节点文献
基于古代医案分析的“肺与大肠相表里”理论的应用研究
【作者】 莫芳芳；
【导师】 高思华；
【作者基本信息】 北京中医药大学 ， 中医基础理论， 2012， 博士
【摘要】 “肺与大肠相表里”理论有着深厚的理论渊源,从《内经》肇始,之后历代医家不断对其进行总结、提炼和升华,使理论逐渐发展完善。本课题依托于历代重要中医古籍,以基础理论、内科和医案类文献为主要研究对象,对“肺与大肠相表里”理论进行古代文献研究。本论文主要分为五个部分进行阐述：第一部分以《中华医典》中医经类、内科类、综合医书类所涉及中医古籍为主要检索书目,再结合《中国医学史》、《各家学说》和《中国中医古籍总目》筛选出各个历史时期比较有影响力的文献著作。以计算机初筛和人工手检相结合,收集“肺与大肠相表里”的有关原始资料。将文献整理与学术史相结合,按照秦汉、晋隋唐、宋金元、明、清五个历史时期对原始资料进行分类汇总。应用文献学的研究方法,结合各个历史时期的社会背景及医学发展特点.、医家主要学术观点等对原始资料进行系统整理与分析,探讨理论发展源流。第二部分基于前章对“肺与大肠相表里”的理论发展脉络梳理情况,以《内经》思想为源头,以总结理论发展要点为主线,以溯本正源为目的,深入探讨“肺与大肠相表里”的理论内涵。并例举古代医家用“肺与大肠相表里”理论指导临床诊疗的典型医案,采用文献学的研究方法总结分析该理论在临床诊断和治疗上的应用特点。研究证实,导师高思华教授提出的“肺与大肠相表里’并非在于表达孰主表孰主里,所表达的是肺与大肠之间生理上功能相合、病理上相互影响、临床证候上相互表征的互为表里关系,这与《内经》本意正相符。研究还发现二者的表里关系主要体现在经脉络属、气机升降、水液代谢、水谷传导、官窍表征以及阴阳五行学说所赋予的哲学思辨性等多个层面。第三部分以《中华医典》中收录的90本医案类古籍为主要检索对象,严格纳入和排除标准,检索出“肺与大肠相表里”指导下的古代医案,并进行规范,建立古代医案数据库。运用描述性统计方法,初步分析肺与大肠相关疾病的证治特征。第四部分基于古代医案数据库,使用Microsoft SQL Server2005的Analysis Services功能,对症状与症状、症状与证型、症状与药物、症状与治法、证型与治法、药物与证型、药物与治法、药物与药物以及症状、证型、治法与药物等内容进行数据挖掘关联规则分析。根据各项分析结果总结出“肺与大肠相表里”理论在古代医案中的两条基本的辨证论治模式：①肺热多导致大肠热盛而出现多种大肠症状,其中泄泻相对较多,治疗以清热润肺为主,常配伍应用黄芩、生地、麦冬等。②肺气壅滞多导致大肠气滞而出现大便秘结症,治疗用宣肺降气以调畅肺肠气机,常配伍应用杏仁、紫菀、瓜蒌、郁金、桔梗等。第五部分基于北京中医药大学2011届博士毕业生郜峦的研究课题《基于文献分析的“肺与大肠相表里”证治规律及其关系研究》为对比对象,对“肺与大肠相表里”理论指导下古今医案中肺肠相关疾病的证治规律研究结论进行对比与分析。发现古今医家在应用“肺与大肠相表里”理论指导临证时应用重点有所不同,古代医家重视应用肺与大肠之间气机升降、水液代谢等功能相合,指导实热、气滞的肺肠疾病实证诊疗。现代医家重视肺与大肠之间气血津液相互资助以及气机升降协调,指导因虚而滞的肺肠疾病虚证诊疗。因此,在现代临床还有待于深入和扩大该理论的指导范围。本课题的创新之处有①初步建立“肺与大肠相表里”指导下的古代医案数据库,并利用关联规则分析的数据挖掘方法,提炼出蕴含在古代医案中的两条基本辨证论治模式。②对“肺与大肠相表里”指导下古今医案辨证施治规律的研究结果进行了对比分析,为加强该理论在现代临床诊疗中的指导作用提供了明确的方向。由于本人时间及水平所限,对文献占有量略显不足,使研究结论存在一定局限性,还有待进一步补充完善。
【Abstract】 The theory of " Lung and Large intestine being interior exteriorly related ",has profound theoretical source. It was first in huangdi neijing, and recorded in alot of medical books in all ages. In china for several thousand years, the theory issummarized, refined, generalized and enriched incessantly. This topic makes TCMancient books of basic theory, internal medicine and medical record as the mainresearch objects, and further discusses "Lung and Large intestine being interiorexteriorly related ".In this paper, there are five parts. In order to system review of all theoreticaldiscussion on " Lung and Large intestine being interior exteriorly related ", itmakes the important TCM ancient books of basic theory, internal medicine andcomprehensive medical works as the main research objects, and does withcomputer and manual retrieval in the first chapter. There are five historical periods,such as the Qin and Han Dynasties, the Jin Sui and Tang Dynasties, the Song Jinand Yuan Dynasties, the Ming Dynasty and the Qing Dynasty. Combined withsocial background, characteristics of medical development and academicviewpoints on TCM of medical practitioners in the different historical period, theauthor generalizes that the origin and development of " Lung and Large intestinebeing interior exteriorly related ".In the second chapter, based on the conclusion of the first chapter, it makeshuangdi neijing as theoretical source, theoretical development period as main line,and further study the connotation and extension of "Lung and Large intestinebeing interior exteriorly related". In order to summarize and analyze the practicalcharacteristics in clinical diagnosis and treatment with using this theory, theauthor puts some typical ancient cases as the way of arguing. Professor Gao pointsout that "Lung and Large intestine being interior exteriorly related" is to expressthe mutual exterior-interior relationship between Lung and Large intestine whichare cooperation in functions on the physiological characters, mutual influence onthe pathological states, and mutual characterization on the clinical syndrome. Theresults of literature research prove that the viewpoint of profressor Gao is wellcoincide with the expression in huangdi neijing. The study also found out the maincontents of the mutual exterior-interior relationship which are meridian, ascendingand descending of functional activities of qi, movement of the body fluid,digestion and absorption of foods, zang-fu correlated with guan-qiao, yin-yang and wu-xing theory.In the third chapter, the author retrieves ninety books of TCM ancient cases which were included in an E-book of zhonghua yidian with the strict inclusion criteria and exclusion criteria, and astablish the database of the ancient cases with using the theory of "Lung and Large intestine being interior exteriorly related". By using descriptive statistics method, the author also summarizes and analyzes the characteristics of syndrome and treatment for the diseases of Lung correlated with Large intestine.In the fourth chapter, based on the database of the ancient cases, it makes symptom-symptom, symptom-syndrome, symptom-Chinese medicine, symptom-therapeutic method, syndrome-therapeutic method, Chinese medicine-syndrome, Chinese medicine-therapeutic method, Chinese medicine-Chinese medicine, symptom-syndrome-therapeutic method-Chinese medicine as a group, and dose association rules analysis by using the Analysis Services of Microsoft SQL Server 2005. According to the results, the author summarizes and analyzes two basic types of the syndrome differentiation and treatment for the diseases of Lung correlated with Large intestine, such as the symptom of diarrhea-Lung heat transfering to Large intestine-reducing fever, nourishing yin-Scutellaria, Radix Rehmanniae, Ophiopogon japonicas; the symptom of constipation-qi stagnation of Lung and Large intestine-Inducing and descending Lung qi-Almond, Aster, Trichosanthes Kirilowii Maxim, Curcuma, Balloonflower.In the fifth chapter, it makes the study of syndrome differentiation and treatment law and exterior-interior relationship between Lung and Large intestine which based on literature analysis as comparison, and analyzes the syndrome differentiation and treatment laws which are different from the ancient cases and the morden medical records with using the theory of "Lung and Large intestine being interior exteriorly related". The author finds that the key points in clinical diagnosis and treatment with using this theory in ancient time and morden time are different. In ancient time, doctors pay attention to the sthenia syndrome by using this theory. In morden time, doctors pay attention to the asthenia syndrome with the relationship between Lung and Large intestine. Thus, it needs to be further discussion and expanded the scope of the direction in morden clinical practice.There are two innovative points in this thesis. First, it preliminarily establishes the database of the ancient cases with using the theory of "Lung and Large intestine being interior exteriorly related", and summarizes two basic types of the syndrome differentiation and treatment for the diseases of Lung correlated with Large intestine. Second, it analyzes the syndrome differentiation and treatment laws which are different from the ancient cases and the morden medical records with using the theory of "Lung and Large intestine being interior exteriorly related". Finally, because of data deficient, the conclusion of this study may not be perfect. Consequently, there are many works to be done in further.