仲景调和寒热学术思想研究
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摘要
目的:寒热不调为临床常见的病机。追溯历史,医圣张仲景,在其传世之作《伤寒论》及《金匮要略》里,早对寒热不调的的证治有详细的论及,其学术思想,对后世医家有着广泛而深远的影响。但目前针对“调和寒热”的理论研究不多见,其重点均偏向于名老中医的医案及经验总结,或重点讨论寒热错杂的类证辨析。系统总结仲景调和寒热学术思想的报告少之又少。本课题横向联系《伤寒》、《金匮》各条文,纵向上溯《内经》理论源流,下及宋元明清诸家学说。目的在于理清探讨寒热的概念及生理病理关系,提出调和寒热的概念,结合《伤寒》、《金匮》条文,总结其有效的治疗原则、治疗方法,以利于系统运用其理论有效地指导临床实践。
方法:首先,探讨“和法”、“寒热”的概念,及寒热之间的生理病理关系,以明确本课题研究范围。而后复习相关理论基础,上溯《内经》,下及宋元明清诸家学说,浅论寒热辨证的源流及发展,结合“和法”及“寒热”的概念,提出调和寒热的定义。接着重点对《伤寒》、《金匮》二书中相关条文进行分析归纳,先从诊断学的辨证上理清调和寒热在仲景学说中的应用,再从寒热在六经辨证体系中的体现运用中,进一步探讨调和寒热这一治疗法则在仲景学说中的具体体现。最后总结仲景调和寒热学术思想的临床指导意义及临床应用。
结论:调和寒热法旨在平调阴阳,恢复人体水火之间的生理平衡。根据辨证可分为:外寒内热、上寒下热、寒热错杂,而在辨证施治的过程中,因先后、标本、主次、缓急的不同,或先解表寒,再清里热;或先清里热,或解表寒;或清上温下;或寒热并用;或先用解表法,再用攻里法。其治疗手段则有方药、针刺、外治法等。调和寒热在《伤寒论》最为核心的六经辨证里也有不同的具体体现。后世的医家,在不同方面补充和发展了仲景的学说,并运用调和寒热法在临床应用上取得很好的疗效。
Purpose:
Incoordination between the cold and heat is the frequent clinical pathogenesis.Zhang Zhong-jing discussed this question particularly in this contributions "Shanghan Lun"(Treatise on Febrile Diseases Caused by Cold) and "Jingui Yaolue"(The Prescription in Golden Cabinet).His academic standpoint has been influencing the faster generation.But these are few researches on the theory of "coordnating cold and heat" now,most of them paid close attention to summarizing rhe experiences of the famous doctors of TCM.In the thesis the valid therapeutic and therapeutics were summarized,based on the theories of 'Shanghan Lun','JinguiYaolue','Nei-jing' and the academic standpoints of the doctors of Song,Yuan,Ming and Qing periods.Through dicerning the physiological functions and pathology of the cold and heat.I hope this study helpful for the clinical practice.
Method:
First,I try to make sure clear the concept of "harmonizing" and "cold and heat",in order to identify my study's circumscription.Second,review the relevant theoretical basis could be traced,"Nei-jing" and the academic standpoints of the doctors of Song,Yuan,Ming and Qing periods light on cold and heat,and the origins of dialectical development,and integration and "cold and heat" concept,put forward to reconcile the definition of "coordinating cold and heat".Third,analyze the differences between different syndromes,to induce the corresponding therapeutics.At last,summarize the significance of this theory and Clinical Application.
Conclusion:
To harmonize Yin and Yang is the purpose of coordinating cold and heat. According to syndrome differentiation divided into "out cold and in heat", "up cold and down heat","cold heat mixed".All diagnosis and treatment are based on an overall analysis of the illness and the patient's condition.Sometimes relieving exterior syndrome at first,then clear heat; Sometimes clear heat at first,then relieving exterior syndrome;sometimes both of them are treated.One of these methods is used,or two of them are used together.Sometimes,one is uesd at first and another is used at last.Accrding to this theory,there are many therapeutics here,for example,prescription and acupuncture.The later doctors developed Zhang Zhong-jing's theory.So that this theory ismore uesfull now.
方法:首先,探讨“和法”、“寒热”的概念,及寒热之间的生理病理关系,以明确本课题研究范围。而后复习相关理论基础,上溯《内经》,下及宋元明清诸家学说,浅论寒热辨证的源流及发展,结合“和法”及“寒热”的概念,提出调和寒热的定义。接着重点对《伤寒》、《金匮》二书中相关条文进行分析归纳,先从诊断学的辨证上理清调和寒热在仲景学说中的应用,再从寒热在六经辨证体系中的体现运用中,进一步探讨调和寒热这一治疗法则在仲景学说中的具体体现。最后总结仲景调和寒热学术思想的临床指导意义及临床应用。
结论:调和寒热法旨在平调阴阳,恢复人体水火之间的生理平衡。根据辨证可分为:外寒内热、上寒下热、寒热错杂,而在辨证施治的过程中,因先后、标本、主次、缓急的不同,或先解表寒,再清里热;或先清里热,或解表寒;或清上温下;或寒热并用;或先用解表法,再用攻里法。其治疗手段则有方药、针刺、外治法等。调和寒热在《伤寒论》最为核心的六经辨证里也有不同的具体体现。后世的医家,在不同方面补充和发展了仲景的学说,并运用调和寒热法在临床应用上取得很好的疗效。
Purpose:
Incoordination between the cold and heat is the frequent clinical pathogenesis.Zhang Zhong-jing discussed this question particularly in this contributions "Shanghan Lun"(Treatise on Febrile Diseases Caused by Cold) and "Jingui Yaolue"(The Prescription in Golden Cabinet).His academic standpoint has been influencing the faster generation.But these are few researches on the theory of "coordnating cold and heat" now,most of them paid close attention to summarizing rhe experiences of the famous doctors of TCM.In the thesis the valid therapeutic and therapeutics were summarized,based on the theories of 'Shanghan Lun','JinguiYaolue','Nei-jing' and the academic standpoints of the doctors of Song,Yuan,Ming and Qing periods.Through dicerning the physiological functions and pathology of the cold and heat.I hope this study helpful for the clinical practice.
Method:
First,I try to make sure clear the concept of "harmonizing" and "cold and heat",in order to identify my study's circumscription.Second,review the relevant theoretical basis could be traced,"Nei-jing" and the academic standpoints of the doctors of Song,Yuan,Ming and Qing periods light on cold and heat,and the origins of dialectical development,and integration and "cold and heat" concept,put forward to reconcile the definition of "coordinating cold and heat".Third,analyze the differences between different syndromes,to induce the corresponding therapeutics.At last,summarize the significance of this theory and Clinical Application.
Conclusion:
To harmonize Yin and Yang is the purpose of coordinating cold and heat. According to syndrome differentiation divided into "out cold and in heat", "up cold and down heat","cold heat mixed".All diagnosis and treatment are based on an overall analysis of the illness and the patient's condition.Sometimes relieving exterior syndrome at first,then clear heat; Sometimes clear heat at first,then relieving exterior syndrome;sometimes both of them are treated.One of these methods is used,or two of them are used together.Sometimes,one is uesd at first and another is used at last.Accrding to this theory,there are many therapeutics here,for example,prescription and acupuncture.The later doctors developed Zhang Zhong-jing's theory.So that this theory ismore uesfull now.
引文
[1]时乐,等.浅论和法的内涵与外延.新疆中医药.2003,21(1).-1-2
[2]孔伟.和法源流考.山西中医学院学报.2007,8(5).-5-6
[3]郭鹏,孔伟.和法的概念及其实质浅论.山东中医药大学学报.2006,30(6).-436-438,440
[4]梅刚.桂枝汤证治规律研究.广州中医药大学04级硕士研究生学位论文
[5]李洪涛.寒热初探.安徽中医学院学报.1999,18(5).-7-9
[6]季绍良,成肇智.中医诊断学.北京:人民卫生出版社.2002
[7]许良银,程宜福.《内经》寒热治疗学理论的探讨.皖南医学院学报,2003,22(3):226-228
[8]李赛美.寒热证—张仲景临证思维方式探微.广州中医药大学学报,1997,3(14):1
[9]吴弥漫.《伤寒论》《金匮要略》方中寒热并用法初探.国医论坛,1995,10(5):1
[10][11]薛飞飞.八纲辨证源流之探究.大同医学专科学校学报,2005,25(2):13
[12]林培政.温病学.中国中医药出版社.2003:4-5
[13]刘景源.明清时期中医疫病学与温病学的形成与发展(下).中国中医药现代远程教育,2004,2(2):27-30
[14]费建平.费伯雄学术思想探讨.江苏中医药.2007,39(10).-22-24
[15]李悦,王秀莲.张锡纯治温“透热”特色探讨.中医杂志.2008,49(1).-89-90
[16]李赛美.寒热证——张仲景临证思维方式探微.广州中医药大学学报.1997,14(1).2-4
[17]丁世幸.《伤寒论》寒温并用治法探述.四川中医.2005,23(2).-20-21
[18]马作峰.《伤寒论》寒热并用十二法.四川中医.2003,21(4).-15-17
[19]顾武军,张民庆等.伤寒论临床学习参考,北京:人民卫生出版社,2002,1;
[20]张再良,杨文喆.从疾病的寒热虚实看六经.河南中医.2009,29(1).-5-7
[21]李怀生.《伤寒论》寒热并用,辛开苦降法初探.光明中医.1998,13(4).-1-2
[22]陈茹琴.半夏泻心汤合四逆散治疗菌群失调性肠炎42例.新中医,2004,36(8):59
[23]蔡静芬,高玲.半夏泻心汤治疗返流性食道炎(胃热脾虚寒)30例.新疆中医药,2007,25(5):29-30
[24]王新华.半夏泻心汤加减治疗慢性胆囊炎胆石症.浙江中医学院学报,996,20(3):33-34
[25]孔月晴,李富英.半夏泻心汤治疗慢性胃炎56例疗效观察.辽宁中医杂志,2007,34(10):1428-1429
[26]张文仙.黄连汤加味治疗慢性萎缩性胃炎97例.国医论坛,2005,20(6):7
[27]李恒,樊振.甘草泻心汤加味治疗消化性溃疡寒热错杂型65例.甘肃中医学院学报,2006,23(4):19-20
[28]胡雄丽,朱迪,周虹,熊湘平.半夏泻心汤治疗寒热错杂型功能性消化不良的临床 研究.湖南中医学院学报,200626(1):40-41
[29]张爱国,马荣.半夏泻心汤加减治疗尿毒症呕吐40例.承德医学院学报,2002,19(2)
[30]孙大兴.生姜泻心汤加减治疗幽门不全性梗阻48例.江苏中医,1997,18(6):16
[31]冯文萍.黄连汤加减应用治胃痛60例临床分析.河南中医学院学报,2006,6(21):44
[32]杨金环.乌梅丸加减治疗慢性胆囊炎69例.河南中医,2006,26(1):73
[33]吴浩祥,万晓刚.《伤寒论》寒温并用方药临床应用验案4则.国医论坛,2003,18(4):6
[34]陈红霞.浅谈《伤寒论》中寒温并用法及应用.新疆中医药,1993,2.9-11
[35]王三虎.寒热并用方治疗内科杂病之验.实用中医内科杂志,1994,8(2):31
[36]王端权.大青龙汤治疗52例慢性支气管炎合并肺部感染.河南中医,2000,20(5):37
[37]张丽玲,李健.寒温并用治疗慢性支气管炎的临床研究.现代诊断与治疗.1999,10(4).-198-200
[38]李学麟,陈少东,杨鸿.寒温并用治小儿咳嗽变异性哮喘临床体会.江西中医药,2005,36(273):31-32
[39]孙嘉庚,胡敏,赵志英.乌梅丸化裁治疗慢性盆腔炎98例.中华中西医学杂志,2008,6(3):53
[40]张艳,催致然.乌梅丸化裁治疗寒热虚实夹杂型带下病60例.河北中医,1994,16(3):45
[41]陈庆华.乌梅丸临证新用.湖北中医杂志,2001,23(4):38
[42]张丽君.半夏泻心汤治疗不明原因不孕症举隅.湖北中医学院学报,2003,5(4):75
[43]荆国民,刘蓉华.半夏泻心汤治愈重症恶阻.长春中医学院学报,1990,6(1):34
[44]郑芳忠.乌梅丸加昧治疗泌尿系结石36例.国医论坛,2006,21(2):10
[45]严育斌.乌梅丸加味治疗男性不育症.中医杂志,1990,31(1):44
[46]王红宇.半夏泻心汤化裁治疗复发性口腔溃疡98例.北京中医,2007,26(3):164
[47]崔前平,程小瑾,李济仁.寒热并用治疗类风湿性关节炎的探讨.皖南医学院学报,1993,12(2):149
[48]申想荣.乌梅丸加减治疗偏头痛48例.湖南中医杂志,2000,16(3):42
[49]郝芬兰,吴立明.半夏泻心汤加味治疗失眠102例.四川中医,2007.25(9):70
[50]唐长金,田乐华.半夏泻心汤治疗嗜酸性细胞增多症31例.安徽中医学院学报,1993,12(3):27
[2]孔伟.和法源流考.山西中医学院学报.2007,8(5).-5-6
[3]郭鹏,孔伟.和法的概念及其实质浅论.山东中医药大学学报.2006,30(6).-436-438,440
[4]梅刚.桂枝汤证治规律研究.广州中医药大学04级硕士研究生学位论文
[5]李洪涛.寒热初探.安徽中医学院学报.1999,18(5).-7-9
[6]季绍良,成肇智.中医诊断学.北京:人民卫生出版社.2002
[7]许良银,程宜福.《内经》寒热治疗学理论的探讨.皖南医学院学报,2003,22(3):226-228
[8]李赛美.寒热证—张仲景临证思维方式探微.广州中医药大学学报,1997,3(14):1
[9]吴弥漫.《伤寒论》《金匮要略》方中寒热并用法初探.国医论坛,1995,10(5):1
[10][11]薛飞飞.八纲辨证源流之探究.大同医学专科学校学报,2005,25(2):13
[12]林培政.温病学.中国中医药出版社.2003:4-5
[13]刘景源.明清时期中医疫病学与温病学的形成与发展(下).中国中医药现代远程教育,2004,2(2):27-30
[14]费建平.费伯雄学术思想探讨.江苏中医药.2007,39(10).-22-24
[15]李悦,王秀莲.张锡纯治温“透热”特色探讨.中医杂志.2008,49(1).-89-90
[16]李赛美.寒热证——张仲景临证思维方式探微.广州中医药大学学报.1997,14(1).2-4
[17]丁世幸.《伤寒论》寒温并用治法探述.四川中医.2005,23(2).-20-21
[18]马作峰.《伤寒论》寒热并用十二法.四川中医.2003,21(4).-15-17
[19]顾武军,张民庆等.伤寒论临床学习参考,北京:人民卫生出版社,2002,1;
[20]张再良,杨文喆.从疾病的寒热虚实看六经.河南中医.2009,29(1).-5-7
[21]李怀生.《伤寒论》寒热并用,辛开苦降法初探.光明中医.1998,13(4).-1-2
[22]陈茹琴.半夏泻心汤合四逆散治疗菌群失调性肠炎42例.新中医,2004,36(8):59
[23]蔡静芬,高玲.半夏泻心汤治疗返流性食道炎(胃热脾虚寒)30例.新疆中医药,2007,25(5):29-30
[24]王新华.半夏泻心汤加减治疗慢性胆囊炎胆石症.浙江中医学院学报,996,20(3):33-34
[25]孔月晴,李富英.半夏泻心汤治疗慢性胃炎56例疗效观察.辽宁中医杂志,2007,34(10):1428-1429
[26]张文仙.黄连汤加味治疗慢性萎缩性胃炎97例.国医论坛,2005,20(6):7
[27]李恒,樊振.甘草泻心汤加味治疗消化性溃疡寒热错杂型65例.甘肃中医学院学报,2006,23(4):19-20
[28]胡雄丽,朱迪,周虹,熊湘平.半夏泻心汤治疗寒热错杂型功能性消化不良的临床 研究.湖南中医学院学报,200626(1):40-41
[29]张爱国,马荣.半夏泻心汤加减治疗尿毒症呕吐40例.承德医学院学报,2002,19(2)
[30]孙大兴.生姜泻心汤加减治疗幽门不全性梗阻48例.江苏中医,1997,18(6):16
[31]冯文萍.黄连汤加减应用治胃痛60例临床分析.河南中医学院学报,2006,6(21):44
[32]杨金环.乌梅丸加减治疗慢性胆囊炎69例.河南中医,2006,26(1):73
[33]吴浩祥,万晓刚.《伤寒论》寒温并用方药临床应用验案4则.国医论坛,2003,18(4):6
[34]陈红霞.浅谈《伤寒论》中寒温并用法及应用.新疆中医药,1993,2.9-11
[35]王三虎.寒热并用方治疗内科杂病之验.实用中医内科杂志,1994,8(2):31
[36]王端权.大青龙汤治疗52例慢性支气管炎合并肺部感染.河南中医,2000,20(5):37
[37]张丽玲,李健.寒温并用治疗慢性支气管炎的临床研究.现代诊断与治疗.1999,10(4).-198-200
[38]李学麟,陈少东,杨鸿.寒温并用治小儿咳嗽变异性哮喘临床体会.江西中医药,2005,36(273):31-32
[39]孙嘉庚,胡敏,赵志英.乌梅丸化裁治疗慢性盆腔炎98例.中华中西医学杂志,2008,6(3):53
[40]张艳,催致然.乌梅丸化裁治疗寒热虚实夹杂型带下病60例.河北中医,1994,16(3):45
[41]陈庆华.乌梅丸临证新用.湖北中医杂志,2001,23(4):38
[42]张丽君.半夏泻心汤治疗不明原因不孕症举隅.湖北中医学院学报,2003,5(4):75
[43]荆国民,刘蓉华.半夏泻心汤治愈重症恶阻.长春中医学院学报,1990,6(1):34
[44]郑芳忠.乌梅丸加昧治疗泌尿系结石36例.国医论坛,2006,21(2):10
[45]严育斌.乌梅丸加味治疗男性不育症.中医杂志,1990,31(1):44
[46]王红宇.半夏泻心汤化裁治疗复发性口腔溃疡98例.北京中医,2007,26(3):164
[47]崔前平,程小瑾,李济仁.寒热并用治疗类风湿性关节炎的探讨.皖南医学院学报,1993,12(2):149
[48]申想荣.乌梅丸加减治疗偏头痛48例.湖南中医杂志,2000,16(3):42
[49]郝芬兰,吴立明.半夏泻心汤加味治疗失眠102例.四川中医,2007.25(9):70
[50]唐长金,田乐华.半夏泻心汤治疗嗜酸性细胞增多症31例.安徽中医学院学报,1993,12(3):27