摘要
目的:五脏相关学说有别于五行学说和脏腑学说,关键在于“相关性”。五脏相关理论是对中医五行学说与脏腑学说的继承与发展,其理论内涵即指在人体大系统中,心、肝、脾、肺、肾及其相应的六腑、四肢、皮毛、筋、脉、肉、五官七窍等组织器官分别组成五个脏腑系统,在生理情况下,各脏腑系统内部、脏腑系统与脏腑系统之间、脏腑系统与人体大系统之间、脏腑系统与自然界、社会之间,存在着横向、纵向和交叉的多维联系,相互促进与制约,以发挥不同的功能,协调机体的正常活动;在病理情况下,五脏系统又相互影响。肝脾相关理论是基于邓铁涛教授五脏相关理论所提出的,是五脏两两相关模式之一,基于肝脾两系统的生理功能与病理特点,决定了二者之间密不可分的关系。中医肝脾相关理论是在中医经典理论的基础上经历代医家不断发挥、发展而形成的理论,是以阐发肝脾相关的生理功能、病理变化机理及其证治方药为中心内容的理论学说。尽管近年来对五脏相关及肝脾相关理论研究有一定进展,但鲜于从肝硬化临床病案回顾进行肝脾相关的研究。本课题基于导师刘友章教授的临床经验及以往研究为基础,认为肝主疏泄与脾主运化,肝藏血与脾统血的生理功能与病理特点是肝脾相关主要内容,对治疗消化系统及血液系统疾病有指导意义,本课题从文献整理及临床回顾病案研究两个方面,对肝脾相关理论进行了探讨。统计分析肝硬化患者临床诊疗中所涉及的肝脾相关性,评价肝脾相关理论的临床运用价值。
方法:研究包括文献与理论研究及临床研究
文献研究:整理了关于五脏相关及肝脾相关理论的文献;探讨五脏相关及肝脾相关的学术内涵。进一步阐明运用肝脾相关理论指导消化系统及血液系统疾病的理论基础及临床可行性。
临床研究:整理回顾222例肝硬化病案,构建包括姓名、性别、年龄、病因、分期、证型、主症、涉及五脏系统症状、中药的种类、药味、药物归经等的数据库,分别做病因、证型、主症、五脏系统症状频数分析,不同分期、年龄所涉及的证型及五脏症状比较,用药种类、性味、归经等的频数分析及用药关联规律等,从多角度探讨肝硬化的五脏相关规律。
2.3结果:肝硬化患者常见病因为病毒性肝炎的肝硬化;证型、主症及五脏系统症状主要以脾系为主;用药种类以健脾利湿为主;用药性味主要为甘、苦,归经以脾、肝、胃为主。
2.4结论:肝硬化患者发病原因及临床表现以脾系病变为主,治疗亦需以“脾”为着眼点;运用肝脾相关理论指导肝硬化的治疗有一定的临床意义,且对肝硬化患者的临床诊疗也有一定的临床价值。
Purpose:
The theory of five-zang viscera correlation of TCM emphasizes on the "correlation, " in which is different from the theory of five elements and entrails theory, but developing from them. It contains every physiological and pathological relation of the five visceral system composed by cardio, liver, spleen, lung, kidney and six hollow organs, limbs, fur, tendon, nervure, muscle and the sensory organs which subordinate to them. The theory of liver-spleen correlation is constituted of the theory of relationships among five organs. Because of the different physiological functions and pathological characteristics, relationship between liver and spleen is very close. It derives from the classic theory of TCM. Its objectives are to explain the physiological function, mechanism of pathological change and clinical case. Though, there are many research on these two theories, there are no one based on the clinical cases. This study, based on Prof. Liu YouZhang's long clinical experience and the past relevant researches, presents the theory that liver maintains free flow of qi and spleen controls the transporting and transforming water, liver reserves blood and spleen products blood. It is valuable for digestive and blood system diseases. The study begins with unscrambling of the literature and the study on the clinical cases. Documentary and theoretical study:
The study sorts out the theories of five viscera correlation and liver-spleen correlation from the ancient literature, and explains their connotations. Furthermore, they can to apply to use the liver-spleen correlation theory to the clinical cases. To analysis and evaluate the correlation referred to the clinical therapeutics of LC (Liver Cirrhosis) Method:
To construct a data bank consisted of name, sex, age, reasons, staging, type, the main symptoms, symptoms referred to the five-viscera systems and TCM regulations, analyzing their frequencies, and also using different views to study the correlation regulations about five visceraof LC in depth. Results:
The main reason of LC is CHB; and main type, symptoms are caused by the malfunction of spleen. Of all the use of TCM are all referred to spleen on its flavor and channel entry.
Conclusion:
The causes of the liver cirrhosis are almost from the malfunction of spleen. Therefore, the treating must starts from the spleen. To relying the theory of liver-spleen correlation in treating LC will get satisfaction curative effects, and even for the digestive and blood systemic diseases.
引文
[1]邓铁涛.邓铁涛医学文集[M].北京:人民卫生出版社,2001:152-158.
[2]邓铁涛.略论五脏相关取代五行学说[J].广州中医学院学报,1988(2):45.
[3]娄少颖,刘毅,王文健.浅析脂肪肝治疗中的“肝脾同治”[J].华夏医药,2007(2)103-105
[4]尹安坤.肝脾同治法治疗小儿目劄75例[J].新中医,2004,36(2)60
[5]肖斌,肖达民.肝脾同治法治疗小儿厌食症84例疗效观察[J].新中医,2003,35(3)31-32
[6]名老中医龚志贤临床经验荟萃(27)[J].中国乡村医药杂志2005,12(9)72-73
[7]何梦瑶.医碥[M].上海:上海科学技术出版社,1982.3-9
[8]陈凯佳,邓铁涛五脏相关理论研究的方法和思路探析[J].中医药学刊,2005,23(4):595-596
[9]山田业广.素问次注集疏[M].北京:学苑出版社,2004.451
[10]刘小斌,邓铁涛教授“五脏相关”学术源流探讨[J].广州中医药大学学报,2006,23(5)424-426
[11]明·李梃.医学入门[M].北京:中国中医药出版社,1995.72.
[12]任继学,人体三维系统新释[J].中医药学刊,2002(5):549.
[13]清·何梦瑶.医碥[M].上海:上海科技出版社,1982.
[14]贾继东,庄辉,中国慢性乙型肝炎治疗进展研讨会会议纪要[J].中华肝脏病杂志,200412(11):698-699。
[15]武荣芳,中医药治疗肝硬化进展[J].辽宁中医药大学学报2007,9(5)187-189
[16]邓铁涛.略论五脏相关取代五行学说[J].广州中医学院学报,1988,(2):62.
[17]肖会泉等.邓铁涛治疗慢性丙型肝麦经验[J].中医杂志,1999,(9):524
[18]华医学会肝病学会。病毒性肝炎防治方案[J].中华肝病杂志2000:8(6):324-329
[19]危北海.肝硬化中西医结合诊治方案[J].现代消化及介入诊疗,2005,10(2):119
[20]王建华,对邓铁涛五脏相关理论学说应用基础研究评语[S]、内部资料,2003
[21]刘小虹,刘琼、培土生金法在治疗慢性阻塞性肺疾病缓解期的应用研究[J].新中医,2002,(10):18
[22]吴焕林.邓铁涛教授调脾法治疗扩张型心肌病验案[J].新中医,2001,(7):13
[23]肖会泉.罗日永,邓铁涛治疗慢性丙型肝炎经验[J].中医杂志,1999。(9):524
[24]谢挂权,尿毒症中医治疗整体观探析[J].新中医,2002,(10):3
[25]张鸣,沈薇,824例肝硬化病因及相关分析[J].重庆医学2006,35(5)438-441
[26]吕福云,134例肝硬化病因及严重并发症分析[J].内蒙古民族大学学报(自然科学版),2007,22(1)106-107
[27]岳峰.刘婕,沈敦,781例肝硬化的病因分析[J].河南科技大学学报(医学版)2005,23(4) 224-225
[28]艾尼.阿布都热衣 木买尔比亚.买买提斯的克木尼拉.马哈德,肝硬化81例病因分析[J].新疆医学2004,34:78-79
[29]梁翔燕 叶春芳,154例黎族肝硬化患者的病因分析及护理[J].中华护理杂志2003,38(11)894-895
[30]颜峻松,张良川,藏族地区肝硬化101例病因分析[J].四川医学,2003,24(11)1145-1146
[31]扎西卓玛 次仁白珍,拉萨地区肝硬化410例分[J].析,西藏医药杂志,2004,25(1)13-14
[32]李华,西宁地区肝硬化218例病因分析[J].青海医药杂志2005,35(11)28-29
[33]李锟 李伟华,鲁北地区826例肝硬化病因分析[J].滨州医学院学报,200528(5)388-389。
[34]姚希贤 南月敏 姚冬梅 张剑,肝硬化病因[J].全科医疗专题研讨,20036(5)362-363。
[35]胡亚平 黄明英,肝硬化并发症110例分析[J].中国误诊学杂志2003,3(2)278-279
[36]吴伟,162例肝硬化并发症分析[J].云南医药2007,28(1)64-65
[37]宋登元,肝硬化并发症的相关性探讨[J].咸宁医学院学报2002,16(4)303-304
[38]杨秀疆 陈士葆,肝炎后肝硬化内科治疗进展[J].世界感染杂志,2002年2(3)190-193
[40]蒋健.关于中医肝病学术的若干思考[J].中西医结合肝病杂志,2005,15(2):65-67。
[41]盛国光,中医肝病临床辨治思路探析[J].中西医结合肝病杂志,2006,16(2):65-67.
[42]李培生主编.伤寒论讲义[M].上海:上海科学技术出版社,1985.137-138
[43]陈庆平,陈冰鸥校注.太平惠民和剂局方[M].北京:中国中医药出版社,1996.205