【作者】 赵凯维；

【导师】 于智敏；

【作者基本信息】 中国中医科学院 ， 中医基础理论， 2010， 硕士

【摘要】 病机是中医基础理论的重要组成部分,是联结理论与实践的桥梁。古今医家对病机重视有加,虽因文释义,代有发展,但见仁见智,各家殊异,尚缺乏系统的理论研究与整理阐发。病机的现代定义中医特色阙如,含义模糊,界限不清,内涵局限,指导临床的普适性不足,给理解、解释与应用带来困难。本文以中医“病机”概念诠释为研究目的,通过“比较异同,梳理嬗变”的比较学研究方法探讨其概念的发生与演变规律；应用“因名责实,昭彰义理”的语言学研究方法,对病机构词进行解读；通过“探微索隐,正本清源”的文献学考察,对病机的含义进行考证,为科学诠释中医病机提供本底资料；应用诠释学研究方法“类纂约注,注证发微”,对病机概念进行诠解,揭示病机概念蕴藏的深层意蕴。旁征博引,提要钩玄,分析临证病机辨识要点,以期为临床攻克疑难病证提供新的思路与借鉴。研究者认为,现代病机概念的提出可能受到现代生理病理学的影响。中医病机“其文简,其意博,其理奥,其趣深”,含义众多,内容包含病因、病位、病性、病势等诸多内容,但又不囿于“因、位、性、势”四者,其地位更高,作用更大,应从全新的思路去理解把握。通过对病机概念的诠释,研究者认为,中医强调四诊合参,目的在于剖析病机；因为证候为表象,病机为根本,以故据证言病要紧扣病机,病证结合宜深入病机,治病求本必详审病机,如此方证相应才能切中病机。由于病机理论蕴含证机标本,反映气机升降,体现枢机开阖,故诊察神机得失可以判断生机有无。指出病机辨识当重视五要素,分为五层次,不同层次的病机辨识具有不同的侧重点与诊疗内涵,反映思维的不同层面,这是临床诊疗的细微之处,必须仔细体悟。因此提出辨证候病机以明标本；察气机升降以明虚实,观枢机开阖以明进退,诊神机得失以明顺逆；断生机有无以决生死的创新观点。此外,本文还探讨了病机与辨证的关系及“治病求本”的实质,以确立并彰显中医病机理论之于临床的核心地位,为中医理论的创新寻找突破口。提出中医辨证在于辨病机,治疗在于调气机、开枢机,目的在于启神机,焕生机的全新概念内涵。并通过对病机内涵的诠释,将中医诊疗思维提升至“机”的高度,揭示健康医学的本质在于顾护神机,把握生机,在科技引领下体现人文关怀,突显中医作为健康医学对“人体-生命”的关注,彰显中医学的地位与优势,这也是本研究的创新点。病机概念的诠释还需从多角度、多层次展开,使其内涵清晰完整,以便指导对中医概念乃至理论体系的正确理解、解释及应用,这对中医理论体系的构建和临床诊疗水平的提高,都将具有重要的理论与实践意义。这也正是本研究的目的、意义与价值所在。更多还原

【Abstract】 Pathogenesis of Chinese medicine is an important component of the basic theories of TCM and links theory and practice as a bridge. Though ancient and modern medical experts paid more attention to it, different people with different views, systemic theory research is lacked now. For the modern definition is short of TCM characteristics, with vague meaning and limited connotation, so it can’t became the general guidance of clinical practice, and makes it difficult to comprehend, explain and apply it correctly.The essay choose the concept of Pathogenesis of Chinese medicine as research object, by means of comparison methods, discussed the how the concept caused and developed; by means of the method of linguistics, researched the word-formation; by means of philological inspection, made a textual research of the concept to provide datum for interpretation; by means of hermeneutics method, made an explanation of the concept and revealed the deep implication the concept contained. By well-documented and extensive evidence to explore the subtle essence, selected the main viewpoint, analyzed the essential about pathogenesis identification when do clinical practice in order to find a new idea to conquer clinical difficulty diseases.A conclusion was made that modern concept of pathogenesis was probably affected by modern physiopathology. Though the concept is brief, connotation is extensive and profound, including etiology, location, nature and trend of disease. Besides that, there are still more meanings inside the concept so it is more important and we should comprehend this concept with a whole new mind. The research revealed that Chinese medicine emphasizes using the four diagnostic methods, Wang, Wen, Wen.Qie, together, with a view to analyze pathogenesis; for pathogenesis is the nature of disease well the syndrome is the external phenomena, so according to syndrome to probe disease should base on pathogenesis and combination of disease, syndrome should have insight into pathogenesis, and searching for the essence in treatment should deeply and detailed study pathogenesis then correspondence of prescription and syndrome could be based of pathogenesis. For pathogenesis of Chinese medicine theory including superficiality and origin of the syndrome and pathogenesis, reflecting the ascending and descending of Qi Ji and the opening and closing of Shu Ji, so examine body’s Shen Ji could judge its Sheng Ji. It pointed out that pathogenesis identification should pay attention to five elements and divided into five levels which has different connotation to disease treatment. So propose the new point that identifying syndrome and pathogenesis could clear which is the superficiality and origin; studying carefully the ascending and descending of Qi Ji could clear the trend of the disease; observing the opening and closing of Shu Ji could clear the Xu and Shi of the disease; examining the being and losing of Shen Ji could clear the trend of disease; searching Sheng Ji could decide whether it having life or not.In addition, the essay is still needed deeply research the relationship between TCM pathogenesis and syndrome differentiation and the essence of searching for the primary cause of disease in treatment, so as to establish the nucleus position of the theory in clinical practice and look for a new idea to the TCM theory innovation. It pointed out the new connation that what syndrome differentiation to identify is pathogenesis, treatment lying in regulating Qi Ji and Shu Ji and with the purpose to own the Shen Ji and Sheng Ji. And by through the annotation put diagnosis and treatment thought to the altitude of "Ji", revealed the nature of Health Physic is protecting Shen Ji and Sheng Ji, which expressed the human care with the guidance of science and technology and made the idea that TCM, as Health Physic, pays more attention to the life stand out and showed the important position and advantage of TCM, which also the innovative points of this research.A research from multi-angle and different levels will be needed, which could make the connotation of the concept distinct and integrity in order to comprehend, explain and apply it correctly, and might be of theoretical and practical significance. This is also the purpose, the significance and the value of the study.更多还原