刘大新教授学术思想总结—玉屏风散合小青龙汤加减治疗“过敏性鼻炎哮喘综合征”临床疗效观察

【作者】 孙静；

【导师】 刘大新；

【作者基本信息】 北京中医药大学 ， 中医学， 2016， 博士

【摘要】 中国传统医药伴随着中华民族整个发展历程,对维护中华民族乃至世界人民健康所做出的贡献有目共睹。为了进一步发挥其现实价值,更好地发挥其潜在的、长期的价值,将其作为人类非物质文化遗产加以保护并传承,意义深远而重大。西学东渐以来,整个中国学术体系和格局受到了重大影响。西方强势文化不仅带来中医药生存环境的改变,而且带来价值取向的重大变化,实用主义、功利思想在很大程度上改变了中医学原有传承方式和传承目的。当前,中医传承自觉性已大大下降,人才培养由师徒授受改变为院校教育,而院校教育则几乎完全套用了西医教育模式,按照自身规律传承模式日趋淡化,中医院西化现象也十分明显。种种现象表明,在中医药事业繁荣发展背后潜在着十分严重的传承危机。另外,中医药有完整理论体系和自身学术发展规律,但由于受西方文化背景和价值取向的影响,评判体系几乎完全采用西方标准,只取其用,忽略学术的内在联系。并且现实中的政策、法规也完全没有顾及中医药的传统性特征。因此中医学发展关键在于是否按照其自身规律延续和传承。中医前辈将中医学术传承当成是自己的历史责任,如张仲景著《伤寒论》,孙思邈撰《千金要方》、《千金翼方》,李时珍编《本草纲目》等除了传承学术以造福后人,不带有任何功利思想。因为有了历代名老中医经验积累和传承,才使得中医学历久弥新,永葆活力。现今名老中医亦是将中医药基本理论、前人经验与当今实践相结合,是解决临床疑难问题的典范,他们的学术思想丰富多彩,临床经验各具特色。因其诊断疾病的标准和判定疗效的方法不尽一致,故难以对名老中医的学术经验进行恰当的评价和疗效比较；因此,必须探索研究建立个体化诊疗评价方法。我们可以借鉴循证医学研究模式,对名老中医学术经验的精华和亮点开展临床科研。中医科研设计与现代医学科研设计一样,都必须遵循随机、对照等原则,同时还应该体现辨证论治的特色。根据名老中医学术经验精华和亮点制订切实可行的研究方案,如采用全国统一的病证诊断评价和疗效判定标准,采用与现代医学相接轨的观察指标,设立有说服力的对照组,对实验研究数据进行科学统计等。在此基础上才能对名老中医的学术经验进行综合评价,如疗效评价、安全性评价、效价比评价、生存质量评价、终点事件评价、跟踪随访评价等。刘大新教授作为国家著名中医专家,数十年潜心医疗,熟读《内经》、《伤寒》、《金贵要略》等经典,善以经方治病,以中医耳鼻喉疾病见长,对内科杂病亦经验丰富、疗效显著。他时常教导我们,要成为合格的医生,首先要仅守医德,还应做到熟读经典、拓展思维、勤奋好学、理论结合实践、勤于临证、不断总结、虚心求教、潜心专研及勇于创新等。刘老师认为几千年来,中国历代名医都是熟读中医经典,灵活运用并创新古代中医经典理论来认识和防治疾病的辨证论治思维、方法及用药原则,并且用药简洁、煎制方便、价格低廉、临床效验。刘教授指出经典理论指导下的整体观念贯穿于中医生理、病理、辨证、治疗等整个理论体系之中,所以在诊疗过程中,从经典出发,灵活掌握加以运用；在实事求是的基础上,与时俱进合理创新,善于提出问题,并潜心实践,从自然-社会-人体的全整体层面认识疾病的病因、病机及转归,而制定治疗法则,才能体现出中医的特色和优势,提高疗效。刘大新教授作为全国名老中医,其学术思想经验是深厚的中医理论与丰富的实践经验相结合的结晶,是中医药学的宝贵财富和重要组成部分。刘教授秉持中医药的“遵循自然,顺应个体,审病求因,扶正祛邪”原则,认为通过整体调节可以实现对局部病患的治疗和修复。通过中医整体调节,可使机体气血阴阳恢复平衡,脏腑功能归于常态,从而使局部疾病痊愈。本研究观察刘教授玉屏风散合小青龙汤加减治疗过敏性鼻炎哮喘综合征,对60例患者临床观察发现症状缓解迅速、兼加症状减轻明显、精神状态、生活质量改善显著。过敏性鼻炎哮喘综合征是近年提出的新概念。虽然早期已经认识到过敏性鼻炎和哮喘之间有一定联系,但未确立联合研究、诊治方案,直至新概念开始使用。故相关临床研究尚不丰富。玉屏风散和小青龙汤是临床常用方剂,检索文献显示,二者用于治疗支气管哮喘临床观察较多,但未见其用于过敏性鼻炎哮喘综合征治疗的临床研究。刘大新教授在临床上对主要矛盾与次要矛盾处理方式的解释中提出,无论是主症、兼证,老师均以中医整体观念为基础,以辨证论治为根本法则进行临床立法、处方。临证既把握住疾病的共性,又不拘泥于成法,旨在调节阴阳,使之逐渐恢复动态平衡。疾病的产生,究其本质,即为阴阳失调,而选方用药的最终目的即为调节阴阳平衡。阴阳越是趋向平衡,疾病就越向好的方面发展。而阴阳得以维持动态平衡,不但疾病向愈,而且机体也不易受病邪困扰。这也是中医所说的“未病先防、既病防变”的临床体现。本课题拟从评价症状缓解、生活质量提高、精神面貌改善、辅助检查支持各个方面入手,通过刘教授玉屏风散合小青龙汤加减治疗过敏性鼻炎哮喘综合征相关指标进行临床研究,旨在全面揭示其提高疗效,改善患者精神状况、生活质量的作用机制,揭示刘教授“遵循自然,顺应个体,审病求因,扶正祛邪”的学术思想,为祖国传统医学防治过敏性疾病探索一个新思路。更多还原

【Abstract】 Chinese traditional medicine is always a part along the whole course of the Chinese development, and its contributions in maintaining the health of the world people are also very significant. Therefore it has profound and significant meanings to protect it and inherit it as an intangible cultural heritage, further developing its real value and better exerting their potential, long-term value.Since the eastward transmission of western sciences, China’s academic system and structure were influenced profoundly that the powerful western culture changed both the survival environment of Chinese medicine and people’s value orientation, making utilitarianism and functionalism prevail, and the original ways and purpose of Chinese medicine inheritance were also been influenced. Currently, people have less awareness of inheriting Chinese traditional medicine. Related education mode of Chinese medicine has also changed from taught by Chinese medical Specialist to taught by schools, in which, on the contrast, also adopt Western medicine education mode. Therefore, the original inheritance mode of Chinese medicine is fading away gradually, added that the phenomena of westernization of Chinese medicine, there appear serious inheritance crisis behind current prosperity of traditional Chinese medicine.Besides, Chinese medicine has a complete theoretical system and their own academic development rule, but due to the influence of western culture and value orientation, the evaluation system almost adopt western standards, leading to that only the usage and effect of Chinese medicine are adopted while its internal academic links were all ignored. In the reality policies and rules, anything about the traditional characteristics of Chinese medicine is also ignored. That is the key in the development of Chinese medicine is whether to success and inherit it according to its own rules or not.Predecessors to academic of traditional Chinese medicine as, such as zhang zhongjing the treatise on febrile disease, sun simiao writes "daughter s", "thousand Jin Yifang", li shizhen "compendium of materia medica", etc in addition to passing on academic to the benefit of future generations, with no thought of utilitarianism. Because of the old and famous historical experience accumulation and inheritance of traditional Chinese medicine, makes TCM enduring, eternal vitality.Many predecessors take the inheritance of traditional Chinese medicine as their historical responsibility, such as Zhang Zhongj ing’s Treatise on Febrile Diseases, Sun Simiao’s Valuable Prescriptions for Emergencies and Supplement to Valuable Prescriptions and Li Shizhen’s Compendium of Materia Medica, all their goals were to inherit the academic knowledge and bring happiness to their descendants instead of for some materialistic purpose. Just because of the experience accumulation and inheritance of these famous TCM doctors, our Chinese medicine can keep the vitality and be eternally renewed during the long course of history.Nowadays, those famous TCM doctors also combine the basic Chinese medicine theory, predecessors’experience with their practice. They have various academic thoughts and different clinical experience, so they also have been the symbol for solving some puzzling questions in clinical practice.it is hard to have an appropriate evaluation and make a contrast on the TCM doctors’academic experience, because their standards on diagnosing the decease and therapeutic effect are not always the same. Therefore, we must try to have a explore and establish an individualized diagnosis and evaluation method system, which means we can adopt the research mode of evidence-based medicine to have a study on the essence and advantages of those TCM doctors’ academic experience. Same with the modern medical scientific research design, scientific research and design of TCM also need to follow the principle of random and comparison, as well as reflect the characteristics of treatment based on syndrome differentiation. We can make a feasible research plan according to the essence and advantages of those TCM doctors’academic experience, such as adopt the unified national criteria on disease diagnosis and effect evaluation, use observation indexes that is in line with modern medicine and to establish a persuasive data group which can make a comparison on the data, through which we can get a scientific research. Based on all of such feasible plans, we can have comprehensive evaluations on TCM doctors’academic experience, such as curative effect evaluation, safety evaluation, titer evaluation, and evaluation of quality of life, evaluation on outcome event and follow-up evaluation.As a famous Chinese medicine professor in China, Mr. Liu Daxin has studied on medicine for few decades. He is familiar with many classic medical books like Canon of Internal Medicine, Treatise on Febrile Diseases, Ancient book etc. and good at treatment with classical prescription. His medical skill in ENT diseases is very good and he also has rich experience on other internal medical diseases, which also have notable curative effect. He often taught us that to be a qualified doctor, the first thing we should do is keeping our medical ethnic, and we also need to expand our thinking though reading the classics, combine theories and practice by industrious study, be diligent to make summary, be willing to take advice and concentrate on study and be innovative. Mr.Liu believes that for thousands of years, all the famous Chinese doctors in history have read the classics for many times, and they can combine the theoretical knowledge they learned with their practice on disease diagnose very flexible and in an innovative way. Based on the theories they’ve learned, they also have their own analogue thinking, methods and principles in diagnosing and preventing disease. Another common characteristic is that their drug use was simple and easy to made, cost was low and clinical efficacy could be got directly.Professor Liu pointed out that the concept under the guidance of classical theory has penetrated into the whole theoretical system of physiology, pathology, syndrome differentiation and treatment of Chinese traditional medicine, so during the diagnose and treatment process, we can start from the classic theories and apply them into the practice flexibly. Based on the principle of seeking truth from facts and keeping up with the times and a view on an overall level of nature-society-human body, we must also be innovative, questionable and practicable in studying the etiology, pathogenesis and outcome of the disease, then an effective therapeutic plan can formulate and the characteristic and advantage of Chinese medicine can be embodied.As a famous Chinese medicine professor in China, his academic thought and experience is a wisdom crystallization of profound Chinese medicine theory and rich practical experience as well as the precious wealth and important part of traditional Chinese medicine (TCM).Keep the principle of "follow the nature, be in harmony with individuals, identify according to the etiology and strengthen body resistance and eliminate evil" in TCM, Professor Liu believes that disease in parts of body can be cured and recuperated through integrated treatment. TCM’s integrated treatment can balance the body’s qi and blood, in and Yang, make the hepatic function be normal, through all of which partial disease also been cured. We had a research on 60 patients who have Combined Allergic Rhinitis and Asthma Syndrome and found that after we adopted Professor Liu’s treatment with Yupingfeng powder and Xiaoqinglong decoction, all their symptoms relieved obviously, and their mental state and life quality are also been improved.Combined Allergic Rhinitis and Asthma Syndrome is a new concept posed in recent years. Although we had realized that Allergic Rhinitis has certain relationship with the Asthma, we didn’t establish joint research and diagnosis and therapy plan until this new concept was adopted, so current clinical research related to this concept is not enough.According to the selecting documents, Yupingfeng powder and Xiaoqinglong decoction are frequently used clinical decoctions for clinical observation of bronchial asthma, but never been used in clinical research on treating Combined Allergic Rhinitis and Asthma Syndrome.In the explanation of how to deal with the primary contradictions and secondary contradictions during the clinical research, Professor Liu pointed out that no matter for primary symptom or accompanied symptom, our treatment and prescription should all based on the overall conception of TCM and the basic principles of syndrome differentiation and treatment. During the TCM Clinical Practice, we must grasp the common characters of the diseases but not stick to the method routine, our aim is to adjust the yin and yang, realizing the effective restoring of dynamic balance. The root cause for the disease is the imbalance of yin and yang, so the ultimate purpose for the drug selections is to balance yin and yang. The more yin and yang become balanced, the sooner the disease is cured. If yin and yang can maintain the dynamic balance, the disease will be cured and the virus in body will also be expelled. This is the principle that TMC doctors often emphasized "prevention before disease onset, early treatment to prevent deterioration."This subject, starts from various aspects, such as symptom relief evaluation, improvement of life quality and mental attitude and auxiliary examination, has some clinical researches on related index of Professor Liu’s treatment of Combined Allergic Rhinitis and Asthma Syndrome with Yupingfeng powder and Xiaoqinglong decoction. The main purpose is to prove its functions and mechanisms in increasing the treatment efficiency, improving patients’ mental condition and life quality, which reveal Professor Liu’s academic thought of "follow the nature, be in harmony with individuals, identify according to the etiology and strengthen body resistance and eliminate evil", hoping that it can provide a new thinking for the exploration of preventing allergic diseases with TMC.更多还原