本文選題：王煥祿 + 名老中醫(yī)��； 參考：《北京中醫(yī)藥大學》2016年博士論文

【摘要】：研究目的：全面整理、研究王煥祿教授學術(shù)思想和診療經(jīng)驗,深入挖掘其臨床價值和科學精髓,進而達到繼承、發(fā)展、傳播、推廣之目的。研究方法和內(nèi)容：采用文獻分析、跟師臨證、隨訪跟蹤、問答談話和臨床觀察等多種方法,對王煥祿教授中醫(yī)藥學術(shù)思想和臨床診療經(jīng)驗進行全面研究,窮本溯源,挖掘提煉,抽提其學術(shù)思想,總結(jié)其診療經(jīng)驗,另外設(shè)計臨床研究方案,對其治療反流性食管炎的經(jīng)驗方進行療效評價。研究結(jié)果：本論文分為如下三個主要部分：第一部分：王煥祿教授學術(shù)思想研究1王煥祿教授醫(yī)學經(jīng)歷與治學特點1.1王煥祿教授醫(yī)學經(jīng)歷梳理王煥祿老師家學影響、師承經(jīng)歷、臨床實踐與研究及獲獎經(jīng)歷等。1.2王煥祿教授治學特點總結(jié)王煥祿老師治學四大特點：1.2.1注重經(jīng)典,熟讀精研1.2.2重視實踐,身體力行1.2.3轉(zhuǎn)益多師,勤求博采1.2.4繼承前人,發(fā)展創(chuàng)新2王煥祿教授主要學術(shù)思想從理論淵源、學術(shù)思想內(nèi)涵及臨床驗案總結(jié)王老師五方面學術(shù)思想：2.1濕熱害人最廣重視濕熱為病,認為濕熱之邪,害人最廣。王煥祿老師深入學習歷代濕熱相關(guān)理論,更重臨床實踐運用；精研濕熱,見解獨到：濕熱發(fā)病,清利為主；濕熱為病,病位廣泛；辨濕熱病審癥求因,擅于尋蹤覓跡。四診注重舌苔、口氣及分泌物的辨識；重視現(xiàn)代醫(yī)學的相關(guān)指標與濕熱病機關(guān)聯(lián)；強調(diào)內(nèi)有濕熱外呈燥象。注重濕熱病的演變,濕熱蘊久成毒,要清熱利濕配合清熱解毒。從濕熱論治,重新認識疾病,解決臨床頑疾。2.2脾胃萬病相關(guān)認為脾胃萬病相關(guān)與脾胃的生理特性密切相關(guān)。在此基礎(chǔ)上提出狹義脾胃病與廣義脾胃病。當脾胃本藏發(fā)病,突出脾胃病要辨虛實,辨證重舌診,實證多見濕熱為患,久病多兼瘀血；強調(diào)治脾重溫補,治胃重清降,久病要治瘀,虛實兼見要權(quán)衡孰重孰輕予以施治。他藏有病,補虛要關(guān)照脾胃,攻伐勿傷脾胃,脾胃病明顯者,他藏之病要暫緩治之,要先調(diào)治脾胃。同時對于脾胃病患者,王老師時時強調(diào)平時調(diào)攝的重要性。強調(diào)“脾胃一虛,百病叢生,從脾論治,諸病易瘥”。2.3女科每關(guān)肝腎臨床治療月經(jīng)不調(diào)特別強調(diào)肝腎的重要性,六味地黃湯加減是王老師常用的方劑。2.4男科病重腎陽對于男科病,尤重溫補腎陽。包括前列腺疾病、性功能障礙、不育癥。以前列腺增生為例予以說明。2.5久病必見血瘀認為久病必見血瘀的成因以久病氣虛致瘀、久病氣滯致瘀和久病濕熱煎熬致瘀為主要特點。久病要善察瘀：久痛多瘀；望面色觀皮膚察瘀；望舌察瘀；化驗檢查提示。祛瘀要分層次、辨病機。第二部分：王煥祿教授臨床辨治經(jīng)驗研究1辨證施治方法特點總結(jié)王煥祿老師臨床施治六方面特點：1.1辨病辨證,兩相結(jié)合1.2中醫(yī)為本,西為中用1.3注重邪正,權(quán)衡標本1.4精于舌診,四診合參1.5喜用經(jīng)方,化裁驗方1.6用藥精準,處方周全2臨床常見病診治經(jīng)驗從相關(guān)疾病診治特點為出發(fā)點,總結(jié)王煥祿老師辨治內(nèi)科、婦科、皮膚科等疾病的獨到見解和診療特色：2.1辨治冠心病心絞痛臨床經(jīng)驗：認為冠心病心絞痛的基本病機是心氣陽不足、瘀血阻于心脈所致。重視詳細問診。察舌脈重舌質(zhì)及舌脈瘀象。重視鑒別診斷。認為益氣活血通絡(luò)是基本治法,處方用藥溫而不燥,升降合宜,動靜有制。2.2辨治慢性便秘臨床經(jīng)驗：認為慢性便秘,是以脾虛為核心病機。脾虛運化無力則糟粕形成異常；脾虛氣機升降失常則腸腑不降；腸道失濡亦源于脾。治療上,益氣健脾是根本之法,調(diào)暢氣機是關(guān)鍵步驟,擅用藥對,用藥分緩急。2.3辨治反流性食管炎臨床經(jīng)驗：認為食管炎應(yīng)立名“食管癉”,病位在胃(食管)、肝,病邪以氣逆、濕熱、血瘀為主,治療以清熱利濕、活血化瘀、和胃降逆為主。經(jīng)驗方紅藤棱莪煎加減為其常用方劑。2.4辨治類風濕性關(guān)節(jié)炎臨床經(jīng)驗：認為類風濕性關(guān)節(jié)炎應(yīng)立名“濕熱痹”,強調(diào)濕熱病機,分期治療,急性期清熱利濕,通絡(luò)止痛；緩解期在適當清熱利濕、清熱解毒的治療同時,必須加大補益的力量。2.5辨治腎臟病臨床經(jīng)驗：治療腎病強調(diào)辨證分期：急性期邪氣辨風邪、熱邪,病位辨在氣在血。慢性期藏腑涉及脾腎,多易夾濁毒、熱毒、血熱、血瘀。分析肺脾腎與腎病的關(guān)系。治療急性期分“風水阻遏,肺氣失宣”、“熱傷血絡(luò),迫血下行”、“毒熱內(nèi)蘊,迫血外溢”三型辨治；慢性期以脾腎兩虛,濁毒失降為主,治從健脾益腎,利濕化濁,活血化瘀入手,突出重點效藥的應(yīng)用。2.6辨治月經(jīng)病臨床經(jīng)驗：辨治月經(jīng)病強調(diào)詳問病史,包括重問診月經(jīng)情況、注重婦科既往病史、注意區(qū)分年齡段不同,病機差異、注意服藥史并注重結(jié)合現(xiàn)代醫(yī)學相關(guān)檢查。強調(diào)辨別虛實。治療月經(jīng)量少——虛從肝腎補；實證逐痰瘀。2.7辨治帶下病臨床經(jīng)驗：帶下病強調(diào)帶下過多須從虛實辨證；帶下過少虛證為主。帶下過多虛證者多用傅青主的完帶湯加減,濕熱下注者多用茵石米甘湯加味,濕熱血瘀者多用經(jīng)驗方清坤寧宮湯加減。帶下少者,多從補益肝腎入手治療。2.8辨治男科病臨床經(jīng)驗：臨床治療男科病時重視溫補腎陽,強調(diào)男科病的辨證以全身和局部相結(jié)合,治療以辨證和辨病相結(jié)合。認為男性不育以腎陽虛多見,但是有瘀者化瘀,兼夾濕熱者適度清利。2.9辨治痤瘡臨床經(jīng)驗：認為痤瘡的治療既要辨痤瘡局部,又要結(jié)合全身整體情況,總結(jié)出痤瘡辨證當分虛實,實證者又分熱毒相結(jié)、脾胃濕熱、相火亢盛等；虛證者除陰虛火旺,還有腎陽虛者,虛實夾雜亦不少見。2.10辨治銀屑病臨床經(jīng)驗：采用辨病辨證分期治療尋常型銀屑病,進行期為濕熱蘊伏,血熱所致,治療清熱利濕,涼血解毒。靜止期為濕熱蘊伏,瘀血阻絡(luò),膚失所養(yǎng),治療清熱利濕,活血化瘀,解毒通絡(luò)。消退期為濕熱蘊伏,血燥膚失所養(yǎng),治療清熱利濕,養(yǎng)血潤燥為主。強調(diào)濕熱病機貫穿疾病全程。。2.11辨治鼻鼽臨床經(jīng)驗：根據(jù)患者的癥狀及現(xiàn)代醫(yī)學理論,認為鼻鼽多由肺氣虛,衛(wèi)表不固,營衛(wèi)失和,風寒乘虛侵入而引起,患者多為免疫功能偏低。治療要益氣固表,調(diào)和營衛(wèi),溫陽散寒,方藥多用玉屏風散、桂枝湯合蒼耳子散加減治療。第三部分：紅藤棱莪煎治療反流性食管炎臨床研究王煥祿老師認為反流性食管炎當從濕熱血瘀辨治,清熱利濕,活血化瘀,和胃降逆是治療大法,創(chuàng)立治療反流性食管炎的經(jīng)驗方紅藤棱莪煎,研究觀察紅藤棱莪煎治療反流性食管炎臨床效果,選擇55例反流性食管炎患者,隨機分為紅藤棱莪煎治療組30例和奧美拉唑?qū)φ战M25例。經(jīng)8周治療,發(fā)現(xiàn)紅藤棱莪煎對反流性食管炎患者臨床癥狀總積分、療效總積分、臨床綜合療效、改善反流性食管炎濕熱證和血瘀證以及胃鏡下食管病變程度和胃鏡下治愈率等方面療效均好于西藥對照組。其在治療反流性食管炎中有應(yīng)用前景,值得今后進一步研究。本論文的創(chuàng)新點：1既往王煥祿教授學生對其學術(shù)思想的整理只是對其重脾胃和重濕熱兩方面進行整理,本論文在進一步加深、完善整理王煥祿老師重脾胃、重濕熱思想之外,還整理了王老師女科和男科的學術(shù)思想以及久病注重活血化瘀的思想,更加全面的整理了老師的學術(shù)思想,另外本論文還在王煥祿教授治學特點、臨床辨證施治特點方面進行了較為全面的整理歸納,使其治學特點、學術(shù)思想得以更全面展示并具有一定的理論深度。2在本人的臨床實踐中,對部分疾病能靈活運用老師的學術(shù)思想進行辨證施治,同時對老師擅長治療的疾病病種能運用以往學到的知識和經(jīng)驗,在某一階段的治療中有自己不同的辨治思路和方藥選擇,取得了較好的臨床療效。3臨床研究方面,從濕熱血瘀辨證對反流性食管炎進行研究,前人未見報道；對于濕熱血瘀證候的選擇,結(jié)合老師個人的辨證特色進行癥狀選擇和組合,不囿于以往文獻的內(nèi)容。是結(jié)合名老中醫(yī)個人辨證特色選擇相關(guān)證的構(gòu)成,濃縮和提煉名老中醫(yī)個人辨證經(jīng)驗,有助于理論聯(lián)系實際繼承學習名老中醫(yī)臨床辨證經(jīng)驗。
[Abstract]:Objective: to make an overall arrangement, to study Professor Wang Huanlu's academic thought and diagnosis and treatment experience, to dig into its clinical value and scientific essence, and to achieve the purpose of inheriting, developing, spreading, and popularizing. Research methods and contents: the methods of literature analysis, follow up with teachers, follow up follow-up, question and answer conversation and clinical observation, and so on, to Professor Wang Huanlu The academic thought of traditional Chinese medicine and clinical diagnosis and treatment experience were comprehensively studied. The poor Ben traced the source, excavated and extracted, drew up its academic ideas, summed up its diagnosis and treatment experience, and designed the clinical research plan to evaluate the curative effect of the treatment of reflux esophagitis. The results were divided into the following three main parts: the first part: Wang Professor Hwan Lu's academic thought research 1 professor Wang Huanlu's medical experience and learning characteristics 1.1 professor Wang Huanlu's medical experience combing the influence of Wang Huanlu's family study, teacher's experience, clinical practice and research and award-winning experience, and so on, Professor.1.2 Wang Huanlu's characteristics summed up by Wang Huanlu's four major characteristics: 1.2.1 pays attention to classics, and is familiar with refined research 1.2.2 Attaching importance to practice, practicing 1.2.3 to more than one teacher, diligently seeking 1.2.4 to inherit the predecessors and developing innovation 2, Professor Wang Huanlu's main academic thought from the theoretical origin, the connotation of academic thought and the clinical case summary of the five academic thoughts of Mr. Wang: 2.1 the most widely attached importance to damp heat as the disease, the evil of damp and hot, the most widespread harm, and Wang Huanlu teacher deep. To study the theory of wet heat related to the previous generation, more clinical practice, and more severe clinical practice. There is a wet heat and heat in the tune. Pay attention to the evolution of damp heat disease, damp heat and poison for a long time, clearing heat and dampness with clearing heat and detoxifying. It is closely related to the physiological characteristics of spleen and stomach disease related to the disease related to the clinical stubborn disease.2.2 spleen stomach diseases. On this basis, the narrow sense spleen and stomach disease and the generalized spleen stomach disease are put forward. When the spleen and stomach is in the disease, the spleen and stomach disease should be distinguished from the deficiency and reality, the diagnosis of the spleen and stomach is heavy and the damp heat is found, the spleen and stomach should be treated with the spleen and stomach, the spleen and stomach, the spleen and stomach, the spleen and stomach, the spleen and stomach, the spleen and stomach, the spleen and stomach, the spleen and stomach disease, the spleen and stomach disease, the spleen and stomach disease obvious, the disease of the spleen and stomach, and the disease of the spleen and stomach. In order to postpone the treatment, the spleen and stomach should be treated first. At the same time, for the spleen and stomach disease patients, Mr. Wang stressed the importance of peacetime regulation. It emphasized that "the spleen and stomach is a deficiency, all diseases are clustered, the spleen is treated, all diseases are easy to treat the liver and kidney," the clinical treatment of the liver and kidney is especially important for the liver and kidney, and the addition and subtraction of the six flavors of Rehmannia glutinosa are the prescription.2 commonly used by Mr. Wang. .4 male disease serious kidney yang for the male disease, especially the kidney yang. Including prostatic disease, sexual dysfunction, infertility. Take prostatic hyperplasia as an example to show that.2.5 long disease must see blood stasis, the cause of blood stasis due to a long illness caused by qi deficiency to blood stasis, long disease qi stagnation to stasis and long disease wet heat Decoction to stasis is the main characteristics. Long disease should be good inspection of stasis: Long pain and much blood stasis; looking at the skin to observe the blood stasis; looking for the stasis of the tongue and examining the blood stasis; the examination and examination hints. The second parts: Professor Wang Huanlu's clinical treatment experience study 1 syndrome differentiation and treatment method characteristics summarize the six aspects of Wang Huanlu's clinical treatment: differentiation of disease syndrome differentiation, two phase combination of 1.2 Chinese medicine, and western for 1.3 notes in middle use To weigh the pathogenic factors and weigh the specimen 1.4 to the tongue diagnosis, the four diagnosis and the 1.5 happy prescription, the 1.6 use of the prescription, the 2 clinical common disease diagnosis and treatment experience from the diagnosis and treatment characteristics of the related diseases, summarize the unique views and diagnosis and treatment characteristics of the diseases such as Wang Huanlu, Department of medicine, gynecology, and Department of Dermatology: 2.1 clinical diagnosis and treatment of angina pectoris Experience: the basic pathogenesis of angina pectoris of coronary heart disease is the insufficiency of Heart Qi Yang, blood stasis obstructing the heart pulse. Pay attention to the detailed inquiry, inspect the tongue vein heavy tongues and the tongue vein blood stasis. Attach importance to the differential diagnosis. It is considered that Yiqi Huoxue Tongluo is the basic treatment. The clinical experience of treating chronic constipation with.2.2 for the treatment of chronic constipation is considered to be warm without dryness. Chronic constipation is an pathogenesis with spleen deficiency as the core. Spleen deficiency and weakness of the dross form abnormal dross; the Spleen Qi Qi Qi Qi disorder is abnormal and the intestines are not reduced; the intestinal loss is also derived from the spleen. On the treatment, Yiqi invigorating the spleen is the fundamental method, the key step of the Qi Qi regulating machine is to use the medicine pair, and the drug is divided into.2.3 to identify the clinical experience of reflux esophagitis. The disease position in the stomach (esophagus), the liver, the disease evil with gas inverse, damp heat, blood stasis mainly, treatment with clearing heat and dampness, activating blood and removing blood stasis, and stomach descending mainly. Experience prescription red vine rizedoary Decoction.2.4 differentiation and treatment of rheumatoid arthritis clinical experience: rheumatoid arthritis should be named "Damp heat Bi", emphasizing dampness Heat disease machine, staging treatment, acute phase of clearing heat and dampness, dredging collaterals to relieve pain; in the remission period, at the same time in proper heat clearing and dampness, treatment of clearing heat and detoxification, we must increase the strength of.2.5 to differentiate and treat the clinical experience of kidney disease. The relationship between the spleen and kidney and kidney kidney and kidney disease is analyzed. The acute phase is divided into three types: "wind water repression, Lung Qi loss", "heat wound blood and collaterals, forced blood downward", "toxic heat accumulation" and "blood flow overflowing"; the chronic period takes the spleen and kidney two deficiency and the turbidity and poison loss as the main, treatment from the spleen and kidney benefit kidney, wet turbid turbid turbid and activating blood and removing stasis. Clinical experience in the application of key medicine.2.6 in the treatment of menstrual diseases: to differentiate and treat menstrual diseases with emphasis on the history of disease, including heavy asking of menstrual conditions, paying attention to the past history of gynecologic diseases, paying attention to differentiation of age groups, differentiating diseases and machines, paying attention to taking medicine history and paying attention to the combination of modern medical examination. The clinical experience of the.2.7 differentiation and treatment of phlegm and blood stasis syndrome: the underscore of the disease emphasizes the excessive deficiency and reality syndrome differentiation, and the lower deficiency syndrome is the main. The clinical experience of.2.8 in the treatment of male diseases was treated with liver and kidney: in the treatment of men's diseases, the clinical treatment of male family disease was paid attention to by warming up the kidney yang, emphasizing the combination of the whole body and the local syndrome in the syndrome differentiation of men's diseases. The treatment was combined with the syndrome differentiation and differentiation of diseases. It is believed that the treatment of acne should not only distinguish the local acne, but also combine the whole body with the whole body, and summarize the syndrome differentiation when the acne is divided into deficiency and reality, the empirical person is also divided into the heat toxic phase, the spleen and stomach damp heat, the phase fire hyperactivity and so on. The deficiency syndrome, except Yin deficiency, the deficiency of the kidney yang, and the deficiency and solid mixture is not uncommon for.2.10 to distinguish the clinical experience of psoriasis. Treatment of psoriasis vulgaris, due to wet heat accumulation, blood heat, treatment of heat and damp, cool blood and detoxification. Static period is damp heat accumulation, blood stasis obstructing collaterals, skin loss, treatment of heat and dampness, blood circulation to remove stasis, detoxification collaterals. The period of subsiding is damp heat accumulation, blood dryness skin is lost, treatment of clearing heat and moisture, nourishing blood and dryness. According to the symptoms and modern medical theory of..2.11: according to the patient's symptoms and modern medical theory, it is believed that the nasal cavity is mostly caused by lung qi deficiency, the guard table is not fixed, the camp and the cold times are intruded and the immune function is on the low side. The third part: the clinical study on the treatment of reflux esophagitis in the third part: a clinical study on reflux esophagitis by red vine, teachers think that reflux esophagitis should be treated from damp heat and blood stasis, heat and dampness, blood circulation and stasis, and stomach reverse is the treatment of Dafa, the experience of treating reflux esophagitis, the decoction of red vine 55 cases of reflux esophagitis were selected and divided randomly into 30 cases of red turmeric Decoction and 25 cases of omeprazole control group. After 8 weeks of treatment, the total integral of clinical symptoms of reflux esophagitis, total curative effect integral, clinical comprehensive effect, improvement of reflux esophagitis damp heat syndrome and blood stasis syndrome and stomach were improved after 8 weeks of treatment. The curative effect of the esophageal lesion and the cure rate under the gastroscope is better than the western medicine control group. It has the prospect of application in the treatment of reflux esophagitis. It is worth further study in the future. The innovation point of this thesis is: 1 the finishing of the academic thought of the previous Professor Wang Huanlu students was only to reorganize the two aspects of its heavy spleen and stomach and heavy damp heat. In order to further deepen and improve the thought of teacher Wang Huanlu's heavy spleen and stomach, heavy and damp heat, he also collates the thought of the academic thought of Mr. Wang's female department and the male family, and the thought of paying attention to blood circulation and removing blood stasis for a long time. It has carried out a more comprehensive arrangement and induction to make its academic characteristics, the academic thought can be displayed in a more comprehensive way and has a certain theoretical depth.2 in my clinical practice, and the academic thought of the teacher can be applied flexibly to some diseases. At the same time, the knowledge and knowledge of the disease disease of the teacher in Changzhi can be used in the past. Experience, in a certain stage of the treatment of different treatment ideas and prescriptions, and achieved good clinical efficacy of.3 clinical research, from the damp and hot blood stasis syndrome of reflux esophagitis, no report of previous reports; for the selection of damp and hot blood stasis syndrome, combined with the teacher's personal characteristics for symptoms selection and group. It is not limited to the contents of the previous literature. It is a combination of the syndrome characteristics of the personal syndrome differentiation of the old Chinese medicine, which concentrates and refines the personal experience of the old Chinese medicine, which is helpful to the theory and practice to inherit the clinical syndrome differentiation experience of the old 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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