张志聪六经气化学说之研究

【作者】 林亭秀；

【导师】 李宇航； 吴彤；

【作者基本信息】 北京中医药大学 ， 中医临床基础， 2010， 博士

【摘要】 张志聪的六经气化学说,以五运六气、标本中气之理来全面阐释《伤寒论》中六经的生理和病理变化,认为三阴三阳之病多为六经气化为病。张氏侧重于从气化的角度去研究《伤寒论》的六经,这种认识,颇受后世医家的赞许。自此以后,六经气化学说成为伤寒研究的一个重要内容,并被运用于临床,指导伤寒、瘟疫以及杂病的辨证论治,极大地丰富了中医的临床治验。另外,张氏精研《内经》、《金匮要略》、《神农本草经》等医学经典,医学功底深厚,并谙熟本草之学,因此其对《伤寒论》的医理阐发每每有卓然独到的地方,是一位伤寒学术思想较为全面的医家。经文献检索发现,当代学者对张志聪学说的论述偏于简略,未能形成专题研究,亟待进一步探讨和发掘其六经气化的奥旨与对伤寒临证方药的指导。研究目的与方法本课题采用文献学和医学史的研究方法,全面收集与张志聪时代相关的历史、文化、社会、气候等资料,分析六经气化学说产生的历史和文化背境；系统梳理六经气化学说的学术源流,阐释该学说的具体内容,分析其在《伤寒论》研究上的成就及对当今临床的指导意义。研究内容论文主体分成四大部分：第一部分主要从张志聪时代的气候条件、社会文化背景及其学派背景来进行分析,认为宋明理学格物重学的风气,所持的宇宙生成论、气一元论以及天人合一的理想境界；维护旧论派提倡“尊经崇古”的思想,强调对《黄帝内经》、《伤寒论》、《金匮要略》和《神农本草经》等医学经典的全面继承；加之当时气候严寒,江浙地区频繁出现的瘟疫与大规模的流行等因素使得张志聪非常重视自然界的六淫邪气对人体健康所产生的影响。因此，张氏受到《内经》运气七篇五运六气学说的启发,试图通过伤寒的学理与方药,统一伤寒和温疫的治疗,应对当时痘疹和伤寒一并流行的趋势,拯救民生,抗击急病,故而选定了“六经气化”为切入点,彰隐发微,以标本中气与开阖枢理论涵盖伤寒六经实质的研究,推动了伤寒学的学术发展,六经气化学说便是在这样的时代背景下应运而生。第二部分论述了张志聪在博采先贤诸家所长的基础上,融汇《内经》的运气学说和天人相应的模式,运用标本中气理论、开阖枢理论、亢害承制理论,主倡六经气化学说,从三阴三阳气化的角度来阐释《伤寒论》中六经的生理和病理变化。张氏认为人身三阴三阳之六气,外布于体表,以应天之六气,内生于五脏,六经是气化、经络、脏腑的统一体；他运用气化学说的观点,在对疾病的分析上,有深浅层次的不同,有表里阴阳之别,也有虚实寒热之分。外邪入侵人体之后,会出现病在气、在经、经气之兼病以及入腑干脏的病理发展趋势,而《伤寒论》中三阴三阳之病多为六经气化为病,涉及经络脏腑本身的病变者只占少数,并突出人体阳气在外感疾病发病进程中的重要作用。他在分析六经气化为病时,依据人体阴阳、表里、寒热、虚实的不同来解释六经病证的标本中气从化规律,阐明了体质是六经病证千差万别的主要原因和对于临证用药的影响。除了重视医理的研究之外,张志聪的临床医术也非常精湛。该部分收集了相关医案6则,从治疗痘疹、伤寒等外感疾病到小便不利、胃脘痈等内科杂证,他运用气化之理统赅百病,其应如响,跃然纸上。第三部分叙述了张志聪探五运六气之源,运用了“格物致知”的方法,将阴阳、五行、四时、六气、药物形色、性味及生长环境、功效等与人体脏腑经络相联系,把药物本身与天、地、人结合成为一个完整的整体,在药物的运用上“知其性而用”。他认为本于天时,应司物备药,若不能为之,则可用炮制之法助药性。在因地制宜方面,认为药材的来源,对于药性的气味有很大影响,因此非常重视药材的产地,寓含了道地药材的思想。同时,他还指出生长环境、饮食习惯、气候等因素会造成体质的差异,这在临证用药中应详细审察。该部分选取了25味仲景方剂中的常用药物,通过张氏对其药性、药用和药理的分析研究,有助于我们进一步理解六经气化学说,并为下一部分《伤寒论》的方证分析作铺垫。第四部分遵从张志聪一派医家学术思想的原意,按照六经病证的特点,选取了12方证：麻黄汤证、桂枝汤证、小青龙汤证、小柴胡汤证、柴胡桂枝干姜汤证、半夏泻心汤证、大承气汤证、茵陈蒿汤证、四逆汤证、黄连阿胶汤证,四逆散证、白头翁汤证为例,并结合前文的药物分析,进行证候与病机治疗之间的全面分析,将抽象的理论落到实处,阐明张志聪如何运用气化理论来分析六经病证,以拓展其对临床的指导意义。研究结论本论文的创新性成果体现在：首次系统、全面地阐发张志聪所创的六经气化理论的学术渊源、发展和具体内涵,彰明其与《内经》、《难经》和《神农本草经》的内在关联,并将该理论与临床证治有机地结合为一体,对当今临床有一定的实用价值。总之,张志聪在博采先贤诸家所长的基础上,融汇《内经》的运气学说和天人相应模式,运用标本中气理论、开阖枢理论、亢害承制理论,主倡六经气化学说,从三阴三阳气化的角度来阐释《伤寒论》中六经的生理和病理变化,他认为六经病证多是气化为病,并依据人体阴阳、表里、寒热、虚实的不同来解释六经病证的标本中气从化规律。张志聪所创的六经气化学说,是经他及其同一派的医家法于经旨,广收博采,承前启后,影响甚为深远的学术思想,推动了伤寒学术的发展,并能直接指导临床实践。张氏之所以能够取得这样辉煌的成就,缘于其深厚的儒学功底,勇于格物实证和观察取验的治学精神,还有他广袤而合理的知识结构。他精研注释经典,通晓运气学说,熟稔本草方药,勤于临床辨治,从其成功经验可充分体现出中医药“天人相应”、“医药一体”的根本特点,对当今中医原创思维的探讨兴许带来有益的启迪。更多还原

【Abstract】 Based on the Yunqi theory (doctrine on medical meteorology corresponding to seasons’ alternation in acient China) form Huangdi Neijing (The Yellow Emperor’s Canon of Internal Medicine), advocated by medical scholar Zhangzhichong in Qing dynasty, the physiology and pathology changes manifested in Shang Han Lun(Treatise on Cold Damage) should be mostly ascribe to Qi activity, which is classified into six categories with the title’Liu Jing(Six Channels)’.Henceforward this view named’Liujing Qihua theory’was supported by the majority of later medical scholars and Zhang’s opinion is considered to be an important item in the study of Cold Damage, which is significance to the treatment of various diseases caused by both internal and exogenous pathogenic factor, such as cold damage disease,plague and so on.Furthermore, the academic achievement of Dr. Zhang Zhichong is comprehensive.He was versed in the study of TCM classic, like Huangdi Neijing, Jinkui Yaolue (Synopsis of Prescriptions from the Golden Chamber), Shennong Bencao Jing (Shennong’s Classic of Materia Medica) and was skillful in materia medica.However, it’s regretfull that modern reaserch on him is ordinary and abbreviated, so more attention and further study should be paid to his academic viewpoint.Founded on the literature reviews and historical records, the material relative to culture, society status and historical condition in Zhang Zhichong’time was collected and a further analyze could be deduced on this special background information, which was favourable to the innovation of his opinion mentioned above. Besides, a trace on the previous discussions by researchers of Qi activity and Yunqi Thoery in different dynastys was also done.With the comparison to these associated viewpoints, the content of Liujing Qihua theory was systematicly elucidated and the achievement or diavantage of this theory would be summarized. Thus, the content of this thesis could be divided into 4 parts as follow:PartⅠ. Base on the background information associate with Zhang Zhichong, such as climate condition, society status, culture, academic school viewpoint, and some factors could be considered to be in the promation of Liujing Qihua theory:the Neo-confucianism in Song and Ming dynasty, a great importance was attached to the medicial Classic, the cold climate and plague in Ming and Qing dynasty.PartⅡ. Leaded by the Yunqi theory in Huangdi Neijing, founded on previous discussions by researchers of Qi activity in different dynasty, with the comparison to these associated viewpoints,the content of Liujing Qihua theory was systematicly elucidated.Some medical cases were also attached in this part to exemplify this theory for the clinical treatment.PartⅢ. In this part, form Zhang’study on the property, usage, pharmacological action of materia medica,25 herbs were selected form Shang Han Lun as auxiliary research of Liujing Qihua theory.Part IV. In order to exemplify its significance to the clinical usage,12 formulas were chosen form Shanghanlun Jizhu (The Variorum on Shanghanlun, which is the masterpiece of Dr.Zhangzhi Chong) to analyse the correlation between materia medica and correspoinding syndrome in Zhang Zhichong’s view.In conclusion, based on the medical classics and previous scholars’study, Zhang’s ’Liujing Qihua theory’is a profound viewpoint which is benefical to both clinical practice and academic development of Shang Han research.His remarkable contribution should be own to his comprehensive knowledge on Confucianiasm and strictly follow an factualistic and observational way to pursue academic investigation.His experience could be serve as a case to manifest TCM characteristic named as "Corresponding between Human and Nature", "Unity between Medicine and Pharmacology",and illuminated to the discussion of TCM original thinking style.更多还原