董湘玉教授情志病学术观点及临床经验总结

发布时间：2018-08-28 12:03

【摘要】：董湘玉教授,籍贯四川省平昌县,毕业于贵阳中医学院,曾师老中医许玉鸣先生,主任医师、硕士生导师、师承硕博士导师,是全国第五批老中医药专家学术经验继承工作指导教师,贵州省第一届名中医。她苦研《内经》、《伤寒论》、《金匮要略》等经典著作,注重前贤医家之说,仲景之学,从“中医基础理论”课、“内经”课教师开始,临证验学。从脾胃病临床入手,渐感所遇脾胃病患者,多为情志所扰。遂逐其奥,探求情志疾病医理,发现运用传统中医心理学理论指导临床,所效者众,但业内实践者少。孜孜以求,近四十载如一日,勤读书,多临证,著书立说,为中医心理学默默奉献,是现今《中医心理学》临床应用的践行者。她开创贵州中医心理学先河,在全国率先创办贵阳中医学院中医医学、心理学双学位办学模式,使中医心理专业学生既有心理学学位又有中医临床学位,将中医心理医生和临床医生二合一,广获赞誉,为中医心理专业培养了大批实用型人才,桃李满天。侍诊中,感受到董老不仅具有深厚的医学知识和丰富的临床经验,而且在工作、生活中和蔼可亲,作风严谨,一丝不苟,是我们学习的榜样。三年的侍诊和学习,不仅看到了董老师对中医事业的求索专研,更是感受到董老扎实的中医内涵和独特的诊疗技术,本文主要从三个方面进行阐述。第一方面是对董老学术渊源的概述及归纳董老对于中医心理学的认识及贡献。董老不仅吸纳了《内经》、《伤寒》、《金匮》中对情志疾病有关的理论体系、诊疗特点及情志与五脏关系方面的学说,且对中医心理学思想进行了挖掘和归纳并实践于临床,为中医心理学的理论研究及推广、教学默默奉献,成果斐然,饯行“形神合一”思想指导情志疾病临床辨证论治。第二方面是对董老学术思想和临床经验的总结。跟师学习三年,随诊和整理董老病案,认为董老学术思想：一是重视中医心理学的临床应用(情志疾病的治疗)。崇尚仲景学说,“方证相应”、“病机相从”使用经方来治疗情志疾病。二是重视“气机”对于情志疾病的重要性。在辨证中处处以“气机”为核心。三是在具体治疗中,老师注重药疗、意疗、放松疗法相结合,始终贯穿“心身同治”学术思想。四是诊法合参重问诊。形成了对于情志疾病特有的治病求本的辨证论治思想体系。临床用药上讲求“药证相应、依法化裁”,善用“气药”。如重视中医心理学的临床应用(情志疾病的治疗)。她不但在理论研究领域硕果累累,而且勤于实践,用自己的行动证明了中医心理学的临床实效性,重视“经方”对于情志疾病治疗的有效性研究,并通过自己几十年的临床实践,总结出了一套运用“经方”药物治疗情志疾病的理论体系,即“方证相应”、“病机相从”学说,并用大量的实例证明了她理论的实效性。重视“气机”对于情志疾病的重要性。董老认为现代生活方式和社会环境特点,凡情志疾病的发生,无论外感或内伤皆源于“气机”失衡,认为情志疾病以“气机调畅”为重。在辨证中处处以“气机”为核心。通过调“气”来调和脏腑阴阳的平衡,达到阴平阳秘,脏腑气血功能和谐的目的。善用疏理气机、滋阴、活血化瘀、调和阴阳法等方法调和“气机”,治疗各种中医情志疾病。在具体治疗中,老师注重药疗、意疗、放松疗法相结合,始终贯穿“心身同治”学术思想,讲究形神合一。所以在辨证治疗上是整体考虑,治疗上也是将药物治疗和情志放松疗法配合使用方能起到良好的效果。如顺情从志、说理开导、情志相胜、移精变气、行为治疗、占梦术、摄心术等等诊法合参重问诊。通过“问诊”与患者进行良好的互动和沟通,运用询问、引导、舒解、共情等技巧和方法,让患者乐于配合,事半功倍。问诊尤重大便与睡眠。通过询问大便情况来掌握疾病的性质。故通过询问大便性状、频率、颜色可反映脾、胃、肠,气机运转情况,脾、胃、肠气机畅顺与否,对于情志疾病的转归、和预后都有着至关重要的作用,对于病情的判断尤为重要；董老问诊,也十分重视询问睡眠情况。因为睡眠与人体卫气的循行和阴阳的气机变化和盛衰有十分密切的关系。阴阳失调,必然影响心神,神志不安乃致失眠,情志疾病多半都会有睡眠的障碍和不调。而且通过对于“梦境”的分析,也能运用“释梦”的方法,分析出情志疾病的根源,有助于情志疾病的诊疗,所以老师临证时每每重视患者睡眠情况的询问。临床用药上也有独特之处。讲求“药证相应、依法化裁”,善用“气药”。所谓“药证相应、依法化裁”是指经方中的每一味药,常常都有它的位置,它的主治。认识了药物主治,以药测证,才会知道方剂的加减；处方时依据每首“经方”所含的“法”,就是“经方法则”进行化裁。通过对“经方”治疗疾病内含的“法则”的认识,有针对性的选择相应的药物达到治疗的目的。也许药味不尽相同,但是“法则”正确,一样可以收到很好的效果；老师在治疗情志疾病时,时刻不忘调理气机,行气导滞,董老认为人的五脏六腑,肌肉筋骨均以气血为纽带相互联系成为整体,如果运行畅顺,没有瘀滞身体就能平和健康,反之则疾病丛生。基于这个观点,老师用药的时候,每首方子都不忘行气药物的运用。第三方面是继承与创新。鉴于董老治疗“不寐”在临床有明显的特色,取得了较为满意的疗效。故对临床侍诊时收集的“不寐”病案,用“中医传承辅助系统”软件,对其组方规律进行分析和总结。达到深入了解处方人对疾病的认识、组方的思路和用药的特点,对中医药的学术继承与创新有重要意义。采用规则分析、改进的互信息法、复杂系统熵聚类、无监督的熵层次聚类、等数据挖掘方法,总结出董老治疗“不寐”的新方和用药内在规律,为实现传统经验数据化做出了有益的尝试。
[Abstract]:Professor Dong Xiangyu, a native of Pingchang County, Sichuan Province, graduated from Guiyang College of Traditional Chinese Medicine, Mr. Xu Yuming, a senior doctor, a master's supervisor, a master's supervisor, and a master's supervisor, is the fifth group of experts of traditional Chinese medicine in China to inherit their academic experience, and the first Chinese medicine teacher in Guizhou Province. Classic works, pay attention to the theory of former doctors, Zhong Jing's learning, from the "basic theory of traditional Chinese medicine" class, "internal classics" class teachers, clinical experience. But there are few practitioners in this field who have been working hard for nearly forty years. They have studied diligently, had more clinical symptoms, written books and written their opinions. They are silently dedicated to the psychology of traditional Chinese medicine, and are practitioners of the clinical application of Psychology of Traditional Chinese Medicine. Students majoring in medical psychology have both a degree in psychology and a degree in clinical medicine. They have combined traditional Chinese medicine psychologists with clinicians and won wide acclaim. They have trained a large number of practical talents for the specialty of Chinese medicine psychology. Three years of attendance and study, not only saw Mr. Dong's pursuit of the cause of Chinese medicine, but also felt that Mr. Dong's solid connotation of Chinese medicine and unique diagnostic and therapeutic techniques, this article mainly from three aspects to elaborate. The first aspect is an overview of Dong's academic origins and This paper summarizes Dong Lao's understanding and contribution to the psychology of traditional Chinese medicine.Dong Lao not only absorbed the theory system related to emotional diseases, diagnosis and treatment characteristics, but also the theory of the relationship between emotions and the five viscera in < Neijing >, < typhoid fever >, < Jinkui >. The second part is the summary of Dong Lao's academic thought and clinical experience. After three years'study with his teachers, he followed up and sorted out Dong Lao's medical records. Advocate Zhongjing theory, use classical prescriptions to treat emotional diseases, and emphasize the importance of Qi-Qi. Put Qi-Qi at the core of syndrome differentiation. Thirdly, in the specific treatment, the teacher pays attention to the combination of medication, intention therapy and relaxation therapy, and always runs through "the same treatment of mind and body". Academic thinking. Fourthly, diagnostic methods combined with consultation. Formed a unique thought system of syndrome differentiation and treatment for emotional diseases. In clinical medication, it emphasized "corresponding medicines and syndromes, tailored according to law", and made good use of "Qi medicine". For example, it emphasized the clinical application of psychology of traditional Chinese medicine (the treatment of emotional diseases). She not only made great achievements in the field of theoretical research, but also made great achievements. And diligent in practice, with their own actions to prove the clinical effectiveness of traditional Chinese medicine psychology, pay attention to the effectiveness of "Jingfang" for the treatment of emotional diseases, and through their own decades of clinical practice, summed up a set of "Jingfang" drug treatment of emotional diseases theoretical system, that is, "recipe and syndrome correspond" and "pathogenesis follow" study. Dong Lao believed that the occurrence of all emotional diseases, whether external or internal, originated from the imbalance of Qi and Qi. He believed that emotional diseases were mainly caused by Qi and Qi. "Qi" is the core. Through "Qi" to balance the Yin and Yang of viscera and viscera, to achieve the purpose of Yin and Yang secretion, viscera and blood function harmony. Combination, always run through the "mind-body treatment" academic thinking, pay attention to the unity of form and spirit. So in the treatment of syndrome differentiation is considered as a whole, treatment is also the combination of drug treatment and emotional relaxation therapy can play a good effect. The patient is willing to cooperate and get twice the result with half the effort through good interaction and communication with the patient through "inquiry". It is especially important to inquire about stool and sleep. It is very important to judge the prognosis and prognosis of emotional diseases, and it is also very important for Dong Lao to inquire about the sleep condition. Yang disorder, will inevitably affect the mind, restlessness is caused by insomnia, emotional diseases will mostly have sleep disorders and imbalance. And through the analysis of "dream" can also be used to "dream" method, analysis of the root causes of emotional diseases, help the diagnosis and treatment of emotional diseases, so the teacher always pay attention to the patient's sleep inquiries. Question. Clinical medication is also unique. Emphasis should be laid on "corresponding medication and syndrome, tailoring according to law" and making good use of "qi medicine". The "method" contained in it is to modify the "principle of classical methods". Through the understanding of the "rule" contained in the "prescription" for the treatment of diseases, we can select the corresponding drugs to achieve the purpose of treatment. Don't forget to regulate Qi and conduct Qi stagnation. Dong Lao thinks that the five viscera, muscles, tendons and bones are linked by Qi and blood as a whole. In view of the obvious clinical characteristics of Dong Lao's treatment of insomnia, satisfactory results have been achieved. Therefore, the "insomnia" medical records collected during clinical service were analyzed and summarized with the software of "Chinese Medicine Inheritance assistant system" to get a better understanding of the prescription's knowledge of the disease and the thinking of the prescription. It is of great significance for the academic inheritance and innovation of traditional Chinese medicine to summarize Dong Lao's new prescription and the inherent law of medication by using data mining methods such as rule analysis, improved mutual information method, complex system entropy clustering, unsupervised entropy hierarchical clustering and so on. Try.
【学位授予单位】：成都中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R277.7

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