周铭心教授学术思想与临床经验总结及调冲法治疗不孕症的研究

【作者】 赵明芬；

【导师】 周铭心；

【作者基本信息】 北京中医药大学 ， 中医内科， 2012， 博士

【摘要】 研究背景：为整理、总结、挖掘名老中医的学术思想和临证经验,2008年国家人事部、教育部、卫生部、国家中医药管理局及国务院学位委员会组织和实施了第四批名老中医药专家学术思想经验继承工作。周铭心教授长期坚持中医诊疗、教学、科研工作30余年,在中医内科疑难杂病、新疆多发疾病和中医妇科病等方面有丰富经验和独到见解。本次在周铭心教授的指导下,进行一次较为系统、全面地研究、整理、总结其数十余年的学术思想、临证经验。研究目的：通过整理、总结名老中医周铭心教授的学术思想与临床经验,以探索其临证规律及学术特色,挖掘其科学内涵,并加以升华和创新。以便于更好地继承名老中医学术经验,弘扬和繁荣中医药事业。研究方法：1.通过每周跟师临证抄方2次,收集处方300份,书写跟师笔记,跟师月记,以及师生问难,老师释疑,定期讲课、口传心授等多种方法随时记录老师的学术观点,再加以重整、疏理、总结、概括老师的学术思想,临证经验和特色。2.全面收集整理关于周铭心教授及其弟子发表的反映其相关学术观点的论文共140余篇、著作2部,结合中医经典理论的学习,查阅相关古文献书籍121部,清华同方文献780篇,追溯老师学术思想的渊源和理论依据,剖析其学术脉络以总结老师的学术思想、临证经验。3.收集周铭心教授近10年治疗不孕症门诊病历及保存完好的原始资料回顾性病历等150例,运用Excel软件进行频数分析,对患者基本情况、处方药物等进行描述。运用聚类分析等相关数理统计与中医药基本理论系统分类归纳相结合的方法,分析其用药规律及特点。结合自己临床实践进行思辩、领悟、总结、分析、凝练其辨证、立法、处方、药物特点,找寻其病因病机、辨证论治及用药规律与特色,并加以挖掘、深化、升华、创新提出新观点,新理论,新治法。研究结果：1.周铭心教授在诊治理论上提出并善用排除辨证法。排除辨证法分为三类,即穷举排除、对举排除和特举排除。2.周铭心教授在论治策略方面提出四种方法,并擅用之：其四种诊治策略即正治策、权变策、矫正策、规诫策四类。在治法方面提出旁治法,即从旁而治。简言之,旁治就是对既定之证采取与其病机部位、性质或时态不相切合的治法治疗。旁治法有旁性、旁位和旁时而治的区别。3.在养生方面提出“王道养生”养生预防思想。提倡修德宁心以长寿,顺应地域、四时气候。虚邪贼风,避之有时,食饮有节,起居有常。反对霸道养生。4.在内科方面提出西北多燥证。针对西北燥证,提出逆治,从治,旁治三法原则。具体遣方用药则有宣、散、通、达、温、清、升、降、柔、润等法。5.在心肺疾病诊治方面,独创排闼宗阳法。排闼宗阳法即畅疏胸憻,振奋宗气之法,启天气于肺系,引中气于脾胃,和血分于心营,使宗气充而顺。内科重视治理脾胃,常将脾胃药运用分作补土、培土、保土、护土四法。6.在妇科临床中,周老师重视奇经理论,尤其重视冲脉的调理。在不孕症时用调冲6法。即注冲、达冲、固冲、降冲、清冲、和冲六法。7.临证处方用药特色：理法方药有据,辨证执简驭繁。遣药主次跌宕,处方量宏力专。相反相成配伍,灵活运用经典。其法遵仲景、鞠通先贤,结合病证各施以寒热并用、攻补兼施、敛散结合、升降相因、润燥互配、刚柔既济、动静相伍、使之相反相成。结论：周铭心教授提出及善用排除辨证法,以正治、权变、矫正、规诫为诊治策略。以“王道养生”为养生预防思想。发现并善治西北燥证。独创排闼宗阳法诊治心肺疾病。内科重视治理脾胃,妇科重视调理冲脉。临证处方具有遣药主次跌宕,处方量宏力专,相反相成配伍,灵活运用经典之特色。更多还原

【Abstract】 Background:In order to organize, summarize, and study the academic thought and clinical experience of the famous and old Traditional Chinese Medicine (TCM) doctor, in 2008 the Ministry of Personnel, Ministry of Education, Ministry of Health, State Administration of Traditional Chinese Medicine and the State Council Academic Degrees Committee of the organization and implementation of the fourth of the old Chinese medicine experts work experience in academic thinking inherited. Professor Zhou Mingxin works in Traditional Chinese Medicine clinics, teaching and research for more than 30 years, has extensive experiences and insights in Miscellaneous Diseases of TCM Internal Medicine, multiple diseases in Xinjiang and diseases in TCM Gynecology. Under the guidance of Professor Zhou Mingxin, to conduct a more systematic and comprehensive research, organize, summarize the dozens of years of academic ideas, clinical experience.Research Objective:To organize, summarize famous and old TCM doctor Professor Zhou Mingxin’s academic thinking and clinical experience to explore the laws of clinical and academic characteristics, tap its scientific connotation, and sublimate and innovation. It makes us to better inherit famous and old TCM doctors’experience, promote and prosper the pharmaceutical industry.Methods:1. Through methods such as copied prescription by 2 times a week with the teacher Clinical,300 prescriptions were collected, write notes, teacher and students to each other discussions, regular lectures, and other way to keep records of the teacher’s academic point of view, and reform, analyse, summary the teacher’s academic thought, clinical experience and features.2. A comprehensive compilation of information on Professor Zhou Mingxin and his disciples published reflect the views of academic papers related to a total of 140 articles, book 2, Combined with Chinese classical theory of learning, access to ancient literature books 121, Tongfang literature 780, traced the origin of the teacher of academic thought and theoretical basis to analyze the academic context in order to summarize the teacher’s academic thinking, clinical experience.3. the collection of Professor Zhou Mingxin the last 10 years the treatment of infertility patient medical records and well-preserved original data reviewed medical records of 150 cases, the use of Excel software for frequency analysis, the basic situation of the patient, prescription drugs are described. The use of cluster analysis and other related mathematical statistics and the basic theory of Chinese medicine grouped together in a combination of methods, analysis of the drug laws and characteristics. In conjunction with their clinical practice for speculation, and understand, summarize, analyze, concise its dialectical, legislation, prescription, drug characteristics, to find its etiology and pathogenesis, diagnosis, treatment, drug laws and characteristics, to excavat, deepened sublimation, innovation put forward new ideas, new theories and new therapies.Results:1. Professor Zhou Mingxin invent and use the pattern identification of exclusion in the diagnosis and treatment. This method is divided into three categories, namely exhaustive exclusion, in contrast to excluded and specialy exclude.2. Professor Zhou Mingxin raised in treatment strategy based on four methods, and using it. diagnosis and treatment of the four policies are straight treatment, contingency measures, correction policy, counsel caution. In the law aspect of treatment, he advocate side to propose treatment the law, namely treatment from side. In short, if side treatment is to decide the card to adopt treatment the law treatment which the pathogenesis spot, the nature or the period do not suit. Side treatment the law to have the difference which the nature, side the position and side treatment from time to time.3. Proposes "the kingly way keeping in good health" in the keeping in good health aspect the keeping in good health prevention thought. To advocate accumulates good conduct germany, the innermost feelings is peaceful, only then may achieve the healthy and longevity, comply with the geographical, climatic seasons. We may avoid vacuity evil and bandit wind. The daily life like diet, the sleep must be orderly. Opposes the overbearing keeping in good health.4. more than dryness pattern in the northwest of medical evidence put forward. For the Northwest dryness pattern, we propose three principle that counteracting treatment, paradoxical treatment and next to the rule. Herbal Prescription is a specific declaration, diffusion, dissipate, free, outthrust, warm, clear, up, down, emolliate, moisten, etc.5. Diagnoses the aspect at heart and lung disease, the original creation law that is Paitazongyang. Paitazongyang law the namely smooth sparse chest, law of rouses the pectoral qi, Turn on the lung Qi and to be interlinked with above internal organs, cited in the air in the stomach, Reconcile the blood reach the heart and yingfen, Cases of pectoral qi adequate and smooth. He is great importance in the medical aspects of conditioning spleen and stomach. this method often divided into effects, cultivating, consolidating, protecting four methods.6. In the gynecological clinic, my teacher attention by the theory, with particular emphasis on the thoroughfare Vessel of the conditioning. In particular, when used in infertility treatment of reconciling thoroughfare Vessel on the importance of conditioning by 6 method. To sum up, there are Six rule:filling, obstruction-removing, solidifing, declining, clearing, and mediating.7. Clinical characteristics of prescription drugs:It has evident to theory, law, herbs. Using Simple method to syndrome differentiation and treatment from complex method Main drugs and secondary drugs is a big difference in the amount of drugs. Because of the drug on prescription volume, it has highly targeted and very good efficacy. Using opposite and yet be complementary. In compatibility of medicines, flexibly to use the classic. The law compliance Zhang zhongjing, Wu ju tong sages, each subjected to using warming and heat-clearing, simultaneously, reinforcement and elimination in combination, constringencing and scattering in combination, uping and lowering in combination, using moistening anddrying simultaneously, coordinating harding and softing, compatibility of medicines using quietness and motion, to achieve opposite and yet be complementary.Conclusion:Professor Zhou Mingxin invent and use the pattern identification of exclusion in the diagnosis. Diagnosis and treatment of the four policies are straight treatment, contingency measures, correction policy, counsel caution. Proposes "the kingly way keeping in good health" in the keeping in good health aspect the keeping in good health prevention thought. He has found and able to diagnosis and treatment of Northwest dryness pattern. Diagnoses the aspect at heart and lung disease, the original creation law that is Paitazongyang. He is great importance in the medical aspects of conditioning spleen and stomach. In the gynecological clinic, he is attention on the thoroughfare Vessel of the conditioning. Clinical characteristics of prescription drugs:Main drugs and secondary drugs is a big difference in the amount of drugs. Because of the drug on prescription volume, it has highly targeted and very good efficacy. Using opposite and yet be complementary. In compatibility of medicines, flexibly to use the classic.更多还原