李玉玲教授学术思想及治疗多囊卵巢综合征临床经验整理

发布时间：2018-07-04 11:49

  本文选题：李玉玲教授 + 学术思想　； 参考：《广州中医药大学》2016年博士论文

【摘要】：导师李玉玲,教授,主任医师,博士生导师,现任海南省人民医院中医科主任。1957年出生于青海西宁,1982年毕业于青海医学院中医系,1988年毕业于同济医科大学中西医结合专业,获硕士学位。2004年入选第一批国家临床优秀人才培训项目,学习期间师从广州中医药大学著名中医妇科专家罗颂平教授,2007年获“国家优秀临床人才”称号,2012年被评为第五批全国老中医药专家学术经验继承工作指导老师。一直从事中医的临床、教学、科研工作,对妇科及内科疾病的诊治积累了非常丰富的经验,尤其对多囊卵巢综合征的诊治方面有独特的体会,总结如下：李老师学术思想和临床经验：1.学术思想：①博采他学,善于创新：李老师强调读经典和做临床,要勤于思考,敢于突破,推陈出新；②注重整体观念,强调辨证施治：整体观念和辨证论治,是中医学之精髓。在妇女疾病的病机演变、疾病诊断,以及防、治、养三者有机结合等方面,要注重整体观念,并强调辨证施治；③重视顾护阳气：现代人多阳气不足,且阳气易伤难复。老师推崇仲景学说,重视阳气亏虚,临证治疗的时候主张温阳扶阳助阳；④主张扶正固本：在疾病的论治过程中,对一些慢性疾病反复发作者,老师重视患者自身体质的调养,强调扶助机体的正气,注重人体的自我修复、自我适应、自我协调、自我抗病的能力；⑤主张中西医结合,能中不西：中医与西医都是研究人类疾病与健康的医学。中医要在继承传统的基础上有所发展,要善于吸收西医学优秀的研究成果。2.临证用药特点：①一药多用：中药的功效是多靶向的,要辨证选用,合理配伍；②变反为正：老师指出掌握药物的毒副作用,通过不同配伍,要善于把副作用变为正作用,利用矛盾,使其相反相成,变废为宝；③寒温同用：临床杂病多以寒热错杂为主,老师结合其多年的临证经验,遣方用药主张寒热并用,以获良效；④补泻兼施：老师指出,临证中少见纯虚纯实之体,故临床用药多补泻兼施。病虚者当扶正为主,但应补中有消。病实者当以攻为主,但应攻中有守;⑤用药精炼：老师喜用小方单药,用药主张少而精,包括药量和药味,反对杂乱无章；⑥善用药对：中药药对既可以协同增强疗效,使用时又具有一定的独立性,在复杂的病情变化中,还可多味药合用；⑦因时制宜：妇科临证,对于不同年龄期间的女科病,结合妇女的生理特点,根据因时制宜的原则,分别从肾、肝、脾论治；⑧结合中药现代药理研究用药：老师喜欢在辨病辨证的基础上,结合中药的现代药理研究用药,达到药半功倍的效果。3.治疗女科经验：①疏肝养肝：疏肝之法不仅靠药物,还要善于运用心理治疗。养肝多配合运用行气药；②滋肾补肾：老师重视肾的阴阳平衡和转化,提出滋肾补肾之品多质重味厚,切忌单用厚味壅补之品；③健脾和胃：脾胃为气血生化之源,“内伤脾胃,百病由生”,老师认为妇科疾病的发生与脾胃关系亦非常密切；④调理气血：调理气血之目的,务必使气血调和,气行血旺,冲任通盛；⑤宣通肺气：肺主治节,胞宫所需的一切精微物质,是由肺气转输和调节的,故治疗时要注意宣通肺气；⑥海南湿热,顾阳护阴：湿热为患,湿伤阳,热伤阴,疾病发展过程中又有伤阴和伤阳的不同转归,故临证治疗时需要注意顾护阴津和阳气。临床研究：目的：在整理、继承老师的学术经验和技术专长的基础上,观察李老师运用开郁化痰法治疗PCOS的临床疗效,探讨其可能作用机制,传承和发展老中医的临床经验。方法：临床将56例PCOS患者随机分为治疗组29例和对照组27例,分别给予自拟开郁化痰方并配合月经周期治疗和达英—35治疗。通过观察治疗前后对月经及中医证候的改善情况,体重指数和内分泌六项治疗前后的变化,初步探讨李玉玲教授开郁化痰法对痰郁互结型多囊卵巢综合征的作用机理。结果：治疗组愈显率37.9%,有效率96.6%,对照组愈显率18.5%,有效率70.4%,治疗组愈显率和有效率与对照组比较,差异有统计学意义；BMI治疗前后组内自身比较方面,两组均有统计学差异,治疗后两组间比较,差异无统计学意义；两组患者在治疗后月经周期均较前有了显著改善,但对治疗后两组患者的月经周期进行比较发现,差异均无统计学意义；两组患者中医证候评分与治疗前比较,差异均有统计学意义,治疗后两组间比较,差异有统计学意义；治疗后两组LH、LH/FSH和T均明显下降,两组内自身比较差异有显著性,治疗后两组间比较,无统计学差异;两组FSH、PRL和E2均进行前后自身比较及组间比较,均无统计学差异。讨论：老师治疗多囊卵巢综合征的经验：①病因病机的认识：临床诊疗PCOS,可结合现代先进的检测技术、方法,查清病因,辨病和辨证相结合。老师结合其多年临证经验认为PCOS的形成主要责之于肝、脾、肾功能失调,痰浊气郁,瘀血阻滞,致肾一天癸-冲任-胞宫之间相互调节失衡而致。并结合海南的地域特点和气候特点,指出当地患者以痰郁互结为最常见证型。②治疗的认识：老师对多囊卵巢综合征的治疗注重调经、怡情,重视整体调节,治疗时多从“痰”、“郁”论治,自拟开郁化痰方配合中药人工周期法治疗。③治养结合：饮食不节、缺乏锻炼是PCOS常见原因,故强调患者生活方式的调节和改变,认为治养结合,才能达到药半功倍的效果。本课题说明运用开郁化痰法治疗PCOS,在调节患者的月经周期和改善中医临床证候方面均有效,并且在总疗效和中医证候评分比较上优于对照组,能降低患者的体重指数和血LH、LH/FSH和T的水平,说明李玉玲教授开郁化痰法能从整体上改善PCOS患者的临床疗效。
[Abstract]:Professor Li Yiling , professor , chief physician , doctor of doctor of doctor , current Hainan Provincial People ' s Hospital of Chinese Medicine Department . In 1957 , he was born in Qinghai Medical College . He graduated from TCM department of Qinghai Medical College in 1982 . He graduated from the Medical University of Qinghai Medical College in 1988 . He has been awarded Master ' s degree in clinical , teaching and scientific research .
( 2 ) Pay attention to the whole concept , emphasize the treatment of syndrome differentiation : the whole idea and the differentiation and treatment , it is the essence of Chinese medicine . In the aspects of the pathogenesis of women ' s disease , the diagnosis of diseases , and the combination of prevention , treatment and culture , we should pay attention to the whole concept and emphasize the treatment of syndrome differentiation ;
Attention should be paid to protecting yang qi : the modern people are more yang - qi deficient , and the yang qi is easy to hurt and difficult to recover . Teachers praise Zhongjing theory , pay attention to yang qi deficiency and deficiency of yang qi , and advocate warming yang to support yang ;
In the course of treating the disease , the author pays attention to the adjustment of the constitution of the patient , emphasizes the healthy qi of the body , pays attention to the self - healing , self - adaptation , self - coordination and self - resistance of the human body ;
The traditional Chinese medicine and western medicine are the medicine for the study of human diseases and health . Traditional Chinese medicine should develop on the basis of inheriting tradition and be good at absorbing the excellent research results of western medicine .
( 2 ) Positive : The teacher pointed out that the toxic side effect of the medicine was mastered , and the side effect was changed into positive effect by different compatibility , and the contradiction was used to make it turn into treasure ;
( 3 ) Cold temperature is the same as that of common use : the clinical complex disease is mainly caused by cold and heat , and the teacher combines the experience of many years of clinical syndrome and the prescription drugs advocate the cold and heat use , so as to obtain good effect ;
( 4 ) tonifying and reducing the diarrhea : the teacher pointed out that there are few pure and solid bodies in the syndrome , so the clinical use is multi - tonifying and diarrhea . When the disease is the main body , the deficiency of the disease should be eliminated . When the disease is the main body , but it should be kept in the attack ; and 5 ) the drug is refined : the teacher likes to use the small prescription alone , and the medicine is advocated to be less refined , including the medicine amount and the medicinal taste , and the medicine is opposed to the miscellaneous .
( 6 ) good medicine pair : the traditional Chinese medicine medicine has certain independence when being used for enhancing the curative effect and the use , and can also be combined with the multi - taste medicine in the complicated condition change ;
( 7 ) According to the local conditions , women ' s disease in different ages , combined with the physiological characteristics of women , is treated according to the principle of local conditions , from kidney , liver and spleen , respectively ;
( 8 ) Combined with the modern pharmacological research of traditional Chinese medicine : the teacher likes to use the modern pharmacology of Chinese medicine to study the effect of half - work time . 3 . Treatment of female family experience : 鈶，

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