本文選題：劉大新 + 玉屏風散�。� 參考：《北京中醫(yī)藥大學》2016年博士論文

【摘要】：中國傳統(tǒng)醫(yī)藥伴隨著中華民族整個發(fā)展歷程,對維護中華民族乃至世界人民健康所做出的貢獻有目共睹。為了進一步發(fā)揮其現(xiàn)實價值,更好地發(fā)揮其潛在的、長期的價值,將其作為人類非物質(zhì)文化遺產(chǎn)加以保護并傳承,意義深遠而重大。西學東漸以來,整個中國學術(shù)體系和格局受到了重大影響。西方強勢文化不僅帶來中醫(yī)藥生存環(huán)境的改變,而且?guī)韮r值取向的重大變化,實用主義、功利思想在很大程度上改變了中醫(yī)學原有傳承方式和傳承目的。當前,中醫(yī)傳承自覺性已大大下降,人才培養(yǎng)由師徒授受改變?yōu)樵盒＝逃?而院校教育則幾乎完全套用了西醫(yī)教育模式,按照自身規(guī)律傳承模式日趨淡化,中醫(yī)院西化現(xiàn)象也十分明顯。種種現(xiàn)象表明,在中醫(yī)藥事業(yè)繁榮發(fā)展背后潛在著十分嚴重的傳承危機。另外,中醫(yī)藥有完整理論體系和自身學術(shù)發(fā)展規(guī)律,但由于受西方文化背景和價值取向的影響,評判體系幾乎完全采用西方標準,只取其用,忽略學術(shù)的內(nèi)在聯(lián)系。并且現(xiàn)實中的政策、法規(guī)也完全沒有顧及中醫(yī)藥的傳統(tǒng)性特征。因此中醫(yī)學發(fā)展關(guān)鍵在于是否按照其自身規(guī)律延續(xù)和傳承。中醫(yī)前輩將中醫(yī)學術(shù)傳承當成是自己的歷史責任,如張仲景著《傷寒論》,孫思邈撰《千金要方》、《千金翼方》,李時珍編《本草綱目》等除了傳承學術(shù)以造福后人,不帶有任何功利思想。因為有了歷代名老中醫(yī)經(jīng)驗積累和傳承,才使得中醫(yī)學歷久彌新,永葆活力。現(xiàn)今名老中醫(yī)亦是將中醫(yī)藥基本理論、前人經(jīng)驗與當今實踐相結(jié)合,是解決臨床疑難問題的典范,他們的學術(shù)思想豐富多彩,臨床經(jīng)驗各具特色。因其診斷疾病的標準和判定療效的方法不盡一致,故難以對名老中醫(yī)的學術(shù)經(jīng)驗進行恰當?shù)脑u價和療效比較；因此,必須探索研究建立個體化診療評價方法。我們可以借鑒循證醫(yī)學研究模式,對名老中醫(yī)學術(shù)經(jīng)驗的精華和亮點開展臨床科研。中醫(yī)科研設計與現(xiàn)代醫(yī)學科研設計一樣,都必須遵循隨機、對照等原則,同時還應該體現(xiàn)辨證論治的特色。根據(jù)名老中醫(yī)學術(shù)經(jīng)驗精華和亮點制訂切實可行的研究方案,如采用全國統(tǒng)一的病證診斷評價和療效判定標準,采用與現(xiàn)代醫(yī)學相接軌的觀察指標,設立有說服力的對照組,對實驗研究數(shù)據(jù)進行科學統(tǒng)計等。在此基礎上才能對名老中醫(yī)的學術(shù)經(jīng)驗進行綜合評價,如療效評價、安全性評價、效價比評價、生存質(zhì)量評價、終點事件評價、跟蹤隨訪評價等。劉大新教授作為國家著名中醫(yī)專家,數(shù)十年潛心醫(yī)療,熟讀《內(nèi)經(jīng)》、《傷寒》、《金貴要略》等經(jīng)典,善以經(jīng)方治病,以中醫(yī)耳鼻喉疾病見長,對內(nèi)科雜病亦經(jīng)驗豐富、療效顯著。他時常教導我們,要成為合格的醫(yī)生,首先要僅守醫(yī)德,還應做到熟讀經(jīng)典、拓展思維、勤奮好學、理論結(jié)合實踐、勤于臨證、不斷總結(jié)、虛心求教、潛心專研及勇于創(chuàng)新等。劉老師認為幾千年來,中國歷代名醫(yī)都是熟讀中醫(yī)經(jīng)典,靈活運用并創(chuàng)新古代中醫(yī)經(jīng)典理論來認識和防治疾病的辨證論治思維、方法及用藥原則,并且用藥簡潔、煎制方便、價格低廉、臨床效驗。劉教授指出經(jīng)典理論指導下的整體觀念貫穿于中醫(yī)生理、病理、辨證、治療等整個理論體系之中,所以在診療過程中,從經(jīng)典出發(fā),靈活掌握加以運用；在實事求是的基礎上,與時俱進合理創(chuàng)新,善于提出問題,并潛心實踐,從自然-社會-人體的全整體層面認識疾病的病因、病機及轉(zhuǎn)歸,而制定治療法則,才能體現(xiàn)出中醫(yī)的特色和優(yōu)勢,提高療效。劉大新教授作為全國名老中醫(yī),其學術(shù)思想經(jīng)驗是深厚的中醫(yī)理論與豐富的實踐經(jīng)驗相結(jié)合的結(jié)晶,是中醫(yī)藥學的寶貴財富和重要組成部分。劉教授秉持中醫(yī)藥的“遵循自然,順應個體,審病求因,扶正祛邪”原則,認為通過整體調(diào)節(jié)可以實現(xiàn)對局部病患的治療和修復。通過中醫(yī)整體調(diào)節(jié),可使機體氣血陰陽恢復平衡,臟腑功能歸于常態(tài),從而使局部疾病痊愈。本研究觀察劉教授玉屏風散合小青龍湯加減治療過敏性鼻炎哮喘綜合征,對60例患者臨床觀察發(fā)現(xiàn)癥狀緩解迅速、兼加癥狀減輕明顯、精神狀態(tài)、生活質(zhì)量改善顯著。過敏性鼻炎哮喘綜合征是近年提出的新概念。雖然早期已經(jīng)認識到過敏性鼻炎和哮喘之間有一定聯(lián)系,但未確立聯(lián)合研究、診治方案,直至新概念開始使用。故相關(guān)臨床研究尚不豐富。玉屏風散和小青龍湯是臨床常用方劑,檢索文獻顯示,二者用于治療支氣管哮喘臨床觀察較多,但未見其用于過敏性鼻炎哮喘綜合征治療的臨床研究。劉大新教授在臨床上對主要矛盾與次要矛盾處理方式的解釋中提出,無論是主癥、兼證,老師均以中醫(yī)整體觀念為基礎,以辨證論治為根本法則進行臨床立法、處方。臨證既把握住疾病的共性,又不拘泥于成法,旨在調(diào)節(jié)陰陽,使之逐漸恢復動態(tài)平衡。疾病的產(chǎn)生,究其本質(zhì),即為陰陽失調(diào),而選方用藥的最終目的即為調(diào)節(jié)陰陽平衡。陰陽越是趨向平衡,疾病就越向好的方面發(fā)展。而陰陽得以維持動態(tài)平衡,不但疾病向愈,而且機體也不易受病邪困擾。這也是中醫(yī)所說的“未病先防、既病防變”的臨床體現(xiàn)。本課題擬從評價癥狀緩解、生活質(zhì)量提高、精神面貌改善、輔助檢查支持各個方面入手,通過劉教授玉屏風散合小青龍湯加減治療過敏性鼻炎哮喘綜合征相關(guān)指標進行臨床研究,旨在全面揭示其提高療效,改善患者精神狀況、生活質(zhì)量的作用機制,揭示劉教授“遵循自然,順應個體,審病求因,扶正祛邪”的學術(shù)思想,為祖國傳統(tǒng)醫(yī)學防治過敏性疾病探索一個新思路。
[Abstract]:With the whole development of the Chinese nation, traditional Chinese medicine has made great contributions to the maintenance of the Chinese nation and the people's health in the world. In order to give full play to its practical value, it is of far-reaching significance to give full play to its potential and long-term value and to protect and inherit it as a human intangible cultural heritage. Since the western learning, the whole Chinese academic system and pattern have been greatly influenced. The western strong culture not only brings about the change in the living environment of traditional Chinese medicine, but also brings great changes in the value orientation. Pragmatism and utilitarianism have greatly changed the original way of inheriting and inheriting the traditional Chinese medicine. It has been greatly reduced, the training of talents is changed from teacher and apprenticeship to college education, and college education is almost completely applied to the mode of Western medicine education. The mode of inheritance in accordance with its own law is desalinated and the Westernization of Chinese medicine hospital is very obvious. In addition, traditional Chinese medicine has a complete theoretical system and the law of its own academic development. However, due to the influence of Western cultural background and value orientation, the evaluation system almost completely adopts the Western standards, only taking it and neglecting the internal relations of the academic. And the policy and regulations in reality have not taken into account the traditional characteristics of traditional Chinese medicine. The key of the exhibition is to continue and inherit in accordance with its own laws. Traditional Chinese medicine predecessors regard traditional Chinese medicine as its own historical responsibility, such as Zhang Zhongjing's treatise on typhoid, Sun Simiao wrote < Qian Jin Fang >, < Qianjin wing >, and Li Shizhen's editor < Compendium of Materia Medica > with no utilitarian thought. The accumulation and inheritance of the experience of the old traditional Chinese medicine has made traditional Chinese medicine new and vigour. The famous traditional Chinese medicine is also the basic theory of traditional Chinese medicine, and the former experience is combined with the practice of today. It is a model to solve the difficult problems in clinical practice. Their academic ideas are rich and colorful and the experience of the bed is different. The methods of curative effect are not consistent, so it is difficult to make a proper evaluation and comparison of the academic experience of the famous old Chinese medicine. Therefore, we must explore and establish an individual diagnosis and treatment evaluation method. We can draw on the research pattern of evidence-based medicine and carry out clinical scientific research on the essence and bright spot of the academic experience of the famous old Chinese medicine. The design of medical scientific research must follow the principles of random, contrast and other principles. At the same time, it should also reflect the characteristics of the syndrome differentiation and treatment. According to the essence and bright spot of the academic experience of the famous old Chinese medicine, we should formulate practical and feasible research programs, such as the adoption of the national unified diagnosis and evaluation of the disease and the criteria for the evaluation of the curative effect, and the adoption of the observation index that is in line with the modern medicine. A convincing control group, scientific statistics on experimental data, and so on. On this basis, the academic experience of the famous old Chinese medicine can be evaluated synthetically, such as the evaluation of the curative effect, the evaluation of safety, the evaluation of the titer, the evaluation of the quality of life, the evaluation of the endpoint events, the follow-up evaluation, etc., as a famous national Chinese medicine expert, Professor Liu Daxin Ten years of medical care, familiar with "internal classics >", "typhoid", "Jin Gui" and other classics, good with the treatment of classical Chinese medicine, with TCM ear nose and throat diseases, rich experience in medical miscellaneous diseases and significant curative effect. He often teaches us to be a qualified doctor, first of all to keep the medical ethics, but also to read classics, expand thinking, study diligently, combine theory with practice. In the past few thousand years, Mr. Liu thinks that all the Chinese famous doctors have been reading traditional Chinese Medicine Classics, using and innovating the classical classical theory of traditional Chinese medicine to understand and prevent the syndrome differentiation and treatment thinking, methods and principles of medicine, and the medicine is simple, convenient and cheap. Professor Liu pointed out that the whole idea under the guidance of classical theory runs through the whole theory system of TCM Physiology, pathology, syndrome differentiation, treatment and so on. So in the process of diagnosis and treatment, we can use it flexibly in the course of diagnosis and treatment. On the basis of seeking truth from facts, it is reasonable and innovative, good at putting forward problems, and concentrating on practice. But the whole whole level of society - the whole body of the human body recognizes the cause of disease, the pathogenesis and the prognosis, and formulating the treatment rules can embody the characteristics and advantages of the traditional Chinese medicine and improve the curative effect. As a national famous old Chinese medicine, Professor Liu Daxin's academic experience is the crystallization of the profound theory of traditional Chinese medicine and the rich practical experience, and the treasure of traditional Chinese medicine. Prof. Liu holds the principle of "following nature, complying with the individual, complying with the individual, seeking the cause of the disease and eliminating the evil", and thinks that the whole regulation of traditional Chinese medicine can make the body's Qi and blood Yin and Yang restore balance and the function of the viscera to the normal state, so that the local disease can be caused by the whole regulation of traditional Chinese medicine. The study observed the treatment of allergic rhinitis asthma syndrome in Yuping Feng San and Xiao Qinglong soup. The clinical observation of 60 patients showed that the symptoms were relieved quickly, the symptoms were relieved, the mental state and the quality of life improved significantly. The allergic rhinitis asthma syndrome was a new concept in recent years. There is a certain connection between allergic rhinitis and asthma, but no joint research and treatment scheme have been established until the new concept is used. So the related clinical studies are not abundant. Yuping wind powder and small Qinglong soup are commonly used as clinical prescriptions. The retrieval literature shows that the two patients are used in the treatment of bronchial asthma with more clinical observations, but they are not used for anaphylaxis. In the clinical study of the treatment of asthma syndrome of rhinitis, Professor Liu Daxin put forward in the explanation of the main and secondary contradictions in the clinical practice that both the main and the secondary contradictions are based on the overall concept of traditional Chinese medicine and based on the principle of syndrome differentiation and treatment as the fundamental law. It is intended to regulate Yin and Yang and gradually restore dynamic balance. The essence of the disease is the imbalance of yin and Yang, and the ultimate purpose of the choice of drugs is to adjust the balance of yin and Yang. The more the Yin and Yang tend to balance, the more the disease becomes better, and the Yin and yang can maintain a dynamic balance, not only the disease is healing, but also the body is not easily ill. This is also the clinical manifestation of "the prevention of disease first, the disease prevention and control". This topic is to evaluate the symptoms, improve the quality of life, improve the mental outlook, and support the support examination in all aspects, and through the treatment of the related indexes of allergic rhinitis asthma syndrome through the Yuping wind powder and small Qinglong Decoction The purpose of this study is to reveal the mechanism of improving the curative effect, improving the patient's mental state and the quality of life, and revealing the academic thought of Professor Liu "following nature, adapting to the individual, seeking the cause of the disease and eliminating the evil", and exploring a new way of thinking for the prevention and treatment of allergic diseases in traditional Chinese medicine.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R249;R259

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