王庆国教授学术思想、临床经验总结及其治疗脾胃病的用药规律研究

发布时间：2018-07-09 23:59

本文选题：王庆国 + 学术思想　；参考：《北京中医药大学》2016年博士论文

【摘要】：王庆国教授师从著名中医专家刘渡舟先生,是我国首批中医专业博士学位获得者之一。王庆国教授教学、行医40余年,临床取法仲景,善用经方,不拘时方,用药精当,对多种消化系统疾病、风湿免疫类疾病、心脑血管病以及妇科、儿科等疑难杂症均有丰富的临床经验和独到见解,疗效突出。1王庆国教授的学术思想渊源王庆国教授1969年参加工作,做过赤脚医生、卫生员,1972年进入辽宁中医学院学习,毕业后在辽河油田职工医院从事中西结合工作7年,奠定了扎实的西医临床基本功,1981年以优异成绩考入北京中医药大学,师承中医药大家刘渡舟教授,曾得任应秋、程士德、赵绍琴等名家授业；临床上随刘渡舟、王绵之、赵绍琴侍诊,得其点拨；工作后也非常注重访学各处名家,博采众长,兼收并蓄。《内经》重视阳气、关于脾胃病的纲领性治则、呕胆之说等等,张仲景创立的六经辨证和脏腑辨证体系是王庆国教授学术思想形成的根基。朱丹溪、李东垣、温病学家及张锡纯中西汇通的观点,都影响了王庆国教授学术思想的形成。在此基础之上,他全面继承了刘渡舟教授的学术思想,临床上注重抓病机、辨病与辨证相结合,在灵活使用柴胡剂、泻心剂的基础上,辨证用药方面亦有所发展,在继承和发扬刘渡舟先生学术观点的基础上,进一步提高了诊断治疗的准确性和综合性,深刻体现了其学术传承的脉络。2012年王庆国教授负责的“燕京刘氏伤寒流派”,名列国家中医药管理局公布的首批64家全国中医药学术流派传承工作室建设单位之首,为推动流派学术传承做出了很大贡献。2王庆国老中医药专家学术思想概述和合通平,重视肝脾。从对健康的总体认识和治疗疾病的总体把控上,王庆国教授认为“五脏元真通畅,人即安和”是保持健康的重要条件,“气血通畅”与“调达平衡”相辅相成,治疗时主张“通畅气血”与“调和阴阳”并重,指出和阴阳之法重在“通”与“平”,旨在恢复自然枢机之性。认为人身之中有少阳表里之枢和脾胃上下之枢,在通畅气机、调和阴阳的功能上相互协调。临证重视顾护建运脾胃,谓其为临证第一法门,强调组方药物的攻补、药味的寒温、药性的升降要平衡合度。常用柴胡汤剂和泻心剂以和少阳、运脾胃。辨病辨证,古今接轨。在临床辨治原则上,王庆国教授强调要“辨病辨证相结合”,辨病为先,辨证为主。在辨证用方时,善于举一反三,只要病机相同,即打破原有方证的应用格局,扩大经方的使用范围。老师遵照刘老“古今接轨”的思想,虽善用经方,但不薄时方,善于将经方与时方合方应用,以应对临床上错综复杂的病证,取效良多。用药尊经,广采众长。在遣方用药上,王庆国教授数十年致力于张仲景《伤寒杂病论》的研究,常以经方的加减法举例,强调仲景用药的精华所在,临证用药常宗仲景心法。此外还历时近20年编写《本草纲目精校注》,对李东垣、叶天士、张锡纯等后世医家的学术经验也多所用心,还十分注重民间效验方,遍读医书,广采众长,临证用药平和,不开贵药、蛮补药,临床取效显著。内外兼治,针药并行。在治疗手段上,王庆国教授治病时不拘泥于内服方,主张内外兼治,除内服药外,还配合外洗、外敷以及按摩等多法共施。老师早年在基层七年的西医内科大夫从医经历,不仅打下了扎实的西医临床基础,而且磨练出了一手过硬的针灸本领。对于难治性疾病单纯用药物治疗力所不逮时,常配合以针刺或灸法,收效显著。知常达变,分步治疗。在临证思维上,王庆国教授谨记《伤寒论》“观其脉证,知犯何逆,随证治之”,不仅掌握病之常态,而且熟知疾病动态转变,知守善变,不落窠臼。注重根据病情的轻重分步治疗,强调用药须中病即止,勿伤正气,特别注意病人体质,斟酌用药。对于慢性病,缓解期常予丸药调理善后。视野宽广,传承发扬。在学科发展上,王庆国教授认为发展中医要基于传统,但不能囿于传统,现代与传统并不是绝对矛盾和对立的；要善于利用现代科技的方法和手段,但又不被其束缚。强调作为中医药继承人,“临床是基础,科研是先导,教学是职责”,三者均不可偏废,唯有将三者紧密结合,才可提高理论水平,增强临床疗效,明晰机理内涵,才能更好的体悟、传承和发展中医。3王庆国老中医药专家治疗脾胃病学术思想概述四诊合参,尤重舌诊。在治疗脾胃病方面,王庆国教授尤其重视舌象。认为舌象变化对脾胃病诊治具有一定的客观性,对脾胃病的辨证用药有重要价值。舌之苔为胃气蒸脾湿上潮而生。舌作为消化系统的一部分,犹如人体外露的内脏,内脏的生理与病理变化通过望舌能客观地反映于外,是病情变化最灵敏的外象反应。舌象对脾胃病反映迅敏而准确,望舌是诊治脾胃病的重要依据。重视气机,兼调肝胆。脾胃居于中焦,是人体气机升降出入的枢纽。脾主升清,胃主降浊,脾胃阴阳相因、升降有序、协调统一才能共同完成饮食物的受纳、消化和水谷精微的吸收、输布。而肝脾“左升右降”,调节全身气机,又相互制约,因此肝胆脾胃息息相关。脾与胃燥湿相济,木能疏土则脾滞以行,肝与胃土木相关,肝主疏泄而藏血,脾主运化而生血,正常情况下,肝的疏泄功能正常,则脾胃升降适度,纳化有权,化源有继,气血轮生,肝得此而长养,更好地发挥疏泄条达作用。补泻兼施,侧重各异。脾与胃同居中焦,脏腑相关,互为表里。在病理情况下,脾胃常常同病,但各有侧重。实则阳明,虚则太阴。胃病多实、热,脾病多虚、寒。而脾胃同病者则多寒热错杂,虚实兼夹。老师根据这一病机特点,在临证用药时常补泻兼施,寒热同调,动静结合,侧重不同。临床应用半夏泻心汤时,非常注重通过调整方中辛苦药味与甘药味比例的变化,而使全方的补泻作用有所侧重。巧妙变通,活用合方。当经方难以适应临床复杂的病因病机病症时,活用合方可以起到出乎意料的效果。既可以经方与经方合方、经方与时方合方,又可以两个或两个以上的时方相合,具体则需据证灵活变通,巧妙化裁。如王庆国教授治疗慢性胃炎的常用药物常选用半夏泻心汤合百合乌药散。此二方契合本病脾胃虚弱,寒热错杂,气机不畅的病机特点,以辛开苦降,行气养阴,平调阴阳为主要治则。4基于关联规则和复杂系统熵聚类的王庆国教授治疗脾胃病的用药规律研究通过收集、整理2013年—2015年王庆国教授在北京中医药大学国医堂治疗慢性萎缩性胃炎、溃疡性结肠炎、反流性食道炎的处方,使用中医传承辅助系统软件,采用关联规则apriori算法、复杂系统熵聚类等无监督数据挖掘方法,分析处方中的药物使用频次以及药物之间的关联规则、处方规律,探讨总结王庆国教授治疗脾胃病的用药经验。研究结果发现,王庆国教授临床治疗慢性萎缩性胃炎以半夏泻心汤为主方,常配伍百合、乌药,益智仁、煅牡蛎两个药对；治疗溃疡性结肠炎的常用药物多出自柴胡桂枝干姜汤和薏苡附子败酱散,其中当归,白芍药物组合出现频次最高；治疗反流性食管炎的常用药物多出自半夏泻心汤和小柴胡汤,其中半夏与黄芩/煅牡蛎最为常用。王教授治疗三种脾胃病常用药中都含有半夏泻心汤中辛开苦降的核心药对,印证了三病均有寒热错杂的病机存在。据其常用药对及合方用药分析,慢性萎缩性胃炎多伴有胃阴虚、脾阳不足等；反流性食管炎多伴有肝郁、胆热；溃疡性结肠炎则以脾阳虚湿热重为主。综上,通过挖掘整理王庆国教授治疗三种常见脾胃系疾病的用药规律,结果体现了王庆国教授治疗脾胃病“和合通平、重视肝脾、补泻兼施、侧重各异”的学术思想,以及恢复脾升胃降气机平衡的治疗理念。此外,研究中还总结出了王教授常用的新方,如“百合乌药泻心汤”和“益仁牡蛎泻心汤”,已申请相关新药研发课题,将通过规范的基础研究,客观评价这些新方的临床疗效,并对其作用机理进行研究,系统探讨其成药性,以期将临床经验再次转化回归临床,从而提高脾胃病的临床治疗水平。本研究通过使用数据挖掘技术研究王庆国教授治疗慢性萎缩性胃炎、溃疡性结肠炎、反流性食管炎的用药规律,获得了传统的医案整理及统计学处理所不能获得的新知识、新信息,对于王教授治疗脾胃病学术思想及经验的系统梳理及传承有一定的参考价值。通过对王庆国老专家治疗脾胃系统疾病学术思想、用药规律的总结及梳理,分享其丰富的临床经验,可为后学者提供宝贵的财富,亦可为新药研发及临床转化提供有力的基础支持。
[Abstract]:Professor Wang Qingguo, Professor Liu Duzhou, a famous doctor of traditional Chinese medicine, is one of the first doctor degree doctorates in Chinese medicine. Professor Wang Qingguo has been teaching and practicing medicine for more than 40 years. Miscellaneous diseases have rich clinical experience and unique insight, the curative effect outstanding.1 professor Wang Qingguo's academic thought origin, Professor Wang Qingguo in 1969 to work, as a barefoot doctor, a hygienist, to study in Liaoning College of Traditional Chinese Medicine in 1972, after graduating in Liaohe Oilfield staff hospital for 7 years, laid a solid clinical basis for western medicine. In 1981, Ben Gong was admitted to Beijing University of Chinese Medicine with excellent results. Liu Duzhou, a Chinese medicine Professor, had been taught by Ren Yingqiu, Cheng Shide, Zhao Shaoqin and other famous families. In clinical, Liu Duzhou, Wang Mianzhi, Zhao Shaoqin had been assigned to the clinic. The basis for the formation of Professor Wang Qingguo's academic thought is the basis for the formation of Professor Wang Qingguo's academic thought by Zhang Zhongjing's syndrome differentiation and viscera syndrome differentiation, on the basis of Zhu Danxi, Li Dongyuan, febrile scientists and Zhang Xichun, which influenced the formation of academic thought of Wang Qingguo teaching. Professor Liu Duzhou's academic thought has been carried out in clinical practice, focusing on pathogenesis, disease discrimination and syndrome differentiation, on the basis of flexible use of Bupleurum and purging agent, and the development of dialectical medication. On the basis of inheriting and carrying forward Mr. Liu Duzhou's academic viewpoint, the accuracy and comprehensiveness of diagnosis and treatment are further improved, and its profound embodiment has been deeply embodied. In the context of academic inheritance, Professor Wang Qingguo was in charge of "Yanjing Liu's typhus school" in.2012. It was the first of the first 64 national traditional Chinese medicine academic schools to inherit the studio, which made a great contribution to the academic inheritance of the school of traditional Chinese medicine (.2), and made a great contribution to the academic thought of the traditional Chinese medicine experts of the Chinese traditional Chinese medicine (.2). From the overall understanding of the health and the overall control of the disease, Professor Wang Qingguo believes that "the five dirty elements are unobstructed and the man is peaceful" is an important condition for maintaining health. The "Qi and blood unobstructed" and "balance the balance" complement each other, and the treatment advocates "unobstructed Qi and blood" and "Yin and Yang", and the Yin and Yang. In order to restore the nature of the natural pivot, the law emphasizes the nature of the natural pivot. It is considered that the pivot of Shaoyang and the upper and lower pivot of the spleen and stomach are in harmony with each other in the function of unobstructing the Qi and regulating yin and Yang. In the principle of clinical differentiation, Professor Wang Qingguo emphasized that "combining disease differentiation and syndrome differentiation", identifying disease as the first and syndrome differentiation, is good at the diagnosis and syndrome differentiation, as long as the disease machine is the same, that is to break the application pattern of the original prescription and expand the meridian. The scope of use of Fang. The teacher follows the thought of Lao Liu 's "ancient and modern integration". Although it is good to use the classics, but not thin, the teacher is good at applying the combination of the warp and the time side to cope with the complicated syndrome in the clinic. It takes a lot of effect. In the use of medicine, Professor Wang Qingguo devoted himself to the research of Zhang Zhongjing's theory of typhoid and miscellaneous diseases for decades. After 20 years of writing < Compendium of Materia Medica fine school note >, the academic experience of Li Dongyuan, ye Tianshi, Zhang Xichun and other generations of physicians has also been more attentively concerned. In the treatment of medical treatment, Professor Wang Qingguo, in the treatment of medical treatment, advocated both internal and external treatment, advocated internal and external treatment, except for internal medicine, and combined external washing, external application and massage. We have laid a solid foundation for the clinical practice of Western medicine, and have honed a strong skill in acupuncture and moxibustion. For the difficult treatment of the disease, it is often accompanied by acupuncture or moxibustion, which is often combined with the acupuncture or moxibustion, and the effect is remarkable. "Not only mastering the normal condition of the disease, but also knowing the dynamic change of the disease, knowing and keeping the change, not being the same. Pay attention to the step of treatment according to the severity of the disease, emphasize that the medicine must be moderate and stop, do not hurt the positive gas, pay special attention to the patient's physique and consider the medicine. Professor Wang Qingguo believes that the development of traditional Chinese medicine should be based on tradition, but cannot be limited to tradition. Modern and traditional Chinese medicine should not be absolutely contradictory and antagonistic. We should be good at using the methods and means of modern science and technology, but are not bound by them. It is emphasized that as the heir of Chinese medicine, "clinical is the foundation, scientific research is the precursor, teaching is duty", the three are all irrelevant, Only with the close combination of the three can we improve the theoretical level, enhance the clinical efficacy and clarify the connotation of the mechanism, so as to better understand, inherit and develop the traditional Chinese medicine experts of traditional Chinese medicine (.3 Wang Qingguo) to treat the academic thought of the spleen and stomach disease, especially the tongue diagnosis. In the treatment of spleen and stomach disease, Professor Wang Qingguo attaches great importance to the tongue image. The diagnosis and treatment of spleen and stomach disease has certain objectivity, and it is of great value to the syndrome differentiation of spleen and stomach disease. The tongue coating is produced by the wet tide of the stomach qi and spleen. As part of the digestive system, the tongue is like the exposed viscera of the human body. The physiological and pathological changes of the viscera can be objectively reflected by the tongue, and the most sensitive external response to the change of the condition. As an important basis for the diagnosis of spleen and stomach disease, the tongue is an important basis for the diagnosis and treatment of the spleen and stomach disease. The liver and spleen "left rise and right drop", "left rise and right drop", regulate the whole body gas machine and restrict each other, so the liver and the spleen and stomach are closely related. The spleen and the stomach are dry and wet, the wood can thinning the soil and the spleen is stagnant, the liver and the stomach are related, the liver is dredging and the blood is hidden, the spleen is transported and the blood is produced, the liver is normal, the spleen and stomach are moderate, and the spleen and stomach are moderate, the power and source of the spleen and stomach are the source. The spleen and the stomach are cohabiting with the stomach, the spleen and the stomach are associated with the Zang Fu, and the spleen and stomach are often the same, but the spleen and stomach are often the same. In accordance with the characteristics of this disease, the teachers often make up and take diarrhea and diarrhea in the treatment of the syndrome, the cold and heat, the combination of moving and static, and the different emphasis. In order to adapt to the complicated pathogeny and pathogenesis of clinical disease, it can be unexpected effect. It can be combined with the prescription, the prescription and the time side, and two or more than two of the time, and the specific evidence is flexible and skillful. For example, the common medicine for the treatment of chronic gastritis is often used by Professor Wang Qingguo. Xiexin Decoction and Liliu Wu Yao powder. The two parties fit the weakness of the spleen and stomach of the disease, the cold and heat are mixed and the machine is not smooth, and the rule of Professor Wang Qingguo, based on the association rules and the entropy clustering of complex system, is the main rule of treating spleen and stomach disease by the association rules and the entropy clustering of complex system. The study through collecting and sorting out Wang Qing from 2013 to 2015. Chinese professor at the state medical Hall of Beijing University of Chinese Medicine is used to treat chronic atrophic gastritis, ulcerative colitis, and reflux esophagitis, using the traditional Chinese Medicine Inheritance auxiliary system software, the association rule Apriori algorithm, the entropy clustering of complex system and other unsupervised data mining methods, analyzing the frequency of drug use in the prescription and the relationship between drugs. According to the results of the study, Professor Wang Qing Guo's clinical treatment for chronic atrophic gastritis with Banxia Xiexin soup is the main recipe for the treatment of chronic atrophic gastritis, and it is often matched with two drugs, Lilium, oysters, and calcined oysters. The commonly used drugs for ulcerative colitis are mostly from Radix Bupleuri and Cinnamomum cinnamomi. The most commonly used drugs for the treatment of reflux esophagitis are mostly from Banxia Xiexin soup and small Bupleurum soup, and the most commonly used Pinellia and scutellaria and calcined oyster are the common drugs for the treatment of reflux esophagitis. Professor Wang has the core medicine for the treatment of three kinds of spleen and stomach diseases. It was confirmed that the pathogenesis of three diseases all had cold, hot and mixed diseases. According to the analysis of the commonly used drugs, the chronic atrophic gastritis was mostly accompanied by the deficiency of stomach yin and Spleen Yang, and the reflux esophagitis was accompanied by liver depression, bile heat, and ulcerative colitis with Spleen Yang deficiency and damp heat. Combined with Professor Wang Qingguo, three common kinds of treatment were found. The rule of drug use in spleen and stomach diseases shows that Professor Wang Qingguo's treatment of spleen and stomach disease and hehe Tong Ping, paying attention to liver and spleen, supplementing diarrhea and combined application, and focusing on the balance of spleen raising and stomach lowering machine, as well as the treatment concept of restoring the balance between spleen raising and stomach lowering machine, are also summarized, in addition, the new methods commonly used by Professor Wang, such as "lily purgant Decoction" and "Yi Ren", are also summarized. Oysters Xiexin soup, which has applied for research and development of new drugs, will objectively evaluate the clinical efficacy of these new parties through a standardized basic study, and study its mechanism of action and systematically explore its drug resistance in order to transform the clinical experience to the clinic again, so as to improve the clinical treatment level of the spleen and stomach disease. Research on the rules of Professor Wang Qingguo's treatment of chronic atrophic gastritis, ulcerative colitis and reflux esophagitis, and obtained new knowledge and new information that can not be obtained by traditional medical case arrangement and statistical treatment. It has some reference value for the systematic combing and inheriting of Professor Wang's academic thought and experience in the treatment of spleen and stomach disease. Through the summary and combing of the academic thought of the treatment of the disease of the spleen and stomach system by Wang Qingguo's old experts and the sharing of its rich clinical experience, it can provide valuable wealth for the post scholars, and also provide powerful basic support for the research and development of new drugs and the clinical transformation.
【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】：R249;R256.3

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