燕小霞诊治肾病学术思想和临床经验整理与研究

发布时间：2018-02-03 16:04

本文关键词： 燕小霞主任医师肾病学术思想　出处：《成都中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：通过对燕小霞导师行医历程的探究,反映其学术思想的形成,再通过亲历侍诊,虚心受教,勤问多记,不断积累学习资料,经整理分析,从多个方面总结诊治规律及遣方用药的特点。并总结导师治疗肾病的临床经验和学术思想。肾病,发病率较高,临床以慢性肾病多见,起因隐匿,病程绵长,是一组常见的而且比较复杂的疾病群,病变往往持续发展,迁延不愈,最后导致肾衰竭,危害较大。通过燕小霞导师30余年诊治慢性肾衰的临床经验,因地制宜,提出温阳益气活血化浊法,采用导师经验方参芪地黄汤加味治疗慢性肾功能衰竭脾肾阳虚证的临床疗效的观察和探讨研究。方法：在跟师过程中努力学习,详细记录病情及病案,累积260余份门诊病案,总结整理完成典型病案,复习中医经典著作《神农本草经》、《内经》、《伤寒论》、《金匮要略》、《温病学》等,探求经文的经义,写了心得体会。总结老师临床经验及诊治用药的心得,并发表论文2篇。研读相关肾病的医论医案,查阅有关现代治疗慢性肾衰的文献资料,并关注中医药诊治慢性肾衰的研究进展,对慢性肾病的诊治有了进一步的认识。经总结归纳,探究燕小霞导师的诊治规律及遣方用药特点,整理其临床经验和学术思想。燕小霞导师依据“天人合一”的经典理论,因地制宜,针对本地区的特点,提出“温阳益气活血化浊法”治疗高海拔地区慢性肾衰脾肾阳虚证。按照科研设计路线和要求筛选临床病例60例,随机分为治疗组31例和对照组29例,治疗2月后观察结果。结论：燕小霞导师从中医整体观出发,依据“邪之所凑,其气必虚”的经典理论,以脏腑辨证为核心,指出正虚是肾病发病的根本原因,外邪是发病重要因素,认为其病之本在脾、肾,湿、浊、瘀、毒等为标。肾脏病的病理改变主要发生在肾,其病理产物不外乎有湿、浊、毒、瘀,只是在肾病发展的不同阶段对机体的影响不一。但人体作为一个完整的有机体,一脏有病往往可以影响到其他脏腑和器官,常表现为多脏腑功能失调的证候。但又以肾、脾两脏最为关键,其病机在于脾肾亏虚,气血生化失常,湿、浊、瘀、毒内蕴,三焦气机不利,脏腑功能失调。临床常见脾肾阳虚、肝肾阴虚、气阴两虚、阴阳两虚,兼风水泛滥、湿热蕴结、湿浊内阻、水瘀交阻证,病机特点是本虚标实,虚实夹杂,以正虚为本,邪实为标。燕小霞导师在肾病的诊治上中医及中西医相结合,取长补短。在临证中辨病与辨证、宏观症状与微观检验相结合,治疗中取其所长的基础上运用中医理论体系,从整体调整入手,谨守病机,治病求本,扶正祛邪,以平为期的指导思想,在临床实践中收到了显著的疗效。
[Abstract]:Objective: to explore the course of Yan Xiaoxia's medical practice, to reflect the formation of his academic thought, and then to collect and analyze the learning data by attending to diagnosis, being taught with an open mind, asking more questions, and accumulating learning materials. From many aspects summarized the diagnosis and treatment law and the characteristics of prescription medication. And summed up the clinical experience and academic thinking of tutor treatment of nephropathy. Nephropathy, the incidence of high, clinical with chronic nephropathy, the cause of hidden, long course of disease. Is a group of common and more complex disease groups, the lesions often continue to develop, delay no recovery, and finally lead to renal failure, great harm. Through Yan Xiaoxia mentor 30 years of clinical experience in the diagnosis and treatment of chronic renal failure. According to local conditions, put forward the method of warming yang, benefiting qi, activating blood circulation and turbid. The clinical effect of Shenqi Dihuang decoction on chronic renal failure syndrome of deficiency of spleen and kidney yang was observed and discussed. Methods: to study hard in the process of following the teacher, and to record the disease condition and the medical record in detail. Accumulate more than 260 outpatient medical records, summarize and complete the typical medical records, review the classic works of traditional Chinese medicine "Shennong Herbal Classic", "Internal Classic", "Theory of febrile Disease", "synopsis of Golden Chamber", "febrile Disease" and so on. To explore the scripture, write the experience, summarize the teacher's clinical experience and experience in the diagnosis and treatment of medication, and publish two papers. Read the medical records of related nephropathy, consult the literature about the modern treatment of chronic renal failure. And concerned about the research progress of TCM in the diagnosis and treatment of chronic renal failure, there is a further understanding of the diagnosis and treatment of chronic nephropathy. Collate its clinical experience and academic thought. According to the classical theory of "integration of nature and man", teacher Yan Xiaoxia, according to local conditions, according to the characteristics of the region. The treatment of chronic kidney failure with deficiency of spleen and kidney yang in high altitude area was put forward. According to the design route and requirement of scientific research, 60 clinical cases were selected and randomly divided into treatment group (31 cases) and control group (29 cases). Conclusion: from the holistic view of traditional Chinese medicine, according to the classical theory of "evil, Qi must be deficiency", taking the syndrome differentiation of zang-fu organs as the core, it is pointed out that the deficiency of justice is the fundamental cause of nephropathy. External pathogenic factor is an important factor in the pathogenesis, it is considered that the disease is based on spleen, kidney, dampness, turbidity, blood stasis, toxin and so on. The pathological changes of kidney disease mainly occur in the kidney, and its pathological products are nothing but dampness, turbidity, poison and stasis. However, as a complete organism, a visceral disease can often affect other organs and organs. It is often manifested as the syndromes of multiple viscera dysfunction. However, the kidney and spleen are the most key, the pathogenesis is deficiency of spleen and kidney, biochemical disorders of qi and blood, dampness, turbidity, blood stasis, toxic connotation, unfavorable to the three coke qi machine. Dysfunction of viscera function. Clinical common spleen and kidney yang deficiency, liver and kidney yin deficiency, qi and yin deficiency, yin and yang deficiency, fengshui flood, damp-heat accumulation knot, dampness and turbid internal obstruction, water stasis and obstruction syndrome, the pathogenesis of the disease is the deficiency of the standard solid, mixed with deficiency. Yan Xiaoxia mentor in the diagnosis and treatment of nephropathy combined traditional Chinese medicine and Western medicine, learn from each other. In the clinical syndrome differentiation and syndrome differentiation, macro symptoms and micro test combined. On the basis of taking its advantage in the treatment, the author uses the theory system of traditional Chinese medicine, starting with the whole adjustment, observing the pathogenesis, treating the disease, seeking the root, strengthening the spirit and dispelling evil, and has received remarkable curative effect in clinical practice with the guiding ideology of leveling out for a long period of time.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R249;R277.5

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