【摘要】：目的：耳鳴居耳科三大難題(耳鳴、耳聾、耳眩暈)之首。由于耳鳴的發(fā)病機制尚不明確,西醫(yī)對此仍缺乏有效的治療手段。中醫(yī)對耳鳴的證型和治療認識也存在很多分歧,同時療效也有不如人意之處。在多年的臨床實踐中,導(dǎo)師王士貞教授對中醫(yī)藥治療耳科疑難病積累了相當(dāng)豐富的經(jīng)驗,尤其擅長從肝脾論治耳鳴。本研究旨在總結(jié)和整理王教授治療耳鳴的常用中醫(yī)用藥規(guī)律以及中醫(yī)藥理論和學(xué)術(shù)思想,總結(jié)出一套中醫(yī)臨床安全有效的診療經(jīng)驗和方法,能夠更好地促進中醫(yī)臨床療效的提高,充分發(fā)揮中醫(yī)治療耳鳴的特色與優(yōu)勢。方法：本研究包括三個部分。第一部分是文獻研究,主要是通過文獻查閱和整理,總結(jié)出目前耳鳴在中西醫(yī)病因機制和治療手段方面的進展。第二部分是總結(jié)王士貞教授治療耳鳴病的學(xué)術(shù)思想和臨床經(jīng)驗。第三部分是以回顧性研究的方式,隨機收集200例在王士貞教授就診的耳鳴患者的首次就診處方,將收集到的資料進行數(shù)據(jù)整理并輸入計算機,運用Microsoft Office Excel軟件進行統(tǒng)計分析。從用藥頻次、功效、歸經(jīng)、藥性方面進行用藥、組方的統(tǒng)計,從而總結(jié)出王士貞教授治療耳鳴的用藥和組方規(guī)律,分析其學(xué)術(shù)經(jīng)驗；另一方面,從中醫(yī)理論的角度討論和分析耳鳴與肝脾的生理病理關(guān)系和密切程度。結(jié)果：在第一部分的文獻研究中,我們發(fā)現(xiàn)現(xiàn)代的名醫(yī)專家很多都主張從肝或從脾論治耳鳴,認為肝膽或脾胃的功能失調(diào)是引起耳鳴的重要病機。在第二部分的經(jīng)驗總結(jié)中,王士貞教授認為耳鳴病的辨證應(yīng)以中醫(yī)整體觀念為指導(dǎo)思想,以臟腑經(jīng)絡(luò)學(xué)說為理論基礎(chǔ),指出耳鳴病的發(fā)生主要責(zé)于肝脾。同時還特別重視中醫(yī)外治法、針灸療法和通竅法治的應(yīng)用；王教授還擅長運用經(jīng)方和對藥治療耳鳴,尤其還對耳鳴病的發(fā)病機制和中醫(yī)治療有著豐富的經(jīng)驗。第三部分,通過對耳鳴處方統(tǒng)計分析,發(fā)現(xiàn)王士貞教授治療耳鳴側(cè)重于使用具有健脾、養(yǎng)血、疏肝、通竅的藥物,同時這些藥物的歸經(jīng)也多以如肝、脾經(jīng)為主,藥性也側(cè)重于溫性和平性。最常用的耳鳴治療經(jīng)驗方為柴胡、白芍、香附、川芎、葛根、石菖蒲、益智仁、黃芪(五爪龍)、黨參、甘草。另一方面,無論是耳的生理功能及特點、耳與肝脾的生理關(guān)系、從肝脾認識耳鳴病因病機、肝脾之間的生理病理關(guān)系還是耳鳴病因與肝脾的關(guān)系等幾方面,從中醫(yī)理論分析發(fā)現(xiàn),耳鳴與肝脾都有著密不可分的關(guān)系。結(jié)論：本研究驗證了王士貞教授從肝脾論治耳鳴的學(xué)術(shù)思想,以調(diào)和肝脾作為治療耳鳴的關(guān)鍵,而情志不暢、飲食不節(jié)、勞倦過度是引起肝脾失調(diào)引發(fā)或加重耳鳴的三個重要因素。大量臨床病案也顯示從肝脾論治耳鳴的療效確切,值得臨床推廣。
[Abstract]:Objective: tinnitus is the first of three difficult problems (tinnitus, deafness and dizziness). Because the pathogenesis of tinnitus is not clear, western medicine still lacks effective treatment. There are also many differences in the understanding of syndrome type and treatment of tinnitus in traditional Chinese medicine, and the curative effect is not satisfactory. In the clinical practice for many years, Professor Wang Shizhen, his mentor, has accumulated a wealth of experience in the treatment of difficult otological diseases with traditional Chinese medicine, especially good at treating tinnitus from the point of view of liver and spleen. The purpose of this study is to summarize and sort out the law of traditional Chinese medicine used in the treatment of tinnitus by Professor Wang, as well as the theory and academic thought of traditional Chinese medicine, and to sum up a set of experiences and methods of clinical safety and effective diagnosis and treatment of traditional Chinese medicine. It can better promote the improvement of clinical curative effect of traditional Chinese medicine and give full play to the characteristics and advantages of traditional Chinese medicine in the treatment of tinnitus. Methods: this study consists of three parts. The first part is the literature research, mainly through the literature review and collation, summed up the current tinnitus in the etiological mechanism and treatment of traditional Chinese and western medicine progress. The second part is to summarize Professor Wang Shizhen's academic thought and clinical experience in the treatment of tinnitosis. In the third part, the first prescription of 200 patients with tinnitus treated in Professor Wang Shizhen was collected by retrospective study. The collected data were collected and input into the computer, and the data were analyzed by Microsoft Office Excel software. From the frequency of drug use, efficacy, meridian, medicinal properties of the use of drugs, group statistics, so as to sum up Professor Wang Shizhen treatment of tinnitus drugs and prescription rules, analysis of its academic experience; On the other hand, the physiological and pathological relationship and close degree between tinnitus and liver and spleen are discussed and analyzed from the point of view of traditional Chinese medicine theory. Results: in the first part of the literature study, we found that many modern famous medical experts advocated the treatment of tinnitus from the liver or spleen, and considered that the dysfunction of liver, gall, spleen and stomach was an important pathogenesis of tinnitus. In the second part of the experience, Professor Wang Shizhen thought that the syndrome differentiation of tinnitosis should be guided by the overall concept of traditional Chinese medicine and based on the theory of Zang-fu-meridian theory, and pointed out that the main responsibility for the occurrence of tinnitosis was on the liver and spleen. At the same time, special attention is paid to the application of external treatment of traditional Chinese medicine, acupuncture and moxibustion, and the rule of law through the passage of the orifice. Professor Wang is also good at treating tinnitus with classics and drugs, especially in the pathogenesis and treatment of tinnitus with rich experience in the pathogenesis and treatment of tinnitus. In the third part, through the statistical analysis of tinnitus prescription, it is found that Professor Wang Shizhen's treatment of tinnitus focuses on the use of drugs with spleen invigorating, nourishing blood, soothing the liver and dredging orifice. At the same time, the meridians of these drugs are mainly liver and spleen meridians. The medicine also focuses on warmth and peace. The most commonly used prescription for tinnitus treatment is Bupleurum, Paeonia lactiflora, Xiangfu, Ligusticum chuanxiong, Pueraria lobata, Acorus calamus, Yizhiren, Astragalus membranaceus (five claw Dragon), Codonopsis pilosula and Glycyrrhiza uralensis Fisch. On the other hand, no matter the physiological function and characteristics of the ear, the physiological relationship between the ear and the liver and spleen, the understanding of the etiology and pathogenesis of tinnitus from the liver and spleen, the physiological and pathological relationship between the liver and spleen, and the relationship between the etiology of tinnitus and the liver and spleen, From the analysis of traditional Chinese medicine theory, it is found that tinnitus and liver and spleen are closely related. Conclusion: this study verifies Professor Wang Shizhen's academic thought of treating tinnitus from liver and spleen, and takes reconciling liver and spleen as the key to the treatment of tinnitus, but the emotion is not smooth and the diet is not good. Overwork is the three important factors causing or aggravating tinnitus caused by liver and spleen disorders. A large number of clinical records also show that the treatment of tinnitus from the liver and spleen is effective and worthy of clinical promotion.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R249;R276.1

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1 何偉平;王士貞教授從肝脾論治耳鳴的理論與臨床用藥研究[D];廣州中醫(yī)藥大學(xué);2016年

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本文編號：2473940