温振英学术思想、临床经验及治疗小儿哮喘临床研究
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摘要
研究目的：
名老中医的学术思想与经验是中医学的宝贵财富,继承、挖掘与传播名老中医的学术思想是加快中医事业发展与创新的重要途径。温振英教授是北京市第一届西医学习中医的中西医结合专家,享受国务院颁发的政府特殊津贴。温教授近60载医、教、研研究重点变换的经历,也反映了新中国成立以来儿童疾病病种的诸多变化。在近60年的中医儿科临床工作中,温振英教授本着“全面继承整理提高”中医的方针政策,孜孜不倦、努力工作,将理论与实践相结合并博采众长,积极向院内外多位名老中医学习,通过大量临床实践,逐渐形成自己诊病、治病理论及方法,临床疗效卓著。全面继承、挖掘整理并进行广泛交流传播温振英教授的学术思想、临床经验具有重要意义
本研究旨在探寻温振英中医儿科学术思想渊源,研究总结其儿科学术思想特色及临床经验,并在此基础上通过学习研究及自身临床实践能够有所创新。
研究方法
1跟随老师临诊,仔细观察老师四诊方法,认真做好跟师笔记。
2认真研读老师的著作如《温振英医话验案精选》、《我的中医传承之路——艰辛与辉煌,继承与创新》、《温振英论整体医疗与辨证》及温老师历年发表的相关文章及教学讲稿90余篇,认真学习、深入体会老师学术思想。
3研读中医四大经典及专业相关中医古籍如《脾胃论》《小儿药证直决》等,将中医经典与老师临证经验相结合,深刻领会老师学术思想渊源。
4检索现代中医儿科相关文献,了解中医儿科各医家学术特点,以便深入体会温老师学术思想及临床经验特色。
5对150例哮喘患儿进行中医体质类型的调查研究,总结分析哮喘患儿的中医体质类型。
6将温老师治疗145例哮喘患儿急性发作的处方进行分析,研究总结、提炼温老师治疗小儿哮喘的常用处方及药物。
7将老师治疗哮喘经验运用于临床,治疗发作期哮喘60例,采用对照观察的方法验证疗效,并检验继承效果。
本论文主要内容分为三大部分：
第一部分温振英学术思想渊源概述及儿科相关流派医家观点
1通过研读中医经典著作及中医儿科古籍文献,印证和感悟温振英中医学术思想的渊源。从《黄帝内经》、《伤寒杂病论》直至明清时期,中医整体观、重视人体正气、重视后天脾胃均为历代所遵循。到金元时期,出现了以李东垣为代表的补土派、以朱丹溪为代表的滋阴派。北宋时期钱乙的《小儿药证直决》提出小儿“五脏六腑,成而未全,全而未壮”及“小儿易为虚实,脾虚不受寒温,服寒则生冷,服温则生热”,明确了小儿的生理特点及脾胃为重的理论。明清时期温病学派的兴起,尤其是吴鞠通的《温病条辨》,提出清络、清营、清宫、育阴等治疗原则。这些理论对温老师学术思想的形成起到了至关重要的影响。温老师不同阶段工作期间,曾跟随秦振廷、祁振华、杨艺农、周慕新等儿科名家学习,从而为日后学术思想的形成打下了深厚基础。
2检索现代文献,了解当代中医儿科医家学术特点,以便深入挖掘温老师学术思想及临床经验特色。文中简要介绍了近现代中医儿科名医祁振华、王子仲与王鹏飞、赵心波、江育仁、刘弼臣等医家的学术观点及特色。
第二部分温振英学术思想、临床经验整理
1主要从六个方面对温振英老师的学术思想及特点进行了研究总结。
1.1整体医疗。温振英老师秉承《内经》、《伤寒杂病论》中整体观的理论,不仅遵循“天人合一”、“内外合一”的人与自然相互影响、人体脏腑相生相克互为关联的整体辨证关系,临床实践中更为注重体质及心理因素在人体辨病辨证中的重要作用,提出诊病、治病结合体质兼顾心理的整体医疗理论,进一步补充、完善了中医整体观理论。
1.2扶正祛邪。“正气存内,邪不可干”,“邪之所凑,其气必虚”,温老师认为正气乃人体之根本,邪气乃疾病之标而已,治疗疾病必须时刻顾护人体之正气,可扶正以祛邪,或扶正祛邪兼施,并要做到祛邪而不伤正。
1.3重视脾胃。脾胃为后天之本、气血生化之源。针对处于发育阶段的小儿,脾胃功能显得更为重要。《脾胃论》中云：“脾胃之气既伤而元气亦不能充,而诸病之所由生也。”然而小儿的生理特点为“脾常虚”,温老师不仅从脾胃入手治疗小儿多种疾病,而且在治疗其他疾病时都时刻注意顾护脾胃,防止因治疗疾病伤及脾胃而再生他病,体现了中医“治未病”的思想。
1.4重视养阴。温老认为,“小儿易热多火”与小儿的生理特点有关,但其所谓之“火”并非实热,而为相对阴虚的表现。加之现今社会小儿常有饮食偏嗜、精神压力加大以及环境的改变等因素,阴虚体质患儿不断增加,因此治疗疾病应结合体质特点,注意养阴润燥,少用温燥或苦寒伤阴之品。
1.5注重营养保健。“预防为主”是我国卫生工作方针之一,当今如何增进小儿身体素质的防病保健成为社会的极大需要。针对时下不合理喂养及小儿保健品的滥用现象,温老师认为根据小儿体质特点,运用中医“整体观”、“辨证论治”原则指导小儿营养保健势在必行。
1.6发展观点。从《黄帝内经》时期到现在已有二千多年的历史,无论是自然条件、人文体系,还是人们体质、疾病的类型都发生了很大的变化,因此温老师强调要有辨证思维,用历史唯物辩证法的观点,分析各时期医学著作所处的时代、社会、地理环境,从而正确理解各医家的观点、方药之运用；要敢于依据当代对疾病更深的认识,结合自然气候、人们体质等特点而有所突破和发展,提出新理论、开创新途径、研制新的中药方剂。
2对温振英老师的中医儿科临床经验进行了整理与研究,主要从养阴益气、扶正祛邪治疗反复呼吸道感染,健脾益气、扶正固本治疗小儿泄泻,养阴益气、清热透邪治疗急性病毒性上呼吸道感染,养阴祛风、润肺平喘治疗小儿哮喘,祛风润肺、健脾柔肝治疗儿童多动症、抽动障碍,健脾润肺、祛风活血治疗痤疮、扶正固本治疗癌症、过敏体质儿童的面部望诊特点、用药主张“一专多能”等九个方面进行了论述。
第三部分养阴祛风、润肺平喘治疗小儿哮喘急性发作期临床研究
从三方面研究温振英老师辨治小儿哮喘的理论依据及临床效果。
1哮喘儿童的体质属于中医学的特禀质。但这种特禀体质在中医辨证上倾向于何种类型目前未见有进一步论述。根据温振英老师多年治疗过敏性疾病的经验,参照中华中医药学会2009年4月发布实施的《中医体质分类与判定》(ZYYXH/T157-2009),并结合小儿的生理病理特点,在临床通过体质量表调查问卷对150名哮喘儿童及其家长进行了流调学研究,分析哮喘儿童的中医体质类型特禀质的进一步分型。
2通过温老师对145例哮喘患儿急性发作的治疗处方,研究总结、提炼温老师治疗小儿哮喘的常用处方及药物,并从传统中药理论、结合现代药理研究进行了详尽的阐述。
3根据温振英老师治疗小儿哮喘发作期的临床经验,以养阴祛风、润肺平喘为法则,运用温老师经验方祛风定喘汤,治疗小儿哮喘急性发作期轻中度患者并与目前现代医学认可的支气管舒张剂及白三烯调节剂作对照进行临床观察,结果发现治疗组与对照组的临床疗效统计学无差异,说明祛风定喘汤治疗小儿哮喘急性发作有较好的疗效。
结论温振英老师的学术思想及临床经验经验是中医儿科学的宝贵财富,继承、发掘与传承温老的学术思想、临床经验对于中医儿科学的发展及高层次技术人才的培养十分必要。通过跟师三年的学习研究,我们对温老的学术思想及临床经验进行了有效的挖掘与总结,同时作为学生的我们在专业理论水平及临床技能等方面均有了长足的进步。
成果
1本论文通过对哮喘采取辨病与辨证相结合、本病与合并症相鉴别的方法,在哮喘治疗上进行了创新,用养阴祛风、润肺平喘之法进行治疗。从研究结果看,该创新方法为过敏性哮喘的中医治疗提供了新思路,提高了疗效。
2论文将变态反应性疾病的病理特点与腠理的特性相结合,提出了从“腠理”论治变态反应性疾病的创新观点,为中医治疗多种变态反应性疾病提供了全新的思路。
3以第一作者在核心期刊发表文章2篇；现为“北京市薪火3+3传承工程温振英工作站”课题组成员(排名第二),本工作站现已被批准为国家级传承工作站。
本研究包括两部分：文献研究及临床研究
研究目的：
1通过对150例哮喘患儿体质特征的临床调查,进行特禀体质的进一步分型,了解其体质分布情况,便于根据哮喘患儿体质特点辨证用药,并对患儿及其家长进行生活调护指导。
2对温振英老师治疗小儿哮喘急性发作用药特点及规律进行研究,以便掌握温老师治疗小儿哮喘急性发作处方原则及用药精髓。
3运用温振英老师的祛风定喘汤治疗小儿哮喘急性发作,并设立对照组,观察疗效,以期为中医治疗小儿哮喘急性发作提供新的思路。
研究方法：
1利用文献检索工具,对小儿哮喘的中西医文献进行研究,掌握古今、中西医对小儿哮喘的病因病机认识及治疗方法。
2运用临床调查的方法,对150例哮喘患儿进行调查,并进行进一步的体质分类。运用统计学分析数据,得出结果。
3对温老师治疗的145例哮喘急性发作患儿的处方进行整理归纳,采用描述性统计分析方法,运用频数、构成比,提炼处方原则及用药精华。
4以温老师常用的祛风定喘汤作为治疗组,与现在西医认可的β2受体激动剂(硫酸沙丁胺醇缓释胶囊)、白三烯调节剂(孟鲁斯司特钠咀嚼片)联合用药作对比,并进行统计学分析,观察疗效。
研究结果：
1所研究的150哮喘患儿均属于中医体质类型中的特禀质,但若进一步划分阴虚及阴虚倾向者123例,占82%；气虚及气虚倾向者4例,占2.67%；气阴两虚者13例,占8.67%；阴虚伴气虚倾向者5例,占3.33%；气虚倾向伴阴虚倾向者2例,占1.33%；滞热型者3例,占2%。
2对温老师治疗的哮喘急性发作患儿145例处方进行统计分析,以不同类药物应用频次占总药味的百分比进行统计,养阴药味所占比例最大,占34.81%；其次为止咳平喘药味及祛风药味,分别占21.86%、17.64%；再其次为清热药味及理气药味,分别占8.53%、8.48%；活血药味所占比例最小,为0.90%。以每位药物应用频次占总处方数百分比的多少来进行统计,在祛风药中以防风应用最多,占100%,醋柴胡及秦艽次之,分别占37.24%、36.55%；养阴药以乌梅、五味子、诃子为多,均占到96%以上,黄精、百合次之,分别占93.79%、62.07%；止咳平喘药石菖蒲最多,占98.62%,白果、紫菀次之,均占93.10%；理气药以苏梗为主,占76.55%；活血药以紫草相对为多,占8.28%。
3祛风定喘汤中药治疗小儿哮喘急性发作临床有效,与现代医学认可的硫酸沙丁胺醇缓释胶囊联合孟鲁司特钠咀嚼片对照组比较,无论在总体疗效还是咳喘主症及鼻部、皮肤、大便等的兼症改善方面均具有较好的临床疗效,两组疗效经统计学检验无显著差异。
结论：
1哮喘患儿中医体质分型属于特禀体质,若再进一步分型,多更倾向于阴虚体质。
2结合患儿体质,运用养阴祛风、润肺平喘治疗小儿哮喘急性发作临床有效,并能够在一定程度上改善鼻塞、皮肤瘙痒、大便干燥等相关症状。
Objective:This study aims to explore the Chinese medicine academic thought origin of Wen Zhen-ying, summarize her characteristics of pediatric academic theory and clinical experience, and improve our own clinical experience at last.
Methods:
1 Follow the teacher in clinical diagnosis; observe seriously of the teacher' four diagnostic methods and take notes carefully.2 Study the teacher's works:"Medical case of Wen Zhen-ying".Seriously study and deeply understand the teacher academic thought.3 Read the four classics of Chinese Medicine, the pediatrics of TCM ancient books, Combine the essence of classic TCM and teacher's clinical experience. Excavate deeply teacher' academic thought origin.4 Retrieve literature related about modern Pediatrics of TCM, and study these TCM pediatrics professors'academic characteristics to make preparations for the excavation work followed.5 Take clinical survey on 150 cases of children with asthma, then make the further classification of constitution, Analyze the data by statistical method to get the results;6 Classify and analyze teacher Wen's prescriptions for 145 treatment cases of children with acute asthma, using analysis method of descriptive statistics, such as the frequency and constituent ratio, in order to extract prescription principles and medication essence; 7 Apply the teacher's experience of asthma treatment in clinic, and 60 cases of asthma will been treated. Observe the curative effects by scientific research method. And then test the treatment effects.
The main content of this thesis is divided into three parts.
Part 1
1 Explore the Chinese medicine academic thought origin of Wen Zhen-ying by reading the classics of Chinese Medicine and ancient books of TCM pediatrics.2 Study the academic characteristics of modern TCM pediatrics doctors by modern literature retrieval, in order to dig deeper into teacher's own academic thoughts characteristic and clinical experience.
Part 2
Summarize and research Wen Zhen-ying's pediatric academic theory from the following six aspects.1:Holistic Medicine;Strengthen healthy qi to eliminate pathogens;Attention to spleen and stomach;Attention to nourishing yin;Attention to nutrition and health care;Development view.
Summarize and research the pediatric clinical experience of Wen Zhen-ying. Mainly from the Nourishing and Qi, strengthening body resistance and eliminating evil to treat recurrent respiratory tract infection. Strengthening the spleen and replenishing qi, strengthening healthy to therapy of infantile diarrhea, dispelling wind and moistening lung to treat pediatric asthma, surporting heaithy energy to treat Cancer,strengthening spleen and softening liver in treatment of children with ADHD, TIC disorder, allergic children face inspection characteristics, advocate" special and multiple effect "medicine application experience and other seven aspects were discussed.
Part 3
The paper summarized the commonly used drugs of Wen Zhen-ying teacher in treatment of children asthma, and discussed in detail combined with the theory of traditional Chinese medicine and modern pharmacological research.
1 The constitution of asthma children is a kind of personal idiosyncrasy classified by the TCM theory. But at present, there has been no further discussion on which type of TCM constitution this idiosyncrasy tends to be. According to experience of Wen Zhen-ying teacher in treatment of allergic disease for many years, referencing to Chinese Medicine Institute issued in 2009 April the" TCM constitution classification and judgment"(ZYYXH/ T157-2009), and combining of pediatric physiologic and pathologic characteristics, we have taken epidemiological investigation and research on 150 asthmatic children and their parents by constitution questionnaire, and analyzed the further classification of children with asthma in TCM constitution types.
2 Research has summarized, refined Wen Zhen-ying teacher's common prescriptions and drugs in the treatment of children asthma, and discussed in detail using the theory of traditional Chinese medicine combined with modern pharmacological research.
3 According to Wen Zhen-ying teacher's clinical treatment experience of pediatric asthma, using the rule of nourishing yin to dispelling wind, moistening lung and relieving asthma, adopting Wen's empirical prescription of expelling wind and relieving asthma, we treated children patients of mild to moderate acute exacerbation of asthma, took clinical observation and used bronchodilator agents and leukotriene modifiers which confirmed by current modern medicine for the control. We found that there were no significant difference between treatment group and the control group in the clinical curative effect. The research indicated that the prescription of empirical prescription of expelling wind and relieving asthma took good effect on treating asthma acute attack of children.
Results:On the basis of inheritance and according to our clinical practice, discusses the theory of "treatment hypersensitiveness disease from muscular interstices".Publish 3 articles as the first author identity, of which 2 published in core journals.
Conclusion:Wen Zhen-ying's academic theory and experience are precious wealth of TCM pediatrics. It is very necessary to inherit, excavate and spread of Wen Zhen-ying's academic thought and clinical experience in pediatrics of traditional Chinese medicine, especially good for the development of high level technical talents. Through three years of study with teacher Wen, We have taken effectively mining and summarization on teacher's academic thought and clinical experience. Our professional theory level and clinical skills have made great progress consequently
This study includes two parts:literature review and clinical research.
Purposes:1. Adopt clinical investigation on 150 cases of children with asthma included their constitution characteristic, to understand physical type distribution and the personal idiosyncrasy for further classification, in order to take syndrome differentiation and treatment according to the physical characteristics, and guide the children and their parents to living or nursing.2. Study on treatment rules of pediatric asthma acute episode invented by Wen Zhen-ying teacher, in order to learn her medication principles and experience essence for pediatric asthma acute episode treatment.3. Treat children attacked by asthma acute episode using Wen Zhen-ying teacher's empirical prescription of expelling wind and relieving asthma, observe curative effect compared with the control group, so as to provide a new idea for the Chinese medical treatment of children with acute asthma.
Methods:1. Using literature search tool, study the literature about pediatric asthma treatment with traditional Chinese medicine and Western medicine, master ancient and modern, Chinese and Western Medicine viewpoint on children asthma pathogenesis and treatment methods; 2. Take clinical survey on 150 cases of children with asthma, then make the further classification of constitution, Analyze the data by statistical method to get the results; 3.Classify and analyze teacher Wen's prescriptions for 145 treatment cases of children with acute asthma, using analysis method of descriptive statistics, such as the frequency and constituent ratio, in order to extract prescription principles and medication essence; 4. The treatment group took Wen Zhen-ying teacher's empirical prescription of expelling wind and relieving asthma. The control group used the combined medication treatment for Beta-2 adrenergic receptor agonists (salbutamol sulfate sustained release capsules), leukotriene modifiers (Montelukast Sodium Chewable Tablets), which is recognized by western medicine for comparison. Take statistics analysis and observe curative effect.
Result:1. All of 150 asthmatic children have personal idiosyncrasy classified by the TCM theory, but if divided further,123 cases belong to the type of Yin deficiency or tend to be Yin deficiency, accounting for 82%; deficiency and Qi tendency in 4 cases,4 cases belong to the type of Qi deficiency or tend to be Qi deficiency, accounting for 2.66%; 13 cases belong to deficiency of both Qi and Yin, accounting for 8.66%; 5 cases belong to the type of Yin deficiency and tend to be Qi deficiency, accounting for 3.33%; 2 cases belong to the type of Qi deficiency and tend to be Yin deficiency, accounting for 1.33%; 3 cases belong to the type of Dampness and Heat, accounting for 2% of.2. Statistical analyze teacher Wen's prescriptions for 145 cases of children with acute asthma, using every kind of drug application frequency of total drugs percentage. Nourishing Yin drugs account for the largest proportion, accounting for 34.81%; followed by the medicine for relieving cough and asthma, the dispelling wind medicine, account for 21.85%,17.64%; and followed by the heat-clearing drug and drugs for regulating Qi flow, respectively accounting for 8.53%,8.48%; and the drugs for invigorating blood circulation take the smallest proportion,0.90%.Take each drug application frequency accounted the total number of prescriptions percentage to statistics, Fang Feng is applied mostly in the dispelling wind medicine, occupy 100%, Chai Hu with vinegar and Qin Jiao take second place, respectively,37.24%, 36.55%; Wu Mei, Wu Weizi and Ke Zi are the most in Yin-nourishing drugs, account for more than 96% times, followed by Huang Jing and Bai He,93.79%, 62.07% respectively; Shi Changpu take the most proportion in the medicine for the treatment of cough and asthma, occupy 98.62%, followed by Bai Guo, Zi Yuan, respectively occupy 93.10%; Sue Geng is the mostly used drugs for regulating Qi flow, accounted for 76.55%;Zi Cao is the mostly used drugs for invigorating blood circulation, accounted for 8.28%.3. The research indicated that the prescription of expelling wind and relieving asthma takes good effect on treating children asthma acute attack. Compared to the control group used the combined medication treatment for salbutamol sulfate sustained release capsules and Montelukast Sodium Chewable Tablets, which is recognized by modern medicine, the Wen's prescription has better clinical efficacy, ether in the overall efficacy or in the controlling of cough main disease and nose, skin, stool minor disorders. The two group treatment effects have no significant difference in statistics.
Conclusions:Children with asthma have personal idiosyncrasy classified by the TCM theory, and most of them belong to the type of Yin deficiency if divided further. Combining with the children's constitution, use the rule of nourishing yin to dispelling wind, moistening lung and relieving asthma to treat children with acute asthma may be clinical effective, it also be help to improving the stuffy nose, itchy skin, dry stool and other related symptoms at some extent,
名老中医的学术思想与经验是中医学的宝贵财富,继承、挖掘与传播名老中医的学术思想是加快中医事业发展与创新的重要途径。温振英教授是北京市第一届西医学习中医的中西医结合专家,享受国务院颁发的政府特殊津贴。温教授近60载医、教、研研究重点变换的经历,也反映了新中国成立以来儿童疾病病种的诸多变化。在近60年的中医儿科临床工作中,温振英教授本着“全面继承整理提高”中医的方针政策,孜孜不倦、努力工作,将理论与实践相结合并博采众长,积极向院内外多位名老中医学习,通过大量临床实践,逐渐形成自己诊病、治病理论及方法,临床疗效卓著。全面继承、挖掘整理并进行广泛交流传播温振英教授的学术思想、临床经验具有重要意义
本研究旨在探寻温振英中医儿科学术思想渊源,研究总结其儿科学术思想特色及临床经验,并在此基础上通过学习研究及自身临床实践能够有所创新。
研究方法
1跟随老师临诊,仔细观察老师四诊方法,认真做好跟师笔记。
2认真研读老师的著作如《温振英医话验案精选》、《我的中医传承之路——艰辛与辉煌,继承与创新》、《温振英论整体医疗与辨证》及温老师历年发表的相关文章及教学讲稿90余篇,认真学习、深入体会老师学术思想。
3研读中医四大经典及专业相关中医古籍如《脾胃论》《小儿药证直决》等,将中医经典与老师临证经验相结合,深刻领会老师学术思想渊源。
4检索现代中医儿科相关文献,了解中医儿科各医家学术特点,以便深入体会温老师学术思想及临床经验特色。
5对150例哮喘患儿进行中医体质类型的调查研究,总结分析哮喘患儿的中医体质类型。
6将温老师治疗145例哮喘患儿急性发作的处方进行分析,研究总结、提炼温老师治疗小儿哮喘的常用处方及药物。
7将老师治疗哮喘经验运用于临床,治疗发作期哮喘60例,采用对照观察的方法验证疗效,并检验继承效果。
本论文主要内容分为三大部分：
第一部分温振英学术思想渊源概述及儿科相关流派医家观点
1通过研读中医经典著作及中医儿科古籍文献,印证和感悟温振英中医学术思想的渊源。从《黄帝内经》、《伤寒杂病论》直至明清时期,中医整体观、重视人体正气、重视后天脾胃均为历代所遵循。到金元时期,出现了以李东垣为代表的补土派、以朱丹溪为代表的滋阴派。北宋时期钱乙的《小儿药证直决》提出小儿“五脏六腑,成而未全,全而未壮”及“小儿易为虚实,脾虚不受寒温,服寒则生冷,服温则生热”,明确了小儿的生理特点及脾胃为重的理论。明清时期温病学派的兴起,尤其是吴鞠通的《温病条辨》,提出清络、清营、清宫、育阴等治疗原则。这些理论对温老师学术思想的形成起到了至关重要的影响。温老师不同阶段工作期间,曾跟随秦振廷、祁振华、杨艺农、周慕新等儿科名家学习,从而为日后学术思想的形成打下了深厚基础。
2检索现代文献,了解当代中医儿科医家学术特点,以便深入挖掘温老师学术思想及临床经验特色。文中简要介绍了近现代中医儿科名医祁振华、王子仲与王鹏飞、赵心波、江育仁、刘弼臣等医家的学术观点及特色。
第二部分温振英学术思想、临床经验整理
1主要从六个方面对温振英老师的学术思想及特点进行了研究总结。
1.1整体医疗。温振英老师秉承《内经》、《伤寒杂病论》中整体观的理论,不仅遵循“天人合一”、“内外合一”的人与自然相互影响、人体脏腑相生相克互为关联的整体辨证关系,临床实践中更为注重体质及心理因素在人体辨病辨证中的重要作用,提出诊病、治病结合体质兼顾心理的整体医疗理论,进一步补充、完善了中医整体观理论。
1.2扶正祛邪。“正气存内,邪不可干”,“邪之所凑,其气必虚”,温老师认为正气乃人体之根本,邪气乃疾病之标而已,治疗疾病必须时刻顾护人体之正气,可扶正以祛邪,或扶正祛邪兼施,并要做到祛邪而不伤正。
1.3重视脾胃。脾胃为后天之本、气血生化之源。针对处于发育阶段的小儿,脾胃功能显得更为重要。《脾胃论》中云：“脾胃之气既伤而元气亦不能充,而诸病之所由生也。”然而小儿的生理特点为“脾常虚”,温老师不仅从脾胃入手治疗小儿多种疾病,而且在治疗其他疾病时都时刻注意顾护脾胃,防止因治疗疾病伤及脾胃而再生他病,体现了中医“治未病”的思想。
1.4重视养阴。温老认为,“小儿易热多火”与小儿的生理特点有关,但其所谓之“火”并非实热,而为相对阴虚的表现。加之现今社会小儿常有饮食偏嗜、精神压力加大以及环境的改变等因素,阴虚体质患儿不断增加,因此治疗疾病应结合体质特点,注意养阴润燥,少用温燥或苦寒伤阴之品。
1.5注重营养保健。“预防为主”是我国卫生工作方针之一,当今如何增进小儿身体素质的防病保健成为社会的极大需要。针对时下不合理喂养及小儿保健品的滥用现象,温老师认为根据小儿体质特点,运用中医“整体观”、“辨证论治”原则指导小儿营养保健势在必行。
1.6发展观点。从《黄帝内经》时期到现在已有二千多年的历史,无论是自然条件、人文体系,还是人们体质、疾病的类型都发生了很大的变化,因此温老师强调要有辨证思维,用历史唯物辩证法的观点,分析各时期医学著作所处的时代、社会、地理环境,从而正确理解各医家的观点、方药之运用；要敢于依据当代对疾病更深的认识,结合自然气候、人们体质等特点而有所突破和发展,提出新理论、开创新途径、研制新的中药方剂。
2对温振英老师的中医儿科临床经验进行了整理与研究,主要从养阴益气、扶正祛邪治疗反复呼吸道感染,健脾益气、扶正固本治疗小儿泄泻,养阴益气、清热透邪治疗急性病毒性上呼吸道感染,养阴祛风、润肺平喘治疗小儿哮喘,祛风润肺、健脾柔肝治疗儿童多动症、抽动障碍,健脾润肺、祛风活血治疗痤疮、扶正固本治疗癌症、过敏体质儿童的面部望诊特点、用药主张“一专多能”等九个方面进行了论述。
第三部分养阴祛风、润肺平喘治疗小儿哮喘急性发作期临床研究
从三方面研究温振英老师辨治小儿哮喘的理论依据及临床效果。
1哮喘儿童的体质属于中医学的特禀质。但这种特禀体质在中医辨证上倾向于何种类型目前未见有进一步论述。根据温振英老师多年治疗过敏性疾病的经验,参照中华中医药学会2009年4月发布实施的《中医体质分类与判定》(ZYYXH/T157-2009),并结合小儿的生理病理特点,在临床通过体质量表调查问卷对150名哮喘儿童及其家长进行了流调学研究,分析哮喘儿童的中医体质类型特禀质的进一步分型。
2通过温老师对145例哮喘患儿急性发作的治疗处方,研究总结、提炼温老师治疗小儿哮喘的常用处方及药物,并从传统中药理论、结合现代药理研究进行了详尽的阐述。
3根据温振英老师治疗小儿哮喘发作期的临床经验,以养阴祛风、润肺平喘为法则,运用温老师经验方祛风定喘汤,治疗小儿哮喘急性发作期轻中度患者并与目前现代医学认可的支气管舒张剂及白三烯调节剂作对照进行临床观察,结果发现治疗组与对照组的临床疗效统计学无差异,说明祛风定喘汤治疗小儿哮喘急性发作有较好的疗效。
结论温振英老师的学术思想及临床经验经验是中医儿科学的宝贵财富,继承、发掘与传承温老的学术思想、临床经验对于中医儿科学的发展及高层次技术人才的培养十分必要。通过跟师三年的学习研究,我们对温老的学术思想及临床经验进行了有效的挖掘与总结,同时作为学生的我们在专业理论水平及临床技能等方面均有了长足的进步。
成果
1本论文通过对哮喘采取辨病与辨证相结合、本病与合并症相鉴别的方法,在哮喘治疗上进行了创新,用养阴祛风、润肺平喘之法进行治疗。从研究结果看,该创新方法为过敏性哮喘的中医治疗提供了新思路,提高了疗效。
2论文将变态反应性疾病的病理特点与腠理的特性相结合,提出了从“腠理”论治变态反应性疾病的创新观点,为中医治疗多种变态反应性疾病提供了全新的思路。
3以第一作者在核心期刊发表文章2篇；现为“北京市薪火3+3传承工程温振英工作站”课题组成员(排名第二),本工作站现已被批准为国家级传承工作站。
本研究包括两部分：文献研究及临床研究
研究目的：
1通过对150例哮喘患儿体质特征的临床调查,进行特禀体质的进一步分型,了解其体质分布情况,便于根据哮喘患儿体质特点辨证用药,并对患儿及其家长进行生活调护指导。
2对温振英老师治疗小儿哮喘急性发作用药特点及规律进行研究,以便掌握温老师治疗小儿哮喘急性发作处方原则及用药精髓。
3运用温振英老师的祛风定喘汤治疗小儿哮喘急性发作,并设立对照组,观察疗效,以期为中医治疗小儿哮喘急性发作提供新的思路。
研究方法：
1利用文献检索工具,对小儿哮喘的中西医文献进行研究,掌握古今、中西医对小儿哮喘的病因病机认识及治疗方法。
2运用临床调查的方法,对150例哮喘患儿进行调查,并进行进一步的体质分类。运用统计学分析数据,得出结果。
3对温老师治疗的145例哮喘急性发作患儿的处方进行整理归纳,采用描述性统计分析方法,运用频数、构成比,提炼处方原则及用药精华。
4以温老师常用的祛风定喘汤作为治疗组,与现在西医认可的β2受体激动剂(硫酸沙丁胺醇缓释胶囊)、白三烯调节剂(孟鲁斯司特钠咀嚼片)联合用药作对比,并进行统计学分析,观察疗效。
研究结果：
1所研究的150哮喘患儿均属于中医体质类型中的特禀质,但若进一步划分阴虚及阴虚倾向者123例,占82%；气虚及气虚倾向者4例,占2.67%；气阴两虚者13例,占8.67%；阴虚伴气虚倾向者5例,占3.33%；气虚倾向伴阴虚倾向者2例,占1.33%；滞热型者3例,占2%。
2对温老师治疗的哮喘急性发作患儿145例处方进行统计分析,以不同类药物应用频次占总药味的百分比进行统计,养阴药味所占比例最大,占34.81%；其次为止咳平喘药味及祛风药味,分别占21.86%、17.64%；再其次为清热药味及理气药味,分别占8.53%、8.48%；活血药味所占比例最小,为0.90%。以每位药物应用频次占总处方数百分比的多少来进行统计,在祛风药中以防风应用最多,占100%,醋柴胡及秦艽次之,分别占37.24%、36.55%；养阴药以乌梅、五味子、诃子为多,均占到96%以上,黄精、百合次之,分别占93.79%、62.07%；止咳平喘药石菖蒲最多,占98.62%,白果、紫菀次之,均占93.10%；理气药以苏梗为主,占76.55%；活血药以紫草相对为多,占8.28%。
3祛风定喘汤中药治疗小儿哮喘急性发作临床有效,与现代医学认可的硫酸沙丁胺醇缓释胶囊联合孟鲁司特钠咀嚼片对照组比较,无论在总体疗效还是咳喘主症及鼻部、皮肤、大便等的兼症改善方面均具有较好的临床疗效,两组疗效经统计学检验无显著差异。
结论：
1哮喘患儿中医体质分型属于特禀体质,若再进一步分型,多更倾向于阴虚体质。
2结合患儿体质,运用养阴祛风、润肺平喘治疗小儿哮喘急性发作临床有效,并能够在一定程度上改善鼻塞、皮肤瘙痒、大便干燥等相关症状。
Objective:This study aims to explore the Chinese medicine academic thought origin of Wen Zhen-ying, summarize her characteristics of pediatric academic theory and clinical experience, and improve our own clinical experience at last.
Methods:
1 Follow the teacher in clinical diagnosis; observe seriously of the teacher' four diagnostic methods and take notes carefully.2 Study the teacher's works:"Medical case of Wen Zhen-ying".Seriously study and deeply understand the teacher academic thought.3 Read the four classics of Chinese Medicine, the pediatrics of TCM ancient books, Combine the essence of classic TCM and teacher's clinical experience. Excavate deeply teacher' academic thought origin.4 Retrieve literature related about modern Pediatrics of TCM, and study these TCM pediatrics professors'academic characteristics to make preparations for the excavation work followed.5 Take clinical survey on 150 cases of children with asthma, then make the further classification of constitution, Analyze the data by statistical method to get the results;6 Classify and analyze teacher Wen's prescriptions for 145 treatment cases of children with acute asthma, using analysis method of descriptive statistics, such as the frequency and constituent ratio, in order to extract prescription principles and medication essence; 7 Apply the teacher's experience of asthma treatment in clinic, and 60 cases of asthma will been treated. Observe the curative effects by scientific research method. And then test the treatment effects.
The main content of this thesis is divided into three parts.
Part 1
1 Explore the Chinese medicine academic thought origin of Wen Zhen-ying by reading the classics of Chinese Medicine and ancient books of TCM pediatrics.2 Study the academic characteristics of modern TCM pediatrics doctors by modern literature retrieval, in order to dig deeper into teacher's own academic thoughts characteristic and clinical experience.
Part 2
Summarize and research Wen Zhen-ying's pediatric academic theory from the following six aspects.1:Holistic Medicine;Strengthen healthy qi to eliminate pathogens;Attention to spleen and stomach;Attention to nourishing yin;Attention to nutrition and health care;Development view.
Summarize and research the pediatric clinical experience of Wen Zhen-ying. Mainly from the Nourishing and Qi, strengthening body resistance and eliminating evil to treat recurrent respiratory tract infection. Strengthening the spleen and replenishing qi, strengthening healthy to therapy of infantile diarrhea, dispelling wind and moistening lung to treat pediatric asthma, surporting heaithy energy to treat Cancer,strengthening spleen and softening liver in treatment of children with ADHD, TIC disorder, allergic children face inspection characteristics, advocate" special and multiple effect "medicine application experience and other seven aspects were discussed.
Part 3
The paper summarized the commonly used drugs of Wen Zhen-ying teacher in treatment of children asthma, and discussed in detail combined with the theory of traditional Chinese medicine and modern pharmacological research.
1 The constitution of asthma children is a kind of personal idiosyncrasy classified by the TCM theory. But at present, there has been no further discussion on which type of TCM constitution this idiosyncrasy tends to be. According to experience of Wen Zhen-ying teacher in treatment of allergic disease for many years, referencing to Chinese Medicine Institute issued in 2009 April the" TCM constitution classification and judgment"(ZYYXH/ T157-2009), and combining of pediatric physiologic and pathologic characteristics, we have taken epidemiological investigation and research on 150 asthmatic children and their parents by constitution questionnaire, and analyzed the further classification of children with asthma in TCM constitution types.
2 Research has summarized, refined Wen Zhen-ying teacher's common prescriptions and drugs in the treatment of children asthma, and discussed in detail using the theory of traditional Chinese medicine combined with modern pharmacological research.
3 According to Wen Zhen-ying teacher's clinical treatment experience of pediatric asthma, using the rule of nourishing yin to dispelling wind, moistening lung and relieving asthma, adopting Wen's empirical prescription of expelling wind and relieving asthma, we treated children patients of mild to moderate acute exacerbation of asthma, took clinical observation and used bronchodilator agents and leukotriene modifiers which confirmed by current modern medicine for the control. We found that there were no significant difference between treatment group and the control group in the clinical curative effect. The research indicated that the prescription of empirical prescription of expelling wind and relieving asthma took good effect on treating asthma acute attack of children.
Results:On the basis of inheritance and according to our clinical practice, discusses the theory of "treatment hypersensitiveness disease from muscular interstices".Publish 3 articles as the first author identity, of which 2 published in core journals.
Conclusion:Wen Zhen-ying's academic theory and experience are precious wealth of TCM pediatrics. It is very necessary to inherit, excavate and spread of Wen Zhen-ying's academic thought and clinical experience in pediatrics of traditional Chinese medicine, especially good for the development of high level technical talents. Through three years of study with teacher Wen, We have taken effectively mining and summarization on teacher's academic thought and clinical experience. Our professional theory level and clinical skills have made great progress consequently
This study includes two parts:literature review and clinical research.
Purposes:1. Adopt clinical investigation on 150 cases of children with asthma included their constitution characteristic, to understand physical type distribution and the personal idiosyncrasy for further classification, in order to take syndrome differentiation and treatment according to the physical characteristics, and guide the children and their parents to living or nursing.2. Study on treatment rules of pediatric asthma acute episode invented by Wen Zhen-ying teacher, in order to learn her medication principles and experience essence for pediatric asthma acute episode treatment.3. Treat children attacked by asthma acute episode using Wen Zhen-ying teacher's empirical prescription of expelling wind and relieving asthma, observe curative effect compared with the control group, so as to provide a new idea for the Chinese medical treatment of children with acute asthma.
Methods:1. Using literature search tool, study the literature about pediatric asthma treatment with traditional Chinese medicine and Western medicine, master ancient and modern, Chinese and Western Medicine viewpoint on children asthma pathogenesis and treatment methods; 2. Take clinical survey on 150 cases of children with asthma, then make the further classification of constitution, Analyze the data by statistical method to get the results; 3.Classify and analyze teacher Wen's prescriptions for 145 treatment cases of children with acute asthma, using analysis method of descriptive statistics, such as the frequency and constituent ratio, in order to extract prescription principles and medication essence; 4. The treatment group took Wen Zhen-ying teacher's empirical prescription of expelling wind and relieving asthma. The control group used the combined medication treatment for Beta-2 adrenergic receptor agonists (salbutamol sulfate sustained release capsules), leukotriene modifiers (Montelukast Sodium Chewable Tablets), which is recognized by western medicine for comparison. Take statistics analysis and observe curative effect.
Result:1. All of 150 asthmatic children have personal idiosyncrasy classified by the TCM theory, but if divided further,123 cases belong to the type of Yin deficiency or tend to be Yin deficiency, accounting for 82%; deficiency and Qi tendency in 4 cases,4 cases belong to the type of Qi deficiency or tend to be Qi deficiency, accounting for 2.66%; 13 cases belong to deficiency of both Qi and Yin, accounting for 8.66%; 5 cases belong to the type of Yin deficiency and tend to be Qi deficiency, accounting for 3.33%; 2 cases belong to the type of Qi deficiency and tend to be Yin deficiency, accounting for 1.33%; 3 cases belong to the type of Dampness and Heat, accounting for 2% of.2. Statistical analyze teacher Wen's prescriptions for 145 cases of children with acute asthma, using every kind of drug application frequency of total drugs percentage. Nourishing Yin drugs account for the largest proportion, accounting for 34.81%; followed by the medicine for relieving cough and asthma, the dispelling wind medicine, account for 21.85%,17.64%; and followed by the heat-clearing drug and drugs for regulating Qi flow, respectively accounting for 8.53%,8.48%; and the drugs for invigorating blood circulation take the smallest proportion,0.90%.Take each drug application frequency accounted the total number of prescriptions percentage to statistics, Fang Feng is applied mostly in the dispelling wind medicine, occupy 100%, Chai Hu with vinegar and Qin Jiao take second place, respectively,37.24%, 36.55%; Wu Mei, Wu Weizi and Ke Zi are the most in Yin-nourishing drugs, account for more than 96% times, followed by Huang Jing and Bai He,93.79%, 62.07% respectively; Shi Changpu take the most proportion in the medicine for the treatment of cough and asthma, occupy 98.62%, followed by Bai Guo, Zi Yuan, respectively occupy 93.10%; Sue Geng is the mostly used drugs for regulating Qi flow, accounted for 76.55%;Zi Cao is the mostly used drugs for invigorating blood circulation, accounted for 8.28%.3. The research indicated that the prescription of expelling wind and relieving asthma takes good effect on treating children asthma acute attack. Compared to the control group used the combined medication treatment for salbutamol sulfate sustained release capsules and Montelukast Sodium Chewable Tablets, which is recognized by modern medicine, the Wen's prescription has better clinical efficacy, ether in the overall efficacy or in the controlling of cough main disease and nose, skin, stool minor disorders. The two group treatment effects have no significant difference in statistics.
Conclusions:Children with asthma have personal idiosyncrasy classified by the TCM theory, and most of them belong to the type of Yin deficiency if divided further. Combining with the children's constitution, use the rule of nourishing yin to dispelling wind, moistening lung and relieving asthma to treat children with acute asthma may be clinical effective, it also be help to improving the stuffy nose, itchy skin, dry stool and other related symptoms at some extent,
引文
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