论文标题:肠澼（溃疡性结肠炎）的古代文献研究
Hypotensive Effect of Huoxuejiangyafang in SHR and Its Mechanism
论文作者 张艳红
论文导师 董尚朴,论文学位 硕士,论文专业 中医基础理论
论文单位 河北医科大学,点击次数 118,论文页数 124页File Size636k
2004-03-01论文网 http://www.lw23.com/lunwen_8533252/ 溃疡性结肠炎;范畴;病因病机;主要症状;辨证论治;方剂;病案
“changpi”; UC;scope;cause and pathogenesis;key symptom;treatment based on syndrome differentiation;prescription, caseUC : Ulcerative Colitis TCM: Traditional Chinese Medicine
近年来由于人们生活水平的不断提高、饮食结构、生活习惯的改变，肠澼（溃疡性结肠炎）发病率呈现逐年上升趋势。本病治愈难度大，愈后又常易复发，与结肠癌的发病存在一定的关系。中医药在防治上积累了丰富的经验，治疗上取得了比较满意的疗效。从春秋战国时代到清末，历经二千多年，积累了大量的文献资料。本文记述了春秋战国时期到清末历代中医文献中有关肠澼（溃疡性结肠炎）的认识。本文主要内容分为五个部分。第一节为肠澼的范畴。肠澼在不同的历史时代，又被称为“久痢”、“休息痢”等，且“休息痢”一词使用广泛，中医学将具有“腹痛、里急后重，赤白脓血便”表现的疾病，统归于中医学的“痢疾”范畴内，故本论文所涉及的文献中“久痢”、“休息痢”与“肠澼”当视为同一概念。我们认为，现代临床上具有脓血便症状而缠绵难愈的疾病主要是慢性溃疡性结肠炎。在本节中也对溃疡性结肠炎与其他病作了鉴别。由于条件所限，本论文只讨论溃疡性结肠炎较常见的慢性持续型和慢性复发型。主要对病因病机、主要症状（腹痛、里急后重、赤白脓血便）、八纲辨证（主要是虚实、寒热辨证）、治法、方剂等进行深入地探讨。第二节为春秋至秦汉时期对痢疾的认识。从这一时期的医学概述、病名、病因、主要症状等方面来阐述对痢疾的认识。这一时期的医学文献反映出本时期对该病的病因病机、症状的认识比较肤浅，所用药物种类及方剂数量较少，而且缺乏变化。东汉时期的张仲景对休息痢的研究提供了初步的认识和方剂。第三节是两晋至隋唐时期对痢疾的认识。这一时期对该病的病因病机、主要症状及休息痢有了较深入的认识，由于这一时期大批方书的出现，治疗本病的方剂较为丰富。第四节为宋金元时期痢疾理论的发展。这一时期，生产力水平较高，中医药也得到了较快的发展，出现了进一步进行理论上的探讨与提高的阶段。以金元时代医学流派的产生达到高潮。这一时期对痢疾病因病机的认识比较全面，主要症状分析较明确，促进了辨证论治原则的具体贯彻，在治法方剂方面也得到了提高，由于在这一时期官方对医学事业的重视，官方颁行的方书盛行，治疗痢疾的方剂比较丰富。对休息痢从病因病机方面也有了新的认识。第五节为明清时期对痢疾的论述。这一时期对该病的病因病机的论述更加全面，主要症状的病因病机、八纲辨证、治法、方剂等方面的分析更加明晰，虚实寒热辨证更加分明，辨证论治更加精当，方药运用上更加灵活，尤其对休息痢的病因病机、分类、治疗等方在更加深入、全面、透彻地进行了剖析。这一时期认为休息痢的病因病机有：一是痢疾补塞太早，又加以不慎调摄，以致余邪不尽而形成休息痢；二是过服凉药，以致气血虚、脾胃虚、肾虚；三是误服涩药余毒不散；四是是肾虚不固，五是寒积在大肠底；六是中气下陷；七是脏寒虚滑；八是冷积日久，竟至药所不到之地，所以多年不愈；九是瘀热伏于膜油隐藏慝之地；十是实因有原虫伏于大小肠曲折之处；十一是非因痢之毒菌未净，实因外感之热潜伏未净，而成休息痢。上述十一条中后三条为这一时期的新见，都是中西会通的观点，但第十条显然是指阿米巴痢和菌痢。这一时期的贡献以辩证用药的精当为突出，还提出了痢疾治疗中的注意事项、误治及其后果，并分析了其中的原因。临床的实际经验也非常丰富。并对患者的病程及分阶段用药进行了详实地记载。对后人的研究提供了借鉴和指导。附录1、附录2分别为肠澼医案选录和历代治疗肠澼的方剂选录，主要收集了唐、宋、明、清时期针对西医溃疡性结肠炎来说，病程接近、证候表现明确、对当今临床溃疡性结肠炎的治疗有指导和实用价值的痢疾的病案和方剂，通过参考这些具体的治疗“久痢”“休息痢”的方剂和病例，我们更进一步了解溃疡性结肠炎的辨证论治和谴方用药，对中医的辨证求因、治病求本等基本原则，有了更深刻的认识，以古为鉴，更好地将理论与临床实践相结合，为广大患者服务。
UC(Ulcerative Colitis)is chronic colitis. The fast tempo of modern life, the improvement of peple’s lives, the development of structure of peple’s diets and the change of the life habits, the incidence of “changpi”(UC) seem to has been presenting a rising trend year after year. It is difficult to cure this disease and often has a relapse even if it has been cured. It is related to the colon cancer. There is unique experience and satisfatory effect using TCM to cure it. The doctors of past dynasties accumulated ample documents and materials in researching prevention and treatment of UC. The article had recorded the knowledge of UC from the Spring and Autumn Period(770～476B.C.)and the Warring States(475～221 B.C.)to the Qing Dynasty.There are five sectors in the thesis. In the first part, the author limits the scope of the “changpi”. The diseases which possess the symptoms including abdominal pain, tenesmus, pus and blood dysentery, reddish and whitish of the dysentery are all belongd to “the dysentery” in the TCM. In terms of the main symptoms, comparing with the syndromes of “the dysentery” in the TCM, the author drew the conclusion that UC belongs to the “changpi”(UC)in the TCM. Chronic dysentery、“changpi” are viewed as the same concept in the article.The paper only discussed the types of the chronic relapse and the chronic continuance of UC because of the restriction of the condition. In the third to the sixth sector, the author discussed documents about UC from the Spring and Autumn Period(770～476B.C.)and the Warring States(475～221 B.C.)to the Qing Dynasty. From many perspectives involving the brief account of the medical development, the etiologic factor and pathomechanism, the main symptoms, syndrome differentiation of asthenia and sthenia, syndrome differentiation of cold and heat, etc, the author analysed the research about these documents. Through the detailed analysis, the author indicated that the cause and pathomechanism of UC covering the main syndromes such as abdominal pain, tenesmus, pus and blood dysentery, reddish and whitish of the dysentery is very complicated and diversified, emphasized the vital importance of etiologic analysis based on syndrome differentiation. During the treatment of UC, the author introduced various treatments and precriptions, there are some matters that should be paid much attention to at the same time. The last sectors are the prescription and case aiming at the “Chronic Dysentery”. The author valued the flexibility of choice of prescriptions and the Chinese traditional medicines and highly underlines the treatment based on syndrome differentiation.
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