【作者】 罗汉文；

【导师】 陈志维；

【作者基本信息】 广州中医药大学 ， 中医骨伤科学， 2011， 博士

【摘要】 目的：脾胃是五脏六腑中具有特色的一对脏腑,理论上说,它们是“后天之本”,具有重要的理论价值；从临床上说,从脾胃着手治疗疾病,更符合中医调理的特色,具有积极的临床价值；脾胃学说也是五脏中唯一的一个自成系统的学说,有其重要的学术价值。本研究目的在于粗浅地探讨中医脾胃理论的形成及其导师陈志维教授在骨伤科方面的运用中医脾胃论的临床经验,为脾胃学说寻找更深刻的理论渊源,拓宽中医脾胃理论治疗骨伤科方面疾病的治疗思路,更好地为临床服务。方法：通过大量阅读和总结前人留下的文献和医案,探讨中医脾胃理论形成的理论渊源,寻求中医脾胃理论的奠基、发展、充实和完善的历史过程。通过跟师随诊,做好随师笔记,收集典型病例,分析随师临证心得,总结导师陈志维教授在骨伤科方面的运用中医脾胃论的临床经验。并通过临床研究,运用健脾的代表方参苓白术散加减治疗120例创伤后皮肉缺损的病人,随机分为中药组和对照组,口服中药后第3,7,13天取创面的组织做活检。观察肉芽组织生长情况、创面组织的毛细血管数和成纤维细胞数,探讨运用中医脾胃理论处方用药能否有效地促进肉芽组织的生长,加速伤口的愈合,从而进一步验证中医脾胃论在骨伤科方面的应用价值。成果：中医脾胃理论的形成分四个阶段即：奠基于秦汉时期、发展于魏晋隋唐、充实于宋金元、完善于明清时期。也就是说：中医脾胃理论,经历了从《内经》、《伤寒论》到李东垣的《脾胃论》方趋形成,直到明清,叶氏胃阴学说的创立,使脾胃理论在阴阳、气血、升降、温燥、刚柔方面更趋完善,从而给后世治疗脾胃病开辟了更宽广的道路。中医认为脾胃乃后天之本,其生理功能主要是胃主受纳,腐熟水谷；脾主运化,主统血,主四肢、肌肉等。脾胃共为气血生化之源。这些功能对维护人的生命起着至关重要的作用。临床运用补益脾胃的方法可以治疗多种疾病,并取得显著的疗效。因此对脾胃学说本质的研究引起了国内医学界广泛的兴趣。目前特别是对脾本质及健脾益气类方药的研究逐渐深入,在中医理论的指导下,运用传统与现代研究相结合的方法,从生理、生化、病理等多学科、多指标、多途径,由临床到实验及动物模型等进行了广泛的研究,取得了可喜的进展。这对加速中医现代化起着很重要的作用。陈志维教授深受此影响,据此,陈志维教授在临床工作中非常重视脾胃,多从脾胃着手进行治疗,形成了一套自己的辨证方法和治疗原则。认为脾胃就好像大地生长万物一样,脾胃是五脏之气协调通畅、正常运转的枢轴；如若内伤脾胃,则百病由生。陈志维教授根据骨伤科的特点从脾胃生理功能、病理特点、以及脾胃的相互关系理解入手,引经据典,结合现代医学知识,深入细致分析,逐步建立了“治伤当重脾胃”的基本思想,认为应在此基础上将调理脾胃法贯穿骨折治疗的始末,并在伤科临证时形成了“治伤三期辨证调理脾胃”的学术思想。将脾胃理论广泛运用于骨折、软组织损伤和伤科杂病方面,大大地丰富了中医骨伤疾病内治法的内涵。我们根据陈志维教授的运用中医脾胃理论的经验,经过临床实验运用健脾的代表方参苓白术散加减治疗创伤后皮肉缺损的病人,发现该组患者创面组织的毛细血管数和成纤维细胞数较对照组多,肉芽组织增生较对照组早而快。运用健脾的方药能有效地促进肉芽组织的生长,增强创面组织中bFGF及EGF蛋白表达,加速伤口的愈合,体现了脾主四肢、肌肉中医理论的临床运用价值。结论：脾胃学说是祖国医学理论体系中的重要组成部分,它丰富的理论在今天仍广泛而有效地指导着临床实践。《内经》和《伤寒论》奠定了脾胃理论的基础。古代医家喻脾胃为土,而土为万物生长发育之本,脾胃不仅仅是指脾胃解剖学的概念,而主要的是以比类取象的方法籍以说明其在人体生命活动中的主导地位。《内经》认为：“脾脉者土也,孤脏以灌四傍者也”。“脾胃者,仓廪之官,五味出焉”。由于“胃为水谷之海”,人“以胃气为本”,而五脏“皆禀气于胃”,故又有脾胃为“五脏之本”,人体气血生化之源泉的说法。李杲以脾胃理论,阐发内伤热中证,不落窠臼,独创新义,自成一家,形成了较系统的中医脾胃理论,对后世医家薛己、张介宾、李中梓、叶桂等人产生巨大的影响。关于脾与胃之间的密切生理联系,《内经》亦作了正确的说明,指出脾胃同居中焦,共同消化吸收水谷精微,所谓“饮入于胃,游溢精气,上输于脾,脾气散津,上归于肺,通调水道,下输膀胧,水津四布,五津并行,合于四时五脏阴阳,撰度以为常也”,即是指此而言。并还把脾胃的重要生理功能称之为“胃气”提出“平人之常气禀于胃……人无胃气曰逆,逆者死”。正因为人体脏腑组织、五官九窍、四肢百骸无不需要脾胃所化生的气血以濡养,所以当脾胃之气既伤,则元气也不能充而衰少,则人体阴阳失衡,从而导致疾病的发生。脾胃是五脏六腑中具有特色的一对脏腑,从理论上说,它们是“后天之本”,具有重要的理论价值；笔者临床实验研究发现根据中医脾胃理论治疗创伤后皮肉缺损的病人能有效地促进肉芽组织的生长,加速伤口的愈合。从临床上说,从脾胃着手治疗疾病,更符合中医调理的特色,具有积极的临床价值；脾胃学说也是五脏中唯一的一个自成系统的学说,有其重要的学术价值。本文粗浅地探讨中医脾胃理论的形成及其在骨伤科方面的运用价值,抛砖引玉,为脾胃学说寻找更深刻的理论渊源,从而拓宽中医脾胃理论治疗骨伤科方面疾病的治疗思路,更好地为临床服务。更多还原

【Abstract】 ObjectiveSpleen-stomach is a pair of characteristic organs of the vital organs of the human body, in theory, they are the foundation of acquired constitution, and of great theoretical value; from the clinical, Treatment of disease through spleen-stomach is more in line with the regulation of Chinese medicine features, and is of positive of clinical value; spleen-stomach theory is also a self-contained system of only one of the five Zang-organs theory, has an important academic value. The objective of the study is superficial discussion on the formation of TCM theory of spleen-stomach and orthopedics Professor and tutor Chen Zhiwei using TCM spleen-stomach theory to clinical experience, looking for deeper theoretical sources for Spleen-stomach theory and broaden the traditional Chinese medicine theory of spleen-stomach in the treatment of Orthopedic diseases treatment, better clinical services.MethodsThrough reading and summarizing a large number of documents and medical records of our predecessors left to explore the origin of TCM spleen-stomach theory, seek foundation of TCM Spleen-stomach theory, history of development, improve and perfect. Through following up along with teacher, writing notes, collecting tyspleencal cases, analyzing of the tutor’s clinic experience of treating disease, summarizing tutor Professor Chen Zhiwei’s clinic experience of using TCM spleen-stomach theory in orthopedics. Through clinical research, with Spleen strong and representatives of the Powder of Ginseng, Poria and Atractylodis Macrocephalae in treating120cases of traumatic skin defect after patients, randomly divided into control group and TCM groups, TCM groups on the3rd,7,13days taking wound tissue to pathological examination. Observation of granulation tissue growth, number of capillary vessel in wound tissue and fibroblasts, discussion on if the application of spleen-stomach theory of TCM prescription drug can effectively promote the growth of granulation tissue, accelerating wound healing, so as to further verify that the value of TCM spleen-stomach theory in orthopedics.ResultsFormation of TCM spleen-stomach theory is divided into four stages:based on the Qin and Han dynasties, developed in the Wei, Jin, Sui and Tang dynasties, enriched in Song, Jin and.Yuan dynasties, perfect in Ming and Qing dynasties. That is to say, Traditional Chinese medicine theory of spleen-stomach, experienced from the 《Huangdi Nei jing》、《Treatise on Fevrile Diseases》 the treatise of Li dongyuan’ s Spleen-wei on the formation of parties, until the Ming and Qing dynasties. Ye’s wei-Yin theory of creation, spleen-stomach theory of yin and Yang, Qi and blood temperature, lifting, and dryness, rigid and perfect, thus later treating spleen-stomach disease has opened up a wider road. These functions play a vital role to the preservation of human life. Clinical application of invigorating spleen-stomach can treat various diseases and achieve significant efficacy. So study on the essence of spleen-stomach theory caused a country wide interest in the medical field. At present particularly on the nature of the spleen and the gradual in-depth study of invigorating spleen and replenishing qi recipe, under the direction of the theory of traditional Chinese medicine, the use of combination of traditional and modern research methods, through physiology, biochemistry, pathology etc. multi-disciplinary, multi-index, multi-channel, by extensive research on clinical laboratories and animal models, gratifying progress has been made. This plays a very important role on accelerating the modernization of traditional Chinese medicine.Professor Chen Zhiwei deeply affected by the method, the growth of spleen-stomach just like all the other things, spleen-stomach is the role of the five zang, which ensure the coordination and the normal operation of it; if it hurted inside, the disease will produce. Accordingly, Professor Chen Zhiwei put great emphasis on Spleen-stomach in Clinical works and proceed treatment from the side and have formed a dialectical approach and treatment principles. Professor Chen Zhiwei according to the characteristics of orthopedic, study from the physiological functions、pathological features and the relationship of them, citing from the post of past, combined with modern medical knowledge, by in-depth and detailed analysis, have gradually established the method of "Spleen-stomach is the primary of the wounded", that is the basic idea should be go throughout the treatment. It has been widely used in the fracture、 soft tissue injury and miscellaneous diseases, the connotation of the orthopedics inner disease treatment have greatly connotations.According to this experience and theory, we use the Powder of Ginseng, Poria and Atractylodis Macrocephalae on the patient with skin defection on trauma,which is the invigorating spleen and replenishing qi Decoction of strengthening spleen, The result is the capillary vessel number and fibroblast cell number of the treat group more than the control group, and more earlier and faster than the control group in the proliferation of granulation tissue. Spleen governing limbs and muscles, so in the traditional Chinese medicine, Spleen can effectively promote the growth of granulation tissue and accelerate wound healing.ConclusionThe theory of Spleen-stomach is the traditional medicine theory system’s important component, it’s rich theory in today is still widely and effectively guide the clinical practice.《Huangdi Nei jing》、《Treatise on Fevrile Diseases》 laid the theoretical foundation of the theory and ancient physicians regarded the spleen and stomach as the soil, and soil is the fundamental of the growth of the universe. Spleen-stomach not only means the spleen and stomach anatomically, primarily symbolization its dominant position in activity of human body life. Because all the organs and tissues, limbs and bones are all needs the Nutrition of Qi and blood provided from Spleen-stomach, So when the Qi of Spleen-stomach hurted, the energy can’t be charged and declined, and the imbalance of Yin and Yang lost and the disease occurred. Spleen-stomach has its characteristics in the viscera, They are" spleen being acquired foundation" from theoretic aspects, and has its important theoretical value. According to the theory we found in the treatment of traumatic skin defect of the patient, growth of granulation tissue, and the wound healing would be accelerated. Treatment from Spleen-stomach would be more in line with the characteristics of Chinese medicine and has positive clinical value From a clinical aspects. The theory is still only a system theory in five organs and has important academic value. This paper briefly discusses the formation of the Spleen-stomach theory and its value in orthopedic. We can search more profound theoretical origin, to widening the treatment ideas on orthopedic diseases and servicing the clinical works better.更多还原