李世增学术思想与临床经验总结及李氏和降汤治疗胃食管反流病脾虚肝郁证的疗效观察
发布时间：2018-07-15 21:32
【摘要】：导师李世增,男,1940年出生于北京一个中医世家,毕业于北京中医学院,首都医科大学教授,主任医师,国家级名老中医。李世增教授从事临床工作近50年,温病学教学工作30余年,具有扎实的中西医理论功底和丰富的临床实践经验,善治内科杂病及妇科、皮科疾病。尤其在温病学理论方面造诣颇深,擅用中医温病学理论指导临床实践,疗效显著。本论文主要从追寻李世增教授学术渊源,整理挖掘其学术思想与临证经验,并应用计算机辅助系统研究其治疗慢性胃炎的临证经验和学术思想,及李氏和降汤治疗胃食管反流病脾虚肝郁证的临床观察研究四部分完成。第一部分是从李世增教授的成长、学习及工作经历各方面探寻其学贯中西,以温病学辨证思维和方法治疗疾病的学术渊源。第二部分总结了李世增教授的学术思想和临证经验。首先总结了李世增教授的四方面学术思想:李老认为中医的根基是"仁术",中医的血脉是"理论与临床"。临床诊断注重中西医结合,望、闻、问、切、验五诊合参。善于根据脾胃特点治疗脾胃病,治病善用药对。养生、治病注重心、肝、脾三脏,创立了养心、清肝、醒脾的新"三宝"思想。同时对李世增教授治疗肺系疾病、心系疾病、脾胃病、妇科疾病和皮肤科疾病的诊疗经验进行了总结。并总结了李世增教授应用"佐金平木"法治疗多种疾病的诊疗经验。第三部分是应用中医传承辅助系统对李世增教授治疗慢性胃炎临证经验及其学术思想的研究。主要应用中国中医科学院中药研究所与中国科学院自动化研究所联合开发的中医传承辅助系统软件,采用规则分析、改进的互信息法、复杂系统熵聚类、无监督的熵层次聚类等多种数据挖掘方法,按照"数据录入→数据管理→数据查询→数据分析→分析结果输出→网络可视化展示"的顺序,对李世增教授治疗慢性胃炎的方剂用药规律进行系统分析。目的:采用中医传承辅助系统软件客观系统分析出李世增教授治疗慢性胃炎的方剂用药规律。方法:收集李世增教授治疗慢性胃炎病历168人次,处方471首,录入"中医传承辅助系统",使用"数据分析"模块中的"方剂分析"功能,进行药物频次、处方规律、新方分析等组方规律分析。结果:李世增教授治疗慢性胃炎使用频次在前32位的药物可归纳为6类:1.健脾益气消食药:太子参、黄芪、白术、茯苓、鸡内金、焦三仙;2.养阴生津药:白芍、北沙参、百合、麦冬、石斛、黄精、枸杞子;3.疏肝理气止痛药:佛手、香橼、枳壳、郁金、延胡索、苏梗、厚朴、杏仁;4.活血化瘀通络药:丹参、三七、丝瓜络;5.清热解毒消痈药:蒲公英、连翘、白花蛇舌草;6.祛湿醒脾药:姜半夏、白豆蔻、藿香、浙贝母。其中太子参、黄芪、白术、茯苓、鸡内金、焦三仙;白芍、北沙参、百合、麦冬、石斛;佛手、香橼、枳壳、郁金、延胡索、苏梗、厚朴;丹参、三七、丝瓜络;蒲公英、连翘、白花蛇舌;姜半夏、白豆蔻、藿香、浙贝母为慢性非萎缩性胃炎与慢性萎缩性胃炎的共用高频药物。常用蒲公英、连翘、白花蛇舌草;郁金、枳壳;香橼、佛手;焦三仙、鸡内金等药对治疗。通过改进的互信息法和复杂系统熵聚类分析,得出药物相关度、核心组合和新处方,其中在慢性胃炎临床治疗实践中常用的有1.延胡索_元胡_白梅花_香附_川楝子;2.薏苡仁_藿香_杏仁_白芍;3.炙甘草_茯苓_白术;4.藿香_苏梗_姜半夏_石斛_百合;5.夜交藤_白菊_白梅花_白蔻仁_焦三仙;6.玄参_酸枣仁_柏子仁_熟大黄_厚朴_瓜蒌;7.焦三仙_炒白术_元胡_白梅花;8.枳壳_香橼_苏梗_醋柴胡_枳实_郁金_白梅花_川楝子。结论:李老治疗慢性胃炎主要采用益气养阴,理气活血,解毒消痈,化湿消食的方法,即传统八法中的和、清、补、消四法。多用蒲公英、连翘、白花蛇舌草解毒消痈,治疗慢性胃炎。在慢性非萎缩性胃炎治疗中尽早使用养阴生津药物。注重肝与脾胃之间的关系,大量应用疏肝理气活血药。第四部分是李氏和降汤治疗胃食管反流病脾虚肝郁证的疗效观察。包括:文献综述:胃食管反流病治疗现状概述和李氏和降汤治疗胃食管反流病脾虚肝郁证的疗效观察两部分。目的:采用随机对照的试验方法客观评价和降汤治疗胃食管反流病脾虚肝郁证的临床疗效,进一步验证和降汤在胃食管反流病治疗中临床疗效及安全性。方法:本研究纳入李世增教授治疗胃食管反流病脾虚肝郁证病例63例,采用随机对照的临床试验方法,分为中药组31例,予以和降汤加减治疗;西药组32例,予以雷贝拉唑治疗,分别治疗4周,观察治疗后和随访1月各症状发生频率积分、RQD总积分和有效率。结果:治疗前两组基线资料无差异,治疗前后症状发作频率积分统计结果提示:中药组疗效优于西药组,组间差异显著,有统计学意义,且停药1月后中药组较西药组疗效稳定。结论:应用李氏和降汤治疗胃食管反流病脾虚肝郁证,具有较好的疗效,为和降汤临床治疗胃食管反流病提供治疗思路。创新点:1.李世增教授治疗GERD脾虚肝郁证的学术思想。GERD症状形成总由胃气上逆,但形成胃气上逆的主要病机是脾虚肝郁,脾胃升降失调,故脾虚肝郁为GERD的主要证型,采用和法治疗,自拟和降汤。和降汤以健脾益气,扶正为本;疏肝解郁,佐金平木,化痰降逆,祛邪为标,补泻兼施,扶正祛邪,标本兼治,扶正不留邪,祛邪不伤正,收效甚佳。2.李世增教授创立了"和降汤"治疗GERD脾虚肝郁证效果显著。治疗采用"和法",包含两方面内容:一是以调和肝脾,调肝和胃为治疗之根本大法,亦常应用佐金平木法,肃肺抑肝和胃。二是用药平和。3.李世增教授治疗GERD脾虚肝郁证的用药特点。用药少,药量轻,药性平和,不用峻剂;善用对药;并未采用临床上广泛使用的旋覆代赭汤、海螵蛸、乌贼骨等重镇降逆、抑酸之品。
[Abstract]:Li Shizeng, male, was born in a family of traditional Chinese medicine in Beijing in 1940. He graduated from the College of traditional Chinese medicine in Beijing, Professor of the Capital Medical University, the director of Capital Medical University, and the national famous old Chinese medicine. Professor Li Shizeng has been engaged in clinical work for nearly 50 years. He has been teaching for more than 30 years in the teaching of febrile diseases and has a solid foundation of Chinese and Western medicine theory and rich clinical experience. The diseases of the family, gynecology and dermatology, especially in the theory of febrile diseases, have been used to guide the clinical practice with the theory of febrile diseases in traditional Chinese medicine. This thesis is mainly to search for the academic origin of Professor Li Shizeng, to dig out his academic thoughts and experience, and to apply the computer aided system to study the treatment of chronic gastritis. The clinical observation and academic thought, and the clinical observation and Study on the spleen deficiency syndrome of gastroesophageal reflux disease with Li's and descending decoction, the four part is completed. The first part is to explore the academic origin of the Chinese and Western learning from Professor Li Shizeng's growth, learning and work experience. The second part summarizes the academic origin of the disease with the dialectical thinking and methods of febrile diseases. The second part sums up the theory of the disease. Professor Li Shizeng's academic thought and experience. First, he summed up professor Li Shizeng's academic thought: Li Lao thought the foundation of Chinese medicine was "benevolence", the blood of traditional Chinese medicine was "theory and clinical". Clinical diagnosis focused on the combination of traditional Chinese and Western medicine, watching, hearing, asking, cutting, and examining the five diagnosis of the spleen and stomach, good at treating spleen and stomach diseases according to the characteristics of the spleen and stomach. Three organs of heart, liver and spleen were paid attention to, and the new "three treasures" thought of nourishing heart, liver and spleen was founded. At the same time, the diagnosis and treatment experience of Li Shi Zang's treatment of lung diseases, heart diseases, spleen and stomach diseases, gynecologic diseases and Department of dermatology diseases was summarized. The diagnosis and treatment experience of Professor Li Shizeng's application of "Zo Jinping wood" method in the treatment of various diseases was summarized. Third Part is the study of Professor Li Shizeng's experience in the treatment of chronic gastritis and his academic thoughts by the auxiliary system of traditional Chinese medicine. It mainly applies the software of traditional Chinese Medicine Inheritance auxiliary system, which is developed by the Chinese Academy of Chinese Medicine Science Institute and the Institute of automation of the Chinese Academy of Sciences. It adopts the rules analysis, the improved mutual information method and the complex system. Entropy clustering, unsupervised entropy hierarchical clustering and other data mining methods, according to the order of "data entry, data management, data query, data analysis, analysis results output and network visualization", the rule of medicine for the treatment of chronic gastritis by Professor Li Shizeng was systematically analyzed. Objective: to adopt the inheritance auxiliary system of traditional Chinese Medicine The software objective system was used to analyze the rule of Professor Li Shizeng's prescription for the treatment of chronic gastritis. Methods: Professor Li Shizeng was used to treat 168 cases of chronic gastritis, 471 prescriptions, "traditional Chinese Medicine Inheritance auxiliary system", and the function of "prescription analysis" in the "data analysis" module. Results: Professor Li Shizeng can be classified into 6 types of drugs used in the first 32 cases of chronic gastritis: Radix Astragalus, Astragalus membranaceus, Rhizoma Atractylodes, tuckahoe, chicken inner gold, Jiao Sanxian; 2. Yangyin Sheng Jin medicine: Paeonia lactiflora, Radix Ophiopogon, lily, Ophiopogon, Dendrobium, yellow essence, Lycium barbarum; 3. liver Qi analgesics: the hand, citron, citron, trifoliate orange, tulips, Yalhuo, Su Teru, Magnolia, almond; 4. blood activating and stasis removing drugs: Danshen, 37, luofan collaterals; 5. heat clearing and detoxifying antipyretic drugs: dandelion, forsythia, hydanth herb, and 6. dampness dampness and spleen herbs: Jiang Banxia, nutmeg, huoxien, Fritillaria thunbergii. Among them, Radix Astragalus, Radix Astragali, Poria, Poria, chicken inner gold, three immortality, white peony, Radix Ophiopogon, Dendrobium; lilies, Ophiopogon, citron, citron Fructus aurantii, tulip, yomanhu, sugomo, Magnolia officinalis, Salvia miltiorrhiza, 37, luofan collaterals, dandelion, forsythia, and white flower tongue; ginger, nutmeg, patchouli, and Fritillaria thunbergii are common high frequency drugs for chronic non atrophic gastritis and chronic atrophic gastritis. Treatment. Through the improved mutual information method and complex system entropy clustering analysis, the drug correlation, the core combination and the new prescription were obtained. In the clinical practice of chronic gastritis, it is commonly used in the clinical practice of chronic gastritis, 1. 5. the white plum blossom of white plum blossom, the white plum blossom of the white chrysanthemum, the white plum blossom, the white plum blossom, the white plum blossom, the white plum blossom, the white plum blossom, the white plum blossom of the 7. coke, and the 8. trifoliate citrus, and the 8. trifoliate Citrus. Elimination of carbuncle, the method of eliminating wet digestion, that is, the traditional eight methods of the and, Qing, mending, and elimination of four methods. More use dandelion, forsythia, white flower Hedyotis relieving carbuncle, treatment of chronic gastritis. In the treatment of chronic non atrophic gastritis, use nourishing yin and nourishing medicine as early as possible. Pay attention to the liver and spleen stomach between the Department, the large number of use of liver qi, Qi and activating blood drugs. The fourth part is Li's family. Treatment of gastroesophageal reflux disease with spleen deficiency syndrome of liver depression, including: literature review: overview of the treatment of gastroesophageal reflux disease and the therapeutic effect of Li's and descending Decoction on the spleen deficiency syndrome of gastroesophageal reflux disease in two parts. Objective: to objectively evaluate and reduce Decoction in the treatment of spleen deficiency liver depression of gastroesophageal reflux disease. To further verify the clinical efficacy and safety of the Decoction in the treatment of gastroesophageal reflux disease. Methods: This study included professor Li Shizeng's treatment of 63 cases of spleen deficiency liver depression of gastroesophageal reflux disease. The randomized controlled clinical trial was used to divide into 31 cases in Chinese medicine group and to reduce Decoction and reduce decoction; 32 cases in western medicine group were given thunder. Bela treatment, treated for 4 weeks respectively, observed the frequency integral of all symptoms after treatment and follow-up in January, total score of RQD and efficiency. Results: there was no difference in baseline data between the two groups before and after treatment. The statistical results of the frequency of symptom onset frequency before and after treatment showed that the curative effect of the Chinese medicine group was better than that of the western medicine group, the difference between the groups was significant, and the difference between the groups was statistically significant and after the withdrawal of the drug after January. The effect of Chinese medicine group is more stable than that of the western medicine group. Conclusion: the application of Li's and descending Decoction in the treatment of spleen deficiency syndrome of gastroesophageal reflux disease has good curative effect. It provides the treatment ideas for the treatment of gastroesophageal reflux disease in the clinic. Innovation point: 1. the academic thought of Professor Li Shi Sheng's academic thought on the syndrome of GERD spleen deficiency liver depression is always reversed by stomach qi, but it is formed. The main pathogenesis of Stomach Qi inversion is spleen deficiency liver depression and spleen and stomach depression, so spleen deficiency liver depression is the main syndrome type of GERD. It is the main syndrome type of spleen deficiency liver depression. .2. Li Shizeng established the effect of "heachen soup" to treat GERD spleen deficiency liver depression. The treatment adopted "and method", including two aspects: one is to reconcile liver and spleen, regulate liver and stomach as the basic method of treatment, also often use the Zuojin ping method, Su lung suppressing liver and stomach. Two is medicine Ping and Professor.3. to treat GERD spleen deficiency liver depression syndrome. The drug is characterized by less drug use, light medicine, mild medicine, no strong agent, good use of the medicine, and no widely used clinic, such as the rotary oversea ochre soup, sea cuttlebone, squid bone and other heavy towns.
【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
[Abstract]:Li Shizeng, male, was born in a family of traditional Chinese medicine in Beijing in 1940. He graduated from the College of traditional Chinese medicine in Beijing, Professor of the Capital Medical University, the director of Capital Medical University, and the national famous old Chinese medicine. Professor Li Shizeng has been engaged in clinical work for nearly 50 years. He has been teaching for more than 30 years in the teaching of febrile diseases and has a solid foundation of Chinese and Western medicine theory and rich clinical experience. The diseases of the family, gynecology and dermatology, especially in the theory of febrile diseases, have been used to guide the clinical practice with the theory of febrile diseases in traditional Chinese medicine. This thesis is mainly to search for the academic origin of Professor Li Shizeng, to dig out his academic thoughts and experience, and to apply the computer aided system to study the treatment of chronic gastritis. The clinical observation and academic thought, and the clinical observation and Study on the spleen deficiency syndrome of gastroesophageal reflux disease with Li's and descending decoction, the four part is completed. The first part is to explore the academic origin of the Chinese and Western learning from Professor Li Shizeng's growth, learning and work experience. The second part summarizes the academic origin of the disease with the dialectical thinking and methods of febrile diseases. The second part sums up the theory of the disease. Professor Li Shizeng's academic thought and experience. First, he summed up professor Li Shizeng's academic thought: Li Lao thought the foundation of Chinese medicine was "benevolence", the blood of traditional Chinese medicine was "theory and clinical". Clinical diagnosis focused on the combination of traditional Chinese and Western medicine, watching, hearing, asking, cutting, and examining the five diagnosis of the spleen and stomach, good at treating spleen and stomach diseases according to the characteristics of the spleen and stomach. Three organs of heart, liver and spleen were paid attention to, and the new "three treasures" thought of nourishing heart, liver and spleen was founded. At the same time, the diagnosis and treatment experience of Li Shi Zang's treatment of lung diseases, heart diseases, spleen and stomach diseases, gynecologic diseases and Department of dermatology diseases was summarized. The diagnosis and treatment experience of Professor Li Shizeng's application of "Zo Jinping wood" method in the treatment of various diseases was summarized. Third Part is the study of Professor Li Shizeng's experience in the treatment of chronic gastritis and his academic thoughts by the auxiliary system of traditional Chinese medicine. It mainly applies the software of traditional Chinese Medicine Inheritance auxiliary system, which is developed by the Chinese Academy of Chinese Medicine Science Institute and the Institute of automation of the Chinese Academy of Sciences. It adopts the rules analysis, the improved mutual information method and the complex system. Entropy clustering, unsupervised entropy hierarchical clustering and other data mining methods, according to the order of "data entry, data management, data query, data analysis, analysis results output and network visualization", the rule of medicine for the treatment of chronic gastritis by Professor Li Shizeng was systematically analyzed. Objective: to adopt the inheritance auxiliary system of traditional Chinese Medicine The software objective system was used to analyze the rule of Professor Li Shizeng's prescription for the treatment of chronic gastritis. Methods: Professor Li Shizeng was used to treat 168 cases of chronic gastritis, 471 prescriptions, "traditional Chinese Medicine Inheritance auxiliary system", and the function of "prescription analysis" in the "data analysis" module. Results: Professor Li Shizeng can be classified into 6 types of drugs used in the first 32 cases of chronic gastritis: Radix Astragalus, Astragalus membranaceus, Rhizoma Atractylodes, tuckahoe, chicken inner gold, Jiao Sanxian; 2. Yangyin Sheng Jin medicine: Paeonia lactiflora, Radix Ophiopogon, lily, Ophiopogon, Dendrobium, yellow essence, Lycium barbarum; 3. liver Qi analgesics: the hand, citron, citron, trifoliate orange, tulips, Yalhuo, Su Teru, Magnolia, almond; 4. blood activating and stasis removing drugs: Danshen, 37, luofan collaterals; 5. heat clearing and detoxifying antipyretic drugs: dandelion, forsythia, hydanth herb, and 6. dampness dampness and spleen herbs: Jiang Banxia, nutmeg, huoxien, Fritillaria thunbergii. Among them, Radix Astragalus, Radix Astragali, Poria, Poria, chicken inner gold, three immortality, white peony, Radix Ophiopogon, Dendrobium; lilies, Ophiopogon, citron, citron Fructus aurantii, tulip, yomanhu, sugomo, Magnolia officinalis, Salvia miltiorrhiza, 37, luofan collaterals, dandelion, forsythia, and white flower tongue; ginger, nutmeg, patchouli, and Fritillaria thunbergii are common high frequency drugs for chronic non atrophic gastritis and chronic atrophic gastritis. Treatment. Through the improved mutual information method and complex system entropy clustering analysis, the drug correlation, the core combination and the new prescription were obtained. In the clinical practice of chronic gastritis, it is commonly used in the clinical practice of chronic gastritis, 1. 5. the white plum blossom of white plum blossom, the white plum blossom of the white chrysanthemum, the white plum blossom, the white plum blossom, the white plum blossom, the white plum blossom, the white plum blossom, the white plum blossom of the 7. coke, and the 8. trifoliate citrus, and the 8. trifoliate Citrus. Elimination of carbuncle, the method of eliminating wet digestion, that is, the traditional eight methods of the and, Qing, mending, and elimination of four methods. More use dandelion, forsythia, white flower Hedyotis relieving carbuncle, treatment of chronic gastritis. In the treatment of chronic non atrophic gastritis, use nourishing yin and nourishing medicine as early as possible. Pay attention to the liver and spleen stomach between the Department, the large number of use of liver qi, Qi and activating blood drugs. The fourth part is Li's family. Treatment of gastroesophageal reflux disease with spleen deficiency syndrome of liver depression, including: literature review: overview of the treatment of gastroesophageal reflux disease and the therapeutic effect of Li's and descending Decoction on the spleen deficiency syndrome of gastroesophageal reflux disease in two parts. Objective: to objectively evaluate and reduce Decoction in the treatment of spleen deficiency liver depression of gastroesophageal reflux disease. To further verify the clinical efficacy and safety of the Decoction in the treatment of gastroesophageal reflux disease. Methods: This study included professor Li Shizeng's treatment of 63 cases of spleen deficiency liver depression of gastroesophageal reflux disease. The randomized controlled clinical trial was used to divide into 31 cases in Chinese medicine group and to reduce Decoction and reduce decoction; 32 cases in western medicine group were given thunder. Bela treatment, treated for 4 weeks respectively, observed the frequency integral of all symptoms after treatment and follow-up in January, total score of RQD and efficiency. Results: there was no difference in baseline data between the two groups before and after treatment. The statistical results of the frequency of symptom onset frequency before and after treatment showed that the curative effect of the Chinese medicine group was better than that of the western medicine group, the difference between the groups was significant, and the difference between the groups was statistically significant and after the withdrawal of the drug after January. The effect of Chinese medicine group is more stable than that of the western medicine group. Conclusion: the application of Li's and descending Decoction in the treatment of spleen deficiency syndrome of gastroesophageal reflux disease has good curative effect. It provides the treatment ideas for the treatment of gastroesophageal reflux disease in the clinic. Innovation point: 1. the academic thought of Professor Li Shi Sheng's academic thought on the syndrome of GERD spleen deficiency liver depression is always reversed by stomach qi, but it is formed. The main pathogenesis of Stomach Qi inversion is spleen deficiency liver depression and spleen and stomach depression, so spleen deficiency liver depression is the main syndrome type of GERD. It is the main syndrome type of spleen deficiency liver depression. .2. Li Shizeng established the effect of "heachen soup" to treat GERD spleen deficiency liver depression. The treatment adopted "and method", including two aspects: one is to reconcile liver and spleen, regulate liver and stomach as the basic method of treatment, also often use the Zuojin ping method, Su lung suppressing liver and stomach. Two is medicine Ping and Professor.3. to treat GERD spleen deficiency liver depression syndrome. The drug is characterized by less drug use, light medicine, mild medicine, no strong agent, good use of the medicine, and no widely used clinic, such as the rotary oversea ochre soup, sea cuttlebone, squid bone and other heavy towns.
【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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8 尚文t，
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