呃逆病证的古今文献研究与学术源流探讨

【作者】 梁克玮；

【导师】 严季澜；

【作者基本信息】 北京中医药大学 ， 中医医史文献， 2009， 博士

【摘要】 呃逆是指气逆上冲、呃呃连声、声短而频、不能自制之证。其表现呃声或疏或密,间歇时间无定,有几分钟或半小时呃一声,亦有连续呃逆七八声方暂止者。呃逆发病时可偶然单独发生,亦可见于它病之兼症,持续时间可连续或间歇性发作。其证有虚实之分;多因寒邪、胃火、气郁、食滞;或中焦虚寒,或下元亏损,或病后虚羸,致使胃气上逆,失于和降所致。病机主要为胃失和降,胃气上逆动膈。作为临床常见的疾病,呃逆的典型表现很早就出现在我国古代文献中,众多的中医古籍中相关记载比比皆是,对于该病的病因病机、辨证分型、治疗方法、预防调摄以及护理、康复等,中医学均积累了丰富的理论与实践经验,值得我们充分挖掘、整理、继承和发扬。本文以文献学研究方法为主,在全面系统搜集历代有关呃逆病证资料的基础上,对相关材料进行了深入的分析研究,系统阐述了先秦时期到民国时期呃逆病证各个历史阶段的学术发展特点,深刻揭示了呃逆证的学术发展源流,对现代医家诊治呃逆证的经验也进行了系统的总结和整理,力图全面反映古今医学诊治该病证的学术理论和临床治疗经验,为临证辨治呃逆病证提供可资借鉴的诊治经验,并开拓呃逆病证的研究和治疗思路。本文分为病名源流考辨、古代医家论治、现代医家论治和相关问题探讨四大部分。第一部分,将呃逆病名的演变过程进行梳理,厘清了呃逆从症状名到病证名的发展脉络,并与其相关或类似病名进行辨别分析。第二、三部分,以历史发展为主线,用断代史的方法,分别对先秦至南北朝、隋唐、宋元、明、清至民国各个历史时期的医学发展特点、呃逆相关理论的发展状况进行了概括与分析,重点研究剖析了各个历史时期与呃逆相关的重要医学文献,内容涉及呃逆的病名、病因病机、诊断、治疗、用药特点、预防调护等。之后系统整理总结了现代医家呃逆辨证治疗的经验和方法。第四部分,就呃逆的相关理论问题进行了初步探讨,尤其是将几种少为今人所用的辨证思路与方药进行论述,以开拓与丰富呃逆的辨证论治思路。更多还原

【Abstract】 Hiccup is the disease which makes the air current in stomach rise adversely, makes the patient keep hiccup,the sound is short and frequent and the patient cannot control it.The sound of hiccup may appear occasionally or frequently, the interval is uncertain,sometimes one may hiccup in a few minutes or half an hour,sometimes one may keep on hiccup for seven or eight times before it stops. The hiccup may occur separately,but may also link with other diseases.The attack of hiccup may happen continuously or at interval.The syndrome can be in the nature of asthenia and sthenia.It is often resulted from cold pathogen,stomach heat, qi depression and food stagnation:or because of the deficient cold of the middle-jiao,loss of kidney qi,or weakness after ill,which leads to the adverse flow of the air in stomach,and it cannot rise and descend as it should.The pathogenesis is the loss of harmony and downbearing of stomach,so the air in stomach moves adversely and causes the flutter of diaphragm.The typical clinical manifestations of hiccup are mentioned in Chinese ancient literatures.And there are a great many related records in ancient books of traditional Chinese medicine(TCM).With abundant medical experience,rich theories of TCM on hiccup were accumulated,including etiology,pathogenesis, syndrome differentiation,treatment,preventive measures,nursing,healing,and so on.So it is worth to dig and collate the literatures and to inherit and develop the theories.This study is basically a study of philology.Based on the data of hiccup in past dynasties collected,further analysis on these materials is made.The academic characters in each stage from pre-qin to the Republic of China Period are expatiated to reveal the origin and development of the learning on hiccup. Clinical experience in diagnosing and treating hiccup by modern physicians of TCM is also summarized to reflect their academic thinking.It provides some references for clinic and will be help to exploit the study and treatment of hiccup.This paper is composed of four parts:study on the headstream of the disease name,the points of view of ancient physicians,the clinical experience of modern physicians,and discussion on related questions.In the first part,the origin and evolvement of the disease name was combed, which clarifies the venation of name evolving from a name for symptom to a name for disease and distinguishes hiccup from related and similar diseases.In the second and third parts,with a dynastic history of medicine development unfolded,the characters of medicine and the theories about hiccup in each stage were summarized,whose emphasis is the study on hiccup,involving disease name, cause and pathogenesis,diagnosis,treatment,characteristic medicine, preventing,nursing,and so on.And the experience and measures of syndrome differentiation and treatment from modern physicians were systemically summarized.In the fourth part,hiccup related questions were discussed,especially in some thoughts of syndrome differentiation and some prescriptions rarely used by the doctors of today,so as to exploit the thoughts of treatment based on syndrome differentiation.更多还原