岭南医学流派对胸痹心痛的主治思想研究
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摘要
[目的]本文通过对文献整理研究及现代岭南名中医医案统计学研究分析相结合的方法,探讨岭南医学流派各医家关于胸痹心痛病的临床各种症状表现的分布规律及方药运用配伍规律,推论岭南地区胸痹心痛病的病因病机及证治规律,为临床及科研提供借鉴。
[方法]采用现代统计学研究,通过收集现代岭南地区名中医有关于胸痹心痛病的完整医案,综合归纳后,分别用频数分析、因子分析及聚类分析这三种统计方法,采用SPSS11.5软件对其症状(包括舌脉象)及用药进行相关统计学分析,并综合分析出岭南医学流派对胸痹心痛证治规律的认识(包括胸痹心痛病的病因病机、治法治则、遣方用药特点及规律等)。同时根据高频数症状和中药聚类分析及高频数中药性味分析的结果,结合岭南地区气候特点,进一步探讨岭南医学胸痹心痛病的病机特点、证型分型及治疗方药的规律。
[结果]综合症状聚类分析结果探讨,胸痹心痛的病机可概括为虚、瘀、痰、热、寒及气滞这六方面,其病位在上焦,与五脏相关,单一证型可分为气阴两虚型、心肾阴虚型、阳气虚衰型、心血瘀阻型、气滞血瘀型、气虚血瘀型、痰阻心脉型、痰热血瘀型、寒凝心脉型九种证型。而结合中药统计结果分析,得出补虚药、活血化瘀药、理气药、化痰止咳平喘药、利水渗湿药、化瘀止血药及发散药为治疗胸痹心痛病的主要药物,及各高频数药物之间的配伍组合,同时亦得出甘、苦、温、辛四种性味的中药在治疗本病中的关键作用。最后通过岭南医家医案统计分析得到的结论,结合岭南地区潮湿炎热的气候,得出胸痹心痛病的另一常见证型,即痰热血瘀型,其在治疗上,以健脾化痰,清热活血为主要治法。
[结论]本文通过传统文献研究及现代医学统计学研究结果可知,胸痹心痛病的病机仍为本虚标实,而结合岭南地区气候特点,本虚为气血阴阳俱虚,常伴随着脾气亏虚为多见,标实为血瘀为主,痰湿、寒凝、气滞次之,同时因岭南气候原因,痰热致病亦多见,此为岭南医学对该病病因病机认识的独特之处。
This thesis probed the clinic symptoms and Traditional Chinese medicine using law in chest stuffiness and pains for school of Lingnan medicine from the overall, which through combining documentary study with modern statistic method. It also inferres the etiology, pathogenesis and Regulation of syndrome-treatment about chest stuffiness and pains in Lingnan region. And the experience is offered for the clinic and basic research.
This research adopts modern statistic methods. I have collected medical cases of chest stuffiness and pains from the famous doctor of Traditional Chinese medicine in Lingnan region, using SPSS 11.5 statistical software, sums up high-frequency symptoms and Traditional Chinese medicines, analyzes the etiology, pathogenesis, treatment and medication characteristics and principles of chest stuffiness and pains in Lingnan region. According to clustering analysis results of high-frequency symptoms and medicines and analysis of nature and flavor of high-frequency medicines, combines with the specialty of the climate in Ling-nan area, the type of syndrome, pathogenesis and medication principles of chest stuffiness and pains will be explored.
According to clustering analysis results of symptoms, the pathogenesis of chest stuffiness and pains can be construed as weak, stasis, phlegm, heat, cold and qi stagnation. The locations of disease is upper jiao. And it is relevant to five internal organs. The single syndrome is divided into nine type of syndrome which includes syndrome of deficiency of both qi and yin, syndrome of deficiency of kidney yin, syndrome of yang deficiency, syndrome of blockade of heart vessel, syndrome of stagnation of qi and blood stasis, syndrome of blood stasis due to qi deficiency, syndrome of phlegm blocking heart vessel, syndrome of phlegm-heat and blood stasis, syndrome of cold condense. At the same time, it draws that the main medicaments of treatment for chest stuffiness and pains are tonifying medicine, blood activating medicine, qi regulation, phlegm transformation, dispel dampness and dispersing medicine according to statistical analysis results of Traditional Chinese medicine. It also points out that the Traditional Chinese medicine contained in sweet flavor, bitter flavor, acrid flavor and warm herb play major roles in the treatment of chest stuffiness and pains. Finally, based on the specialty of the damp and torrid climate in Ling-nan area and the statistical analysis results of medical cases, it has got another common syndrome which is syndrome of phlegm-heat and blood stasis. And the treatment of this syndrome of chest stuffiness and pains includes strengthening the spleen, resolving the phlegm, heat clearing and blood activating.
On the basis of the traditional documentary study and modern statistic method and the specialty of the climate in Ling-nan area, the pathogenesis of chest stuffiness and pains is deficiency of Ben and repletion of Biao.The root is deficiency of yin and yang of solar term blood while the branch is blood stasis, phlegmy wet, cold condense and stagnation of qi. And blood stasis plays a great role in it. At the same time, because of the climate of Ling-nan, the syndrome of phlegm-heat is also found in the present tense and that is its own peculiarity of cognition on etiology and mechanism of chest stuffiness and pains in canton medicine.
[方法]采用现代统计学研究,通过收集现代岭南地区名中医有关于胸痹心痛病的完整医案,综合归纳后,分别用频数分析、因子分析及聚类分析这三种统计方法,采用SPSS11.5软件对其症状(包括舌脉象)及用药进行相关统计学分析,并综合分析出岭南医学流派对胸痹心痛证治规律的认识(包括胸痹心痛病的病因病机、治法治则、遣方用药特点及规律等)。同时根据高频数症状和中药聚类分析及高频数中药性味分析的结果,结合岭南地区气候特点,进一步探讨岭南医学胸痹心痛病的病机特点、证型分型及治疗方药的规律。
[结果]综合症状聚类分析结果探讨,胸痹心痛的病机可概括为虚、瘀、痰、热、寒及气滞这六方面,其病位在上焦,与五脏相关,单一证型可分为气阴两虚型、心肾阴虚型、阳气虚衰型、心血瘀阻型、气滞血瘀型、气虚血瘀型、痰阻心脉型、痰热血瘀型、寒凝心脉型九种证型。而结合中药统计结果分析,得出补虚药、活血化瘀药、理气药、化痰止咳平喘药、利水渗湿药、化瘀止血药及发散药为治疗胸痹心痛病的主要药物,及各高频数药物之间的配伍组合,同时亦得出甘、苦、温、辛四种性味的中药在治疗本病中的关键作用。最后通过岭南医家医案统计分析得到的结论,结合岭南地区潮湿炎热的气候,得出胸痹心痛病的另一常见证型,即痰热血瘀型,其在治疗上,以健脾化痰,清热活血为主要治法。
[结论]本文通过传统文献研究及现代医学统计学研究结果可知,胸痹心痛病的病机仍为本虚标实,而结合岭南地区气候特点,本虚为气血阴阳俱虚,常伴随着脾气亏虚为多见,标实为血瘀为主,痰湿、寒凝、气滞次之,同时因岭南气候原因,痰热致病亦多见,此为岭南医学对该病病因病机认识的独特之处。
This thesis probed the clinic symptoms and Traditional Chinese medicine using law in chest stuffiness and pains for school of Lingnan medicine from the overall, which through combining documentary study with modern statistic method. It also inferres the etiology, pathogenesis and Regulation of syndrome-treatment about chest stuffiness and pains in Lingnan region. And the experience is offered for the clinic and basic research.
This research adopts modern statistic methods. I have collected medical cases of chest stuffiness and pains from the famous doctor of Traditional Chinese medicine in Lingnan region, using SPSS 11.5 statistical software, sums up high-frequency symptoms and Traditional Chinese medicines, analyzes the etiology, pathogenesis, treatment and medication characteristics and principles of chest stuffiness and pains in Lingnan region. According to clustering analysis results of high-frequency symptoms and medicines and analysis of nature and flavor of high-frequency medicines, combines with the specialty of the climate in Ling-nan area, the type of syndrome, pathogenesis and medication principles of chest stuffiness and pains will be explored.
According to clustering analysis results of symptoms, the pathogenesis of chest stuffiness and pains can be construed as weak, stasis, phlegm, heat, cold and qi stagnation. The locations of disease is upper jiao. And it is relevant to five internal organs. The single syndrome is divided into nine type of syndrome which includes syndrome of deficiency of both qi and yin, syndrome of deficiency of kidney yin, syndrome of yang deficiency, syndrome of blockade of heart vessel, syndrome of stagnation of qi and blood stasis, syndrome of blood stasis due to qi deficiency, syndrome of phlegm blocking heart vessel, syndrome of phlegm-heat and blood stasis, syndrome of cold condense. At the same time, it draws that the main medicaments of treatment for chest stuffiness and pains are tonifying medicine, blood activating medicine, qi regulation, phlegm transformation, dispel dampness and dispersing medicine according to statistical analysis results of Traditional Chinese medicine. It also points out that the Traditional Chinese medicine contained in sweet flavor, bitter flavor, acrid flavor and warm herb play major roles in the treatment of chest stuffiness and pains. Finally, based on the specialty of the damp and torrid climate in Ling-nan area and the statistical analysis results of medical cases, it has got another common syndrome which is syndrome of phlegm-heat and blood stasis. And the treatment of this syndrome of chest stuffiness and pains includes strengthening the spleen, resolving the phlegm, heat clearing and blood activating.
On the basis of the traditional documentary study and modern statistic method and the specialty of the climate in Ling-nan area, the pathogenesis of chest stuffiness and pains is deficiency of Ben and repletion of Biao.The root is deficiency of yin and yang of solar term blood while the branch is blood stasis, phlegmy wet, cold condense and stagnation of qi. And blood stasis plays a great role in it. At the same time, because of the climate of Ling-nan, the syndrome of phlegm-heat is also found in the present tense and that is its own peculiarity of cognition on etiology and mechanism of chest stuffiness and pains in canton medicine.
引文
[1]王剑引,王继如,王培炜.古汉语大词典[M].上海：上海辞书出版社,1998.1117.
[2]汪沪双,诸淑平.试述新安医学的“学派”与“流派”[J].中医文献杂志,2000(4)：3-4.
[3]王云飞,吴焕林.邓铁涛教授与岭南医学[J].新中医,2007,39(6)：92-93.
[4]国家中医药管理局.中医病证诊断疗效标准[S].南京：南京大学出版社,1994.29-30.
[5]王剑引,王继如,王培炜.古汉语大词典[M].上海：上海辞书出版社,1998.405.
[6]吴粤昌.岭南医徵略[M].广州：中华全国中医学会广州分会,1984.41-42.
[7]王伟彪,郑洪.岭南人体质特点与何梦瑶火热论[J].广东医学,1998,19(1)：68-69.
[8]杨利.邓铁涛教授治疗冠心病经验采菁[J].湖北民族学院学报·医学版,2005,22(3)：35-37.
[9]林晓忠,吴焕林,严夏.邓铁涛运用调脾护心法治疗冠心病经验[J].中医杂志,2002,43(6)：415-416.
[10]班秀文.班秀文临床经验辑要[M].北京：中国医药科技出版社,2000.101-104.
[11]史宇广,单书健.冠心病专辑-当代名医临证精华[M].北京：中国古籍出版社,1988.61-69.
[12]邓铁涛主编.碥石集(第五集)：二十一位著名中医学家经验传薪[M].广东：广东人民出版社,2003.417.
[13]马凤彬.何炎燊教授临证经验介绍[J].新中医,2006,38(6)：11.
[14]赵军礼,钟少听.陈镜合教授从郁论治冠心病经验[J].新中医,2000,32(4)：11-12.
[15]叶志中,李思宁.陈镜合教授论治冠心病的临证思路[J].中国中医急症,2005,14(7)：660-661.
[16]王磊,郭力恒,颜芳,等.黄春林论治急性心肌梗死经验撷英[J].辽宁中医杂志,2007,34(5)：554-555.
[17]肖政,陈力.黄春林教授介绍真心痛经验介绍[J].新中医,2007,39(9)：16-17.
[18]李芳,徐大基.黄春林教授健脾无法简介[J].现代中西医结合杂志,2004,13(23)：3108-3109.
[19]杨忠奇.赵立诚教授从痰论治冠心病[J].按摩与引导,2006,22(9)：39-40.
[20]郭晋梅,李南夷.赵立诚教授运用沮胆汤治疗心脑血管病的经验[J].新中医, 1999,,31(7)：11-13.
[21]司徒宝珍.罗陆一治疗冠心病心绞痛经验[J].江西中医药,2009,40(8)：14-15.
[22]司徒宝珍.罗陆一教授经方治疗冠心病经验[J].中国中医药现代远程教育,2009,7(11)：18-20.
[23]杨晓正,陈鹏.钱海凌教授补虚逐瘀法治疗老年冠心病经验[J].四川中医,2007,25(3)：8-9.
[14]苏慧,靳利利,李典鸿.王清海教授治疗冠心病心绞痛的经验介绍[J].中两医结合心脑血管病杂志.2008,10(6)：1206-1207.
[25]冼绍祥,黄鹂,刘小虹,等.冠心病心血瘀阻证和血瘀证差异的临床研究[J].中药新药与临床药理.2001,12(5)：321-323.
[26]冼绍祥,黄鹂,刘小虹,等.气虚、气滞在冠心病心血瘀阻证的发病作用研究[J].广州中医药大学学报.2001,18(1)：34-37.
[27]冼绍祥,黄鹂,刘小虹,等.益气、行气活血法在冠心病心血瘀阻证中的作用机理探讨[J].新中医.2001,33(4)：14-16.
[28]张双伟,冼绍祥,杨忠奇,等.血府逐瘀汤干预冠心病心血瘀阻证心肌纤维化的临床研究[J].广州中医药大学学报.2009,26(1)：13-15.
[2]汪沪双,诸淑平.试述新安医学的“学派”与“流派”[J].中医文献杂志,2000(4)：3-4.
[3]王云飞,吴焕林.邓铁涛教授与岭南医学[J].新中医,2007,39(6)：92-93.
[4]国家中医药管理局.中医病证诊断疗效标准[S].南京：南京大学出版社,1994.29-30.
[5]王剑引,王继如,王培炜.古汉语大词典[M].上海：上海辞书出版社,1998.405.
[6]吴粤昌.岭南医徵略[M].广州：中华全国中医学会广州分会,1984.41-42.
[7]王伟彪,郑洪.岭南人体质特点与何梦瑶火热论[J].广东医学,1998,19(1)：68-69.
[8]杨利.邓铁涛教授治疗冠心病经验采菁[J].湖北民族学院学报·医学版,2005,22(3)：35-37.
[9]林晓忠,吴焕林,严夏.邓铁涛运用调脾护心法治疗冠心病经验[J].中医杂志,2002,43(6)：415-416.
[10]班秀文.班秀文临床经验辑要[M].北京：中国医药科技出版社,2000.101-104.
[11]史宇广,单书健.冠心病专辑-当代名医临证精华[M].北京：中国古籍出版社,1988.61-69.
[12]邓铁涛主编.碥石集(第五集)：二十一位著名中医学家经验传薪[M].广东：广东人民出版社,2003.417.
[13]马凤彬.何炎燊教授临证经验介绍[J].新中医,2006,38(6)：11.
[14]赵军礼,钟少听.陈镜合教授从郁论治冠心病经验[J].新中医,2000,32(4)：11-12.
[15]叶志中,李思宁.陈镜合教授论治冠心病的临证思路[J].中国中医急症,2005,14(7)：660-661.
[16]王磊,郭力恒,颜芳,等.黄春林论治急性心肌梗死经验撷英[J].辽宁中医杂志,2007,34(5)：554-555.
[17]肖政,陈力.黄春林教授介绍真心痛经验介绍[J].新中医,2007,39(9)：16-17.
[18]李芳,徐大基.黄春林教授健脾无法简介[J].现代中西医结合杂志,2004,13(23)：3108-3109.
[19]杨忠奇.赵立诚教授从痰论治冠心病[J].按摩与引导,2006,22(9)：39-40.
[20]郭晋梅,李南夷.赵立诚教授运用沮胆汤治疗心脑血管病的经验[J].新中医, 1999,,31(7)：11-13.
[21]司徒宝珍.罗陆一治疗冠心病心绞痛经验[J].江西中医药,2009,40(8)：14-15.
[22]司徒宝珍.罗陆一教授经方治疗冠心病经验[J].中国中医药现代远程教育,2009,7(11)：18-20.
[23]杨晓正,陈鹏.钱海凌教授补虚逐瘀法治疗老年冠心病经验[J].四川中医,2007,25(3)：8-9.
[14]苏慧,靳利利,李典鸿.王清海教授治疗冠心病心绞痛的经验介绍[J].中两医结合心脑血管病杂志.2008,10(6)：1206-1207.
[25]冼绍祥,黄鹂,刘小虹,等.冠心病心血瘀阻证和血瘀证差异的临床研究[J].中药新药与临床药理.2001,12(5)：321-323.
[26]冼绍祥,黄鹂,刘小虹,等.气虚、气滞在冠心病心血瘀阻证的发病作用研究[J].广州中医药大学学报.2001,18(1)：34-37.
[27]冼绍祥,黄鹂,刘小虹,等.益气、行气活血法在冠心病心血瘀阻证中的作用机理探讨[J].新中医.2001,33(4)：14-16.
[28]张双伟,冼绍祥,杨忠奇,等.血府逐瘀汤干预冠心病心血瘀阻证心肌纤维化的临床研究[J].广州中医药大学学报.2009,26(1)：13-15.