【作者】 樊新荣；

【导师】 朱文锋；

【作者基本信息】 湖南中医药大学 ， 中医诊断学， 2008， 博士

【摘要】 目的:用证素辨证对《伤寒论》三阳三阴病证进行整合、统一与发展。方法:(1)对《伤寒论》三阳三阴病证所收集的文献资料运用共时与历时研究、分析与综合方法进行整理分类,以提炼结果;(2)对《伤寒论》三阳三阴病证涉及的381条原文(上海中医学院中医基础理论教研组校注.《伤寒论》[M].上海:上海人民出版社,1976.)进行分析,提炼证素,组成实质证型,并根据情况,对原文适当调整,辅以十纲证类之病位为框架,以证素病位为基点对调整后的原文进行重新归类;(3)以太阴病证为例,选择208例名老中医医案运用WF文锋-Ⅲ中医辅助诊疗软件进行理论验证与计量诊断研究;(4)按照中医理论造成太阴病脾虚寒湿证与阳明病肠热腑实证大鼠模型,对其进行组织形态学、微观指标研究。结果:(1)《伤寒论》的辨太阳病、阳明病、少阳病、太阴病、少阴病、厥阴病,实为三阳三阴辨证,后人称其为“六经辨证”,并成为《伤寒论》约定成俗的辨证体系称谓。从原文分析,三阳三阴辨证的实质主要为辨病位病性。(2)运用证素辨证对三阳三阴证进行分析,可以涵盖绝大多数条文,并且辨证目的确切,辨证内容完整、统一,证素的内涵外延明确,证素特征规范,理论层次清楚,术语统一,表述严密,证名规范,可克服以往《伤寒论》研究古今诸法混用的情况。(3)WF文锋-Ⅲ中医辅助诊疗软件可提高辨证的精确性,并论证《伤寒论》的“病”即证类,其囊括若干证型的论断是正确的。(4)根据中医学理论,采用复合造模的方法,成功制备出太阴病脾虚寒湿证、阳明病肠热腑实证动物模型,比较符合中医病因病机。体温、D-木糖吸收率、Na~+-K~+-ATP酶活性以及胃、肝、小肠、脾脏、结肠的部分组织形态学改变可作为二证的鉴别指标。结论:用证素辨证可以整合、统一和发展《伤寒论》的三阳三阴病证。更多还原

【Abstract】 Objective: To modify and develop the syndrome differentiation of Three-Yang and Three-Yin discussed in the classic of Treatise on Febrile Disease.Methods: 1. To draw a conclusion synchronically and diachronically from the collected documents about the syndrome differentiation of three-yang and three-yin. 2. Analysis and modification is carried out about 381 items abstracted from texts that discuss the syndrome of three-yang and three-yin, and that were proofread by the Research Group of Treatise on Febrile Disease in Shanghai College of Traditional Chinese Medicine in 1976, thereby the syndromes and elements are abstracted and a framework of syndrome-elements are established. 3. 208 case reports are collected. With the extreme-yin syndrome in consideration, a theoretical examination and a quantitive diagnostic research are made with the aid of software named WenFeng’s Computer-Aided Diagnostic System (3rd edition). 4. Experimental rat models are established, one of which produces cold-damp-deficient syndrome of extreme-yin disorders, the other excess of fu-organs due to heat of the intestines in yangming disorders. After this, indices involving morphology and other specific points are observed and measured.Results: 1. The six-meridian syndrome differentiation, which in Treatise on Febrile Disease refers to diseases of taiyang, yangming, shaoyang, taiyin, shaoyin and jueyin, is actually an alternative term for three-yang and three-yin syndrome differentiation. It is obvious from the original texts of Treatise on Febrile Disease that differentiating syndromes of three-yin and three-yang are to locate the disorders and to determine the nature of the diseases. 2. Analyzing the three-yin and three-yang syndromes by use of syndrome-element differentiation may obtain more accurate results such as a larger coverage of the texts mentioned above, an easily-controlled direction in differentiating syndromes, unified results from syndrome differentiation, standardized features for each of syndromes and elements, clear connotation and denotation of terms, etc. As a result, the long-time confused conditions in the research of Treatise on Febrile Disease may be overcome. 3. Wenfeng’s Computer-Aided Diagnostic System has capability in promoting the accuracy of syndrome differentiation and it ascertains the argument that syndromes of Treatise on Febrile Disease can be the generalization of various types of diseases. 4. The levels of temperature, D-xyl absorptivity, Na~+-K~+-ATP, and the indices in the morphological changes in the stomach, spleen, small intestine, liver and cola can all be references in distinguishing the two types of syndromes. The experimental animal models are successfully established under the guidance of the theories of traditional Chinese medicine; all of the process is controlled strictly based on the etiology and pathogenesis of traditional Chinese medicine.Conclusion: To modify and develop the syndrome differentiation of Three-Yang and Three-Yin discussed in the classic of Treatise on Febrile Disease.更多还原