何复东学术思想与临床经验总结及“补肾通阳法”治疗心肾阳虚型慢性心衰的临床研究

发布时间：2018-05-17 07:08

本文选题：何复东 + 临床经验　；参考：《北京中医药大学》2016年博士论文

【摘要】：目的：(1)总结第五批全国名老中医药专家学术思想传承工作指导老师何复东主任医师的学术思想和临床经验；(2)通过对何复东主任医师“补肾通阳法”治疗心肾阳虚型慢性心衰的临床研究,探索慢性心衰的病机特点及临床辨治思辨,总结老师临床经验,挖掘名老中医学术思想,进一步升华、发扬光大名老中医学术思想。方法：(1)通过对历代中医古籍经典及近现代医家的医著、医论、文献的查阅,结合临证侍诊、跟师抄方老师言传身教,跟师笔记总结,综述何复东老师学术思想渊源及慢性心衰的中医临床诊治进展；(2)总结何复东老师学术思想和临床经验,结合学术继承人对中医理论的认识和历代医家学说及临床经验提出继承人自己的创新点。经过三年时间的跟师学习,通过跟师抄方、言传身教、质难答疑、经典学习、查阅文献,对老师学术理论认识、临床诊治思维特点及处方组方规律、用药特点进行总结、升华至理论高度,总结老师的临床经验,挖掘老师的学术思想,结合中医理论及各家认识提出“从脾肾论治”的创新学术观点；(3)通过对何复东主任医师“补肾通阳法”治疗心肾阳虚型慢性心衰的临床研究,采取随机对照盲法的方法,将符合纳入标准的113例心肾阳虚型慢性心衰患者随机分为治疗组和对照组,治疗组给予西药基础治疗加服“补肾通阳法”免煎剂口服治疗,对照组给予单纯西药基础治疗,观察疗程为四周。除去剔除、脱落后将纳入的慢性心衰患者治疗组50例和对照组50例每组治疗前后的临床症状和相关指标进行对比,探讨慢性心衰的病机特点及“补肾通阳法”治疗慢性心衰作用机理及处方用药规律,挖掘名老中医诊治慢性心衰的学术思想并将其发扬光大。结果：(1)追溯何复东老师的学术思想渊源：与《黄帝内经》关于“肾”生理功能的论述、孙一奎之命门学说“命门乃肾间动气”、张介宾“阴常不足、阳非有余”学术思想、张仲景之“以病为纲、病证结合、辨证论治”理论体系、姜良铎之“状态医学”、王琦之“辨体、辨病、辨证三结合”辨治模式学术思想、李可名老中医的《李可老中医急危重症疑难病经验专集》的“重剂起沉疴”用药思想以及其他医家的“对药、角药”用药思想等医家医论存在学术渊源。何复东老师通过反思医圣张仲景中医传统意义上的《伤寒杂病论》的辨证论治思想,认识到疾病的病机本质即为阴阳失衡,中医临床施治的根本就是对机体失衡状态的调整,结合“脏象理论体系、阴阳理论、状态辨治、体质学说”等,据此提出“五脏以肾为本、肾虚体质状态辨治、调和阴阳平衡”学术思想观点,认为“善调治者,尤善调肾；善扶正者,尤善扶肾；多一分肾阳,便多一分生机”,“善调阴阳者,必阴中求阳、阳中求阴,以求以平为期”,并创方补肾基础方“自拟葛九汤”及系列自拟方剂,临证加减,每获良效。(2)总结何复东老师学术思想,何老中医临床涉及内科、妇科、儿科、针灸科诸多病证,其学术思想可谓博大精深,其理奥,其趣深,主要包括：①“综合辨治”学术思想——本辨治、标辨治、兼辨治;②“从肾论治”学术思想——以肾为本、调和五脏、平衡阴阳；③“复方重剂用药三量”学术思想——调理量、治疗量、毒量；④“特异性辨治用药”学术思想——衷中参西、西为中用。(3)关于何复东老师的临床经验,主要包括：①“自拟葛九汤”的创方、方义、运用；②“补肾通阳法”治疗慢性心衰的临床经验；③“自拟宣痹汤”加减治疗胸痹的临床经验；④“自拟葛九汤”加减治疗胃病诸证的临床经验；⑤“葛九脱敏汤”治疗风咳的临床经验；⑥“重剂全蝎汤”治疗头痛的临床经验；⑦“自拟葛九汤”加减治疗更年期综合征的临床经验；⑧“自拟银甲汤”治疗痤疮的临床经验；⑨“犀角地黄汤”加减治疗过敏性紫癜的临床经验;⑩“自拟葛九汤”加减治疗肢体诸痹的临床经验；11“自拟重剂柴胡石膏汤”治疗内伤发热的临床经验。结合总结何复东老师的学术思想,学术思想传承人根据相关文献研究及个人临床心得体会,提出“以肾为主,兼顾脾胃,从脾肾论治”、“温通活血法治疗胸痹心痛”创新观点。(4)关于临床科研,两组的年龄、性别、基础病、病程以及重要观察指标的数据分布经统计学检验,P值均大于0.05,表明随机分组的两组患者的基线均衡,齐同可比。本研究表明：“补肾通阳法”治疗方案,在中医症状改善方面,心悸(P=0.0110.05)、气喘(P=0.0050.05)、胸闷(P=0.0050.05)、面肢浮肿(P=0.0390.05)四个症状改善显著,而气短(P=0.1230.05)、畏寒肢冷(P=0.1530.05)、小便短少(P=0.2090.05)三个症状改善不明显；在中医证候整体疗效方面,疗效显著(P=0.0370.05)；在心功能、LVEF、步行试验改善方面,无论是具体的心功能分级分布(P=0.0310.05)、心功能整体疗效(P=0.0310.05)、LVEF改善(P=0.0170.05)亦或是6分钟步行距离(P=0.0300.05),疗效均显著；在BNP指标的改善方面,疗效显著(P=0.0400.05)。需要指出的是,对于心胸比的改善不理想(P=0.1600.05)。结论：(1)何复东老师的学术思想主要包括“综合辨治”、“从肾论治”、“复方重剂用药三量”、“特异性辨治用药”等学术思想；(2)何复东老师的学术思想应用于临床诸多疾病如慢性心衰、胸痹、胃病诸证、风咳、头痛、更年期综合征、痤疮、过敏性紫癜、肢体诸痹、内伤发热等病证中每获良效；(3)临床研究表明,运用何复东老师“补肾通阳法”治疗心肾阳虚型慢性心衰中治疗组(补肾通阳法联合西药基础治疗)在临床证候症状改善、心功能改善、6分钟步行距离及对LVEF、BNP等指标的改善方面优于对照组(单纯西药基础治疗),在改善心胸比方面治疗组虽优于对照组,但差异不显著。经过对何复东老师“补肾通阳法”治疗心肾阳虚型慢性心衰的研究,在临床及科研层面,探讨论证了何复东老师对慢性心衰病因病机的认识和临证经验的科学性,进一步挖掘了老师的学术思想。
[Abstract]:Objective: (1) to summarize the academic thought and clinical experience of the fifth batch of He Fudong, the director of the academic thought inheritance work of the fifth batch of experts on traditional Chinese medicine. (2) through the clinical study of the "tonifying kidney and Yang Yang method" in the treatment of chronic heart failure of the heart and kidney yang deficiency, the characteristics of the pathogenesis and the clinical discrimination of the chronic heart failure were explored. To distinguish, summarize the clinical experience of the teacher, excavate the academic thought of the famous old Chinese medicine, further sublimate and develop the academic thought of old Chinese medicine. Methods: (1) through the classics of the ancient Chinese ancient books and the medical works of the modern doctors, the medical theory, the reference of the literature, the teacher, the teacher, the teacher and the teacher, and the summary of the teacher's notes, and the summary of the teacher He Fudong. The origin of academic thought and the progress of TCM clinical diagnosis and treatment of chronic heart failure; (2) summing up the academic thought and clinical experience of Mr. He Fudong, combining the knowledge of the academic successors to the theory of traditional Chinese medicine and the medical theory and clinical experience of the past dynasties. It is difficult to answer the question, the classical learning, the literature review, the understanding of the academic theory of the teacher, the thinking characteristics of the clinical diagnosis and treatment, the prescription rule of the prescription, the characteristics of the prescription, the sublimation to the theoretical height, the clinical experience of the teacher, the academic thought of the teacher, and the innovative academic viewpoint of "the treatment of spleen and kidney from the spleen and kidney" with the theory of traditional Chinese medicine and the understanding of the family. (3 Through the clinical study of the "tonifying kidney and Yang Yang method" in the treatment of heart and kidney yang deficiency chronic heart failure by He Fudong's chief physician, a randomized controlled blind method was adopted to randomly divide 113 patients with chronic heart failure of heart and kidney yang deficiency into the treatment group and the control group. The treatment group was given the basic treatment of Western medicine plus the "tonifying kidney Tong Yang" method. In the control group, the treatment group was given the basic treatment of Western medicine and the treatment course was four weeks. 50 patients with chronic heart failure and 50 cases in the control group were compared with the clinical symptoms and related indexes before and after the treatment. The characteristics of chronic heart failure and the treatment of chronic heart failure by "tonifying the kidney through the Yang method" were used to treat chronic heart failure. The mechanism of action and the rule of prescription drug use to excavate the academic thought of the old Chinese medicine for the diagnosis and treatment of chronic heart failure. Results: (1) trace back to the origin of He Fudong's academic thought: and the discussion on the physiological function of "kidney" by the Huangdi Nei Jing, the theory of "the fate of the life of the kidney", "Zhang Jiebin" "Non surplus" academic thought, Zhang Zhongjing's theory system of "disease as the outline, combination of disease and syndrome, syndrome differentiation and treatment", "state medicine" of Jiang Liang Du, Wang Qizhi "differentiation of body, disease discrimination, syndrome differentiation three combination" academic thought, "Li Ke old Chinese Medicine" "Li Ke old Chinese medicine emergency critical and difficult disease experience special collection >" "heavy agent start meditation" medication thought There is an academic origin of the medical theory of medicine, such as "the medicine, the angle medicine" thought of other doctors and other doctors. Mr. He Fudong has realized that the essence of the disease is the imbalance of yin and Yang, and the basic of the clinical treatment of Chinese medicine is the imbalance state of the body by reflecting on the traditional meaning of the traditional Chinese medicine of medicine Saint Zhang Zhongjing's traditional Chinese medicine. The adjustment, combined with the "viscera theory system, yin and yang theory, state differentiation and treatment, Physique Theory" and so on, according to the above proposed "the five organs are kidney based, kidney deficiency constitution state differentiation and treatment, regulate the balance of yin and Yang" academic ideas, think that "good governs, especially good to regulate the kidney; good centralizer, especially good to help the kidney; more kidney yang, then more vitality", "good tone Yin". "Good tone Yin" Yang, must Yin in the sun, Yang in the Yin, in order to flat for a period of time, and create a prescription for the foundation of the kidney "nine soup" and a series of self-made prescriptions, to be added and reduced, every good effect. (2) sum up He Fudong's academic thought, he old Chinese medicine clinical medicine, gynecology, pediatrics, acupuncture and moxibustion Department of many diseases, its academic thought is broad and profound, its logical, logical, It mainly includes: (1) the academic thought of "comprehensive differentiation and treatment" - differentiation and treatment, identification and treatment, and discrimination; (2) "kidney treatment" academic thought - kidney based, harmonizing the five zang organs, balancing yin and Yang; (3) "three doses of compound heavy agents" academic thought - the amount of conditioning, treatment, toxic quantity; (4) "specific treatment of drug use" academic thought - (3) the clinical experience of Mr. He Fudong, mainly including: (1) "self-made Ge nine soup" creation, Fang Yi, application; (2) the clinical experience of treating chronic heart failure by "tonifying the kidney through Yang method"; (3) "self drawing Bi Decoction" in the treatment of chest obstruction; (4) "self-made Ge nine soup" plus subtraction for the treatment of stomach diseases Clinical experience of syndrome: (5) the clinical experience of "Ge nine desensitization soup" in treating wind cough; (6) the clinical experience of treating headache with "heavy dose of scorpion soup" in the treatment of headache; (7) the clinical experience of treating climacteric syndrome with "self-made Ge nine soup" and the clinical experience of treating acne Clinical experience of Henoch Schonlein purpura; the clinical experience of adding and subtraction of Ge nine soup in the treatment of limb arthralgia; 11 the clinical experience of treating internal injury and fever by "self-made heavy agent Chaihu gypsum soup". Combined with the academic thoughts of teacher He Fudong, the academic thought inheritors put forward "kidney mainly according to relevant literature research and personal clinical experience." Taking into account the spleen and stomach, from the spleen and kidney treatment, "Wen Tong blood activating therapy" for the treatment of chest pain and heart pain. (4) on the clinical scientific research, the data distribution of the two groups of age, sex, basic disease, course and important observation index are statistically tested, the P value is more than 0.05, indicating that the baseline equilibrium of the two groups of patients in random grouping is comparable. In the improvement of TCM symptoms, the four symptoms of palpitation (P=0.0110.05), asthma (P=0.0050.05), chest tightness (P=0.0050.05), and facial swelling (P=0.0390.05) were improved significantly in the improvement of TCM symptoms, while three symptoms of P=0.1230.05, P= 0.1530.05 (P= 0.1530.05) and short urine (P=0.2090.05) were not improved. The effect of physical therapy was significant (P=0.0370.05); in the improvement of cardiac function, LVEF, and walking test, no matter the specific distribution of cardiac function (P=0.0310.05), the overall effect of cardiac function (P=0.0310.05), LVEF improvement (P=0.0170.05) or 6 minute walk distance (P=0.0300.05), the curative effect was significant, and the curative effect of BNP index was significant ( P=0.0400.05). It should be pointed out that the improvement of the heart ratio is not ideal (P=0.1600.05). Conclusion: (1) He Fudong's academic thoughts mainly include "comprehensive treatment", "treatment from kidney", "three doses of compound heavy agents", "specific treatment of drugs", and (2) the academic thought of teacher He Fudong is applied to clinical various kinds of ideas. Many diseases such as chronic heart failure, chest obstruction, stomach disease, wind cough, headache, climacteric syndrome, acne, anaphylactoid purpura, limb arthralgia, internal injury fever, and other good effects. (3) clinical study showed that the treatment group (tonifying kidney Tongyang method combined with western medicine basic treatment) was used in the treatment group of heart kidney yang deficiency type chronic heart failure. The symptom improvement of clinical syndrome, the improvement of heart function, 6 minute walking distance and the improvement of LVEF, BNP and other indexes were superior to the control group (simple western medicine). Although the treatment group was better than the control group in improving the ratio of heart and chest, the difference was not significant. After the treatment of He Fudong old teacher "tonifying kidney through Yang", the treatment group was treated with chronic heart failure of heart kidney yang deficiency type. At the level of clinical and scientific research, the study demonstrated that teacher He Fudong's understanding of the pathogenesis of chronic heart disease and the scientific experience of her clinical experience further excavated the academic thought of the teacher.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R259

【相似文献】