本文選題：王常綺 + 老中醫(yī)�。� 參考：《成都中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：本學(xué)位論文包括兩個(gè)部分：王常綺名老中醫(yī)學(xué)術(shù)思想及臨床經(jīng)驗(yàn)總結(jié)、繼承部分及相關(guān)臨床研究部分。(一)學(xué)術(shù)思想及臨床經(jīng)驗(yàn)總結(jié)、繼承部分王常綺名老中醫(yī),為青海省名醫(yī),懸壺濟(jì)患五十載,擅治脾胃病,并積累了豐富的臨床經(jīng)驗(yàn)。王老尤其擅治慢性萎縮性胃炎,指出治療慢性萎縮性胃炎的具體法則與臨床經(jīng)驗(yàn)如下：治療慢性萎縮性胃炎務(wù)必調(diào)暢氣機(jī),升降并用,升清降濁,氣機(jī)暢達(dá)則痛脹可平；須標(biāo)本兼顧,補(bǔ)瀉并用,治本為主,重在扶正,正氣得助則病邪易祛；宜運(yùn)脾化濕,芳香醒脾,和胃降濁,濕濁盡去則脾得健運(yùn)；必理氣活血,氣血同治,重在化瘀,氣暢血行則疾病可愈；倡寒溫并用,辛開苦降,寒熱盡去則痞滿可除；重清熱解毒,熱毒得解則病根可除；遣方用藥以平潤為宜,以平衡為期,燥潤相濟(jì),涼溫相宜,勿過滋過燥。此外,王老擅治久瀉,認(rèn)為治療久瀉應(yīng)從濕論治,注重化濕滲濕,健脾益氣,脾健濕化則久瀉可止；治療久瀉不可一味溫補(bǔ)固澀,宜視兼夾證之不同而分別佐用調(diào)暢氣機(jī)、消食化滯、化濕止瀉、清熱利濕、升清降濁等法。除上述所述疾病外,王老還擅于治療其它脾胃疾病,如治療反流性食管炎以疏肝理氣,調(diào)和肝胃,開膈化痰,活血化瘀,降逆清熱為要,兼以養(yǎng)陰生津；治療膽汁反流性胃炎則必當(dāng)疏肝利膽,和胃降逆,清泄膽熱,化痰散結(jié)；治療消化性潰瘍重在補(bǔ)虛,治病求本；強(qiáng)調(diào)活血,促進(jìn)愈合；結(jié)合辨病,靈活施治;疏木培土,從肝論治。(二)臨床研究部分1.目的：(1)系統(tǒng)觀察與研究王常綺老中醫(yī)治療反流性食管炎的經(jīng)驗(yàn)方治療該病的臨床療效和預(yù)防控制復(fù)發(fā)的效果。(2)觀察研究精神社會(huì)心理因素與反流性食管炎發(fā)病之間的關(guān)系。(3)觀察王常綺老中醫(yī)經(jīng)驗(yàn)方治療反流性食管炎伴發(fā)抑郁癥、焦慮癥的療效。2.方法：(1)按照隨機(jī)、對(duì)照原則,將入選病例分為兩組：即采用王常綺名老中醫(yī)治療反流性食管炎經(jīng)驗(yàn)方治療的中醫(yī)治療組及常規(guī)西藥治療的西藥對(duì)照組,兩組均收集50例病例。兩組病例治療方法如下：中醫(yī)治療組：采用王常綺老中醫(yī)治療反流性食管炎經(jīng)驗(yàn)方研細(xì)末,裝膠囊口服治療,每粒0.4g,每次服3粒,每日3次,飯后服。西藥對(duì)照組：予奧美拉唑腸溶膠囊40mg口服,每日1次,莫沙比利分散片5mg口服,每日3次。療程均為1個(gè)月。兩組病例療程結(jié)束后均復(fù)查胃鏡,分別計(jì)算兩組的臨床治愈率、顯效率、有效率及總有效率。在療程結(jié)束后的1個(gè)月、3個(gè)月及6個(gè)月后采用GerdQ量表對(duì)兩組患者進(jìn)行隨訪問卷調(diào)查,并在療程結(jié)束6個(gè)月后兩組病例均再次復(fù)查胃鏡,分別計(jì)算兩組的復(fù)發(fā)率。(2)對(duì)上述已經(jīng)分組的兩組病例,在治療前依據(jù)診斷標(biāo)準(zhǔn),結(jié)合Zung抑郁自評(píng)量表(SDS)及焦慮自評(píng)量表(SAS)對(duì)兩組病例進(jìn)行抑郁癥、焦慮癥篩查診斷,統(tǒng)計(jì)兩組病例中伴發(fā)抑郁癥、焦慮癥的總病例數(shù)以及兩組病例中伴發(fā)抑郁癥、焦慮癥的發(fā)病率,觀察王常綺老中醫(yī)經(jīng)驗(yàn)方治療反流性食管炎伴發(fā)抑郁癥、焦慮癥的療效。3.結(jié)果：(1)治療反流性食管炎的療效：中醫(yī)治療組臨床治愈24例,顯效13例,有效9例,無效3例,臨床治愈率48.98%,顯效率26.53%,有效率18.37%,總有效率93.88%,而西藥對(duì)照組臨床治愈25例,顯效10例,有效9例,無效2例,臨床治愈率54.35%,顯效率21.74%,有效率19.57%,總有效率95.65%,兩組的臨床治愈率、顯效率、有效率、總有效率比較均無顯著性差異(均P0.05)。(2)中醫(yī)治療組在療程結(jié)束后的1個(gè)月后、3個(gè)月后及6個(gè)月后復(fù)發(fā)率分別為12.5%、19.15%、22.22%,而西藥對(duì)照組在療程結(jié)束后的1個(gè)月后、3個(gè)月后及6個(gè)月后復(fù)發(fā)率分別為32.61%、37.78%、40.91%,兩組療程結(jié)束后的1個(gè)月、3個(gè)月及6個(gè)月后的復(fù)發(fā)率比較均具有顯著性差異(均P0.05)。(3)兩組共100例病例中有伴發(fā)抑郁癥患者39例,占39%,伴發(fā)焦慮癥患者41例,占41%。(4)治療反流性食管炎伴發(fā)抑郁癥、焦慮癥的療效：反流性食管炎伴發(fā)抑郁癥的療效如下：中醫(yī)治療組臨床治愈2例,顯效10例,有效7例,無效1例,臨床治愈率10%,顯效率50%,有效率35%,總有效率95%,而西藥對(duì)照組臨床治愈1例,顯效3例,有效7例,無效8例,臨床治愈率5.26%,顯效率15.79%,有效率36.84%,總有效率57.89%。反流性食管炎伴發(fā)焦慮癥的療效如下：中醫(yī)治療組臨床治愈3例,顯效12例,有效4例,無效2例,臨床治愈率14.29%,顯效率57.14%,有效率19.05%,總有效率90.48%,而西藥對(duì)照組臨床治愈1例,顯效5例,有效5例,無效9例,臨床治愈率5%,顯效率25%,有效率25%,總有效率55%。兩組反流性食管炎伴發(fā)抑郁癥的顯效率、總有效率比較均具有顯著性差異(P0.05,P0.01),兩組反流性食管炎伴發(fā)焦慮癥的顯效率、總有效率比較均具有顯著性差異(P0.05,P0.05)。4.結(jié)論：(1)此次臨床研究結(jié)果表明王常綺老中醫(yī)經(jīng)驗(yàn)方治療反流性食管炎與常規(guī)西藥治療相比較臨床療效相當(dāng),但王常綺名老中醫(yī)經(jīng)驗(yàn)方治療反流性食管炎無明顯不良反應(yīng),安全可靠,具有良好的依從性,且藥價(jià)低廉,可以認(rèn)為王常綺老中醫(yī)經(jīng)驗(yàn)方治療反流性食管炎具有獨(dú)特優(yōu)勢與自身特點(diǎn),值得在臨床進(jìn)一步推廣應(yīng)用,并為臨床推廣應(yīng)用調(diào)和肝胃,開膈化痰,理氣降逆法治療反流性食管炎提供了可靠依據(jù)。(2)此次臨床研究結(jié)果還表明王常綺老中醫(yī)經(jīng)驗(yàn)方預(yù)防反流性食管炎復(fù)發(fā)具有良好效果,其預(yù)防復(fù)發(fā)的效果明顯優(yōu)于常規(guī)西藥治療,值得在臨床進(jìn)一步推廣應(yīng)用,從而為臨床預(yù)防和控制反流性食管炎復(fù)發(fā)提供了有效措施,以有效降低該病復(fù)發(fā)率。(3)此次臨床研究結(jié)果表明精神社會(huì)心理因素與反流性食管炎發(fā)病之間存在較為密切的關(guān)系,精神社會(huì)心理因素參與了反流性食管炎的發(fā)病。(4)王常綺老中醫(yī)經(jīng)驗(yàn)方治療反流性食管炎伴發(fā)的抑郁癥、焦慮癥療效顯著,優(yōu)于西藥對(duì)照組,顯示出中醫(yī)藥治療反流性食管炎伴發(fā)的抑郁癥、焦慮癥的自身優(yōu)勢和特點(diǎn),同時(shí)也從臨床治療效果印證了精神社會(huì)心理因素與反流性食管炎發(fā)病之間存在較為密切的關(guān)系。
[Abstract]:This thesis consists of two parts : the summary of the academic thoughts and clinical experience of Wang Changi ' s famous old Chinese medicine , the part of the inheritance and the relevant clinical research . ( 1 ) The academic thought and clinical experience summarize , inherit the part of Wang Changqi ' s famous traditional Chinese medicine , and have accumulated rich clinical experience . Wang is especially good at treating chronic atrophic gastritis , and points out that the specific law and clinical experience in treating chronic atrophic gastritis are as follows :
The specimen should be taken into consideration , and the herbs should be used for tonifying and diarrhea , and the main body of the disease should be treated as the main body , and the main body weight should be healthy and healthy , so that the pathogen of the disease is easy to remove ;
It is suitable to transport the spleen and dampness , wake up the spleen , and reduce the turbidity of the stomach , and the spleen must be healthy and transported ;
It has the effects of regulating qi , promoting blood circulation , regulating qi and blood , promoting blood circulation , removing blood stasis , regulating qi and blood circulation , and recovering diseases ;
the cold and warm are advocated , and the cold and heat are used , and the cold and heat are exhausted , and the abdominal distention can be eliminated ;
clearing away heat and toxic materials , removing heat and toxic materials , and removing root ;
In addition , Wang is good at treating chronic diarrhea , and it is believed that the treatment of chronic diarrhea should be treated by wet theory , and it should be emphasized that the treatment of chronic diarrhea should be treated with wet theory , and it should be emphasized that the treatment for chronic diarrhea should be treated with damp infiltration , spleen invigorating and qi invigorating , and spleen invigorating and dampness eliminating .
In addition to the diseases mentioned above , the king is also good at treating other spleen and stomach diseases , such as treating reflux esophagitis , dispersing stagnated liver qi , regulating the liver and stomach , opening the diaphragm , eliminating phlegm , promoting blood circulation , removing blood stasis , reducing adverse heat clearing and clearing away heat , and is also used for nourishing yin and promoting fluid production ;
For the treatment of bile reflux gastritis , the liver and gallbladder can be depressed , the stomach is reduced , the gallbladder heat is cleared , and the phlegm is dissipated ;
treating peptic ulcer with deficiency of tonifying deficiency and treating diseases ;
Emphasis is placed on promoting blood circulation and promoting healing ;
Methods : ( 1 ) To observe the relationship between the psychologic factors and the incidence of reflux esophagitis . ( 2 ) To observe the relationship between the psychologic factors and the incidence of reflux esophagitis . ( 2 ) To observe the relationship between the psychological factors and the incidence of reflux esophagitis . ( 3 ) To observe the clinical cure rate , the obvious efficiency , the effective rate and the total effective rate of the two groups . Results : ( 1 ) The clinical cure rate was 48.98 % , the effective rate was 26.53 % , the effective rate was 54.35 % , the total effective rate was 21.74 % , the effective rate was 19.57 % , the total effective rate was 95.65 % , the clinical cure rate was 21.74 % , the effective rate was 19.57 % , the total effective rate was 95.65 % , the clinical cure rate was 21.74 % , the effective rate was 19.57 % , the total effective rate was 95.65 % , the total effective rate was 21.74 % , the effective rate was 19.57 % , the total effective rate was 95.65 % . ( 2 ) After 1 month after the end of treatment , the recurrence rates were 12.5 % , 19.15 % and 22.22 % after 3 months and 6 months respectively . The recurrence rates were 32.61 % , 37.78 % and 40.91 % after 3 months and 6 months after the end of treatment . ( 4 ) The curative effect of treating reflux esophagitis with depression and anxiety was as follows : 2 cases were cured in the traditional Chinese medicine treatment group , 10 cases were markedly effective , 7 cases were effective , 1 case was ineffective , the effective rate was 14.29 % , the effective rate was 57.14 % , the effective rate was 15.79 % , the effective rate was 36.84 % , the total effective rate was 5 % , the effective rate was 25 % , the effective rate was 25 % , the total effective rate was 55 % . Conclusion : ( 1 ) The results of this clinical study indicate that Wang Changqi ' s traditional Chinese medicine experience has a good effect on the treatment of reflux esophagitis , and it is worthy of being popularized and applied in clinic .
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R249;R256.3

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