本文選題：王彥恒 + 腦主神明��； 參考：《北京中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：王彥恒老中醫(yī)在精神科�？漆t(yī)院的中醫(yī)科從事臨床工作逾55年,臨床經(jīng)驗(yàn)豐富,形成了獨(dú)特的中醫(yī)精神科學(xué)術(shù)思想,具有相當(dāng)?shù)拇硇?研究王老的學(xué)術(shù)思想與臨床經(jīng)驗(yàn),對(duì)于中醫(yī)精神科學(xué)術(shù)發(fā)展和傳承十分必要。學(xué)術(shù)思想淵源王老學(xué)術(shù)思想淵源受到傳統(tǒng)中醫(yī)的神志病學(xué)說,如心主神明學(xué)說、五神臟理論、癲狂癇學(xué)說、郁證學(xué)說和有關(guān)情志病治肝學(xué)說等的深遠(yuǎn)影響,但主要還是受到以下三個(gè)學(xué)說的影響：第一,是傷寒學(xué)派陽明病有關(guān)學(xué)說；第二,活血化瘀學(xué)說；第三,中西醫(yī)結(jié)合思潮和實(shí)踐。學(xué)術(shù)思想特點(diǎn)王老主張腦主神明,注重腦神在神志病和各種疾病發(fā)病和傳變中的作用,強(qiáng)調(diào)在神志病治療中治腦調(diào)神,其中最為重視活血、清熱、補(bǔ)腎。主張百病治療康復(fù)要治腦調(diào)神,怪病、難癥治療不忘腦神,防病調(diào)神。王老主張,腦主神明,以通為用。腦神“不通則亂,亂則不通”是腦神病的基本病機(jī),活血通腦是最重要的治則治法。腎腦相通,“精”“神”互用,腎精不足,腦髓失養(yǎng)是腦神病基本病機(jī)之二,補(bǔ)腎強(qiáng)腦、安神寧神是治療腦神病的基本治法之二。熱擾腦神,熱毒上攻,是腦神病的基本病機(jī)之三,清熱寧腦乃為腦神病的基本治法之三。王老治療精神科藥物反應(yīng)和精神科藥源性疾病主要采取清熱、養(yǎng)陰、解毒和活血之法,主張治未病,講究治病時(shí)機(jī),積極探索辨證使用西藥。主要臨床經(jīng)驗(yàn)1.關(guān)于精神分裂癥(癲病)王彥恒老師認(rèn)為,精神分裂癥屬于中醫(yī)癲病范疇,是精神科最常見的病種。但中醫(yī)癲病的臨床范圍大于精神分裂癥,很多伴有精神病性癥狀的疾患也可以診為中醫(yī)的癲病,均可以在治療原發(fā)病的基礎(chǔ)上參考癲病進(jìn)行辨證論治。王彥恒老師早年總結(jié)癲病的病機(jī)規(guī)律為：“始發(fā)于肝,并發(fā)于心,失調(diào)于臟,上擾于腦,癲病乃作”。王彥恒老師經(jīng)驗(yàn)中癲病治療臨床思路,強(qiáng)調(diào)掌握以下三點(diǎn)：第一抓住證候特征,第二分析病位,第三確定病性,癲病之病性,為本虛標(biāo)實(shí),初期為邪實(shí),中期為虛實(shí)夾雜,后期以虛為主。邪實(shí)即氣滯、痰盛、血瘀；正虛即氣、血、津液虧虛。腦神、五臟功能下降,應(yīng)注意整體調(diào)理。王老認(rèn)為中醫(yī)治療癲病,要時(shí)時(shí)不忘“治未病”和“治病求本”,不要僅僅緊盯住癥狀本身,過分重視中西藥物的作用；應(yīng)時(shí)時(shí)從不同角度、不同層面把握患者的心理、情志、腦神因素,對(duì)患者所關(guān)注的婚戀、生活、工作問題予以積極的指導(dǎo)和引導(dǎo),治未病,防止癲病向陰性癥狀(癲病呆癥)發(fā)展和藥源性疾病的產(chǎn)生。王老主張,癲病康復(fù)的關(guān)鍵在于預(yù)防復(fù)發(fā)。2.雙相情感障礙(狂郁病) 王彥恒老師認(rèn)為雙相情感障礙的臨床雖然表現(xiàn)為兩種矛盾情緒狀態(tài)(狂、郁)的情感精神疾病,卻有著內(nèi)在統(tǒng)一的病機(jī),二者可以相互轉(zhuǎn)換,郁久可以化火,火性炎上則化為狂；狂久則耗傷氣血陰陽,導(dǎo)致陰陽不足,氣機(jī)升發(fā)不利而為郁,從狂而轉(zhuǎn)郁,由此而見狂郁兼見或轉(zhuǎn)換,治療難度較大。抑郁發(fā)作的治療思路必須掌握以下三點(diǎn)：第一,抓住證候特征；第二,確定病位；第三,確定病性。躁狂狀態(tài)的治療思路是要對(duì)四診獲得的臨床資料進(jìn)行全面綜合分析,確定病位、病性及制定相應(yīng)的治法、用藥,是提高療效,縮短療程的關(guān)鍵所在。對(duì)待雙相情感障礙的轉(zhuǎn)相問題,要注意其內(nèi)在機(jī)制,一方面可能是本病病勢(shì)的自然體現(xiàn),另一方面要考慮到與應(yīng)用的藥物有關(guān)。應(yīng)及時(shí)調(diào)整藥物和藥量,不可過亦不可不及,臨床上要根據(jù)正虛邪實(shí)的進(jìn)退情況靈活運(yùn)用藥物。3.抑郁障礙(郁病) 溫陽腎開郁是王老從腎論治腦神病的一個(gè)重要學(xué)術(shù)思想。王老主張,傳統(tǒng)的郁證和癲病都很難包容我們現(xiàn)在所說的抑郁障礙范疇,腎陽不足,全身氣機(jī)動(dòng)力不足,是郁病(抑郁障礙)的重要病機(jī)之一。在使用溫陽開郁法治療抑郁障礙時(shí),溫陽補(bǔ)腎是關(guān)鍵與核心。溫腎扶陽,但不可過于溫燥。4.焦慮障礙焦慮癥的癥狀“點(diǎn)多面廣”,病因涉及心理因素、社會(huì)因素、生理因素；其病位在腦而涉及五臟六腑,特別是腦、心、腎；病機(jī)是各種身心因素引起的腦神不寧、神機(jī)不暢。腎陰不足,腦神失養(yǎng)是焦慮癥病機(jī)病性之本。焦慮的臨床復(fù)雜病機(jī)類型包括臟腑未損,神機(jī)紊亂；寒熱并見,虛實(shí)夾雜；上熱下寒,癥狀繁雜等。王老治療焦慮癥,首重調(diào)養(yǎng)腦神,滋陰、清熱、理氣并舉,安心神、鎮(zhèn)肝魂以重鎮(zhèn)祛為常法；辨別標(biāo)本,補(bǔ)瀉兼施；慎用溫補(bǔ),見寒慎用祛寒,不忘散郁；清上溫下,不忘調(diào)理脾胃。若已長(zhǎng)期使用西藥,要注意解毒,更重清熱養(yǎng)陰。焦慮患者要怡情養(yǎng)性,加強(qiáng)戶外運(yùn)動(dòng),飲食宜清淡。中西醫(yī)結(jié)合治療焦慮癥,就是要發(fā)揮兩個(gè)醫(yī)學(xué)體系的不同價(jià)值觀、不同診治方法的優(yōu)勢(shì),取“西藥起效快,中醫(yī)治根本”的雙重優(yōu)勢(shì),以病人為本,盡快取得療效,縮短病程,減少病痛和殘留癥狀,加快康復(fù)。5.中醫(yī)防治精神科藥物不良反應(yīng) 王老主張中醫(yī)防治精神科藥物不良反應(yīng)要注意發(fā)揮自身優(yōu)勢(shì)。王老對(duì)精神藥物導(dǎo)致不良反應(yīng)和藥源性疾患的總體認(rèn)識(shí)是：“藥物毒邪,始發(fā)于胃,并發(fā)于脾,侵及臟腑；病勢(shì)多途,筋骨受損,傷正毀形,諸病皆生。”治療精神科藥物不良反應(yīng),如遲發(fā)性運(yùn)動(dòng)障礙、藥源性閉經(jīng),要特別注意,清熱,養(yǎng)陰,活血,解毒是常用方法。在精神科防治藥毒關(guān)鍵是抓住“治未病”的時(shí)機(jī)。基于中醫(yī)傳承輔助平臺(tái)2.5對(duì)王彥恒老師用藥經(jīng)驗(yàn)進(jìn)行了初步統(tǒng)計(jì)分析。將篩選出的1903個(gè)處方轉(zhuǎn)錄入中醫(yī)傳承輔助平臺(tái)2.5的“方劑分析”模塊進(jìn)行統(tǒng)計(jì)分析,包括頻次統(tǒng)計(jì)、組方規(guī)律、新方分析。通過軟件統(tǒng)計(jì),總結(jié)出王彥恒老師治療腦神病的主要藥物和主要組合規(guī)律。分析顯示王彥恒老師治療腦神病常用治法,包括活血、清熱(陽明熱)、鎮(zhèn)肝、補(bǔ)腎、養(yǎng)陰、通便、解毒、行氣、化痰等。依據(jù)關(guān)聯(lián)規(guī)則網(wǎng)絡(luò)展示圖所展示的支持度40%的核心組合是由川芎、丹參、菊花、石膏、珍珠母、山萸肉、何首烏、炒棗仁這七味藥組成。這個(gè)核心組合可以看作是王彥恒老師治療各種腦神病的核心方劑。該數(shù)據(jù)分析研究還深層次揭示了王彥恒老師腦神病治療的一些具體用藥規(guī)律。健脾補(bǔ)腎法治療精神分裂癥陰性癥狀研究本研究對(duì)精神分裂癥陰性癥狀的西醫(yī)研究現(xiàn)狀進(jìn)行了綜述,提示對(duì)于精神分裂癥陰性癥狀的治療,非典型抗精神病藥物、抗精神病藥物聯(lián)合阿立哌唑或氨磺必利,抗精神病藥物聯(lián)合抗抑郁劑、抗精神病藥物聯(lián)合心理行為治療以及抗精神病藥物聯(lián)合經(jīng)顱磁刺激治療均能使患者獲益。對(duì)中醫(yī)、中西醫(yī)結(jié)合治療精神分裂癥進(jìn)行了全面綜述,提示其主要病因病機(jī)是脾腎兩虛(脾腎陽虛)。對(duì)脾藏意主思的神經(jīng)心理學(xué)內(nèi)涵進(jìn)行了初步探討,脾藏意主思,對(duì)人體信息的接受、識(shí)別、短期記憶、初步加工處理,提取、初步儲(chǔ)藏關(guān)系密切,即對(duì)初步形成思維、短時(shí)記憶相關(guān),而相應(yīng)的腎主封藏的功能與信息的深度處理、長(zhǎng)期記憶有關(guān),由此可以假設(shè)脾意與腎志精神活動(dòng)的認(rèn)知與情感功能具有不同程度的聯(lián)系,并體現(xiàn)在認(rèn)知與情感活動(dòng)的不同環(huán)節(jié)。如果出現(xiàn)脾虛,脾藏意主思的功能下降,相應(yīng)的記憶學(xué)習(xí)功能就會(huì)出現(xiàn)認(rèn)知障礙和負(fù)性情緒障礙。脾藏意主思的這些認(rèn)知、情感內(nèi)涵與脾臟的功能性質(zhì)高度一致,并與腎藏志主恐的內(nèi)涵相區(qū)別。脾虛脾意不足容易出現(xiàn)相應(yīng)認(rèn)知情感功能失常。對(duì)精神分裂癥和精神分裂癥的陰性癥狀中醫(yī)范疇和中醫(yī)病名進(jìn)行了思考,建議將精神分裂癥的陰性癥狀,稱為“癲病呆證(或癲呆癥、癲呆病)”探討了健脾(意)治療精神分裂癥陰性癥狀的中醫(yī)理論基礎(chǔ),在老師補(bǔ)腎法治療陰性癥狀的基礎(chǔ)上,提出運(yùn)用健脾(意)補(bǔ)腎(志)法治療精神分裂癥陰性癥狀(癲病呆證),是對(duì)老師經(jīng)驗(yàn)和學(xué)術(shù)觀點(diǎn)的發(fā)展與創(chuàng)新。由于健脾與補(bǔ)腎作用對(duì)認(rèn)知過程和情感過程環(huán)節(jié)不同,二者的作用存在疊加和加強(qiáng),推測(cè)健脾補(bǔ)腎治療陰性癥狀的療效會(huì)優(yōu)于單純補(bǔ)腎法。對(duì)健脾補(bǔ)腎法治療精神分裂癥陰性癥狀進(jìn)行了臨床觀察：目的：精神分裂癥陰性癥狀是精神科疾病主要致殘因素,尚無可靠治療方法。根據(jù)中醫(yī)五臟和“五神藏”理論,陰性癥狀應(yīng)與“脾”和“腎”有關(guān)。因此本研究試用健脾補(bǔ)腎法治療精神分裂癥陰性癥狀,探討本病的中醫(yī)治療規(guī)律。方法：選取男性精神分裂癥患者、符合中醫(yī)虛證標(biāo)準(zhǔn)60例,隨機(jī)分為兩組,治療組予以利培酮的同時(shí)服用健脾補(bǔ)腎湯劑。對(duì)照組服用利培酮的同時(shí)服用補(bǔ)腎湯劑。療程為12周。利培酮用量為2-4mg。分別于基線(入組第一天)、第4、8和12周末進(jìn)行量表評(píng)定,精神癥狀評(píng)定用陽性和陰性癥狀量表(PANSS)。全部數(shù)據(jù)應(yīng)用SPSS 13.0軟件進(jìn)行統(tǒng)計(jì)處理。對(duì)陽性癥狀量表總分、陰性癥狀量表總分、7個(gè)陰性癥狀量表分分別進(jìn)行了重復(fù)測(cè)量數(shù)據(jù)多因素方差分析(MANOVA)。結(jié)果：對(duì)陽性癥狀量表分,治療組、對(duì)照組治療前后有明顯差異,但是兩組間無顯著性差異。對(duì)陰性癥狀量表分,治療組、對(duì)照組治療前后有明顯差異,且12周末時(shí)兩組間有顯著性差異,治療組改善優(yōu)于對(duì)照組。對(duì)各陰性癥狀量表亞量表分,治療組、對(duì)照組治療前后有明顯差異,且12周末時(shí)治療組對(duì)情感退縮、交談缺乏自發(fā)性和流暢性、刻板思維等亞量表分改善優(yōu)于對(duì)照組,尤其是治療組在4、8、12周末時(shí)對(duì)情感交流障礙亞量表分改善優(yōu)于對(duì)照組。討論：健脾補(bǔ)腎法比單純補(bǔ)腎法對(duì)精神分裂癥患者陰性癥狀改善作用更加全面。健脾補(bǔ)腎法治療精神分裂癥陰性癥狀(癲病呆癥)值得深入研究。
[Abstract]:Wang Yanheng ' s traditional Chinese medicine has been engaged in clinical work for more than 55 years in the medical department of the specialty hospital of the psychiatric department . The clinical experience is abundant . It has formed a unique academic thought and clinical experience of TCM . It is very necessary to study the academic development and inheritance of the traditional Chinese medicine .
Second , the theory of promoting blood circulation and removing blood stasis ;
Third , the Chinese and western medicine combined with thought and practice . Wang Lao advocated the role of brain god in the pathogenesis and transmission of various diseases , and emphasized the role of the brain god in the pathogenesis and transmission of various diseases . The main clinical experience was that the schizophrenia belonged to the basic pathogenesis of the brain ' s disease . The clinical idea of treating epilepsy in the experience of Wang Yanheng ' s teacher is to grasp the following three points : the first grasping the syndrome characteristics , the second analyzing the disease position , the third determining the disease resistance and the disease resistance of the epilepsy .
The deficiency of qi , blood , body fluid and deficiency of body fluid is the deficiency of qi , blood and body fluid , and the functions of brain and five zang organs decrease , attention should be paid to the whole conditioning . Wang always thinks that the traditional Chinese medicine is treating epilepsy , should not forget to cure the disease " and " cure the disease " in time , don ' t just focus on the symptom itself , pay much attention to the effect of Chinese and western medicine ;
Wang Yanheng , a professor of bipolar disorder ( manic depression ) , believes that the clinical characteristics of bipolar affective disorder lie in two contradictory emotional states ( manic and depressed ) .
The treatment of depressive episode must grasp the following three points : First , grasp the syndrome characteristics ;
secondly , determining the disease position ;
Third , the treatment of manic state is to carry out comprehensive analysis on the clinical data obtained from four visits , to determine the disease position , the disease property and to develop the corresponding treatment method , the medicine is the key to improve the curative effect and shorten the course of treatment .
The disease is in the brain and involves five zang - fu organs , especially the brain , heart and kidney ;
The disease machine is caused by various psychological and psychological factors , and the Shenyin deficiency is caused by the deficiency of the kidney yin and the loss of the brain and mind is the disease of the anxiety disorder .
Cold and hot , see , false - solid inclusion ;
The king used to treat anxiety , head to nourish the brain , nourish yin , clear heat , regulate qi and lift , tranquilize the spirit , and the soul of the town is removed from the heavy town as the normal method ;
distinguishing the specimen and tonifying the diarrhea ;
Use temperature supplement carefully , see cold with caution and dispel cold , do not forget to disperse stagnation ;
The traditional Chinese medicine and the western medicine have the advantages of different values and different diagnosis and treatment methods , taking the patient as the book , achieving the advantages of different values of the two medical systems , shortening the disease course , reducing the pain and residual symptoms and accelerating the recovery . This paper reviews the current situation of Chinese medicine and traditional Chinese and western medicine in the treatment of schizophrenia negative symptoms , including blood circulation , heat clearing ( Yangming heat ) , antipsychotic drugs , combination of antipsychotic drugs , anti - psychotic drugs , psychobehavioral therapy and anti - psychotic drugs . Identification , short - term memory , preliminary processing , extraction and preliminary storage are closely related , that is , the function of the primary thinking and short - term memory is related to the depth treatment and long - term memory of the information . Objective : To study the effect of spleen tonifying and kidney tonifying in the treatment of schizophrenia negative symptoms ( PANSS ) .
【學(xué)位授予單位】：北京中醫(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;R277.7
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本文編號(hào)：1999716