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  本文關(guān)鍵詞：田金洲教授學(xué)術(shù)思想與臨床經(jīng)驗總結(jié)及從肝論治失眠整理與研究　出處：《北京中醫(yī)藥大學(xué)》2016年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 從肝論治 臨床經(jīng)驗 臨床思想 失眠 田金洲 學(xué)術(shù)思想

【摘要】：導(dǎo)師田金洲教授是我國著名的腦病專家,長江學(xué)者,第五批國家級名老中醫(yī)藥專家學(xué)術(shù)經(jīng)驗繼承指導(dǎo)老師,從事腦病臨床、科研和教學(xué)工作己40余年,長期致力于老年神經(jīng)精神病學(xué)的研究,在老年癡呆、帕金森病、失眠、卒中、頭痛等疾病的診治領(lǐng)域有自己獨到的見解。通過三年的跟師學(xué)習(xí),采用臨證抄方、跟師筆記、記錄心得、重讀典籍、查閱文獻,以及師生問難、老師釋疑、定期講課、口傳心授等方式,記錄、領(lǐng)悟、整理、總結(jié)老師的學(xué)術(shù)思想、臨證經(jīng)驗和診療特色。通過追溯導(dǎo)師學(xué)術(shù)思想淵源及理論依據(jù),整理其師承學(xué)術(shù)脈絡(luò)。同時應(yīng)用現(xiàn)代統(tǒng)計方法,深入研究田金洲教授從肝論治失眠理論,總結(jié)其用藥特點,歸納診療思路,闡述其理論創(chuàng)新點,以求進一步挖掘其臨床經(jīng)驗及學(xué)術(shù)思想。本研究分為四部分。1.學(xué)術(shù)思想淵源：探究田金洲教授學(xué)術(shù)思想形成的淵源和根基。熟讀經(jīng)典是導(dǎo)師學(xué)術(shù)思想形成的基礎(chǔ),恩師引導(dǎo)為其學(xué)術(shù)之路指明了方向,海外留學(xué)拓展了其學(xué)術(shù)視野,堅持臨床豐富了其臨床經(jīng)驗�！白x典、跟師、留學(xué)、臨證”,既是田金洲教授成為名老中醫(yī)之路,又因此形成了田金洲教授中西合璧的學(xué)術(shù)特點。2.學(xué)術(shù)思想及臨床經(jīng)驗總結(jié)：在學(xué)術(shù)上導(dǎo)師倡導(dǎo)中西結(jié)合的靈活運用,提倡將中醫(yī)的辨證論治與西藥的靶點治療相結(jié)合,辨證與辨病相結(jié)合,在中西醫(yī)不同診療思路的交匯中找尋切入點,調(diào)動中西醫(yī)優(yōu)勢。無論是提出從肝論治失眠,還是針對癡呆的三期劃分及階梯變化規(guī)律,彰顯了導(dǎo)師在繼承基礎(chǔ)上的創(chuàng)新。導(dǎo)師強調(diào)治病求本,善抓主要矛盾,掌握標(biāo)本轉(zhuǎn)化的規(guī)律,從而做到“胸中了然”。導(dǎo)師認(rèn)為腎虛髓減是神經(jīng)變性病病本,因此補腎填髓在其治療中占有重要的地位�！八脑\合參”是收集患者信息的重要手段,田老師尤其注重舌象、脈象的變化,將其與臨床癥狀巧妙結(jié)合,綜合辨證,體現(xiàn)其中醫(yī)臨床診斷思維特色。對于每一種疾病的診治思路中,都包涵著導(dǎo)師不斷深入的臨床思維過程。通過總結(jié)其臨床經(jīng)驗,可進一步深入挖掘?qū)煹膶W(xué)術(shù)理念。針對癡呆導(dǎo)師提出分期論治策略,即平臺期強調(diào)補虛,波動期注重化痰,惡化期功專解毒。在分期論治的同時,結(jié)合虛實辨證,體現(xiàn)出田老師對癡呆發(fā)展過程的整體把握。失眠是常見病、難治病之一。田金洲教授認(rèn)為慢性失眠多與肝密切相關(guān),肝藏血,血舍魂,魂不入肝則生不寐�；暌税�,有疏肝、清肝、養(yǎng)肝治法；臨床上貴在圓機活法,靈活應(yīng)用。帕金森病非運動癥狀的發(fā)病率逐年升高,其對患者生活質(zhì)量影響已越來越引起關(guān)注,其中頑固性便秘更為常見。導(dǎo)師提出陰虛腸燥為其病本,故而滋陰潤腸是治療根本,調(diào)補脾腎是關(guān)鍵,調(diào)暢氣機為輔助,長期調(diào)理必不可少。導(dǎo)師認(rèn)為腦積水屬本虛標(biāo)實,脾腎虧虛為本,瘀血、水濕阻滯為標(biāo),病機關(guān)鍵是顱腦水瘀,腦竅不通,治療重在“補虛,化瘀,利水”。原發(fā)性頭痛中醫(yī)治療具有極大的優(yōu)勢。田老師提出治療頭痛診斷為先、分經(jīng)論治及重用川芎的診療思路,對臨床幫助很大。分經(jīng)論治頭痛可以明確病位、確定病性、了解致病邪氣的性質(zhì),為準(zhǔn)確有效地治療提供了保障。川芎辛溫,既有活血祛瘀通經(jīng)之效,又有行氣開郁止痛之功,可引藥上至顛頂,有血中氣藥之稱,是治療頭痛之要藥。田老師常在辨證論治的基礎(chǔ)上,應(yīng)用川芎治療多種類型的頭痛,臨床療效明顯。多汗也是帕金森病患者自主神經(jīng)功能障礙的表現(xiàn)。導(dǎo)師將當(dāng)歸六黃湯靈活運用于帕金森病多汗證的治療,擴大了原方的適用范圍,不僅臨床療效突出,而且對治療多汗證有提綱攜領(lǐng)之意。多系統(tǒng)萎縮根據(jù)其臨床表現(xiàn)和發(fā)病特點,中醫(yī)有“厥證”、“顫證”、“眩暈”、“虛勞”。病性或以本虛為主,或虛實兼顧。治療重在扶正治本,或兼以治標(biāo)。導(dǎo)師臨證善用蟲類藥以搜風(fēng)通絡(luò)。通過用藥的升降并舉,以恢復(fù)機體正常的升降之職。眩暈是臨床經(jīng)常遇到的疾病,包括中樞性眩暈、周圍性眩暈和其他原因引起的眩暈。田老師提出“治暈首辨病”,應(yīng)首先明確導(dǎo)致眩暈病因,對因治療,判斷預(yù)后；眩暈病屬本虛標(biāo)實,病變涉及肝、脾、腎三臟,故強調(diào)“治暈不忘調(diào)肝養(yǎng)腎”,調(diào)肝施以疏肝、清肝、平肝、柔肝、鎮(zhèn)肝；養(yǎng)腎重在補腎填精、養(yǎng)陰益髓；“治暈宜分緩急”,急性期泄實為主,緩解期兼顧補虛。3.從肝論治失眠的挖掘整理研究失眠尤其慢性失眠是臨床常見病、多發(fā)病,現(xiàn)代醫(yī)學(xué)多對癥治療,不能從根本調(diào)節(jié)患者失眠狀況,停藥后病情多易反復(fù),且長期服用對其認(rèn)知功能有一定的損害。由于中藥毒副作用相對較少,并可針對病因進行整體調(diào)節(jié),故很多失眠患者轉(zhuǎn)而尋求中醫(yī)治療。選取2012年11月至2014年12月東直門醫(yī)院腦�、罂铺锝鹬藿淌谑罩蔚�60例失眠患者作為研究對象,觀察其臨床治療效果,并進行證候統(tǒng)計及藥物統(tǒng)計,通過對統(tǒng)計結(jié)果深入分析,挖掘整理老師從肝論治失眠的經(jīng)驗。主要結(jié)論：1.失眠的病因病機：病位以肝為主,涉及心、脾、腎；痰、熱、郁、瘀、虛皆為致病因素,病性總屬陰陽不交,氣血失和。2.治療失眠12位核心藥物組成基礎(chǔ)方如下：炒棗仁、五味子、夜交藤、丹參、黃連、醋柴胡、三七面、枳殼、生地、白芍、珍珠母、生甘草。3.治療失眠的基本法則是清熱安神、解郁活血、養(yǎng)血安神。4.治療失眠常在辨證論治的基礎(chǔ)上,參以辨病論治,合理使用靶向作用明確的中草藥。但強調(diào)辨證論治是基礎(chǔ),不可本末倒置。5.補虛藥在總體藥物的使用占第一位,其中以補血藥與補陰藥為主,在安神藥的使用中滋養(yǎng)安神為主,充分體現(xiàn)陰血不足是失眠正虛的病理基礎(chǔ)。6.重用酸棗仁是治療失眠的特色,并且有量增效佳之勢。7.通過學(xué)習(xí)總結(jié)田金洲治療失眠經(jīng)驗,自己的體會如下：(1)很多失眠常伴胃氣不和癥狀,所謂“胃不和則臥不安”。因而在疏肝理氣的同時,還應(yīng)從調(diào)理脾胃入手,達到安魂助眠之效。(2)針對失眠停藥復(fù)發(fā)問題,初診和復(fù)發(fā)再診失眠患者,何為恰當(dāng)有效的治療時程,尚需進一步長期觀察研究。(3)將老師治療失眠從肝論治經(jīng)驗推而廣之,帕金森合并失眠從其病機推導(dǎo)和臨床實踐觀察發(fā)現(xiàn),通過補養(yǎng)肝血,滋陰潛陽可以改善睡眠狀況。但同中有異,在養(yǎng)肝、清肝、疏肝的基礎(chǔ)上,全蝎、龜板、鱉甲等平肝熄風(fēng)藥常貫穿治療始終。4.清肝化痰寧魂湯治療失眠臨床研究在挖掘、整理田金洲教授從肝論治失眠的理論基礎(chǔ)上,觀察清肝化痰寧魂湯治療痰熱內(nèi)擾型失眠臨床療效。選取2014年12月-2015年5月宣武中醫(yī)院老年病科門診病例72例,采用隨機對照的研究方法。治療組36例清肝化痰寧魂湯治療,對照組36例睡前服用艾司唑侖。期間治療組脫落病例1例,對照組脫落2例,有效病例治療組35例,對照組34例。結(jié)論：中醫(yī)癥候量化積分和匹茲堡睡眠質(zhì)量積分經(jīng)尼莫地平法定性后,經(jīng)過秩和檢驗,得出清肝化痰寧魂湯治療失眠與西藥艾司唑侖效果相當(dāng)。但中藥組在惡夢、頭目昏沉、口黏痰多、口苦心煩改善突出,尤其是惡夢、頭目昏沉、口黏痰多三方面中醫(yī)癥候改善優(yōu)于對照組。中藥組在睡眠障礙、日間功能改善方面均優(yōu)于西藥對照組。且在觀察期間未出現(xiàn)日間困倦、乏力、口干等不良反應(yīng)。提示清肝化痰寧魂湯治療失眠療效肯定,且在提高患者白天生活、工作狀態(tài),提高患者睡眠質(zhì)量,從整體調(diào)整痰熱內(nèi)擾癥候方面優(yōu)勢明顯。
[Abstract]:Professor Tian Jinzhou is a famous Chinese encephalopathy experts, Changjiang Scholars, the fifth batch of national TCM expert guidance teacher of academic experience inheritance, has been engaged in clinical work and scientific research and teaching encephalopathy 40 years, long-term commitment to the elderly Neuropsychiatry, have their own unique insights in the field of diagnosis and treatment of elderly dementia and Parkinson disease insomnia, headache, stroke and other diseases. Through three years of learning with the teacher, using the clinical side, copy with teacher notes, records, books, literature reading experience, teachers and students, teacher questioning construction, regular lectures, etc. records, oral teaching that inspires true understanding within, understanding and summarizing the teacher's academic thought and clinical experience and treatment characteristics. By tracing the tutor academic ideological origins and theoretical basis, finishing their teachers academic development. At the same time, we apply modern statistical methods to further study Professor Tian Jinzhou's theory of insomnia from the liver, summarize the characteristics of its medication, summarize the diagnosis and treatment ideas, and elaborate its theoretical innovation so as to further explore its clinical experience and academic thoughts. This study is divided into four parts. 1. origin of academic thought: To explore the origin and foundation of the formation of Professor Tian Jinzhou's academic thought. Read the classics is the formation of academic thought of the tutor, mentor and guide pointed out the direction for the academic road, overseas students expand the academic vision, adhere to enrich the clinical experience in clinical. "Classic reading, studying, with the teacher, Clinical Professor Tian Jinzhou", is to become an old Chinese road, and thus formed the academic characteristics of Professor Tian Jinzhou's Chinese and Western. 2. academic thoughts and clinical experience in the Academic Advisor: flexible use of a combination of Chinese and western, advocates the treatment based on syndrome differentiation of TCM combined with western medicine treatment target, combination of syndrome differentiation and disease differentiation, find the starting point in the intersection of Chinese and Western medicine treatment in different ways, their advantages in Western medicine. Whether it is proposed from the liver to treat insomnia, or for the three stages of dementia and the rules of the ladder, highlight the innovation of the tutor on the basis of inheritance. The tutor emphasizes the treatment of the disease, grasps the main contradictions, and grasps the law of the transformation of the specimen, so as to achieve "in the chest clear". The tutor believes that kidney deficiency myelosis is a neurodegenerative disease, so kidney filling plays an important role in the treatment of the disease. "Four diagnostic methods" is an important means to collect patient information, Tian teacher with particular emphasis on the changes of tongue and pulse, which combined with clinical symptoms, dialectical and comprehensive, embodies the characteristics of thinking in clinical diagnosis of tcm. In the diagnosis and treatment of every kind of disease, it includes the continuous thinking process of the tutor. By summarizing the clinical experience, we can further dig out the academic ideas of the tutor. In view of the dementia tutor, the strategy of staging is put forward, that is, the stage emphasizes the deficiency, and the fluctuation period pays attention to the phlegm, and the deterioration period is specially detoxified. At the same time, combined with the syndrome differentiation of virtual reality, the teacher's overall grasp of the development process of dementia is reflected. Insomnia is one of the common and refractory diseases. Professor Tian Jinzhou believes that chronic insomnia is closely related with the liver, liver blood, blood shed soul, the soul of liver health insomnia. The soul should, have the liver, liver, liver treatment; clinical in round way, flexible application. The incidence of non motor symptoms of Parkinson's disease has increased year by year, and its influence on the quality of life of the patients has attracted more and more attention, of which the intractable constipation is more common. The tutor put forward that yin deficiency and intestinal dryness is its disease, so nourishing yin and moistening intestines is the root of treatment, regulating the spleen and kidney is the key, regulating Qi Qi machine is auxiliary, long term conditioning is essential. Hydrocephalus instructors believe that this standard is false, the spleen and kidney deficiency, blood stasis, wet block as the standard, the key pathogenesis is brain water and blood stasis, brain orifices, treatment focuses on "tonic, removing blood stasis and diuresis". Traditional Chinese medicine for primary headache has great advantages. Tian teachers put forward the diagnosis and treatment of headache, treatment and reuse of Ligusticum chuanxiong, which is very helpful to the clinic. The headache can clear the disease, determine the disease, understand the nature of pathogens, provide a guarantee for the accurate and effective treatment. Chuanxiong Xinwen both blood stasis dredging effect, and qi stagnation relieving pain can lead to drugs on the top of the head, blood gas medicine said, is a headache to the drug. On the basis of syndrome differentiation and treatment, field teachers often use Ligusticum chuanxiong to treat various types of headache, and the clinical effect is obvious. Parkinson is sweating in patients with the symptoms of autonomic dysfunction. The instructor will use Angelica six Decoction in treating Parkinson's disease perspiration syndrome, expanding the scope of the original party, not only the clinical curative effect, and the outline of the treatment of hyperhidrosis syndrome. According to the clinical manifestation and the characteristics of the disease, the Chinese medicine has "syncope", "tremor", "vertigo" and "deficiency". The disease or the deficiency of the main, or the deficiency and reality. The treatment is on the basis of centralizability, or at the same time. The tutor uses the insect medicine to search the wind and dredge the collaterals. Through the lifting and lifting of drugs to restore the body's normal lifting and lifting. Vertigo is a common clinical disease, including vertigo, central vertigo, peripheral vertigo, and other causes. Tian teacher pointed out that "no halo first disease", we should determine the cause of vertigo due to the etiology, treatment, prognosis of vertigo; this standard is false, lesions involving the liver, spleen, kidney three dirty, so that "halo did not forget the liver and kidney, regulating" liver with Shugan, liver, liver, liver, liver and kidneys in the town; Bushentianjing, Yin marrow; treatment of halo should be divided into priorities ", acute diarrhea is mainly that remission both tonic. 3., the treatment and treatment of insomnia from the liver is a common disease and frequently occurring disease. Insomnia is often treated by modern symptomatic treatment. The condition of insomnia can not be fundamentally adjusted. After taking the medicine, the condition is more likely to relapse, and taking it for a long time has some damage on its cognitive function.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R249;R256.23

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