本文選題：何復(fù)東 + 臨床經(jīng)驗(yàn)　； 參考：《北京中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：目的：(1)總結(jié)第五批全國名老中醫(yī)藥專家學(xué)術(shù)思想傳承工作指導(dǎo)老師何復(fù)東主任醫(yī)師的學(xué)術(shù)思想和臨床經(jīng)驗(yàn)；(2)通過對何復(fù)東主任醫(yī)師“補(bǔ)腎通陽法”治療心腎陽虛型慢性心衰的臨床研究,探索慢性心衰的病機(jī)特點(diǎn)及臨床辨治思辨,總結(jié)老師臨床經(jīng)驗(yàn),挖掘名老中醫(yī)學(xué)術(shù)思想,進(jìn)一步升華、發(fā)揚(yáng)光大名老中醫(yī)學(xué)術(shù)思想。方法：(1)通過對歷代中醫(yī)古籍經(jīng)典及近現(xiàn)代醫(yī)家的醫(yī)著、醫(yī)論、文獻(xiàn)的查閱,結(jié)合臨證侍診、跟師抄方老師言傳身教,跟師筆記總結(jié),綜述何復(fù)東老師學(xué)術(shù)思想淵源及慢性心衰的中醫(yī)臨床診治進(jìn)展；(2)總結(jié)何復(fù)東老師學(xué)術(shù)思想和臨床經(jīng)驗(yàn),結(jié)合學(xué)術(shù)繼承人對中醫(yī)理論的認(rèn)識和歷代醫(yī)家學(xué)說及臨床經(jīng)驗(yàn)提出繼承人自己的創(chuàng)新點(diǎn)。經(jīng)過三年時(shí)間的跟師學(xué)習(xí),通過跟師抄方、言傳身教、質(zhì)難答疑、經(jīng)典學(xué)習(xí)、查閱文獻(xiàn),對老師學(xué)術(shù)理論認(rèn)識、臨床診治思維特點(diǎn)及處方組方規(guī)律、用藥特點(diǎn)進(jìn)行總結(jié)、升華至理論高度,總結(jié)老師的臨床經(jīng)驗(yàn),挖掘老師的學(xué)術(shù)思想,結(jié)合中醫(yī)理論及各家認(rèn)識提出“從脾腎論治”的創(chuàng)新學(xué)術(shù)觀點(diǎn)；(3)通過對何復(fù)東主任醫(yī)師“補(bǔ)腎通陽法”治療心腎陽虛型慢性心衰的臨床研究,采取隨機(jī)對照盲法的方法,將符合納入標(biāo)準(zhǔn)的113例心腎陽虛型慢性心衰患者隨機(jī)分為治療組和對照組,治療組給予西藥基礎(chǔ)治療加服“補(bǔ)腎通陽法”免煎劑口服治療,對照組給予單純西藥基礎(chǔ)治療,觀察療程為四周。除去剔除、脫落后將納入的慢性心衰患者治療組50例和對照組50例每組治療前后的臨床癥狀和相關(guān)指標(biāo)進(jìn)行對比,探討慢性心衰的病機(jī)特點(diǎn)及“補(bǔ)腎通陽法”治療慢性心衰作用機(jī)理及處方用藥規(guī)律,挖掘名老中醫(yī)診治慢性心衰的學(xué)術(shù)思想并將其發(fā)揚(yáng)光大。結(jié)果：(1)追溯何復(fù)東老師的學(xué)術(shù)思想淵源：與《黃帝內(nèi)經(jīng)》關(guān)于“腎”生理功能的論述、孫一奎之命門學(xué)說“命門乃腎間動氣”、張介賓“陰常不足、陽非有余”學(xué)術(shù)思想、張仲景之“以病為綱、病證結(jié)合、辨證論治”理論體系、姜良鐸之“狀態(tài)醫(yī)學(xué)”、王琦之“辨體、辨病、辨證三結(jié)合”辨治模式學(xué)術(shù)思想、李可名老中醫(yī)的《李可老中醫(yī)急危重癥疑難病經(jīng)驗(yàn)專集》的“重劑起沉疴”用藥思想以及其他醫(yī)家的“對藥、角藥”用藥思想等醫(yī)家醫(yī)論存在學(xué)術(shù)淵源。何復(fù)東老師通過反思醫(yī)圣張仲景中醫(yī)傳統(tǒng)意義上的《傷寒雜病論》的辨證論治思想,認(rèn)識到疾病的病機(jī)本質(zhì)即為陰陽失衡,中醫(yī)臨床施治的根本就是對機(jī)體失衡狀態(tài)的調(diào)整,結(jié)合“臟象理論體系、陰陽理論、狀態(tài)辨治、體質(zhì)學(xué)說”等,據(jù)此提出“五臟以腎為本、腎虛體質(zhì)狀態(tài)辨治、調(diào)和陰陽平衡”學(xué)術(shù)思想觀點(diǎn),認(rèn)為“善調(diào)治者,尤善調(diào)腎；善扶正者,尤善扶腎；多一分腎陽,便多一分生機(jī)”,“善調(diào)陰陽者,必陰中求陽、陽中求陰,以求以平為期”,并創(chuàng)方補(bǔ)腎基礎(chǔ)方“自擬葛九湯”及系列自擬方劑,臨證加減,每獲良效。(2)總結(jié)何復(fù)東老師學(xué)術(shù)思想,何老中醫(yī)臨床涉及內(nèi)科、婦科、兒科、針灸科諸多病證,其學(xué)術(shù)思想可謂博大精深,其理奧,其趣深,主要包括：①“綜合辨治”學(xué)術(shù)思想——本辨治、標(biāo)辨治、兼辨治;②“從腎論治”學(xué)術(shù)思想——以腎為本、調(diào)和五臟、平衡陰陽；③“復(fù)方重劑用藥三量”學(xué)術(shù)思想——調(diào)理量、治療量、毒量；④“特異性辨治用藥”學(xué)術(shù)思想——衷中參西、西為中用。(3)關(guān)于何復(fù)東老師的臨床經(jīng)驗(yàn),主要包括：①“自擬葛九湯”的創(chuàng)方、方義、運(yùn)用；②“補(bǔ)腎通陽法”治療慢性心衰的臨床經(jīng)驗(yàn)；③“自擬宣痹湯”加減治療胸痹的臨床經(jīng)驗(yàn)；④“自擬葛九湯”加減治療胃病諸證的臨床經(jīng)驗(yàn)；⑤“葛九脫敏湯”治療風(fēng)咳的臨床經(jīng)驗(yàn)；⑥“重劑全蝎湯”治療頭痛的臨床經(jīng)驗(yàn)；⑦“自擬葛九湯”加減治療更年期綜合征的臨床經(jīng)驗(yàn)；⑧“自擬銀甲湯”治療痤瘡的臨床經(jīng)驗(yàn)；⑨“犀角地黃湯”加減治療過敏性紫癜的臨床經(jīng)驗(yàn);⑩“自擬葛九湯”加減治療肢體諸痹的臨床經(jīng)驗(yàn)；11“自擬重劑柴胡石膏湯”治療內(nèi)傷發(fā)熱的臨床經(jīng)驗(yàn)。結(jié)合總結(jié)何復(fù)東老師的學(xué)術(shù)思想,學(xué)術(shù)思想傳承人根據(jù)相關(guān)文獻(xiàn)研究及個(gè)人臨床心得體會,提出“以腎為主,兼顧脾胃,從脾腎論治”、“溫通活血法治療胸痹心痛”創(chuàng)新觀點(diǎn)。(4)關(guān)于臨床科研,兩組的年齡、性別、基礎(chǔ)病、病程以及重要觀察指標(biāo)的數(shù)據(jù)分布經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn),P值均大于0.05,表明隨機(jī)分組的兩組患者的基線均衡,齊同可比。本研究表明：“補(bǔ)腎通陽法”治療方案,在中醫(yī)癥狀改善方面,心悸(P=0.0110.05)、氣喘(P=0.0050.05)、胸悶(P=0.0050.05)、面肢浮腫(P=0.0390.05)四個(gè)癥狀改善顯著,而氣短(P=0.1230.05)、畏寒肢冷(P=0.1530.05)、小便短少(P=0.2090.05)三個(gè)癥狀改善不明顯；在中醫(yī)證候整體療效方面,療效顯著(P=0.0370.05)；在心功能、LVEF、步行試驗(yàn)改善方面,無論是具體的心功能分級分布(P=0.0310.05)、心功能整體療效(P=0.0310.05)、LVEF改善(P=0.0170.05)亦或是6分鐘步行距離(P=0.0300.05),療效均顯著；在BNP指標(biāo)的改善方面,療效顯著(P=0.0400.05)。需要指出的是,對于心胸比的改善不理想(P=0.1600.05)。結(jié)論：(1)何復(fù)東老師的學(xué)術(shù)思想主要包括“綜合辨治”、“從腎論治”、“復(fù)方重劑用藥三量”、“特異性辨治用藥”等學(xué)術(shù)思想；(2)何復(fù)東老師的學(xué)術(shù)思想應(yīng)用于臨床諸多疾病如慢性心衰、胸痹、胃病諸證、風(fēng)咳、頭痛、更年期綜合征、痤瘡、過敏性紫癜、肢體諸痹、內(nèi)傷發(fā)熱等病證中每獲良效；(3)臨床研究表明,運(yùn)用何復(fù)東老師“補(bǔ)腎通陽法”治療心腎陽虛型慢性心衰中治療組(補(bǔ)腎通陽法聯(lián)合西藥基礎(chǔ)治療)在臨床證候癥狀改善、心功能改善、6分鐘步行距離及對LVEF、BNP等指標(biāo)的改善方面優(yōu)于對照組(單純西藥基礎(chǔ)治療),在改善心胸比方面治療組雖優(yōu)于對照組,但差異不顯著。經(jīng)過對何復(fù)東老師“補(bǔ)腎通陽法”治療心腎陽虛型慢性心衰的研究,在臨床及科研層面,探討論證了何復(fù)東老師對慢性心衰病因病機(jī)的認(rèn)識和臨證經(jīng)驗(yàn)的科學(xué)性,進(jìn)一步挖掘了老師的學(xué)術(shù)思想。
[Abstract]:Objective: (1) to summarize the academic thought and clinical experience of the fifth batch of He Fudong, the director of the academic thought inheritance work of the fifth batch of experts on traditional Chinese medicine. (2) through the clinical study of the "tonifying kidney and Yang Yang method" in the treatment of chronic heart failure of the heart and kidney yang deficiency, the characteristics of the pathogenesis and the clinical discrimination of the chronic heart failure were explored. To distinguish, summarize the clinical experience of the teacher, excavate the academic thought of the famous old Chinese medicine, further sublimate and develop the academic thought of old Chinese medicine. Methods: (1) through the classics of the ancient Chinese ancient books and the medical works of the modern doctors, the medical theory, the reference of the literature, the teacher, the teacher, the teacher and the teacher, and the summary of the teacher's notes, and the summary of the teacher He Fudong. The origin of academic thought and the progress of TCM clinical diagnosis and treatment of chronic heart failure; (2) summing up the academic thought and clinical experience of Mr. He Fudong, combining the knowledge of the academic successors to the theory of traditional Chinese medicine and the medical theory and clinical experience of the past dynasties. It is difficult to answer the question, the classical learning, the literature review, the understanding of the academic theory of the teacher, the thinking characteristics of the clinical diagnosis and treatment, the prescription rule of the prescription, the characteristics of the prescription, the sublimation to the theoretical height, the clinical experience of the teacher, the academic thought of the teacher, and the innovative academic viewpoint of "the treatment of spleen and kidney from the spleen and kidney" with the theory of traditional Chinese medicine and the understanding of the family. (3 Through the clinical study of the "tonifying kidney and Yang Yang method" in the treatment of heart and kidney yang deficiency chronic heart failure by He Fudong's chief physician, a randomized controlled blind method was adopted to randomly divide 113 patients with chronic heart failure of heart and kidney yang deficiency into the treatment group and the control group. The treatment group was given the basic treatment of Western medicine plus the "tonifying kidney Tong Yang" method. In the control group, the treatment group was given the basic treatment of Western medicine and the treatment course was four weeks. 50 patients with chronic heart failure and 50 cases in the control group were compared with the clinical symptoms and related indexes before and after the treatment. The characteristics of chronic heart failure and the treatment of chronic heart failure by "tonifying the kidney through the Yang method" were used to treat chronic heart failure. The mechanism of action and the rule of prescription drug use to excavate the academic thought of the old Chinese medicine for the diagnosis and treatment of chronic heart failure. Results: (1) trace back to the origin of He Fudong's academic thought: and the discussion on the physiological function of "kidney" by the Huangdi Nei Jing, the theory of "the fate of the life of the kidney", "Zhang Jiebin" "Non surplus" academic thought, Zhang Zhongjing's theory system of "disease as the outline, combination of disease and syndrome, syndrome differentiation and treatment", "state medicine" of Jiang Liang Du, Wang Qizhi "differentiation of body, disease discrimination, syndrome differentiation three combination" academic thought, "Li Ke old Chinese Medicine" "Li Ke old Chinese medicine emergency critical and difficult disease experience special collection >" "heavy agent start meditation" medication thought There is an academic origin of the medical theory of medicine, such as "the medicine, the angle medicine" thought of other doctors and other doctors. Mr. He Fudong has realized that the essence of the disease is the imbalance of yin and Yang, and the basic of the clinical treatment of Chinese medicine is the imbalance state of the body by reflecting on the traditional meaning of the traditional Chinese medicine of medicine Saint Zhang Zhongjing's traditional Chinese medicine. The adjustment, combined with the "viscera theory system, yin and yang theory, state differentiation and treatment, Physique Theory" and so on, according to the above proposed "the five organs are kidney based, kidney deficiency constitution state differentiation and treatment, regulate the balance of yin and Yang" academic ideas, think that "good governs, especially good to regulate the kidney; good centralizer, especially good to help the kidney; more kidney yang, then more vitality", "good tone Yin". "Good tone Yin" Yang, must Yin in the sun, Yang in the Yin, in order to flat for a period of time, and create a prescription for the foundation of the kidney "nine soup" and a series of self-made prescriptions, to be added and reduced, every good effect. (2) sum up He Fudong's academic thought, he old Chinese medicine clinical medicine, gynecology, pediatrics, acupuncture and moxibustion Department of many diseases, its academic thought is broad and profound, its logical, logical, It mainly includes: (1) the academic thought of "comprehensive differentiation and treatment" - differentiation and treatment, identification and treatment, and discrimination; (2) "kidney treatment" academic thought - kidney based, harmonizing the five zang organs, balancing yin and Yang; (3) "three doses of compound heavy agents" academic thought - the amount of conditioning, treatment, toxic quantity; (4) "specific treatment of drug use" academic thought - (3) the clinical experience of Mr. He Fudong, mainly including: (1) "self-made Ge nine soup" creation, Fang Yi, application; (2) the clinical experience of treating chronic heart failure by "tonifying the kidney through Yang method"; (3) "self drawing Bi Decoction" in the treatment of chest obstruction; (4) "self-made Ge nine soup" plus subtraction for the treatment of stomach diseases Clinical experience of syndrome: (5) the clinical experience of "Ge nine desensitization soup" in treating wind cough; (6) the clinical experience of treating headache with "heavy dose of scorpion soup" in the treatment of headache; (7) the clinical experience of treating climacteric syndrome with "self-made Ge nine soup" and the clinical experience of treating acne Clinical experience of Henoch Schonlein purpura; the clinical experience of adding and subtraction of Ge nine soup in the treatment of limb arthralgia; 11 the clinical experience of treating internal injury and fever by "self-made heavy agent Chaihu gypsum soup". Combined with the academic thoughts of teacher He Fudong, the academic thought inheritors put forward "kidney mainly according to relevant literature research and personal clinical experience." Taking into account the spleen and stomach, from the spleen and kidney treatment, "Wen Tong blood activating therapy" for the treatment of chest pain and heart pain. (4) on the clinical scientific research, the data distribution of the two groups of age, sex, basic disease, course and important observation index are statistically tested, the P value is more than 0.05, indicating that the baseline equilibrium of the two groups of patients in random grouping is comparable. In the improvement of TCM symptoms, the four symptoms of palpitation (P=0.0110.05), asthma (P=0.0050.05), chest tightness (P=0.0050.05), and facial swelling (P=0.0390.05) were improved significantly in the improvement of TCM symptoms, while three symptoms of P=0.1230.05, P= 0.1530.05 (P= 0.1530.05) and short urine (P=0.2090.05) were not improved. The effect of physical therapy was significant (P=0.0370.05); in the improvement of cardiac function, LVEF, and walking test, no matter the specific distribution of cardiac function (P=0.0310.05), the overall effect of cardiac function (P=0.0310.05), LVEF improvement (P=0.0170.05) or 6 minute walk distance (P=0.0300.05), the curative effect was significant, and the curative effect of BNP index was significant ( P=0.0400.05). It should be pointed out that the improvement of the heart ratio is not ideal (P=0.1600.05). Conclusion: (1) He Fudong's academic thoughts mainly include "comprehensive treatment", "treatment from kidney", "three doses of compound heavy agents", "specific treatment of drugs", and (2) the academic thought of teacher He Fudong is applied to clinical various kinds of ideas. Many diseases such as chronic heart failure, chest obstruction, stomach disease, wind cough, headache, climacteric syndrome, acne, anaphylactoid purpura, limb arthralgia, internal injury fever, and other good effects. (3) clinical study showed that the treatment group (tonifying kidney Tongyang method combined with western medicine basic treatment) was used in the treatment group of heart kidney yang deficiency type chronic heart failure. The symptom improvement of clinical syndrome, the improvement of heart function, 6 minute walking distance and the improvement of LVEF, BNP and other indexes were superior to the control group (simple western medicine). Although the treatment group was better than the control group in improving the ratio of heart and chest, the difference was not significant. After the treatment of He Fudong old teacher "tonifying kidney through Yang", the treatment group was treated with chronic heart failure of heart kidney yang deficiency type. At the level of clinical and scientific research, the study demonstrated that teacher He Fudong's understanding of the pathogenesis of chronic heart disease and the scientific experience of her clinical experience further excavated the academic thought of the teacher.
【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;R259

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1 王W，

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