【作者】 王琳；

【导师】 陈小野；

【作者基本信息】 中国中医科学院 ， 中医基础理论， 2008， 硕士

【摘要】 近十几年来,证候源流角度的研究越来越受到重视。《太平圣惠方》(以下简称《圣惠方》)的证候学说在中医辨证论治学说的历史发展中具有一定的重要地位。脏腑辨证是《圣惠方》辨证论治有代表性的一个方面。本课题运用文献、理论研究方法,结合计量,系统研究《圣惠方》中脾脏相关证候与现代脾脏相关证候比较的特点,并简要探讨其产生原因、分析其对现代证候学说的意义。以从一个角度反映《圣惠方》作为中医辨证论治学说发展的一个历史阶段的意义。1《圣惠方》中脾脏相关证候与现代脾脏相关证候比较的特点1.1从证候名称角度本部分从证候名称角度探讨《圣惠方》脾脏相关证候的特点,以反映其对疾病病理机制主观性认识的特点。为此,分步骤进行了证候提取、证候名称形成、证候名称统一等工作,在此基础上,以现代脾脏相关证候为比较对象,从证候名称角度,总结了《圣惠方》脾脏相关证候的特点。1.1.1一些在现代层次较高的证候,在《圣惠方》中被作为具体证候。反映《圣惠方》的证候名称尚有概念化痕迹,所以上述证候概念的概括性不足。对虚证来说尚未分化。1.1.2现代虚证多有气、血、阴、阳、精之分,而《圣惠方》虚证可直指“脾”、“脾胃”、“脾肺”、“心脾”、“脾肾”;且只有“气虚”,无“血、阴、阳、精”之虚。反映《圣惠方》的虚证尚未充分分化。1.1.3《圣惠方》有相对较多的“脾气不和”、“脾胃不和”、“脾胃气不和”证,而“不和”的含义较为笼统,因此,反映《圣惠方》的证候尚未充分分化。1.1.4《圣惠方》一些证候相关概念辨析不清。反映《圣惠方》对某些证候相关概念内涵的把握尚不完全确定。1.1.5从《圣惠方》虚(频数260)/实(频数303)、寒(频数158)/热(频数119)证候(包括脾系证、脾与其它脏腑兼证)的比例,反映其实证、热证比例明显大于现代、可能与《圣惠方》五脏各性质证候基本对称的主观认识有关。《圣惠方》实证中,涉及“湿”的证候的频数仅为7个,特别是无湿热证。涉及“痰”的证候的频数仅为7个。均明显少于现代。1.1.6《圣惠方》脾脏相关证候的实证中,外邪直接相犯者比例较大。反映《圣惠方》在对脾脏相关证候的病理机制认识中,外因占重要地位。1.1.7《圣惠方》认为证候虚多兼寒、实多兼热。1.1.8《圣惠方》脾与它脏兼证有明显的特点。1.2从症状表现角度本部分在前一部分证候提取、证候名称形成、证候名称统一等工作的基础上,选择《圣惠方》三个频数最高的脾脏相关证候(脾胃气虚证、脾胃虚冷证、脾胃虚弱证)作为代表,总结其症状表现,并与现代相关证候的症状表现进行比较。从症状表现角度,总结了《圣惠方》脾脏相关证候的特点,以反映其对疾病病理机制客观性认识的特点。1.2.1《圣惠方》每一脾脏相关证候各自的症状表现有较明显的集中趋势。1.2.2《圣惠方》名称有明显差别的脾脏相关证候间,症状表现的差别有的不是很明显。1.2.3《圣惠方》脾脏相关证候与现代同名证候比较,症状表现差别较大。1.3《圣惠方》三～七卷脏虚补脏诸门证候特点《圣惠方》三～七卷分门比较系统地论述了脏腑证治,本部分对《圣惠方》三～七卷脏虚补脏诸门的证候特点做较深入探讨,认为证候理论和经验的相分离是其主要特点。从另一角度完善对《圣惠方》证候特点的认识。1.3.1脏虚补脏诸门的证候与现代各脏虚证比较有较大差别(1)证候名称有较大差别。(2)各脏总症状有较大差别。(3)《圣惠方》各脏具体虚证的症状与其现代理解比较,也有较大差别。1.3.2脏虚补脏诸门证候的特点是理论和经验的分离脏虚补脏诸门各脏总症状尚有较强的独立性。但从同一脏内相同证候的角度看,脏虚补脏诸门的证候以理论(以证候名称为代表)和经验(以症状为代表)的分离为特点。表现在:(1)同一脏内相同证候的不同条文间,相同症状频数与不同症状频数的比值较小。(2)上述的“《圣惠方》各脏具体虚证的症状与其现代理解比较,也有较大差别”,也说明从同一脏内相同证候的角度看,脏虚补脏诸门的证候以理论(以证候名称为代表)和经验(以症状为代表)的分离为特点。2《圣惠方》中脾脏相关证候特点的产生原因《圣惠方》脾脏相关证候的上述特点,应是源于宋初辨证论治学说发展的初步性。2.1由于辨证论治学说发展的初步性,所以《圣惠方》脾脏相关证候中,证候名称尚有概念化痕迹、对某些证候相关概念内涵的把握也尚不完全确定、证候(包括虚证)也尚未充分分化、实证和热证的比例明显大于现代(具有五脏各性质证候基本对称的主观认识)。由于辨证论治学说发展的初步性,所以《圣惠方》在对脾脏相关证候病理机制的认识中,外因占重要地位;与现代同名证候比较,症状表现差别也较大。由于辨证论治学说发展的初步性,所以《圣惠方》三～七卷脏虚补脏诸门的证候中,与现代各脏虚证比较证候名称有较大差别、各脏总症状有较大差别、各脏具体虚证的症状与其现代理解比较也有较大差别。2.2《圣惠方》的理论和经验具有不同来源。理论方面以《内经》——《诸病源候论》为主要来源;经验方面来源于当时及以前各家验方。由于辨证论治学说发展的初步性,使不同来源的《圣惠方》的理论和经验未能完全统一,从而形成证候理论和经验相分离的特点。这表现在:2.2.1《圣惠方》脾脏相关证候中,虽每一脾脏相关证候各自的症状表现有较明显的集中趋势(反映证候理论和经验一定程度的统一),但名称有明显差别的脾脏相关证候间,症状表现的差别有的不是很明显(反映证候理论和经验一定程度的分离)。2.2.2《圣惠方》三～七卷脏虚补脏诸门的证候中,虽各脏总症状尚有较强的独立性(反映证候理论和经验一定程度的统一),但同一脏内相同证候的不同条文间,相同症状频数与不同症状频数的比值较小;各脏具体虚证的症状与其现代理解比较,也有较大差别(反映证候理论和经验一定程度的分离)。3《圣惠方》中脾脏相关证候特点对现代证候学说的意义脾脏相关证候的上述特点和产生原因,提示现代研究中医辨证论治学说:3.1应有发展的观点,不可把数千年的资料等同视之。3.2应有全面的观点,对古代的证候不可简单地按字面意义理解,而应根据其在当时整个证候体系中的位置以及所代表的临床信息(病因、症状表现、治疗方药等)准确了解其内涵。4本研究的创新点《圣惠方》的证候体系在中医证候学说的历史发展中具有一定的重要地位,对《圣惠方》中脾脏相关证候特点的系统研究,有助于弥补目前对该书理论方面研究的不足,完善对中医辨证论治学说发展历史的认识,为现代证候学说提供借鉴。5本研究的可行性5.1《圣惠方》成书背景比较明确,版本比较单一;5.2对《圣惠方》知识来源的看法比较明确。其理论性论述主要以隋·巢元方的《诸病源候论》为依据,故理论观点较为统一;而具体病证的诊疗经验则主要来自宋以前的各医家、医籍的经验医方,且来源广泛,资料丰富。5.3《圣惠方》集宋以前医学之大成,充分反映了当时的医学发展(包括证候学说发展)状况。更多还原

【Abstract】 In the recent several years,studies on origin and development of the syndrome have been paid more and more attention.The syndrome doctrine of The Peaceful Holy Benevolence Formulae plays an important role in the development of the TCM reatment with syndrome differentiation theory.And syndrome differentiation of the Zang-fu organs is quite typical among it.By using traditional literature,theoretical research methods,together with calculating,this research investigates features of spleen syndromes in this book comparing with that in modern times.Meanwhile,the reasons of the features and senses towards the contemporary syndrome doctrine are discussed.By means of this,it reflects its history staged significance in the development of the TCM reatment with syndrome differentiation theory.1 Features of spleen syndromes in The Peaceful Holy Benevolence Formulae comparing with that in modern times1.1 From the view point of syndrome nameIn this part,features of spleen syndromes in this book from the view of syndrome name are discussed,which reflects the subjectivity view points.Therefore,syndrome extraction, syndrome name formation and unification have been done step by step.Then,summarize the features of spleen syndromes comparing with that in modern times.1.1.1 Certain syndromes,which are believed in higher layer in modern times,are seen as concrete ones in this book.It reflects that syndrome names in this book have some conceptualization trails.1.1.2 Modern deficient syndrome are devided into Qi,blood,Yin,Yang and essence deficiency,while there’s only qi deficiency in this book which are referred to spleen,spleen and stomach,spleen and lung,spleen and heart,spleen and kidney.1.1.3 There are quite a lot of disorder of spleen Qi,incoordination between the spleen and stomach,disorder of spleen-stomach Qi and so on.But the significance of the "disorder" is not very clear.1.1.4 Some syndrome concepts are not quite clear in this book,which means the connotation of the concepts are not completely sure.1.1.5 From the syndrome ratio:deficiency(260)/excess(303),cold(158)/heat(119),it can be seen that there are more excess syndromes and heat syndromes in this book.And among the excess syndromes,there are only 7 related to "damp",6 related to "sputum",while there are no damp-heat.1.1.6 Among the excess syndromes,there are a large number of exopathogens which invade humans directly.It reflects that exopathic causes are quite important in the pathomechanism of the spleen syndrome.1.1.7 It’s believed that cold is connected with deficiency syndromes,while heat with excess ones in this book.1.1.8 It’s shown that there are evident features about spleen with other Zang organs.1.2 From the view point of symptomIn this part,three spleen syndromes(syndrome of spleen-stomach Qi deficiency, syndrome of spleen-stomach deficiency-cold,syndrome of spleen-stomach deficiency) which appear the most often in this book are selected.Summary their symptoms,then compare with that in modern times.Therefore,it’s shown the objectivity features of the pathomechanism.1.2.1 Each spleen syndrome has its own pathomechanism apparente central tendency.1.2.2 There are significant differences between some syndrome names,yet the symptoms differences are not very clear.1.2.3 Compared with modern syndromes,smptoms about spleen are quite different.1.3 Syndrome feature about the deficiency of Zang-organs(three to seven volumes) in The Peaceful Holy Benevolence FormulaeAs three to seven volumes of this book describes syndromes and treatment of Zang-fu organs,in this part,we discuss the features more deeply.And the separation between theory and experience of the syndrome is its chief characteristic.1.3.1 Compared with modern deficiency,syndromes of the Zang-organs deficiency are quite different:(1) The syndrome name are quite different.(2) The total symptoms are quite different. (2) The total symptoms are quite different.(3)The concrete symptoms are also quite different comparing with modern apprehension.1.3.2 Syndrome features about the deficiency of Zang-organs result from the separation of theory and experience of the syndrome is its chief characteristic.Though the total symptoms are separate,this feature is refected in the same syndromes of the same organ.It’s to show in two aspects.2 The reasons of the spleen syndrome features in The Peaceful Holy Benevolence FormulaeThe features induced above are origining from the rudiment of the reatment with syndrome differentiation theory in the beginning of the Song Dynasty.2.1 Because of the rudiment,some syndrome concepts are not quite clear,more excess syndromes and heat syndromes are appeared in this book,there are a large number of exopathogens which invade humans directly,and so on.2.2 The theory and experience in this book have different sources.The former comes from The Yellow Emperor’s Internal Classic and The General Treatise on the Pathogeneses and Symptoms of All Diseases,while the later is from all effective formulas at that time and before.2.2.1 Though each spleen syndrome has its own pathomechanism apparente central tendency, symptom differences are not quite clear about the syndrome whose names are different obviously.2.2.2 The total symptoms of the Zang-organs deficiency syndromes are separate. But different articles in the same syndromes of the same organ,the ratio between the same and different symptoms is low.And the concrete symptoms are also quite different with modern apprehension.3 The significance of the spleen syndrome feature in The Peaceful Holy Benevolence FormulaeAs its shown above,when we study on the TCM reatment with syndrome differentiation theory,we should: 3.1 own development viewpoint,not look on all traditional data as the same.3.2 own allround viewpoint,not comprehend the ancient syndrome according to the words simply.Instead,we should grasp its connotation by its position in the whole syndrome system(the pathogenisis,the symptom,the prescription,and so on).4 Innovation of the topicThe syndrome system of The Peaceful Holy Benevolence Formulae plays an important role in the development of the TCM reatment with syndrome differentiation theory.So,by studying on the syndrome feature,it can retrieve the theory research deficiency,develop the history of this theory,and provide a model for the syndrome doctrine in modern times.5 Feasibility about the topic5.1 The writing background of the work is quite clear,and the edition is single.5.2 The opinion of the knowledge resource is identify.It’s theory is according to The General Treatise on the Pathogeneses and Symptoms of All Diseases,while the concrete syndromes are from all effective formulas at that time and before which are quite abundant.5.3 The Peaceful Holy Benevolence Formulae sums up the medical science before Song Dynasty,which reflects the whole development of the TCM thoroughly(including the syndrome doctrine development).更多还原