庄国康教授学术经验传承及重潜搜风法治疗瘙痒性皮肤病的研究

发布时间：2018-05-11 18:04

本文选题：庄国康教授 + 重潜搜风法　；参考：《中国中医科学院》2016年博士论文

【摘要】：一、中医理论的博大精深,跟师三年余来,系统继承和总结了庄国康教授的学术思想：1庄国康教授的辨证特点：审疹论治。皮肤病的特点就在于其可见性与特异性,即皮肤病病变在于肌表,可用肉眼直接观察,且每种皮肤病都有其独特的表现和特点,“有诸内必形于外”,皮肤病明显的外在表现反应了机体内部的正邪变化,在漫长的时间里,经过历代外科医家们不断的摸索、总结,发展出了一条有别于内科“望闻问切”四诊合参的诊断模式,即以皮损的不同表现、特点为主、以舌苔脉象为辅,来进行辨病辨证、分型论治。因此,审疹论治是中医皮肤病学的特色思想。庄国康教授师承阎效然、朱仁康、段馥亭等名家,深刻的领会了审疹论治的思想并将之贯彻于临床。2庄国康教授的立法特点：法法结合。庄国康教授临床治疗皮肤病确立了很多的治疗法则：(1)疏风清热法(2)养血润燥、消风止痒法(3)健脾除湿法(4)清利湿热法(5)芳香化湿法(6)活血清热法(7)凉血活血法(凉血活血止血法)(8)滋阴活血法(9)养血活血法(10)活血通络软坚散结法(11)温经活血法(12)凉血清营法(13)重镇搜风法(14)酸收固表法(15)滋肾抑火法(16)温阳补肾法(17)玄府开窍法等。庄国康教授临诊时,常抓住患者病证病情主要矛盾,辨证论治,确定相应的治疗法则,并灵活配伍,取得好的疗效。比如同样是顽固性瘙痒皮肤病,庄国康教授会抓住主要矛盾顽固性瘙痒确立重潜搜风的治则,但是要提高重潜搜风药物的疗效,其配伍的灵活运用至关重要。在治疗顽固性瘙痒皮肤病时,需根据皮疹颜色、形态、整体辨证论治,如养血者配伍当归,熟地黄；润燥者配伍生地、玄参、制何首乌；活血者配伍丹参、降香、当归、川芎、茜草、三棱、莪术；滋阴者配伍天冬、麦冬、石斛、黄精：凉血者配伍生地、牡丹皮、紫草、生槐花；化痰者配伍莱菔子、白芥子、海浮石、海蛤壳；健脾利湿者配伍陈皮、半夏、茯苓、甘草；舒肝解郁者配伍香附、柴胡、郁金；清热者配伍白茅根、白花蛇舌草、大青叶；发于四肢者,常加鸡血藤、首乌藤。3庄国康教授的方药特点：(1)经验用药：凉血：羚羊角,玳瑁、生地、牡丹皮；紫草、生槐花、白茅根；活血：丹参、降香、当归、川芎、茜草,三棱、莪术；养血：当归、熟地黄、首乌；益气：黄精、太子参、黄芪；滋阴：生地黄、玄参、天冬、麦冬、玉竹、石斛：泻火：生石膏、栀子；燥湿：黄连、黄芩、黄柏、苦参；除湿：平胃散(陈皮、厚朴、苍术、甘草)：化痰：莱菔子、白芥子、海浮石、海蛤壳；散结：土贝母、瓜蒌、海藻、昆布、生牡蛎；通络：鸡血藤、钩藤、伸筋草、千年健；凉血清营：生地、丹皮、赤芍、生石膏、知母、玄参、淡竹叶、银花、滑石粉；清热解毒：银花、菊花、苦地丁、蒲公英,土茯苓、白花蛇舌草、大青叶；敛汗固表：麻黄根、生牡蛎、乌梅、五味子、黄芪、防风、白术；重潜：煅磁石、煅赭石、生龙骨、生牡蛎、珍珠母、石决明、紫贝齿；祛风：荆芥、防风、炒蒺藜；疏风清热：羌活、荆芥、防风、白芷、牛蒡子、黄芩。(2)结合中西医理论：庄国康教授几十年来在中西医结合思路指导下,对皮肤病的治疗用药方面,做了广泛、深入的探讨,积累了相当可贵的临床经验,在临床辨症、辨证治疗基础上,结合了疾病病机特点及中药本身的性味功用,应用药理研究成果,针对性的选择对疾病的客观指标、病理改变等有明确治疗作用的中药。其中常用的有红斑鳞屑性——抗肿瘤中药：白英、蛇莓、龙葵、白花蛇舌草、北豆根、半枝莲、半边莲；红肿热痛性——抗感染中药：马齿苋、败酱草、紫草、大青叶、板蓝根、木贼、香附、金银花；真菌性皮肤病——抗真菌中药：肉桂、黄精、丁香、藿香、佩兰、木香、白矾、冰片、五倍子；光化学治疗——增加光敏作用的中药：白芷、补骨脂、独活、虎杖、苍术等。(3)经验方：重镇汤、滋阴除湿汤、玄府开窍、凉血活血汤、凉血消风散、凉血消风散、芳香化湿汤、活血清热汤、酸收固表汤等。4治疗皮肤科常见病的经验：(1)治疗湿疹,首当滋阴除湿；(2)治疗银屑病的一些经验：凉血解毒、凉血活血、滋阴活血法；玄府开窍,适当配伍一些抗肿瘤中药。(3)顽固性瘙痒性皮肤病——重潜搜风。理论：顽固性瘙痒多伴有情志的改变：心神失养,肝失疏泄——治以平肝风、宁心神；心主火,火性上炎——治以重潜清热；核心处方：煅磁石、煅赭石、生龙骨、生牡蛎、珍珠母、石决明、紫贝齿各30g(凡应用其中5个及以上药物的均视为核心处方)。(3)运用“以色补色法”治疗色素病如白癜风：黑芝麻,雄黑豆,桑葚,何首乌,熟地黄,肉苁蓉等；黄褐斑：白术、白茯苓、白芷,白扁豆,白芍,白芨,白僵蚕,白前,白芥子,白蔹,白英,白附子等。5庄国康教授常用治法及方药心得：除湿法中有滋阴除湿法、健脾除湿法、清利湿热法、芳香化湿法、温阳化湿法等,凉血法中有凉血活血法、凉血清营法、凉血止血法等,活血化瘀法中有活血清热法、凉血活血法、滋阴活血法、养血活血法、活血通络,软坚散结法、温经活血法等,清热法中有清热解毒法、疏风清热法、清肺降火、泻胃除热等,其他内治法还有重潜搜风法、玄府开窍法、养血润燥、消风止痒、酸收固表法、滋肾抑火法、温补肝肾法等,外治法主要有增白明目、增白止痒、凉血清热、燥湿杀虫、活血化瘀、清热敛湿等。庄国康教授在各具体的治法下有对应的习惯用药及经验用药。6庄国康教授治疗皮肤瘙痒的经验：庄国康教授在临诊时,采用理法方药的思维模式,条理清晰,认为立法准确是提高临床疗效的前提,而立法的依据是辨证恰当,辨证就是辨疾病的病因病机。瘙痒的病因病机复杂,难以一证蔽之,既有内因,亦有外因。辨明瘙痒病因病机后,庄国康教授针对具体病因的确立治法,其中注重治法的配伍应用,非常灵活,“法法结合,复方用药”,收到了很好的疗效。二、临床研究：系统建立了庄国康教授近10年门诊病历的大数据库,规范了门诊诊断病名。第一次从大数据库中数据挖掘重潜搜风法治疗顽固性瘙痒皮肤病的经验及应用研究结果。本数据库共有8820诊次,226条诊断。重潜搜风法是庄国康教授治疗顽固性瘙痒的经验治法,经长期临床观察,疗效确切,但传统的个案总结、报告难以采集齐全许多有用的信息,使经验的推广缺乏大数据支持。本研究建立并丰富了庄国康教授经验数据库,引入了“循证”思想,强化了“证据”概念,形成一系列数据分析挖掘方法,人机结合,以人为主,总结庄国康教授经验,不仅可发现庄国康教授应用重潜搜风法治疗顽固性瘙痒皮肤病总体诊疗特点,也能为后续深层次的挖掘分析提供工作基础,保证了本研究获得高级别证据及成果的真实性、可靠性,可实现经验的可重复性及稳定性。三、继承与发展：1、温阳法在皮科的应用：在跟师过程中,受庄国康教授玄府开窍法运用的启发,临床处方在运用庄国康教授经验时,辨证佐以附子等温阳药,取得了较好的疗效。皮肤病,顾名思义,是发于身体最外层的皮肤,头而亦多见。皮疹特点表现红、肿、热、痒居多。单纯皮疹辨证为热、火,治以清热解毒凉血药,如果患者本身为阳虚体质,皮疹表现实质是虚火上炎或虚火外越,也许短期内会收到效果,但从长期疗效来看,更多的是久治不愈甚或越治越差,从而失治、误治,所以皮肤科疾病中,如痤疮,尤其是囊肿性痤疮、穿凿性毛囊炎,在化痰散结的基础上,辨证佐以附子潜阳、温阳,往往能收到意想不到的效果。2、进一步按照GCP规范进行随机、对照研究,客观验证了朱仁康、庄国康教授治疗手足癣的经验疗效。上世纪七十年代,庄国康、许铣教授在我国著名中医皮外科专家朱仁康名老中医治疗手足癣的有效经验方——醋泡方(主要药物组成：荆芥18g,防风18g,红花18g,地骨皮18g,皂角刺30g,大枫子30g,明矾18g等)基础上开发研究了改良醋泡方(即现在院内制剂醋泡方),即将上方药物按比例捣碎,醋酸浸泡后渗滤出浸液,加入苯甲酸制备而成；并使用“改良醋泡方治疗手足癣”进行了临床观察总结,真菌抑制试验及扫描电镜的观察等系统研究工作,证实醋泡方有杀菌、抑菌作用,治疗角化型手足癣的近期及远期效果均佳,但因未按照GCP规范,未与现代医学认可的外用抗真菌药物进行严格的临床观察对照,醋泡方治疗角化型手足癣的疗效及安全性难以得到国内、国际同行认可。跟师三年来,完成了所级课题——醋泡方(即原改良醋泡方)治疗角化型手足癣的临床疗效研究：采用阳性药物平行对照、随机临床试验设计方法,评价了醋泡方治疗血虚风燥证角化型手足癣的临床疗效及其安全性,并进一步研究该药物对角化型手足癣皮损单项症状(包括部位、面积、红斑、丘疹、角化、皲裂、脱屑、瘙痒、疼痛)的作用。我们抽取了我科门诊年龄在18～65岁角化型手足癣患者142例,随机分为2组,分别采用“醋泡方”、1%盐酸特比萘芬乳膏治疗后,每周临床观察1次,疗程结束后进行疗效判定及数据统计学分析。结果显示醋泡方治疗角化型手足癣的总有效率(96.49%)明显优于对照组(85.46%)(P0.05),而在改善皮损单项症状方面,醋泡方能更好地改善手足癣病的丘疹、角化、鳞屑和瘙痒症状。
[Abstract]:First, the theory of traditional Chinese medicine is extensive and profound. After more than three years with the teacher, the academic ideas of Professor Zhuang Guokang are systematically inherited and summarized. The characteristics of the syndrome differentiation of 1 Zhuang Kang Kang: the characteristic of the skin disease is its visibility and specificity, that is, the dermatosis lies in the muscle surface, can be observed directly by the naked eye, and each skin disease has its unique characteristics. The manifestations and characteristics, "there must be in shape in the outside", the apparent external manifestations of skin diseases reflect the internal and positive changes in the body. In the long period of time, through the continuous exploration of the surgeons in the past dynasties, a diagnostic model is developed, which is different from the four diagnosis of the internal medicine, that is, the different manifestations of the skin lesions, and the characteristics of the diagnosis. The Lord, taking the pulse of tongue coating as a supplement, carries out differentiation of syndrome differentiation and classification and treatment. Therefore, the trial of rash is the characteristic thought of the Chinese medicine dermatology. Zhuang Guokang, Shi Chengyan, and Zhu Renkang, Duan Fu ting and other famous people, deeply comprehend the thought of trial rash and put it into clinical.2 Zhuang Guo Kang's legislative characteristics: Law and law combination. Zhuang Guokang Clinical treatment of dermataosis has established a number of treatment principles: (1) wind clearing and clearing heat method (2) nourishing blood and moistening dryness, eliminating wind and antipruritic (3) invigorating spleen and removing damp (4) clearing away wet heat method (5) (6) activating blood and clearing heat method (7) cooling blood and activating blood method (8) nourishing blood and blood activating method (9) nourishing blood and activating blood method (10) activating blood circulation collaterals soft hard loose knot method (11) warm meridian Blood activating method (12) cold blood clearing camp method (13) heavy town search wind method (14) acid collecting and fixing table method (15) nourishing kidney and suppressing fire (16) warming Yang kidney method (17) to open the orifices of Xuan Fu (17). When Professor Zhuang Guo Kang is in the clinic, he often seize the main contradiction of the patient's disease syndrome, make a dialectical treatment, determine the corresponding treatment rule, and get good curative effect. For example, it is also obstinate itching. Skin disease, Professor Zhuang Guokang will seize the main contradiction of stubborn itching to establish the treatment of heavy submersible search wind, but to improve the curative effect of heavy submersible search wind drugs, the flexible use of its compatibility is essential. In the treatment of stubborn pruritus skin disease, it should be based on the skin rash color, form, the whole syndrome differentiation, such as the combination of Chinese angelica, cooked ground yellow; moistening dryness. People with the combination of raw land, Radix Sophorae, and Polygonum multiflorum; the living blood is compatible with Salvia miltiorrhiza, anoda, angelica, Ligusticum chuanxiong, Rhizoma rhizome, zedoary and zedoary; it is compatible with the winter, Ophiopogon, Dendrobium, and yellow semen, the peony skin, the purple grass and the Sophora japonica; the phlegm people with wood foramen, the white mustard, the sea float stone and the sea clam shell; Glycyrrhiza uralensis (licorice); soothing liver depressive in combination with Xiang Fu, bupleurum, tulip; heat clearing people with white mauru root, white flower Hedyotis, and leaf; often added to the extremities, often adding chicken blood VAT, Professor Wu Kun.3 Zhuang Guo Kang: (1) herbal medicine: cold blood: antelope horn, tortoise shell, peony skin; purple grass, Sophora japonica, root; blood activating: Salvia miltiorrhiza, antifragrance, Angelica, Ligusticum chuanxiong, alizara, three prism, zedoary turmeric; nourishing blood: Angelica, radix rehmanniae, Radix Polygoni multiflorum; yhuangjing, Radix Astragalus, Astragalus membranaceus; Radix Astragalus, Radix Ophiopogon, Radix Ophiopogon, Dendrobium: raw gypsum, Fructus Gardenia: Huanglian, Radix Scutellariae, Radix Sophorae, Sophora flavescens; dehumidification: Ping stomach powder (citrus peel, Magnolia officinalis, CAC, licorice): phlegm: Raphani, Raphani, semen Raphani, White mustard, pumice, clam shell; scattered: Fritillaria, Trichosanthes, kelp, Kun cloth, raw oysters; collaterals: Cynthia Coriolis, runchus rimonifolia, stretch weeds, komoeqing camps: raw land, peony root, red peony root, gypsum, Anemarrhena, light bamboo leaves, silverflower, talcum powder; clearing heat and detoxification: silver flower, chrysanthemum, dandelion, dandelion, tuckahoe, tuckahoe, tuckahoe, Hedyotis davidae, big Green leaf; collect sweat and fixed table: ephedra root, oyster, black plum, Schisandra, Radix Astragali, anti wind, Atractylodes; calcined magnets, calcined ochre, raw oysters, raw oyster, mother of pearl, stone cassia, pericentine; dispel wind: mustard, wind control, Tribulus tribulus; thinning wind, mustard, Radix Angelicae, Angelica dahurica, burdock seed, Scutellaria. (2) combined Chinese and Western medicine theory: Zhuang Guo Kang Education Under the guidance of the combination of traditional Chinese and Western medicine for decades, we have made extensive and in-depth discussion on the treatment of skin diseases, and accumulated considerable valuable clinical experience. On the basis of clinical discrimination, syndrome differentiation and treatment, combined with the characteristics of disease pathogenesis and the use of sexual flavor of traditional Chinese medicine, the results of pharmacological research are applied, and the targeted selection of the disease is on the disease. Objective indicators, pathological changes and other traditional Chinese medicine. Among them, the commonly used erythematous scales - antitumor Chinese medicine: white English, snake rberry, dragon anemone, white flower Hedyotis, North bean root, Scutellaria, and half lotus; red and swollen heat pain - anti infective Chinese medicine: Purslane, Patrinia, Herba, latitum, Radix Isatidis, thicchins, periclum, honeysuckle Fungous dermatosis - antifungal Chinese medicine: Cinnamon, yellow essence, clove, huoxifang, Perrin, wood aroma, alum, borneol, gallnut; photochemical therapy: Radix Angelicae dahuricae, psoralen, single live, Polygonum cuspidatum, Cang Atractylodes, etc. (3) experienced prescription: heavy Town soup, Yin Fu dehumidification soup, Xuan Xue Huo Xue soup, cool blood Xiao Feng Feng powder, cool blood Xiaofeng powder, aromatic wet soup, blood activating and clearing soup, acid collection soup and other.4 treatment experience in Department of Dermatology: (1) treatment of eczema, first when nourishing yin and dehumidification; (2) some experience in the treatment of psoriasis: cool blood and detoxification, cool blood and blood circulation, nourishing yin and activating blood method, Xuan Fu opening, suitable for combination with some anti tumor Chinese medicine. (3) stubborn pruritus dermatosis - (3) Heavy submersible search wind. Theory: obstinate itching with more emotional changes: heart loss, liver loss relief - treatment with liver wind, Ningxin, heart fire, fire inflammation - treatment with heavy submersible and heat; the core prescription: Calcined magnets, calcined ochre, raw oysters, mother of oyster, stone cassia, 30g (3) (3) the use of "color supplement" to treat pigmentary diseases such as vitiligo: black sesame, male black bean, mulberry, Radix Polygoni multiflorum, Radix Cistanche, Cistanche and so on; chloasma: Atractylodes, white Poria, Radix Angelicae dahuricae, white Radix Paeoniae, Bletilla Bletilla, white Bombyx, white mustard, white mustard, white British, white aconite and so on. In addition to wet method, there are nourishing yin and removing wet method, invigorating spleen and wet method, clearing wet heat method, aromatization wet method, warming Yang chemical method and so on. There are cold blood and blood activating method, cool blood clearing camp method, cold blood stasis method and so on. In the method of activating blood and removing blood stasis, there are activating blood and clearing heat method, cooling blood and activating blood method, nourishing yin and living blood method, nourishing blood and activating blood method, activating blood circulation and collaterals, soft hard and loose knot method, warming through blood circulation method Methods such as law, heat clearing and detoxification, clearing and clearing heat, clearing fire to reduce fire and removing heat from stomach, other internal treatment methods, including heavy submersion and search wind, mystery house opening and resuscitation, nourishing blood and moistening dryness, eliminating wind and Antipruritus, acid collecting and fixing table, nourishing kidney and inhibiting fire, nourishing liver and kidney, etc., external treatment mainly include whitening and clearing the eyes, increasing whitening and itching, cooling blood and clearing heat, drying wet and removing insect pests, activating blood circulation and removing stasis, Qing Dynasty Professor Zhuang Guo Kang has the experience of treating skin pruritus by Professor Zhuang Guo Kang under the specific treatment methods: Professor Zhuang Guokang's experience in treating skin pruritus: Professor Zhuang Guokang used the thinking mode of theory and prescription in the treatment of medical treatment. It is clear that the legislative accuracy is the premise to improve the clinical efficacy, and the basis of the legislation is to differentiate and identify the appropriate and appropriate differentiation. Syndrome is the etiology and pathogenesis of the disease. The etiology and pathogenesis of itching is complicated, it is difficult to identify the cause of the disease. It has both internal and external causes. After identifying the pathogenesis of pruritus, Professor Zhuang Guokang focused on the treatment of specific causes, which paid attention to the compatibility and Application of the treatment. It was very flexible, "combination of law and compound medicine", and received good curative effect. Two, clinical treatment. Research: the system established a large database of Professor Zhuang Guokang's outpatient medical records for nearly 10 years, standardized the outpatient diagnosis name. The first time from the large database data mining heavy submersible search wind method for the treatment of refractory pruritus skin disease and its application research results. This database has 8820 diagnosis and 226 diagnosis. The heavy submarine search wind method is Professor Zhuang Guokang treatment. The experience of stubborn pruritus, after long-term clinical observation, has a definite curative effect, but it is difficult to collect many useful information from the traditional case summary, which makes the popularization of experience lack large data support. This study has established and enriched the experience database of Professor Zhuang Guokang, introduced the "evidence-based" idea and strengthened the concept of "evidence". A series of data analysis and mining methods, the combination of human-computer and human beings, and a summary of Professor Zhuang Guokang's experience, can not only discover the general diagnosis and treatment characteristics of Professor Zhuang Guokang's application of heavy submersible search wind to treat refractory itchy skin diseases, but also provide a basis for the further analysis of further deep mining and guarantee the high level of evidence and achievements in this study. Authenticity, reliability, can realize the repeatability and stability of experience. Three, inheritance and development: 1, the application of Wen Yang method in dermatology: in the course of following the teacher, enlightened by the application of Zhuang Guokang, Professor Xuan Fu, the clinical prescription, when using professor Zhuang Guokang's experience, has achieved good curative effect. As the name suggests, it is the outermost skin of the body. The skin rash features red, swollen, hot, and itching. The skin rash is heat, heat, and antipyretic and cool blood medicine. If the patient itself is a yang deficiency constitution, the skin rash is in essence is an asthenia fire or an empty fire, and may receive effect in the short term, but from a long term effect, In the Department of Dermatology diseases, such as acne, especially cystic acne, and penetrating folliculitis, on the basis of phlegm and phlegm, the syndrome differentiation with Aconitum latent Yang, Wen Yang, often can receive the unexpected effect of.2, further according to the GCP standard, the random, objective and objective study, objective study, objective To verify the therapeutic effect of Professor Zhu Renkang and Professor Zhuang Guokang on the treatment of tinea hand and foot ringworm. In 70s, Zhuang Guo Kang, Professor Xu Milu, an effective prescription for the treatment of tinea pedis, Zhu Renkang, famous Chinese medicine specialist in Chinese medicine, Zhu Renkang, the main drugs: the main drugs: the main drugs: the main drugs: 18G, 18G, 18G, 18G, 30g, and maple On the basis of sub30g, alum 18G and so on, we developed and studied the modified vinegar bubble square (that is, the present prescription of vinegar bubble in hospital preparation), and then mashed the drugs in proportion to the above, and then percolate the soaked liquid after the acetic acid soaking, and add benzoic acid to prepare it. And the clinical observation, fungal inhibition test and scanning electron microscope view of the treatment of tinea pedis with "modified vinegar bubble recipe" was used. It proved that the vinegar bubble has bactericidal and bacteriostasis effect, and the effect of treating keratosis type of tinea pedis and tinea pedis is good in the near and long term. However, the efficacy and safety of vinegar bubble prescription in the treatment of keratinized and tinea pedis are difficult to get at home because it is not in accordance with the standard of GCP and not strictly observed with the external use antifungal drugs approved by modern medicine. In the past three years, we have completed the clinical efficacy of the "vinegar bubble" prescription in the treatment of keratosis and tinea pedis. The clinical efficacy and safety of vinegar bubble prescription in the treatment of keratosis of blood deficiency and wind dryness were evaluated by using the positive drug parallel control and the design method of the randomized clinical trial. One step was to study the effect of the drug on the unilateral symptoms of keratosis type of tinea pedis (including site, area, erythema, papule, keratosis, chap, desquamation, pruritus, pain). We selected 142 cases of 18~65 year old keratosis patients in our department, randomly divided into 2 groups, respectively, using "vinegar bubble square" and 1% terbinafine hydrochloride cream for treatment, respectively. 1 times a week, the curative effect was determined and the data were analyzed. The results showed that the total effective rate (96.49%) was significantly better than the control group (85.46%) (P0.05). The vinegar bubble could improve the papules, keratinization, scaly and pruritus of the psoriasis in the skin lesions. Shape.

【学位授予单位】：中国中医科学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R275.9

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