本文選題：名醫(yī)經(jīng)驗　切入點：傳承研究　出處：《湖北中醫(yī)藥大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 回顧性總結(jié)倪珠英教授治療小兒腎性血尿有效病例,驗證其“小兒血尿熱因論”學(xué)術(shù)觀點；利用文獻(xiàn)整理法,整理分析國內(nèi)近十年各種醫(yī)學(xué)期刊上的中醫(yī)腎病專家治療血尿經(jīng)驗的文獻(xiàn),總結(jié)出中醫(yī)專家血尿診療的群體規(guī)律。并將二者進(jìn)行對比,探討倪珠英特色的個體診療規(guī)律,制定倪珠英特色的小兒血尿診療常規(guī),使其源于臨床,高于臨床,又能回歸、指導(dǎo)臨床,進(jìn)而探索名醫(yī)經(jīng)驗傳承的有效形式和方法。 方法 查閱倪珠英教授診治的192例腎性血尿患兒有效病例資料,觀察其初期、中期、后期舌脈變化及常用治法、方藥,將相關(guān)內(nèi)容輸入Excel進(jìn)行統(tǒng)計歸類,綜合分析,歸納小兒血尿病機(jī)演變規(guī)律；檢索相關(guān)期刊論文(CNKI,2001-2010年)公開發(fā)表的中醫(yī)專家治療血尿經(jīng)驗的文獻(xiàn),選用關(guān)鍵詞組成文獻(xiàn)檢索式進(jìn)行電子檢索,通過閱讀文章題目、內(nèi)容摘要進(jìn)行初篩。初篩選中文獻(xiàn)進(jìn)行逐篇全文閱讀,參照納入標(biāo)準(zhǔn)進(jìn)行選擇。將相關(guān)內(nèi)容輸入Excel進(jìn)行統(tǒng)計歸類,采用頻數(shù)統(tǒng)計分析法和聚類分析法,歸納小兒血尿常見證型及分布規(guī)律。 結(jié)果 一、倪珠英教授學(xué)術(shù)思想的驗證 通過回顧性總結(jié)倪珠英教授192份小兒血尿有效病例之舌脈變化、常用治法,歸納小兒血尿的病機(jī)演變規(guī)律。 (一)證型 初期：熱證83次(43%),濕熱67次(35%),虛證42次(18%)；中期：熱證38次(46%),濕熱13次(15%),虛證33次(39%)；后期：熱證19次(45%),濕熱7次(17%),虛證16次(38%)。在三期中,熱證均占有主導(dǎo)地位,從中期開始,濕熱證的比例下降,虛證的比例上升。 (二)治法 初期：主要以清熱利濕408次(44.32%)、涼血止血271次(25.02%)、健脾益氣140次(12.93%)、清熱解毒106次(9.79%)為主；中期：以清熱利濕50次(33.11%)、涼血止血30次(19.87%)、健脾益氣29次(19.21%)為主；后期：以清熱利濕25次(22.94%)、健脾益氣22次(20.18%)、涼血止血16次(14.68%)、清熱解毒13次(13.98%)為主。倪老在血尿的治療中,清熱利濕、涼血止血、健脾益氣法貫穿疾病的始終。 倪老關(guān)于小兒血尿的主要治法有：清熱利濕483次(34.92%)、涼血止血317次(22.92%)、健脾益氣191次(14.66%)、清熱解毒128次(9.82%),另外活血化瘀81次(5.86%)、滋陰清熱43次(3.11%)、補腎健脾45次(3.45%)、溫補腎陽42次(3.04%)也占有一定比例。 二、中醫(yī)專家的群體規(guī)律 (一)證型 陰虛火旺35次(14.06%)、氣陰兩虛29次(11.33%)、風(fēng)熱犯肺28次(10.94%)占有主導(dǎo)地位。此外,濕熱內(nèi)蘊23次(8.98%)、瘀血內(nèi)阻20次(7.81%)、脾腎兩虛24次(9.38%)、脾不統(tǒng)血19次(7.42%),也占有很大比例。 利用頻數(shù)進(jìn)行二次歸一,再進(jìn)行聚類分析,各證型所占比例分別為：“虛證”35次(14%)、“實熱證”59次(23%)、“濕熱證”39次(45%)、“虛熱證”35次(14%)、“氣滯血瘀證”25次(10%)。 (二)類方分析 通過聚類分析,中醫(yī)專家選擇的類方包括：“清熱利濕涼血解毒類方”66次(28%)、“滋陰清熱類方”64次(26%)、“溫補腎陽”43次(18%)、“補肺健脾益氣類方”35次(14%)、“疏風(fēng)清熱利咽類方”17次(7%)、“行氣活血化瘀類方”17次(7%)。 三、倪珠英教授特色個體診療規(guī)律與中醫(yī)專家群體規(guī)律的對比 倪老和中醫(yī)專家都認(rèn)為“濕”、“熱”、“虛”在血尿的發(fā)生發(fā)展過程中有占有重要地位,也不能忽視“瘀血”之作用；在治法上,都以“清熱利濕”、“清熱解毒”、“涼血解毒”為主,但倪老還重視“益氣健脾”,中醫(yī)專家偏重于“溫補腎陽”。 結(jié)論 1.通過回顧性總結(jié)倪老診治的小兒腎性血尿病例,驗證了其“小兒血尿因熱論”學(xué)術(shù)思想及“以熱為先,因濕為重,因?qū)嵵绿摗辈C(jī)演變規(guī)律的科學(xué)性。 2.利用文獻(xiàn)整理的方法,總結(jié)了中醫(yī)專家關(guān)于血尿的群體規(guī)律,對臨床工作具有指導(dǎo)意義。 3.個體差異與群體規(guī)律進(jìn)行對比,實現(xiàn)了名醫(yī)之間基于同期的研究資料的比較研究。 4.傳統(tǒng)方法與現(xiàn)代方法相結(jié)合、個體研究與群體研究相結(jié)合是名醫(yī)經(jīng)驗傳承的有效形式和方法。
[Abstract]:objective
A retrospective summary of Professor Ni Zhuying in treating renal hematuria effective cases, verify the "heat because of hematuria in children on the academic point of view; using literature method, analysis of China in the past ten years of various medical journals of TCM expert's experience in treating hematuria literature, summed up the law in medical expert group clinics and two hematuria. By contrast, the individual characteristics of the rule of diagnosis and treatment of Ni Zhuying, Ni Zhuying made the routine diagnosis of hematuria in children's characteristics, the source in the clinic, but also higher than the clinical, regression, clinical guidance, and then explore the effective forms and methods of clinical experience inheritance.
Method
192 cases of renal hematuria were effective information of Professor Ni Zhuying on the treatment, to observe the early, middle, late tongue pulse change and the common treatment, prescription, comprehensive analysis of the related input Excel statistical classification, induction, hematuria disease in children machine evolution; retrieval China Journal Full-text Database (CNKI, 2001-2010) of traditional Chinese medicine the expert's experience in treating hematuria published literature, using literature retrieval of electronic component keyword retrieval, by reading the title, abstract screening. Screening of selected literature by reading the full text, according to the inclusion criteria were selected. The related input Excel statistical classification, using frequency statistics analysis and cluster analysis law, summed up the common syndromes of infantile hematuria and distribution.
Result
First, the verification of Professor Ni Zhuying's academic thoughts
Through a retrospective summary of Professor Ni Zhuying's 192 effective cases of pediatric hematuria, the change of tongue and vein was commonly used, and the regularity of the pathogenesis of children's hematuria was summed up.
(1) syndrome type
At the beginning of 83: heat syndrome (43%), 67 (35%), damp heat syndrome in 42 (18%): 38; middle heat syndrome (46%), 13 (15%), damp heat syndrome 33 times (39%); later: heat syndrome 19 times (45%), 7 (17%) of damp heat 16, Qi deficiency (38%). In the three period, heat syndrome were dominant, starting from the mid damp ratio decreased, the proportion of deficiency increased.
(two) the rule of law
At the beginning of the 408: mainly qingrelishi (44.32%), 271 (25.02%) cooling blood to stop bleeding, spleen qi 140 times (12.93%), 106 (9.79%) Qingrejiedu; medium: 50 to qingrelishi (33.11%), 30 (19.87%) cooling blood to stop bleeding, spleen qi 29 times (19.21%). Late: qingrelishi; 25 (22.94%), spleen qi 22 (20.18%), 16 (14.68%) cooling blood, detoxification 13 times (13.98%). Ni Lao in the treatment of hematuria, heat dampness, cooling blood to stop bleeding, invigorating Qi through the disease from the beginning to the end.
Ni Lao on the main treatment of hematuria in children: qingrelishi 483 times (34.92%), 317 (22.92%) cooling blood to stop bleeding, spleen qi 191 times (14.66%), 128 (9.82%) detoxification, blood circulation also 81 times (5.86%), 43 (3.11%) of nourishing yin and clearing heat, invigorating the kidney and strengthening the spleen (45 times 3.45%), warming Yang 42 times (3.04%) also occupy a certain proportion.
Two, the group law of traditional Chinese medicine experts
(1) syndrome type
Yin deficiency, Huo Huo 35 times (14.06%), Qi and yin deficiency 29 times (11.33%), wind heat invading the lung 28 times (10.94%) takes the leading position. In addition, damp heat contains 23 times (8.98%), blood stasis is 20 times (7.81%), spleen and kidney are two and empty, 20 times (two), and spleen does not belong to blood.
Using frequency to do two normalization and cluster analysis, the proportion of each syndrome is: "deficiency syndrome" 35 times (14%), "real heat syndrome" 59 times (23%), "Damp heat syndrome" 39 times (45%), "asthenia heat syndrome" 35 times (14%), "qi stagnation and blood stasis syndrome" 25 times (10%).
(two) class square analysis
Through cluster analysis, traditional Chinese medicine experts to select the class include: "qingrelishi Decoction Liangxue Jiedu" 66 times (28%), "the 64 kind of nourishing yin and clearing heat" (26%), "Kidney Yang" 43 times (18%), "Bufei Jianpi Yiqi Decoction" for 35 times (14%). "Shufeng Qingre Liyan Decoction" for 17 times (7%), "Qi blood circulation" 17 times (7%).
Three, the comparison of the law of Professor Ni Zhuying's characteristic individual diagnosis and treatment and the law of the group of Chinese medicine experts
Ni Lao and Chinese experts believe that the "wet", "hot", "virtual" in the occurrence and development of hematuria in occupies an important position, also can not ignore the "blood stasis" effect; in principle, with "dampness", "detoxification", "detoxification", but also the old Ni pay attention to "Spleen Qi", Chinese medicine experts on "Kidney Yang".
conclusion
1. through the retrospective summary of pediatric renal hematuria cases and verify the Ni Lao, "because of hematuria in children's academic thought and" hot "hot for the first, because the wet weight, because scientific excess caused by deficiency pathogenesis evolution.
2. by using the method of document sorting, the rule of group of Chinese medicine experts on hematuria is summarized, which is of guiding significance for clinical work.
The comparison of 3. individual differences and group rules has achieved a comparative study of research data based on the same period between famous doctors.
4. the combination of the traditional method and the modern method, the combination of individual research and group research is an effective form and method for the inheritance of famous doctors' experience.

【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R272;R249.2

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