栗德林教授学术思想与临床经验总结及自拟连夏芪麦汤治疗慢性非萎缩性胃炎寒热错杂证的临床研究

发布时间：2018-05-29 00:44

本文选题：寒热错杂证 + 连夏芪麦汤　；参考：《北京中医药大学》2017年博士论文

【摘要】：栗德林教授,主任医师,博士生导师,国家级名老中医。自幼因父亲和自己患病立下医学梦,考入黑龙江中医学院,秉承龙江医派学术教育,研读古籍,深受《黄帝内经》、《伤寒论》、《脾胃论》、《丹溪心法》、《医宗金鉴》、《温热论》、《医林改错》等影响,从师于马骥教授,聆听名师教诲,夯实了中医基础,积累了临床经验,逐渐形成了自己独具特色的学术思想。总结栗德林教授学术思想如下:1固本求源,注重脾肾:在内伤杂病论治中,要固护脾肾正常的生理功能,充分重视脾、肾二脏在疾病发生、发展和防治衍变中的作用,采取针对性治疗策略。2寒热多态,顺逆平调:寒热错杂证具有多态性,对其治疗除寒热并用、调和阴阳方法,还要根据内在病机,采用或因势利导或逆势而行的治疗方法。3病证结合,主抓病理:针对传统中医无证可辨的情况,只有抓住西医病理特点,探究中医病机本质,辨病与辨证相结合,摸索规律,才能确立治疗法则,遣方用药。4中西并举,注重药理:在中医辨证论治原则基础上,结合现代西医药理研究成果,从临床疗效、药效机理等方面开展中西并举的研究,是时代发展的需要。总结栗德林教授具有代表性的临床诊疗经验,并附典型医案。1慢性萎缩性胃炎:多属中医"痞满",病因有脾胃素虚、饮食失宜、情志所伤、久病劳倦等,病机为脾胃亏虚、气机壅塞、升降不利,主要证型为寒热错杂证,研制延参健胃胶囊,汤药用半夏泻心汤合扶正驱邪之品。提出固定方药是治疗的发展趋势,注重脾胃养护。2糖尿病及其并发症:"消渴"相当于西医糖尿病,病因病机为"五脏柔弱、内热熏蒸、伤津耗气、血稠液浓","气阴两虚和血滞不畅是贯穿糖尿病全过程的基本病理变化",立"益气养阴、清热生津、活血化瘀"基本治法,研制芪黄消渴胶囊,汤药用自拟芪连葛参汤。"瘀阻痰凝"并发冠心病,研制芪玄益心胶囊。"蓄浊失精"并发糖尿病肾病,研制麦地参肾消胶囊。"瘀塞毒壅"并发糖尿病足,研制降糖解毒胶囊。并发周围神经病变,按五体痹辨治。并发胃轻瘫表现痞满者,合半夏泻心汤加减治疗等。3类风湿关节炎:总属"痹证",日久属"历节"。病因病机早期因营卫失和,腠理不密,风寒湿热等邪气乘虚而入,病久则邪入脏腑、痰瘀交结、正气受损。治疗早期宜驱邪通络、调和营卫并重。病久则以扶助正气为主,驱邪通络为辅。基本方用自拟二龙蠲痹汤。4外伤后癫痫:属"痫证"范畴,致病因素有瘀血阻窍、痰浊蒙窍,肝风内动易引发作。常合并肢体不遂,初期为血瘀气滞,病久则气虚血瘀。以活血化瘀通窍、逐痰豁痰开窍、平熄内动肝风为基本法,辅以益气活血通络。治疗常用通窍活血汤、礞石滚痰丸、黄芪桂枝五物汤,善加治肝平木熄风之品。5温热病:卫气营血辨证最重要的是气分阶段,此"气"指的是宗气,气分证是宗气生理功能失常所造成的一系列病理变化。把握气分证,及时甚至提前施药,"清气"不使邪气传营入血,是治疗温热病提高疗效、缩短病程的关键。栗德林教授善治脾胃病,近年来治疗CNAG,除采用辛开苦降、调理脾胃法,常加益气养阴、活血化瘀之品,临床疗效较好。为了客观评价栗教授治疗慢性非萎缩性胃炎寒热错杂证的临床疗效,本课题将栗教授常用方剂整理总结,进行了临床研究。首先整理文献综述如下:西医尚未阐明CNAG发病机制,治疗以对症为主。对CNAG→CAG→PLGC→胃癌演变模式达成共识,但无有效治疗手段。中医对CNAG病因认识一致,病机和辨证分型未统一,治疗总体效果优于西药。开始重视CNAG→胃癌演变模式的研究,但尚未达成共识。目前治疗多局限于CNAG阶段的随证辨治,对CNAG→胃癌预防治疗应用很少。其次总结汇报自拟连夏芪麦汤治疗慢性非萎缩性胃炎寒热错杂证的临床研究。目的:观察栗德林教授常用自拟方剂连夏芪麦汤治疗慢性非萎缩性胃炎寒热错杂证的临床疗效,以及深入挖掘其学术思想。方法:按照1:1随机分组原则,将88例患者分为治疗组、对照组各44例。试验结束每组各有4例脱落,每组各完成40例。治疗组:予栗德林教授临床常用基本方连夏芪麦汤治疗。对照组:口服六味安消胶囊。两组均治疗8周。观察指标为两组治疗前、后痞满等症状、胃镜检查分级情况、Hp感染情况。结果:治疗组中医证候疗效总有效率92.5%,对照组75%,有统计学意义。两组治疗后证候积分均较前明显下降,有显著统计学意义,但治疗组明显优于对照组。治疗组CNAG疾病疗效总有效率80%,对照组62.5%,有统计学意义。两组治疗后胃镜检查分级情况,有统计学意义,治疗组优于对照组。两组治疗后Hp阳性率,无统计学意义。结论:栗德林教授连夏芪麦汤不仅能够明显改善CNAG寒热错杂证的症状,获得很好的中医证候疗效,而且能够改善胃镜下胃黏膜病变,使其痊愈或好转。但本课题未显示连夏芪麦汤对Hp有杀灭作用。本课题挖掘了栗教授治疗CNAG寒热错杂证的学术思想,提出CNAG发生发展的根本原因是脾胃气阴两虚,且贯穿始终,造成寒热错杂多见,最终导致阴虚加重、瘀血内阻、甚至恶变。CNAG核心病机为"气阴两虚、寒热错杂",确立"辛开苦降、益气养阴"为主、"活血化瘀"为辅的治法,为临床治疗CNAG提供了新的思路,也可能为防治CNAG→胃癌发展演变提供了新的思路。通过本课题证实了栗德林教授寒热并用治疗脾胃病学术思想和"治未病"学术思想的有效性和实际应用价值。创新观点:首次挖掘提炼栗德林教授治疗CNAG寒热错杂证的学术思想:将"治未病"思想应用于CNAG,提出脾胃气阴两虚是发生、发展的根本原因,是贯穿始终的病理变化,逐渐加重可导致阴液大亏、瘀血内阻、蕴毒恶变。寒热错杂证是脾胃气阴两虚引发的表现形式,临床最为常见。提出核心病机为"气阴两虚、寒热错杂",制定了 "辛开苦降、益气养阴"为主针对CNAG、"活血化瘀"为辅防止进展的治疗方法和预防策略,分析了连夏芪麦汤的组方特点。提出CNAG寒热错杂证的治疗应重视CNAG发生、发展、演变的全过程,辛开苦降和益气养阴、活血化瘀法同用。本课题为临床治疗CNAG提供了新的思路,也可能为防治CNAG →胃癌发展演变提供了新的思路。
[Abstract]:Professor Li Delin, chief physician, doctorate tutor, national famous old Chinese medicine. Since his father and his own illness, he was admitted to the Heilongjiang College of traditional Chinese medicine, accepted the academic education of Longjiang medical school, studied the ancient books, was deeply influenced by the Huangdi Neijing, the theory of typhoid, the theory of spleen and stomach, the heart law of Dan Xi, the thermo heat theory, the medical forest error, and so on. Professor Ma Ji, Professor Ma Ji, listened to the teachings of the famous teacher, rammed the foundation of traditional Chinese medicine, accumulated the clinical experience, and gradually formed his own unique academic thought. The academic thought of Professor chestin was summarized as follows: 1 solid source and spleen and kidney: in the treatment of internal injuries, the normal physiological function of the spleen and kidney should be fixed, the spleen and the two organs of the kidney were paid full attention to the disease. The function of birth, development and prevention and control evolution, adopt the targeted treatment strategy.2 cold and heat polymorphism, smooth and reverse adjustment: the syndrome of cold and heat confusion is polymorphic, the treatment of cold and heat, the use of cold and heat, the method of regulating yin and Yang, and the combination of the internal disease machine, the combination of the treatment method of.3 disease, or the use of the potential guidance or the adverse potential, and the pathology of the traditional Chinese Medicine To distinguish the situation, only by grasping the pathological features of Western medicine, exploring the essence of the pathogenesis of traditional Chinese medicine, combining disease identification with syndrome differentiation, and exploring the law, can we establish the rule of treatment, take the medicine of.4 and pay attention to pharmacology: on the basis of the principle of TCM syndrome differentiation and treatment, combined with the pharmacological research results of modern western medicine, to carry out the Chinese and Western medicine from the clinical effect and the mechanism of drug effect. The research in the same way is the need of the development of the times. It is a summary of the representative clinical diagnosis and treatment experience of Professor chestin and the typical medical case.1 chronic atrophic gastritis. Many of them belong to the "ruffian" of traditional Chinese medicine. The cause is the deficiency of the spleen and stomach, the discomfort of the diet, the injury of the mood, the long illness, the deficiency of the spleen and stomach, the congestion of the Qi and the detrimental rise and fall, the main syndrome type is the cold and heat error. The development trend of the treatment is fixed prescription medicine, which pays attention to the maintenance of.2 diabetes and its complications: "Xiaoke" is equivalent to western medicine diabetes. The etiology and pathogenesis are "five dirty weak, internal heat fumigation, injury of Qi consumption, thick blood liquid", "Qi Yin deficiency and blood stagnation" Through the basic pathological changes of the whole process of diabetes, the basic treatment of Qi and nourishing Yin, clearing heat and nourishing blood, promoting blood circulation and removing stasis is the basic treatment, the Qi Huang Xiaoke Capsule is developed, the decoction of Qi Lian Ge Shen decoction is prepared with the stasis of stagnation of phlegm coagulating with coronary heart disease, and the Qi Xuan Yixin Capsule is developed. Diabetic foot, the development of Jiangtang detoxification capsule. Complicated peripheral neuropathy, according to the five body syndrome differentiation and treatment. Complicated with gastric hemiplegia, combined with Banxia Xiexin Decoction and the treatment of.3 rheumatoid arthritis: the general genus "Bi syndrome", a long term "calendar". In the early period of treatment, it is advisable to drive evil to collaterals and coordinate with the camp and Wei. For a long time, it is mainly to help the Zheng Qi, and to exorcise the collaterals and collaterals for the auxiliary. The basic prescription is to draw up the epilepsy of.4 after the two dragon Juan Bi soup. It belongs to the category of "epileptic syndrome", the pathogenic factors include blood stasis, phlegm and the orifices and the internal movement of the liver. Qi stagnation, Qi deficiency and blood stasis for a long time. The basic law is to promote blood circulation and dissipate blood stasis, make phlegm and open the phlegm to open the orifices, adjust the internal movement of the liver wind as the basic law, supplemented by qi activating blood circulation and dredging collaterals. It is used to treat the commonly used Tongqiao activating blood circulation soup, the stone rolling phlegm pills, the Astragalus cinnamon branch five substances soup and the good treatment of the liver flat wood extinguishing wind: the most important phase of the Qi Qi camp blood syndrome differentiation is the Qi "Qi" refers to Zong Qi and Qi syndrome are a series of pathological changes caused by the abnormal function of Zong Qi. It is the key to treat the disease of spleen and stomach to cure the spleen and stomach disease. In recent years, Professor chestin is good at treating the spleen and stomach disease and treating CNAG. In order to objectively evaluate the clinical efficacy of Professor chestnut in the treatment of chronic non atrophic gastritis, the clinical study of Professor Chestnut's common prescription is summarized and the clinical study is carried out. First, the literature review is summarized as follows: Western medicine has not yet elucidated the pathogenesis of CNAG and the treatment is mainly symptomatic. To C NAG - CAG - PLGC - gastric cancer evolution model reached consensus, but there was no effective treatment. Traditional Chinese medicine was unanimous to the etiology of CNAG, the pathogenesis and syndrome differentiation were not unified, the overall effect of the treatment was better than western medicine. It began to pay attention to the study of CNAG to gastric cancer evolution mode, but no consensus had been reached. At present, the treatment and treatment are mostly limited to the identification and treatment of the CNAG stage, and CNAG The application of the prevention and treatment of gastric cancer is very few. Secondly, we summarize the clinical study of Lian Xia Qi Mai Decoction in the treatment of chronic non atrophic gastritis. Objective: To observe the clinical effect of Professor chestlin in the treatment of chronic non atrophic gastritis with cold and heat syndrome in the treatment of chronic non atrophic gastritis, and to dig out its academic ideas. According to the principle of random grouping of 1:1, 88 patients were divided into treatment group and 44 cases in control group. 4 cases in each group were separated and 40 cases were completed in each group. The treatment group was treated by Professor Li dlin's clinical commonly used basic prescription Lian Xia Qi Mai decoction. The control group was treated with six taste Anxiao capsules. The two groups were treated for 8 weeks. The observation indexes were two groups before treatment, and after the fullness of the posterior ruffian. Symptoms, gastroscopy classification and Hp infection. Results: the total effective rate of TCM syndrome in the treatment group was 92.5%, and the control group was 75%. The scores of the two groups were significantly lower than those in the former, but the treatment group was significantly better than the control group. The total effective rate of CNAG disease in the treatment group was 80%, and the control group was 62.5%. There were 62.5% of the control group. Statistical significance. The classification of gastroscopy after treatment in the two groups was statistically significant. The treatment group was better than the control group. The positive rate of Hp in the two groups was not statistically significant. Conclusion: Li dlin Lian Xia Qi Mai decoction can not only improve the symptoms of CNAG cold and heat syndrome obviously, get good TCM syndrome effect, but also can improve the gastroscope under the gastroscope. But this topic did not show the effect of Lian Xia Qi Mai Decoction on Hp. This subject excavated the academic thought of Professor Chestnut's treatment of CNAG cold and heat syndrome, and put forward that the basic reason for the development of CNAG was the deficiency of spleen and stomach, and through all the time, it resulted in the confusion of cold and heat, which eventually led to the aggravation of yin deficiency and blood stasis. Resistance, even malignant transformation of.CNAG core disease machine is "Qi Yin deficiency, cold and heat and mixed", the establishment of "Xin Kai bitterness, nourishing yin nourishing Yin", "activating blood and removing blood stasis" as the supplement, provides a new way of thinking for clinical treatment of CNAG, and may also provide new ideas for the prevention and control of the development and evolution of CNAG and gastric cancer. The academic thought of spleen and stomach disease and the practical value of the academic thought of "treating the disease without disease". Innovative viewpoint: the first time to excavate the academic thought of refining Professor Chestnut's treatment of CNAG cold and heat syndrome: applying the idea of "treating the disease without disease" to the CNAG, and putting forward that the spleen and Stomach Qi Yin deficiency is the root cause of the development, and the gradual addition of the pathological changes. The syndrome of cold and heat disorder is the manifestation of spleen and stomach qi and yin deficiency, and the most common clinic. The core disease machine is "Qi Yin deficiency, cold and hot mixed", and the treatment method and prevention strategy of "Xin Kai bitterness, nourishing yin and nourishing Yin" for CNAG and "activating blood and removing stasis" as supplemented to prevent progress. The characteristics of Lian Xia Qi Mai soup was analyzed. It was suggested that the treatment of CNAG cold and heat syndrome should pay attention to the whole process of CNAG occurrence, development and evolution. It is a new way of thinking for clinical treatment of CNAG, and a new idea for the prevention and control of the development and evolution of CNAG to gastric cancer.
【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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