危北海教授学术思想与临床经验总结及治疗非酒精性脂肪性肝炎临床研究
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摘要
研究目的：
研究继承和发展名老中医的学术思想和临床经验,是创新和发展中医药事业、提高临床疗效的重要途径和方法。危北海教授是国内知名的中西医结合内科专家,是开展中西医结合脾胃学说研究的创始人之一,从事脾胃学说和脾胃病的临床和试验研究工作近60年,主持了北京市的七五、八五、九五科研课题的攻关,在进行脾胃理论研究时,首先建立了400余万字的国内最大的脾胃理论知识库。在复制模拟脾气虚证的动物模型和建立观察指标方面,都做出了重大创新性工作,率先发现木糖吸收试验可作为脾虚证辅助辨证的新指标,提出融合中西医理论于一炉的新观点,得到了该领域内同行的公认和好评。危北海教授近60年的工作经历,见证了中国中西医结合事业,发展壮大的历程,为中国中西医结合事业的发展做出了巨大贡献,在全面继承前人学术思想的前提下,结合现代医学的进展,通过大量实践,形成了独特的治疗脾胃疾病的学术思想,临床疗效卓著。
本研究旨在探索危北海老师脾胃理论学术思想渊源,总结和继承老师脾胃理论学术思想及临床经验,探索、学习、继承和研究名老中医学术思想和临床经验的方法,提高自我学术水平和专业技能,丰富和发展脾胃理论学术思想及临床运用范围,为更好地传承和研究名老中医学术思想打下良好基础。
研究方法：
1.跟师临诊,仔细观察老师四诊方法,认真做好跟师笔记,分析老师用药经验和辨证思路,探索老师临症用药规律。
2.认真研读和整理老师的著作及发表的学术论文,虚心向老师请教,结合临床经验,认真书写跟师学习心得,总结老师学术思想。
3.阅读老师所列中医古籍书目,探索老师学术思想渊源,加深对老师学术思想的理解。
4.将老师的临床经验和学术思想,主动用于临床,进一步总结和学习老师的学术思想,在实践中验证学习成果。
研究内容：
1.危北海脾胃理论学术思想渊源及相关学术流派医家学术思想研究
通过对历代医家重要学术著作的研读,研究表明,脾胃学说是祖国传统医学的一个重要组成部分,脾胃学派也是在中医学发展过程中形成的一个著名流派,它的发生发展过程与中医学的发展进程密不可分,为历代各科医家所重视。而在脾胃学说形成和发展的过程中,中医学现存最早的经典著作《黄帝内经》奠定了脾胃学说的理论基础。汉代张仲景《伤寒论》,开创了辨证论治的先河,创建了脾胃学说临床证治的基础。唐宋金元时期诸医家,特别是金元四大家,丰富和发展了脾胃学说,推动了脾胃理论的全面发展,特别是李东垣创作的《脾胃论》,发展了《黄帝内经》的学术思想,在总结前人经验和理论的基础上,形成了独特的脾胃理论学说。明清时期,脾胃理论得到了进一步充实和完善,逐步形成了祖国医学理论体系中具有重大影响的完整的脾胃学说。
在继承前人学术思想的基础上,当代医家从不同角度对脾胃理论多有所发展,各具特色,使脾胃学说更为广泛地运用于临床各科,本文简要介绍了当代部分医家脾胃理论学术思想和临床特色。
2危北海老师学术思想研究
老师依据脾胃疾病的病因病机,根据脾胃疾病复杂多样的临床表现,结合现代医学的研究成果,灵活运用辨证与辨病相结合的方法,形成了以“益脾胃、调升降、通胃络、降阴火”为核心的治疗方法。本文把老师的学术思想从益脾胃、调升降、通胃络、降阴火四个方面进行了高度概括,每一方面都从学术渊源、学术思想、辨治规律、及临床应用阐述和总结,是本文的核心,也是对老师学术思想及临床经验进行总结的研究方法的探讨。
2.1益脾胃
益脾胃是老师学术思想核心之一,不论治疗脾胃自身疾病还是其他脏腑疾病证属脾胃虚者多从脾胃考虑,对脾虚证的实验研究和临床研究,则是老师对我国脾胃理论研究的重大贡献,开创了脾胃理论实验研究的先河,运用祖国医学传统的研究方法和现代科学的实验研究方法相结合,首先对祖国医学经典中有关脾胃学说的理论阐述和经验诊治等进行全面而系统的归纳整理。在此基础上提出了一个脾虚证型的理论假设,并根据现代实验设计学和数理统计学的知识和方法,进行了科学严谨的实验研究,把临床和基础,宏观和微观结合起来,采取多水平、多指标,多途径的综合观察方案,经过系统而深入的临床观察和实验研究,提出了脾虚综合证的临床概念,胃肠复原的治疗学方法,及一系列治疗脾胃虚损的方法。本文探索了老师脾虚理论的形成过程、研究方法、研究成果及临床益脾胃的学术思想及临床证治规律。
2.2调升降
老师宗《内经》气机升降出入之旨,法东垣脾升胃降之理,合历代医家脾胃学说,取长补短,结合脾胃“脾宜升则健,胃宜降则和”的临床特点,临床上,特别重视脾胃的升降功能,并把脾胃的升降功能与其他脏腑的升降功能相联系,突出脾胃为升降功能中枢的同时,兼顾肝之生发、肺之肃降、肾水之上济、心火之下交的生理功能。认为只有脾胃健运,升降有序,才能维持机体“清阳出上窍,浊阴出下窍,清阳发腠理,浊阴走五脏,清阳实四肢,浊阴归六腑”的正常功能。将虚实寒热、气血津液辨证融入调理气机的升降出入之中,顺应脾胃脏腑气机的升降出入之性,结合脏腑辨证,执简驭繁,形成独特的辨证治疗方法。老师认为调其出入当责之于肝、肺,顺其升降当以脾胃为主,兼顾心肾。调理气机升降的关键有三点：一者和降肺胃；二者升脾；三者条达肝木。系统总结了老师调气机升降的学术思想及临床经验。
2.3通胃络
通胃络是老师重要的学术思想之一。胃络不通就会导致胃脘部疼痛不适,而胃脘痛亦是慢性脾胃疾病临床常见症状,多见于慢性胃炎、胃溃疡、十二指肠球部溃疡等,病程较长,多迁延难愈,其病多由饮食所伤、外感邪气、内伤七情、先天禀赋不足,导致脾胃阴阳气血不足、湿热内蕴、痰浊内生、瘀血阻络、毒邪内阻,湿热、痰浊、瘀血、邪毒阻于胃络,不通则痛,导致胃脘痛的发生。然脾胃气血阴阳不足,亦可使胃络失养,导致不荣则痛。因此老师认为脾胃阴阳气血不足、湿热、瘀血、痰浊、邪毒阻滞胃络是导致脾胃疾病的基本病机,而治疗则有温阳益气通络、清热除湿通络、活血通络、化痰通络、解毒通络之不同。本文详细论述了胃络不通的病因病机及老师通胃络临床常用的方法,是老师脾胃理论学术思想的重要组成部分。
2.4降阴火
老师根据历代医家“阴火”理论的研究成果,认为阴火的根本病机是脾肾之不足,治疗“大忌苦寒之药损其脾胃”,主张在补中升阳的同时,适当佐用苦寒降火之品,如果出现火势较重,亦可加大苦寒清降之力。本文从益气升阳降火、清心降火、潜降相火、滋阴活血降火四个方面总结了老师“降阴火”的学术思想和临床经验。
3危北海老师临床经验研究
本文对老师临床治疗常见病的经验进行了整理与研究,主要包括便秘、慢性结肠炎、头痛、胃痞证、失眠、肝之为病及消化性溃疡的治疗经验,治疗经验多能体现老师的主要学术思想,亦是老师学术思想的具体运用,特别是比较全面和详细地总结了老师治疗肝之为病及消化性溃疡的临床经验和具体用药规律。
4.健脾疏肝活血化痰法治疗非酒精性脂肪性肝炎临床研究
4.1研究目的：观察运用健脾疏肝活血化痰法治疗非酒精性脂肪性肝炎的临床疗效,验证继承老师学术经验的成效,为非酒精性脂肪性肝炎的中医干预提供切实可行的方法和依据。
4.2研究方法：根据随机对照的原则,运用随机数字表法将诊断为非酒精性脂肪性肝炎的患者随机分为治疗组和对照组,在饮食、运动干预的基础上,两组患者分别运用健脾疏肝活血化痰法和西药水飞蓟宾胶囊进行临床干预,疗程3个月,选择肝脏酶学(ALT)、血脂(TC、TG)作为主要的效评价指标,同时考虑肝脏B超及中医证候学指标,评价健脾疏肝活血化痰法治疗非酒精性脂肪性肝炎的临床疗效。
4.3结果
两组患者综合疗效比较,治疗组显效16例(35.6%),有效26例(57.7%),总有效42例(93.3%)。对照组显效9例(17.8%),有效19例(42.2%),总有效28例(62.2%)。两组患者综合疗效经卡方检验,综合疗效差异有统计学意义,治疗组综合疗效明显优于对照组。治疗组与对照组治疗后血清ALT、AST均有降低,治疗组治疗前后ALT、AST匕较,差异有统计学意义(P<0.01,P<0.05),对照组治疗前后ALT、AST匕较,差异亦有统计学意义(P<0.0l,P<0.05)；治疗后治疗组与对照组ALT比较差异有统计学意义(P<0.05),表明治疗组和对照组都有改善血清ALT、AST的作用,在改善血清ALT方面治疗组明显优于对照组。治疗后治疗组TC、TG均显著降低,治疗前后TC、TG差异具有统计学意义(P<0.01),治疗后两组TC、TG比较,差异具有统计学意义(P<0.05；P<0.01),治疗组明显低于对照组。治疗后两组BMI均显著降低,治疗前后BMI差异均具有统计学意义(P<0.05)。治疗后两组中医证候积分均显著降低,治疗前后两组自身中医证候积分比较,差异具有统计学意义(P<0.01)。治疗后两组中医证候积分比较,两组积分差异具有统计学意义(P<0.01)。表明两组均具有改善临床症候的作用,而治疗组在改善临床症候方面明显优于对照组。治疗组治疗后胃脘痞满、胁肋胀满、食少纳差、倦怠乏力、大便溏薄等主要症候均有显著改善(P<0.01)；对照组治疗后胁肋胀满、食少纳差、倦怠乏力有明显改善(P<0.05)。治疗后两组比较,治疗组在胃脘痞满、胁肋胀满、食少纳差、倦怠乏力、大便溏薄等主要症候方面均明显优于对照组(P<0.01，P<0.05)。
4.4结论
以上研究结果表明：健脾疏肝活血化痰法治疗非酒精性脂肪性肝炎,能够明显改善患者的临床症状和体征,特别是改善非酒精性脂肪性肝炎患者临床常见的胃脘痞满、胁肋胀满、食少纳差、倦怠乏力、大便溏薄等主要症候,能够显著改善患者的肝功能,并具有一定的调节血脂及降低体重的作用。与现代医学常用的治疗非酒精性脂肪性肝炎的水飞蓟宾胶囊对比,在改善临床症状、肝功能及调节血脂方面具有明显优势。
成果：
通过三年的跟师学习和对老师著作及学术论文的深入研究,对老师学术思想和临床经验进行了深入挖掘和系统总结,提出了老师“益脾胃、调升降、通胃络、降阴火”的治疗学学术思想核心,并运用老师的学术思想及临床经验对临床常见病及疑难病的治疗进行了有益的探索,取得了较好疗效,达到了对老师的学术思想和临床经验进行很好传承和发扬的目的,临床技能及学术水平均有较大提高。
Objectives:
The research was aimed to explore the academic origins of Prof. Wei Beihai's spleen-stomach theory, summarize and inherit academic thought and clinical experience of spleen-stomach theory, explore the way of learning, inheritance, and research on famous veteran TCM doctors'academic thinking and clinical experience, improve academic standards and professional skills, enrich and develop academic thinking and clinical use of the spleen-stomach theory, and lay a good foundation for better inheritance and research on famous veteran TCM doctors'academic thinking.
Methods:
1. Sever and learn the supervisor's clinical diagnosis, carefully observe the four diagnostic methods, take serious notes, analyze the medication experience and thinking of syndrome differentiation, and explore clinical medication laws.
2. Carefully read and summarize supervisor's articles or published papers, humbly inquiry, combining with clinical experience, seriously write the learning thinking, and summarize up the supervisor's academic thinking.
3. Read the ancient Chinese medicine materials listed by the supervisor, and explore the origins of academic thought to have a better understanding about the academic thinking.
4. Use the supervisor's clinical experience and academic thinking in clinic to summarize and verify the learning outcomes in practice.
Contents:
1. Research on Prof. Wei Beihai's academic thinking on spleen-stomach theory and related academic genre's academic thought
By studying the ancient physicians' important academic works, research shows that the spleen-stomach theory is an important composition of traditional Chinese medicine, and spleen-stomach is also a well-known genre in TCM development process, of which the formation and development process were inseparable with TCM. valued by physicians among dynasties. While in the process of formation and development of this theory, the existing earliest classics in TCM, the "Huangdis Internal Classic", laid the theoretical foundation.'Treatise on Cold Damage Diseases", written by Zhang Zhongjing in Han Dynasty, pioneered the syndrome differentiation and created the clinical foundation. And physicians during the Tang, Song, Jin and Yuan dynasties, especially the four famous physicians in Jinyuan dynasties, enriched and developed the spleen-stomach theory, promote its comprehensive development. In particular the "Treatise on the Spleen and Stomach", written by Li Dongyuan, developed "Huangdi s Internal Classic" academic thinking, and created a unique theory based on previous experience and theory. And in Ming and Qing Dynasties, the spleen-stomach theory got further strengthened and improved, and gradually formed a complete theoretical system which had a significant impact on clinic.
Contemporary physicians developed their own characteristics from different angles on the basis of inherited academic thinking, so that the theory was more widely used in clinical. This paper briefly described the part of contemporary physicians'academic thinking and clinical characteristics on spleen-stomach theory.
2. Research on Prof. Wei Beihai's academic thinking
Based on etiology and pathogenesis of the stomach diseases, the complex and diverse clinical manifestations, combined with modern medical research, and flexibility in the use of the method of differentiation of disease and syndrome, the core treatment method,"tonify the spleen-stomach, modify the ascending and descending, regulating the stomach meridian, and descending yin fire " was formed. This article highly summarized four aspects as "tonify the spleen-stomach, modify the ascending and descending, regulating the stomach meridian, and descending yin fire", and in each aspect, the academic origins, thinking, differentiation-treatment laws, and clinical application were described and summarized as the core of this article, which was also a discussion on the way to summary of the research methods on Prof. Wei's academic thought and clinical experience.
3. Research on Prof. Wei Beihai's clinical experience
The Prof. Wei's clinical experience in the treatment of common diseases, including constipation, chronic colitis, headache, stomach-pi syndrome, insomnia, liver disease and peptic ulcer, was summarized and researched. The experience represented main academic thought, and its specific clinical use. In particular, a more comprehensive and detailed treatment of the liver disease clinical experience and specific medication law were summarized.
4. Clinical research on Prof. Wei Beihai's method of "tonify the spleen, regulate the liver, activate the blood circulation and expel the phlegm" as the treatment for non-alcoholic steatohepatitis
4.1Objectives:To observe clinical efficacy and use the "tonify the spleen, regulate the liver, activate the blood circulation and expel the phlegm" method (TRAEM) for the treatment of non-alcoholic steatohepatitis, to verify the effect of academic experience inheritance, and to provide practical TCM methods and evidence for non-alcoholic steatohepatitis.
4.2Methods:According to the principle of randomized controlled trials, random number table was used, and the patients of non-alcoholic steatohepatitis were randomly divided into treatment and control groups. And based on diet, exercise intervention, the two groups were respectively treated by TRAEM and silibinin capsules for3months. After treatment, liver enzymatic (ALT) and blood lipids (TC, TG) were selected as the main objective items for the diagnosis and efficacy evaluation. And the liver B-ultrasound and Chinese medicine syndrome indicators observation were also taken to evaluate TCM treatment efficacy for non-alcoholic steatohepatitis.
4.3Results
Comparing to comprehensive effect of two patient groups, in the treatment group,16cases (35.6%) with obvious effect, and26cases (57.7%) with effect, and the total effective rate was42cases (93.3%). In the control group,9cases (17.8%) with obvious effect, and19cases (42.2%) with effect, and the total effective rate was28cases (62.2%). Comprehensive effects of two groups tested by chi-square test were statistically significant, and the treatment group was significantly better than the control group. After treatment, the serum ALT, AST in two groups had been lowered. Before and after treatment in the treatment group, the differences of ALT and AST were statistically significant (P＜0.01. P＜0.05). and in the control group, the differences of ALT and AST were also statistically significant (P＜0.01, P＜0.05); ALT of the treatment group and control group difference was statistically significant (P＜0.05), indicating that the treatment group and the control group had improved serum ALT, AST, in improving serum ALT treatment group was significantly better than the control group. After treatment, the TC and TG were significantly lowered, and before and after treatment. TC and TG had statistically significant difference (P＜0.01). After treatment. TC, and TG in two groups, differences were statistically significant (P＜0.05; P＜0.01). and the treatment group was significantly lower than the control group. After treatment, the BMI were significantly reduced in two groups, and the BMI differences were statistically significant (P ＜0.05) before and after treatment. After treatment, the symptom pattern scores were significantly reduced in two groups. Before and after treatment, the differences were statistically significant (P＜0.01). After treatment, the symptom pattern scores in two groups were statistically significant (P＜0.01), which showed that the clinical symptoms in both groups had been improved, while the treatment group had a better effect than the control group. After the treatment, the main symptoms as the epigastric fullness, hypochondrium distention, anorexia, lassitude, loose stools and so on in two groups were statistically significant (P＜0.01), which showed that the clinical symptoms in both groups had been improved, while the treatment group had a better effect than the control group.
4.4Conclusions:
The results above showed that, the TRAEM for non-alcoholic steatohepatitis, could significantly improve the clinical signs and symptoms, especially the epigastric fullness, hypochondrium distention, anorexia, lassitude, loose stools and so on. Also liver function, regulation of blood lipids and reducing the body weight could be significantly improved. Comparing to the modern western medicine, silibinin capsules for non-alcoholic steatohepatitis, the TRAEM had obvious advantages on liver function improvement and blood lipids regulation.
Conclusions
Through three years'learning and researching in-depth on articles and papers of Prof.Wei, the academic thinking and clinical experience were deeply mined and systematic summarized. The core of academic thinking,"tonify the spleen-stomach, modify the ascending and descending, regulating the stomach meridian, and descending yin fire", was proposed, useful exploration was conducted by applying the academic thinking and clinical experience with good effect. So the aim of good inheritance and development was achieved, and clinical skills and academic levels were greatly improved.
研究继承和发展名老中医的学术思想和临床经验,是创新和发展中医药事业、提高临床疗效的重要途径和方法。危北海教授是国内知名的中西医结合内科专家,是开展中西医结合脾胃学说研究的创始人之一,从事脾胃学说和脾胃病的临床和试验研究工作近60年,主持了北京市的七五、八五、九五科研课题的攻关,在进行脾胃理论研究时,首先建立了400余万字的国内最大的脾胃理论知识库。在复制模拟脾气虚证的动物模型和建立观察指标方面,都做出了重大创新性工作,率先发现木糖吸收试验可作为脾虚证辅助辨证的新指标,提出融合中西医理论于一炉的新观点,得到了该领域内同行的公认和好评。危北海教授近60年的工作经历,见证了中国中西医结合事业,发展壮大的历程,为中国中西医结合事业的发展做出了巨大贡献,在全面继承前人学术思想的前提下,结合现代医学的进展,通过大量实践,形成了独特的治疗脾胃疾病的学术思想,临床疗效卓著。
本研究旨在探索危北海老师脾胃理论学术思想渊源,总结和继承老师脾胃理论学术思想及临床经验,探索、学习、继承和研究名老中医学术思想和临床经验的方法,提高自我学术水平和专业技能,丰富和发展脾胃理论学术思想及临床运用范围,为更好地传承和研究名老中医学术思想打下良好基础。
研究方法：
1.跟师临诊,仔细观察老师四诊方法,认真做好跟师笔记,分析老师用药经验和辨证思路,探索老师临症用药规律。
2.认真研读和整理老师的著作及发表的学术论文,虚心向老师请教,结合临床经验,认真书写跟师学习心得,总结老师学术思想。
3.阅读老师所列中医古籍书目,探索老师学术思想渊源,加深对老师学术思想的理解。
4.将老师的临床经验和学术思想,主动用于临床,进一步总结和学习老师的学术思想,在实践中验证学习成果。
研究内容：
1.危北海脾胃理论学术思想渊源及相关学术流派医家学术思想研究
通过对历代医家重要学术著作的研读,研究表明,脾胃学说是祖国传统医学的一个重要组成部分,脾胃学派也是在中医学发展过程中形成的一个著名流派,它的发生发展过程与中医学的发展进程密不可分,为历代各科医家所重视。而在脾胃学说形成和发展的过程中,中医学现存最早的经典著作《黄帝内经》奠定了脾胃学说的理论基础。汉代张仲景《伤寒论》,开创了辨证论治的先河,创建了脾胃学说临床证治的基础。唐宋金元时期诸医家,特别是金元四大家,丰富和发展了脾胃学说,推动了脾胃理论的全面发展,特别是李东垣创作的《脾胃论》,发展了《黄帝内经》的学术思想,在总结前人经验和理论的基础上,形成了独特的脾胃理论学说。明清时期,脾胃理论得到了进一步充实和完善,逐步形成了祖国医学理论体系中具有重大影响的完整的脾胃学说。
在继承前人学术思想的基础上,当代医家从不同角度对脾胃理论多有所发展,各具特色,使脾胃学说更为广泛地运用于临床各科,本文简要介绍了当代部分医家脾胃理论学术思想和临床特色。
2危北海老师学术思想研究
老师依据脾胃疾病的病因病机,根据脾胃疾病复杂多样的临床表现,结合现代医学的研究成果,灵活运用辨证与辨病相结合的方法,形成了以“益脾胃、调升降、通胃络、降阴火”为核心的治疗方法。本文把老师的学术思想从益脾胃、调升降、通胃络、降阴火四个方面进行了高度概括,每一方面都从学术渊源、学术思想、辨治规律、及临床应用阐述和总结,是本文的核心,也是对老师学术思想及临床经验进行总结的研究方法的探讨。
2.1益脾胃
益脾胃是老师学术思想核心之一,不论治疗脾胃自身疾病还是其他脏腑疾病证属脾胃虚者多从脾胃考虑,对脾虚证的实验研究和临床研究,则是老师对我国脾胃理论研究的重大贡献,开创了脾胃理论实验研究的先河,运用祖国医学传统的研究方法和现代科学的实验研究方法相结合,首先对祖国医学经典中有关脾胃学说的理论阐述和经验诊治等进行全面而系统的归纳整理。在此基础上提出了一个脾虚证型的理论假设,并根据现代实验设计学和数理统计学的知识和方法,进行了科学严谨的实验研究,把临床和基础,宏观和微观结合起来,采取多水平、多指标,多途径的综合观察方案,经过系统而深入的临床观察和实验研究,提出了脾虚综合证的临床概念,胃肠复原的治疗学方法,及一系列治疗脾胃虚损的方法。本文探索了老师脾虚理论的形成过程、研究方法、研究成果及临床益脾胃的学术思想及临床证治规律。
2.2调升降
老师宗《内经》气机升降出入之旨,法东垣脾升胃降之理,合历代医家脾胃学说,取长补短,结合脾胃“脾宜升则健,胃宜降则和”的临床特点,临床上,特别重视脾胃的升降功能,并把脾胃的升降功能与其他脏腑的升降功能相联系,突出脾胃为升降功能中枢的同时,兼顾肝之生发、肺之肃降、肾水之上济、心火之下交的生理功能。认为只有脾胃健运,升降有序,才能维持机体“清阳出上窍,浊阴出下窍,清阳发腠理,浊阴走五脏,清阳实四肢,浊阴归六腑”的正常功能。将虚实寒热、气血津液辨证融入调理气机的升降出入之中,顺应脾胃脏腑气机的升降出入之性,结合脏腑辨证,执简驭繁,形成独特的辨证治疗方法。老师认为调其出入当责之于肝、肺,顺其升降当以脾胃为主,兼顾心肾。调理气机升降的关键有三点：一者和降肺胃；二者升脾；三者条达肝木。系统总结了老师调气机升降的学术思想及临床经验。
2.3通胃络
通胃络是老师重要的学术思想之一。胃络不通就会导致胃脘部疼痛不适,而胃脘痛亦是慢性脾胃疾病临床常见症状,多见于慢性胃炎、胃溃疡、十二指肠球部溃疡等,病程较长,多迁延难愈,其病多由饮食所伤、外感邪气、内伤七情、先天禀赋不足,导致脾胃阴阳气血不足、湿热内蕴、痰浊内生、瘀血阻络、毒邪内阻,湿热、痰浊、瘀血、邪毒阻于胃络,不通则痛,导致胃脘痛的发生。然脾胃气血阴阳不足,亦可使胃络失养,导致不荣则痛。因此老师认为脾胃阴阳气血不足、湿热、瘀血、痰浊、邪毒阻滞胃络是导致脾胃疾病的基本病机,而治疗则有温阳益气通络、清热除湿通络、活血通络、化痰通络、解毒通络之不同。本文详细论述了胃络不通的病因病机及老师通胃络临床常用的方法,是老师脾胃理论学术思想的重要组成部分。
2.4降阴火
老师根据历代医家“阴火”理论的研究成果,认为阴火的根本病机是脾肾之不足,治疗“大忌苦寒之药损其脾胃”,主张在补中升阳的同时,适当佐用苦寒降火之品,如果出现火势较重,亦可加大苦寒清降之力。本文从益气升阳降火、清心降火、潜降相火、滋阴活血降火四个方面总结了老师“降阴火”的学术思想和临床经验。
3危北海老师临床经验研究
本文对老师临床治疗常见病的经验进行了整理与研究,主要包括便秘、慢性结肠炎、头痛、胃痞证、失眠、肝之为病及消化性溃疡的治疗经验,治疗经验多能体现老师的主要学术思想,亦是老师学术思想的具体运用,特别是比较全面和详细地总结了老师治疗肝之为病及消化性溃疡的临床经验和具体用药规律。
4.健脾疏肝活血化痰法治疗非酒精性脂肪性肝炎临床研究
4.1研究目的：观察运用健脾疏肝活血化痰法治疗非酒精性脂肪性肝炎的临床疗效,验证继承老师学术经验的成效,为非酒精性脂肪性肝炎的中医干预提供切实可行的方法和依据。
4.2研究方法：根据随机对照的原则,运用随机数字表法将诊断为非酒精性脂肪性肝炎的患者随机分为治疗组和对照组,在饮食、运动干预的基础上,两组患者分别运用健脾疏肝活血化痰法和西药水飞蓟宾胶囊进行临床干预,疗程3个月,选择肝脏酶学(ALT)、血脂(TC、TG)作为主要的效评价指标,同时考虑肝脏B超及中医证候学指标,评价健脾疏肝活血化痰法治疗非酒精性脂肪性肝炎的临床疗效。
4.3结果
两组患者综合疗效比较,治疗组显效16例(35.6%),有效26例(57.7%),总有效42例(93.3%)。对照组显效9例(17.8%),有效19例(42.2%),总有效28例(62.2%)。两组患者综合疗效经卡方检验,综合疗效差异有统计学意义,治疗组综合疗效明显优于对照组。治疗组与对照组治疗后血清ALT、AST均有降低,治疗组治疗前后ALT、AST匕较,差异有统计学意义(P<0.01,P<0.05),对照组治疗前后ALT、AST匕较,差异亦有统计学意义(P<0.0l,P<0.05)；治疗后治疗组与对照组ALT比较差异有统计学意义(P<0.05),表明治疗组和对照组都有改善血清ALT、AST的作用,在改善血清ALT方面治疗组明显优于对照组。治疗后治疗组TC、TG均显著降低,治疗前后TC、TG差异具有统计学意义(P<0.01),治疗后两组TC、TG比较,差异具有统计学意义(P<0.05；P<0.01),治疗组明显低于对照组。治疗后两组BMI均显著降低,治疗前后BMI差异均具有统计学意义(P<0.05)。治疗后两组中医证候积分均显著降低,治疗前后两组自身中医证候积分比较,差异具有统计学意义(P<0.01)。治疗后两组中医证候积分比较,两组积分差异具有统计学意义(P<0.01)。表明两组均具有改善临床症候的作用,而治疗组在改善临床症候方面明显优于对照组。治疗组治疗后胃脘痞满、胁肋胀满、食少纳差、倦怠乏力、大便溏薄等主要症候均有显著改善(P<0.01)；对照组治疗后胁肋胀满、食少纳差、倦怠乏力有明显改善(P<0.05)。治疗后两组比较,治疗组在胃脘痞满、胁肋胀满、食少纳差、倦怠乏力、大便溏薄等主要症候方面均明显优于对照组(P<0.01，P<0.05)。
4.4结论
以上研究结果表明：健脾疏肝活血化痰法治疗非酒精性脂肪性肝炎,能够明显改善患者的临床症状和体征,特别是改善非酒精性脂肪性肝炎患者临床常见的胃脘痞满、胁肋胀满、食少纳差、倦怠乏力、大便溏薄等主要症候,能够显著改善患者的肝功能,并具有一定的调节血脂及降低体重的作用。与现代医学常用的治疗非酒精性脂肪性肝炎的水飞蓟宾胶囊对比,在改善临床症状、肝功能及调节血脂方面具有明显优势。
成果：
通过三年的跟师学习和对老师著作及学术论文的深入研究,对老师学术思想和临床经验进行了深入挖掘和系统总结,提出了老师“益脾胃、调升降、通胃络、降阴火”的治疗学学术思想核心,并运用老师的学术思想及临床经验对临床常见病及疑难病的治疗进行了有益的探索,取得了较好疗效,达到了对老师的学术思想和临床经验进行很好传承和发扬的目的,临床技能及学术水平均有较大提高。
Objectives:
The research was aimed to explore the academic origins of Prof. Wei Beihai's spleen-stomach theory, summarize and inherit academic thought and clinical experience of spleen-stomach theory, explore the way of learning, inheritance, and research on famous veteran TCM doctors'academic thinking and clinical experience, improve academic standards and professional skills, enrich and develop academic thinking and clinical use of the spleen-stomach theory, and lay a good foundation for better inheritance and research on famous veteran TCM doctors'academic thinking.
Methods:
1. Sever and learn the supervisor's clinical diagnosis, carefully observe the four diagnostic methods, take serious notes, analyze the medication experience and thinking of syndrome differentiation, and explore clinical medication laws.
2. Carefully read and summarize supervisor's articles or published papers, humbly inquiry, combining with clinical experience, seriously write the learning thinking, and summarize up the supervisor's academic thinking.
3. Read the ancient Chinese medicine materials listed by the supervisor, and explore the origins of academic thought to have a better understanding about the academic thinking.
4. Use the supervisor's clinical experience and academic thinking in clinic to summarize and verify the learning outcomes in practice.
Contents:
1. Research on Prof. Wei Beihai's academic thinking on spleen-stomach theory and related academic genre's academic thought
By studying the ancient physicians' important academic works, research shows that the spleen-stomach theory is an important composition of traditional Chinese medicine, and spleen-stomach is also a well-known genre in TCM development process, of which the formation and development process were inseparable with TCM. valued by physicians among dynasties. While in the process of formation and development of this theory, the existing earliest classics in TCM, the "Huangdis Internal Classic", laid the theoretical foundation.'Treatise on Cold Damage Diseases", written by Zhang Zhongjing in Han Dynasty, pioneered the syndrome differentiation and created the clinical foundation. And physicians during the Tang, Song, Jin and Yuan dynasties, especially the four famous physicians in Jinyuan dynasties, enriched and developed the spleen-stomach theory, promote its comprehensive development. In particular the "Treatise on the Spleen and Stomach", written by Li Dongyuan, developed "Huangdi s Internal Classic" academic thinking, and created a unique theory based on previous experience and theory. And in Ming and Qing Dynasties, the spleen-stomach theory got further strengthened and improved, and gradually formed a complete theoretical system which had a significant impact on clinic.
Contemporary physicians developed their own characteristics from different angles on the basis of inherited academic thinking, so that the theory was more widely used in clinical. This paper briefly described the part of contemporary physicians'academic thinking and clinical characteristics on spleen-stomach theory.
2. Research on Prof. Wei Beihai's academic thinking
Based on etiology and pathogenesis of the stomach diseases, the complex and diverse clinical manifestations, combined with modern medical research, and flexibility in the use of the method of differentiation of disease and syndrome, the core treatment method,"tonify the spleen-stomach, modify the ascending and descending, regulating the stomach meridian, and descending yin fire " was formed. This article highly summarized four aspects as "tonify the spleen-stomach, modify the ascending and descending, regulating the stomach meridian, and descending yin fire", and in each aspect, the academic origins, thinking, differentiation-treatment laws, and clinical application were described and summarized as the core of this article, which was also a discussion on the way to summary of the research methods on Prof. Wei's academic thought and clinical experience.
3. Research on Prof. Wei Beihai's clinical experience
The Prof. Wei's clinical experience in the treatment of common diseases, including constipation, chronic colitis, headache, stomach-pi syndrome, insomnia, liver disease and peptic ulcer, was summarized and researched. The experience represented main academic thought, and its specific clinical use. In particular, a more comprehensive and detailed treatment of the liver disease clinical experience and specific medication law were summarized.
4. Clinical research on Prof. Wei Beihai's method of "tonify the spleen, regulate the liver, activate the blood circulation and expel the phlegm" as the treatment for non-alcoholic steatohepatitis
4.1Objectives:To observe clinical efficacy and use the "tonify the spleen, regulate the liver, activate the blood circulation and expel the phlegm" method (TRAEM) for the treatment of non-alcoholic steatohepatitis, to verify the effect of academic experience inheritance, and to provide practical TCM methods and evidence for non-alcoholic steatohepatitis.
4.2Methods:According to the principle of randomized controlled trials, random number table was used, and the patients of non-alcoholic steatohepatitis were randomly divided into treatment and control groups. And based on diet, exercise intervention, the two groups were respectively treated by TRAEM and silibinin capsules for3months. After treatment, liver enzymatic (ALT) and blood lipids (TC, TG) were selected as the main objective items for the diagnosis and efficacy evaluation. And the liver B-ultrasound and Chinese medicine syndrome indicators observation were also taken to evaluate TCM treatment efficacy for non-alcoholic steatohepatitis.
4.3Results
Comparing to comprehensive effect of two patient groups, in the treatment group,16cases (35.6%) with obvious effect, and26cases (57.7%) with effect, and the total effective rate was42cases (93.3%). In the control group,9cases (17.8%) with obvious effect, and19cases (42.2%) with effect, and the total effective rate was28cases (62.2%). Comprehensive effects of two groups tested by chi-square test were statistically significant, and the treatment group was significantly better than the control group. After treatment, the serum ALT, AST in two groups had been lowered. Before and after treatment in the treatment group, the differences of ALT and AST were statistically significant (P＜0.01. P＜0.05). and in the control group, the differences of ALT and AST were also statistically significant (P＜0.01, P＜0.05); ALT of the treatment group and control group difference was statistically significant (P＜0.05), indicating that the treatment group and the control group had improved serum ALT, AST, in improving serum ALT treatment group was significantly better than the control group. After treatment, the TC and TG were significantly lowered, and before and after treatment. TC and TG had statistically significant difference (P＜0.01). After treatment. TC, and TG in two groups, differences were statistically significant (P＜0.05; P＜0.01). and the treatment group was significantly lower than the control group. After treatment, the BMI were significantly reduced in two groups, and the BMI differences were statistically significant (P ＜0.05) before and after treatment. After treatment, the symptom pattern scores were significantly reduced in two groups. Before and after treatment, the differences were statistically significant (P＜0.01). After treatment, the symptom pattern scores in two groups were statistically significant (P＜0.01), which showed that the clinical symptoms in both groups had been improved, while the treatment group had a better effect than the control group. After the treatment, the main symptoms as the epigastric fullness, hypochondrium distention, anorexia, lassitude, loose stools and so on in two groups were statistically significant (P＜0.01), which showed that the clinical symptoms in both groups had been improved, while the treatment group had a better effect than the control group.
4.4Conclusions:
The results above showed that, the TRAEM for non-alcoholic steatohepatitis, could significantly improve the clinical signs and symptoms, especially the epigastric fullness, hypochondrium distention, anorexia, lassitude, loose stools and so on. Also liver function, regulation of blood lipids and reducing the body weight could be significantly improved. Comparing to the modern western medicine, silibinin capsules for non-alcoholic steatohepatitis, the TRAEM had obvious advantages on liver function improvement and blood lipids regulation.
Conclusions
Through three years'learning and researching in-depth on articles and papers of Prof.Wei, the academic thinking and clinical experience were deeply mined and systematic summarized. The core of academic thinking,"tonify the spleen-stomach, modify the ascending and descending, regulating the stomach meridian, and descending yin fire", was proposed, useful exploration was conducted by applying the academic thinking and clinical experience with good effect. So the aim of good inheritance and development was achieved, and clinical skills and academic levels were greatly improved.
引文
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