刘大新教授学术思想总结—玉屏风散合小青龙汤加减治疗“过敏性鼻炎哮喘综合征”临床疗效观察

发布时间：2018-06-03 22:39

本文选题：刘大新 + 玉屏风散　；参考：《北京中医药大学》2016年博士论文

【摘要】：中国传统医药伴随着中华民族整个发展历程,对维护中华民族乃至世界人民健康所做出的贡献有目共睹。为了进一步发挥其现实价值,更好地发挥其潜在的、长期的价值,将其作为人类非物质文化遗产加以保护并传承,意义深远而重大。西学东渐以来,整个中国学术体系和格局受到了重大影响。西方强势文化不仅带来中医药生存环境的改变,而且带来价值取向的重大变化,实用主义、功利思想在很大程度上改变了中医学原有传承方式和传承目的。当前,中医传承自觉性已大大下降,人才培养由师徒授受改变为院校教育,而院校教育则几乎完全套用了西医教育模式,按照自身规律传承模式日趋淡化,中医院西化现象也十分明显。种种现象表明,在中医药事业繁荣发展背后潜在着十分严重的传承危机。另外,中医药有完整理论体系和自身学术发展规律,但由于受西方文化背景和价值取向的影响,评判体系几乎完全采用西方标准,只取其用,忽略学术的内在联系。并且现实中的政策、法规也完全没有顾及中医药的传统性特征。因此中医学发展关键在于是否按照其自身规律延续和传承。中医前辈将中医学术传承当成是自己的历史责任,如张仲景著《伤寒论》,孙思邈撰《千金要方》、《千金翼方》,李时珍编《本草纲目》等除了传承学术以造福后人,不带有任何功利思想。因为有了历代名老中医经验积累和传承,才使得中医学历久弥新,永葆活力。现今名老中医亦是将中医药基本理论、前人经验与当今实践相结合,是解决临床疑难问题的典范,他们的学术思想丰富多彩,临床经验各具特色。因其诊断疾病的标准和判定疗效的方法不尽一致,故难以对名老中医的学术经验进行恰当的评价和疗效比较；因此,必须探索研究建立个体化诊疗评价方法。我们可以借鉴循证医学研究模式,对名老中医学术经验的精华和亮点开展临床科研。中医科研设计与现代医学科研设计一样,都必须遵循随机、对照等原则,同时还应该体现辨证论治的特色。根据名老中医学术经验精华和亮点制订切实可行的研究方案,如采用全国统一的病证诊断评价和疗效判定标准,采用与现代医学相接轨的观察指标,设立有说服力的对照组,对实验研究数据进行科学统计等。在此基础上才能对名老中医的学术经验进行综合评价,如疗效评价、安全性评价、效价比评价、生存质量评价、终点事件评价、跟踪随访评价等。刘大新教授作为国家著名中医专家,数十年潜心医疗,熟读《内经》、《伤寒》、《金贵要略》等经典,善以经方治病,以中医耳鼻喉疾病见长,对内科杂病亦经验丰富、疗效显著。他时常教导我们,要成为合格的医生,首先要仅守医德,还应做到熟读经典、拓展思维、勤奋好学、理论结合实践、勤于临证、不断总结、虚心求教、潜心专研及勇于创新等。刘老师认为几千年来,中国历代名医都是熟读中医经典,灵活运用并创新古代中医经典理论来认识和防治疾病的辨证论治思维、方法及用药原则,并且用药简洁、煎制方便、价格低廉、临床效验。刘教授指出经典理论指导下的整体观念贯穿于中医生理、病理、辨证、治疗等整个理论体系之中,所以在诊疗过程中,从经典出发,灵活掌握加以运用；在实事求是的基础上,与时俱进合理创新,善于提出问题,并潜心实践,从自然-社会-人体的全整体层面认识疾病的病因、病机及转归,而制定治疗法则,才能体现出中医的特色和优势,提高疗效。刘大新教授作为全国名老中医,其学术思想经验是深厚的中医理论与丰富的实践经验相结合的结晶,是中医药学的宝贵财富和重要组成部分。刘教授秉持中医药的“遵循自然,顺应个体,审病求因,扶正祛邪”原则,认为通过整体调节可以实现对局部病患的治疗和修复。通过中医整体调节,可使机体气血阴阳恢复平衡,脏腑功能归于常态,从而使局部疾病痊愈。本研究观察刘教授玉屏风散合小青龙汤加减治疗过敏性鼻炎哮喘综合征,对60例患者临床观察发现症状缓解迅速、兼加症状减轻明显、精神状态、生活质量改善显著。过敏性鼻炎哮喘综合征是近年提出的新概念。虽然早期已经认识到过敏性鼻炎和哮喘之间有一定联系,但未确立联合研究、诊治方案,直至新概念开始使用。故相关临床研究尚不丰富。玉屏风散和小青龙汤是临床常用方剂,检索文献显示,二者用于治疗支气管哮喘临床观察较多,但未见其用于过敏性鼻炎哮喘综合征治疗的临床研究。刘大新教授在临床上对主要矛盾与次要矛盾处理方式的解释中提出,无论是主症、兼证,老师均以中医整体观念为基础,以辨证论治为根本法则进行临床立法、处方。临证既把握住疾病的共性,又不拘泥于成法,旨在调节阴阳,使之逐渐恢复动态平衡。疾病的产生,究其本质,即为阴阳失调,而选方用药的最终目的即为调节阴阳平衡。阴阳越是趋向平衡,疾病就越向好的方面发展。而阴阳得以维持动态平衡,不但疾病向愈,而且机体也不易受病邪困扰。这也是中医所说的“未病先防、既病防变”的临床体现。本课题拟从评价症状缓解、生活质量提高、精神面貌改善、辅助检查支持各个方面入手,通过刘教授玉屏风散合小青龙汤加减治疗过敏性鼻炎哮喘综合征相关指标进行临床研究,旨在全面揭示其提高疗效,改善患者精神状况、生活质量的作用机制,揭示刘教授“遵循自然,顺应个体,审病求因,扶正祛邪”的学术思想,为祖国传统医学防治过敏性疾病探索一个新思路。
[Abstract]:With the whole development of the Chinese nation, traditional Chinese medicine has made great contributions to the maintenance of the Chinese nation and the people's health in the world. In order to give full play to its practical value, it is of far-reaching significance to give full play to its potential and long-term value and to protect and inherit it as a human intangible cultural heritage. Since the western learning, the whole Chinese academic system and pattern have been greatly influenced. The western strong culture not only brings about the change in the living environment of traditional Chinese medicine, but also brings great changes in the value orientation. Pragmatism and utilitarianism have greatly changed the original way of inheriting and inheriting the traditional Chinese medicine. It has been greatly reduced, the training of talents is changed from teacher and apprenticeship to college education, and college education is almost completely applied to the mode of Western medicine education. The mode of inheritance in accordance with its own law is desalinated and the Westernization of Chinese medicine hospital is very obvious. In addition, traditional Chinese medicine has a complete theoretical system and the law of its own academic development. However, due to the influence of Western cultural background and value orientation, the evaluation system almost completely adopts the Western standards, only taking it and neglecting the internal relations of the academic. And the policy and regulations in reality have not taken into account the traditional characteristics of traditional Chinese medicine. The key of the exhibition is to continue and inherit in accordance with its own laws. Traditional Chinese medicine predecessors regard traditional Chinese medicine as its own historical responsibility, such as Zhang Zhongjing's treatise on typhoid, Sun Simiao wrote < Qian Jin Fang >, < Qianjin wing >, and Li Shizhen's editor < Compendium of Materia Medica > with no utilitarian thought. The accumulation and inheritance of the experience of the old traditional Chinese medicine has made traditional Chinese medicine new and vigour. The famous traditional Chinese medicine is also the basic theory of traditional Chinese medicine, and the former experience is combined with the practice of today. It is a model to solve the difficult problems in clinical practice. Their academic ideas are rich and colorful and the experience of the bed is different. The methods of curative effect are not consistent, so it is difficult to make a proper evaluation and comparison of the academic experience of the famous old Chinese medicine. Therefore, we must explore and establish an individual diagnosis and treatment evaluation method. We can draw on the research pattern of evidence-based medicine and carry out clinical scientific research on the essence and bright spot of the academic experience of the famous old Chinese medicine. The design of medical scientific research must follow the principles of random, contrast and other principles. At the same time, it should also reflect the characteristics of the syndrome differentiation and treatment. According to the essence and bright spot of the academic experience of the famous old Chinese medicine, we should formulate practical and feasible research programs, such as the adoption of the national unified diagnosis and evaluation of the disease and the criteria for the evaluation of the curative effect, and the adoption of the observation index that is in line with the modern medicine. A convincing control group, scientific statistics on experimental data, and so on. On this basis, the academic experience of the famous old Chinese medicine can be evaluated synthetically, such as the evaluation of the curative effect, the evaluation of safety, the evaluation of the titer, the evaluation of the quality of life, the evaluation of the endpoint events, the follow-up evaluation, etc., as a famous national Chinese medicine expert, Professor Liu Daxin Ten years of medical care, familiar with "internal classics >", "typhoid", "Jin Gui" and other classics, good with the treatment of classical Chinese medicine, with TCM ear nose and throat diseases, rich experience in medical miscellaneous diseases and significant curative effect. He often teaches us to be a qualified doctor, first of all to keep the medical ethics, but also to read classics, expand thinking, study diligently, combine theory with practice. In the past few thousand years, Mr. Liu thinks that all the Chinese famous doctors have been reading traditional Chinese Medicine Classics, using and innovating the classical classical theory of traditional Chinese medicine to understand and prevent the syndrome differentiation and treatment thinking, methods and principles of medicine, and the medicine is simple, convenient and cheap. Professor Liu pointed out that the whole idea under the guidance of classical theory runs through the whole theory system of TCM Physiology, pathology, syndrome differentiation, treatment and so on. So in the process of diagnosis and treatment, we can use it flexibly in the course of diagnosis and treatment. On the basis of seeking truth from facts, it is reasonable and innovative, good at putting forward problems, and concentrating on practice. But the whole whole level of society - the whole body of the human body recognizes the cause of disease, the pathogenesis and the prognosis, and formulating the treatment rules can embody the characteristics and advantages of the traditional Chinese medicine and improve the curative effect. As a national famous old Chinese medicine, Professor Liu Daxin's academic experience is the crystallization of the profound theory of traditional Chinese medicine and the rich practical experience, and the treasure of traditional Chinese medicine. Prof. Liu holds the principle of "following nature, complying with the individual, complying with the individual, seeking the cause of the disease and eliminating the evil", and thinks that the whole regulation of traditional Chinese medicine can make the body's Qi and blood Yin and Yang restore balance and the function of the viscera to the normal state, so that the local disease can be caused by the whole regulation of traditional Chinese medicine. The study observed the treatment of allergic rhinitis asthma syndrome in Yuping Feng San and Xiao Qinglong soup. The clinical observation of 60 patients showed that the symptoms were relieved quickly, the symptoms were relieved, the mental state and the quality of life improved significantly. The allergic rhinitis asthma syndrome was a new concept in recent years. There is a certain connection between allergic rhinitis and asthma, but no joint research and treatment scheme have been established until the new concept is used. So the related clinical studies are not abundant. Yuping wind powder and small Qinglong soup are commonly used as clinical prescriptions. The retrieval literature shows that the two patients are used in the treatment of bronchial asthma with more clinical observations, but they are not used for anaphylaxis. In the clinical study of the treatment of asthma syndrome of rhinitis, Professor Liu Daxin put forward in the explanation of the main and secondary contradictions in the clinical practice that both the main and the secondary contradictions are based on the overall concept of traditional Chinese medicine and based on the principle of syndrome differentiation and treatment as the fundamental law. It is intended to regulate Yin and Yang and gradually restore dynamic balance. The essence of the disease is the imbalance of yin and Yang, and the ultimate purpose of the choice of drugs is to adjust the balance of yin and Yang. The more the Yin and Yang tend to balance, the more the disease becomes better, and the Yin and yang can maintain a dynamic balance, not only the disease is healing, but also the body is not easily ill. This is also the clinical manifestation of "the prevention of disease first, the disease prevention and control". This topic is to evaluate the symptoms, improve the quality of life, improve the mental outlook, and support the support examination in all aspects, and through the treatment of the related indexes of allergic rhinitis asthma syndrome through the Yuping wind powder and small Qinglong Decoction The purpose of this study is to reveal the mechanism of improving the curative effect, improving the patient's mental state and the quality of life, and revealing the academic thought of Professor Liu "following nature, adapting to the individual, seeking the cause of the disease and eliminating the evil", and exploring a new way of thinking for the prevention and treatment of allergic diseases in traditional Chinese medicine.
【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

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