【作者】 黄智敏；

【导师】 吴清和；

【作者基本信息】 广州中医药大学 ， 中药学， 2009， 博士

【摘要】 现代社会都市化,经济工商业化,造成生活节奏加快,而导致人民精神紧张,人与人之间关系疏离,致使情绪难得排解,心理失衡而出现西方医学之精神病。精神病和心理学在西医已是一门专业学科,中医方面虽然也有学者在致力研究,但至现时亦只在本科课程中的一门必修或选修课而已。至于香港中医取得法定行医地位才不过10年光景,加上本地中西两种医学有严格之区分,中医从家庭医学方向发展,处于与民众接触的最前线,而本地社会结构近年出视急速变迁,人们于情志上之波动,甚至影晌心理健康,造成日益增加的精神病问题,使中医于情志病的治疗服务及研究上出现广大之发展空间。目前,国家中医药管理局已将情志医学列入“十五”攻关项目,香港正处于中医成为法定医疗体系之初期,因应目前社会的需要,发展以中医中药疗法协助情志病患者康服,具有一定的必要性。中医对人心理行为的认识,早有《内经》天人合一之学说、五志配以五行和五脏与以归类,互相胜济造成内伤七情,并以此为情志病之治疗的理论依据。金元四大家之一的张从正利用中医方药、情志相胜疗法、行为疗法和移情易性疗法,成为独树一帜的中医心理疗法,应用于情志病患者,疗效显着,是为古代中医情志病临床医家最具代表性人物,而他的情志理论和临床医案都全包含在其著作《儒门事亲》之内,为研究中医情志病最值得借鉴学习的文献。研究张氏理论学者回顾了近10年来对张从正学术思想研究的部分文献,以及2000年以来坚持每年组织召开的全国张子和学术研讨会和众多中医杂志后指出“当下社会中仍然存在的尚补恶攻之时弊在作怪吧!攻下思想推行不易,更反衬其可贵性。”本论文把《儒门事亲》情志病医案作全面分析和统计,结果正显示以下法于治疗情志病极具参考价值。就上述论题本文共分四部份作探讨研究,第一部份分两节,首先从历史、文化、哲学层面去剖析本文研究之古医籍论着《儒门事亲》作者张从正的成书背景。张从正生逢战事频盈,政治局面相对稳定的时代,但当政者在此乱世却十分重视发展文官统治,大力培养知识分子、选拔文士,科技文化不断进步,经济繁荣,这为医学发展提供了有利的条件。根据当时的文化发展,人文思想备受儒家思想的人道主义精神所影响,同时也决定了中医学发展的特殊道路,其中特别是社会心理、价值观和思维方式,贯注入中医学作为治病救人宗旨,必须具备一颗”仁心”,行医被视为施以”仁术”,许多失意文人都转而从事医术,原因正是这种以”人”和”仁”为本位的文化氛围形成了儒生转业机遇,也为中医学盈聚一般软力量。张氏由早年饱读经书,从军旅,当御医,有儒家的修身齐家治国平天下的入世心态;晚年失意而隐逸,与其医疗方略,由熟读医经宗于灵素、伤寒,及至批评罔用温补,更发展出独树一帜的汗、吐、下祛邪疗法,均充份隐含着张氏晚年偏向于道家遗世独行之脉络,故长期以来学者将张从正之定位“儒医”,对于其中的“道医”部分都被分略,本文则从《儒门事亲》内隐含的道家哲学思想探究之。第二节讨论张氏在医学上自成一家,以个人历练和见识,除了独竖汗吐下的祛邪疗法外,还结合《内经》心、神之道与天人合一思想发挥为一套情志病理论,可见于《儒门事亲》于情志病之病因、病机的九气与五积之说的论述,展现出创新治疗手段。在保守的旧封建社会,官僚权贵喜温补,对于感觉难受之吐泻视之忌讳,新创见、新思维是难以得到群众所认同的,同时在此蜚短流长的环境下,张氏仍坚持其屹立独行,形成了”攻邪已病”的独到见解,充份展现出他的心理情绪素质极高,用之于应付情志病难治之证,在驾驭顽强抗拒治疗的病者,分析理解病者之心结,使之成为中国古代医家之中展示出最具特色,及符合现代精神病治疗意义的情志病治疗方案。第二部份把《儒门事亲》全书记载的二百多个医案中,抽出全部有关情志病的,总共有23个,并将之指出证、理、法、方、药所在,之后每案作综合分析。再把各医案所用之治疗方法进行统计,结果以下法使用次数最多,这点或对后学者有启示作用。从《儒门事亲》卷六～卷八之《十形三疗》之139条计162例案中,运用下剂达93例,占全部病例的74%。可以看到下剂在攻邪三法中所占具的重要地位。吐法在张氏情志病医案中被使用的频次仅于下法之后,然而吐在临床运用上都有一定的难度和危险性,因为吐法的作用对人体来说是一个强刺激,作用结果并不是每个临床医师能把握的,如果吐法对机体的刺激强度不够,则病不能愈,如果刺激过强,病亦不能愈,甚至迅速出现逆证危象。现代医学技术的发展,不少催吐法被新的医疗手段所代替,致使一些医家本身都不愿意去尝试吐法。至于另一张氏治疗情志病时较多使用的以情胜情意疗法,占使用频次的第三位,这种中医意疗类似西方的行为疗法,但张氏却超前了多个世纪已用之于临床,这开创先河的治疗方案值得业者将之继续发展与发扬。第三部份共分三节讨论,首先说明了近代中医学于情志病、心理学的学术发展。随着社会的转型与发展,我国精神卫生工作面临着巨大的挑战,精神疾病在我国疾病总负担中排名首位。至于中国国民的普遍精神健康问题,国家主席胡锦涛有鉴于随着我国经济高速发展,有社会生活中也存在一些不健康、不文明现象,提出要引导广大干部群众特别是青少年树立社会主义荣辱观,以“八荣八耻”为具体内容的社会主义荣辱观,为我国公民道德建设树起了新的标杆,对加强社会主义思想道德建设产生积极的影响。在学术层面上,自上世纪八十年代开始已开始就中医心理学每年举行学术会议,中医心理学从中医学领域内被提升出来,成为一门新兴学科。第二节本文探讨了西方医学也开始重视以传统民族医学应付现代社会的情志病,在西方社会讨论心理学的未来发展,产生了具批判性的后现代主义Postmodernism,倡导者们主张重新检视研究人类情志变化的心理学,心理学由西方学术作主导转而加入中国传统民族医学内容被认同为另一股新的趋势。至于中医于情志病应用下法,从中医理论可理解作开郁与疏泄,从现代生理学亦说明情绪低落或长期性的抑郁,神经细胞受分泌失常所影响,都会导致消化不良以至便秘两者互有关系,值得本地中医研究应用之。而第三节讨论香港政治、经济环境的发展与人口结构之变迁,在香港经济繁荣、社会有序发展的背后,有一个被人忽略的因素,就是香港人口群体自身的重大变化,这种的人口流动令香港注入了一批新力军,舒缓了和其它高度发展的地区一样所出现的人口老化问题,但同时亦产生了不少社会问题。近10年来由内地来港结婚的女子,由于文化、经济、年龄的差异,导致感情基础较为薄弱,因此家庭生活容易产生冲突,轻则关系疏离,严重者有闹出离婚,甚至双方情绪抑郁下造成严重的狂躁行为,发生流血事件或自杀,或祸延至年幼的子女,为香港社会备受关注的精神健康问题。第四部份总结《儒门事亲》对香港中医治疗情志病的启示,是次研究通过对金元四大家之一的张从正在《儒门事亲》中之所有情志病医案全面检视分析,不单进一步找到古代情志病理论与临床的一些脉络,除了在临床治疗用下法和意疗,值得进一步研究学习外,同时也展现了张从正作为一位医者的心路历程,在逆境中庄敬自强,专业上择善固执,值得为现今新一代中医的专业精神楷模。伴随着中医在全港的医疗服务角色日渐吃重,中医在门诊医疗中的比重相对地增大,而西医抗精神病药物有较多的副作用,情志病患者求诊于中医或会不断增加,利用本地中医被定位为前线医疗,采取家庭医学为服务模式的特点,总结了香港中医应付情志病下面几项建议其:以缓急有别、防病为先;治疗上明辨虚实、应用下法;同时在意疗、行为疗法的范畴上更可变化多端作综合治疗,进而无限创新,利用中医固有的注重个体、辨证施治的优势为大众精神健康工作上发光发热。更多还原

【Abstract】 In the modern world,we have experienced with metropolitan city life and highly industrialize economy growth.The fast living pace caused stress.The individualism is a kind of by product in this modern era.People can’t help each other to solve their psychological problems.That is the main reason to cause people’s psychological imbalance in the western world.Psychics or psychology is a special topic in western medicine.The Chinese medicine specialists also established a certain attention on the subject in the recent years as well.However,the TCM psychology only maintains as a regular course in the undergraduate syllabus.In Hong Kong under the Basic Law,Chinese medicine received a legal statue 10 years ago.There are very restrictive guidelines on differential the practicing of TCM and western medicine.The local TCM has been planned to develop as a family medicine service to the community on the frontline.As our society structure have rapid changed in the recent years,mental health would also be a major social issue at the same time.In response to these social needs,TCM professions would see a great opportunity in develop their specialties service to the society.The theory of unifying human and environment from the ancient literature of "The Yellow Emperor’s Internal Classic"(黄帝内經)let the Chinese medicine professions have a better understanding of human behaviors.The five emotions match with five elements and five organs which can cross affect each other as pathogenic factors and psychology illness. It is practically worth noting that in Jin(金) and Yuan(元) Dynasties,one of the four famous physicians Zhang CongZhen(张从正)intergrated Chinese medical theories and human behaviors to create a brand new and effective psychological treatment.Zhang CongZhen also known as a representative clinical practitioner in the field of psychology during the ancient period of time.Most of Zhang’s theories are covered by his main works Rumen Shigin《儒门事亲》.It is a famous and valuable literature for examining the Chinese medicine psychology thoughts.Chinese medicine scholars reviewed almost all Zhang’s literatures and conferences concluded that due to the public prefer for invigoration than purgation,the purgation is a kind of philosophy which is tough to promote.However,this thesis conducted a complete review the clinical psychology cases of Rumen Shigin.The findings stated that the purgation therapy is a valuable in the treatment of psychological illness with providing a great inspiration to further study.There are four sections in this research.The first section contains two parts discussion. Zhang Congzheng is the author of Chinese medicinal literature Rumen Shigin.In the first part we analysis the author background base from the aspects of historical,cultural and philosophical.Zhang Congzheng was live in a wartime era but stable in the political environments.At that time intellects were respected by the government.Economy and technology have been great improvement.It make a better circumstance for the development of medicine knowledge and services.According to the cultural development, the general thinking and Chinese medicine philosophy was impact by the Confucius’ humanities thought.Confucius’ social philosophy largely revolves around the concept of Ren"仁","compassion" or "loving others." The Confusian scholars cltivating or practicing such concern for others"仁術" when they change their profession from scholar to medicine practitioner.When Zhang suffer from downward of his career,he apparently becomes a Taoism believer.However,most of the researchers would recognize Zhang as a Confusian believer than a Taoism scholar.In this paper,we have a special topic to discuss some of Zhang’s works actually are root from Taoism.The second part of the first section review Zhang specialty on using the methods of sweating,vomiting,and purging therapy in clinical practicing.He created an idea of nine qi (力氣)and five obstacles(五積)from The Yellow Emperor’s Classic theories of five elements(五行),five expressions of emotions(五志)and seven mode of emotions(七情) as well.The idea also support Zhang to develop a new Chinese medicine psychological therapy.The emerging of human and heaven is the central theme of Zhang’s works.In the conservative ancient’s society,people prefer the warmish and nourish health care services than the purgation methods.New ideas are difficult to gain support from the general public in the old days.Zhang was praised in overcoming such Challenges with a strong mind and solid personality.This may be the best resources for Zhang to become the pioneer of clinical psychologist in the field of Chinese medicine.The second section of this research is look into the over 200 clinical cases of Chinese medicine literature Rumen Shigin.We are focusing only on the 23 psychological illness cases.Those cases have been analysis from its information of symptoms,therapy, decoctions and medicine.Since there are a significant negative side effects in using of the vomiting method,we have found that the purgation method is the most popular and effective therapy in curing the psychological health problems in Zhang’s clinical practising. Zhang also is expertise in using the non-medicine psychological therapy for the mental patients.It is apparently an innovative clinical invention in the history of medicine world. Despite its limitations,Zhang’s clinical psychological theories has provided a rich body of information on some fundamental areas for further study.The third section of this research contains three parts.Part one is review psychology as a kind of academic profession and how did it develop in the modern China.Mental health is the top burden in our nation’s health care system.Chairman Wu has announced some guidelines on mental health promotion campaign.Those guidelines called eight honor and eight shame(八榮八恥).These descriptive guidelines presented benchmark information on the physical and mental health of the population,prevalence of major moral problems and socialism lifestyle practices,constructive socialism promotion,as well as life attitudes taken by citizens in a socialism society.In the early 80’s of last century,the Chinese medicine professions review its role in the psychology academic field.Psychology in Chinese medicine conferences have been held and research papers have been published. Part two focus on the issue of the west meet east in the field of psychology.The postmodernism supporters are suggested a new trend that the traditional Chinese medicine should be integrate and play an active role in the mainstream psychology academic world. With increasing economic integration and social interactions between Hong Kong and China’s mainland,in the third part we have figures to prove cross-border marriages is a significant social phenomenon in recent years.It was also found that Hong Kong grooms often married much younger brides due to their own delayed marriages and second plus marriages.In this case,lots of social and economic problems have been increased substantially among those cross border marriage families.One of the major issue is psychiatric disorder that occurs in those marriage couples have been caused many bloody tragedies as a result.更多还原