掘其學術(shù)思想與臨證經(jīng)驗,并應用計算機輔助系統(tǒng)研究其治療慢性胃炎的臨證經(jīng)驗和學術(shù)思想,及李氏和降湯治療胃食管反流病脾虛肝郁證的臨床觀察研究四部分完成。第一部分是從李世增教授的成長、學習及工作經(jīng)歷各方面探尋其學貫中西,以溫病學辨證思維和方法治療疾病的學術(shù)淵源。第二部分總結(jié)了李世增教授的學術(shù)思想和臨證經(jīng)驗。首先總結(jié)了李世增教授的四方面學術(shù)思想:李老認為中醫(yī)的根基是"仁術(shù)",中醫(yī)的血脈是"理論與臨床"。臨床診斷注重中西醫(yī)結(jié)合,望、聞、問、切、驗五診合參。善于根據(jù)脾胃特點治療脾胃病,治病善用藥對。養(yǎng)生、治病注重心、肝、脾三臟,創(chuàng)立了養(yǎng)心、清肝、醒脾的新"三寶"思想。同時對李世增教授治療肺系疾病、心系疾病、脾胃病、婦科疾病和皮膚科疾病的診療經(jīng)驗進行了總結(jié)。并總結(jié)了李世增教授應用"佐金平木"法治療多種疾病的診療經(jīng)驗。第三部分是應用中醫(yī)傳承輔助系統(tǒng)對李世增教授治療慢性胃炎臨證經(jīng)驗及其學術(shù)思想的研究。主要應用中國中醫(yī)科學院中藥研究所與中國科學院自動化研究所聯(lián)合開發(fā)的中醫(yī)傳承輔助系統(tǒng)軟件,采用規(guī)則分析、改進的互信息法、復雜系統(tǒng)熵聚類、無監(jiān)督的熵層次聚類等多種數(shù)據(jù)挖掘方法,按照"數(shù)據(jù)錄入→數(shù)據(jù)管理→數(shù)據(jù)查詢→數(shù)據(jù)分析→分析結(jié)果輸出→網(wǎng)絡(luò)可視化展示"的順序,對李世增教授治療慢性胃炎的方劑用藥規(guī)律進行系統(tǒng)分析。目的:采用中醫(yī)傳承輔助系統(tǒng)軟件客觀系統(tǒng)分析出李世增教授治療慢性胃炎的方劑用藥規(guī)律。方法:收集李世增教授治療慢性胃炎病歷168人次,處方471首,錄入"中醫(yī)傳承輔助系統(tǒng)",使用"數(shù)據(jù)分析"模塊中的"方劑分析"功能,進行藥物頻次、處方規(guī)律、新方分析等組方規(guī)律分析。結(jié)果:李世增教授治療慢性胃炎使用頻次在前32位的藥物可歸納為6類:1.健脾益氣消食藥:太子參、黃芪、白術(shù)、茯苓、雞內(nèi)金、焦三仙;2.養(yǎng)陰生津藥:白芍、北沙參、百合、麥冬、石斛、黃精、枸杞子;3.疏肝理氣止痛藥:佛手、香櫞、枳殼、郁金、延胡索、蘇梗、厚樸、杏仁;4.活血化瘀通絡(luò)藥:丹參、三七、絲瓜絡(luò);5.清熱解毒消癰藥:蒲公英、連翹、白花蛇舌草;6.祛濕醒脾藥:姜半夏、白豆蔻、藿香、浙貝母。其中太子參、黃芪、白術(shù)、茯苓、雞內(nèi)金、焦三仙;白芍、北沙參、百合、麥冬、石斛;佛手、香櫞、枳殼、郁金、延胡索、蘇梗、厚樸;丹參、三七、絲瓜絡(luò);蒲公英、連翹、白花蛇舌;姜半夏、白豆蔻、藿香、浙貝母為慢性非萎縮性胃炎與慢性萎縮性胃炎的共用高頻藥物。常用蒲公英、連翹、白花蛇舌草;郁金、枳殼;香櫞、佛手;焦三仙、雞內(nèi)金等藥對治療。通過改進的互信息法和復雜系統(tǒng)熵聚類分析,得出藥物相關(guān)度、核心組合和新處方,其中在慢性胃炎臨床治療實踐中常用的有1.延胡索_元胡_白梅花_香附_川楝子;2.薏苡仁_藿香_杏仁_白芍;3.炙甘草_茯苓_白術(shù);4.藿香_蘇梗_姜半夏_石斛_百合;5.夜交藤_白菊_白梅花_白蔻仁_焦三仙;6.玄參_酸棗仁_柏子仁_熟大黃_厚樸_瓜蔞;7.焦三仙_炒白術(shù)_元胡_白梅花;8.枳殼_香櫞_蘇梗_醋柴胡_枳實_郁金_白梅花_川楝子。結(jié)論:李老治療慢性胃炎主要采用益氣養(yǎng)陰,理氣活血,解毒消癰,化濕消食的方法,即傳統(tǒng)八法中的和、清、補、消四法。多用蒲公英、連翹、白花蛇舌草解毒消癰,治療慢性胃炎。在慢性非萎縮性胃炎治療中盡早使用養(yǎng)陰生津藥物。注重肝與脾胃之間的關(guān)系,大量應用疏肝理氣活血藥。第四部分是李氏和降湯治療胃食管反流病脾虛肝郁證的療效觀察。包括:文獻綜述:胃食管反流病治療現(xiàn)狀概述和李氏和降湯治療胃食管反流病脾虛肝郁證的療效觀察兩部分。目的:采用隨機對照的試驗方法客觀評價和降湯治療胃食管反流病脾虛肝郁證的臨床療效,進一步驗證和降湯在胃食管反流病治療中臨床療效及安全性。方法:本研究納入李世增教授治療胃食管反流病脾虛肝郁證病例63例,采用隨機對照的臨床試驗方法,分為中藥組31例,予以和降湯加減治療;西藥組32例,予以雷貝拉唑治療,分別治療4周,觀察治療后和隨訪1月各癥狀發(fā)生頻率積分、RQD總積分和有效率。結(jié)果:治療前兩組基線資料無差異,治療前后癥狀發(fā)作頻率積分統(tǒng)計結(jié)果提示:中藥組療效優(yōu)于西藥組,組間差異顯著,有統(tǒng)計學意義,且停藥1月后中藥組較西藥組療效穩(wěn)定。結(jié)論:應用李氏和降湯治療胃食管反流病脾虛肝郁證,具有較好的療效,為和降湯臨床治療胃食管反流病提供治療思路。創(chuàng)新點:1.李世增教授治療GERD脾虛肝郁證的學術(shù)思想。GERD癥狀形成總由胃氣上逆,但形成胃氣上逆的主要病機是脾虛肝郁,脾胃升降失調(diào),故脾虛肝郁為GERD的主要證型,采用和法治療,自擬和降湯。和降湯以健脾益氣,扶正為本;疏肝解郁,佐金平木,化痰降逆,祛邪為標,補瀉兼施,扶正祛邪,標本兼治,扶正不留邪,祛邪不傷正,收效甚佳。2.李世增教授創(chuàng)立了"和降湯"治療GERD脾虛肝郁證效果顯著。治療采用"和法",包含兩方面內(nèi)容:一是以調(diào)和肝脾,調(diào)肝和胃為治療之根本大法,亦常應用佐金平木法,肅肺抑肝和胃。二是用藥平和。3.李世增教授治療GERD脾虛肝郁證的用藥特點。用藥少,藥量輕,藥性平和,不用峻劑;善用對藥;并未采用臨床上廣泛使用的旋覆代赭湯、海螵蛸、烏賊骨等重鎮(zhèn)降逆、抑酸之品。
[Abstract]:Li Shizeng, male, was born in a family of traditional Chinese medicine in Beijing in 1940. He graduated from the College of traditional Chinese medicine in Beijing, Professor of the Capital Medical University, the director of Capital Medical University, and the national famous old Chinese medicine. Professor Li Shizeng has been engaged in clinical work for nearly 50 years. He has been teaching for more than 30 years in the teaching of febrile diseases and has a solid foundation of Chinese and Western medicine theory and rich clinical experience. The diseases of the family, gynecology and dermatology, especially in the theory of febrile diseases, have been used to guide the clinical practice with the theory of febrile diseases in traditional Chinese medicine. This thesis is mainly to search for the academic origin of Professor Li Shizeng, to dig out his academic thoughts and experience, and to apply the computer aided system to study the treatment of chronic gastritis. The clinical observation and academic thought, and the clinical observation and Study on the spleen deficiency syndrome of gastroesophageal reflux disease with Li's and descending decoction, the four part is completed. The first part is to explore the academic origin of the Chinese and Western learning from Professor Li Shizeng's growth, learning and work experience. The second part summarizes the academic origin of the disease with the dialectical thinking and methods of febrile diseases. The second part sums up the theory of the disease. Professor Li Shizeng's academic thought and experience. First, he summed up professor Li Shizeng's academic thought: Li Lao thought the foundation of Chinese medicine was "benevolence", the blood of traditional Chinese medicine was "theory and clinical". Clinical diagnosis focused on the combination of traditional Chinese and Western medicine, watching, hearing, asking, cutting, and examining the five diagnosis of the spleen and stomach, good at treating spleen and stomach diseases according to the characteristics of the spleen and stomach. Three organs of heart, liver and spleen were paid attention to, and the new "three treasures" thought of nourishing heart, liver and spleen was founded. At the same time, the diagnosis and treatment experience of Li Shi Zang's treatment of lung diseases, heart diseases, spleen and stomach diseases, gynecologic diseases and Department of dermatology diseases was summarized. The diagnosis and treatment experience of Professor Li Shizeng's application of "Zo Jinping wood" method in the treatment of various diseases was summarized. Third Part is the study of Professor Li Shizeng's experience in the treatment of chronic gastritis and his academic thoughts by the auxiliary system of traditional Chinese medicine. It mainly applies the software of traditional Chinese Medicine Inheritance auxiliary system, which is developed by the Chinese Academy of Chinese Medicine Science Institute and the Institute of automation of the Chinese Academy of Sciences. It adopts the rules analysis, the improved mutual information method and the complex system. Entropy clustering, unsupervised entropy hierarchical clustering and other data mining methods, according to the order of "data entry, data management, data query, data analysis, analysis results output and network visualization", the rule of medicine for the treatment of chronic gastritis by Professor Li Shizeng was systematically analyzed. Objective: to adopt the inheritance auxiliary system of traditional Chinese Medicine The software objective system was used to analyze the rule of Professor Li Shizeng's prescription for the treatment of chronic gastritis. Methods: Professor Li Shizeng was used to treat 168 cases of chronic gastritis, 471 prescriptions, "traditional Chinese Medicine Inheritance auxiliary system", and the function of "prescription analysis" in the "data analysis" module. Results: Professor Li Shizeng can be classified into 6 types of drugs used in the first 32 cases of chronic gastritis: Radix Astragalus, Astragalus membranaceus, Rhizoma Atractylodes, tuckahoe, chicken inner gold, Jiao Sanxian; 2. Yangyin Sheng Jin medicine: Paeonia lactiflora, Radix Ophiopogon, lily, Ophiopogon, Dendrobium, yellow essence, Lycium barbarum; 3. liver Qi analgesics: the hand, citron, citron, trifoliate orange, tulips, Yalhuo, Su Teru, Magnolia, almond; 4. blood activating and stasis removing drugs: Danshen, 37, luofan collaterals; 5. heat clearing and detoxifying antipyretic drugs: dandelion, forsythia, hydanth herb, and 6. dampness dampness and spleen herbs: Jiang Banxia, nutmeg, huoxien, Fritillaria thunbergii. Among them, Radix Astragalus, Radix Astragali, Poria, Poria, chicken inner gold, three immortality, white peony, Radix Ophiopogon, Dendrobium; lilies, Ophiopogon, citron, citron Fructus aurantii, tulip, yomanhu, sugomo, Magnolia officinalis, Salvia miltiorrhiza, 37, luofan collaterals, dandelion, forsythia, and white flower tongue; ginger, nutmeg, patchouli, and Fritillaria thunbergii are common high frequency drugs for chronic non atrophic gastritis and chronic atrophic gastritis. Treatment. Through the improved mutual information method and complex system entropy clustering analysis, the drug correlation, the core combination and the new prescription were obtained. In the clinical practice of chronic gastritis, it is commonly used in the clinical practice of chronic gastritis, 1. 5. the white plum blossom of white plum blossom, the white plum blossom of the white chrysanthemum, the white plum blossom, the white plum blossom, the white plum blossom, the white plum blossom, the white plum blossom, the white plum blossom of the 7. coke, and the 8. trifoliate citrus, and the 8. trifoliate Citrus. Elimination of carbuncle, the method of eliminating wet digestion, that is, the traditional eight methods of the and, Qing, mending, and elimination of four methods. More use dandelion, forsythia, white flower Hedyotis relieving carbuncle, treatment of chronic gastritis. In the treatment of chronic non atrophic gastritis, use nourishing yin and nourishing medicine as early as possible. Pay attention to the liver and spleen stomach between the Department, the large number of use of liver qi, Qi and activating blood drugs. The fourth part is Li's family. Treatment of gastroesophageal reflux disease with spleen deficiency syndrome of liver depression, including: literature review: overview of the treatment of gastroesophageal reflux disease and the therapeutic effect of Li's and descending Decoction on the spleen deficiency syndrome of gastroesophageal reflux disease in two parts. Objective: to objectively evaluate and reduce Decoction in the treatment of spleen deficiency liver depression of gastroesophageal reflux disease. To further verify the clinical efficacy and safety of the Decoction in the treatment of gastroesophageal reflux disease. Methods: This study included professor Li Shizeng's treatment of 63 cases of spleen deficiency liver depression of gastroesophageal reflux disease. The randomized controlled clinical trial was used to divide into 31 cases in Chinese medicine group and to reduce Decoction and reduce decoction; 32 cases in western medicine group were given thunder. Bela treatment, treated for 4 weeks respectively, observed the frequency integral of all symptoms after treatment and follow-up in January, total score of RQD and efficiency. Results: there was no difference in baseline data between the two groups before and after treatment. The statistical results of the frequency of symptom onset frequency before and after treatment showed that the curative effect of the Chinese medicine group was better than that of the western medicine group, the difference between the groups was significant, and the difference between the groups was statistically significant and after the withdrawal of the drug after January. The effect of Chinese medicine group is more stable than that of the western medicine group. Conclusion: the application of Li's and descending Decoction in the treatment of spleen deficiency syndrome of gastroesophageal reflux disease has good curative effect. It provides the treatment ideas for the treatment of gastroesophageal reflux disease in the clinic. Innovation point: 1. the academic thought of Professor Li Shi Sheng's academic thought on the syndrome of GERD spleen deficiency liver depression is always reversed by stomach qi, but it is formed. The main pathogenesis of Stomach Qi inversion is spleen deficiency liver depression and spleen and stomach depression, so spleen deficiency liver depression is the main syndrome type of GERD. It is the main syndrome type of spleen deficiency liver depression. .2. Li Shizeng established the effect of "heachen soup" to treat GERD spleen deficiency liver depression. The treatment adopted "and method", including two aspects: one is to reconcile liver and spleen, regulate liver and stomach as the basic method of treatment, also often use the Zuojin ping method, Su lung suppressing liver and stomach. Two is medicine Ping and Professor.3. to treat GERD spleen deficiency liver depression syndrome. The drug is characterized by less drug use, light medicine, mild medicine, no strong agent, good use of the medicine, and no widely used clinic, such as the rotary oversea ochre soup, sea cuttlebone, squid bone and other heavy towns.
【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
[Abstract]:Li Shizeng, male, was born in a family of traditional Chinese medicine in Beijing in 1940. He graduated from the College of traditional Chinese medicine in Beijing, Professor of the Capital Medical University, the director of Capital Medical University, and the national famous old Chinese medicine. Professor Li Shizeng has been engaged in clinical work for nearly 50 years. He has been teaching for more than 30 years in the teaching of febrile diseases and has a solid foundation of Chinese and Western medicine theory and rich clinical experience. The diseases of the family, gynecology and dermatology, especially in the theory of febrile diseases, have been used to guide the clinical practice with the theory of febrile diseases in traditional Chinese medicine. This thesis is mainly to search for the academic origin of Professor Li Shizeng, to dig out his academic thoughts and experience, and to apply the computer aided system to study the treatment of chronic gastritis. The clinical observation and academic thought, and the clinical observation and Study on the spleen deficiency syndrome of gastroesophageal reflux disease with Li's and descending decoction, the four part is completed. The first part is to explore the academic origin of the Chinese and Western learning from Professor Li Shizeng's growth, learning and work experience. The second part summarizes the academic origin of the disease with the dialectical thinking and methods of febrile diseases. The second part sums up the theory of the disease. Professor Li Shizeng's academic thought and experience. First, he summed up professor Li Shizeng's academic thought: Li Lao thought the foundation of Chinese medicine was "benevolence", the blood of traditional Chinese medicine was "theory and clinical". Clinical diagnosis focused on the combination of traditional Chinese and Western medicine, watching, hearing, asking, cutting, and examining the five diagnosis of the spleen and stomach, good at treating spleen and stomach diseases according to the characteristics of the spleen and stomach. Three organs of heart, liver and spleen were paid attention to, and the new "three treasures" thought of nourishing heart, liver and spleen was founded. At the same time, the diagnosis and treatment experience of Li Shi Zang's treatment of lung diseases, heart diseases, spleen and stomach diseases, gynecologic diseases and Department of dermatology diseases was summarized. The diagnosis and treatment experience of Professor Li Shizeng's application of "Zo Jinping wood" method in the treatment of various diseases was summarized. Third Part is the study of Professor Li Shizeng's experience in the treatment of chronic gastritis and his academic thoughts by the auxiliary system of traditional Chinese medicine. It mainly applies the software of traditional Chinese Medicine Inheritance auxiliary system, which is developed by the Chinese Academy of Chinese Medicine Science Institute and the Institute of automation of the Chinese Academy of Sciences. It adopts the rules analysis, the improved mutual information method and the complex system. Entropy clustering, unsupervised entropy hierarchical clustering and other data mining methods, according to the order of "data entry, data management, data query, data analysis, analysis results output and network visualization", the rule of medicine for the treatment of chronic gastritis by Professor Li Shizeng was systematically analyzed. Objective: to adopt the inheritance auxiliary system of traditional Chinese Medicine The software objective system was used to analyze the rule of Professor Li Shizeng's prescription for the treatment of chronic gastritis. Methods: Professor Li Shizeng was used to treat 168 cases of chronic gastritis, 471 prescriptions, "traditional Chinese Medicine Inheritance auxiliary system", and the function of "prescription analysis" in the "data analysis" module. Results: Professor Li Shizeng can be classified into 6 types of drugs used in the first 32 cases of chronic gastritis: Radix Astragalus, Astragalus membranaceus, Rhizoma Atractylodes, tuckahoe, chicken inner gold, Jiao Sanxian; 2. Yangyin Sheng Jin medicine: Paeonia lactiflora, Radix Ophiopogon, lily, Ophiopogon, Dendrobium, yellow essence, Lycium barbarum; 3. liver Qi analgesics: the hand, citron, citron, trifoliate orange, tulips, Yalhuo, Su Teru, Magnolia, almond; 4. blood activating and stasis removing drugs: Danshen, 37, luofan collaterals; 5. heat clearing and detoxifying antipyretic drugs: dandelion, forsythia, hydanth herb, and 6. dampness dampness and spleen herbs: Jiang Banxia, nutmeg, huoxien, Fritillaria thunbergii. Among them, Radix Astragalus, Radix Astragali, Poria, Poria, chicken inner gold, three immortality, white peony, Radix Ophiopogon, Dendrobium; lilies, Ophiopogon, citron, citron Fructus aurantii, tulip, yomanhu, sugomo, Magnolia officinalis, Salvia miltiorrhiza, 37, luofan collaterals, dandelion, forsythia, and white flower tongue; ginger, nutmeg, patchouli, and Fritillaria thunbergii are common high frequency drugs for chronic non atrophic gastritis and chronic atrophic gastritis. Treatment. Through the improved mutual information method and complex system entropy clustering analysis, the drug correlation, the core combination and the new prescription were obtained. In the clinical practice of chronic gastritis, it is commonly used in the clinical practice of chronic gastritis, 1. 5. the white plum blossom of white plum blossom, the white plum blossom of the white chrysanthemum, the white plum blossom, the white plum blossom, the white plum blossom, the white plum blossom, the white plum blossom, the white plum blossom of the 7. coke, and the 8. trifoliate citrus, and the 8. trifoliate Citrus. Elimination of carbuncle, the method of eliminating wet digestion, that is, the traditional eight methods of the and, Qing, mending, and elimination of four methods. More use dandelion, forsythia, white flower Hedyotis relieving carbuncle, treatment of chronic gastritis. In the treatment of chronic non atrophic gastritis, use nourishing yin and nourishing medicine as early as possible. Pay attention to the liver and spleen stomach between the Department, the large number of use of liver qi, Qi and activating blood drugs. The fourth part is Li's family. Treatment of gastroesophageal reflux disease with spleen deficiency syndrome of liver depression, including: literature review: overview of the treatment of gastroesophageal reflux disease and the therapeutic effect of Li's and descending Decoction on the spleen deficiency syndrome of gastroesophageal reflux disease in two parts. Objective: to objectively evaluate and reduce Decoction in the treatment of spleen deficiency liver depression of gastroesophageal reflux disease. To further verify the clinical efficacy and safety of the Decoction in the treatment of gastroesophageal reflux disease. Methods: This study included professor Li Shizeng's treatment of 63 cases of spleen deficiency liver depression of gastroesophageal reflux disease. The randomized controlled clinical trial was used to divide into 31 cases in Chinese medicine group and to reduce Decoction and reduce decoction; 32 cases in western medicine group were given thunder. Bela treatment, treated for 4 weeks respectively, observed the frequency integral of all symptoms after treatment and follow-up in January, total score of RQD and efficiency. Results: there was no difference in baseline data between the two groups before and after treatment. The statistical results of the frequency of symptom onset frequency before and after treatment showed that the curative effect of the Chinese medicine group was better than that of the western medicine group, the difference between the groups was significant, and the difference between the groups was statistically significant and after the withdrawal of the drug after January. The effect of Chinese medicine group is more stable than that of the western medicine group. Conclusion: the application of Li's and descending Decoction in the treatment of spleen deficiency syndrome of gastroesophageal reflux disease has good curative effect. It provides the treatment ideas for the treatment of gastroesophageal reflux disease in the clinic. Innovation point: 1. the academic thought of Professor Li Shi Sheng's academic thought on the syndrome of GERD spleen deficiency liver depression is always reversed by stomach qi, but it is formed. The main pathogenesis of Stomach Qi inversion is spleen deficiency liver depression and spleen and stomach depression, so spleen deficiency liver depression is the main syndrome type of GERD. It is the main syndrome type of spleen deficiency liver depression. .2. Li Shizeng established the effect of "heachen soup" to treat GERD spleen deficiency liver depression. The treatment adopted "and method", including two aspects: one is to reconcile liver and spleen, regulate liver and stomach as the basic method of treatment, also often use the Zuojin ping method, Su lung suppressing liver and stomach. Two is medicine Ping and Professor.3. to treat GERD spleen deficiency liver depression syndrome. The drug is characterized by less drug use, light medicine, mild medicine, no strong agent, good use of the medicine, and no widely used clinic, such as the rotary oversea ochre soup, sea cuttlebone, squid bone and other heavy towns.
【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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