王焕禄教授学术思想与临床经验总结及红藤棱莪煎治疗反流性食管炎的研究

发布时间：2018-06-05 03:27

本文选题：王焕禄 + 名老中医　；参考：《北京中医药大学》2016年博士论文

【摘要】：研究目的：全面整理、研究王焕禄教授学术思想和诊疗经验,深入挖掘其临床价值和科学精髓,进而达到继承、发展、传播、推广之目的。研究方法和内容：采用文献分析、跟师临证、随访跟踪、问答谈话和临床观察等多种方法,对王焕禄教授中医药学术思想和临床诊疗经验进行全面研究,穷本溯源,挖掘提炼,抽提其学术思想,总结其诊疗经验,另外设计临床研究方案,对其治疗反流性食管炎的经验方进行疗效评价。研究结果：本论文分为如下三个主要部分：第一部分：王焕禄教授学术思想研究1王焕禄教授医学经历与治学特点1.1王焕禄教授医学经历梳理王焕禄老师家学影响、师承经历、临床实践与研究及获奖经历等。1.2王焕禄教授治学特点总结王焕禄老师治学四大特点：1.2.1注重经典,熟读精研1.2.2重视实践,身体力行1.2.3转益多师,勤求博采1.2.4继承前人,发展创新2王焕禄教授主要学术思想从理论渊源、学术思想内涵及临床验案总结王老师五方面学术思想：2.1湿热害人最广重视湿热为病,认为湿热之邪,害人最广。王焕禄老师深入学习历代湿热相关理论,更重临床实践运用；精研湿热,见解独到：湿热发病,清利为主；湿热为病,病位广泛；辨湿热病审症求因,擅于寻踪觅迹。四诊注重舌苔、口气及分泌物的辨识；重视现代医学的相关指标与湿热病机关联；强调内有湿热外呈燥象。注重湿热病的演变,湿热蕴久成毒,要清热利湿配合清热解毒。从湿热论治,重新认识疾病,解决临床顽疾。2.2脾胃万病相关认为脾胃万病相关与脾胃的生理特性密切相关。在此基础上提出狭义脾胃病与广义脾胃病。当脾胃本藏发病,突出脾胃病要辨虚实,辨证重舌诊,实证多见湿热为患,久病多兼瘀血；强调治脾重温补,治胃重清降,久病要治瘀,虚实兼见要权衡孰重孰轻予以施治。他藏有病,补虚要关照脾胃,攻伐勿伤脾胃,脾胃病明显者,他藏之病要暂缓治之,要先调治脾胃。同时对于脾胃病患者,王老师时时强调平时调摄的重要性。强调“脾胃一虚,百病丛生,从脾论治,诸病易瘥”。2.3女科每关肝肾临床治疗月经不调特别强调肝肾的重要性,六味地黄汤加减是王老师常用的方剂。2.4男科病重肾阳对于男科病,尤重温补肾阳。包括前列腺疾病、性功能障碍、不育症。以前列腺增生为例予以说明。2.5久病必见血瘀认为久病必见血瘀的成因以久病气虚致瘀、久病气滞致瘀和久病湿热煎熬致瘀为主要特点。久病要善察瘀：久痛多瘀；望面色观皮肤察瘀；望舌察瘀；化验检查提示。祛瘀要分层次、辨病机。第二部分：王焕禄教授临床辨治经验研究1辨证施治方法特点总结王焕禄老师临床施治六方面特点：1.1辨病辨证,两相结合1.2中医为本,西为中用1.3注重邪正,权衡标本1.4精于舌诊,四诊合参1.5喜用经方,化裁验方1.6用药精准,处方周全2临床常见病诊治经验从相关疾病诊治特点为出发点,总结王焕禄老师辨治内科、妇科、皮肤科等疾病的独到见解和诊疗特色：2.1辨治冠心病心绞痛临床经验：认为冠心病心绞痛的基本病机是心气阳不足、瘀血阻于心脉所致。重视详细问诊。察舌脉重舌质及舌脉瘀象。重视鉴别诊断。认为益气活血通络是基本治法,处方用药温而不燥,升降合宜,动静有制。2.2辨治慢性便秘临床经验：认为慢性便秘,是以脾虚为核心病机。脾虚运化无力则糟粕形成异常；脾虚气机升降失常则肠腑不降；肠道失濡亦源于脾。治疗上,益气健脾是根本之法,调畅气机是关键步骤,擅用药对,用药分缓急。2.3辨治反流性食管炎临床经验：认为食管炎应立名“食管瘅”,病位在胃(食管)、肝,病邪以气逆、湿热、血瘀为主,治疗以清热利湿、活血化瘀、和胃降逆为主。经验方红藤棱莪煎加减为其常用方剂。2.4辨治类风湿性关节炎临床经验：认为类风湿性关节炎应立名“湿热痹”,强调湿热病机,分期治疗,急性期清热利湿,通络止痛；缓解期在适当清热利湿、清热解毒的治疗同时,必须加大补益的力量。2.5辨治肾脏病临床经验：治疗肾病强调辨证分期：急性期邪气辨风邪、热邪,病位辨在气在血。慢性期藏腑涉及脾肾,多易夹浊毒、热毒、血热、血瘀。分析肺脾肾与肾病的关系。治疗急性期分“风水阻遏,肺气失宣”、“热伤血络,迫血下行”、“毒热内蕴,迫血外溢”三型辨治；慢性期以脾肾两虚,浊毒失降为主,治从健脾益肾,利湿化浊,活血化瘀入手,突出重点效药的应用。2.6辨治月经病临床经验：辨治月经病强调详问病史,包括重问诊月经情况、注重妇科既往病史、注意区分年龄段不同,病机差异、注意服药史并注重结合现代医学相关检查。强调辨别虚实。治疗月经量少——虚从肝肾补；实证逐痰瘀。2.7辨治带下病临床经验：带下病强调带下过多须从虚实辨证；带下过少虚证为主。带下过多虚证者多用傅青主的完带汤加减,湿热下注者多用茵石米甘汤加味,湿热血瘀者多用经验方清坤宁宫汤加减。带下少者,多从补益肝肾入手治疗。2.8辨治男科病临床经验：临床治疗男科病时重视温补肾阳,强调男科病的辨证以全身和局部相结合,治疗以辨证和辨病相结合。认为男性不育以肾阳虚多见,但是有瘀者化瘀,兼夹湿热者适度清利。2.9辨治痤疮临床经验：认为痤疮的治疗既要辨痤疮局部,又要结合全身整体情况,总结出痤疮辨证当分虚实,实证者又分热毒相结、脾胃湿热、相火亢盛等；虚证者除阴虚火旺,还有肾阳虚者,虚实夹杂亦不少见。2.10辨治银屑病临床经验：采用辨病辨证分期治疗寻常型银屑病,进行期为湿热蕴伏,血热所致,治疗清热利湿,凉血解毒。静止期为湿热蕴伏,瘀血阻络,肤失所养,治疗清热利湿,活血化瘀,解毒通络。消退期为湿热蕴伏,血燥肤失所养,治疗清热利湿,养血润燥为主。强调湿热病机贯穿疾病全程。。2.11辨治鼻鼽临床经验：根据患者的症状及现代医学理论,认为鼻鼽多由肺气虚,卫表不固,营卫失和,风寒乘虚侵入而引起,患者多为免疫功能偏低。治疗要益气固表,调和营卫,温阳散寒,方药多用玉屏风散、桂枝汤合苍耳子散加减治疗。第三部分：红藤棱莪煎治疗反流性食管炎临床研究王焕禄老师认为反流性食管炎当从湿热血瘀辨治,清热利湿,活血化瘀,和胃降逆是治疗大法,创立治疗反流性食管炎的经验方红藤棱莪煎,研究观察红藤棱莪煎治疗反流性食管炎临床效果,选择55例反流性食管炎患者,随机分为红藤棱莪煎治疗组30例和奥美拉唑对照组25例。经8周治疗,发现红藤棱莪煎对反流性食管炎患者临床症状总积分、疗效总积分、临床综合疗效、改善反流性食管炎湿热证和血瘀证以及胃镜下食管病变程度和胃镜下治愈率等方面疗效均好于西药对照组。其在治疗反流性食管炎中有应用前景,值得今后进一步研究。本论文的创新点：1既往王焕禄教授学生对其学术思想的整理只是对其重脾胃和重湿热两方面进行整理,本论文在进一步加深、完善整理王焕禄老师重脾胃、重湿热思想之外,还整理了王老师女科和男科的学术思想以及久病注重活血化瘀的思想,更加全面的整理了老师的学术思想,另外本论文还在王焕禄教授治学特点、临床辨证施治特点方面进行了较为全面的整理归纳,使其治学特点、学术思想得以更全面展示并具有一定的理论深度。2在本人的临床实践中,对部分疾病能灵活运用老师的学术思想进行辨证施治,同时对老师擅长治疗的疾病病种能运用以往学到的知识和经验,在某一阶段的治疗中有自己不同的辨治思路和方药选择,取得了较好的临床疗效。3临床研究方面,从湿热血瘀辨证对反流性食管炎进行研究,前人未见报道；对于湿热血瘀证候的选择,结合老师个人的辨证特色进行症状选择和组合,不囿于以往文献的内容。是结合名老中医个人辨证特色选择相关证的构成,浓缩和提炼名老中医个人辨证经验,有助于理论联系实际继承学习名老中医临床辨证经验。
[Abstract]:Objective: to make an overall arrangement, to study Professor Wang Huanlu's academic thought and diagnosis and treatment experience, to dig into its clinical value and scientific essence, and to achieve the purpose of inheriting, developing, spreading, and popularizing. Research methods and contents: the methods of literature analysis, follow up with teachers, follow up follow-up, question and answer conversation and clinical observation, and so on, to Professor Wang Huanlu The academic thought of traditional Chinese medicine and clinical diagnosis and treatment experience were comprehensively studied. The poor Ben traced the source, excavated and extracted, drew up its academic ideas, summed up its diagnosis and treatment experience, and designed the clinical research plan to evaluate the curative effect of the treatment of reflux esophagitis. The results were divided into the following three main parts: the first part: Wang Professor Hwan Lu's academic thought research 1 professor Wang Huanlu's medical experience and learning characteristics 1.1 professor Wang Huanlu's medical experience combing the influence of Wang Huanlu's family study, teacher's experience, clinical practice and research and award-winning experience, and so on, Professor.1.2 Wang Huanlu's characteristics summed up by Wang Huanlu's four major characteristics: 1.2.1 pays attention to classics, and is familiar with refined research 1.2.2 Attaching importance to practice, practicing 1.2.3 to more than one teacher, diligently seeking 1.2.4 to inherit the predecessors and developing innovation 2, Professor Wang Huanlu's main academic thought from the theoretical origin, the connotation of academic thought and the clinical case summary of the five academic thoughts of Mr. Wang: 2.1 the most widely attached importance to damp heat as the disease, the evil of damp and hot, the most widespread harm, and Wang Huanlu teacher deep. To study the theory of wet heat related to the previous generation, more clinical practice, and more severe clinical practice. There is a wet heat and heat in the tune. Pay attention to the evolution of damp heat disease, damp heat and poison for a long time, clearing heat and dampness with clearing heat and detoxifying. It is closely related to the physiological characteristics of spleen and stomach disease related to the disease related to the clinical stubborn disease.2.2 spleen stomach diseases. On this basis, the narrow sense spleen and stomach disease and the generalized spleen stomach disease are put forward. When the spleen and stomach is in the disease, the spleen and stomach disease should be distinguished from the deficiency and reality, the diagnosis of the spleen and stomach is heavy and the damp heat is found, the spleen and stomach should be treated with the spleen and stomach, the spleen and stomach, the spleen and stomach, the spleen and stomach, the spleen and stomach, the spleen and stomach, the spleen and stomach, the spleen and stomach disease, the spleen and stomach disease, the spleen and stomach disease obvious, the disease of the spleen and stomach, and the disease of the spleen and stomach. In order to postpone the treatment, the spleen and stomach should be treated first. At the same time, for the spleen and stomach disease patients, Mr. Wang stressed the importance of peacetime regulation. It emphasized that "the spleen and stomach is a deficiency, all diseases are clustered, the spleen is treated, all diseases are easy to treat the liver and kidney," the clinical treatment of the liver and kidney is especially important for the liver and kidney, and the addition and subtraction of the six flavors of Rehmannia glutinosa are the prescription.2 commonly used by Mr. Wang. .4 male disease serious kidney yang for the male disease, especially the kidney yang. Including prostatic disease, sexual dysfunction, infertility. Take prostatic hyperplasia as an example to show that.2.5 long disease must see blood stasis, the cause of blood stasis due to a long illness caused by qi deficiency to blood stasis, long disease qi stagnation to stasis and long disease wet heat Decoction to stasis is the main characteristics. Long disease should be good inspection of stasis: Long pain and much blood stasis; looking at the skin to observe the blood stasis; looking for the stasis of the tongue and examining the blood stasis; the examination and examination hints. The second parts: Professor Wang Huanlu's clinical treatment experience study 1 syndrome differentiation and treatment method characteristics summarize the six aspects of Wang Huanlu's clinical treatment: differentiation of disease syndrome differentiation, two phase combination of 1.2 Chinese medicine, and western for 1.3 notes in middle use To weigh the pathogenic factors and weigh the specimen 1.4 to the tongue diagnosis, the four diagnosis and the 1.5 happy prescription, the 1.6 use of the prescription, the 2 clinical common disease diagnosis and treatment experience from the diagnosis and treatment characteristics of the related diseases, summarize the unique views and diagnosis and treatment characteristics of the diseases such as Wang Huanlu, Department of medicine, gynecology, and Department of Dermatology: 2.1 clinical diagnosis and treatment of angina pectoris Experience: the basic pathogenesis of angina pectoris of coronary heart disease is the insufficiency of Heart Qi Yang, blood stasis obstructing the heart pulse. Pay attention to the detailed inquiry, inspect the tongue vein heavy tongues and the tongue vein blood stasis. Attach importance to the differential diagnosis. It is considered that Yiqi Huoxue Tongluo is the basic treatment. The clinical experience of treating chronic constipation with.2.2 for the treatment of chronic constipation is considered to be warm without dryness. Chronic constipation is an pathogenesis with spleen deficiency as the core. Spleen deficiency and weakness of the dross form abnormal dross; the Spleen Qi Qi Qi Qi disorder is abnormal and the intestines are not reduced; the intestinal loss is also derived from the spleen. On the treatment, Yiqi invigorating the spleen is the fundamental method, the key step of the Qi Qi regulating machine is to use the medicine pair, and the drug is divided into.2.3 to identify the clinical experience of reflux esophagitis. The disease position in the stomach (esophagus), the liver, the disease evil with gas inverse, damp heat, blood stasis mainly, treatment with clearing heat and dampness, activating blood and removing blood stasis, and stomach descending mainly. Experience prescription red vine rizedoary Decoction.2.4 differentiation and treatment of rheumatoid arthritis clinical experience: rheumatoid arthritis should be named "Damp heat Bi", emphasizing dampness Heat disease machine, staging treatment, acute phase of clearing heat and dampness, dredging collaterals to relieve pain; in the remission period, at the same time in proper heat clearing and dampness, treatment of clearing heat and detoxification, we must increase the strength of.2.5 to differentiate and treat the clinical experience of kidney disease. The relationship between the spleen and kidney and kidney kidney and kidney disease is analyzed. The acute phase is divided into three types: "wind water repression, Lung Qi loss", "heat wound blood and collaterals, forced blood downward", "toxic heat accumulation" and "blood flow overflowing"; the chronic period takes the spleen and kidney two deficiency and the turbidity and poison loss as the main, treatment from the spleen and kidney benefit kidney, wet turbid turbid turbid and activating blood and removing stasis. Clinical experience in the application of key medicine.2.6 in the treatment of menstrual diseases: to differentiate and treat menstrual diseases with emphasis on the history of disease, including heavy asking of menstrual conditions, paying attention to the past history of gynecologic diseases, paying attention to differentiation of age groups, differentiating diseases and machines, paying attention to taking medicine history and paying attention to the combination of modern medical examination. The clinical experience of the.2.7 differentiation and treatment of phlegm and blood stasis syndrome: the underscore of the disease emphasizes the excessive deficiency and reality syndrome differentiation, and the lower deficiency syndrome is the main. The clinical experience of.2.8 in the treatment of male diseases was treated with liver and kidney: in the treatment of men's diseases, the clinical treatment of male family disease was paid attention to by warming up the kidney yang, emphasizing the combination of the whole body and the local syndrome in the syndrome differentiation of men's diseases. The treatment was combined with the syndrome differentiation and differentiation of diseases. It is believed that the treatment of acne should not only distinguish the local acne, but also combine the whole body with the whole body, and summarize the syndrome differentiation when the acne is divided into deficiency and reality, the empirical person is also divided into the heat toxic phase, the spleen and stomach damp heat, the phase fire hyperactivity and so on. The deficiency syndrome, except Yin deficiency, the deficiency of the kidney yang, and the deficiency and solid mixture is not uncommon for.2.10 to distinguish the clinical experience of psoriasis. Treatment of psoriasis vulgaris, due to wet heat accumulation, blood heat, treatment of heat and damp, cool blood and detoxification. Static period is damp heat accumulation, blood stasis obstructing collaterals, skin loss, treatment of heat and dampness, blood circulation to remove stasis, detoxification collaterals. The period of subsiding is damp heat accumulation, blood dryness skin is lost, treatment of clearing heat and moisture, nourishing blood and dryness. According to the symptoms and modern medical theory of..2.11: according to the patient's symptoms and modern medical theory, it is believed that the nasal cavity is mostly caused by lung qi deficiency, the guard table is not fixed, the camp and the cold times are intruded and the immune function is on the low side. The third part: the clinical study on the treatment of reflux esophagitis in the third part: a clinical study on reflux esophagitis by red vine, teachers think that reflux esophagitis should be treated from damp heat and blood stasis, heat and dampness, blood circulation and stasis, and stomach reverse is the treatment of Dafa, the experience of treating reflux esophagitis, the decoction of red vine 55 cases of reflux esophagitis were selected and divided randomly into 30 cases of red turmeric Decoction and 25 cases of omeprazole control group. After 8 weeks of treatment, the total integral of clinical symptoms of reflux esophagitis, total curative effect integral, clinical comprehensive effect, improvement of reflux esophagitis damp heat syndrome and blood stasis syndrome and stomach were improved after 8 weeks of treatment. The curative effect of the esophageal lesion and the cure rate under the gastroscope is better than the western medicine control group. It has the prospect of application in the treatment of reflux esophagitis. It is worth further study in the future. The innovation point of this thesis is: 1 the finishing of the academic thought of the previous Professor Wang Huanlu students was only to reorganize the two aspects of its heavy spleen and stomach and heavy damp heat. In order to further deepen and improve the thought of teacher Wang Huanlu's heavy spleen and stomach, heavy and damp heat, he also collates the thought of the academic thought of Mr. Wang's female department and the male family, and the thought of paying attention to blood circulation and removing blood stasis for a long time. It has carried out a more comprehensive arrangement and induction to make its academic characteristics, the academic thought can be displayed in a more comprehensive way and has a certain theoretical depth.2 in my clinical practice, and the academic thought of the teacher can be applied flexibly to some diseases. At the same time, the knowledge and knowledge of the disease disease of the teacher in Changzhi can be used in the past. Experience, in a certain stage of the treatment of different treatment ideas and prescriptions, and achieved good clinical efficacy of.3 clinical research, from the damp and hot blood stasis syndrome of reflux esophagitis, no report of previous reports; for the selection of damp and hot blood stasis syndrome, combined with the teacher's personal characteristics for symptoms selection and group. It is not limited to the contents of the previous literature. It is a combination of the syndrome characteristics of the personal syndrome differentiation of the old Chinese medicine, which concentrates and refines the personal experience of the old Chinese medicine, which is helpful to the theory and practice to inherit the clinical syndrome differentiation experience of the old 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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