藏医“津尼萨枯”病理论的文献研究及其在临床中的应用探讨
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摘要
藏医学是一门理论完整、内容丰富、历史悠久、科学性极强的传统民族医学。早在远古时期生活在青藏高原的先祖们在同各种疾病的斗争中,逐渐认识了以植物、矿物、动物药为主的大自然万事万物的性能及其药理作用,探索、积累和掌握了丰富的疾病诊疗经验和方法。
经研究,早在两千多年前,藏医医学古籍中已经对“津尼萨枯”(糖尿病diabetes mellitus)的病因、分类、治疗措施等有零星的记载。随着藏医药学的发展,藏医药学重要典籍《四部医典》、《医著千万舍利》、《秘诀遗补》、《秘诀汇集》等中均对“津尼萨枯”病及其并发症的诊治方面提出了系统详细的理论与临床诊疗措施。
近年来,随着人类社会与生活水平的不断提高,糖尿病(津尼萨枯病)的发病率不断增升。如今,该病已经成为继心血管疾病及肿瘤之后,威胁人类健康的第三大疾病。但由于糖尿病的病因及慢性并发症的发病机制非常复杂,现代医学尚不能根治糖尿病,其慢性并发症缺少理想的防治措施。因此,如何合理运用以藏医学为主的传统替代医学为广大患者排忧解难,是我们藏医药工作者的责任,也是广大患者的热切期望。本人此次特别选定藏医“津尼萨枯”的理论与临床诊疗方法研究课题,旨在通过系统开展藏医学有关“津尼萨枯”病的文献研究及其临床经验整理的基础上,借助现代医学成果,对藏医诊疗“津尼萨枯”做出较全面、系统的研究。本论文主要成果有：
1.虽然在《敦煌藏医文献》、《月王药诊》、《辈吉补德卡塞》等吐蕃时期的医典中对“津尼萨枯”已有所记载,但详细探讨其病理病机、诊断分类及治疗措施的医典实属《四部医典》和《八支集要》。由此推断出藏医对该病的诊疗方法和措施完善于十二世纪初期的结论。
2.藏医典籍《四部医典》归纳“津尼萨枯”病的发病机理为“培根”过盛引发的糖质代谢紊乱、血糖升高和营养物质摄取不当的疾病。但后藏知名医师藏杜·达玛贡布、恰多贡布等则认为其发病机理是肾功能衰竭及膀胱功能紊乱所致。经研究,本人分析得出“津尼萨枯”病实质为体液消化不良病,其发病机理为体内“培根”病理性增升后,引起的脏腑功能衰竭,进而导致糖质代谢紊乱的病变过程。
3.现代医学认为糖尿病主要是由于胰岛素分泌障碍或功能紊乱导致血糖升高形成的疾病。本人通过比较研究,初步提出了胰岛素作为人体吸收代谢糖分的主要物质基础,是由作为脾脏系统的多个成分共同分泌的一种功能物质的观点。同时,分析提出了其对消化系统及血液循环的作用,认为胰岛素与脾脏之澡具有相辅相成的作用。
4.在充分开展藏医古籍文献和相关临床经验纪要的基础上,结合藏医临床实际,总结提出了“津尼萨枯”病七种指纹性病症,该诊断标准有望为“津尼萨枯”病的藏医临床诊疗标准建设提供理论依据。
5.通过重点开展治疗“津尼萨枯”病的藏药典方研究工作,分析得出了对“津尼萨枯”病有确切疗效的四种基础药材及其药效机制,为藏医临床创新开发新型津尼萨枯”治疗药方提供了科学依据和物质基础。
6.通过对本课题的研究,为后续开展“津尼萨枯”病临床诊疗工作提供了较丰富的学术资料。
Tibetan medicine is one of ethnomedicine, which has comprehensive theory, profound content, very long history, and many scientific approaches. And which was found by Tibetan ancestors, In the ancient time, when they fight to varieties diseases at daily life, especially they discovered the function and effect of plants, minerals and animal production.
Though two thousands years ago, ancient Tibetan medical texts had recorded some descriptions about the causes, classification and treatment of diabetes mellitus. the detailed description about treatment of diabetes and its complications, After development of Tibetan medicine,recorded by classical Tibetan medicine books like Four Treatises, Relic of Millions, Supplement to Instruction Tantra, and Compilation of the Essentials.
As we all know that because of social and life style changes, the patients of diabetes have been increased. Even which had already became third leading risk of human health.(Today, after cardiovascular disease and cancer.) But the causes of the diabetes and its complications are more complex, so modern medicine still cannot treat the diabetes effectively and also there is lack of ideal prevention and treatment for complication of the diabetes. As a result, using alternative medicine, such as Tibetan medicine, to serve diabetes'patients is a great obligation and a urgent task of Tibetan medicine. In addition, patients-who are suffered by diabetes have great expectation to many traditional medicines. Because of these reasons; I had chosen the theory of the diabetes, and the diagnosis and treatment of the diabetes as my research topic.
Through studying Tibetan medical literature review and analyzing clinical experiences, and consulting with modern medical achievement, I have done a comprehensive and systemic research on the diagnosis and treatment of diabetes. There are following achievements in my thesis:
1. There is a brief record about diabetes in famous Tibetan medical texts during the Tibetan Empire period, such as Dunhuang Tibetan medical documents. King of the Moon, Yellow-edged Volume and so on. But the detailed description about the causes, classification, diagnosis, and treatment the disease can been found in the Four Treatises and Astangahrdayasamhita, so having based on this reason, we could believe that the systematic theory of the diagnosis and treatment of the diabetes was established in12th century.
2. The Four Treatises states that diabetes is caused by rising phlegm which cause the disorder of sugar metabolism, increasing sugar in blood, and absorbing nutrition incorrectly. But Tsangdod Darma Gompo and Chakdor Gompo believed that diabetes is caused by losing kidney fire and the malfunction of the bladder. According to my research, diabetes is cause by indigestion of bodily liquid. Rising phlegm cause malfunction of organs. Then it causes disorder of sugar metabolism.
3. Modern medicine believes that diabetes is a disorder in which blood sugar level are abnormally high because the body does not produce enough insulin. By comparison study, in this research I state that insulin, which released from the pancreas, is basic materials that control the amount of sugar in the blood. Besides, I also show that the function of insulin to the digestive and cardiovascular system is. All in all, I think that insulin and pancreas are interdependent.
4. According to ancient medical texts and clinical practice,I had pointed out seven basic symptoms of diabetes. It laid a foundation for creating standard for diagnosing diabetes in Tibetan medicine.
5. By doing research on formula for diabetes in the Tibetan medical texts and clinical experience, and consulting with clinical practice, I found four basic medical materials function and clinical effect for treat diabetes and their function. It laid a research foundation for inventing new treatments of the diabetes.
6. This dissertation of this research could provides a good reference for future clinical research on this diabetes.
经研究,早在两千多年前,藏医医学古籍中已经对“津尼萨枯”(糖尿病diabetes mellitus)的病因、分类、治疗措施等有零星的记载。随着藏医药学的发展,藏医药学重要典籍《四部医典》、《医著千万舍利》、《秘诀遗补》、《秘诀汇集》等中均对“津尼萨枯”病及其并发症的诊治方面提出了系统详细的理论与临床诊疗措施。
近年来,随着人类社会与生活水平的不断提高,糖尿病(津尼萨枯病)的发病率不断增升。如今,该病已经成为继心血管疾病及肿瘤之后,威胁人类健康的第三大疾病。但由于糖尿病的病因及慢性并发症的发病机制非常复杂,现代医学尚不能根治糖尿病,其慢性并发症缺少理想的防治措施。因此,如何合理运用以藏医学为主的传统替代医学为广大患者排忧解难,是我们藏医药工作者的责任,也是广大患者的热切期望。本人此次特别选定藏医“津尼萨枯”的理论与临床诊疗方法研究课题,旨在通过系统开展藏医学有关“津尼萨枯”病的文献研究及其临床经验整理的基础上,借助现代医学成果,对藏医诊疗“津尼萨枯”做出较全面、系统的研究。本论文主要成果有：
1.虽然在《敦煌藏医文献》、《月王药诊》、《辈吉补德卡塞》等吐蕃时期的医典中对“津尼萨枯”已有所记载,但详细探讨其病理病机、诊断分类及治疗措施的医典实属《四部医典》和《八支集要》。由此推断出藏医对该病的诊疗方法和措施完善于十二世纪初期的结论。
2.藏医典籍《四部医典》归纳“津尼萨枯”病的发病机理为“培根”过盛引发的糖质代谢紊乱、血糖升高和营养物质摄取不当的疾病。但后藏知名医师藏杜·达玛贡布、恰多贡布等则认为其发病机理是肾功能衰竭及膀胱功能紊乱所致。经研究,本人分析得出“津尼萨枯”病实质为体液消化不良病,其发病机理为体内“培根”病理性增升后,引起的脏腑功能衰竭,进而导致糖质代谢紊乱的病变过程。
3.现代医学认为糖尿病主要是由于胰岛素分泌障碍或功能紊乱导致血糖升高形成的疾病。本人通过比较研究,初步提出了胰岛素作为人体吸收代谢糖分的主要物质基础,是由作为脾脏系统的多个成分共同分泌的一种功能物质的观点。同时,分析提出了其对消化系统及血液循环的作用,认为胰岛素与脾脏之澡具有相辅相成的作用。
4.在充分开展藏医古籍文献和相关临床经验纪要的基础上,结合藏医临床实际,总结提出了“津尼萨枯”病七种指纹性病症,该诊断标准有望为“津尼萨枯”病的藏医临床诊疗标准建设提供理论依据。
5.通过重点开展治疗“津尼萨枯”病的藏药典方研究工作,分析得出了对“津尼萨枯”病有确切疗效的四种基础药材及其药效机制,为藏医临床创新开发新型津尼萨枯”治疗药方提供了科学依据和物质基础。
6.通过对本课题的研究,为后续开展“津尼萨枯”病临床诊疗工作提供了较丰富的学术资料。
Tibetan medicine is one of ethnomedicine, which has comprehensive theory, profound content, very long history, and many scientific approaches. And which was found by Tibetan ancestors, In the ancient time, when they fight to varieties diseases at daily life, especially they discovered the function and effect of plants, minerals and animal production.
Though two thousands years ago, ancient Tibetan medical texts had recorded some descriptions about the causes, classification and treatment of diabetes mellitus. the detailed description about treatment of diabetes and its complications, After development of Tibetan medicine,recorded by classical Tibetan medicine books like Four Treatises, Relic of Millions, Supplement to Instruction Tantra, and Compilation of the Essentials.
As we all know that because of social and life style changes, the patients of diabetes have been increased. Even which had already became third leading risk of human health.(Today, after cardiovascular disease and cancer.) But the causes of the diabetes and its complications are more complex, so modern medicine still cannot treat the diabetes effectively and also there is lack of ideal prevention and treatment for complication of the diabetes. As a result, using alternative medicine, such as Tibetan medicine, to serve diabetes'patients is a great obligation and a urgent task of Tibetan medicine. In addition, patients-who are suffered by diabetes have great expectation to many traditional medicines. Because of these reasons; I had chosen the theory of the diabetes, and the diagnosis and treatment of the diabetes as my research topic.
Through studying Tibetan medical literature review and analyzing clinical experiences, and consulting with modern medical achievement, I have done a comprehensive and systemic research on the diagnosis and treatment of diabetes. There are following achievements in my thesis:
1. There is a brief record about diabetes in famous Tibetan medical texts during the Tibetan Empire period, such as Dunhuang Tibetan medical documents. King of the Moon, Yellow-edged Volume and so on. But the detailed description about the causes, classification, diagnosis, and treatment the disease can been found in the Four Treatises and Astangahrdayasamhita, so having based on this reason, we could believe that the systematic theory of the diagnosis and treatment of the diabetes was established in12th century.
2. The Four Treatises states that diabetes is caused by rising phlegm which cause the disorder of sugar metabolism, increasing sugar in blood, and absorbing nutrition incorrectly. But Tsangdod Darma Gompo and Chakdor Gompo believed that diabetes is caused by losing kidney fire and the malfunction of the bladder. According to my research, diabetes is cause by indigestion of bodily liquid. Rising phlegm cause malfunction of organs. Then it causes disorder of sugar metabolism.
3. Modern medicine believes that diabetes is a disorder in which blood sugar level are abnormally high because the body does not produce enough insulin. By comparison study, in this research I state that insulin, which released from the pancreas, is basic materials that control the amount of sugar in the blood. Besides, I also show that the function of insulin to the digestive and cardiovascular system is. All in all, I think that insulin and pancreas are interdependent.
4. According to ancient medical texts and clinical practice,I had pointed out seven basic symptoms of diabetes. It laid a foundation for creating standard for diagnosing diabetes in Tibetan medicine.
5. By doing research on formula for diabetes in the Tibetan medical texts and clinical experience, and consulting with clinical practice, I found four basic medical materials function and clinical effect for treat diabetes and their function. It laid a research foundation for inventing new treatments of the diabetes.
6. This dissertation of this research could provides a good reference for future clinical research on this diabetes.
引文
1. 伤寒杂病论,张仲景,上海科技出版社,2002：
2. 千金方,孙思邈,北京人民军医出版社,1986：
3. 糖尿病及其并发病中西医诊治学,吕仁和,人民出版社,1997：
4. 糖尿病病与心血管疾病,王长华,北京人民军医出版社,2000：
5. 糖尿病名医秘验绝技,王明慧,北京人民军医出版社,2005：
6. 糖尿病肾病三焦辩治,仁爱华,中国医药科技出版社,1994：
7. 糖尿病肾病综合征病因诊治探讨,张晓青,上海科技出版社,2008：
8. 使用中医肾病学,张天,上海人民出版社,2009：
9. 糖尿病与肾病中医诊治,吕仁和,北京中医药大学学报,2002年第3期。
10.益肾通络法治糖尿病32例,张国山,上海中医药大学学报,2012年第4期。
11.中西医结合治疗糖尿病肾病56例,盛梅笑,北京中医药大学学报,2013年第1期。
12.活血化瘀治疗糖尿病慢性并发病的机理探讨,孙爱华,中医研究,2013：
13.医学史,阿尔图罗,卡斯蒂廖尼著,程之范,甄橙主译,译林出版社2013：
14.叶山东,朱禧星,临床糖尿病学,安徽科学技术出版社,2005：
15.张俊忠,试论糖尿病脾虚湿滞证,北京中医药大学学报2002,25：
2. 千金方,孙思邈,北京人民军医出版社,1986：
3. 糖尿病及其并发病中西医诊治学,吕仁和,人民出版社,1997：
4. 糖尿病病与心血管疾病,王长华,北京人民军医出版社,2000：
5. 糖尿病名医秘验绝技,王明慧,北京人民军医出版社,2005：
6. 糖尿病肾病三焦辩治,仁爱华,中国医药科技出版社,1994：
7. 糖尿病肾病综合征病因诊治探讨,张晓青,上海科技出版社,2008：
8. 使用中医肾病学,张天,上海人民出版社,2009：
9. 糖尿病与肾病中医诊治,吕仁和,北京中医药大学学报,2002年第3期。
10.益肾通络法治糖尿病32例,张国山,上海中医药大学学报,2012年第4期。
11.中西医结合治疗糖尿病肾病56例,盛梅笑,北京中医药大学学报,2013年第1期。
12.活血化瘀治疗糖尿病慢性并发病的机理探讨,孙爱华,中医研究,2013：
13.医学史,阿尔图罗,卡斯蒂廖尼著,程之范,甄橙主译,译林出版社2013：
14.叶山东,朱禧星,临床糖尿病学,安徽科学技术出版社,2005：
15.张俊忠,试论糖尿病脾虚湿滞证,北京中医药大学学报2002,25：