史纪教授儿科学术思想及“肺病治肝”治疗小儿咳嗽变异性哮喘的证治规律研究

发布时间：2018-06-24 22:34

本文选题：史纪教授 + 学术思想　；参考：《山东中医药大学》2015年博士论文

【摘要】：目的：系统整理及分析史纪教授临证治疗儿科疾病的经验,通过临床规范化研究,总结导师“肺病治肝”治疗小儿咳嗽变异性哮喘的学术经验,辨证论治方法,遣方用药规律,并对导师的学术思想进行研究。方法：1.通过跟师理论与临证结合学习,整理临证验案,体会导师临床辨治规律,对诊疗过程进行评述分析,以按语的形式进行阐述总结；同时自己独立门诊,将导师的经验用于临床,并在导师经验的基础上进行创新；2.结合患儿症状、舌脉等,制定出“咳嗽变异性哮喘的中医症候观察表”,归纳出咳嗽变异性哮喘患儿的中医证型,统计中医证型与发病年龄、病程长短的关系,从中药用药频数、归经、五味、药性频数、药物功效分析进行统计,总结导师用药分布规律及特点。结果：1.论文第一部分总结了导师的学术思想渊源、学术思想及临证治疗经验：①导师的学术思想上源于《黄帝内经》、《伤寒杂病论》,下承于张子和、万全之说,师于郑颉云教授。②导师的学术思想是脾常不足,易生虚证,临证时时固护脾胃之气,用药注意方小量轻,调理脾胃为要；肝常有余,易生实证,若肝阳上逆之证,则以疏肝理气为则,加以清肝、柔肝、镇肝之法；若脾虚肝亢或肝脾不和之证,则以运脾平肝为治则,以运脾为主,佐以疏肝、平肝、柔肝之品。③导师认为小儿脾胃尚未发育完善,“成而未全,全而未壮”,若进食过多、过饱则易伤胃,若太过饥饿则易伤脾。治疗脾胃病常重在健运,以和为贵,反对动则以峻补、峻攻之法治疗脾胃疾病,是导师继承万全关于小儿脾胃病治疗学术思想的精髓所在。导师常采用健脾益气法、健脾和胃法、行气燥湿法、清热泻脾法、滋脾养胃法、温中祛寒法六法从脾论治小儿脾胃疾病。④导师认为“肝常有余”反映了小儿特有的生理、病理特点,临床遣方用药时,要始终把握儿小儿的生理特点,同时还要注意肝脏“体阴而用阳”的特点,刚柔并济,补虚泻实,使肝气始终保持通畅调达,勿妄伐生之气而使充盛有余的蓬勃生机受戕,采用清热凉肝法、泄肝和胃法、培土平木法、清金平木法四法从肝论治。⑤导师认为《伤寒论》的六经辨证和脏腑辨证可以并行不悖,无论外感咳嗽还是内伤咳嗽,均可以采用六经辨证进行临床治疗。小儿五脏六腑成而不全,脾常不足,经方方小量少,不伤脾胃之气,正好方便小儿服用,若临床方证相符,可首先考虑经方治疗,善用经方,常采用六经辨证治疗小儿咳嗽。⑥导师认为肝郁是小儿抽动症的基本核心病机,由于小儿生理特性和病理特点不同于成人,故肝郁多为实证,治疗宜达之,或表或里,但使气血乖和,则木郁自散。风动是小儿抽动症的核心病机之诱发因素,若人体气机升降出入正常,内风无以为生,外风不能侵袭,则无法引动肝风壅盛,抽动不能发作。导师认为“肝郁风动”是小儿抽动症的中医核心病机,采用从肝论治小儿抽动症。⑦史老师指出,迁延性腹泻病程长,反复迁延不愈,其病机属性以脾虚为主,脾气虚弱,不能正常运化水湿,湿邪反盛,困阻中焦,运化失权,.发为泄泻,若外感湿邪,内外湿邪交相呼应则病情迁延难愈。若小儿久泻不愈,往往可损伤脾阳,脾阳不振则累及肾阳而肾阳不足,命门火衰不能温煦脾土,从而导致脾肾阳虚。导师从小儿“脾常不足”、“肾常虚”着手,立足于从脾肾治疗小儿迁延性腹泻。2.论文第二部分临床观察并讨论导师“肺病治肝”治疗小儿咳嗽变异性哮喘的证治规律研究及学术思想。导师认为,咳嗽变异性哮喘的患儿发病特点具有肝病的病理特征、病因病机、临床表现,表明“肝失疏泄”为其主要病机,肺失肃降为其次要病机,因而独辟蹊径,提出“肺病治肝”的学术思想,临床治疗咳嗽变异性哮喘患儿以定风散为核心,进行辨证论治,通过多年的临床观察,导师将咳嗽变异性哮喘分为四型辨证治疗。治疗从小儿的生理、病理特点出发,以疏泄气机、保持肝疏泄畅通为主,药物常采用疏肝、柔肝、平肝、养肝等,反对过度采用苦寒、辛热、攻伐甚至有毒之品,从而导致伤及脾胃之气,耗损阴津,甚至引起气阴两虚的严重情况。临证时,采用药物常补泻相宜,苦寒适度,攻伐有节,中病即止,治疗中时时注重固护脾胃之气,防止土虚木亢。结论：①导师学术思想的产生不是一蹴而就的,是在继承古今医学前贤的理论经验基础上,结合自己长期的临床实践经验,进一步创新而发展起来的。②导师从事儿科40余年,注重经典理论学习,临床辨证用药常从小儿生理、病理特点出发,施药简洁,治疗方法独具匠心,治疗小儿疾病从肝脾论治,取得了较好的疗效。③本课题首先提炼了导师的学术思想,详实记录了导师临证遣方用药的各种医案,是导师学术水平的综合体现,其中从脾肾论治小儿迁延性腹泻、从肝郁血瘀论治小儿抽动症及从六经辨证治疗小儿咳嗽等学术思想都在医案中闪现,是导师临床治疗的特色经验。导师提出“肺病治肝”治疗小儿咳嗽变异性哮喘的学术思想,通过临床观察,治疗效果显著,导师的学术思想丰富了咳嗽变异性哮喘的治法,提出了新方法、新思路,进一步了丰富了中医儿科学临床辨证体系及学术思想,为中医儿科学的发展作出了重要贡献。
[Abstract]:Objective: to systemically arrange and analyze the experience of Professor Shi Ji in the treatment of paediatric diseases, and to summarize the academic experience of "lung disease treatment of liver" in the treatment of children with cough variant asthma through the clinical standardization study. Combined with learning, sorting out the case, experience the rule of clinical diagnosis and treatment of the tutor, review and analyze the process of diagnosis and treatment, and summarize it in the form of the massage; at the same time, independent outpatient, the experience of the tutor is used in clinical, and on the basis of the experience of the tutor; 2. the symptoms of the children, the tongue and so on, make out "cough variant asthma". The traditional Chinese medicine syndrome of cough variant asthma was summed up. The relationship between TCM syndrome type and the age of disease and the length of the disease was summed up. From the frequency of medicine, the five flavors, the frequency of drug properties, the analysis of drug efficacy were statistically analyzed, and the distribution rules and characteristics of the drug use were summarized. The results were summarized in the first part of the 1. thesis. The academic thought origin of the tutor, the academic thought and the experience of clinical treatment: (1) the academic thought of the tutor was derived from the Yellow Emperor's internal classics, and the theory of typhoid and miscellaneous diseases. Under the theory of Zhang Zi and, the teacher is in Professor Zheng Jieyun. The academic thought of the teacher is the deficiency of the spleen, the deficiency of the syndrome, the breath of the spleen and the stomach at the time of the syndrome, the light of the attention side of the medicine, and the conditioning The spleen and stomach for the need; the liver is often more than the evidence, if the liver Yang on the inverse of the evidence, the liver qi, the liver, the liver, the liver of the liver, if the spleen deficiency liver or liver and spleen of the syndrome, the spleen and the liver as the treatment, to transport the spleen, with the liver, liver, soft liver products. 3. Tutor thinks children spleen and stomach is not perfected, "adult and incomplete, complete and incomplete," If you eat too much, if you eat too much, you can easily hurt the stomach by overeating. If you are too hungry, it is easy to hurt the spleen. The treatment of spleen and stomach disease is often heavy in health, and it is expensive, the opposition moves to the spleen and stomach disease, which is the essence of the treatment of spleen stomach disease. The tutor often uses the method of strengthening spleen and stomach, strengthening spleen and stomach. The method of air dryness, clearing heat and spleen, nourishing the stomach, nourishing the stomach and nourishing the stomach and removing cold from the spleen are used to treat children's spleen and stomach diseases. (4) the tutor thinks that "liver is often remaining" reflects the unique physiological and pathological characteristics of children. The soft and relieved, make up the deficiency and diarrhea, make the liver Qi always keep smooth and smooth, do not try to kill the vitality of the life to cause the vigorous vitality to kill, use the method of clearing the liver and the liver, the method of relieving the liver and stomach, the method of raising the earth and the wood method, the four methods of the Qing Jin Ping wood method from the liver. It is an internal wound cough which can be treated with the syndrome differentiation of six meridians. The five viscera of the children are not complete, the spleen is not enough, the spleen is short, the spleen and the stomach are small, the spleen and the stomach are small, the spleen and the stomach are not hurt, it is just convenient for children to take. If the clinical prescription is consistent, it can first consider the treatment of the meridians, use the meridians and treat the children's cough. 6. The tutor thinks liver depression is small. The basic core pathogenesis of children's aspiration is different from that of the adult, because the physiological and pathological characteristics of children are different from those of the adult. Therefore, the liver depression is more positive, the treatment should be reached, or the table or inside, but it makes the Qi and blood be good and the wood depression is scattered. The wind is the trigger factor of the core pathogenesis of children's aspiration. If the body and the air machine is in and out of normal, the internal wind is not born, the external wind can not invade. The teacher thinks that "liver depression and wind movement" is the core pathogenesis of children's aspiration of traditional Chinese medicine, using the liver theory to treat children with twitches. If the external feeling is wet and evil, the internal and external damp evil, the disease is difficult to recover. If the child's long diarrhea is not healed, the spleen yang can be damaged, the Spleen Yang is not vibrant and the kidney yang is insufficient, the spleen and kidney yang deficiency can not be warm, and the spleen and kidney yang deficiency is caused by the teacher. Hand, based on the clinical observation of the second part of the.2. paper on the treatment of children's deferred diarrhea from the spleen and kidney, and discussing the study and academic thoughts of the treatment of children with cough variant asthma by the tutor "lung disease treatment of liver". "Liver loss of Dredging" is the main pathogenesis, the lung is lost and the second is the next disease machine. Therefore, the academic thought of "treating the liver" with "lung disease" is put forward, and the clinical treatment of cough variant asthma in children with fixed wind is the core and is treated with syndrome differentiation. Through years of clinical observation, the cough variant asthma is divided into four types of syndrome differentiation treatment. From the physiological and pathological characteristics of children, the main way is to dredge the gas machine and keep the liver unobstructed and smooth. The drugs often adopt the liver dredging, the soft liver, the liver, the liver and so on, and oppose the excessive use of bitter cold, symplectic heat, tapping and even poisonous products, thus causing the spleen and stomach qi, wasting the Yin, and even causing the deficiency of Qi and Yin. Appropriate, bitter and moderate, tapping with a section, the disease is stop, in the treatment of the spleen and stomach to protect the Qi, to prevent the hyperactivity of soil. Conclusion: (1) the academic thought of the tutor is not achieved overnight. It is based on the theoretical experience of ancient and modern medical predecessors, combined with his long clinical experience and further innovation and development. (2) the tutor engaged in Pediatrics for more than 40 years and paid attention to the classical theory of learning. The clinical dialectical medication often started from the physiological and pathological characteristics of children, the treatment method was simple, the treatment method was ingenious, and the treatment of children's disease was treated from the liver and spleen. 3. Firstly, the academic thought of the tutor was extracted and the medication of the tutor was recorded in detail. Various medical cases are the comprehensive embodiment of the academic level of the tutor. Among them, the academic thought of treating children with deferred diarrhea from the spleen and kidney, treating children with stagnation of the liver and blood stasis and treating children's cough from the six meridian syndrome, is the characteristic experience of the clinical treatment of the tutor. The tutor puts forward the treatment of children's cough variant asthma by the "lung disease treatment of liver". Through clinical observation, the therapeutic effect of asthma is remarkable. The academic thought of the tutor enriches the treatment of cough variant asthma, puts forward new methods and new ideas, further enriches the clinical syndrome differentiation system and academic thought of Pediatrics, and has made important contributions to the development of Pediatrics in traditional Chinese medicine.
【学位授予单位】：山东中医药大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R249;R272

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