常振森主任医师学术思想总结及肾与气血相关论的临床运用

发布时间：2018-06-28 05:53

本文选题：常振森 + 学术思想　；参考：《山东中医药大学》2016年博士论文

【摘要】：常振森主任医师是山东省名中医,全国第五批老中医药专家学术经验继承工作指导教师,从医40余年,医德醇厚、学验俱丰。常老师擅用经方,尤其是《伤寒论》及《金贵要略》的方剂,思辨过程中重视先天,遵经旨“阳气者,若天与日,失其所则折寿而不彰”,重视肾中真阳之气化及肾气、肾阳的作用,强调肾对人体五脏六腑的温煦、推动、长养作用。在临床实践中不断探索、总结,并在继承的基础上寻发展、求创新,通过多年的临床实践,结合自己的感悟,形成一套自己的临证思辨特点和养生、治未病的理念,提出了肾与气血相关论。1.学术思想渊源《内经》是中医临床理论建构的奠基之作,它示人从整体角度认识人与天地相参,与日月四时相应之理,用阴阳五行之哲学概念和辩证法思想阐述中医藏象、病机、诊法、治则等内容。构筑了中医学思想体系,奠定了指导临床实践的理论基础,指导着中医的进一步发展。《伤寒论》、《金匮要略》合称《伤寒杂病论》,是继《内经》之后又一部中医巨著,“为医方之祖,而治杂病之宗也”。以六经论伤寒,系统了六经辨证,并开创了病、脉、证相结合的先河,完善了辨证体系,给学医者树立了规矩,明晰了方法。结合多年的临证及对人体生理、病理的思辨总结,常老师崇尚张景岳“重阳气”,“阳非有余,真阴不足”的思想,认同脏腑活动以命门为中心及治病“助阳为本”的思路。对常老师重视先天,补肾、调肾为本的思想及肾与气血相关论的形成有着很大的影响。郑钦安,被称为郑附子,擅用附子、干姜等热药来治疗各种重症、险症,由后人整理的《郑钦安全书》全面反映了其重阳,崇阳的观点,正是基于其“阳者,阴之主也,阳气流通,阴气无滞”等重阳理论的大量论述,结合对肾、肾命、气、血各自生理功能及病理变化的深刻认识,最终形成了常老师的学术思想----肾与气血相关论。肾所藏之精归化,化生阴阳二气,即元阴元阳,故张景岳云“人之盛衰皆本于肾”。肾中阳气通过三焦布敷,总领五脏六腑、营卫经络、内外上下左右之气,肾气充足,阳气旺盛,则生机活跃,阴平阳秘,精神乃治。气血由肾精化生,由肾之施泄方可充塞周身流布不已,维持人之正常生命活动。2.学术思想及临床经验总结2.1学术思想总结常老师注重读经典,用经典,强调经方至重,牢固树立辩证施治,只有很好向经典的学习,深悟其精髓,并用之于临床,多临证,重实践,才能谈创新,才更好的创新,否则创新就会成为无源之水,无根之木。在学习及临床思辨的过程中,常老师注重天人合一,崇尚整体观念,“天地合气命之曰人”,人为自然之子,人在漫长的进化、生长过程中,不仅适应了自然,而且形成了自然对其影响的许多象态。我们应该熟习古代朴素的思维观,在诊疗思辨过程中,从天道推及人道,运用天地阴阳气化之理论探讨脏腑及精气血生理、病理之变化规律,从中感悟治病之理。把人体的五脏六腑,气血阴阳,四肢百骸有机的联系起来看问题,并形成其完整的诊病、治病及养生的理论体系,临证治疗时强调辨证施治重气化,治病求本,力求和合;重视气血阴阳,以平为期;标本相移,不执于一端,灵活应变,从正邪标本、因变标本、先后标本、缓急标本、表里标本、上下标本六方面来抓疾病的主要矛盾,并把明体、识病、辨证有机融合,提高了辩证施治的准确性。常老师整个思辨过程中始终围绕着重视先天的思想,强调治未病,养肾以健五脏,未病时注重养肾、固肾、强肾,已病则强调补肾、调肾、温肾。重化,求和的提出,更是明晰了中医养病的根本思想。2.2临床经验及验案论述常老师强调学习经典,用经方,重视补肾,调肾、养肾,使用频率较高的补肾气经方主要为肾气丸,并广泛应用于内外妇儿。在长期的临床实践中,形成了自己的用药特色——补肾药对。并选取了喘证、慢性泄泻、ve瘕病等方面的典型病案,从其对病因病机的认识、治疗特色方面加以论述、总结,阐明老师的“肾与气血相关论学说”这一学术观点,进一步牢固树立以肾为中心的五脏观。常老师认为肾藏精,为先天之本,内寄元阳、元阴;肾气、肾阳是肾的气化功能外在表现。对人体气血的运行及五脏六腑功能的正常发挥起着推动、温煦、营养的作用。如果肾气、肾阳功能低下,则其推动、温煦、营养的功能失于正常,推动无力,气血运行不畅而成瘀;其次温煦失司,虚寒内生,致经脉拘急,血运迟滞而成瘀;第三、肾气虚不能温煦脾阳,致运化水湿功能减退,聚湿成痰,阻于脏腑脉络,胶着难除,与血相搏,结久而致痰瘀互结;第四、肾气虚弱,化生气血的能力低下,气血亏虚不能充盈五脏六腑,抵御外邪能力下降,“至虚之处,便是留邪之所”,邪气易于入侵,而与内在已虚的气血胶结致病。肾虚可致血瘀痰阻,这些病理产物阻滞气机运行而胶着,又可加重肾虚,相互为因,形成肾虚血瘀、肾虚痰阻、肾虚痰瘀互结之病机。在治疗上,治病必求于本,常老师从重视肾的气化功能出发,强调肾气、肾阳对全身的温煦、推动、激发作用,并由此提出温肾以灌四旁的治疗大法,以肾气丸为主方生少火,温肾气治本,并随症加减以治标,验之于临床。3温肾通脉汤治疗肾虚血瘀型稳定型心绞痛的临床观察目的观察常振森主任医师自拟方温肾通脉汤治疗肾虚血瘀型稳定型心绞痛的临床疗效,验证温肾通脉法治疗该病的临床特色经验,进一步深化常老师学术观点——肾与气血相关论。方法选择60例稳定型心绞痛且辨证为肾虚血瘀型的患者60例,随机分为试验组和对照组各30例。对照组给予阿司匹林肠溶片、他汀类、硝酸酯类、?受体阻滞剂作为基础治疗;试验组:在上述治疗基础上加用温肾通脉汤,疗程4周,治疗前后记录临床症状。结果试验组患者心悸、倦怠乏力,腰膝酸软等气阳虚的症状,得到了明显的改善,症状的改善、心电图及硝酸甘油的停减率与对照组相比统计学有差异(P0.05)。结论西药治疗配合温肾通脉汤对肾虚血瘀型稳定型心绞痛临床症状的改善疗效较好,减少了硝酸甘油使用,提高了患者的生存质量。
[Abstract]:Mr. Chang Zong, the chief physician of Shandong Province, is the teacher of the fifth batch of Chinese traditional Chinese medicine experts' academic experience. After 40 years of medical treatment, the medical ethics is rich and rich. We should pay more attention to the gasification and kidney qi of true Yang in the kidney, the role of kidney yang, the role of kidney yang, and emphasize the warmth, promotion and long nourishing of the kidney to the organs of the human body. In the clinical practice, we continue to explore and summarize, and seek the development and innovation on the basis of inheritance. Characteristics and health care, the idea of treating the disease without disease, put forward the.1. academic thought origin of kidney and Qi blood correlation theory, "inner classics >" is the foundation of the construction of clinical theory of traditional Chinese medicine. It shows people to understand the relationship between man and the world, and the corresponding principle of day four from the whole point of view. The philosophical concept and dialectics of the five lines of yin and yang are used to explain the traditional Chinese medicine, the pathogenesis, the diagnosis, the treatment and the treatment. It has established the ideological system of traditional Chinese medicine, established the theoretical basis for guiding clinical practice, guiding the further development of traditional Chinese medicine. It has created a combination of disease, pulse, and syndrome, perfected the system of syndrome differentiation, set up the rules and clear methods for the medical practitioners. Combined with years of evidence and the dialectical summary of human physiology and pathology, teachers often advocate Zhang Jingyue's "heavy Yang Qi", "Yang is not more than, the true Yin is ineffective", and the viscera activities are centered on the fate of the viscera and the cure "to cure the disease". It has a great influence on the formation of the idea that teachers attach importance to birth, kidney and kidney, and the formation of the theory of kidney and Qi and blood. Zheng Qinan, known as Zheng Kun Zi, is used to treat all kinds of severe and dangerous diseases with Kun Zi, dry ginger and other pyretic drugs. Based on the profound understanding of the theory of "Yang, Yin main, yang qi circulation, Yin Qi and no stagnation", a profound understanding of the physiological functions and pathological changes of kidney, kidney life, Qi and blood, and finally formed a teacher's academic thought - kidney and Qi and blood related theory. Jing Yueyun "the prosperity and decline of human beings are all in the kidney". The Yang Qi in the kidney is applied by the three jiao cloth, the chief of the five viscera and the inner and the six organs, the inner and outer meridians, the inside and outside, the kidney qi, the Yang Qi, the vitality active, the Yin and the sun, the spirit and the treatment. The Qi and blood are refined by the kidney, and the body of the kidney can fill the body and keep the normal life activities of the human being.2.. Summary of academic thought and clinical experience summary 2.1 academic thought summary, Teacher Chang is paying attention to reading classics, using classics, emphasizing Confucian classics to heavy, firmly establishing dialectical treatment, only learning from the classics well, deeply understanding its essence, using it in clinical, more syndromes and practice, can we talk about innovation and make better innovation, otherwise innovation will become passive water without root. In the process of learning and clinical thinking, teachers often pay attention to the unity of heaven and man, advocate the idea of the whole, "the man of heaven and earth say", the son of nature, the long evolution, the growth process, not only adapts nature, but also forms a lot of phenomena of nature to its influence. In the course of treatment and differentiation, from the heaven and the road to humanitarianism, the theory of Qi and Yin and the Qi and Yang gasification is used to explore the physiology of the viscera and the blood, the law of pathological changes and the understanding of the principle of cure. In the treatment, the treatment of syndrome differentiation and treatment is emphasized, the treatment of the disease and the combination, and the emphasis on the Qi and blood Yin and Yang, and the level of the specimen, the specimen, the specimen, the specimen, the upper and lower specimens, six aspects of the main contradictions of the disease, and the organic fusion of the clear body, the disease recognition and the syndrome differentiation, and the improvement of the syndrome. In the whole process of thinking, Mr. Chang has always attached importance to the idea of innate character, emphasizing the treatment of the disease, nourishing the kidney to healthy five zang organs, paying attention to the kidney, fixing the kidney, and strengthening the kidney in the absence of disease, and emphasizing the kidney, kidney, temperature and kidney. Mr. Chang emphasizes learning classics, using the classics, paying attention to tonifying the kidney, regulating the kidney and nourishing the kidney, and using the kidney qi pill, which has a high frequency of kidney qi, and widely used in the internal and external women. In the long-term clinical practice, it has formed its own characteristics of the medicine - the tonifying kidney medicine, and selected the typical cases of asthma, chronic diarrhea, ve disease and so on. The understanding of etiology and pathogenesis, the characteristics of treatment, summarized and clarified the academic viewpoint of the teacher's "kidney and Qi and blood correlation theory", and further firmly establish the kidney centered five zang viscera. Often teachers think that kidney essence is a congenital basis, Yuanyang, Yuan Yin, kidney qi and kidney yang are the external manifestations of kidney gasification. The operation of blood and the function of the organs of the five viscera play a promotion, warm and nutritious function. If the kidney qi and kidney yang function are low, the function of the kidney and kidney yang is low, the function of the nourishment is lost to the normal, the weakness of the blood and blood circulation and the stagnation of Qi and blood; secondly, the warm loss of the Secretary, the deficiency cold endogenetic, the blood stasis and blood stasis; third, the deficiency of kidney qi can't be found. The warm Spleen Yang, causing the dehumidifier of the water humidifier, accumulating dampness and phlegm, hinder the viscera choroid, the glue is difficult to be removed from the viscera, with the blood phase, and the stagnation of phlegm and blood stasis. Fourth, the kidney qi is weak, the capacity of the Qi and blood is low, the deficiency of Qi and blood can not fill the five viscera, and the ability to resist the evil is the place of evil, and the evil is easy to invade and invade. And evil is easy to invade and invade. The kidney deficiency can cause blood stasis and blood stasis. The kidney deficiency can cause blood stasis and phlegm obstruction, these pathological products block the gas machine running and glue, and can aggravate kidney deficiency and mutual cause, form kidney deficiency and blood stasis, kidney deficiency phlegm resistance, kidney deficiency and phlegm stasis. Body warm, promoting, stimulating effect, and thus put forward the treatment of warm kidney by the four sides of the treatment of the great law, kidney qi pills mainly to produce less fire, warm kidney qi, and reduce with the symptoms, clinical observation of the clinical.3 Wenshen Tongmai soup treatment of kidney deficiency and blood stasis type of stable angina pectoris The clinical curative effect of treating the kidney asthenia and blood stasis type of stable angina pectoris, verifying the clinical characteristic experience of the treatment of the disease by the method of warm kidney and kidney circulation, and further deepening the academic viewpoint of normal teachers - the correlation of kidney and Qi and blood. Methods 60 patients with stable angina pectoris and 60 cases of kidney deficiency and blood stasis type were selected and randomly divided into the experimental group and the control group, 30 cases each. The group was treated with Aspirin Enteric-coated Tablets, statins, nitrates, and receptor blockers as the basic treatment. The experimental group was treated with warm kidney Tongmai soup on the basis of the above treatment, and the clinical symptoms were recorded before and after treatment. Results the symptoms of palpitation, fatigue and weakness of the waist and knees were observed in the experimental group, and the improvement of the symptoms was obviously improved and the symptoms were improved. The reduction rate of electrocardiogram and nitroglycerin was different from that of the control group (P0.05). Conclusion the therapeutic effect of Western medicine and Wenshen Tongmai Decoction on the clinical symptoms of stable angina pectoris of kidney deficiency and blood stasis type is better, and the use of nitroglycerin is reduced, and the quality of life of the patients is improved.
【学位授予单位】：山东中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249

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