王琦教授学术思想和临床经验总结及从“瘀浊”分期论治慢性前列腺炎的临床研究

【作者】 李东；

【导师】 王琦；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2011， 博士

【摘要】 目的：非常有幸成为王琦教授的学术继承人,跟师学习,受益匪浅,跟师过程中见证了其广博的学术思想和丰富的临床经验,体验了其治疗疑难杂病用方之灵巧,疗效之精准,深感名医大师高尚的医德和严谨的治学态度。为进一步提高自己并惠及他人的学习,发挥中医师承教育的作用,将王琦教授的学术思想和临床经验加以总结和传承,尤其是其从体质出发,辨体治病,以及治疗男科的学术思想和临床经验,治疗内科杂症的临床用方思想和经验等,期望能不断提高自己的疗效,更好的服务于患者。临床研究以慢性前列腺炎的临床研究为例,探讨王琦教授的临床用方思想和经验。慢性前列腺炎为泌尿男科常见病和疑难病,该病病因病理复杂,症状表现多样,体征不典型,病情迁延,反复发作,经久难愈,临床发病率呈上升趋势,且给患者精神、健康和生活质量带来严重影响。临床研究课题旨在运用中医药理论全面认识慢性前列腺炎,对王琦教授治疗慢性前列腺炎的学术思想和临床经验进行总结,通过临床科学研究将其经验升华为科学性,从而为临床上更好地治疗慢性前列腺炎提供一定的理论依据。方法：因属于师承学习,所以不同于一般的基础和临床研究,首先回顾了指导老师的学术渊源,王琦教授并没有出身于中医世家,主要靠自己长期的临床实践,系统的研究生学习,勤奋努力,勤求古训,博采众长,最终形成自身的学术思想。文章重点进行了王琦教授学术思想和临床经验的整理和研究,首先概述了王琦教授在体质学和男科学方面最重要的学术观点,如体质学上“体病相关”、“体质可调”的理论；男科学上“阳痿从肝论治”；男性不育,应“补肾益精、活血化瘀、兼清湿热”的学术思想和观点。其中最重要的是对王琦教授临床经验的整理与研究,用具体实例探讨了王琦教授“辨体治病”的临床经验；男科病方面的学术思想和临床经验；治疗内科杂病的临床经验,对其用方思想进行了细致的梳理,概括为注重辨体用方、用方广博兼容、方剂小巧凝练、用方依理多发挥、重视合方思想、基于临床经验自拟方等,并通过大量的案例进行了临床经验的整理与研究,在典型医案后面都进行了讨论和分析,提出自己跟师学习以来的感悟和对指导老师经验的探讨和体会。最后进行了指导老师学术经验的临床研究,针对慢性前列腺炎的多发性、复杂性以及王琦教授在慢性前列腺炎方面独到见解和丰富的临床经验,以及治疗上用方的特殊性,进行了王琦教授治疗慢性前列腺炎的临床研究,采用随机对照的研究方法,共纳入120例慢性前列腺炎病例,分为两组,每组60例,每组又按证候分组为初中期和后期。治疗组根据王琦教授的临床经验,初中期以当归贝母苦参丸合五草汤加减；后期以复元活血汤合(或)桂枝茯苓丸加减。对照组按常规初中期以八正散加减；后期以少腹逐瘀汤加减。两组均以60天为一疗程,一疗程后,对治疗前后慢性前列腺炎症状评分(NIH-CPSI)、前列腺按摩液的变化以及前列腺指诊结果进行评价,对王琦教授论治慢性前列腺炎临床效果进行综合评定。结果：通过对王琦教授学术思想的研究,探寻了中医名家的成才之路；通过对临床经验的整理和研究,不仅提高了继承人的临床技能和理论水平,而且所总结出的名家临床经验,必定惠及广大的患者,使中医传承系列化、规范化,真正发挥中医传承教育的作用。临床研究结果对慢性前列腺炎的治疗具有重要的指导意义,通过临床科学研究将王琦教授的临床经验升华为科学理论,从而为临床上更好地治疗慢性前列腺炎提供一定的理论依据。临床研究总体疗效评定：治疗组60天治愈率、显效率、有效率、无效率分别为30%、40%、23.3%、6.7%；对照组分别为16.7%、25%、30%、28.3%(P<0.05)。结论：通过对慢性前列腺炎患者症状评分(NIH-CPSI)、前列腺按摩液的变化以及前列腺指诊结果进行评价,证明王琦教授“分期论治”,从“瘀浊”辨治慢性前列腺炎的学术思想具有临床实用价值,说明王琦教授临床用方思想和用药临床疗效显著,值得进一步研究和推广。意义：跟师过程中见证了中医临床治疗疑难杂症的奥秘,及用方准确对于临床疗效的意义。观王琦教授临证擅用传统经方、名医名方,也自拟用方,难得的是每方必有大法,而法必明于理,用方灵活多变通,游刃有余。而我们作为中医临床师承学生,如果能很好的总结和提炼中医名师的临床治疗经验和临证用方用药经验,不仅能不断提高自已的疗效,更好的服务于患者,而且能更好的发挥中医传承教育的作用,使名师的学术思想和临床经验发扬光大,惠及后学者,为中医的进一步发展做出我们应有的贡献。王琦教授擅治内科杂症,同时作为男科大家,在慢性前列腺炎的治疗中更是积累了丰富的理论和临床经验,以点带面,总结其治疗慢性前列腺炎的思路和临床经验无疑能丰富中医理论内涵,提高临床疗效,造福患者,为中医的学科传承奠定良好的基础。个人见解：三年的师承学习感慨颇多,先后经历了兴奋、困惑、顿悟、欣喜的不同阶段,首先成为名中医的弟子,能够与名家近距离接触和学习感到无比的兴奋,随后中医管理局严格的考勤制度,书写经典学习笔记、跟师日记、撰写导师临床医案等众多要求与自己繁忙的工作和生活相冲突时,真是感到非常困惑和怀疑,老师严格的要求,更是使我无所适从。随着自己工作学习中对中医认识的进一步增强,临床疗效的不断提高,顿悟到师承学习的重要性和有效性,也对自已经受磨练后的不断进步感到非常欣喜。师承教育是中医教育不可或缺的补充,它可以进一步强化既往学习的不足,尤其是对经典学习的强化,对老师临床经验的总结和感悟,所有这些都将成为我们今后学习和工作的宝贵财富。目的：总结王琦教授治疗慢性前列腺炎的学术思想和临床经验,通过临床研究进一步验证其科学性。采用随机对照的方法评价王琦教授“从瘀浊论治”、“分期论治”慢性前列腺炎的临床疗效。总结王琦教授对慢性前列腺炎病因病机的认识；以及临床不同于其他医家的治疗特色,用方思想,用药特色和规律,使老中医经验发挥其优势和特长,以便更好的指导临床治疗,丰富慢性前列腺炎的治疗思路和方法,为中医治疗学提供更全面的理论基础和指导思想。方法：根据王琦教授治疗慢性前列腺炎的经验和特色,将120例慢性前列腺炎患者随机分为两组,每组60例,每组又按证候分组为初中期和后期。治疗组初中期以当归贝母苦参丸合五草汤加减；后期以复元活血汤合(或)桂枝茯苓丸加减。对照组初中期以八正散加减；后期以少腹逐瘀汤加减。观察组和对照组均每日1剂,煎取.600ml,分两次服用,每次300ml,早晚饭后各一次。两组均以60天为一疗程,一疗程后,对治疗前后慢性前列腺炎症状评分(NIH-CPSI)、前列腺按摩液的变化以及前列腺指诊结果,以及总有效率进行评价。结果：治疗组总有效率为93.3%,对照组总有效率71.7%,两组疗效比较有显著性差异(P<0.05)；治疗组与对照组治疗后NIH-CPSI总分评分均有显著降低,治疗组较对照组NIH-CPSI总分差值差异具有统计学意义,治疗组疗效优于对照组(P<0.05)。无论是初中期还是后期,治疗组在改善疼痛程度方面、排尿症状方面、以及改善生活质量方面都优于对照组,差异具有统计学意义(P<0.05)。治疗组在改善前列腺液中白细胞数、卵磷脂小体密度方面优于对照组,差异具有统计学意义(P<0.05)。结论：采用王琦教授的临床经验,治疗慢性前列腺炎“从瘀浊论治”、“分期论治”、以及运用“辨体—辨病—辨证诊疗模式”确能明显改善慢性前列腺炎患者的疼痛症状、排尿症状,以及改善前列腺液中白细胞和卵磷脂小体情况、改善前列腺指诊情况,明显提高患者生活质量。王琦教授对慢性前列腺炎病机从“湿热、瘀浊阻滞精室”认识具有其科学性,其治疗特色包括辨证论治与分期论治相结合,采用“辨体—辨病—辨证”相结合的三辨诊疗模式,紧密结合现代医学的病因病理,标本兼顾,同时各有侧重等具有高度的临床实用性和有效性；其治疗慢性前列腺炎擅用经方,活用名人名方,根据个人经验自拟方等都值得我们学习和效仿,尤其是其独具一格的用药特色,如谨守病机,慎重选择用药；针对慢性前列腺炎热毒与湿、瘀、浊互结的基本病机,选用清热解毒祛湿、活血化瘀、散结通络之品；用药忌一味苦寒清热,以防苦寒易助湿伤阳,造成疾病缠绵难愈；治疗疾病主张使用黄柏、乌药等药对；提倡白花蛇舌草、威灵仙等专药的使用等对于提高临床疗效更具有实用意义。更多还原

【Abstract】 Purpose:It’s my honor to be an academic successor of professor Wang Qi. During the period of following teacher’s clinic, I benefit a great deal from his extensive academic thoughts and rich clinical experience, feel his dexterous herbal prescription and accurate curative effect on treating difficult and complicated diseases, and understand his noble medical ethics and rigorous academic attitude. It’s necessary to summarize and inherit professor’s academic thoughts and treatment experience in order to improve learners’ clinical level and play a role of master-disciple education of Chinese medicine, especially thinks from constitution differentiation, his academic thoughts and clinical experience in TCM andriatry and internal medicine. It’s an important way of nurturing talents and carrying forward academic thoughts and clinical experience of prestigious experts of Chinese medicine.The study is discussing professor Wang Qi’s academic thoughts and clinical experience in treating chronic prostatitis. Chronic prostatitis is a commonly encountered disease in clinic and is a difficult disease to cure, whose pathological characteristics are complicated, symptoms are diversified and signs aren’t typical. The clinical incidence of chronic prostatitis rises in recent years. It has seriously affected patients’spirit, health and quality of life because it’s recurrent episodes and extremely difficult to be treating. This paper understands chronic prostatitis from the theory of traditional Chinese medicine and summarizes professor Wang Qi’s academic thoughts and clinical experience in treating chronic prostatitis and comprehensively in order to provide certain theoretical basis with better clinical cure effect.Method:Master-disciple education of Chinese medicine is different from the common basic and clinical research. Firstly review professor’s academic origin. He wasn’t born in TCM family of generations. His most important academic contribution is constructing and perfecting constitution and andriatry of Traditional Chinese Medicine (TCM) mainly relying on his own long-term clinical practice, working hard, learning widely from others. Secondly collect and research professor Wang Qi’s academic thoughts and clinical experience. Summarize the most important academic perspectives in TCM constitution and andriatry, such as the theory of "physique relating to disease", "physique being recuperable" in TCM constitution, "treating sexual impotence from liver" in TCM andriatry, "tonifying kidney and benefiting essence, activating blood and resolving stasis with removing dampness and heat" in male infertility. The important job is collating and researching professor Wang Qi’s clinic prescription methods and experience. Professor Wang Qi’s clinic prescription methods are summarized that stressing constitution differentiation, prescription widely and compatibilitily, compact decoction and combined prescription. Manage and research clinical experience through a large number of cases, discuss and analyze typical cases and put forward the insights of own. Finally carrying out clinical research of chronic prostatitis according to the professor’s academic thoughts and clinical experience. The experiment is consist of control and treated phase and includes 60 patients in each group with random control method. In treated group, at the early and middle stages, using modified angelica fritillaria sophora pill and Wu Cao Decoction. At the late stages, using modified decoction for restoration and (or) Guizhi Fuling pill. In control group, at the early and middle stages, using modified Bazhengsan. At the late stages, using modified decoction of shaofuzhuyu.60 days as a treatment course. Comprehensively evaluating clinical effect on treating chronic prostatitis according to the chronic prostatitis symptom index (NIH-CPSI), expressed prostatic secretion, and prostate digital examination between pre and post treatment.Result:Exploring the road to success of Professor Wang Qi based on studying His academic thoughts. Improving the heir’s clinical skills and theoretical level, important guiding significance to treatment of chronic prostatitis through collating and researching professor Wang Qi’s clinic experience. The general efficacy:the curative rate, obvious effective rate, effective rate and ineffective rate at the 60th day respectively are:30%、40%、23.3%、6.7%, they in control group respectively are:16.7%、25%、30%、28.3%,(P<0.05).Conclusion:Based on the assessment of chronic prostatitis symptom index (NIH-CPSI), expressed prostatic secretion, and prostate digital examination, proving effective treatment of chronic prostatitis from blood stasis and blood turbid aspect and clinical feasibility of syndrome differentiation in stage. It is worth to study on popularization of professor Wang Qi’s academic thoughts and clinical experience.Significance:Witnessing magical clinical curative effect of TCM to difficult and complicated cases, and importance of accurate method to clinical curative effect, professor Wang Qi is good at using classical prescription, famous prescription and self-made formula. Every herbal prescriptions he uses must include the fundamental law and more flexible. Summing up and refining clinical experience and prescription methods can prove student’s clinical level and make TCM inheritance seriation and standardization. Professor Wang Qi is good at treatment not only in medicine disease but also in andrology, Especially in treating chronic prostatitis. So summarizing professor’s thoughts and clinical experience in treating chronic prostatitis can enrich the connotation of TCM theory, improve clinical curative effect, benefit patients and lay foundation for TCM inheritance.Personal views:During three years, I experience a lot including excitement, confusion, epiphany, joy and others. I feel excited when I can be a student of a famous doctor and close contact and learning from teacher. Conflictis between strict attendance system, the heavy burden of homework and busy job and life make me really very confused and doubt. I am at loose ends under the professor’s strict requirements. However, I feel glad and realize the necessity and effectiveness of master-disciple education when I enhance understanding of TCM and clinical efficacy. Master-disciple education is indispensable supplement of TCM and it can further strengthen the deficiency of previous learning, especially for TCM classics and summary and sentiment of professor’s clinical experience. All of these will be precious wealth in our future study and work. Purpose:Summarize professor Wang Qi’s academic thoughts and clinical experience in treating chronic prostatitis, which can be promoted to science from clinic research. Evaluate clinical effect of professor Wang Qi’s treating chronic prostatitis from blood stasis and blood turbid aspect and different treatment stages by randomized control method. Summarize etiology and pathogenesis of chronic prostatitis, therapeutic features, prescription thought, characteristics and regularity. It can give full play in veteran physician’s experience in TCM, guide better clinical therapy, enrich ideas and methods in treating chronic prostatitis, and provide comprehensive theoretical basis and guiding ideology for TCM therapeutics.Methods:Based on Professor Wang Qi’s clinical experiences, the experiment is consist of control and treated phase and includes 60 patients in each group with chronic prostatitis. In treated group, at the early and middle stages, using modified angelica fritillaria sophora pill and Wu Cao Decoction. At the late stages, using modified decoction for restoration and (or) Guizhi Fuling pill. In control group, at the early and middle stages, using modified Bazhengsan. At the late stages, using modified decoction of shaofuzhuyu. One dose daily,600 ml were decocted, twice a day,300ml each time. Comprehensively evaluating clinical effect on treating chronic prostatitis according to the NIH-CPSI, prostatic fluid test, and prostate digital examination before treatment and 60 days after treatment.Results:Significant differences were detected in the total effective rates between group and control group (93.3% vs 71.7%, P＜0.05). Remarkable decreases of NIH-CPSI were noted in treatment group and control group (P<0.05). Statistical difference was detected in treatment group compared with control group (P<0.05). Remarkable improvements were observed in the pain relief, urination, life quality, amount of white blood cells and density of lecithin body in prostatic fluid of the treatment group compared with control group (P<0.05).Conclusion:According to professor Wang Qi’s clinical experience, treatment from ’blood stasis and blood turbid aspect’,’different treatment stages’and’model of differentiation of physique, disease and syndrome’, can obviously improve the pain scores, the micturition symptom scores, white blood cells, lecithin body in expressed prostatic secretions and prostate digital examination. And also improve significantly patients’quality of life. The understanding of professor Wang Qi for treating chronic prostatitis from’damp-heat, stagnation of blood stasis in essence room’has scientificalness. The characteristics of therapy are summarized as follows combining syndrome differentiation and treatment in different stages, and model of differentiation of physique, disease and syndrome. Treatment combines with etiology and pathology in modern medicine and clinical practicality and efficiency. Professor Wang is good at using classical prescription, famous prescription and self-made formula in treating chronic prostatitis. Professor Wang’s administration features is worth studying, including adhering to interpretation of the cause; medicine chosen carefully according to basic pathogenesis of chronic prostatitis; choosing heat-clearing and detoxifying, blood-activating and stasis-dissolving, and dredging collaterals and dispersing stagnation herbs; using bitter and cold medicines totally is contraindication, otherwise bitter and cold impairing yang; advocating to use drug pair, such as ’phellodendron and combined spicebush’; using specific medicines such as ’hedyotis diffusa willd, clematis root’ to improve the clinical efficacy.更多还原