陈宝田教授学术思想、临床经验总结及腰痛方治疗腰椎间盘突出症的临床疗效观察
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摘要
目的对陈宝田教授的学术思想、临床经验进行整理、挖掘、总结。以陈宝田教授的头痛方为基础方,加葛根、菟丝子等形成的腰痛方治疗腰椎间盘突出症(Lumbar Disc Herniation LDH),观察“腰痛方”治疗腰椎间盘突出症的临床疗效及安全性。
方法通过跟师实践,对陈宝田教授临证的病案进行记录,对诊治资料完整的病案进行整理分析；对陈教授的临证治疗、用药特点及经验进行阶段性地总结；对已公开出版和发表反映陈教授学术思想的专著、论文进行学习整理分析；在陈教授治疗头痛的经验方头痛方的基础上,加葛根、菟丝子等形成腰痛方,用于治疗LDH进行临床观察。将60例腰椎间盘突出症患者随机分为2组,治疗组30例,对照组30例,分别服用腰痛方及西乐葆4周。以治疗前和治疗后第7天、14天、28天的主观症状及客观体征作为观察(测)指标,对两组患者的临床疗效进行观察和对比,同时监测肝肾功能等安全性指标。
结果
(一)陈宝田教授学术思想
1、“循证”论治新观点。陈教授指出二十一世纪是循证医学的世纪,这是一个时代的进步。中医必须跟上时代的发展,走“循证”论治的道路,这将提高中医临床疗效、创新中医理论、促进中医药的现代化。
2、审证求因,辨病为主,辨病与辨证相结合。陈教授认为每一种疾病都有其独特的运动规律,都有着与其他疾病相异的地方,有时,虽然有部分临床表现相同,但其实病理生理上却是有着不同的地方,因此,陈宝田教授强调辨病(其中包涵了西医诊断),只有疾病明确,其病因病理生理过程才有可能明晰,病之不存,证归何处,单纯强调辨证,有时会失去了对疾病的总体把握。只有辨病清楚了,在其基础上审证求因,才能更好地治疗疾病,提高治愈率。
(二)陈宝田教授临床经验总结
陈教授从医近半个世纪,积累了丰富的临床经验,对很多疾病的治疗形成了自己的诊治风格,提倡经方的合方应用,并创新法,立新方,提倡补消合用,提出了将“安神法”列为治疗大法,并自创了很多疗效卓著的方剂如新正天丸等应用于临床。陈教授临床经验丰富,治疗病种广泛,其学术思想渗透在每种疾病的治疗之中。
(三)腰痛方治疗腰椎间盘突出症的临床观察结果
治疗7天后两组内各主要临床症状、体征及症候总积分比较差异有统计学意义(P<0.05),两组间比差异无统计学意义(P>0.05)。治疗14天后两组均能升高腰椎间盘突出症患者的主要临床症状、体征及症候总积分(P<0.05),组间比较治疗组疗效优于对照组,差异有统计学意义(P<0.05)。治疗28天后治疗组在升高腰椎间盘突出症患者的症候总积分,改善腰腿痛、运动障碍等主要临床症状和体征及整体临床疗效方面明显优于对照组(P<0.01)。
结论陈教授认为治疗宜“循证”论治,主张辨病为主,辨病与辨证相结合,提倡消补合用。腰痛方确实具有活血化瘀,温经散寒,通络止痛,补肾益气的作用。可以改善腰椎间盘突出症患者主要临床症状和体征,提高生活质量和疾病整体疗效。具有简单、方便、安全、毒副作用少及有效率高等优点,值得临床推广应用。
Objective:To collate、mining、summary the academic thinking、clinical experience of doctor Chen baotian.Yao Tong Fang formed by adding GeGen and TuSiZi et al on the basic of TouTongFang. The clinical effect and security of the Yao Tong Fang treating patients with LDH Were investigated.
Methods:To record the medical report and analyze the information of complete diagnosis and treatment during clinical practice with professor Chen baotian. To stage summary the clinical treatment medication characteristics、during the medical pretice with professor Chen. To study and analyze these published treatises and papers which response to professor Chen's academic thinking. To observe the clinical efficacy of the TouTongFang on treating the LDH patients.60cases with LDH were divided into two groups randomly. Observation group (30cases) were received Yao Tong Fang treatment during4weeks. Control group (30cases) were received Celecoxib Capsules capsule during4weeks. The clinical therapeutic effect of the two groups were compared by observing the change of the subjective symptoms, impersonal physical signs, quality of life before taking the capsule on7thd ay,14th day,28th day after taking it. It also monitored the drug's security at the same time.
Results:
(一) The academic thinking of doctor Chen
1、The new concept of "evidence-base Chinese medician".Professor Chen give this new concept and conside it will promote the Traditional Chinese Medician in the future.
2、Professor Chen advocated treatment based on syndrome differentiation. Differentiation of disease is foundation, determination of etiologic factors based on differentiation. professor Chen considered the differentiation of disease is the basic of the clinical diagnosis and treatment, the reason is (1) Accurately distinguish disease directly related to the clinical diagnosis;(2)Each disease has its specific etiology、pathophysiology, and distinguish the disease will help to understand the nature of the disease from the whole process and the characteristics of the disease.
(二) Chinical experience summarize of professor Chen
Professor Chen had nearly half-century career in medicine, accumulated a wealth of clinical experience, formulated his own style about the treatment of many diseases, invented a lot of curative effect of distinguished formula., such as Xinzhengtianwan which is used to treat chronic headache. He advocated to treat disease with combination of two-to-three traditional Chinese formula, and he innovated new method of "AnShenFa" to treat many diseases.
(三) The results of the YaoTongFang
The clinical observation showed that two groups could reduce the score of the subjective symptoms, impersonal physical signs and quality of life in LDH patient, and there was no statistic significant difference between two groups after7days'treatment (P>0.05). However, there was statistic significant difference between two groups in the score of the subjective symptoms, impersonal physical signs and clinical curative effect of LDH patient after14days'treatment and after28days treatment (P<0.05); And observation group was better than control group. There was also a great statistic significant difference between two groups in the quality of life of LDH patient after28days'treatment (P<0.05).
Conclusion:The Yao Tong Fang could promote blood circulation and remove blood stasis, and it has the effect of nourishing kidney, relaxing the menstruation, relieving pain indeed. It also could reduce the patient's subjective symptoms, impersonal physical signs and improve the patient's quality of life and clinical curative effect of the disease. The Yao Tong Fang has many merits such as simplicity convenience、safely、less side-effect and advanced effects, and it is worth clinical application and dissemination.
方法通过跟师实践,对陈宝田教授临证的病案进行记录,对诊治资料完整的病案进行整理分析；对陈教授的临证治疗、用药特点及经验进行阶段性地总结；对已公开出版和发表反映陈教授学术思想的专著、论文进行学习整理分析；在陈教授治疗头痛的经验方头痛方的基础上,加葛根、菟丝子等形成腰痛方,用于治疗LDH进行临床观察。将60例腰椎间盘突出症患者随机分为2组,治疗组30例,对照组30例,分别服用腰痛方及西乐葆4周。以治疗前和治疗后第7天、14天、28天的主观症状及客观体征作为观察(测)指标,对两组患者的临床疗效进行观察和对比,同时监测肝肾功能等安全性指标。
结果
(一)陈宝田教授学术思想
1、“循证”论治新观点。陈教授指出二十一世纪是循证医学的世纪,这是一个时代的进步。中医必须跟上时代的发展,走“循证”论治的道路,这将提高中医临床疗效、创新中医理论、促进中医药的现代化。
2、审证求因,辨病为主,辨病与辨证相结合。陈教授认为每一种疾病都有其独特的运动规律,都有着与其他疾病相异的地方,有时,虽然有部分临床表现相同,但其实病理生理上却是有着不同的地方,因此,陈宝田教授强调辨病(其中包涵了西医诊断),只有疾病明确,其病因病理生理过程才有可能明晰,病之不存,证归何处,单纯强调辨证,有时会失去了对疾病的总体把握。只有辨病清楚了,在其基础上审证求因,才能更好地治疗疾病,提高治愈率。
(二)陈宝田教授临床经验总结
陈教授从医近半个世纪,积累了丰富的临床经验,对很多疾病的治疗形成了自己的诊治风格,提倡经方的合方应用,并创新法,立新方,提倡补消合用,提出了将“安神法”列为治疗大法,并自创了很多疗效卓著的方剂如新正天丸等应用于临床。陈教授临床经验丰富,治疗病种广泛,其学术思想渗透在每种疾病的治疗之中。
(三)腰痛方治疗腰椎间盘突出症的临床观察结果
治疗7天后两组内各主要临床症状、体征及症候总积分比较差异有统计学意义(P<0.05),两组间比差异无统计学意义(P>0.05)。治疗14天后两组均能升高腰椎间盘突出症患者的主要临床症状、体征及症候总积分(P<0.05),组间比较治疗组疗效优于对照组,差异有统计学意义(P<0.05)。治疗28天后治疗组在升高腰椎间盘突出症患者的症候总积分,改善腰腿痛、运动障碍等主要临床症状和体征及整体临床疗效方面明显优于对照组(P<0.01)。
结论陈教授认为治疗宜“循证”论治,主张辨病为主,辨病与辨证相结合,提倡消补合用。腰痛方确实具有活血化瘀,温经散寒,通络止痛,补肾益气的作用。可以改善腰椎间盘突出症患者主要临床症状和体征,提高生活质量和疾病整体疗效。具有简单、方便、安全、毒副作用少及有效率高等优点,值得临床推广应用。
Objective:To collate、mining、summary the academic thinking、clinical experience of doctor Chen baotian.Yao Tong Fang formed by adding GeGen and TuSiZi et al on the basic of TouTongFang. The clinical effect and security of the Yao Tong Fang treating patients with LDH Were investigated.
Methods:To record the medical report and analyze the information of complete diagnosis and treatment during clinical practice with professor Chen baotian. To stage summary the clinical treatment medication characteristics、during the medical pretice with professor Chen. To study and analyze these published treatises and papers which response to professor Chen's academic thinking. To observe the clinical efficacy of the TouTongFang on treating the LDH patients.60cases with LDH were divided into two groups randomly. Observation group (30cases) were received Yao Tong Fang treatment during4weeks. Control group (30cases) were received Celecoxib Capsules capsule during4weeks. The clinical therapeutic effect of the two groups were compared by observing the change of the subjective symptoms, impersonal physical signs, quality of life before taking the capsule on7thd ay,14th day,28th day after taking it. It also monitored the drug's security at the same time.
Results:
(一) The academic thinking of doctor Chen
1、The new concept of "evidence-base Chinese medician".Professor Chen give this new concept and conside it will promote the Traditional Chinese Medician in the future.
2、Professor Chen advocated treatment based on syndrome differentiation. Differentiation of disease is foundation, determination of etiologic factors based on differentiation. professor Chen considered the differentiation of disease is the basic of the clinical diagnosis and treatment, the reason is (1) Accurately distinguish disease directly related to the clinical diagnosis;(2)Each disease has its specific etiology、pathophysiology, and distinguish the disease will help to understand the nature of the disease from the whole process and the characteristics of the disease.
(二) Chinical experience summarize of professor Chen
Professor Chen had nearly half-century career in medicine, accumulated a wealth of clinical experience, formulated his own style about the treatment of many diseases, invented a lot of curative effect of distinguished formula., such as Xinzhengtianwan which is used to treat chronic headache. He advocated to treat disease with combination of two-to-three traditional Chinese formula, and he innovated new method of "AnShenFa" to treat many diseases.
(三) The results of the YaoTongFang
The clinical observation showed that two groups could reduce the score of the subjective symptoms, impersonal physical signs and quality of life in LDH patient, and there was no statistic significant difference between two groups after7days'treatment (P>0.05). However, there was statistic significant difference between two groups in the score of the subjective symptoms, impersonal physical signs and clinical curative effect of LDH patient after14days'treatment and after28days treatment (P<0.05); And observation group was better than control group. There was also a great statistic significant difference between two groups in the quality of life of LDH patient after28days'treatment (P<0.05).
Conclusion:The Yao Tong Fang could promote blood circulation and remove blood stasis, and it has the effect of nourishing kidney, relaxing the menstruation, relieving pain indeed. It also could reduce the patient's subjective symptoms, impersonal physical signs and improve the patient's quality of life and clinical curative effect of the disease. The Yao Tong Fang has many merits such as simplicity convenience、safely、less side-effect and advanced effects, and it is worth clinical application and dissemination.
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