刘华为教授学术思想述要及治疗高脂蛋白血症的临床研究
摘要
刘华为教授在长期的临床实践中对中医气机和气化理论进行了深入的研究和探索,他将中医五行学说与脏腑、气化理论紧密结合起来,提出了五行脏腑气化的学术观点,用于指导临床实践,治疗内科疾病。
中医学将古代哲学中的气学理论引入到医学领域用以解释人体的生理和病理现象,指导临床治疗,并成为中医理论形成的基础。中医气化理论源于《内经》,认为气化是指气的运动所产生的变化。气机是指气的运动,以升、降、出、入为四种基本形式。东汉时期张仲景创造性地将其运用于临床,将六气和脏腑经络病证相结合,奠定了中医气化理论的脏腑、物质基础,并提出“抑其太过,弥其不及”的治疗理念。隋唐之后,气化理论得到进一步阐发,“亢害承制”、“水气互化”与“三焦气化”观点均促进了气化理论的发展。
刘华为教授认为,气机是人体脏腑、经络之气的运行规律,其主要表现形式是升、降、出、入。气化是中医学对人体新陈代谢的高度概括。气化以五脏为中心,通过脏腑之间循环往复的生克制化(气化)过程,把饮食物变成人体所需要的精微物质。相生是精微物质的合成过程；相克则是精微物质的分解过程。若生克制化(气化)失司,则就会变为病态的相乘相侮,导致痰、饮、水、湿、瘀等病理产物的产生,形成继发性致病病因,“痰瘀”会进一步导致气机升降失常、气化失司,形成复杂的因果互致关系。他认为内科疾病尤其是代谢性疾病的产生都与“气化失司,痰瘀互结”有关。在治疗时要谨守病机,着眼气机,着手气化,目的在于恢复人体正常的气化功能。
高脂蛋白血症是一种代谢异常性疾病,本病的发生,内因在于脏腑气机升降失调,气化失司；外因嗜食肥甘厚味,外源性脂质摄入过多,二者互为因果,影响水谷精微的正常代谢,导致痰、饮、水、湿、瘀等病理性代谢产物滋生,脂质代谢异常。他认为“气化失司,痰瘀互结”是本病的核心病机,脾胃是人体气机升降之枢纽,主张治疗时从脾胃入手,通过调节脾胃气机,运用化痰活血等治法,消除痰、饮、水、湿、瘀等病理性代谢产物,恢复人体正常的气化功能,这样就从根本上治疗高脂蛋白血症。
本课题依据刘华为教授五行脏腑气化的学术观点以及治疗高脂蛋白血症的临床经验,设计了一项随机、对照试验。对照组服用西药阿托伐他汀片治疗；治疗组服用中药化痰活血汤治疗,以3月为一疗程,观察患者的中医临床症状及血脂的改善情况。
本研究共入组病例68例,脱落6例,脱落率为8.82%,剔除2例。按照试验要求,实际完成病例60例,其中治疗组30例,对照组30例。通过观察总体疗效、中医症状总积分、血脂改善情况以及血常规、尿常规、便常规、肝肾功、心电图等安全性指标,用以评价化痰活血汤治疗高脂蛋白血症的临床疗效和安全性。
通过对刘华为教授运用五行脏腑气化学术思想,辨治高脂蛋白血症的临床经验进行研究和总结,结果提示：①高脂蛋白血症是人体脏腑气机失常,气化失司所导致的疾病,“气化失司、痰瘀互结”是高脂蛋白血症的核心病机；②化痰活血法是治疗高脂蛋白血症的有效治法之一。③化痰活血汤可以提高高脂蛋白血症总体疗效,改善临床症状,并具有改善血脂(TC、TG)的疗效。④运用五行脏腑气化学术思想,确立化痰活血法治疗高脂蛋白血症,安全性较好,值得进一步研究。
Professor Liu Huawei, the tutor, has made further study and exploration on "Qi transformation theory" of TCM in the long-term clinic work and closely combined the five elements theory with it. He put forward an systematic idea of qi transformation taking the five zang organs as the centre to guide the clinic practice and treat internal diseases.
"Qi transformation theory" is one of the important scientific achievements in traditional Chinese culture, and it was introduced into the medical area to explain the physiological and pathological symptoms of the body in TCM, to guide the clinic work and to become the base of TCM theory. The theory of Qi transformation comes from the book of Huang Di Nei Jing, which says Qi transformation refers to the transformation of material and energy aroused by Qi in the movement. The mechanism of Qi refers to the moving regulation of qi including four movements of ascending, descending, exiting and entering. It was creatively used in the clinic practice by Zhang Zhongjin in East Han period who combined the six qi with symptoms in zang and fu organs and meridians, which laid a foundation of zang-fu and material basis in the theory of "mechanism of Qi". He put forward a treatment idea of "restraining excesses and replenishing deficiency". The theory was further elucidated after Sui and Tang dynasty, and was developed by the ideas of "the avoidance of harm by restraining excesses","mutual transformation of water in the body" and " qi trasnformation of San Jiao".
The tutor thinks that the mechanism of qi is the moving regulation of qi in zang-fu organs and meridines of the body with the manifestation of ascending, descending, exiting and entering. Qi transformation highly generalized the body metabolism with TCM. Qi transformation takes five zang organs as the certre and turns food into the essence needed by the body through the process of qi transformation in cycles. Interpromoting relation is consisdered to compose the essence and restriction relation is conceived to decompose the essence. It the qi transformation is in disorder, it will causes subjugation or encroachment and violation or reverse restriction in abnormal state, which produces some pathological reults like phlegm, retained fluid, dampness, stagnation and so on and forms the secondary pathogeny to cause problems. Phlegm stasis will make further disorder of ascending and descending of qi mechanism and qi transformation to form a complicated relation of mutual cause and effect. In his view, the internal problems, especially the metabolism dieases, are concerned with the disorder of qi transformation and phlegm stasis. In the treatment, doctors are suggested to think of mechanism of dieases and start from qi transformation to improve the normal function of qi transformation.
Hyperlipoproteinemia is a disease of abnormal metabolism. Pathogenesis of this disease is considered to have two aspects. One is caused by deficiency of spleen and stomach, disorder of ascending and descending of qi mechanism in Middle Jiao and disorder of qi transformation. The other is caused by addicting to fat and sweet food and overtaking exogenic fat. The two, with a mutual relation of cause and effect, influence the normal metabolism of food essence to produce phlegm, retained fluid, dampness, stagnation and to cause the abnormal metabolism. He thinks that "disorder of qi transformation and phlegm stasis" is considered to be the key mechanism of disease for hyperlipoprotein and the spleen and stomach is taken as the key position of general qi transformation. Suggesting that the treatment should be started from the spleen and stomach with the method of activating blood to resolve phlegm in the treatment, and eliminating phlegm stasis by regulating the ascending and descending of qi transformation in spleen and stomach to recover the normal function of qi transformation. And hyperlipoproteinemia is treated once and for all.
The research topic did a random and controlled experiment according to the tutor's systematic idea and his clinic experience for hyperlipoproteinemia. Patients in controlled group took atrovatatin while those in treatment group took "Hua Tan Huo Xue Decoction".3months is one treatment course and testing the clinic symptoms of TCM and blood-fat.
68cases were taken into the research with6cases dropped and2cases rejected. There were60cases finishing the test actually according to requirement of experiment, and30cases in each group. Having taken the observation on general treatment, integral of TCM symptoms, improvement of blood-fat and other safety index to evaluate the safety and treatment effect. The result showed that (1) Hu Tan Huo Xue Decoction can improve the general treatment for hyperlipoproteinemia and clinic symptoms.(2) The method of activating blood to resolve phlegm to treat hyperlipoproteinemia accords with the clinic practice and reflects the internal regulation of happening and developing of the disease in certain degree.(3) It has nice safty to use the method of activating blood to resolve phlegm to treat hyperlipoproteinemia with the theory of "qi transformation" and it can be popularized.
Having done the summerizing and study on the method of treating hyperlipoproteinemia with "phlegm stasis and disorder of qi transformation" theory done by the tutor and made a further verify that (1) hyperlipoproteinemia is caused by the disorder of qi transformation of the body, and phlegm stasis is the main mechanism of disease. The method of activating blood to resolve phlegm is effective for hyperlipoproteinemia.(2) The idea of "qi transformation" taking five zang organs as the centre gives a penetrating explaination on the process of metabolism, which offers a new theory basis on difficult and complicated cases in internal section with TCM.
中医学将古代哲学中的气学理论引入到医学领域用以解释人体的生理和病理现象,指导临床治疗,并成为中医理论形成的基础。中医气化理论源于《内经》,认为气化是指气的运动所产生的变化。气机是指气的运动,以升、降、出、入为四种基本形式。东汉时期张仲景创造性地将其运用于临床,将六气和脏腑经络病证相结合,奠定了中医气化理论的脏腑、物质基础,并提出“抑其太过,弥其不及”的治疗理念。隋唐之后,气化理论得到进一步阐发,“亢害承制”、“水气互化”与“三焦气化”观点均促进了气化理论的发展。
刘华为教授认为,气机是人体脏腑、经络之气的运行规律,其主要表现形式是升、降、出、入。气化是中医学对人体新陈代谢的高度概括。气化以五脏为中心,通过脏腑之间循环往复的生克制化(气化)过程,把饮食物变成人体所需要的精微物质。相生是精微物质的合成过程；相克则是精微物质的分解过程。若生克制化(气化)失司,则就会变为病态的相乘相侮,导致痰、饮、水、湿、瘀等病理产物的产生,形成继发性致病病因,“痰瘀”会进一步导致气机升降失常、气化失司,形成复杂的因果互致关系。他认为内科疾病尤其是代谢性疾病的产生都与“气化失司,痰瘀互结”有关。在治疗时要谨守病机,着眼气机,着手气化,目的在于恢复人体正常的气化功能。
高脂蛋白血症是一种代谢异常性疾病,本病的发生,内因在于脏腑气机升降失调,气化失司；外因嗜食肥甘厚味,外源性脂质摄入过多,二者互为因果,影响水谷精微的正常代谢,导致痰、饮、水、湿、瘀等病理性代谢产物滋生,脂质代谢异常。他认为“气化失司,痰瘀互结”是本病的核心病机,脾胃是人体气机升降之枢纽,主张治疗时从脾胃入手,通过调节脾胃气机,运用化痰活血等治法,消除痰、饮、水、湿、瘀等病理性代谢产物,恢复人体正常的气化功能,这样就从根本上治疗高脂蛋白血症。
本课题依据刘华为教授五行脏腑气化的学术观点以及治疗高脂蛋白血症的临床经验,设计了一项随机、对照试验。对照组服用西药阿托伐他汀片治疗；治疗组服用中药化痰活血汤治疗,以3月为一疗程,观察患者的中医临床症状及血脂的改善情况。
本研究共入组病例68例,脱落6例,脱落率为8.82%,剔除2例。按照试验要求,实际完成病例60例,其中治疗组30例,对照组30例。通过观察总体疗效、中医症状总积分、血脂改善情况以及血常规、尿常规、便常规、肝肾功、心电图等安全性指标,用以评价化痰活血汤治疗高脂蛋白血症的临床疗效和安全性。
通过对刘华为教授运用五行脏腑气化学术思想,辨治高脂蛋白血症的临床经验进行研究和总结,结果提示：①高脂蛋白血症是人体脏腑气机失常,气化失司所导致的疾病,“气化失司、痰瘀互结”是高脂蛋白血症的核心病机；②化痰活血法是治疗高脂蛋白血症的有效治法之一。③化痰活血汤可以提高高脂蛋白血症总体疗效,改善临床症状,并具有改善血脂(TC、TG)的疗效。④运用五行脏腑气化学术思想,确立化痰活血法治疗高脂蛋白血症,安全性较好,值得进一步研究。
Professor Liu Huawei, the tutor, has made further study and exploration on "Qi transformation theory" of TCM in the long-term clinic work and closely combined the five elements theory with it. He put forward an systematic idea of qi transformation taking the five zang organs as the centre to guide the clinic practice and treat internal diseases.
"Qi transformation theory" is one of the important scientific achievements in traditional Chinese culture, and it was introduced into the medical area to explain the physiological and pathological symptoms of the body in TCM, to guide the clinic work and to become the base of TCM theory. The theory of Qi transformation comes from the book of Huang Di Nei Jing, which says Qi transformation refers to the transformation of material and energy aroused by Qi in the movement. The mechanism of Qi refers to the moving regulation of qi including four movements of ascending, descending, exiting and entering. It was creatively used in the clinic practice by Zhang Zhongjin in East Han period who combined the six qi with symptoms in zang and fu organs and meridians, which laid a foundation of zang-fu and material basis in the theory of "mechanism of Qi". He put forward a treatment idea of "restraining excesses and replenishing deficiency". The theory was further elucidated after Sui and Tang dynasty, and was developed by the ideas of "the avoidance of harm by restraining excesses","mutual transformation of water in the body" and " qi trasnformation of San Jiao".
The tutor thinks that the mechanism of qi is the moving regulation of qi in zang-fu organs and meridines of the body with the manifestation of ascending, descending, exiting and entering. Qi transformation highly generalized the body metabolism with TCM. Qi transformation takes five zang organs as the certre and turns food into the essence needed by the body through the process of qi transformation in cycles. Interpromoting relation is consisdered to compose the essence and restriction relation is conceived to decompose the essence. It the qi transformation is in disorder, it will causes subjugation or encroachment and violation or reverse restriction in abnormal state, which produces some pathological reults like phlegm, retained fluid, dampness, stagnation and so on and forms the secondary pathogeny to cause problems. Phlegm stasis will make further disorder of ascending and descending of qi mechanism and qi transformation to form a complicated relation of mutual cause and effect. In his view, the internal problems, especially the metabolism dieases, are concerned with the disorder of qi transformation and phlegm stasis. In the treatment, doctors are suggested to think of mechanism of dieases and start from qi transformation to improve the normal function of qi transformation.
Hyperlipoproteinemia is a disease of abnormal metabolism. Pathogenesis of this disease is considered to have two aspects. One is caused by deficiency of spleen and stomach, disorder of ascending and descending of qi mechanism in Middle Jiao and disorder of qi transformation. The other is caused by addicting to fat and sweet food and overtaking exogenic fat. The two, with a mutual relation of cause and effect, influence the normal metabolism of food essence to produce phlegm, retained fluid, dampness, stagnation and to cause the abnormal metabolism. He thinks that "disorder of qi transformation and phlegm stasis" is considered to be the key mechanism of disease for hyperlipoprotein and the spleen and stomach is taken as the key position of general qi transformation. Suggesting that the treatment should be started from the spleen and stomach with the method of activating blood to resolve phlegm in the treatment, and eliminating phlegm stasis by regulating the ascending and descending of qi transformation in spleen and stomach to recover the normal function of qi transformation. And hyperlipoproteinemia is treated once and for all.
The research topic did a random and controlled experiment according to the tutor's systematic idea and his clinic experience for hyperlipoproteinemia. Patients in controlled group took atrovatatin while those in treatment group took "Hua Tan Huo Xue Decoction".3months is one treatment course and testing the clinic symptoms of TCM and blood-fat.
68cases were taken into the research with6cases dropped and2cases rejected. There were60cases finishing the test actually according to requirement of experiment, and30cases in each group. Having taken the observation on general treatment, integral of TCM symptoms, improvement of blood-fat and other safety index to evaluate the safety and treatment effect. The result showed that (1) Hu Tan Huo Xue Decoction can improve the general treatment for hyperlipoproteinemia and clinic symptoms.(2) The method of activating blood to resolve phlegm to treat hyperlipoproteinemia accords with the clinic practice and reflects the internal regulation of happening and developing of the disease in certain degree.(3) It has nice safty to use the method of activating blood to resolve phlegm to treat hyperlipoproteinemia with the theory of "qi transformation" and it can be popularized.
Having done the summerizing and study on the method of treating hyperlipoproteinemia with "phlegm stasis and disorder of qi transformation" theory done by the tutor and made a further verify that (1) hyperlipoproteinemia is caused by the disorder of qi transformation of the body, and phlegm stasis is the main mechanism of disease. The method of activating blood to resolve phlegm is effective for hyperlipoproteinemia.(2) The idea of "qi transformation" taking five zang organs as the centre gives a penetrating explaination on the process of metabolism, which offers a new theory basis on difficult and complicated cases in internal section with TCM.
引文
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