【作者】 李建英；

【导师】 于俊生；

【作者基本信息】 山东中医药大学 ， 中医内科学（专业学位）， 2016， 博士

【摘要】 目的:采用中医传承研究方法,从理论探讨、数据挖掘及临床研究等方面总结于俊生教授的临床经验、用药特点及方药组成规律,继承和发扬导师的学术思想及临床经验。方法:1.通过每周跟师学习,收集导师处方,书写跟师笔记及学习心得,导师口授心传等多种方式,以及全面整理关于于俊生教授的反映其学术观点与临床经验的学术论文,查阅相关文献,追溯导师的学术渊源,找寻理论依据,总结导师的学术思想及临证经验。2.收集于俊生教授近三年治疗慢性肾衰的门诊病历及住院病案,根据课题设计筛选处方175首,运用“中医传承辅助系统(V2.5)”,对于俊生教授治疗慢性肾衰的方剂用药规律进行系统分析,挖掘深层次的用药规律,系统总结于俊生教授治疗慢性肾衰的用药特点及经验。3.基于于俊生教授慢性肾衰“肾络淤滞”病机,以及钙磷代谢紊乱并发症与“脾虚生风”相关的理论,从“和络泄浊、培土宁风”的角度组方和络宁风颗粒,通过临床研究评价该方对慢性肾衰合并钙磷代谢紊乱的疗效特点。结果:1.学术思想渊源:于俊生教授师从齐鲁伤寒大家李克绍先生,为齐鲁伤寒流派代表性传承人,善于运用六经辨证理论治疗肾脏疾病,创造性地提出了“慢性肾衰关乎少阳病变”、“慢性肾衰治从和法”的新理论、新方法,并创立了治疗慢性肾衰和解三法,即和解少阳,泄浊解毒;燮理升降,和中解毒;和络渗湿,泄浊解毒三法,临证重视专病专方、专药应用,临床治疗慢性肾衰取得显著疗效,积累了丰富的临床经验。2.概述于俊生教授运用和法治疗慢性肾衰的学术思想,对慢性肾衰和解三法进行理论阐述及临床解读,介绍于俊生教授运用和法治疗慢性肾衰的经验方及运用对药治疗慢性肾衰的临床经验,结合临床实例对典型医案进行分析。3.基于中医传承辅助系统对于俊生教授治疗慢性肾衰病案进行分析,得出使用频次前十位药物分别为六月雪、归芍和络方、黄芪、黄芩、水蛭、淫羊藿、党参、苏叶、柴胡、砂仁,通过关联规则分析得出慢性肾衰药物组合规律,基于熵方法得出慢性肾衰方剂组方规律。4.临床研究显示和络宁风颗粒能有效改善慢性肾衰竭合并钙磷代谢紊乱患者的临床症状,纠正钙磷代谢紊乱,改善患者贫血及营养状况,改善肾功能,延缓肾衰进展。结论:1.于俊生教授创造性地提出了“慢性肾衰关乎少阳病变”、“慢性肾衰治从和法”的新理论,总结出慢性肾衰和解三法:和解少阳,泄浊解毒;燮理升降,和中解毒;和络渗湿,泄浊解毒。基于中医传承辅助系统对于俊生教授治疗慢性肾衰的临床经验进行分析,总结其运用和法治疗慢性肾衰的组方用药特点:即和解少阳、和络泄浊—治疗之本;辨证施治、补泻兼施—标本同治;联合对药、重视配伍—选药精当;博采众方、谨守病机—合方巧妙。2.根据于俊生教授和法理论研制的和络宁风颗粒能有效改善慢性肾衰竭合并钙磷代谢紊乱患者临床症状,纠正钙磷代谢紊乱状态,改善患者贫血及营养状况,改善肾功能,延缓肾衰进展。提示基于于俊生教授慢性肾衰“肾络淤滞”以及钙磷代谢紊乱并发症与“脾虚生风”相关的理论,从“和络泄浊、培土宁风”的角度治疗慢性肾衰合并钙磷代谢紊乱并发症疗效肯定,值得进一步进行开发研究。更多还原

【Abstract】 Objective : Using Chinese medicine inheritance research methods, summarizing proffessor Yu Junsheng’s clinical experience, medication characteristics and prescription composition from the theoretical discussion, data mining and clinical research.Inherit and develop tutor’s academic thoughts and clinical experience.Method:1. Through weekly learning from teachers, collecting prescriptions of the tutor, writing teacher’s notes and learning experience, listening to the tutor’s dictation and so on, and thoroughly arranging professor Yu Junsheng’s academic papers which can reflect his academic thought and clinical experience, accessing to the relevant literature, tracing the tutor’s academic origin, looking for a theoretical basis, summarizing tutor’s academic thoughts and clinical experience.2. Collecting professor Yu Junsheng’s outpatient and inpatient medical records in treating chronic renal failure(CRF);Optimizing 175 prescriptions according to the project design, using TCM inheritance auxiliary system(v2.5), systematically analyzing professor Yu Junsheng’s treatment and prescription rules in treating CRF, deeply digging the medication rules, and systematically summarizing professor Yu Junsheng’s medical characteristics and experience in treating CRF.3. Based on professor Yu Junsheng’s “kidney collateral stasis pathogenesis”of CRF, and the theory of calcium and phosphorus metabolism disorder complication related to “spleen deficiency and generating wind”, forme Heluoningfeng Granule by harmonizing collaterals and inducing dampness, purging turbid pathogenic factors, removing toxic substances, and elevating earth to tranquilize wind,valuate Heluoningfeng Granule’s effect on the CRF with the disorders of calcium and phosphorus metabolism through clinical research.Results:1. Academic ideological origins: Professor Yu Junsheng is the student of Mr. Li keshao, professor of Qilu typhoid, and is the representative heritage of Qilu shanghan school, good use of syndrome differentiation of the Six Meridians Theory for the treatment of renal diseases, creatively proposed new theories and methods such as “CRF related to shaoyang disease”, “CRF treated with harmonizing therapy”, and created three settlement methods in the treatment of CRF, namely, reconciling shaoyang, purging turbid pathogenic factors and removing toxic substance; regulating ascending and descending, harmonizing middle energizer and removing toxic substance, harmonizing collaterals and inducing dampness, purging turbid pathogenic factors and removing toxic substances. Attention to special disease with special prescription and special medicine, achieved remarkable curative effect in CRF treatment and accumulated rich clinical experience.2. It overviewed professor Yu Junsheng’s academic thought on the treatment of CRF with harmonizing therapy, theoretically and clinically explains the CRF harmonizing theory, introduced his clinical experience on the use of treatment of CRF and use of medicine in the treatment of CRF, and analyzed the typical medical cases with the clinical examples.3. Based on TCM inheritance auxiliary system, analyzed professor Yu Junsheng’s treatment of CRF medical record radix astragali, radix scutellariae, leech, epimedium, radix codonopsis, sage, bupleurum root, amomum villosum. Found the combination pattern of CRF drugs by use of the association rules and the pattern of CRF based on entropy method.4. Clinical study indicated that Heluoningfeng Granule could improve the clinical symptoms of CRF patients with calcium and phosphorus metabolism disorder, correct calcium and phosphorus metabolism, improve anemia and nutritional status and renal function, and delay the progress of renal failure.Conclusions:1.Precise, professor Yu Junsheng has creatively put forward the theories that “CRF related to shaoyang disease” and “CRF treated with harmonizing therapy”, summerized three methods of CRF harmonizing therapy which are reconciling shaoyang, purging turbid pathogenic factors and removing toxic substance; regulating ascending and descending, harmonizing middle energizer and removing toxic substance, harmonizing collaterals and inducing dampness, purging turbid pathogenic factors and removing toxic substances. Base on the TCM inheritance auxiliary system, analyse professor Yu Junsheng’s clinical experience in treating CRF, summerize the prescription characteristics with harmonizing therapy: first,reconciling shaoyang and harmonizing collaterals, inducing dampness, purging turbid pathogenic factors and removing toxic substances are the base treatment; second, syndrome differentiation, using replenish and removing at the same time which are also called both incidental and fundamental aspects treatment; third, combination pair drugs, pay attention to compatibility;fourth, gambling the characteristic of different prescriptions and make combination ingenious prescriptions based on the mechanism of the disease.2. Heluoningfeng Granule which is based on professor Yu Junsheng harmonizing therapy theory, can effectively improve patients’ clinical symptoms in CRF with calcium and phosphorus metabolism disorder, correct calcium and phosphorus metabolism disorder, improve anemia and nutritional status, improve renal function, delay the progress of renal failure. Prompt the theory based on professor Yu Junsheng’s CRF “kidney collateral stasis” and calcium and phosphorus metabolism disorder complication with “spleen deficiency generating wind”, from harmonizing collaterals, inducing dampness, purging turbid pathogenic factors removing toxic substances, and elevating earth to tranquilize wind in the treatment of chronic renal failure with calcium phosphorus metabolic disorder complication have curative effect affirmation, worthy of further research and development.更多还原