王書臣教授治療慢性咳喘病經(jīng)驗總結(jié)及診治特發(fā)性肺纖維化經(jīng)驗的數(shù)據(jù)挖掘
發(fā)布時間：2018-08-19 13:19
【摘要】：王書臣教授是全國著名的中醫(yī)呼吸病專家,是第五批全國老中醫(yī)藥專家學(xué)術(shù)經(jīng)驗繼承工作指導(dǎo)老師,是中國中醫(yī)科學(xué)院西苑醫(yī)院肺病科學(xué)科帶頭人,王教授從事呼吸臨床、教學(xué)和科研工作40余年,筆者有幸?guī)煆耐踅淌?通過近三年的跟師學(xué)習(xí),在王教授的指導(dǎo)下,從筆者的理解層次,總結(jié)出王教授從元氣論治慢性咳喘病本虛證和從“金郁泄之”論治慢性咳喘病標(biāo)實證的臨床經(jīng)驗。并通過數(shù)據(jù)挖掘方法總結(jié)王教授診療特發(fā)性肺纖維化的具體臨床經(jīng)驗。第一部分王書臣教授治療慢性咳喘病經(jīng)驗總結(jié)目的:通過總結(jié)王書臣教授治療慢性咳喘病的臨床經(jīng)驗,從而使我們能夠繼承和運用王教授的經(jīng)驗。方法:通過臨床跟師學(xué)習(xí)、師生問答、診后教學(xué)、病案分析、結(jié)合中醫(yī)經(jīng)典理論和文獻(xiàn)研究,從點到面的具體分析,再從面到點的總結(jié),整體化一,提綱挈領(lǐng),總結(jié)王書臣教授診療肺病的思路方法和用藥精華,并形成學(xué)術(shù)思想。結(jié)果:1.王書臣教授從元氣論治肺病虛證的學(xué)術(shù)思想,包含“溫煦命門、激發(fā)元氣”,“培補元氣、升舉元氣”,“疏通三焦、敷布元氣”的具體思路方法。此三大方法相輔相成,一脈相承,以仙茅、仙靈脾、補骨脂三味要藥溫煦水臟,使命門之火得“動氣”之激發(fā)而上升,同時配合大量黃芪,引黃芪之氣于命門之間,直填命門真元之氣,并以黃芪和葛根共同升舉元氣上騰,從而行于中土,促脾胃之精微以灌四傍;舉于胸中,助肺氣精微澤布周身。2.王書臣教授以“金郁泄之”論治慢性咳喘病的臨床經(jīng)驗,其理論立足于《黃帝內(nèi)經(jīng)》,從五運六氣推演“金郁泄之”的基本含義,從肺的宣發(fā)肅降功能拓展“金郁泄之”理論的運用范疇,并在臨床運用時,形成了“宣泄法”、“透泄法”、“清泄法”、“開泄法”、“疏泄法”(包括疏肺解郁法和疏理氣血法)、“滲泄法”、“通泄法”七大具體治療思路。結(jié)論:王書臣教授認(rèn)為慢性咳喘病多為本虛標(biāo)實證,常常以從元氣論治本虛證,從“金郁泄之”論治標(biāo)實證,標(biāo)本結(jié)合。第二部分王書臣教授診治特發(fā)性肺纖維化經(jīng)驗的數(shù)據(jù)挖掘目的:運用數(shù)據(jù)挖掘技術(shù),總結(jié)王書臣教授診治特發(fā)性肺纖維化的具體臨床經(jīng)驗。對象:納入研究對象為2015年02月—2017年02月期間,就診于中國中醫(yī)科學(xué)院西苑醫(yī)院王書臣教授門診的初診IPF患者,根據(jù)納入標(biāo)準(zhǔn)篩選出107例符合要求的病例。方法:采用中國中醫(yī)科學(xué)院西苑醫(yī)院病例采集系統(tǒng),通過《名老中醫(yī)學(xué)術(shù)思想挖掘平臺》進(jìn)行挖掘,統(tǒng)計特發(fā)性肺纖維化患者的臨床癥狀、證候分型、治法治則及用藥頻次等;運用Apriori算法,挖掘王書臣教授診治IPF的藥物配伍關(guān)系和規(guī)律;通過雙聚類分析法,挖掘王教授治療IPF的用藥特點。采用人機結(jié)合的方式,全面整體和總結(jié)王書臣教授診治特發(fā)性肺纖維化的臨床經(jīng)驗。結(jié)果:1.主要臨床表現(xiàn):經(jīng)過王教授診療的107例IPF患者中,挖掘結(jié)果顯示喘息、倦怠乏力、胸悶胸痛、咳嗽痰多為主,多伴有嘴唇色暗、杵狀指等,其他常見的伴隨癥狀為周身困重、納差、口干、便秘、咽部異物感、夜尿頻繁、失眠、頭昏頭暈、心悸、畏寒、咽痛、眼睛干澀、多汗、腰膝酸軟等。2.舌脈:本次挖掘統(tǒng)計中,舌脈按照舌色、舌形、舌苔,脈象按照浮沉、虛實、遲數(shù)、寬細(xì)分別列出記錄和統(tǒng)計,并根據(jù)王教授的經(jīng)驗和指導(dǎo)進(jìn)行確認(rèn)。結(jié)果顯示常見的舌色為舌暗、舌色降紅、舌色淡白、舌紅;常見舌形為舌下絡(luò)脈瘀曲、老舌、嫩舌、胖大舌、齒痕舌、瘦薄舌、裂紋舌、點刺舌;常見舌苔為苔少、薄黃苔、黃膩苔、白膩苔、薄白苔、剝落苔。脈象浮沉:三關(guān)各異,寸部浮脈77.6%、沉脈13.1%,關(guān)部浮脈67.3%、沉脈16.8%,尺部浮脈2.8%、沉脈84.1%;脈象虛實:虛脈63.6%,實脈30.8%;脈象相對數(shù)緩遲分別為:數(shù)脈71%,緩脈21.5%,遲脈7.5%;脈象寬細(xì):寬脈12.2%,細(xì)脈54.2%,其余的33.6%。3.中醫(yī)證型:常見中醫(yī)證型依次為血瘀證、氣虛證、風(fēng)濕痹阻證、肺經(jīng)郁熱證、氣陰兩虛證、陰津虧虛證、痰濕內(nèi)蘊證、痰熱壅肺證、陽虛證、寒飲停肺證。4.治則治法:常用治法治則依次為:培補元氣102次(95.3%),活血化瘀99次(92.5%),祛濕通絡(luò)88次(82.2%),清熱瀉肺47次(43.9%),化痰散結(jié)44次(41.1%),養(yǎng)陰生津35次(32.7%),止咳平喘27次(25.2%),祛風(fēng)透邪19次(17.8%),溫陽散寒11次(10.3%)。對于本虛證,治法以培補元氣、養(yǎng)陰生津、溫陽為主;對于標(biāo)實證,以活血化瘀、祛濕通絡(luò)、清熱瀉肺、化痰散結(jié)、祛風(fēng)透邪、散寒為主。5.中藥:在107例病例中,共使用93種,前25味藥物依次為炙黃芪、仙茅、淫羊藿、莪術(shù)、水蛭、絡(luò)石藤、威靈仙、地龍、穿山龍、青風(fēng)藤、姜半夏、桑白皮、干姜、麥冬、地骨皮、絲瓜絡(luò)、黃連、虎杖、南沙參、黃芩、浙貝母、前胡、蟬蛻、炒杏仁、葛根,其中前16味藥物用藥頻次均超過50%。根據(jù)關(guān)聯(lián)挖掘出的常用藥物配伍為仙茅與淫羊藿,黃芪與威靈仙,黃芪與仙茅、淫羊藿,黃芪與莪術(shù),黃芪與水蛭,仙茅與威靈仙,威靈仙與水蛭,威靈仙與絡(luò)石藤,水蛭與地龍,地龍與穿山龍等,并且炙黃芪、仙茅、淫羊藿、莪術(shù)、水蛭、絡(luò)石藤、威靈仙、地龍八味藥的關(guān)聯(lián)支持度高達(dá)0.628125。中藥用藥異常點挖掘顯示炒棗仁、燈芯草、茉莉花、苦參、大棗等。而這些常用藥物均體現(xiàn)了前面的常用治法治則。結(jié)論:1.本病為本虛標(biāo)實之證,本虛以氣虛、氣陰兩虛為主,標(biāo)實以瘀血、風(fēng)寒濕阻、肺經(jīng)郁熱、痰濕、痰熱、寒飲為主。2.王教授以培補、激發(fā)、升舉、敷布元氣的方法治療肺痹本虛證,從“金郁泄之”的思路治療肺痹標(biāo)實證。
[Abstract]:Professor Wang Shuchen is a well-known expert on respiratory disease of traditional Chinese medicine in China. He is the fifth instructor to inherit the academic experience of the experts of traditional Chinese medicine. He is the leader of the Department of pulmonary disease in Xiyuan Hospital of Chinese Academy of Traditional Chinese Medicine. Professor Wang has been engaged in respiratory clinic, teaching and scientific Research for more than 40 years. Under the guidance of Professor Wang and from the understanding level of the author, this paper summarizes Professor Wang's clinical experience in treating chronic cough and asthma with the theory of Yuan Qi and the syndrome of deficiency of root and syndrome of chronic cough and asthma with the theory of "Jin Yu Xie Zhi". Objective: To summarize Professor Wang Shuchen's clinical experience in treating chronic cough and asthma, so that we can inherit and apply Professor Wang's experience. Methods: Through clinical follow-up study, teachers and students question and answer, teaching after diagnosis, case analysis, combined with classical theory of Chinese medicine and literature research, from point to face specific points. Results: 1. Professor Wang Shuchen's academic thought of treating deficiency syndrome of lung disease from the theory of vital energy, including "warming vital gate, stimulating vital energy", "cultivating vital energy, lifting vital energy", "dredging triple-focus, compressing" These three methods complement each other and come down in one continuous line. They are Xianmao, Xianling Spleen and Psoralea corylifolia to warm the water and viscera. The fire of the mission gate is stimulated by "dynamic qi" and rises. At the same time, with a large number of astragalus, the Qi of Astragalus is induced between Mingmen, filling the true vitality of Mingmen, and with Astragalus and pueraria to lift the vitality together. Professor Wang Shuchen's clinical experience in treating chronic cough and asthma based on the theory of "Huangdi Neijing". He deduced the basic meaning of "Jinyu Xie" from the five movements and six qi, and expanded the function of "Jinyu Xie" from the proclamation and purge of the lung. The application category of the theory of Jinyu Xiezhi has formed seven specific treatment methods in clinical application. Conclusion: Professor Wang Shuchen thinks that chronic cough and asthma are mostly based on the theory of "catharsis", "catharsis", "catharsis", "catharsis", "catharsis", "catharsis", "catharsis", "catharsis", "catharsis". The second part is the data mining purpose of Professor Wang Shuchen's experience in the diagnosis and treatment of idiopathic pulmonary fibrosis. From February 2015 to February 2017, 107 IPF patients were selected according to the inclusion criteria. Methods: The case collection system of Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine, was used to excavate the IPF patients through the platform of academic thought excavation of famous and old Chinese medicine. The clinical symptoms, syndrome types, therapeutic principles and drug use frequency of patients with idiopathic pulmonary fibrosis were calculated; Apriori algorithm was used to excavate the compatibility and regularity of Professor Wang Shuchen in the treatment of IPF; the characteristics of Professor Wang's medication in the treatment of IPF were excavated by double cluster analysis. Results: 1. Main clinical manifestations: In 107 IPF patients treated by Professor Wang, the digging results showed that wheezing, tiredness, chest tightness, chest pain, cough and sputum were mainly accompanied by dark lips, clubbing fingers, and other common accompanying symptoms were body distress, poor appetite, dry mouth, constipation, pharyngeal foreign bodies. Feeling, frequent nocturia, insomnia, dizziness, palpitations, chills, sore throat, dry eyes, sweating, waist and knee soreness and so on. 2. Tongue and pulse: In this excavation statistics, according to tongue color, tongue shape, tongue fur, pulse according to floating, virtual and real, late number, width and subdivision of records and statistics, and according to Professor Wang's experience and guidance to confirm. The color of the tongue is dark, the color of the tongue is reddish, the color of the tongue is pale, the color of the tongue is red; the common tongue is sublingual collateral blood stasis, old tongue, tender tongue, fat tongue, dental mark tongue, thin tongue, cracked tongue, puncture tongue; the common tongue fur is less fur, thin yellow fur, yellow greasy fur, white fur, thin white fur, peeling fur. 8%, ulnar floating pulse 2.8%, sinking pulse 84.1%; pulse deficiency and excess: deficiency pulse 63.6%, solid pulse 30.8%; relative number of pulse retardation are: several pulse 71%, slow pulse 21.5%, late pulse 7.5%; pulse width: wide pulse 12.2%, fine pulse 54.2%, the rest 33.6%. 3. TCM syndromes: common TCM syndromes are blood stasis, Qi deficiency syndrome, rheumatic arthralgia syndrome, lung meridian depression and heat syndrome, Qi and yin deficiency syndrome, Yin deficiency syndrome, Yin and yin deficiency syndrome. Syndrome of deficiency of body fluid, accumulation of phlegm and dampness, phlegm-heat obstruction of lung, Yang-deficiency syndrome, cold-drink stopping lung syndrome. 4. Therapeutic principles and methods: 102 times (95.3%), 99 times (92.5%) of promoting blood circulation and removing stasis, 88 times (82.2%) of dispelling dampness and dredging collaterals, 47 times (43.9%) of clearing away heat and purging lung, 44 times (41.1%) of dissipating phlegm, 35 times (32.7%) of nourishing yin, 27 times (25.2%) of relieving cough and relieving asthma, 27 times (eliminating wind 19 times of evil (17.8%), 11 times of Warming Yang and dispersing cold (10.3%). For this deficiency syndrome, the treatment methods are mainly to nourish the vital energy, nourish yin and promote fluid flow, and warm yang; for the syndrome, the main treatment methods are promoting blood circulation and removing blood stasis, dispelling dampness and dredging collaterals, clearing away heat and reducing lung, resolving phlegm and dispelling stagnation, dispelling wind and clearing away evil, and dispersing cold. 5. Rhizoma Atractylodis, Leech, Lushiteng, Willingxian, Earthworm, Pangolin, Sinensis, Pinellia ternate, Morus alba, Dry ginger, Ophiopogon japonicus, Earthbone bark, Luffa gourd collateral, Coptis chinensis, Polygonum cuspidatum, Radix Astragali, Nanshashen, Radix Scutellariae, Fritillariae Fritillariae Fritillariae, Peucedanum, Cicada mollus, Puerariae Root, of which the first 16 medicines are more than 50%. Supportive degree of association between Astragalus membranaceus, celestial fescue, epimedium, Astragalus and zedoary, Astragalus and leech, celestial fescue and celestial fescue, celestial fescue and celestial fescue, leech and leech, celestial fescue, leech and earthworm, earthworm and pangolin, and fried astragalus, celestial fescue, epimedium, zedoary turmeric, leech, celestial fescue, earthworm and eight kinds of medicines were as high as 0.8125. Frequent excavation showed stir-fried jujube kernel, rush grass, Jasmine flower, Sophora flavescens, jujube and so on. And these commonly used drugs reflect the previous common treatment principles. Conclusion: 1. This disease is based on deficiency and excess syndrome, deficiency of Qi, deficiency of both Qi and Yin, excess with blood stasis, wind-cold-dampness obstruction, lung meridian depression and heat, phlegm-heat, cold drinks mainly. 2. Professor Wang to invigorate, stimulate, ascend. To apply the method of compacting cloth and Qi to treat asthenia syndrome of lung Bi syndrome, and to treat lung Bi syndrome by the idea of "Jin Yu Xie".
【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R249;R256.12
本文編號：2191769
[Abstract]:Professor Wang Shuchen is a well-known expert on respiratory disease of traditional Chinese medicine in China. He is the fifth instructor to inherit the academic experience of the experts of traditional Chinese medicine. He is the leader of the Department of pulmonary disease in Xiyuan Hospital of Chinese Academy of Traditional Chinese Medicine. Professor Wang has been engaged in respiratory clinic, teaching and scientific Research for more than 40 years. Under the guidance of Professor Wang and from the understanding level of the author, this paper summarizes Professor Wang's clinical experience in treating chronic cough and asthma with the theory of Yuan Qi and the syndrome of deficiency of root and syndrome of chronic cough and asthma with the theory of "Jin Yu Xie Zhi". Objective: To summarize Professor Wang Shuchen's clinical experience in treating chronic cough and asthma, so that we can inherit and apply Professor Wang's experience. Methods: Through clinical follow-up study, teachers and students question and answer, teaching after diagnosis, case analysis, combined with classical theory of Chinese medicine and literature research, from point to face specific points. Results: 1. Professor Wang Shuchen's academic thought of treating deficiency syndrome of lung disease from the theory of vital energy, including "warming vital gate, stimulating vital energy", "cultivating vital energy, lifting vital energy", "dredging triple-focus, compressing" These three methods complement each other and come down in one continuous line. They are Xianmao, Xianling Spleen and Psoralea corylifolia to warm the water and viscera. The fire of the mission gate is stimulated by "dynamic qi" and rises. At the same time, with a large number of astragalus, the Qi of Astragalus is induced between Mingmen, filling the true vitality of Mingmen, and with Astragalus and pueraria to lift the vitality together. Professor Wang Shuchen's clinical experience in treating chronic cough and asthma based on the theory of "Huangdi Neijing". He deduced the basic meaning of "Jinyu Xie" from the five movements and six qi, and expanded the function of "Jinyu Xie" from the proclamation and purge of the lung. The application category of the theory of Jinyu Xiezhi has formed seven specific treatment methods in clinical application. Conclusion: Professor Wang Shuchen thinks that chronic cough and asthma are mostly based on the theory of "catharsis", "catharsis", "catharsis", "catharsis", "catharsis", "catharsis", "catharsis", "catharsis", "catharsis". The second part is the data mining purpose of Professor Wang Shuchen's experience in the diagnosis and treatment of idiopathic pulmonary fibrosis. From February 2015 to February 2017, 107 IPF patients were selected according to the inclusion criteria. Methods: The case collection system of Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine, was used to excavate the IPF patients through the platform of academic thought excavation of famous and old Chinese medicine. The clinical symptoms, syndrome types, therapeutic principles and drug use frequency of patients with idiopathic pulmonary fibrosis were calculated; Apriori algorithm was used to excavate the compatibility and regularity of Professor Wang Shuchen in the treatment of IPF; the characteristics of Professor Wang's medication in the treatment of IPF were excavated by double cluster analysis. Results: 1. Main clinical manifestations: In 107 IPF patients treated by Professor Wang, the digging results showed that wheezing, tiredness, chest tightness, chest pain, cough and sputum were mainly accompanied by dark lips, clubbing fingers, and other common accompanying symptoms were body distress, poor appetite, dry mouth, constipation, pharyngeal foreign bodies. Feeling, frequent nocturia, insomnia, dizziness, palpitations, chills, sore throat, dry eyes, sweating, waist and knee soreness and so on. 2. Tongue and pulse: In this excavation statistics, according to tongue color, tongue shape, tongue fur, pulse according to floating, virtual and real, late number, width and subdivision of records and statistics, and according to Professor Wang's experience and guidance to confirm. The color of the tongue is dark, the color of the tongue is reddish, the color of the tongue is pale, the color of the tongue is red; the common tongue is sublingual collateral blood stasis, old tongue, tender tongue, fat tongue, dental mark tongue, thin tongue, cracked tongue, puncture tongue; the common tongue fur is less fur, thin yellow fur, yellow greasy fur, white fur, thin white fur, peeling fur. 8%, ulnar floating pulse 2.8%, sinking pulse 84.1%; pulse deficiency and excess: deficiency pulse 63.6%, solid pulse 30.8%; relative number of pulse retardation are: several pulse 71%, slow pulse 21.5%, late pulse 7.5%; pulse width: wide pulse 12.2%, fine pulse 54.2%, the rest 33.6%. 3. TCM syndromes: common TCM syndromes are blood stasis, Qi deficiency syndrome, rheumatic arthralgia syndrome, lung meridian depression and heat syndrome, Qi and yin deficiency syndrome, Yin deficiency syndrome, Yin and yin deficiency syndrome. Syndrome of deficiency of body fluid, accumulation of phlegm and dampness, phlegm-heat obstruction of lung, Yang-deficiency syndrome, cold-drink stopping lung syndrome. 4. Therapeutic principles and methods: 102 times (95.3%), 99 times (92.5%) of promoting blood circulation and removing stasis, 88 times (82.2%) of dispelling dampness and dredging collaterals, 47 times (43.9%) of clearing away heat and purging lung, 44 times (41.1%) of dissipating phlegm, 35 times (32.7%) of nourishing yin, 27 times (25.2%) of relieving cough and relieving asthma, 27 times (eliminating wind 19 times of evil (17.8%), 11 times of Warming Yang and dispersing cold (10.3%). For this deficiency syndrome, the treatment methods are mainly to nourish the vital energy, nourish yin and promote fluid flow, and warm yang; for the syndrome, the main treatment methods are promoting blood circulation and removing blood stasis, dispelling dampness and dredging collaterals, clearing away heat and reducing lung, resolving phlegm and dispelling stagnation, dispelling wind and clearing away evil, and dispersing cold. 5. Rhizoma Atractylodis, Leech, Lushiteng, Willingxian, Earthworm, Pangolin, Sinensis, Pinellia ternate, Morus alba, Dry ginger, Ophiopogon japonicus, Earthbone bark, Luffa gourd collateral, Coptis chinensis, Polygonum cuspidatum, Radix Astragali, Nanshashen, Radix Scutellariae, Fritillariae Fritillariae Fritillariae, Peucedanum, Cicada mollus, Puerariae Root, of which the first 16 medicines are more than 50%. Supportive degree of association between Astragalus membranaceus, celestial fescue, epimedium, Astragalus and zedoary, Astragalus and leech, celestial fescue and celestial fescue, celestial fescue and celestial fescue, leech and leech, celestial fescue, leech and earthworm, earthworm and pangolin, and fried astragalus, celestial fescue, epimedium, zedoary turmeric, leech, celestial fescue, earthworm and eight kinds of medicines were as high as 0.8125. Frequent excavation showed stir-fried jujube kernel, rush grass, Jasmine flower, Sophora flavescens, jujube and so on. And these commonly used drugs reflect the previous common treatment principles. Conclusion: 1. This disease is based on deficiency and excess syndrome, deficiency of Qi, deficiency of both Qi and Yin, excess with blood stasis, wind-cold-dampness obstruction, lung meridian depression and heat, phlegm-heat, cold drinks mainly. 2. Professor Wang to invigorate, stimulate, ascend. To apply the method of compacting cloth and Qi to treat asthenia syndrome of lung Bi syndrome, and to treat lung Bi syndrome by the idea of "Jin Yu Xie".
【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R249;R256.12
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相關(guān)期刊論文 前10條
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