《金匮要略》温法方证应用研究

【作者】 杨开瑞；

【导师】 王新佩；

【作者基本信息】 北京中医药大学 ， 中医临床基础， 2011， 硕士

【摘要】 阳气是人体生命的原动力,有阳气则生,阳气亡则死。古人重阳的思想并非凭空而想,它是符合自然及人体生命生化的法则的。首先从《易经》的阳主阴从观、《黄帝内经》的阳气为主导生化观、补土派的元气观、命门学派的命门观、扶阳学派的阳气观,来探讨古人从不同的角度对阳气在自然及人体生化过程中的重要作用,从而得出重阳思想的本质,一是重气化,重阳气在气化和形化中的重要作用；二是重正气,重人体阳气作为正气在对寒湿水饮等阴邪及阴火的对抗作用,为下面温法的研究提供理论依据。温法是用温热药消除病人体内的寒湿水饮等阴寒邪气治疗实证,或温养阳气治疗虚证的一种治法。故温法对于培补人体的正气,消除人体的邪气,对于人体气化和形化过程的持续性和持久性有着重要的作用。正如祝味菊所云：“温药含有强壮之意,非温不足以振衰惫,非温不足以彰气化。”外来的寒湿之邪可直接损伤人体的阳气,欲驱逐之,温法是正治之法。阳气不足,不仅可内生寒湿水饮等阴邪,而且易令神浮而生阴火,还可令阴血的化生乏源,故温法亦是治疗气血阴阳虚损不足之证的根本治法。气虚、阳虚用温补阳气之法治疗毋庸置疑。生化之道,阳生阴长,故若要阴血生长,还需要阳气的作用,故补阴血时不要只补阴血而障碍阴血的生化。《中医治法与方剂》中云：“治法是针对病机而拟定的。”病机,是指病变过程中不同阶段的致病机理,是对四诊材料进行理性分析,综合病因、病位、病性得出的结论,故病机包括病因、病位、病性三方面的内容。存世的仲景书中并没有明显的“温法”一词,但提出了诸条与此相似的概念,如“复其阳”、“急温之”、“当温之”、“当温其上、灸之”、“当与温药”、“当以温药和之”等,即蕴含温法的思想,“当与温药”即是温法的应用。仲景温法的推出是依据外来及内生病邪的性质、阳气的多寡和病情的轻重而确立的。《医学阶梯》云：“神农尝百草,辨味而知性。岐伯作汤液醪醴,随时而制宜。汉·张仲景立方定法,又开古今之医门,始于八味地黄丸,用治消渴,遂有一百十三方,三百九十七法,变化无穷。但方法精奥,务要体认,若知方而不知法,用亦无济。故仲景用方惟在用法,乃法在方之先,方又在法之后……又按仲景用药,尽得岐伯心法,不在语词,而在用意,意在法到,法到方无不到”法的运用是要通过方来体现,仲景的治法就蕴含方的运用中,只有对法有了清晰的认识,才能做到依法用方；并且每种治法有其常用之药,在方的运用上根据具体的病机而有变化,故研究温法的常用之药有助于临床上做到以法立方,化裁用方,用药而不用方；而对温法方组方规律的研究有助于使所用之方药不失法度。更多还原

【Abstract】 Yang-qi is the driving force of human life, and there is the yang-qi could survive, conversely death. The ancients idea of valuing yang-qi were not without foundation, it is consistent with biochemical nature and the laws of human life. First, from the "Book of Changes" from the concept of Yin Yang Master, the yang-oriented biological concept of the Medical Classic of the Yellow Emperor of, school of invigorating the earth’s yuanqi view, the Gate of Life School of Life Gate Fire concept, supporting yangqi school’s concept of yangqi, to investigate the ancients from a different perspective on the yangqi in natural and human biochemical processes important role to arrive at the Essence of the view of Double yangqi:first re-gasification, re-gasification and yangqi in the form of the important role; Second, re-healthy qi, value the yangqi’s important role of resist cold dempness and water-dempness as healthy qi,and this provide a theoretical basis for the following research of warming method.Warming method is the treatment with warm and hot drug to eliminate patients’ pathogenic factor of cold dampness and water-dempness with drinking water, and to warm yang-qi to treat deficiency syndrome. Therefore, make the body warming method for the training of healthy qi, to eliminate human evil, and plays an important role for the persistence and durability of the process of gasification shape changement. As zhu weiju puts it:"A warm drug with strong meaning, not warm enough to vibration failure exhausted, not warm enough to reveal gasification." Warming method is the right treatment of expelling evil of cold and dampness from extrance,which can derectly harm body’s yangqi.If yang-qi is not enough,not only can Yin Xie as phlegm dempness andwater-dempness produce, but also god floats to produce Yin Fire, but make lack of metaplasia of Blood.So the warming method is the fundamental treatment of the disease of yin and yang deficiency and blood deficiency.The fundamental governing law permits. It is not doubt that warming for yang deficiency and qi deficiency. Following the biochemistry procession, when yang grows yin follow it.therefore,the growth of yin blood cannot without the role of yang,so we can not only nourish yin blood,which can barrier the metaplasia of yin blood.Medical Treatment and Prescription said:"therapeutic method is drawn different stages of disease, is a comprehensive conclusion that integrates etiology disease bits and ill sex,which is worked out from rational analysis of four diagnostic material.Therefore pathogenesis includes etiology disease bits and ill sex.In Zhongjing’s books that survived in the world, there is no obvious "warming method", but the various pieces of this proposed similar concepts such as…"renew the yang," "hurriedly warm it," "should warm it ", "should warm the adove and moxibustion, "" should give the warm drug, "" should give the warm drug to harmonize it "and so on. " should give the warm drug to harmonize it’ contains a warm thought"."should give the warm drug",that is the application of warming method. Zhongjing warming method is based on the introduction of the nature of external pathogenic factors, the nature of evil within the sick, the amount of yang and the severity of established disease.medical ladder says:"Shen Nong tasted a hundred herbs, distinguishing taste and knowing properties. Qi Bo made soup liquid mash sweet wine, which were reserved for need at any time. Han·Zhongjing originate prescription and formulate therapeutic method,and created the gate of chinese medicine of ancient and modern,beginning with treating drinking urine weith and eight flavour glutinosa pill, diabetes with treatment, and leaving one hundred and thirteen prescription and three hundred ninety-seven therapeutic methods, which are with countless changes. But prescription and therapeutic methods are profound,so we must enlighten them.If we only know prescription and do not know therapeutic method,use in vain. Therefore Zhongjing prescribed following therapeutic methods, methods were created before prescription and prescriptions were prescribed behind methods…and Zhongjing prescribed medication by learning Qihuan’s neo-confucianism and not the surface meaning of words but the profound meaning "The application of therapeutic methods are reflected by prescriptions,and Zhongjing’s methods are implied in the application of prescriptions. Only understand the prescriptions profoundly, can we use them following the methods. In addition,every method has its commonly used herbs, and herbs will be changed with the change pathogenesis, the research of commonly used herbs can make us to achieve the aims of applying prescriptions following methods,adding and subtracting,and applying herbs, no prescriptions. The research of the combinition of law of warming prescriptions can ensure the use of herbs not break laws.更多还原