刘华为学术思想及开降分消汤治疗冠心病心绞痛（痰浊痹阻）临床研究

发布时间：2018-08-30 13:40

【摘要】：刘华为教授为全国第四、五批老中医药专家学术经验继承工作指导老师,陕西省名中医,从医四十载,中医理论造诣深厚,临床经验丰富,擅治内科疑难杂症,尤其对冠心病、高血压病、心律失常等疾病有着自己独特的学术见解和临床经验,研究总结导师的学术特色与临床经验,从而继承与发扬传承中医。1.刘华为教授学术思想与临床经验的整理研究刘华为教授熟谙经典,博览群书,师古而不泥古,重视对《内经》、《伤寒论》、《金匮要略》、《温病学》四大经典的研究,临床精于辨证,强调脾胃,重视肝胆,崇尚重阳的学术理念。总结刘华为教授学术思想有：强调整体观念；坚持辨病、辨证相结合；注重脏腑气机气化；强调脾胃,重视肝胆；临床常用“调气机,促气化”理念的方剂；重视阳气；秉承“少火生气”理念,临床擅用附子;充分发挥合方优势,体现整体思维。刘华为教授临床擅治内科疑难杂症,对心血管疾病治疗有自己的特色,总结刘华为教授临床经验,以“辛开苦降法”为主导创制的开降分消汤治疗冠心病心绞痛(痰浊痹阻证)；运用脏腑辨证,以“脏腑气机气化”理念指导心律失常、高血压病、肺癌、食道癌、慢性胃炎及肝硬化等疾病的治疗。创新点：(1)以“辛开苦降法”为主导创制的开降分消汤,是以半夏泻心汤、温胆汤及五苓散合方变化而来,全方通过化痰、降痰、消痰达到畅气机、促气化、通心脉之功效,体现了中医的整体观。(2)开降分消汤可以改善临床症状及血脂、血清纤维蛋白原水平,为中医药治疗冠心病心绞痛提供了新的思路和方法。(3)本研究通过运用“脏腑气机气化”理念对冠心病心绞痛的病机及治疗的阐释,首次系统总结了刘华为教授的学术渊源及学术理念,对继承和推广刘华为教授的经验具有十分重要的意义。2.开降分消汤对冠心病心绞痛(痰浊痹阻证)的临床研究冠心病心绞痛相当于中医学“胸痹”、“心痛”、“真心痛”等范畴。近年来随着人们生活节奏的加快及生活方式、饮食结构的改变,冠心病心绞痛的发病率呈逐年上升趋势,且发病年龄趋于年轻化,严重威胁着人们的生命和健康,已成为当今社会的常见疾病。中医学在冠心病的证候研究、病因病机及治疗方面积累了丰富的经验,因此探索从中医药预防和治疗冠心病的道路势在必行。刘华为教授总结各家对冠心病中医病因病机的认识,沿袭《金匮要略》中胸痹“阳微阴弦”的病机,认为冠心病是由于脏腑气机失调,气化失司,导致痰、湿、水、浊、瘀等病理性代谢产物内停,痹阻心脉而致,而痰浊痹阻是冠心病发病的主要病机,其病位在心,涉及肝、脾、肾,但与胆及脾(胃)关系密切相关。临床采用“辛开苦降法”为主导创制的开降分消汤对冠心病患者进行临床疗效及血脂、血清纤维蛋白原等临床观察研究,以探讨开降分消汤治疗冠心病的临床疗效及作用机制,从而进一步总结和发扬名老中医的学术经验。研究目的：(1)总结刘华为教授学术思想和临床经验,在此基础上进行继承和发扬。(2)通过观察以“辛开苦降法”为主导创制的开降分消汤对冠心病心绞痛(痰浊痹阻证)患者治疗前后临床疗效及心电图的影响,对血脂、血清纤维蛋白原水平的影响,探讨开降分消汤对冠心病的疗效及对血脂、血清纤维蛋白原指标的干预机制以及中西医结合治疗冠心病心绞痛的独特优势。方法：(1)学习老师发表的论文和著作,整理学术思想。(2)跟师过程中,通过老师授课、抄方学习的方法,记录老师处方用药及辩证施治的特点,对其临床经验进行总结。(3)临床研究：采用随机对照试验方法,选取冠心病稳定型心绞痛患者120例。所有患者按对照组：治疗组=1：1比例分为西药组(对照组)及中西药结合组(治疗组),每组60例。西药组口服单硝酸异山梨酯片、拜阿斯匹灵片及阿托伐他汀钙片。中西药结合组在西药组治疗基础上联合口服开降分消汤,共给药4周。4周末观察治疗前后两组患者的临床病情评分及心电图疗效,检测患者总胆固醇、甘油三酯、高、低密度脂蛋白及血清纤维蛋白原水平,上述结果均进行治疗前后组内对比观察及治疗后组间对比观察。数值用均数±标准差(x±S)表示,计量资料分析采用t检验及方差分析：组间比较采用独立样本t检验,组内治疗前后比较采用配对样本t检验,组间比较采用方差分析；计数资料分析采用卡方检验：率的比较采用卡方检验；等级资料比较采用Riddit分析。结果：(1)治疗前后组内比较,两组心绞痛疗效及中医症状评分均明显降低(P0.05)；两组在心绞痛疗效、心电图疗效、中医证候疗效显效率及总有效率方面均有不同程度改善。治疗前后组间比较,治疗组在心绞痛、心电图及中医证候疗效显效率方面明显优于对照组(P0.01)。(2)治疗前后血脂比较,对照组TG、TC、LDL-C、HDL-C值治疗前后无显著性差异(P0.05)；治疗组TC、LDL-C值显著降低(P0.05), HDL-C值显著升高(P0.01),TG值治疗前后无显著性差异(P0.05),说明治疗组能显著降低TC、LDL-C值,升高HDL-C值。两组间治疗后比较,治疗组在降低LDL-C值及升高HDL-C值方面疗效优于西药组(P0.05)。(3)治疗前后血清纤维蛋白原(FIB)组内比较：对照组P0.05,统计学无显著性差异；治疗组P0.05,统计学有显著性差异,说明治疗组能显著降低FIB水平。治疗前后组间比较,治疗组在降低FIB值方面疗效明显优于对照组(P0.01)。结论：研究表明开降分消汤治疗冠心病心绞痛(痰浊痹阻证)患者,可改善心绞痛症状,而且在心绞痛、心电图及中医证候疗效方面效果显著,并可降低患者TC、LDL-C值,升高HDL-C值及降低血清纤维蛋白原水平。可见痰浊痹阻是冠心病心绞痛发生发展的重要病机之一。由此推测运用“辛开苦降法”即通过化痰利湿,畅气机,促气化来调节体内血脂、血清纤维蛋白原水平可能是抗冠心病心绞痛的机制之一。开降分消汤联合鲁南欣康、拜阿斯匹灵及阿托伐他汀钙片的中西医结合治疗,能明显改善心绞痛及血脂、血清纤维蛋白原水平。本研究为中西医结合治疗冠心病心绞痛(痰浊痹阻证)提供了科学、客观的依据,为进一步探讨该方作用机理的研究奠定了基础。
[Abstract]:Professor Liu Huawei is the fourth and fifth group of experts of traditional Chinese medicine in China who have inherited their academic experience. He has been a famous Chinese doctor in Shaanxi Province for forty years. He has profound theoretical knowledge and rich clinical experience in traditional Chinese medicine. He is good at treating difficult and complicated diseases in internal medicine, especially coronary heart disease, hypertension and arrhythmia. Professor Liu Huawei's academic thought and clinical experience collation and research Professor Liu Huawei familiar with the classics, read a large number of books, teach ancient but not muddy ancient, attach importance to the < Neijing >, < typhoid fever theory >, < Jinkui Yaojie >, < Febrile Disease > four classics of research, clinical proficiency in syndrome differentiation. Professor Liu Huawei's academic thoughts are summarized as follows: emphasizing the overall concept; insisting on the combination of disease differentiation and syndrome differentiation; emphasizing the viscera-qi qi-qi-qi-qi-qi-qi-qi-qi-qi-qi-qi-qi-qi-regulating; emphasizing the spleen-stomach and liver-gallbladder-qi-regulating; emphasizing yang-qi-regulating; adhering to the principle of "less fire-qi-qi-qi-qi-regulating" Professor Liu Huawei is good at treating difficult and complicated diseases in internal medicine and has its own characteristics in the treatment of cardiovascular diseases. Differentiation of zang-fu organs, the concept of "Zang-fu Qi Qi Qi Qi" to guide the treatment of arrhythmia, hypertension, lung cancer, esophageal cancer, chronic gastritis and liver cirrhosis. (2) Kaijiangfenxiao Decoction can improve clinical symptoms and blood lipids, serum fibrinogen levels, and provide new ideas and methods for the treatment of coronary heart disease angina pectoris. (3) This study through the use of the concept of "viscera-qi Qi qi" on coronary heart disease angina pectoris. The explanation of the pathogenesis and treatment of pain is the first systematic summary of Professor Liu Huawei's academic origins and academic concepts. It is of great significance to inherit and promote Professor Liu Huawei's experience. 2. Clinical study of Kaijiang Fenxiao Decoction on coronary heart disease angina pectoris (phlegm turbidity obstruction syndrome). Angina pectoris equivalent to "chest pain" and "heart pain" in TCM. In recent years, with the acceleration of people's life rhythm and the change of lifestyle and dietary structure, the incidence of coronary heart disease angina is increasing year by year, and the age of onset tends to be younger, seriously threatening people's lives and health, has become a common disease in today's society. Professor Liu Huawei summarized the understanding of the etiology and pathogenesis of coronary heart disease, followed the pathogenesis of "Yang-Wei-Yin-string" in "Synopsis of the Golden Chamber" and "Zhongxiong-Bi". He believed that coronary heart disease was caused by the disorder of viscera-qi and qi-qi. The main pathogenesis of coronary heart disease is phlegm turbidity obstruction, which is located in the heart, involving the liver, spleen and kidney, but closely related to the gallbladder and spleen (stomach). Objective: (1) Summarize Professor Liu Huawei's academic thought and clinical experience, and carry forward and carry forward on this basis. To observe the effect of Kaijiangfenxiao Decoction on clinical efficacy and electrocardiogram, blood lipid and serum fibrinogen levels in patients with coronary heart disease and angina pectoris (phlegm turbidity obstruction syndrome) before and after treatment, and to explore the effect of Kaijiangfenxiao Decoction on coronary heart disease and its intervention on blood lipid and serum fibrinogen indexes. Methods: (1) Learn the papers and works published by the teacher, sort out the academic ideas. (2) In the process of follow-up, record the characteristics of prescription medication and dialectical treatment by the teacher, and summarize the clinical experience. 120 patients with stable angina pectoris were divided into western medicine group (control group) and combination of traditional Chinese and Western medicine group (treatment group) according to the ratio of 1:1. The western medicine group was given isosorbide mononitrate tablets, aspirin tablets and atorvastatin calcium tablets orally. On the basis of the treatment of the drug group and oral Kaijiangfenxiao Decoction, the clinical condition score and electrocardiographic efficacy of the two groups were observed at the end of 4 weeks. The levels of total cholesterol, triglyceride, high, low density lipoprotein and serum fibrinogen were detected. The results were compared before and after treatment in the two groups. The data were analyzed by t test and variance analysis. The comparison between groups was performed by independent sample t test. The comparison between groups before and after treatment was performed by paired sample t test. The comparison between groups was performed by variance analysis. Results: (1) Before and after treatment, the curative effect of angina pectoris and the score of TCM symptoms were significantly lower in both groups (P Pain, electrocardiogram and TCM syndromes were significantly better than the control group (P 0.01). (2) Before and after treatment, blood lipid, control group TG, TC, LDL-C, HDL-C before and after treatment, there was no significant difference (P 0.05); treatment group TC, LDL-C value significantly decreased (P 0.05), HDL-C value significantly increased (P 0.01), TG value before and after treatment had no significant difference (P 0.05), indicating that treatment group TC, LDL-C value significantly increased (P 0.05). After treatment, the therapeutic effect of the treatment group was better than that of the western medicine group (P 0.05). (3) Serum fibrinogen (FIB) before and after treatment in the control group P 0.05, there was no significant difference between the control group P 0.05, the treatment group P 0.05, there was significant difference between the two groups, indicating that the treatment group P 0.05, there was significant difference between the two groups. The treatment group can significantly reduce the level of FIB. Before and after treatment, the treatment group in reducing the FIB value was significantly better than the control group (P It can also reduce TC, LDL-C, increase HDL-C and decrease serum fibrinogen level. It is concluded that phlegm turbidity obstruction is one of the important pathogenesis of angina pectoris in coronary heart disease. Kaijiang Fenxiao Decoction combined with Lunan Xinkang, BaiAspirin and Atorvastatin Calcium Tablets can significantly improve angina pectoris, blood lipids and serum fibrinogen levels. This study provides a scientific and objective basis for the treatment of coronary heart disease angina pectoris (phlegm turbidity obstruction syndrome). The study laid a foundation for further study of the mechanism of action.
【学位授予单位】：中国中医科学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R259

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