丘和明教授血证学术思想及临床经验研究
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摘要
本研究主要总结了丘和明教授的血证学术思想和临床经验。丘和明教授从医五十年,在血证专业领域具有深厚的造诣和丰富的临床经验。丘和明教授博采众长,从《内经》、刘河间、朱丹溪、张景岳、以及温病学说得到启发,在血证临证中主张从火热论辨析血证病机,依从温病的卫气营血和三焦辨证理论,分析恶性血液病的病机,辨证时强调整体观和病证结合的思想。临证时注重阴阳平衡的治疗原则,推崇《血证论》止血、活血、宁血、补虚的四大法则。
丘和明教授临证中善于灵活应用中医基础理论,结合自身经验,开创了多种治疗血证的新方法新技术。丘和明教授创造性地将“肝藏血”理论阐述引申到血证临床,创立柔肝方治疗特发性血小板减少性紫癜,通过清肝、平肝、疏肝、养肝四法,促进肝藏血功能,减少血小板破坏,提高血小板水平。在多发性骨髓瘤的临证中,丘和明教授充分认识到了肾虚血瘀是多发性骨髓瘤的基本病机,建立了补肾活血治疗多发性骨髓瘤的基本法则,并创立补肾活血方,在临证中随症加减,提高多发性骨髓瘤疗效。对于再障的治疗,丘和明教授抓住了肾阴虚的实质,创立养阴补肾方,治疗再障,获得较好的效果。丘和明教授认为白血病的病机为邪实本虚,治疗应驱邪补虚并重,注重阴阳平衡。
本研究同时设计了应用丘和明教授的补肾活血方治疗多发性骨髓瘤的实验研究,实验研究采用随机对照的试验方法,把多发性骨髓瘤患者随机分为实验组、对照组,对照组仅予4-6个疗程化疗及支持治疗,实验组在化疗同时给予补肾活血方汤药口服,每次化疗服中药21天,六个月后评价骨髓缓解程度、β：-微球蛋白、淋巴细胞亚群和调节性T细胞水平的变化。骨髓缓解程度通过骨髓细胞形态学方法评价,淋巴细胞亚群和调解性T细胞的检测应用流式细胞仪的方法。结果显示,实验组获得了稍高的CR率、PR率和有效率,但是差异无统计意义,实验组治疗后的β：-微球蛋白较对照组减低明显,差异有统计学意义。实验组CD4+细胞较对照组升高,调节T细胞水平较对照组减低,差异有统计学意义。结论：补肾活血方能够降低多发性骨髓瘤肿瘤负荷,提高CD4+细胞水平,减低调节T细胞水平,改善免疫功能。
This study has two parts. Part one aims at a general summary on the academic thoughts and clinical experiences of Professor Qiu Heming on hemorrhagic syndromes. With nearly half century's medical practice, Professor Qiu developed profound academic achievements in medical research and got rich experiences in treating hemorrhagic syndrome.
His academic achievements rooted deeply from classical works of Chinese traditional medicine and theories of other medical masters in history such as Canon of Huangdi, Liu Hejian, Zhu Danxi, Zhang Jingyue, and theory of warm disease school.
During the clinical practice on hemorrhagic syndrome, Professor Qiu believes that fires act as important reasons for hemorrhagic syndromes. He always uses three energizer differentiation method and wei-qi-ying-xue methods to differentiate hemorrhagic syndrome besides ba-gang principles. Professor Qiu emphasize entirety conceptions in the differentiation process, he always takes syndromes and diseases together into differentiation. He always takes it carefully to balance the two sides of yin and yang during the treatment for hemorrhagic syndromes. He also give high praise to the treatise on hemorrhagic syndromes an famous classical medical work by Tang Rong-chuan who first established the four major hemostatic methods which are to stop bleeding, to dissipate coagulation, to cool down circulation and to reinforce sufficiency.
Professor Qiu is very expert at applying basic principles of Chinese medicine in the complicated clinical problems. With his profound experiences of medical practice he developed many new theories and new methods for hemorrhagic syndromes. Professor Qiu creatively applied the principle about the liver's holding blood in the treatment of idiopathic thrombocytopenic purpura (ITP). He found that ITP was caused by liver's incapacity to hold blood, so he use methods of soothing liver, nourishing liver, pacifying liver and clearing liver to treat ITP to promote the liver's blood holding ability and to decrease the damage of platelets. This method gets very good results in elevating platelets level.
Professor Qiu believes that insufficiency of kidney and hemostasis are responsible for the development of multiple myeloma, so he created a herbal formula of Bushen Huoxue Fang to promote the curing efficacy for multiple myeloma. He also created an Yangyin Bushen formula for aplastic anemia (AA) with his accurate understanding about the focal pathological lesion in AA which is the yin deficiency of kidney. Professor Qiu believes that excessive pathogens and insufficient essences are both important in the development of leukemia, so he insists that expelling external pathogens and supplying inner insufficiencies play the same important roles in curing leukemia.
The second part of this study is about the clinical and laboratory researches on multiple myeloma(MM) treated with bushen huoxue fang.
This study applies random and control methods. About22Patients with MM were allotted into experiment group and control group, all the patients of the two groups were treated with the M2chemotherapy regimen for4to6cycles which lasted nearly half a year. The patients in experiment group were applied with oral decoction of bushen huoxue fang daily for21days per cycle lasting for half a year. At the end of treatment, all patients were tested on bone marrow cellularity, serial β2-microglobulin and lymphocytic subgroups including the regulatory T cells (CD4+CD25+Treg). The results show that the experiment group has higher CR rate, PR rate and effective rate than the control group but with no statistical significance. The serial β2-microglobulin level in experiment group is higher than that in control group with statistic significance. The lymphocyte analysis shows higher levels of CD4+T and CD4+CD25+Teg in experiment group than in control group with statistic significance. So it is concluded that bushen huoxue fang is effective in treating MM to reduce tumor burden and increasing CD4+T cells and decreasing regulatory T cells which means the immune function will be intensified.
丘和明教授临证中善于灵活应用中医基础理论,结合自身经验,开创了多种治疗血证的新方法新技术。丘和明教授创造性地将“肝藏血”理论阐述引申到血证临床,创立柔肝方治疗特发性血小板减少性紫癜,通过清肝、平肝、疏肝、养肝四法,促进肝藏血功能,减少血小板破坏,提高血小板水平。在多发性骨髓瘤的临证中,丘和明教授充分认识到了肾虚血瘀是多发性骨髓瘤的基本病机,建立了补肾活血治疗多发性骨髓瘤的基本法则,并创立补肾活血方,在临证中随症加减,提高多发性骨髓瘤疗效。对于再障的治疗,丘和明教授抓住了肾阴虚的实质,创立养阴补肾方,治疗再障,获得较好的效果。丘和明教授认为白血病的病机为邪实本虚,治疗应驱邪补虚并重,注重阴阳平衡。
本研究同时设计了应用丘和明教授的补肾活血方治疗多发性骨髓瘤的实验研究,实验研究采用随机对照的试验方法,把多发性骨髓瘤患者随机分为实验组、对照组,对照组仅予4-6个疗程化疗及支持治疗,实验组在化疗同时给予补肾活血方汤药口服,每次化疗服中药21天,六个月后评价骨髓缓解程度、β：-微球蛋白、淋巴细胞亚群和调节性T细胞水平的变化。骨髓缓解程度通过骨髓细胞形态学方法评价,淋巴细胞亚群和调解性T细胞的检测应用流式细胞仪的方法。结果显示,实验组获得了稍高的CR率、PR率和有效率,但是差异无统计意义,实验组治疗后的β：-微球蛋白较对照组减低明显,差异有统计学意义。实验组CD4+细胞较对照组升高,调节T细胞水平较对照组减低,差异有统计学意义。结论：补肾活血方能够降低多发性骨髓瘤肿瘤负荷,提高CD4+细胞水平,减低调节T细胞水平,改善免疫功能。
This study has two parts. Part one aims at a general summary on the academic thoughts and clinical experiences of Professor Qiu Heming on hemorrhagic syndromes. With nearly half century's medical practice, Professor Qiu developed profound academic achievements in medical research and got rich experiences in treating hemorrhagic syndrome.
His academic achievements rooted deeply from classical works of Chinese traditional medicine and theories of other medical masters in history such as Canon of Huangdi, Liu Hejian, Zhu Danxi, Zhang Jingyue, and theory of warm disease school.
During the clinical practice on hemorrhagic syndrome, Professor Qiu believes that fires act as important reasons for hemorrhagic syndromes. He always uses three energizer differentiation method and wei-qi-ying-xue methods to differentiate hemorrhagic syndrome besides ba-gang principles. Professor Qiu emphasize entirety conceptions in the differentiation process, he always takes syndromes and diseases together into differentiation. He always takes it carefully to balance the two sides of yin and yang during the treatment for hemorrhagic syndromes. He also give high praise to the treatise on hemorrhagic syndromes an famous classical medical work by Tang Rong-chuan who first established the four major hemostatic methods which are to stop bleeding, to dissipate coagulation, to cool down circulation and to reinforce sufficiency.
Professor Qiu is very expert at applying basic principles of Chinese medicine in the complicated clinical problems. With his profound experiences of medical practice he developed many new theories and new methods for hemorrhagic syndromes. Professor Qiu creatively applied the principle about the liver's holding blood in the treatment of idiopathic thrombocytopenic purpura (ITP). He found that ITP was caused by liver's incapacity to hold blood, so he use methods of soothing liver, nourishing liver, pacifying liver and clearing liver to treat ITP to promote the liver's blood holding ability and to decrease the damage of platelets. This method gets very good results in elevating platelets level.
Professor Qiu believes that insufficiency of kidney and hemostasis are responsible for the development of multiple myeloma, so he created a herbal formula of Bushen Huoxue Fang to promote the curing efficacy for multiple myeloma. He also created an Yangyin Bushen formula for aplastic anemia (AA) with his accurate understanding about the focal pathological lesion in AA which is the yin deficiency of kidney. Professor Qiu believes that excessive pathogens and insufficient essences are both important in the development of leukemia, so he insists that expelling external pathogens and supplying inner insufficiencies play the same important roles in curing leukemia.
The second part of this study is about the clinical and laboratory researches on multiple myeloma(MM) treated with bushen huoxue fang.
This study applies random and control methods. About22Patients with MM were allotted into experiment group and control group, all the patients of the two groups were treated with the M2chemotherapy regimen for4to6cycles which lasted nearly half a year. The patients in experiment group were applied with oral decoction of bushen huoxue fang daily for21days per cycle lasting for half a year. At the end of treatment, all patients were tested on bone marrow cellularity, serial β2-microglobulin and lymphocytic subgroups including the regulatory T cells (CD4+CD25+Treg). The results show that the experiment group has higher CR rate, PR rate and effective rate than the control group but with no statistical significance. The serial β2-microglobulin level in experiment group is higher than that in control group with statistic significance. The lymphocyte analysis shows higher levels of CD4+T and CD4+CD25+Teg in experiment group than in control group with statistic significance. So it is concluded that bushen huoxue fang is effective in treating MM to reduce tumor burden and increasing CD4+T cells and decreasing regulatory T cells which means the immune function will be intensified.
引文
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