王书臣教授治疗慢性咳喘病经验总结及诊治特发性肺纤维化经验的数据挖掘

发布时间：2018-08-19 13:19

【摘要】：王书臣教授是全国著名的中医呼吸病专家,是第五批全国老中医药专家学术经验继承工作指导老师,是中国中医科学院西苑医院肺病科学科带头人,王教授从事呼吸临床、教学和科研工作40余年,笔者有幸师从王教授,通过近三年的跟师学习,在王教授的指导下,从笔者的理解层次,总结出王教授从元气论治慢性咳喘病本虚证和从“金郁泄之”论治慢性咳喘病标实证的临床经验。并通过数据挖掘方法总结王教授诊疗特发性肺纤维化的具体临床经验。第一部分王书臣教授治疗慢性咳喘病经验总结目的:通过总结王书臣教授治疗慢性咳喘病的临床经验,从而使我们能够继承和运用王教授的经验。方法:通过临床跟师学习、师生问答、诊后教学、病案分析、结合中医经典理论和文献研究,从点到面的具体分析,再从面到点的总结,整体化一,提纲挈领,总结王书臣教授诊疗肺病的思路方法和用药精华,并形成学术思想。结果:1.王书臣教授从元气论治肺病虚证的学术思想,包含“温煦命门、激发元气”,“培补元气、升举元气”,“疏通三焦、敷布元气”的具体思路方法。此三大方法相辅相成,一脉相承,以仙茅、仙灵脾、补骨脂三味要药温煦水脏,使命门之火得“动气”之激发而上升,同时配合大量黄芪,引黄芪之气于命门之间,直填命门真元之气,并以黄芪和葛根共同升举元气上腾,从而行于中土,促脾胃之精微以灌四傍;举于胸中,助肺气精微泽布周身。2.王书臣教授以“金郁泄之”论治慢性咳喘病的临床经验,其理论立足于《黄帝内经》,从五运六气推演“金郁泄之”的基本含义,从肺的宣发肃降功能拓展“金郁泄之”理论的运用范畴,并在临床运用时,形成了“宣泄法”、“透泄法”、“清泄法”、“开泄法”、“疏泄法”(包括疏肺解郁法和疏理气血法)、“渗泄法”、“通泄法”七大具体治疗思路。结论:王书臣教授认为慢性咳喘病多为本虚标实证,常常以从元气论治本虚证,从“金郁泄之”论治标实证,标本结合。第二部分王书臣教授诊治特发性肺纤维化经验的数据挖掘目的:运用数据挖掘技术,总结王书臣教授诊治特发性肺纤维化的具体临床经验。对象:纳入研究对象为2015年02月—2017年02月期间,就诊于中国中医科学院西苑医院王书臣教授门诊的初诊IPF患者,根据纳入标准筛选出107例符合要求的病例。方法:采用中国中医科学院西苑医院病例采集系统,通过《名老中医学术思想挖掘平台》进行挖掘,统计特发性肺纤维化患者的临床症状、证候分型、治法治则及用药频次等;运用Apriori算法,挖掘王书臣教授诊治IPF的药物配伍关系和规律;通过双聚类分析法,挖掘王教授治疗IPF的用药特点。采用人机结合的方式,全面整体和总结王书臣教授诊治特发性肺纤维化的临床经验。结果:1.主要临床表现:经过王教授诊疗的107例IPF患者中,挖掘结果显示喘息、倦怠乏力、胸闷胸痛、咳嗽痰多为主,多伴有嘴唇色暗、杵状指等,其他常见的伴随症状为周身困重、纳差、口干、便秘、咽部异物感、夜尿频繁、失眠、头昏头晕、心悸、畏寒、咽痛、眼睛干涩、多汗、腰膝酸软等。2.舌脉:本次挖掘统计中,舌脉按照舌色、舌形、舌苔,脉象按照浮沉、虚实、迟数、宽细分别列出记录和统计,并根据王教授的经验和指导进行确认。结果显示常见的舌色为舌暗、舌色降红、舌色淡白、舌红;常见舌形为舌下络脉瘀曲、老舌、嫩舌、胖大舌、齿痕舌、瘦薄舌、裂纹舌、点刺舌;常见舌苔为苔少、薄黄苔、黄腻苔、白腻苔、薄白苔、剥落苔。脉象浮沉:三关各异,寸部浮脉77.6%、沉脉13.1%,关部浮脉67.3%、沉脉16.8%,尺部浮脉2.8%、沉脉84.1%;脉象虚实:虚脉63.6%,实脉30.8%;脉象相对数缓迟分别为:数脉71%,缓脉21.5%,迟脉7.5%;脉象宽细:宽脉12.2%,细脉54.2%,其余的33.6%。3.中医证型:常见中医证型依次为血瘀证、气虚证、风湿痹阻证、肺经郁热证、气阴两虚证、阴津亏虚证、痰湿内蕴证、痰热壅肺证、阳虚证、寒饮停肺证。4.治则治法:常用治法治则依次为:培补元气102次(95.3%),活血化瘀99次(92.5%),祛湿通络88次(82.2%),清热泻肺47次(43.9%),化痰散结44次(41.1%),养阴生津35次(32.7%),止咳平喘27次(25.2%),祛风透邪19次(17.8%),温阳散寒11次(10.3%)。对于本虚证,治法以培补元气、养阴生津、温阳为主;对于标实证,以活血化瘀、祛湿通络、清热泻肺、化痰散结、祛风透邪、散寒为主。5.中药:在107例病例中,共使用93种,前25味药物依次为炙黄芪、仙茅、淫羊藿、莪术、水蛭、络石藤、威灵仙、地龙、穿山龙、青风藤、姜半夏、桑白皮、干姜、麦冬、地骨皮、丝瓜络、黄连、虎杖、南沙参、黄芩、浙贝母、前胡、蝉蜕、炒杏仁、葛根,其中前16味药物用药频次均超过50%。根据关联挖掘出的常用药物配伍为仙茅与淫羊藿,黄芪与威灵仙,黄芪与仙茅、淫羊藿,黄芪与莪术,黄芪与水蛭,仙茅与威灵仙,威灵仙与水蛭,威灵仙与络石藤,水蛭与地龙,地龙与穿山龙等,并且炙黄芪、仙茅、淫羊藿、莪术、水蛭、络石藤、威灵仙、地龙八味药的关联支持度高达0.628125。中药用药异常点挖掘显示炒枣仁、灯芯草、茉莉花、苦参、大枣等。而这些常用药物均体现了前面的常用治法治则。结论:1.本病为本虚标实之证,本虚以气虚、气阴两虚为主,标实以瘀血、风寒湿阻、肺经郁热、痰湿、痰热、寒饮为主。2.王教授以培补、激发、升举、敷布元气的方法治疗肺痹本虚证,从“金郁泄之”的思路治疗肺痹标实证。
[Abstract]:Professor Wang Shuchen is a well-known expert on respiratory disease of traditional Chinese medicine in China. He is the fifth instructor to inherit the academic experience of the experts of traditional Chinese medicine. He is the leader of the Department of pulmonary disease in Xiyuan Hospital of Chinese Academy of Traditional Chinese Medicine. Professor Wang has been engaged in respiratory clinic, teaching and scientific Research for more than 40 years. Under the guidance of Professor Wang and from the understanding level of the author, this paper summarizes Professor Wang's clinical experience in treating chronic cough and asthma with the theory of Yuan Qi and the syndrome of deficiency of root and syndrome of chronic cough and asthma with the theory of "Jin Yu Xie Zhi". Objective: To summarize Professor Wang Shuchen's clinical experience in treating chronic cough and asthma, so that we can inherit and apply Professor Wang's experience. Methods: Through clinical follow-up study, teachers and students question and answer, teaching after diagnosis, case analysis, combined with classical theory of Chinese medicine and literature research, from point to face specific points. Results: 1. Professor Wang Shuchen's academic thought of treating deficiency syndrome of lung disease from the theory of vital energy, including "warming vital gate, stimulating vital energy", "cultivating vital energy, lifting vital energy", "dredging triple-focus, compressing" These three methods complement each other and come down in one continuous line. They are Xianmao, Xianling Spleen and Psoralea corylifolia to warm the water and viscera. The fire of the mission gate is stimulated by "dynamic qi" and rises. At the same time, with a large number of astragalus, the Qi of Astragalus is induced between Mingmen, filling the true vitality of Mingmen, and with Astragalus and pueraria to lift the vitality together. Professor Wang Shuchen's clinical experience in treating chronic cough and asthma based on the theory of "Huangdi Neijing". He deduced the basic meaning of "Jinyu Xie" from the five movements and six qi, and expanded the function of "Jinyu Xie" from the proclamation and purge of the lung. The application category of the theory of Jinyu Xiezhi has formed seven specific treatment methods in clinical application. Conclusion: Professor Wang Shuchen thinks that chronic cough and asthma are mostly based on the theory of "catharsis", "catharsis", "catharsis", "catharsis", "catharsis", "catharsis", "catharsis", "catharsis", "catharsis". The second part is the data mining purpose of Professor Wang Shuchen's experience in the diagnosis and treatment of idiopathic pulmonary fibrosis. From February 2015 to February 2017, 107 IPF patients were selected according to the inclusion criteria. Methods: The case collection system of Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine, was used to excavate the IPF patients through the platform of academic thought excavation of famous and old Chinese medicine. The clinical symptoms, syndrome types, therapeutic principles and drug use frequency of patients with idiopathic pulmonary fibrosis were calculated; Apriori algorithm was used to excavate the compatibility and regularity of Professor Wang Shuchen in the treatment of IPF; the characteristics of Professor Wang's medication in the treatment of IPF were excavated by double cluster analysis. Results: 1. Main clinical manifestations: In 107 IPF patients treated by Professor Wang, the digging results showed that wheezing, tiredness, chest tightness, chest pain, cough and sputum were mainly accompanied by dark lips, clubbing fingers, and other common accompanying symptoms were body distress, poor appetite, dry mouth, constipation, pharyngeal foreign bodies. Feeling, frequent nocturia, insomnia, dizziness, palpitations, chills, sore throat, dry eyes, sweating, waist and knee soreness and so on. 2. Tongue and pulse: In this excavation statistics, according to tongue color, tongue shape, tongue fur, pulse according to floating, virtual and real, late number, width and subdivision of records and statistics, and according to Professor Wang's experience and guidance to confirm. The color of the tongue is dark, the color of the tongue is reddish, the color of the tongue is pale, the color of the tongue is red; the common tongue is sublingual collateral blood stasis, old tongue, tender tongue, fat tongue, dental mark tongue, thin tongue, cracked tongue, puncture tongue; the common tongue fur is less fur, thin yellow fur, yellow greasy fur, white fur, thin white fur, peeling fur. 8%, ulnar floating pulse 2.8%, sinking pulse 84.1%; pulse deficiency and excess: deficiency pulse 63.6%, solid pulse 30.8%; relative number of pulse retardation are: several pulse 71%, slow pulse 21.5%, late pulse 7.5%; pulse width: wide pulse 12.2%, fine pulse 54.2%, the rest 33.6%. 3. TCM syndromes: common TCM syndromes are blood stasis, Qi deficiency syndrome, rheumatic arthralgia syndrome, lung meridian depression and heat syndrome, Qi and yin deficiency syndrome, Yin deficiency syndrome, Yin and yin deficiency syndrome. Syndrome of deficiency of body fluid, accumulation of phlegm and dampness, phlegm-heat obstruction of lung, Yang-deficiency syndrome, cold-drink stopping lung syndrome. 4. Therapeutic principles and methods: 102 times (95.3%), 99 times (92.5%) of promoting blood circulation and removing stasis, 88 times (82.2%) of dispelling dampness and dredging collaterals, 47 times (43.9%) of clearing away heat and purging lung, 44 times (41.1%) of dissipating phlegm, 35 times (32.7%) of nourishing yin, 27 times (25.2%) of relieving cough and relieving asthma, 27 times (eliminating wind 19 times of evil (17.8%), 11 times of Warming Yang and dispersing cold (10.3%). For this deficiency syndrome, the treatment methods are mainly to nourish the vital energy, nourish yin and promote fluid flow, and warm yang; for the syndrome, the main treatment methods are promoting blood circulation and removing blood stasis, dispelling dampness and dredging collaterals, clearing away heat and reducing lung, resolving phlegm and dispelling stagnation, dispelling wind and clearing away evil, and dispersing cold. 5. Rhizoma Atractylodis, Leech, Lushiteng, Willingxian, Earthworm, Pangolin, Sinensis, Pinellia ternate, Morus alba, Dry ginger, Ophiopogon japonicus, Earthbone bark, Luffa gourd collateral, Coptis chinensis, Polygonum cuspidatum, Radix Astragali, Nanshashen, Radix Scutellariae, Fritillariae Fritillariae Fritillariae, Peucedanum, Cicada mollus, Puerariae Root, of which the first 16 medicines are more than 50%. Supportive degree of association between Astragalus membranaceus, celestial fescue, epimedium, Astragalus and zedoary, Astragalus and leech, celestial fescue and celestial fescue, celestial fescue and celestial fescue, leech and leech, celestial fescue, leech and earthworm, earthworm and pangolin, and fried astragalus, celestial fescue, epimedium, zedoary turmeric, leech, celestial fescue, earthworm and eight kinds of medicines were as high as 0.8125. Frequent excavation showed stir-fried jujube kernel, rush grass, Jasmine flower, Sophora flavescens, jujube and so on. And these commonly used drugs reflect the previous common treatment principles. Conclusion: 1. This disease is based on deficiency and excess syndrome, deficiency of Qi, deficiency of both Qi and Yin, excess with blood stasis, wind-cold-dampness obstruction, lung meridian depression and heat, phlegm-heat, cold drinks mainly. 2. Professor Wang to invigorate, stimulate, ascend. To apply the method of compacting cloth and Qi to treat asthenia syndrome of lung Bi syndrome, and to treat lung Bi syndrome by the idea of "Jin Yu Xie".
【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】：2017
【分类号】：R249;R256.12

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