【作者】 陈文芳；

【导师】 林昌松；

【作者基本信息】 广州中医药大学 ， 中医临床基础， 2008， 硕士

【摘要】 历节病是临床常见病证之一,以遍历关节疼痛,不可屈伸,甚则肿大变形为主症,因其疼痛遍历关节而得名。历节作为一个古病名,历代医家都十分重视,尽管目前临床上较少使用此病名,但整理相关的资料,可以发现历代医家的认识和临床经验对当今与历节相关疾病的辨证论治极有参考价值。本研究主要剖析历代医家对历节病证治的论述,探讨历节病现代临床的治疗,以便理清本病的脉络,为临床提供有益的参考。目的:本研究通过对历节病脉因证治源流的探究,以便理清本病的脉络,从而更好地挖掘仲景理论指导临床风湿类疾病的防治。方法:以《金匮要略》有关“历节病”的论述为基础,利用现代计算机网络先进设备,以中国期刊网、维谱全文期刊数据库为主要检索源,同时采用文献追溯的方法,整理历代医家医著的相关论述,从以下几个方面进行研究:1、阐释历节病名义源流;2、阐释历节病病因病机源流;3、阐述历节病脉证源流;4、阐述历节病治法方药源流;5、历节病的现代研究。结果:1、《内经》关于痹病的论述是历节病的理论基础,张仲景继承《内经》中关于痹是肢体关节疼痛的认识,在《金匮要略》中首立“历节病”名,并设专篇论述,开历节病辨证论治之先河。仲景明确提出了肝肾亏损,气血不足是历节病发生的内在因素,风寒湿邪是致病的外在因素;创立了治疗历节的两首方:桂枝芍药知母汤和乌头汤。可见,历节病证治理论的源头在于《内经》和《金匮要略》。2、后世医家继承发扬了仲景理论,在其论述的基础上各持己见,充实了历节病的认识。如在病因病机上,补充了暑、热、毒、痰、瘀、内风等的致病作用的认识;在治法上,重视仲景祛风散寒除湿,以祛邪为主的治法之外,还提出了扶正祛邪兼顾的理论,补充了补肝肾,益气血法、清热除湿法、清解暑热法、祛痰法、活血祛瘀法、凉血清热解毒法、虫类搜剔法、外治法等等,创立了疗效确切的独活寄生汤、身痛逐瘀汤、犀角汤、麝香丸等方剂。仲景之后历代医家对本病认识的不断补充,形成了历节病证治理论的流派,对临床进一步提高本病治疗的效果开拓了思路。3、仲景所创立治疗历节的两首方:桂枝芍药知母汤和乌头汤,至今仍为医家所推崇,并经大量临床实践和实验研究表明了仲景方的科学内涵。结论:历节病的辨证论治从仲景时期至今已经在病名、病因病机、病证、治法方药等方面有了很大的发展。仲景经方及历代医家创立的方剂,对当今本病的辨证论治仍具有积极的指导意义。今后,《金匮》古方以及后世大量的经验方,包括现代临床新创立的治法方药,都是值得我们继续发掘和深入研究的内容。更多还原

【Abstract】 Lijie disease(acute athritis) is commonly seen in clinic with joint pain all over the body, restricted extension and flexion, or even swelling and deformed joints as its chief symptoms. As Lijie is an ancient name, it is seldom so called clinically. However, Chinese medicine practitioners all through the history have paid much attention to it. Relative literature has proved that the understanding and empirical experience of some ancient doctors as well as their syndrome differentiation and treatment on relative diseases nowadays are of great value for reference. This study mainly aims to analyze the description on syndrome differention and treatment of Lijie disease by ancient Chinese medicine doctors, further probe into its therapies nowadays, and therefore provide beneficial clinical reference with clear clues on the treatment of Lijie disease.Objective:This study aims to better utilize the theory from Zhang Zhongjing to prevent and treat arthritis by means of probation into the origin of syndrome differention and treatment of Lijie disease.Method:Based on the description on Lijie disease in Synopsis of the Golden Chamber, modern advanced computer network was employed to sum up corelated description by ancient Chinese medicine practitioners in the retrospective literature method, and China Periodical Network and Weipu Full-text Periodical Network were two main retrieval sources. This study was carried out in the following aspects: 1. to expain the name of the disease from its origin, 2. to expound the origin of its etiology and pathology, 3. to explain its origin of syndrome differentiation, 4. to expound on its origin of treament with herbal medicine and decotion, 5. to probe into its contemporary studiesResults:1. Lijie disease was initially named by Zhang Zhongjing in Synopsis of the Golden Chambe, who initiated the syndrome differentiation and treatment of Lijie disease with detailed explanation in an exclusive chapter. From then on till Qing dynasty, various names such as Lijie wind, White tiger Lijie, windy pain and arrow wind were once given to this disease. Nowadays, the majority of Chinese medicine practitioners hold that Lijie disease is different from common Bi syndrome, and some even recommend some other names like obstinate arthralgia for better description of the characteristics and nature of this disease. 2. Zhang Zhongjing has clearly pointed out in Synopsis of the Golden Chamber that deficiency of liver and kidney and insufficient qi and blood are Lijie disease’s internal pathogenesis, while pathogenic factors of wind, cold, dampness are its external pathogenesis. This is of great clinical significance in the guidance of its syndrome differentiation. Later generation of doctors sticked to their own view on Lijie disease after Zhang Zhongjing and therefore enriched the knowledge of Lijie disease.. For example, its etiology and pathology has been further supplemented with other internal and external pathogenesises. Also, its therapeutic principles are amended to dispel pathogenic factors in the period of onset, and to cultivate qi and blood, harmonize yin and yang, tonify liver and kidney in catabasis, ect. All these have contributed to the better curative effect of this disease.3 Two decotions established by Zhang Zhongjing for the treatment of Lijie disease are Guizhi Shaoyao Zhimu Tang(Decoction of Ramulus Cinnamomi, Radix Paeoniae and Rhizoma Anemarrhenae) and Wutou Tang (Radix Aconitis Decoction), which are strongly recommended by contemporary Chinese Medicine doctors and have been proved to be scientific by a lot of clinical practice and experimental studies.Conclusion:Syndrome differentiation and treatment of Lijie disease have developed a lot since the age of Zhang Zhongjing in its denomination, understanding of etiology and pathology, syndromes,therapeutic principles,decotions and herbal medicine. The decotions established both by Zhang Zhongjing and other ancient Chinese medicine doctors are still of great positive significance in the guidance of syndrome differentiation and treatment of this disease. Ancient decotions in Jin Gui Yao Lve(Synopsis of the Golden Chamber) or other empirical decotions from later generations, as well as contemporary thrapeutic principles, newly invented decotions are all deserved further study and investigation.更多还原