【作者】 郭强；

【导师】 刘小斌；

【作者基本信息】 广州中医药大学 ， 中医医史文献， 2012， 博士

【摘要】 一、研究目的岭南土地卑湿、气候炎热,湿热易熏蒸,人多易患喉疾眼病。历史上岭南地区有很多五官科名家,对喉病、眼病的治疗有丰富的经验。他们把这些经验形诸文字,有的写成专著,有的收录在岭南综合性医著、方书、本草、医案著作中,有的发表在中医期刊上。此外,一些喉科和眼科的名著也曾在岭南刊刻出版。对本地医家产生深刻影响。总之,岭南中医喉科眼科文献是相当丰富的,是前人留给我们的珍贵遗产。但目前的情况是这些文献分布比较零散,不利于研究。本论文旨在对岭南现存的喉科眼科文献进行一次全面系统的整理,挖掘岭南中医喉科眼科医家的学术思想、学术源流,总结岭南医家喉科眼科方面的诊治经验,为临床提供借鉴,并在此基础上评价岭南中医喉科眼科在国内喉科眼科学术发展史中的地位及影响。二、研究方法本文主要运用文献调研的方法全面搜集整理岭南中医喉科眼科专著,辑录出岭南综合医著、方书、医案、本草著作中的喉科眼科文献,收集民国广东中医期刊中的喉科眼科论文,进而运用版本学、目录学和比较研究等方法考证喉科眼科专著的作者、版本和学术源流,总结岭南中医喉科眼科医家的学术思想,整理岭南喉科眼科医家诊治疾病的经验,总结岭南喉科眼科发展的历史。三、研究内容和结果论文具体分为六个章节进行撰写：第一章分萌芽、发展、兴盛和嬗变四个时期,分别概述我国古代中医喉科学和眼科学的发展史,以此为背景,研究岭南喉科眼科学的发展及在国内的影响和地位。第二章主要研究现存岭南中医喉科专著和教材。专著有4种,为《喉舌备要》、《喉证指南》、《喉证图说》和《喉症全书》,分别介绍其主要内容,考证版本和学术源流,总结其学术思想。经研究发现：《喉舌备要》不同版本的内容差异较大,书中摘录了《景岳全书》和《喉科指掌》等书的部分内容,对喉病的命名参考了郑梅涧的《重楼玉钥》一书,该书重视喉痹辨证,善用甘桔汤、玉龙散。《喉证指南》的作者为余泽春,周兆璋将其与《时疫白喉证论》合刻出版,该书主张喉病慎用表药,总宜宣肺。《喉证图说》主张治喉宜降品以杀其势,忌疏散苦寒,勿食生冷慎用针火。《喉症全书》由中西医喉科书汇编而成,重视白喉病的治疗。喉科教材有古昭典、邬宝杰、钟锦涛、李藻云主编的4种,亦分别介绍其主要内容和学术思想。第三章主要研究现存岭南中医眼科专著和教材。专著有清代黄岩的《眼科纂要》、颜尔梧的《眼科约编》、邓雄勋的《眼科启明》、黄惠然的《黄乔岳眼科全集》、民国时期黄荔洲出版的《救目慈航》,教材有梁翰芬编写的《广东中医药专门学校眼科学讲义》。经研究发现：《眼科纂要》将主要内容撮为歌括,学术上首重经络辨证,治法上主张补水泻火,清热除湿,自创方剂较多,疗效显著。《眼科约编》提倡五轮定经,主张虚证从肾,实证从肝。《眼科启明》大部分内容源自《银海精微》。《黄乔岳眼科全集》认为新症多属火,对翳膜的诊断有独到见解。《救目慈航》将喉疾受病脏腑多归之心、肝、肾。梁翰芬的《眼科学讲义》“废五轮八廓,倡脏腑络病”,以“目之为体,应乎五脏”解释眼部的生理病理。第四章研究曾在岭南刊刻出版喉科和眼科的名著,包括《咽喉脉证通论》、《咽喉秘集》、《喉症全科紫珍集》、《白喉治法忌表抉微》、《时疫白喉捷要》、《审视瑶函》、《程松崖眼科》和《异授眼科》等,考证版本,探究他们对岭南中医喉科眼科学术发展的影响。第五章研究岭南历代综合性医著、妇科、儿科、本草、针灸、中西汇通等医著中的喉科眼科医论、病症治法、验方、治疗喉病眼病的药物等内容,研究民国时期广东的中医期刊上刊发的喉科眼科论文。基于以上内容,勾勒出岭南中医喉科眼科发展史的基本轮廓。第六章总结民国时期广州喉科名医古绍尧、钟锦涛、王俊民、李藻云、杨志仁等人的治喉经验。四、研究结论(一)岭南中医喉科眼科学术源远流长,后期发展多元。晋代葛洪的《肘后备急方》是岭南现存最早的一部医学著作,该书总结了晋以前国内的医学成就,岭南喉科眼科学术也自此开始发展。唐代一些流寓岭南的医家经过长期的实践,总结出一些喉科眼科疾病的治疗方法和方药,如郑景岫的《南中四时摄生论》、刘禹锡的《传信方》。宋代南海陈昭遇参与主编的《太平圣惠方》,其中喉科眼科方剂达3卷之多；刘防的《幼幼新书》中喉科眼科的内容约有2卷,并且出现了“青盲”、“雀目”、“喉痹”、“缠喉风”等专业学术名词,说明此时岭南地区喉科眼科已独立分科,学术体系已经成形。清代是岭南喉科眼科学高速发展时期,其学术传承呈现多元化发展。随着地方刻书业的发展,历代著名医家的著作得以在广东广泛流传,对喉科眼科影响较大者为张景岳的《景岳全书》,后世甚至民国时期岭南的一些喉科眼科医家都宗其学说。此外,岭南医家还取法于《证治准绳》、《喉科指掌》、《时疫白喉捷要》、《白喉治法忌表抉微》、《银海精微》等著作。就整体而言,清代岭南喉科眼科著作在理论方面有所发挥的不多,而多注重临证实用。独创内容较多的为清代黄岩的《眼科纂要》,学术界普遍认为其学术价值较高。(二)岭南医家对喉科眼科的理论和治疗用药有独特的见解。在喉科眼科理论方面,何梦瑶、黄岩等认为任何一经得病均可以使喉部致病。任赞、何梦瑶、周兆璋等认为岭南气候炎热,咽喉之病皆属火证、热证,杨志仁认为南方人所患喉病,以热证与阴虚者较多。黄岩治喉虚实辨证,认为虚实二者,无地不有,无症不有,当分何脏何腑、在气在血。钟锦涛认为乳蛾、喉闭、缠喉等症皆为痹类。治疗喉痹,岭南医家大多尊张仲景之“甘桔汤”。郭元峰自创有一套“察目”诊断疾病病因、预后的方法,程康圃积累了一些小儿眼目看证经验。历代岭南医家创制了不少治疗喉病眼病的验方,如黄岩自制的除湿汤、新制柴连汤、消翳汤、泻肺饮等皆为眼科著名方剂,配伍严谨,疗效确凿,见收于《中医眼科学》各版教材。古绍尧的“指甲散”、王俊民的“喉科解毒汤”、杨志仁的“疏风清热汤”都是闻名于广东的秘方。用药方面,岭南医家善用本地药物。如《救目慈航》的作者常用岭南本土药物消山虎、刺仔花、龙眼叶、芙蓉叶等,古绍尧、王俊民治疗喉病常用咸竹蜂,陈定泰善于使用蜘蛛、酸梅、蠄螃、蜗牛等常见之物。(三)岭南中医喉科眼科教育专业化较早。岭南是西医传入中国的窗口,医学传教士在这里建立了现代医院、西医学校,开设解剖、西医眼科等课程。受西式教育以及近代文化思潮、时局政治的影响,岭南的一些中医界人士开始积极筹划建立中医院校,以获得中医生存空间及中医教育的话语地位,早期创办有医学求益社、医学卫生社、中医教员养成所、广东医学实习馆等机构,这在当时国内属于首创。然而这些机构所开设的课程较为零散,中医系统教育的真正建立,始自广东中医药专门学校和广东光汉中医学校。这两所学校开设有专门的喉科和眼科学课程,编写了专门的教材,据笔者所查,喉科讲义有3种共5个版本,而梁翰芬编的《眼科讲义》,两个学校均使用。这些讲义是国内同类讲义中编写较早的,足见岭南中医喉科眼科教育专业化较早。(四)岭南中医喉科眼科学在近代中国具有领先地位。近代,广东作为全国开风气之先的门户,中西医汇通最早发生在这里。陈定泰的《医谈传真》中所收录的解剖图谱,最早为我们展示了现代医学意义的咽喉、眼睛的解剖位置；陈珍阁不但吸取了西医的学术精华,而且还对中医进行了反思与批判,首次提出古传之五轮八廓学说为谬论的观点；朱沛文则通过引用《内经》、《难经》、《总录》、《类经》以及洋医对咽喉、眼部器官的解剖学解释,并结合解剖图谱的对照,去让世人自行判断孰是孰非。这些在中医近代史上都是相当有创见的举动。民国期间,广东较早建立了中医学校,开展中医喉科眼科学教育,在国内率先编写了中医喉科、眼科学教材,而且有多种版本,一举奠定了广东中医喉科眼科学在国内的领先地位。因此,建国后的全国第一版中医喉科、眼科学教材的编写花落广东也就顺理成章了。更多还原

【Abstract】 Aim:Lingnan’s land is lower and wet, Its weather is so hot and humid that many people are susceptible to throat and eye diseases. There were many famous historic physicians have much experience in treating throat and eye diseases in Lingnan region. Many experiences was recorded into text, some was written into monographs, some were collected into comprehensive medical books, prescription books, herbal works and medical records of Lingnan, and some were published in the journal of Chinese medicine. In addition, some famous throat and eye monographs outside Lingnan were also inscribed here. All these have a profound impact on local doctors. In short, the throat and eye literatures of Lingnan which predecessors left us are quite rich, However, the current situation is that the literature is fragmented distributed and is not convenient to study.This paper aims to conduct a thorough and systematic collection on the existing throat and eye literature of Lingnan, excavate the academic thoughts and academic origins of throat and eye doctors in Lingnan, and Summarize their clinical experiences and provide reference of treatment, finally evaluate status and influence of lingnan’s laryngological and ophthalmological academic development in chinaMethods:In this paper, we mainly use the method of investigating documents to fully collect laryngological and ophthalmological monographs, compile the related materials in comprehensive medical books, prescription books, medical records, herbal works, And collect papers about throat and eye in the Chinese medical journals of Guangdong in the Republic of China, and then use the methods of bibliography and comparative study to find out the authors, versions and academic origins of the monographs, summarize the academic thoughts of the Lingnan’s throat and eye doctors, Collate the experience on diagnosing the throat and eye diseases of doctors, and outline the history of the development on laryngology and ophthalmology in Lingnan.Contents and Results:The paper is specifically divided into six chapters:The first chapter outlines the history of the development of ancient laryngology and ophthalmology in China respectively from four periods which are the bud, development, prosperity, and transmutation, and on this background, we outlined the history of the development on laryngology and ophthalmology in Lingnan.The second chapter studies the existing throat monographs and textbooks of Lingnan. The four monographs are "Hou She Bei Yao","Hou Zheng Tu Shuo","Hou Zheng Zhi Nan" and "Hou Zheng Quan Shu ".We described their main contents, versions and academic origins, Further summed up their academic thoughts. The study results:The contents of "Hou She Bei Yao" diverge greatly in different versions, this book excerpt parts of the contents of "Jing Yue Quan Shu" and "Hou Ke Zhi Zhang". And the Names of the laryngeal diseases likely referred to Zheng MeiJian’s "Chong Lou Yu Yue".This book emphasis on the differentiation of "Hou bi", The author was good at using the prescriptions of "Gan Jie Tang" and "Yu Long San". Yu Ze Chun is the author of "Hou Zheng Zhi Nan", Zhou Zhaozhang co-published this book and "Shi Yi Bai Hou Jie Yao", the author advocates using diaphoretic carefully and always Ventilate the lung."Hou Zheng Tu Shuo" advocates using the drugs to control the diseases, avoiding using the diaphoretic bitter and cold drugs, not eating the raw and cold food and not using acupuncture and moxibustion."Hou Zheng Zhi Nan" compiled the chinese and western medical throat books, emphasized on the treatment of diphtheria. The four textbook of throat are respectively written by Gu Zhao Dian, Wu Bao Jie, Zhong Jintao, and Li Zaoyun, and their the main content and academic thought were of course introducedThe third chapter studies the existing eye monographs and textbooks of Lingnan. The five monographs are "Yan Ke Zuan Yao","Yan Ke Yue Pian","Yan Ke Qi Ming","Huang Qiaoyue Yan Ke Quan Ji" and "Jiu Mu Ci Hang". The study result:the author of "Yan Ke Zuan Yao" edited the contents the book into rhymes to remember easily. He paid more attention on the differentiation of meridians, insisted on replenishing the water and reducing the fire, clearing heat dissolving dampness, and created many effective prescriptions. The author of "Yan Ke Yue Pian" emphasized the relationship of the "Wu Lun" of the eye with the meridians and claimed that deficiency syndrome is attribute to the kidney, sthenia syndrome is attribute to the liver. The content of "Yan Ke Qi Ming" mainly comes from the monograph "Yin Hai Jing Wei". The author of "Huang Qiao yue Yan Ke Quan Ji" considered that the new eye diseases always belong to fire syndrome, and he had many creative ideas on diagnosing the nebula of the eyes."Jiu Mu Ci Hang" mainly considered that the eye diseases attribute to the heart, liver and kidney. Liang Han fen’s "Yan Ke Xue Jiang Yi" criticized the "Wu Lun doctrine" and "Ba Kuo doctrine", thought that the eye diseases attribute to the disorder of meridians, and interpret the physiology and pathology of the eyes through the relationship of eye and organs.The fourth chapter studies the famous throat and eye books of northern regions published in the Lingnan, including "Yan Hou Mai Zheng Tong Lun","Hou Zheng Quan Ke Zi Zhen Ji","Bai Hou Zhi Fa Ji Biao Jue Wei","Shi Yi Bai Hou Jie Yao","Shen Shi Yao Han","Cheng Song Ai Yan Ke" and "Yi Shou Yan Ke". Study their versions and find out their impacts on the academic development of the laryngology and ophthalmology in Lingnan.The fifth chapter studies the medical theories, therapies, prescriptions, drugs about throat and eyes contained in the ancient comprehensive medical books, gynecological books, pediatric books, herbal works, acupunctural books, Chinese and Western combined medical works, and articles in the journals of Lingnan, and finally we have outlined lingnan’s history of laryngology and ophthalmologyThe sixth chapter summarized the experience of throat physicians of Guangzhou in the Republic of China such as Gu Shao yao, Zhong Jin tao, Wang Jun min, Li Zao yun, and Yang Zhi ren.Conclusions:(A) The science of throat and eye in Lingnan has a long history, and develops toward diversification in Ming and Qing dynasty.In Jin Dynasty, Ge Hong’s "Zhou Hou Bei Ji Fang" was earliest medical monograph in Lingnan, This book summarized the domestic medical achievements before the Jin Dynasty, and lingnan’s laryngology and ophthalmology began to develop from then on. In Tang dynasty, some physicians immigrated to Lingnan through long-term practice, had summed up a lot of throat and eye disease treating methods and prescriptions, such as Zheng Jing Xiu and his "Nan Zhong Si Shi She Sheng Lun", Liu Yuxi and his "Chuan Xin Fang ". In Song Dynasty, Chen Zhaoyu of Nan hai who edited "Tai Ping Sheng Hui Fang", which has ophthalmological eye Laryngological prescription as many as three volumes, Liu Fang’s "You You Xin Shu" also contains about two volumes of relevant content, and have "Qing mang","Que Mu","Hou Bi","Chan Hou Feng" and other academic terms, and this indicates that the Ophthalmology and laryngology had been independently divided and the academic system had been formed at that time in Lingnan region.In Qing dynasty, Laryngology and Ophthalmology experienced a rapid development in Lingnan, the academic heritage develops toward diversification. with the development of publishing, the writings of the famous physicians in past dynasties of the north were widely spreaded in Guangdong, the most important book which has influence on throat and eye were Zhang Jing yue’s "Jing Yue Quan Shu", which produced far-reaching effects for the later generations in Lingnan, and even the doctors in the Republic of China. Many physicians abided by its doctrine. In addition, the doctors of Lingnan often learned form "Zheng Zhi Zhun Sheng""Hou Ke Zhi Zhang ","Shi Yi Bai Hou Jie Yao","Bai Hou Zhi Fa Ji Biao Jue Wei","Yin Hai Jing Wei" and so on. On the whole, there are little throat and Eye works of Lingnan which have constructive theories in Qing dynasty, but have more emphasis on the clinical practice. Huang yan’s "Yan Ke Zuan Yao " has more innovation and more original content which was evaluated by many specialists.(B) The throat and eye doctors of Lingnan have many special theories and treatments.In the respect of theory, He Mengyao and Huangyan both think that any meridian disorder can result in the throat disease. Ren Zan, He Mengyao and Zhou Zhaozhang thought that the climate of Lingnan is very hot, and throat disease are fire, heat, Dr Yang Zhiren considers that Southerners are suffering from throat diseases which have more heat and Yin deficiency. Huang yan paid more attention to the deficiency and excess situation in diagnosing and treating laryngeal disease, he believed that any diseases has deficiency and excess situation, must find out they belongs what viscera, and differentiate whether they are in qi or blood. Dr Zhong Jintao of Panyu in republic of china thought of "Ru E","Hou Bi" and "Chan Hou Feng" as "Bi" diseases. For the treatment "Hou Bi", Lingnan physicians often use Zhang Zhongjing’s "Gan Jie Tang". Guo Yuanfeng also created a set of methods diagnosing the etiology, prognosis of diseases through looking the eyes. Dr Cheng Kang pu accumulated some experience in diagnosing the children’s disease from the eye.Many doctors created a lot of prescriptions to treat throat and eye diseases, Huang yan made great contribution to the development of Lingnan’s Ophthalmology, some of his prescriptions, such as "Chu Shi Tang","Xin Zhi Chai Lian Tang","Xiao Yi Tang" and "Xie Fei Yin", are very famous, and these prescriptions has rigorous compatibility and conclusive effect, and have been collected by many Chinese ophthalmological textbooks. Gu Shaoyao’s "Zhi Jia San", Wang Jun min’s "Hou Ke Jie Du Tang", Yang Zhiren’s "Shu Feng Qing Re Tang" are well known in Guangdong, as regard to the drugs, Lingnan physicians make the best use of local drugs, such as "Xiao Shan Hu","Ci Zai Hua","Long Yan leaves","Fu Rong leaves". Dr Gu Shaoyao, and Wang Jun min commonly used "Xian Zhu Feng"(a kind of bee) in the treatment of laryngeal diseases. Chen Dingtai is more good at the use of local drugs in treating laryngeal diseases, such as "spiders","plum","Qin lao", and "snails".(C)The specialization of the Lingnan’s laryngological and ophthalmological education is earlier in china.Medical missionaries took Guangdong as a window to spread Western medicine and religion to Chinese in modern china, where they established hospitals, schools, curriculum of the anatomy, ophthalmology. Being affected by western education, modern cultural and ideology, and the political situation, some Lingnan’s physicians began actively planning to establish the Chinese medical schools to get discourse of the living and education of TCM. These schools contained "Yi Xue Qiu Yi She"," Yi Xue Wei Sheng She","Zhong Yi Jiao Yuan Yang Cheng Suo","Guangdong Yi Xue Shi Xi Guan", which are considered as the earliest educational institutions in china at that time. But the early courses of these schools are very fragmented. The institutes that truly established a systematic education of TCM in Guangdong began form "Guangdong Zhong Yi Yao Zhuan Men Xue Xiao" and "Guangdong Guang Han Zhong Yi Xue Xiao", The two schools had the curriculums of Laryngology and Ophthalmology and edited the professional textbooks, according to my investigation, the number of Laryngological textbook is three in five versions. the number of Ophthalmological textbook is two which both of all are edited by Liang Han fen. These textbooks were edited earlier than other medical schools, which demonstrate the specialization of the Lingnan’s laryngological and ophthalmological education is earlier.(D)The laryngology and ophthalmology of Lingnan have a leading position in modern China.In modern times, Guangdong is the gateway of learning the western medicine, here appeared the earliest combination of chinese and western medicine, we can see the earliest anatomical pictures in Chen Dingtai’s "Yi Tan Chuan Zhen" and it was first local book that show us the anatomical location of eye and throat in modern medical sense. Chen Zhen ge not only absorbed the essence of Western medicine, but also carry out a reflection and criticism for the Chinese medicine. Furthermore, for the first time, He firstly put forward views that "Wu Lun Xue Shuo" and "Ba Kuo Xue Shuo" are ridiculous, while Zhu Pei wen listed the explanations about the throat and eye anatomic location of "Nei Jing","Nan Jing ","Zong Lu","Lei Jing" and western doctors to let readers judge its merits and demerits for themselves, all these have much creativity in the modern history of Chinese medicine. During the Republic of China, Guangdong earlier established schools of TCM, carried out education in laryngology and ophthalmology, compiled the textbooks, and finally got the leading position in china, therefore, after the people’s republic of china was founded, it was of course that the first versions of laryngology and ophthalmology textbooks of traditional Chinese medicine were compiled respectively by Guangdong.更多还原