裴正学教授“异病同治”学术思想初探及冠心宁治疗心脑血管病临床观察
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摘要
[目的]基于中医“异病同治”理论渊源探求裴正学教授“心脑同治”学术思想,通过观察中药制剂冠心宁对“不稳定性心绞痛”和“缺血性脑卒中”的临床疗效,探讨用同一种治疗方法分别干预心血管疾病和脑血管病的临床疗效,进一步证实中医“异病同治”理论的科学性,为中医药防治心脑血管病提供新的理论依据和有效方药。
[方法]1.理论研究方法：(1)基于“异病同治”理论探讨裴正学教授“心脑同治”学术思想。采用文献学方法,探讨中医“异病同治”“同病异治”理论渊源,诠释裴正学教授“心脑同治”学说涵义,进一步探讨中医学对“心脑同治”的认识。(2)全面汇总、整理、归类裴正学教授的临床资料,通过分析总结裴教授治疗心律失常、脑血管意外、高血压病、冠心病疾病的临床经验,深入探析裴教授学术思想精髓,挖掘导师学术思想。
2.临床研究方法：基于“异病同治”思想探讨冠心宁对心脑血管疾病的临床疗效。(1)冠心宁治疗不稳定性心绞痛30例临床疗效观察。以30例不稳定性心绞痛为研究对象,口服“冠心宁”4周,按积分记录症状体征,检测疗效指标：包括中医证候疗效,心电图,血脂指标(TC、TG、HDL、LDL),血液流变指标(全血比粘度、血浆比粘度、纤维蛋白原),血清炎性指标(C反应蛋白)等。同时监测血、尿、大便常规、肝、肾功能等安全性指标。并与30例常规治疗对照组作比较研究。(2)冠心宁治疗缺血性脑卒中30例临床疗效观察。以30例缺血性脑卒中为研究对象,口服冠心宁4周,按积分记录症状体征,检测疗效指标：包括中医证候疗效,神经功能缺损(NIHSS)水平,认知功能障碍(MMSE)水平,日常生活活动能力(Barthel),血脂指标(TC、 TG、 HDL、 LDL),血液流变指标(全血比粘度、血浆比粘度、纤维蛋白原),血清炎性指标(C反应蛋白)等。同时监测血、尿、大便常规、肝、肾功能等安全性指标。并与30例常规治疗对照组作比较研究。
[结果]1.理论研究结果：(1)裴正学教授基于“西医诊断,中医辨证,中药为主,西药为辅”的中西医治疗原则,发展了“异病同治”“同病异治”的学术思想。(2)裴正学教授认为缺血性心脑血管病可“心脑同治”,从“虚、痰、瘀”论治,确立“益气、化痰、祛瘀”的治疗原则,经验方冠心宁为有效方剂之一,值得进一步深入研究。2.临床研究结果：(1)4周后,患者证候积分较治疗前明显下降,胸痛、胸闷、心悸、气短、乏力、自汗改善最为明显(P<0.05),心绞痛发作情况、心电图等各项检测指标明显改善(P<0.05)。血液粘度、血脂水平治疗后明显改善(P<0.05)。降低C反应蛋白水平,治疗前后有显著性差异(P<0.05)。统计表明,治疗组疗效与对照组相比具有显著性差异(P<0.05)。(2)4周后,患者证候积分较治疗前明显下降,半身不遂、肢体麻木改善最为明显(P<0.05),口舌歪斜积分也有下降(P<0.05)。神经功能缺损水平,认知功能障碍水平,日常生活活动能力,(P<0.05)。血液粘度、血脂水平较治疗前明显下降(P<0.05)。降低C反应蛋白水平(P<0.05)。治疗组总体疗效优于对照组,具有显著性差异(P<0.05)。
[结论]通过将裴正学教授“心脑同治”学术思想应用于临床实践,发现中药冠心宁对不稳定性心绞痛和缺血性脑卒中均具有一定的临床疗效,研究结果证实了裴正学“异病同治”“心脑同治”理论的科学性,表明裴正学学术思想和用药经验值得临床推广应用。
[Objective] To explore the TCM theory origins about "Different Diseases with Same Therapy" and the academic thought of Professor Pei about "Heart and Brain with Same Therapy", through observing the clinical efficacy of Chinese medicine Guanxinning on "unstable angina" and "ischemic stroke", To explore the clinical efficacy on cardiovascular disease and cerebrovascular disease by the same treatment, further to get evidence about "Different Diseases with Same Therapy" theory, and provide a new theoretical basis and effective herbs for the prevention and treatment of cardiovascular and cerebrovascular disease。
[Methods]1.Theory Research Methods:(1) based on "Different Diseases with Same Therapy" theory to explore the"Heart and Brain with Same Therapy "academic thought of Professor Pei. Using literature study method to explore TCM "Different Diseases with Same Therapy" and " Same Diseases with Different Therapy " theory origins, to interpretate the theory meaning about "Heart and Brain with Same Therapy "of Professor Pei, to further study the opinion on the "Heart and Brain with Same Therapy".(2)Analyze and summarize the clinical experience of Professor Pei about treatment of arrhythmias, cerebrovascular accidents, hypertension, Coronary heart disease, and then to analyze the essence of academic thought of Professor Pei, mining tutor academic thought.
2. Clinical Research Methods:Based on "Different Diseases with Same Therapy" theory to explore the clinical efficacy of Guanxinning on cardiovascular disease.(1) Clinical efficacy of Guanxinning on30cases of unstable angina pectoris.30patients with unstable angina for the study, oral Guanxinning4weeks, signs and symptoms recorded by integration, testing the efficacy indicators:including TCM syndromes, electrocardiogram, lipids indicators (TC, TG, HDL, LDL), blood rheology indicators (whole blood viscosity, plasma viscosity, fibrinogen), serum inflammatory indexes (C-reactive protein), etc. At the same time, monitoring the blood, urine, stool, liver, kidney and other safety indicators. And compared with30cases of control group with conventional treatment.(2) Clinical efficacy of Guanxinning on30cases of ischemic stroke.30patients with ischemic stroke for the study, oral Guanxinning4weeks, signs and symptoms recorded by integration, testing the efficacy indicators: including TCM syndromes, neurological deficit (NIHSS) level, cognitive dysfunction (MMSE) level, activities of daily living (Barthel), serum lipids (TC, TG, HDL, LDL), blood rheology indicators (whole blood viscosity, plasma viscosity, fibrinogen), serum inflammatory indexes (C-reactive protein) and so on. At the same time, monitoring the blood, urine, stool, liver, kidney and other safety indicators. And compared with30cases of control group with conventional treatment.
[Results]1. Theory Research Results:(1) On the basis of "diagnosis by Western Medicine, differentiation of symptoms and signs by TCM,based on Chinese, medicine supplemented western medicine "policy, Professor Pei has developed of this theory,TCM idea about "Different Diseases with Same Therapy" and " Same Diseases with Different Therapy".(2) Professor Pei Zhengxue think that ischemic cerebral vascular disease can "Heart and Brain with Same Therapy". From the treatment about "deficiency、phlegm and blood stasis". Established principles of treatment about "augment Qi, resolving phlegm, removing blood stasis". Experience of Guan Xin Ning was a valid prescription, and worthy of further study.
2.. Clinical Research Results::(1) Unstable Angina Study Results Show:4weeks after treatment the syndrome score significantly decreased, chest pain, chest tightness, palpitations, shortness of breath, fatigue, spontaneous improvement was more significant (P<0.05), the onset of angina, ECG was significantly improved (P <0.05). Blood viscosity, blood lipid levels improved significantly after treatment (P <0.05). Lower C-reactive protein levels, before and after treatment there is a significant difference (P<0.05). Statistics show that the treatment group compared with the control group with significant difference (P<0.05).(2) Ischemic Stroke Study Results Show:4weeks after treatment the syndrome score significantly decreased, hemiplegia, numbness improved most significantly (P<0.05),(P<0.05). The level of neurological deficit, cognitive impairment level, activities of daily living, quality of life significantly improved integrated (P<0.05). Blood viscosity, blood lipid levels than before treatment significantly decreased (P<0.05). Overall efficacy of the treatment group than the control group, with significant difference (P<0.05).
[Conclusion] Through applying Professor Pei "Heart and Brain to Treat Together" academic thought in clinical practice, found that there is a certain clinical efficacy of Guanxinning on unstable angina and ischemic stroke, the results confirmed TCM"Different Diseases with Same Therapy" and "Heart and Brain with Same Therapy " theory of Professor Peiy is scientific. Aacademic and clinical experience of Professor Pei be worthy of clinical application.
[方法]1.理论研究方法：(1)基于“异病同治”理论探讨裴正学教授“心脑同治”学术思想。采用文献学方法,探讨中医“异病同治”“同病异治”理论渊源,诠释裴正学教授“心脑同治”学说涵义,进一步探讨中医学对“心脑同治”的认识。(2)全面汇总、整理、归类裴正学教授的临床资料,通过分析总结裴教授治疗心律失常、脑血管意外、高血压病、冠心病疾病的临床经验,深入探析裴教授学术思想精髓,挖掘导师学术思想。
2.临床研究方法：基于“异病同治”思想探讨冠心宁对心脑血管疾病的临床疗效。(1)冠心宁治疗不稳定性心绞痛30例临床疗效观察。以30例不稳定性心绞痛为研究对象,口服“冠心宁”4周,按积分记录症状体征,检测疗效指标：包括中医证候疗效,心电图,血脂指标(TC、TG、HDL、LDL),血液流变指标(全血比粘度、血浆比粘度、纤维蛋白原),血清炎性指标(C反应蛋白)等。同时监测血、尿、大便常规、肝、肾功能等安全性指标。并与30例常规治疗对照组作比较研究。(2)冠心宁治疗缺血性脑卒中30例临床疗效观察。以30例缺血性脑卒中为研究对象,口服冠心宁4周,按积分记录症状体征,检测疗效指标：包括中医证候疗效,神经功能缺损(NIHSS)水平,认知功能障碍(MMSE)水平,日常生活活动能力(Barthel),血脂指标(TC、 TG、 HDL、 LDL),血液流变指标(全血比粘度、血浆比粘度、纤维蛋白原),血清炎性指标(C反应蛋白)等。同时监测血、尿、大便常规、肝、肾功能等安全性指标。并与30例常规治疗对照组作比较研究。
[结果]1.理论研究结果：(1)裴正学教授基于“西医诊断,中医辨证,中药为主,西药为辅”的中西医治疗原则,发展了“异病同治”“同病异治”的学术思想。(2)裴正学教授认为缺血性心脑血管病可“心脑同治”,从“虚、痰、瘀”论治,确立“益气、化痰、祛瘀”的治疗原则,经验方冠心宁为有效方剂之一,值得进一步深入研究。2.临床研究结果：(1)4周后,患者证候积分较治疗前明显下降,胸痛、胸闷、心悸、气短、乏力、自汗改善最为明显(P<0.05),心绞痛发作情况、心电图等各项检测指标明显改善(P<0.05)。血液粘度、血脂水平治疗后明显改善(P<0.05)。降低C反应蛋白水平,治疗前后有显著性差异(P<0.05)。统计表明,治疗组疗效与对照组相比具有显著性差异(P<0.05)。(2)4周后,患者证候积分较治疗前明显下降,半身不遂、肢体麻木改善最为明显(P<0.05),口舌歪斜积分也有下降(P<0.05)。神经功能缺损水平,认知功能障碍水平,日常生活活动能力,(P<0.05)。血液粘度、血脂水平较治疗前明显下降(P<0.05)。降低C反应蛋白水平(P<0.05)。治疗组总体疗效优于对照组,具有显著性差异(P<0.05)。
[结论]通过将裴正学教授“心脑同治”学术思想应用于临床实践,发现中药冠心宁对不稳定性心绞痛和缺血性脑卒中均具有一定的临床疗效,研究结果证实了裴正学“异病同治”“心脑同治”理论的科学性,表明裴正学学术思想和用药经验值得临床推广应用。
[Objective] To explore the TCM theory origins about "Different Diseases with Same Therapy" and the academic thought of Professor Pei about "Heart and Brain with Same Therapy", through observing the clinical efficacy of Chinese medicine Guanxinning on "unstable angina" and "ischemic stroke", To explore the clinical efficacy on cardiovascular disease and cerebrovascular disease by the same treatment, further to get evidence about "Different Diseases with Same Therapy" theory, and provide a new theoretical basis and effective herbs for the prevention and treatment of cardiovascular and cerebrovascular disease。
[Methods]1.Theory Research Methods:(1) based on "Different Diseases with Same Therapy" theory to explore the"Heart and Brain with Same Therapy "academic thought of Professor Pei. Using literature study method to explore TCM "Different Diseases with Same Therapy" and " Same Diseases with Different Therapy " theory origins, to interpretate the theory meaning about "Heart and Brain with Same Therapy "of Professor Pei, to further study the opinion on the "Heart and Brain with Same Therapy".(2)Analyze and summarize the clinical experience of Professor Pei about treatment of arrhythmias, cerebrovascular accidents, hypertension, Coronary heart disease, and then to analyze the essence of academic thought of Professor Pei, mining tutor academic thought.
2. Clinical Research Methods:Based on "Different Diseases with Same Therapy" theory to explore the clinical efficacy of Guanxinning on cardiovascular disease.(1) Clinical efficacy of Guanxinning on30cases of unstable angina pectoris.30patients with unstable angina for the study, oral Guanxinning4weeks, signs and symptoms recorded by integration, testing the efficacy indicators:including TCM syndromes, electrocardiogram, lipids indicators (TC, TG, HDL, LDL), blood rheology indicators (whole blood viscosity, plasma viscosity, fibrinogen), serum inflammatory indexes (C-reactive protein), etc. At the same time, monitoring the blood, urine, stool, liver, kidney and other safety indicators. And compared with30cases of control group with conventional treatment.(2) Clinical efficacy of Guanxinning on30cases of ischemic stroke.30patients with ischemic stroke for the study, oral Guanxinning4weeks, signs and symptoms recorded by integration, testing the efficacy indicators: including TCM syndromes, neurological deficit (NIHSS) level, cognitive dysfunction (MMSE) level, activities of daily living (Barthel), serum lipids (TC, TG, HDL, LDL), blood rheology indicators (whole blood viscosity, plasma viscosity, fibrinogen), serum inflammatory indexes (C-reactive protein) and so on. At the same time, monitoring the blood, urine, stool, liver, kidney and other safety indicators. And compared with30cases of control group with conventional treatment.
[Results]1. Theory Research Results:(1) On the basis of "diagnosis by Western Medicine, differentiation of symptoms and signs by TCM,based on Chinese, medicine supplemented western medicine "policy, Professor Pei has developed of this theory,TCM idea about "Different Diseases with Same Therapy" and " Same Diseases with Different Therapy".(2) Professor Pei Zhengxue think that ischemic cerebral vascular disease can "Heart and Brain with Same Therapy". From the treatment about "deficiency、phlegm and blood stasis". Established principles of treatment about "augment Qi, resolving phlegm, removing blood stasis". Experience of Guan Xin Ning was a valid prescription, and worthy of further study.
2.. Clinical Research Results::(1) Unstable Angina Study Results Show:4weeks after treatment the syndrome score significantly decreased, chest pain, chest tightness, palpitations, shortness of breath, fatigue, spontaneous improvement was more significant (P<0.05), the onset of angina, ECG was significantly improved (P <0.05). Blood viscosity, blood lipid levels improved significantly after treatment (P <0.05). Lower C-reactive protein levels, before and after treatment there is a significant difference (P<0.05). Statistics show that the treatment group compared with the control group with significant difference (P<0.05).(2) Ischemic Stroke Study Results Show:4weeks after treatment the syndrome score significantly decreased, hemiplegia, numbness improved most significantly (P<0.05),(P<0.05). The level of neurological deficit, cognitive impairment level, activities of daily living, quality of life significantly improved integrated (P<0.05). Blood viscosity, blood lipid levels than before treatment significantly decreased (P<0.05). Overall efficacy of the treatment group than the control group, with significant difference (P<0.05).
[Conclusion] Through applying Professor Pei "Heart and Brain to Treat Together" academic thought in clinical practice, found that there is a certain clinical efficacy of Guanxinning on unstable angina and ischemic stroke, the results confirmed TCM"Different Diseases with Same Therapy" and "Heart and Brain with Same Therapy " theory of Professor Peiy is scientific. Aacademic and clinical experience of Professor Pei be worthy of clinical application.
引文
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