衢州雷氏医学的形成、源流及学术思想

[目的]探索挖掘衢州雷氏医学的形成背景、源流及学术思想特色。[方法]采用传统医史文献整理研究方法和现代数据库挖掘技术相结合的研究手段,对雷氏医学的形成背景、源流及学术思想特色进行系统分析和总结。[结果]衢州地理环境优越、地区经济繁荣、历史文化深厚、社会环境独特等各种因素为雷氏医学的形成奠定了基础。随着新安名医程芝田至衢州行医后,将程氏医学与各家学说融汇贯通,并把以心法审证用药的学术特色也带到衢州,衢州先后涌现出雷少逸、雷大震、程曦、江诚、龚香圃等许多医家,并形成了独具特色的衢州雷氏医学。雷氏医学学术思想来源于中医经典,传承于学术交流,创新于融会新知,重视衷中参西,提倡分层论治,用药四因制宜。[结论]衢州地理位置独特,人杰地灵,孕育了灿烂的医学文明。随着程芝田授其徒雷逸仙为始肇端,逐渐形成了崇尚经典、博采众长、勇于创新、知时辨治的雷氏医学,其学术思想对现代中医临床仍有较大的指导意义,值得深入研究和借鉴。     

衢州雷氏医学的学术特色

[目的]探索挖掘衢州雷氏医学的学术特色。[方法]采用传统医史文献整理研究的方法，从时病、内科、儿科、女科、老年病、杂病、针灸等方面对雷氏医学的学术特色进行系统分析、总结。[结果]衢州作为“丹溪医派”“新安医学”“杨继洲针灸”之融汇处、涵养地，在诊治疾病方面独具特色。雷氏医学认为时医应正确掌握四时五运六气的变化规律，并构建了全新的以四时六气为纲目“知时论证、辨体立法”的时病辨治体系，立法处方提倡用法而不用方。内科广泛运用脏腑辨证，同时还结合六经辨证、三焦辨证、卫气营血辨证、八纲辨证及病因辨证，临证依据病邪特点而治。儿科强调四诊合参，首重望诊，临证当明辨体质差异，治疗因人而异；小儿脾胃易伤，治疗时重视小儿脾胃的特点，处处顾及脾胃。女科注意圆机活法，通权达变，善于抓住妇人经、带、胎、产的生理特点辨证用药。老年病大多本虚标实，治疗首先以扶正为主，祛邪为辅，并且扶正多从先、后天之本着眼。杂病需提纲挈领，以常见病因病机为纲，又注意区分常证变证、兼证夹证，临证不忘多法并用以提高临床疗效。针灸融合了新安针灸名家和杨继洲针灸的学术思想和理论，选穴注意辨病与辨证相结合。[结论]衢州雷氏医学在传承中医精华的...     

衢州雷氏医学著作编撰特点浅析

[目的] 归纳衢州雷氏医学著作编撰特点,并浅要探讨其形成原因。[方法] 以雷氏医学著作为研究对象,并选取代表性著作进行重点挖掘,对其内容、体例进行系统分析梳理,总结流派著作在编撰方面的共性和特点,同时联系雷氏医学的学术特色、当地特定的地域文化及历史背景,总结规律,探讨成因。 [结果] 雷氏医学诞生于清代晚期,地域文化底蕴深厚,以著述立学传家是衢州雷氏医学主要传承方式之一,通过对其医著著作形式、编排方式的梳理,发现雷氏医著具备编排体例独特、源流考证清明、要言不烦、切于实用、利于传承等共性特色,其成因或与清代学界思潮和雷氏医家医儒相济的学术背景有关。[结论] 对衢州雷氏医著的编撰特点及成因进行浅要阐析,能够为探索衢州雷氏医学流派发展脉络提供新的思路和尝试。     

丹溪学派与雷氏医学的交汇融通

[目的]探索挖掘雷氏医学与丹溪学派之间的渊源以及雷氏医学对丹溪学说的传承发挥。[方法]采用传统医史文献整理研究方法和现代数据库挖掘技术相结合的研究手段,对雷氏医学与丹溪学派之间的渊源以及雷氏医学对丹溪学说的传承发挥进行系统分析、总结。[结果]位于金华义乌的丹溪学派和与之邻近的衢州雷氏医学多有交融互鉴,雷氏医学深受丹溪学说的影响,在融通提高中泛化,促进了雷氏医学兼收并蓄且独具特色的学术特色及体系形成。丹溪学派与雷氏医学均源远流长,两者地域邻近、环境相似、文化融合、交流频繁,而且学派传人均素养精良。雷氏医学充分地继承发挥了丹溪学说,对中医经典提倡继承与创新并重,辨证论治以“气、血、痰、郁”为纲,临证处方注意审因制宜,用药主张养阴调胃扶正气,将治未病思想贯穿治疗始终。[结论]丹溪学派促进了雷氏医学学术思想的形成,而雷氏医学在传承的基础上进行了发展创新,扩大了丹溪学派的影响,促进了中医学的理论体系创新及临床实践发展。     

林钦甫运用雷氏活血祛风法治疗肢体麻木经验浅谈

《时病论》成书于1882年,由清代医家雷丰所著,他是衢州雷氏医学学术思想的主要构建者。衢州雷氏医学发源于新安医学,至今已有200多年的历史,是衢州地区主要的医学流派。林钦甫,衢州市雷氏医学第五代传承人,行医60余年,其医疗事迹及名录收录于《浙江当代中医名人志》和《中医名医列传·当代卷》[1]。     

林钦甫儿科临证特色

[目的]总结衢州雷氏医学第五代学术传承人林钦甫儿科临证特色。[方法]通过长期跟师衢州雷氏医学第五代学术传承人林钦甫老中医抄方学习,观察林老诊治方式,体悟林老辨证方法和用药思想,同时通过整理林老典型临床医案,查阅林老论文著作,综合探寻林老儿科临证特色。[结果]林钦甫儿科辨证重视经典理论,立法注意药性升降,辅偏救弊,治疗儿童时病,遵循雷丰六十法;诊断上特别重视望诊,通过观神色定病势,审苗窍定病位,审三关定病性,重视小儿嫩阴嫩阳之生理,通过平复心神、平衡阴阳、平和治法,平和药性调理,且处处顾及脾胃。[结论]林钦甫儿科学术思想上传承汇通新安王氏医学和衢州雷氏医学,诊断上在四诊合参的基础上重视望诊,立法用药上重视小儿体质,以平和方法、药物达到小儿阴阳平衡,具有鲜明特色。     

少弱精子症中医辨治策略初探

[目的]探析少弱精子症的中医辨治策略,为男性不育症的规范诊治提供理论依据。[方法]通过对少弱精子症的辨病辨证、微观辨精、脏腑辨证、遣方用药、方证辨证、体质调理、摄生调养等方面的分析,探讨男性不育症辨治策略,并结合临床验案予以佐证。[结果]中医治疗少弱精子症策略当先辨病后辨证,辨病用药与辨证用药相结合,辨证求因,审因论治,此外须重视微观辨证以及辨精论治;遣方用药上,方证辨证具有高效、便捷的优点,方剂不仅可以直接治疗相应的证,还可以直接针对体质进行调理;补肾法固然是中医治疗男性不育症的重要法则,但临床治疗少弱精子症不应拘泥于补肾,同时兼顾其他脏腑,重视肝肾同源理论的运用;不忘摄生调养,采取综合治疗措施的辨治策略。"审症—诊病—辨人(体质)—识证"的辨治模式来选方用药诊治少弱精子不育症,灵活变通,可取得良好的临床疗效。[结论]上述中医少弱精子症的辨治原则和方法经验独到,疗效卓著,为男性不育症的规范诊治提供理论依据,值得临床推广与进一步研究。     

方剂学教学中突出新安医学特色的方法

安徽中医药大学在办学过程中,十分重视新安医学的传承、研究和开发,逐渐形成“弘扬新安医学,培育中医人才”的办学特色。方剂学教学应在完成教学大纲规定任务的同时,根据课程特点,将新安医家的学术思想、诊疗经验以及新安医学的现代研究进展等融入其中。具体方法为总论概述新安医家对方剂学理论的贡献,各论突出新安医家学术思想和制方特点,联系新安医家有关论述和用药经验剖析药物。     

试析儒家孝文化对新安医学的影响

[目的]探析儒家孝文化对新安医学的影响。[方法]采用文献分析法,以新安医家生平事迹及其相关著作为主要研究对象,从内在动力、传承方式、行医准则、经世致用四个方面,对儒家孝文化对新安医学的影响进行归纳与分析。[结果]儒家孝文化对新安医学的影响体现在：为新安医学提供优质的儒医资源、铸就父子相传与师徒相授的医学传承方式、培养新安医家“仁”“义”兼修的行医准则、推动新安医家发挥程朱理学的“经世致用”精神。基于对儒家孝文化精神内涵与外延的深刻把握,新安医家孝而行医、精研医理、延续医术、修仁行义、关注民生、尽忠报国,实现了修身、齐家、治国、平天下的人生理想与目标。[结论]新安医学中所体现的儒文化特质与人文精神,对于当代医学生与医务工作者的医疗实践活动具有一定借鉴意义。     

王孟英辨脉治肺经验浅析

[目的]总结《王氏医案》中辨脉论治肺病的临床经验。[方法]分析《王氏医案》中的六则医案,整理王氏以脉理释病机、辨治肺病及选方用药的思路。[结果]王氏所选六则肺病医案,均为他医误治,或久治、延治不愈的重症顽疾,或虚实难辨,或寒热错杂,或脏腑同病。王氏诊察三部九候之脏腑定位,细推气血阴阳之变化,明辨寒热虚实之真伪,以脉解证,以脉定证;阐述重症顽疾中滑数脉、弦滑脉、滑而缓脉的临床意义,寸滑如珠、尺中小细的脏腑定位,真脏脉如雀啄脉、解索脉的病因病机,指导精准用药,为后世医家拓展了辨证论治思路。[结论]脉诊对于临证,尤其是肺病重症顽疾的辨治,具有重要指导意义。王氏临证重视脉诊,辨脉治肺经验丰富,值得进一步探索和学习。     

Holistic Approach to Functional Constipation: Perspective of Traditional Persian Medicine

Traditional Persian medicine (TPM) proposes a different viewpoint to the chronic diseases. Diagnosis and implemented treatment are based on individual differences among patients. Constipation or Ea''teghal-e-batn is a condition in which the patient develops difficult or painful defecation. Based on TPM concepts, the first digestion step starts from halq (oral cavity), and ends via defecation from the maq''ad (anus). Avicenna believed that four faculties, ha''zemeh (digestive), ja''zebeh (absorptive), ma''sekeh (retentive) and da''fe''eh (propulsive), are involved in the process of digestion and absorption of the ingested food and expelling the waste materials. The bowel movement and appearance of the stool is a measure for evaluating the gastrointestinal healthy function. Defecation should be with no pain and fecal material should have no burning and acuity. Low food intake or foods with dry temperament, dryness of gastrointestinal tract, diaphoresis and heavy exercise as well as intestine sensory loss were discussed as main causes of constipation. Management of constipation in TPM includes dietary schemes, oil massages and subsequently simple herbal medicines. According to TPM theories, the first step in treating a disease is the elimination of disease causes (asbab e-maraz) and also providing the causes of health (asbab-e-sehhat). Health care providers should know the proper condition which the herbal medicines should be administered in and be able to guide the patients about the benefits and hazards of herbal remedies, commonly used in their living origin.     

Wilson''s Disease: Update on Integrated Chinese and Western Medicine

Wilson’s disease (WD), or hepatolenticular degeneration, is an autosomal recessive inheritance disorder of copper metabolism caused by ATP7B gene mutation. As WD is an inherited disease of the nervous system that is not curable; early diagnosis with early and life-long treatment leads to better prognoses. Currently, the recommended treatment for WD is integrated Chinese and Western medicine. A number of studies indicate that treatment of integrative medicine can not only enforce the de-copper effect but also improve liver function, intelligence, and other factors. This article reviewed in detail the advantages of WD treated with Chinese and Western medicine together.     

A Survey of Application of Complementary and Alternative Medicine in Chinese Patients with Parkinson''s Disease: A Pilot Study

Objective: To investigate the prevalence and spectrum of complementary and alternative medicine (CAM) application and its related-factors in Parkinson''s disease (PD) patients in China. Methods: A structured questionnaire regarding the use of CAMs was administered to PD patients by face-to-face interview. Demographic and social variables, clinical characteristics and treatments, and the related factors of PD were also surveyed. Results: Ninety out of 113 patients (79.6%) reported that they had received CAMs treatment, of which 48.6% (55/113) patients had received CAMs treatment for PD. The top 3 kinds of CAMs for PD were Chinese materia medica, rehabilitation exercise, and acupuncture ordinally. The source of information regarding CAMs treatment mainly came from relatives and friends (51.8%, 73 cases), followed by physicians (31.9%, 45 cases), and medias such as television, newspapers or the internet (16.3%, 28 cases). Fifty percent of CAM users reported a good therapeutic efficacy, whereas 39% patients reported that they felt neither better nor worse after the treatment, while 11% patients claimed worsening of symptoms. Multiple correspondence analyses survey found the main factors affecting the selectivity of CAMs ranked in the following order: income, education, occupation, habitation, age at onset, Hoehn and Yahr staging, PD duration, and gender. Conclusion: CAMs, especially Chinese materia medica, rehabilitation exercise, and acupuncture, are widely used for PD patients in China.     

Herbal Medicine in the Treatment of Alzheimer’s Disease

Associated with the aging of our world population is a sharp increase in the incidence of Alzheimer’s disease,which not only poses a significant health issue but also presents a serious social problem.Although pharmacological treatments were developed based on existing hypotheses,the disease pathogenesis remains to be fully elucidated.Given the complexity of Alzheimer’s disease,Chinese herbal medicine appears to have therapeutic potential for Alzheimer’s disease through multi-target and multi-pathway approach at cellular and molecular levels and holistic adjustment of the body at organ system levels.Recently,a significant breakthrough has been made in the research of Chinese medicine for Alzheimer’s disease.In this article,we review the experimental research progress in understanding how Chinese medicine could be used for the treatment of Alzheimer’s disease.     

中医药治疗阿尔茨海默症的研究进展

中医药作为治疗阿尔茨海默症的方法之一,近年来取得了一定的研究进展。对针灸、中药方剂、针药结合治疗阿尔茨海默症的临床应用特点及其相关作用机制进行总结,对中医药在治疗阿尔茨海默症中的应用进行了展望,以期为阿尔茨海默症的治疗提供新思路、新方法。      

帕金森病自主神经功能障碍中西医结合诊治专家共识(2020)

帕金森病(Parkinson's disease, PD)自主神经功能障碍是常见的非运动症状之一,贯穿疾病始终,其临床表现复杂,个体差异性大,严重影响患者生活质量,是PD治疗的重点与难点。治疗上西医多遵循指南,但证据有限,重在对症处理;而中医的整体观念和辨证论治可以多症兼顾,临床经验积累较多,是对西医治疗的有效补充,中西医结合则可更有效地改善PD自主神经功能障碍。国内PD领域的中、西医专家秉承“病证结合,诊治协同”的理念,综合各自优势,形成PD自主神经功能障碍中西医结合诊治专家共识,以期为临床医师对PD自主神经功能障碍的诊疗提供参考。      

Chinese Medicine for Alzheimer's Disease: A Meta-Analysis of Randomized Controlled Trials

Objective: To evaluate the efficacy of oral Chinese medicine(CM) in comparison with donepezil, a cholinesterase inhibitor(ChEI), for the treatment of Alzheimer's disease(AD). Methods: Randomized controlled trials(RCTs) have been searched, and the effect of CM compared with donepezil in AD has been investigated. An electronic search of MEDLINE, Excerpta Medica Database(EMBASE), Cochrane Library, Chinese Biological Medicine Database(CBMdisc), and China National Knowledge Infrastructure(CNKI) to identify articles in English and Chinese from the inception of the database until October 18, 2015. A modified Jadad score(7-points) to judge the methodological quality of studies, comprehensive meta-analysis was performed with Cochrane Collaboration Revman 5.3. Dichotomous data were analyzed by relative risk(RR) with a 95% confidence interval(CI), while continuous variables were analyzed by using mean differences(MD) with 95% CI for effect size. Results: Six studies involving 596 AD patients through Jadad assessment with low bias were included in the meta-analysis. No significant difference was observed in cognitive improvement and daily abilities of patients using the Mini Mental State Examination(MMSE)(MD: 0.69, 95% CI: –0.17 to 1.56) and Activities of Daily Living(ADL) scale(MD: 0.94, 95% CI: –1.54 to 3.43). There were no significant differences in status of illness or MD for mild-moderate AD patients at 24 weeks(MD: 0.62, 95% CI: –2.99 to 4.23) and 48 weeks(MD: –0.73, 95% CI: –5.02 to 3.56). Severe AD patients were also assessed at 24 weeks(MD: 3.13, 95% CI: –6.92 to 13.18) and 48 weeks(MD: 4.23, 95% CI: –6.38 to 14.84). Furthermore, compared with donepezil, Xin(Heart)-regulating CM and Shen(Kidney)-tonifying groups were observed(MD: –1.50, 95% CI: –3.08 to 0.08; MD: –1.92, 95% CI: –3.50 to –0.33; respectively). CM had fewer side effects in AD patients. Conclusion: Compared with donepezil, oral CM showed no significant difference in effectiveness in AD patients, and more evidence is needed to verify the findings.     

Chinese Medicine for Idiopathic Parkinson's Disease: A Meta Analysis of Randomized Controlled Trials

Objective:To evaluate the efficacy of Chinese medicine(CM) adjunct to conventional medications for idiopathic Parkinson's disease(PD).Methods:Electronic English and Chinese databases including PubMed,Cochrane Library,Web of Science,Chinese Medical Current Contents,China National Knowledge Infrastructure,China Science and Technology Journal Database,Wanfang Med Database,and Traditional Chinese Medical Database System were used for key words searching in a highly sensitive search strategy.The extracted data was analyzed by the Review Manager 5.0.Results:Twelve trials involving 869 participants were included in the meta-analysis.Unified PD Rating Scale(UPDRS) I,Ⅱ,Ⅲ,Ⅳ scores and UPDRS Ⅰ-Ⅳ total scores were used to be the primary outcomes,Parkinson Disease Question-39(PDQ-39) and Scores of Chinese Medical Symptoms were the secondary outcomes.CM adjunct therapy had greater improvement in UPDRS Ⅰ[2 trials;standardized mean difference(SMD)-0.40,95%confidence interval(CI)-0.71 to-0.09;Z=2.49(P=0.01)],Ⅱ[5 trials;SMD-0.47,95%CI-0.69 to-0.25;Z=4.20(P0.01)],Ⅲ[5 trials;SMD-0.35,95%CI-0.57 to-0.13;Z=3.16(P=0.002)],Ⅳ scores[3 trials;SMD-0.32,95%CI-0.60 to-0.03;Z=2.17(P=0.03)],UPDRS Ⅰ-Ⅳ total scores[7 trials;SMD-0.36,95%CI-0.53 to-0.20;Z=4.24(P0.05)].PDQ-39 and Chinese medical symptoms compared to the conventional medication only.Conclusion:CM adjunct therapy has potential therapeutic benefits by decreasing UPDRS scores and reducing adverse effect.     

Traditional Chinese Medicine for Modern Treatment of Parkinson''s Disease

Parkinson’s disease (PD) is a chronic and progressive degenerative disorder of brain commonly seen among the elderly. As conventionally medical therapy is of limited relief and potential side effects, complementary and alternative medicine (CAM) has attracted growing public and professional attention. Therapies such as acupuncture, musical/rhythmic therapy and deep brain stimulation have been gradually proved positively in clinic. In this review, we retrospected the scientifific or evidence-based-medicine advances of application and research for modern treatment of PD by CAM, especially traditional Chinese medicine in categories.     

Analysis of Clinical Evaluation of Response to Treatment of Parkinson’s Disease with Integrated Chinese and Western Medicine Therapy

Objective:To analyze the clinical evaluation of Parkinson's disease(PD) patients receiving integrated Chinese and Western medicine therapy.Methods:One hundred and twenty patients were enrolled and randomly allocated to a control group or treatment group.Patients in the two groups received placebo and Bushen Huoxue Granule(补肾活血颗粒,BHG),respectively.Both groups received baseline levodopa and benserazide(Madopar).The effects of treatment were assessed monthly during the 9-month treatment.Means of evaluation included Unified PD Rating Scale(UPDRS) scores(Ⅱ and Ⅲ),sleep scale score,10 m turn back test(getting up time,10 m×2 times,and turning time),timing motor test(TMT)-left and TMT-right,which were treated as the dependent variables;and age,sex,duration of PD,Hoehn and Yahr(H-Y) stage and Madopar dosage of admitted PD patients were as the independent variables.Multiple linear regression was used to analyze these factors.Results:H-Y stage significantly affected UPDRS Ⅱ score,UPDRS Ⅲ score,and getting up time(P0.01).Madopar dosage and H-Y stage significantly affected the 10 m×2 times(P0.05 or P0.01).Madopar dosage significantly affected the sleep scale score(P0.05).There were also significant correlations between age and TMT-left or TMT-right(P0.01),and duration of PD and TMT-right(P0.05).Conclusions:The six assessed means of clinical evaluation(including UPDRS Ⅱ and UPDRS Ⅲ scores,sleep scale score,getting up time,10 m×2 times,and turning time) are sensitive indexes in all PD patients.H-Y stage and Madopar dosage are the major factors influencing means of clinical assessment of PD treatment.