陈安民辨治血液病学术思想、临床经验总结及过敏性紫癜治疗思路归纳

发布时间：2018-09-11 11:24

【摘要】：背景:陈安民教授为第五批全国老中医药专家学术经验继承工作指导老师。从事医疗工作近五十年,在血液系统疾病治疗领域积累了丰富的临床经验,形成了自己独特的学术思想。擅长中医、中西医结合治疗白血病、再生障碍性贫血、免疫性血小板减少性紫癜、骨髓增殖性肿瘤、过敏性紫癜等各种血液系统疾病。过敏性紫癜病因不明,亦属免疫相关疾病。临床主要表现皮肤出血点,腹痛,甚或便血,关节痛及尿中出现潜血及蛋白。而现代医学缺乏特异性治疗的药物,存在疗效不理想且容易复发、副作用大等弊端。中医药在治疗此类疾病方面积累了丰富的经验,具有整体调节、疗效可靠、副作用小、价格低廉等独特优势。陈安民教授对于过敏性紫癜的病因病机及中医辨证论治进行了深入而细致的研究,并在临床治疗上取得了显著的疗效。经过3年的跟师学习,通过对导师临床治疗的观察,病例的收集、整理和总结逐渐形成了对导师学术思想的认识,并在自己的临床实践中积极运用,取得满意疗效。本篇对陈安民老师的学术思想和临床经验进行全面系统深入的总结,对于其治疗过敏性紫癜思路和方法进行系统的整理与归纳。目的:全面系统的总结陈安民教授的学术思想和临床经验,以期更深层次的挖掘其学术思想的精髓。内容:分析陈安民教授的学术渊源;全面总结陈安民教授治疗血液系统疾病的临床经验并总结归纳老师的学术思想;对陈安民教授所擅长的过敏性紫癜进行深入的总结归纳。总结过敏性紫癜的治疗思路及用药规律。方法:本研究分三部分。1学术思想渊源部分:通过对导师影响较大的中医古籍、各学派医家学术思想的分析,探求陈安民教授学术思想渊源。2学术思想及临床经验总结部分:从陈安民教授“辨病与辨证”、“病机”、“注重补法”“和中求效”、“科学共治”等方面总结其学术思想;结合病例,分别论述陈安民教授治疗部分血液系统疾病及杂病的辨治思路及用药规律的临床经验。3过敏性紫癜总结归纳部分:通过临床跟师学习及病例的总结,了解陈安民教授对过敏性紫癜的治疗思路,总结其对本病的用药规律。结论:1学术思想渊源部分:陈安民老师的学术思想,来源于中医经典古籍,受历代医家思想影响,重视脏腑辨证及八纲辨证,重视脾肾为本,故而治疗上重视顾护脾肾,平调阴阳。2学术思想及临床经验总结部分:陈安民老师的学术思想包括如下几项:病症结合,辨证为主;辨明病机,祛邪扶正;重视补法:气血阴阳,同补同调,先天后天并重;缓图治本,和中求效;以人为本,保命延生;科学共治,中西合璧。陈安民老师的临床经验主要有:对于白血病,陈安民老师提出白血病治疗十法,对于诱导白血病细胞凋亡、缓解症状、治疗各种并发症、减轻化疗的毒副作用、巩固化疗药效、延长生存期、提高生存质量具有不可替代的优势。对于再生障碍性贫血等疾病,陈安民老师立法是气血阴阳共调,强先天之肾,补后天之脾,先天生机强旺,后天化源充盛,生血补血之功俱有,贫血诸病、气血虚弱诸证可除。对于骨髓增殖性肿瘤,陈安民教授认为骨髓增殖性疾病多为血瘀疾患,多为热毒侵犯骨髓致骨髓造血细胞无序生长,且变性而为病态细胞,疯狂克隆致生髓瘀,血瘀内结,聚而成形。治疗需从热毒、血瘀两方面着手。对于免疫性血小板减少症,陈安民教授推崇《血证论》观点,认为治疗此病首先明确血证机制:邪热迫血妄行,气虚不能摄血,阴虚火旺营血不守,血瘀血不归经。治疗之法需止血、行血、调气。对于白细胞减少症,陈安民老师认为其属于虚劳范畴,以中气不足、肾气亏虚及脾肾亏虚为其病机,治则为扶正固本,调补脾肾。陈安民教授对内科杂病亦有较深造诣,本文仅以感冒的治疗思路及用药规律为例来阐明。陈安民教授认为临床所见感冒患者多为病程较长,或经他药干预后,已不是桂枝汤、麻黄汤、银翘散、桑菊饮所能及。其以小柴胡汤为基本方,或合方或加减化裁,于临床治疗效果甚好。3过敏性紫癜归纳整理部分:陈安民老师认为过敏性紫癜的病机归纳为风、热、瘀、虚。治疗思路有以下几点:辨病辨证相结合,病型证型基本统一;病久证变,亦虚亦瘀;新病治当清热凉血,但需分轻症重症;病久论治,从虚从瘀;好生养护,预防复发。由此形成自己独特的用药规律。本课题较为全面的总结了名老中医药专家陈安民老师治疗血液病的学术思想和临床经验,以使之得以传承并发扬光大。对于过敏性紫癜的中医辨病辨证治疗提供了较为完整的治疗思路。以藉为更多的患者解除痛苦,提高生活质量。
[Abstract]:BACKGROUND: Professor Chen Anmin is the instructor of the fifth batch of experts of traditional Chinese medicine in China. He has been engaged in medical work for nearly 50 years. He has accumulated abundant clinical experience in the field of hematological diseases treatment and formed his own unique academic thought. He is good at traditional Chinese medicine, integrated traditional Chinese and Western medicine in the treatment of leukemia, aplastic anemia and immunity. Henoch-Schonlein purpura (HSP) is an immune-related disease with unknown etiology. The main clinical manifestations are bleeding spots on the skin, abdominal pain, even bloody stools, arthralgia and occult blood and protein in urine. However, modern medicine lacks specific treatment drugs and has curative effects. Chinese medicine has accumulated abundant experience in the treatment of this kind of disease, which has the unique advantages of overall regulation, reliable curative effect, small side effects and low price. After three years of follow-up study, through the observation of clinical treatment, case collection, collation and summary gradually formed the understanding of the instructor's academic thinking, and actively used in their own clinical practice, and achieved satisfactory results. Objective: To summarize Professor Chen Anmin's academic thought and clinical experience comprehensively and systematically in order to dig deeper the essence of his academic thought. Methods: This study was divided into three parts. 1. The origin of the academic thought: through the influence of the tutor on the ancient books of Chinese medicine, Analyzing the academic thoughts of various schools of physicians and exploring the origin of Professor Chen Anmin's academic thoughts. 2 Summary of academic thoughts and clinical experience: Professor Chen Anmin's academic thoughts are summarized from the aspects of "differentiation and differentiation of diseases", "pathogenesis", "emphasizing complementary methods", "seeking effect in harmony" and "scientific co-treatment". Professor Chen Anmin's academic thoughts are discussed in combination with cases. Conclusion: 1. Academic thought origin part: Chen Anmin senior citizen old age Teacher's academic thought, originated from classical Chinese medicine books, influenced by the thoughts of physicians in the past dynasties, attaches importance to the differentiation of viscera and organs, eight principles of differentiation, pay attention to the spleen and kidney, so pay attention to the treatment of the spleen and kidney, calm the Yin and yang. 2 academic thought and clinical experience summary part: Chen Anmin's academic thought includes the following: symptoms and symptoms combined, syndrome differentiation based; Pathogenesis, eliminating pathogens and strengthening the right; pay attention to tonifying methods: Qi and blood Yin and Yang, with the same tonic tone, congenital and acquired equal importance; slow to cure the root, and seek effect; people-oriented, life preservation; scientific co-treatment, the combination of Chinese and Western. Chen Anmin's clinical experience is mainly: for leukemia, Mr. Chen Anmin proposed ten methods for leukemia treatment, for the induction of leukemia cell apoptosis, alleviate symptoms. For aplastic anemia and other diseases, Professor Chen Anmin's legislation is to harmonize qi and blood Yin and yang, strengthen congenital kidney, tonify acquired spleen, congenital vitality, congenital enrichment of blood and blood. For myeloproliferative tumors, Professor Chen Anmin believes that myeloproliferative diseases are mostly blood stasis, mostly disorderly growth of bone marrow hematopoietic cells caused by heat toxicity invasion of bone marrow, and degeneration into pathological cells. Crazy cloning results in marrow stasis, blood stasis internal knot, agglomeration and formation. For immune thrombocytopenia, Professor Chen Anmin advocates the viewpoint of "Blood Syndrome Theory". He believes that the treatment of this disease should first clarify the mechanism of blood syndrome: excessive heat and blood pressure, Qi deficiency can not take blood, Yin deficiency, fire and blood stasis are not observed, blood stasis does not return to menstruation. It belongs to the category of deficiency of qi, deficiency of kidney-qi and deficiency of spleen and kidney as its pathogenesis, the treatment is to strengthen and strengthen the root, tonify the spleen and kidney. After drug intervention, it is not Guizhi Decoction, Mahuang Decoction, Yinqiao San, Sangju Yin can reach. Xiaochaihu Decoction as the basic prescription, or combination or reduction of tailoring, in clinical treatment is very good. 3 Allergic purpura summarized part: Chen Anmin teachers think that the pathogenesis of allergic purpura summarized as wind, heat, blood stasis, deficiency. The combination of syndromes, the basic unity of the disease type; long-term syndrome changes, but also deficiency and blood stasis; new disease treatment should be clear heat and cool blood, but need to be divided into mild and severe; long-term treatment, from deficiency to blood stasis; good health care, prevention of recurrence. Thus forming their own unique law of medication. This topic more comprehensive summarized the famous old Chinese medicine expert Chen Anmin's academic thinking on the treatment of blood diseases. Want and clinical experience, so that it can be inherited and carried forward. For allergic purpura syndrome differentiation and treatment of traditional Chinese medicine provides a more complete treatment ideas.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R249;R259

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