杨明会教授治疗失眠临证经验研究
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摘要
导师杨明会教授从事中西医结合临床工作30年,勤求古训,博采众方,临证经验十分丰富,对多种疾病有自己独到的见解。他认为:气虚肾虚血瘀和免疫功能紊乱是老年病的共同病理基础。人至耄耋之年,气血衰少,肾中精气逐渐亏虚,推动和温煦作用减弱,久则脉道阻塞成瘀,虚瘀互为因果,虚可致瘀,瘀又致虚,从而形成虚瘀互见的老年病病因病机。对帕金森病的认识,导师在尊重经典的基础上,突破了“诸风掉眩,皆属于肝”的传统认识,从补肾活血,益精填髓立论,拟“补肾活血饮”治疗帕金森病,应用于临床,取得可喜的疗效。中医治疗帕金森病具有多层次、多靶点的优势,中西医结合治疗方能提高疗效。导师认为:现代人胃病的病机随着饮食结构的变化而有所改变,以“寒热错杂,虚实互见”为主,治疗上提倡“攻补兼施,寒热并用”的辛开苦降之法。对恶性肿瘤的治疗提出“扶正固本,适时攻邪,随证治之”的基本原则。提出糖尿病的病机为“脾肾气虚为本,阴虚燥热血瘀为标”的独特见解。同时,他还提出“辨人识体”“审证求因”是辨证论治之关键的学术思想。
导师对失眠的病因病机,推崇“胃不和则卧不安”之论。认为失眠的病位主要在于心、脑。并从失眠发生的病因病机及睡眠与心、脑的关系深入研究,挖掘“胃不和”与“卧不安”的相关性,他主张从和胃安神论治失眠,因“胃和”则营卫和调,人始安寐;“胃和”则阴阳升降有序,寤寐有常;“胃和”则神有所藏,寤寐自晓。“和胃”安神,神安瞑寐乃知。故倡导以和胃安神法辨治失眠,拟“和胃安神汤”应用于临床。
在临床研究中发现:“和胃安神汤”在改善患者的总睡眠时间、深睡眠时间、总觉醒时间方面优于柏子养心丸。“和胃安神汤”使患者在睡眠改善的同时,日间功能、醒后感觉得到改善。在研究中还发现:失眠患者存在着脑内神经递质的异常变化,两法治疗失眠可通过改善中枢神经递质GABA、Glu、5-HT、EXC、NE、DA、Ach、INH的含量得以实现。但其改善睡眠的疗效只与GABA、EXC、DA改善的程度相关。由此得出初步结论:以和胃安神法治疗失眠安全有效。
My tutor,Professor Yang Minghui,has been engaged in the clinic work of integrated traditional and western medicine for 30 years.Assiduously learning from the ancient adages and widely adopting other's effective therapeutic methods,he gained rich clinical experience and formed original views toward many kinds of diseases.He thinks that qi deficiency with blood stasis and kidney deficiency and immunological functional disorder are the common pathologic basis of senile diseases.In the aged,as qi-blood and kidney essence becomes insufficient,the warming and promoting function declines and blood stasis forms. The "deficiency" and the "stasis" interact as both cause and effect,which forms the cause and mechanism of senile diseases.Based on the classics,breaking through the traditional understanding on Parkinson's disease that "all wind with vertigo and shaking is ascribed to the liver",Prof.Yang grounded the therapeutic argument of tonifying kidney-activating blood and replenishing essence-supplementing marrow,and treated PD with Bushen Huoxue Yin which indicated heartening effects.Having the advantages of multistrata and multitarget in the treatment of PD with TCM,combined treatment of traditional Chinese medicine and western medicine can improve the therapeutic effect.Regarding stomach disease,the tutor pointed out that the pathogenesis of it in modern people changes with diet and characterized by heat-cold complex and deficiency-excess complex.Accordingly,in the treatment,the method of dispersing with pungent-and-downbearing with bitter should be adopted which is characterized by treating with both tonifying and purgation,cooling and warming.Regarding the treatment of tumor,Prof.Yang pointed out the basic principles of "reinforcing the healthy qi-and-strengthening the root,eliminating the pathogenic factors at the right moment,and treating according to the syndrome".Regarding the mechanism of diabetes,Prof.Yang put forward the distinctive opinions that spleen-kidney qi deficiency is the primary aspect,whereas yin deficiency,dryness-heat and blood stasis is the secondary aspect".In addition,He raised the academic thought that the key to syndrome differentiation and treatment is constitution identification and cause seeking from careful examination.
Regarding the cause and mechanism of insomnia,the tutor emphasizes the theory of "stomach disharmony resulting in disturbed sleep".He thinks that the main location of insomnia is heart and brain.By researching the cause and mechanism of insomnia and the relation between sleep and heart-brain,he found out the associativity between" stomach disharmony" and " disturbed sleep".He advocates treating insomnia by harmonizing the stomach to tranquilize and applicates Hewei Anshen Tang in clinical practice,because he thinks only with the harmony stomach,the nutrient and defense harmony and the yin-yang upbearing-downbearing order can remains,the spirit can be stored and then the easy sleep can be available.
It was found in the clinical research that Hewei Anshen Tang was better than Baizi Yangxin Wan in prolonging patients' total and deep sleep time and shortening their total awake time.Besides the patients' sleep,Hewei Anshen Tang improved their daytime action and awake feeling.It was also found that the neurotransmitters changed in the insomnia patient's brain,and the two methods might better sleep by improving the contents of central neurotransmitters such as GABA、Glu、5—HT、EXC、NE、DA、Ach、INH、and so on,but the therapeutic effect is only in relation to the improvement degree of GABA,EXC and DA.To conclude,treating insomnia with Hewei Anshen Tang is safe and effective.
导师对失眠的病因病机,推崇“胃不和则卧不安”之论。认为失眠的病位主要在于心、脑。并从失眠发生的病因病机及睡眠与心、脑的关系深入研究,挖掘“胃不和”与“卧不安”的相关性,他主张从和胃安神论治失眠,因“胃和”则营卫和调,人始安寐;“胃和”则阴阳升降有序,寤寐有常;“胃和”则神有所藏,寤寐自晓。“和胃”安神,神安瞑寐乃知。故倡导以和胃安神法辨治失眠,拟“和胃安神汤”应用于临床。
在临床研究中发现:“和胃安神汤”在改善患者的总睡眠时间、深睡眠时间、总觉醒时间方面优于柏子养心丸。“和胃安神汤”使患者在睡眠改善的同时,日间功能、醒后感觉得到改善。在研究中还发现:失眠患者存在着脑内神经递质的异常变化,两法治疗失眠可通过改善中枢神经递质GABA、Glu、5-HT、EXC、NE、DA、Ach、INH的含量得以实现。但其改善睡眠的疗效只与GABA、EXC、DA改善的程度相关。由此得出初步结论:以和胃安神法治疗失眠安全有效。
My tutor,Professor Yang Minghui,has been engaged in the clinic work of integrated traditional and western medicine for 30 years.Assiduously learning from the ancient adages and widely adopting other's effective therapeutic methods,he gained rich clinical experience and formed original views toward many kinds of diseases.He thinks that qi deficiency with blood stasis and kidney deficiency and immunological functional disorder are the common pathologic basis of senile diseases.In the aged,as qi-blood and kidney essence becomes insufficient,the warming and promoting function declines and blood stasis forms. The "deficiency" and the "stasis" interact as both cause and effect,which forms the cause and mechanism of senile diseases.Based on the classics,breaking through the traditional understanding on Parkinson's disease that "all wind with vertigo and shaking is ascribed to the liver",Prof.Yang grounded the therapeutic argument of tonifying kidney-activating blood and replenishing essence-supplementing marrow,and treated PD with Bushen Huoxue Yin which indicated heartening effects.Having the advantages of multistrata and multitarget in the treatment of PD with TCM,combined treatment of traditional Chinese medicine and western medicine can improve the therapeutic effect.Regarding stomach disease,the tutor pointed out that the pathogenesis of it in modern people changes with diet and characterized by heat-cold complex and deficiency-excess complex.Accordingly,in the treatment,the method of dispersing with pungent-and-downbearing with bitter should be adopted which is characterized by treating with both tonifying and purgation,cooling and warming.Regarding the treatment of tumor,Prof.Yang pointed out the basic principles of "reinforcing the healthy qi-and-strengthening the root,eliminating the pathogenic factors at the right moment,and treating according to the syndrome".Regarding the mechanism of diabetes,Prof.Yang put forward the distinctive opinions that spleen-kidney qi deficiency is the primary aspect,whereas yin deficiency,dryness-heat and blood stasis is the secondary aspect".In addition,He raised the academic thought that the key to syndrome differentiation and treatment is constitution identification and cause seeking from careful examination.
Regarding the cause and mechanism of insomnia,the tutor emphasizes the theory of "stomach disharmony resulting in disturbed sleep".He thinks that the main location of insomnia is heart and brain.By researching the cause and mechanism of insomnia and the relation between sleep and heart-brain,he found out the associativity between" stomach disharmony" and " disturbed sleep".He advocates treating insomnia by harmonizing the stomach to tranquilize and applicates Hewei Anshen Tang in clinical practice,because he thinks only with the harmony stomach,the nutrient and defense harmony and the yin-yang upbearing-downbearing order can remains,the spirit can be stored and then the easy sleep can be available.
It was found in the clinical research that Hewei Anshen Tang was better than Baizi Yangxin Wan in prolonging patients' total and deep sleep time and shortening their total awake time.Besides the patients' sleep,Hewei Anshen Tang improved their daytime action and awake feeling.It was also found that the neurotransmitters changed in the insomnia patient's brain,and the two methods might better sleep by improving the contents of central neurotransmitters such as GABA、Glu、5—HT、EXC、NE、DA、Ach、INH、and so on,but the therapeutic effect is only in relation to the improvement degree of GABA,EXC and DA.To conclude,treating insomnia with Hewei Anshen Tang is safe and effective.
引文
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