發(fā)布時(shí)間：2018-01-11 22:22

  本文關(guān)鍵詞：黃漢儒教授學(xué)術(shù)經(jīng)驗(yàn)總結(jié)及壯醫(yī)“濕毒”論治痛風(fēng)的臨床觀察　出處：《廣州中醫(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： 黃漢儒 壯醫(yī)藥 學(xué)術(shù)經(jīng)驗(yàn) 痛風(fēng) 濕毒 黃漢儒 壯醫(yī)藥 學(xué)術(shù)經(jīng)驗(yàn) 痛風(fēng) 濕毒

【摘要】：廣西是壯族人口最多的少數(shù)民族地區(qū),民族醫(yī)藥資源豐富,成就了不少治學(xué)嚴(yán)謹(jǐn)、醫(yī)德高尚、醫(yī)術(shù)精湛的民族醫(yī)藥大家。系統(tǒng)挖掘整理和傳承廣西名老壯醫(yī)的學(xué)術(shù)思想和技術(shù)專長(zhǎng),不僅是為了傳承他們的寶貴經(jīng)驗(yàn),而且有利于培養(yǎng)具有學(xué)術(shù)特色和技術(shù)專長(zhǎng)的高層次民族醫(yī)藥人才。黃漢儒教授是我國(guó)壯醫(yī)藥學(xué)的主要?jiǎng)?chuàng)建者和學(xué)術(shù)帶頭人、壯醫(yī)學(xué)理論體系的主要奠基人。在五十多年的臨床診療和三十年的壯醫(yī)藥發(fā)掘整理研究工作中,形成了自己鮮明的學(xué)術(shù)思想和獨(dú)特的診療技術(shù),積累了豐富的臨床經(jīng)驗(yàn)。傳承他的學(xué)術(shù)思想和技術(shù)專長(zhǎng),是壯民族醫(yī)藥薪火相傳、創(chuàng)新發(fā)展的基石。本研究分為三大部分：黃漢儒教授學(xué)術(shù)思想淵源研究、黃漢儒教授學(xué)術(shù)思想和臨床經(jīng)驗(yàn)整理研究和壯醫(yī)“濕毒”論治痛風(fēng)的臨床研究。一、學(xué)術(shù)思想淵源研究探析導(dǎo)師的學(xué)術(shù)淵源。主要對(duì)黃漢儒教授的成長(zhǎng)經(jīng)歷、求學(xué)之路、事業(yè)成就、治學(xué)精神等人生歷程以及祖國(guó)傳統(tǒng)醫(yī)學(xué)經(jīng)典古籍、歷代醫(yī)家關(guān)于壯族醫(yī)藥的論述等方面進(jìn)行溯源。探討黃漢儒教授學(xué)術(shù)思想、臨床經(jīng)驗(yàn)形成的過(guò)程。通過(guò)分析導(dǎo)師學(xué)術(shù)淵源及成才之路,尋找繼承其學(xué)術(shù)思想及臨床經(jīng)驗(yàn)的思路和方法。二、學(xué)術(shù)思想和臨床經(jīng)驗(yàn)整理研究目的：對(duì)黃漢儒教授學(xué)術(shù)思想和臨床經(jīng)驗(yàn)進(jìn)行全面的整理與總結(jié)。方法：通過(guò)對(duì)黃漢儒教授臨證醫(yī)案、學(xué)術(shù)專著、公開發(fā)表論文等資料的整理,運(yùn)用文獻(xiàn)研究、回顧性分析等方法,對(duì)黃漢儒教授的學(xué)術(shù)思想、臨證經(jīng)驗(yàn)進(jìn)行系統(tǒng)的疏理和研究。1.對(duì)黃漢儒教授壯醫(yī)理論的整體學(xué)術(shù)思想進(jìn)行概括闡述；2.對(duì)黃漢儒教授在運(yùn)用壯醫(yī)理法方藥診療疾病過(guò)程中形成的學(xué)術(shù)觀點(diǎn)、學(xué)術(shù)特色進(jìn)行歸納總結(jié)；3.結(jié)合典型醫(yī)案分析,分別從“痧瘴蠱毒風(fēng)濕”、“三道兩路”等各類壯醫(yī)常見病對(duì)黃漢儒教授診療疾病的具體經(jīng)驗(yàn)進(jìn)行梳理,總結(jié)出黃漢儒教授運(yùn)用壯醫(yī)理法方藥診治疾病的方法特色和用藥經(jīng)驗(yàn)；4.采用回顧性分析法探討黃漢儒教授治療痛風(fēng)的用藥規(guī)律。5.對(duì)自己獨(dú)立臨床工作中治療隆芡(痛風(fēng))、滾克(類風(fēng)濕性關(guān)節(jié)炎)以及駱芡(多發(fā)性骨關(guān)節(jié)炎)等風(fēng)濕性骨關(guān)節(jié)病的實(shí)踐經(jīng)驗(yàn)進(jìn)行總結(jié),傳承導(dǎo)師經(jīng)驗(yàn),創(chuàng)新發(fā)揚(yáng)。結(jié)果：1.黃漢儒教授首次提出“毒虛致病”的壯醫(yī)病因病機(jī)論。黃漢儒教授臨床上主張辨病與辨證相結(jié)合,以辨病為主；治療上主張專病專方專藥；提出“調(diào)氣、解毒、補(bǔ)虛”的壯醫(yī)治療總則,提倡公母搭配的用藥原則。2.分門別類的歸納總結(jié)了黃老診治痧病、瘴病、濕病、氣道病、谷道病、水道病、龍路、火路等壯醫(yī)常見疾病的特色方法和經(jīng)驗(yàn)用藥。3.對(duì)118張痛風(fēng)診斷處方的回顧性分析,篩選出黃老治療痛風(fēng)的核心藥物,總結(jié)出黃老治療痛風(fēng)的基本方為：葫蘆茶60g,金銀花30g,見腫消15g,葛根20g,絞股藍(lán)20g,薏苡仁15g,土茯苓10g,土牛膝15g,車前子10g,白術(shù)8g。4.在汲取黃漢儒教授風(fēng)濕痹癥的治療經(jīng)驗(yàn)的基礎(chǔ)上,結(jié)合自己的臨床實(shí)踐,從辯證分型、治則治法、用藥等方面總結(jié)了本人在治療隆芡(痛風(fēng))、滾克(類風(fēng)濕性關(guān)節(jié)炎)以及駱芡(多發(fā)性骨關(guān)節(jié)炎)3種風(fēng)濕性骨關(guān)節(jié)病的臨床經(jīng)驗(yàn)。結(jié)論：黃漢儒教授有自己鮮明的學(xué)術(shù)觀點(diǎn)和獨(dú)特的診療技術(shù),學(xué)生學(xué)以致用、繼承發(fā)揚(yáng)。三、壯醫(yī)“濕毒”論治痛風(fēng)的臨床研究目的：以黃漢儒教授治療痛風(fēng)的經(jīng)驗(yàn)為指導(dǎo),從濕毒理論角度出發(fā),自擬藥方葫蘆茶除濕解毒湯,并對(duì)該方治療痛風(fēng)進(jìn)行臨床研究,使黃漢儒教授治療痛風(fēng)的經(jīng)驗(yàn)得以傳承、創(chuàng)新。方法：60例痛風(fēng)患者隨機(jī)分成治療組和對(duì)照組各30例。治療組予葫蘆茶除濕解毒湯治療,對(duì)照組予雙氯芬酸鈉雙釋放腸溶膠囊等藥物治療。觀察兩組治療前后相關(guān)生化指標(biāo)血尿酸(SUA)、C反應(yīng)蛋白(CRP)、血沉(ESR)以及安全性指標(biāo)的檢測(cè)、關(guān)節(jié)腫痛指數(shù)評(píng)價(jià)、關(guān)節(jié)疼痛VAS評(píng)分和中醫(yī)癥候評(píng)分等的變化,對(duì)葫蘆茶除濕解毒湯治療痛風(fēng)的臨床療效進(jìn)行綜合評(píng)價(jià)。結(jié)果：①對(duì)實(shí)驗(yàn)室指標(biāo)的影響：治療組SUA治療后比治療前顯著降低(P0.01),治療組降低SUA的作用明顯優(yōu)于對(duì)照組(P0.01)；治療組CRP治療后比治療前明顯降低(P0.05),治療組的抗炎作用與對(duì)照組等效(P0.05)；治療組ESR治療后比治療前顯著降低(P0.01),降低紅細(xì)胞沉降率的作用明顯優(yōu)于對(duì)照組(P0.01)。②對(duì)癥狀體征的影響：治療組疼痛VAS評(píng)分治療后比治療顯著前低(P0.01),但在緩解疼痛方面作用稍遜于對(duì)照組(P0.05)；治療組關(guān)節(jié)腫痛積分治療后比治療前顯著降低(P0.01),治療組緩解關(guān)節(jié)炎癥的作用與對(duì)照組等效(P0.05)；兩組關(guān)節(jié)腫痛指數(shù)比較差異無(wú)統(tǒng)計(jì)學(xué)意義(PO.05),說(shuō)明兩組在控制關(guān)節(jié)炎癥方面效果相似；治療組關(guān)節(jié)功能評(píng)分治療后比治療前顯著降低(P0.01),在改善關(guān)節(jié)功能方面與對(duì)照組等效(PO.05)；治療組中醫(yī)證候評(píng)分治療后比治療前顯著減低(P0.01),改善中醫(yī)證候的作用優(yōu)于對(duì)照組(P0.01),治療組中醫(yī)證侯積分指數(shù)明顯高于對(duì)照組(P0.01)。③綜合療效：治療組總有效率93.3%,對(duì)照組總有效率82.1%,兩組總有效率相似(P0.05);經(jīng)Ridict分析,治療組綜合療效優(yōu)于對(duì)照組(P0.01)。④藥物安全性：治療組藥物對(duì)安全性指標(biāo)影響不大,不良反應(yīng)發(fā)生率為0,明顯優(yōu)于對(duì)照組。結(jié)論：治療組在改善痛風(fēng)的癥狀和體征方面能夠達(dá)到對(duì)照組的效果,治療組的降低尿酸作用明顯優(yōu)于對(duì)照組。葫蘆茶除濕解毒湯能夠避免西藥產(chǎn)生的不良反應(yīng),同時(shí)又能有效提高痛風(fēng)患者的臨床癥狀緩解率。
[Abstract]:Guangxi is the Zhuang population of minority areas most, ethnic medicine is rich in resources, a lot of achievements in scholarship, noble medical ethics, the skills of the national medicine. All academic and technical expertise system to excavate and inheritance of Guangxi old Zhuang medicine, not only to pass on their valuable experience, but also conducive to the cultivation of high level national medical talents with academic and technical expertise. Professor Huang Hanru is the main founder and academic leaders in China's strong medicine, the main founder of Zhuang medicine theory. In the clinical diagnosis and treatment of more than 50 years and thirty years of Zhuang medicine excavated in the research work, formed their own distinctive academic thoughts and unique treatment technology, has accumulated rich clinical experience. Inheritance of academic and technical expertise is his, Zhuang nationality medicine generation, foundation of innovation development. This research is divided into Three parts: Analysis on Professor Huang Hanru's academic ideological origins, academic thought and clinical experience of Professor Huang Hanru collation and study of Zhuang medicine "damp" theory. A clinical study on the treatment of gout, academic origin, academic ideological origins of tutor. Mainly on Professor Huang Hanru's growing experience, study the road of achievement, the spirit of learning life and the course of traditional Chinese Medicine Classics, ancient physicians about Zhuang medicine and other aspects of traceability. Discusses the academic thoughts of Professor Huang Hanru, the process of clinical experiences. Through the analysis of teacher academic origin and the road to success, find the ideas and methods of inheriting the academic thought and clinical experience. Two, academic thought and clinical experience of finishing Objective: To study on the academic thought and clinical experience of Professor Huang Hanru to conduct a comprehensive review and summary. Methods: Based on Professor Huang Hanru clinical medicine, The academic monographs, published papers and other information collection, the use of literature study, retrospective analysis, Huang Han Dynasty Confucians professor's academic thoughts and clinical experience of research professor Huang Hanru.1. on the whole theory of Zhuang medicine academic thoughts are summarized; 2. of Professor Huang Hanru formed in the use of strong medical method medicine treatment of the disease process of the academic point of view, the academic characteristics are summarized; 3. with typical case analysis, respectively, from the "cholera poison miasma rheumatism" "three, two other types of Zhuang medicine common disease diagnosis and treatment of diseases of Professor Huang Hanru specific experience to sort out, summed up the characteristics of method used by Professor Huang Hanru Zhuang Medical Law medicine for the treatment of disease and medication experience; 4. by retrospective analysis of Professor Huang Hanru in the treatment of gout medication of.5. on their own independent clinical therapy of lung thickening (gout) Roll, G (rheumatoid arthritis) and Luo Qian (multiple bone arthritis) are summarized such as rheumatic osteoarthrosis experience, inheritance of tutor's experience, develop innovation. Results: 1. "was first proposed by Professor Huang Han Dynasty Confucians Zhuang medicine etiology and pathogenesis of deficiency of toxic pathogenic" on clinical professor Huang Hanru. Claim on combination of disease and syndrome differentiation, to identify disease treatment claims; special disease medicine; put forward the "Regulating Qi, detoxification, general treatment of Zhuang medicine tonic",.2. medication to advocate the principle of male and female collocation summing up be arranged Huang Lao Sha of diagnosis and treatment of disease, malaria, rheumatism, airway Valley Road disease, disease, disease of channel, long road, a retrospective analysis of 118 gout diagnosis prescription characteristics method and experience of drug.3. common diseases fire Lu Zhuang medicine, selected core drugs in the treatment of gout of Huang Lao, summed up the basic treatment of gout: old yellow gourd tea 60g, honeysuckle 30g, See the BZX 15g, Pueraria 20g, Gynostemma 20g, coix seed 15g, Poria 10g, Eupatorium 15g, Plantago 10g, Atractylodes 8g.4. based treatment experience in drawing on Professor Huang Hanru rheumatism, combined with clinical practice, from the dialectical type, treatment, medication and other aspects summarized my in the treatment of lung thickening (gout), roll g (rheumatoid arthritis) and Luo Qian (multiple bone arthritis) clinical experience of 3 rheumatic osteoarthropathy. Conclusion: Professor Huang Hanru has its own distinctive academic viewpoint and unique treatment technology, students learn to use, inherit and carry forward the three., "damp" theory of Zhuang medicine: clinical study of antipodagric by professor Huang Hanru in the treatment of gout experience as a guide, from the perspective of the theory of damp, prescription bottle gourd tea chushijiedutang, and clinical research on the treatment of gout, gout to Professor Huang Han Confucianism treatment experience In succession, innovation. Methods: 60 cases of gout patients were randomly divided into treatment group and control group with 30 cases in each group. The treatment group received gourd tea chushijiedutang treatment, control group received Diclofenac Sodium Dual Release Enteric-coated Capsules drug treatment. Two groups were observed before and after treatment of related biochemical indicators of blood uric acid (SUA), C reactive protein (CRP), erythrocyte sedimentation rate (ESR) and safety index test, evaluation of joint swelling index, joint pain changes VAS score and TCM syndrome score, to evaluate the clinical efficacy of gourd tea chushijiedutang gout treatment. Results: the effect on laboratory index: the treatment group SUA after treatment decreased significantly than before treatment (P0.01) SUA, the treatment group decreased significantly than the control group (P0.01); the treatment group CRP after treatment were significantly lower than those before treatment (P0.05), anti-inflammatory effects in the treatment group and the control group (P0.05); equivalent treatment group after treatment of ESR Bridge Before treatment was significantly decreased (P0.01), erythrocyte sedimentation rate decreased significantly than the control group (P0.01). The influence of signs and symptoms: the treatment group VAS pain score after treatment than before treatment was significantly lower (P0.01), but the pain relief effect was slightly lower than the control group (P0.05); joint treatment group swelling and pain scores after treatment decreased significantly than before treatment (P0.01), the treatment group to relieve joint inflammation and equivalent control group (P0.05); there was no significant difference between the two groups in joint pain index (PO.05), indicating that the two groups in the control of joint inflammation effect similar to treatment group; joint function score after treatment than before treatment significantly decreased (P0.01), to improve the joint function and the equivalent control group (PO.05); treatment group of TCM syndrome score after treatment than before treatment significantly decreased (P0.01), improve the TCM syndrome effect is better than that of the control group (P0.01), the treatment group of TCM symptoms Integral index was significantly higher than the control group (P0.01). The comprehensive curative effect: treatment group total effectiveness 93.3%, control group total effective rate was 82.1%, the total efficiency of two groups was similar (P0.05); Ridict analysis of comprehensive effect in treatment group than in control group (P0.01). The drug safety: the treatment group had little effect on the drug the safety index, incidence of adverse reactions was 0, significantly better than the control group. Conclusion: the treatment group to the control group in improving the symptoms and signs of gout effect, reduce uric acid was significantly better than the control group. The treatment group gourd tea chushijiedutang can avoid the adverse reaction of medicine, but also can effectively improve the the remission rate of clinical symptoms in patients with gout.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R249;R29

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