《黄帝内经》预测死亡时间的理论研究

【作者】 黄玉燕；

【导师】 翟双庆；

【作者基本信息】 北京中医药大学 ， 中医基础理论， 2010， 博士

【摘要】 判断预后是诊疗中必不可少的一项内容,在疾病危重时刻预计死期也很重要。本文对《内经》预测死亡时间的理论进行了研究,围绕《内经》对预测死亡时间的原则、方法的论述,对其具体内容及理论源流进行了梳理,并以临床病例数据及古代医案作为依据,对其临床应用的细节如阴阳、五行、运气理论的使用范围,以及各诊法在预测死亡时间远近方面的作用进行了探讨。论文分为四部分,并附结语：第一部分是中医预测死亡时间研究概况。本部分分别考察了《内经》以前古医经医案、《内经》、《难经》、《内经》注家及现代研究者、后世有代表性的医家对预测死亡时间理论的认识。指出中医预测死亡时间的理论,在《内经》之前已有学术渊源,《内经》中有较为系统的论述,后世医家对其传承、发展、丰富,并验之于临床实践。第二部分是《内经》预测死亡时间的文献分析及理论探讨。本部分对《内经》预测死亡时间的条文进行了梳理,提出《内经》预测死亡时间是以天人相应为法则,以四时阴阳、五行生克、运气理论为指导,强调人体正气在疾病发展中的作用,对病机的把握是预测死亡时间的关键；方法是色、脉、症诸诊参合,诊察脏腑经脉气血盛衰,尤其是胃气与神的有无,根据疾病发展规律经验预测死亡时间,或确定死期远近的时间尺度后,结合时令对疾病的可能影响,判断正气最虚、邪气最盛、阴阳最不平衡的时间为死亡时间。在此基础上,讨论了阴阳、五行理论的使用范围及预测死亡时间远近方面的简要诊断标准,指出天人相应是应用阴阳五行理论预测死亡时间的前提,正气盛衰是决定死亡时间远近的标尺。第三部分是从临床病例死亡时间探讨用干支与运气预测死亡时间方法的运用范围。本部分研究了东直门医院内科、儿科十年间死亡病例,分析其死亡时间的五行、运气属性与五脏病的关系,探讨五行生克及运气理论在预测死亡时间中的适用范围。结果表明,在年的尺度上预测五脏病的死亡时间时,年天干的五行属性较岁运更有意义。第四部分是从古代涉及死亡时间的医案探讨预测死亡时间理论的应用。本部分考察《名医类案》及《续名医类案》中含患者死亡时间或医家预测死亡时间的医案,考察各诊法、推算死亡时间理论的应用情况。提出五行生克理论和脉诊分别是医家最常用的理论工具和诊法,正气盛衰是确定死亡时间远近的决定因素,也决定了根据理论工具推算与参考经验预测死亡时间的步骤先后。并提示确定死亡病机时,色诊比脉诊有更早期诊断的意义。结语对本文的结论、创新点进行了总结,并对今后的研究进行了展望。更多还原

【Abstract】 Prognosis is an important part in clinical work, and predicting time of death is also very significant when the disease deteriorates and becomes dangerous. This article study on the theory of predicting time of death in the Internal Classic, by searching and studying words about principals and methods of predicting time of death in this book, learning the relative research work and theory, discussing on some details of methods of predicting time of death, such as when to use Yin and Yang, Five Elements and Yunqi theory while predicting, and the use of each diagnosing method in confirming the length of time to death, on the bas is of ana lyzing clinical cases and ancient medical records.It is made up of following four parts and a conclusion part:The first part is about the overview of the research work on predicting time of death with Chinese medicine theory. The theory in books and cases before the Internal Classic, the Internal Classic itself, and the Classic on Medical Problems, resea rch work on th is theory in the Internal Classic, and some ancient doctors good at predicting time of death were mentioned here. It refers that this theory has history, and was well stated in the Internal Classic, still well used and developed afterwards.The second part is about the content of this theory in Internal Classic. It’s based on the principle of correspondence between man and universe, using Yin and Yang, Five Elements and Yunqi theory, emphasizing the importance of vital Qi in resisting d i sease, and considering finding out pathogenes is as the key to predicting time of death. The method is detecting the power and quantity of Qi and Blood of Zang and Fu oragans and meridians, especial ly the presence or absence of the Stomach Qi and Spirit, by using diagnosis methods such as observing color of face, pulse, symptoms and their combination, which is advocated, then predicting with experience, or firstly confirming time seale, then considering the influence of time on disease to predicting a time when vital Qi is most weaken, pathogenic factor is most powerful, and Yin and Yang the most out of balance to be the probable time of death. On th is bas is, some deta ils are discussed, such as when to use Yin and Yang and Five Elements theory while predicting, and a simple diagnostic criteria for confirming the length of time to death. It refers that correspondence between man and universe is the premise to use Yin and Yang and Five Elements theory to predict time of death, and the power of vital Qi is a "ruler" for confirming the length of time to death. The third part is the analysis of time of death in clinical cases for discussing when to use heavenly stems and earthly branches and Yunqi theory in predicting time of death. Cases of death in interal medical ward and pediatric ward in Dongzhimen Hospital in a decade were studied. The relationship of five Zang organ disease and Five Element property and Yunqi property of time of death were studied, to discuss when to use Five Elements and Yunqi theory while predicting. It refers that Five Element property of heavenly stems of year would give more influence to five Zang organ disease than Suiyun (Yunqi of year which may infer from Tiangan of year).The fourth part is discussion on application of the theory of predicting time of death, includ i ng the application of the diagnosing methods and the theory for predicting Calculating time, by studying ancient medical records which contain time of death, whether the time when patients die or the time doctors predict patients would die on. It refers that Five Element theory and diagnosis by feeling the pulse are each the most used in predicting time of death, and the power of vital Qi is key for confirming the length of time to death, and key for confirming when to predict acrrording to experience. It also indicates that diagnosis by observing color of face would be more useful than feel ing the pulse for diagnosing patients would die in early time.The conclusion part contains conclusion and innovation of this article, and outlook of some future research directions.更多还原