【作者】 刘洋；

【导师】 潘桂娟；

【作者基本信息】 中国中医科学院 ， 中医基础理论， 2008， 博士

【摘要】 中医学情志理论在基本认识上继承了中国传统文化尤其是儒家思想。秦汉以远即创建了七情、六志、五气、五性等名词术语。明确情志一同,情动为志,志更偏重于情感表达,揭示了《内经》论述情感情绪重在五志的根源。天人相应,不同时间、气象条件所带来的环境改变可以影响人的情感变化。注意到社会境遇的改变程度,可以导致喜乐忧哀情感变化的性质与程度,是《内经》贫富贵贱致脱精失营观念的滥觞。建立了通过面貌行为判断情志表达的方法,奠定了《内经》怒象判断的依据。描述了“喜怒欲惧忧”的特征性行为心理,将其与气关联,称作内畜五气,这种畜与藏、气与性的关系,与《内经》“人有五藏化五气,以生喜怒悲忧恐”的情志发生理论构成了默契。构建了情志与五方、五脏配伍的理论。提出情志表达缺乏正面意义的论述,情志表达难于控制,过节生害,成为病因的理念。申明情志中和的主张,奠定了中医情志病因学的基础和节喜怒戒嗔恚的情志养生观。中医学在继承秦汉以前有关情志基本认识的基础上,将其贯穿于医学实践,形成了以情志病因学为中心的发病、辨证、治疗与养生的系统理论体系。情志成为病因的原因是情志太过,可分为发生突然的“暴”,程度剧烈的“过”,持续难释的“久”,反复刺激的“多”等四种情况。根据情志病因的致病作用,总结出情志病因具有泛病因(在疾病发生过程中,情志具有宽泛而无导致具体疾病的作用)和指向性病因(在病因作用下能够致发具体疾病)两种情况。泛病因理念在强调调摄情志防病养生方面具有理论意义。指向性病因又分为:单一情志病因,是指情志中的某一情志直接导致具体疾病;复合情志病因,是指二种或更多情志因素复合致病;内伤复合病因,是指情志与其他内伤病因(饮食、起居)复合致病;情志外感合邪,是指内伤情志外与感六淫合邪致病等四种情况。总结提出情志致病传化没有次第的两个特点,一者邪气不得传移,气留本脏则重伤本脏;二者我不胜之脏来乘,本脏受伤更重。两者都可“令人有大病”。怒是致病作用较为强烈的情志病因,《内经》对怒进行了多方位的深入系统研究。形成了以面貌辨怒象,以形动分怒质,以肝立胆横为怒体的基本认识,并指出《内经》是唯一提出发怒有肝胆形态变化的医学文献。怒致气上逆是怒的根本病机,与正常人体阳气下交阴气上承、“气从以顺”成相反状态,直接导致气行的反向运动。气上逆致气离位,气离位致气错位,气错位则气行悖,气行悖则病作矣。按照情志损伤“志伤气,气伤脏,乃病脏”的一般规律,怒伤气包括伤气、伤阴两个层次。根据邪气作用后人体反应的整体状态判断邪气性质的原则,提出怒为阳邪。怒伤脏则有伤本脏肝和伤母脏肾之别,引申出凡见近记忆减退者,都应该从增强肾的封藏作用着手,可扩展至老年性痴呆预防和延缓性治疗。提出“毛悴色夭”为情志病程较久的望诊特征。怒志单一病因致病可引起的薄厥、呕血、飧泄、消瘅等。气逆除致血逆外,还易引起脾胃升降的反作,同时说明脾胃是最容易受到气运行方向改变而发生升降反作的脏腑。怒志复合病因致病详分可见复合饮食起居或六淫等情况,主要有痈疽、痈膈、爪病、积,寒痹等。分析“爪病”为丝虫感染所致的慢性期阻塞性鞘膜积液(睾丸肿大),纠正了以往注释为癞疝的错误。痈膈是在肠道寄生虫导致胃脘痈或腹内痈基础上形成消化道梗阻,提出了一种新的寄生虫性消化道梗阻的发病机制。怒既是病因,可以导致发病;同时也是症状,在疾病过程中由于病邪或脏腑气血阴阳自身偏颇所导致。怒发生的原因大致有,肝血气实(提出怒是中医测知肝气血状态的一个基本指标)、肝气未得主时自振作怒、胆气郁、胆气逆、木郁土壅、阴阳气血紊乱、春夏肝心中风、刺不随时、刺不当位、饮酒等,都可以见怒。分析这些怒产生的原因,为确定病机制定治则提供了依据。并简要介绍了《内经》怒的刺禁和刺后医嘱。最后根据《内经》怒的内容,从病因学角度,对典型怒作出以下描述:怒,是以肝举胆横的脏腑形态变化为基础,以横眉立目发竖面青为面貌表情依据,以肌肉瘦削、立眉深视、言寡行隐为易发形体特征,以气上逆导致的气行反动为病机特点,以肝胆郁滞气盛、阴阳气血乖乱的状态反应为症状表现,以损伤阴气肝肾为主要病理环节的阳邪内因。《内经》作为两汉以前中国医学集大成者,集中展现了其时系统、丰富、翔实的情志基本理论和应用理论。可以毫不夸张地说,这些理论认识达到了一个相当的高度。就怒来说,其记载的临床病象弥足珍贵,阐述的医学理论令人惊叹。如果能利用这个高度,无论俯瞰还是远望,眼界都会开阔许多。学以致用,望能为临床提供一些帮助。更多还原

【Abstract】 Emotion Theory of Traditional Chinese Medicine mainly comes from traditional Chinese culture,especially from Confucianism.As far as Qin and Han Dynasties, there were many technical terms about emotion,and the ancient people showed us the relationship between emotion and aspiration.For example,man,as a microcosm, is connected with the macrocosm;different time and the changes of surroundings caused by different meteorological states could affect the emotion of human beings; also the different social conditions could decide the character and extent of emotional changes.Based on these,The Yellow Emperor’s Internal Classic explained the relationship among emotion and aspiration,five directions,and five Zang-viscera.According to The Yellow Emperor’s Internal Classic,emotion and aspiration were harmful to human’s health,meanwhile,emotion and aspiration were hard to control,and easy to become the etiological factor,so people should control their feelings,no matter it was happiness or anger,to get longevity.These theories became the foundation of emotional etiology in Traditional Chinese Medicine.Based on the knowledge of emotion before Qin and Han Dynasties,and tested by the clinical practice,a systematic theory about emotion emerged.This theory talked mainly about the emotional etiology,also about the start of illness, differentiation of symptoms and signs,treatment and health cultivation.And according to this theory,emotion became the etiological factor through mainly 4 ways.According to the pathopoiesis of emotional factors,the etiopathogenisis of emotion can be divided into general etiopathogenisis and directional etiopathogenisis. The general etiopathogenisis emphasizes on the health-care function of regulating emotion.The directional etiopathogenisis also can be divided into single etiopathogenisis and complex etiopathogenisis.There are two main characters of the pathopoiesis and transmission of emotional factors,and both of them can do great harm to health. Anger is one of the strongest emotional factor,and The Yellow Emperor’ s Internal Classic has deep record about it.According to The Yellow Emperor’ s Internal Classic,anger can lead to the pathological changes of appearance on face, the activity and the function of viscera,however,the superinverse of Qi is the basic pathogenesis of the diseases caused by anger.Anger is Yang evil,there is a law about the damage caused by emotion: emotion dose harm to Qi,then Qi does harm to viscera,and then the viscera get ill. Liver is corresponded to anger,thus anger always does harm to liver.In the theory of Traditional Chinese Medicine,kidney is the mother of liver,so we can treat the kidney to cure the liver disease caused by anger.Single anger factor can lead to a series of diseases such as raged syncope, haematemesis,and so on.Adverse rising of Qi can lead to adverse rising of blood, and the abnormal function of spleen and stomach.Besides these,anger factor can act with many pathological factors such as bad surroundings and six evil.Anger is not only the pathological factor but also the symptom.The main reason which leads to anger is the excess of liver blood and liver Qi,and so on.Analyzing the reason of anger,we can get the pathogenesis and therapeutical principle.At the end of this article,according to The Yellow Emperor’ s Internal Classic, anger is defined as following:Anger is based on the morphologic change of liver and gallbladder,and leads to the bluish complexion,thin and weak,few words.It’s characterized by the superinverse of Qi.In the clinic,the main symptoms are stagnation of liver and gall bladder,excess of Qi,abnormal movement of yin and yang,Qi and blood.And anger does great harm to Yin and Qi,liver and kidney.The theory about anger in The Yellow Emperor’ s Internal Classic is very believable;all of the records are very precious.The author hopes all of us can learn much from it.更多还原