熄风化痰法及其临床运用研究

发布时间：2018-08-09 14:07

【摘要】：1研究目标厘清风痰及熄风化痰法的学术源流,明确相关概念内涵的演变；从病因病机、临床常见证候、复合治法、方药分析等方面,阐明熄风化痰法的基本理论；总结熄风化痰法在中风、痫证、眩晕、颤证、小儿惊风中的运用。2研究方法2.1文献学方法(1)古代文献：以“痰”为检索词,对《中华医典》(第五版)所收录的古籍进行检索,并结合《中医临床必读丛书》、“读秀”等,搜集和“风痰”相关的资料,并按照医论、本草、方书、医案医话等四部分加以分类整理。(2)现代期刊：以“风痰”“熄风”“化痰”等为检索词,在中国知网、万方、维普等数据库中,搜集相关论文共852篇。其中,期刊论文798篇、学位论文30篇、会议论文24篇,分析并综述理论、实验、临床相关进展。(3)工具书、教材及现代论著：参考《中医大辞典》等工具书10部；《中医内科学》等教材12部；《中医痰病研究与临床》等专著50部,对其中和“风痰”“熄风化痰”相关的理论、方药、临床诊疗经验等进行分析和归纳。2.2医史学方法运用医史学方法,纵向梳理古代文献中关于风痰的理法方药、医案医话等,概要阐明各历史时期的发展特点；厘清风痰、熄风化痰法的学术源流。2.3理论研究方法对已收集的相关资料,通过分析总结代表性医家关于风痰、熄风化痰法的学术观点,阐明风痰、熄风化痰法的基本理论；对古今医家的临床诊疗经验进行理论提炼,归纳临床运用熄风化痰法治疗相关疾病的规律与法则。3研究结果3.1学术源流先秦两汉时代《黄帝内经》记载了和“肝风内动”相关的理论,出现了与后世所言“风痰”相似的证候描述；《神农本草经》记载了多种后世认为具有祛风痰功效的药物。魏晋隋唐时代《诸病源候论》提出了“风痰可致头痛”、“风痰可致目病”等相关理论；《千金要方》记载了徐嗣伯“痰热相感而动风”的论述,为“痰热生风”的理论发展奠定了基础；记载了不少治疗风痰的方药。两宋时代有关于风痰证成因及相关证候特点的论述；提出“治疗风痰当先顺其气”的治疗原则；关于风痰证的治法和方药记载也更为具体,记载了被后世认为具有熄风化痰功效、治疗内风挟痰证的方剂。金元时代发展了内风学说,朱丹溪更是提出了“痰热生风”的理论；多位医家从风痰的病因病机、临床证候等角度对风痰进行阐释,但仍缺乏对“内风挟痰”的理论探讨；创制了不少后世认为具有熄风化痰功效、治疗内风挟痰证的代表方剂,如搜风化痰丸(《丹溪心法》)、真方白丸子(《瑞竹堂经验方》)等。明清时代从外风挟痰、内风挟痰两个层面补充、丰富了风痰的基本理论；基本确立了“疏风化痰法治疗外风挟痰证,熄风化痰法治疗内风挟痰证”的原则；方药记载更为具体,提出“熄风化痰”法,并明确其治疗内风挟痰证。近现代界定了风痰、熄风化痰法的范畴。更加明确熄风化痰法是治疗风痰之内风挟痰证的治法。同时拓宽了熄风化痰法治疗疾病的范围；临床诊治时,尤善注重熄风化痰法和活血化瘀法等治法的结合。3.2基本理论3.2.1熄风化痰法的基本概念熄风化痰法,是指运用熄风药配伍化痰药为主,治疗内风挟痰证的治法。具体包括涤痰熄风、豁痰熄风、搜风化痰、截风化痰等法。临床运用时,常针对所治疾病的病机及其具体证候特点,适当结合通络法、开窍法、燥湿法、清热法、滋阴法、活血法等,治疗以内风挟痰为基本病机的相关病证。3.2.2熄风化痰法的适用范围(1)内风挟痰证的病因病机,主要病因包含情志不遂、劳逸失度、饮食不节、年老体衰等,基本病机指肝风内动、挟痰内扰。(2)内风挟痰证常见以下三种证候类型：肝风挟痰、闭阻经络；肝风挟痰、上扰清窍,及肝风挟痰,内蒙心神。3.2.3熄风化痰法的复合治法熄风化痰通络法指在熄风化痰基础上,结合通络法,治疗以口眼?斜、半身不遂等为主要临床表现的风痰阻络证的治法；代表方剂有真方白丸子、搜风化痰丸等。熄风化痰开窍法指在熄风化痰基础上,结合开窍法,治疗以突然昏倒、神志不清等为主要临床表现的风痰蒙蔽心窍证的治法；代表方剂有金箔镇心丸等。燥湿熄风化痰法指熄风化痰法和燥湿法相合,治疗以头痛、眩晕等为主要临床表现的肝风兼挟痰湿证的治法；代表方剂有半夏白术天麻汤等。清热熄风化痰法指清热法和熄风化痰法合用,治疗以高热抽搐、两目上视等为主要临床表现的痰热动风证的治法；代表方剂有琥珀抱龙丸等。滋阴熄风化痰法指滋阴法和熄风化痰法合用,治疗风痰兼夹阴虚证的治法；其适应证除见内风挟痰的基本证候外,还常伴腰膝酸软、面色潮红、手足心热等；代表方剂有六味地黄丸、大补阴丸等加减。熄风化痰活血法指熄风化痰法和活血化瘀法合用,治疗风痰挟瘀证的治法；其适应证除见内风挟痰的基本证候外,还常伴肢体麻木疼痛、舌质紫暗有瘀斑等；代表方剂在熄风化痰的基础上配伍当归、丹参等活血化瘀之品。3.2.4熄风化痰法的代表方剂半夏白术天麻汤熄风化痰,健脾燥湿,主治肝风挟痰上扰所致头痛、眩晕。定痫丸涤痰熄风,清热定痫,主治肝风挟痰热内扰所致痫证。神仙解语丹化痰开窍,熄风通络,主治肝风挟痰、阻滞经络之中风不语。真方白丸子熄风化痰通络,主治肝风挟痰,闭阻经络之中风病中经络证。琥珀抱龙丸熄风化痰,清热定惊,主治肝风挟痰热内扰之小儿惊风、惊悸。金箔镇心丸熄风化痰,开窍安神,主治肝风挟痰内扰之急慢惊风、慢脾、胎惊、天吊。3.2.5熄风化痰法的常用药物归纳了熄风化痰法的代表药物,如胆南星、僵蚕、天南星、牛黄；并对具有熄风化痰功效的方剂进行了药物频次分析。发现除熄风药和化痰药之外,配伍频率最高的,是解表药、清热药、补气药等；单味药物使用频率最高的,是天麻、全蝎、僵蚕、天南星等；熄风药配伍化痰药的组合中,以天麻配伍白附子、天麻配伍半夏、僵蚕配伍白附子等最为常见。3.3熄风化痰法的临床运用选取常用熄风化痰法治疗的中风、痫证、眩晕、颤证、小儿惊风等五种疾病,对该病的病因病机及适用证候进行分析和总结,并佐以相应医案分析。中风熄风化痰法治疗中风,主要用于治疗中风病肝风挟痰闭阻之中经络证、肝风挟痰内扰之中脏腑闭证及中风恢复期之风痰瘀阻证。其中,肝风挟痰闭阻之中经络证,是由于肝肾阴虚,阳亢风动,挟痰闭阻经络所致,代表方剂有真方白丸子、搜风化痰丸加减方等；肝风挟痰内扰之中脏腑闭证,是由于肝风挟痰内蒙清窍,代表方剂有涤痰汤等加减方；中风恢复期之风痰瘀阻证,是由于风痰挟瘀阻滞经络所致,代表方剂有神仙解语丹加减方等。痫证熄风化痰法治疗痫证,主要治疗痫证之风痰闭阻证。代表方剂有定痫丸等。若因痰浊日久,郁而化热生风,肝风挟痰热内扰所致,配伍黄芩、黄连等清热之品。若痰浊素盛,复因头部外伤、脑手术等导致瘀血内生,痰瘀交阻,肝风内动证,在熄风化痰的基础上当配伍当归、丹参等活血化瘀之品。眩晕熄风化痰法治疗眩晕,主要治疗眩晕之风痰上扰证。代表方剂有半夏白术天麻汤等。颤证熄风化痰法治疗颤证,主要治疗颤证之痰热动风证。由于久病多瘀,风痰闭阻日久,血行不畅,而致瘀血内生,则佐以活血化瘀。代表方剂有羚角钩藤汤等加减。小儿惊风熄风化痰法治疗小儿惊风,主要治疗小儿惊风之痰热动风证。代表方剂有琥珀抱龙丸、金箔镇心丸等加减方。其他疾病临床上,熄风化痰法还常用于治疗其他病证,如风痰闭阻经络导致的麻木、痉证,风痰上扰清窍导致的头痛,风痰蒙蔽心神导致的厥证、癫证、狂证等。在临床诊疗疾病时,应当病证结合,仔细分辨,合理运用。4研究结论(1)熄风化痰法,是指运用熄风药配伍化痰药为主,治疗内风挟痰证的治法。具体包括涤痰熄风、豁痰熄风、搜风化痰、截风化痰等法。临床运用时,常针对所治疾病的病机及其具体证候特点,适当结合通络法、开窍法、燥湿法、清热法、滋阴法、活血法等,治疗以内风挟痰为主要病机的相关病证。内风挟痰证的病因,主要包含情志不遂、劳逸失度、饮食不节及年老体衰等；基本病机为肝风旋动,挟痰内扰。熄风化痰法适用的临床证候,包含肝风挟痰、闭阻经络证；肝风挟痰、上扰清窍证；及肝风挟痰,内蒙心神证三种。代表方剂有半夏白术天麻汤、定痫丸、神仙解语丹、真方白丸子、琥珀抱龙丸、金箔镇心丸等；具有熄风化痰功效的代表药物有胆南星、白僵蚕、天南星、牛黄等。(2)临床运用熄风化痰法治疗的疾病有多种,主要用于中风、痫证、眩晕、颤证、小儿惊风等疾病。通过分析,熄风化痰法主要治疗中风病肝风挟痰闭阻之中经络证、肝风挟痰内扰之中脏腑闭证,及中风恢复期之风痰瘀阻证；痫证之风痰闭阻证；眩晕之风痰上扰证；颤证之痰热动风证；小儿惊风之痰热动风证等。除此之外,常用于治疗风痰闭阻经络导致的麻木、痉证,风痰上扰清窍导致的头痛,风痰蒙蔽心神导致的厥证、癫证、狂证等。临床上,当病证结合,辨证立法。
[Abstract]:1 the objective of this study was to clarify the academic origin of wind and sputum and extinguish the weathering phlegm, to clarify the evolution of the connotation of related concepts, and to clarify the basic theory of the method of extinguishing weathering phlegm from the etiology and pathogenesis, clinical syndromes, compound treatment and prescription analysis, and to sum up the application of.2 research method in the study of stroke, epilepsy, vertigo, tremor, and infantile wind. 2.1 Literature method (1) Ancient Literature: with the "phlegm" as the retrieval word, the ancient books included in the Chinese medical code (Fifth Edition) were retrieved, and the data related to "wind phlegm" were collected and collected in combination with the clinical compulsory reading series of Chinese medicine, "reading show" and so on. And four parts were classified according to the medical theory, the herbal medicine, the prescription book, the medical case medicine and so on. (2) modern periodicals: With "wind phlegm", "extinguishing the wind" and "phlegm" as the retrieval words, in the Chinese knowledge network, Wanfang, VIP and other databases, 852 articles are collected. Among them, 798 papers, 30 dissertations and 24 conference papers, analysis and summary of theory, experiment, clinical related development. (3) tool books, textbooks and modern Treatises: reference < Chinese Dictionary > > > > 10 parts of the instrument book, 12 parts of the textbook of internal medicine medicine, and 50 books of "TCM phlegm disease research and clinical", including the theories related to "wind phlegm", "wind and phlegm extinguishing and phlegm," and the experience of clinical diagnosis and treatment, such as "wind phlegm", "Fang Feng" and "clinical diagnosis and treatment", are analyzed and summed up by the methods of medical history in.2.2 medical history and the longitudinal combing of ancient literature about wind phlegm. Medicine, medical case medicine and so on, outline the development characteristics of each historical period; to clarify the academic origin of the academic origin of the wind and phlegm and extinguish the phlegm by the.2.3 theory research method on the collected data, through the analysis and summary of the academic viewpoint of the representative doctors on wind phlegm, extinguishing the phlegm method, clarifying the basic theory of wind phlegm, extinguishing the wind and removing phlegm, and to the ancient and modern doctors The experience of clinical diagnosis and treatment was abstracted, and the rules and rules of clinical application of weathering phlegm in the treatment of related diseases were summed up. The results of.3 study were 3.1. The theories related to the "internal movement of the liver" in the period of the Han Dynasty and the Han Dynasty in the Pre-Qin and Han Dynasties and the "internal movement of the liver" were recorded, and the description of the syndrome similar to "wind phlegm" in the later generations was described; < Shennong Ben Cao Jing > recorded In the Sui and Tang Dynasties, the theory of "wind phlegm can cause headache", "wind phlegm can lead to eye disease" and other related theories were put forward in the Wei, Jin, Sui and Tang Dynasties, and the exposition of Xu Sibo's "phlegm heat phase and dynamic wind" has laid a foundation for the theory development of "phlegm heat generating wind"; many records have been recorded. The prescription for the treatment of wind phlegm. In the two Song period, there was a discussion about the causes of the wind phlegm syndrome and the characteristics of the related syndromes; the treatment principle of "treating wind phlegm first along its Qi" was put forward; the treatment method and prescription of the wind phlegm syndrome were more specific, and the prescription for the later generations believed to have the effect of extinguishing the phlegm and treating the internal wind and carrying the phlegm syndrome. The theory of "internal wind" has been developed, and Zhu Danxi has put forward the theory of "phlegm heat generating wind". Many doctors interpret wind phlegm from the etiology, pathogenesis and clinical syndromes of wind and sputum, but still lack theoretical discussion on "internal wind carrying phlegm", and have created many representative prescriptions for later generations to put out the efficacy of weathering phlegm and treat the internal wind with phlegm syndrome. In the Ming and Qing Dynasties, the basic theory of wind and phlegm was enriched in the Ming and Qing Dynasties, and the principle of "Shu Feng and phlegm method to treat the external wind and the phlegm syndrome, the rule of extinguishing the phlegm with the wind and carrying the phlegm syndrome" was basically established. The records of the prescription were more specific, The method of "extinguishing the phlegm and eliminating phlegm" is put forward, and its treatment of internal wind and phlegm is clearly defined. In recent modern times, wind phlegm and wind and phlegm method are defined. The method of eliminating weathering phlegm is the treatment of wind phlegm with the wind and sputum. At the same time, it widens the scope of the treatment of disease by the method of extinguishing weathering phlegm; especially in clinical diagnosis and treatment, it pays more attention to the method of eliminating weathering phlegm and the method of activating blood and removing blood stasis. Combined with the basic theory of ".3.2", the basic concept of "3.2.1" to extinguish the weathering phlegm method is to extinguish the weathering phlegm method, which refers to the treatment of the internal wind carrying the phlegm with the combination of the prescription of the extinguishing wind medicine and the treatment of the internal wind with the phlegm. The specific methods include the elimination of the wind, the sputum extinguishing, the wind and the phlegm, the wind and the phlegm. In combination with the method of dredging collaterals, opening the orifices, dryness and damp method, clearing heat method, nourishing yin method, and activating blood method, the applicable scope of the related disease syndrome.3.2.2 extinguishing phlegm method (1) the etiology and pathogenesis of the internal wind carrying phlegm syndrome, the main cause of the disease includes the emotional failure, the loss of fatigue, the diet, the aging body and failure, the basic pathogenesis refers to the internal movement of the liver, the basic pathogenesis refers to the liver wind, and the basic pathogenesis. (2) there are three types of syndromes in the syndrome of internal wind carrying phlegm: liver wind carrying phlegm, blocking meridian, liver wind carrying phlegm, disturbing clear orifices, and carrying phlegm in the liver wind, the combined treatment of.3.2.3 quenching and weathering phlegm method of the heart God, the method of extinguishing the wind and phlegm and collaterals on the basis of extinguishing the wind and eliminating phlegm, combined with the method of dredging collaterals, is the main clinical treatment with the mouth eye, oblique, hemiplegia and so on. The treatment of wind and phlegm obstructing the collaterals of wind and collaterals of wind and phlegm obstructing the collaterals; the representative prescription has the true Fang Bazi pill, the wind and the phlegm pill, etc. the method of extinguishing the wind and eliminating phlegm, combining the method of opening the orifices on the basis of extinguishing the wind and eliminating phlegm, is used to treat the main clinical manifestation of the wind phlegm, which is the golden foil town heart pill and so on. The method refers to the treatment of the main clinical manifestations of the liver wind and the phlegm damp syndrome, with the treatment of headache and vertigo as the main clinical manifestation. The representative prescription is Banxia Baizhi Tianma soup. The method of clearing heat and eliminating weathering phlegm is used in combination with the method of clearing heat and extinguishing the weathering phlegm, and treating the phlegm thermal wind syndrome with high fever and two eyes as the main clinical manifestation. The treatment method: the representative prescription has amber holding the Dragon pill and so on. The method of nourishing yin and eliminating weathering phlegm means the combination of the method of nourishing yin and the method of eliminating the weathering phlegm. The treatment of wind phlegm and yin deficiency syndrome is treated; its indications are often accompanied by the basic syndromes of the internal wind and the phlegm, and often accompanied by the soft, flush, hand, foot and heart of the waist and knees, and the representative prescription has six flavors of rehmannia pill and Da tonic Yin pill. The method of extinguishing wind and promoting phlegm and activating blood circulation refers to the treatment of wind phlegm and blood stasis syndrome by quenching the sputum and activating blood and removing stasis. Its indications are often accompanied by numbness and pain of the limbs, purple dark and bruises in the tongue, except for the basic syndromes of internal wind carrying phlegm; the prescription of the representative prescription is on the basis of extinguishing the wind and phlegm, and the products of activating blood and removing blood stasis, such as Salvia miltiorrhiza,.3.2.4 extinguish weathering phlegm. The representative prescription of the method is the Banxia Baizhi Tianma soup to extinguish the weathered phlegm, invigorate the spleen and dampness, mainly treat the liver wind and the phlegm disturbance caused by the headache and vertigo. The treatment of phlegm and collaterals, the main treatment of the liver wind and phlegm, obstruct the meridian syndrome in the apoplexy of the meridian. The amber hold the Dragon pill to extinguish the weathering phlegm, to clear the heat and to be frightened, to treat the children with the wind and the phlegm heat, to extinguish the weathering phlegm in the golden foil town heart pill, to open the orifices, to treat the acute and slow shock with the liver wind to disturb the phlegm, the slow spleen, the fetal shock and the commonly used drugs to extinguish the weathering phlegm by.3.2.5. The representative drugs, such as Dun Nan star, Bombyx Silkworm, Southern Star, and bezoar, were summed up, and the frequency analysis of the prescriptions with the efficacy of extinguishing the wind and eliminating phlegm was carried out. It was found that the highest frequency of compatibility except for the extinguishing of wind and phlegm drugs was the antipyretic drug, the antipyretic drug, and the supplement of Qi, and the highest frequency of the single flavor drugs was the Gastrodia elata, scorpion, stiffness. Five diseases, such as apoplexy, epileptic syndrome, vertigo, vertigo, tremor, and infantile wind, were used in the combination of the combination of Rhizoma Aconiti with gastrodia elata, the compatibility of Rhizoma Pinelliae and Rhizoma Pinelliae in the combination of Gastrodia elata, Rhizoma silkworm and white aconite, and five diseases such as apoplexy, epilepsy syndrome, vertigo, tremor, and infantile wind. Analysis and summary are conducted with the analysis of the corresponding medical cases. Stroke is used to treat stroke with the treatment of weathering phlegm. It is mainly used to treat the meridian syndrome, the liver wind carries the phlegm and the wind phlegm stasis syndrome in the recovery period of the stroke, among which the liver wind carries the phlegm obstruction and the meridian syndrome, which is due to the deficiency of the liver kidney yin and the hyperactivity of yang hyperactivity, It is caused by blocking phlegm and obstructing the meridian and collaterals. The representative prescription has the real white ball, the wind and the phlegm pill added, the liver wind carries the phlegm in the viscera closed syndrome, which is due to the liver wind carrying the phlegm in Inner Mongolia Qing Qiao, representing the prescription with Ditan soup and so on; the wind phlegm stasis syndrome caused by the wind phlegm and stasis is caused by the wind phlegm and stasis block. The epilepsy syndrome is treated with the method of weathering phlegm to treat epileptic syndrome, the main treatment of epilepsy with wind phlegm blocking syndrome. On the basis of the wind internal motion, in the foundation of extinguishing the phlegm and eliminating phlegm on the basis of the combination of Chinese angelica, Salvia miltiorrhiza and blood circulation to remove stasis, vertigo and weathering phlegm method were used to treat vertigo, mainly to treat vertigo and phlegm disturbance. For a long time, the blood flow is not smooth, and the blood stasis is caused by blood stasis and blood stasis. The representative prescriptions are added and subtracted by the antelope horn and hooked Riner soup. The children's wind extinguishing wind and weathering phlegm method is used to treat children's wind, mainly treating the phlegm and thermal wind syndrome of children's wind. The representative prescription is amber holding dragon pill, Jin foil town heart pill, etc. In the treatment of other syndromes, such as the numbness of the wind and phlegm obstructing the meridians, the spasmodic syndrome, the headache caused by the wind phlegm, the wind phlegm and the mind caused by the heart, the epilepsy, the madness, etc.. In the clinical diagnosis and treatment of the disease, the combination of the disease and the syndrome, the rational use of the.4 research conclusion (1) to extinguish the weathering phlegm method, is to use the combination of the extinguishing drug and the chemical phlegm medicine. The treatment of internal wind and phlegm syndrome, including eliminating the wind, eliminating phlegm and extinguishing the wind, searching wind and eliminating phlegm, cutting wind and eliminating phlegm, often aimed at the pathogenesis of the disease and its specific syndrome characteristics, combined with the method of dredging collaterals, opening the orifices, dry wet method, heat clearing, nourishing yin method, living blood method and so on, in the treatment of the internal wind carrying the phlegm as the main pathogenesis of the disease. The cause of the wind carrying the phlegm syndrome mainly includes the emotional failure, the loss of labor, the diet and the aging and aging, the basic pathogenesis is the liver wind whirling, the phlegm disturbance and the extinguishing phlegm, including the liver wind carrying phlegm, the obstruction of the meridian syndrome, the liver wind carrying phlegm, the perturbed clearing syndrome, the liver wind carrying phlegm, the Inner Mongolia heart God syndrome. The representative prescription has Banxia. Baizhi Tianma soup, fixed eclampsia pill, fairy Jieyu Dan, real white ball, amber pellet, golden foil town heart pill, and other representative drugs with extinguishing wind and phlegm effect are Dan Nan star, white Bombyx Silkworm, Tiannan star, bezoar and so on. (2) there are a variety of diseases treated by clinical use of weathering sputum method, mainly used for stroke, epilepsy, vertigo, tremor, children's wind and other diseases. The method of analysis and extinguishing the weathering phlegm was mainly used to treat the meridian syndrome, the liver wind carrying the phlegm obstruction in the phlegm, the wind phlegm stasis syndrome in the recovery period of the stroke, the wind phlegm obstruction syndrome of the epileptic syndrome, the vertigo wind sputum perturbed syndrome, the phlegm heat syndrome of the tremor syndrome, the phlegm heat syndrome of the infantile wind, and so on. Besides, it was commonly used in treatment. Wind phlegm closed the meridian caused by numbness, spasmodic syndrome, wind phlegm to disturb the headache caused by clearing the orifices, wind phlegm blinded by the mind caused by the syncope, epilepsy, madness, and so on. Clinical, when the combination of disease and syndrome, dialectical legislation.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R242

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