脓耳辨证论治的古今文献研究

发布时间：2018-06-24 06:24

本文选题：脓耳 + 古今文献研究　；参考：《云南中医学院》2017年硕士论文

【摘要】：研究目的:课题主要对脓耳的辨证论治规律进行研究,通过对古代和现代文献的查阅和研究,对资料的整理和分析,总结古代和现代医家对脓耳的辨证论治等方面的规律,提出治疗脓耳的辨证论治之法,希望对现代医学研究和临床治疗脓耳提供参考。研究方法:本课题通过各种检索方式,确定入选文献,并对文献整理总结后,通过对比分析,对治疗脓耳的证治规律及用药进行比较,确定古今治疗脓耳的异同点,并提出个人观点,以供参考。研究对象来源:古文献主要查阅各年代医家著作,查找记录与脓耳有关文献并精读总结,确定入选文献。现代文献主要选取自1990年至2016年在国内学术期刊中公开发表的与治疗脓耳相关的中医及中西医文献。文献纳入标准:文章内容与脓耳治疗有关。文章发表单位属于国家新闻出版署正规法定刊物,时间为1990年到2016年间。患者明确诊断为脓耳,文章所报道病例数不少于10例。辨证分型治疗明确者优先。方药纳入标准:为中药或中西医结合用药。方药有明确药物组成,治疗效果获得认可。外治、内服药物均可入选。方药排除标准:只有西药治疗。方剂组成不明确。数据库的建立:使用Excel软件建立研究数据库。其内容主要包括:病因病机、治法、方药等。使用Excel软件,对所要研究的内容进行分析,得出结果。研究结果:(1)纳入研究文献:古代文献共从45部医家著作中查找到52卷与脓耳病因病机或治疗用药有关内容。现代文献通过维普、知网等数据库检索,共检索与脓耳有关文献430篇,再进行高级检索关键字“化脓性中耳炎”“中医”、“脓耳”等,对每篇文献进行细读总结后,排除不符合研究标准文献,共筛选出符合条件文献61篇。(2)病因病机学分析:古代文献中,论述脓耳与脏腑之关系,主要可分为:与肾相关:共23篇,其中肾气热结12篇,肾气虚7篇,肾阴虚4篇。与肝相关:共11篇,肝胆火盛8篇,肝风妄动3篇。与心相关:共7篇,心火亢盛1篇,风热邪毒随心经上壅6篇。与脾相关:共4篇,脾虚胃湿4篇。与肺相关:共1篇,肺气虚1篇。现代61篇文献主要从肺、肝、脾、肾四脏论治。主要可分为:与肺相关:共36篇,肺经风热36篇。与肝相关:共35篇,肝胆火盛26篇,风热外侵随肝经上犯耳窍9篇。与肾相关:共21篇,肾元亏损21篇。与脾相关:共27篇,脾胃虚弱27篇。(3)辨证论治分析古代医家主要将脓耳分为六种证型:肾气热结证、肝胆火盛证、肾元亏损证、风热外侵证、脾虚胃湿证、肝风妄动证。现代医家主要将脓耳分为四种证型:风热外侵证、脾胃虚弱证、肝胆火盛证次、肾元亏损证。(4)用药分析:古代外用药以解毒杀虫燥湿止痒药(矾石统一用白矾代替)、开窍药(麝香、冰片)、拔毒化腐生肌药(铅粉、轻粉)、活血化瘀药(干胭脂)为主。古代内服药用药以清热药(地黄、栀子、黄芩、赤芍、牡丹皮、连翘、野菊花、天花粉、玄参)、解表药(柴胡、防风、升麻、蔓荆子、荆芥、牛蒡子)、补气药(甘草、人参、山药、黄芪)、利水渗湿药(茯苓、木通、泽泻、车前子)为主。现代外用药出现频率最高的分别是清热药(黄连、黄柏、苦参、黄芩)、开窍药(冰片、麝香)、解毒杀虫燥湿止痒药(白矾)。现代内服药出现频率较高的为清热药(金银花、蒲公英、黄芩、黄柏、野菊花、玄参、连翘)、补气药(甘草、黄芪、白术、党参、山药)、利水渗湿药(茯苓、薏苡仁、泽泻、车前子)、解表药(白芷、柴胡、防风、升麻)。讨论:通过学习总结与脓耳相关的古今文献,本文对脓耳的病因病机、辨证思路、辨证论治等提出了讨论意见。本人认为脓耳的辨证治疗与外科学治疗疮疡之法有异曲同工之妙。可将脓耳的发病分为前、中、后三期,前期采用“消”法,中期采用“托”法,后期采用“补”法,此三法灵活运用于每一期的治疗当中。前期的主要证型有肺经风热证、少阳风热证、肝胆火盛证;中期的主要证型为脾虚湿滞证;后期的主要证型有肾阴亏虚证、肾阳亏虚证。
[Abstract]:The purpose of this study is to study the rule of syndrome differentiation and treatment of the pus. Through the consultation and study of the ancient and modern literature, the paper collated and analyzed the data, summed up the laws of the ancient and modern doctors on the syndrome differentiation and treatment of the pus, and put forward the method of treatment for the treatment of the pus, hoping to study the modern medical research and clinical treatment. To provide reference for pus. Research methods: the subject through a variety of retrieval methods to determine the selected literature, and after a summary of the literature, through comparative analysis, comparison and analysis of the treatment of pus and ear of the rule and use of drugs to determine the similarities and differences between ancient and modern treatment of pus, and put forward a personal point of view for reference. Age medical works, search for records and purulent ear related literature and read summary, to determine the selected literature. Modern literature mainly selected from 1990 to 2016 published in domestic academic journals related to the treatment of pus related Chinese medicine and traditional Chinese and Western medicine. The literature included the standard: the article is related to the suppurative ear treatment. The article published in the country belongs to the country. The regular and statutory publication of the home press and publication department was from 1990 to 2016. Patients were clearly diagnosed as pus, and the number of cases reported in this article was not less than 10. Only western medicine exclusion criteria: only western medicine treatment. The composition of the prescription is not clear. The establishment of the database: the use of Excel software to establish the research database. Its main contents include: etiology, pathogenesis, treatment, prescription and so on. Use Excel software to analyze the contents of the research and get the results: (1) the research literature: ancient literature from 4 Of the 5 medical works, 52 volumes were found to be related to the pathogenesis or treatment of the pyogenic ear disease. The modern literature retrieved 430 articles related to the pyogenic ear, and then the advanced retrieval keyword "suppurative otitis media", "purulent otitis", "pus ear" and so on. According to the standard literature of the study, a total of 61 eligible documents were selected. (2) etiological and pathogenesis analysis: in ancient literature, the relationship between the purulent ear and the viscera was discussed. It was mainly divided into 23 articles, including 23 articles, 12 of the kidney qi heat, 7 of kidney Qi, 4 in the kidney yin deficiency, 11, 8 of the liver and gallbladder, 3 in the liver wind, and 3 with the liver wind. 7 articles were related to the heart: 7 articles related to heart: 7 pieces of heart related There are 1 pieces of hyperactivity of heart fire and 6 pieces of wind and fever with the heart meridian obstruction. A total of 4 articles and 4 spleen asthenia stomach dampness. 1 articles and 1 lung qi deficiency are related to the lung. The 61 modern literature mainly consists of lung, liver, spleen and four kidney. It can be divided into 36 articles, 36 articles of the lung and heat, 36 articles with the liver: altogether 35, liver and gallbladder fire 26, the wind and heat transgression along the liver 9 articles of the kidneys. Related to the kidney: a total of 21 articles, kidney element loss 21. 27 articles and 27 spleen and stomach weakness. (3) syndrome differentiation and treatment analysis of ancient doctors divided the ear into six types of syndrome: Kidney Qi heat syndrome, liver and gallbladder fire syndrome, kidney element loss syndrome, wind heat invasion syndrome, spleen deficiency stomach damp syndrome, liver wind disregard syndrome. Modern doctors mainly divide the pus into four kinds of syndromes. Type: wind heat external invasion syndrome, spleen and stomach weakness syndrome, liver and gallbladder fire syndrome, kidney element loss syndrome. (4) ancient external use medicine to detoxify and kill the worm and relieve itching medicine (alum instead of alum), open the orifices (musk, borneol), extract poisonous saprophytic muscle drugs (lead powder, light powder), promote blood circulation and remove stasis medicine (dry Rouge). Gardenia, Radix Scutellariae, Radix Paeoniae, peony skin, forsythia forsythia, wild chrysanthemum, trichosanthin, Radix scabra and Radix Sophorae and Radix Sophorae (Radix scabra). It is the most important medicine (Rhizoma Coptidis, cypress, Radix Sophorae, Radix Astragalus), and the highest frequency of modern external use medicine (Rhizoma Coptidis, phellodendron, Radix Sophorae, Radix Sophorae), and the highest frequency of modern external use medicine (Huanglian, cypress, Sophora flavescens, yellow, yellow). Baicalin), Kaiqiao (borneol, musk), detoxification and dampness antipruritic antipruritic medicine (Bai Fan). Modern internal medicine has a high frequency of antipyretic drugs (honeysuckle, dandelion, Scutellaria, cypress, chrysanthemum, forsythia), gas supplement (licorice, astragalus, Atractylodes, Radix Codonopsis, yam), Li Shui osmotic drugs (Poria cocos, coix seed, Alisma, car), antipyretic drugs (Radix Angelicae dahuricae, Radix Bupleuri, prevention and control) Discussion: through learning to summarize the ancient and modern literature related to the pyogenic ear, this article puts forward some suggestions on the etiology, pathogenesis, syndrome differentiation and syndrome differentiation of pyogenic ear. I think that the dialectical treatment of pyogenic ear and the surgical treatment of sores are the same. It can be divided into the first, middle, three stages, and the early use of "elimination". "The" method "in the middle period adopts the" support "method and the later" supplement "method. The three methods are used flexibly in each period of treatment. The main syndrome types in the early stage are lung and meridian wind heat syndrome, Shaoyang wind and heat syndrome, liver and Gallbladder Heat Syndrome; the main syndrome type is spleen deficiency dampness stagnation syndrome in the middle period; the main syndrome types in the later period are kidney yin deficiency deficiency syndrome and kidney yang deficiency deficiency syndrome.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R276.1

【参考文献】