黄丽娟教授学术思想临床经验总结及治疗高脂血症的临床研究

发布时间：2018-01-23 21:12

本文关键词： 黄丽娟学术思想临床经验总结高脂血症临床研究　出处：《北京中医药大学》2016年博士论文　论文类型：学位论文

【摘要】：黄丽娟教授在其近50年的医学临床及教学中,积累了丰富的经验,对疾病的认识和诊疗有自己独到的见解,深入学习和挖掘她的学术思想和诊疗规律,对于继承和发扬有着重要的意义。1.黄丽娟教授学术思想渊源黄丽娟教授勤于学习,为离职西学中班学员,在系统学习西医知识后,又系统学习中医四部经典等医书,中医的整体观念、辨证论治、重视后天脾胃等理论都对黄教授学术思想的形成起到了重要的影响。黄丽娟认真好学,广采博纳,师从王为兰、吉良晨、方和谦、孙伯扬等名老中医,吸取他们的学术观点和临证经验。结合自己的临床实践,灵活的将各家理论融会贯通,在理论上、用药上形成了自己的特色。高脂血症造成的心、脑血管疾病的危害日益引起人们的重视,近年来黄老师将一部分研究的重点放在了高脂血症的中西医结合治疗上,提出高脂血症的重要病机是脾失健运,痰浊血瘀内阻,以健脾利湿化浊、活血化瘀为主要治则。2.黄丽娟教授学术思想概述2.1强调中医整体观念,重视“天人合一”《内经》整体观的理论对黄丽娟教授有深远的影响,人生存于自然界,“天人合一”,与自然界相互影响,同时人体本身亦是一个有机的整体,各脏腑间又相互为用,相互制约。临床诊疗疾病,要重视整体观念,注意季节气候、环境因素、人体自身的因素等,坚持“三因”的用药原则。2.2五脏相关,重视脏腑辨证心肝脾肺肾五脏之间是相互依赖、相互制约的关系。五脏之间彼此协调,保证人体健康,若相生、相克、相乘、相侮规律发生混乱,则人体易出现疾病。黄丽娟教授认为,临床诊治本脏疾病的同时,注意保护相关的脏腑,才能促进疾病的好转。2.3重视后天之本-脾胃黄丽娟教授重视“脾胃为后天之本”的理论,多种疾病均强调饮食不节的发病病因及脾胃损伤的病理机制,故诊疗时时刻顾护脾胃,诊治包括心血管在内的多种疾病,注重脾胃的调理。2.4气血同治,强调气的重要在人体的生理活动中,气血占有重要的地位,两者之间存在“气为血帅、血为气母”的关系,二者在生理、病理上互相影响。黄丽娟教授治疗疾病注重调理气血,并认为“气行则血行”,气血同治时注重气的重要性。2.5坚持辨证、辨病相结合黄丽娟教授中西并用,中医辨证论治的同时,重视西医的诊断。强调西医诊断的重要性,只有明确诊断,方能明确疾病发展演变及预后,从而指导用药。辨证论治则能明确疾病某一阶段的具体证候。在辨病辨证、诊疗施治时,重视西医药理对中医药的研究进展,从而辨病使用中药。3.黄丽娟教授临床经验总结3.1血浊病(高脂血症)黄丽娟教授认为血浊病的病理机制为脾虚失运、痰瘀内阻,为本虚标实,脾虚失运为本,标实为痰瘀。治法以健脾利湿化浊、活血化瘀为主,以三黄消脂片的组成方药为基本方进行加减,配合饮食、运动,取得较好的降脂效果。同时近年来有肝郁脾虚、肝肾阴虚的血浊患者,用药应对症加减。3.2胸痹心痛病(冠心病)教授秉承“阳微阴弦”是该病的基本病机,“阳微”即本虚,既有心脏本身气血阴阳的虚损,也有肺脾肝肾他脏的不足;“阴弦”即标实,为气滞、痰浊、寒凝、血瘀等影响五脏的功能所致的不通则痛。基本治则为扶正祛邪：养阴益气、温阳通经、活血化瘀、祛痰通络,注意应一并调治五脏的失衡。3.3心衰病(心力衰竭)心衰的病位在心,但常累及到其它四脏。老师认为心衰病机多为虚实夹杂,以气、阴、阳的亏虚为主、为本,病理产物痰饮血瘀为标。老师常用基本治则为温阳益气、活血利水,照顾心肺及脾胃的阴津。往往辨病与辨证相联合,辨证的同时注重心脏原发疾病的特点。3.4心悸病(心律失常)黄丽娟教授认为本病病位在心,与脾、肺、肾、肝均有着密切的关系,属于本虚标实证,其虚在阴阳气血之失调,其实与寒热、痰瘀、七情等有关。治疗多以生脉散为基本方加减治疗,同时注重活血化瘀、养心安神。根据脏腑辨证,随症加减治之。治疗上要区分快速与缓慢两种类型的心律失常,辨病用药。3.5眩晕病(高血压病)本病病位在肝肾,影响及脑,与心脾关系密切,因情志、劳倦、年老、饮食等失调,致使气机升降紊乱,气血失和,风、火、郁、痰、瘀上扰清窍,病性为本虚标实。黄丽娟教授认为肾精不足、肝阳上亢、痰湿中阻、肝气郁结等证为临床常见证型,治疗注重脏腑辨证。3.6消渴病(糖尿病)消渴病是目前临床常见病,是冠心病的等危症。阴虚为本,燥热为标是本病公认的病机。黄丽娟教授结合现代人们的生活方式及临床所见,认为脾胃功能失常、瘀血内停是其目前常见的病因病机。治疗除以养阴清热外,调理脾胃、活血化瘀是其常用的治法。3.7瘿病(甲状腺疾病)黄丽娟教授认为,气滞、痰凝、血瘀是瘿病(甲状腺结节)发生的主要病理机制,治疗首要的是以调理气机为法,适当佐以活血软坚、化痰散结等法辨证施治。亚甲炎的主要病因病机是外感风热邪毒,或情志不遂导致的局部热毒壅盛,治疗以清热疏肝,消肿止痛、滋阴等为主。4.黄丽娟教授治疗高脂血症的临床研究4.1健脾利湿化浊、活血化瘀治疗高脂血症的临床研究目的：观察健脾利湿化浊、活血化瘀治疗高脂血症的临床疗效及安全性。方法：将门诊60例脾失健运,痰浊内生高脂血症患者,随机分为治疗组和对照组。治疗组用三黄消脂片主方,对照组应用血脂康胶囊,观察8周。观察患者中医证候、血脂等的改变。结果：两组患者胸闷、气短、乏力等症状均有明显改善(P0.05)。治疗后两组TG、TC水平均较疗前明显改善(P0.05),治疗组在降低LDL-C、升高HDL-C方面,疗前后有统计学差异(P0.05)。结论：健脾利湿化浊、活血化瘀法可改善患者的临床症状,降低血脂水平,对防治高脂血症疗效明显。4.2黄丽娟教授治疗高脂血症用药规律的研究通过对黄教授辨证治疗的156例高脂血症患者的三类常见中医证候进行构成比分析,结果发现：脾失健运,痰浊内生型最为多见；其次为肝气郁结,脾虚气滞型；肝肾阴虚临床亦不少见。黄丽娟教授辨证治疗高脂血症的常用药物主要包括健脾、疏肝、行气、活血、补肾、化湿、化痰、温阳等药物,常用治法为：益气健脾、利湿祛痰、活血化瘀。所使用药物频次前十位的有：马齿苋、姜黄、虎杖、鬼箭羽、蒲黄、泽泻、佛手、郁金、石菖蒲、萆參。在治疗甘油三酯高的患者中,所使用药物频次前十位的有：马齿苋、姜黄、荷叶、虎杖、蒲黄、茯苓、泽泻、生白术、生薏米、决明子。在治疗混合型高脂血症患者中,所使用药物频次前十位的有：荷叶、虎杖、蒲黄、鬼箭羽、黄芪、决明子、何首乌、扁豆、马齿苋、姜黄。
[Abstract]:Professor Huang Lijuan in the nearly 50 years of clinical medicine and teaching, has accumulated rich experience, have their own unique insights and understanding of the diagnosis and treatment of diseases, in-depth study and mining her academic thought and treatment rules, to inherit and carry forward the important significance of.1. professor Huang Lijuan academic thought origin of Professor Huang Lijuan, eager to learn, to leave the Western shift students in learning western knowledge system, and system to study Chinese medicine four classic medical books, the holistic concept of traditional Chinese medicine, syndrome differentiation, attention to spleen and stomach theory has important influence on the formation of the academic thought of Professor Huang. Huang Lijuan studious, guangcaibonatake under the tutelage of Wang Weilan, Ji Liangchen Fang Heqian, Sun Boyang, and other old Chinese medicine, academic ideas and clinical experience from them. Combined with clinical practice, the flexibility of the theory of mastery, in theory, use form Into their own features. Hyperlipidemia caused by heart damage, cerebrovascular disease has attracted much attention in recent years, Huang will be part of the study focuses on the combination of traditional Chinese and Western medicine treatment of hyperlipidemia, put forward the important pathogenesis of hyperlipidemia is spleen, phlegm and blood stasis the internal resistance to spleen dampness turbidity, blood stasis as the main rule is.2. overview of the academic thought of Professor Huang Lijuan 2.1 stressed that the overall concept of traditional Chinese medicine, pay attention to "harmony" in the whole view of the < > theory of Professor Huang Lijuan have a profound effect, life in nature, "harmony", the mutual influence and nature at the same time, the human body is an organic whole, the organs between each other with, restrict each other. The clinical diagnosis and treatment of disease, should pay attention to the overall concept, pay attention to seasonal climate, environmental factors, human factors, adhere to the "three principles for the use of.2.2" Correlation of five viscera, attention between heart spleen and lung and kidney are interdependent and mutual restriction between each other. Between five and coordination, to ensure the health of human body, and if, G, multiplication, violation of law confusion, is prone to human disease. Professor Huang Lijuan believes that the clinical diagnosis and treatment of cardiac disorders at the same time, pay attention to the protection of the relevant the viscera, in order to promote the improvement of disease.2.3 attention to the day after tomorrow - Professor Huang Lijuan attached great importance to "spleen and stomach spleen and stomach for the day after tomorrow" theory, many diseases have stressed the pathogeny and pathology of spleen and stomach injury diet, the treatment time of spleen and stomach diseases including cardiovascular treatment, pay attention to the spleen and stomach conditioning.2.4 blood gas in Tongzhi, emphasizing the important physiological activities of the human body, and plays an important role between the two "handsome gas for blood, blood gas", the two students in the Daniel, pathology professor Huang Lijuan in the treatment of diseases affecting each other. Pay attention to regulating qi and blood, and that the gas line is blood, blood gas.2.5 Tongzhi significance of dialectical combination of disease differentiation, Professor Huang Lijuan combination of traditional Chinese and Western medicine, TCM syndrome differentiation and diagnosis of Western medicine. The importance of attention to western medicine diagnosis. Only a clear diagnosis, in order to clear the disease development and prognosis, so as to guide the treatment. Syndrome differentiation can clear disease specific syndromes of a stage. In the differentiation of diseases, diagnosis and treatment, pay attention to research progress of traditional Chinese medicine and Western medicine disease using traditional Chinese medicine pharmacology,.3. professor Huang Lijuan 's clinical experience of 3.1 blood the turbid yellow disease (hyperlipidemia) Professor Li Juan thinks that the pathological mechanism of turbid blood disease is spleen deficiency, phlegm and blood stasis resistance, superficiality, deficiency of the spleen is the standard treatment with phlegm and turbid. Spleen dampness, promoting blood circulation to remove blood stasis The main composition, in Sanhuang tablets fat as the basic side addition and subtraction, diet, exercise, has good lipid-lowering effect. At the same time, in recent years, liver stagnation and spleen deficiency, turbid blood in patients with liver and kidney yin deficiency,.3.2 disease medication response chest pain disease (CHD), adhering to the "Yin Yang micro string" is the basic pathogenesis this disease, "Yang micro" that this deficiency, deficiency of both qi and Yin and Yang of heart, lung and spleen and kidney has the defects of his dirty; "Yin namely biaoshi, qi stagnation, phlegm, cold coagulation and blood stasis caused by the five barrier function and effect of basic rule is pain. To uphold: Yin Qi, warming yang and dredging, blood stasis, expectorant Tongluo, attention should be regulating the five imbalance of heart failure (heart failure).3.3 heart failure disease in the heart, but often involves other dirty. Four teachers think that the pathogenesis of heart failure is mixed with the actual situation, with gas, Yin, Yang deficiency for this, disease. Physical product of phlegm and blood stasis as the standard. The teacher used the rule for Yang Qi, blood and water, take care of heart lung and stomach yin. Often combined disease and syndrome differentiation, syndrome differentiation and focus on.3.4 features of primary cardiac disease palpitations (arrhythmia) Professor Huang Lijuan that the disease in the heart and, spleen, lung, kidney and liver are closely related, belonging to the false positive, the false imbalance in the Yin and Yang Qi, in fact, with the cold and heat, phlegm and blood stasis, emotions and so on. Treatment with Shengmai San as basic decoction treatment, at the same time pay attention to blood stasis, Yangxin Anshen. According to syndrome differentiation. With disease treatment. The treatment should distinguish between fast and slow two types of arrhythmia disease medication.3.5 vertigo disease (hypertension) the disease in the liver, brain and spleen and influence, closely related, because of emotional, Laojuan, age, eating disorders, resulting in Qi Qi and blood disorders. And The wind, fire, phlegm, blood stasis, qi stagnation, disturbing orifices, disease of superficiality. Professor Huang Lijuan believes that the Kidney Deficiency Hyperactivity of liver Yang, phlegm dampness, liver qi stagnation syndrome is a common clinical syndrome type, treatment of diabetes.3.6 on viscera syndrome (diabetes) diabetes is present clinical common disease, is a great risk of coronary heart disease. Yin deficiency is the standard for heat is the pathogenesis of this disease. The accepted way of life and the modern people with clinical professor Huang Lijuan think, the function of the spleen and stomach disorders, blood stasis is the most common etiology of disease. Treatment divided by Nourishing Yin and clearing away heat, spleen and stomach that is the commonly used treatment of Huoxue Huayu.3.7 gall disease (thyroid disease) Professor Huang Lijuan, qi stagnation, phlegm, blood stasis is the gall disease (thyroid nodules) the main pathological mechanism, treatment is the first to regulate Qi as the appropriate method, combined with Huoxue Ruanjian phlegm, method of syndrome differentiation. Subacute thyroiditis The main pathogenesis is due to heat toxin, or emotional upset caused by partial heat treatment with heat dampness, liver, relieving pain, clinical study of 4.1 spleen dampness Huazhuo Yin based.4. professor Huang Lijuan in the treatment of hyperlipidemia, clinical research purpose of promoting blood circulation and removing blood stasis in the treatment of hyperlipidemia: Observation of spleen dampness turbidity, clinical efficacy and safety of blood circulation in the treatment of hyperlipidemia. Methods: 60 patients with spleen, phlegm in patients with hyperlipidemia were randomly divided into treatment group and control group. The treatment group was treated with Sanhuang tablets and reducer used in the control group, Xuezhikang Capsule, 8 weeks of observation observe syndrome patients, blood lipid changes. Results: two groups of patients with chest tightness, shortness of breath, fatigue and other symptoms were significantly improved (P0.05). After treatment, two groups of TG, TC levels were significantly improved compared with before treatment (P0.05), in the treatment group decreased LDL-C, increased HDL-C, before treatment After a statistical difference (P0.05). Conclusion: the clinical symptoms of spleen dampness turbidity, promoting blood circulation and removing blood stasis can improve patients, reduce blood lipid levels of hyperlipidemia on medication of treating hyperlipemia.4.2 curative effect of Professor Huang Lijuan in treating the constituent ratio analysis, results showed that the three kinds of common TCM Syndromes in 156 cases the treatment of patients with hyperlipidemia syndrome: Professor Huang splenism, endogenous phlegm type is most common; followed by liver qi stagnation, spleen deficiency and qi stagnation; Yin deficiency of liver and kidney is not rare. The clinical commonly used drugs of Professor Huang Lijuan syndrome differentiation and treatment of hyperlipidemia including the spleen, liver, Qi, blood, kidney, dampness, phlegm, warming yang and other drugs, commonly used method is: Qi and spleen, dampness phlegm, blood stasis. The drug use frequency of the top ten are: Purslane, turmeric, Polygonum cuspidatum, euonymusalatus, pollen Typhae, Alisma, bergamot, turmeric, shichangpu, Effects of ginseng. In the treatment of patients with high triglyceride, drug use frequency of the top ten are: Purslane, turmeric, lotus leaf, giant knotweed, pollen Typhae, Poria, Alisma, white atractylodes rhizome, raw coix seed, cassia seed. In the treatment of mixed hyperlipidemia patients, drug use frequency of the top ten are: lotus leaf, Polygonum cuspidatum, pollen Typhae, euonymusalatus, astragalus, cassia seed, Polygonum multiflorum, lentils, purslane, turmeric.

【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】：2016
【分类号】：R259;R249

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