胡国俊教授诊治郁证学术思想与经验总结及临床研究
发布时间：2018-07-28 07:33
【摘要】：祖国医学通过辨证论治,在郁证治疗方面有自己的特色和优势。胡国俊教授从医五十余年,在治疗郁证方面积累了丰富的临床经验。本研究拟通过文献研究和理论研究的方式,对胡国俊教授诊治郁证的学术思想进行溯源,进一步深入研究,提炼出对临床工作具有指导意义的学术思想；通过跟师学习、授课等形式,总结出胡国俊教授治疗郁证的临床经验；并随机选取气虚血瘀型卒中后抑郁患者112例,运用益气活血解郁汤化裁与氟西汀进行对照研究,比较两者的临床疗效,检验跟师成果。本研究分为三个部分。第一部分胡国俊学术思想渊源胡国俊教授出身中医世家,其父胡翘武为新安医学流派传承人。通过仔细拜阅胡国俊教授的著作、文章,跟师学习以及与胡国俊教授的朝夕交流,总结出胡国俊教授学术思想源于《内经》,秉承于新安医学流派。第二部分胡国俊诊治郁证学术思想和临床经验的整理与研究胡国俊教授在郁证的诊治过程中非常重视脏腑辨证,认为气机郁滞是郁证早期的主要机因；气滞痰结,气郁化火为病情进一步进展；郁证后期多表现为虚证,茹阴虚血亏。1.总结出胡国俊教授诊治郁证“郁证调气,必先疏肝”,“郁证实多虚少”“治疗以理气为主,顾护阴液”的学术思想。(1)郁证调气,必先疏肝：胡国俊教授认为肝为木脏主疏泄,性喜畅达,最恶抑郁。木郁则生机萎顿,肝郁则失于疏泄,凡情志不遂,肝者最易郁滞,则疏泄不及,气逆厥阴经络。此外,肝气具有直接调畅情志的作用,气机条畅,气血和调则心情开朗。(2)郁证实多虚少：郁证病机是随着病程的发展而不断变化的,以实证多见。气机郁滞为郁证早期的主要机因；气机疏解不利,则进一步导致气滞痰结,气滞血郁,气郁化火。此阶段主要病理因素为“气”、“火”、“痰”、“血”；病程后期多表现为虚证,如阴虚血亏、心脾两虚。(3)治疗以理气为主,顾护阴液：胡国俊教授认为,顾护阴液的思想应贯穿于郁证治疗的全过程。郁证早期,以气机郁滞为主,此阶段宜采用疏理气机,行气解郁之品,但不宜长久运用,以免耗津伤液,以变他病。针对气郁化火、痰结之候,在清热泻火,化痰散结的同时,应适当佐以养阴生津之品,以顾护阴液。火热之邪进一步加剧,灼津耗液,加之治疗郁证病程中多有运用芳香理气,燥烈之品,郁证病程后期无不具有阴液暗耗之候,此时期,应以养阴生津治其本虚为当务之急,忌用理气解郁等芳香燥烈之品。2.此外,还总结出了胡国俊教授治疗围绝经期抑郁,睡眠障碍,癔症,奔豚等临床经验。(1)围绝经期抑郁：胡国俊教授认为围绝经期抑郁患者通常表现为两大症候群,一类以烦躁不安,焦虑紧张,情绪不宁为主要症候；一类以忧郁,情绪低落,不善言语为主。虽表现出两类不同的症候群,但其发病机制均为气机郁滞,然气机郁滞亦各有不同。烦躁不安,焦虑紧张多由于肝气不舒所致,其病位在肝,当从肝治,应予疏肝解郁法；围绝经期表现出来的忧郁,情绪低落表现当与肺脏相关,其病位在肺,当从肺治,应予开降肺气之法。(2)郁而失眠论治：胡国俊教授认为郁证本身是一种情志疾病,同时也是引起失眠的一个病因。失眠与郁证发病有着共同的病理机制。随着社会的不断发展与进步,现代人们的学习、工作节奏越来越快；生活、精神压力不断增加,由此引发的情绪不宁,心情怫郁等郁证引起的失眠也越来越多,从郁治失眠,郁解而寐安,是治病求本的体现,也是对失眠辨证论治方法的一种补充。(3)癔症治疗经验：胡师认为,虽然癔症的临床表现形式繁杂,但情志不遂或精神刺激为其主要机因。癔症时久,亦可变生他病,最多见的为喘促过度以致阳虚气脱；汗泪俱下以致阴液不足。治疗的原则以心理疏导为主,辅以药物治疗。(4)降敛冲气治疗奔豚：胡国俊教授认为,奔豚之症状,可表现于各种疾病当中,其关键机因为“气逆里急”,与肝肺肾三脏关系密切。对于奔豚的治疗,在治本脏不应时,应投降敛冲气之法,或可收立竿见影之效。3.通过对208例郁证患者病案的整理以及中药使用频次的数据挖掘,整理出郁证的10种辨证分型,包括肝气郁结型、气郁化火型、肝火犯胃型、气滞血郁型、痰气郁结型、肺失宣肃型、阴虚血亏型、心脾两虚型、肝肾阴虚型、脾虚气滞型。处方中使用中药共计213种,其中使用超过100次的有13味,包括柴胡、枳壳、郁金、生龙骨、生牡蛎、茯神、半夏、远志、黄芪、夜交藤、酸枣仁、白术、黄芩；使用次数在40-100次之间的有24味,包括太子参、焦山栀、炙甘草、黄连、白芍、知母、薏苡仁、桂枝、桔梗、柏子仁、甘草、旱莲草、玄参、茯苓、旋复花、龟板、苍术、珍珠母、生地、香附、葛根、瓜蒌皮、琥珀、合欢皮、川贝母；使用比例超过50%的单味药有四味,分别为柴胡、枳壳、郁金、茯神。第三部分益气活血解郁法治疗卒中后抑郁气虚血瘀型临床研究观察运用益气活血解郁法治疗卒中后抑郁临床疗效,为中医药防治卒中后抑郁提供临床依据。选择112例符合诊断标准、纳入标准的卒中后抑郁患者,随机分为治疗组(n=57),采用益气活血解郁法治疗；对照组(n=55),采用盐酸氟西汀治疗,均以6周为疗程。在治疗前后观察两组的HAMD评分、NIHSS评分、Barthe1评分,评价益气活血解郁汤的临床疗效。通过比较,两组治疗前HAMD评分、NIHSS评分、Barthe1评分比较无差异,P0.05;治疗6周后两组在iAMD评分、NIHSS评分、Barthe1评分上与治疗前相比较,均有明显差异P0.01。治疗组在治疗6周后,患者HAMD评分、NIHSS评分、Barthe1评分均较对照组改善明显,两组比较,P0.01。说明中药益气活血解郁汤可以明显改善患者HAMD评分,减轻抑郁症状,同时可以改善了卒中患者的神经功能缺损的体征,以及提升了患者的日程生活能力。较盐酸氟西汀在改善患者抑郁症状,神经功能康复及提升生活能力方面更有优势。
[Abstract]:Chinese medicine has its own characteristics and advantages in the treatment of stagnation by syndrome differentiation. Professor Hu Guojun has accumulated rich clinical experience in the treatment of depression for more than fifty years. This study intends to trace the academic thought of Professor Hu Guojun's Zhen Zhiyu's evidence through literature research and theoretical research. In this paper, the academic thought which has guiding significance to clinical work is extracted, and the clinical experience of Professor Hu Guojun's treatment of depression is summarized through the form of learning with teachers and teaching, and 112 patients with depression after stroke are randomly selected and compared with fluoxetine by using Yiqi Huoxue Jieyu Decoction and fluoxetine to compare the clinical treatment of the two. This study is divided into three parts. The first part of this study is divided into three parts. The first part of Hu Guojun's academic thought, Professor Hu Guojun, is a family of traditional Chinese medicine, and his father Hu Qiaowu is the inheritor of the school of medicine. Through careful reading of Professor Hu Guojun's works, articles, learning from teachers, and exchanges with Professor Hu Kuo Jun, Professor Hu Guojun learns to learn from Professor Hu Guojun. The thought originated from < inner Jing >, adhering to the medical school of Xin'an. The second part of Hu Guojun's academic thought and clinical experience in the diagnosis and treatment of Yu syndrome. Professor Hu Guojun pays great attention to the syndrome differentiation of the viscera during the diagnosis and treatment of the qi stagnation syndrome. The Qi stagnation is the main cause of the early depression; the qi stagnation, the qi stagnation and the qi stagnation fire are the further progress of the disease. At the later stage of Yu syndrome, many manifestations of the deficiency syndrome and the deficiency of the yin deficiency.1. summed up professor Hu Guojun's diagnosis and treatment of qi stagnation syndrome, "qi stagnation and Qi regulating", "Qi deficiency is required first", "Qi is proved to be more deficiency and less", and the academic thought of "treating with Qi and protecting Yin liquid" is "the treatment of Qi and Yin liquid". (1) qi stagnation and Qi adjustment is necessary to remove the liver first: Professor Hu Guojun thinks that the liver is the main discharge of the wood dirty, sexual joy unimpeded and most depressive depression Wood depression, the vitality of the stagnation, liver depression is lost, the liver is the most likely to stagnant, the liver is the most stagnant, and the Qi reverse Yin meridian. In addition, the liver Qi has a direct unobstructed emotion, Qi Qi, Qi and blood and the mood is bright. (2) depression is proved to be more virtual and less: Qi stagnation pathogenesis is constantly changing with the development of the course, with empirical evidence. Qi stagnation is the main cause of the early stagnation of the syndrome; the qi stagnation is unfavorable, then the qi stagnation phlegm knot, qi stagnation and qi stagnation, qi stagnation fire. The main pathological factors in this stage are "Qi", "fire", "phlegm" and "blood"; the period of the course of disease is manifested as deficiency syndrome, such as yin deficiency and blood loss, two deficiency of the heart and spleen. (3) the treatment is mainly physical Qi and Gu Yin liquid, Hu Guo Professor Jun thinks that the thought of Gu Yin Yin liquid should run through the whole process of the treatment of qi stagnation. In the early stage of depression, qi stagnation is the main factor. This stage should be used to remove the Qi, but it should not be used for a long time. Nourishing yin and nourishing Yin fluid, taking care of the nourishing Yin fluid, further aggravation of the fever, burning the fluid, and treating the stagnation of the stagnation of the syndrome with the fragrance of Qi, the hot and dry product, the late period of the stagnation of the syndrome with Yin liquid and dark consumption. At this time, it should be taken by the nourishing yin to treat its deficiency as an urgent matter, and avoid the aromatic and dry products,.2., and so on. The clinical experiences of Professor Hu Guojun in the treatment of perimenopausal depression, sleep disorder, hysteria and dolphin were summarized. (1) perimenopausal depression: Professor Hu Guojun believed that perimenopausal depression patients usually showed two major syndromes, one with irritability, anxiety, and emotional restlessness as the main symptom, and a class of melancholy, depression, and bad words. Although there are two different syndromes, the pathogenesis is all the qi stagnation, but the qi stagnation is also different. Irritability, anxiety and tension are caused by liver qi, the disease is in the liver, when the liver is treated, it should be removed from the liver, and the depression and depression of the peri menopause are related to the lung, and its disease is related to the lung, its disease Position in the lung, when the lung treatment, should be given the method of reducing lung qi. (2) depression and insomnia treatment: Professor Hu Guojun thinks that depression itself is a kind of emotional disease, but also a cause of insomnia. Insomnia and depression have a common pathological mechanism. With the continuous development and progress of the society, modern people study, work rhythm is getting faster and faster. Life, the mental pressure is increasing, the emotion caused by the emotional restlessness, depression and other depression caused by insomnia is also more and more, from depression to insomnia, depression and insomnia, is the embodiment of treatment, but also a supplement to the syndrome differentiation method of insomnia. (3) hysteria treatment experience: Although the clinical manifestations of hysteria, although hysteria clinical manifestations of complex, complex hysteria, complicated, although hysteria clinical manifestations forms, complicated, hysteria clinical manifestations, complex clinical forms, although hysteria clinical manifestations, complex clinical forms, hysteria, though the clinical forms of hysteria, complex, hysteria clinical manifestations of complex, But there is no attempt or mental stimulation for the main cause. When hysteria is long, he can also change his disease, and most of them are overdue to excessive asthmatic and asthenia, so that sweat and tears are so bad that the Yin fluid is insufficient. The principle of treatment is psychological guidance, supplemented by drug treatment. (4) Professor Hu Guojun believes that the symptoms of the dolphin can be displayed in each of the symptoms. Among the diseases, the key machine is closely related to the three organs of the liver, lung and kidney, which is closely related to the "Qi reverse in the inside". For the treatment of the run of the dolphin, in the treatment of the cure, we should surrender the method of collecting and punching the gas, or receive the immediate effect.3. through the arrangement of 208 cases of depression and the data mining of the frequency of traditional Chinese medicine, to sort out the 10 types of syndrome differentiation. Type, including liver qi stagnation type, qi stagnation and stomach type, qi stagnation and blood depression type, phlegm stagnation type, lung lost Xuan Su type, yin deficiency and blood loss type, deficiency of heart and spleen two, liver kidney yin deficiency type, spleen deficiency syndrome type, 213 kinds of traditional Chinese medicine used in the prescription, including 13 flavors with more than 100 times, including Bupleurum bupleurum, Fructus aurantii, tulips, raw oysters, raw oysters, portral God, half In summer, Radix Polygala, Radix Astragali, Radix Astragalus, Chinese jujube kernel, Rhizoma Atractylodes, Radix Scutellariae, 24 flavors, including Radix Aconiti, jaman gardenia, licorice, Rhizoma Coptidis, Coix Paeonia, coix seed, cassia branch, Platycodon, Platycodon Zi Ren, Rhizoma licorice, Rhizoma cassia, tuckahoe, Rhizoma cangifera, tortoise board, Atractylodes, pearl mother, root, Pericarpium, pericarp, amber, and bark of Acacia The clinical study on the treatment of depression Qi deficiency and blood stasis in the third part of the treatment of post stroke depression Qi deficiency and blood stasis, the clinical effect of treating post apoplexy depression with the method of Supplementing Qi and activating blood and relieving depression, and providing clinical basis for the prevention and treatment of post stroke depression in Chinese medicine, the third part of the clinical study on the treatment of qi deficiency and blood stasis after stroke. 112 cases of post-stroke depression were randomly divided into treatment group (n=57), the treatment group was treated with Supplementing Qi and activating blood and relieving depression, and the control group (n=55) was treated with fluoxetine hydrochloride for 6 weeks. The HAMD score, NIHSS score, and Barthe1 score of two groups were observed before and after the treatment, and the clinical efficacy of Yiqi Huoxue Jieyu Decoction was evaluated. By comparison, there was no difference between the two groups before treatment HAMD score, NIHSS score, and Barthe1 score, P0.05. After 6 weeks of treatment, the two groups in the iAMD score, the NIHSS score, and the Barthe1 score were significantly different from those before the treatment, and the HAMD score, NIHSS score, and Barthe1 score of the patients were significantly better than the control group after 6 weeks of treatment, and the two groups were compared with the control group. P0.01. shows that the TCM Yiqi Huoxue Jieyu Decoction can obviously improve the patient's HAMD score, reduce the depressive symptoms, improve the signs of the nerve function defect in the stroke patients, and improve the patient's ability to live. There is an advantage.
【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R277.7
本文编号：2149368
[Abstract]:Chinese medicine has its own characteristics and advantages in the treatment of stagnation by syndrome differentiation. Professor Hu Guojun has accumulated rich clinical experience in the treatment of depression for more than fifty years. This study intends to trace the academic thought of Professor Hu Guojun's Zhen Zhiyu's evidence through literature research and theoretical research. In this paper, the academic thought which has guiding significance to clinical work is extracted, and the clinical experience of Professor Hu Guojun's treatment of depression is summarized through the form of learning with teachers and teaching, and 112 patients with depression after stroke are randomly selected and compared with fluoxetine by using Yiqi Huoxue Jieyu Decoction and fluoxetine to compare the clinical treatment of the two. This study is divided into three parts. The first part of this study is divided into three parts. The first part of Hu Guojun's academic thought, Professor Hu Guojun, is a family of traditional Chinese medicine, and his father Hu Qiaowu is the inheritor of the school of medicine. Through careful reading of Professor Hu Guojun's works, articles, learning from teachers, and exchanges with Professor Hu Kuo Jun, Professor Hu Guojun learns to learn from Professor Hu Guojun. The thought originated from < inner Jing >, adhering to the medical school of Xin'an. The second part of Hu Guojun's academic thought and clinical experience in the diagnosis and treatment of Yu syndrome. Professor Hu Guojun pays great attention to the syndrome differentiation of the viscera during the diagnosis and treatment of the qi stagnation syndrome. The Qi stagnation is the main cause of the early depression; the qi stagnation, the qi stagnation and the qi stagnation fire are the further progress of the disease. At the later stage of Yu syndrome, many manifestations of the deficiency syndrome and the deficiency of the yin deficiency.1. summed up professor Hu Guojun's diagnosis and treatment of qi stagnation syndrome, "qi stagnation and Qi regulating", "Qi deficiency is required first", "Qi is proved to be more deficiency and less", and the academic thought of "treating with Qi and protecting Yin liquid" is "the treatment of Qi and Yin liquid". (1) qi stagnation and Qi adjustment is necessary to remove the liver first: Professor Hu Guojun thinks that the liver is the main discharge of the wood dirty, sexual joy unimpeded and most depressive depression Wood depression, the vitality of the stagnation, liver depression is lost, the liver is the most likely to stagnant, the liver is the most stagnant, and the Qi reverse Yin meridian. In addition, the liver Qi has a direct unobstructed emotion, Qi Qi, Qi and blood and the mood is bright. (2) depression is proved to be more virtual and less: Qi stagnation pathogenesis is constantly changing with the development of the course, with empirical evidence. Qi stagnation is the main cause of the early stagnation of the syndrome; the qi stagnation is unfavorable, then the qi stagnation phlegm knot, qi stagnation and qi stagnation, qi stagnation fire. The main pathological factors in this stage are "Qi", "fire", "phlegm" and "blood"; the period of the course of disease is manifested as deficiency syndrome, such as yin deficiency and blood loss, two deficiency of the heart and spleen. (3) the treatment is mainly physical Qi and Gu Yin liquid, Hu Guo Professor Jun thinks that the thought of Gu Yin Yin liquid should run through the whole process of the treatment of qi stagnation. In the early stage of depression, qi stagnation is the main factor. This stage should be used to remove the Qi, but it should not be used for a long time. Nourishing yin and nourishing Yin fluid, taking care of the nourishing Yin fluid, further aggravation of the fever, burning the fluid, and treating the stagnation of the stagnation of the syndrome with the fragrance of Qi, the hot and dry product, the late period of the stagnation of the syndrome with Yin liquid and dark consumption. At this time, it should be taken by the nourishing yin to treat its deficiency as an urgent matter, and avoid the aromatic and dry products,.2., and so on. The clinical experiences of Professor Hu Guojun in the treatment of perimenopausal depression, sleep disorder, hysteria and dolphin were summarized. (1) perimenopausal depression: Professor Hu Guojun believed that perimenopausal depression patients usually showed two major syndromes, one with irritability, anxiety, and emotional restlessness as the main symptom, and a class of melancholy, depression, and bad words. Although there are two different syndromes, the pathogenesis is all the qi stagnation, but the qi stagnation is also different. Irritability, anxiety and tension are caused by liver qi, the disease is in the liver, when the liver is treated, it should be removed from the liver, and the depression and depression of the peri menopause are related to the lung, and its disease is related to the lung, its disease Position in the lung, when the lung treatment, should be given the method of reducing lung qi. (2) depression and insomnia treatment: Professor Hu Guojun thinks that depression itself is a kind of emotional disease, but also a cause of insomnia. Insomnia and depression have a common pathological mechanism. With the continuous development and progress of the society, modern people study, work rhythm is getting faster and faster. Life, the mental pressure is increasing, the emotion caused by the emotional restlessness, depression and other depression caused by insomnia is also more and more, from depression to insomnia, depression and insomnia, is the embodiment of treatment, but also a supplement to the syndrome differentiation method of insomnia. (3) hysteria treatment experience: Although the clinical manifestations of hysteria, although hysteria clinical manifestations of complex, complex hysteria, complicated, although hysteria clinical manifestations forms, complicated, hysteria clinical manifestations, complex clinical forms, although hysteria clinical manifestations, complex clinical forms, hysteria, though the clinical forms of hysteria, complex, hysteria clinical manifestations of complex, But there is no attempt or mental stimulation for the main cause. When hysteria is long, he can also change his disease, and most of them are overdue to excessive asthmatic and asthenia, so that sweat and tears are so bad that the Yin fluid is insufficient. The principle of treatment is psychological guidance, supplemented by drug treatment. (4) Professor Hu Guojun believes that the symptoms of the dolphin can be displayed in each of the symptoms. Among the diseases, the key machine is closely related to the three organs of the liver, lung and kidney, which is closely related to the "Qi reverse in the inside". For the treatment of the run of the dolphin, in the treatment of the cure, we should surrender the method of collecting and punching the gas, or receive the immediate effect.3. through the arrangement of 208 cases of depression and the data mining of the frequency of traditional Chinese medicine, to sort out the 10 types of syndrome differentiation. Type, including liver qi stagnation type, qi stagnation and stomach type, qi stagnation and blood depression type, phlegm stagnation type, lung lost Xuan Su type, yin deficiency and blood loss type, deficiency of heart and spleen two, liver kidney yin deficiency type, spleen deficiency syndrome type, 213 kinds of traditional Chinese medicine used in the prescription, including 13 flavors with more than 100 times, including Bupleurum bupleurum, Fructus aurantii, tulips, raw oysters, raw oysters, portral God, half In summer, Radix Polygala, Radix Astragali, Radix Astragalus, Chinese jujube kernel, Rhizoma Atractylodes, Radix Scutellariae, 24 flavors, including Radix Aconiti, jaman gardenia, licorice, Rhizoma Coptidis, Coix Paeonia, coix seed, cassia branch, Platycodon, Platycodon Zi Ren, Rhizoma licorice, Rhizoma cassia, tuckahoe, Rhizoma cangifera, tortoise board, Atractylodes, pearl mother, root, Pericarpium, pericarp, amber, and bark of Acacia The clinical study on the treatment of depression Qi deficiency and blood stasis in the third part of the treatment of post stroke depression Qi deficiency and blood stasis, the clinical effect of treating post apoplexy depression with the method of Supplementing Qi and activating blood and relieving depression, and providing clinical basis for the prevention and treatment of post stroke depression in Chinese medicine, the third part of the clinical study on the treatment of qi deficiency and blood stasis after stroke. 112 cases of post-stroke depression were randomly divided into treatment group (n=57), the treatment group was treated with Supplementing Qi and activating blood and relieving depression, and the control group (n=55) was treated with fluoxetine hydrochloride for 6 weeks. The HAMD score, NIHSS score, and Barthe1 score of two groups were observed before and after the treatment, and the clinical efficacy of Yiqi Huoxue Jieyu Decoction was evaluated. By comparison, there was no difference between the two groups before treatment HAMD score, NIHSS score, and Barthe1 score, P0.05. After 6 weeks of treatment, the two groups in the iAMD score, the NIHSS score, and the Barthe1 score were significantly different from those before the treatment, and the HAMD score, NIHSS score, and Barthe1 score of the patients were significantly better than the control group after 6 weeks of treatment, and the two groups were compared with the control group. P0.01. shows that the TCM Yiqi Huoxue Jieyu Decoction can obviously improve the patient's HAMD score, reduce the depressive symptoms, improve the signs of the nerve function defect in the stroke patients, and improve the patient's ability to live. There is an advantage.
【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R277.7
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