【摘要】：目的:通過對趙振昌教授治療慢性腎功能衰竭的病案收集、整理與數(shù)據(jù)分析,總結(jié)出名老中醫(yī)趙振昌教授治療慢性腎功能衰竭的臨床經(jīng)驗及用藥規(guī)律,傳承其學(xué)術(shù)思想。方法:收集趙振昌教授2014年1月-2015年12月門診醫(yī)案,應(yīng)用當代名老中醫(yī)醫(yī)案分析挖掘系統(tǒng)(北京科技大學(xué)—北京金靈蘭信息技術(shù)有限責任公司)軟件,通過關(guān)聯(lián)分析、用藥分析、組方分析、群體分析等數(shù)據(jù)分析路徑,挖掘?qū)ο筇幏街兴幬锸褂玫囊?guī)律,分析趙振昌教授治療慢性腎功能衰竭的用藥經(jīng)驗,整理學(xué)術(shù)思想、探討用藥規(guī)律。結(jié)果:分析篩選出的500首處方,計算每味中藥的出現(xiàn)頻次,挖掘各味中藥之間的關(guān)聯(lián)規(guī)則,使用頻次最高的前15位中藥依次是熟地黃,生地黃,山萸肉,黃芪,黨參,白術(shù),茯苓,山藥,土茯苓,白茅根,鱉甲,杜仲,蟬蛻,僵蠶,萆參。所用藥物歸腎、肝、脾經(jīng)為主,所用藥物的性味以溫、甘、酸、平為主。其次為辛、涼之品,藥物組合出現(xiàn)頻次最高的前5位依次是生地黃-熟地黃;熟地黃-山萸肉;生地黃-山萸肉;黨參-白術(shù);黃芪-白術(shù);并挖掘出個5核心組合和4首新處方。結(jié)論:趙振昌教授臨床上將慢性腎功能衰竭分以下幾型:(1)脾腎氣虛:治以益氣補腎健脾,方選四君子湯合濟生腎氣丸加減,藥用太子參、黃芪、生地黃、白術(shù)、茯苓、澤瀉、山茱萸、山藥、車前子、牛膝、甘草;(2)脾腎氣陰兩虛:治以益氣養(yǎng)陰,補腎健脾,方選六味地黃湯合太子參、黃芪加減,藥用太子參、黃芪、生地、澤瀉、茯苓、山茱萸、山藥、丹參、大黃;(3)肝腎陰虛:治以滋肝養(yǎng)腎,方選六味地黃丸合一貫煎加減,藥用山茱萸、生地、茯苓、枸杞、山藥、車前子、澤瀉、沙參、當歸、川楝子、懷牛膝、鱉甲;(4)陰陽兩虛,治以補養(yǎng)氣血,陰陽雙補,方選麥味地黃丸合黃芪、當歸加減,藥用生地、熟地、麥冬、茯苓、山藥、山茱萸、黃芪、當歸、肉蓯蓉。趙振昌教授在多年臨證中發(fā)現(xiàn),本病以正虛為本,濁邪為標,多兼夾瘀毒,故在臨床上喜用補腎健脾之藥味,諸如生地黃、熟地黃、白術(shù)、茯苓、黃芪、山藥等;當機體以邪實為主要表現(xiàn)時,趙振昌教授則酌情加以祛濕泄?jié)嶂幬?諸如豬苓、澤瀉、車前子、大黃、郁李仁等;久病入絡(luò),經(jīng)絡(luò)氣滯血瘀,故趙振昌教授喜用活血化瘀中藥以使瘀血得以運行,經(jīng)絡(luò)氣血通達,臨床常用丹參、地龍、赤芍、當歸、三七等活血之品。通過本研究發(fā)現(xiàn)論文趙振昌教授治療慢性腎功能衰竭經(jīng)驗豐富,多用補腎健脾泄?jié)嶂?喜配伍活血化瘀藥。通過頻數(shù)分析及聚類分析等統(tǒng)計學(xué)方法對藥物進行統(tǒng)計分析,數(shù)據(jù)挖掘得出慢性功能衰竭是脾腎虧虛為本,濕、熱、毒、瘀等邪氣瘀阻為標,當以補腎填精益髓,健脾益氣養(yǎng)血,清熱化濕解毒、活血化瘀通絡(luò)等為其治療大法,為我們繼承和發(fā)揚名老中醫(yī)治療慢性腎衰理論和治療方法提供了參考。
[Abstract]:Objective: to collect, arrange and analyze the medical records of Professor Zhao Zhenchang in treating chronic renal failure (CRF), sum up the clinical experience and medication law of Professor Zhao Zhenchang in the treatment of chronic renal failure (CRF), and pass on his academic thoughts. Methods: professor Zhao Zhenchang's outpatient medical records were collected from January 2014 to December 2015, and the software was used to analyze and excavate the medical records of famous traditional Chinese medicine (Beijing University of Science and Technology-Beijing Jinlinglan Information Technology Co., Ltd.). The data of drug use analysis, group analysis and so on are analyzed, the rule of drug use in prescription is excavated, the experience of professor Zhao Zhenchang in the treatment of chronic renal failure is analyzed, the academic thought is sorted out, and the law of drug use is discussed. Results: 500 prescriptions were analyzed, the occurrence frequency of each Chinese medicine was calculated, and the association rules between different Chinese medicines were excavated. The top 15 Chinese medicines with the highest frequency of use were Rehmannia glutinosa, Radix Corni, Radix Astragali, Codonopsis pilosula, Atractylodes macrocephalae. Poria cocos, yam, Poria cocos, Maomaogan, Biejia, Eucommia, cicada slough, silkworm, Bishen. The drugs used are mainly kidney, liver and spleen, and the properties of the drugs are warm, sweet, sour and flat. Followed by Xin, cool products, the drug combination of the highest frequency of the first five places are Rehmannia glutinosa; cooked Rehmannia officinalis; Codonopsis macrocephala; Astragalus macrocephala; And dig out a 5-core combination and 4 new prescriptions. Conclusion: professor Zhao Zhenchang clinically divided chronic renal failure into the following types: (1) deficiency of spleen and kidney qi: treating spleen with supplementing qi and tonifying kidney and invigorating spleen, adding and subtracting decoction of Fangxuan Sijunzi decoction combined with Jisheng Shenqi pills, Radix Pseudostellariae, Astragalus, Radix Rehmanniae, Atractylodes macrocephala, Poria cocos; Alisma, Cornus officinalis, yam, plantain, Achyranthes bidentata, licorice; (2) deficiency of spleen and kidney qi and yin: treat with supplementing qi and nourishing yin, tonifying kidney and invigorating spleen, selecting Liuwei Dihuang decoction with Radix Pseudostellariae, adding and subtracting Radix Astragali, Radix Pseudostellariae, Radix Astragali, Radix Alismatis, Poria cocos, Cornus officinalis, Chinese yam, Salvia miltiorrhiza and Rh (3) liver and kidney yin deficiency: to treat liver and kidney nourishing kidney, the prescription chooses Liuwei Dihuang pill to add and subtract consistently, medicinal dogwood, raw land, Poria cocos, Lycium barbarum, yam, plantain seed, Alismatis, Sachshen, Angelica sinensis, Chuanelianzi, Achyranthes bidentata, Biejia; (4) deficiency of yin and yang, cure by nourishing qi and blood, nourishing both yin and yang, combining Huangqi with Radix Rehmanniae pills and Radix angelicae Sinensis, adding and subtracting Radix angelicae Sinensis, medicinal land, ripe land, Ophiopogon japonicus, Poria cocos, Chinese yam, Cornus officinalis, Astragalus membranaceus, Angelica sinensis, Cistanche deserticola. Professor Zhao Zhenchang in many years of clinical syndrome found that this disease is based on the deficiency, turbid evil as the standard, more and more blood stasis poison, so in the clinic like to use the medicine flavor of tonifying kidney and spleen, such as Rehmannia, Atractylodes macrocephala, Poria cocos, Astragalus, Chinese yam and so on. When the body is the main performance of evil, Professor Zhao Zhenchang as appropriate to remove the smell of dampness and turbidity, such as Polyporus, alisma, plantain, rhubarb, Yu Li Ren and so on; Long illness into the collaterals, meridian Qi stagnation and blood stasis, so Professor Zhao Zhenchang likes to use blood stasis Chinese medicine to make blood stasis to run, meridian Qi and blood access, clinical commonly used salvia miltiorrhiza, Dilong, Radix Paeoniae Alba, angelica sinensis, Panax notoginseng and so on. It is found that Professor Zhao Zhenchang has rich experience in the treatment of chronic renal failure. By means of statistical methods such as frequency analysis and cluster analysis, the data mining shows that chronic functional failure is based on deficiency of spleen and kidney, dampness, heat, poison, stasis and other evil qi stagnation should be used as standard, and the essence and marrow of kidney should be filled with tonifying kidney. Invigorating spleen and invigorating qi and nourishing blood, clearing heat and removing dampness and detoxifying, activating blood circulation and removing blood stasis and dredging collaterals, etc., provide reference for the treatment of chronic renal failure by inheriting and carrying forward the famous traditional Chinese medicine in treating chronic renal failure.
【學(xué)位授予單位】：長春中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R249;R277.5

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