周仲瑛教授基于脏腑病机辨治常见消化系统疾病经验研究

发布时间：2018-03-17 08:34

  本文选题：病案回顾性分析　切入点：数据挖掘　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：首批国医大师周仲瑛教授主张临证应"活化辨证",强调辨证应首重病机,提出"病机十三条",构建了"中医病机辨证新体系",基本思路是"以病理因素为纲,脏腑理论为基础",表明辨识脏腑病机是临床辨证的重要内容,充分体现周仲瑛教授从中医整体观出发,认为五脏六腑实为一个整体,其内涵包括五脏相关、脏腑表里、脏腑同治等多个方面。本研究以周仲瑛教授辨治四种常见消化系统疾病为例,总结其重视脏腑病机进行辨证论治的临床经验。研究目的:以周仲瑛教授临床病案为研究对象,通过数据挖掘分析与研读典型病案的方法,探讨周教授基于整体观,运用脏腑病机相关理论,倡导"脏腑同治"法治疗消化系统四种常见疾病(肝硬化、胆石病、慢性胃炎、慢性结肠炎)的临床经验。研究方法:在周仲瑛教授工作室病案数据库资料的基础上,筛选、清洗常见的消化系统疾病病案,严格按照诊断与排除标准,将符合要求的600例病案纳入研究范围并建立新的数据库,包括有肝硬化、胆石病、慢性胃炎、慢性结肠炎四个西医疾病。借助数据统计分析软件着重对病案的病机、脏腑病位、处方用药、药物归经、处方配伍等进行分析,采用频数统计、复杂网络核心成分分析、关联规则等方法,以及人机结合、病案研读,客观总结周仲瑛教授在治疗常见消化系统疾病方面的临床经验。研究结果:(1)一般情况:四种疾病各150例病人,其性别人数及平均年龄分别为:肝硬化患者男性104例,女性46例,平均年龄(46.90±12.83)岁;胆石病患者男性58例,女性92例,平均年龄(49.92±13.75)岁;慢性胃炎患者男性60例,女性90例,平均年龄(47.14±14.13)岁;慢性结肠炎患者男性80例,女性70例,平均年龄(40.27±13.51)岁。(2)病机分布:600例病案中涉及病机描述261种,较为常见的脏腑关系病机有:肝胃不和(103次)、肝脾两伤(79次),肝胆疏泄失司(72次),肝胆湿热(56次),腑气失调(49次),肝郁脾虚(31次),肝脾不调(30次)等。(3)药物归经分布:600例病案共出现药物331种,其中肝硬化的治疗用药归经主要以肝、脾经为主(84.4%),胆石病的治疗用药归经主要以肝、胆经为主(78.3%),慢性胃炎的治疗用药归经主要以脾、胃经为主(89.7%),慢性结肠炎的治疗用药归经主要以肝、脾、胃、肠经为主(88.1%)。(4)常用核心方剂:治疗肝硬化时,常选用茵陈蒿汤、鳖甲煎丸、犀角地黄汤、茵陈四苓汤、一贯煎、六味地黄丸、己椒苈黄丸等;治疗胆石病时,常选用四金散、大柴胡汤、柴胡疏肝散、逍遥散、半夏厚朴汤、左金丸等;治疗慢性胃炎时,常选用四君子汤、(香砂)六君子汤、左金丸、二陈汤、沙参麦冬汤、橘皮竹茹汤、(黄连)温胆汤等;治疗慢性结肠炎时,常选用乌梅丸、赤石脂禹余粮丸、参苓白术散、二妙丸、交泰丸、木香槟榔丸、痛泻要方等。(5)关联规则结果:通过关联规则分析常见脏腑病机与药物之间的关系,如与肝肾亏虚病机有关的药物有女贞子、旱莲草、枸杞子等。研究结论:(1)周教授从整体观、复合病机出发,认为五脏六腑为一整体,重视脏腑病机相关,结合病理因素,以"脏腑同治"法辨治常见消化系统疾病。(2)治疗肝硬化时,抓住肝脾病机为核心,重视通腑,配合利胆、和胃、理肠等治疗思路。治疗胆结石时,主要以疏肝利胆排石为主,常选方剂四金散和大柴胡汤,佐以调理脾胃与肠的功能。治疗慢性胃炎时,从气机角度出发,调理脾胃气机,重视肝胆气机。治疗慢性结肠炎时,肝脾肠同治,兼顾其他脏腑。(3)在病机的描述中,周教授常采用脏腑病位与病理因素相结合的形式,如肝胆湿热等,选方用药在兼顾脏腑归经的前提下,针对病理因素,复法组方。(4)重视顾护脾胃功能,在消化系统不同疾病中均有用药体现。
[Abstract]:The first batch of Chinese medicine master professor Zhou Zhongying advocated the clinical "activation" syndrome differentiation, syndrome differentiation should first emphasize ill machine, put forward the "pathogenesis thirteen", to build a new system of TCM syndrome differentiation, the basic idea is "to the pathological factors as the key link, based on the theory of viscera", shows that the identification of viscera pathogenesis is important the content of clinical syndrome, fully embodies the holistic concept of traditional Chinese medicine Professor Zhou Zhongying from the view that the viscera is a whole, its connotation includes the correlation of five viscera table, and multiple organs Tongzhi etc. in this study by Professor Zhou Zhongying treating four common diseases of the digestive system as an example, to summarize the clinical experience of the viscera pathogenesis syndrome the treatment. Objective: To study clinical professor Zhou Zhongying as the research object, method of analysis and study of typical cases through data mining, based on the overall view of Professor Zhou, the viscera pathogenesis theory, advocate "viscera Tongzhi "method in the treatment of digestive system of four kinds of common diseases (liver cirrhosis, cholelithiasis, chronic gastritis, chronic colitis). Methods: the clinical experience of screening based on Professor Zhou Zhongying studio record database data, cleaning, the common disease of digestive system of medical records, in strict accordance with the diagnosis and exclusion criteria, will meet the requirements of the medical records of 600 cases into the scope of the study and the establishment of a new database, including cirrhosis, cholelithiasis, chronic gastritis, chronic colitis four western medicine disease. By means of statistical analysis software on the pathogenesis of medical records, viscera disease, prescription drugs, prescription drugs go through, such as analysis, using frequency statistics, analysis of complex network core composition, association rules method, and case study, the objective of man-machine combination, summarize the clinical experience of Professor Zhou Zhongying in the treatment of common diseases of the digestive system. The results of the study: (1) general 鍐，

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