本文選題：通前絡(luò)湯 + 慢性前列腺炎�。� 參考：《北京中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：一、李曰慶導(dǎo)師學(xué)術(shù)經(jīng)驗總結(jié)李曰慶導(dǎo)師是我國著名中醫(yī)外科大家,畢業(yè)于北京中醫(yī)學(xué)院(北京中醫(yī)藥大學(xué)前身),主任醫(yī)師,二級教授,博士研究生導(dǎo)師,東直門醫(yī)院首席教授,享受國務(wù)院政府特殊津貼。主編全國中醫(yī)藥行業(yè)高等教育“十一五”和“十二五”規(guī)劃教材《中醫(yī)外科學(xué)》,主持國家十一五科技支撐計劃項目“中醫(yī)外治特色療法和外治技術(shù)示范研究”,是國家重點學(xué)科“中醫(yī)男科學(xué)”和“中醫(yī)外科學(xué)”學(xué)術(shù)帶頭人,北京市第四批、國家第五批名老中醫(yī)藥專家。從醫(yī)已逾四十六載,中年以后尤其專注中醫(yī)男科的臨床、科研、教學(xué)工作,對中醫(yī)男科學(xué)的發(fā)展做出了卓越的貢獻,被譽為我國中醫(yī)男科學(xué)四大奠基人之一。導(dǎo)師對運用中醫(yī)、中西醫(yī)結(jié)合的方法治療男科常見疾病、疑難疾病積累了豐富的經(jīng)驗,提出了許多創(chuàng)新的學(xué)術(shù)見解和觀點。對失眠、過敏性鼻炎、濕疹等疾病的辨證論治也尤為擅長。李曰慶導(dǎo)師治學(xué)嚴謹,兼收并蓄。他對經(jīng)典精研細讀,從《內(nèi)經(jīng)》、《難經(jīng)》、《傷寒雜病論》、《景岳全書》、《妙一齋醫(yī)學(xué)正印種子編》等論著中逐漸形成自己學(xué)術(shù)觀點和思想的同時,又不斷在臨證中對古籍經(jīng)典繼承和創(chuàng)新,融會貫通中西醫(yī)療法,形成了“辨病與辨證相結(jié)合”、“宏觀與微觀相結(jié)合”、“整體與局部相結(jié)合”、“標本兼治、男女同治、身心同調(diào)”等學(xué)術(shù)思想。導(dǎo)師在臨證時精于辨證,處方往往不拘一格,常加入療效確切的草藥,出奇制勝；同時結(jié)合現(xiàn)代醫(yī)學(xué)檢查手段,明確診斷,防止誤診、漏診和誤治,將現(xiàn)代醫(yī)學(xué)的微觀檢查作為中醫(yī)手眼的延伸,充分體現(xiàn)了導(dǎo)師“病證結(jié)合”的學(xué)術(shù)思想。并在實踐中提出“補腎生精,微調(diào)陰陽,清補結(jié)合治療男性不育癥”,“從瘀、從絡(luò)論治慢性前列腺炎”,“陽痿從肝腎論治”,“良性前列腺增生癥從腎虛血瘀論治”等行之有效的治療思路,取得了良好的療效。我在跟師學(xué)習(xí)期間系統(tǒng)地學(xué)習(xí)和整理了導(dǎo)師的學(xué)術(shù)思想和臨床經(jīng)驗,在論文中進行了闡述。二、“活血通絡(luò)法”治療慢性前列腺炎隨機對照臨床研究目的：活血通絡(luò)法治療慢性前列腺炎是我跟師學(xué)習(xí)期間總結(jié)發(fā)現(xiàn)李曰慶導(dǎo)師的學(xué)術(shù)思想,“通前絡(luò)湯”是導(dǎo)師在該法指導(dǎo)下常用的經(jīng)驗方。本研究通過觀察通前絡(luò)湯對慢性前列腺炎(氣滯血瘀證)患者美國國立衛(wèi)生研究院慢性前列腺炎癥狀評分(NIH-CPSI)、9條目病人健康問卷評分(PHQ-9)、前列腺液中白細胞數(shù)量及磷脂小體數(shù)量的影響,客觀評價通前絡(luò)湯治療慢性前列腺炎(氣滯血瘀證)的臨床療效。方法：采用隨機、對照臨床試驗研究方法,通過美國國立衛(wèi)生研究院慢性前列腺炎癥狀評分(NIH-CPSI)、前列腺按摩液常規(guī)(EPS)等納入排除標準,篩選出120例慢性前列腺炎氣滯血瘀證患者,隨機分為試驗組(60例,脫落1例)和對照組(60例,脫落6例)。試驗組患者服用通前絡(luò)湯免煎顆粒,早晚各一袋,飯前40分鐘,溫水沖服,療程4周。對照組口服前列欣膠囊,6粒／次,每天3次,飯前40分鐘,溫水送服,療程4周。所有患者均在入組時、治療第2周、第4周時門診隨訪并進行NIH-CPSI、PHQ-9評分,在治療結(jié)束后第4周門診或電話隨訪,進行NIH-CPSI、PHQ-9評分。結(jié)果：試驗組痊愈5例(8.47%),顯效19例(32.20%),有效28(47.46%),總有效率88.14%。對照組痊愈3例(5.56%),顯效13例(24.07%),有效22例(40.74%),總有效率70.37%。兩組治療前后NIH-CPSI積分的自身對比差異均有顯著性(P0.01);組間比較,試驗組較對照組第4周和第8周NIH-CPSI總分、疼痛和生活質(zhì)量評分差異均有顯著性(P0.05);兩組治療前后PHQ-9評分的自身對比差異均有顯著性(P0.01),組間比較,試驗組較對照組第2周、第4周和第8周PHQ-9總分差異均有顯著性(P0.05)；兩組治療后EPS白細胞數(shù)量計數(shù)與療前相比變化差異均顯著(P0.01)；組間比較,治療后第2周及第4周試驗組較對照組在EPS白細胞計數(shù)上差異均顯著(P0.01)；兩組治療后磷脂小體數(shù)量與療前相比變化差異均顯著(P0.01),治療第2周與第4周比較,兩組均有顯著性差異(P0.05)；組間比較,治療后第2周,試驗組較對照組卵磷脂小體計數(shù)上無顯著性差異(P0.05),療后第4周試驗組較對照組卵磷脂小體計數(shù)上有顯著性差異(P0.01)。結(jié)論：通前絡(luò)湯對慢性前列腺炎(氣滯血瘀證)的臨床癥狀有不同程度的改善,尤其能夠緩解患者疼痛不適的癥狀,改善患者的生活質(zhì)量和改變患者的抑郁狀態(tài),客觀上能夠降低前列腺液中白細胞的數(shù)量,增加卵磷脂小體的含量。因此,本方可以有效的治療該類型的慢性前列腺炎。
[Abstract]:First, Li Yueqing's tutor's academic experience summarizes Li Yueqing's tutor, a famous Chinese medicine surgeon in China, graduated from the Beijing Institute of traditional Chinese medicine (the predecessor of the Beijing University of Chinese Medicine), the chief physician, the two level Professor, the doctoral supervisor, the chief professor of the Dongzhimen hospital, and the special allowance of the State Department of the State Council. The chief editor of the national traditional Chinese medicine industry, "ten" 15 "and" 12th Five-Year "program textbook" Chinese Medicine Surgery > ", the state 11th Five-Year science and technology support program" traditional Chinese medicine treatment and external treatment technology demonstration research ", is the national key discipline" male science of traditional Chinese medicine "and" Chinese medicine surgery "academic leader, the fourth batch of Beijing City, the country's fifth batch of old traditional Chinese medicine experts. After more than forty-six years of medical treatment, after middle age, especially the clinical, scientific research and teaching work of Chinese medicine, it has made outstanding contributions to the development of male science of traditional Chinese medicine. It has been praised as one of the four founders of male science of Chinese medicine. The tutor has accumulated rich classics on the treatment of common diseases of male subjects and difficult diseases by the combination of traditional Chinese medicine and Chinese and Western medicine. A lot of innovative academic opinions and viewpoints were put forward. The syndrome differentiation and treatment of diseases such as insomnia, allergic rhinitis, eczema and other diseases were especially good. Li Yueqing's tutor was strict in scholarly study. At the same time of his own academic views and ideas, they continue to inherit and innovate the classics of ancient books, integrate the Chinese and Western medical law, and form a "combination of disease discrimination and syndrome differentiation", "combination of macro and micro", "combination of the whole and the local", "specimen and treatment, CO treatment of men and women, physical and mental homology". On the basis of syndrome differentiation, the prescriptions are often unconstrained, often added to the effective herbal medicine to win the victory; at the same time, combining modern medical examination methods, clear diagnosis, prevention of misdiagnosis, missed diagnosis and mistaken treatment, the microscopic examination of modern medicine as the extension of the hand eye of traditional Chinese medicine, fully embodies the academic thought of "combination of diseases and syndromes" of the instructor and put forward in practice "Invigorating the kidney to produce sperm, adjusting Yin and Yang, clearing up the combination therapy for male infertility", "Treating Chronic Prostatitis from the stasis, from the collaterals", "treating the impotence from the liver and kidney", "treating the benign prostatic hyperplasia from the kidney deficiency and blood stasis" and so on, has achieved good therapeutic effect. I systematically studied and arranged the guide during my study with the teacher. The academic thought and clinical experience of the teacher were expounded in the paper. Two, the purpose of the randomized controlled clinical study of the treatment of chronic prostatitis by "activating blood circulation and collaterals method" is the purpose of the treatment of chronic prostatitis: the academic thought of Li Yueqing tutor was summed up during my study with the teacher. "Tongqian collaterals" is the guide of the tutor under the guidance of this law. In this study, the effect of Tongqian collaterals on chronic prostatitis (qi stagnation and blood stasis) on chronic prostatitis symptom score (NIH-CPSI), 9 items of patients' Health Questionnaire (PHQ-9), the number of white blood cells in prostatic fluid and the number of phospholipid corpuscles in the prostatic fluid were observed in this study, and the chronic prostatic soup was objectively evaluated for the chronic treatment of chronic prostatitis. The clinical effect of prostatitis (qi stagnation and blood stasis syndrome). Methods: 120 cases of chronic prostatitis qi stagnation and blood stasis syndrome were selected and divided into experimental group randomly and compared with the standard of chronic prostatitis symptom score (NIH-CPSI) and prostatic massage routine (EPS) in the National Institutes of health of the United States. (60 cases, shedding 1 cases) and the control group (60 cases, 6 cases). The patients in the experimental group took the free Decoction granule of Tongqian Luo decoction, each one bag, 40 minutes before meals, warm water for 4 weeks. The control group took the forefront of the capsule, 6 grains per time, 3 times a day, 40 minutes before meals, warm water for 4 weeks. All patients were treated for second weeks, fourth weeks. Follow-up and NIH-CPSI, PHQ-9 score, after fourth weeks of outpatient or telephone follow-up after the end of the treatment, NIH-CPSI, PHQ-9 score. Results: the test group recovered 5 cases (8.47%), 19 cases (32.20%), effective 28 (47.46%), total effective 88.14%. control group recovered 3 cases (5.56%), 13 cases (24.07%), effective 22 cases (40.74%), total effective efficiency 70.37%. two group The differences of NIH-CPSI scores before and after treatment were significant (P0.01). Compared with the fourth and eighth weeks NIH-CPSI total scores in the experimental group, the scores of pain and quality of life were significantly different (P0.05), and the difference of the contrast between the two groups before and after the treatment of the two groups was significant (P0.01). The comparison between the group and the control group was more than that of the control group. There were significant differences in the total score of PHQ-9 in the second weeks, fourth weeks and eighth weeks. The number of EPS white blood cells in the two groups was significantly different from that before treatment (P0.01). Compared with the control group at second weeks and 4 weeks after treatment, the differences in the EPS white blood cell count were significantly higher than those in the control group (P0.01). The number of phospholipid corpuscles in the two groups after treatment and the number of phospholipid bodies in the two groups were compared with those in the two groups. The difference was significant (P0.01) before treatment, and there was significant difference between the two groups (P0.05) for second weeks and fourth weeks. There was no significant difference in the count of lecithin body between the experimental group and the control group at second weeks after the treatment (P0.05). There was a significant difference in the count of lecithin body in the test group after fourth weeks after treatment (P0.01). The clinical symptoms of Tongqian collaterals can improve the clinical symptoms of chronic prostatitis (qi stagnation and blood stasis syndrome) to varying degrees, especially to relieve the symptoms of the discomfort of the patients, improve the quality of life and the depressive state of the patients, objectively reduce the number of white blood cells in the prostatic fluid and increase the content of the lecithin body. Effective treatment of this type of chronic prostatitis.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R277.5;R249

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