本文選題：常振森 + 學(xué)術(shù)思想��； 參考：《山東中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：常振森主任醫(yī)師是山東省名中醫(yī),全國(guó)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)教師,從醫(yī)40余年,醫(yī)德醇厚、學(xué)驗(yàn)俱豐。常老師擅用經(jīng)方,尤其是《傷寒論》及《金貴要略》的方劑,思辨過程中重視先天,遵經(jīng)旨“陽(yáng)氣者,若天與日,失其所則折壽而不彰”,重視腎中真陽(yáng)之氣化及腎氣、腎陽(yáng)的作用,強(qiáng)調(diào)腎對(duì)人體五臟六腑的溫煦、推動(dòng)、長(zhǎng)養(yǎng)作用。在臨床實(shí)踐中不斷探索、總結(jié),并在繼承的基礎(chǔ)上尋發(fā)展、求創(chuàng)新,通過多年的臨床實(shí)踐,結(jié)合自己的感悟,形成一套自己的臨證思辨特點(diǎn)和養(yǎng)生、治未病的理念,提出了腎與氣血相關(guān)論。1.學(xué)術(shù)思想淵源《內(nèi)經(jīng)》是中醫(yī)臨床理論建構(gòu)的奠基之作,它示人從整體角度認(rèn)識(shí)人與天地相參,與日月四時(shí)相應(yīng)之理,用陰陽(yáng)五行之哲學(xué)概念和辯證法思想闡述中醫(yī)藏象、病機(jī)、診法、治則等內(nèi)容。構(gòu)筑了中醫(yī)學(xué)思想體系,奠定了指導(dǎo)臨床實(shí)踐的理論基礎(chǔ),指導(dǎo)著中醫(yī)的進(jìn)一步發(fā)展�！秱摗贰ⅰ督饏T要略》合稱《傷寒雜病論》,是繼《內(nèi)經(jīng)》之后又一部中醫(yī)巨著,“為醫(yī)方之祖,而治雜病之宗也”。以六經(jīng)論傷寒,系統(tǒng)了六經(jīng)辨證,并開創(chuàng)了病、脈、證相結(jié)合的先河,完善了辨證體系,給學(xué)醫(yī)者樹立了規(guī)矩,明晰了方法。結(jié)合多年的臨證及對(duì)人體生理、病理的思辨總結(jié),常老師崇尚張景岳“重陽(yáng)氣”,“陽(yáng)非有余,真陰不足”的思想,認(rèn)同臟腑活動(dòng)以命門為中心及治病“助陽(yáng)為本”的思路。對(duì)常老師重視先天,補(bǔ)腎、調(diào)腎為本的思想及腎與氣血相關(guān)論的形成有著很大的影響。鄭欽安,被稱為鄭附子,擅用附子、干姜等熱藥來治療各種重癥、險(xiǎn)癥,由后人整理的《鄭欽安全書》全面反映了其重陽(yáng),崇陽(yáng)的觀點(diǎn),正是基于其“陽(yáng)者,陰之主也,陽(yáng)氣流通,陰氣無滯”等重陽(yáng)理論的大量論述,結(jié)合對(duì)腎、腎命、氣、血各自生理功能及病理變化的深刻認(rèn)識(shí),最終形成了常老師的學(xué)術(shù)思想----腎與氣血相關(guān)論。腎所藏之精歸化,化生陰陽(yáng)二氣,即元陰元陽(yáng),故張景岳云“人之盛衰皆本于腎”。腎中陽(yáng)氣通過三焦布敷,總領(lǐng)五臟六腑、營(yíng)衛(wèi)經(jīng)絡(luò)、內(nèi)外上下左右之氣,腎氣充足,陽(yáng)氣旺盛,則生機(jī)活躍,陰平陽(yáng)秘,精神乃治。氣血由腎精化生,由腎之施泄方可充塞周身流布不已,維持人之正常生命活動(dòng)。2.學(xué)術(shù)思想及臨床經(jīng)驗(yàn)總結(jié)2.1學(xué)術(shù)思想總結(jié)常老師注重讀經(jīng)典,用經(jīng)典,強(qiáng)調(diào)經(jīng)方至重,牢固樹立辯證施治,只有很好向經(jīng)典的學(xué)習(xí),深悟其精髓,并用之于臨床,多臨證,重實(shí)踐,才能談創(chuàng)新,才更好的創(chuàng)新,否則創(chuàng)新就會(huì)成為無源之水,無根之木。在學(xué)習(xí)及臨床思辨的過程中,常老師注重天人合一,崇尚整體觀念,“天地合氣命之曰人”,人為自然之子,人在漫長(zhǎng)的進(jìn)化、生長(zhǎng)過程中,不僅適應(yīng)了自然,而且形成了自然對(duì)其影響的許多象態(tài)。我們應(yīng)該熟習(xí)古代樸素的思維觀,在診療思辨過程中,從天道推及人道,運(yùn)用天地陰陽(yáng)氣化之理論探討臟腑及精氣血生理、病理之變化規(guī)律,從中感悟治病之理。把人體的五臟六腑,氣血陰陽(yáng),四肢百骸有機(jī)的聯(lián)系起來看問題,并形成其完整的診病、治病及養(yǎng)生的理論體系,臨證治療時(shí)強(qiáng)調(diào)辨證施治重氣化,治病求本,力求和合;重視氣血陰陽(yáng),以平為期;標(biāo)本相移,不執(zhí)于一端,靈活應(yīng)變,從正邪標(biāo)本、因變標(biāo)本、先后標(biāo)本、緩急標(biāo)本、表里標(biāo)本、上下標(biāo)本六方面來抓疾病的主要矛盾,并把明體、識(shí)病、辨證有機(jī)融合,提高了辯證施治的準(zhǔn)確性。常老師整個(gè)思辨過程中始終圍繞著重視先天的思想,強(qiáng)調(diào)治未病,養(yǎng)腎以健五臟,未病時(shí)注重養(yǎng)腎、固腎、強(qiáng)腎,已病則強(qiáng)調(diào)補(bǔ)腎、調(diào)腎、溫腎。重化,求和的提出,更是明晰了中醫(yī)養(yǎng)病的根本思想。2.2臨床經(jīng)驗(yàn)及驗(yàn)案論述常老師強(qiáng)調(diào)學(xué)習(xí)經(jīng)典,用經(jīng)方,重視補(bǔ)腎,調(diào)腎、養(yǎng)腎,使用頻率較高的補(bǔ)腎氣經(jīng)方主要為腎氣丸,并廣泛應(yīng)用于內(nèi)外婦兒。在長(zhǎng)期的臨床實(shí)踐中,形成了自己的用藥特色——補(bǔ)腎藥對(duì)。并選取了喘證、慢性泄瀉、ve瘕病等方面的典型病案,從其對(duì)病因病機(jī)的認(rèn)識(shí)、治療特色方面加以論述、總結(jié),闡明老師的“腎與氣血相關(guān)論學(xué)說”這一學(xué)術(shù)觀點(diǎn),進(jìn)一步牢固樹立以腎為中心的五臟觀。常老師認(rèn)為腎藏精,為先天之本,內(nèi)寄元陽(yáng)、元陰;腎氣、腎陽(yáng)是腎的氣化功能外在表現(xiàn)。對(duì)人體氣血的運(yùn)行及五臟六腑功能的正常發(fā)揮起著推動(dòng)、溫煦、營(yíng)養(yǎng)的作用。如果腎氣、腎陽(yáng)功能低下,則其推動(dòng)、溫煦、營(yíng)養(yǎng)的功能失于正常,推動(dòng)無力,氣血運(yùn)行不暢而成瘀;其次溫煦失司,虛寒內(nèi)生,致經(jīng)脈拘急,血運(yùn)遲滯而成瘀;第三、腎氣虛不能溫煦脾陽(yáng),致運(yùn)化水濕功能減退,聚濕成痰,阻于臟腑脈絡(luò),膠著難除,與血相搏,結(jié)久而致痰瘀互結(jié);第四、腎氣虛弱,化生氣血的能力低下,氣血虧虛不能充盈五臟六腑,抵御外邪能力下降,“至虛之處,便是留邪之所”,邪氣易于入侵,而與內(nèi)在已虛的氣血膠結(jié)致病。腎虛可致血瘀痰阻,這些病理產(chǎn)物阻滯氣機(jī)運(yùn)行而膠著,又可加重腎虛,相互為因,形成腎虛血瘀、腎虛痰阻、腎虛痰瘀互結(jié)之病機(jī)。在治療上,治病必求于本,常老師從重視腎的氣化功能出發(fā),強(qiáng)調(diào)腎氣、腎陽(yáng)對(duì)全身的溫煦、推動(dòng)、激發(fā)作用,并由此提出溫腎以灌四旁的治療大法,以腎氣丸為主方生少火,溫腎氣治本,并隨癥加減以治標(biāo),驗(yàn)之于臨床。3溫腎通脈湯治療腎虛血瘀型穩(wěn)定型心絞痛的臨床觀察目的觀察常振森主任醫(yī)師自擬方溫腎通脈湯治療腎虛血瘀型穩(wěn)定型心絞痛的臨床療效,驗(yàn)證溫腎通脈法治療該病的臨床特色經(jīng)驗(yàn),進(jìn)一步深化常老師學(xué)術(shù)觀點(diǎn)——腎與氣血相關(guān)論。方法選擇60例穩(wěn)定型心絞痛且辨證為腎虛血瘀型的患者60例,隨機(jī)分為試驗(yàn)組和對(duì)照組各30例。對(duì)照組給予阿司匹林腸溶片、他汀類、硝酸酯類、?受體阻滯劑作為基礎(chǔ)治療;試驗(yàn)組:在上述治療基礎(chǔ)上加用溫腎通脈湯,療程4周,治療前后記錄臨床癥狀。結(jié)果試驗(yàn)組患者心悸、倦怠乏力,腰膝酸軟等氣陽(yáng)虛的癥狀,得到了明顯的改善,癥狀的改善、心電圖及硝酸甘油的停減率與對(duì)照組相比統(tǒng)計(jì)學(xué)有差異(P0.05)。結(jié)論西藥治療配合溫腎通脈湯對(duì)腎虛血瘀型穩(wěn)定型心絞痛臨床癥狀的改善療效較好,減少了硝酸甘油使用,提高了患者的生存質(zhì)量。
[Abstract]:Mr. Chang Zong, the chief physician of Shandong Province, is the teacher of the fifth batch of Chinese traditional Chinese medicine experts' academic experience. After 40 years of medical treatment, the medical ethics is rich and rich. We should pay more attention to the gasification and kidney qi of true Yang in the kidney, the role of kidney yang, the role of kidney yang, and emphasize the warmth, promotion and long nourishing of the kidney to the organs of the human body. In the clinical practice, we continue to explore and summarize, and seek the development and innovation on the basis of inheritance. Characteristics and health care, the idea of treating the disease without disease, put forward the.1. academic thought origin of kidney and Qi blood correlation theory, "inner classics >" is the foundation of the construction of clinical theory of traditional Chinese medicine. It shows people to understand the relationship between man and the world, and the corresponding principle of day four from the whole point of view. The philosophical concept and dialectics of the five lines of yin and yang are used to explain the traditional Chinese medicine, the pathogenesis, the diagnosis, the treatment and the treatment. It has established the ideological system of traditional Chinese medicine, established the theoretical basis for guiding clinical practice, guiding the further development of traditional Chinese medicine. It has created a combination of disease, pulse, and syndrome, perfected the system of syndrome differentiation, set up the rules and clear methods for the medical practitioners. Combined with years of evidence and the dialectical summary of human physiology and pathology, teachers often advocate Zhang Jingyue's "heavy Yang Qi", "Yang is not more than, the true Yin is ineffective", and the viscera activities are centered on the fate of the viscera and the cure "to cure the disease". It has a great influence on the formation of the idea that teachers attach importance to birth, kidney and kidney, and the formation of the theory of kidney and Qi and blood. Zheng Qinan, known as Zheng Kun Zi, is used to treat all kinds of severe and dangerous diseases with Kun Zi, dry ginger and other pyretic drugs. Based on the profound understanding of the theory of "Yang, Yin main, yang qi circulation, Yin Qi and no stagnation", a profound understanding of the physiological functions and pathological changes of kidney, kidney life, Qi and blood, and finally formed a teacher's academic thought - kidney and Qi and blood related theory. Jing Yueyun "the prosperity and decline of human beings are all in the kidney". The Yang Qi in the kidney is applied by the three jiao cloth, the chief of the five viscera and the inner and the six organs, the inner and outer meridians, the inside and outside, the kidney qi, the Yang Qi, the vitality active, the Yin and the sun, the spirit and the treatment. The Qi and blood are refined by the kidney, and the body of the kidney can fill the body and keep the normal life activities of the human being.2.. Summary of academic thought and clinical experience summary 2.1 academic thought summary, Teacher Chang is paying attention to reading classics, using classics, emphasizing Confucian classics to heavy, firmly establishing dialectical treatment, only learning from the classics well, deeply understanding its essence, using it in clinical, more syndromes and practice, can we talk about innovation and make better innovation, otherwise innovation will become passive water without root. In the process of learning and clinical thinking, teachers often pay attention to the unity of heaven and man, advocate the idea of the whole, "the man of heaven and earth say", the son of nature, the long evolution, the growth process, not only adapts nature, but also forms a lot of phenomena of nature to its influence. In the course of treatment and differentiation, from the heaven and the road to humanitarianism, the theory of Qi and Yin and the Qi and Yang gasification is used to explore the physiology of the viscera and the blood, the law of pathological changes and the understanding of the principle of cure. In the treatment, the treatment of syndrome differentiation and treatment is emphasized, the treatment of the disease and the combination, and the emphasis on the Qi and blood Yin and Yang, and the level of the specimen, the specimen, the specimen, the specimen, the upper and lower specimens, six aspects of the main contradictions of the disease, and the organic fusion of the clear body, the disease recognition and the syndrome differentiation, and the improvement of the syndrome. In the whole process of thinking, Mr. Chang has always attached importance to the idea of innate character, emphasizing the treatment of the disease, nourishing the kidney to healthy five zang organs, paying attention to the kidney, fixing the kidney, and strengthening the kidney in the absence of disease, and emphasizing the kidney, kidney, temperature and kidney. Mr. Chang emphasizes learning classics, using the classics, paying attention to tonifying the kidney, regulating the kidney and nourishing the kidney, and using the kidney qi pill, which has a high frequency of kidney qi, and widely used in the internal and external women. In the long-term clinical practice, it has formed its own characteristics of the medicine - the tonifying kidney medicine, and selected the typical cases of asthma, chronic diarrhea, ve disease and so on. The understanding of etiology and pathogenesis, the characteristics of treatment, summarized and clarified the academic viewpoint of the teacher's "kidney and Qi and blood correlation theory", and further firmly establish the kidney centered five zang viscera. Often teachers think that kidney essence is a congenital basis, Yuanyang, Yuan Yin, kidney qi and kidney yang are the external manifestations of kidney gasification. The operation of blood and the function of the organs of the five viscera play a promotion, warm and nutritious function. If the kidney qi and kidney yang function are low, the function of the kidney and kidney yang is low, the function of the nourishment is lost to the normal, the weakness of the blood and blood circulation and the stagnation of Qi and blood; secondly, the warm loss of the Secretary, the deficiency cold endogenetic, the blood stasis and blood stasis; third, the deficiency of kidney qi can't be found. The warm Spleen Yang, causing the dehumidifier of the water humidifier, accumulating dampness and phlegm, hinder the viscera choroid, the glue is difficult to be removed from the viscera, with the blood phase, and the stagnation of phlegm and blood stasis. Fourth, the kidney qi is weak, the capacity of the Qi and blood is low, the deficiency of Qi and blood can not fill the five viscera, and the ability to resist the evil is the place of evil, and the evil is easy to invade and invade. And evil is easy to invade and invade. The kidney deficiency can cause blood stasis and blood stasis. The kidney deficiency can cause blood stasis and phlegm obstruction, these pathological products block the gas machine running and glue, and can aggravate kidney deficiency and mutual cause, form kidney deficiency and blood stasis, kidney deficiency phlegm resistance, kidney deficiency and phlegm stasis. Body warm, promoting, stimulating effect, and thus put forward the treatment of warm kidney by the four sides of the treatment of the great law, kidney qi pills mainly to produce less fire, warm kidney qi, and reduce with the symptoms, clinical observation of the clinical.3 Wenshen Tongmai soup treatment of kidney deficiency and blood stasis type of stable angina pectoris The clinical curative effect of treating the kidney asthenia and blood stasis type of stable angina pectoris, verifying the clinical characteristic experience of the treatment of the disease by the method of warm kidney and kidney circulation, and further deepening the academic viewpoint of normal teachers - the correlation of kidney and Qi and blood. Methods 60 patients with stable angina pectoris and 60 cases of kidney deficiency and blood stasis type were selected and randomly divided into the experimental group and the control group, 30 cases each. The group was treated with Aspirin Enteric-coated Tablets, statins, nitrates, and receptor blockers as the basic treatment. The experimental group was treated with warm kidney Tongmai soup on the basis of the above treatment, and the clinical symptoms were recorded before and after treatment. Results the symptoms of palpitation, fatigue and weakness of the waist and knees were observed in the experimental group, and the improvement of the symptoms was obviously improved and the symptoms were improved. The reduction rate of electrocardiogram and nitroglycerin was different from that of the control group (P0.05). Conclusion the therapeutic effect of Western medicine and Wenshen Tongmai Decoction on the clinical symptoms of stable angina pectoris of kidney deficiency and blood stasis type is better, and the use of nitroglycerin is reduced, and the quality of life of the patients is improved.
【學(xué)位授予單位】：山東中醫(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

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1 肖成;牛興東教授學(xué)術(shù)思想總結(jié)和腹瀉型腸易激綜合征（脾胃虛弱型）臨床研究[D];北京中醫(yī)藥大學(xué);2016年

2 王梅生;常振森主任醫(yī)師學(xué)術(shù)思想總結(jié)及腎與氣血相關(guān)論的臨床運(yùn)用[D];山東中醫(yī)藥大學(xué);2016年

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