【作者】 黄桃园；

【导师】 刘小斌；

【作者基本信息】 广州中医药大学 ， 中医医史文献， 2009， 硕士

【摘要】 研究目的本论文以清代医家高秉钧《疡科心得集》为研究对象,在现有文献和论著的基础上,系统总结明清外科三大流派之一的“心得派”代表人物高秉钧外科学术思想的形成背景及学术特点。对其在“治外必本于内”思想的指导下,引温病理论入疡科独创三部病机学说、创三陷变局、阐明疡科四绝证证治以及在疡科治法上的创新,进行重点研究;同时探讨“心得派”与“正宗派”、“全生派”学术思想之间的内在联系和不同特点。通过论文研究,充实国内外关于明清外科三大派学术思想研究的内容,期望能对中医外科学的传承和发扬提供新的思路和方法,对如何更好地把握中医系统理论与专科发展之间“整体”与“局部”的标本关系有所启示。研究方法以2006年人民卫生出版社出版的山东中医药大学文献研究所田代华教授点校的嘉庆十一年《疡科心得集》初刻本为研究版本,在传统的学术思想文献整理方法的基础上,采用网络数据库技术,结合训诂研究、类分研究、比较研究,以及提要、索引等方法,对《疡科心得集》全文、《疡科心得集》学术特点理论研究文献及临床应用研究文献进行梳理、分析、归纳,总结提炼出高氏疡科理论的系统学术思想。并以断代史研究和文献研究相结合的方式,从明至清代中期中医药学特别是中医外科学发展的历史、特点和成就出发,对高秉钧学术思想形成的时代背景、明清外科三大学派的不同特点和内在联系进行辅助研究,分别用以明晰高氏疡科学术思想的渊源、探讨当代中医外科学发展的方向。研究结果高秉钧的中医外科“心得派”学术思想,博大精深,既有渊源可循,又能大胆创新。高氏外科学术思想深受清代温病学说的影响,并首次将其引入外科领域,开温病理论与外科结合之先河。其代表著作《疡科心得集》集清以前外科学之大成,并结合自己的临证经验有所创新与突破,集中体现在:1、倡治外必本于内,确立以阴阳虚实表里寒热为本的疮疡辨治大法。2、引温病理论入疡科。3、创中医外科三陷变局学说。4、提出毒攻五脏的主要证候及治疗方法。5、论述疡科四绝证证治,强调扶正气畅情志。6、善用清、攻、温、补四法,尺度严谨;三方化裁,尽括疡科三部治法之要;善用手术排脓,对蚀法多有发挥;7、公开家用秘方体现大家风范。8、以鉴别诊断立论,创新外科著作体例。研究结论高秉钧的《疡科心得集》是一部理论与实践相结合的中医外科专著,其中所体现的既要继承又必须创新的治学精神具有深远的意义,特别是将中医温病学说引入中医外科理论之中,对后世中医外科学的发展产生了深远的影响,该书在中医外科理论、中药学、方剂学、诊断学及临床各科治疗方面的贡献不可磨灭。以高秉钧为代表的明清外科三大派医家所倡导的疡科内治法则,对于指导目前中医外科学的发展方向具有重大的现实意义。我们应很好地研究、体会其临床及理论价值,进一步开发利用,推动、丰富中医外科学的发展。更多还原

【Abstract】 Objective:Taking the《Yangke Xinde Ji》written by Gao Bingjun in the Qing Dynasty as the object of study,on the basis of existing literatures and works,this thesis summarizes the formation background and academic characteristics of surgical academic thinking on Gao Bingjun who is the representative of "experience sect",which belong to the three major groups of Surgery between the Ming and Qing Dynasties.Under the guidance of thinking "the treatment of outside disease must base on inside pathogenesis." and introducing the theory on epidemic febrile disease into ulcer branch,he creates own three theories of pathogenesis and "three collapse change",illuminates the treatment of four kinds of incurable disease of ulcer and innovates for the treatments of ulcer,aiming at the above aspects we do primary studies and supplies a gap of systematic study on Gao’ s theory.simultaneously we also explore the different characteristics and the internal relations of academic thoughts between "experience sect","Authentic send" and "Quansheng send". By studying for thesis,enrich the content of research for academic thoughts about the major three surgery factions between the Ming and Qing Dynasties at home and abroad,hope to give some new ideas and methods for succession and development of the surgery of TCM.,get some revelation about how to get a better hold of the relation between symptom and root of the part and the whole between systemic theories of TCM and the development of special section.Methods:Taking the《Yangke Xinde Ji》written by Professor Tian Daihua of Shandong university of TCM literature research institute and published by People’s medical publishing house in 2006 as the study version,based on the sorting of the traditional academic thought literature,using network database technology,combining exegetical research,classification research, comparative study,and abstract,index method etc.We reviewed,analysed and induced the full text,the academic characteristic theory research literature and clinical application research literature of the《Yangke Xinde Ji》,then summarized Gao’ s academic thoughts on the theory of abscess.In order to clarity the origin of Gao’ s academic thoughts about ulcers,to explore the direction of development of the contemporary surgery of TCM,also we studied the historical background of the formation of Gao bingjun’ s academic thoughts, the different characteristics and the internal relations of the major three surgery factions between the Ming and Qing Dynasties,combining the history of research and literature study,starting with the history of the development, characteristics and achievements of Chinese medicine,especially Chinese traditional surgery from the Ming to the mid-Qing Dynasty.Results:The academic thinking of Xinde sect on the surgery of Traditional Chinese Medicine of Gao bingjun is profound,not only does it follow the origin,but also it can innovate boldly.Being influenced deeply by the theory of Warm Diseases in Qing Dynastie,the academic thinking of Surgery of Gao has introduced it into the field of Surgery for the first time and created a precedent for the theory of Surgery.His representative works《Yang - ke Xin-de Ji》is a synthesis of knowledge of Surgery of the Qing and previous dynasties, combining with his own clinical experience,it has some innovation and breakthrough,being embodied as follows:l.Sparkplug the thinking "the treatment of outside disease must base on inside pathogenesis ",establish dialectical treatment of ulcer basing on Yin,Yang,Deficiency,Excess, Exterior,Interior,Cold and Heat.2.introduce the theory on epidemic febrile disease into ulcer branch.3.creates the "three collapse change" theory of surgery of TCM.4 put forward the main syndromes and therapies when five zang organs are invaded by the pathogens.5.discuss the treatment of four kinds of incurable disease of ulcer and emphasize that reinforcing vital Qi makes the people’ minds at ease.6.Use of four methods such as Clearing away, attacking,warming,nourishing and hold the exact measure of value.Tripartite Conference,generalize almost all points of three treatments of ulcer;Be good at discharging pus by operation,have a good exertion for corrosion therapeutics.70pen household secret recipes to represent generous demeanor 8.Ground the argument on differential diagnosis and innovate for the style of surgery worksConclusions:The《Yangke Xinde Ji》written by Gao Bingjun is a surgical monograph of TCM which combining theory with practice.The spirit of scholarship including it,emphasizing not only innovation but also succession,has a profound historical significance,especially have a far-reaching and indelible impact on the future development of surgery of TCM,surgical theory of TCM,TCM, TCM recipe,Diagnostics and all subjects of clinical treatment.The internal treatment principles of ulcers sparkplug by the major three surgery factions represented by Gao Bingjun between the Ming and Qing Dynasties are of great practical significance to guide current direction of development of surgery of TCM.We should study and experience the value of clinic and theory well and further develop and utilize it to speed development of surgery of TCM.更多还原