老昌辉老师学术思想和临床经验的整理和总结Word文档下载推荐.docx
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专业名称中医内科学
指导教师姓名老昌辉
申请学位类型硕士
论文提交日期2016年3月
广州中医药大学学位论文原创性声明
本人郑重声明:
所呈交的学位论文,是个人在导师的指导下,独立进行研究工作所取得的成果。
除文中已经特别加以注明引用的内容外,本论文不含任何其他个人或集体己经发表或撰写过的作品成果。
对本文的研究做出重要贡献的个人和集体,均已在文中以明确方式标明并致谢。
本人完全意识到本声明的法律结果由本人承担。
学位论文作者签名:
梁可云
日期:
2016年3月2日
关于学位论文使用授权的声明
本人完全了解广州中医药大学有关保留使用学位论文的规定,同意学校保留或向国家有关部门机构送交论文的复印件和电子版,允许被查阅和借阅。
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(保密论文在解密后应遵守此规定)
论文作者签名:
梁可云论文导师签名:
老昌辉
2016年3月2日
摘要
目的:
①老昌辉老师学术思想的渊源,剖析其学术脉络和学术思想的形成;
②整理、总结老昌辉老师的学术思想、临证经验,继承老昌辉老师的学术精髓,促进学术继承的深入;
③整理老昌辉老师治疗小儿咳嗽变异性哮喘的临床经验,探讨中药直流电离子导入联合益肺养阴胶囊内外合治小儿咳嗽变异性哮喘的临床疗效。
方法:
①收集整理老昌辉老师的各类资料:
老师从医以来临证的验案、验方、各类公开刊物上发表的论文、或未公开发表的个人心得和读书笔记、或各类学术讲座的讲稿、幻灯片、视频、或学生的跟师记录等资料;
②通过跟师和查询病案,记录初诊、复诊病人的病案,包括其辨证、用药及诊疗全过程;
③全面总结老昌辉老师临证过程中形成的学术思想,包括辨证思路、治则治法、选方用药、预防调摄等。
精炼出老昌辉老师论治各种疾病的中医诊疗方案,并整理成文,继而推广运用临床;
④在老昌辉学术经验总结的基础上,进行深入的临床研究,即以中药直流电离子导入联合益肺养阴胶囊治疗小儿咳嗽变异性哮喘,通过临床疗效观察,对比咳嗽症状评分、中医症状评分,对比结合治疗前后及与对照组的实验室指标的变化情况,即呼出气一氧化氮、免疫功能等,为中药直流电离子导入联合益肺养阴胶囊内外合治小儿咳嗽变异性哮喘这一疗法在临床的应用推广上提供临床与实验室依据,为中医药治疗小儿咳嗽变异性哮喘提供新思路。
结果:
老昌辉老师在长期的临床实践过程中,逐渐形成了独特的学术思想和临证经验。
一、学术思想:
①强调整体观念,身心同治,②注重扶正祛邪,补泻互寓;
③重视调畅气机,因势利导;
④主张师古不泥,衷中参西;
⑤倡导饮食疗法,治养结合;
⑥擅用内外合治,增强疗效。
二、总结了老昌辉老师辨证治肺络张、肺胀、哮证、咳嗽、崩漏、痛经、郁证、胃脘痛的经验。
老师在辨治肺络张时认为,本病多为素体阴虚火旺,每因外感六淫之邪、饮食不当或七情内伤而诱发,以恼怒、肝郁诱发为主因。
扶正气、祛痰化瘀和疏肝解郁调情志三个要点贯穿在整个治疗过程。
对肺胀的辨治,老师认为正气亏虚是内因,外邪侵袭为诱因,痰、瘀既是病理产物又是致病因素,正虚邪恋为其病机;
治疗当发时攻邪,缓时固本,兼用化痰、活血、利水之法,辅以饮食调养和呼吸锻炼。
治疗哮证,老师衷中参西,发作时在西医规范治疗的基础上,配合中医药利气豁痰祛邪治疗;
缓解期固本培元,从而减轻发作的程度,预防复发。
对咳嗽的辨治,老师提出辨证时外感首别寒热次问痰,内伤先明脏腑;
治疗上外感宜宣宜降,内伤宜养宜敛,用药不宜过于寒凉。
对于崩漏一病,老师认为脾肾亏虚为根本,瘀血贯穿其中,治疗时止血不忘化瘀;
塞流、澄源、复旧相兼为用;
顺应月经周期,恢复胞宫藏泻功能。
老师认为郁证的发生,禀赋为内因,情志不遂为诱因,气郁为先,治疗应疏肝解郁为主,兼可化痰降浊,适当补益元气,辅以心理治疗。
老师提出,肝脾同调在脾胃病的治疗中具有重要作用,以疏肝理气,健脾和胃之法治疗慢性胃炎,收效甚佳。
三、中药直流电离子导入联合益肺养阴胶囊内外合治小儿咳嗽变异性哮喘的临床研究提示:
中药直流电离子导入能够较单纯的西医常规治疗更迅速、有效地控制患儿的咳嗽症状,在中医单症状积分方面较对照组具有显著优势,且无明显的不良反应。
吸入糖皮质激素及口服益肺养阴胶囊联用时,患儿的中医证候总积分、咳嗽积分及咽痒积分等均显著优于单一药物治疗方案,其控显率亦显著优于单一药物治疗组。
在评价对患儿气道反应性的影响方面,益肺养阴胶囊能够改善患儿的临床症状,但其降低FeNO、IgE的作用不及吸入性糖皮质激素(ICS),而提高血清IgA、IgG方面则有明显优势。
当吸入ICS与口服益肺养阴胶囊联用时,患者血清IgA、IgG及FeNO均较单纯的ICS吸入治疗有更显著改善,其疗效优于上述两种药物的单药治疗方案。
结论:
①总结了老昌辉老师从事中医临床、教学、科研工作40余年,积累了丰富的临证经验,并逐渐形成了自己的学术思想和临床诊疗经验,取得一定的学术成就。
②老昌辉老师学术经验的总结、继承有较高的学术和临床价值。
③以老昌辉老师学术思想和临证经验传承为根本,立足于临床实践,可发挥名医的优势,突显中医特色,培养中医后备人才,推动中医的传承和发展。
④面向广大中医药工作者,从学术思想、辨证特色、治法方药、专方专治、自制药剂、饮食调护等诸多方面,推广老昌辉老师的学术经验,推动中医药的传承和发展,惠及广大病患者。
⑤中药直流电离子导入能够迅速改善咳嗽变异性哮喘患儿的咳嗽症状;
益肺养阴胶囊可能通过调节患儿的免疫功能,与西医常规治疗协同降低患儿的气道高反应性,从而达到提高咳嗽变异性哮喘疗效的目的。
益肺养阴胶囊治疗小儿CVA的疗效确切,当与西医常规联用时具有更高的有效率。
中药直流电离子导入联合益肺养阴胶囊内外合治小儿咳嗽变异性哮喘,临床疗效确切,远期疗效较佳,无毒副作用,值得在临床进一步推广应用。
关键词老昌辉;
学术思想;
经验总结;
儿童咳嗽变异性哮喘;
临床研究;
疗效观察
Abstract
Objective
1.ToanalyzetheformationofacademiccontextandacademicthoughtofDr.LaoChanghui’sacademicthoughts.2.Toanalyzeoftheclinicaldiagnosisandtreatmentstrategiesandthecharacteristicsofthemedicine,theteacher'
suniqueclinicalexperienceinthetreatmentwassummarized.3.ToexploretheclinicalcurativeeffectoftraditionalChinesemedicineiontophoresiscombinedYifeiYincapsulecombinedwithexternaltreatmentofchildrenwithcoughvariantasthma,byevaluatingthetreatmentofchildrenwithcoughvariantasthma(CVA)withinternalandexternaltherapy.
Methods
1.Tocollectandanalyzeallkindsofmaterials,includingtestcase,provedrecipe,papers,unpublishedpersonalexperienceandlecturesofacademicforums,slides,videos.
2.Throughlearningfromtheteacherandresearchcase.Torecordthefirstandsecondvisittodoctor.includingSyndromedifferentiation,treatmentanddiagnosis.
3.Tosummarizetheacademicthoughtsintheprocessofsyndromedifferentiation,treatmentprinciple,medicine,preventionandrehabilitation.Torefinethetreatmentanddiagnosisplanofmanydiseasesandorganizetouseinclinic.4.TohaveclinicalstudyusingDr.lao’sacademicthought.TousedirectcurrentelectricionofChinesetraditionalmedicinecombinedwithYifeiyangyincapsuleinthetreatmentofchildrencoughvariantasthma(CVA).Toobservetheclinicalresult,tocomparecoughsyndromescoreTCMsymptomsscore.TocompareexhalationofNOandimmunefunction.ToprovideclinicalandexperimentalevidenceofapplicationthismethodinthetreatmentofCVA.
Result
Inmanyyearsofclinicalpractice,hegraduallyformedhisownuniqueacademicthoughtandclinicalexperience.
Academicthoughts
1.DrLaostressedtheoverallconcept,physicalandpsychologicaltreatmentatthesametime.2.Payattentiontostrengtheningthebodyresistancetoeliminatepathogenicfactors,reinforcingandreducingmutualblending.3.Payattentiontoconditioninggasmachine,theoccasion.4.claimsdivisionisnottheancientmud,sincerelyparticipateintheWest.5.ThehomologyofMedicineandfood,dietforthefirst.6.unauthorizeduseofinternalandexternalgovernance,enhancethecurativeeffect.
Dr.LaointreatingbronchiectasisbelievesthatthisdiseaseisferriteYinHuoWang,eachforexogenoussixexogenouspathogens,improperdietoremotionalinjuriesandinduced,withexasperation,stagnationoftheliverqiandevokedasitsmainfactor.Hebelievesthattreatmentofthediseasedistributionforstageandremissionstage,dependingonitsinternalorgansandevilistheactualsituationandrule,clinicaluseofdrugs,cold,sweet,lessbittercolddrugssoastoavoidinjurytotheYin;
Mr.Laoholdonthethreepoints:
strengtheninghealthyqi,eliminatingphlegmandresolvingstasisandShuganjieyuflirtChi,throughouttheentirecourseoftreatment.Thesyndromedifferentiationandtreatmentonchronicobstructivepulmonarydisease,theteacherthinksthatdeficiencyofvitalqiistheinternalcause,externalevilinvasionasanincentiveforsputum,bloodstasisisthepathologicalproductandpathogenicfactors,positiveimaginaryevilloveasthemainpathogenesis;
Whenthetreatmentcomprehensive:
whentheattackevil,slowwhenfixingthedual-purposephlegm,promotingbloodanddiuresismethod,supplementedbydietnursedbacktohealthandbreathingexercises.Treatmentofasthma,theteacherthoughtshouldbesincerelyparticipateinthewest,theattackonthebasisofWesternmedicinestandardizedtreatmentmustcombinedwithtraditionalChinesemedicinephlegmQuxietreatment,remissionoftonifyingkidney,soastoreducethedegreeofattackandpreventionofrecurrence.Foruterinebleedingdisease,theteacherthinkastheniaofboththespleenandkidneyastheroot,andbloodstatsispenetratesthetreatmentofbleedingdidnotforgettoremovebloodstasis;
plugflow,clarifyingthesourceandinvolutionphaseandfortheuseof;
atthesametimeshouldbepayattentiontoreplytotheuterusofstoringanddischargingfunction..Mr.Laothinkmelancholia,endowmentisinternal,emotionalfailtomaterializeasanincentive,qidepressionisthefirst,treatmentshouldbeShuganJieyu,anddissipatingphlegmanddescendingtheturbid,theappropriatetonicvitality,combinedwithpsychologicaltreatment..Theteacherpresents,thehomologyofliverandspleeninthetreatmentofdiseasesofthespleenandstomachhasanimportantrole,withsoothingtheliverandregulatingthecirculationofQi,spleenandstomachmethodinthetreatmentofchronicgastritis,withgratifyingresults.Differentiationandtreatmentofchronicurticaria,.Mr.Laothoughtaboutthediseaseincidenceanddeficiency,wind,heat,istheproofofcoldandheat,deficiencyandexcesssyndromes,treatmentshouldbecoldandheat,rousing,Qiregulating,idiomaticWumeiPilltocurethe,eachreceivedgoodeffect.Insyndromedifferentiationandtreatmentofcough,theteacherpresentsthedifferentiationwhenexogenouscolddon'
tfirstaskedsputum,internalinjuryfirstidentifyviscera;
treatmentofexogenousshoulddispersingdescending,internalinjuriesshouldraisetheappropriateconvergence,medicationshouldnotbetoocold.
TheclinicalresearchandevaluationofLaoChanghuiinthetreatmentofchildrencoughvariantasthma(CVA)suggest:
directcurrentelectricionofChinesetraditionalmedicinecancontrolcoughquicklyandefficientlythanthecontrolgroupwithwesternmedicinewithoutadverseeffect.YifeiyangyincapsulecanimprovetheimmunologicfunctionoftheCVApatientandenhancetheefficiencyofFluticasonePropionateInhaledAerosoltherapyforCVApatient.ToevaluatetheairwayreactivityYifeiyangyincapsulecaneaseclinicalsymptom.Butit’snotbetterthanICSintheloweringFeNO,IgEwhileit’scanraiseIgAIgG.WhencombinewithICSandYifeiyangyincapsule,IgAIgGFeNOimprovedsignificantlythanICSgroup.ThedirectcurrentelectricionofChinesetraditionalmedicinecaneasethesymptomofCVAmorequickly.
Conclusion
1.Dr.LaoChanghuiaccumulatedabundantclinicalexperienceafterfortyyearsofclinic,teachingandresearch.thenformedhisuniqueacademicthoughtsandclinicalexperimentsandachievedclinicalaccomplishments.2.ThesummaryandinheritanceofDr.Lao’sacademicexperiencehashighacademicandclinicalvalue.3.BasedonDr.Lao’sacademicthoughtsandclinicalexperiencecanbringTCM’ssuperiorityintofullplay.TomakeTCMcharacteristicimportant.Cultivatepersonwithability.PromotetheinheritanceanddevelopmentofTCM.4.TofaceTCMworkers.Promotetheacademicexperienceonacademicthoughts.Syndromedifferentioncharacteristics.Medicinetreatment.Recipes.self-mademedicineanddietrecuperation.5.CombiningwithFluticasonePropionateInhaledAerosoltherapy,DirectcurrentelectricionofChinesetraditionalmedicineandYifeiyangyincapsulecancontrolthecoughsymptomofCVApatientmorequicklyandefficiently.YifeiyangyincapsulecanimprovetheimmunologicfunctionoftheCVApatientandenhancetheefficiencyforC