刘启廷“感冒病因无热论”学术思想总结及固本解热汤临床应用研究

发布时间：2018-09-11 10:56

【摘要】：【研究背景】刘启廷教授是山东省名中医,国家级名中医药传承工作室中医专家,第二届国医大师候选人。60年来刘老师一直在临床一线工作,治学严谨,熟读经典,勤于实践,临床经验丰富,是中医全科医师倡导者,善于纯中医药治疗内外妇儿各科疑难杂病,不夹杂西药,临床疗效显著。本论文总结整理导师治学经验、学术思想及临床经验。刘老在中医药治疗感冒方面有高深的造诣,他在《黄帝内经》等中医理论的指导下,创造性的提出“感冒病因无热论”,治宜“散寒透热,扶正祛邪”。在此理论基础上临床创立了固本解热汤治疗感冒,本论文对固本解热汤治疗风寒感冒的疗效、安全性进行系统临床研究,为中医药治疗本病提供新的理论与方法。【研究目的】总结整理导师刘老的学术思想及临床经验;对导师运用固本解热汤治疗风寒感冒疗效及安全性进行临床观察,进一步对导师学术思想、临床经验验证及总结。【研究方法】理论研究部分:通过每周系统跟师临证诊疗、聆听老师授课、结合集中培训学习及临床病例资料整理总结等多种形式,查阅有关的历代中医经典文献,追溯导师学术渊源,总结老师治学经验、学术思想、临床经验及用药特色等。临床研究部分:采用随机阳性对照临床试验设计。选取门诊风寒感冒90例病人,病人随机设立中药治疗组、西药对照组、中成药对照组,中药治疗组服用固本解热汤,西药对照组服用复方氨酚烷胺片,中成药对照组服用荆防颗粒。3天为一观察周期,观察三组治疗后感冒临床症状缓解消失时间,与中药治疗组的差异,应用统计学处理做数据分析,评价中药治疗组的效果,服药后的副作用。【研究结果】理论总结结果:1.治学经验:(1)心系病人,高尚医德。为医,不仅要具有精良的医术,还要具备高尚的医德,只有正确解决好医患关系,才能不断提高医疗水平。要处处以孙思邈大师为榜样,把大医精诚落实到行动上,认真接诊每一个病人。(2)熟读经典,精研岐黄。中医理论广博深奥,中医古籍不可胜数,不计其数,系统学习《黄帝内经》、《伤寒论》、《金匮要略》、《神农本草经》四大经典著作是学习中医的基石,熟读四大经典是临证的基础,所以提出:书非深不能精,非熟不能用,非博不能广。(3)学古不泥古,学中不弃西。古代的医案、方药经验是继承的基础,发扬的途径,提高的手段,但要继承学习不是简单的重复,也不是思想的墨守常规和方法上的故步自封,要师古而不泥古。西医常见病的病因、发病机理、诊断治疗也要熟悉,容易与病人沟通,得到病人的认可。2.学术思想(1)倡导养生防病,提出养生护正论。诊治疾病,治疗与预防密不可分,中医养生重在调理阴阳,调气和血,以维护人体功能的动态平衡。在临诊时,要把上工治未病思想放在第一位,未病先防,既病防变,指导病人把养生护正落实在日常生活中去,总结出六要、六不要、保健粥与保健操,编著了《健康的诀窍》一书。(2)主张辨病与辨证相结合,倡导常见病一方通用。刘老认为中医理论指导下辨病与辨证结合,以症为先导,以病为基础,以证定治,以治立方,以方组药,充分发挥药物专效的特殊效能。与中医的同病异治、异病同治相符合,编著了《常见病一方通用经验方》。(3)首先提出“感冒病因无热论”。依据《黄帝内经》:“人伤于寒也,则为病热”,“邪之所凑,其气必虚”等理论。认为感冒的病因为风寒,多因人体正气不足,体表阳气虚弱不能固护肌表,风寒之邪外袭所致。所以感冒初期治疗主以辛温解表,避免应用辛凉之药,以免引邪入内病情加重。根据《黄帝内经》“虚则补之”的原则,结合《证治汇补.伤风》:“如虚人伤风,……,又当补中,而佐以和解,……。”刘老创立“益气固表,散寒解热”的固本解热汤。临床研究结果:1.中西医疗效分析比较,固本解热汤的愈显率与对照组相比P0.05,差异有统计学意义。2.急性上呼吸道感染症状缓解比较,治疗3天后三组间临床症状缓解例数与未缓解例数的对比,表明固本解热汤组对急性上呼吸道感染症状缓解优于西药对照组及中成药对照组。3.三组治疗后组间症状总积分比较,治疗3天后变化中药治疗组与中成药对照组相比较,T=-2.0106,中药治疗组与西药对照组相比,T=-2.0461,p0.05,差异有统计学意义;3天前后差值变化中中药治疗组与中成药对照组对比,T=-2.0031,中药治疗组与西药对照组相比,T=-2.0151,p0.05,差异有统计学意义,治疗后组间症状总积分对比差异有统计学意义。4.实验室检查结果比较,三组对比无差异统计学无意义。5.安全性评价,试验过程中无特殊不良反应,仅有3例病人诉用药后胃脘轻微不适,停用药物后症状缓解,西药对照组复方氨酚烷胺片、中成药对照组荆防颗粒仅有少数患者有药物说明书的轻微不良反应。【结论】刘老总结自己60余年治疗感冒的临床经验,认为感冒的病因为风寒为标,正气亏虚为本,因此他首先提出“感冒病因无热论”。治疗时要扶助正气,标本兼治疗效较好。刘老治疗感冒万余人,其中发现中医辨证属风寒感冒的病人治疗时单纯祛邪疗效不佳,需与扶正药物并用才能进一步提高疗效,服用感冒药3天不能治愈的病人,均需要扶助正气。刘老创立“益气固表,散寒解热”的固本解热汤治疗万余人有确切的疗效,有必要加以整理以示后人,发挥中医药对感冒认知与实践的优势,发掘中医药治疗感冒新理论与方法,对提高临床疗效、控制感冒传播具有重要意义。该方组方遵循传统中医药理论,能及时有效解除患者的临床症状,不加重患者的经济负担,无明显毒副反应,值得推广应用。
[Abstract]:[Background] Professor Liu Qiting is a famous doctor of traditional Chinese medicine in Shandong Province, a national famous expert of traditional Chinese Medicine Inheritance studio, and a candidate for the 2nd National Master of Traditional Chinese Medicine. Since 60 years ago, Professor Liu has been working in the clinical frontline with rigorous scholarship, familiar with classics, diligent in practice and rich clinical experience. He is an advocate of general practitioners of traditional Chinese medicine and is good at treating both internal and external medicine with pure Chinese medicine. This paper summarizes the tutor's academic experience, academic thinking and clinical experience. Liu Lao has a profound accomplishment in the treatment of cold. Under the guidance of the theory of traditional Chinese medicine such as Huang Di Nei Jing, he creatively put forward the theory of "the cause of cold without heat" and "dispelling cold and permeating heat". On the basis of this theory, Guben Jiere Decoction was established to treat cold. This paper made a systematic clinical study on the efficacy and safety of Guben Jiere Decoction in the treatment of cold caused by wind and cold, providing a new theory and method for the treatment of this disease. The instructor used Guben Jiere Decoction to observe the efficacy and safety of treating cold and cold, and further verified and summarized the instructor's academic thinking, clinical experience. [Research Methods] Theoretical part: Through weekly systematic clinical diagnosis and treatment with the instructor, listening to the teacher's lectures, combined with concentrated training and learning and clinical case data collection and summary. In the clinical research part, a randomized positive control clinical trial design was adopted. 90 outpatients with cold and wind were selected and randomly assigned to Chinese medicine treatment group and Western medicine control group. Chinese medicine control group, Chinese medicine treatment group take Guben Jiere decoction, western medicine control group take compound paracetamol alkylamine tablets, Chinese patent medicine control group take Jingfang granules. 3 days for an observation cycle, observe the three groups after treatment of clinical symptoms relief disappearance time, and Chinese medicine treatment group differences, using statistical processing to do data analysis, evaluation of Chinese medicine treatment group. To be a doctor, one must not only have excellent medical skills, but also have noble medical ethics. Only by correctly solving the doctor-patient relationship, one can improve the medical level continuously. Actually, take every patient seriously. (2) Read the classics well and study Qi Huang carefully. The theory of Chinese medicine is broad and profound, the ancient books of Chinese medicine are numerous, countless, systematic study < Huang Di Nei Jing >, < typhoid fever theory >, < Jin Kui Yao Xue >, < Shen Nong Materia Medica Jing > the four classics are the cornerstone of learning Chinese medicine, familiar reading the four classics is the basis of clinical symptoms, so put forward. (3) learning from the past is not muddy, learning from the west is not abandoned. Ancient medical plans, prescription experience is the basis for inheritance, the way to carry forward, means of improvement, but to inherit learning is not a simple repetition, nor is it the idea of sticking to conventional and methodological self-proclaimed, to learn from the past but not muddy. Western medicine is common. The etiology, pathogenesis, diagnosis and treatment of the disease should also be familiar with, easy to communicate with the patient, and get the approval of the patient. 2. Academic thinking (1) advocate health and disease prevention, put forward the theory of health care. The thought of "treating disease by work" is the first, and "preventing disease before disease" is the first. It guides patients to carry out health care in their daily life. It summarizes six essentials and six No. Health porridge and health exercises. It compiles a book entitled "Health Tips". (2) It advocates the combination of disease differentiation and syndrome differentiation, and advocates the universality of common diseases. Combining with syndrome differentiation, taking symptoms as forerunner, basing on syndrome differentiation, treating cubes and prescriptions, giving full play to the special efficacy of drugs. It is thought that the cause of cold is wind-cold, mostly due to insufficient vital energy of the human body, weak yang-qi on the body surface can not protect the muscle surface, wind-cold pathogen caused by external attack. According to the principle of : "If the deficiency of cold,... and should be supplemented, and with reconciliation,..." Liu Lao founded "Yiqi solid table, dispelling cold and heat" Guben Jiere Decoction. Clinical research results: 1. Comparison of Chinese and Western medical efficacy analysis, Guben Jiere Decoction, the more obvious rate compared with the control group, P 0.05, the difference was statistically significant.2. Comparing the remission of symptoms of acute upper respiratory tract infection, the remission and non-remission of clinical symptoms among three groups after 3 days of treatment showed that the remission of symptoms of acute upper respiratory tract infection in Guben Jiere Decoction group was better than that in western medicine control group and Chinese patent medicine control group. T=-2.0106 compared with the control group of Chinese patent medicine, Chinese medicine treatment group and Western medicine control group, T=-2.0461, p0.05, the difference was statistically significant; 3 days before and after the difference between Chinese medicine treatment group and Chinese patent medicine control group, T=-2.0031, Chinese medicine treatment group and Western medicine control group, T=-2.0151, p0.05, the difference was statistically significant, after treatment between the two groups. There was no significant difference between the three groups. 5. Safety evaluation, no special adverse reactions during the test, only 3 patients complained of slight discomfort in the stomach after drug use, symptoms relieved after drug withdrawal, the control group of Western medicine compound paracetamol and alkylamine tablets, Chinese patent medicine control group. [Conclusion] Liu Lao summarized his clinical experience in treating cold for more than 60 years. He believed that the cause of cold was wind-cold and deficiency of vital energy was the main cause, so he first put forward the theory that there was no fever in the etiology of cold. More than ten thousand old people have been treated with cold, among them, it is found that the curative effect of traditional Chinese medicine is not good for the patients with wind-cold and cold, and the curative effect can only be further improved by combining it with the medicines for strengthening the body. All the patients who can not be cured after taking the medicines for cold for three days need to help the healthy qi. It is necessary to arrange the prescriptions so as to show the definite curative effect, give full play to the superiority of traditional Chinese medicine in cognition and practice of colds, and explore new theories and methods of treating colds with traditional Chinese medicine, which is of great significance to improve clinical efficacy and control the spread of colds. The economic burden of patients has no obvious side effects, and is worthy of popularization and application.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R249;R254.9

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