藏医补养疗法理论体系及其应用方法研究

【作者】 次仁德吉；

【导师】 占堆；

【作者基本信息】 北京中医药大学 ， 民族医学， 2014， 博士

【摘要】 藏医补养疗法是藏医两大治疗体系的分支,属于临床基础内容。是在藏医药理论指导下,应用食物、药物、行为、外治来调节五源缺乏导致的体质虚弱、消瘦疾病的治疗方法,藏文名词为“哒哇”,根据治疗对象分为藏医特殊人群补养疗法和临床疾病的补养疗法两大分类,其治疗思路相近与现代医学的营养治疗学,只是研究方法和措施各异。此治疗方法是体现藏医提倡“人体与自然和谐统一”论的主要表现,也是体现藏医注重治病不伤体质的治疗原则,更是突出藏医重视生理、心理、病理相互关联的健康观念。随着医学治疗观念的改变,营养与疾病相关的课题不断涌现,特别是健康观念的转变,临床治疗已经走出单纯的临床治病模式,营养与疾病预防、治疗、康复的作用倍受重视和应用。据调查显示,在营养不良的住院病人中：感染和非感染性并发症高2-6倍；住院费增高75%,科学合理的营养治疗可以使平均住院时间缩短1-2天,从而提高床位周转率20%左右①,可见临床营养学科建设具有必要性。藏医药理论博大精深,同样也体现在营养治疗学方面,也就是藏医补养疗法,藏医药发展历史上的众多著作就已经记载了人体基础体质代谢与健康、疾病、治疗、康复的密切关系,并通过反复临床实践证实了补养疗法在预防和治疗疾病、康复中的重大作用,形成了藏医独特的补养疗法理论体系。当前在现代营养治疗发展年代,藏医补养疗法在不失去核心的前提下,分析藏医补养疗法应用总体现状,如何选择符合自身的发展途径将成为传统藏医药共同面临的问题。本文全篇分五个章节。第一章论述了藏医补养疗法的发展历史：分萌芽期,成熟期和发展期三个阶段。通过考古资料和历代丰富的文献,论述了藏医补养疗法的发展及成就,从而探讨了藏医补养疗法的渊源及发展规律。第二章论述了藏医补养疗法的基础理论体系。以藏医理论中的五源、三因、七精、三物、胃火、脏腑、脉络、体质辩证等基础理论,论述了藏医补养疗法的形成体系特点。第三章论述了藏医补养疗法体系的内涵：分人群的补养方法和疾病的补养治疗方法两大内容。论证了补养疗法在预防、治疗、康复中的重要作用和实践意义,特别是四大补养治疗方法的分类、运用原则、体质辩证、疾病分类等在个体化治疗中的合理运用,以及补养支持疗法的实际意义。第四章论述了藏医补养疗法与其它医学的比较研究,主要是与印度医学、中医营养学、现代营养学之间的比较分析,提出了个人的几点认识。第五章论述了补养治疗的应用方法。主要采用临床调查法,选择在西藏自治区藏医院2012年1月至12月消化内科、肝病科、心脑血管科、妇产科、骨科、外科6个专科400份住院病例中调查各个专科补养支持应用情况,结合现代营养支持与临床结局的热点研究课题,提出藏医学在继承自身独特的理论前提下,如何更好地发展自身的特色方面提出了个人的几点看法。总之,藏医补养疗法不仅仅是运用在保健强身方面,更重要的作用还在疾病的预防、治疗、康复中起到积极的治疗和辅助作用。随着全球营养治疗模式发展的趋势,外科治疗逐步转向营养治疗也是今后医学必然发展的结果,人们对营养治疗的重视也会得到提高,与此同时,对传统医学来说既是发展的机遇,也面临着巨大的挑战,虽然藏医补养支持得到继承和弘扬,但是针对慢性疾病的蔓延,危重症疾病的补养支持疗法还有待于进一步研究和发展,大力开发和应用藏医补养疗法具有现实意义。通过此次研究,本人对藏医补养疗法的理论体系有了新的认识和新的发现,其应用方法方面也通过参加现代医学营养科室、重症监护室进行学习和了解,借鉴了现代营养治疗方式方法,并对藏医的补养治疗的继承和发展有了自己的一些看法,因本人的学识和时间有限,疏误之处在所难免,祈望对今后的临床系统深入的研究工作奠定坚实的基础,更能为藏医临床和学科发展起到一定的促进作用。更多还原

【Abstract】 The clinical basic contents of Tibetan medicinal nourishing therapy is one of branches of Tibetan medicine two treatment system.It is based on the theory of Tibetan medicine and it use the application of food, medicine, behavior, external treatment to adjust five source resulted in the lack of physical weakness.Treatment of wasting disease is called as Dawa in Tibetan. According to the treatment object is divided as two classification, which are nourishing therapy and nourishing therapy of clinical disease.The treatment of nutritional therapy is similar with modern medical science, though their difference is between research methods and measures.This method of treatment is the embodiment of Tibetan medicine advocates harmonious of human and nature mainly unified theory. It also paid attention to the treatment principle of Tibetan medicine treatment that not to hurt the body. It is the concept of health, psychological, physiological prominent Tibetan attention pathological correlation.With the changes in the concept of medical treatment, subjects of nutrition that related to diseases related have emerged. Especially the transformation of health conceited. Clinical treatment has get out of the simple clinical cure model. Nutrition and disease prevention, treatment, rehabilitation effect are paid more attention and Application. According to the survey, patients with malnutrition of infectious and are2-6times higher than non infectious complications. Their treatment fee is75%higher. Scientific and reasonable nutrition treatment can shorten the average hospitalization time for1-2days. Therefore it can improve20%of the turnover rate. So clinical nutrition discipline construction is necessary. Tibetan medicine theory is broad and profound. It also reflected in the nutritional therapy, which is the Tibetan nourishing therapy. Many Tibetan works of development of medical history has recorded the close relationship of human body metabolism and health foundation, disease, treatment, and rehabilitation. And through repeated clinical practice confirms the important role of the nourishing therapy in disease prevention, treatment, and rehabilitation. The unique nourishing therapy system of Tibetan medicine took shape. In the time of development of modern nutrition treatment. Without losing the core of nourishing therapy, to analysis of the overall situation of Tibetan medicine nourishing therapy. How to choose the development way will become the common problems faced of traditional Tibetan medicine.The thesis is divided into five chapters.The first chapter discusses the development history of Tibetan medicine conservative therapy. It is divided into embryonic period, mature period and development period of three stages. Through the archaeological data and the rich literature, discussed the development and achievement of Tibetan medicine conservative therapy. And explore the origin and development of Tibetan medicine conservative therapy.The second chapter discusses the basic theory system of Tibetan nourishing therapy. Based on The five source, three factors, seven substances, three excrements, stomach, viscera, context, physical dialectical theory of Tibetan medicine, I discussed the form of system characteristics of Tibetan nourishing therapy.The third chapter discusses the connotation of Tibetan medicine conservative therapy system. It contains two contents, which are nourishing nourishing treatment method and disease population. It discussed the important role and practical significance of the conservative therapy in the prevention, treatment, and rehabilitation. Especially the use of the four conservative treatment classification, application principle, constitution. and classification of diseases, dialectical in individual treatment.And the practical significance for support therapy.The fourth chapter discusses the comparative study of Tibetan medicine for therapy and other medical. Mainly put forward a few personal awareness on a comparative analysis of traditional Chinese medicine, India medicine., and modern nutrition.The fifth chapter discusses the application of method of-nourishing therapy. Mainly used clinical investigation, to choose6specialist departments of internal medicine, liver diseases, cardiovascular of Obstetrics and Gynecology, surgery, orthopedics,400hospitalized cases of Tibetan Hospital of Tibet autonomous region in2012January to December, to investigate various special nourishing support application. I combine the hot research topic in support of modern nutrition and clinical outcome, under the Tibetan medicine in the succession of its unique theoretical premise, to better develop their own characteristics.In Tibetan medicine nourishing therapy is not only used in health care, but play more important role therapy and positive role in prevention, treatment, rehabilitations.With the development of the global trend of nutritional therapy mode, surgical treatment is also gradually turned to the nutritional therapy in medical development inevitable result, the nutritional therapy, attention will also be improved.Although the Tibetan nourishing support get to inherit and carry forward. For chronic diseases and serious illness nourishing support therapy remains to be further research and development.the development and application of Tibetan nourishing therapy has practical significance.Through this research, I gained new knowledge and new discovery on Tibetan nourishing therapy theory system.The application method is by taking part in modern medical nutrition department, learning the ICU. By views of modern nutrition therapy I gained the inheritance and development of Tibetan medicine conservative treatment. There must be some mistakes in this paper because of my limited knowledge and time inevitably.1’11keep on my research work in the future and lay a solid foundation further clinical system. This essay will play an important role for clinical and academic development of Tibetan medicine.更多还原