本文選題：史紀(jì)教授 + 學(xué)術(shù)思想��； 參考：《山東中醫(yī)藥大學(xué)》2015年博士論文

【摘要】：目的：系統(tǒng)整理及分析史紀(jì)教授臨證治療兒科疾病的經(jīng)驗,通過臨床規(guī)范化研究,總結(jié)導(dǎo)師“肺病治肝”治療小兒咳嗽變異性哮喘的學(xué)術(shù)經(jīng)驗,辨證論治方法,遣方用藥規(guī)律,并對導(dǎo)師的學(xué)術(shù)思想進(jìn)行研究。方法：1.通過跟師理論與臨證結(jié)合學(xué)習(xí),整理臨證驗案,體會導(dǎo)師臨床辨治規(guī)律,對診療過程進(jìn)行評述分析,以按語的形式進(jìn)行闡述總結(jié)；同時自己獨立門診,將導(dǎo)師的經(jīng)驗用于臨床,并在導(dǎo)師經(jīng)驗的基礎(chǔ)上進(jìn)行創(chuàng)新；2.結(jié)合患兒癥狀、舌脈等,制定出“咳嗽變異性哮喘的中醫(yī)癥候觀察表”,歸納出咳嗽變異性哮喘患兒的中醫(yī)證型,統(tǒng)計中醫(yī)證型與發(fā)病年齡、病程長短的關(guān)系,從中藥用藥頻數(shù)、歸經(jīng)、五味、藥性頻數(shù)、藥物功效分析進(jìn)行統(tǒng)計,總結(jié)導(dǎo)師用藥分布規(guī)律及特點。結(jié)果：1.論文第一部分總結(jié)了導(dǎo)師的學(xué)術(shù)思想淵源、學(xué)術(shù)思想及臨證治療經(jīng)驗：①導(dǎo)師的學(xué)術(shù)思想上源于《黃帝內(nèi)經(jīng)》、《傷寒雜病論》,下承于張子和、萬全之說,師于鄭頡云教授。②導(dǎo)師的學(xué)術(shù)思想是脾常不足,易生虛證,臨證時時固護(hù)脾胃之氣,用藥注意方小量輕,調(diào)理脾胃為要；肝常有余,易生實證,若肝陽上逆之證,則以疏肝理氣為則,加以清肝、柔肝、鎮(zhèn)肝之法；若脾虛肝亢或肝脾不和之證,則以運脾平肝為治則,以運脾為主,佐以疏肝、平肝、柔肝之品。③導(dǎo)師認(rèn)為小兒脾胃尚未發(fā)育完善,“成而未全,全而未壯”,若進(jìn)食過多、過飽則易傷胃,若太過饑餓則易傷脾。治療脾胃病常重在健運,以和為貴,反對動則以峻補、峻攻之法治療脾胃疾病,是導(dǎo)師繼承萬全關(guān)于小兒脾胃病治療學(xué)術(shù)思想的精髓所在。導(dǎo)師常采用健脾益氣法、健脾和胃法、行氣燥濕法、清熱瀉脾法、滋脾養(yǎng)胃法、溫中祛寒法六法從脾論治小兒脾胃疾病。④導(dǎo)師認(rèn)為“肝常有余”反映了小兒特有的生理、病理特點,臨床遣方用藥時,要始終把握兒小兒的生理特點,同時還要注意肝臟“體陰而用陽”的特點,剛?cè)岵?jì),補虛瀉實,使肝氣始終保持通暢調(diào)達(dá),勿妄伐生之氣而使充盛有余的蓬勃生機(jī)受戕,采用清熱涼肝法、泄肝和胃法、培土平木法、清金平木法四法從肝論治。⑤導(dǎo)師認(rèn)為《傷寒論》的六經(jīng)辨證和臟腑辨證可以并行不悖,無論外感咳嗽還是內(nèi)傷咳嗽,均可以采用六經(jīng)辨證進(jìn)行臨床治療。小兒五臟六腑成而不全,脾常不足,經(jīng)方方小量少,不傷脾胃之氣,正好方便小兒服用,若臨床方證相符,可首先考慮經(jīng)方治療,善用經(jīng)方,常采用六經(jīng)辨證治療小兒咳嗽。⑥導(dǎo)師認(rèn)為肝郁是小兒抽動癥的基本核心病機(jī),由于小兒生理特性和病理特點不同于成人,故肝郁多為實證,治療宜達(dá)之,或表或里,但使氣血乖和,則木郁自散。風(fēng)動是小兒抽動癥的核心病機(jī)之誘發(fā)因素,若人體氣機(jī)升降出入正常,內(nèi)風(fēng)無以為生,外風(fēng)不能侵襲,則無法引動肝風(fēng)壅盛,抽動不能發(fā)作。導(dǎo)師認(rèn)為“肝郁風(fēng)動”是小兒抽動癥的中醫(yī)核心病機(jī),采用從肝論治小兒抽動癥。⑦史老師指出,遷延性腹瀉病程長,反復(fù)遷延不愈,其病機(jī)屬性以脾虛為主,脾氣虛弱,不能正常運化水濕,濕邪反盛,困阻中焦,運化失權(quán),.發(fā)為泄瀉,若外感濕邪,內(nèi)外濕邪交相呼應(yīng)則病情遷延難愈。若小兒久瀉不愈,往往可損傷脾陽,脾陽不振則累及腎陽而腎陽不足,命門火衰不能溫煦脾土,從而導(dǎo)致脾腎陽虛。導(dǎo)師從小兒“脾常不足”、“腎常虛”著手,立足于從脾腎治療小兒遷延性腹瀉。2.論文第二部分臨床觀察并討論導(dǎo)師“肺病治肝”治療小兒咳嗽變異性哮喘的證治規(guī)律研究及學(xué)術(shù)思想。導(dǎo)師認(rèn)為,咳嗽變異性哮喘的患兒發(fā)病特點具有肝病的病理特征、病因病機(jī)、臨床表現(xiàn),表明“肝失疏泄”為其主要病機(jī),肺失肅降為其次要病機(jī),因而獨辟蹊徑,提出“肺病治肝”的學(xué)術(shù)思想,臨床治療咳嗽變異性哮喘患兒以定風(fēng)散為核心,進(jìn)行辨證論治,通過多年的臨床觀察,導(dǎo)師將咳嗽變異性哮喘分為四型辨證治療。治療從小兒的生理、病理特點出發(fā),以疏泄氣機(jī)、保持肝疏泄暢通為主,藥物常采用疏肝、柔肝、平肝、養(yǎng)肝等,反對過度采用苦寒、辛熱、攻伐甚至有毒之品,從而導(dǎo)致傷及脾胃之氣,耗損陰津,甚至引起氣陰兩虛的嚴(yán)重情況。臨證時,采用藥物常補瀉相宜,苦寒適度,攻伐有節(jié),中病即止,治療中時時注重固護(hù)脾胃之氣,防止土虛木亢。結(jié)論：①導(dǎo)師學(xué)術(shù)思想的產(chǎn)生不是一蹴而就的,是在繼承古今醫(yī)學(xué)前賢的理論經(jīng)驗基礎(chǔ)上,結(jié)合自己長期的臨床實踐經(jīng)驗,進(jìn)一步創(chuàng)新而發(fā)展起來的。②導(dǎo)師從事兒科40余年,注重經(jīng)典理論學(xué)習(xí),臨床辨證用藥常從小兒生理、病理特點出發(fā),施藥簡潔,治療方法獨具匠心,治療小兒疾病從肝脾論治,取得了較好的療效。③本課題首先提煉了導(dǎo)師的學(xué)術(shù)思想,詳實記錄了導(dǎo)師臨證遣方用藥的各種醫(yī)案,是導(dǎo)師學(xué)術(shù)水平的綜合體現(xiàn),其中從脾腎論治小兒遷延性腹瀉、從肝郁血瘀論治小兒抽動癥及從六經(jīng)辨證治療小兒咳嗽等學(xué)術(shù)思想都在醫(yī)案中閃現(xiàn),是導(dǎo)師臨床治療的特色經(jīng)驗。導(dǎo)師提出“肺病治肝”治療小兒咳嗽變異性哮喘的學(xué)術(shù)思想,通過臨床觀察,治療效果顯著,導(dǎo)師的學(xué)術(shù)思想豐富了咳嗽變異性哮喘的治法,提出了新方法、新思路,進(jìn)一步了豐富了中醫(yī)兒科學(xué)臨床辨證體系及學(xué)術(shù)思想,為中醫(yī)兒科學(xué)的發(fā)展作出了重要貢獻(xiàn)。
[Abstract]:Objective: to systemically arrange and analyze the experience of Professor Shi Ji in the treatment of paediatric diseases, and to summarize the academic experience of "lung disease treatment of liver" in the treatment of children with cough variant asthma through the clinical standardization study. Combined with learning, sorting out the case, experience the rule of clinical diagnosis and treatment of the tutor, review and analyze the process of diagnosis and treatment, and summarize it in the form of the massage; at the same time, independent outpatient, the experience of the tutor is used in clinical, and on the basis of the experience of the tutor; 2. the symptoms of the children, the tongue and so on, make out "cough variant asthma". The traditional Chinese medicine syndrome of cough variant asthma was summed up. The relationship between TCM syndrome type and the age of disease and the length of the disease was summed up. From the frequency of medicine, the five flavors, the frequency of drug properties, the analysis of drug efficacy were statistically analyzed, and the distribution rules and characteristics of the drug use were summarized. The results were summarized in the first part of the 1. thesis. The academic thought origin of the tutor, the academic thought and the experience of clinical treatment: (1) the academic thought of the tutor was derived from the Yellow Emperor's internal classics, and the theory of typhoid and miscellaneous diseases. Under the theory of Zhang Zi and, the teacher is in Professor Zheng Jieyun. The academic thought of the teacher is the deficiency of the spleen, the deficiency of the syndrome, the breath of the spleen and the stomach at the time of the syndrome, the light of the attention side of the medicine, and the conditioning The spleen and stomach for the need; the liver is often more than the evidence, if the liver Yang on the inverse of the evidence, the liver qi, the liver, the liver, the liver of the liver, if the spleen deficiency liver or liver and spleen of the syndrome, the spleen and the liver as the treatment, to transport the spleen, with the liver, liver, soft liver products. 3. Tutor thinks children spleen and stomach is not perfected, "adult and incomplete, complete and incomplete," If you eat too much, if you eat too much, you can easily hurt the stomach by overeating. If you are too hungry, it is easy to hurt the spleen. The treatment of spleen and stomach disease is often heavy in health, and it is expensive, the opposition moves to the spleen and stomach disease, which is the essence of the treatment of spleen stomach disease. The tutor often uses the method of strengthening spleen and stomach, strengthening spleen and stomach. The method of air dryness, clearing heat and spleen, nourishing the stomach, nourishing the stomach and nourishing the stomach and removing cold from the spleen are used to treat children's spleen and stomach diseases. (4) the tutor thinks that "liver is often remaining" reflects the unique physiological and pathological characteristics of children. The soft and relieved, make up the deficiency and diarrhea, make the liver Qi always keep smooth and smooth, do not try to kill the vitality of the life to cause the vigorous vitality to kill, use the method of clearing the liver and the liver, the method of relieving the liver and stomach, the method of raising the earth and the wood method, the four methods of the Qing Jin Ping wood method from the liver. It is an internal wound cough which can be treated with the syndrome differentiation of six meridians. The five viscera of the children are not complete, the spleen is not enough, the spleen is short, the spleen and the stomach are small, the spleen and the stomach are small, the spleen and the stomach are not hurt, it is just convenient for children to take. If the clinical prescription is consistent, it can first consider the treatment of the meridians, use the meridians and treat the children's cough. 6. The tutor thinks liver depression is small. The basic core pathogenesis of children's aspiration is different from that of the adult, because the physiological and pathological characteristics of children are different from those of the adult. Therefore, the liver depression is more positive, the treatment should be reached, or the table or inside, but it makes the Qi and blood be good and the wood depression is scattered. The wind is the trigger factor of the core pathogenesis of children's aspiration. If the body and the air machine is in and out of normal, the internal wind is not born, the external wind can not invade. The teacher thinks that "liver depression and wind movement" is the core pathogenesis of children's aspiration of traditional Chinese medicine, using the liver theory to treat children with twitches. If the external feeling is wet and evil, the internal and external damp evil, the disease is difficult to recover. If the child's long diarrhea is not healed, the spleen yang can be damaged, the Spleen Yang is not vibrant and the kidney yang is insufficient, the spleen and kidney yang deficiency can not be warm, and the spleen and kidney yang deficiency is caused by the teacher. Hand, based on the clinical observation of the second part of the.2. paper on the treatment of children's deferred diarrhea from the spleen and kidney, and discussing the study and academic thoughts of the treatment of children with cough variant asthma by the tutor "lung disease treatment of liver". "Liver loss of Dredging" is the main pathogenesis, the lung is lost and the second is the next disease machine. Therefore, the academic thought of "treating the liver" with "lung disease" is put forward, and the clinical treatment of cough variant asthma in children with fixed wind is the core and is treated with syndrome differentiation. Through years of clinical observation, the cough variant asthma is divided into four types of syndrome differentiation treatment. From the physiological and pathological characteristics of children, the main way is to dredge the gas machine and keep the liver unobstructed and smooth. The drugs often adopt the liver dredging, the soft liver, the liver, the liver and so on, and oppose the excessive use of bitter cold, symplectic heat, tapping and even poisonous products, thus causing the spleen and stomach qi, wasting the Yin, and even causing the deficiency of Qi and Yin. Appropriate, bitter and moderate, tapping with a section, the disease is stop, in the treatment of the spleen and stomach to protect the Qi, to prevent the hyperactivity of soil. Conclusion: (1) the academic thought of the tutor is not achieved overnight. It is based on the theoretical experience of ancient and modern medical predecessors, combined with his long clinical experience and further innovation and development. (2) the tutor engaged in Pediatrics for more than 40 years and paid attention to the classical theory of learning. The clinical dialectical medication often started from the physiological and pathological characteristics of children, the treatment method was simple, the treatment method was ingenious, and the treatment of children's disease was treated from the liver and spleen. 3. Firstly, the academic thought of the tutor was extracted and the medication of the tutor was recorded in detail. Various medical cases are the comprehensive embodiment of the academic level of the tutor. Among them, the academic thought of treating children with deferred diarrhea from the spleen and kidney, treating children with stagnation of the liver and blood stasis and treating children's cough from the six meridian syndrome, is the characteristic experience of the clinical treatment of the tutor. The tutor puts forward the treatment of children's cough variant asthma by the "lung disease treatment of liver". Through clinical observation, the therapeutic effect of asthma is remarkable. The academic thought of the tutor enriches the treatment of cough variant asthma, puts forward new methods and new ideas, further enriches the clinical syndrome differentiation system and academic thought of Pediatrics, and has made important contributions to the development of Pediatrics in traditional Chinese medicine.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R249;R272

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