刘永年教授治疗血液病的经验及凉血散血法治疗免疫性血小板减少症的临床研究

发布时间：2018-05-25 13:19

本文选题：刘永年 + 学术思想　；参考：《南京中医药大学》2016年博士论文

【摘要】：本文总结了国家级名中医刘永年教授的学术思想和临床经验,他临床工作五十余年,在内科疑难病的中医诊治方面积累了丰富的临床经验。刘老的学术思想来自《内经》、《伤寒论》、温病学派及金陵医派的传承,对刘老学术思想影响最大的是傅宗翰先生。刘老提出对内科疑难病的诊治当辨病与辨证相结合,可利用西医的技术方法协助中医的辨病辨证,寻求疾病的核心病机,如乏证可辨,则可从显证辨治,在辨治时应注意对体质的辨识,有情志因素的疑难病可从治肝达郁治疗。刘老在血液病的中医诊治方面重视中医辨病诊治,血虚补而不滞,止血而不留瘀,依血液病标本缓急的不同阶段而制定相应治法。对缺铁性贫血的治疗重在增源截流,强调补养脾胃的重要性,阐述了“有质无质”的意义。在再生障碍性贫血的诊治方面提出精气内夺造成虚损是疾病的核心病机,病程中有瘀血与热毒等实证因素参与,提倡辨察病势的重要性,重视补肾与补脾胃的协调。在白细胞减少症方面依虚实辨证为纲,以补脾肾益精血为主要治法,有时用化瘀祛邪的治法也可升白。在过敏性紫癜方面强调风邪为重要病因,孙络瘀滞是疾病的主要病理特征,活血散瘀的遣药颇具特色。在免疫性血小板减少症(ITP)辨治方面以瘀热为核心病机,针对瘀热病机采用凉血散血的治法,组成了经验方：水天升板汤。目的：临床研究观察刘老经验方水天升板汤治疗免疫性血小板减少症的疗效及安全性,并初步探求其机理。方法：采用随机对照的临床研究方法,将免疫性血小板减少症(血热妄行证)患者分为治疗组和对照组各30例,对照组仅予激素治疗,治疗组在激素治疗的同时给予汤剂水天升板汤内服,每个病例服中药28天,治疗前及治疗后28天观察病人血小板数量变化,观察中医临床证候变化包括紫斑、出血、发热、烦渴、关节腰腹疼痛、溲赤、便秘等并积分。治疗前及治疗后第28天观察病人白细胞、血红蛋白、血小板、肝肾功能、全血比粘度(低切、高切)和血浆比粘度。结果：治疗后两组患者血小板数量较治疗前均有升高,治疗后治疗组较对照组明显升高,升血小板疗效评价方面较对照组有显著优势。在中医证候评分方面治疗组中医证候积分改善较对照组明显有统计学意义。治疗前后两组白细胞、血红蛋白、肝肾功能、全血比粘度(低切、高切)和血浆比粘度对比无统计学意义。结论：水天升板汤能够提升免疫性血小板减少症患者的血小板数量,明显改善患者中医证候。研究表明刘永年教授在血液病的中医诊治方面有独特的思路,组成的经验方水天升板汤治疗免疫性血小板减少症安全有效。
[Abstract]:This paper summarizes the academic thought and clinical experience of the national famous professor of Chinese medicine Liu Yongnian. He has accumulated rich clinical experience in the diagnosis and treatment of difficult and difficult diseases in internal medicine for more than 50 years. Liu Lao's academic thought comes from the Internal Classic, the Theory of febrile Disease, the inheritance of febrile Disease School and Jinling Medical School, and the most important influence on Liu Lao's academic thought is Mr. Fu Zonghan. Liu Lao proposed that the diagnosis and treatment of difficult diseases in internal medicine should be combined with differentiation of symptoms and signs, and that the technical methods of western medicine could be used to assist TCM in differentiating diseases and symptoms, and to seek the core pathogenesis of diseases. Attention should be paid to the identification of physique in differentiation and treatment, and the difficult diseases with emotional factors can be treated from the treatment of liver depression. Liu Lao attached great importance to the diagnosis and treatment of blood diseases in TCM, blood deficiency and not stagnation, hemostasis without leaving blood stasis, according to the different stages of blood diseases to formulate the corresponding treatment. The treatment of iron deficiency anemia is mainly focused on increasing source closure, emphasizing the importance of nourishing spleen and stomach, and expounding the significance of "having quality and no quality". In the diagnosis and treatment of aplastic anemia, it is pointed out that deficiency of vital qi and internal capture is the core pathogenesis of the disease, and there are positive factors such as blood stasis and heat toxin in the course of the disease, which advocates the importance of discerning the disease, and attaches importance to the coordination of tonifying the kidney and reinforcing the spleen and stomach. In leukopenia, according to the deficiency of the syndrome as the outline, to invigorate spleen and kidney tonifying essence and blood as the main treatment, sometimes with the treatment of removing blood stasis and evil can also be raised to white. In Henoch-Schonlein purpura, wind evil is emphasized as an important etiology, Sun collateral stasis is the main pathological feature of the disease, and the medicine for activating blood circulation and dispersing stasis is quite characteristic. In the aspect of differentiation and treatment of immune thrombocytopenia (ITP), stasis and heat are the core pathogenesis, and the treatment method of cooling blood and dispersing blood is adopted in the mechanism of blood stasis and fever. The prescription of experience is made up: Shuitian Shengban decoction. Objective: to observe the efficacy and safety of Liu Lao experience Fang Shuitian Shengban decoction in the treatment of immune thrombocytopenia and to explore its mechanism. Methods: the patients with immune thrombocytopenia were divided into treatment group (n = 30) and control group (n = 30). The treatment group was treated with decoction Shuitianshengban decoction for 28 days. Before and 28 days after treatment, the changes of platelet count were observed, and the changes of clinical syndromes of TCM including purple spot, hemorrhage, fever, were observed. Irritation, abdominal pain, Deutzia, constipation, etc. WBC, hemoglobin, platelet, liver and kidney function, whole blood specific viscosity (low shear, high shear) and plasma specific viscosity were observed before and 28 days after treatment. Results: after treatment, the platelet count in both groups was higher than that before treatment, and the treatment group was significantly higher than that in the control group after treatment, and there was a significant advantage in the evaluation of the therapeutic effect of the treatment group compared with the control group. In TCM syndromes score, the improvement of TCM syndromes in the treatment group was significantly higher than that in the control group. Before and after treatment, there was no significant difference in leukocyte, hemoglobin, liver and kidney function, whole blood specific viscosity (low shear, high shear) and plasma specific viscosity. Conclusion: Shuitianshengban decoction can improve the platelet count of patients with immune thrombocytopenia and improve TCM syndrome. The research shows that Professor Liu Yongnian has a unique idea in the diagnosis and treatment of hematological diseases. The experience of Fangshui Tianshengban decoction in the treatment of immune thrombocytopenia is safe and effective.
【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R259

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