胡兰贵教授临证治疗类风湿性关节炎经验总结

发布时间：2018-04-03 12:15

本文选题：类风湿性关节炎　切入点：胡兰贵教授　出处：《山西省中医药研究院》2017年硕士论文

【摘要】：类风湿性关节炎是属于世界范围的疑难病,它与中医痹症中\*痹相对应。目前,随着生活方式的剧变,心理压力的增大,体质的改变,使得类风湿性关节炎的患病率逐年增高,因其预后不好,致残率高,极大的影响人们的生活质量和工作能力。然而到目前为止,无论是中医还是西医,对该病的认识和治疗都有所欠缺。到目前为止,西医尚未确切解开类风湿性关节炎的发病机制,但是在免疫学方面也已经有了很大的突破。西药治疗类风湿性关节炎所使用的普通抗风湿药物、非甾体类抗炎药、糖皮质激素,因具有药物依赖性,同时长期服药可给人体各生理系统带来很大的损伤等缺陷,故而不能为患者完全接受。目前新型的生物制剂研究也尚未成熟,还不能为患者服务。中医各家对本病病因病机的认识也不径相同,因其地理及文化的差异,即使有好的治疗思路和方剂也未得到推广。本文通过对类风湿性关节的文献综述及总结导师胡兰贵教授运用中医药治疗该病的经验,以期高有关类风湿性关节炎的理论水平,为本病的中医辨证论治提供新的方法和思路,最终可以更高效的指导临床治疗。本文经验总结部分以胡兰贵教授“疑难病从肝论治”、“以脉为根”、“风湿病从五脏论治”的基础上提出“元气损伤”的学术思想为指导,从理论方面进行了类风湿性关节炎病因病机的深入讨论,将中医总结归纳出来静的“证”,以“元气”动的思想表达;门诊治类风湿关节炎病例为基础;以及在治疗过程中率先推广中草药膏剂等学术特点,全面概括了导师中医诊治类风湿性关节炎的临证经验,以期为临床中治疗类风湿性关节炎提供手段,也是中医药学术特色的集中体现,非常具有传承研究价值。文献综述部分,根据大量的期刊及相关书籍等文献资料阐述了中西医治疗类风湿性关节炎的研究进展,分别从其西医发病机制、临床表现、诊断标准和治疗及中医病因病机、辨证分型和治疗等方面进行论述,同时概括了中医各家对类风湿性关节炎的认识及诊治经验。胡兰贵教授认为该病的发生发展与人的体质和风寒湿热等致病因素,加以气机失调,最终导致人体元气亏损和瘀血形成,其中由于用药量时间长、用药量大、用药错误、中西医结合用药或者失治误治导致的元气受损成为本病久治不愈的根本原因。因此治疗过程中,导师强调用药一定要注意疏理气机和温补元气;治疗中则运用膏方,长期用药,以平为期,令三焦通畅,元气自然。临床辨证有肝郁血虚、肝气郁结、寒湿外客、寒湿化热、气阴两虚,湿热痹阻、瘀血阻滞、气虚阴阳亏虚等分型,酌情选用逍遥散、桂枝芍药知母汤、白虎桂枝汤、木防己汤、痹症合方、十四味温胆汤、逍狗归芪汤、补阴益气汤、附桂六味汤、四逆香佛二花汤、类风灵验方、类风经验方、芪脉石膏汤等治疗。
[Abstract]:Rheumatoid arthritis is a difficult disease worldwide, which corresponds to arthralgia in traditional Chinese medicine.At present, with the dramatic change of life style, the increase of psychological pressure and the change of physique, the prevalence rate of rheumatoid arthritis increases year by year. Because of its poor prognosis and high disability rate, it greatly affects people's quality of life and ability to work.However, so far, both TCM and Western medicine, there is a lack of understanding and treatment of the disease.So far, Western medicine has not exactly unraveled the pathogenesis of rheumatoid arthritis, but has also made a great breakthrough in immunology.The common antirheumatic drugs, non-steroidal anti-inflammatory drugs, glucocorticoids used in the treatment of rheumatoid arthritis by western medicine, because of their drug dependence, and long-term medication can bring great damage to various physiological systems of the human body, and so on.Therefore, it can not be fully accepted by the patient.At present, new biological agents are not mature enough to serve patients.The understanding of the etiology and pathogenesis of this disease is not the same, because of its geographical and cultural differences, even if there is a good treatment ideas and prescriptions have not been popularized.Based on the literature review of rheumatoid joint and the experience of professor Hu Langui in treating the disease with traditional Chinese medicine, the author hopes to raise the theoretical level of rheumatoid arthritis and provide new methods and ideas for the treatment of this disease based on syndrome differentiation.In the end, it can guide the clinical treatment more efficiently.In this paper, the author puts forward the academic thought of "Yuan Qi damage" on the basis of professor Hu Langui's "treating difficult diseases from liver", "taking pulse as root" and "rheumatism from five viscera".This paper discusses the etiology and pathogenesis of rheumatoid arthritis in theory, and sums up the static "syndrome" of TCM, which is based on the expression of "yuan qi" movement, the diagnosis and treatment of rheumatoid arthritis cases, and the diagnosis and treatment of rheumatoid arthritis.And in the course of treatment, the academic characteristics such as Chinese herbal medicine plaster and so on are first popularized. The clinical experience of Chinese medicine tutor in the diagnosis and treatment of rheumatoid arthritis is summarized in order to provide a means for clinical treatment of rheumatoid arthritis.It is also a concentrated embodiment of the academic characteristics of traditional Chinese medicine, which is very valuable for inheritance and research.In the part of literature review, according to a large number of journals and related books, the research progress in the treatment of rheumatoid arthritis by traditional Chinese medicine and western medicine was described, respectively from the pathogenesis, clinical manifestations, diagnostic criteria, treatment and etiology and pathogenesis of traditional Chinese medicine.Syndrome differentiation and treatment are discussed, and the experience of diagnosis and treatment of rheumatoid arthritis in TCM is summarized.Professor Hu Langui believes that the occurrence and development of the disease and human physique and pathogenic factors such as wind-cold, dampness and heat, and so on, will eventually lead to the loss of vital energy and the formation of blood stasis in the human body. Among them, due to the long time of drug use, the large amount of medicine used, and the wrong use of drugs,The damage of vital energy caused by combined Chinese and western medicine or lost treatment is the root cause of the long-term cure.Therefore, in the course of treatment, the tutor stressed that the medication must pay attention to soothing Qi and warming and replenishing vital qi; while in treatment, plaster prescription should be used for a long period of time, so that Sanjiao can be unobstructed and Yuan Qi will be natural.Arthralgia syndromes, 14 kinds of warm gall decoction, Xiao Dou Gui Qi Tang, Yin Yiqi decoction, Fu Gui Liu Wei Tang, four inverse fragrant Buddha Erhua decoction, like Fengling Test prescription, similar Wind experience prescription, Qi Mai Gypsum decoction and so on.
【学位授予单位】：山西省中医药研究院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R249;R259

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