全国名老中医戴永生教授治疗泄泻的证治规律研究

发布时间：2018-06-09 15:37

本文选题：泄泻 + 学术思想　；参考：《成都中医药大学》2016年博士论文

【摘要】：目的：中医脾胃病学源远流长,起源于《黄帝内经》,金元时期李东垣师徒创立了脾胃学说,后世医家又发展丰富了中医脾胃学说,戴永生教授为全国第五批老中医药专家学术经验继承工作指导老师,贵州省首届名中医,教授,主任中医师,悬壶近五十载,学验俱丰,既继承经旨,又善于临床发挥,辨证用药遣方,独具匠心,尤其对中医脾胃病有独到的临床经验和学术思想。因此,为传承和发扬名老中医的学术思想而开展戴永生教授对泄泻证治规律学术思想的研究。方法：通过临床传承研究,包括传统的临床四诊、收集分析泄泻临证案例、阅读整理反映戴永生教授学术思想及临证经验的论文及著作等方式和方法,总结戴永生教授的主要学术思想和临床经验,结合现代数据挖掘技术,利用中医传承辅助平台系统软件(V2.5)进行关联规则分析等,对戴永生教授的泄泻诊疗临证医案中的处方等数据进行整理分析归纳,总结戴永生教授的辨证特色及遣方用药规律。通过观察四君子汤合平胃散合方治疗功能性腹泻脾虚湿盛证的临床效果,从临床研究的角度进一步挖掘戴永生教授治疗泄泻的学术思想。结果：中医传承辅助平台系统软件整理了戴永生教授泄泻诊疗处方180例次,通过数据挖掘,提炼分析,发现戴永生教授治疗泄泻的主要证候有21种,主要用药是补气类、化湿类药物；基于关联分析出常用“药对”及组合,使用频次55次以上的“药对”及组合20组,如茯苓、甘草频率为122次,茯苓、白术频率为99次,白术、甘草96次,南沙参、茯苓94次等,常用药味为白术、南沙参、茯苓、甘草等.药物四气分布中以温性为主,五味分布中,以甘味最多,基于复杂系统熵聚类的核心组合分析,演化出3-5味药的核心组合,共计10个,基于层次聚类的治疗泄泻的新方5个,由4-5味药组成。通过整理分析临床医案180例,得出戴永生教授治疗泄泻的几个特点：1、辨证方法上的独特性,2、临床分型的独特性3、中医五行理论与泄泻辨治的相关性4、泄泻用药上的经方组合。临床研究结果显示,戴永生教授运用四君子汤合平胃散治疗功能性腹泻脾虚湿盛证,治疗组临床疗效为90%,西医对照组为73.3%,临床疗效明显高于对照组(P0.05),治疗结束4周后,对病人进行随访。其中治疗组,有效随访24人,3人复发,复发率为12.5%；对照组,有效随访18人,8人复发,复发率为44.4%,两组进行卡方检验,差异有统计学意义(P0.05),对照组复发率明显高于治疗组。结论：通过整理,总结戴永生教授的主要学术思想是辨证灵活,方法多样；异病同治,同病异治；善用经方,方方组合；认为脾胃病的病因与感受外邪、饮食失宜、情志所伤、劳逸太过和它脏病变有关,脾胃病病机以脾常虚、肝常郁、胃常滞为主,辨证中戴老常常采取是辨证与辨病相结合,微观辨证与临床症状辨证相合,多种辨证方法结合,交叉运用。治则治法上,主张肝、脾、胃脏腑合治,疏肝、健脾、和胃诸法并施,用药选方用量上,戴老以脾胃病“虚则太阴,实则阳明”为据,补脾胃者多以甘味药为主,酸味药次之；泻脾胃者多以苦味药为主,辛味药次之,而补泻之中药性又有寒温之分,故应随证选用。戴永生教授认为泄泻发生其本在脾虚,其标是脾虚生内湿,但与大、小肠、肝胆、肺肾等脏腑有关,主要用药是健脾益气、化湿类药物；常用药味为南沙参、茯苓、白术、甘草等,戴永生教授首推泄泻辨证方法的优化组合,采用脏腑辨证、气血津液辨证、五行辨证等多种辨证方法交叉运用,体现临证的灵活性,满足临床辨证辨治的需要,是中医同病异治理论指导临床的具体体现。利用中医传承辅助平台系统软件,将传统与现代相结合的研究方法,有利于新药开发研究,充分体现中医药特色和优势,是继承与创新工作的要求。临床研究表明戴永生教授采用经方与经方组合治疗泄泻有较好的临床疗效,且无明显毒副反应,值得临床推广运用。
[Abstract]:Objective: Traditional Chinese medicine has a long history of spleen and stomach disease, which originated from "Huangdi Neijing". Li Dong Yuan, the teacher and apprentice of Li Yuan, founded the theory of spleen and stomach in the Jin Yuan period, and the later Physicians developed the spleen and stomach theory of traditional Chinese medicine. Professor Dai Yongsheng was the old teacher of the fifth batch of academic experience of old Chinese medicine experts in the country, the first Chinese medicine, Professor, and director of Chinese medicine in Guizhou province. There are nearly fifty loads of the pot, which inherits the tenor, and is good at clinical practice. It has a unique clinical experience and academic thought, especially for the spleen and stomach disease of traditional Chinese medicine. Therefore, the academic thought of Dai Yongsheng teaching on the rule of diarrhea syndrome is carried out and carried out in order to inherit and carry forward the academic thought of the old Chinese medicine. The clinical inheritance research, including the traditional clinical four diagnosis, the collection and analysis of the case of diarrhoea, the reading and sorting of the papers and works reflecting professor Dai Yongsheng's academic thought and experience, summarized the main academic thought and clinical experience of Professor Dai Yongsheng, combined with the present generation of data mining technology, and used the auxiliary platform of traditional Chinese medicine. The system software (V2.5) carries on the analysis of the association rules and so on, collate and analyze the data of the prescription in the medical case of Professor Dai Yongsheng's diarrhea diagnosis and treatment, summarize the characteristics of Professor Dai Yongsheng's syndrome differentiation and the rule of the prescription medication. By observing the clinical effect of the treatment of the spleen deficiency dampness syndrome with the four gentlemen soup and the combination of the stomach scattered prescription, the clinical effect of the syndrome of the spleen deficiency and the dampness of the diarrhea is treated from the clinic. The academic thought of Professor Dai Yongsheng's treatment for diarrhea was further excavated. Results: 180 cases of Professor Dai Yongsheng's diarrhea diagnosis and treatment prescription were compiled by the system software of the inheritance auxiliary platform of traditional Chinese medicine. Through data mining and refining analysis, there were 21 main syndromes of Professor Dai Yongsheng's treatment of diarrhea. The main drugs used were Qi tonifying and humidification drugs. Based on the correlation analysis of the commonly used "drug pairs" and combination, the use of "drug pair" and combination of 55 times more than 20 groups, such as Poria cocos, 122 times the frequency of Glycyrrhiza, tuckahoe, 99 times the frequency of Atractylodes, 96 times in Atractylodes, 96 times of Glycyrrhiza, 94 times in Nansha, and poria cocos, commonly used as Atractylodes macrocephala, Nansha ginseng, Poria cocos and Glycyrrhiza etc. in the four gas distribution, five in the four gas distribution, five temperature, five In the taste distribution, the core combination analysis based on the entropy clustering of complex system, based on the core combination analysis of complex system entropy, has evolved the core combination of 3-5 flavors, totaling 10, 5 new prescriptions for treating diarrhea based on hierarchical clustering, and composed of 4-5 flavors. Through sorting and analyzing 180 cases of clinical medical cases, several characteristics of Dai Yong Sheng professor's treatment of diarrhea are obtained: 1, dialectic method. Uniqueness, 2, the uniqueness of the clinical classification of 3, the theory of five lines of traditional Chinese medicine and the correlation of diarrhea and diarrhea 4, the treatment of diarrhea on the combination of prescriptions. The clinical results showed that Professor Dai Yongsheng used four gentlemen soup and stomach powder to treat the spleen deficiency dampness syndrome of functional diarrhea, the treatment group was 90% in clinical treatment and 73.3% in the western medicine control group, and the clinical effect was obviously higher than that of the control group. The control group (P0.05), 4 weeks after the end of the treatment, the patients were followed up. In the treatment group, 24 people were followed up effectively, 3 people had relapse and the recurrence rate was 12.5%. The control group was followed up 18 people, 8 relapsed and the recurrence rate was 44.4%. The difference was statistically significant (P0.05), and the recurrence rate of the control group was significantly higher than that in the treatment group. Conclusion: through tidy The main academic thoughts of Professor Dai Yongsheng are dialectical and flexible, the method is varied, the disease is treated with the same disease, the same disease and different treatment; the treatment of the spleen and stomach disease is related to the external pathogenic factors, the food discomfort, the emotional injury, the labor and ease too much and its dirty disease. The spleen and stomach disease pathogenesis is often deficiency of the spleen, the liver is often stagnant and the stomach is often stagnant, and the syndrome of Dai Lao syndrome differentiation is based on the syndrome differentiation. The combination of syndrome differentiation and disease differentiation, the combination of the microscopic syndrome differentiation and the clinical symptoms, the combination of various dialectical methods and the cross application. On the rule of rule, the liver, the spleen, the stomach viscera, the liver, the spleen, and the stomach are used and the dosage of the stomach is used. Medicine is the main medicine, and the acid taste medicine is the second. The people who purge the spleen and stomach are mainly bitter medicine, and the bitter medicine is the second. And the medicine is cold and warm, so it should be selected with the syndrome. Professor Dai Yongsheng thinks that the diarrhea occurred in spleen deficiency, which is the spleen deficiency and internal humidity, but it is related to the big, small intestine, liver and gallbladder, lung kidney and other viscera. The main medicine is to strengthen the spleen, invigorate Qi, and humidification medicine. The commonly used medicine is Nansha ginseng, Poria cocos, Atractylodes macrocephala, liquorice and so on. Professor Dai Yongsheng first pushed the combination of syndrome differentiation methods of diarrhea, using viscera syndrome differentiation, Qi and blood body fluid syndrome differentiation, five lines of syndrome differentiation and other dialectical methods, reflecting the flexibility of the clinical syndrome and meeting the needs of clinical differentiation and treatment. Using traditional Chinese medicine to inherit the auxiliary platform system software, the combination of traditional and modern research method is beneficial to the research of new drug development, fully embodying the characteristics and advantages of traditional Chinese medicine. It is the requirement of inheritance and innovation. The clinical study shows that Professor Dai Yongsheng has good clinical effect on treating diarrhea with the combination of the classics and the classics, and it does not have a good clinical effect. The obvious toxic and side effects are worthy of clinical application.
【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

【参考文献】