本文選題：泄瀉 + 學(xué)術(shù)思想��； 參考：《成都中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：目的：中醫(yī)脾胃病學(xué)源遠(yuǎn)流長,起源于《黃帝內(nèi)經(jīng)》,金元時(shí)期李東垣師徒創(chuàng)立了脾胃學(xué)說,后世醫(yī)家又發(fā)展豐富了中醫(yī)脾胃學(xué)說,戴永生教授為全國第五批老中醫(yī)藥專家學(xué)術(shù)經(jīng)驗(yàn)繼承工作指導(dǎo)老師,貴州省首屆名中醫(yī),教授,主任中醫(yī)師,懸壺近五十載,學(xué)驗(yàn)俱豐,既繼承經(jīng)旨,又善于臨床發(fā)揮,辨證用藥遣方,獨(dú)具匠心,尤其對(duì)中醫(yī)脾胃病有獨(dú)到的臨床經(jīng)驗(yàn)和學(xué)術(shù)思想。因此,為傳承和發(fā)揚(yáng)名老中醫(yī)的學(xué)術(shù)思想而開展戴永生教授對(duì)泄瀉證治規(guī)律學(xué)術(shù)思想的研究。方法：通過臨床傳承研究,包括傳統(tǒng)的臨床四診、收集分析泄瀉臨證案例、閱讀整理反映戴永生教授學(xué)術(shù)思想及臨證經(jīng)驗(yàn)的論文及著作等方式和方法,總結(jié)戴永生教授的主要學(xué)術(shù)思想和臨床經(jīng)驗(yàn),結(jié)合現(xiàn)代數(shù)據(jù)挖掘技術(shù),利用中醫(yī)傳承輔助平臺(tái)系統(tǒng)軟件(V2.5)進(jìn)行關(guān)聯(lián)規(guī)則分析等,對(duì)戴永生教授的泄瀉診療臨證醫(yī)案中的處方等數(shù)據(jù)進(jìn)行整理分析歸納,總結(jié)戴永生教授的辨證特色及遣方用藥規(guī)律。通過觀察四君子湯合平胃散合方治療功能性腹瀉脾虛濕盛證的臨床效果,從臨床研究的角度進(jìn)一步挖掘戴永生教授治療泄瀉的學(xué)術(shù)思想。結(jié)果：中醫(yī)傳承輔助平臺(tái)系統(tǒng)軟件整理了戴永生教授泄瀉診療處方180例次,通過數(shù)據(jù)挖掘,提煉分析,發(fā)現(xiàn)戴永生教授治療泄瀉的主要證候有21種,主要用藥是補(bǔ)氣類、化濕類藥物；基于關(guān)聯(lián)分析出常用“藥對(duì)”及組合,使用頻次55次以上的“藥對(duì)”及組合20組,如茯苓、甘草頻率為122次,茯苓、白術(shù)頻率為99次,白術(shù)、甘草96次,南沙參、茯苓94次等,常用藥味為白術(shù)、南沙參、茯苓、甘草等.藥物四氣分布中以溫性為主,五味分布中,以甘味最多,基于復(fù)雜系統(tǒng)熵聚類的核心組合分析,演化出3-5味藥的核心組合,共計(jì)10個(gè),基于層次聚類的治療泄瀉的新方5個(gè),由4-5味藥組成。通過整理分析臨床醫(yī)案180例,得出戴永生教授治療泄瀉的幾個(gè)特點(diǎn)：1、辨證方法上的獨(dú)特性,2、臨床分型的獨(dú)特性3、中醫(yī)五行理論與泄瀉辨治的相關(guān)性4、泄瀉用藥上的經(jīng)方組合。臨床研究結(jié)果顯示,戴永生教授運(yùn)用四君子湯合平胃散治療功能性腹瀉脾虛濕盛證,治療組臨床療效為90%,西醫(yī)對(duì)照組為73.3%,臨床療效明顯高于對(duì)照組(P0.05),治療結(jié)束4周后,對(duì)病人進(jìn)行隨訪。其中治療組,有效隨訪24人,3人復(fù)發(fā),復(fù)發(fā)率為12.5%；對(duì)照組,有效隨訪18人,8人復(fù)發(fā),復(fù)發(fā)率為44.4%,兩組進(jìn)行卡方檢驗(yàn),差異有統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)照組復(fù)發(fā)率明顯高于治療組。結(jié)論：通過整理,總結(jié)戴永生教授的主要學(xué)術(shù)思想是辨證靈活,方法多樣；異病同治,同病異治；善用經(jīng)方,方方組合；認(rèn)為脾胃病的病因與感受外邪、飲食失宜、情志所傷、勞逸太過和它臟病變有關(guān),脾胃病病機(jī)以脾常虛、肝常郁、胃常滯為主,辨證中戴老常常采取是辨證與辨病相結(jié)合,微觀辨證與臨床癥狀辨證相合,多種辨證方法結(jié)合,交叉運(yùn)用。治則治法上,主張肝、脾、胃臟腑合治,疏肝、健脾、和胃諸法并施,用藥選方用量上,戴老以脾胃病“虛則太陰,實(shí)則陽明”為據(jù),補(bǔ)脾胃者多以甘味藥為主,酸味藥次之；瀉脾胃者多以苦味藥為主,辛味藥次之,而補(bǔ)瀉之中藥性又有寒溫之分,故應(yīng)隨證選用。戴永生教授認(rèn)為泄瀉發(fā)生其本在脾虛,其標(biāo)是脾虛生內(nèi)濕,但與大、小腸、肝膽、肺腎等臟腑有關(guān),主要用藥是健脾益氣、化濕類藥物；常用藥味為南沙參、茯苓、白術(shù)、甘草等,戴永生教授首推泄瀉辨證方法的優(yōu)化組合,采用臟腑辨證、氣血津液辨證、五行辨證等多種辨證方法交叉運(yùn)用,體現(xiàn)臨證的靈活性,滿足臨床辨證辨治的需要,是中醫(yī)同病異治理論指導(dǎo)臨床的具體體現(xiàn)。利用中醫(yī)傳承輔助平臺(tái)系統(tǒng)軟件,將傳統(tǒng)與現(xiàn)代相結(jié)合的研究方法,有利于新藥開發(fā)研究,充分體現(xiàn)中醫(yī)藥特色和優(yōu)勢(shì),是繼承與創(chuàng)新工作的要求。臨床研究表明戴永生教授采用經(jīng)方與經(jīng)方組合治療泄瀉有較好的臨床療效,且無明顯毒副反應(yīng),值得臨床推廣運(yùn)用。
[Abstract]:Objective: Traditional Chinese medicine has a long history of spleen and stomach disease, which originated from "Huangdi Neijing". Li Dong Yuan, the teacher and apprentice of Li Yuan, founded the theory of spleen and stomach in the Jin Yuan period, and the later Physicians developed the spleen and stomach theory of traditional Chinese medicine. Professor Dai Yongsheng was the old teacher of the fifth batch of academic experience of old Chinese medicine experts in the country, the first Chinese medicine, Professor, and director of Chinese medicine in Guizhou province. There are nearly fifty loads of the pot, which inherits the tenor, and is good at clinical practice. It has a unique clinical experience and academic thought, especially for the spleen and stomach disease of traditional Chinese medicine. Therefore, the academic thought of Dai Yongsheng teaching on the rule of diarrhea syndrome is carried out and carried out in order to inherit and carry forward the academic thought of the old Chinese medicine. The clinical inheritance research, including the traditional clinical four diagnosis, the collection and analysis of the case of diarrhoea, the reading and sorting of the papers and works reflecting professor Dai Yongsheng's academic thought and experience, summarized the main academic thought and clinical experience of Professor Dai Yongsheng, combined with the present generation of data mining technology, and used the auxiliary platform of traditional Chinese medicine. The system software (V2.5) carries on the analysis of the association rules and so on, collate and analyze the data of the prescription in the medical case of Professor Dai Yongsheng's diarrhea diagnosis and treatment, summarize the characteristics of Professor Dai Yongsheng's syndrome differentiation and the rule of the prescription medication. By observing the clinical effect of the treatment of the spleen deficiency dampness syndrome with the four gentlemen soup and the combination of the stomach scattered prescription, the clinical effect of the syndrome of the spleen deficiency and the dampness of the diarrhea is treated from the clinic. The academic thought of Professor Dai Yongsheng's treatment for diarrhea was further excavated. Results: 180 cases of Professor Dai Yongsheng's diarrhea diagnosis and treatment prescription were compiled by the system software of the inheritance auxiliary platform of traditional Chinese medicine. Through data mining and refining analysis, there were 21 main syndromes of Professor Dai Yongsheng's treatment of diarrhea. The main drugs used were Qi tonifying and humidification drugs. Based on the correlation analysis of the commonly used "drug pairs" and combination, the use of "drug pair" and combination of 55 times more than 20 groups, such as Poria cocos, 122 times the frequency of Glycyrrhiza, tuckahoe, 99 times the frequency of Atractylodes, 96 times in Atractylodes, 96 times of Glycyrrhiza, 94 times in Nansha, and poria cocos, commonly used as Atractylodes macrocephala, Nansha ginseng, Poria cocos and Glycyrrhiza etc. in the four gas distribution, five in the four gas distribution, five temperature, five In the taste distribution, the core combination analysis based on the entropy clustering of complex system, based on the core combination analysis of complex system entropy, has evolved the core combination of 3-5 flavors, totaling 10, 5 new prescriptions for treating diarrhea based on hierarchical clustering, and composed of 4-5 flavors. Through sorting and analyzing 180 cases of clinical medical cases, several characteristics of Dai Yong Sheng professor's treatment of diarrhea are obtained: 1, dialectic method. Uniqueness, 2, the uniqueness of the clinical classification of 3, the theory of five lines of traditional Chinese medicine and the correlation of diarrhea and diarrhea 4, the treatment of diarrhea on the combination of prescriptions. The clinical results showed that Professor Dai Yongsheng used four gentlemen soup and stomach powder to treat the spleen deficiency dampness syndrome of functional diarrhea, the treatment group was 90% in clinical treatment and 73.3% in the western medicine control group, and the clinical effect was obviously higher than that of the control group. The control group (P0.05), 4 weeks after the end of the treatment, the patients were followed up. In the treatment group, 24 people were followed up effectively, 3 people had relapse and the recurrence rate was 12.5%. The control group was followed up 18 people, 8 relapsed and the recurrence rate was 44.4%. The difference was statistically significant (P0.05), and the recurrence rate of the control group was significantly higher than that in the treatment group. Conclusion: through tidy The main academic thoughts of Professor Dai Yongsheng are dialectical and flexible, the method is varied, the disease is treated with the same disease, the same disease and different treatment; the treatment of the spleen and stomach disease is related to the external pathogenic factors, the food discomfort, the emotional injury, the labor and ease too much and its dirty disease. The spleen and stomach disease pathogenesis is often deficiency of the spleen, the liver is often stagnant and the stomach is often stagnant, and the syndrome of Dai Lao syndrome differentiation is based on the syndrome differentiation. The combination of syndrome differentiation and disease differentiation, the combination of the microscopic syndrome differentiation and the clinical symptoms, the combination of various dialectical methods and the cross application. On the rule of rule, the liver, the spleen, the stomach viscera, the liver, the spleen, and the stomach are used and the dosage of the stomach is used. Medicine is the main medicine, and the acid taste medicine is the second. The people who purge the spleen and stomach are mainly bitter medicine, and the bitter medicine is the second. And the medicine is cold and warm, so it should be selected with the syndrome. Professor Dai Yongsheng thinks that the diarrhea occurred in spleen deficiency, which is the spleen deficiency and internal humidity, but it is related to the big, small intestine, liver and gallbladder, lung kidney and other viscera. The main medicine is to strengthen the spleen, invigorate Qi, and humidification medicine. The commonly used medicine is Nansha ginseng, Poria cocos, Atractylodes macrocephala, liquorice and so on. Professor Dai Yongsheng first pushed the combination of syndrome differentiation methods of diarrhea, using viscera syndrome differentiation, Qi and blood body fluid syndrome differentiation, five lines of syndrome differentiation and other dialectical methods, reflecting the flexibility of the clinical syndrome and meeting the needs of clinical differentiation and treatment. Using traditional Chinese medicine to inherit the auxiliary platform system software, the combination of traditional and modern research method is beneficial to the research of new drug development, fully embodying the characteristics and advantages of traditional Chinese medicine. It is the requirement of inheritance and innovation. The clinical study shows that Professor Dai Yongsheng has good clinical effect on treating diarrhea with the combination of the classics and the classics, and it does not have a good clinical effect. The obvious toxic and side effects are worthy of clinical application.
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R249;R256.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 吳春艷;張艷;史偉;龍彥;范玉仙;魏文會(huì);樊峰萍;;腹瀉的診斷治療進(jìn)展[J];中國醫(yī)藥導(dǎo)報(bào);2009年30期

2 葉禮燕;陳鳳欽;;腹瀉病診斷治療指南[J];實(shí)用兒科臨床雜志;2009年19期

3 張會(huì)永;;從《脾胃論》發(fā)揮到萎縮性胃炎以癰論治學(xué)說——解讀李玉奇教授脾胃病臨床經(jīng)驗(yàn)[J];中華中醫(yī)藥學(xué)刊;2007年02期

4 邵燕;;泄瀉的中醫(yī)研究進(jìn)展[J];浙江中西醫(yī)結(jié)合雜志;2006年03期

5 葉放,霍介格,周仲瑛;周仲瑛教授辨治脾胃病驗(yàn)案探析[J];南京中醫(yī)藥大學(xué)學(xué)報(bào);2005年03期

6 谷玉紅;雙苓止瀉口服液治療病毒性腸炎33例[J];中國中西醫(yī)結(jié)合消化雜志;2004年04期

7 孫艷淑,鄭啟仲;燥邪致瀉說[J];浙江中醫(yī)雜志;2004年02期

8 廖志峰,展銳,廖挺;泄瀉證治經(jīng)驗(yàn)[J];中國醫(yī)藥學(xué)報(bào);2003年12期

9 何任;脾胃病證診治說略[J];浙江中醫(yī)學(xué)院學(xué)報(bào);2003年03期

10 邵桂華;扶脾益腎抑肝湯治療慢性腹瀉120例臨床觀察[J];北京中醫(yī);2002年02期

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本文編號(hào)：2000244