【作者】 沈创鹏；

【导师】 张横柳；

【作者基本信息】 广州中医药大学 ， 中医临床基础， 2012， 博士

【摘要】 研究背景：传承是中医药文化的特色,历代医家对临证经验不断总结,形成独特的学术思想,各有阐发,百花齐放,百家争鸣,薪火相传以不断推动着中医学的发展。岭南伤寒学是中医药学的重要组成部分,始于晋代,至今约一千七百年,古代岭南地处偏隅,发展缓慢,现代岭南医家非常重视先辈学术思想的研究,为岭南伤寒学之传承而掇菁撷华。当代岭南伤寒学家的学术思想和临证经验是中医药学术特色、岭南地域特质的集中体现,相对于浩如烟海的古籍文献而言,更直观,更实效,更贴近名老中医的学术思想,也更具有传承研究价值。在名老中医的指导下,积极整理和研究其学术思想是传承和挖掘中医学精华的重要手段。张横柳教授从医从教四十四年,善于经典,尤重伤寒,师承岭南伤寒名家何志雄教授,旁纳百家,师于先贤又多有发挥,如先生据以仲景原文、对太阳之气的理解以及自身临证经验的总结,大胆提出肺属太阳论；临证非常重视顾胃存津,认为顾胃存津贯穿于六经证治的始终,提出“变”与“辨”的辨证思路；对痫证、儿童多动症、抑郁症、岭南外感病等的经方证治深有体会,临床疗效显著。张老学验俱丰,德艺双馨,是当代岭南伤寒学的理论家、教育家、临床家,对其学术思想的研究,为当代岭南伤寒学,乃至中医学的继承与发展有着很大的意义。目的：全面系统研究张横柳教授对仲景学说的精辟阐发,如对《伤寒论》原文的独到见解、顾胃存津在六经证治中作用、《伤寒论》中阳气与津液的研究、仲景“变”与“辨”的证治思路等,挖掘其学术内涵,继承发扬其学术思想。总结张横柳教授运用经方治疗痫证、儿童多动症、抑郁症、岭南外感病的临证特色,探索其临证证治规律,裨益后学者。方法：运用伤寒学理论和临床研究方法,通过收集整理张横柳教授相关学术文献、采访张老及相关专家,结合中医医史文献、中医各家学说的研究方法对张老学术思想进行深入系统的整理和研究,有利于岭南伤寒学术的传承和发展。结果：本研究主要分为三部分：第一部分：简述张老的学术成才之路。张老1968年广州中医学院(现广州中医药大学)本科(六年)毕业后响应毛主席关于知识分子接受再教育的号召,在广东省恩平县山区大田公社(镇)卫生院开始长达11年的基层临床工作,尽管条件艰苦,但是张老静心安欲,专攻学术,日间工作夜间思,以精洪的医术,高尚的医德名闻当地。1979年,虽已将近不惑之年,但张老为实现其对学术不断追求进取的理想,勤奋刻苦,考上广州中医学院第二届硕士研究生,师承岭南伤寒名家何志雄教授。毕业留校后更是勤耕不辍,钻研经典,其在伤寒学界之成就,以临证疗效而享誉,已然为其精诚济世之高尚情操,精湛技术的回报。工作之余,张老心系基层,带领医疗专家对基层医院进行医疗援助,十余年如一日,无私奉献,“斯世穷耕伤寒论,平生怀抱仁寿图”是其最好的写照。第二部分：研究张老的学术精华。张老深谙伤寒,融汇百家,立足原著,结合临证实践,提出肺属太阳论,颇有创见,对《伤寒论》中许多存疑之处提出了独到的见解,突破了以经解经之局限,更贴切于仲景的意旨和临床实践,解惑于后学者。张老也详细阐述了论中“胃家实”、“脾家实”、“合病并病”之经旨,重视论中“阳气与津液”的研究,强调顾胃存津贯穿于六经证治的始终,提出“变”与“辨”的证治思路,为当代医家所推崇。第三部分：总结张老运用六经辨治痫证、儿童多动症、抑郁症、岭南外感病之临证特色,探索其证治规律。张老从事癫痫的临床实践三十余年,认为脾虚痰阻,营卫不和,阴阳气不相顺接为痫证的基本病机,着眼于痫证的缓解期,从虚论治,以脾虚为本,厥阴风动为标,立益气熄风化痰,调枢机,和营卫为法,化裁柴胡桂枝汤为芪僵柴桂汤,随证治之,创立纯中药抗癫痫医院制剂“痫宁片”,救治痫证近万例,效显而弊微,’实为患者之福,社会之福。张老根据小儿肝常有余、脾常不足、心火独亢、肾常虚之生理病理特点,结合六经辨证,认为儿童多动症的病因病机以太阳脾虚为本,少阳枢机不利,厥阴风动,少阴热化为标,本虚标实,虚实火杂。。立调和少阳厥阴,补脾益气,滋水涵木,交通心、肾的治法,临证更据以少阳、厥阴、少阴、太阴四经病证之孰轻孰重而各有偏倚,观其兼证,随证加减,效如桴鼓,得到国内外学者的肯定,其发表于《中国中医结合杂志》之《儿童轻微脑功能障碍综合征的中医治疗初探——附100例分析》被美国权威期刊《INDFX MEDICUS》杂志摘录。张老数十年临证经验,认为容易发生抑脬症的体质特点为木形体质,其病机为少阳厥阴郁结失枢,乘伐脾土。随着疾病的发展,或失治误治,久病木气生发发不及,虚气郁滞,三焦不能主持营卫,寤寐常。张老临证首分“因郁致病”和“因病致郁”,再定虚实,实者木郁失疏,立疏汇为常法,以柴胡剂为基本方；虚者木虚生发及,立温润酸甘为常法,以桂枝剂加北芪为基本方,随证加减,并强调药物和心理治疗并重,两者缺一不可。外感病为临床常见病多发病,张老认为岭南外感病同时具备外感病的特点和岭南的地域特质,发病多兼有湿邪,虚人外感为多,尽管岭南气候炎热,但是张老数十年临床实践,认为邪气在表,辛温发汗法为正治法,以桂麻各半汤为基本方,兼顾湿邪,驱邪不忘扶正,融合六经表证,随证加减。结论：一、张横柳教授继承发扬,立足临证,以原文为据,阐发六经,颇有见地。二、重视阳气与津液,顾胃存津以扶正气是张横柳教授的中心学术思想。三、“变”与“辨”辨证思维是张横柳教授的重大伤寒学术研究成果。四、补益脾胃是张横柳教授的主要临证特色。五、运用“阴阳往来”之说辨治发作性病证是张横柳教授独到的临证经验。六、张横柳教授非常重视体质在病证中的指导作用。七、善和法,专“柴、桂”二方,重黄芪是张横柳教授立法遣药的特点。更多还原

【Abstract】 BackgroundHeritage is a cultural characteristic of Traditional Chinese Medicine (TCM), ancient TCM physicians continue to review their clinical experiences to form unique academic thoughts to drive the development of TCM. The Lingnan Shanghan school is an important part of TCM dating back to2000years. In ancient times development was slow due to geographical limitations. Modern Lingnan TCM doctors focus on reviewing past experiences in both academic and clinical aspects of TCM to progress in the Lingnan school of Shanghan. This school of thought is more direct, effective, more in staying with the experiences of the older TCM doctors and has more heritage value than the sea of classical TCM texts. Under the guidance of such doctors, the sorting and investigation of their theoretical thinking and clinical characteristics are crucial to the passing and investigation of TCM essence.Professor Zhang llengliu has been a doctor and a teacher for44years, being the apprentice of the famed Professor He Zhixiong and specializes in TCM classics and the Shanghan in particular. Through clinic and thorough examination of the Shanghan Lun, he developed further understanding of the Tai Yang Qi, and proposes the notion of the Lung being a part of the Tai Yang system. In clinic he focuses on preserving the Stomach fluids and uses this across the6Channel systems. He also proposes’Chang’and ’Differentiation’in his pattern differentiation thought process. He has great experience in using classical TCM methods in treating epilepsy, ADHD, depression, TCM exterior diseases. Professor is well respected for his contributions i n TCM theory, education, clinical effects and the development of TCM.Object i veThe st udy systemi cally analyzed Professor Zhang’s experience with applying the Shanghan theory for future generations to effectively learn such methodology. This was done by analyzing his understandings of the text, preserving Yin fluids when treating the6Channel diseases, the research of Yang Qi and Fluids in the Shanghan Lun, and Zhang Zhong Jing’s clinical application using’Deterioration’and’Differentiation’. Professor Zhang’s treatment of epilepsy, ADHD, depression, external syndromes are also reviewed in detail.MethodsUsing Shanghan theory and clinical research, the collection of Professor’ publications, interviews with Professor and related specialists, combing classical TCM texts, and various schools of TCM to systemically review professor Zhang’s critical thoughts for future studies.ResultsThis study is comprised of3sections:A detailed profile of professor Zhang’s life history. Professor Zhang graduated from his bachelor’s degree from the Guangzhou University of TCM in the1968, he then worked in the clinical field for11years before returning to the university in1979to complete his master’s degree. Studying under the famed He Zhi Xiong and accumulating experience, he eventually became a highly regarded TCM doctor himself.The second section focuses on professor Zhang’s theoretical essence, Professor Zhang has a deep understanding of the Shanghan theory, being able to combine the thoughts of various previous TCM doctors. Building on the foundation and clinical observation, professor Zhang proposes that the Lung is a part of the Taiyang system. He also contributed to the terms’Stomach repletion’,’Spleen repletion’’Concurrent and Consecutive Patterns’ as used in the original Shanghan Lun text. Professor Zhang focuses on preserving the Middle the Fluids and Yangqi in his treatments, while also proposes the notion of’Deterioration’ and ’Differentiation’The third section reviews professor Zhang’s treatment of epilepsy, ADHD, depression and exterior syndromes.Professor Zhang has over30years of clinical experience of HP, he believes Spleen deficiency with phlegm obstruction, disharmony between the Ying and the Wei, and the imbalance of the Yin Yang as the basic pathomechanism of epilepsy. Treatment should be focused on supplementing the Spleen vacuity, resolving the Jueyin Wind, harmonizing the Ying Wei and Qi function complemented by resolving phlegm. For such conditions the Chaihu Guizhi Tang would be the basic formula and modified for each individual. Professor Zhang also created the Chinese Herbal pill’ Xian Ling Pian’ which has little side effects for treatment of epilepsy.Professor Zhang combines the fact that children usually being excess in the Liver while insufficient in the Spleen, Kidney vacuity with Heart Fire rising with6Channel differentiation to conclude that ADHD is a consequence of a few pathological causes. These causes include Yaiyin Spleen vacuity, Shaovang Gal1Bladder heat, Jueyin wind disturbing, heat forming in the Shaoyin, Wind and Heat combining to form a complicated pattern of Yin and Yang, internal vacuity but external repletion and the combined effects of general vacuity and repletion. Treatment principles are therefore harmonizing the Shaoyang and the Jueyin, supplementing the Spleen, reinforcing the Water to nourish the Wood, and connecting the Heart and the Kidney. Treatments usually depend on the predominant patterns that includes the Shaoyang, Jueyin, Shaoyin and the Taiyin and their inter-reactions. The resulting treatment is therefore a tailored strategy for each individual.With decades of clinical experience, professor Zhang believes depression mainly manifests in patients of the TCM Wood type, it’s mechanism being the disharmony in the Shaoyang and Jueyin which attacks the Spleen opportunistically. Depending on the progression of the disease, the rising function of the Wood diminishes, and vacuity causes obstruction, with this the Sanjiao cannot control the Ying Wei and causes insomnia. In the clinic, professor Zhang first differentiates between’obstruction causing disease’ and’disease causing obstruction’, then vacuity from repletion. For repletion cases, treatment revolves around dispersing and restoring the Wood’s normal function, and Chaihu type formulas are preferred. In vacuity patterns, sourness and sweetness are used to warm and nourish the Wood, and Guizhi type formulas are modified to each case. It is imperative that psychological treatments are used in conjunction to herbal remedies. Exterior syndromes are common in the clinical environment, professor Zhang believes they inherit special characterist ics of the Lingnan region of China as well as their typical mani festations. Exterior syndromes of the Lingnan exhibi t more Damp qualities and are more prone in constitutionally vacuous patients. According to professor Zhang, warm aromatic methods are appropriate for such conditions despite the hot weather of the Lingnan. He believes when the exterior pathogen is in the superficial layer, Guizhi Mahuang ge ban Tang is an appropriate basic formula which can be modified with agents to expel the damp pathogen. During the treatment, supplementing the Zhengqi is also vital, and should be complemented by appropriate6Channel pattern specific strategies.Conelusion1. Building on the deeply understanding of the six-channel syndrome differentiation and clinical observation, Professor Zhang Hengliu proposes some knowledgeable insights.2. Attaching the importance in preserving Stomach fluids and Yangqi is the central academic thinking of Professor Zhang Hengliu.3. Professor Zhang Hengliu contributed greatly on the notion of ’Deterioration’and’Differentiation" in Shanghan theory.4. Nourishing the Spleen and enriching the Stomach is a chief feature of pattern differentiation and treatment of Professor Zhang Hengliu.5. Professor Zhang Hengliu has unique methods of treating paroxysmal disorders through applying the theory of’YinYarig WangLai"6. Professor Zhang Hengliu highly values the causal relationship between body constitutions and the process of disease.7. The characteristics of clinical herb-prescribing and recipe constru Cting of Professor Zhang Hengliu is exper at using harmonizing theraphy, Xiao Chaihu Tang, Guizhi Tang and high-dose astragalus root.更多还原