呕吐病证的古今文献研究与学术源流探讨

【作者】 陈蕾蕾；

【导师】 严季澜；

【作者基本信息】 北京中医药大学 ， 中医医史文献， 2009， 博士

【摘要】 呕吐是临床常见病证之一,是指胃失和降,气逆于上,胃中之物从口吐出的一种病证。胃居中焦,主受纳腐熟水谷,其气以降为顺,无论是外邪、饮食、情志、脏腑失和,干于胃腑,导致胃失和降,均会导致呕吐的发生,但无论是邪气犯胃,或脾胃虚弱,发生呕吐的基本病机在于胃失和降,胃气上逆。自秦汉以来,历代医家通过长期的临床观察与实践积累,逐步完善和发展着呕吐证的理论认识与辨证治疗。对于该病的病因病机、辨证分型、治疗方法、预防调摄及护理、康复等,中医学均积累了丰富的理论与实践经验,值得我们充分挖掘、整理、继承和发扬。本文在系统搜集历代文献资料的基础上,以“辨章学术,考镜源流”的文献学方法为主,从医史学角度深入分析了历史背景与呕吐证学术发展的影响与联系,系统概括了呕吐证的学术发展规律,全面总结了历代医家的辨治经验,并进行了分析。本文分为病名源流考辨、医家论治和相关问题探讨三大部分。第一部分为第一节,是病名源流考辨部分。本部分介绍了呕吐相关病名的历史沿革以及相关病名的名义考辨,从中医角度对呕吐病名进行了明确定义。第二部分为第二节至第七节,是本文的主体部分。这一部分用了大量的篇幅,以历史发展为主线,以断代史的方法将本文分为先秦至三国、晋唐、宋金元、明、清至民国、现代等几个时期分别进行论述。其中第二节至第六节属于古代部分,该部分对各个时期的主要医家及主要论著的观点进行了深入地挖掘和剖析,总结和提炼了其独到的学术观点与辨治经验。在每一阶段中首先概述本时期中医对呕吐的认识;其次对有代表性的医家及著作进行深入细致地分析,从病因、病机、诊断、鉴别诊断、辨证论治、用药特点及调护等几个方面理清了不同医家对呕吐的独到认识及在学术上的继承性和发展性。第七节为现代部分,该部分对呕吐病证的现代研究进行了总结归纳,分别对呕吐的系统规范、呕吐的治法研究、呕吐的药物治疗、现代名老中医治疗呕吐的经验、呕吐的外治法等内容进行了阐述、总结和归纳,理清了现代医家对本病的研究情况。第三部分为第八节。这一部分对与呕吐证相关的一些问题进行了讨论,包括呕吐与五脏的关系、呕吐从三焦论治、呕吐当下不当下的思考及易被忽视的几个问题,分别阐述了自己的观点和认识。更多还原

【Abstract】 Vomiting is one of the common clinic symptoms.Vomiting is due to heat accumulated in stomach,cold coagulation,qi stagnation,stagnation of phlegm-dampness,qi deficiency,xue deficiency,yin deficiency,yang deficiency,and so on.During the period of more than 2000 years from the Pre-Qin Dynasty,the experts and doctors have accumulated rich medicating experience via long-term clinic observation and practices.Their comprehension on the causes,the characters and dialectic medication of vomiting are gradually perfected, rich medicating experiences are accumulated and a great number of data and materials are left.The healing effects of many methods were proved to be definited and reliable after long-term repeat.This article focuses on summarizing and analyzing the differences and similarities of experts’ views during a certain period.Then analyzing the relationships between the inheritance and developments of these views after collecting a great number of data on vomiting and undertaking an examination, classification and analysis of the concerning data,and then lays out the entire awareness of Chinese medicine on vomiting Syndrome this period.The inheritance and development of doctors’ views are be sloved,and choroid of cognitive development of vomiting Syndrome from the Pre-Qin Dynasty is obtained by analyzing the similarities and differences of academic views between different doctors at different periods.This paper is composed of three parts:study on the distinguish of the disease name,the points of view of physicians,and discussion on the related questions.The first part introduces History and the Name study of relevant name of vomiting syndrome,defines clearly vomiting from the perspective of Chinese medicine,and then lists on the classification of vomiting,reviews the innate character,the meaning,the argument,the advantages and disadvantages of the related classification.The second part is the most important part of the paper.The article devotes to interpreting and analyzing the main works and experts’ thoughts at every periods,analyzing their uniqueness.The mainline of the article is constructed basing on all the dynasties from Pre-Qin dynasty to modern which includes Pre-Qin to Xi-han dynasty,Dong-Han dynasty,Jin dynasty, NanBei dynasty,Sui dynasty,Tang,Song,Yuan,Ming,Qing,the republic of china.First it gives a comprehensive introduction on the cognition of vomiting,and then set out a specific analysis on those representative works which involves many aspects including the causes of the disease, interpretations of the cause,diagnosis and examinations,treatments, medicine characteristic and aftercare and so on.the third part is discussing on some special topics which associated with the vomiting,states the author’s views.更多还原