本文選題：劉永年 + 學(xué)術(shù)思想�。� 參考：《南京中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：本文總結(jié)了國家級名中醫(yī)劉永年教授的學(xué)術(shù)思想和臨床經(jīng)驗,他臨床工作五十余年,在內(nèi)科疑難病的中醫(yī)診治方面積累了豐富的臨床經(jīng)驗。劉老的學(xué)術(shù)思想來自《內(nèi)經(jīng)》、《傷寒論》、溫病學(xué)派及金陵醫(yī)派的傳承,對劉老學(xué)術(shù)思想影響最大的是傅宗翰先生。劉老提出對內(nèi)科疑難病的診治當(dāng)辨病與辨證相結(jié)合,可利用西醫(yī)的技術(shù)方法協(xié)助中醫(yī)的辨病辨證,尋求疾病的核心病機,如乏證可辨,則可從顯證辨治,在辨治時應(yīng)注意對體質(zhì)的辨識,有情志因素的疑難病可從治肝達郁治療。劉老在血液病的中醫(yī)診治方面重視中醫(yī)辨病診治,血虛補而不滯,止血而不留瘀,依血液病標(biāo)本緩急的不同階段而制定相應(yīng)治法。對缺鐵性貧血的治療重在增源截流,強調(diào)補養(yǎng)脾胃的重要性,闡述了“有質(zhì)無質(zhì)”的意義。在再生障礙性貧血的診治方面提出精氣內(nèi)奪造成虛損是疾病的核心病機,病程中有瘀血與熱毒等實證因素參與,提倡辨察病勢的重要性,重視補腎與補脾胃的協(xié)調(diào)。在白細胞減少癥方面依虛實辨證為綱,以補脾腎益精血為主要治法,有時用化瘀祛邪的治法也可升白。在過敏性紫癜方面強調(diào)風(fēng)邪為重要病因,孫絡(luò)瘀滯是疾病的主要病理特征,活血散瘀的遣藥頗具特色。在免疫性血小板減少癥(ITP)辨治方面以瘀熱為核心病機,針對瘀熱病機采用涼血散血的治法,組成了經(jīng)驗方：水天升板湯。目的：臨床研究觀察劉老經(jīng)驗方水天升板湯治療免疫性血小板減少癥的療效及安全性,并初步探求其機理。方法：采用隨機對照的臨床研究方法,將免疫性血小板減少癥(血熱妄行證)患者分為治療組和對照組各30例,對照組僅予激素治療,治療組在激素治療的同時給予湯劑水天升板湯內(nèi)服,每個病例服中藥28天,治療前及治療后28天觀察病人血小板數(shù)量變化,觀察中醫(yī)臨床證候變化包括紫斑、出血、發(fā)熱、煩渴、關(guān)節(jié)腰腹疼痛、溲赤、便秘等并積分。治療前及治療后第28天觀察病人白細胞、血紅蛋白、血小板、肝腎功能、全血比粘度(低切、高切)和血漿比粘度。結(jié)果：治療后兩組患者血小板數(shù)量較治療前均有升高,治療后治療組較對照組明顯升高,升血小板療效評價方面較對照組有顯著優(yōu)勢。在中醫(yī)證候評分方面治療組中醫(yī)證候積分改善較對照組明顯有統(tǒng)計學(xué)意義。治療前后兩組白細胞、血紅蛋白、肝腎功能、全血比粘度(低切、高切)和血漿比粘度對比無統(tǒng)計學(xué)意義。結(jié)論：水天升板湯能夠提升免疫性血小板減少癥患者的血小板數(shù)量,明顯改善患者中醫(yī)證候。研究表明劉永年教授在血液病的中醫(yī)診治方面有獨特的思路,組成的經(jīng)驗方水天升板湯治療免疫性血小板減少癥安全有效。
[Abstract]:This paper summarizes the academic thought and clinical experience of the national famous professor of Chinese medicine Liu Yongnian. He has accumulated rich clinical experience in the diagnosis and treatment of difficult and difficult diseases in internal medicine for more than 50 years. Liu Lao's academic thought comes from the Internal Classic, the Theory of febrile Disease, the inheritance of febrile Disease School and Jinling Medical School, and the most important influence on Liu Lao's academic thought is Mr. Fu Zonghan. Liu Lao proposed that the diagnosis and treatment of difficult diseases in internal medicine should be combined with differentiation of symptoms and signs, and that the technical methods of western medicine could be used to assist TCM in differentiating diseases and symptoms, and to seek the core pathogenesis of diseases. Attention should be paid to the identification of physique in differentiation and treatment, and the difficult diseases with emotional factors can be treated from the treatment of liver depression. Liu Lao attached great importance to the diagnosis and treatment of blood diseases in TCM, blood deficiency and not stagnation, hemostasis without leaving blood stasis, according to the different stages of blood diseases to formulate the corresponding treatment. The treatment of iron deficiency anemia is mainly focused on increasing source closure, emphasizing the importance of nourishing spleen and stomach, and expounding the significance of "having quality and no quality". In the diagnosis and treatment of aplastic anemia, it is pointed out that deficiency of vital qi and internal capture is the core pathogenesis of the disease, and there are positive factors such as blood stasis and heat toxin in the course of the disease, which advocates the importance of discerning the disease, and attaches importance to the coordination of tonifying the kidney and reinforcing the spleen and stomach. In leukopenia, according to the deficiency of the syndrome as the outline, to invigorate spleen and kidney tonifying essence and blood as the main treatment, sometimes with the treatment of removing blood stasis and evil can also be raised to white. In Henoch-Schonlein purpura, wind evil is emphasized as an important etiology, Sun collateral stasis is the main pathological feature of the disease, and the medicine for activating blood circulation and dispersing stasis is quite characteristic. In the aspect of differentiation and treatment of immune thrombocytopenia (ITP), stasis and heat are the core pathogenesis, and the treatment method of cooling blood and dispersing blood is adopted in the mechanism of blood stasis and fever. The prescription of experience is made up: Shuitian Shengban decoction. Objective: to observe the efficacy and safety of Liu Lao experience Fang Shuitian Shengban decoction in the treatment of immune thrombocytopenia and to explore its mechanism. Methods: the patients with immune thrombocytopenia were divided into treatment group (n = 30) and control group (n = 30). The treatment group was treated with decoction Shuitianshengban decoction for 28 days. Before and 28 days after treatment, the changes of platelet count were observed, and the changes of clinical syndromes of TCM including purple spot, hemorrhage, fever, were observed. Irritation, abdominal pain, Deutzia, constipation, etc. WBC, hemoglobin, platelet, liver and kidney function, whole blood specific viscosity (low shear, high shear) and plasma specific viscosity were observed before and 28 days after treatment. Results: after treatment, the platelet count in both groups was higher than that before treatment, and the treatment group was significantly higher than that in the control group after treatment, and there was a significant advantage in the evaluation of the therapeutic effect of the treatment group compared with the control group. In TCM syndromes score, the improvement of TCM syndromes in the treatment group was significantly higher than that in the control group. Before and after treatment, there was no significant difference in leukocyte, hemoglobin, liver and kidney function, whole blood specific viscosity (low shear, high shear) and plasma specific viscosity. Conclusion: Shuitianshengban decoction can improve the platelet count of patients with immune thrombocytopenia and improve TCM syndrome. The research shows that Professor Liu Yongnian has a unique idea in the diagnosis and treatment of hematological diseases. The experience of Fangshui Tianshengban decoction in the treatment of immune thrombocytopenia is safe and effective.
【學(xué)位授予單位】：南京中醫(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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