【摘要】：【研究背景】劉啟廷教授是山東省名中醫(yī),國家級(jí)名中醫(yī)藥傳承工作室中醫(yī)專家,第二屆國醫(yī)大師候選人。60年來劉老師一直在臨床一線工作,治學(xué)嚴(yán)謹(jǐn),熟讀經(jīng)典,勤于實(shí)踐,臨床經(jīng)驗(yàn)豐富,是中醫(yī)全科醫(yī)師倡導(dǎo)者,善于純中醫(yī)藥治療內(nèi)外婦兒各科疑難雜病,不夾雜西藥,臨床療效顯著。本論文總結(jié)整理導(dǎo)師治學(xué)經(jīng)驗(yàn)、學(xué)術(shù)思想及臨床經(jīng)驗(yàn)。劉老在中醫(yī)藥治療感冒方面有高深的造詣,他在《黃帝內(nèi)經(jīng)》等中醫(yī)理論的指導(dǎo)下,創(chuàng)造性的提出“感冒病因無熱論”,治宜“散寒透熱,扶正祛邪”。在此理論基礎(chǔ)上臨床創(chuàng)立了固本解熱湯治療感冒,本論文對(duì)固本解熱湯治療風(fēng)寒感冒的療效、安全性進(jìn)行系統(tǒng)臨床研究,為中醫(yī)藥治療本病提供新的理論與方法�！狙芯磕康摹靠偨Y(jié)整理導(dǎo)師劉老的學(xué)術(shù)思想及臨床經(jīng)驗(yàn);對(duì)導(dǎo)師運(yùn)用固本解熱湯治療風(fēng)寒感冒療效及安全性進(jìn)行臨床觀察,進(jìn)一步對(duì)導(dǎo)師學(xué)術(shù)思想、臨床經(jīng)驗(yàn)驗(yàn)證及總結(jié)�！狙芯糠椒ā坷碚撗芯坎糠�:通過每周系統(tǒng)跟師臨證診療、聆聽老師授課、結(jié)合集中培訓(xùn)學(xué)習(xí)及臨床病例資料整理總結(jié)等多種形式,查閱有關(guān)的歷代中醫(yī)經(jīng)典文獻(xiàn),追溯導(dǎo)師學(xué)術(shù)淵源,總結(jié)老師治學(xué)經(jīng)驗(yàn)、學(xué)術(shù)思想、臨床經(jīng)驗(yàn)及用藥特色等。臨床研究部分:采用隨機(jī)陽性對(duì)照臨床試驗(yàn)設(shè)計(jì)。選取門診風(fēng)寒感冒90例病人,病人隨機(jī)設(shè)立中藥治療組、西藥對(duì)照組、中成藥對(duì)照組,中藥治療組服用固本解熱湯,西藥對(duì)照組服用復(fù)方氨酚烷胺片,中成藥對(duì)照組服用荊防顆粒。3天為一觀察周期,觀察三組治療后感冒臨床癥狀緩解消失時(shí)間,與中藥治療組的差異,應(yīng)用統(tǒng)計(jì)學(xué)處理做數(shù)據(jù)分析,評(píng)價(jià)中藥治療組的效果,服藥后的副作用。【研究結(jié)果】理論總結(jié)結(jié)果:1.治學(xué)經(jīng)驗(yàn):(1)心系病人,高尚醫(yī)德。為醫(yī),不僅要具有精良的醫(yī)術(shù),還要具備高尚的醫(yī)德,只有正確解決好醫(yī)患關(guān)系,才能不斷提高醫(yī)療水平。要處處以孫思邈大師為榜樣,把大醫(yī)精誠落實(shí)到行動(dòng)上,認(rèn)真接診每一個(gè)病人。(2)熟讀經(jīng)典,精研岐黃。中醫(yī)理論廣博深?yuàn)W,中醫(yī)古籍不可勝數(shù),不計(jì)其數(shù),系統(tǒng)學(xué)習(xí)《黃帝內(nèi)經(jīng)》、《傷寒論》、《金匱要略》、《神農(nóng)本草經(jīng)》四大經(jīng)典著作是學(xué)習(xí)中醫(yī)的基石,熟讀四大經(jīng)典是臨證的基礎(chǔ),所以提出:書非深不能精,非熟不能用,非博不能廣。(3)學(xué)古不泥古,學(xué)中不棄西。古代的醫(yī)案、方藥經(jīng)驗(yàn)是繼承的基礎(chǔ),發(fā)揚(yáng)的途徑,提高的手段,但要繼承學(xué)習(xí)不是簡(jiǎn)單的重復(fù),也不是思想的墨守常規(guī)和方法上的故步自封,要師古而不泥古。西醫(yī)常見病的病因、發(fā)病機(jī)理、診斷治療也要熟悉,容易與病人溝通,得到病人的認(rèn)可。2.學(xué)術(shù)思想(1)倡導(dǎo)養(yǎng)生防病,提出養(yǎng)生護(hù)正論。診治疾病,治療與預(yù)防密不可分,中醫(yī)養(yǎng)生重在調(diào)理陰陽,調(diào)氣和血,以維護(hù)人體功能的動(dòng)態(tài)平衡。在臨診時(shí),要把上工治未病思想放在第一位,未病先防,既病防變,指導(dǎo)病人把養(yǎng)生護(hù)正落實(shí)在日常生活中去,總結(jié)出六要、六不要、保健粥與保健操,編著了《健康的訣竅》一書。(2)主張辨病與辨證相結(jié)合,倡導(dǎo)常見病一方通用。劉老認(rèn)為中醫(yī)理論指導(dǎo)下辨病與辨證結(jié)合,以癥為先導(dǎo),以病為基礎(chǔ),以證定治,以治立方,以方組藥,充分發(fā)揮藥物專效的特殊效能。與中醫(yī)的同病異治、異病同治相符合,編著了《常見病一方通用經(jīng)驗(yàn)方》。(3)首先提出“感冒病因無熱論”。依據(jù)《黃帝內(nèi)經(jīng)》:“人傷于寒也,則為病熱”,“邪之所湊,其氣必虛”等理論。認(rèn)為感冒的病因?yàn)轱L(fēng)寒,多因人體正氣不足,體表陽氣虛弱不能固護(hù)肌表,風(fēng)寒之邪外襲所致。所以感冒初期治療主以辛溫解表,避免應(yīng)用辛涼之藥,以免引邪入內(nèi)病情加重。根據(jù)《黃帝內(nèi)經(jīng)》“虛則補(bǔ)之”的原則,結(jié)合《證治匯補(bǔ).傷風(fēng)》:“如虛人傷風(fēng),……,又當(dāng)補(bǔ)中,而佐以和解,……�！眲⒗蟿�(chuàng)立“益氣固表,散寒解熱”的固本解熱湯。臨床研究結(jié)果:1.中西醫(yī)療效分析比較,固本解熱湯的愈顯率與對(duì)照組相比P0.05,差異有統(tǒng)計(jì)學(xué)意義。2.急性上呼吸道感染癥狀緩解比較,治療3天后三組間臨床癥狀緩解例數(shù)與未緩解例數(shù)的對(duì)比,表明固本解熱湯組對(duì)急性上呼吸道感染癥狀緩解優(yōu)于西藥對(duì)照組及中成藥對(duì)照組。3.三組治療后組間癥狀總積分比較,治療3天后變化中藥治療組與中成藥對(duì)照組相比較,T=-2.0106,中藥治療組與西藥對(duì)照組相比,T=-2.0461,p0.05,差異有統(tǒng)計(jì)學(xué)意義;3天前后差值變化中中藥治療組與中成藥對(duì)照組對(duì)比,T=-2.0031,中藥治療組與西藥對(duì)照組相比,T=-2.0151,p0.05,差異有統(tǒng)計(jì)學(xué)意義,治療后組間癥狀總積分對(duì)比差異有統(tǒng)計(jì)學(xué)意義。4.實(shí)驗(yàn)室檢查結(jié)果比較,三組對(duì)比無差異統(tǒng)計(jì)學(xué)無意義。5.安全性評(píng)價(jià),試驗(yàn)過程中無特殊不良反應(yīng),僅有3例病人訴用藥后胃脘輕微不適,停用藥物后癥狀緩解,西藥對(duì)照組復(fù)方氨酚烷胺片、中成藥對(duì)照組荊防顆粒僅有少數(shù)患者有藥物說明書的輕微不良反應(yīng)。【結(jié)論】劉老總結(jié)自己60余年治療感冒的臨床經(jīng)驗(yàn),認(rèn)為感冒的病因?yàn)轱L(fēng)寒為標(biāo),正氣虧虛為本,因此他首先提出“感冒病因無熱論”。治療時(shí)要扶助正氣,標(biāo)本兼治療效較好。劉老治療感冒萬余人,其中發(fā)現(xiàn)中醫(yī)辨證屬風(fēng)寒感冒的病人治療時(shí)單純祛邪療效不佳,需與扶正藥物并用才能進(jìn)一步提高療效,服用感冒藥3天不能治愈的病人,均需要扶助正氣。劉老創(chuàng)立“益氣固表,散寒解熱”的固本解熱湯治療萬余人有確切的療效,有必要加以整理以示后人,發(fā)揮中醫(yī)藥對(duì)感冒認(rèn)知與實(shí)踐的優(yōu)勢(shì),發(fā)掘中醫(yī)藥治療感冒新理論與方法,對(duì)提高臨床療效、控制感冒傳播具有重要意義。該方組方遵循傳統(tǒng)中醫(yī)藥理論,能及時(shí)有效解除患者的臨床癥狀,不加重患者的經(jīng)濟(jì)負(fù)擔(dān),無明顯毒副反應(yīng),值得推廣應(yīng)用。
[Abstract]:[Background] Professor Liu Qiting is a famous doctor of traditional Chinese medicine in Shandong Province, a national famous expert of traditional Chinese Medicine Inheritance studio, and a candidate for the 2nd National Master of Traditional Chinese Medicine. Since 60 years ago, Professor Liu has been working in the clinical frontline with rigorous scholarship, familiar with classics, diligent in practice and rich clinical experience. He is an advocate of general practitioners of traditional Chinese medicine and is good at treating both internal and external medicine with pure Chinese medicine. This paper summarizes the tutor's academic experience, academic thinking and clinical experience. Liu Lao has a profound accomplishment in the treatment of cold. Under the guidance of the theory of traditional Chinese medicine such as Huang Di Nei Jing, he creatively put forward the theory of "the cause of cold without heat" and "dispelling cold and permeating heat". On the basis of this theory, Guben Jiere Decoction was established to treat cold. This paper made a systematic clinical study on the efficacy and safety of Guben Jiere Decoction in the treatment of cold caused by wind and cold, providing a new theory and method for the treatment of this disease. The instructor used Guben Jiere Decoction to observe the efficacy and safety of treating cold and cold, and further verified and summarized the instructor's academic thinking, clinical experience. [Research Methods] Theoretical part: Through weekly systematic clinical diagnosis and treatment with the instructor, listening to the teacher's lectures, combined with concentrated training and learning and clinical case data collection and summary. In the clinical research part, a randomized positive control clinical trial design was adopted. 90 outpatients with cold and wind were selected and randomly assigned to Chinese medicine treatment group and Western medicine control group. Chinese medicine control group, Chinese medicine treatment group take Guben Jiere decoction, western medicine control group take compound paracetamol alkylamine tablets, Chinese patent medicine control group take Jingfang granules. 3 days for an observation cycle, observe the three groups after treatment of clinical symptoms relief disappearance time, and Chinese medicine treatment group differences, using statistical processing to do data analysis, evaluation of Chinese medicine treatment group. To be a doctor, one must not only have excellent medical skills, but also have noble medical ethics. Only by correctly solving the doctor-patient relationship, one can improve the medical level continuously. Actually, take every patient seriously. (2) Read the classics well and study Qi Huang carefully. The theory of Chinese medicine is broad and profound, the ancient books of Chinese medicine are numerous, countless, systematic study < Huang Di Nei Jing >, < typhoid fever theory >, < Jin Kui Yao Xue >, < Shen Nong Materia Medica Jing > the four classics are the cornerstone of learning Chinese medicine, familiar reading the four classics is the basis of clinical symptoms, so put forward. (3) learning from the past is not muddy, learning from the west is not abandoned. Ancient medical plans, prescription experience is the basis for inheritance, the way to carry forward, means of improvement, but to inherit learning is not a simple repetition, nor is it the idea of sticking to conventional and methodological self-proclaimed, to learn from the past but not muddy. Western medicine is common. The etiology, pathogenesis, diagnosis and treatment of the disease should also be familiar with, easy to communicate with the patient, and get the approval of the patient. 2. Academic thinking (1) advocate health and disease prevention, put forward the theory of health care. The thought of "treating disease by work" is the first, and "preventing disease before disease" is the first. It guides patients to carry out health care in their daily life. It summarizes six essentials and six No. Health porridge and health exercises. It compiles a book entitled "Health Tips". (2) It advocates the combination of disease differentiation and syndrome differentiation, and advocates the universality of common diseases. Combining with syndrome differentiation, taking symptoms as forerunner, basing on syndrome differentiation, treating cubes and prescriptions, giving full play to the special efficacy of drugs. It is thought that the cause of cold is wind-cold, mostly due to insufficient vital energy of the human body, weak yang-qi on the body surface can not protect the muscle surface, wind-cold pathogen caused by external attack. According to the principle of : "If the deficiency of cold,... and should be supplemented, and with reconciliation,..." Liu Lao founded "Yiqi solid table, dispelling cold and heat" Guben Jiere Decoction. Clinical research results: 1. Comparison of Chinese and Western medical efficacy analysis, Guben Jiere Decoction, the more obvious rate compared with the control group, P 0.05, the difference was statistically significant.2. Comparing the remission of symptoms of acute upper respiratory tract infection, the remission and non-remission of clinical symptoms among three groups after 3 days of treatment showed that the remission of symptoms of acute upper respiratory tract infection in Guben Jiere Decoction group was better than that in western medicine control group and Chinese patent medicine control group. T=-2.0106 compared with the control group of Chinese patent medicine, Chinese medicine treatment group and Western medicine control group, T=-2.0461, p0.05, the difference was statistically significant; 3 days before and after the difference between Chinese medicine treatment group and Chinese patent medicine control group, T=-2.0031, Chinese medicine treatment group and Western medicine control group, T=-2.0151, p0.05, the difference was statistically significant, after treatment between the two groups. There was no significant difference between the three groups. 5. Safety evaluation, no special adverse reactions during the test, only 3 patients complained of slight discomfort in the stomach after drug use, symptoms relieved after drug withdrawal, the control group of Western medicine compound paracetamol and alkylamine tablets, Chinese patent medicine control group. [Conclusion] Liu Lao summarized his clinical experience in treating cold for more than 60 years. He believed that the cause of cold was wind-cold and deficiency of vital energy was the main cause, so he first put forward the theory that there was no fever in the etiology of cold. More than ten thousand old people have been treated with cold, among them, it is found that the curative effect of traditional Chinese medicine is not good for the patients with wind-cold and cold, and the curative effect can only be further improved by combining it with the medicines for strengthening the body. All the patients who can not be cured after taking the medicines for cold for three days need to help the healthy qi. It is necessary to arrange the prescriptions so as to show the definite curative effect, give full play to the superiority of traditional Chinese medicine in cognition and practice of colds, and explore new theories and methods of treating colds with traditional Chinese medicine, which is of great significance to improve clinical efficacy and control the spread of colds. The economic burden of patients has no obvious side effects, and is worthy of popularization and application.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R249;R254.9

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相關(guān)期刊論文 前1條

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本文編號(hào)：2236494

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