【摘要】：時光荏苒,歲月如梭,至今我已跟隨周德安老師學(xué)習(xí)了三年。我在全面梳理跟師筆記、臨床醫(yī)案、月記、聽課筆記的基礎(chǔ)上,對老師的學(xué)術(shù)思想淵源、學(xué)術(shù)思想做了系統(tǒng)的總結(jié),并在老師的悉心指導(dǎo)下完成了“周德安教授針?biāo)幗Y(jié)合治療成人突發(fā)性耳聾的臨床療效觀察”。1周德安教授學(xué)術(shù)淵源周老師的學(xué)術(shù)思想是在中醫(yī)經(jīng)典的熏陶下、在北京中醫(yī)醫(yī)院針灸科各位名醫(yī)的指點下、經(jīng)過多種不同工作環(huán)境的錘煉而形成的。2周德安教授學(xué)術(shù)思想周老師通過多年的臨床實踐,形成了獨特的學(xué)術(shù)思想：①六治理論：治神、治痰、治痛、治風(fēng)、治聾、治動,其中治神是首要。②人體正常的臟腑功能是以氣的升降出入和順為前提的,氣機調(diào)和才能達(dá)到陰平陽秘。③針?biāo)幐饔兴?針?biāo)幗Y(jié)合,才能取得最佳的治療效果。2.1六治理論2.1.1治神周老師認(rèn)為,神的失常是致病的重要因素,“治神”是治病過程中最關(guān)鍵的一環(huán)。通過醫(yī)者調(diào)神、藥物調(diào)神和針灸調(diào)神,全方位體現(xiàn)“治病先治神”的學(xué)術(shù)觀點,最終的目的是使患者達(dá)到“陰平陽秘,精神乃治”的健康狀態(tài)。針灸調(diào)神方面,他提出了腦心同治的理念,創(chuàng)立了四神方作為基礎(chǔ)方,五臟俞加膈俞作為補益安神方,督脈十三針作為重鎮(zhèn)安神方,開四關(guān)作為調(diào)肝安神方,治神諸方用于治療各種精神、情志疾患以及其他疾病伴隨的精神異常癥狀。2.1.2治痰周老師認(rèn)為,治療因痰引起的疾病應(yīng)調(diào)氣為先,實脾為本,祛痰為要。針刺能直達(dá)病所,對調(diào)和氣血有獨到的作用。周老師提出了針灸治痰的基礎(chǔ)方-化痰方,并由此延伸出滌痰方、豁痰方、消痰方；同時還兼以湯藥調(diào)節(jié)氣血、健脾化痰。他擅長針?biāo)幗Y(jié)合治療因痰引起的癲癇、眩暈、梅核氣、肥胖癥、喘證、ve瘕等病癥。2.1.3治痛周老師在治療痛證時均先針刺四神方或百會、攢竹,然后針刺“調(diào)氣止痛方”,最后根據(jù)經(jīng)絡(luò)辨證或臟腑辨證加減取穴。整個治療過程體現(xiàn)了周老師治療痛證的“兩大原則”,它們分別是：1、先調(diào)神后調(diào)氣。周老師認(rèn)為通過先調(diào)神可以使心寂而痛減,同時使氣血趨于平和。然后采用各種調(diào)氣的方法使得氣血通暢,最后達(dá)到通則不痛。他創(chuàng)立了由三個絡(luò)穴(肺經(jīng)絡(luò)穴列缺、胃經(jīng)絡(luò)穴豐隆、肝經(jīng)絡(luò)穴蠡溝)組成的調(diào)氣止痛方以行氣活血止痛。2、厘清經(jīng)病臟病。分清疼痛的部位是在經(jīng)絡(luò)還是臟腑。一般來說,疼痛初期是經(jīng)絡(luò)痛,病位在表,十二皮部和十二筋經(jīng)是常見部位,疼痛較重,治療上以經(jīng)絡(luò)辨證為主�；疾∪站�,病位由表及里到臟腑,此時一般疼痛較緩,治療上以臟腑辨證為主�！傲笾畏ā卑ǎ喊采穸ㄖ痉�、移情減痛法、行氣活血法、通督溫陽法、培元扶正法、清熱瀉火法。2.1.4治風(fēng)風(fēng)有外風(fēng)和內(nèi)風(fēng)之別。周老師擅長治療由外風(fēng)引起的周圍性面癱,由內(nèi)風(fēng)引起的中風(fēng)和帕金森病。他認(rèn)為治療周圍性面癱的方法要根據(jù)不同的病位、病程、外邪的屬性來確定。在面癱急性期,他主張針刺手法要輕柔、穴位少而精；湯藥由經(jīng)驗方白芥子、白附子、白僵蠶、白芷、葛根、板藍(lán)根、蜈蚣、全蝎、防風(fēng)為主方,并辨證加減。后遺癥期常采用細(xì)火針針刺,強調(diào)火針整個操作過程要規(guī)范、嫻熟、一氣呵成；并輔以湯藥調(diào)理。中風(fēng)有中經(jīng)絡(luò)和中臟腑之別,周老師將中經(jīng)絡(luò)常分為三種證型：氣虛血瘀、風(fēng)痰阻絡(luò)、陰虛陽亢。常用的針灸處方為四神方加手足十二針、補中益氣方、祛痰方,湯藥用補陽還五湯、半夏白術(shù)天麻湯、鎮(zhèn)肝熄風(fēng)湯加減。中風(fēng)中臟腑也分為三種證型,分別為肝陽暴張(陽閉)、痰蒙清竅(陰閉)、陰陽離絕(脫證)。周老師創(chuàng)立的醒神開竅方(人中、內(nèi)關(guān)、涌泉、豐隆、手足十二井穴)適用于閉證,回陽固脫方(百會、素骼、神闕、關(guān)元、足三里)適用于脫證,其中神闕,氣海,關(guān)元常施以隔鹽灸。周老師擅用真武湯治療帕金森病,認(rèn)為該病是因為患者體內(nèi)腎精衰減、肝腎陰虧、精血俱耗,以致筋脈失于濡養(yǎng),虛風(fēng)所致震顫。若陰癥重,常配合在任督脈的重要穴位上施灸以溫陽利水、榮養(yǎng)筋脈。2.1.5治動周老師將注意力缺陷多動障礙和抽動癥合稱為“動證”,認(rèn)為動證乃五臟功能失調(diào)所致,尤其是心、肝、脾三臟。動證分虛、實兩種證型,實證有肝風(fēng)內(nèi)動、痰火擾心,虛證是心(肝)脾兩虛、筋脈失養(yǎng)。治療時以安神為要,實證同時予以平肝熄風(fēng)、清熱化痰；虛證予以健脾益氣、養(yǎng)血榮筋。針刺以四神方加開四關(guān)為基礎(chǔ),實證加化痰方(中脘、內(nèi)關(guān)、列缺、豐隆、公孫),虛證加補中益氣方。中藥實證用半夏白術(shù)天麻湯或溫膽湯加減,虛證用逍遙散或歸脾湯加減。2.1.6治聾周老師近五十年的實踐發(fā)現(xiàn),超過30%經(jīng)過西醫(yī)治療無效的神經(jīng)性耳聾患者,接受針灸加中藥治療后聽力均有提升。他將大部分神經(jīng)性耳聾分成虛實兩型,其中實證為氣滯血瘀型,虛證為腎精不足或陰虛陽亢型。針刺取百會、神庭、角孫、耳門透聽會、翳風(fēng)、筑賓。實證加合谷、中渚、丘墟、太沖,虛證加中脘、關(guān)元、手足三里、太溪；湯藥用自擬的聰耳方,并辨證加減。在治聾的自擬湯藥中,加上了桔梗、杏仁、郁金和陳皮四味藥,體現(xiàn)其“耳聾治肺”的學(xué)術(shù)思想。2.2氣機調(diào)和陰平陽秘氣是人體臟腑功能活動和精神狀態(tài)的物質(zhì)基礎(chǔ)之一,升降出入運動正常是人體陰平陽秘的重要因素。周老師認(rèn)為：1、百病生于氣也,臟腑正常的氣機是：脾主升清、肝主升發(fā)、腎陽主升、肺主肅降、胃主降濁、膽氣主降、腎陰主降,如若升降不及、升降太過、升降反常皆可出現(xiàn)各種病變；2、中焦肝膽脾胃是五臟六腑氣機運化的核心,脾升胃降,肝升膽降乃常態(tài),肝膽的升降依賴于脾胃的升降。外感邪氣是否向內(nèi)傳變惡化還是向外傳變好轉(zhuǎn),也取決于脾胃之氣是否足夠強盛。3、他還根據(jù)氣機理論遣方選穴,注重通過宣暢肺氣、調(diào)理中焦脾胃肝膽來實現(xiàn)全身氣機正常的升降出入。常用的治法有：氣滯者行之,氣逆者平之,氣陷者升之,氣散者斂之。他還創(chuàng)立了“補中益氣方”、“理氣健脾方”、“調(diào)氣止痛方”三個臨床常用的針灸處方用來調(diào)理氣機。2.3針?biāo)幗Y(jié)合相得益彰周老師在臨床工作中的突出特點是常常針?biāo)幗Y(jié)合、雙管齊下。他認(rèn)為：1、針?biāo)幐饔兴L,針之所長,長于有余之實邪耳。藥之所長,長于臟氣不足虛也。發(fā)揮所長,針?biāo)幗Y(jié)合能大大提高療效,值得大力提倡。2、他將針?biāo)幗Y(jié)合的關(guān)系比喻成中藥配伍關(guān)系中的單行、相須、相使。既有單用針或藥、又有針?biāo)幉⒅?還有針?biāo)幹鞔斡袆e。3、針?biāo)幎?理無二致,以藥理明針理,他將臨床常用的組穴分成了十大類共28個針灸處方,分別是補益門、治風(fēng)門、外感門、通便門、止瀉門、泌尿生殖門、調(diào)氣門、祛痰門、安神門、五官門,涵蓋了治療內(nèi)外婦兒的各個學(xué)科的常見病的針灸處方。針灸處方如同方劑的配伍,君臣佐使,組織嚴(yán)密,效專力弘。臨床中他常用的湯劑不超過二十個,常用小而精的對藥加減。取穴方面,他常用28個針灸處方加減對穴和單穴。3周德安教授針?biāo)幗Y(jié)合治療成人突發(fā)性耳聾的臨床療效觀察采用非隨機對照研究方法,評估周德安教授針?biāo)幗Y(jié)合治療成人難治性突發(fā)性耳聾的療效。通過臨床研究,驗證了周老師針?biāo)幗Y(jié)合治療方案的臨床療效,確定了病程超過14天的難治性突聾患者的治療方案,便于下一步臨床推廣使用。
[Abstract]:Time flies, time flies, so far, I have been learning from teacher Zhou Dean for three years. On the basis of comprehensive combing with teachers' notes, clinical medical cases, monthly notes and lecture notes, I have systematically summarized the academic thought origin and academic thought of the teacher, and completed "Professor Zhou Dean combination of acupuncture and medicine to treat adults" under the guidance of the teacher. The clinical effect of sudden deafness: Professor.1 Zhou Dean academic origin Zhou's academic thought is under the edification of traditional Chinese medicine, under the guidance of the famous doctors in the Department of acupuncture and moxibustion of Beijing Chinese Medicine Hospital, the teacher of Professor.2, Professor Zhou Dean through many years of clinical practice, formed by many different working conditions. It has become a unique academic thought: (1) the six treatment theory: treating God, treating phlegm, treating pain, treating the wind, treating deafness, and treating the movement, which is the first. (2) the function of the normal viscera of the human body is the premise of the Qi and descending in and out of the Qi, and the air machine harmonization can reach the Yin Ping Yang constipation. 3. The best treatment effect.2.1 six can be obtained. 2.1.1 God Zhou teacher thinks that God's aberration is an important factor in the disease. "Cure the God" is the most critical part of the treatment process. Through the doctor to adjust God, the medicine to adjust God and the acupuncture and tune God, embody the academic viewpoint of "cure the God first" in all directions, and the ultimate aim is to make the patient achieve the healthy form of "Yin and Yang, the spirit is the cure" In the aspect of acupuncture and moxibustion, he put forward the idea of the same treatment of the brain and heart, set up the four gods as the foundation, the five Zang Yu and Gyu Shu as the tonifying and Anshen prescription, the thirteen needles of the governor vein as the heavy Town, the four customs as the prescription for regulating the liver, and treating various spirits, emotional disorders and other mental disorders accompanied by other diseases.2.1.2. To cure phlegm, the teacher thinks that the treatment of phlegm caused by phlegm should be adjusted first, the spleen is the foundation, and the expectorant is the essential. The acupuncture can reach the disease directly, and it has the unique function to harmonize the Qi and blood. Zhou proposed the basic prescription of acupuncture and phlegm to treat phlegm, and then extended the prescription of phlegm, the prescription of phlegm, the elimination of phlegm, and the decoction to regulate qi and blood and strengthen the spleen and the phlegm. He is good at combining acupuncture and medicine with the treatment of phlegm induced epilepsy, vertigo, plum, nuclear gas, obesity, asthma, VE and other symptoms of pain Zhou teachers in the treatment of pain syndrome, when treating pain syndrome, he first needles the four gods or hundreds of meetings, save bamboo, and then acupuncture "Qi Qi analgesic prescription", and finally according to the syndrome differentiation of meridians and collaterals or viscera syndrome differentiation and reduction of acupoints. The whole treatment process embodies the treatment of Zhou teacher treatment. The "two principles" of pain syndrome are: 1, and then adjust Qi after adjusting God. Zhou thinks that by adjusting God first, he can make heart silence and pain, and make Qi and blood leveling, and then use various methods of regulating qi to make the Qi and blood unobstructed, and finally reach the general rule without pain. He founded three collaterals (lung meridian acupoint deficiency, stomach meridian acupoint Feng long, liver) The prescription of regulating qi and relieving pain of meridian acupoint Li Gou to relieve pain.2 and clarify the disease of menstrual disease. The location of the pain is in meridian or viscera. Generally speaking, the initial pain is meridian pain, the disease position is in the table, the twelve skin parts and twelve tendons are common parts, the pain is heavy, the treatment is based on the meridian syndrome differentiation. To the viscera, the pain is slow at this time, and the treatment is based on the syndrome differentiation of the viscera. The "six major treatments" include: the Anshen determination method, the empathy and the reduction of pain, the method of activating blood and blood, the method of activating the Qi and warming Yang, the method of raising the yang to help the wind and the internal wind in the treatment of the wind and the internal wind. Mr. Zhou is good at treating the peripheral facial paralysis caused by the external wind, which is caused by the internal wind. Apoplexy and Parkinson's disease. He believed that the treatment of peripheral facial paralysis should be determined according to the different position, course, and external pathogenic factors. In the acute stage of facial paralysis, he advocated that the acupuncture manipulation should be gentle and the acupoints were less and more precise; the decoction was made up of experienced white mustard, white aconite, white angelica, Radix Angelica, Radix Isatis Root, centipede, scorpion, wind proof. A fine needle acupuncture is used in the period of sequelae. It emphasizes that the whole operation process of the fire needle should be standardized, skillful, and at one time, and supplemented by the decoction of decoction. The apoplexy has the middle meridian and the middle viscera. Zhou is often divided into three types of syndrome types: Qi deficiency and blood stasis, wind phlegm obstructing collaterals, yin deficiency and yang hyperactivity. The commonly used acupuncture prescriptions are four gods plus hand feet and feet of ten. Two needles, supplementing qi and eliminating phlegm, decoction of tonifying yang and five soup, Banxia Baizhi Tianma soup, Zang Fu Decoction of Zhen liver qi and subtract. There are three types of syndrome in the apoplexy, which are liver Yang violent Zhang (Yang Bi), phlegm and Mongolia Qing Qiao (Yin closed), Yin and Yang (yin and Yang). In closing the syndrome, Hui Yang Gu Fang (Baihui, Shenque, Shenque, Guan yuan, Zusanli) is suitable for the removal of evidence, in which the Shenque, Qi Hai, and Guan yuan are often treated with salt separated moxibustion. Mr. Zhou used Zhenwu Decoction to treat Parkinson's disease. It is considered that the disease is due to the attenuation of kidney essence, the deficiency of liver and kidney, blood and blood, so that the veins are lost in the nourishment and the asthenia wind causes tremor. If Yin Syndrome is heavy, We often cooperate with the important acupoints on the supervisor pulse to make moxibustion with Warm Yang Li water, and the teacher of.2.1.5, who has the vein of Rong Yang, treats the attention deficit hyperactivity disorder and the twitch syndrome as "motion syndrome", and thinks that the movement syndrome is the result of the dysfunction of the five zang organs, especially the three organs of the heart, the liver and the spleen. The syndrome is divided into two types, and the demonstration has the liver wind, the phlegm fire and the deficiency syndrome. Heart (liver) spleen two deficiency, pulse loss of nourishing. In the treatment of God for the treatment, the demonstration at the same time to put out the liver, clearing heat and phlegm; deficiency syndrome to strengthen the spleen and nourishing qi, nourishing blood and reinforcement. The acupuncture is based on the four gods to add four customs, empirical plus Phlegm Recipe (Zhongwan, Neiguan, deficiency, Feng long, grandson), deficiency syndrome plus Zhongyi Qi Fang. Chinese medicine empirical use Banxia Baizhu Tianma soup, or Chinese medicine empirical use Banxia Baizhu Tianma soup soup or the Chinese medicine empirical evidence or Decoction of Banxia Baizhu Tianma soup or With the addition and subtraction of Wendan Decoction (Wendan Decoction), the practice of "Xiaoyao" or "Jia PI Decoction" for the treatment of the teacher of.2.1.6 for the past fifty years has found that more than 30% of the patients with neurogenic deafness who have been treated with western medicine and treated with Acupuncture plus Chinese Medicine have improved their hearing. Most of them are divided into virtual reality type two, of which the syndrome is Qi stagnation and blood stasis type and deficiency syndrome is a deficiency syndrome The kidney essence is insufficient or yin deficiency and yang hyperactivity type. The acupuncture takes hundreds of meetings, the God court, the horn sun, the ear door through the hearing, the Yifeng, the building of the bin. The positive combination of the valley, the Zhu Xu, the Tai Chi, the deficiency syndrome and the Zhong Wan, the Guan yuan, the hand foot three li, the Tai Xi, the decoction of the self made Cong ear, and the syndrome differentiation and subtract in the deafness self-made decoction, are added with the medicine of Platycodon grandiflorum, almonds, tulip and Chen peel. The academic thought of "hearing loss for the lung".2.2 Qi machine harmonization Yin Pingyang constipation is one of the material basis of the functional activities and mental state of the human viscera. The normal movement of the ascending and descending movement is an important factor of the human body's Yin and Yang. Zhou thinks that 1, the disease is born in Qi, the normal Qi of the viscera is the spleen ascending, the liver main rise, the kidney yang rising, And the main descending of the stomach, the main descending of the stomach, the main descending of the stomach, the main descending of the kidney yin, the descending of the kidney yin, such as if the ascending and descending, the ascending and descending, the ascending and descending all kinds of pathological changes; 2, the heart of the liver and the spleen and stomach is the core of the movement of the organs of the five viscera and six organs, the spleen rises to the stomach, the liver rises the gallbladder descending the normal state, the rise and fall of the liver and gallbladder depends on the ascending and descending of the spleen and stomach. It also depends on whether the spleen and stomach can be improved, and whether the spleen and stomach qi is strong enough for.3, he also chooses the hole according to the theory of Qi, pays attention to the control of the Qi and spleen of the spleen and stomach to realize the normal lift and exit of the whole body. "Zhongyi Qi Fang", "Qi Qi Jianpi Fang", "Qi Qi analgesic prescription" three clinical commonly used acupuncture prescriptions used to regulate the combination of.2.3 needle and medicine in Qi machine. The combination of acupuncture and medicine can greatly improve the efficacy of the combination of acupuncture and medicine, and it is worth advocating.2. He compares the relationship between the combination of acupuncture and medicine as a single line in the compatibility of traditional Chinese medicine. The commonly used acupoints are divided into ten kinds of 28 acupuncture and moxibustion prescriptions, which are the tonic gate, the cure door, the external sensation gate, the open door, the antidiarrheal gate, the genitourinary door, the valve, the expectorant gate, the antiphlegm door, the five Guan gate, covering the common diseases in the various subjects of the internal and external women. His commonly used decoction is not more than twenty, commonly used in small and fine medicine. In the area of acupoints, he often uses 28 acupuncture prescriptions to add and subtract the clinical efficacy of acupuncture and medicine combined with.3 Zhou Dean, a single point in the treatment of sudden deafness in adults, to evaluate the combined treatment of Professor Zhou Dean with a combination of acupuncture and medicine. The therapeutic effect of refractory sudden deafness in adults was treated. Through clinical study, the clinical efficacy of the combination of acupuncture and medicine was verified by Mr. Zhou, and the treatment scheme for patients with refractory sudden deafness for more than 14 days was determined to facilitate the next clinical application.
【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】：R249;R246.81

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