【作者】 朱爱松；

【导师】 郑洪新；

【作者基本信息】 辽宁中医药大学 ， 中医基础理论， 2009， 博士

【摘要】 目的:对《诸病源候论》有关“毒”的条文进行系统分类整理,并综合运用文献计量学、文字学、分类学、统计学、诠释学等研究方法,对“毒”的涵义、病因病机、证候特征、致病特点、致病范围、治法用药等内容进行归纳整理和系统研究,从而进一步完善、发展中医“毒”学说。材料与方法:本研究以1991年人民卫生出版社出版、以元刊本为底本的丁光迪校注本《诸病源候论》为蓝本,以湖南电子音像出版社出版的大型电子图书《中华医典》升级版为工具,使用《中华医典》软件中的检索功能,以“毒”为关键字,进行检索,并比对《诸病源候论》原文,建立《诸病源候论》有关病因范畴“毒”的数据库。1数据库纳入条件:《诸病源候论》中以“毒”为关键词检索到的全部条目。2数据库剔除条件:其一,条目内容中与病因范畴“毒”无关者;其二,条目内容与病因范畴“毒”有关,但未明确病因种类者;其三,条目内容与病因范畴“毒”有关,病因种类明确,但无症状记载者。3数据库的建立及记录的录入:采用Microsoft office excel 2003建立《诸病源候论》有关病因范畴“毒”的数据库,数据库的变量名为病因和症状。将符合条件的条目逐条录入,录入完毕进行核对。在总库的基础上,根据统计分析的需要,按病因“毒”的种类,分别拆成多个子库。在数据录入过程中,根据数理统计的需要,对病因及一些症状,进行适当的合并,如病因:虫蛇鸟毒(蛇毒、虫毒、雀毒、蛊毒、蜂毒、虫蛆毒、蚍蜉毒、蜣螂毒、虾蟆毒、蝗蜡毒、蛙毒);症状:烦闷(烦、闷)、肿痈(肿、痈、成脓)、发热(壮热、发热、寒热)、出血(吐血、利血、便脓血、鼻衄)、吐哕(吐、哕)、呼吸不利(上气、短气、气喘)、斑疹疱(斑、疹、疱)、腹满痞大(痞满、腹满、腹大)、二阴异常(阴缩、阴肿、肛烂)、眼部异常(眼生翳、眼赤白膜、眼息肉)。4统计学方法:采用统计软件包SPSS软件11.0进行数据管理和统计分析。为了使数据的分析合理,对有关变量的量纲作了变换规定。其中,有某种症状时记为“1”,无此症状时记为“0”。采用SPSS.11.0软件编程对病因范畴“毒”及由“毒”所致病证的常见症状进行频数分析、聚类分析。5运用文献计量学、文字学、分类学、诠释学等研究方法,对“毒”的涵义、病因病机、证候特征、致病特点、致病范围、治法用药等内容作全面、系统地整理、分类、归纳、挖掘。结果:1《诸病源候论》作为中医学第一部病因病机证候学专著,记载有关“毒”的条文共有251条,有关毒邪的记载多而广泛,包括风毒、寒毒、热毒、疫毒、湿毒、水毒、毒气、鬼毒、蛊毒、酒毒、食毒、药毒、虫毒、漆毒等40种毒邪,其中频数出现5次以上的有:热毒(40)、毒气(31)、虫蛇鸟毒(24)、风毒(17)、食毒(12)、寒毒(6)、风热毒(5)、酒毒(5)、湿毒(5)、鬼毒(5),涉及患斑毒病候、脚气痹弱候、夏日沸烂疮候、喉痛候、时气取吐候、时气烦候、时气口疮候、伤寒取吐候、伤寒咽喉痛候、伤寒斑疮候、伤寒豌豆疮候、吐血候,中恶候、卒忤候、毒注候等共186条。2《诸病源候论》从邪正盛衰、阴阳失调、气血失调、脏腑病机等4个方面,全面论述“毒”的病机,其中涉及邪正盛衰病机的有脚气痹弱候、中恶候等27条;涉及阴阳失调病机的有时气六日候、时气烦候、时气喉咽痛候、温病烦候、卒忤死候、伤寒咽喉痛候、阴黄候、中热喝候、中恶霍乱候、时气阴阳毒候,共10条;涉及气血失调病机的有伤寒后下利候、伤寒下部痛候、时气腹满候、伤寒病后胃气不和利候、伤寒病后脚气候、脚气风经五脏惊悸候、目封塞候、喉痹候、喉咽肿痛候、喉痛候、脚气肿满候、蛊注候、蛊毒利候、卒忤候、伤寒上气候、饮酒大醉连日不解候、恶酒候、饮酒后诸病候、吐血候、雀瘘候、伤寒心痞候、伤寒结胸候、伤寒热毒利候等33条;涉及脏腑病机的有伤寒后下利候、伤寒下部痛候、时气腹满候、伤寒病后胃气不和利候、伤寒病后脚气候、脚气风经五脏惊悸候、目封塞候、喉痹候、喉咽肿痛候、喉痛候、脚气肿满候、蛊注候、蛊毒利候、卒忤候、伤寒上气候、饮酒大醉连日不解候、恶酒候、饮酒后诸病候、吐血候、雀瘘候、伤寒心痞候等77条。3《诸病源候论》中含“毒”字病名的条文共15条,涉及伤寒阴阳毒候、时气阴阳毒候、温病食复候、毒注候、蛊毒候、水毒候、风毒肿候、毒肿候、毒肿入腹候、马毒入疮候、毒疮候、妊娠咽喉身体着毒肿候、妊娠中蛊毒候、患斑毒病候、蛊毒利候。有关证候名中含“毒”字的条文涉及伤寒热毒利候、伤寒阴阳毒候、伤寒毒流肿候、时气阴阳毒候等53条。4《诸病源候论》中病因范畴“毒”所致病证的常见症状共计27种,依次为:疼痛、烦闷、肿痈、生疮、下利、发热、出血、斑疹疱、吐哕、瘙痒、溃瘘、腹满痞大、麻痹、呼吸不利、胀、口干、发黄、二阴异常、眼部异常、谵语、生恶肉、便秘、口噤、四肢厥逆、惊悸、身重、面赤。其中频数出现15次以上的有:疼痛(54)、烦闷(50)、肿痈(48)、生疮(47)、下利(33)、发热(28)、出血(21)、斑疹疱(17)。5不同的毒,具有不同的致病特点,归纳分析《诸病源候论》有关“毒”的条目,可将病因之“毒”的致病特点归类为暴发性、危重性、广泛性、易感性、善变性、传染性、内损性、趋本性、兼挟性、顽固性、季节性、地域性。6《诸病源候论》有关“毒”的记载,详细叙述内、外、妇、儿、皮肤等临床各科44种疾病的病源和症状,另外还涉及有关“毒”的诊断、养生及导引等内容。7《诸病源候论》不仅提出“消毒灭瘢”与“解毒药法”,还提出治疗风热湿毒、风毒、酒毒、热毒、水毒、温湿风毒、瘴毒、毒气、蛊毒、箭毒、风湿阴阳毒的各种治法。8《诸病源候论》有关药物之“毒”的条文仅有4条,见于解诸毒候、解诸药毒候、服汤中毒毒气吐下候、蛊毒候。结论:1《诸病源候论》有关“毒”的概念内涵较多,涉及病因之毒、病机之毒、病证名之毒、药物之毒、治法之毒,但以病因之“毒”为主。2《诸病源候论》有关“毒”的病因共有40种,以热毒、毒气、虫蛇鸟毒、风毒、食毒、寒毒、风热毒、酒毒较为多见。3正气不足是“毒”邪发病的内在根源;“毒”邪侵袭是发病的重要条件;毒邪侵袭导致气血阴阳的失调是脏腑病变的根本原因,也是脏腑病变的前提条件。4《诸病源候论》有关病因之“毒”所致病证的常见症状依次为疼痛、烦闷、肿痈、生疮、下利、发热、出血、斑疹疱、吐哕、瘙痒、溃瘘、腹满痞大等。5《诸病源候论》有关病因之“毒”的致病特点可以归类为暴发性、危重性、广泛性、易感性、善变性、传染性、内损性、趋本性、兼挟性、顽固性、季节性、地域性。6《诸病源候论》提出关于“毒”的治法治则,包括:“消毒灭瘢”与“解毒药法”、导引法、汗法、下法、吐法及外治法等多种方法。7《诸病源候论》有关药物之“毒”的条文仅涉及“毒有大小”、“毒药”、“胜毒”、“乌头毒”4条。8《诸病源候论》有关“毒”的记载,涉及临床各科,所述之“毒”主要是病因学范畴,对中医“毒”学说的发展起到了承前启后的作用。更多还原

【Abstract】 【Objective】This paper concludes the significance,pathogenesis, characteristic,syndrome,evolving regularity and therapeutical principle of toxin and genealogical classify the clauses about toxin in the〈Treatise on the Causes and Manifestation of Diseases〉using the research method of bibliography, metrology,taxonomy,conception,statistics and annotation.The genealogical research in toxin in this paper consummates and develops the theory of toxin.【Material & Method】We retrieval the content of〈Treatise on the Causes and Manifestation of Diseases〉using the key word of "Du" and set up database of〈Treatise on the Causes and Manifestation of Diseases〉about "toxin" related to etiopathogenisis.In the process of retrieval we take the〈Treatise on the Causes and Manifestation of Diseases〉published by People’ s Medical Publishing House in 1991 and checked by Ding Guangdi as the original,the electronic book of〈Dictionary of Chinese Medicine〉published by Hunan Electron Media Press as the implement.1.Internalizing Condition:all the clauses searched in〈Treatise on the Causes and Manifestation of Diseases〉with the key word of "Du"2.Rejecting Condition:A."Du" not mentioned in the parts of etiological factors;B."Du" mentioned in the parts of etiological factors,but no identified description of the etiological factor;C."Du" mentioned in the parts of etiological factors,with the identified description,but no record of the syndrome.3.Establish and Register Data Bank This paper establishes a databank of the causes and syndrome related with "Du". The variance includes causes and syndrome.According to the condition,register the coincident clauses,and then check it up.Divide the general data bank into different branches according to the different types of "toxin".In the process of data register,we adequately combined some related causes or syndromes referring to the expertise.For example,in etiological factor insect-snake-bird toxin includes snake toxin,insect toxin,sparrow toxin,parasitic tympanties, beetoxin and so on,and breathing disadvantage includes short breath and breathlessness in syndrome fields.4.Statistics method This paper applies SPSS 11.0 to manage and analyze the data and sets transforming regulation for the dimensions of the related variance to make the analysis more reasonable.Among the data,ones with the syndrome will be signed with 1,and ones without the syndrome will be signed with O.We use the SPSS 11.0 to make frequency statistics and cluster analysis to the clauses which record the disease caused by "toxin" or the syndrome induced by "toxin"5.This paper overall and systematically concludes the significance, pathogenesis,characteristic,syndrome,evolving regularity and therapeutical principle of toxin by the way of bibliography,metrology,taxonomy,conception, statistics and annotation.【Result】1.As the first monograph about pathogenesis and Manifestation,〈Treatise on the Causes and Manifestation of Diseases〉records the 250 clauses about "toxin" There are many records about toxin like bee venom,severe pathogenic cold, yin-yang toxin,ghost toxin,parasitic tympanties,herbal toxicity,insect poison,over 40 kinds.The toxin mentioned over 5 times includes pyretic toxicity (40),poisonous Qi(31),insect-snake-bird toxin(24),wind toxicity(17),food toxin(12),severe pathogenic cold(6),wind-heat toxin(5),vina toxin(5) and damp toxin(5) and ghost toxin(5).Further more,186 clauses talked about the syndromes caused by toxin.2.〈Treatise on the Causes and Manifestation of Diseases〉detailed discussed the pathogenesis of toxin in the 4 aspects of excess and weakness of pathogen and vital Qi,imbalance of Yin and Yang,disorder of vital energy and blood and entrails.There are 27 clauses related to excess and weakness of pathogen and vital QI,10 clauses related to imbalance of Yin and Yang like syndrome of yin-yang toxin caused by seasonal epidemic pathogens,syndrome of pestilent cholera etc.,33 clauses related to disorder of vital energy and blood like syndrome of disorder of stomach-QI and ysentery & diarrhea after enterotyphus, syndrome of thoracic retention in enterotyphus etc.,and 77 clauses related to entrails pathogenesis like syndrome of laryngalgia,syndrome of dysentery and diarrhea after enterotyphus,syndrome of stasis in abdomen caused by seasonal epidemic pathogens etc..3.In〈Treatise on the Causes and Manifestation of Diseases〉there are 15 pieces of clause related to "toxin" in name of disease including syndrome of yin-yang toxin in enterotyphus,syndrome of hydropoisoning and so on.There are 53 pieces of clause related to "toxin" in syndrome including syndrome of yin-yang toxin in enterotyphus,syndrome of yin-yang toxin caused by seasonal epidemic pathogens and so on.4.In〈Treatise on the Causes and Manifestation of Diseases〉there are 27 kinds of common symptoms caused by "toxin" including aching,annoyed,swelling, febricity,non-traumatic hemorrhage,itching,lockjaw,acute thoracic pain in four limbs and so on.The symptom occurring over 15 times includes aching(54), annoyed(50),swelling(48),ulcer(47),dysentery and diarrhea(33),febricity (28),hemorrhage(21),and exanthema maculosum(17).5.Different toxin,different pathopoiesis characters.Unscrambling the clause about toxin in〈Treatise on the Causes and Manifestation of Diseases〉,we classify the pathopoiesis characters of toxin into outbreak,danger,catholicity, affectability,capricious、communicability,internal damaging,refractoriness, vulnerability,seasonality and provincialism.6.〈Treatise on the Causes and Manifestation of Diseases〉records the source and syndrome of 44 kinds of diseases,otherwise relates to the diagnosis of toxin, health cultivation and daoyin,which settles theory foundation for the doctors in later generation to study toxin in all the clinical diseases.7.〈Treatise on the Causes and Manifestation of Diseases〉proposed not only the sterilizing and alexipharmic but also the daoyin technique,sweating process, purgation,inducing vomiting and external treatment of healing wind-heat-damp toxin,wind toxin,vina toxin,pyretic toxicity,hydropoisoning,mild-damp-wind toxin,miasm,toxic Qi,parasitic tympanties arrow poison and wind-damp Yin-yang toxin.8.There are 4 pieces of clause in〈Treatise on the Causes and Manifestation of Diseases〉talked about the toxin of medicine like neutralizing poison, neutralize poison of medicine,vomiting & diarrhea poisoned by soup and parasitic tympanties.【Conclusion】1."Toxin" recorded in〈Treatise on the Causes and Manifestation of Diseases〉refers to the cause of disease,pathogenesis,syndrome,name of disease,drug and treatment.Cause of disease is the most mentioned in book.2.In〈Treatise on the Causes and Manifestation of Diseases〉there are 40 kinds of causes about toxin for example pyretic toxicity,poisonous Qi, insect-snake-bird toxin,food toxin,severe pathogenic cold,wind-heat toxin, and vina toxin.3.Insufficiency of healthy energy is the internal cause of the "toxin" invasion.Pathogenic factor is the important condition.Disproportion of Qi-blood and ying-yang caused by toxin is the key factor and precondition of entrails pathological changes.4.The common syndrome of toxin mainly shows aching,annoyed,swelling, anthracoma,sore,febrility,dysentery & diarrhea,vomiting,non-traumatic hemorrhage,obnubilation and so on.5.The pathopoiesis feature of "toxin" can be described into outbreak,danger, catholicity,affectability,capricious,communicability,internal damaging, refractoriness,vulnerability,seasonality and provincialism. 6.The therapeutical principle and treatment proposed in〈Treatise on the Causes and Manifestation of Diseases〉includes sterilizing,alexipharmacon,daoyin technique,perspiration,therapy for inducing vomiting,external treatment and so on.7.Four clauses about toxin of medicine in〈Treatise on the Causes and Manifestation of Diseases〉refer to "magnitude of toxin","poisonous drug" "tolerating toxin" and "toxin in aconiti sinensis tuber".8.The records about "toxin" in〈Treatise on the Causes and Manifestation of Diseases〉contain all the branch of the clinical medicine.The toxin mentioned in the book mainly talks about the aetiology,that serve as a link between past and future in formation and development of toxin-Qi theory.更多还原