王文友老师学术思想与临床经验总结及从少阳论治代谢综合征的理论与临床研究

发布时间：2018-01-01 20:16

本文关键词：王文友老师学术思想与临床经验总结及从少阳论治代谢综合征的理论与临床研究　出处：《北京中医药大学》2017年博士论文　论文类型：学位论文

【摘要】：本论文主要分为三个部分。第一部分追溯了王文友老师的学术渊源。王老自少年时代即立志从医,通过对《黄帝内经》等经典著作的研究,奠定了深厚的中医理论基础,并树立了脾胃为后天之本、升降之枢,肝脾密切相关,湿热源自脾土等学术观点。成年后王老至京行医、学习,师从伤寒大家,深受仲景学术思想的影响,注重方证对应,强调顾护脾胃,治肝兼顾体用,善用经方苦辛药法治疗湿热病证。此后王老又随肝病名家工作,愈加重视治肝脾、调气机、祛湿热,阐释诸病多从肝脾立论,常用柴胡剂施治,对肝胆脾胃疾患积累了丰富的治疗经验。通过博览医籍和积极实践,王老在妇科、儿科、皮科等学科的诊疗中也形成了自身特色和专长,在临床医疗、科研和师承教育等多个领域都取得了丰硕的成果。第二部分首先对王文友老师"保脾胃,调肝气,祛湿热"的学术思想进行了概括阐述。王老认为脾胃是化生气血,调畅气机的关键,易为饮食、劳倦、情志所伤,治疗要点在于消除阻滞,恢复升降。对肝病的诊治,王老则提出应根据体、用矛盾的变化动态调整治法,临床常肝脾二脏同治。王老还指出湿热致病日益广泛,祛邪之法重在调理中焦气机,兼以疏利肝胆。在理论探讨之后,对王老辨治脾阴虚证和其它9种病症的经验做了具体总结。脾阴虚证可致运化失常、濡养不足和血失统摄,在面、唇、舌、脉等各方面有特征表现,用药多选甘平、甘凉,佐以健脾补气之品。慢性胃炎以肝胃不和为基本病机,王老通过观苔、按腹辨其虚实,治疗以疏肝降逆,和胃消积为原则。肝囊肿的病机为肝郁脾虚,血瘀水停,治疗当疏肝健脾,活血利水,临床随机对照研究显示验方王氏疏肝消囊汤可使肝囊肿缩小,症状改善,抑制囊肿生长,效果优于西药对症治疗。肝硬化腹水发生于肝病晚期,不但肝体受到损伤,且病变已累及于肾,故当用一贯煎为基础方滋水涵木,柔养肝肾。胆囊炎发病源于肝失疏泄,胆失通降,辨证可分虚实两端,治实证用疏肝利胆之法,治虚证则疏补兼施,通过望诊目睛可未病先防,对合并胆囊结石、胆囊息肉者亦有经验用药。失眠一病王老多从肝论治,以和解少阳,祛邪调气,通降六腑为法,用小柴胡汤加减为基础方。王老对心律失常的辨治取法《伤寒论》方证对应,药物用量遵循经典,对预后的判断则参考脉诊。月经来源于肾中天癸,其正常来潮有赖于五脏功能的协调,故治闭经虚证用补肾健脾,调和五脏之法,治实证则活血疏肝,祛邪通经,对用疏肝药物调整月经周期亦有心得。小儿具有肺、脾、肾三脏不足的生理特点,易因食积而患咳嗽,王老以葶苈丸化裁验方泻肺消积,并总结了多个宿食积滞的望诊要点。湿疹病由内外合邪而发,治疗需辨别血热、风盛、湿淫为患孰轻孰重,王老多用藿朴夏苓汤为基本方以祛湿疏表。论文的第三部分从少阳角度对代谢综合征治疗进行集中探讨。内容包括文献综述,少阳理论阐释,少阳病验方柴胡三仁汤的方证研究及其治疗代谢综合征的临床观察。文献综述回顾了代谢综合征的研究概况和近10年来的进展,指出该病的现代医学研究以对病因和发病机制的探讨为热点,中医学者则对临床治疗更为关注。中医药多途径、多靶点的治疗作用能同时纠正代谢综合征的多种代谢紊乱,与西医学针对各个组分的治疗相比,具有一定的优势和发展前景。对少阳理论的阐释涉及其内涵意义、生理功能和病理特点。联系代谢综合征的病因、病机、病位,得出了该病可从少阳论治的结论并提出了该法的优势所在。对少阳病验方柴胡三仁汤的方证研究采用回顾性方法,将145例医案纳入统计,分析症状、舌脉、柴胡剂量、加味药物。结果显示,该方证的主症为小便短黄、大便粘滞、胁胀、脘痞、口苦、思凉、形体肥胖,兼症为咽痰不利、纳呆、头晕、呃逆、多梦、耳鸣、身重、嗜睡。典型舌象为淡红舌,薄黄腻苔。典型脉象为弦滑脉。常用柴胡剂量为20g,多以化湿药、清热药、活血化瘀药、消食药、理气药、泻下药、补虚药等加味。由此总结出柴胡三仁汤证的病机为少阳气郁,湿热蕴结。临床观察通过随机对照方式检验了柴胡三仁汤对代谢综合征的疗效。选择符合2005年IDF诊断标准和中医湿热困脾证辨证标准的代谢综合征患者共70例,按随机数字表法分为对照组、治疗组各35例。在改善生活方式基础上,对照组口服盐酸吡格列酮片15mg,每日一次。治疗组服用柴胡三仁汤中药配方颗粒,每日1剂。共治疗12周。观察治疗前后两组在腹型肥胖、糖脂代谢、静息心率和血压、炎症指标和中医症状分级量化积分等方面的改变。共66例患者完成治疗,两组患者的空腹血糖、空腹胰岛素、胰岛素抵抗指数、胆固醇、甘油三酯、低密度脂蛋白、C反应蛋白、中医症状积分都显著降低。治疗组在改善腹型肥胖、降低胆固醇、甘油三酯和低密度脂蛋白、提升高密度脂蛋白、控制静息血压和心率、改善证候等方面优于对照组。中医疗效评价中,治疗组显效率72.7%,有效率27.3%,对照组有效率63.6%,两组差异显著。两组治疗依从性和不良事件无统计学差异。结果表明从少阳论治代谢综合征理论确有临床指导意义,提示其作用机制与抑制交感神经的兴奋性有关,或涉及神经反射、神经内分泌途径。
[Abstract]:This thesis is mainly divided into three parts. The first part traces the academic origin of Wang Wenyou teacher. Wang Lao from the youth that wanted a doctor, through the study of "Huangdi Neijing classics > etc., laid a solid theoretical foundation of traditional Chinese medicine, and set up the spleen and stomach for the day after tomorrow, lifting the pivot and close the wet heat from the spleen, such academic point of view. The adult Wang Lao Beijing to practice, learn from typhoid everyone, deeply influenced by Zhang Zhongjing's academic thought, pay attention to that formula corresponding to syndromes, treatment of liver and spleen and stomach with both bitter medicine, use by law treatment of damp heat syndrome with liver disease. Then Wang Lao and famous work, pay more attention to treatment of liver and spleen, regulating qi, dispelling dampness and heat, the interpretation of disease from liver and spleen theory, common Bupleurum treatment, has accumulated rich experience in the treatment of liver and spleen diseases. The Expo medical books and actively practice, Wang Lao in the Department of Gynecology, pediatrics, dermatology, etc. The diagnosis and treatment, also formed its own characteristics and expertise in clinical care, many areas of scientific research and teacher education has made great achievements. The second part of teacher Wang Wenyou Paul regulating liver qi, spleen and stomach, dampness heat "academic thoughts are summarized. The old king that is the spleen and stomach qi and blood the key, regulating qi, easy for diet, overstrain, hurt by emotion, treatment is to eliminate the block, restore lift. Diagnosis and treatment of liver disease, Wang Laoze should be put forward according to body, with dynamic adjustment method of contradiction, clinical liver and spleen two dirty Tongzhi. Wang Lao also pointed out that damp heat pathogen widely, eliminating the by focusing on conditioning air focus, and to disperse the hepatobiliary. In theoretical study, on Wang Lao's treatment of spleen yin deficiency and other 9 kinds of illness experience specific summary. Spleen yin deficiency can cause the transport of disorders, nutrition deficiency and blood loss in the prostate, face, lips, tongue, pulse The medicine has the characteristics which gamping, Ganliang, accompanied by spleen Qi of chronic gastritis. In liver and stomach is the basic pathogenesis of Wang Lao, through the view of moss, to identify the actual situation in the treatment of abdominal, liver and stomach Jiangni, Xiaoji principle. The pathogenesis of hepatic cyst of liver stagnation and spleen deficiency stop, blood stasis and water treatment, when the liver and spleen, promoting blood circulation and diuresis, randomized clinical study showed that the prescription Shugan Wang xiaonang Tang can make liver cysts, improve symptoms, inhibition of cyst growth, better than western medicine treatment. Liver cirrhosis ascites occurred in patients with end-stage liver disease, not only liver damage, and has been involved in the renal lesion therefore, when using the Yiguanjian basic prescription for nourishing kidney and liver, liver and kidney. A soft cholecystitis from the liver and bile loss of Tongjiang, differentiation can be divided and ends with the method of empirical treatment of shuganlidan, treatment of deficiency is sparse supplementation, by which the eye can prevent disease before the merger, gallbladder Stones, gallbladder polyps are also experience insomnia medication. A disease more than the old king from the liver, in Shaoyang, Quxie gas regulation Tongjiang quickly for law, with Xiao Chaihu Tang based on arrhythmia. Wang Lao's method "Treatise on Febrile Diseases > prescription corresponding drug dosage, follow the classic. The prognostic reference pulse. Menstruation from the kidney meridian decanoate, coordinate the normal cramps depends on the function of internal organs, so the treatment of amenorrhea of deficiency of kidney and spleen, and the five internal organs, empirical treatment of Huoxue Shugan, eliminating menstrual flow, also experience to adjust the menstrual cycle. Liver drugs in children with lung and spleen. The physiological characteristics of the kidney three dirty insufficient, and easy to cough due to indigestion, Wang Lao cut prescription pill Tinglizi xiefei Xiaoji, and summarizes the inspection points places dyspepsia. Eczema by internal and external evil. The treatment needed to identify blood heat, wind Sheng, wet with the pros and cons, old king Using huopuxialing Decoction to eliminate dampness and sparse table. The third part of the thesis from the perspective of Shaoyang syndrome treatment focuses on metabolism. The content includes literature review, theoretical explanation of Shaoyang, research and clinical observation on the treatment of metabolic syndrome shaoyang disease prescription Bupleurum Sanren decoction. Review of research the metabolic syndrome and in the past 10 years, it is pointed out that modern medical research of this disease to explore the etiology and pathogenesis of traditional Chinese medicine for the hot spots, scholars pay more attention to the clinical treatment of traditional Chinese medicine. In many ways, the treatment effect of multiple targets at the same time can correct multiple metabolic disorders and metabolic syndrome, and the west medical treatment for each component compared, has certain advantages and development prospects. The connotation of Shaoyang relates to the explanation of the theory, the physiological and pathological characteristics of metabolic syndrome. Etiology, pathogenesis, disease A, the disease on the treatment results from the Shaoyang and puts forward the advantage. Research of shaoyang disease experience Fang Chaihu soup Sanren by a retrospective study, 145 cases were included in the statistical analysis, symptoms, tongue and pulse, bupleurum dose, added drugs. The results showed that the main symptoms of the syndrome to urinate short yellow, sticky stool, abdominal distension, abdominal distension, pain, thinking of cold, body fat, and disease for pharyngeal sputum negative, anorexia, dizziness, tinnitus, hiccup, dreaminess, body weight, sleepiness. Typical of the tongue is pale red tongue, thin yellow greasy fur. Typical pulse string slippery pulse. Bupleurum the dose of 20g, with the wet medicine, antipyretic, blood stasis, digestion medicine, Qi medicine, diarrhea medicine, tonic medicine etc.. It summed up the pathogenesis of modified Bupleurum Sanren Decoction syndrome for Shaoyang qi stagnation, damp heat accumulation. Clinical observation on the therapeutic effect of bupleurum root test Sanren Decoction on metabolic syndrome by with 200 random control. 5 years IDF diagnosis criteria and TCM damp spleen syndrome criteria of metabolic syndrome patients with a total of 70 cases were randomly divided into control group and treatment group with 35 cases in each group. In the improvement of life style on the basis of control group were treated with Pioglitazone Hydrochloride Tablets 15mg, once a day. The treatment group taking Bupleurum Sanren Decoction prescription of traditional Chinese medicine 1 particles, agent a day. The treatment lasted 12 weeks. To observe the two groups before and after treatment in abdominal obesity, lipid metabolism, resting heart rate and blood pressure, inflammation index and TCM symptom classification of quantitative points has changed. A total of 66 patients completed the treatment, two groups of patients with fasting blood glucose, fasting insulin, insulin resistance index, cholesterol, triglyceride, low density lipoprotein, C reactive protein, TCM symptom score were significantly decreased. The treatment group decreased cholesterol in improving abdominal obesity, triglyceride and low density lipoprotein, high density lipoprotein increase, resting blood pressure control And heart rate, improve syndrome than the control group. Clinical evaluation of Chinese medicine, the treatment group was 72.7%, efficiency was 27.3%, the effective rate of control group 63.6%, two groups had significant difference. No significant differences between the two groups of treatment compliance and adverse events. The results show that the treatment of metabolic syndrome theory has clinical significance from the theory of Shaoyang that, its mechanism and inhibition of sympathetic nerve excitability, or involving nerve reflex, neuroendocrine pathway.

【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R249;R259

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