本文關(guān)鍵詞： 臨床研究 名老中醫(yī)經(jīng)驗(yàn) 姚乃禮教授 胃食管反流病　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:總結(jié)姚乃禮教授對胃食管反流病(Gastroesophageal reflux disease,GERD)的診療經(jīng)驗(yàn),并深入探究姚乃禮教授對GERD診療的學(xué)術(shù)思想,目的在于繼承和發(fā)揚(yáng)名老中醫(yī)經(jīng)驗(yàn),為年輕一輩中醫(yī)人提供學(xué)習(xí)的寶貴資料。方法:通過收集及整理姚乃禮教授治療GERD門診病例,門診跟師學(xué)習(xí)及在姚乃禮教授親自指導(dǎo)下總結(jié)其對于GERD病因病機(jī)的認(rèn)識、辨治體會、遣方用藥的經(jīng)驗(yàn),最終總結(jié)出姚乃禮教授對于GERD的學(xué)術(shù)觀點(diǎn)。采取自身前后對照的研究方法對姚乃禮教授運(yùn)用經(jīng)驗(yàn)方啟陷湯治療GERD患者進(jìn)行臨床觀察,即以啟陷湯為基礎(chǔ)方進(jìn)行加減治療60例GERD患者,治療12周,隨訪4周,分別于治療前、治療4周、治療8周、治療12周、停藥4周觀察記錄患者的Gerd Q問卷評分和臨床癥狀,治療前后記錄患者的血常規(guī)、尿常規(guī)、便常規(guī)+潛血、肝、腎功能指標(biāo)。使用SPSS21.0分析臨床數(shù)據(jù)及評價(jià)療效。結(jié)果:總結(jié)了姚乃禮教授治療GERD的經(jīng)驗(yàn)。對于病因病機(jī)的認(rèn)識,姚乃禮教授認(rèn)為GERD的主要病因?yàn)轱嬍巢徽{(diào)、情志失調(diào)、脾胃素虛以及外邪侵襲,其中飲食不節(jié)、情緒不暢乃常見病因;在對于病機(jī)的基本認(rèn)識上,姚乃禮教授提出脾胃虛弱,運(yùn)化失宜為發(fā)病基礎(chǔ),氣機(jī)失于調(diào)暢貫穿疾病始終,胃失和降、胃氣上逆為病機(jī)關(guān)鍵,痰、熱為重要病理因素,痰、熱并存,氣陰耗傷為疾病發(fā)展后期;在治療方面,姚乃禮教授倡導(dǎo)既要辨主病又要辨主癥,強(qiáng)調(diào)舌脈的重要性,明確疾病的病位、病性、疾病分期,使宏觀辨證與微觀辨證相結(jié)合方能更加準(zhǔn)確地診治疾病。在治療細(xì)則方面,姚乃禮教授將以潤為降貫穿整個(gè)治療過程,重視宣通氣機(jī),恢復(fù)氣機(jī)正常運(yùn)行,不忘在清熱化痰活血的同時(shí)調(diào)補(bǔ)氣陰,散結(jié)通絡(luò),體現(xiàn)了攻補(bǔ)兼施、標(biāo)本兼治的治療理念。在選方用藥方面,姚乃禮教授靈活運(yùn)用經(jīng)方治療的同時(shí),善于使用對藥,體現(xiàn)了在熟諳中藥、方劑理論的前提下,可以從各個(gè)層次、各種角度地更加全面地治療疾病。啟陷湯作為基礎(chǔ)方治療GERD,在癥狀總積分方面,治療4周、治療8周、治療12周及停藥4周后相比治療前的基線而言,積分均降低,差異均具有統(tǒng)計(jì)學(xué)意義(P0.001)。在單一癥狀療效方面,反酸、燒心、胸骨后疼痛、胃脘脹痛、嘈雜、納差、口苦、暖氣、眠差、不良情緒各自治療后的積分與治療前的基線相比較,積分均降低,差異均具有統(tǒng)計(jì)學(xué)意義(P0.001)。無論是癥狀總積分還是單一癥狀積分,在治療4周、治療8周、治療12周與治療前基線相比,積分均降低,說明隨著治療時(shí)間的延長癥狀明顯減輕。因此,可以表明啟陷湯基礎(chǔ)方治療GERD療效明顯。結(jié)論:姚乃禮教授對于GERD的病因、病機(jī)、辨證、治療、用藥以及生活調(diào)護(hù)方面都有深層次的獨(dú)到見解,使用啟陷湯為基礎(chǔ)方治療GERD驗(yàn)證于臨床、療效肯定、優(yōu)勢突出、安全性好。
[Abstract]:Objective: to summarize the experience of Professor Yao Nai-li in the diagnosis and treatment of gastroesophageal reflux disease (GERD), and to probe into Professor Yao Nai-li 's academic thoughts on the diagnosis and treatment of GERD in order to inherit and develop the famous and old TCM experience. Methods: by collecting and arranging Professor Yao Naili's treatment of GERD outpatient cases, the outpatients studied with their teachers and their understanding of the etiology and pathogenesis of GERD was summarized under the guidance of Professor Yao Nai-li himself. Finally, Professor Yao Naili's academic views on GERD were summed up. The clinical observation was carried out on the treatment of GERD patients by Professor Yao Naili using experiential Fangqi decoction. 60 patients with GERD were treated with Qiqi decoction for 12 weeks and followed up for 4 weeks. Before treatment, 4 weeks, 8 weeks and 12 weeks respectively, the patients' Gerd Q scores and clinical symptoms were observed and recorded after 4 weeks of withdrawal. The blood routine, urine routine, occult blood, liver and kidney function were recorded before and after treatment. The clinical data were analyzed by SPSS21.0 and the curative effect was evaluated. Results: professor Yao Naili's experience in treating GERD was summarized. Professor Yao Nai-li believes that the main causes of GERD are food disorders, emotional disorders, deficiency of spleen and stomach, and invasion of exogenous pathogens. Among them, poor diet and poor mood are common causes. On the basic understanding of the pathogenesis, Professor Yao Nai-li suggested that the spleen and stomach are weak. The pathogenesis is based on the loss of Qi, the loss of Qi and the unobstructed flow of qi throughout the disease, stomach disharmony, stomach qi inversion is the key to pathogenesis, phlegm and heat are important pathological factors, phlegm and heat coexist, Qi and Yin wasting injury is the late stage of disease development, and in the treatment, there are two main pathological factors, which are phlegm and heat. Professor Yao Nai-li advocated that both the main disease and the main disease should be distinguished, emphasizing the importance of the tongue vein, defining the disease's location, nature, and stages of the disease, so that the combination of macro and micro syndrome differentiation can make the diagnosis and treatment of the disease more accurate. In terms of treatment rules, Professor Yao Naili will take moistening as the drop throughout the whole treatment process, attach importance to the ventilator, restore the normal operation of the qi machine, and not forget to regulate Qi and Yin while clearing heat, resolving phlegm and activating blood, and dispersing the collaterals, thus reflecting both attack and nourishment. The concept of treating both the symptoms and the symptoms. Professor Yao Naili is flexible in the use of prescriptions, and at the same time he is good at using the prescription. This shows that under the premise of being familiar with the theory of traditional Chinese medicine and prescription, he can use it from all levels. Qiqi decoction was used as the basic prescription to treat GERD. in terms of total symptom score, the scores decreased after 4 weeks of treatment, 8 weeks of treatment, 12 weeks of treatment and 4 weeks of withdrawal of drugs, compared with the baseline before treatment. The difference was statistically significant (P 0.001). The scores of reflux, heartburn, poststernal pain, epigastric distension, noise, anorexia, bitter mouth, warm air, sleep, and bad mood were compared with baseline before treatment. The scores were all decreased, and the differences were statistically significant (P 0.001). The scores were decreased at 4 weeks, 8 weeks, 12 weeks after treatment, compared with the baseline before treatment, regardless of the total symptom score or the single symptom score. Conclusion: professor Yao Naili is effective on the etiology, pathogenesis, syndrome differentiation and treatment of GERD. There are profound original opinions on medicine and daily nursing. The treatment of GERD based on Qiqi decoction is proved to be effective, superior and safe.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R249;R259

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