唐宋教授治疗消渴（中消）病的经验

发布时间：2018-07-26 13:30

【摘要】：目的:1.据世界卫生组织估计,2005年到2015年间我国20岁以上成年人的糖尿病患病率为9.7%,糖尿病前期的比例为15.5%,成人糖尿病总数已达9240多万,有1.482亿成人处于糖尿病前期。再次证实我国可能已成为世界上糖尿病患病人数最多的国家[1]。糖尿病可能为继心脑血管疾病、肿瘤之后另一个严重违害人民健康的重要慢性非传染性疾病。因此,在普通人群中预防、诊断和治疗糖尿病是我们目前需紧急处理的问题。糖尿病是临床常见病、多发病,严重危害着人们的健康,影响着人们的生活质量。近年的多项调查表明,无论是欧美发达国家还虽发展中国家,糖尿病控制状况均不容乐观[1]。西医治疗糖尿病是对症处理,不仅有严重的肝肾功能损害,且可导致低血糖,体重增加,胃肠道不良反应及胰岛素抵抗,疗效并不理想,并可出现心脑肾等慢性严重并发症。因此发掘中医药治疗糖尿病的治疗经验迫在眉睫。2.根据糖尿病的临床特征,类似于祖国医学的“消渴”。历代医家不断发展丰富“消渴”理论,创新疗法,中医药治疗糖尿病具有快速改善症状,延缓并发症的进展过程,提高生活质量,减轻经济负担,无毒副作用等特点,有独特的疗效和优势,得到医学界普遍关注。因此梳理《内经》及有关文献对消渴病的论述,认识《内经》消渴病理论的原貌,学习重要医家关于“消渴”病的治疗,对“消渴”病进行中医药创新治疗的研究具有重要的学术价值和现实意义。3.唐宋教授在治疗消渴病中积累了丰富的临床经验与学术思想,能重新理解经典内涵及创新消渴理论,擅长用新理论新观点治疗疾病。自《内经》提出“消渴病”以后,在病位方面,历代医家有不同看法,影响最大的是三消理论,在治疗上也多以肺、胃、肾三脏为主进行辨治,但与“五脏皆可发消瘅”的理论不尽吻合,唐宋教授认为,临床实践中,不乏五脏(腑)皆可发消渴的实例,应该正确、深入、全面认识“五脏皆可发消瘅”的病机,开辟新的治疗途径,提高疗效。特别是对“消渴”病中消的诊治有许多宝贵经验未能及时整理归纳。通过对唐宋老师的门疹病例、讲课课件、论文著作等资料及个人的临床体会进行系统归纳整理并探讨其学术思想和临床经验,望能对中医药事业的继承与发展尽微薄之力。4.首次系统整理总结唐宋教授辨治消渴(中消)病的的经验。方法:查阅文献,跟师临床,总结唐宋教授临床诊治消渴的原始门诊医案和既往经验,进一步探讨诊法特点,临床辨治规律及遣方用药特色。收集病人疗效及信息反馈;收集整理老师的诊余谈话、讲课记录和课件;通过临床实践,加深临床感悟与理解,收集唐老师治疗“消渴”病的处方,对其进行统计分析,统计药物使用频次和频率。观察有关中药的降低血糖和降低尿糖的效果,以期广泛用于临床和指导临床,提高患者生活质量。系统归纳老师治疗“消渴”病中消的学术经验和思想。成果与结论:三年来,整理唐老师的临床病案和辨治思路,并加以探讨、分析、归纳、总结,查阅文献结合唐老师的临床经验和个人的临床体会,对唐老师论治“消渴”病的学术思想有了初步的认识,唐老师根据“消渴”病的生理病理特点,在临床中形成了系统的“消渴”病学术思想。唐老师论治“消渴”病的主要学术思想有以下几个方面。1.消渴病的发生与脾胃功能密切相关。《内经》“消渴”病理论明确指出五脏与“消渴”病皆有密切联系。历代医家每论及消渴多认为病因系素体阴虚,饮食不节所致,不能深刻阐明消渴病的基本病因。《内经》曰:“有所劳倦,形气衰少,谷气不盛。”即气虚导致谷气留于胃中,郁而为热,进而发生中消;李东垣对消渴病的论治,体现其学术观点,即“内伤脾胃,百病由生”、“阴火”病机理论及“甘温除热”的治疗法则,遣方用药均以“升发脾胃阳气而泻阴火”为基本原则;喻嘉言《寓意草》中云:“夫既瘅成为消中,随其或上或下,火热炽盛之区,以次传入矣。”“至于胃以其热由关门下传于肾,肾或以石药耗其真、女色竭其精者,阳强于外,阴不内守,而小溲混浊如膏,饮一溲一,肾消之证成矣”。均指出“消渴”病与脾的关系密切。2.中消与脾关系更为重要,中消者消谷善饥。脾为太阴湿土,胃为阳明燥土,两者以膜相连,脏腑表里相合,同居中焦,燥润相济,升降有序,纳运配合,脾为胃运化水谷化生之精微,达于五脏六腑,四肢百骸,充养肌肤。若脾不能为胃行其津液,故消谷多食。四肢百骸亦不得禀水谷之气,筋骨肌肉皆无以充养,而形体日见消瘦,甚则肢体痪废不用。对此,汉代张仲景《金匮要略》消渴病篇似已有所论述,治疗当清胃热兼滋脾阴,其理亦显而易见。《丹溪心法》云“热蓄主于中,脾虚受之,伏阳蒸胃,消谷善饥,饮食倍常,不生肌肉”。《证治汇补》更明确指出:“中消消脾,脾气热燥,饮食倍常,皆消为小便”。3.消渴病的根本病理变化在于脾的传输功能失常及代谢紊乱,虽出现“消谷”症状,但不能化生精微物质为人体正常利用,导致水津不足或失于濡养,且伴有大量水谷精微丢失于体外。传统的“阴虚燥热”病理观只能反映机体局部水津匮乏的病理改变,未能概括水谷精微大量丢失的病理变化,而舍去起根本病理作用的脾,仅从肺胃肾脏去论三消,不能揭示消渴病的病理实质及把握其病机转趋。且消渴渴饮无度,必内溃于脾,单从“阴虚燥热”病机出发,滥用滋腻寒凉产,愈滞脾运,使病情加重之教训亦不乏见。4.消渴病的辨证治疗应重视脾胃的功能。其发病基础在于脾,渴饮无度伤于脾,治疗更应顾及脾。《内经》云:“治之以兰,除陈气也”,“兰”者佩兰之谓,原具化湿醒脾之功。有学者统计汉唐以来治消渴方,其中配用治脾之药者达半数以上。如近代名医张锡纯消渴方玉液汤、滋伒饮中均重用黄芪。现代药理研究已经证实,许多治脾药物如人参、黄芪、山药、白术、苍术、茯苓、玉竹等具有降血糖的作用,从而显示了从脾探索消渴病的有效治疗途径是大有希望的。5.消渴病中脾之病变应审因而治。消渴病患者起病隐匿,病因复杂,病程较长,症候繁杂,提高辨证施治能力,规范辨证分型是关键问题。方药是中医治病的工具,方药的功效要烂熟于心,临床才能运用自如,取得桴鼓疗效。唐老师巧辨合方,擅施对药,有主有次,升降配合,补泄兼施,寒热并用,多脏兼顾而提高疗效。善调脾胃,安定五脏。○1泻脾热,脾有伏火,则蒸胃熏肺。○2化脾湿,使湿不困脾运化自健。○3益脾气,脾气旺而阴自升;○4健脾运,气血化源充足而脏腑得养;○5养脾阴,脾为太阴,太阴者二阴之长,脾阴足自能灌溉诸脏腑;○6温脾阳,用于消渴病渴饮无度,脾土内溃,或过用寒凉,克伐中阳者。治脾诸法,或可与滋脾益肾相兼,或与清胃同施,或专药独任,直培中宫,贵在使脾运得健,水谷精微得转输与利用恢复正常为目的。总之,健运脾胃,益气养阴,温清兼施,知常达变。6.现行“三消”理论经肺、胃、肾对应上、中、下三消在脏腑辨证上有失偏颇。临床治疗“消渴”病需要重视五脏均与“消渴”病有密切关系,尤其是脾、胃在“消渴”中的影响。
[Abstract]:Objective: 1. according to WHO, the WHO estimated that between 2005 and 2015, the prevalence of diabetes in adults aged 20 and over was 9.7%, the proportion of pre diabetes was 15.5%, the total number of adult diabetes reached about 92400000, and 148 million 200 thousand adults were in prediabetes. Again, it was confirmed that China can become the country with the largest number of diabetes in the world. [1]. diabetes in the family may be an important chronic non communicable disease following the cardiovascular and cerebrovascular diseases. After the tumor, it is a serious chronic non communicable disease which seriously violates the health of the people. Therefore, the prevention, diagnosis and treatment of diabetes in the general population are the urgent problems we need to deal with at present. In recent years, a number of investigations have shown that the control of diabetes in both developed and developing countries in Europe and America is not so optimistic that the treatment of diabetes in [1]. western medicine is a symptomatic treatment, not only has severe liver and kidney function damage, but also causes hypoglycemia, weight gain, gastrointestinal adverse reactions and insulin resistance. It is not ideal, and can have chronic serious complications such as heart, brain and kidney. Therefore, it is imminent to explore the therapeutic experience of Chinese medicine in the treatment of diabetes. According to the clinical characteristics of diabetes,.2. is similar to the "thirst" of the Chinese medicine. The doctors of the past generation have developed the theory of "thirst", innovative therapy, and Chinese medicine to treat diabetes with rapid improvement. Symptoms, delay the progress of the complications, improve the quality of life, reduce the economic burden, non toxic and side effects and other characteristics, have unique curative effect and advantages, and get the general attention of the medical community. Therefore, it combs the discussion of the internal classics and the related literature on the thirst disease, understands the original appearance of the pathology of "internal classics > thirst", and studies the treatment of the "thirst" disease of the important doctors. The research on the innovation and treatment of Chinese medicine for "thirst" disease has important academic value and practical significance.3. Tang and song professors have accumulated rich clinical experience and academic ideas in the treatment of thirst disease. They can re understand the classical connotation and the theory of innovation and thirst, and are good at treating disease with new theories and new ideas. After the disease, in the area of the disease, the doctors of the past dynasties have different views, and the greatest influence is the theory of "San Xiao". In the treatment, the three organs of the lungs, the stomach and the kidneys are mainly identified, but they are not consistent with the theory of "the five zang organs are all capable of eliminating them". In particular, there are many valuable experiences in the diagnosis and treatment of "Xiaoke" disease, in particular, there are many valuable experiences in the diagnosis and treatment of "Xiaoke" disease. To discuss his academic thought and clinical experience, we hope that the inheritance and development of the cause of Chinese medicine can be carried out with little strength.4. for the first time to systematically summarize and summarize the experience of Professor Tang and song in the discrimination and treatment of Xiaozhong (Zhong Xiao) disease. Methods: consult the literature, follow the clinical experience of the teacher, summarize the original outpatient medical case and experience of the clinical diagnosis and treatment of the thirst in the Tang and Song Dynasties, and further discuss the diagnosis of the doctor. Point, the rule of clinical discrimination and the characteristic of the prescription drug use. Collect the patient's curative effect and information feedback; collect and collate the teacher's talk, the lecture record and the courseware; through the clinical practice, deepen the clinical perception and understanding, collect the prescription of Tang's treatment of "thirst" disease, carry on the statistical analysis to it, statistics the frequency and frequency of the use of drugs. Observe the relation between the frequency and frequency of drug use. The effect of traditional Chinese medicine on reducing blood sugar and reducing urine sugar in order to be widely used in clinical and clinical guidance and to improve the quality of life of patients. The academic experience and ideas of teachers' treatment of "Xiaoke" were systematically summed up. Results and conclusions: in the past three years, the clinical case records and the thinking of discrimination and treatment were arranged and discussed, analyzed, summed up, and summed up, Cha Yuewen On the basis of the clinical experience and personal experience of Mr. Tang, Mr. Tang has a preliminary understanding of his academic thought on "Xiaoke" disease. According to the physiological and pathological characteristics of "Xiaoke" disease, Mr. Tang has formed a systematic academic thought of "Xiaoke" disease in clinical. In several aspects, the occurrence of.1. thirst is closely related to the function of the spleen and stomach. The theory of "inner Sutra > thirst" clearly points out that there is a close connection between the five zang organs and the "thirst" disease. The Qi deficiency causes the Qi deficiency to cause the valley Qi to stay in the stomach, and the depression is hot and then the medium and the elimination. The theory of Li Dong Yuan's treatment for the disease of thirst, that is, the theory of "internal injury to the spleen and the stomach, all kinds of diseases by birth", "Yin Fire" pathogenesis theory and the principle of "Gan Wen removing heat", which are used as the basis for "raising spleen and stomach Yang Qi and reducing Yin Fire" As for the heat from the door to the kidney, the kidney or the kidney, the kidney or the stone is consumed in the kidney, the kidney or the stone is consumed, the woman's color is exhausted, the sun is stronger than the outside, the Yin is not kept, and the small cloudy is like the ointment. The relationship between "Xiaoke" disease and the spleen is closely related to the relationship between the.2. medium and the spleen and the spleen and the spleen, the spleen is too wet soil, the spleen is too wet soil, the stomach is Yangming dryness soil, the two are connected by the membrane, the Zang Fu inner and the inside are conjoined, the central coke is cohabitation, the dryness is the same, the ascending and descending order, the transport coordination, the spleen as the metaplasia of the stomach and the valleys, which reach the five viscera, bones, and filling muscles. Skin. If the spleen can not make its body fluid for the stomach, so the valley can not be eaten by the valley. The muscles and muscles are not filled with water, the muscles and muscles are not filled, and the body is thinning, and the limb paralysis is not used. For this, the Han Dynasty Zhang Zhongjing "the Golden Chamber" and the thirst disease has been discussed. The treatment of the stomach heat and the spleen yin, the reason is also obvious. < Dan Xi Xin method > > < Dan Xi Xin method > > The basic pathological changes of.3. Xiaoke disease in the spleen are the abnormal transmission function and metabolic disorder of the spleen, though the symptoms of "eliminating the valley", but inability to change, are not changed. The traditional "Yin deficiency and hot" pathology view can only reflect the pathological changes of the local water and water deficiency, and can not generalize the pathological changes of the water and valley, but the spleen which has the fundamental pathological effect is removed only from the spleen. The kidney and kidney of the lung can not reveal the pathological essence of the disease and grasp the pathogenesis of the disease. And the thirst and thirst of the disease can not be grasped, and the thirst and thirst drink will be lost in the spleen. Starting from the disease machine of "Yin deficiency and heat", the abuse of the nourishing and cold and cold production, the more stagnant spleen, the syndrome differentiation treatment of.4. thirst should pay attention to the function of the spleen and stomach. Lies in the spleen, thirst drink without injury to the spleen, treatment should be more concerned with the spleen. < internal classics > > Yun: "cure to orchid, except Chen Qi", "blue" Perrin, the former has the work of reducing the damp and striking the spleen. Modern pharmacological studies have confirmed that many of the spleen drugs such as ginseng, astragalus, yam, Atractylodes, Atractylodes, Poria, and yyuzhu have the effect of hypoglycemic effect, which shows that the effective treatment way from the spleen to explore the thirst of thirst is the most promising.5. thirst disease in the spleen, the disease is hidden, the cause of the disease is complicated, and the course of disease is complicated. Long, symptomatic complex, improve the syndrome differentiation and treatment ability, standardize the differentiation and classification is the key problem. Prescription medicine is the tool of TCM treatment, the efficacy of prescription medicine should be well cooked in the heart. Good tune spleen and stomach, stability five zang organs. 1 diarrhea spleen heat, spleen has volt fire, steam stomach fumigating lung. 0 2 spleen damp, make wet spleen to transport and self health. 0 3 Spleen Qi, spleen transport, Qi and blood source abundant and viscera nourishing; 0 5 nourishing spleen yin, the spleen is Tai Yin two Yin long, spleen yin foot can irrigate Zhufu organs; 0 6 Wen splenic Yang, used for elimination Thirst and thirst drink no degree, spleen soil collapse, or the use of chill and cold, Kelling of Zhongyang. Treatment of spleen all methods, or with the nourishing spleen and kidney phase, or with the clearing of the stomach, or special medicine in the palace, the spleen is transported healthy, the water valley has to transfer and use recovery to normal for the purpose. In a word, healthy transportation of spleen and stomach, nourishing yin nourishing Yin, warming and cleaning, know often become.6. current " The theory of "three elimination" through the lungs, the stomach and the kidney corresponds to, the middle and the kidney, in the viscera syndrome differentiation. The clinical treatment of "Xiaoke" disease needs to pay attention to the close relationship between the five zang organs and the "thirst" disease, especially the influence of the spleen and the stomach in the "thirst".
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R249;R255.4

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