王常绮老中医脾胃病学术思想及临床经验的总结、继承及相关临床研究

发布时间：2018-06-09 03:39

本文选题：王常绮 + 老中医　；参考：《成都中医药大学》2016年博士论文

【摘要】：本学位论文包括两个部分：王常绮名老中医学术思想及临床经验总结、继承部分及相关临床研究部分。(一)学术思想及临床经验总结、继承部分王常绮名老中医,为青海省名医,悬壶济患五十载,擅治脾胃病,并积累了丰富的临床经验。王老尤其擅治慢性萎缩性胃炎,指出治疗慢性萎缩性胃炎的具体法则与临床经验如下：治疗慢性萎缩性胃炎务必调畅气机,升降并用,升清降浊,气机畅达则痛胀可平；须标本兼顾,补泻并用,治本为主,重在扶正,正气得助则病邪易祛；宜运脾化湿,芳香醒脾,和胃降浊,湿浊尽去则脾得健运；必理气活血,气血同治,重在化瘀,气畅血行则疾病可愈；倡寒温并用,辛开苦降,寒热尽去则痞满可除；重清热解毒,热毒得解则病根可除；遣方用药以平润为宜,以平衡为期,燥润相济,凉温相宜,勿过滋过燥。此外,王老擅治久泻,认为治疗久泻应从湿论治,注重化湿渗湿,健脾益气,脾健湿化则久泻可止；治疗久泻不可一味温补固涩,宜视兼夹证之不同而分别佐用调畅气机、消食化滞、化湿止泻、清热利湿、升清降浊等法。除上述所述疾病外,王老还擅于治疗其它脾胃疾病,如治疗反流性食管炎以疏肝理气,调和肝胃,开膈化痰,活血化瘀,降逆清热为要,兼以养阴生津；治疗胆汁反流性胃炎则必当疏肝利胆,和胃降逆,清泄胆热,化痰散结；治疗消化性溃疡重在补虚,治病求本；强调活血,促进愈合；结合辨病,灵活施治;疏木培土,从肝论治。(二)临床研究部分1.目的：(1)系统观察与研究王常绮老中医治疗反流性食管炎的经验方治疗该病的临床疗效和预防控制复发的效果。(2)观察研究精神社会心理因素与反流性食管炎发病之间的关系。(3)观察王常绮老中医经验方治疗反流性食管炎伴发抑郁症、焦虑症的疗效。2.方法：(1)按照随机、对照原则,将入选病例分为两组：即采用王常绮名老中医治疗反流性食管炎经验方治疗的中医治疗组及常规西药治疗的西药对照组,两组均收集50例病例。两组病例治疗方法如下：中医治疗组：采用王常绮老中医治疗反流性食管炎经验方研细末,装胶囊口服治疗,每粒0.4g,每次服3粒,每日3次,饭后服。西药对照组：予奥美拉唑肠溶胶囊40mg口服,每日1次,莫沙比利分散片5mg口服,每日3次。疗程均为1个月。两组病例疗程结束后均复查胃镜,分别计算两组的临床治愈率、显效率、有效率及总有效率。在疗程结束后的1个月、3个月及6个月后采用GerdQ量表对两组患者进行随访问卷调查,并在疗程结束6个月后两组病例均再次复查胃镜,分别计算两组的复发率。(2)对上述已经分组的两组病例,在治疗前依据诊断标准,结合Zung抑郁自评量表(SDS)及焦虑自评量表(SAS)对两组病例进行抑郁症、焦虑症筛查诊断,统计两组病例中伴发抑郁症、焦虑症的总病例数以及两组病例中伴发抑郁症、焦虑症的发病率,观察王常绮老中医经验方治疗反流性食管炎伴发抑郁症、焦虑症的疗效。3.结果：(1)治疗反流性食管炎的疗效：中医治疗组临床治愈24例,显效13例,有效9例,无效3例,临床治愈率48.98%,显效率26.53%,有效率18.37%,总有效率93.88%,而西药对照组临床治愈25例,显效10例,有效9例,无效2例,临床治愈率54.35%,显效率21.74%,有效率19.57%,总有效率95.65%,两组的临床治愈率、显效率、有效率、总有效率比较均无显著性差异(均P0.05)。(2)中医治疗组在疗程结束后的1个月后、3个月后及6个月后复发率分别为12.5%、19.15%、22.22%,而西药对照组在疗程结束后的1个月后、3个月后及6个月后复发率分别为32.61%、37.78%、40.91%,两组疗程结束后的1个月、3个月及6个月后的复发率比较均具有显著性差异(均P0.05)。(3)两组共100例病例中有伴发抑郁症患者39例,占39%,伴发焦虑症患者41例,占41%。(4)治疗反流性食管炎伴发抑郁症、焦虑症的疗效：反流性食管炎伴发抑郁症的疗效如下：中医治疗组临床治愈2例,显效10例,有效7例,无效1例,临床治愈率10%,显效率50%,有效率35%,总有效率95%,而西药对照组临床治愈1例,显效3例,有效7例,无效8例,临床治愈率5.26%,显效率15.79%,有效率36.84%,总有效率57.89%。反流性食管炎伴发焦虑症的疗效如下：中医治疗组临床治愈3例,显效12例,有效4例,无效2例,临床治愈率14.29%,显效率57.14%,有效率19.05%,总有效率90.48%,而西药对照组临床治愈1例,显效5例,有效5例,无效9例,临床治愈率5%,显效率25%,有效率25%,总有效率55%。两组反流性食管炎伴发抑郁症的显效率、总有效率比较均具有显著性差异(P0.05,P0.01),两组反流性食管炎伴发焦虑症的显效率、总有效率比较均具有显著性差异(P0.05,P0.05)。4.结论：(1)此次临床研究结果表明王常绮老中医经验方治疗反流性食管炎与常规西药治疗相比较临床疗效相当,但王常绮名老中医经验方治疗反流性食管炎无明显不良反应,安全可靠,具有良好的依从性,且药价低廉,可以认为王常绮老中医经验方治疗反流性食管炎具有独特优势与自身特点,值得在临床进一步推广应用,并为临床推广应用调和肝胃,开膈化痰,理气降逆法治疗反流性食管炎提供了可靠依据。(2)此次临床研究结果还表明王常绮老中医经验方预防反流性食管炎复发具有良好效果,其预防复发的效果明显优于常规西药治疗,值得在临床进一步推广应用,从而为临床预防和控制反流性食管炎复发提供了有效措施,以有效降低该病复发率。(3)此次临床研究结果表明精神社会心理因素与反流性食管炎发病之间存在较为密切的关系,精神社会心理因素参与了反流性食管炎的发病。(4)王常绮老中医经验方治疗反流性食管炎伴发的抑郁症、焦虑症疗效显著,优于西药对照组,显示出中医药治疗反流性食管炎伴发的抑郁症、焦虑症的自身优势和特点,同时也从临床治疗效果印证了精神社会心理因素与反流性食管炎发病之间存在较为密切的关系。
[Abstract]:This thesis consists of two parts : the summary of the academic thoughts and clinical experience of Wang Changi ' s famous old Chinese medicine , the part of the inheritance and the relevant clinical research . ( 1 ) The academic thought and clinical experience summarize , inherit the part of Wang Changqi ' s famous traditional Chinese medicine , and have accumulated rich clinical experience . Wang is especially good at treating chronic atrophic gastritis , and points out that the specific law and clinical experience in treating chronic atrophic gastritis are as follows :
The specimen should be taken into consideration , and the herbs should be used for tonifying and diarrhea , and the main body of the disease should be treated as the main body , and the main body weight should be healthy and healthy , so that the pathogen of the disease is easy to remove ;
It is suitable to transport the spleen and dampness , wake up the spleen , and reduce the turbidity of the stomach , and the spleen must be healthy and transported ;
It has the effects of regulating qi , promoting blood circulation , regulating qi and blood , promoting blood circulation , removing blood stasis , regulating qi and blood circulation , and recovering diseases ;
the cold and warm are advocated , and the cold and heat are used , and the cold and heat are exhausted , and the abdominal distention can be eliminated ;
clearing away heat and toxic materials , removing heat and toxic materials , and removing root ;
In addition , Wang is good at treating chronic diarrhea , and it is believed that the treatment of chronic diarrhea should be treated by wet theory , and it should be emphasized that the treatment of chronic diarrhea should be treated with wet theory , and it should be emphasized that the treatment for chronic diarrhea should be treated with damp infiltration , spleen invigorating and qi invigorating , and spleen invigorating and dampness eliminating .
In addition to the diseases mentioned above , the king is also good at treating other spleen and stomach diseases , such as treating reflux esophagitis , dispersing stagnated liver qi , regulating the liver and stomach , opening the diaphragm , eliminating phlegm , promoting blood circulation , removing blood stasis , reducing adverse heat clearing and clearing away heat , and is also used for nourishing yin and promoting fluid production ;
For the treatment of bile reflux gastritis , the liver and gallbladder can be depressed , the stomach is reduced , the gallbladder heat is cleared , and the phlegm is dissipated ;
treating peptic ulcer with deficiency of tonifying deficiency and treating diseases ;
Emphasis is placed on promoting blood circulation and promoting healing ;
Methods : ( 1 ) To observe the relationship between the psychologic factors and the incidence of reflux esophagitis . ( 2 ) To observe the relationship between the psychologic factors and the incidence of reflux esophagitis . ( 2 ) To observe the relationship between the psychological factors and the incidence of reflux esophagitis . ( 3 ) To observe the clinical cure rate , the obvious efficiency , the effective rate and the total effective rate of the two groups . Results : ( 1 ) The clinical cure rate was 48.98 % , the effective rate was 26.53 % , the effective rate was 54.35 % , the total effective rate was 21.74 % , the effective rate was 19.57 % , the total effective rate was 95.65 % , the clinical cure rate was 21.74 % , the effective rate was 19.57 % , the total effective rate was 95.65 % , the clinical cure rate was 21.74 % , the effective rate was 19.57 % , the total effective rate was 95.65 % , the total effective rate was 21.74 % , the effective rate was 19.57 % , the total effective rate was 95.65 % . ( 2 ) After 1 month after the end of treatment , the recurrence rates were 12.5 % , 19.15 % and 22.22 % after 3 months and 6 months respectively . The recurrence rates were 32.61 % , 37.78 % and 40.91 % after 3 months and 6 months after the end of treatment . ( 4 ) The curative effect of treating reflux esophagitis with depression and anxiety was as follows : 2 cases were cured in the traditional Chinese medicine treatment group , 10 cases were markedly effective , 7 cases were effective , 1 case was ineffective , the effective rate was 14.29 % , the effective rate was 57.14 % , the effective rate was 15.79 % , the effective rate was 36.84 % , the total effective rate was 5 % , the effective rate was 25 % , the effective rate was 25 % , the total effective rate was 55 % . Conclusion : ( 1 ) The results of this clinical study indicate that Wang Changqi ' s traditional Chinese medicine experience has a good effect on the treatment of reflux esophagitis , and it is worthy of being popularized and applied in clinic .
【学位授予单位】：成都中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R256.3

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