苏荣扎布学术思想和临床经验继承及心身疗法治疗心刺痛病临床与机理研究

发布时间：2018-03-17 12:12

  本文选题：疗效机制　切入点：microRNA　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】：研究目的：总结和整理苏荣扎布教授学术思想及临床经验；观察研究苏荣扎布验方与心身互动疗法结合治疗心刺痛病的临床疗效,并探讨其疗效机制。研究方法和研究内容:1.通过整理苏老师艰苦的生活、学习、行医、教学等生活和成长经历,感悟这些特殊的生活经历对老师的人格形成以及成为国医大师的影响作用；学习和研究苏老师的论文、专著等文献,分析和总结苏老师学术思想渊源及其特点,在此基础上就蒙医整体观思想和医学模式提出继承人自己的新见解。2.通过阅读苏老师的论文、专著和相关蒙医经典著作以及跟导师出门诊学习,筛选出导师擅长治疗的11个优势病种,阐述导师对这些疾病的病因分析、症状观察以及治疗的特点和优势,并从每个病种选择两个典型病例予以分析,从而总结和归纳导师的学术思想和临床经验特点。再对老师诊疗过的190名心刺痛病患者从病因病机、病型特点、治则治法、护理要点和用药特点、组方使用频率以及疗程方面进行回顾性研究,总结老师治疗心刺痛病的学术思想和临床经验,并提出苏老师验方结合心身互动疗法治疗心刺痛病的新方法。3.根据诊断标准选择90名心刺痛病患者,随机分为苏老师治疗组(蒙药组)、苏老师验方与心身互动疗法结合治疗组(观察组)和丹参滴丸治疗组(对照组)三组,每组30名,七天为一个疗程,共三个疗程。通过观察临床症状、心电图以及SCL90心理量表等指标,对照三组的临床疗效。4.在以上临床研究的基础上,对观察组6名心刺痛病患者治疗前与治疗后的血清microRNA表达进行分析,探讨其疗效机制。又取6名正常人血清样本作为对照组来使用。具体操作为每人抽取10ml血样,分离血清,从血清提取总RNA,进行基因芯片(Microarray)检测,做生物信息学分析。结果：1.苏老师学术思想总结：苏老师最突出的学术思想是关于蒙医整体观思想的丰富与发展。苏老师于1980年发表了“关于蒙医学整体观思想的初谈”为题目的论文,使他成为现代蒙医学领域中最早研究蒙医学整体观思想的学者。苏老师提出了“以阴阳学说为基础的蒙医整体观思想是蒙医学理论的要点所在。人与自然的相关性、五行与三根的相关性、三根与七素三秽的相关性是它的基本内涵。和三根与七素关系相关联的‘精浊代谢’理论是其精髓也。”从而丰富和发展了现代蒙医学整体观理论内涵。苏老师的典型学术思想还体现在：以寻根治源为根本：以把握赫依的治疗为关键点；以促进气血运行疏通经脉为具体步骤：调解胃火与体素间平衡为目的；重视清除陈热；注重心理作用；心-身-言三业相结合；强调养生保健等共9个方面。学习中感悟到,苏老师是一名博学多识、临床经验丰富且具有自身独特思维特点和诊疗技术的一代蒙医大师。除技术以外他的大慈大悲、仁心仁术等做人品德和人格魅力也是造就他成长为国医大师的主要因素所在。在导师的指点下,纵览蒙医学理论,本人就蒙医学整体观思想的结构提出：“人体内部的整体统一、身与心的整体统一、人与社会的整体统一、人与自然的整体统一和人与宇宙(时间和空间)的整体统一”等五个层面的新见解,又从这样的理解进一步推理、思考医学模式问题,认为蒙医学医学模式应该关系到：“生物-心理-社会自然-时空(宇宙)”五维结构组成的新观点。2.苏老师临床经验总结：通过文献整理和跟师学习,对苏老师最擅长诊治的心刺痛病,心律失常,心肌炎,肾结石,慢性支气管炎,慢性胃炎,失眠症,神志病,癫痫病,月经不调,子宫肌瘤等十一个病种的概念、病因分析、症状观察以及辩证治疗的阐述中总结了苏老师的独到见解和诊疗经验、手法特点。发现苏老师在综合运用治病四施,灵活联合用药,巧妙调配药引子等辩证施治方面的特色较为突出。对苏老师最擅长治疗的心刺痛病进行回顾性研究,总结出以下7个内容。①病因病机和病型特点：苏老师认为导致冠脉阻塞的最根本原因是精浊代谢不良,浊物黏着在血管壁所致；此病在临床上以赫依和其素合并型为居多。②治则治法：主要以助胃火、促进精浊代谢,疏通经脉改善气血循环,镇痛及针对具体病情辩证论治。③常用药方组合模式：早：吉如很希莫吉乐10粒,浩道敦-10味丸或壮西-14味丸10粒；午：新—Ⅱ号13粒,赞丹-7味汤1.5克,伊和汤1.5克；晚：额日敦乌日勒15粒,阿嘎日-35味散3克。④使用频率最高的前6位药方为：额日敦乌日勒100%,阿嘎日-35味散100%,伊和汤95.3,吉如很希莫吉乐89.5%,新—Ⅱ号68.9%,赞丹-7味汤57.9%。⑤辩证施治常见药方：失眠用苏格木勒-4味汤,胃胀用毛勒日达布斯-4味汤,心悸用书沙-7味丸或阿敏额日敦,咳嗽用沏其日-11味散或萨楚-3味散,有风湿样酸痛感用森登-4味汤、查千古古勒-10味丸或森登-11味散等。⑥饮食调摄与心理养生等护理要求：饮食宜进易消化,忌油腻食物；起居方面避免过度劳累,不宜久留喧哗环境,适当参加体育锻炼；避免生气、过度悲伤、兴奋,鼓励参与愉悦心身的文体活动等。⑦平均疗程：27.18±22.89日。在诊治心刺痛病方面,苏老师以助胃火、促进精浊代谢,强调赫依与其素并调的治疗原则的正确性以及他发明的吉如很希莫吉乐和新-Ⅱ号两个新药的特殊效果均得到了临床验证。继承人在吸收苏老师学术思想和临床经验过程中提出了治疗心刺痛病的新技术----苏老师验方与心身互动疗法结合治疗的方法。3.90名心刺痛病病例疗效评价：①临床症状：治疗后三组所有症状比治疗前均有明显改善(P0.05)。分析各组特点发现,观察组的胸闷症状好转程度更加明显,蒙药组的口干、心慌症状好转的比较明显,以上两组各自的优势症状均好于对照组；②心电图：无明显差异(P0.05); ③SCL90心理量表：观察组心理治疗疗效明显优于蒙药组和对照组,但组间无差异(P0.05)。三组临床总有效率分别为观察组86.7%,蒙药组80.0%,对照组76.7%,三组之间无差异(P0.05)。4.治疗机制：治疗前和治疗后血清之间差异表达microRNA有34个(P0.05),治疗前与正常人血清之间差异表达microRNA有19个(P0.05),而三组血清之间差异表达microRNA有7个(P0.05)。其中Hsa-miRNA-766-3P有相关研究报道,其他6种尚未找到研究报道。通过对其靶基因的进一步分析发现了21个候选基因,其中FLT4和ADAM9与血管硬化有关,尤其FLT4对于血管网络的发展和促进内皮细胞的增殖、存活和迁移、并调控血管生成有关,且是、VEGFC和VEGFD的表面受体。而VEGF与心刺痛病严重程度相关。以此可以推理Hsa-miRNA-766-3P可能与苏荣扎布验方结合心身互动疗法治疗心刺痛具有相关性,但作用机理还需进一步进行深入研究。结论：①苏老师学术思想中最突出的一点是对蒙医整体观思想提出了自己的新见解,从而丰富和发展了其理论内涵。建立在此思想基础之上的以寻根治源为根本、以把握赫依的治疗为关键点、以促进气血运行疏通经脉为具体步骤、调解胃火与体素间平衡为目的、重视清除陈热的治疗原则、注重心理作用、心-身-言三业相结合、强调养生保健等临床诊疗思维也充分体现了现代医学《生物—心理—社会》医学模式理念。这些学术思想对我们临床实践中具有很高的指导价值。②苏老师是一名博学多识、临床经验丰富且具有自身独特思维特点和诊疗手法技术的一代蒙医大师。除技术以外他的仁心医德是造就他成长为国医大师的主要因素所在。在诊治心刺痛病方面,苏老师的以助胃火、促进精浊代谢,强调赫依与其素并调的治疗原则的正确性以及他发明的吉如很希莫吉乐和新-Ⅱ号两个新药的特殊效果均得到了临床验证。③继承人在吸收苏老师学术思想过程中提出了治疗心刺痛病的新技术----苏老师验方与心身互动疗法结合治疗方法,在蒙医学整体观理论基础上提供了方法上的创新,并有效提高了心刺痛病的治疗效果。④治疗机制研究发现,Hsa-microRNA-766-3P可能与苏老师验方结合蒙医心身互动疗法治疗心刺痛病治疗相关。这对蒙医治病提供了科学依据。但是,更深层次的作用机理还需进一步去深入研究和验证。
[Abstract]:Objective: To summarize and organize the academic thought and clinical experience of Professor Sue Ron Jabu; Study on Su Rong Jabu prescription and psychosomatic therapy clinical curative effect of combined treatment of heart pain disease, and to explore its therapeutic mechanism. The research methods and research contents: 1. through the collation of teacher Su hard life, learning, teaching practice, life and growth experience, perception of these special life experience of teacher's personality formation and become the effect of Chinese medicine master's study and research; teacher Su papers, monographs and literature, analyzing and summarizing the Su teacher academic thought source and its characteristics, based on the traditional Mongolian medicine overall thought and medical model proposed heir own new insights.2. by reading classics teacher Su papers, monographs and related Mongolian as well as tutor clinic study, selected 11 tutors at the treatment of dominant diseases, this Analysis of these tutors on the cause of the disease, symptoms and treatment characteristics and advantages, and select two typical cases to be analyzed from each category of academic thoughts and clinical experience to summarize and sum up the characteristics of teachers. 190 patients had the diagnosis and treatment of heart hurt teacher from the etiology and pathogenesis, disease characteristics, treatment treatment, nursing and medication characteristics, in terms of frequency of use and treatment prescription were analyzed retrospectively. The treatment of heart disease a summary of the teacher's academic thoughts and clinical experience, and put forward the teacher Su prescription combined with.3. new method of psychosomatic therapy in the treatment of heart disease according to the diagnostic criteria of tingling 90 heart disease patients were randomly divided into pain. Su treatment group (Mongolian medicine group) teacher, teacher Su prescription and psychosomatic therapy combined with treatment group (observation group) and Danshen treatment group (control group) three groups, each group of 30, seven days for a course of treatment, a total of The three course of treatment. Through the observation of clinical symptoms, ECG and SCL90 psychological scale and other indicators, the control group in the clinical efficacy of.4. three or above on the basis of clinical studies, the observation group of 6 heart disease patients before treatment and pain after treatment of serum microRNA expression were analyzed to investigate the curative effect and mechanism of 6. Normal human serum samples as control group. The specific operation is to use each extraction 10ml blood, serum separation, extraction of total RNA from serum, gene chip (Microarray) detection, bioinformatics analysis. Results: 1. Su teacher summary of academic thought: the most prominent teacher Su's academic thoughts about the overall view of Mongolian medicine rich and development. Mr. Su in 1980 issued "on the whole view of Mongolian medicine on" as the topic, make him become a modern Mongolian medicine in the field of the research of Mongolian medicine overall thought of Su scholars. The teacher put forward to the theory of yin and Yang based Mongolian holism is the crux of Mongolian medicine theory. Relationship between man and nature, the five line and three correlation, correlation between the three and seven - three of their basic connotation of it. And the three and seven factors related to "jingzhuo the theory is the essence of" metabolism ". To enrich and develop the modern Mongolian medicine holistic theory connotation. The typical academic teacher Su is also reflected in: the roots of governance for the fundamental source: to grasp the key points for the treatment of taking Heiyi; to promote blood circulation to dredge the meridians specific steps: mediation gastropyretic and voxel for the purpose of balance; pay attention to remove Chen heat; pay attention to the psychological effect; mind body language three combination; a total of 9 aspects of health care. The study emphasizes Ganwudao, Mr. Su is a knowledgeable, rich clinical experience and has its own unique Thinking of the characteristics and treatment technology of a generation of Mongolian medicine master. In addition to technology of his infinite compassion and mercy and other life and character, with both a benevolent mind and heart charm also makes him grow into the main factors of Chinese medicine master. In the teacher's guidance, an overview of Mongolian medicine theory, I put forward the whole structure of Mongolian medicine thought: "whole body the unity of body and mind, the unity of man and society, man and nature and the unity of man and the universe (time and space) new insights into the five aspects of the overall unity", and from this understanding further reasoning, thinking of medical model, medical model that Mongolian medicine should be related to "biological - psychological - social - spatial nature (the universe)" clinical experience of new ideas.2. Su five dimensional structure composed of summary: through literature review and learning with the teacher, the teacher Su the most adept at diagnosis and treatment A heart disease, arrhythmia, myocarditis, renal calculi, chronic bronchitis, chronic gastritis, insomnia, mental disorders, epilepsy, irregular menstruation, concept, uterine fibroids and other eleven kinds of causes, symptoms and explain the dialectical treatment were summarized in the Su Lao division of the unique insights and experience of diagnosis and treatment, technique characteristics. The teacher found Su cure four in use, flexible combination, clever dispensing the dialectical characteristics of attractor is more prominent. The teacher Su specializes in the treatment of heart disease. Most were retrospectively studied, summed up the following 7 aspects. The characteristics of pathogenesis and disease type 1: Su teachers believe that the fundamental causes of coronary artery occlusion is jingzhuo poor metabolism, turbidity adhesion to the vessel wall due to the clinical disease; and the element with taking Heiyi type for the majority. The treatment method: mainly to help promote stomach, turbid sperm metabolism, thinning 閫氱粡鑴夋敼鍠勬皵琛，

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