于凯成教授治疗冠心病及心脏神经官能症的临证经验挖掘研究

发布时间：2018-01-12 08:30

本文关键词：于凯成教授治疗冠心病及心脏神经官能症的临证经验挖掘研究　出处：《长春中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:总结于凯成教授治疗冠心病及心脏神经官能症的临床诊疗经验和思辨特点,使名老中医工作经验更好的传承和发扬,为年轻医生提供丰富的临床诊疗经验,进一步提高对冠心病及心脏神经官能症的治疗水平。方法:收集于凯成教授以2014年11月-2015年12月于凯成教授门诊患者,冠心病合格病例总数为209例,722诊次;心脏神经官能症合格病例总数为327例,共1079诊次。通过名老中医医案管理系统进行数据采集,直接将采集的病例导入到当代名老中医议案分析挖掘系统中进行挖掘,经分析的结果再次与于老探讨并总结其诊疗经验、思辨特点及用药规律。结果:327名冠心病患者的辨证分型结果显示气阴两虚、心血瘀阻居多,其次是肾阴亏虚、肾虚血瘀、痰阻血瘀;治法主要以养阴、化瘀、通络、益气为主要治法,补肾、清热、除烦、止痛等法也常见;心脏神经官能症的分析辨证结果为:肾阴亏虚为主,肾虚血瘀、肝郁气滞也颇为常见证型;治法主要以补肾、除烦、滋阴、清热为主要治法,常见的还有安神、宁心、活血、化瘀、解郁、疏肝治法等。冠心病用药出现频次排名前30名的药有:黄芪、丹参、川芎、百合、麦冬、太子参、白芍、山茱萸、地龙、生牡蛎、淫羊藿、酸枣仁、生龟板、生龙骨、熟地黄、青皮、红花、郁金、葛根、当归、合欢花等药物为主;其性味选择甘温最多,归经主要归肝经。心脏神经官能症用药出现频次排名前30名的药有:百合、熟地黄、青皮、生牡蛎、山茱萸、生龟板、葛根、生龙骨、丹参、地龙、白芍、酸枣仁、合欢花、川芎、夜交藤、枸杞子、淫羊藿、磁石、天麻、宧蔹草、骨碎补、珍珠母、土鳖虫、郁金、杜仲、远志等药物为主;其性味选择甘平最多,归经主要归肝经。结论:于凯成教授诊疗冠心病常以气阴两虚、心血瘀阻为多见,用药特色于老认为安神方能养阴血,用补阳药以阳中求阴,使滋阴而不腻,加以补气药使气机升降出入运行畅通,气行则血行,血行则瘀散,通则不痛的特点;治疗心脏神经官能症常以滋补肾阴为主,用药特色为从肾论治,利用肾主冲任,肝肾同源、乙癸同源、精血同源为特点,心肾关系(精血关系),心血依赖于肾之阴精的补充,则常用滋补肾阴药物来治疗本病。
[Abstract]:Objective: to summarize the clinical diagnosis and treatment experience of Professor Yu Kaicheng in the treatment of coronary heart disease and cardiac neurosis, so as to better inherit and carry forward the working experience of famous old Chinese medicine. To provide a wealth of clinical experience for young doctors. To further improve the treatment of coronary heart disease and cardiac neurosis. Methods: professor Yu Kaicheng from November 2014 to December 2015 in the outpatient clinic. The total number of eligible cases of coronary heart disease was 722; The total number of qualified cardiac neurosis cases was 327, a total of 1079 visits. The collected cases were directly introduced into the analysis and mining system of the motion of famous old Chinese medicine. The results of the analysis were again discussed with the elderly and summarized their experience in diagnosis and treatment. Results the results of syndrome differentiation of 327 patients with coronary heart disease showed that deficiency of qi and yin, blood stasis of heart, deficiency of kidney yin, blood stasis of kidney, phlegm and blood stasis; The main methods of treatment are nourishing yin, removing blood stasis, unblocking collaterals, benefiting qi, tonifying the kidney, clearing away heat, removing annoyance, relieving pain and so on. The results of analysis and differentiation of cardiac neurosis are as follows: deficiency of kidney yin, deficiency of kidney and blood stasis, stagnation of liver and qi are common syndromes; The main treatment method is to tonify the kidney, except vexation, nourishing yin, clearing heat as the main treatment method, the common treatment is also tranquilizing the mind, calming the heart, activating blood circulation, removing stasis, relieving depression, soothing the liver, and so on. The drugs in the top 30 of the frequency of the treatment for coronary heart disease are: astragalus membranaceus (Astragalus membranaceus). Salvia miltiorrhiza, Chuanxiong, Lily, Ophiopogon, Radix Pseudostellariae, Radix Paeoniae Alba, Fructus Corni, Rhizoma Rehmanniae, Raw Oyster, Epimedium, Sweet Jujube Kernel, Turtle Plate, Raw keel, ripe Rehmannia, Green Peel, Red Flower, Tujin, Pueraria root, The main drugs such as acacia flower; The most frequently used drugs for cardiac neurosis are lily, ripe Rehmannia glutinosa, green skin, raw oyster, Cornus officinalis, tortoise shell, pueraria root and keel. Salvia miltiorrhiza, Rhizoma Rehmanniae, Radix Paeoniae Albiziae, Jujube seed, Ligusticum chuanxiong, Rhizoma Lycii, Herba Epimedii, Magnolium, Gastrodia elata, Ampelopsis japonica, Dioscorea chinensis, Tulip, Eucommia ulmoides, Radix Polygoni and so on; Conclusion: professor Yu Kaicheng often treats coronary heart disease with deficiency of qi and yin, blood stasis of heart and blood stasis, and the medicine is characterized by the old thought that the formula of soothing the spirit can nourish yin and blood. The characteristics of invigorating Yang and seeking yin in yang, nourishing yin but not greasy, making Qi machine move up and down and running smoothly, blood flow, blood stasis, and general principle are not painful; The treatment of cardiac neurosis is usually based on nourishing the kidney yin. The characteristics of medication are from the kidney, using the kidney, liver and kidney, liver and kidney, and essence and blood as the characteristics, and the relationship between heart and kidney (essence and blood). The heart blood depends on the supplement of the kidney yin essence, then it is commonly used to nourish the kidney yin medicine to treat this disease.
【学位授予单位】：长春中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R249;R259

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