王鸿度教授“皮腠神气变生机制”学术思想及临床经验总结和研究

发布时间：2018-02-26 12:05

本文关键词： 王鸿度营卫皮腠神气学术思想　出处：《成都中医药大学》2016年博士论文　论文类型：学位论文

【摘要】：研究目的：营气、卫气是人身的重要精微物质。在《黄帝内经》中,关于营卫来源、生成及运行均有明确的论述,并得到历代医家重视。《难经》、《伤寒论》均运用并发挥了营卫生会的理论。后世医家,特别是明清众多知名医学家,不约而同地反复争论这一理论,形成了“卫气清降而产阴精……营血温升而化阳神”的结论,成为明清之际中医学界蔚为壮观的营卫问题大论战的重要理论成果。全国第五批名老中医师承专家王鸿度教授继承先贤学术观点,进一步提出营卫气化完成新陈代谢,是营卫问题的实质。但既往中医基本理论对其说理不清,甚至相互淆混。营卫由摄入水谷精微在中焦生成,并逐级运行到皮肤腠理,再返回体内的过程,这一由内向外、并由外之内的过程,正是为了完成营卫新陈代谢,包括营卫的交感离合、相互转化、合以大气、变生神气等环节,并在这些环节中发挥其重要生理功用。本研究以王老师的“皮腠神气变生机制”为核心,整理其学术思想渊源、立论依据及主要内容等。同时结合王老师临床治疗周围神经性面瘫和带状疱疹后遗留神经痛的经验,说明此理论的实际运用。为更好地认识这一重要理论,又实施了“围刺法治疗带状疱疹后遗留神经痛”的临床实验,从“浅针围刺,激神止痛”角度,验证皮腠构造、皮腠神气以及带状疱疹后遗留神经痛相关性,以临床实验数据初步阐明其临床疗效。研究方法：1.跟师临证：笔者在三年跟师过程中,坚持跟师门诊,在老师诊疗过程中细心观察,用心体会老师临证的过程,详细记录老师的望、闻、问、切收集的临床资料,以利于诊后的思考和总结。坚持随时记录老师用药的心得体会,坚持多看、多想、多问,坚持对老师典型的医案进行总结,体会和揣摩老师的辨证心路和用药依据。2.研读经典：在老师的指导下,多读相关的经典著作,全面理解老师的学术思想渊源,对经典中的重点条文能理解到字的内涵,且在此过程中参考历代注家之言,尽量做到融会贯通。3.研读和探讨老师论著中的学术观点：对老师已经发表的学术论文认真研读,领会其思想,并在平日的跟师过程中对其中不甚清晰的理论和思路及时向老师请教,使自己更好地体会老师的学术观点和理论渊源。4.临床运用：将老师的理论和学术经验运用于临床实践,在老师皮腠神气变生理论指导下,在临床上,常常运用治表以和里、调和营卫的方法治疗疾病,拓展了自己的临床思路,且将这一理论用于指导临床实验研究。研究内容：1.王鸿度教授“皮腠神气变生机制”的学术渊源和立论依据辑集《黄帝内经》及后世众多医家关于营卫生会的论述中,探讨营卫之气生会的意义,皮腠及皮腠间存在特殊构造——“络脉一孙脉”的生理功能；整理前贤营卫升降之气的气化过程：包括交感、离合,以及合以大气,变生皮腠神气等。论证营卫气化是人体新陈代谢的重要过程；营卫气化的目的是“弃旧用新”,包含物质、能量代谢以及神气变生；皮腠是营卫气化的重要场所,因此也是神气变生的加工厂。2.王鸿度教授“皮腠神气变生机制”学术思想内涵以及临床经验包括“皮腠神气变生机制”的论据和论证、神气主要性用等内容。并选择出周围性面瘫和带状疱疹后遗留神经痛为例,系统整理和总结王鸿度教授应用“皮腠神气变生机制”于针灸常见病的临床经验,包括对病因病机、病证分期的新认识,治则治法的选用,方药和穴位的选择配伍等等。3.“皮腠神气变生机制”运用于治疗带状疱疹后遗留神经痛的临床实验观察。带状疱疹后遗留神经痛的疼痛因年龄、体质等因素有较大差别。带状疱疹后遗留神经痛临床主要表现为刺痛、或灼热样疼痛或皮肤的异常感觉,笔者在王老师的指导下,以“浅针围刺,激神止痛”为法,选围刺法治疗这种典型的皮腠感觉异常的病证,进行随机对照临床观察,且测量带状疱疹后遗留神经痛在治疗前后的疼痛程度、情绪、睡眠以及血清中P物质的含量,以科学检测数据验证围刺法对于带状疱疹后遗留神经痛的有效性。结论：1.王鸿度教授在营卫气化理论的基础上,论证营卫之气在皮腠经由络脉—孙脉这一特殊结构,交感气化,并合以大气,以变生神气的过程,概括为“皮腠神气变生机制”。这一机制是对营卫气化学说的补充,也是对中医关于营卫生理认识的升华。而皮腠神气是人体生理调衡及中医众多外治方法的作用基础。2.王鸿度教授运用该理论指导临床,形成了对周围性面瘫、带状疱疹后遗留神经痛等的独具特色临床诊疗经验,取得良好的疗效,这一理论也启发了笔者的深入思考和理解。3.运用“皮腠神气变生机制”为指导,观察围刺法治疗带状疱疹后遗留神经痛的临床实验观察,以血清中P物质的定量测定作为观察指标之一,客观地论证了皮腠神气的变化与疼痛产生的相关性,以及经皮治疗的有效性。
[Abstract]:Objective: To study the camp gas, Wei Qi is an important nutrient substance. People in "Neijing", on Ying Wei source, production and operation are clearly discussed, and get the attention of successive dynasties. Nanjing >, < > was applied in Treatise on Febrile Diseases and play the health camp theory. Doctors later. Especially in Ming and Qing Dynasties many well-known medical experts, invariably debate this theory, formed a "Wei Qi and Yin ofqingjiang. Camp blood temperature rise and Yang God" conclusion, become the important theoretical achievements of the Ming and Qing Dynasties traditional Chinese medicine Wei Ying Wei problem spectacular big debate over fifth. Number of old Chinese Medicine expert Professor Wang Hongdu inherited from the sages academic point of view, put forward to complete the Ying Wei gasification is the essence of Ying and Wei The new supersedes the old., the basic theory of traditional Chinese medicine. But the previous reasoning is not clear, even confusion mixed. Ying Wei generated by the intake of cereal essence in middle Jiao, and gradually. The skin striae, back in the process, from inside to outside, and from within the process, it is in order to complete the transformation of The new supersedes the old. Ying Wei, sympathetic clutch, including Ying Wei, in the atmosphere, air and other aspects of life change, and play an important physiological function in the process of this. Study on Wang's "skin cou air variable mechanism" as the core, finishing its academic origins, theoretical basis and main content. At the same time according to the clinical treatment of peripheral nerve paralysis and Wang postherpetic neuralgia, experience shows that the actual use of this theory. For a better understanding of this important theory in clinical trials, and the implementation of the "Wai Needling Treatment of postherpetic neuralgia", from "shallow needle waici, angle of bowel God pain, verify the skin cou structure, skin cou air and postherpetic neuralgia related to clinical practice. The experimental data clarify its clinical curative effect. Methods: 1. with clinical division: the author in three years with the division process, adhere to with the teacher in the teacher clinic, diagnosis and treatment process of careful observation, experience the process of teacher certificate, a detailed record of the teacher's look, smell, ask, cut to collect clinical data. For after thinking and summary. To find the record at any time teacher use experience, to see more, think more, ask more, insist on the typical case the teacher summed up the experience and try to figure out the teacher's psychological differentiation and medication on the basis of.2.: in the study of classical teacher under the guidance of reading related classics, comprehensive understanding the teacher's academic ideological origins, the key provisions of the classic of understanding to the word meaning, the note reference words and in the process, try to achieve mastery.3. reading and Discussion on the academic point of view: the teacher of teachers have been published The papers carefully read, understand their thoughts, theories and ideas and in everyday with the teacher in the process of which is not very clear in time to ask the teacher, to better understand the teacher's academic viewpoints and theoretical origin of the clinical application of.4.: the theory of teacher experience in academic and applied in clinical practice, the teacher in the skin cou was changed under the guidance of the theory, in clinical treatment, often used to and in the method of regulating Ying and Wei to treat disease, expand the clinical thinking of their own, and this theory will be used to guide the clinical and experimental research. The research contents: 1. Professor Wang Hongdu "the skin cou metaplasia air mechanism" of the academic origin and argument on the basis of the anthology < Neijing > and later many doctors will discuss about the camp health, explore the Yingqi and Weiqi students the significance of physiological function has special structure of skin and skin -- "cou cou collaterals a sun pulse of the whole; The gasification process of the gas lift and former Ying Wei: including sympathetic, clutch, and in the atmosphere, air. That variable hides cou Ying Wei gasification is an important process of human The new supersedes the old.; Ying Wei gasification is to abandon the old with the new, including material, energy metabolism and air change; the skin is cou an important place for Ying Wei gasification, and therefore air change students "Professor.2. Wang Hongdu leather processing factory with variable mechanism be" academic thoughts and clinical experience including "skin cou air variable mechanism" argument, mainly by air content. And the choice of the peripheral facial paralysis and postherpetic neuropathic pain as an example, the system summarizes professor Wang Hongdu used "the skin cou air change mechanism" on the clinical experience of acupuncture of common diseases, including the pathogenesis of the disease, a new understanding of staging, selection of therapeutic methods, prescription and acupuncture points The clinical observation of the choice of compatibility and so on.3. skin cou metaplasia air mechanism employed in the treatment of postherpetic neuralgia. Postherpetic neuralgia pain due to age, have great differences in physical factors. Postherpetic neuralgia clinical manifestations were tingling or burning pain or abnormal sensation the skin, the king under the guidance of teachers, in order to "light around needle thorn, bowel pain God" method, choose confining needling method for treatment of skin cou the typical syndrome of abnormal feeling, conducted randomized controlled clinical observation, measurement and postherpetic neuralgia left in the degree of pain before and after treatment, mood. Sleep as well as the content of substance P in serum, with scientific detection data validation waici method is effective for postherpetic neuralgia. Conclusion: 1. professor Wang Hongdu based on the theory of Ying Wei gasification demonstration, Ying Qi and Wei Qi in Through the skin cou collaterals - Sun veins of this special structure, and sympathetic gasification, to the atmosphere, to change the students with the process, summed up as "skin cou air variable mechanism. This mechanism is to supplement Qi chemical said, but also on the Chinese camp on health physical understanding of sublimation. An effect of.2. on skin striae of Professor Wang Hongdu using treatment methods of human physiological balance and many outside of the traditional Chinese medicine theory to guide clinical, formation of peripheral facial paralysis, postherpetic neuralgia and other unique clinical experience, good curative effect, this theory also inspired the author's deep thinking and understanding.3. the use of" air variable skin cou mechanism "as the guide, the clinical observation of peri needling method for treatment of postherpetic neuralgia, with quantitative substance P in serum as observed indexes of objectively demonstrates the skin cou gas become God The association with pain and the effectiveness of percutaneous treatment.

【学位授予单位】：成都中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249

【相似文献】