腹痛病证的古今文献研究与学术源流探讨

【作者】 李永红；

【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】 腹痛是指胃脘以下,耻骨毛际以上部位发生疼痛为主要表现的一种临床常见病证。其病因多为风寒暑湿火等外邪入侵,以及热积、食积、酒积、气滞、血凝、寒积、痰积、虫积、血虚、气虚等内伤病因所致。腹痛病机为腹部脏腑经脉痹阻,或经脉失于温养,气血运行无力,而致气机阻滞不通而痛。作为临床常见的疾病,关于腹痛的记载很早就出现在我国古代文献中。明代以前,腹痛和胃脘痛经常混称,明代以后才将两者明确分开,专立腹痛病名。其资料散见于多种疾病,对于该病的病因病机、辨证分型、治疗方法、预防调摄以及护理、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。本文以文献学研究方法为主,在全面系统搜集历代有关腹痛病证资料的基础上,对相关材料进行了深入地分析研究,系统阐述了先秦到民国时期各个历史阶段的学术发展特点,揭示了腹痛证的学术发展源流;对现代医家诊治腹痛证的经验也进行了系统地总结和整理,力图全面反映古今医家对此病的学术理论和临床治疗经验,为现代临床辨治腹痛病证提供可资借鉴的诊治经验,并开拓腹痛病证研究和治疗的新思路。本文分为病名源流探讨、古代医家论治研究、名老中医经验总结、现代治疗研究,以及相关问题探讨五大部分。第一部分,将腹痛病名的演变过程进行梳理,厘清了腹痛从症状名到病证名,从与胃脘痛混称到成为独立病名的发展脉络,并将与其相关或类似病名进行辨析。第二部分,以历史发展为主线,用断代史的方法,分别对先秦至南北朝、隋唐、宋元、明、清至民国各个历史时期的医学发展特点、腹痛相关理论的发展状况进行了概括与分析,重点研究剖析了各个历史时期与腹痛相关的重要医学文献,内容涉及腹痛的病名、病因病机、诊断、治疗、用药特点等多个方面。第三部分,整理总结了近现代名老中医对腹痛辨证治疗的经验和方法,并附以医案加以论证。第四部分,收集整理了现代对腹痛的病因病机分析、辨证诊断、用药特点、其他疗法、民族医药等多个方面的内容。第五部分,对腹痛的相关问题进行探讨。对腹痛治法需灵活多变提出自己的见解;阐述了自己对腹痛治疗中广义通法、汗法应用;芍药止痛并非只限于血虚类型;对“痛无补法”的探讨以及补法治疗腹痛的分析等各个方面的认识。在总结前人论述的基础之上,提出了自己对腹痛治疗的认识和见解。更多还原

【Abstract】 Abdominal pain is a familiar disease characterized by pain between gastric area and pubis.The pathogenesis of abdominal pain include external cause and internal causes. Exogenous evil,such as wind,summerheat,dampness,dryness and cold invade. Internal causes,such as the heat-evil accumulates in the interior,food retention, alcohol mass,blood stasis,qi stagnation,stagnation of cold-evil,the stagnancy of phlegm,worm stagnation,deficiency of the blood,deficiency of qi,and so on.They are the causes of internal injuries that lead to abdominal pain.The etiology of abdominal pain are obstrucion of the channels in zang and fu which in abdomen,or malnutrition of the channels,impeded circulation of blood.These factor lead to hindrance of functional activities of qi.It is the obstruction that causes the pain.Abdominal pain is a disease commonly seen in clinical.As a common clinical disease,the typical clinical manifestations of it are mentioned in Chinese ancient literatures,there are a great many related records in ancient books of traditional Chinese Medicine.Before the Ming Dynasty,abdominal pain often mixed with epigastralgia.After the Ming Dynasty,there is a clear separation between the two diseases and abdominal pain become an independent name of disease.The data about abdominal pain scattered in many diseases.The etiology and pathogenesis of the disease,syndrome type,treatment,prevention measures,nursing,healing, rehabilitation,it has accumulated rich experience in traditional Chinese medicine theory and practice.So it is worth to dig and collate the literatures and to excavation, organize,inherit and carry forward.Mainly mothed used in this work is document research.Based on the data of abdominal pain in various dynasties collected,further analysis on these materials is made.The academic characters in each stage from pre-qin to the Republic of China Period are expatiated to reveal the origin and development of the learning on abdominal pain.Clinical experience in diagnosing and treating abdominal pain of many famous doctors is also be summarized systemly to reflect their academic thinking.It provides some references for clinic and will be help to exploit the study and treatment of abdominal pain.This article is divided into six parts.They are disease name origin and devolopment;various doctor’s study about diagnose and treatment in ancient;experirence summary of famous doctors;modern therapy study;diet and nursing;the relevant questions to explore.In the first part,the origin and evolvement of the disease name was combed, which clarifies the venation of name evolving from a name for symptom to a name for disease and distinguishes abdominal pain from related and similar diseases.In the second part,with a dynastic history of medicine development unfolded, the characters of medicine and the theories about abdominal pain in each stage were summarized.Emphasis of the study is analyze related documents about abdominal pain in various dynasty.the content involves disease name,cause and pathogenesis, diagnosis,treatment,characteristic medicine,preventing,nursing,and so on.In the third part,systemically summarized the experience and measures of syndrome differentiation and treatment from modern physicians.Add medical record to expound and prove.In the fourth part,collect and arrange materials about abdominal pain,such as cause and pathogenesis;diagnosis;treatment;characteristic medicine;other therapy; medicine of national minority,and so on.In the fifth part,abdominal pain related questions were discussed,especially in some thoughts of syndrome differentiation and some prescriptions rarely used by the doctors of today,so as to exploit the thoughts of treatment based on syndrome differentiation.更多还原