【作者】 林建佑；

【导师】 刘友章；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2010， 博士

【摘要】 目的本论文尝试从明清以前消渴学术源流的历代具有代表性的论述作一归类整理研究,使前贤宝贵的学术经验更清晰地呈现在今人及后学者面前,对今后的研究及临床疗效产生借鉴价值和指导意义。同时本研究还从循证医学的角度,将明清以前治疗消渴病方药建立数据库,并对其进行描述性分析和因子分析。从方药的高频药物、剂型、性味归经等角度,分析研究明清以前各个历史时期和中医学整体上对消渴病的辨证用药规律和特点。方法本研究将分为三个部分：第一部分,运用文献学方法对中医诊治消渴证的学术源流探讨,按照历史年代沿革之先后,先秦两汉晋唐宋金元,对历代医家之论述,从流溯源,知其由来,审其变迁,从纵向进行研究。第二部分,中医诊治消渴病文献整理研究,重点对消渴病的病因、病机、治疗进行分类研究,归类整理发掘,从横向进行研究。第三部分,收集《中华医典》(光盘版)明清以前有关治疗消渴病的方药文献,包括综合性医著、方书、专书、本草、类书、医案、医论、医话等多种古代医籍。归类整理,分析研究明清以前各个历史时期和中医学整体上对消渴病的辨证用药规律和特点。结果明清以前各医家多采用丸剂和汤剂来治疗消渴病,通过对其处方所用药物的种类和性味归经的研究,发现补益药、清热药,是治疗消渴病主要的两大类药物。药味以甘、苦、辛为主,重用甘药补益脏腑,质润滋燥,配伍苦药清热泻火燥湿,辛药发散行血,针对肺燥、胃热、肾虚、瘀血等不同病机辨证治疗。药性多选用寒凉药、温热药、平药,共奏补泻结合,寒热并用,刚柔相济,协同作用等功效。由药物归经可以推知,消渴病多累及多个脏腑,其中以肺胃肾三脏关系较为密切。通过因子分析得出明清以前消渴病常见的证候类型有津伤燥热、气阴两虚、脏腑气血虚弱等,治疗方剂多以清燥热、泄肺热,补益脾、肺、肾等脏腑的功效为主。治疗原则以补益脏腑、养阴生津、清热泻火、行气活血为主。药物配伍呈现寒热并用、攻补兼施的形式,如清热药与养阴药配伍、健脾药与祛痰药同用等。常用的治疗方剂有“白茯苓丸方”、“猪肚丸”、“人参汤”、“麦门冬饮”、“肉苁蓉丸”、“八味肾气丸”、“钱氏白术散”、“铅丹散”等。结论通过文献研究及统计分析,我们所在的课题组认为明清以前历代医家治疗消渴辨证用药大体可以分为两个阶段：唐宋以前消渴病的治疗思路及金元时期的治疗思路。唐宋以前医家消渴病治疗方法主要以补益、清热为主,辅以利水渗湿,同时兼顾发散、收涩、理气、化痰等法的应用,显示出此期医家在本病治疗上更注重补益药的应用。金元时期炽热伤津认为是消渴病的主导病机,故此期治疗以清热、补益为主,辅以活血化瘀、理气等法。更多还原

【Abstract】 ObjectiveThe dispersion-thirst disease (Xiao Ke Bing)is a kind of disease name of Chinese Medieine(CM). Dispersion-thirst disease includes some diabetes mellitus(DM). DM morality is close to those of cardiovascular disease and neoplasia. Its complications affect all organs and entirebody, and threaten the life of humanity. Modern medicine’s treatment of efficacy of DM is extremely limited. The treatment of the dispersion-thirst disease has a long history. We can find the record of dispersion-thirst disease in the documents that were written two thousand years ago. In the following years, the Chinese Medieine(CM) doctors learned the dispersion-thirst disease more and more. So it is very necessary for us to study the academic history of the dispersion-thirst disease.MethodsThe paper included two parts. The first part systematically summarized the evolution of the academic history of the dispersion-thirst disease before Ming and Qing dynasties.Firstly, we used documentary method to gather and sort out ancient diabetic documents of TCM, then summarized and reviewed generally diabetic cases of those doctors recorded before the Ming and Qing dynasties from history developing angle, and analyzed systematically its name history, disease cause, pathogenesis, differentiation of symptoms and signs, principles of treatment, prescription-drugs, and so on. We try to explore the developing regular of treating diabetes of TCM in accordance with differentiation of symptoms and signs, which was basic research of documentary study in future.In the second part, we made suggestions about how to show characteristic and superiority of treating the dispersion-thirst disease with TCM methods, Using the software of Epidata to establish the database of ancient prescription treating Diabetes of TCM, By software of SPSS15.0, descriptive analysis and factor analysis was used to analyze the regulation and characteristics of syndrome-treatment of diabetes of TCM both in the dynasties before Ming and Qing on concept of wholism of TCM from frequency and dosages.ResultsDuring my research, an important result was made that tonifying drug and heat-clearing drug were two main kinds of drugs treating diabetes of TCM with bispcetrum relevance method, and it was also concluded that pathogenesis changes of diabetes of TCM were deficiency of fluid due to exuberant fire, deficiency of qi and yin and Water-dampness stagnating in body through factor analysis, and prescription drugs matching relation of diabetes of TCM were also go through factor analysis.ConclusionAt last, we make a conclusion that the methods the doctors had used in ancient time before Ming and Qing dynasties were two types. Before Song dynasty, the heat-clearing drug drugs were the major drugs in descriptions, while in Jin and Yuan dynasties, the tonifying drugs were the major drugs in descriptions.更多还原