欧阳恒论治硬皮病经验总结及“以皮治皮”法治疗硬皮病的临床研究
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摘要
目的：
跟师目的：
通过跟师临证及精读古典医籍和医案的学习与总结,拓展继承人的知识领域,加深对中医理论的理解和临床运用,培育深厚的传统文化基础,提高中医理论水平,提高运用中医理论进行辨证论治的水平,提升继承、整理和总结指导老师学术思想、学术经验和技术专长的能力。配合三年紧密的临床跟师学习及独立临床实践工作,全面、系统地承秉指导老师的崇高的医德和学术思想、临床经验或技术专长,提高继承人的学术水平、科研能力、及诊疗技术、为传承和发展中医做出努力。
科研目的：
总结欧阳恒教授从事中医外科领域五十余年来对硬皮病的治疗体会和临床有效方药,建立相对完善的系统性硬皮病辨证论治体系,更好为临床和科研服务。同时,采用分层随机对照的方法,客观评价欧阳恒教授“以皮治皮法”治疗系统性硬皮病的疗效,同时观察以皮治皮法对皮肤硬度积分、最大齿距、最大指距、TGF-β1、β2、 IgG、IgA、IgM、 C3、C4等临床及实验室指标的影响,为以皮治皮法的临床应用提供临床及实验室依据,为临床治疗系统性硬皮病提供新的思路和方法。
方法：
跟师方法：
首先采用以自学为主、集中授课,个别辅导为辅的学习方式,包括网上学习四大经典课程。在欧阳恒、刘庆思教授指导下,深入学习钻研,领悟和发掘古典文献精华,做好读书笔记,写出学习体会。在3年临床跟师学习及独立临床实践工作中,做好跟师笔记、随诊医案、操作记录,撰写心得体会,细心揣摩、仔细领会,尽可能全面总结和继承老师的学术思想,从而提高自己的临床诊疗技术水平。
科研方法：
(一)临床研究：遴选符合纳入标准的系统性硬皮病患者78例,分为软皮汤治疗组和积雪甙对照组,观察结束后对皮肤受累严重程度的评估、关节功能积分以及其他症状指标的动态变化情况。
(二)实验研究：治疗后,检测患者血清中治疗前后转化生长因子β和免疫学指标。
结果：
跟师成果：
理论学习考核成绩优秀,并按质按量地按照国家中医药管理局的要求完成了跟师学习和独立临床实践工作。已提交较高质量的学习经典的心得体会11篇,详尽记录跟师笔记180余篇,撰写心得体会36篇,整理临床医案60余份。跟师期间在国内高质量的期刊上发表了2篇继承、总结欧阳恒教授学术思想和技术专长的论文。
科研结果：
1、“以皮治皮法”治疗SSc,能有效减少皮肤硬度积分、增加最大齿距、最大指距值,治疗前后比较,积分差异有统计学意义(P<0.05),两组治疗2疗程后,各类积分比较差值有统计学意义(P<0.05),说明“以皮治皮法”治疗组疗效优于积雪甙对照组。
2.两组治疗前,TGF-β1、β2水平差值无统计学意义(P>0.05)：治疗两疗程前后比较,两组组内TGF-β1、β2水平前后变化差异有统计学意义(P<0.05)；两组治疗后,两组之间TGF-β1、β2水平差值有统计学意义(P<0.05),说明“以皮治皮法”治疗组在改善TGF-β表达方面优于积雪甙对照组。。
3.两组治疗前,IgG、IgA、IgM、C3、C4差值无统计学意义(P>0.05)；治疗两疗程前后比较,治疗组IgG、IgM、C3水平前后变化组内比较,及对照组IgG、C4水平前后变化组内比较,差异有统计学意义(P<0.05)；两组治疗后,两组之间IgG、 C3水平差值比较,有统计学意义(P<0.05),说明“以皮治皮法”治疗组在改善IgG、 IgM、C3等免疫学指标有显著意义,且治疗后IgG、C3的改善明显优于积雪甙对照组；两组与正常参考值比较均有升高。
结论：
跟师结论：
三年的师承学习任务已顺利完成,通过三年的努力,全面学习并总结了欧阳恒教授的祟高医德和其中心的学术思想：①应以明病为先；②病证取舍以实用为原则；③病证并论,注意发挥中医特色；④辨证与辨病相结合,以提高疗效为出发点。在具体治法上,运用取象比类法,倡导以色治色法、以形治形法、以皮治皮法、寓搔意治瘙法、以毒攻毒、参用“红升白降外科家当”说等理论观点,并在自己独立的临床实践中加以运用与推广,效果是满意的。三年的跟师学习,获益颇丰,受益匪浅、感受颇多,老师的敬业精神,勤奋学习,严谨的治学态度,令我感动,他成为我终身学习的榜样和楷模。三年的师承学习即将结束,但中医发展之路坎坷途遥、仍需要我们同仁继续传承下去,所以我们今后的学习、工作任务仍十分繁重。我们应责无旁贷地把握机遇,扛起重任,坚定信念,走中医之路,为弘扬祖国医学事业做出更大贡献。
科研结论：
“以皮治皮法”治疗SSc,能有效减少皮肤硬度积分、增加最大齿距、最大指距值,在改善症状体征方面明显优于积雪甙对照组。实验室指标说明“以皮治皮法”治疗组在改善TGF-β表达方面优于积雪甙对照组,在改善IgG、IgM、C3等免疫学指标有显著意义,且治疗后IgG、C3的改善明显优于积雪甙对照组。
Objective:
With the teacher:
With the division's clinical and intensive reading of classical medical books and medical case study and summary expand heir knowledge, deepen their understanding of Chinese medicine theory, the understanding and clinical use, foster a strong tradition of cultural foundation, improve traditional Chinese medicine theory level to improve the diagnosis and treatment using traditional Chinese medicine theory level, to enhance the inheritance, the instructor organize and summarize academic thinking, experience and technical expertise of academic ability. Closely with the three-year clinical study with the division of clinical practice and independent work, comprehensive and systematic order of Bing's lofty medical ethics instructor and academic thinking, clinical experience or technical expertise to improve the heirs of the academic level, research capacity, and treatment technology, for the development of Chinese heritage and efforts.
Research Objective:
Professor Ouyang Heng surgery in the field of medicine over50years experience on the treatment of scleroderma and clinically effective prescription to establish a relatively complete system of diagnosis and treatment of systemic sclerosis, better clinical and research services. Meanwhile, a stratified randomized method, objective evaluation of Professor Ouyang Heng "skin to skin treatment method," the efficacy of the treatment of systemic scleroderma, while observing the skin to skin treatment method for skin hardness points, maximum pitch, the maximum span, TGF-β1,β, IgG, IgA, IgM, C3, C4and other clinical and laboratory implications for the governance of the skin to skin on clinical applications of clinical and laboratory basis, to provide for the clinical treatment of systemic scleroderma new ideas and methods.
Methods:
With the teacher:
First used to self-oriented, focused on teaching, learning, supplemented by individual counseling, including the four classical e-learning courses. Hang in Ouyang, under the guidance of Professor Liu Qingsi depth in learning, understanding and to explore the essence of classical literature, good study notes, write a learning experience. In three years, and independent clinical study with teachers working in clinical practice, good With the teacher notes, follow-up medical records, operational records, write their feelings and experiences, carefully try to figure out, carefully and understand, and inheritance as a comprehensive summary of the teacher's academic thought, which clinical diagnosis and treatment to improve their skills.
Research methods:
1. Clinical studies:the selection met the inclusion criteria of78patients with systemic scleroderma, Pi-Tang treatment group is divided into soft snow glycosides and the control group to observe the results after Additional constraints assessment of the severity of skin involvement, joint feature points, and other symptoms of the dynamic changes of indicators.
2. Experimental study:After treatment, testing before and after treatment serum transforming growth factor β and immunological parameters.
Results:
With the teacher:
Excellent examination results of theoretical study, sufficient quantity and quality according to the State Drug Administration in accordance with the requirements of complete independence with a teacher to learn and work in clinical practice. Has been submitted to a high quality learning experience the classic experience of11, a detailed record of more than180articles with teacher notes, write their feelings and experiences36, finishing more than60copies of the clinical medical cases. With the teacher in the country during the high-quality journals published two inheritance, concluded Professor Ouyang Heng ideas and technical expertise of academic papers.
Research Results:
The clinical, experimental results:
1."Skin to Skin treatment method" treatment SSc, the skin can effectively reduce the hardness points, increasing the maximum pitch, the maximum span values before and after treatment, points difference was statistically significant (P<0.05), treatment
2. After treatment, comparing various points statistically significant difference (P<0.05), that "skin to skin treatment method" treatment group than the control group glycosides snow.(See Table5)2between the two groups before treatment, TGF-β1,β2level was no significant difference (P>0.05); before and after two courses of treatment, two groups within the TGF-β1,β2levels before and after the change in the difference statistically significant (P<0.05); two groups after treatment between the two groups TGF-β1,β2level difference was statistically significant (P<0.05), that "skin to skin treatment method" to improve the TGF-treatment group glycosides β expression in the control group is better than snow.
3. The two groups before treatment, IgG, IgA, IgM, C3, C4no statistically significant difference (P>0.05); before and after two courses of treatment, the treatment group IgG, IgM, C3levels before and after the change in comparison group, and control group IgG, C4levels before and after the change in the group, the difference was statistically significant (P<0.05); two groups after treatment, between the two groups IgG, C3level difference comparison was statistically significant (P<0.05), shows "Skin to skin treatment method" in the treatment group improved IgG, IgM, C3and other immunological parameters were significant, and after treatment, IgG, C3glycosides to improve the control group was significantly better than the snow; two groups were compared with normal reference values increased.
Conclusion:
With the teacher:
Three years of studying under the learning task has been successfully completed three years of efforts, and summarizes a comprehensive study, Professor Ouyang Heng's greatness is its center of ethics and academic thought:①should be out sick for the first;②Diseases of the principle of choice in practical;③Syndrome and theory, giving play to the characteristics of traditional Chinese medicine;④combining syndrome differentiation with disease, to improve efficacy as a starting point. In the specific law governing the use of law to take over as class, method advocated by the color rule color to shape laws governing shape, skin to skin treatment methods, integrating scratch Italian law governing will take place, fire with fire, make reference to the "red or white surgical belongings down "said the other theoretical perspectives, and in their own independent clinical practice to use and promotion, the effect is satisfactory. Three years with a teacher to learn, benefit quite good, benefit, many feel, the teacher's professionalism, hard study, rigorous scholarship, I was moved, he became my role model and a model of lifelong learning. Coming to an end three years of studying under study, but the bumpy road of development of Chinese medicine way away, still need our colleagues to continue to be passed along, so our future study, work is still very arduous task. We should be duty-bound to grasp the opportunity to carry the heavy, strong faith, take the road of Chinese medicine, to promote the cause of the motherland and make greater contributions to medicine.
Research conclusion:
"Skin to Skin treatment method" treatment SSc, the skin can effectively reduce the hardness points, increasing the maximum pitch, the maximum span value in improving symptoms and signs in the control group was significantly better than the snow glycosides. Laboratory parameters that "skin to skin treatment method" in the treatment group improved expression of TGF-β is better than snow glycosides control group, in improving the IgG, IgM, C3and other immunological parameters were significant, and after treatment, IgG, C3of glycosides to improve the control group was significantly better than the snow.
跟师目的：
通过跟师临证及精读古典医籍和医案的学习与总结,拓展继承人的知识领域,加深对中医理论的理解和临床运用,培育深厚的传统文化基础,提高中医理论水平,提高运用中医理论进行辨证论治的水平,提升继承、整理和总结指导老师学术思想、学术经验和技术专长的能力。配合三年紧密的临床跟师学习及独立临床实践工作,全面、系统地承秉指导老师的崇高的医德和学术思想、临床经验或技术专长,提高继承人的学术水平、科研能力、及诊疗技术、为传承和发展中医做出努力。
科研目的：
总结欧阳恒教授从事中医外科领域五十余年来对硬皮病的治疗体会和临床有效方药,建立相对完善的系统性硬皮病辨证论治体系,更好为临床和科研服务。同时,采用分层随机对照的方法,客观评价欧阳恒教授“以皮治皮法”治疗系统性硬皮病的疗效,同时观察以皮治皮法对皮肤硬度积分、最大齿距、最大指距、TGF-β1、β2、 IgG、IgA、IgM、 C3、C4等临床及实验室指标的影响,为以皮治皮法的临床应用提供临床及实验室依据,为临床治疗系统性硬皮病提供新的思路和方法。
方法：
跟师方法：
首先采用以自学为主、集中授课,个别辅导为辅的学习方式,包括网上学习四大经典课程。在欧阳恒、刘庆思教授指导下,深入学习钻研,领悟和发掘古典文献精华,做好读书笔记,写出学习体会。在3年临床跟师学习及独立临床实践工作中,做好跟师笔记、随诊医案、操作记录,撰写心得体会,细心揣摩、仔细领会,尽可能全面总结和继承老师的学术思想,从而提高自己的临床诊疗技术水平。
科研方法：
(一)临床研究：遴选符合纳入标准的系统性硬皮病患者78例,分为软皮汤治疗组和积雪甙对照组,观察结束后对皮肤受累严重程度的评估、关节功能积分以及其他症状指标的动态变化情况。
(二)实验研究：治疗后,检测患者血清中治疗前后转化生长因子β和免疫学指标。
结果：
跟师成果：
理论学习考核成绩优秀,并按质按量地按照国家中医药管理局的要求完成了跟师学习和独立临床实践工作。已提交较高质量的学习经典的心得体会11篇,详尽记录跟师笔记180余篇,撰写心得体会36篇,整理临床医案60余份。跟师期间在国内高质量的期刊上发表了2篇继承、总结欧阳恒教授学术思想和技术专长的论文。
科研结果：
1、“以皮治皮法”治疗SSc,能有效减少皮肤硬度积分、增加最大齿距、最大指距值,治疗前后比较,积分差异有统计学意义(P<0.05),两组治疗2疗程后,各类积分比较差值有统计学意义(P<0.05),说明“以皮治皮法”治疗组疗效优于积雪甙对照组。
2.两组治疗前,TGF-β1、β2水平差值无统计学意义(P>0.05)：治疗两疗程前后比较,两组组内TGF-β1、β2水平前后变化差异有统计学意义(P<0.05)；两组治疗后,两组之间TGF-β1、β2水平差值有统计学意义(P<0.05),说明“以皮治皮法”治疗组在改善TGF-β表达方面优于积雪甙对照组。。
3.两组治疗前,IgG、IgA、IgM、C3、C4差值无统计学意义(P>0.05)；治疗两疗程前后比较,治疗组IgG、IgM、C3水平前后变化组内比较,及对照组IgG、C4水平前后变化组内比较,差异有统计学意义(P<0.05)；两组治疗后,两组之间IgG、 C3水平差值比较,有统计学意义(P<0.05),说明“以皮治皮法”治疗组在改善IgG、 IgM、C3等免疫学指标有显著意义,且治疗后IgG、C3的改善明显优于积雪甙对照组；两组与正常参考值比较均有升高。
结论：
跟师结论：
三年的师承学习任务已顺利完成,通过三年的努力,全面学习并总结了欧阳恒教授的祟高医德和其中心的学术思想：①应以明病为先；②病证取舍以实用为原则；③病证并论,注意发挥中医特色；④辨证与辨病相结合,以提高疗效为出发点。在具体治法上,运用取象比类法,倡导以色治色法、以形治形法、以皮治皮法、寓搔意治瘙法、以毒攻毒、参用“红升白降外科家当”说等理论观点,并在自己独立的临床实践中加以运用与推广,效果是满意的。三年的跟师学习,获益颇丰,受益匪浅、感受颇多,老师的敬业精神,勤奋学习,严谨的治学态度,令我感动,他成为我终身学习的榜样和楷模。三年的师承学习即将结束,但中医发展之路坎坷途遥、仍需要我们同仁继续传承下去,所以我们今后的学习、工作任务仍十分繁重。我们应责无旁贷地把握机遇,扛起重任,坚定信念,走中医之路,为弘扬祖国医学事业做出更大贡献。
科研结论：
“以皮治皮法”治疗SSc,能有效减少皮肤硬度积分、增加最大齿距、最大指距值,在改善症状体征方面明显优于积雪甙对照组。实验室指标说明“以皮治皮法”治疗组在改善TGF-β表达方面优于积雪甙对照组,在改善IgG、IgM、C3等免疫学指标有显著意义,且治疗后IgG、C3的改善明显优于积雪甙对照组。
Objective:
With the teacher:
With the division's clinical and intensive reading of classical medical books and medical case study and summary expand heir knowledge, deepen their understanding of Chinese medicine theory, the understanding and clinical use, foster a strong tradition of cultural foundation, improve traditional Chinese medicine theory level to improve the diagnosis and treatment using traditional Chinese medicine theory level, to enhance the inheritance, the instructor organize and summarize academic thinking, experience and technical expertise of academic ability. Closely with the three-year clinical study with the division of clinical practice and independent work, comprehensive and systematic order of Bing's lofty medical ethics instructor and academic thinking, clinical experience or technical expertise to improve the heirs of the academic level, research capacity, and treatment technology, for the development of Chinese heritage and efforts.
Research Objective:
Professor Ouyang Heng surgery in the field of medicine over50years experience on the treatment of scleroderma and clinically effective prescription to establish a relatively complete system of diagnosis and treatment of systemic sclerosis, better clinical and research services. Meanwhile, a stratified randomized method, objective evaluation of Professor Ouyang Heng "skin to skin treatment method," the efficacy of the treatment of systemic scleroderma, while observing the skin to skin treatment method for skin hardness points, maximum pitch, the maximum span, TGF-β1,β, IgG, IgA, IgM, C3, C4and other clinical and laboratory implications for the governance of the skin to skin on clinical applications of clinical and laboratory basis, to provide for the clinical treatment of systemic scleroderma new ideas and methods.
Methods:
With the teacher:
First used to self-oriented, focused on teaching, learning, supplemented by individual counseling, including the four classical e-learning courses. Hang in Ouyang, under the guidance of Professor Liu Qingsi depth in learning, understanding and to explore the essence of classical literature, good study notes, write a learning experience. In three years, and independent clinical study with teachers working in clinical practice, good With the teacher notes, follow-up medical records, operational records, write their feelings and experiences, carefully try to figure out, carefully and understand, and inheritance as a comprehensive summary of the teacher's academic thought, which clinical diagnosis and treatment to improve their skills.
Research methods:
1. Clinical studies:the selection met the inclusion criteria of78patients with systemic scleroderma, Pi-Tang treatment group is divided into soft snow glycosides and the control group to observe the results after Additional constraints assessment of the severity of skin involvement, joint feature points, and other symptoms of the dynamic changes of indicators.
2. Experimental study:After treatment, testing before and after treatment serum transforming growth factor β and immunological parameters.
Results:
With the teacher:
Excellent examination results of theoretical study, sufficient quantity and quality according to the State Drug Administration in accordance with the requirements of complete independence with a teacher to learn and work in clinical practice. Has been submitted to a high quality learning experience the classic experience of11, a detailed record of more than180articles with teacher notes, write their feelings and experiences36, finishing more than60copies of the clinical medical cases. With the teacher in the country during the high-quality journals published two inheritance, concluded Professor Ouyang Heng ideas and technical expertise of academic papers.
Research Results:
The clinical, experimental results:
1."Skin to Skin treatment method" treatment SSc, the skin can effectively reduce the hardness points, increasing the maximum pitch, the maximum span values before and after treatment, points difference was statistically significant (P<0.05), treatment
2. After treatment, comparing various points statistically significant difference (P<0.05), that "skin to skin treatment method" treatment group than the control group glycosides snow.(See Table5)2between the two groups before treatment, TGF-β1,β2level was no significant difference (P>0.05); before and after two courses of treatment, two groups within the TGF-β1,β2levels before and after the change in the difference statistically significant (P<0.05); two groups after treatment between the two groups TGF-β1,β2level difference was statistically significant (P<0.05), that "skin to skin treatment method" to improve the TGF-treatment group glycosides β expression in the control group is better than snow.
3. The two groups before treatment, IgG, IgA, IgM, C3, C4no statistically significant difference (P>0.05); before and after two courses of treatment, the treatment group IgG, IgM, C3levels before and after the change in comparison group, and control group IgG, C4levels before and after the change in the group, the difference was statistically significant (P<0.05); two groups after treatment, between the two groups IgG, C3level difference comparison was statistically significant (P<0.05), shows "Skin to skin treatment method" in the treatment group improved IgG, IgM, C3and other immunological parameters were significant, and after treatment, IgG, C3glycosides to improve the control group was significantly better than the snow; two groups were compared with normal reference values increased.
Conclusion:
With the teacher:
Three years of studying under the learning task has been successfully completed three years of efforts, and summarizes a comprehensive study, Professor Ouyang Heng's greatness is its center of ethics and academic thought:①should be out sick for the first;②Diseases of the principle of choice in practical;③Syndrome and theory, giving play to the characteristics of traditional Chinese medicine;④combining syndrome differentiation with disease, to improve efficacy as a starting point. In the specific law governing the use of law to take over as class, method advocated by the color rule color to shape laws governing shape, skin to skin treatment methods, integrating scratch Italian law governing will take place, fire with fire, make reference to the "red or white surgical belongings down "said the other theoretical perspectives, and in their own independent clinical practice to use and promotion, the effect is satisfactory. Three years with a teacher to learn, benefit quite good, benefit, many feel, the teacher's professionalism, hard study, rigorous scholarship, I was moved, he became my role model and a model of lifelong learning. Coming to an end three years of studying under study, but the bumpy road of development of Chinese medicine way away, still need our colleagues to continue to be passed along, so our future study, work is still very arduous task. We should be duty-bound to grasp the opportunity to carry the heavy, strong faith, take the road of Chinese medicine, to promote the cause of the motherland and make greater contributions to medicine.
Research conclusion:
"Skin to Skin treatment method" treatment SSc, the skin can effectively reduce the hardness points, increasing the maximum pitch, the maximum span value in improving symptoms and signs in the control group was significantly better than the snow glycosides. Laboratory parameters that "skin to skin treatment method" in the treatment group improved expression of TGF-β is better than snow glycosides control group, in improving the IgG, IgM, C3and other immunological parameters were significant, and after treatment, IgG, C3of glycosides to improve the control group was significantly better than the snow.
引文
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