發(fā)布時(shí)間：2018-06-24 06:24

  本文選題：膿耳 + 古今文獻(xiàn)研究��； 參考：《云南中醫(yī)學(xué)院》2017年碩士論文

【摘要】：研究目的:課題主要對(duì)膿耳的辨證論治規(guī)律進(jìn)行研究,通過對(duì)古代和現(xiàn)代文獻(xiàn)的查閱和研究,對(duì)資料的整理和分析,總結(jié)古代和現(xiàn)代醫(yī)家對(duì)膿耳的辨證論治等方面的規(guī)律,提出治療膿耳的辨證論治之法,希望對(duì)現(xiàn)代醫(yī)學(xué)研究和臨床治療膿耳提供參考。研究方法:本課題通過各種檢索方式,確定入選文獻(xiàn),并對(duì)文獻(xiàn)整理總結(jié)后,通過對(duì)比分析,對(duì)治療膿耳的證治規(guī)律及用藥進(jìn)行比較,確定古今治療膿耳的異同點(diǎn),并提出個(gè)人觀點(diǎn),以供參考。研究對(duì)象來源:古文獻(xiàn)主要查閱各年代醫(yī)家著作,查找記錄與膿耳有關(guān)文獻(xiàn)并精讀總結(jié),確定入選文獻(xiàn)�，F(xiàn)代文獻(xiàn)主要選取自1990年至2016年在國內(nèi)學(xué)術(shù)期刊中公開發(fā)表的與治療膿耳相關(guān)的中醫(yī)及中西醫(yī)文獻(xiàn)。文獻(xiàn)納入標(biāo)準(zhǔn):文章內(nèi)容與膿耳治療有關(guān)。文章發(fā)表單位屬于國家新聞出版署正規(guī)法定刊物,時(shí)間為1990年到2016年間�；颊呙鞔_診斷為膿耳,文章所報(bào)道病例數(shù)不少于10例。辨證分型治療明確者優(yōu)先。方藥納入標(biāo)準(zhǔn):為中藥或中西醫(yī)結(jié)合用藥。方藥有明確藥物組成,治療效果獲得認(rèn)可。外治、內(nèi)服藥物均可入選。方藥排除標(biāo)準(zhǔn):只有西藥治療。方劑組成不明確。數(shù)據(jù)庫的建立:使用Excel軟件建立研究數(shù)據(jù)庫。其內(nèi)容主要包括:病因病機(jī)、治法、方藥等。使用Excel軟件,對(duì)所要研究的內(nèi)容進(jìn)行分析,得出結(jié)果。研究結(jié)果:(1)納入研究文獻(xiàn):古代文獻(xiàn)共從45部醫(yī)家著作中查找到52卷與膿耳病因病機(jī)或治療用藥有關(guān)內(nèi)容�，F(xiàn)代文獻(xiàn)通過維普、知網(wǎng)等數(shù)據(jù)庫檢索,共檢索與膿耳有關(guān)文獻(xiàn)430篇,再進(jìn)行高級(jí)檢索關(guān)鍵字“化膿性中耳炎”“中醫(yī)”、“膿耳”等,對(duì)每篇文獻(xiàn)進(jìn)行細(xì)讀總結(jié)后,排除不符合研究標(biāo)準(zhǔn)文獻(xiàn),共篩選出符合條件文獻(xiàn)61篇。(2)病因病機(jī)學(xué)分析:古代文獻(xiàn)中,論述膿耳與臟腑之關(guān)系,主要可分為:與腎相關(guān):共23篇,其中腎氣熱結(jié)12篇,腎氣虛7篇,腎陰虛4篇。與肝相關(guān):共11篇,肝膽火盛8篇,肝風(fēng)妄動(dòng)3篇。與心相關(guān):共7篇,心火亢盛1篇,風(fēng)熱邪毒隨心經(jīng)上壅6篇。與脾相關(guān):共4篇,脾虛胃濕4篇。與肺相關(guān):共1篇,肺氣虛1篇�，F(xiàn)代61篇文獻(xiàn)主要從肺、肝、脾、腎四臟論治。主要可分為:與肺相關(guān):共36篇,肺經(jīng)風(fēng)熱36篇。與肝相關(guān):共35篇,肝膽火盛26篇,風(fēng)熱外侵隨肝經(jīng)上犯耳竅9篇。與腎相關(guān):共21篇,腎元虧損21篇。與脾相關(guān):共27篇,脾胃虛弱27篇。(3)辨證論治分析古代醫(yī)家主要將膿耳分為六種證型:腎氣熱結(jié)證、肝膽火盛證、腎元虧損證、風(fēng)熱外侵證、脾虛胃濕證、肝風(fēng)妄動(dòng)證�，F(xiàn)代醫(yī)家主要將膿耳分為四種證型:風(fēng)熱外侵證、脾胃虛弱證、肝膽火盛證次、腎元虧損證。(4)用藥分析:古代外用藥以解毒殺蟲燥濕止癢藥(礬石統(tǒng)一用白礬代替)、開竅藥(麝香、冰片)、拔毒化腐生肌藥(鉛粉、輕粉)、活血化瘀藥(干胭脂)為主。古代內(nèi)服藥用藥以清熱藥(地黃、梔子、黃芩、赤芍、牡丹皮、連翹、野菊花、天花粉、玄參)、解表藥(柴胡、防風(fēng)、升麻、蔓荊子、荊芥、牛蒡子)、補(bǔ)氣藥(甘草、人參、山藥、黃芪)、利水滲濕藥(茯苓、木通、澤瀉、車前子)為主。現(xiàn)代外用藥出現(xiàn)頻率最高的分別是清熱藥(黃連、黃柏、苦參、黃芩)、開竅藥(冰片、麝香)、解毒殺蟲燥濕止癢藥(白礬)�，F(xiàn)代內(nèi)服藥出現(xiàn)頻率較高的為清熱藥(金銀花、蒲公英、黃芩、黃柏、野菊花、玄參、連翹)、補(bǔ)氣藥(甘草、黃芪、白術(shù)、黨參、山藥)、利水滲濕藥(茯苓、薏苡仁、澤瀉、車前子)、解表藥(白芷、柴胡、防風(fēng)、升麻)。討論:通過學(xué)習(xí)總結(jié)與膿耳相關(guān)的古今文獻(xiàn),本文對(duì)膿耳的病因病機(jī)、辨證思路、辨證論治等提出了討論意見。本人認(rèn)為膿耳的辨證治療與外科學(xué)治療瘡瘍之法有異曲同工之妙�？蓪⒛摱陌l(fā)病分為前、中、后三期,前期采用“消”法,中期采用“托”法,后期采用“補(bǔ)”法,此三法靈活運(yùn)用于每一期的治療當(dāng)中。前期的主要證型有肺經(jīng)風(fēng)熱證、少陽風(fēng)熱證、肝膽火盛證;中期的主要證型為脾虛濕滯證;后期的主要證型有腎陰虧虛證、腎陽虧虛證。
[Abstract]:The purpose of this study is to study the rule of syndrome differentiation and treatment of the pus. Through the consultation and study of the ancient and modern literature, the paper collated and analyzed the data, summed up the laws of the ancient and modern doctors on the syndrome differentiation and treatment of the pus, and put forward the method of treatment for the treatment of the pus, hoping to study the modern medical research and clinical treatment. To provide reference for pus. Research methods: the subject through a variety of retrieval methods to determine the selected literature, and after a summary of the literature, through comparative analysis, comparison and analysis of the treatment of pus and ear of the rule and use of drugs to determine the similarities and differences between ancient and modern treatment of pus, and put forward a personal point of view for reference. Age medical works, search for records and purulent ear related literature and read summary, to determine the selected literature. Modern literature mainly selected from 1990 to 2016 published in domestic academic journals related to the treatment of pus related Chinese medicine and traditional Chinese and Western medicine. The literature included the standard: the article is related to the suppurative ear treatment. The article published in the country belongs to the country. The regular and statutory publication of the home press and publication department was from 1990 to 2016. Patients were clearly diagnosed as pus, and the number of cases reported in this article was not less than 10. Only western medicine exclusion criteria: only western medicine treatment. The composition of the prescription is not clear. The establishment of the database: the use of Excel software to establish the research database. Its main contents include: etiology, pathogenesis, treatment, prescription and so on. Use Excel software to analyze the contents of the research and get the results: (1) the research literature: ancient literature from 4 Of the 5 medical works, 52 volumes were found to be related to the pathogenesis or treatment of the pyogenic ear disease. The modern literature retrieved 430 articles related to the pyogenic ear, and then the advanced retrieval keyword "suppurative otitis media", "purulent otitis", "pus ear" and so on. According to the standard literature of the study, a total of 61 eligible documents were selected. (2) etiological and pathogenesis analysis: in ancient literature, the relationship between the purulent ear and the viscera was discussed. It was mainly divided into 23 articles, including 23 articles, 12 of the kidney qi heat, 7 of kidney Qi, 4 in the kidney yin deficiency, 11, 8 of the liver and gallbladder, 3 in the liver wind, and 3 with the liver wind. 7 articles were related to the heart: 7 articles related to heart: 7 pieces of heart related There are 1 pieces of hyperactivity of heart fire and 6 pieces of wind and fever with the heart meridian obstruction. A total of 4 articles and 4 spleen asthenia stomach dampness. 1 articles and 1 lung qi deficiency are related to the lung. The 61 modern literature mainly consists of lung, liver, spleen and four kidney. It can be divided into 36 articles, 36 articles of the lung and heat, 36 articles with the liver: altogether 35, liver and gallbladder fire 26, the wind and heat transgression along the liver 9 articles of the kidneys. Related to the kidney: a total of 21 articles, kidney element loss 21. 27 articles and 27 spleen and stomach weakness. (3) syndrome differentiation and treatment analysis of ancient doctors divided the ear into six types of syndrome: Kidney Qi heat syndrome, liver and gallbladder fire syndrome, kidney element loss syndrome, wind heat invasion syndrome, spleen deficiency stomach damp syndrome, liver wind disregard syndrome. Modern doctors mainly divide the pus into four kinds of syndromes. Type: wind heat external invasion syndrome, spleen and stomach weakness syndrome, liver and gallbladder fire syndrome, kidney element loss syndrome. (4) ancient external use medicine to detoxify and kill the worm and relieve itching medicine (alum instead of alum), open the orifices (musk, borneol), extract poisonous saprophytic muscle drugs (lead powder, light powder), promote blood circulation and remove stasis medicine (dry Rouge). Gardenia, Radix Scutellariae, Radix Paeoniae, peony skin, forsythia forsythia, wild chrysanthemum, trichosanthin, Radix scabra and Radix Sophorae and Radix Sophorae (Radix scabra). It is the most important medicine (Rhizoma Coptidis, cypress, Radix Sophorae, Radix Astragalus), and the highest frequency of modern external use medicine (Rhizoma Coptidis, phellodendron, Radix Sophorae, Radix Sophorae), and the highest frequency of modern external use medicine (Huanglian, cypress, Sophora flavescens, yellow, yellow). Baicalin), Kaiqiao (borneol, musk), detoxification and dampness antipruritic antipruritic medicine (Bai Fan). Modern internal medicine has a high frequency of antipyretic drugs (honeysuckle, dandelion, Scutellaria, cypress, chrysanthemum, forsythia), gas supplement (licorice, astragalus, Atractylodes, Radix Codonopsis, yam), Li Shui osmotic drugs (Poria cocos, coix seed, Alisma, car), antipyretic drugs (Radix Angelicae dahuricae, Radix Bupleuri, prevention and control) Discussion: through learning to summarize the ancient and modern literature related to the pyogenic ear, this article puts forward some suggestions on the etiology, pathogenesis, syndrome differentiation and syndrome differentiation of pyogenic ear. I think that the dialectical treatment of pyogenic ear and the surgical treatment of sores are the same. It can be divided into the first, middle, three stages, and the early use of "elimination". "The" method "in the middle period adopts the" support "method and the later" supplement "method. The three methods are used flexibly in each period of treatment. The main syndrome types in the early stage are lung and meridian wind heat syndrome, Shaoyang wind and heat syndrome, liver and Gallbladder Heat Syndrome; the main syndrome type is spleen deficiency dampness stagnation syndrome in the middle period; the main syndrome types in the later period are kidney yin deficiency deficiency syndrome and kidney yang deficiency deficiency syndrome.
【學(xué)位授予單位】：云南中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R276.1

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