【摘要】：劉華為教授為全國第四、五批老中醫(yī)藥專家學術經(jīng)驗繼承工作指導老師,陜西省名中醫(yī),從醫(yī)四十載,中醫(yī)理論造詣深厚,臨床經(jīng)驗豐富,擅治內(nèi)科疑難雜癥,尤其對冠心病、高血壓病、心律失常等疾病有著自己獨特的學術見解和臨床經(jīng)驗,研究總結導師的學術特色與臨床經(jīng)驗,從而繼承與發(fā)揚傳承中醫(yī)。1.劉華為教授學術思想與臨床經(jīng)驗的整理研究劉華為教授熟諳經(jīng)典,博覽群書,師古而不泥古,重視對《內(nèi)經(jīng)》、《傷寒論》、《金匱要略》、《溫病學》四大經(jīng)典的研究,臨床精于辨證,強調(diào)脾胃,重視肝膽,崇尚重陽的學術理念�？偨Y劉華為教授學術思想有：強調(diào)整體觀念；堅持辨病、辨證相結合；注重臟腑氣機氣化；強調(diào)脾胃,重視肝膽；臨床常用“調(diào)氣機,促氣化”理念的方劑；重視陽氣；秉承“少火生氣”理念,臨床擅用附子;充分發(fā)揮合方優(yōu)勢,體現(xiàn)整體思維。劉華為教授臨床擅治內(nèi)科疑難雜癥,對心血管疾病治療有自己的特色,總結劉華為教授臨床經(jīng)驗,以“辛開苦降法”為主導創(chuàng)制的開降分消湯治療冠心病心絞痛(痰濁痹阻證)；運用臟腑辨證,以“臟腑氣機氣化”理念指導心律失常、高血壓病、肺癌、食道癌、慢性胃炎及肝硬化等疾病的治療。創(chuàng)新點：(1)以“辛開苦降法”為主導創(chuàng)制的開降分消湯,是以半夏瀉心湯、溫膽湯及五苓散合方變化而來,全方通過化痰、降痰、消痰達到暢氣機、促氣化、通心脈之功效,體現(xiàn)了中醫(yī)的整體觀。(2)開降分消湯可以改善臨床癥狀及血脂、血清纖維蛋白原水平,為中醫(yī)藥治療冠心病心絞痛提供了新的思路和方法。(3)本研究通過運用“臟腑氣機氣化”理念對冠心病心絞痛的病機及治療的闡釋,首次系統(tǒng)總結了劉華為教授的學術淵源及學術理念,對繼承和推廣劉華為教授的經(jīng)驗具有十分重要的意義。2.開降分消湯對冠心病心絞痛(痰濁痹阻證)的臨床研究冠心病心絞痛相當于中醫(yī)學“胸痹”、“心痛”、“真心痛”等范疇。近年來隨著人們生活節(jié)奏的加快及生活方式、飲食結構的改變,冠心病心絞痛的發(fā)病率呈逐年上升趨勢,且發(fā)病年齡趨于年輕化,嚴重威脅著人們的生命和健康,已成為當今社會的常見疾病。中醫(yī)學在冠心病的證候研究、病因病機及治療方面積累了豐富的經(jīng)驗,因此探索從中醫(yī)藥預防和治療冠心病的道路勢在必行。劉華為教授總結各家對冠心病中醫(yī)病因病機的認識,沿襲《金匱要略》中胸痹“陽微陰弦”的病機,認為冠心病是由于臟腑氣機失調(diào),氣化失司,導致痰、濕、水、濁、瘀等病理性代謝產(chǎn)物內(nèi)停,痹阻心脈而致,而痰濁痹阻是冠心病發(fā)病的主要病機,其病位在心,涉及肝、脾、腎,但與膽及脾(胃)關系密切相關。臨床采用“辛開苦降法”為主導創(chuàng)制的開降分消湯對冠心病患者進行臨床療效及血脂、血清纖維蛋白原等臨床觀察研究,以探討開降分消湯治療冠心病的臨床療效及作用機制,從而進一步總結和發(fā)揚名老中醫(yī)的學術經(jīng)驗。研究目的：(1)總結劉華為教授學術思想和臨床經(jīng)驗,在此基礎上進行繼承和發(fā)揚。(2)通過觀察以“辛開苦降法”為主導創(chuàng)制的開降分消湯對冠心病心絞痛(痰濁痹阻證)患者治療前后臨床療效及心電圖的影響,對血脂、血清纖維蛋白原水平的影響,探討開降分消湯對冠心病的療效及對血脂、血清纖維蛋白原指標的干預機制以及中西醫(yī)結合治療冠心病心絞痛的獨特優(yōu)勢。方法：(1)學習老師發(fā)表的論文和著作,整理學術思想。(2)跟師過程中,通過老師授課、抄方學習的方法,記錄老師處方用藥及辯證施治的特點,對其臨床經(jīng)驗進行總結。(3)臨床研究：采用隨機對照試驗方法,選取冠心病穩(wěn)定型心絞痛患者120例。所有患者按對照組：治療組=1：1比例分為西藥組(對照組)及中西藥結合組(治療組),每組60例。西藥組口服單硝酸異山梨酯片、拜阿斯匹靈片及阿托伐他汀鈣片。中西藥結合組在西藥組治療基礎上聯(lián)合口服開降分消湯,共給藥4周。4周末觀察治療前后兩組患者的臨床病情評分及心電圖療效,檢測患者總膽固醇、甘油三酯、高、低密度脂蛋白及血清纖維蛋白原水平,上述結果均進行治療前后組內(nèi)對比觀察及治療后組間對比觀察。數(shù)值用均數(shù)±標準差(x±S)表示,計量資料分析采用t檢驗及方差分析：組間比較采用獨立樣本t檢驗,組內(nèi)治療前后比較采用配對樣本t檢驗,組間比較采用方差分析；計數(shù)資料分析采用卡方檢驗：率的比較采用卡方檢驗；等級資料比較采用Riddit分析。結果：(1)治療前后組內(nèi)比較,兩組心絞痛療效及中醫(yī)癥狀評分均明顯降低(P0.05)；兩組在心絞痛療效、心電圖療效、中醫(yī)證候療效顯效率及總有效率方面均有不同程度改善。治療前后組間比較,治療組在心絞痛、心電圖及中醫(yī)證候療效顯效率方面明顯優(yōu)于對照組(P0.01)。(2)治療前后血脂比較,對照組TG、TC、LDL-C、HDL-C值治療前后無顯著性差異(P0.05)；治療組TC、LDL-C值顯著降低(P0.05), HDL-C值顯著升高(P0.01),TG值治療前后無顯著性差異(P0.05),說明治療組能顯著降低TC、LDL-C值,升高HDL-C值。兩組間治療后比較,治療組在降低LDL-C值及升高HDL-C值方面療效優(yōu)于西藥組(P0.05)。(3)治療前后血清纖維蛋白原(FIB)組內(nèi)比較：對照組P0.05,統(tǒng)計學無顯著性差異；治療組P0.05,統(tǒng)計學有顯著性差異,說明治療組能顯著降低FIB水平。治療前后組間比較,治療組在降低FIB值方面療效明顯優(yōu)于對照組(P0.01)。結論：研究表明開降分消湯治療冠心病心絞痛(痰濁痹阻證)患者,可改善心絞痛癥狀,而且在心絞痛、心電圖及中醫(yī)證候療效方面效果顯著,并可降低患者TC、LDL-C值,升高HDL-C值及降低血清纖維蛋白原水平�？梢娞禎岜宰枋枪谛牟⌒慕g痛發(fā)生發(fā)展的重要病機之一。由此推測運用“辛開苦降法”即通過化痰利濕,暢氣機,促氣化來調(diào)節(jié)體內(nèi)血脂、血清纖維蛋白原水平可能是抗冠心病心絞痛的機制之一。開降分消湯聯(lián)合魯南欣康、拜阿斯匹靈及阿托伐他汀鈣片的中西醫(yī)結合治療,能明顯改善心絞痛及血脂、血清纖維蛋白原水平。本研究為中西醫(yī)結合治療冠心病心絞痛(痰濁痹阻證)提供了科學、客觀的依據(jù),為進一步探討該方作用機理的研究奠定了基礎。
[Abstract]:Professor Liu Huawei is the fourth and fifth group of experts of traditional Chinese medicine in China who have inherited their academic experience. He has been a famous Chinese doctor in Shaanxi Province for forty years. He has profound theoretical knowledge and rich clinical experience in traditional Chinese medicine. He is good at treating difficult and complicated diseases in internal medicine, especially coronary heart disease, hypertension and arrhythmia. Professor Liu Huawei's academic thought and clinical experience collation and research Professor Liu Huawei familiar with the classics, read a large number of books, teach ancient but not muddy ancient, attach importance to the < Neijing >, < typhoid fever theory >, < Jinkui Yaojie >, < Febrile Disease > four classics of research, clinical proficiency in syndrome differentiation. Professor Liu Huawei's academic thoughts are summarized as follows: emphasizing the overall concept; insisting on the combination of disease differentiation and syndrome differentiation; emphasizing the viscera-qi qi-qi-qi-qi-qi-qi-qi-qi-qi-qi-qi-qi-qi-regulating; emphasizing the spleen-stomach and liver-gallbladder-qi-regulating; emphasizing yang-qi-regulating; adhering to the principle of "less fire-qi-qi-qi-qi-regulating" Professor Liu Huawei is good at treating difficult and complicated diseases in internal medicine and has its own characteristics in the treatment of cardiovascular diseases. Differentiation of zang-fu organs, the concept of "Zang-fu Qi Qi Qi Qi" to guide the treatment of arrhythmia, hypertension, lung cancer, esophageal cancer, chronic gastritis and liver cirrhosis. (2) Kaijiangfenxiao Decoction can improve clinical symptoms and blood lipids, serum fibrinogen levels, and provide new ideas and methods for the treatment of coronary heart disease angina pectoris. (3) This study through the use of the concept of "viscera-qi Qi qi" on coronary heart disease angina pectoris. The explanation of the pathogenesis and treatment of pain is the first systematic summary of Professor Liu Huawei's academic origins and academic concepts. It is of great significance to inherit and promote Professor Liu Huawei's experience. 2. Clinical study of Kaijiang Fenxiao Decoction on coronary heart disease angina pectoris (phlegm turbidity obstruction syndrome). Angina pectoris equivalent to "chest pain" and "heart pain" in TCM. In recent years, with the acceleration of people's life rhythm and the change of lifestyle and dietary structure, the incidence of coronary heart disease angina is increasing year by year, and the age of onset tends to be younger, seriously threatening people's lives and health, has become a common disease in today's society. Professor Liu Huawei summarized the understanding of the etiology and pathogenesis of coronary heart disease, followed the pathogenesis of "Yang-Wei-Yin-string" in "Synopsis of the Golden Chamber" and "Zhongxiong-Bi". He believed that coronary heart disease was caused by the disorder of viscera-qi and qi-qi. The main pathogenesis of coronary heart disease is phlegm turbidity obstruction, which is located in the heart, involving the liver, spleen and kidney, but closely related to the gallbladder and spleen (stomach). Objective: (1) Summarize Professor Liu Huawei's academic thought and clinical experience, and carry forward and carry forward on this basis. To observe the effect of Kaijiangfenxiao Decoction on clinical efficacy and electrocardiogram, blood lipid and serum fibrinogen levels in patients with coronary heart disease and angina pectoris (phlegm turbidity obstruction syndrome) before and after treatment, and to explore the effect of Kaijiangfenxiao Decoction on coronary heart disease and its intervention on blood lipid and serum fibrinogen indexes. Methods: (1) Learn the papers and works published by the teacher, sort out the academic ideas. (2) In the process of follow-up, record the characteristics of prescription medication and dialectical treatment by the teacher, and summarize the clinical experience. 120 patients with stable angina pectoris were divided into western medicine group (control group) and combination of traditional Chinese and Western medicine group (treatment group) according to the ratio of 1:1. The western medicine group was given isosorbide mononitrate tablets, aspirin tablets and atorvastatin calcium tablets orally. On the basis of the treatment of the drug group and oral Kaijiangfenxiao Decoction, the clinical condition score and electrocardiographic efficacy of the two groups were observed at the end of 4 weeks. The levels of total cholesterol, triglyceride, high, low density lipoprotein and serum fibrinogen were detected. The results were compared before and after treatment in the two groups. The data were analyzed by t test and variance analysis. The comparison between groups was performed by independent sample t test. The comparison between groups before and after treatment was performed by paired sample t test. The comparison between groups was performed by variance analysis. Results: (1) Before and after treatment, the curative effect of angina pectoris and the score of TCM symptoms were significantly lower in both groups (P Pain, electrocardiogram and TCM syndromes were significantly better than the control group (P 0.01). (2) Before and after treatment, blood lipid, control group TG, TC, LDL-C, HDL-C before and after treatment, there was no significant difference (P 0.05); treatment group TC, LDL-C value significantly decreased (P 0.05), HDL-C value significantly increased (P 0.01), TG value before and after treatment had no significant difference (P 0.05), indicating that treatment group TC, LDL-C value significantly increased (P 0.05). After treatment, the therapeutic effect of the treatment group was better than that of the western medicine group (P 0.05). (3) Serum fibrinogen (FIB) before and after treatment in the control group P 0.05, there was no significant difference between the control group P 0.05, the treatment group P 0.05, there was significant difference between the two groups, indicating that the treatment group P 0.05, there was significant difference between the two groups. The treatment group can significantly reduce the level of FIB. Before and after treatment, the treatment group in reducing the FIB value was significantly better than the control group (P It can also reduce TC, LDL-C, increase HDL-C and decrease serum fibrinogen level. It is concluded that phlegm turbidity obstruction is one of the important pathogenesis of angina pectoris in coronary heart disease. Kaijiang Fenxiao Decoction combined with Lunan Xinkang, BaiAspirin and Atorvastatin Calcium Tablets can significantly improve angina pectoris, blood lipids and serum fibrinogen levels. This study provides a scientific and objective basis for the treatment of coronary heart disease angina pectoris (phlegm turbidity obstruction syndrome). The study laid a foundation for further study of the mechanism of action.
【學位授予單位】：中國中醫(yī)科學院
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R249;R259

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