王坤根教授代谢综合征诊治经验探析
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摘要
[目的]探讨王坤根教授诊疗代谢综合征(Metabolic Syndrome,MS)的经验。[方法]通过对王师论文、著作的学习,聆听教诲,以及对典型医案的收集、整理,分别从病名归属、病因病机、遣方用药三方面总结其MS诊治经验,并举验案予以佐证。[结果]王师研读经典、兼收并蓄,并结合多年临证经验指出:MS属中医"肥满"范畴,可合并"肝癖""脾瘅""消渴""眩晕""头痛""胸痹""历节"等病症。先天不足、后天失养、情志所伤、年事增长为其发病原因;病位主要在中焦脾胃,而与肾、肝密切相关;脾胃运化失司、肾气虚惫、肝失疏泄为其基本病机;膏、浊、痰、瘀为其主要病理产物;本病多属本虚标实,肾气亏虚为其本,膏浊痰瘀内阻为其标。治疗常以自拟方三术二陈一桂汤加减温肾运脾、调肝理气、化浊活血,随证加减既注重根据患者主诉进行辨证论治,亦强调参照发病机理辨病用药。所举案例,亦获良效。[结论]王师诊疗MS注重气化,标本兼顾,常取佳效,值得后学借鉴。
[Objective] To explore Prof. WANG Kungen's academic thought in diagnosing and treating metabolic syndrome(MS). [Method] To study and research Professor WANG's papers and books, to follow his guidance and to collect and arrange typical cases record, by these methods to summarize Prof.WANG Kungen's academic thought in treating MS. The summarization is divided into three parts, that is, the name of the disease, the etiology and pathogenesis, curative doctrine and medication. And two solid cases were presented to prove it. [Result] Combined with classic theories and personal experience, Professor WANG points out: MS belongs to "grossness"in TCM, which can cause dozens of complications, such as fatty liver, glucose tolerance abnormal, diabetes, hypertension, coronary heart disease, gout, etc. The etiology is congenital deficiency, improper diet, emotional factors and aging. The spleen and the stomach is the main location of the disease. While the kidney and liver are also related. It is caused by disorder of spleen and stomach transportation and transformation, liver dysfunction, deficiency of kidney Qi and accumulation of paste, turbid, phlegm and blood stasis. This disease is basically asthenia in origin and in superficiality. Kidney Qi deficiency is the original cause, while paste, turbid, phlegm and blood stasis accumulation are the superficial phenomena. The main formula is San Zhu Er Chen Yi Gui Tang which attaches importance to warming kidney Qi and promoting spleen Qi,regulating the liver Qi, as well as resolving turbidity and activating blood. And the cases in this article have obtained good result.[Conclusion] While paying attention to Qi transformation and taking account of both manifestation and root cause, Prof. WANG has a remarkable effect on treating MS, which is worth learning.
[Objective] To explore Prof. WANG Kungen's academic thought in diagnosing and treating metabolic syndrome(MS). [Method] To study and research Professor WANG's papers and books, to follow his guidance and to collect and arrange typical cases record, by these methods to summarize Prof.WANG Kungen's academic thought in treating MS. The summarization is divided into three parts, that is, the name of the disease, the etiology and pathogenesis, curative doctrine and medication. And two solid cases were presented to prove it. [Result] Combined with classic theories and personal experience, Professor WANG points out: MS belongs to "grossness"in TCM, which can cause dozens of complications, such as fatty liver, glucose tolerance abnormal, diabetes, hypertension, coronary heart disease, gout, etc. The etiology is congenital deficiency, improper diet, emotional factors and aging. The spleen and the stomach is the main location of the disease. While the kidney and liver are also related. It is caused by disorder of spleen and stomach transportation and transformation, liver dysfunction, deficiency of kidney Qi and accumulation of paste, turbid, phlegm and blood stasis. This disease is basically asthenia in origin and in superficiality. Kidney Qi deficiency is the original cause, while paste, turbid, phlegm and blood stasis accumulation are the superficial phenomena. The main formula is San Zhu Er Chen Yi Gui Tang which attaches importance to warming kidney Qi and promoting spleen Qi,regulating the liver Qi, as well as resolving turbidity and activating blood. And the cases in this article have obtained good result.[Conclusion] While paying attention to Qi transformation and taking account of both manifestation and root cause, Prof. WANG has a remarkable effect on treating MS, which is worth learning.
引文
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[15]张介宾.类经图翼·类经附翼评注[M].西安:陕西科学技术出版社,1996:395-400.ZHANG Jiebin.Commentary of the Book Wings to the Classified Canon[M].Xi'an:Shanxi Science and Technology Press,1996:395-400.
[16]秦越人.难经[M].北京:科学技术文献出版社,1996:30-31.QI Yueren.Classic on Medical Problems[M].Beijing:Science and Technology Literature Publishing House,1996:30-31.
[2]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中国糖尿病杂志,2018,10(1):43.Chinese Diabetes Society.Guidelines for the prevention and control of type 2 diabetes in China(2017 edition)[J].Chinese Journal of Diabetes,2018,10(1):43.
[3]Targher G.Day CP,Bonora E.Risk of Cardiovascular Disease in Patients with Nonalcoholic Fatty Liver Disease[J].New England Journal of Medicine,2018,10(1):4-6.
[4]Tchernof A,Despres JP.Pathophysiology of human visceral obesity:an update[J].Physilogical Reviews,2013,93(1):359-365.
[5]刘艳飞,李博,刘玥,等.中药制剂对代谢综合征干预效应的Meta分析[J].医学研究杂志,2017,46(8):49-55.LIU Yanfei,LI Bo,LIU Yue,et al.Meta-analysis of the intervention effect of traditional Chinese medicine on metabolic syndrome[J].Journal of Medical Research,2017,46(8):49-55.
[6]韩曼,周丽波.基于专家访谈的代谢综合征中医病名、基本证候、病因病机及用药规律研究[J]中医杂志,2011,52(22):1918-1920.HAN Man,ZHOU Libo.Study on the name of the disease,basic syndrome,pathogenesis and law of prescription of the metabolic syndrome,based on experts interviews[J]Journal of Traditional Chinese Medicine,2011,52(22):1918-1920.
[7]高凡.周易新解[M].北京:中央编译出版社,2014:95.GAO Fan.New Explanation of the Book Changes[M].Beijing:Central compilation&translation press,2014:95.
[8]张年顺.李东垣医学全书[M].北京:中国中医药出版社,2006:34.ZHANG Nianshun.Medical encyclopedia of Li Dongyuan[M].Beijing:China Press of Traditional Chinese Medicine,2006:34.
[9]任继学.任继学经验集[M].北京:人民卫生出版社,2009:75.REN Jixue.Collection of Ren Jixue’s Medical Experience[M].Beijing:People's Health Press,2009:75.
[10]何梦瑶.医碥[M].北京:中国中医药出版社,2009:8.HE Mengyao.Fundamentals of Medicine[M].Beijing:China Press of Traditional Chinese Medicine,2009:8.
[11]唐容川.血证论[M].北京:人民卫生出版社,2005:11.TANG Rongchuan.A Treatise on Blood Troubles[M].Beijing:People's Medical Publishing House,2005:11.
[12]黄璐琦,张瑞贤.道地药材理论与文献研究[M].上海:上海科学技术出版社,2016:104-106.HUANG Luqi,ZHANG Ruixian.Study on the theory and literature of Famous-region drug[M].Shanghai:Shanghai Scientific and Technical Publishers,2016:104-106.
[13]吴昆.医方考[M].北京:中国中医药出版社,2007.WU Kun.Medical Formulae Investigations[M].Beijing:China Press of Traditional Chinese Medicine,2007.
[14]李中梓.医宗必读[M].天津:天津科学技术出版社,1999:7.LI Zhongzi.Essential Readings for Medical Professionals[M].Tianjin:Tianjin Science and Technology Press,1999:7.
[15]张介宾.类经图翼·类经附翼评注[M].西安:陕西科学技术出版社,1996:395-400.ZHANG Jiebin.Commentary of the Book Wings to the Classified Canon[M].Xi'an:Shanxi Science and Technology Press,1996:395-400.
[16]秦越人.难经[M].北京:科学技术文献出版社,1996:30-31.QI Yueren.Classic on Medical Problems[M].Beijing:Science and Technology Literature Publishing House,1996:30-31.
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