【摘要】：董湘玉教授,籍貫四川省平昌縣,畢業(yè)于貴陽中醫(yī)學院,曾師老中醫(yī)許玉鳴先生,主任醫(yī)師、碩士生導師、師承碩博士導師,是全國第五批老中醫(yī)藥專家學術(shù)經(jīng)驗繼承工作指導教師,貴州省第一屆名中醫(yī)。她苦研《內(nèi)經(jīng)》、《傷寒論》、《金匱要略》等經(jīng)典著作,注重前賢醫(yī)家之說,仲景之學,從“中醫(yī)基礎(chǔ)理論”課、“內(nèi)經(jīng)”課教師開始,臨證驗學。從脾胃病臨床入手,漸感所遇脾胃病患者,多為情志所擾。遂逐其奧,探求情志疾病醫(yī)理,發(fā)現(xiàn)運用傳統(tǒng)中醫(yī)心理學理論指導臨床,所效者眾,但業(yè)內(nèi)實踐者少。孜孜以求,近四十載如一日,勤讀書,多臨證,著書立說,為中醫(yī)心理學默默奉獻,是現(xiàn)今《中醫(yī)心理學》臨床應(yīng)用的踐行者。她開創(chuàng)貴州中醫(yī)心理學先河,在全國率先創(chuàng)辦貴陽中醫(yī)學院中醫(yī)醫(yī)學、心理學雙學位辦學模式,使中醫(yī)心理專業(yè)學生既有心理學學位又有中醫(yī)臨床學位,將中醫(yī)心理醫(yī)生和臨床醫(yī)生二合一,廣獲贊譽,為中醫(yī)心理專業(yè)培養(yǎng)了大批實用型人才,桃李滿天。侍診中,感受到董老不僅具有深厚的醫(yī)學知識和豐富的臨床經(jīng)驗,而且在工作、生活中和藹可親,作風嚴謹,一絲不茍,是我們學習的榜樣。三年的侍診和學習,不僅看到了董老師對中醫(yī)事業(yè)的求索專研,更是感受到董老扎實的中醫(yī)內(nèi)涵和獨特的診療技術(shù),本文主要從三個方面進行闡述。第一方面是對董老學術(shù)淵源的概述及歸納董老對于中醫(yī)心理學的認識及貢獻。董老不僅吸納了《內(nèi)經(jīng)》、《傷寒》、《金匱》中對情志疾病有關(guān)的理論體系、診療特點及情志與五臟關(guān)系方面的學說,且對中醫(yī)心理學思想進行了挖掘和歸納并實踐于臨床,為中醫(yī)心理學的理論研究及推廣、教學默默奉獻,成果斐然,餞行“形神合一”思想指導情志疾病臨床辨證論治。第二方面是對董老學術(shù)思想和臨床經(jīng)驗的總結(jié)。跟師學習三年,隨診和整理董老病案,認為董老學術(shù)思想：一是重視中醫(yī)心理學的臨床應(yīng)用(情志疾病的治療)。崇尚仲景學說,“方證相應(yīng)”、“病機相從”使用經(jīng)方來治療情志疾病。二是重視“氣機”對于情志疾病的重要性。在辨證中處處以“氣機”為核心。三是在具體治療中,老師注重藥療、意療、放松療法相結(jié)合,始終貫穿“心身同治”學術(shù)思想。四是診法合參重問診。形成了對于情志疾病特有的治病求本的辨證論治思想體系。臨床用藥上講求“藥證相應(yīng)、依法化裁”,善用“氣藥”。如重視中醫(yī)心理學的臨床應(yīng)用(情志疾病的治療)。她不但在理論研究領(lǐng)域碩果累累,而且勤于實踐,用自己的行動證明了中醫(yī)心理學的臨床實效性,重視“經(jīng)方”對于情志疾病治療的有效性研究,并通過自己幾十年的臨床實踐,總結(jié)出了一套運用“經(jīng)方”藥物治療情志疾病的理論體系,即“方證相應(yīng)”、“病機相從”學說,并用大量的實例證明了她理論的實效性。重視“氣機”對于情志疾病的重要性。董老認為現(xiàn)代生活方式和社會環(huán)境特點,凡情志疾病的發(fā)生,無論外感或內(nèi)傷皆源于“氣機”失衡,認為情志疾病以“氣機調(diào)暢”為重。在辨證中處處以“氣機”為核心。通過調(diào)“氣”來調(diào)和臟腑陰陽的平衡,達到陰平陽秘,臟腑氣血功能和諧的目的。善用疏理氣機、滋陰、活血化瘀、調(diào)和陰陽法等方法調(diào)和“氣機”,治療各種中醫(yī)情志疾病。在具體治療中,老師注重藥療、意療、放松療法相結(jié)合,始終貫穿“心身同治”學術(shù)思想,講究形神合一。所以在辨證治療上是整體考慮,治療上也是將藥物治療和情志放松療法配合使用方能起到良好的效果。如順情從志、說理開導、情志相勝、移精變氣、行為治療、占夢術(shù)、攝心術(shù)等等診法合參重問診。通過“問診”與患者進行良好的互動和溝通,運用詢問、引導、舒解、共情等技巧和方法,讓患者樂于配合,事半功倍。問診尤重大便與睡眠。通過詢問大便情況來掌握疾病的性質(zhì)。故通過詢問大便性狀、頻率、顏色可反映脾、胃、腸,氣機運轉(zhuǎn)情況,脾、胃、腸氣機暢順與否,對于情志疾病的轉(zhuǎn)歸、和預(yù)后都有著至關(guān)重要的作用,對于病情的判斷尤為重要；董老問診,也十分重視詢問睡眠情況。因為睡眠與人體衛(wèi)氣的循行和陰陽的氣機變化和盛衰有十分密切的關(guān)系。陰陽失調(diào),必然影響心神,神志不安乃致失眠,情志疾病多半都會有睡眠的障礙和不調(diào)。而且通過對于“夢境”的分析,也能運用“釋夢”的方法,分析出情志疾病的根源,有助于情志疾病的診療,所以老師臨證時每每重視患者睡眠情況的詢問。臨床用藥上也有獨特之處。講求“藥證相應(yīng)、依法化裁”,善用“氣藥”。所謂“藥證相應(yīng)、依法化裁”是指經(jīng)方中的每一味藥,常常都有它的位置,它的主治。認識了藥物主治,以藥測證,才會知道方劑的加減；處方時依據(jù)每首“經(jīng)方”所含的“法”,就是“經(jīng)方法則”進行化裁。通過對“經(jīng)方”治療疾病內(nèi)含的“法則”的認識,有針對性的選擇相應(yīng)的藥物達到治療的目的。也許藥味不盡相同,但是“法則”正確,一樣可以收到很好的效果；老師在治療情志疾病時,時刻不忘調(diào)理氣機,行氣導滯,董老認為人的五臟六腑,肌肉筋骨均以氣血為紐帶相互聯(lián)系成為整體,如果運行暢順,沒有瘀滯身體就能平和健康,反之則疾病叢生�；谶@個觀點,老師用藥的時候,每首方子都不忘行氣藥物的運用。第三方面是繼承與創(chuàng)新。鑒于董老治療“不寐”在臨床有明顯的特色,取得了較為滿意的療效。故對臨床侍診時收集的“不寐”病案,用“中醫(yī)傳承輔助系統(tǒng)”軟件,對其組方規(guī)律進行分析和總結(jié)。達到深入了解處方人對疾病的認識、組方的思路和用藥的特點,對中醫(yī)藥的學術(shù)繼承與創(chuàng)新有重要意義。采用規(guī)則分析、改進的互信息法、復雜系統(tǒng)熵聚類、無監(jiān)督的熵層次聚類、等數(shù)據(jù)挖掘方法,總結(jié)出董老治療“不寐”的新方和用藥內(nèi)在規(guī)律,為實現(xiàn)傳統(tǒng)經(jīng)驗數(shù)據(jù)化做出了有益的嘗試。
[Abstract]:Professor Dong Xiangyu, a native of Pingchang County, Sichuan Province, graduated from Guiyang College of Traditional Chinese Medicine, Mr. Xu Yuming, a senior doctor, a master's supervisor, a master's supervisor, and a master's supervisor, is the fifth group of experts of traditional Chinese medicine in China to inherit their academic experience, and the first Chinese medicine teacher in Guizhou Province. Classic works, pay attention to the theory of former doctors, Zhong Jing's learning, from the "basic theory of traditional Chinese medicine" class, "internal classics" class teachers, clinical experience. But there are few practitioners in this field who have been working hard for nearly forty years. They have studied diligently, had more clinical symptoms, written books and written their opinions. They are silently dedicated to the psychology of traditional Chinese medicine, and are practitioners of the clinical application of Psychology of Traditional Chinese Medicine. Students majoring in medical psychology have both a degree in psychology and a degree in clinical medicine. They have combined traditional Chinese medicine psychologists with clinicians and won wide acclaim. They have trained a large number of practical talents for the specialty of Chinese medicine psychology. Three years of attendance and study, not only saw Mr. Dong's pursuit of the cause of Chinese medicine, but also felt that Mr. Dong's solid connotation of Chinese medicine and unique diagnostic and therapeutic techniques, this article mainly from three aspects to elaborate. The first aspect is an overview of Dong's academic origins and This paper summarizes Dong Lao's understanding and contribution to the psychology of traditional Chinese medicine.Dong Lao not only absorbed the theory system related to emotional diseases, diagnosis and treatment characteristics, but also the theory of the relationship between emotions and the five viscera in < Neijing >, < typhoid fever >, < Jinkui >. The second part is the summary of Dong Lao's academic thought and clinical experience. After three years'study with his teachers, he followed up and sorted out Dong Lao's medical records. Advocate Zhongjing theory, use classical prescriptions to treat emotional diseases, and emphasize the importance of Qi-Qi. Put Qi-Qi at the core of syndrome differentiation. Thirdly, in the specific treatment, the teacher pays attention to the combination of medication, intention therapy and relaxation therapy, and always runs through "the same treatment of mind and body". Academic thinking. Fourthly, diagnostic methods combined with consultation. Formed a unique thought system of syndrome differentiation and treatment for emotional diseases. In clinical medication, it emphasized "corresponding medicines and syndromes, tailored according to law", and made good use of "Qi medicine". For example, it emphasized the clinical application of psychology of traditional Chinese medicine (the treatment of emotional diseases). She not only made great achievements in the field of theoretical research, but also made great achievements. And diligent in practice, with their own actions to prove the clinical effectiveness of traditional Chinese medicine psychology, pay attention to the effectiveness of "Jingfang" for the treatment of emotional diseases, and through their own decades of clinical practice, summed up a set of "Jingfang" drug treatment of emotional diseases theoretical system, that is, "recipe and syndrome correspond" and "pathogenesis follow" study. Dong Lao believed that the occurrence of all emotional diseases, whether external or internal, originated from the imbalance of Qi and Qi. He believed that emotional diseases were mainly caused by Qi and Qi. "Qi" is the core. Through "Qi" to balance the Yin and Yang of viscera and viscera, to achieve the purpose of Yin and Yang secretion, viscera and blood function harmony. Combination, always run through the "mind-body treatment" academic thinking, pay attention to the unity of form and spirit. So in the treatment of syndrome differentiation is considered as a whole, treatment is also the combination of drug treatment and emotional relaxation therapy can play a good effect. The patient is willing to cooperate and get twice the result with half the effort through good interaction and communication with the patient through "inquiry". It is especially important to inquire about stool and sleep. It is very important to judge the prognosis and prognosis of emotional diseases, and it is also very important for Dong Lao to inquire about the sleep condition. Yang disorder, will inevitably affect the mind, restlessness is caused by insomnia, emotional diseases will mostly have sleep disorders and imbalance. And through the analysis of "dream" can also be used to "dream" method, analysis of the root causes of emotional diseases, help the diagnosis and treatment of emotional diseases, so the teacher always pay attention to the patient's sleep inquiries. Question. Clinical medication is also unique. Emphasis should be laid on "corresponding medication and syndrome, tailoring according to law" and making good use of "qi medicine". The "method" contained in it is to modify the "principle of classical methods". Through the understanding of the "rule" contained in the "prescription" for the treatment of diseases, we can select the corresponding drugs to achieve the purpose of treatment. Don't forget to regulate Qi and conduct Qi stagnation. Dong Lao thinks that the five viscera, muscles, tendons and bones are linked by Qi and blood as a whole. In view of the obvious clinical characteristics of Dong Lao's treatment of insomnia, satisfactory results have been achieved. Therefore, the "insomnia" medical records collected during clinical service were analyzed and summarized with the software of "Chinese Medicine Inheritance assistant system" to get a better understanding of the prescription's knowledge of the disease and the thinking of the prescription. It is of great significance for the academic inheritance and innovation of traditional Chinese medicine to summarize Dong Lao's new prescription and the inherent law of medication by using data mining methods such as rule analysis, improved mutual information method, complex system entropy clustering, unsupervised entropy hierarchical clustering and so on. Try.
【學位授予單位】：成都中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R249;R277.7

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