王焕禄教授学术思想与临床经验总结及红藤棱莪煎治疗反流性食管炎的研究

【作者】 王洪蓓；

【导师】 王焕禄；

【作者基本信息】 北京中医药大学 ， 中医内科， 2016， 博士

【摘要】 研究目的：全面整理、研究王焕禄教授学术思想和诊疗经验,深入挖掘其临床价值和科学精髓,进而达到继承、发展、传播、推广之目的。研究方法和内容：采用文献分析、跟师临证、随访跟踪、问答谈话和临床观察等多种方法,对王焕禄教授中医药学术思想和临床诊疗经验进行全面研究,穷本溯源,挖掘提炼,抽提其学术思想,总结其诊疗经验,另外设计临床研究方案,对其治疗反流性食管炎的经验方进行疗效评价。研究结果：本论文分为如下三个主要部分：第一部分：王焕禄教授学术思想研究1王焕禄教授医学经历与治学特点1.1王焕禄教授医学经历梳理王焕禄老师家学影响、师承经历、临床实践与研究及获奖经历等。1.2王焕禄教授治学特点总结王焕禄老师治学四大特点：1.2.1注重经典,熟读精研1.2.2重视实践,身体力行1.2.3转益多师,勤求博采1.2.4继承前人,发展创新2王焕禄教授主要学术思想从理论渊源、学术思想内涵及临床验案总结王老师五方面学术思想：2.1湿热害人最广重视湿热为病,认为湿热之邪,害人最广。王焕禄老师深入学习历代湿热相关理论,更重临床实践运用；精研湿热,见解独到：湿热发病,清利为主；湿热为病,病位广泛；辨湿热病审症求因,擅于寻踪觅迹。四诊注重舌苔、口气及分泌物的辨识；重视现代医学的相关指标与湿热病机关联；强调内有湿热外呈燥象。注重湿热病的演变,湿热蕴久成毒,要清热利湿配合清热解毒。从湿热论治,重新认识疾病,解决临床顽疾。2.2脾胃万病相关认为脾胃万病相关与脾胃的生理特性密切相关。在此基础上提出狭义脾胃病与广义脾胃病。当脾胃本藏发病,突出脾胃病要辨虚实,辨证重舌诊,实证多见湿热为患,久病多兼瘀血；强调治脾重温补,治胃重清降,久病要治瘀,虚实兼见要权衡孰重孰轻予以施治。他藏有病,补虚要关照脾胃,攻伐勿伤脾胃,脾胃病明显者,他藏之病要暂缓治之,要先调治脾胃。同时对于脾胃病患者,王老师时时强调平时调摄的重要性。强调“脾胃一虚,百病丛生,从脾论治,诸病易瘥”。2.3女科每关肝肾临床治疗月经不调特别强调肝肾的重要性,六味地黄汤加减是王老师常用的方剂。2.4男科病重肾阳对于男科病,尤重温补肾阳。包括前列腺疾病、性功能障碍、不育症。以前列腺增生为例予以说明。2.5久病必见血瘀认为久病必见血瘀的成因以久病气虚致瘀、久病气滞致瘀和久病湿热煎熬致瘀为主要特点。久病要善察瘀：久痛多瘀；望面色观皮肤察瘀；望舌察瘀；化验检查提示。祛瘀要分层次、辨病机。第二部分：王焕禄教授临床辨治经验研究1辨证施治方法特点总结王焕禄老师临床施治六方面特点：1.1辨病辨证,两相结合1.2中医为本,西为中用1.3注重邪正,权衡标本1.4精于舌诊,四诊合参1.5喜用经方,化裁验方1.6用药精准,处方周全2临床常见病诊治经验从相关疾病诊治特点为出发点,总结王焕禄老师辨治内科、妇科、皮肤科等疾病的独到见解和诊疗特色：2.1辨治冠心病心绞痛临床经验：认为冠心病心绞痛的基本病机是心气阳不足、瘀血阻于心脉所致。重视详细问诊。察舌脉重舌质及舌脉瘀象。重视鉴别诊断。认为益气活血通络是基本治法,处方用药温而不燥,升降合宜,动静有制。2.2辨治慢性便秘临床经验：认为慢性便秘,是以脾虚为核心病机。脾虚运化无力则糟粕形成异常；脾虚气机升降失常则肠腑不降；肠道失濡亦源于脾。治疗上,益气健脾是根本之法,调畅气机是关键步骤,擅用药对,用药分缓急。2.3辨治反流性食管炎临床经验：认为食管炎应立名“食管瘅”,病位在胃(食管)、肝,病邪以气逆、湿热、血瘀为主,治疗以清热利湿、活血化瘀、和胃降逆为主。经验方红藤棱莪煎加减为其常用方剂。2.4辨治类风湿性关节炎临床经验：认为类风湿性关节炎应立名“湿热痹”,强调湿热病机,分期治疗,急性期清热利湿,通络止痛；缓解期在适当清热利湿、清热解毒的治疗同时,必须加大补益的力量。2.5辨治肾脏病临床经验：治疗肾病强调辨证分期：急性期邪气辨风邪、热邪,病位辨在气在血。慢性期藏腑涉及脾肾,多易夹浊毒、热毒、血热、血瘀。分析肺脾肾与肾病的关系。治疗急性期分“风水阻遏,肺气失宣”、“热伤血络,迫血下行”、“毒热内蕴,迫血外溢”三型辨治；慢性期以脾肾两虚,浊毒失降为主,治从健脾益肾,利湿化浊,活血化瘀入手,突出重点效药的应用。2.6辨治月经病临床经验：辨治月经病强调详问病史,包括重问诊月经情况、注重妇科既往病史、注意区分年龄段不同,病机差异、注意服药史并注重结合现代医学相关检查。强调辨别虚实。治疗月经量少——虚从肝肾补；实证逐痰瘀。2.7辨治带下病临床经验：带下病强调带下过多须从虚实辨证；带下过少虚证为主。带下过多虚证者多用傅青主的完带汤加减,湿热下注者多用茵石米甘汤加味,湿热血瘀者多用经验方清坤宁宫汤加减。带下少者,多从补益肝肾入手治疗。2.8辨治男科病临床经验：临床治疗男科病时重视温补肾阳,强调男科病的辨证以全身和局部相结合,治疗以辨证和辨病相结合。认为男性不育以肾阳虚多见,但是有瘀者化瘀,兼夹湿热者适度清利。2.9辨治痤疮临床经验：认为痤疮的治疗既要辨痤疮局部,又要结合全身整体情况,总结出痤疮辨证当分虚实,实证者又分热毒相结、脾胃湿热、相火亢盛等；虚证者除阴虚火旺,还有肾阳虚者,虚实夹杂亦不少见。2.10辨治银屑病临床经验：采用辨病辨证分期治疗寻常型银屑病,进行期为湿热蕴伏,血热所致,治疗清热利湿,凉血解毒。静止期为湿热蕴伏,瘀血阻络,肤失所养,治疗清热利湿,活血化瘀,解毒通络。消退期为湿热蕴伏,血燥肤失所养,治疗清热利湿,养血润燥为主。强调湿热病机贯穿疾病全程。。2.11辨治鼻鼽临床经验：根据患者的症状及现代医学理论,认为鼻鼽多由肺气虚,卫表不固,营卫失和,风寒乘虚侵入而引起,患者多为免疫功能偏低。治疗要益气固表,调和营卫,温阳散寒,方药多用玉屏风散、桂枝汤合苍耳子散加减治疗。第三部分：红藤棱莪煎治疗反流性食管炎临床研究王焕禄老师认为反流性食管炎当从湿热血瘀辨治,清热利湿,活血化瘀,和胃降逆是治疗大法,创立治疗反流性食管炎的经验方红藤棱莪煎,研究观察红藤棱莪煎治疗反流性食管炎临床效果,选择55例反流性食管炎患者,随机分为红藤棱莪煎治疗组30例和奥美拉唑对照组25例。经8周治疗,发现红藤棱莪煎对反流性食管炎患者临床症状总积分、疗效总积分、临床综合疗效、改善反流性食管炎湿热证和血瘀证以及胃镜下食管病变程度和胃镜下治愈率等方面疗效均好于西药对照组。其在治疗反流性食管炎中有应用前景,值得今后进一步研究。本论文的创新点：1既往王焕禄教授学生对其学术思想的整理只是对其重脾胃和重湿热两方面进行整理,本论文在进一步加深、完善整理王焕禄老师重脾胃、重湿热思想之外,还整理了王老师女科和男科的学术思想以及久病注重活血化瘀的思想,更加全面的整理了老师的学术思想,另外本论文还在王焕禄教授治学特点、临床辨证施治特点方面进行了较为全面的整理归纳,使其治学特点、学术思想得以更全面展示并具有一定的理论深度。2在本人的临床实践中,对部分疾病能灵活运用老师的学术思想进行辨证施治,同时对老师擅长治疗的疾病病种能运用以往学到的知识和经验,在某一阶段的治疗中有自己不同的辨治思路和方药选择,取得了较好的临床疗效。3临床研究方面,从湿热血瘀辨证对反流性食管炎进行研究,前人未见报道；对于湿热血瘀证候的选择,结合老师个人的辨证特色进行症状选择和组合,不囿于以往文献的内容。是结合名老中医个人辨证特色选择相关证的构成,浓缩和提炼名老中医个人辨证经验,有助于理论联系实际继承学习名老中医临床辨证经验。更多还原

【Abstract】 Objective:Comprehensive collation and study of Professor Wang Huanlu’s academic thoughts and clinical experience, in-depth study of its clinical value and the essence of science, and then achieve the inheritance, development, dissemination, promotion purposes.Research methods and contents:Using methods of literature analysis, following the teacher in clinical,following up the patients,questions and answers with the teacher,conversation with the teacher,clinical observation,et al,to comprehensive study of the academic thinking and clinical experience of Professor Wang Huanlu, tracing to the source, mining extraction, extraction of its academic thinking, summed up the experience of diagnosis and treatment. And design clinical research program to evaluate the clinical efficacy of Professor Wang Huanlu’s experienced prescription in treating reflux esophagitis evaluation.Research results:This paper is divided into 3 parts: Part One:Study on Professor Wang Huanlu’s academic thoughts1 Professor Wang Huanlu’s medical experience and study characteristics1.1 Professor Wang Huanlu’s medical experience1.2 Professor Wang Huanlu’s study characteristics1.2.1 Focus on and carefully research the classic1.2.2 Pay attention to practice and set an example by personally taking part1.2.3To learn from a number of Teachers and draw their strong points1.2.4Inherit the experience of the past,development and innovation 2Professor Wang Huanlu’s main academic thoughts2.1 Wetness-heat harm most widelyWang thought wetness-heat as the important pathological mechanisms and pathogenic factors of some diseases.Professor not only deeply study the theories about dampness and heat in the past dynasties,but also pay attention to the experiences of the theories of dampness and heat and has his own opinions:Qilishire is the main treatment to the diseases and syndromes of dampness and heat.The diseases and syndromes of dampness and heat involve many Zangfu and other location of disease.Pay attention to differentiation of symptoms and signs to identify etiology,such as the coating on the tongue, oral odor, body secretion.Pay attention to the phenomenon of inner dampness while dryness appearance.Pay attenntion to the explanation by TCM of the results of lab text. Regonanize the diseases and resolve the difficult diseases with the theories of damp-heat,and introduction a medical case.2.2 Spleen and stomach relate a lot of diseasesPay attention to the close combination of TCM Classics of the past dynasties with clinical practice.Put forward the concept of the narrow sense of the spleen and stomach disease and the generalized spleen stomach disease.Identification of the spleen and stomach disease has many unique understanding.Identify the diseases of the spleen and stomach (in narrow sense) in detailed types.Applicate the theories of spleen and stomach in other diseases except digestive diseases.2.3Irregular menstruation is often related with deficiency of liver and kidney.Wang Huanlu’s clinical treatment of irregular menstruation with special emphasis on the importance of liver and kidney. Six Wei Di Huang Decoction is uesed as a basic prescription by Professor Wang.2.4 Male division disease closely related with the kidney-yang.Male division disease closely related with the kidney-yang.Including prostate disease,sexual dysfunction,barrenness.Prostate hyperplasia as an example.2.5A long illness will see blood stasisWang believed that Qi deficiency with chronic illness lead to blood stasis,qi stagnation with chronic illness lead to blood stasis, wetness-heat with chronic illness lead to blood stasis.Discovering the signs of blood stasis:Long pain often point to blood stasis; looking at the complexion of the skin to observe the blood stasis; discovering blood stasis with the help of the test index.It should be treated according to the severity of the blood stasis and pathogenesis of the diseases.Part Two:Study on Professor Wang Huanlu’s clinical experience of syndrome differentiation and treatment1The characteristics of syndrome differentiation and treatment method1.1 The combination of syndrome differentiation and disease differentiation1.2The differentiation and treatment of traditional Chinese medicine is the fundamental,Chinese medicine should learn from the results of modern medical research.1.3Pay attention to xie-qi and vital-qi,weigh the biao and ben1.4 Be good at tongue diagnosis,emphasize the synthesis of four diagnostic methods1.5 Likes using classical prescription,changing the classical prescription based on clinical conditiong to form experienced prescriptions.1.6 Using medicine accurate and refined,the prescription under thoughtful and comprehensive consideration.2 The summary of Professor Wang Huanlu’s clinical experiences2.1 Professor Wang Huanlu’s treatment of angina pectoris of coronary heart disease2.2 Professor Wang Huanlu’s treatment of chronic constipation through strengthening the TCM spleen2.3 Professor Wang Huanlu’s treatment of reflux esophagitis experiences2.4 Professor Wang Huanlu’s treatment of rheumatoid arthritis experiences2.5Professor Wang Huanlu’s experiences of treatment of nephropathy2.6 Professor Wang Huanlu’s treatment of menstrual disease experiences2.7 Professor Wang Huanlu’s treatment of leucorrhea diseases2.8 Professor Wang Huanlu’s treatment of male infertility and sexual dysfunction2.9 Professor Wang Huanlu’s treatment of acne2.10 Professor Wang Huanlu’s treatment of psoriasis2.11 Professor Wang Huanlu’s treatment of Allergic rhinitis(biqiu) experiencePart Three:The clinical study of the Hongtenglenge decoction in treating reflux esophagitisWang Huanlu consider damp, heat and blood stasis are the main disease mechanism of reflux esophagitis.The main treatment are clearing away Heat and promoting dieresis,invigorate blood and dissolve stasis.He developed Hongtenglenge decoction to treat this disease.In the part of clinical study, the study was carried out in 55 patients suffering from RE, the patients were randomly divided into treatment group (30 cases)with Hongtenglenge decoction and control group (25 cases) with omeprazole. The course of treatment was 8 weeks, the results showed:in the treatment group,the total integral of clinical symptoms and effective and the comprehensive effectiveness rate are is obviously superior to that of the control group.In improvement the syndromes of damp-heat and blood stasis, the treatment group is obviously superior to that of the control group.Treatment group improve the severity of esophageal than the control group under endoscopy,cure rate of treatment group was significantly higher than the control group. It has application prospects in treating reflux esophagitis and worth further research in the future.更多还原