李曰庆教授学术经验总结及“活血通络法”治疗慢性前列腺炎随机对照临床研究

发布时间：2018-06-17 01:19

本文选题：通前络汤 + 慢性前列腺炎　；参考：《北京中医药大学》2016年博士论文

【摘要】：一、李曰庆导师学术经验总结李曰庆导师是我国著名中医外科大家,毕业于北京中医学院(北京中医药大学前身),主任医师,二级教授,博士研究生导师,东直门医院首席教授,享受国务院政府特殊津贴。主编全国中医药行业高等教育“十一五”和“十二五”规划教材《中医外科学》,主持国家十一五科技支撑计划项目“中医外治特色疗法和外治技术示范研究”,是国家重点学科“中医男科学”和“中医外科学”学术带头人,北京市第四批、国家第五批名老中医药专家。从医已逾四十六载,中年以后尤其专注中医男科的临床、科研、教学工作,对中医男科学的发展做出了卓越的贡献,被誉为我国中医男科学四大奠基人之一。导师对运用中医、中西医结合的方法治疗男科常见疾病、疑难疾病积累了丰富的经验,提出了许多创新的学术见解和观点。对失眠、过敏性鼻炎、湿疹等疾病的辨证论治也尤为擅长。李曰庆导师治学严谨,兼收并蓄。他对经典精研细读,从《内经》、《难经》、《伤寒杂病论》、《景岳全书》、《妙一斋医学正印种子编》等论著中逐渐形成自己学术观点和思想的同时,又不断在临证中对古籍经典继承和创新,融会贯通中西医疗法,形成了“辨病与辨证相结合”、“宏观与微观相结合”、“整体与局部相结合”、“标本兼治、男女同治、身心同调”等学术思想。导师在临证时精于辨证,处方往往不拘一格,常加入疗效确切的草药,出奇制胜；同时结合现代医学检查手段,明确诊断,防止误诊、漏诊和误治,将现代医学的微观检查作为中医手眼的延伸,充分体现了导师“病证结合”的学术思想。并在实践中提出“补肾生精,微调阴阳,清补结合治疗男性不育症”,“从瘀、从络论治慢性前列腺炎”,“阳痿从肝肾论治”,“良性前列腺增生症从肾虚血瘀论治”等行之有效的治疗思路,取得了良好的疗效。我在跟师学习期间系统地学习和整理了导师的学术思想和临床经验,在论文中进行了阐述。二、“活血通络法”治疗慢性前列腺炎随机对照临床研究目的：活血通络法治疗慢性前列腺炎是我跟师学习期间总结发现李曰庆导师的学术思想,“通前络汤”是导师在该法指导下常用的经验方。本研究通过观察通前络汤对慢性前列腺炎(气滞血瘀证)患者美国国立卫生研究院慢性前列腺炎症状评分(NIH-CPSI)、9条目病人健康问卷评分(PHQ-9)、前列腺液中白细胞数量及磷脂小体数量的影响,客观评价通前络汤治疗慢性前列腺炎(气滞血瘀证)的临床疗效。方法：采用随机、对照临床试验研究方法,通过美国国立卫生研究院慢性前列腺炎症状评分(NIH-CPSI)、前列腺按摩液常规(EPS)等纳入排除标准,筛选出120例慢性前列腺炎气滞血瘀证患者,随机分为试验组(60例,脱落1例)和对照组(60例,脱落6例)。试验组患者服用通前络汤免煎颗粒,早晚各一袋,饭前40分钟,温水冲服,疗程4周。对照组口服前列欣胶囊,6粒／次,每天3次,饭前40分钟,温水送服,疗程4周。所有患者均在入组时、治疗第2周、第4周时门诊随访并进行NIH-CPSI、PHQ-9评分,在治疗结束后第4周门诊或电话随访,进行NIH-CPSI、PHQ-9评分。结果：试验组痊愈5例(8.47%),显效19例(32.20%),有效28(47.46%),总有效率88.14%。对照组痊愈3例(5.56%),显效13例(24.07%),有效22例(40.74%),总有效率70.37%。两组治疗前后NIH-CPSI积分的自身对比差异均有显著性(P0.01);组间比较,试验组较对照组第4周和第8周NIH-CPSI总分、疼痛和生活质量评分差异均有显著性(P0.05);两组治疗前后PHQ-9评分的自身对比差异均有显著性(P0.01),组间比较,试验组较对照组第2周、第4周和第8周PHQ-9总分差异均有显著性(P0.05)；两组治疗后EPS白细胞数量计数与疗前相比变化差异均显著(P0.01)；组间比较,治疗后第2周及第4周试验组较对照组在EPS白细胞计数上差异均显著(P0.01)；两组治疗后磷脂小体数量与疗前相比变化差异均显著(P0.01),治疗第2周与第4周比较,两组均有显著性差异(P0.05)；组间比较,治疗后第2周,试验组较对照组卵磷脂小体计数上无显著性差异(P0.05),疗后第4周试验组较对照组卵磷脂小体计数上有显著性差异(P0.01)。结论：通前络汤对慢性前列腺炎(气滞血瘀证)的临床症状有不同程度的改善,尤其能够缓解患者疼痛不适的症状,改善患者的生活质量和改变患者的抑郁状态,客观上能够降低前列腺液中白细胞的数量,增加卵磷脂小体的含量。因此,本方可以有效的治疗该类型的慢性前列腺炎。
[Abstract]:First, Li Yueqing's tutor's academic experience summarizes Li Yueqing's tutor, a famous Chinese medicine surgeon in China, graduated from the Beijing Institute of traditional Chinese medicine (the predecessor of the Beijing University of Chinese Medicine), the chief physician, the two level Professor, the doctoral supervisor, the chief professor of the Dongzhimen hospital, and the special allowance of the State Department of the State Council. The chief editor of the national traditional Chinese medicine industry, "ten" 15 "and" 12th Five-Year "program textbook" Chinese Medicine Surgery > ", the state 11th Five-Year science and technology support program" traditional Chinese medicine treatment and external treatment technology demonstration research ", is the national key discipline" male science of traditional Chinese medicine "and" Chinese medicine surgery "academic leader, the fourth batch of Beijing City, the country's fifth batch of old traditional Chinese medicine experts. After more than forty-six years of medical treatment, after middle age, especially the clinical, scientific research and teaching work of Chinese medicine, it has made outstanding contributions to the development of male science of traditional Chinese medicine. It has been praised as one of the four founders of male science of Chinese medicine. The tutor has accumulated rich classics on the treatment of common diseases of male subjects and difficult diseases by the combination of traditional Chinese medicine and Chinese and Western medicine. A lot of innovative academic opinions and viewpoints were put forward. The syndrome differentiation and treatment of diseases such as insomnia, allergic rhinitis, eczema and other diseases were especially good. Li Yueqing's tutor was strict in scholarly study. At the same time of his own academic views and ideas, they continue to inherit and innovate the classics of ancient books, integrate the Chinese and Western medical law, and form a "combination of disease discrimination and syndrome differentiation", "combination of macro and micro", "combination of the whole and the local", "specimen and treatment, CO treatment of men and women, physical and mental homology". On the basis of syndrome differentiation, the prescriptions are often unconstrained, often added to the effective herbal medicine to win the victory; at the same time, combining modern medical examination methods, clear diagnosis, prevention of misdiagnosis, missed diagnosis and mistaken treatment, the microscopic examination of modern medicine as the extension of the hand eye of traditional Chinese medicine, fully embodies the academic thought of "combination of diseases and syndromes" of the instructor and put forward in practice "Invigorating the kidney to produce sperm, adjusting Yin and Yang, clearing up the combination therapy for male infertility", "Treating Chronic Prostatitis from the stasis, from the collaterals", "treating the impotence from the liver and kidney", "treating the benign prostatic hyperplasia from the kidney deficiency and blood stasis" and so on, has achieved good therapeutic effect. I systematically studied and arranged the guide during my study with the teacher. The academic thought and clinical experience of the teacher were expounded in the paper. Two, the purpose of the randomized controlled clinical study of the treatment of chronic prostatitis by "activating blood circulation and collaterals method" is the purpose of the treatment of chronic prostatitis: the academic thought of Li Yueqing tutor was summed up during my study with the teacher. "Tongqian collaterals" is the guide of the tutor under the guidance of this law. In this study, the effect of Tongqian collaterals on chronic prostatitis (qi stagnation and blood stasis) on chronic prostatitis symptom score (NIH-CPSI), 9 items of patients' Health Questionnaire (PHQ-9), the number of white blood cells in prostatic fluid and the number of phospholipid corpuscles in the prostatic fluid were observed in this study, and the chronic prostatic soup was objectively evaluated for the chronic treatment of chronic prostatitis. The clinical effect of prostatitis (qi stagnation and blood stasis syndrome). Methods: 120 cases of chronic prostatitis qi stagnation and blood stasis syndrome were selected and divided into experimental group randomly and compared with the standard of chronic prostatitis symptom score (NIH-CPSI) and prostatic massage routine (EPS) in the National Institutes of health of the United States. (60 cases, shedding 1 cases) and the control group (60 cases, 6 cases). The patients in the experimental group took the free Decoction granule of Tongqian Luo decoction, each one bag, 40 minutes before meals, warm water for 4 weeks. The control group took the forefront of the capsule, 6 grains per time, 3 times a day, 40 minutes before meals, warm water for 4 weeks. All patients were treated for second weeks, fourth weeks. Follow-up and NIH-CPSI, PHQ-9 score, after fourth weeks of outpatient or telephone follow-up after the end of the treatment, NIH-CPSI, PHQ-9 score. Results: the test group recovered 5 cases (8.47%), 19 cases (32.20%), effective 28 (47.46%), total effective 88.14%. control group recovered 3 cases (5.56%), 13 cases (24.07%), effective 22 cases (40.74%), total effective efficiency 70.37%. two group The differences of NIH-CPSI scores before and after treatment were significant (P0.01). Compared with the fourth and eighth weeks NIH-CPSI total scores in the experimental group, the scores of pain and quality of life were significantly different (P0.05), and the difference of the contrast between the two groups before and after the treatment of the two groups was significant (P0.01). The comparison between the group and the control group was more than that of the control group. There were significant differences in the total score of PHQ-9 in the second weeks, fourth weeks and eighth weeks. The number of EPS white blood cells in the two groups was significantly different from that before treatment (P0.01). Compared with the control group at second weeks and 4 weeks after treatment, the differences in the EPS white blood cell count were significantly higher than those in the control group (P0.01). The number of phospholipid corpuscles in the two groups after treatment and the number of phospholipid bodies in the two groups were compared with those in the two groups. The difference was significant (P0.01) before treatment, and there was significant difference between the two groups (P0.05) for second weeks and fourth weeks. There was no significant difference in the count of lecithin body between the experimental group and the control group at second weeks after the treatment (P0.05). There was a significant difference in the count of lecithin body in the test group after fourth weeks after treatment (P0.01). The clinical symptoms of Tongqian collaterals can improve the clinical symptoms of chronic prostatitis (qi stagnation and blood stasis syndrome) to varying degrees, especially to relieve the symptoms of the discomfort of the patients, improve the quality of life and the depressive state of the patients, objectively reduce the number of white blood cells in the prostatic fluid and increase the content of the lecithin body. Effective treatment of this type of chronic prostatitis.
【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】：R277.5;R249

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