周德安老师主要学术特点及针药结合治疗成人突发性耳聋的临床疗效观察

发布时间：2018-08-03 07:16

【摘要】：时光荏苒,岁月如梭,至今我已跟随周德安老师学习了三年。我在全面梳理跟师笔记、临床医案、月记、听课笔记的基础上,对老师的学术思想渊源、学术思想做了系统的总结,并在老师的悉心指导下完成了“周德安教授针药结合治疗成人突发性耳聋的临床疗效观察”。1周德安教授学术渊源周老师的学术思想是在中医经典的熏陶下、在北京中医医院针灸科各位名医的指点下、经过多种不同工作环境的锤炼而形成的。2周德安教授学术思想周老师通过多年的临床实践,形成了独特的学术思想：①六治理论：治神、治痰、治痛、治风、治聋、治动,其中治神是首要。②人体正常的脏腑功能是以气的升降出入和顺为前提的,气机调和才能达到阴平阳秘。③针药各有所宜,针药结合,才能取得最佳的治疗效果。2.1六治理论2.1.1治神周老师认为,神的失常是致病的重要因素,“治神”是治病过程中最关键的一环。通过医者调神、药物调神和针灸调神,全方位体现“治病先治神”的学术观点,最终的目的是使患者达到“阴平阳秘,精神乃治”的健康状态。针灸调神方面,他提出了脑心同治的理念,创立了四神方作为基础方,五脏俞加膈俞作为补益安神方,督脉十三针作为重镇安神方,开四关作为调肝安神方,治神诸方用于治疗各种精神、情志疾患以及其他疾病伴随的精神异常症状。2.1.2治痰周老师认为,治疗因痰引起的疾病应调气为先,实脾为本,祛痰为要。针刺能直达病所,对调和气血有独到的作用。周老师提出了针灸治痰的基础方-化痰方,并由此延伸出涤痰方、豁痰方、消痰方；同时还兼以汤药调节气血、健脾化痰。他擅长针药结合治疗因痰引起的癫痫、眩晕、梅核气、肥胖症、喘证、ve瘕等病症。2.1.3治痛周老师在治疗痛证时均先针刺四神方或百会、攒竹,然后针刺“调气止痛方”,最后根据经络辨证或脏腑辨证加减取穴。整个治疗过程体现了周老师治疗痛证的“两大原则”,它们分别是：1、先调神后调气。周老师认为通过先调神可以使心寂而痛减,同时使气血趋于平和。然后采用各种调气的方法使得气血通畅,最后达到通则不痛。他创立了由三个络穴(肺经络穴列缺、胃经络穴丰隆、肝经络穴蠡沟)组成的调气止痛方以行气活血止痛。2、厘清经病脏病。分清疼痛的部位是在经络还是脏腑。一般来说,疼痛初期是经络痛,病位在表,十二皮部和十二筋经是常见部位,疼痛较重,治疗上以经络辨证为主。患病日久,病位由表及里到脏腑,此时一般疼痛较缓,治疗上以脏腑辨证为主。“六大治法”包括：安神定志法、移情减痛法、行气活血法、通督温阳法、培元扶正法、清热泻火法。2.1.4治风风有外风和内风之别。周老师擅长治疗由外风引起的周围性面瘫,由内风引起的中风和帕金森病。他认为治疗周围性面瘫的方法要根据不同的病位、病程、外邪的属性来确定。在面瘫急性期,他主张针刺手法要轻柔、穴位少而精；汤药由经验方白芥子、白附子、白僵蚕、白芷、葛根、板蓝根、蜈蚣、全蝎、防风为主方,并辨证加减。后遗症期常采用细火针针刺,强调火针整个操作过程要规范、娴熟、一气呵成；并辅以汤药调理。中风有中经络和中脏腑之别,周老师将中经络常分为三种证型：气虚血瘀、风痰阻络、阴虚阳亢。常用的针灸处方为四神方加手足十二针、补中益气方、祛痰方,汤药用补阳还五汤、半夏白术天麻汤、镇肝熄风汤加减。中风中脏腑也分为三种证型,分别为肝阳暴张(阳闭)、痰蒙清窍(阴闭)、阴阳离绝(脱证)。周老师创立的醒神开窍方(人中、内关、涌泉、丰隆、手足十二井穴)适用于闭证,回阳固脱方(百会、素骼、神阙、关元、足三里)适用于脱证,其中神阙,气海,关元常施以隔盐灸。周老师擅用真武汤治疗帕金森病,认为该病是因为患者体内肾精衰减、肝肾阴亏、精血俱耗,以致筋脉失于濡养,虚风所致震颤。若阴症重,常配合在任督脉的重要穴位上施灸以温阳利水、荣养筋脉。2.1.5治动周老师将注意力缺陷多动障碍和抽动症合称为“动证”,认为动证乃五脏功能失调所致,尤其是心、肝、脾三脏。动证分虚、实两种证型,实证有肝风内动、痰火扰心,虚证是心(肝)脾两虚、筋脉失养。治疗时以安神为要,实证同时予以平肝熄风、清热化痰；虚证予以健脾益气、养血荣筋。针刺以四神方加开四关为基础,实证加化痰方(中脘、内关、列缺、丰隆、公孙),虚证加补中益气方。中药实证用半夏白术天麻汤或温胆汤加减,虚证用逍遥散或归脾汤加减。2.1.6治聋周老师近五十年的实践发现,超过30%经过西医治疗无效的神经性耳聋患者,接受针灸加中药治疗后听力均有提升。他将大部分神经性耳聋分成虚实两型,其中实证为气滞血瘀型,虚证为肾精不足或阴虚阳亢型。针刺取百会、神庭、角孙、耳门透听会、翳风、筑宾。实证加合谷、中渚、丘墟、太冲,虚证加中脘、关元、手足三里、太溪；汤药用自拟的聪耳方,并辨证加减。在治聋的自拟汤药中,加上了桔梗、杏仁、郁金和陈皮四味药,体现其“耳聋治肺”的学术思想。2.2气机调和阴平阳秘气是人体脏腑功能活动和精神状态的物质基础之一,升降出入运动正常是人体阴平阳秘的重要因素。周老师认为：1、百病生于气也,脏腑正常的气机是：脾主升清、肝主升发、肾阳主升、肺主肃降、胃主降浊、胆气主降、肾阴主降,如若升降不及、升降太过、升降反常皆可出现各种病变；2、中焦肝胆脾胃是五脏六腑气机运化的核心,脾升胃降,肝升胆降乃常态,肝胆的升降依赖于脾胃的升降。外感邪气是否向内传变恶化还是向外传变好转,也取决于脾胃之气是否足够强盛。3、他还根据气机理论遣方选穴,注重通过宣畅肺气、调理中焦脾胃肝胆来实现全身气机正常的升降出入。常用的治法有：气滞者行之,气逆者平之,气陷者升之,气散者敛之。他还创立了“补中益气方”、“理气健脾方”、“调气止痛方”三个临床常用的针灸处方用来调理气机。2.3针药结合相得益彰周老师在临床工作中的突出特点是常常针药结合、双管齐下。他认为：1、针药各有所长,针之所长,长于有余之实邪耳。药之所长,长于脏气不足虚也。发挥所长,针药结合能大大提高疗效,值得大力提倡。2、他将针药结合的关系比喻成中药配伍关系中的单行、相须、相使。既有单用针或药、又有针药并重,还有针药主次有别。3、针药二途,理无二致,以药理明针理,他将临床常用的组穴分成了十大类共28个针灸处方,分别是补益门、治风门、外感门、通便门、止泻门、泌尿生殖门、调气门、祛痰门、安神门、五官门,涵盖了治疗内外妇儿的各个学科的常见病的针灸处方。针灸处方如同方剂的配伍,君臣佐使,组织严密,效专力弘。临床中他常用的汤剂不超过二十个,常用小而精的对药加减。取穴方面,他常用28个针灸处方加减对穴和单穴。3周德安教授针药结合治疗成人突发性耳聋的临床疗效观察采用非随机对照研究方法,评估周德安教授针药结合治疗成人难治性突发性耳聋的疗效。通过临床研究,验证了周老师针药结合治疗方案的临床疗效,确定了病程超过14天的难治性突聋患者的治疗方案,便于下一步临床推广使用。
[Abstract]:Time flies, time flies, so far, I have been learning from teacher Zhou Dean for three years. On the basis of comprehensive combing with teachers' notes, clinical medical cases, monthly notes and lecture notes, I have systematically summarized the academic thought origin and academic thought of the teacher, and completed "Professor Zhou Dean combination of acupuncture and medicine to treat adults" under the guidance of the teacher. The clinical effect of sudden deafness: Professor.1 Zhou Dean academic origin Zhou's academic thought is under the edification of traditional Chinese medicine, under the guidance of the famous doctors in the Department of acupuncture and moxibustion of Beijing Chinese Medicine Hospital, the teacher of Professor.2, Professor Zhou Dean through many years of clinical practice, formed by many different working conditions. It has become a unique academic thought: (1) the six treatment theory: treating God, treating phlegm, treating pain, treating the wind, treating deafness, and treating the movement, which is the first. (2) the function of the normal viscera of the human body is the premise of the Qi and descending in and out of the Qi, and the air machine harmonization can reach the Yin Ping Yang constipation. 3. The best treatment effect.2.1 six can be obtained. 2.1.1 God Zhou teacher thinks that God's aberration is an important factor in the disease. "Cure the God" is the most critical part of the treatment process. Through the doctor to adjust God, the medicine to adjust God and the acupuncture and tune God, embody the academic viewpoint of "cure the God first" in all directions, and the ultimate aim is to make the patient achieve the healthy form of "Yin and Yang, the spirit is the cure" In the aspect of acupuncture and moxibustion, he put forward the idea of the same treatment of the brain and heart, set up the four gods as the foundation, the five Zang Yu and Gyu Shu as the tonifying and Anshen prescription, the thirteen needles of the governor vein as the heavy Town, the four customs as the prescription for regulating the liver, and treating various spirits, emotional disorders and other mental disorders accompanied by other diseases.2.1.2. To cure phlegm, the teacher thinks that the treatment of phlegm caused by phlegm should be adjusted first, the spleen is the foundation, and the expectorant is the essential. The acupuncture can reach the disease directly, and it has the unique function to harmonize the Qi and blood. Zhou proposed the basic prescription of acupuncture and phlegm to treat phlegm, and then extended the prescription of phlegm, the prescription of phlegm, the elimination of phlegm, and the decoction to regulate qi and blood and strengthen the spleen and the phlegm. He is good at combining acupuncture and medicine with the treatment of phlegm induced epilepsy, vertigo, plum, nuclear gas, obesity, asthma, VE and other symptoms of pain Zhou teachers in the treatment of pain syndrome, when treating pain syndrome, he first needles the four gods or hundreds of meetings, save bamboo, and then acupuncture "Qi Qi analgesic prescription", and finally according to the syndrome differentiation of meridians and collaterals or viscera syndrome differentiation and reduction of acupoints. The whole treatment process embodies the treatment of Zhou teacher treatment. The "two principles" of pain syndrome are: 1, and then adjust Qi after adjusting God. Zhou thinks that by adjusting God first, he can make heart silence and pain, and make Qi and blood leveling, and then use various methods of regulating qi to make the Qi and blood unobstructed, and finally reach the general rule without pain. He founded three collaterals (lung meridian acupoint deficiency, stomach meridian acupoint Feng long, liver) The prescription of regulating qi and relieving pain of meridian acupoint Li Gou to relieve pain.2 and clarify the disease of menstrual disease. The location of the pain is in meridian or viscera. Generally speaking, the initial pain is meridian pain, the disease position is in the table, the twelve skin parts and twelve tendons are common parts, the pain is heavy, the treatment is based on the meridian syndrome differentiation. To the viscera, the pain is slow at this time, and the treatment is based on the syndrome differentiation of the viscera. The "six major treatments" include: the Anshen determination method, the empathy and the reduction of pain, the method of activating blood and blood, the method of activating the Qi and warming Yang, the method of raising the yang to help the wind and the internal wind in the treatment of the wind and the internal wind. Mr. Zhou is good at treating the peripheral facial paralysis caused by the external wind, which is caused by the internal wind. Apoplexy and Parkinson's disease. He believed that the treatment of peripheral facial paralysis should be determined according to the different position, course, and external pathogenic factors. In the acute stage of facial paralysis, he advocated that the acupuncture manipulation should be gentle and the acupoints were less and more precise; the decoction was made up of experienced white mustard, white aconite, white angelica, Radix Angelica, Radix Isatis Root, centipede, scorpion, wind proof. A fine needle acupuncture is used in the period of sequelae. It emphasizes that the whole operation process of the fire needle should be standardized, skillful, and at one time, and supplemented by the decoction of decoction. The apoplexy has the middle meridian and the middle viscera. Zhou is often divided into three types of syndrome types: Qi deficiency and blood stasis, wind phlegm obstructing collaterals, yin deficiency and yang hyperactivity. The commonly used acupuncture prescriptions are four gods plus hand feet and feet of ten. Two needles, supplementing qi and eliminating phlegm, decoction of tonifying yang and five soup, Banxia Baizhi Tianma soup, Zang Fu Decoction of Zhen liver qi and subtract. There are three types of syndrome in the apoplexy, which are liver Yang violent Zhang (Yang Bi), phlegm and Mongolia Qing Qiao (Yin closed), Yin and Yang (yin and Yang). In closing the syndrome, Hui Yang Gu Fang (Baihui, Shenque, Shenque, Guan yuan, Zusanli) is suitable for the removal of evidence, in which the Shenque, Qi Hai, and Guan yuan are often treated with salt separated moxibustion. Mr. Zhou used Zhenwu Decoction to treat Parkinson's disease. It is considered that the disease is due to the attenuation of kidney essence, the deficiency of liver and kidney, blood and blood, so that the veins are lost in the nourishment and the asthenia wind causes tremor. If Yin Syndrome is heavy, We often cooperate with the important acupoints on the supervisor pulse to make moxibustion with Warm Yang Li water, and the teacher of.2.1.5, who has the vein of Rong Yang, treats the attention deficit hyperactivity disorder and the twitch syndrome as "motion syndrome", and thinks that the movement syndrome is the result of the dysfunction of the five zang organs, especially the three organs of the heart, the liver and the spleen. The syndrome is divided into two types, and the demonstration has the liver wind, the phlegm fire and the deficiency syndrome. Heart (liver) spleen two deficiency, pulse loss of nourishing. In the treatment of God for the treatment, the demonstration at the same time to put out the liver, clearing heat and phlegm; deficiency syndrome to strengthen the spleen and nourishing qi, nourishing blood and reinforcement. The acupuncture is based on the four gods to add four customs, empirical plus Phlegm Recipe (Zhongwan, Neiguan, deficiency, Feng long, grandson), deficiency syndrome plus Zhongyi Qi Fang. Chinese medicine empirical use Banxia Baizhu Tianma soup, or Chinese medicine empirical use Banxia Baizhu Tianma soup soup or the Chinese medicine empirical evidence or Decoction of Banxia Baizhu Tianma soup or With the addition and subtraction of Wendan Decoction (Wendan Decoction), the practice of "Xiaoyao" or "Jia PI Decoction" for the treatment of the teacher of.2.1.6 for the past fifty years has found that more than 30% of the patients with neurogenic deafness who have been treated with western medicine and treated with Acupuncture plus Chinese Medicine have improved their hearing. Most of them are divided into virtual reality type two, of which the syndrome is Qi stagnation and blood stasis type and deficiency syndrome is a deficiency syndrome The kidney essence is insufficient or yin deficiency and yang hyperactivity type. The acupuncture takes hundreds of meetings, the God court, the horn sun, the ear door through the hearing, the Yifeng, the building of the bin. The positive combination of the valley, the Zhu Xu, the Tai Chi, the deficiency syndrome and the Zhong Wan, the Guan yuan, the hand foot three li, the Tai Xi, the decoction of the self made Cong ear, and the syndrome differentiation and subtract in the deafness self-made decoction, are added with the medicine of Platycodon grandiflorum, almonds, tulip and Chen peel. The academic thought of "hearing loss for the lung".2.2 Qi machine harmonization Yin Pingyang constipation is one of the material basis of the functional activities and mental state of the human viscera. The normal movement of the ascending and descending movement is an important factor of the human body's Yin and Yang. Zhou thinks that 1, the disease is born in Qi, the normal Qi of the viscera is the spleen ascending, the liver main rise, the kidney yang rising, And the main descending of the stomach, the main descending of the stomach, the main descending of the stomach, the main descending of the kidney yin, the descending of the kidney yin, such as if the ascending and descending, the ascending and descending, the ascending and descending all kinds of pathological changes; 2, the heart of the liver and the spleen and stomach is the core of the movement of the organs of the five viscera and six organs, the spleen rises to the stomach, the liver rises the gallbladder descending the normal state, the rise and fall of the liver and gallbladder depends on the ascending and descending of the spleen and stomach. It also depends on whether the spleen and stomach can be improved, and whether the spleen and stomach qi is strong enough for.3, he also chooses the hole according to the theory of Qi, pays attention to the control of the Qi and spleen of the spleen and stomach to realize the normal lift and exit of the whole body. "Zhongyi Qi Fang", "Qi Qi Jianpi Fang", "Qi Qi analgesic prescription" three clinical commonly used acupuncture prescriptions used to regulate the combination of.2.3 needle and medicine in Qi machine. The combination of acupuncture and medicine can greatly improve the efficacy of the combination of acupuncture and medicine, and it is worth advocating.2. He compares the relationship between the combination of acupuncture and medicine as a single line in the compatibility of traditional Chinese medicine. The commonly used acupoints are divided into ten kinds of 28 acupuncture and moxibustion prescriptions, which are the tonic gate, the cure door, the external sensation gate, the open door, the antidiarrheal gate, the genitourinary door, the valve, the expectorant gate, the antiphlegm door, the five Guan gate, covering the common diseases in the various subjects of the internal and external women. His commonly used decoction is not more than twenty, commonly used in small and fine medicine. In the area of acupoints, he often uses 28 acupuncture prescriptions to add and subtract the clinical efficacy of acupuncture and medicine combined with.3 Zhou Dean, a single point in the treatment of sudden deafness in adults, to evaluate the combined treatment of Professor Zhou Dean with a combination of acupuncture and medicine. The therapeutic effect of refractory sudden deafness in adults was treated. Through clinical study, the clinical efficacy of the combination of acupuncture and medicine was verified by Mr. Zhou, and the treatment scheme for patients with refractory sudden deafness for more than 14 days was determined to facilitate the next clinical application.
【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;R246.81

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