基于文献整理的倪珠英教授治疗小儿血尿经验的回顾性研究

发布时间：2018-03-06 11:11

本文选题：名医经验　切入点：传承研究　出处：《湖北中医药大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的回顾性总结倪珠英教授治疗小儿肾性血尿有效病例,验证其“小儿血尿热因论”学术观点；利用文献整理法,整理分析国内近十年各种医学期刊上的中医肾病专家治疗血尿经验的文献,总结出中医专家血尿诊疗的群体规律。并将二者进行对比,探讨倪珠英特色的个体诊疗规律,制定倪珠英特色的小儿血尿诊疗常规,使其源于临床,高于临床,又能回归、指导临床,进而探索名医经验传承的有效形式和方法。方法查阅倪珠英教授诊治的192例肾性血尿患儿有效病例资料,观察其初期、中期、后期舌脉变化及常用治法、方药,将相关内容输入Excel进行统计归类,综合分析,归纳小儿血尿病机演变规律；检索相关期刊论文(CNKI,2001-2010年)公开发表的中医专家治疗血尿经验的文献,选用关键词组成文献检索式进行电子检索,通过阅读文章题目、内容摘要进行初筛。初筛选中文献进行逐篇全文阅读,参照纳入标准进行选择。将相关内容输入Excel进行统计归类,采用频数统计分析法和聚类分析法,归纳小儿血尿常见证型及分布规律。结果一、倪珠英教授学术思想的验证通过回顾性总结倪珠英教授192份小儿血尿有效病例之舌脉变化、常用治法,归纳小儿血尿的病机演变规律。 (一)证型初期：热证83次(43%),湿热67次(35%),虚证42次(18%)；中期：热证38次(46%),湿热13次(15%),虚证33次(39%)；后期：热证19次(45%),湿热7次(17%),虚证16次(38%)。在三期中,热证均占有主导地位,从中期开始,湿热证的比例下降,虚证的比例上升。 (二)治法初期：主要以清热利湿408次(44.32%)、凉血止血271次(25.02%)、健脾益气140次(12.93%)、清热解毒106次(9.79%)为主；中期：以清热利湿50次(33.11%)、凉血止血30次(19.87%)、健脾益气29次(19.21%)为主；后期：以清热利湿25次(22.94%)、健脾益气22次(20.18%)、凉血止血16次(14.68%)、清热解毒13次(13.98%)为主。倪老在血尿的治疗中,清热利湿、凉血止血、健脾益气法贯穿疾病的始终。倪老关于小儿血尿的主要治法有：清热利湿483次(34.92%)、凉血止血317次(22.92%)、健脾益气191次(14.66%)、清热解毒128次(9.82%),另外活血化瘀81次(5.86%)、滋阴清热43次(3.11%)、补肾健脾45次(3.45%)、温补肾阳42次(3.04%)也占有一定比例。二、中医专家的群体规律 (一)证型阴虚火旺35次(14.06%)、气阴两虚29次(11.33%)、风热犯肺28次(10.94%)占有主导地位。此外,湿热内蕴23次(8.98%)、瘀血内阻20次(7.81%)、脾肾两虚24次(9.38%)、脾不统血19次(7.42%),也占有很大比例。利用频数进行二次归一,再进行聚类分析,各证型所占比例分别为：“虚证”35次(14%)、“实热证”59次(23%)、“湿热证”39次(45%)、“虚热证”35次(14%)、“气滞血瘀证”25次(10%)。 (二)类方分析通过聚类分析,中医专家选择的类方包括：“清热利湿凉血解毒类方”66次(28%)、“滋阴清热类方”64次(26%)、“温补肾阳”43次(18%)、“补肺健脾益气类方”35次(14%)、“疏风清热利咽类方”17次(7%)、“行气活血化瘀类方”17次(7%)。三、倪珠英教授特色个体诊疗规律与中医专家群体规律的对比倪老和中医专家都认为“湿”、“热”、“虚”在血尿的发生发展过程中有占有重要地位,也不能忽视“瘀血”之作用；在治法上,都以“清热利湿”、“清热解毒”、“凉血解毒”为主,但倪老还重视“益气健脾”,中医专家偏重于“温补肾阳”。结论 1.通过回顾性总结倪老诊治的小儿肾性血尿病例,验证了其“小儿血尿因热论”学术思想及“以热为先,因湿为重,因实致虚”病机演变规律的科学性。 2.利用文献整理的方法,总结了中医专家关于血尿的群体规律,对临床工作具有指导意义。 3.个体差异与群体规律进行对比,实现了名医之间基于同期的研究资料的比较研究。 4.传统方法与现代方法相结合、个体研究与群体研究相结合是名医经验传承的有效形式和方法。
[Abstract]:objective
A retrospective summary of Professor Ni Zhuying in treating renal hematuria effective cases, verify the "heat because of hematuria in children on the academic point of view; using literature method, analysis of China in the past ten years of various medical journals of TCM expert's experience in treating hematuria literature, summed up the law in medical expert group clinics and two hematuria. By contrast, the individual characteristics of the rule of diagnosis and treatment of Ni Zhuying, Ni Zhuying made the routine diagnosis of hematuria in children's characteristics, the source in the clinic, but also higher than the clinical, regression, clinical guidance, and then explore the effective forms and methods of clinical experience inheritance.
Method
192 cases of renal hematuria were effective information of Professor Ni Zhuying on the treatment, to observe the early, middle, late tongue pulse change and the common treatment, prescription, comprehensive analysis of the related input Excel statistical classification, induction, hematuria disease in children machine evolution; retrieval China Journal Full-text Database (CNKI, 2001-2010) of traditional Chinese medicine the expert's experience in treating hematuria published literature, using literature retrieval of electronic component keyword retrieval, by reading the title, abstract screening. Screening of selected literature by reading the full text, according to the inclusion criteria were selected. The related input Excel statistical classification, using frequency statistics analysis and cluster analysis law, summed up the common syndromes of infantile hematuria and distribution.
Result
First, the verification of Professor Ni Zhuying's academic thoughts
Through a retrospective summary of Professor Ni Zhuying's 192 effective cases of pediatric hematuria, the change of tongue and vein was commonly used, and the regularity of the pathogenesis of children's hematuria was summed up.
(1) syndrome type
At the beginning of 83: heat syndrome (43%), 67 (35%), damp heat syndrome in 42 (18%): 38; middle heat syndrome (46%), 13 (15%), damp heat syndrome 33 times (39%); later: heat syndrome 19 times (45%), 7 (17%) of damp heat 16, Qi deficiency (38%). In the three period, heat syndrome were dominant, starting from the mid damp ratio decreased, the proportion of deficiency increased.
(two) the rule of law
At the beginning of the 408: mainly qingrelishi (44.32%), 271 (25.02%) cooling blood to stop bleeding, spleen qi 140 times (12.93%), 106 (9.79%) Qingrejiedu; medium: 50 to qingrelishi (33.11%), 30 (19.87%) cooling blood to stop bleeding, spleen qi 29 times (19.21%). Late: qingrelishi; 25 (22.94%), spleen qi 22 (20.18%), 16 (14.68%) cooling blood, detoxification 13 times (13.98%). Ni Lao in the treatment of hematuria, heat dampness, cooling blood to stop bleeding, invigorating Qi through the disease from the beginning to the end.
Ni Lao on the main treatment of hematuria in children: qingrelishi 483 times (34.92%), 317 (22.92%) cooling blood to stop bleeding, spleen qi 191 times (14.66%), 128 (9.82%) detoxification, blood circulation also 81 times (5.86%), 43 (3.11%) of nourishing yin and clearing heat, invigorating the kidney and strengthening the spleen (45 times 3.45%), warming Yang 42 times (3.04%) also occupy a certain proportion.
Two, the group law of traditional Chinese medicine experts
(1) syndrome type
Yin deficiency, Huo Huo 35 times (14.06%), Qi and yin deficiency 29 times (11.33%), wind heat invading the lung 28 times (10.94%) takes the leading position. In addition, damp heat contains 23 times (8.98%), blood stasis is 20 times (7.81%), spleen and kidney are two and empty, 20 times (two), and spleen does not belong to blood.
Using frequency to do two normalization and cluster analysis, the proportion of each syndrome is: "deficiency syndrome" 35 times (14%), "real heat syndrome" 59 times (23%), "Damp heat syndrome" 39 times (45%), "asthenia heat syndrome" 35 times (14%), "qi stagnation and blood stasis syndrome" 25 times (10%).
(two) class square analysis
Through cluster analysis, traditional Chinese medicine experts to select the class include: "qingrelishi Decoction Liangxue Jiedu" 66 times (28%), "the 64 kind of nourishing yin and clearing heat" (26%), "Kidney Yang" 43 times (18%), "Bufei Jianpi Yiqi Decoction" for 35 times (14%). "Shufeng Qingre Liyan Decoction" for 17 times (7%), "Qi blood circulation" 17 times (7%).
Three, the comparison of the law of Professor Ni Zhuying's characteristic individual diagnosis and treatment and the law of the group of Chinese medicine experts
Ni Lao and Chinese experts believe that the "wet", "hot", "virtual" in the occurrence and development of hematuria in occupies an important position, also can not ignore the "blood stasis" effect; in principle, with "dampness", "detoxification", "detoxification", but also the old Ni pay attention to "Spleen Qi", Chinese medicine experts on "Kidney Yang".
conclusion
1. through the retrospective summary of pediatric renal hematuria cases and verify the Ni Lao, "because of hematuria in children's academic thought and" hot "hot for the first, because the wet weight, because scientific excess caused by deficiency pathogenesis evolution.
2. by using the method of document sorting, the rule of group of Chinese medicine experts on hematuria is summarized, which is of guiding significance for clinical work.
The comparison of 3. individual differences and group rules has achieved a comparative study of research data based on the same period between famous doctors.
4. the combination of the traditional method and the modern method, the combination of individual research and group research is an effective form and method for the inheritance of famous doctors' experience.

【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R272;R249.2

【参考文献】