【作者】 王丽华；

【导师】 洪广祥；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2012， 博士

【摘要】 本论文是在导师洪广祥教授指导下,论文运用中医学宗气理论对慢性阻塞性肿疾病稳定期的病因病机、病理因素、证候特点、治则治法、具体方药、临床研究进行了深入的探讨。论文的前言部分,简要介绍了慢性阻塞性肺疾病的定义、诊断、发病机制、流行病学,指出了慢性阻塞性肺疾病稳定期的治疗至关重要,这也是中医的优势,并指出洪广祥教授治疗慢性阻塞性肺疾病积累了丰富的经验,总结其学术思想及治疗经验,具有十分重要意义。论文的第一部分,系统回顾了古代中医学文献对宗气理论的认识,后世医家在《内经》有关论述的基础上,不断发展,逐步认识了宗气的形成、分布与生理功能。宗气作为一种活力之气,在人体气学理论中发挥着重要作用,宗气与人身诸气发生着密切的联系,宗气的盛衰直接关系到一身之气的盛衰,接着本文又论述了宗气与元气、卫气的关系。论文继续深入阐明了宗气与脏腑的关系：宗气既是脏腑功能活动的结果,又是保障脏腑功能正常活动的原动力。论文的第二部分,详细探讨了中医对慢性阻塞性肺疾病的诊治概况：古代文献及现代中医对慢性阻塞性肺疾病的病因病机认识多立足于本虚标实。发作期以外邪、痰瘀互结为标实,稳定期正虚为主。接着综述了现代中医对慢性阻塞性肺疾病的治则治法,分析了中医治疗慢性阻塞性肺疾病的优势。论文的第三部分,论述了洪广祥教授运用宗气理论治疗慢性阻塞性肺疾病稳定期的临床经验。为中医药辨治慢性阻塞性肺疾病提供临床思路与方法。论文分别从病因病机、证候特点、治则治法、常用方药等方面进行了论述。洪教授在宗气理论的指导下,指出宗气虚是慢性阻塞性肺疾病发病的中心环节：宗气虚是慢性阻塞性肺疾病本虚的关键因素,是引起痰瘀伏肺的主要原因,是导致外邪反复入侵的根本原因,呼吸肌疲劳是宗气虚衰的结果。因此补益宗气是慢性阻塞性肺疾病稳定期的重要治则。接着论文论述了洪教授补益宗气临床的具体运用,包括补益肺脾、益气温阳护卫、益气温阳培元三种治法,重点指出补益宗气重在补益肺脾。益气温阳是补益宗气的重要内容,并强调治疗慢性阻塞性肺疾病需坚持补虚泻实,补益宗气不忘涤痰行瘀。明确指出补中益气汤为补益宗气的核心方药,并详细介绍了随症加减方药,接着对益气(温阳)护卫汤,补元汤的适应症进行分析。指出形成痰、瘀的原因有虚有实,排痰可通畅气道,活血化瘀可提高整体疗效,补虚泻实需全程进行,论述了导师涤痰行瘀的具体方药。并列举三个典型病例,对补益肺脾、益气温阳、涤痰行瘀的具体运用时机、方药及疗效进行了分析,论证了洪教授运用宗气理论治疗该病的思路及有效性。最后论文指出补益宗气治疗慢性阻塞性肺疾病稳定期具有治“未病”的意义。论文的第四部分,观察补元汤加味对慢性阻塞性肺疾病稳定期BODE指数的影响。方法是将60例符合慢性阻塞性肺疾病稳定期诊断标准的患者,随机分为治疗组及对照组,每组各30例。治疗组服用中药汤剂：补元汤加味,每日一剂。对照组按需使用吸入型支气管舒张剂：可必特。两组观察时间均为六个月。每2个月对患者BODE指数各因素进行跟踪检测：体重指数、FEVI测定、呼吸困难分级、6分钟步行距离。动态观察两种治疗对各因素的影响程度及BODE指数水平的变化,并比较差异性。结果：治疗6个月后,治疗组与对照组相比较,FEV1%pred、6分种步行距离(6MWT)、体重指数(BMI)、呼吸困难以及BODE指数改善明显(P<0.05)。治疗组在6个月的治疗过程中,随着疗程的增加,各项因素及BODE指数水平改善更加显著。得出结论：补元汤加味能有效改善慢性阻塞性肺疾病稳定期患者肺功能、运动耐力、营养状况及BODE指数,BODE指数是一项客观、系统的COPD稳定期疗效评价指标。论文的第五部分,回顾了近年来中医对慢性阻塞性肺疾病的病因病机、治则治法的认识,中医药在慢性阻塞性肺疾病预防与治疗方面取得的进步以及存在的问题,并指出今后的发展思路及方向。更多还原

【Abstract】 This paper is completed in her teacher, Professor Hong Guang-xiang’s guidance. And in this article, the write presents Professor Hong Guangxiang’s experience in applying the theory of Zong Qi in treating chronic obstructive pulmonary disease (COPD) in stable stage of academic thought, and treatment experience of system consolidation summary. Papers using Zong Qi theories on etiology and mechanism of stable stage of COPD, pathological factors, characteristics of syndrome and treatment principle of therapeutic methods, clinical studies, in-depth discussions of specific prescriptions.In the introduction, the author presents the definition, diagnosis occurrence, Epidemiology and the treatment of COPD. Points out it is very important to the treatment of COPD in stable stage.This is also the advantages of TCM. Moreover, the writer Points out that Professor Hong has accumulated affluent experience in the treatment of COPD, so this study of his academic idea and clinical experience is very important.In the first section of the paper, the author presents a systematic review of ancient Chinese medical literature on Zong Qi in theory, Doctors through the ages on the basis of relevant expositions of the 《NeiJing》, continuous development, understand the characteristic of Zong Qi, on the formation and distribution and physiological function. Zong Qi as a kind of vitality of the gas, playing an important role in the human body gas theory, Zong Qi and personal the gas has close relations, it directly relate to the ups and downs of the human body gas, then this paper discusses the relationship between Zong Qi and Yuan Qi Wei Qi. To further clarify the relations of zang-fu organs and Zong Qi in the paper:Zong Qi is not only the result of the active visceral functions, and ensure the normal visceral functions the driving force of the function.In the second section, the paper provides a systemic statement for the TCM on the COPD diagnosis and treatment:the ancient times literature and modern Chinese medicine thought the etiology of COPD more based on deficiency Ben and excessive Biao. Exogenous evils and phlegm and blood stasis obstructed in Lung collaterals are mainly focus in the stage of attack, the weakness of vital-qi is t he emphasis in stable. The paper reviews the principle of COPD by the Modern Chinese medicine, analyzes the advantage of TCM therapy. In the third section, this paper discusses the clinical experience of professor Hong’s treatment of COPD in stable about Zong Qi’s theory. They are respectively discussed from the etiology, principle therapies and commonly medicine, etc in this paper. Professor Hong points out that the attack of COPD is due to the insufficiency of Zong Qi in the direction of the theory of Zong Qi:the insufficiency of Zong Qi is virtual key factors, can cause phlegm and blood stasis, can cause the Exogenous evils repeated invasion, can cause respiratory muscle fatigue. Therefore, the main therapeutic principle of COPD in stable is benefiting Zong Qi. Then this paper discusses professor Hong’s clinical application of benefiting Zong Qi, including lung, spleen, Warming yang, filling vigour, the emphasis is on the benefiting lung and spleen. Warming Yang is the important content of the benefiting Zong Qi. The paper insists that reducing the excessive and replenishing the deficient, insists clearing polyester phlegm and stasis while benefiting Zong Qi. The core of the benefit of Zong Qi’s prescriptions and herbs is Buzhong Yiqi Tang. And introduces the formulas to add and subtract in clinic, then analysing the Zong Qi indications of YiQi (WenYang) Hu Wei Tang and BuYuan Tang. The paper points out that the cause of formation phlegm and stasis has deficiency and excess. Rowing phlegm can unobstructed airway. Removing blood stasis can improve the overall efficacy. So the paper declares the professor Hong’s prescriptions and herbs on phlegm and stasis. The paper list three typical cases to illustrate the concrete application of time and curative effect from strengthening the spleen and tonifying the lung, benefitting Qi Yang, clearing blood stasis and sputum. These cases demonstrate the thoughts of Zong Qi theory by professor Hong and effective. Final the paper points out that benefitting Zong Qi for COPD including meaning of "treating before illness".In the fourth section. Objective:To observe the effect of modified Bu-yuan-tang on the BODE index in patients with COPD in stable stage. The methods:60patients who met the Diagnostic Criteria for COPD in stable stage were randomly and equally allocated to the treatment group (30patients) and control group (30patients). The treatment group was given traditional Chinese medicine:modified Bu-yuan-tang, one dose per day, while the control group was given Compound Ipratropium Bromide according to need. Six-months are need for clinical observation on the two groups. Then tracking the factors of patient every two months, such as body mass index (BMI). FEV1%pred. grades of Dyspnea, six minute walking distance (6MWT), and observing and comparing the changes in various factors and BODE index between two groups treated with different methods dynamically. The result:After6month’s treatment, Comparing with those in the control group or before therapy, the level of the various factors and BODE index in the treatment group were significantly improved (P<0.05), and the level of the various factors and BODE index improve greatly with the increase in treatment. The colclusion: Clinical studies with modified Bu-yuan-tang have shown substantial improvement in lung function, exercise capacity, nutritional status and BODE index. BODE index is an objective and systematic evaluating indicator for curative effect in patients with COPD in stable stage.In the last section, the author reviews the important development of the prevention and therapeutics of COPD in TCM that we have recently achieved, but there are many questions, too. At last, the author points out the development and the direction of the research of COPD.更多还原