發(fā)布時間：2018-02-03 16:04

  本文關(guān)鍵詞： 燕小霞主任醫(yī)師 腎病 學(xué)術(shù)思想　出處：《成都中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過對燕小霞導(dǎo)師行醫(yī)歷程的探究,反映其學(xué)術(shù)思想的形成,再通過親歷侍診,虛心受教,勤問多記,不斷積累學(xué)習(xí)資料,經(jīng)整理分析,從多個方面總結(jié)診治規(guī)律及遣方用藥的特點。并總結(jié)導(dǎo)師治療腎病的臨床經(jīng)驗和學(xué)術(shù)思想。腎病,發(fā)病率較高,臨床以慢性腎病多見,起因隱匿,病程綿長,是一組常見的而且比較復(fù)雜的疾病群,病變往往持續(xù)發(fā)展,遷延不愈,最后導(dǎo)致腎衰竭,危害較大。通過燕小霞導(dǎo)師30余年診治慢性腎衰的臨床經(jīng)驗,因地制宜,提出溫陽益氣活血化濁法,采用導(dǎo)師經(jīng)驗方參芪地黃湯加味治療慢性腎功能衰竭脾腎陽虛證的臨床療效的觀察和探討研究。方法：在跟師過程中努力學(xué)習(xí),詳細(xì)記錄病情及病案,累積260余份門診病案,總結(jié)整理完成典型病案,復(fù)習(xí)中醫(yī)經(jīng)典著作《神農(nóng)本草經(jīng)》、 《內(nèi)經(jīng)》、《傷寒論》、《金匱要略》、《溫病學(xué)》等,探求經(jīng)文的經(jīng)義,寫了心得體會�？偨Y(jié)老師臨床經(jīng)驗及診治用藥的心得,并發(fā)表論文2篇。研讀相關(guān)腎病的醫(yī)論醫(yī)案,查閱有關(guān)現(xiàn)代治療慢性腎衰的文獻(xiàn)資料,并關(guān)注中醫(yī)藥診治慢性腎衰的研究進(jìn)展,對慢性腎病的診治有了進(jìn)一步的認(rèn)識。經(jīng)總結(jié)歸納,探究燕小霞導(dǎo)師的診治規(guī)律及遣方用藥特點,整理其臨床經(jīng)驗和學(xué)術(shù)思想。燕小霞導(dǎo)師依據(jù)“天人合一”的經(jīng)典理論,因地制宜,針對本地區(qū)的特點,提出“溫陽益氣活血化濁法”治療高海拔地區(qū)慢性腎衰脾腎陽虛證。按照科研設(shè)計路線和要求篩選臨床病例60例,隨機(jī)分為治療組31例和對照組29例,治療2月后觀察結(jié)果。結(jié)論：燕小霞導(dǎo)師從中醫(yī)整體觀出發(fā),依據(jù)“邪之所湊,其氣必虛”的經(jīng)典理論,以臟腑辨證為核心,指出正虛是腎病發(fā)病的根本原因,外邪是發(fā)病重要因素,認(rèn)為其病之本在脾、腎,濕、濁、瘀、毒等為標(biāo)。腎臟病的病理改變主要發(fā)生在腎,其病理產(chǎn)物不外乎有濕、濁、毒、瘀,只是在腎病發(fā)展的不同階段對機(jī)體的影響不一。但人體作為一個完整的有機(jī)體,一臟有病往往可以影響到其他臟腑和器官,常表現(xiàn)為多臟腑功能失調(diào)的證候。但又以腎、脾兩臟最為關(guān)鍵,其病機(jī)在于脾腎虧虛,氣血生化失常,濕、濁、瘀、毒內(nèi)蘊,三焦氣機(jī)不利,臟腑功能失調(diào)。臨床常見脾腎陽虛、肝腎陰虛、氣陰兩虛、陰陽兩虛,兼風(fēng)水泛濫、濕熱蘊結(jié)、濕濁內(nèi)阻、水瘀交阻證,病機(jī)特點是本虛標(biāo)實,虛實夾雜,以正虛為本,邪實為標(biāo)。燕小霞導(dǎo)師在腎病的診治上中醫(yī)及中西醫(yī)相結(jié)合,取長補短。在臨證中辨病與辨證、宏觀癥狀與微觀檢驗相結(jié)合,治療中取其所長的基礎(chǔ)上運用中醫(yī)理論體系,從整體調(diào)整入手,謹(jǐn)守病機(jī),治病求本,扶正祛邪,以平為期的指導(dǎo)思想,在臨床實踐中收到了顯著的療效。
[Abstract]:Objective: to explore the course of Yan Xiaoxia's medical practice, to reflect the formation of his academic thought, and then to collect and analyze the learning data by attending to diagnosis, being taught with an open mind, asking more questions, and accumulating learning materials. From many aspects summarized the diagnosis and treatment law and the characteristics of prescription medication. And summed up the clinical experience and academic thinking of tutor treatment of nephropathy. Nephropathy, the incidence of high, clinical with chronic nephropathy, the cause of hidden, long course of disease. Is a group of common and more complex disease groups, the lesions often continue to develop, delay no recovery, and finally lead to renal failure, great harm. Through Yan Xiaoxia mentor 30 years of clinical experience in the diagnosis and treatment of chronic renal failure. According to local conditions, put forward the method of warming yang, benefiting qi, activating blood circulation and turbid. The clinical effect of Shenqi Dihuang decoction on chronic renal failure syndrome of deficiency of spleen and kidney yang was observed and discussed. Methods: to study hard in the process of following the teacher, and to record the disease condition and the medical record in detail. Accumulate more than 260 outpatient medical records, summarize and complete the typical medical records, review the classic works of traditional Chinese medicine "Shennong Herbal Classic", "Internal Classic", "Theory of febrile Disease", "synopsis of Golden Chamber", "febrile Disease" and so on. To explore the scripture, write the experience, summarize the teacher's clinical experience and experience in the diagnosis and treatment of medication, and publish two papers. Read the medical records of related nephropathy, consult the literature about the modern treatment of chronic renal failure. And concerned about the research progress of TCM in the diagnosis and treatment of chronic renal failure, there is a further understanding of the diagnosis and treatment of chronic nephropathy. Collate its clinical experience and academic thought. According to the classical theory of "integration of nature and man", teacher Yan Xiaoxia, according to local conditions, according to the characteristics of the region. The treatment of chronic kidney failure with deficiency of spleen and kidney yang in high altitude area was put forward. According to the design route and requirement of scientific research, 60 clinical cases were selected and randomly divided into treatment group (31 cases) and control group (29 cases). Conclusion: from the holistic view of traditional Chinese medicine, according to the classical theory of "evil, Qi must be deficiency", taking the syndrome differentiation of zang-fu organs as the core, it is pointed out that the deficiency of justice is the fundamental cause of nephropathy. External pathogenic factor is an important factor in the pathogenesis, it is considered that the disease is based on spleen, kidney, dampness, turbidity, blood stasis, toxin and so on. The pathological changes of kidney disease mainly occur in the kidney, and its pathological products are nothing but dampness, turbidity, poison and stasis. However, as a complete organism, a visceral disease can often affect other organs and organs. It is often manifested as the syndromes of multiple viscera dysfunction. However, the kidney and spleen are the most key, the pathogenesis is deficiency of spleen and kidney, biochemical disorders of qi and blood, dampness, turbidity, blood stasis, toxic connotation, unfavorable to the three coke qi machine. Dysfunction of viscera function. Clinical common spleen and kidney yang deficiency, liver and kidney yin deficiency, qi and yin deficiency, yin and yang deficiency, fengshui flood, damp-heat accumulation knot, dampness and turbid internal obstruction, water stasis and obstruction syndrome, the pathogenesis of the disease is the deficiency of the standard solid, mixed with deficiency. Yan Xiaoxia mentor in the diagnosis and treatment of nephropathy combined traditional Chinese medicine and Western medicine, learn from each other. In the clinical syndrome differentiation and syndrome differentiation, macro symptoms and micro test combined. On the basis of taking its advantage in the treatment, the author uses the theory system of traditional Chinese medicine, starting with the whole adjustment, observing the pathogenesis, treating the disease, seeking the root, strengthening the spirit and dispelling evil, and has received remarkable curative effect in clinical practice with the guiding ideology of leveling out for a long period of time.
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R249;R277.5

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