王裕颐教授学术思想与临床经验总结及治疗眩晕证治规律研究
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摘要
王裕颐教授是山西省中医院主任医师、博硕士研究生导师、名医,全国第三、四批继承老中医药专家学术经验指导老师,从事中西医临床、教学、科研工作50载,临床经验丰富,治学严谨,擅长治疗内科疑难杂病,在中医师承、创新和临证中独具匠心,形成了别具风格的中医药临证诊疗体系。本论文在探析老师学术渊源的基础上,进一步挖掘、整理,凝炼其学术思想,总结其治疗部分内科杂病的临床经验和用药特色,并通过对眩晕病案的整理,梳理其证治规律。
第一部分探析老师的学术渊源。王老师的学术思想和临床经验的形成过程大致经历了四个阶段,系统学习中西医知识,奠定临床基础知识；拜名师,兼收并蓄,汲取各家精华；壮志不已,走医教研管之路；“临证——学习——再临证——再学习”,不断学习,勤于总结,勇于创新,最终成为一代名医。
第二部分根据三年来跟师体会及老师的口传心授,通过经典及文献查阅,参考王老师论文、论著、科研成果、教案、医案,归纳总结王老师有效且有治疗特色的疾病；分析总结其辨证辨病方法,治则治法特色,用药处方特点,总结其临床经验,凝炼其学术思想。
本论文从七个方面对王老师的学术思想内容进行具体阐述。①中西汇通,兼收并蓄,表现在：灵活运用辨证与辨病相结合,察色按脉与现代检查并用,遣药组方吸收现代药理。②重视整体观念,重视脏腑相关学说。③辨证论治,抓主症,抓病机。④擅用经方名方,结合实践刨制新方。⑤疑难杂病,痰瘀论治。⑥补虚祛瘀是抗衰老的根本大法。
诊治经验的总结从慢性心力衰竭、心律失常、高血压病、椎动脉型颈椎病、汗证、缺血性心脑血管病等病种入手,从病因病机、辨证分型、治则治法、用药特点,体会等方面,将老师重视整体观念,辨证论治,抓主症,抓病机,中西汇通,擅用经方名方,疑难杂病,痰瘀论治的治学思想贯穿其中。
第三部分王裕颐教授治疗眩晕证治规律研究
目的：
采用数理统计和多因素分析方法,通过对王裕颐教授临床治疗眩晕辨证用药进行总结,探索其辨证论治规律,为中医辨证论治眩晕提供客观科学的依据。
方法：
本次研究自2010年12月至2012年5月,用临床流行病学研究方法,根据设计的临床观察表对山西省中医院王裕颐教授门诊321例眩晕病例进行调查,运用EPldata3.0进行数据库的建立与管理,采用二次录入进行审核,采用频数分析、聚类分析、因子分析等多因素分析方法,通过对中医症状频数及指标聚类分析,梳理出眩晕中医证候分布规律。并对每一证型中的症状、体征变量进行因子分析,确定其辨证要点。通过对中药频数及指标聚类分析,总结出老师治疗眩晕的辨证用药规律。
结果：
1、本研究321例患者男性为33.33%,女性66.67%；年龄分布在57.48±8.99岁；病程在为49.04±27.11月。
2、通过对55个症状聚类分析,总结出7个中医证型,通过因子分析,归纳出7个证型的辨证要点。肝肾阴虚证：眩晕久发不止、腰酸膝软、五心烦热；痰热上扰证：头闷痛、脉滑数、舌质红、胸闷脘痞胀满；肝阳上亢、脉络瘀阻证：眩晕头重脚轻、脉弦数、头痛且胀、肢麻手抖；风痰上扰证：脉滑、视物旋转、胸闷呕恶、耳聋耳鸣、多寐多梦；胆郁痰扰证：胸胁脘腹胀闷、情绪抑郁、眠差、咽部不适；脾胃虚弱证：面色萎黄、神疲懒言、食少便溏、视物昏花、舌淡；太阳经气不利证：颈椎侧弯后伸时,头晕症状加重、上肢麻木、后枕、颈肩部酸痛不适。
3、中药频数分析,排前10位的是：天麻、菊花、法半夏、陈皮、泽泻、白术、地龙、茯苓、钩藤、枸杞子。治疗药物主要为入肝经药物(29.65%)、脾经(26.16%)；治疗药性温性药占34.78%,寒凉药占39.13%,平性药总占26.09%,说明王裕颐教授治疗眩晕偏于平性,寒热同调。总结出治疗眩晕的基本方剂：肝肾阴虚证用滋水清肝饮,痰热上扰证用半夏白术天麻汤加黄连温胆汤,肝阳上亢、脉络瘀阻证用地菊平肝汤,风痰上扰证用半夏白术天麻汤加泽泻汤,胆郁痰扰证用柴胡加龙骨牡蛎定志汤,脾胃虚弱证用归脾汤,太阳经气不利证用桂枝加葛根汤、泽泻汤。
结论：
采用流行病学调查方法,采用频数分析、聚类分析、因子分析等多因素分析方法,总结出王裕颐教授治疗眩晕中医证候分布规律。风、痰、虚、瘀、郁是眩晕的重要发病因素,肝、脾功能失调是眩晕病机的关键。得出7种证型及其辨证要点,总结出治疗眩晕的基本方剂。为眩晕的临床辨证治疗提供了客观依据。
Professor Wang Yuyi is the chief physician, the Postgraduate Supervisor, one of the most remarkable doctors of Shanxi Province hospital of Traditional Chinese Medicine, and is one of academic experienced guide teachers of Traditional Chinese Medicine. He engaged in clinical trivials, scientific research, and teaching more than50years. He has accumulated rich clinical experience, paid attention to the modern research of traditional Chinese medicine, done academic research scrupulous, exceled in treating the medicine difficulty disease, had great originality in master-apprentice of Traditional Chinese Medicine in the clinical, and eventually formed a unique style of traditional Chinese Medicine clinical diagnosis and treatment system. The aim of this dissertation is to arrange and concentrate its academic thought and to sum up the therapeutic experience and drug characteristics of treating a part of difficult disease in internal medicine on the basis of the analysis of the tutor academic origin. The dissertation hackles the therapy regularity by sorting vertigo medical record.
Part one analysis the mentor's academic origin. Professor Wang's academic thoughts and clinical experience have roughly experienced four stages:to establish the clinical basic knowledge by learning knowledge system of traditional Chinese and western medicine; to learn from the masters and take in everything and derive their essence; to be ambitious unceasingly and go on to medical teaching research road, experience-study-re-experience-re-study. Continuous learning, frequent summary, and be bold in making innovations make him ultimately become a great master.
Part two To summarize Professor Wang's effective and distinctive treatment of the disease by consulting the classical materials and literature, referring to teacher Wang's theses、 treatises、scientific achievements、teaching plans、medical cases, and according to three years' experience with tutor and teacher's pass on knowledge.To analyze and summarize methods of the differentiation of syndromes of different disease, treatment characteristics, drug prescription characteristics. To sum up the clinical experience and concentrate his academic ideas.
The dissertation discussed teacher Wang's academic ideas from six aspects.①To achieve comprehensive understanding through the confluence of Chinese and western medicine and to take in everything. It shows that:flexible use of combination the differentiation of syndromes and diagnosis of disease, combining complexion location and modern tests, judging curative effect in objective index; providing the scientific basis.②Paying attention to the relevant organs of doctrine.③The treatment based on syndrome differentiation, grasping the main disease, and scratch disease machine.④The use of classical prescriptions side and combining the practice of planning new system.⑤The complex diseases, treating phlegm and blood stasis.⑥The tonic and blood stasis is the fundamental law of anti aging.
Experience of diagnosis and treatment of chronic heart failure from the summary of arrhythmia, hypertension,vertebral artery type of cervical spondylitis, Hanzheng. It can be started from the analysis of disease, etiology and pathogenesis, syndrome differentiation, treatment principles and methods of drug characteristics, with the teacher's experience, we should pay attention to the overall concept, syndrome differentiation, grasping study of Chinese and western medicine, using the classical side, complex diseases, treating phlegm and blood stasis research idea which.
Part three Researching rules of Wang Yuyi's treatment of vertigo
Objective:
Using the mathematical statistics and factor to analyze in the main disease, to scratch disease machine, and to achieve mastery through a comprehensive method, to objectively summarize the treatment of vertigo by Professor Wang Yuyi, to explore the dialectical differentiation rule, to sum up the clinical experience and condense his academic thoughts, and to provide the vertigo objective scientific evidence for Chinese medicine diagnosis treatment.
Methods:
This study was started from December2010to May2012, with clinical epidemiological survey method, According to Clinical inspection table, Shanxi institute of Chinese medicine outpatient service321cases of vertigo were investigated, the use of EPldata3.0database establishment and management, and the second entry way audit. He adopted frequency analysis, cluster analysis, factors analysis and multiple factors analysis method. Through TCM symptom frequency and index clustering analysis, He sorted out the vertigo distribution regularity of TCM Syndromes. He also used orthogonal rotating the factor analysis clustery form the each type of symptoms, analyzed signs variable, conclude dialectical points, and summed up the teacher in treating the dialectical differentiation rule of vertigo through TCM symptom frequency and index clustering analysis.
Results:
1.This study's321patients is composed of33.33%men and66.67%women; Age distribution in57.48±8.98years; Course in49.04±27.11months.
2. Symptoms of55by clustering analysis, summing up the rule7card type, by factor analysis, Summed up7types of dialectical points, liver-kidney yin deficiency syndrome:long time vertigo, soreness and weakness of waist and knees,vexing heat in the chest, palms and soles; syndrome of internal harassment of phlegm-heat:Headache, rapid slippery pulse, reddened tongue, oppression and distension in the chest and hypochondriac region; Liver yang hyperactivity, choroid and blood stasis:vertigo and heavy head and light feet, rapid string pulse, Headache, Limbs numb and Vibration; syndrome of wind phlegm invading upward:slippery pulse, Circumrotating,nausea, vomiting, Deafness tinnitus, insomnia and dreamful sleep; syndrome of depressed gallbladder with harassing phlegm:oppression and distension in the chest and hypochondriac region, insomnia and dreamful sleep, emotional depression, Throat discomfort; The weakness of the spleen and stomach syndrome:sallow complexion, general lassitude, poor appetite and loose stools, the patient suffers from blurred vision,pale tongue; the disorder qi of taiyang meridian,:Cervical lateral bending extension, dizziness symptoms worsen, upper extremity numbness, occipital, neck and shoulder pain discomfort.
3.Drug frequency analysis, the top10:rhizoma gastrodiae, flos chrysanthemi, rhizoma pinelliae, pericarpium citri reticulatae, rhizoma alismatis, rhizoma atractylodis macrocephalae, Earthworm, poria, gambir plant nod, fructus lycii.Treatment for the main The liver (29.65%), spleen (26.16%); The treatment to Wen sexual medicine34.78%, cold LiangYao accounted for39.13%, Ping sexual medicine26.09%. Summed up the basic prescription of treating vertigo:liver-kidney yin deficiency syndrome used in the treatment of Zishuiqinggan Decoction; syndrome of internal harassment of phlegm-heat used in the treatment of Banxiabaizhutianma Decoction Plus Huanglianwendan Decoction; Liver yang hyperactivity, choroid and blood stasis used in the treatment of Dijupinggan Decoction; syndrome of wind phlegm invading upward used in the treatment of Banxiabaizhutianma Decoction Plus Zexie Decoction; syndrome of depressed gallbladder with harassing phlegm used in the treatment of Chaihu Plus Longgumulidingzhi Decoction; The weakness of the spleen and stomach syndrome used in the treatment of Guipi Decoction, the disorder qi of taiyang meridian,used in the treatment of Guizhi Plus Gegen Decoction Plus Zexie Decoction。
Conclusion:
The epidemiological survey methods, adopting frequency analysis, cluster analysis, factor analysis and multiple factor analysis methods application index clustering mathematical statistics and many factor analysis methods. Summarizing syndromes distribution rule to treatment vertigo by Professor Wang Yuyi syndromes distribution rule. The wind, phlegm, blood stasis, deficiency, depression is vertigo pathology product, liver, spleen dysfunction of vertigo is the key to pathogenesis. Drawing7card type and key points of syndrome differentiation, treatment to the spleen and liver is given priority, and summing up the basic prescription in treating vertigo. For the vertigo clinical differentiation provides objective basis.
第一部分探析老师的学术渊源。王老师的学术思想和临床经验的形成过程大致经历了四个阶段,系统学习中西医知识,奠定临床基础知识；拜名师,兼收并蓄,汲取各家精华；壮志不已,走医教研管之路；“临证——学习——再临证——再学习”,不断学习,勤于总结,勇于创新,最终成为一代名医。
第二部分根据三年来跟师体会及老师的口传心授,通过经典及文献查阅,参考王老师论文、论著、科研成果、教案、医案,归纳总结王老师有效且有治疗特色的疾病；分析总结其辨证辨病方法,治则治法特色,用药处方特点,总结其临床经验,凝炼其学术思想。
本论文从七个方面对王老师的学术思想内容进行具体阐述。①中西汇通,兼收并蓄,表现在：灵活运用辨证与辨病相结合,察色按脉与现代检查并用,遣药组方吸收现代药理。②重视整体观念,重视脏腑相关学说。③辨证论治,抓主症,抓病机。④擅用经方名方,结合实践刨制新方。⑤疑难杂病,痰瘀论治。⑥补虚祛瘀是抗衰老的根本大法。
诊治经验的总结从慢性心力衰竭、心律失常、高血压病、椎动脉型颈椎病、汗证、缺血性心脑血管病等病种入手,从病因病机、辨证分型、治则治法、用药特点,体会等方面,将老师重视整体观念,辨证论治,抓主症,抓病机,中西汇通,擅用经方名方,疑难杂病,痰瘀论治的治学思想贯穿其中。
第三部分王裕颐教授治疗眩晕证治规律研究
目的：
采用数理统计和多因素分析方法,通过对王裕颐教授临床治疗眩晕辨证用药进行总结,探索其辨证论治规律,为中医辨证论治眩晕提供客观科学的依据。
方法：
本次研究自2010年12月至2012年5月,用临床流行病学研究方法,根据设计的临床观察表对山西省中医院王裕颐教授门诊321例眩晕病例进行调查,运用EPldata3.0进行数据库的建立与管理,采用二次录入进行审核,采用频数分析、聚类分析、因子分析等多因素分析方法,通过对中医症状频数及指标聚类分析,梳理出眩晕中医证候分布规律。并对每一证型中的症状、体征变量进行因子分析,确定其辨证要点。通过对中药频数及指标聚类分析,总结出老师治疗眩晕的辨证用药规律。
结果：
1、本研究321例患者男性为33.33%,女性66.67%；年龄分布在57.48±8.99岁；病程在为49.04±27.11月。
2、通过对55个症状聚类分析,总结出7个中医证型,通过因子分析,归纳出7个证型的辨证要点。肝肾阴虚证：眩晕久发不止、腰酸膝软、五心烦热；痰热上扰证：头闷痛、脉滑数、舌质红、胸闷脘痞胀满；肝阳上亢、脉络瘀阻证：眩晕头重脚轻、脉弦数、头痛且胀、肢麻手抖；风痰上扰证：脉滑、视物旋转、胸闷呕恶、耳聋耳鸣、多寐多梦；胆郁痰扰证：胸胁脘腹胀闷、情绪抑郁、眠差、咽部不适；脾胃虚弱证：面色萎黄、神疲懒言、食少便溏、视物昏花、舌淡；太阳经气不利证：颈椎侧弯后伸时,头晕症状加重、上肢麻木、后枕、颈肩部酸痛不适。
3、中药频数分析,排前10位的是：天麻、菊花、法半夏、陈皮、泽泻、白术、地龙、茯苓、钩藤、枸杞子。治疗药物主要为入肝经药物(29.65%)、脾经(26.16%)；治疗药性温性药占34.78%,寒凉药占39.13%,平性药总占26.09%,说明王裕颐教授治疗眩晕偏于平性,寒热同调。总结出治疗眩晕的基本方剂：肝肾阴虚证用滋水清肝饮,痰热上扰证用半夏白术天麻汤加黄连温胆汤,肝阳上亢、脉络瘀阻证用地菊平肝汤,风痰上扰证用半夏白术天麻汤加泽泻汤,胆郁痰扰证用柴胡加龙骨牡蛎定志汤,脾胃虚弱证用归脾汤,太阳经气不利证用桂枝加葛根汤、泽泻汤。
结论：
采用流行病学调查方法,采用频数分析、聚类分析、因子分析等多因素分析方法,总结出王裕颐教授治疗眩晕中医证候分布规律。风、痰、虚、瘀、郁是眩晕的重要发病因素,肝、脾功能失调是眩晕病机的关键。得出7种证型及其辨证要点,总结出治疗眩晕的基本方剂。为眩晕的临床辨证治疗提供了客观依据。
Professor Wang Yuyi is the chief physician, the Postgraduate Supervisor, one of the most remarkable doctors of Shanxi Province hospital of Traditional Chinese Medicine, and is one of academic experienced guide teachers of Traditional Chinese Medicine. He engaged in clinical trivials, scientific research, and teaching more than50years. He has accumulated rich clinical experience, paid attention to the modern research of traditional Chinese medicine, done academic research scrupulous, exceled in treating the medicine difficulty disease, had great originality in master-apprentice of Traditional Chinese Medicine in the clinical, and eventually formed a unique style of traditional Chinese Medicine clinical diagnosis and treatment system. The aim of this dissertation is to arrange and concentrate its academic thought and to sum up the therapeutic experience and drug characteristics of treating a part of difficult disease in internal medicine on the basis of the analysis of the tutor academic origin. The dissertation hackles the therapy regularity by sorting vertigo medical record.
Part one analysis the mentor's academic origin. Professor Wang's academic thoughts and clinical experience have roughly experienced four stages:to establish the clinical basic knowledge by learning knowledge system of traditional Chinese and western medicine; to learn from the masters and take in everything and derive their essence; to be ambitious unceasingly and go on to medical teaching research road, experience-study-re-experience-re-study. Continuous learning, frequent summary, and be bold in making innovations make him ultimately become a great master.
Part two To summarize Professor Wang's effective and distinctive treatment of the disease by consulting the classical materials and literature, referring to teacher Wang's theses、 treatises、scientific achievements、teaching plans、medical cases, and according to three years' experience with tutor and teacher's pass on knowledge.To analyze and summarize methods of the differentiation of syndromes of different disease, treatment characteristics, drug prescription characteristics. To sum up the clinical experience and concentrate his academic ideas.
The dissertation discussed teacher Wang's academic ideas from six aspects.①To achieve comprehensive understanding through the confluence of Chinese and western medicine and to take in everything. It shows that:flexible use of combination the differentiation of syndromes and diagnosis of disease, combining complexion location and modern tests, judging curative effect in objective index; providing the scientific basis.②Paying attention to the relevant organs of doctrine.③The treatment based on syndrome differentiation, grasping the main disease, and scratch disease machine.④The use of classical prescriptions side and combining the practice of planning new system.⑤The complex diseases, treating phlegm and blood stasis.⑥The tonic and blood stasis is the fundamental law of anti aging.
Experience of diagnosis and treatment of chronic heart failure from the summary of arrhythmia, hypertension,vertebral artery type of cervical spondylitis, Hanzheng. It can be started from the analysis of disease, etiology and pathogenesis, syndrome differentiation, treatment principles and methods of drug characteristics, with the teacher's experience, we should pay attention to the overall concept, syndrome differentiation, grasping study of Chinese and western medicine, using the classical side, complex diseases, treating phlegm and blood stasis research idea which.
Part three Researching rules of Wang Yuyi's treatment of vertigo
Objective:
Using the mathematical statistics and factor to analyze in the main disease, to scratch disease machine, and to achieve mastery through a comprehensive method, to objectively summarize the treatment of vertigo by Professor Wang Yuyi, to explore the dialectical differentiation rule, to sum up the clinical experience and condense his academic thoughts, and to provide the vertigo objective scientific evidence for Chinese medicine diagnosis treatment.
Methods:
This study was started from December2010to May2012, with clinical epidemiological survey method, According to Clinical inspection table, Shanxi institute of Chinese medicine outpatient service321cases of vertigo were investigated, the use of EPldata3.0database establishment and management, and the second entry way audit. He adopted frequency analysis, cluster analysis, factors analysis and multiple factors analysis method. Through TCM symptom frequency and index clustering analysis, He sorted out the vertigo distribution regularity of TCM Syndromes. He also used orthogonal rotating the factor analysis clustery form the each type of symptoms, analyzed signs variable, conclude dialectical points, and summed up the teacher in treating the dialectical differentiation rule of vertigo through TCM symptom frequency and index clustering analysis.
Results:
1.This study's321patients is composed of33.33%men and66.67%women; Age distribution in57.48±8.98years; Course in49.04±27.11months.
2. Symptoms of55by clustering analysis, summing up the rule7card type, by factor analysis, Summed up7types of dialectical points, liver-kidney yin deficiency syndrome:long time vertigo, soreness and weakness of waist and knees,vexing heat in the chest, palms and soles; syndrome of internal harassment of phlegm-heat:Headache, rapid slippery pulse, reddened tongue, oppression and distension in the chest and hypochondriac region; Liver yang hyperactivity, choroid and blood stasis:vertigo and heavy head and light feet, rapid string pulse, Headache, Limbs numb and Vibration; syndrome of wind phlegm invading upward:slippery pulse, Circumrotating,nausea, vomiting, Deafness tinnitus, insomnia and dreamful sleep; syndrome of depressed gallbladder with harassing phlegm:oppression and distension in the chest and hypochondriac region, insomnia and dreamful sleep, emotional depression, Throat discomfort; The weakness of the spleen and stomach syndrome:sallow complexion, general lassitude, poor appetite and loose stools, the patient suffers from blurred vision,pale tongue; the disorder qi of taiyang meridian,:Cervical lateral bending extension, dizziness symptoms worsen, upper extremity numbness, occipital, neck and shoulder pain discomfort.
3.Drug frequency analysis, the top10:rhizoma gastrodiae, flos chrysanthemi, rhizoma pinelliae, pericarpium citri reticulatae, rhizoma alismatis, rhizoma atractylodis macrocephalae, Earthworm, poria, gambir plant nod, fructus lycii.Treatment for the main The liver (29.65%), spleen (26.16%); The treatment to Wen sexual medicine34.78%, cold LiangYao accounted for39.13%, Ping sexual medicine26.09%. Summed up the basic prescription of treating vertigo:liver-kidney yin deficiency syndrome used in the treatment of Zishuiqinggan Decoction; syndrome of internal harassment of phlegm-heat used in the treatment of Banxiabaizhutianma Decoction Plus Huanglianwendan Decoction; Liver yang hyperactivity, choroid and blood stasis used in the treatment of Dijupinggan Decoction; syndrome of wind phlegm invading upward used in the treatment of Banxiabaizhutianma Decoction Plus Zexie Decoction; syndrome of depressed gallbladder with harassing phlegm used in the treatment of Chaihu Plus Longgumulidingzhi Decoction; The weakness of the spleen and stomach syndrome used in the treatment of Guipi Decoction, the disorder qi of taiyang meridian,used in the treatment of Guizhi Plus Gegen Decoction Plus Zexie Decoction。
Conclusion:
The epidemiological survey methods, adopting frequency analysis, cluster analysis, factor analysis and multiple factor analysis methods application index clustering mathematical statistics and many factor analysis methods. Summarizing syndromes distribution rule to treatment vertigo by Professor Wang Yuyi syndromes distribution rule. The wind, phlegm, blood stasis, deficiency, depression is vertigo pathology product, liver, spleen dysfunction of vertigo is the key to pathogenesis. Drawing7card type and key points of syndrome differentiation, treatment to the spleen and liver is given priority, and summing up the basic prescription in treating vertigo. For the vertigo clinical differentiation provides objective basis.
引文
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