滋阴法的文献整理及用药规律探究

发布时间：2018-01-17 15:19

  本文关键词：滋阴法的文献整理及用药规律探究　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 滋阴 内科杂病 刘燕池 数据挖掘

【摘要】：三年的硕士研究生学习期间,有幸在刘燕池教授身侧侍诊。刘教授秉承燕京医派的学术思想,在三因制宜思想的指导下,结合北京独特的地理气候和人文环境,在继承古人、师承刘奉五及家学的基础上,形成了自己一套诊病、治病的特色和用药规律。其在诊疗过程中,重视对于人体阴液的顾护,多取法滋阴降火,在临床内、外、妇、儿各科的治疗过程中,其效果颇得患者认同。为了深入挖掘其滋阴思想,本文从以下几个方面进行研究:第1部分,从哲学渊源和医学渊源两大方面,依次介绍了滋阴法的理论渊源。哲学渊源着重介绍了古有三易,即除了《周易》外其它两易——《归藏易》、《连山易》中的重阴思想,是滋阴法的最初渊源。另外,宋明理学尤其是其中的"理气"思想也对后世医学产生了很大影响。其"重天理"的观点,直接促使朱丹溪自成滋阴一派。医学渊源则大致从内经以降,按照年代依次进行了介绍,从仲景学说对滋阴法的发挥到金元时期滋阴思想的成熟,到后来明清时期的进一步深化,可以看出理论传承的清晰脉络。第2部分,滋阴法作为临床诊疗过程中一种具体的治疗方法,是各位医家在一定的时代背景下,在其对于人体疾病的阴阳辨证的指导下的具体的治疗方法。同是滋阴法,各医家对于具体药物的使用也各具特色。本文从仲景、河间、丹溪及张景岳各家、温病派的吴鞠通、叶天士二家入手,逐次分析了他们的滋阴法的具体用药特色。第3部分,刘燕池教授,国家级名老中医,其学术思想有家学肝病重清化的思想、师承刘奉五妇科"瓜石汤"等养阴凉血清热的思想渊源,另外,刘老私淑丹溪、吴鞠通等。其父刘玉初公曾侍诊北京四大名医萧龙友之侧,而刘奉五亦是京城御医韩一斋之后。本章重点阐述了刘老师基于北京疾病谱系下传承与发展的滋阴法的用药规律和特色。第4部分,为探讨刘燕池内科门诊的临床用药规律,以刘燕池教授2015年全年内科门诊病历为基础,基于"中医传承辅助平台系统(V2.5)构建处方数据库,采用软件方剂统计等模块,分析刘燕池教授处方用药基本特点。除了对处方药物的基本信息进行显性信息的统计,还采用了基于改进互信息法、复杂系统熵聚类等算法数据挖掘方法,进行处方分析等隐性信息的挖掘。结果:刘老师2015年内科门诊病历共361份,药物频次分析可得,降序排列前十位的依次为,石斛、麦冬、黄连、北沙参、生地黄、炒白术、茯苓、陈皮、黄芩、丹皮;就四气而言,降序排列为:寒性(2944)、温性(1629)、平性(920)、凉性(93)、热性(19);就五味而言,苦味药物频次最多(3258),其次为甘味(3108)、辛味(1862)、咸味(527)、涩味(371)酸味(336);就归经而言,肝肺胃为主,分别为肝经(2813)、肺经(2257)、胃经(2064),其次肾经(1707)、脾经(1669)、心经(1665次)。另外,高频药物组合共20对,包括12味药物;关联规则分析得到58条药物关联规则,演化得到核心药物组合22个,新处方11首。结论如下:(1)滋阴法的形成源于哲学,始于《内经》。其形成与发展与特定的时代背景、地理、人文相应。滋阴法的哲学渊源可以追溯到易经和宋明理学,《归藏易》《连山易》中的重阴思想,是滋阴法的最初渊源。而医学渊源,则始于《黄帝内经》,发扬于《伤寒论》和金元时期,并在明清进一步深入。(2)滋阴法作为临床常用的治疗方法,其用药规律和特色随时代而不断完善:仲景根据"伤阴"的病因、病机,创立了许多滋阴生津的大法和名方。河间、丹溪开寒凉、滋阴一派,并创制知柏地黄丸等滋阴降火剂,开后世滋阴泻火之滥觞,及至张景岳的左归丸,戴思恭的"辛燥伤阴"说使养阴法进一步发展,清代温病大家吴鞠通、叶天士不仅善于外感温病的治疗,亦创制了甘寒养阴法和复脉汤等系列方剂。(3)刘燕池教授的滋阴思想有家学、师承、私淑等相关,并注重分层次分脏腑论治,提出阴虚多肝肾阴虚和肺胃津伤病机。刘燕池教授的滋阴思想有家学、师承和私淑的渊源,在继承与发展的基础上,因时、因地、因人地指出滋阴法对于京城疾病谱系的适用性,并提出阴虚多伤及肝肾肺和胃咽等,滋阴多分脏腑施治。肺胃阴虚喜用沙参、麦冬、生石斛,而肝肾阴虚多用生地、玄参、山茱萸等。具体而言,滋肺阴常用沙参、麦冬、百合、玉竹,养心阴多用麦冬、百合,养肾阴可用生地、元参、天冬、枸杞,肝阴虚多为血虚,治疗以四物汤汤为基础方。刘燕池教授学术思想有家学肝病重清化的思想、师承刘奉五妇科"瓜石汤"等养阴凉血清热的思想渊源。另外,刘老私淑丹溪、吴鞠通等滋阴泻火、甘寒养阴的思想,可以看出,刘老师基于北京疾病谱系下传承与发展的滋阴法的用药规律和特色是有学术渊源和理论依托的。(4)基于中医传承辅助平台挖掘刘燕池滋阴用药规律符合刘老师力主滋阴清热、凉血生津法而取效,并且与其倡导的阴虚多肝肾肺胃虚损病机的用药规律所吻合。以刘燕池教授2015年全年内科门诊病历为基础,基于"中医传承辅助平台系统(V2.5)构建处方数据库,采用软件方剂统计等模块,分析刘燕池教授处方用药基本特点,结果如下:刘燕池处方用药以寒性药为主,即使温补也多以温性为主,少用热性,五味则以苦、甘和辛味药居多,符合甘寒养阴法和甘淡实脾的思想,与刘燕池教授滋阴清热思想特点相吻合;药物归经以肝经和肺胃经为主,其间脾胃经尤为突出,体现出刘老师滋阴不忘顾护脾胃,及清热药多入胃经,及近些年在诊疗过程中对于脾胃的重视。
[Abstract]:During the three years of post-graduate master's degree study, Professor Liu Yanchi has been at the side of waitresses. Professor Liu Yanjing medical school uphold the academic thought of the three factors under the guidance of thinking, combined with Beijing unique geographical and cultural environments, inherited the ancient inheritance, based on the Fengwu and Liu family, formed a diagnosis, characteristics and medication rules for medical treatment. In the treatment process, pay attention to the body of Yin fluid nursing care, many of the method of Nourishing Yin, in clinical, and treatment process, all kinds of, the effect quite patient identity. In order to dig the Yin thought, this paper the research from the following aspects: the first part, from the origin of philosophy and medicine origin two aspects, introduces the theoretical origin of nourishing yin. Focuses on the philosophical origin of the ancient three, which in addition to the other two book < > - < < > Guizhang Yi, Caroline Yi > in the heavy overcast Thought is the origin of nourishing yin. In addition, the Neo Confucianism especially the "Qi" theory also has a great influence on later generations. The medical "justice" point of view, since the Zhu Danxi led directly to a medical sources of Yin. The roughly from down, according to the age are introduced and from Zhongjing theory play on Nourishing Yin to nourishing Yin in Jin and Yuan Dynasty, the maturity of the thought, to further deepen the later period of the Ming and Qing Dynasties, we can see clearly the theory of inheritance. In the second part, nourishing Yin as a clinical diagnosis and specific treatment method, all physicians in a certain historical background, specific in the treatment for human diseases under the guidance of yin and Yang syndrome. With nourishing Yin, the doctors for the use of specific drugs also have their own characteristics. This paper from Zhongjing, Hejian, Dan and Zhang Jingyue's disease, Wen sent Wu Jutong, leaves Two days, starting with the analysis of the specific characteristics of successive drug Ziyin them. In the third part, Professor Liu Yanchi, national famous doctors, the academic thoughts of home school of thought from the ill liver clearing, Liu Fengwu gynecological "GUASHITANG Decoction" Nourishing Yin blood heat the thought origin, in addition, Liu Lao thought Dan Xi, Wu Jutong. His father Liu Yuchu had male waitresses Beijing four doctors Xiao Longyou side, Liu Fengwu is also the capital of Korea. After his yizhai this chapter focuses on the teacher Liu drug law and characteristics of nourishing yin and development of the heritage of Beijing on the basis of the disease spectrum. In the fourth part, to discuss the rule of clinical medication Liu Yanchi medical clinic, by Professor Liu Yanchi in 2015 the year of outpatient medical records as the basis of TCM inheritance auxiliary system based on "(V2.5) to construct prescription database software using prescription statistics module, Professor Liu Yanchi analysis of prescription 鑽�鍩烘湰鐗圭偅�

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