姚乃礼教授治疗胃食管反流病的临床经验研究

发布时间：2018-02-10 15:26

本文关键词： 临床研究名老中医经验姚乃礼教授胃食管反流病　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:总结姚乃礼教授对胃食管反流病(Gastroesophageal reflux disease,GERD)的诊疗经验,并深入探究姚乃礼教授对GERD诊疗的学术思想,目的在于继承和发扬名老中医经验,为年轻一辈中医人提供学习的宝贵资料。方法:通过收集及整理姚乃礼教授治疗GERD门诊病例,门诊跟师学习及在姚乃礼教授亲自指导下总结其对于GERD病因病机的认识、辨治体会、遣方用药的经验,最终总结出姚乃礼教授对于GERD的学术观点。采取自身前后对照的研究方法对姚乃礼教授运用经验方启陷汤治疗GERD患者进行临床观察,即以启陷汤为基础方进行加减治疗60例GERD患者,治疗12周,随访4周,分别于治疗前、治疗4周、治疗8周、治疗12周、停药4周观察记录患者的Gerd Q问卷评分和临床症状,治疗前后记录患者的血常规、尿常规、便常规+潜血、肝、肾功能指标。使用SPSS21.0分析临床数据及评价疗效。结果:总结了姚乃礼教授治疗GERD的经验。对于病因病机的认识,姚乃礼教授认为GERD的主要病因为饮食不调、情志失调、脾胃素虚以及外邪侵袭,其中饮食不节、情绪不畅乃常见病因;在对于病机的基本认识上,姚乃礼教授提出脾胃虚弱,运化失宜为发病基础,气机失于调畅贯穿疾病始终,胃失和降、胃气上逆为病机关键,痰、热为重要病理因素,痰、热并存,气阴耗伤为疾病发展后期;在治疗方面,姚乃礼教授倡导既要辨主病又要辨主症,强调舌脉的重要性,明确疾病的病位、病性、疾病分期,使宏观辨证与微观辨证相结合方能更加准确地诊治疾病。在治疗细则方面,姚乃礼教授将以润为降贯穿整个治疗过程,重视宣通气机,恢复气机正常运行,不忘在清热化痰活血的同时调补气阴,散结通络,体现了攻补兼施、标本兼治的治疗理念。在选方用药方面,姚乃礼教授灵活运用经方治疗的同时,善于使用对药,体现了在熟谙中药、方剂理论的前提下,可以从各个层次、各种角度地更加全面地治疗疾病。启陷汤作为基础方治疗GERD,在症状总积分方面,治疗4周、治疗8周、治疗12周及停药4周后相比治疗前的基线而言,积分均降低,差异均具有统计学意义(P0.001)。在单一症状疗效方面,反酸、烧心、胸骨后疼痛、胃脘胀痛、嘈杂、纳差、口苦、暖气、眠差、不良情绪各自治疗后的积分与治疗前的基线相比较,积分均降低,差异均具有统计学意义(P0.001)。无论是症状总积分还是单一症状积分,在治疗4周、治疗8周、治疗12周与治疗前基线相比,积分均降低,说明随着治疗时间的延长症状明显减轻。因此,可以表明启陷汤基础方治疗GERD疗效明显。结论:姚乃礼教授对于GERD的病因、病机、辨证、治疗、用药以及生活调护方面都有深层次的独到见解,使用启陷汤为基础方治疗GERD验证于临床、疗效肯定、优势突出、安全性好。
[Abstract]:Objective: to summarize the experience of Professor Yao Nai-li in the diagnosis and treatment of gastroesophageal reflux disease (GERD), and to probe into Professor Yao Nai-li 's academic thoughts on the diagnosis and treatment of GERD in order to inherit and develop the famous and old TCM experience. Methods: by collecting and arranging Professor Yao Naili's treatment of GERD outpatient cases, the outpatients studied with their teachers and their understanding of the etiology and pathogenesis of GERD was summarized under the guidance of Professor Yao Nai-li himself. Finally, Professor Yao Naili's academic views on GERD were summed up. The clinical observation was carried out on the treatment of GERD patients by Professor Yao Naili using experiential Fangqi decoction. 60 patients with GERD were treated with Qiqi decoction for 12 weeks and followed up for 4 weeks. Before treatment, 4 weeks, 8 weeks and 12 weeks respectively, the patients' Gerd Q scores and clinical symptoms were observed and recorded after 4 weeks of withdrawal. The blood routine, urine routine, occult blood, liver and kidney function were recorded before and after treatment. The clinical data were analyzed by SPSS21.0 and the curative effect was evaluated. Results: professor Yao Naili's experience in treating GERD was summarized. Professor Yao Nai-li believes that the main causes of GERD are food disorders, emotional disorders, deficiency of spleen and stomach, and invasion of exogenous pathogens. Among them, poor diet and poor mood are common causes. On the basic understanding of the pathogenesis, Professor Yao Nai-li suggested that the spleen and stomach are weak. The pathogenesis is based on the loss of Qi, the loss of Qi and the unobstructed flow of qi throughout the disease, stomach disharmony, stomach qi inversion is the key to pathogenesis, phlegm and heat are important pathological factors, phlegm and heat coexist, Qi and Yin wasting injury is the late stage of disease development, and in the treatment, there are two main pathological factors, which are phlegm and heat. Professor Yao Nai-li advocated that both the main disease and the main disease should be distinguished, emphasizing the importance of the tongue vein, defining the disease's location, nature, and stages of the disease, so that the combination of macro and micro syndrome differentiation can make the diagnosis and treatment of the disease more accurate. In terms of treatment rules, Professor Yao Naili will take moistening as the drop throughout the whole treatment process, attach importance to the ventilator, restore the normal operation of the qi machine, and not forget to regulate Qi and Yin while clearing heat, resolving phlegm and activating blood, and dispersing the collaterals, thus reflecting both attack and nourishment. The concept of treating both the symptoms and the symptoms. Professor Yao Naili is flexible in the use of prescriptions, and at the same time he is good at using the prescription. This shows that under the premise of being familiar with the theory of traditional Chinese medicine and prescription, he can use it from all levels. Qiqi decoction was used as the basic prescription to treat GERD. in terms of total symptom score, the scores decreased after 4 weeks of treatment, 8 weeks of treatment, 12 weeks of treatment and 4 weeks of withdrawal of drugs, compared with the baseline before treatment. The difference was statistically significant (P 0.001). The scores of reflux, heartburn, poststernal pain, epigastric distension, noise, anorexia, bitter mouth, warm air, sleep, and bad mood were compared with baseline before treatment. The scores were all decreased, and the differences were statistically significant (P 0.001). The scores were decreased at 4 weeks, 8 weeks, 12 weeks after treatment, compared with the baseline before treatment, regardless of the total symptom score or the single symptom score. Conclusion: professor Yao Naili is effective on the etiology, pathogenesis, syndrome differentiation and treatment of GERD. There are profound original opinions on medicine and daily nursing. The treatment of GERD based on Qiqi decoction is proved to be effective, superior and safe.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R249;R259

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