杨生民主任医师治疗膝骨性关节病学术思想及临床经验研究

发布时间：2019-03-01 08:59

【摘要】：杨生民老师是洛阳正骨医院主任医师,全国名老中医,第五批全国名老中医药专家学术继承指导老师,从事临床工作30余年,治学严谨、医德高尚。杨老师对中医经典著作和历代名家学术思想颇有研究,在结合传统中医骨伤基础理论的基础上,注重中医现代化研究,临床经验丰富,勤求古训,博采众长,在总结前人经验的基础上,结合自身的临床经验,形成了系统的学术思想和临证思路。杨生民老师认为膝关节骨性关节病病因病机为本虚标实,肝肾亏虚为本,痰凝血瘀,脉络瘀阻为标。根据上述病机,杨老师认为,膝关节骨性关节病的治则应以补益肝肾,化痰祛瘀,通经活络为大法。同时提倡内治与外治相结合,中西医结合,以内治为主,兼用外治。外治法,包括手法治疗,中药熏洗治疗,中药塌渍治疗,灸法,小针刀治疗,膏药外敷,中药外用方法是以活血通络,化瘀止痛的中药,通过皮肤吸收直达病所,起效快,无毒副作用,患者依从性好,有利于疾病痊愈。杨老师临症重视把辨证论治、辨病论治与对症治疗相结合,在疾病不同阶段采取不同方法,急则治其标,缓则治其本,对于早期疼痛剧烈患者应取手法治疗,小针刀治疗,对病久关节软骨退变严重及关节间隙严重狭窄患者行关节置换手术。“未病先防,既病防变”一直是中医学临床的重要指导思想。关于膝骨性关节病的预防,主要针对可能导致本病发生的的机制,阻断疾病发生发展的过程,才能预防疾病发生。本病的主要病因包括感受外感风寒湿邪、肝肾不足、气滞血瘀、脉络瘀阻,从而导致疾病发生发展。所以补肝肾,益气血在预防和治疗本病中具有重要作用。为了全面系统学习及传承杨老师的临床经验和学术思想,本文采用了临床研究与回顾性文献研究相结合的方法,从膝关节骨性关节病的发病病因病机,诊断方法、治疗原则,以及疾病预防方面进行整理总结。结合三年跟师学习知识,应用于临床,制定治疗方案,观察治疗效果,证实内治和外治相结合,中西医相结合治疗膝关节骨性关节病疗效更好,更科学。
[Abstract]:Teacher Yang Shengmin is the chief physician in Luoyang Orthopaedic Hospital, a well-known senior Chinese medicine practitioner throughout the country, and the fifth group of senior Chinese medicine experts in the country. He has been engaged in clinical work for more than 30 years, and is rigorous in his studies and noble in medical ethics. On the basis of combining the basic theory of traditional Chinese medicine bone injury, teacher Yang pays attention to the study of modernization of traditional Chinese medicine, has rich clinical experience, diligently pursues ancient training, and draws lessons from all kinds of people. On the basis of summarizing the predecessors' experience and combining their own clinical experience, the systematic academic thought and clinical thinking have been formed. Teacher Yang Shengmin thought that the pathogeny and pathogenesis of knee osteoarthropathy were deficiency-based, deficiency of liver and kidney, phlegm-blood stasis and choroidal stasis. According to the above-mentioned pathogenesis, Yang believes that the treatment of knee osteoarthropathy should be based on nourishing the liver and kidney, removing phlegm and removing blood stasis, and activating meridians and activating collaterals. At the same time, promote the combination of internal and external treatment, the combination of traditional Chinese and western medicine, mainly internal treatment, both external treatment. External treatment, including manipulation treatment, traditional Chinese medicine fumigation and washing treatment, traditional Chinese medicine collapse treatment, moxibustion method, small needle knife treatment, plaster external application, the external use of traditional Chinese medicine is to Huoxue Tongluo, removing blood stasis and pain relief of the traditional Chinese medicine, through the skin absorption directly to the disease, effective quickly. Non-toxic side effects, patient compliance is good, conducive to the recovery of the disease. Teacher Yang attaches great importance to the treatment of syndrome differentiation, differentiation of diseases and symptomatic treatment. In different stages of the disease, different methods are adopted to treat the symptoms as soon as possible and slowly, and the patients with severe pain in the early stage should be treated by manipulation and small needle knife. The patients with severe degeneration of articular cartilage and severe stenosis of joint space were treated with arthroplasty. It has always been an important guiding ideology of TCM clinical practice that "prevent disease first, prevent disease and change". The prevention of knee osteoarthropathy is mainly aimed at the mechanism that may lead to the occurrence of the disease, blocking the process of the occurrence and development of the disease, so as to prevent the occurrence of the disease. The main causes of the disease include feeling external wind, cold and dampness, deficiency of liver and kidney, stagnation of qi and blood stasis, obstruction of vein, thus leading to the occurrence and development of the disease. Therefore, tonifying the liver and kidney, nourishing qi and blood play an important role in the prevention and treatment of this disease. In order to comprehensively and systematically study and inherit teacher Yang's clinical experience and academic ideas, this paper adopts the method of combining clinical research and retrospective literature study, from the etiology, pathogenesis, diagnosis, treatment principle of knee joint bony arthropathy. And the disease prevention aspect carries on the sorting summary. Combined with the knowledge of the teacher for three years, it is better and more scientific to apply it to the clinic, to formulate the treatment plan, to observe the therapeutic effect, to confirm the combination of internal treatment and external treatment, and to combine the traditional Chinese medicine and western medicine in the treatment of knee joint bony joint disease.
【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;R274.9

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