《金匮要略》历节病证治源流探讨

【作者】 王颖；

【导师】 艾华；

【作者基本信息】 辽宁中医药大学 ， 中医临床基础， 2009， 硕士

【摘要】 《金匮要略》是张仲景《伤寒杂病论》中的杂病部分,也是祖国医学的经典著作之一。书中首列“中风历节病脉证并治”篇,从病因病机、症状、治法等几个方面进行的了详细的阐述,形成了比较完善的理论体系。在此基础上,历代医家通过对历节病的理论创新和临床实践研究,使历节病的辨证要点逐渐完善,并总结了丰富的临床用药经验,积累了大量的文献资料。本文通过探讨先秦至今历代中医文献中历节病的因机证治及各时期对该病证论述的发展过程,归纳和总结了历节病在不同阶段的特点,这对今后深入探讨历节病的辨证治疗是非常有益的。历节病是临床较常见的一类疾病,其病因病机主要是由于素体肝肾先虚,气血不足或阳气虚弱,再加上汗出入水中、饮酒后汗出当风、风血相搏等,致风寒湿痹阻关节,气血运行不畅而形成本病。临床上以肿痛遍历多个关节,甚至关节活动障碍,身体赢瘦为主的病证。随着现代社会生活方式的改变,该病有逐渐增加的趋势,是威胁人类健康及生活质量的主要病证之一。我国的传统医学历史悠久,积累了丰富的防治经验,因而备受关注。第一部分论述了历节病名的发展。由于“历节”是一古病名,本文通过对历节病名的含义、历节出现的年代及历节病名的演变三个方面来解释历节病。历节病最早在《金匮要略》中得到阐发,经过历代医家的研究和阐释,到了隋唐时期形成了比较明确的定义,因其表现为周身关节疼痛,故曰“历节”。第二部分按照时代的沿革,将秦汉、晋隋唐、宋金元、明清、近现代等五个时期涉及到的历节病的病名、病因、病机、诊断、治疗等内容,做源流探讨。秦汉时期,张仲景在《内经》论“痹”的基础上,对历节病做了详细的论述,指出了历节病的内因是由于肝肾不足、气血亏虚,外因为复感风邪,治则上提出以扶正祛邪为主;晋隋唐时期,孙思邈提出的“毒邪”的理论为临床治疗历节病提供了新的思路,在治疗上有了很大的进步;宋金元时期,是历节病理论丰富和发展阶段,人们对历节病的认识逐渐深入,治疗经验日渐丰富。《圣济总录》中,较详细的总结了前人的治疗经验,将历节病分为风胜、寒胜、湿胜、阴邪留滞等证型分别论治。朱丹溪在前贤的基础上提出“痰瘀致病”之说。明清时期,多数医家将历节病归属于痹证范畴,由于在病名方面的统一,使得历节病在辨证治疗上更加的细致入微,如张景岳在《景岳全书》中,对于历节病的治疗上就提出了“峻补真阴”的方法。这些丰富的治疗用药理论和经验,对现代临床的研究具有宝贵的借鉴价值和指导意义。第三部分。从横向对历节病的病因病机、治法方药进行了归纳总结,从而提炼出历节病的辨证论治规律。更多还原

【Abstract】 Synopsis of Golden Chamber is part of Treatise on Exogenous Febrile and Miscellaneous Diseases written by Zhang Zhongjing. Many doctors and clinicians gradually consummate its onset law and main points of syndrome differentiation and summarize comprehensive experience of clinical administration and accumulate plenty of relative literatures during their clinical observation and practical recognition over two thousand years from the pre-Qin to today. Historical original and development special advance in each dynasty was narrated in the literatures of traditional Chinese medicine from pre-Qin to today and characteristics in different phase was retrospect and studied in this article and made which will be beneficial to make profound exploration on the treatment and syndrome differentiation of lijie in latter times.Lijie is one of common clinical syndromes. It results from the kidney and liver, the yang qi is low, the overcast blood is lost emptily experience the pathogenic wind, pathogenic cold, pathogenic damp, and pathogenic dryness cause the passages through which vital energy circulates numbness to hinder abstractedly, Its incidence tends to increase gradually with the change of lifestyle and dietary structure in the modern society. It is one of disease syndromes which endanger the health of the people. It has complicated manifestations and pathological change. Traditional Chinese medicine and pharmacy therapy is widely concerned as its predominance over comprehensive action resulting from its taking the whole body into consideration.The first part discussed the definition of lijie in this paper. As one ancient name of disease, It explains the definition of lijie through the age which appears and wording significance of lijie . Lijie elucidates in Synopsis of Golden Chamber firstly. Studied and expounded by many doctors and clinicians, it forms the quite explicit definition until the Sui-Tang dynasty period. Have shown for the whole body arthritis pain , so it was called lijie.The second part has discussed the cause of disease, the pathogenesis, the diagnosis, the treatment and so on according to the time evolution to divided into the following several stages as Qin - Han , Jin -Sui-Tang, Song- Jin- Yuan, Ming - Qing Dynasty and the modern age. In the Qin- Han Dynasty, Zhang Zhongjing has made the detailed elaboration of lijie in the foundation of Nei Jing. He pointed out the internal cause of lijie is because the hepatorenal insufficiency, the vitality owe empty, the duplicate feeling external injuries influences, external injuries influences emphasis common cold, in the treatment proposed strengthens the body’ s natural resistance and removes harmful factors for big method. In the Jin-Sui-Tang dynasty, Sun Simiao thought and put forward the concept that "pathogenic wind" for the first time and had opened up the new train of thought. From the Song- Jin -Yuan to the Ming -Qing Dynasty , studies of lijie was enriched and developed, in this period, with the society economy and culture developed , people recognized lijie deeply, treatment is richer gradually and theory system developed and perfected gradually. Zhu Danxi proposed the saying of the phlegm stasis pathogenesis in past worthies’ foundation. In the phase of Ming Qing dynasty, most medicines think that Lijie belongs to Bi-zheng. In the phase of Ming Qing dynasty, more details were given in the syndrome differentiation, therapy was gradually consummated because unification the name of lijie. Zhang Jingyue proposed in the treatment made up the really cloudy method toweringly, "Aided Total Record in Saint", in the treatment was more careful, Zhu-bi made the pain, divided into the wind to win, the cold victory, the wet victory, cloudy stays the division to think of something else evilly governs, These colorful treatment medication theory and experience has the precious model value and the guiding sense to modern clinical research.The third part, it carried on the induction summary of selection of according to diagnosis of lijie from an overall analysis of the diagnosis and treatment.更多还原