中医诊治胸痹心痛证学术源流探讨及文献整理研究
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摘要
研究目的
胸痹心痛证,是由于正气亏虚,痰浊,瘀血,气滞,寒凝而引起心脉痹阻不畅,临床以膻中或左胸部发作性憋闷疼痛为主要表现的一种病症,轻者偶发短暂轻微的胸部沉闷或隐痛,或为发作性膻中或左胸不适感；重者疼痛剧烈,或呈压榨样绞痛。相当于西医冠状动脉粥样硬化性心脏病(以下简称冠心病)心绞痛,其重者相当于心肌梗死。随着现代社会生活方式及饮食结构改变,心血管疾病发病率及死亡率有逐年上升趋势,被列为重大疾病,在一些国家和地区已成为第一位的死亡原因。因此,无论是中医或者是西医对该病都予以高度的重视。
历代中医对胸痹心痛证的诊治给我们留下了宝贵的内容,值得我们研究效法与发扬光大。现代中医对冠心病论治多参考古代胸痹心痛的论述,并且认为胸痹心痛相当于西医的冠状动脉粥样硬化性心脏病,心绞痛,其重者相当于心肌梗死,故胸痹心痛证的研究受到广泛的关注。可见胸痹心痛证治不仅为古代医家所重视,亦为现代医家及科研工作者不可忽视的重要课题。
目前研究现状。胸痹心痛证治研究重点仍然在临床与药物,而对于学术源流理论探讨以及文献整理,远远未能满足临床研究与药物开发需求。因此,本论文研究目的意义,在于梳理中医诊治胸痹心痛证学术源流,存徵信而资考鉴,通过文献资料收集分析,对胸痹心痛证由点至线、由线至面的切入铺开,在古人的论述与今人的研究中找出与相关的创新点,冀望胸痹心痛领域研究更加之深入。研究方法
采用传统医史文献研究与现代文献研究整理相结合的方法。传统医史文献研究,强调原创资料的来源、收集,注重理论学说的凝练：现代文献研究方法手段先进,注重信息处理与计算机技术应用。上述两种方法都应该在论文撰写中得到体现。
学术源流研究的方法：它关注在学术发展过程中的演变与分析,所谓“溯本穷源,贯穿百家”。胸痹心痛证作为一个中医病名已存在一千多年,然而作为一个中医病证名,要寻找到相关联的西医疾病,需经过一番文献整理和临床探讨过程。例如民国时期陆渊雷认为古书所称胸痹心痛,以心胸部特异感觉为主,赅括心绞痛及大动脉之炎症、瘤症；医家赵锡武亦认为胸痹包括心痛,属现代医学冠心病范围疾患；岳美中认为今之冠心病属《金匮》胸痹范围之内,然胸痹非此一病,还包括一部分消化系疾病在内；阚方旭认为胸痹不但包括现代医学的冠心病、心肌梗塞等,而且包括慢阻肺、肺心病等；医家奚肇庆等认为胸痹心痛,除包括冠心病外还当有消化系统疾患；而秦伯未、刘寿康等则直接认为胸痹属消化系统见证,与心脏无关。此后一系列词典和教材经过反复讨论,依然口径不一,难以对胸痹心痛的西医对应范围做统一；直至国家技术监督局颁布的中医临床诊疗术语,将胸痹心痛合并归入心系病类,并有高原胸痹病名；《国家标准应用·中医内科疾病诊疗常规》指出,胸痹(心痛)相当于西医学所说的缺血性心脏病；1998年国家中医药管理局医政司胸痹急症协作组制定的诊疗规范中将胸痹分为胸痹心痛(冠心病心绞痛)、胸痹心厥(冠心病心肌梗死)、胸痹心衰(冠心病心力衰竭)、胸痹心悸(冠心病心律失常),并提出他因、他证、他病均不属本规范范围,明确将胸痹等同于冠心病,至此胸痹等同于冠心病的说法逐渐得到各机构及学者的承认。
文献整理研究的方法：《中华医典》电子图书、中国生物医学文献光盘数据库(CBM)、中国中医药科技文献数据库(TCMLRS)光盘数据库等,作为一种工具是必不可少的。但不能完全依赖它。笔者是台湾执业医师,临床诊治心血管疾病多年,体会中医临证指南仍然是历代名医学术经验。因此,本学位论文资料来源以及学术观点的形成,主要是对于中医古籍原著的研读与养分的吸取,同时旁参西说。考虑到在台湾地区图书馆中医古籍书资料收集的困难,将充分汇辑近人点校出版及当代学者汇编的中医书籍,如鲁兆麟等点校之《中国医学名著珍品全书》、清代陈梦雷等主编之《古今图书集成医部全书》；另外近人搜集收采范围详尽的中医典籍套书,如天津科学技术出版社总汇之《金元四大家医书全书》、中国中医药出版社之《明清名医全书大成》(收载明代13位、清代17位医家全书)。《中华医典》关于“胸痹心痛”文献检索；中国生物医学文献光盘数据库(CBM)关于“胸痹心痛”文献检索；《中文科技期刊数据库(维普期刊数据库)》,关于冠心病,心绞痛,心律失常等文献检索；手工检索当代有关胸痹心痛证(病)相关文献,都成为论文引述资料的来源。
研究结论
基于上述研究方法,形成的学位论文,结构分为两个部分：第一部分,中医诊治胸痹心痛证学术源流探讨。从学术发展纵向的角度,从先秦的文献资料及经验积累,到以《内经》《难经》《伤寒》《金匮》为标志的中医学体系的创立。两汉时期,《金匮要略》将本病的病因病机归纳为阳微阴弦,治法方药方面,多以辛温通阳或温补阳气为治疗大法,隋唐时期巢元方认为“心痛”的病因为“风冷邪气乘于心”,并根据病位在正经还是在别络,将心痛分为“真心痛”和“久心痛”。还将胸痹的内涵做了扩展,除指心、肺疾病,还包括了一些胸壁病患。宋金元时期对胸痹心痛仍延续两汉时期的认识,心痛分为九种,心痛与胃痛混为一谈。发展至明清则出现了三方面的进展：对心痛、胃脘痛已能鉴别；辨证论治体系基本形成；对真心痛危重病证救治积累有成功经验。清代医家叶天士对诊治胸痹心痛证贡献包括师法仲景,辛滑通阳；畅通气机,调理五脏；活血祛瘀,宣通络痹等三方面。上述研究虽有学者进行,但不够系统全面。因此,论文第一部分创新点,是补充考证了历代医家对胸痹心痛论述的资料,使之更为系统准确,尤其是具体明确了马王堆古汉墓帛书对胸痹心痛的记载。
第二部分,中医诊治胸痹心痛证文献尤其是近现代文献整理,从横向的角度探讨胸痹心痛证的病名概念、病因病机、辨证特点、方药治疗、医案举隅及防护等方面进行分类,取有代表性的文献资料,进行归类整理发掘。本部分着重于中医诊治胸痹心痛证的理论学说内涵,将搜集到的胸痹心痛论文依其内容分类归于论文中不同病因导致的胸痹心痛证中,还有胸痹心痛证与五脏的关系、从五脏论治,及根据西医病名分型论治等。治疗方面有药物治疗和其它疗法及治疗药物的现代研究。论文第二部分内容丰富,要处理的资料较多,具有一定的可读性。研究过程中发现胸痹心痛证不仅为古代医家所重视,更是近代医家及科研者所重视的重点,尤其是冠心病的高发病率和死亡率使得对胸痹心痛证的研究更为重要,值得我辈投注时间精力加以整理研究。因此,论文第二部分创新点是胸痹心痛证与五脏关系的文献整理与归类,如心为肺之邻,冠心病从肺论治；肝主疏泄藏血,冠心病从肝论治；心与胆通,治心温胆,冠心病从胆论治；心肾相交,冠心病从肾论治；心脾相关,冠心病从脾胃论治。
研究结果
本论文第一部分以朝代为主轴,阐述先秦到明清文献中胸痹心痛证的历史源流及各时期对胸痹心痛论述的发展。大体而言,心痛胸痛最早见于马王堆古汉墓出土帛书、《内经》,汉代张仲景《金匮要略·胸痹心痛短气病脉证治》奠定辨证论治基础,晋唐时期扩展了对胸痹心痛的认识,除指心、肺疾病,还包括了一些胸壁病患。宋金元时期,仍延续唐汉以来的认识,心痛分为九种,心痛与胃痛合一论述。明清对胸痹心痛证诊治出现了三方面的重大进展：对心痛、胃脘痛已能鉴别；辨证论治体系基本形成；对真心痛危重病证救治积累有成功经验。
本论文第二部分对胸痹心痛证学术内涵进行分类研究,从名称概念、病因病机、辨证特点、方药治疗等横向角度,取有代表性的文献资料,进行归类整理发掘。根据胸痹心痛的病因病机分为寒凝型、气滞型、血瘀型、痰阻型、虚损型等证型,对症治疗以中医方药。重点研究了胸痹心痛证与五脏的关系,从五脏来论治冠心病。如心肺相关,冠心病从肺论治；心肝相关,冠心病从肝论治；心与胆通,冠心病从胆论治；心肾相关,冠心病从肾论治；调脾护心,冠心病从脾胃论治。此外,还总结了对胸痹心痛证的治疗方药。冀望能对未来胸痹心痛证的临床诊治提供更多的参考依据及更充分的理论基础。
中医诊治胸痹心痛证的理法方药,饱含了从秦汉到明清二千多年的时间长河里历代医家经验,可以无愧的说,无论是从时间的跨度,或是从检验人群的广度,都是无出其右者。因此,作为中医诊治胸痹心痛证经验的载体----中医古籍文献与现代文献,绝对是珍贵的宝藏,它影射出历代医家诊治胸痹心痛的理方法药以及在临床经验基础上形成不同的流派,整理这些资料便于学者深入继续研究与发展。
Purpose:
Chest obstruction witnesses because righteousness deficiency, phlegm, blood stasis, qi stagnation, cold coagulation, caused heart vessel blockage., poor clinical to tanzhong paroxysmal feel oppressed or left chest obstruction as the main manifestation of a disease, mild symptom leads chest dull pain, or paroxysmal tanzhong or left chest discomfort; severe symptom makes patient feels severe pain, or the chest were squeezed like cramps. It is similar to what the Western medicine called the coronary heart disease (hereinafter referred to as coronary heart disease) angina pectoris, myocardial infarction of their weight are equivalent. With the modern lifestyle and diet changes, cardiovascular disease morbidity and mortality have increased year by year, are classified as major diseases. In some countries and regions it has become the first cause of death. So, whether Chinese or Western medicine pays high attention to such disease.
Ancient Chinese medicine treatment on the certificate of Chest obstruction left us with valuable content, worthy of our study to follow and flourish. Modern Chinese medicine treatment of coronary heart disease and more information on the exposition of ancient chest obstruction, chest obstruction, and that the Western equivalent of coronary atherosclerotic heart disease, angina, myocardial infarction of their weight are equal. Therefore, chest obstruction evidence draws a lot of concern. Treatment of Chest obstruction is not only valued by the ancient physician, but also by the modern physicians and scientists.
Under present condition, the treatment of Chest obstruction research still focuses on clinical drug. The academic theories of origin and literature review can hardly meet the demand for clinical research and drug development. Therefore, the purpose and significance of this research is to sort out evidence of academic medicine diagnosis and treatment of chest obstruction origin, keep credit and capital test Kam, data collection through literature analysis, evidence of Chest obstruction from the point to line by line to cut into the paved surface open discussion of ancient and modern people in the study identified, and find a new point of view to hopefully lead to an in-depth study of Chest obstruction.
Methods:
Adopting traditional medical history and modern literature. Medical history of the traditional literature, emphasizes the source of original data collection, focus on theories of condensation; research methods and advanced methods of modern literature, focusing on information processing and computer technology. The two methods would be reflected in the thesis writing.
Research Method of Academic Origin:
It focuses on the academic development and analysis of the evolution process, the so-called "back the source of the through 100." Chest obstruction Medicine as a disease name certificate has been in existence a thousand years, but as a Chinese medicine syndromes name, to find the associated Western diseases, and subject to some process of literature review and clinical study. For example, the Republic of China Lu Yuan Lei believed ancient books called chest obstruction, cardiac chest to specific sensory-based, Gai including angina and artery of inflammation, tumor disease. Zhaoxi Wu also think of Chest Physicians, including heart pain, coronary heart disease is the scope of modern medical disorders. Yue United States and that of coronary heart disease today is a "Golden" within the scope of Chest, Chest However, none of this disease, but also part of the digestive diseases, including.Kan Fang Xu, including not only modern medicine that the Chest of coronary heart disease, myocardial infarction, etc., but also chronic obstructive pulmonary disease, pulmonary heart disease, etc. Physician Zhao-Qing Xi so that the chest obstruction, among things, including coronary heart disease when there are digestive system; and Qin Bowei, Liu Shoukang so that the Chest is digested directly system witness has nothing to do with the heart.
After a series of dictionaries and teaching materials through repeated discussions, still bore different, it is difficult to uniform the scope of Western counterparts; until the Bureau of Technical Supervision issued by the Chinese medicine clinical diagnosis and treatment terms, the merger will be chest obstruction heart disease classified as type, and a plateau of Chest disease name; "for the application of conventional treatment·Chinese medical disease," said Chest (Heartburn) is equivalent to what Western medicine ischemic heart disease. In 1998,the State Administration of Traditional Medical Administration Emergency Chest obstruction collaborative group developed the theory that diagnostic and treatment practices will be divided into the chest obstruction Chest (angina pectoris), Chest Heart Jue (myocardial infarction), Chest heart failure (congestive heart failure), and Chest palpitations (crown heart arrhythmia
Research Methodology of Literature Review:
"Chinese Medical Classics," e-books, CD-ROM Chinese Biological Medicine Database (CBM), Chinese Medicine literature database (TCMLRS) CD-ROM databases, are used as essential tools, but we should not totally rely on it. The author is a practicing physician in Taiwan, clinical diagnosis and treatment of cardiovascular disease for many years to appreciate a guide to clinical medicine is still the academic experience of ancient famous doctor. Therefore, this dissertation sources of information and the formation of the academic point of view, mainly for reading the original works of ancient Chinese medicine and nutrition lessons, and next to participate in the West said. Taking into account that it is difficult to collect ancient Chinese book library in Taiwan, the full publication of the Repertoire neighbor points, and contemporary scholars, school compilation of Chinese medicine books, such as Lu Zhaolin peer schools the "treasures of Chinese medicine classic book," Qing Meng-Lei editor of the "Integrated Medical Department of the book Ancient and Modern Books"; another neighbor to collect detailed income range of Chinese books collected set of books, such as the Tianjin Science and Technology Press Center of the "dollar Four medical text book," Journal of Chinese Medicine "Ming Shing famous doctor book" (collection contains 13 Ming Dynasty, Qing Dynasty physician book 17). "Chinese Medical Classics," on "Chest obstruction" literature search; Chinese Biomedical CD Database (CBM) on the "chest obstruction" literature search; "Chinese Science and Technology journal database (VIP journal database)", on coronary heart disease, angina, arrhythmia and other literature search; manual search of contemporary evidence relating to chest obstruction (disease) literature, have become the paper quoted sources of information.
Results
Based on the above methods, the dissertation structure is divided into two parts:the first part of academic medicine diagnosis and treatment of chest obstruction Sources of evidence. From the perspective of academic development vertical, from the pre-Qin literature and experience, to the "Classic" "Classic" "Typhoid," "Golden" in the medical system marked by the creation. Han Dynasty, "Golden Chamber" will be the disease pathogenesis summarized yin yang micro strings law governing prescription, the more use or Wenbu Yang Xin Wen Yang Qi for the treatment of Dafa, Sui and Tang Chao Yuan Fang, that "heartache" of disease because "Air evil by heart," and according to the patient or in the other bit in serious contact, the heartache into "really sad" and "long heartache." The content will also be doing Chest expansion, except that the heart, lung disease, chest wall also includes a number of patients. Song, Jin and Yuan Dynasties of the chest obstruction still continued awareness of the Han Dynasty, divided into nine kinds of heartache, heartache mixed with stomach pain. Development to the Qing appeared in the three areas of progress:on the heartache, stomachache has been able to identify; syndrome differentiation system of shape; on the real Pain Treatment of Diseases of accumulation of critical success. Doctors Qing Ye Tianshi card contribution on the treatment of Chest obstruction, including a solicitor Zhongjing, sliding Yang Xin; unimpeded qi, regulating the five internal organs; blood stasis, paralysis and other publicity collaterals three. Although the research scholars, but not systematically and comprehensively. Therefore, the first part of the innovation thesis, is to supplement the research of the ancient physicians discussed information on chest obstruction, to make it more accurate, in particular, specifically defined the ancient Tomb Mawangdui silk on the record of Chest obstruction.
The second part of Chinese medicine diagnosis and treatment of chest obstruction card literature, especially modern literature review, from a horizontal perspective of the disease name card Chest obstruction concept of pathogenesis, differentiation characteristics, Prescriptions, Medical Case Examples, and protection and other aspects classification, taking representative documents, classified and finishing excavation. This section focuses on diagnosis and treatment of chest obstruction medicine card meaning theories, the chest obstruction will be collected according to the contents of papers attributed to paper due to different causes of chest obstruction permits, there are five internal organs of Chest obstruction Syndrome and Relationship from the five organs of governance, and Western disease name according to type of treatment, etc.. Treatment with medication and other therapies and treatments of modern research. The second part is rich in content, more information has to be dealt with, has some readability. Course of the study found evidence of Chest obstruction is not only valued by the ancient physicians, more recent research by the physicians and the focus of attention, especially in the high coronary morbidity and mortality makes evidence of chest obstruction is more important is worthy of my time and energy generation to order of betting. Therefore, the paper is the second part of the innovation of Chest obstruction Syndrome and Relationship between the five organs literature review and classification, such as the heart of the adjacent lung, coronary heart disease from the Lung; liver controlling dispersion store blood, coronary heart disease from liver; heart and gall bladder through, the mind Wendan, coronary heart disease from the bile of governance; heart and kidney intersection, coronary heart disease from kidney; heart and spleen associated with coronary heart disease from the spleen and stomach.
Conclusions:
The first part of this thesis as the main dynasties, Qin to the Qing described in the literature evidence of the historical origins of Chest obstruction and the period of discussion on the development of chest obstruction. In general, the heartache of chest obstruction was first seen in the ancient Han Dynasty silk Mawangdui, "via", Han Zhang, "Golden Chamber·chest obstruction syndrome and treatment with short pulse gas disease," lay the basis of syndrome differentiation, Jin and Tang period extends to the chest Bi painful awareness, in addition to that heart, lung disease, chest wall also includes a number of patients. Song and Yuan Dynasties, has still continued Tanghan knowledge is divided into nine kinds of heartache, the heartache and the stomach-one discussion. Ming on the Diagnosis and Treatment of Chest obstruction appeared significant progress in three areas:the heartache, stomachache has been able to identify; syndrome differentiation system of shape; on the real Pain Treatment of Diseases of accumulation of critical success.
The second part of this thesis, the academic content of the Chest obstruction classification of evidence, from the name of the concept of pathogenesis, differentiation characteristics, prescription treatment horizontal angle, taking representative documents, classified and finishing excavation. According to Etiology and Pathogenesis of Chest obstruction into cold coagulation type, Qi stagnation, blood stasis, phlegm-type, type of deficiency and other syndromes, symptomatic treatment with Chinese herbs. Focuses on the five internal organs of Chest obstruction Syndrome and the relationship between the five internal organs came from the Treatment of Coronary Heart Disease. Such as heart and lung related to coronary heart disease from the Lung; heart and liver related to coronary heart disease from liver; heart and gall bladder through, coronary heart disease from the bile of governance; heart and kidney-related, coronary heart disease from kidney; transferred spleen care center, crown heart disease from the spleen and stomach. In addition, it summarizes the evidence on the treatment of chest obstruction prescriptions. Can look to the future diagnosis and treatment of Chest obstruction Syndrome more references and more fully the theoretical basis.
Chinese medicine diagnosis and treatment of chest obstruction card Li-fa, herbs, full of a thousand years from the Qin and Han to the Ming and Qing dynasties of the time the long history of physician experience, worthy of that, either from the time span, or the breadth of the crowd from the test are not out of his right person. Therefore, as the Chinese Experience in Chest obstruction Diagnosis and treatment of the carrier ---- Ancient Chinese literature and modern literature, is absolutely precious treasure, it is mapping out the historical and recent medical diagnosis and treatment of chest obstruction of mathematical methods and clinical experience in medicine form the basis of different the school, organize information to facilitate further research and development scholars.
胸痹心痛证,是由于正气亏虚,痰浊,瘀血,气滞,寒凝而引起心脉痹阻不畅,临床以膻中或左胸部发作性憋闷疼痛为主要表现的一种病症,轻者偶发短暂轻微的胸部沉闷或隐痛,或为发作性膻中或左胸不适感；重者疼痛剧烈,或呈压榨样绞痛。相当于西医冠状动脉粥样硬化性心脏病(以下简称冠心病)心绞痛,其重者相当于心肌梗死。随着现代社会生活方式及饮食结构改变,心血管疾病发病率及死亡率有逐年上升趋势,被列为重大疾病,在一些国家和地区已成为第一位的死亡原因。因此,无论是中医或者是西医对该病都予以高度的重视。
历代中医对胸痹心痛证的诊治给我们留下了宝贵的内容,值得我们研究效法与发扬光大。现代中医对冠心病论治多参考古代胸痹心痛的论述,并且认为胸痹心痛相当于西医的冠状动脉粥样硬化性心脏病,心绞痛,其重者相当于心肌梗死,故胸痹心痛证的研究受到广泛的关注。可见胸痹心痛证治不仅为古代医家所重视,亦为现代医家及科研工作者不可忽视的重要课题。
目前研究现状。胸痹心痛证治研究重点仍然在临床与药物,而对于学术源流理论探讨以及文献整理,远远未能满足临床研究与药物开发需求。因此,本论文研究目的意义,在于梳理中医诊治胸痹心痛证学术源流,存徵信而资考鉴,通过文献资料收集分析,对胸痹心痛证由点至线、由线至面的切入铺开,在古人的论述与今人的研究中找出与相关的创新点,冀望胸痹心痛领域研究更加之深入。研究方法
采用传统医史文献研究与现代文献研究整理相结合的方法。传统医史文献研究,强调原创资料的来源、收集,注重理论学说的凝练：现代文献研究方法手段先进,注重信息处理与计算机技术应用。上述两种方法都应该在论文撰写中得到体现。
学术源流研究的方法：它关注在学术发展过程中的演变与分析,所谓“溯本穷源,贯穿百家”。胸痹心痛证作为一个中医病名已存在一千多年,然而作为一个中医病证名,要寻找到相关联的西医疾病,需经过一番文献整理和临床探讨过程。例如民国时期陆渊雷认为古书所称胸痹心痛,以心胸部特异感觉为主,赅括心绞痛及大动脉之炎症、瘤症；医家赵锡武亦认为胸痹包括心痛,属现代医学冠心病范围疾患；岳美中认为今之冠心病属《金匮》胸痹范围之内,然胸痹非此一病,还包括一部分消化系疾病在内；阚方旭认为胸痹不但包括现代医学的冠心病、心肌梗塞等,而且包括慢阻肺、肺心病等；医家奚肇庆等认为胸痹心痛,除包括冠心病外还当有消化系统疾患；而秦伯未、刘寿康等则直接认为胸痹属消化系统见证,与心脏无关。此后一系列词典和教材经过反复讨论,依然口径不一,难以对胸痹心痛的西医对应范围做统一；直至国家技术监督局颁布的中医临床诊疗术语,将胸痹心痛合并归入心系病类,并有高原胸痹病名；《国家标准应用·中医内科疾病诊疗常规》指出,胸痹(心痛)相当于西医学所说的缺血性心脏病；1998年国家中医药管理局医政司胸痹急症协作组制定的诊疗规范中将胸痹分为胸痹心痛(冠心病心绞痛)、胸痹心厥(冠心病心肌梗死)、胸痹心衰(冠心病心力衰竭)、胸痹心悸(冠心病心律失常),并提出他因、他证、他病均不属本规范范围,明确将胸痹等同于冠心病,至此胸痹等同于冠心病的说法逐渐得到各机构及学者的承认。
文献整理研究的方法：《中华医典》电子图书、中国生物医学文献光盘数据库(CBM)、中国中医药科技文献数据库(TCMLRS)光盘数据库等,作为一种工具是必不可少的。但不能完全依赖它。笔者是台湾执业医师,临床诊治心血管疾病多年,体会中医临证指南仍然是历代名医学术经验。因此,本学位论文资料来源以及学术观点的形成,主要是对于中医古籍原著的研读与养分的吸取,同时旁参西说。考虑到在台湾地区图书馆中医古籍书资料收集的困难,将充分汇辑近人点校出版及当代学者汇编的中医书籍,如鲁兆麟等点校之《中国医学名著珍品全书》、清代陈梦雷等主编之《古今图书集成医部全书》；另外近人搜集收采范围详尽的中医典籍套书,如天津科学技术出版社总汇之《金元四大家医书全书》、中国中医药出版社之《明清名医全书大成》(收载明代13位、清代17位医家全书)。《中华医典》关于“胸痹心痛”文献检索；中国生物医学文献光盘数据库(CBM)关于“胸痹心痛”文献检索；《中文科技期刊数据库(维普期刊数据库)》,关于冠心病,心绞痛,心律失常等文献检索；手工检索当代有关胸痹心痛证(病)相关文献,都成为论文引述资料的来源。
研究结论
基于上述研究方法,形成的学位论文,结构分为两个部分：第一部分,中医诊治胸痹心痛证学术源流探讨。从学术发展纵向的角度,从先秦的文献资料及经验积累,到以《内经》《难经》《伤寒》《金匮》为标志的中医学体系的创立。两汉时期,《金匮要略》将本病的病因病机归纳为阳微阴弦,治法方药方面,多以辛温通阳或温补阳气为治疗大法,隋唐时期巢元方认为“心痛”的病因为“风冷邪气乘于心”,并根据病位在正经还是在别络,将心痛分为“真心痛”和“久心痛”。还将胸痹的内涵做了扩展,除指心、肺疾病,还包括了一些胸壁病患。宋金元时期对胸痹心痛仍延续两汉时期的认识,心痛分为九种,心痛与胃痛混为一谈。发展至明清则出现了三方面的进展：对心痛、胃脘痛已能鉴别；辨证论治体系基本形成；对真心痛危重病证救治积累有成功经验。清代医家叶天士对诊治胸痹心痛证贡献包括师法仲景,辛滑通阳；畅通气机,调理五脏；活血祛瘀,宣通络痹等三方面。上述研究虽有学者进行,但不够系统全面。因此,论文第一部分创新点,是补充考证了历代医家对胸痹心痛论述的资料,使之更为系统准确,尤其是具体明确了马王堆古汉墓帛书对胸痹心痛的记载。
第二部分,中医诊治胸痹心痛证文献尤其是近现代文献整理,从横向的角度探讨胸痹心痛证的病名概念、病因病机、辨证特点、方药治疗、医案举隅及防护等方面进行分类,取有代表性的文献资料,进行归类整理发掘。本部分着重于中医诊治胸痹心痛证的理论学说内涵,将搜集到的胸痹心痛论文依其内容分类归于论文中不同病因导致的胸痹心痛证中,还有胸痹心痛证与五脏的关系、从五脏论治,及根据西医病名分型论治等。治疗方面有药物治疗和其它疗法及治疗药物的现代研究。论文第二部分内容丰富,要处理的资料较多,具有一定的可读性。研究过程中发现胸痹心痛证不仅为古代医家所重视,更是近代医家及科研者所重视的重点,尤其是冠心病的高发病率和死亡率使得对胸痹心痛证的研究更为重要,值得我辈投注时间精力加以整理研究。因此,论文第二部分创新点是胸痹心痛证与五脏关系的文献整理与归类,如心为肺之邻,冠心病从肺论治；肝主疏泄藏血,冠心病从肝论治；心与胆通,治心温胆,冠心病从胆论治；心肾相交,冠心病从肾论治；心脾相关,冠心病从脾胃论治。
研究结果
本论文第一部分以朝代为主轴,阐述先秦到明清文献中胸痹心痛证的历史源流及各时期对胸痹心痛论述的发展。大体而言,心痛胸痛最早见于马王堆古汉墓出土帛书、《内经》,汉代张仲景《金匮要略·胸痹心痛短气病脉证治》奠定辨证论治基础,晋唐时期扩展了对胸痹心痛的认识,除指心、肺疾病,还包括了一些胸壁病患。宋金元时期,仍延续唐汉以来的认识,心痛分为九种,心痛与胃痛合一论述。明清对胸痹心痛证诊治出现了三方面的重大进展：对心痛、胃脘痛已能鉴别；辨证论治体系基本形成；对真心痛危重病证救治积累有成功经验。
本论文第二部分对胸痹心痛证学术内涵进行分类研究,从名称概念、病因病机、辨证特点、方药治疗等横向角度,取有代表性的文献资料,进行归类整理发掘。根据胸痹心痛的病因病机分为寒凝型、气滞型、血瘀型、痰阻型、虚损型等证型,对症治疗以中医方药。重点研究了胸痹心痛证与五脏的关系,从五脏来论治冠心病。如心肺相关,冠心病从肺论治；心肝相关,冠心病从肝论治；心与胆通,冠心病从胆论治；心肾相关,冠心病从肾论治；调脾护心,冠心病从脾胃论治。此外,还总结了对胸痹心痛证的治疗方药。冀望能对未来胸痹心痛证的临床诊治提供更多的参考依据及更充分的理论基础。
中医诊治胸痹心痛证的理法方药,饱含了从秦汉到明清二千多年的时间长河里历代医家经验,可以无愧的说,无论是从时间的跨度,或是从检验人群的广度,都是无出其右者。因此,作为中医诊治胸痹心痛证经验的载体----中医古籍文献与现代文献,绝对是珍贵的宝藏,它影射出历代医家诊治胸痹心痛的理方法药以及在临床经验基础上形成不同的流派,整理这些资料便于学者深入继续研究与发展。
Purpose:
Chest obstruction witnesses because righteousness deficiency, phlegm, blood stasis, qi stagnation, cold coagulation, caused heart vessel blockage., poor clinical to tanzhong paroxysmal feel oppressed or left chest obstruction as the main manifestation of a disease, mild symptom leads chest dull pain, or paroxysmal tanzhong or left chest discomfort; severe symptom makes patient feels severe pain, or the chest were squeezed like cramps. It is similar to what the Western medicine called the coronary heart disease (hereinafter referred to as coronary heart disease) angina pectoris, myocardial infarction of their weight are equivalent. With the modern lifestyle and diet changes, cardiovascular disease morbidity and mortality have increased year by year, are classified as major diseases. In some countries and regions it has become the first cause of death. So, whether Chinese or Western medicine pays high attention to such disease.
Ancient Chinese medicine treatment on the certificate of Chest obstruction left us with valuable content, worthy of our study to follow and flourish. Modern Chinese medicine treatment of coronary heart disease and more information on the exposition of ancient chest obstruction, chest obstruction, and that the Western equivalent of coronary atherosclerotic heart disease, angina, myocardial infarction of their weight are equal. Therefore, chest obstruction evidence draws a lot of concern. Treatment of Chest obstruction is not only valued by the ancient physician, but also by the modern physicians and scientists.
Under present condition, the treatment of Chest obstruction research still focuses on clinical drug. The academic theories of origin and literature review can hardly meet the demand for clinical research and drug development. Therefore, the purpose and significance of this research is to sort out evidence of academic medicine diagnosis and treatment of chest obstruction origin, keep credit and capital test Kam, data collection through literature analysis, evidence of Chest obstruction from the point to line by line to cut into the paved surface open discussion of ancient and modern people in the study identified, and find a new point of view to hopefully lead to an in-depth study of Chest obstruction.
Methods:
Adopting traditional medical history and modern literature. Medical history of the traditional literature, emphasizes the source of original data collection, focus on theories of condensation; research methods and advanced methods of modern literature, focusing on information processing and computer technology. The two methods would be reflected in the thesis writing.
Research Method of Academic Origin:
It focuses on the academic development and analysis of the evolution process, the so-called "back the source of the through 100." Chest obstruction Medicine as a disease name certificate has been in existence a thousand years, but as a Chinese medicine syndromes name, to find the associated Western diseases, and subject to some process of literature review and clinical study. For example, the Republic of China Lu Yuan Lei believed ancient books called chest obstruction, cardiac chest to specific sensory-based, Gai including angina and artery of inflammation, tumor disease. Zhaoxi Wu also think of Chest Physicians, including heart pain, coronary heart disease is the scope of modern medical disorders. Yue United States and that of coronary heart disease today is a "Golden" within the scope of Chest, Chest However, none of this disease, but also part of the digestive diseases, including.Kan Fang Xu, including not only modern medicine that the Chest of coronary heart disease, myocardial infarction, etc., but also chronic obstructive pulmonary disease, pulmonary heart disease, etc. Physician Zhao-Qing Xi so that the chest obstruction, among things, including coronary heart disease when there are digestive system; and Qin Bowei, Liu Shoukang so that the Chest is digested directly system witness has nothing to do with the heart.
After a series of dictionaries and teaching materials through repeated discussions, still bore different, it is difficult to uniform the scope of Western counterparts; until the Bureau of Technical Supervision issued by the Chinese medicine clinical diagnosis and treatment terms, the merger will be chest obstruction heart disease classified as type, and a plateau of Chest disease name; "for the application of conventional treatment·Chinese medical disease," said Chest (Heartburn) is equivalent to what Western medicine ischemic heart disease. In 1998,the State Administration of Traditional Medical Administration Emergency Chest obstruction collaborative group developed the theory that diagnostic and treatment practices will be divided into the chest obstruction Chest (angina pectoris), Chest Heart Jue (myocardial infarction), Chest heart failure (congestive heart failure), and Chest palpitations (crown heart arrhythmia
Research Methodology of Literature Review:
"Chinese Medical Classics," e-books, CD-ROM Chinese Biological Medicine Database (CBM), Chinese Medicine literature database (TCMLRS) CD-ROM databases, are used as essential tools, but we should not totally rely on it. The author is a practicing physician in Taiwan, clinical diagnosis and treatment of cardiovascular disease for many years to appreciate a guide to clinical medicine is still the academic experience of ancient famous doctor. Therefore, this dissertation sources of information and the formation of the academic point of view, mainly for reading the original works of ancient Chinese medicine and nutrition lessons, and next to participate in the West said. Taking into account that it is difficult to collect ancient Chinese book library in Taiwan, the full publication of the Repertoire neighbor points, and contemporary scholars, school compilation of Chinese medicine books, such as Lu Zhaolin peer schools the "treasures of Chinese medicine classic book," Qing Meng-Lei editor of the "Integrated Medical Department of the book Ancient and Modern Books"; another neighbor to collect detailed income range of Chinese books collected set of books, such as the Tianjin Science and Technology Press Center of the "dollar Four medical text book," Journal of Chinese Medicine "Ming Shing famous doctor book" (collection contains 13 Ming Dynasty, Qing Dynasty physician book 17). "Chinese Medical Classics," on "Chest obstruction" literature search; Chinese Biomedical CD Database (CBM) on the "chest obstruction" literature search; "Chinese Science and Technology journal database (VIP journal database)", on coronary heart disease, angina, arrhythmia and other literature search; manual search of contemporary evidence relating to chest obstruction (disease) literature, have become the paper quoted sources of information.
Results
Based on the above methods, the dissertation structure is divided into two parts:the first part of academic medicine diagnosis and treatment of chest obstruction Sources of evidence. From the perspective of academic development vertical, from the pre-Qin literature and experience, to the "Classic" "Classic" "Typhoid," "Golden" in the medical system marked by the creation. Han Dynasty, "Golden Chamber" will be the disease pathogenesis summarized yin yang micro strings law governing prescription, the more use or Wenbu Yang Xin Wen Yang Qi for the treatment of Dafa, Sui and Tang Chao Yuan Fang, that "heartache" of disease because "Air evil by heart," and according to the patient or in the other bit in serious contact, the heartache into "really sad" and "long heartache." The content will also be doing Chest expansion, except that the heart, lung disease, chest wall also includes a number of patients. Song, Jin and Yuan Dynasties of the chest obstruction still continued awareness of the Han Dynasty, divided into nine kinds of heartache, heartache mixed with stomach pain. Development to the Qing appeared in the three areas of progress:on the heartache, stomachache has been able to identify; syndrome differentiation system of shape; on the real Pain Treatment of Diseases of accumulation of critical success. Doctors Qing Ye Tianshi card contribution on the treatment of Chest obstruction, including a solicitor Zhongjing, sliding Yang Xin; unimpeded qi, regulating the five internal organs; blood stasis, paralysis and other publicity collaterals three. Although the research scholars, but not systematically and comprehensively. Therefore, the first part of the innovation thesis, is to supplement the research of the ancient physicians discussed information on chest obstruction, to make it more accurate, in particular, specifically defined the ancient Tomb Mawangdui silk on the record of Chest obstruction.
The second part of Chinese medicine diagnosis and treatment of chest obstruction card literature, especially modern literature review, from a horizontal perspective of the disease name card Chest obstruction concept of pathogenesis, differentiation characteristics, Prescriptions, Medical Case Examples, and protection and other aspects classification, taking representative documents, classified and finishing excavation. This section focuses on diagnosis and treatment of chest obstruction medicine card meaning theories, the chest obstruction will be collected according to the contents of papers attributed to paper due to different causes of chest obstruction permits, there are five internal organs of Chest obstruction Syndrome and Relationship from the five organs of governance, and Western disease name according to type of treatment, etc.. Treatment with medication and other therapies and treatments of modern research. The second part is rich in content, more information has to be dealt with, has some readability. Course of the study found evidence of Chest obstruction is not only valued by the ancient physicians, more recent research by the physicians and the focus of attention, especially in the high coronary morbidity and mortality makes evidence of chest obstruction is more important is worthy of my time and energy generation to order of betting. Therefore, the paper is the second part of the innovation of Chest obstruction Syndrome and Relationship between the five organs literature review and classification, such as the heart of the adjacent lung, coronary heart disease from the Lung; liver controlling dispersion store blood, coronary heart disease from liver; heart and gall bladder through, the mind Wendan, coronary heart disease from the bile of governance; heart and kidney intersection, coronary heart disease from kidney; heart and spleen associated with coronary heart disease from the spleen and stomach.
Conclusions:
The first part of this thesis as the main dynasties, Qin to the Qing described in the literature evidence of the historical origins of Chest obstruction and the period of discussion on the development of chest obstruction. In general, the heartache of chest obstruction was first seen in the ancient Han Dynasty silk Mawangdui, "via", Han Zhang, "Golden Chamber·chest obstruction syndrome and treatment with short pulse gas disease," lay the basis of syndrome differentiation, Jin and Tang period extends to the chest Bi painful awareness, in addition to that heart, lung disease, chest wall also includes a number of patients. Song and Yuan Dynasties, has still continued Tanghan knowledge is divided into nine kinds of heartache, the heartache and the stomach-one discussion. Ming on the Diagnosis and Treatment of Chest obstruction appeared significant progress in three areas:the heartache, stomachache has been able to identify; syndrome differentiation system of shape; on the real Pain Treatment of Diseases of accumulation of critical success.
The second part of this thesis, the academic content of the Chest obstruction classification of evidence, from the name of the concept of pathogenesis, differentiation characteristics, prescription treatment horizontal angle, taking representative documents, classified and finishing excavation. According to Etiology and Pathogenesis of Chest obstruction into cold coagulation type, Qi stagnation, blood stasis, phlegm-type, type of deficiency and other syndromes, symptomatic treatment with Chinese herbs. Focuses on the five internal organs of Chest obstruction Syndrome and the relationship between the five internal organs came from the Treatment of Coronary Heart Disease. Such as heart and lung related to coronary heart disease from the Lung; heart and liver related to coronary heart disease from liver; heart and gall bladder through, coronary heart disease from the bile of governance; heart and kidney-related, coronary heart disease from kidney; transferred spleen care center, crown heart disease from the spleen and stomach. In addition, it summarizes the evidence on the treatment of chest obstruction prescriptions. Can look to the future diagnosis and treatment of Chest obstruction Syndrome more references and more fully the theoretical basis.
Chinese medicine diagnosis and treatment of chest obstruction card Li-fa, herbs, full of a thousand years from the Qin and Han to the Ming and Qing dynasties of the time the long history of physician experience, worthy of that, either from the time span, or the breadth of the crowd from the test are not out of his right person. Therefore, as the Chinese Experience in Chest obstruction Diagnosis and treatment of the carrier ---- Ancient Chinese literature and modern literature, is absolutely precious treasure, it is mapping out the historical and recent medical diagnosis and treatment of chest obstruction of mathematical methods and clinical experience in medicine form the basis of different the school, organize information to facilitate further research and development scholars.
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