岭南近代伤寒四大家扶阳学术思想及其临床运用研究
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摘要
目的:
由于诸多原因,晚清至今岭南中医学常被等同于岭南温病学,甚至等同于岭南中草药、岭南凉茶,形成所谓“温证十有六七,伤寒十无一二”,重温热病尚寒凉药以至过于偏颇的观点。其实,岭南伤寒也是客观存在的。历史上岭南名医治疗疑难杂病,多崇尚仲景,妙用经方,善用温法救人无算,对仲景学说研究得心应手者不乏其人。岭南近代专研仲景经方之新会陈伯坛、顺德黎庇留、鹤山易巨荪、南海谭星缘,同生活在清末民初,最具有代表性,被后人合称为“四大金刚”。
一、抢救岭南近代伤寒派代表医家之学术经验,迫在眉睫,再过几年收集更加困难,有散失危险。
二、填补岭南近代伤寒医家学术思想专题汇编缺少有分量研究的空白。从实用角度出发,以汇编形式整理出其学术思想内核,能较快地指导和服务临床。
三、找出岭南近代伤寒四家学术思想的共性和特色,有助于客观地看待岭南地方疾病的中医辨证分型,并在一定程度上完善岭南中医学的辨证论治体系。
方法:
本研究综合运用文献调查、统计分析、历史研究、中医学术研究、医案研究、横向汇编比较、纵向师承考察等研究方法,通过收集整理岭南近代伤寒四家的《读过伤寒论》、《读过金匮卷十九》、《麻痘蠡言》、《伤寒论崇正编》、《黎庇留医案》、《集思医案》等6部医学著作,参阅《广州近代老中医医案医话选编》、《程祖培先生医学遗著》等2部著作和临证132例医案,以“扶阳”专题汇编的形式,对扶阳病案进行初步分类和统计分析,结合医论医著中的“扶阳思想”,对岭南近代伤寒代表名家学术思想和临床经验的内核,进行了较详实的整理和挖掘,并分析了岭南“阳亏现象”产生的客观原因,以期寻找其中对岭南医学同道较有借鉴意义的思想和经验。
内容:
共分五个部分:
一、绪论部分之相关研究现状:对近年来涉及近代岭南伤寒四家的研究、岭南瘟疫史中有关港粤甲午鼠疫的研究、建国后岭南伤寒学派学术思想和临床经验继承与发展等进行了初步梳理和回顾。
二、岭南近代伤寒四家生平简介、扶阳学术思想与临床经验总结:每位医家的临床经验又包括医案、医话、验方、总结与讨论四部分,并将收集到的各医家现存病案某方面的代表方剂进行证治分型,找出其中共性规律和特色,展示岭南近代伤寒四家扶阳的学术特色等。
三、理论分析部分:先试从岭南气候、地理环境、人群体质、生活习惯等与阳气的关系,展开理论探讨和分析,得出阳虚证型存在的客观依据;次则探讨了岭南近代伤寒学派代表医家扶阳特色产生原由。
四、理论发挥和临床运用部分:包括两部分:一是伤寒教研室张横柳教授(笔者导师)对营卫学说和肝阳学说的认识和临床发挥,对未来“扶阳思想”在治疗一些现代疾病中具有一定的启发意义。二是运用岭南近代伤寒家扶阳的思想和经验于临床,从收集到的430例典型病案中,列举10例典型医案,以示验证与运用。
五、问题解答与前景展望:解答了在课题主体部分未探讨的一些问题;突出“扶阳思想”对岭南中医临床的纠偏、救误作用及扶阳思想对临床的指导意义。
结论:
一、岭南近代伤寒四家学术思想具有共性和特色
从132例医案和案中寓有的学术思想上,可以得出岭南近代伤寒四家重视扶阳观点和善从保护人体阳气角度出发遣方用药。其有四大共性:
(一)继承了中原伤寒学派“阳主阴从”思想:几位医家扶阳的具体治法中,温阳属于第一位,占总病例之52.27%。其中温肾阳、温脾阳又占温阳法之大部分,为95.65%。余扶阳思想还体现在温中补虚、益气温阳、温经止痛、温经活血、升阳托毒凉血等具体治法中;另外对许多兼夹证的处理,如夹虚、夹瘀、夹痰、夹湿、夹毒等,多在以扶阳为先导的基础上兼治夹杂证,且终多以温复先后天脾肾之阳为根本落脚点。(二)重视经方的运用,且药味精专,合方或加减有度,使用时方和地方草药甚少。(三)扶阳运用范围广泛,涉及阴阳欲绝、昏迷、血证等急危重证及内、外、妇、儿各科。(四)善于以经解经,以论解论,或结合临床分析《伤寒论》中各方方规,扩大临床运用范围。
与岭南医家相比,岭南近代伤寒四家更有以下特色:
(一)岭南之地,所用药物剂量偏大,尤其是温热药剂量惊人。以陈伯坛为例“附子常用三两、甚至六两;干姜经常用二两,甚至四两,桂枝亦常用至一两以上。”(二)皆极重视温法在急、危、重证中的运用。(三)创大剂升阳托毒活血法治疗港粤甲午鼠疫。(四)善用温法,尤其是温阳法在急、重出血证中的运用。(五)注重温法在饮食疗法中的运用。
二、岭南近代伤寒四家扶阳思想及其特色与诸多客观因素有关
首先,岭南损害人体阳气的因素客观存在:
(一)气候及地理环境所致阳易亏损:岭南的气候特点是天气炎热、雨湿偏盛,在这种特定环境生活的岭南人,由于多种因素的综合作用,形成了“腠理不密”、“阳不下降”、“阴不上腾”、“中焦多湿”、“上热中湿下寒”的体质特点,而在治疗上易侧重上焦多火,而忽略中焦多脾阳虚夹湿,下焦多肾阳虚夹寒湿的特点。(二)岭南湿气更易损伤脾胃之阳。(三)岭南生活方式易致阴损及阳。(四)岭南部分饮食习惯不利于顾护脾胃之阳。
其次,滥用寒凉现象存在是损阳的人为因素:
(一)过于注重标病导致滥用寒凉。(二)虚火、郁火、实火辨识含糊导致过用寒凉。(三)岭南寒邪直中三阴证最易被忽视。
岭南近代伤寒四家扶阳特色产生原由探讨:
(一)与中原伤寒医家具有共性,崇尚经典,重视人体阳气,临证“法在救阳”。(二)重视扶阳代表经方经旨发挥,扩大运用范围,提供扶阳的具体理论支持。(三)岭南地区兼夹证偏多又使岭南近代伤寒四家温法上较中原医家丰富而自具特色。(四)善用温阳大剂、重剂与病种及四大家对中药性味的认识有关。(五)岭南近代伤寒四家使用凉性药及其规律能反衬其扶阳特色。(六)注重变换剂型、药食并用、寓扶阳于食疗中,适应岭南饮食文化。
三、岭南近代伤寒四家扶阳思想随着病种的变化将在亚健康、抑郁证等疾病的治疗上有一定启发意义
岭南近代伤寒四家扶阳学术思想,尤其是其温阳法在急、危、重证中的运用,由于纯中医治疗阵地大块丧失,未来扶阳学派运用前景将在阳气微虚、营卫不调所导致的岭南反复性外感、各类亚健康疾病上;随着城市生活节奏加快,肝阳虚所致的神经症、抑郁证、各类精神性疾病增多,疏解肝气、温补肝阳也日渐受到重视,故在理论探讨部分结合门诊所见病种,进一步挖掘了营卫学说和肝阳学说。引用经典和导师观点阐明:提倡卫主营从,调和营卫,以建中为本,顾护卫阳之根在于肾阳等学术观点;温肝阳在治疗精神类现代疾病的重要意义。
四、岭南近代伤寒四家使用凉性药及其规律对扶阳思想的反证意义
岭南近代伤寒四家寒凉之药的出色运用,证明其不是温法偏家,而是以辨证论治为基础的,更进一步证明扶阳病案所占比例过重,是基于临床,从而反证扶阳学术思想在岭南具有现实指导意义。另外其用寒凉或滋阴药的总体特点:一是除治疗鼠疫外在所有医案中占的比例较低。二是所使用之寒凉或滋阴方药多为仲景经方,而非后世温病方或时方。三是服寒凉药中病即止,以暂时性缓解病情为多,较之愈后用法中以温补法居多形成宣明对比。从另一面增加了“阳主阴从”思想在岭南适用的可行性。
五、岭南近代伤寒四家治学经验给后人的启迪
岭南近代伤寒四家扶阳学术思想和治学经验对本人收获很大的尚有:一是课题研究对本人学习经典著作之启示。二是结合营卫学说对人体阳气之运行的一些认识。三是结合伏寒学说认识到太阳与少阴之关系在六经中具有显著地位。
Aim:
Due to various reasons, TCM in south China has been identified as seasonal febrile disease, or south China herbs or even herbal tea since the end of Qing dynasty. And doctors laid excessive stress on seasonal febrile disease and cold-natured herbs. Actually, the Cold-induced febrile diseases objectively existed in south China. Most notable TCM doctors in south China advocated classical prescriptions and were good at using method of replenishing Yang when treating difficult miscellaneous diseases historically. Representative TCM doctors Chen bo-tan in Xinhui, Li bi-liu in Shunde, Yi ju-shun in Heshan and Tan xin-yuan in Nanhai who lived at the end of Qing dynasty and the beginning of China Republic focused on studying classical prescriptions were named "Four Masters".
1.To rescue the academic experience of the south China representative TCM doctors in the modern times.
2.To make up a deficiency on the blank area on symposium study on academic thoughts of south China Cold-induced febrile diseases doctors . Practically, to guide and serve for TCM clinic.
3. Sorting for the commonness and characteristics of south China school of theory on exogenous febrile disease in the modern times, which will help to understand the differentiation of symptoms and signs for classification of syndrome in south China spectrum of disease and correct the bias of emphasizing warm disease and cold -natured herbs, so as to consummate south China TCM" the system of determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs to some extent.
Methods: this study synthetically used methods of literatures investigation, statistic analysis, historical study, TCM academic research, medical records research, transversal assembly comparison, instructor inheriting investigation etc. Though collecting and sorting 5 medical books of the south China notable TCM doctors in modern times as well as consulting books of "selections of medical records and talks of Guangzhou notable TCM doctors in modern times ", "posthumous medical work of Mr. Chen zhu-pei ", classified and analyzed the medical records with assisting Yang method with the symposium about "assisting Yang".
We did an initial classification and statistic analysis, summarized and dig the detailed academic thoughts and clinical experience of the south China representative TCM doctors. Also analyzed the objective reasons of "Yang deficiency" in south China, so as to search useful medical thoughts and experience for south China medical doctors.
Contents:
Five chapters: 1 .Introduction part: major point is about relative research status: Reviewed and combed the recent studies on south China school of theory on exogenous febrile disease in modern times, plague in the south China pest history, inheritance and development of academic thoughts and clinical experience about "assisting Yang" in south China after 1949. 2. Introductions to the four TCM masters specializing on exogenous febrile disease in the modern times in south China, summary of the "assisting Yang" medical thoughts and clinical experience: Clinical experience of each doctor consists of medical records, medical talks, effective prescriptions and discussions. Classified the existed medical records and formulas according to different syndromes and found out the common principles and characteristics of "assisting Yang" of the school of theory of exogenous febrile disease in south China in modern times. 3. Theoretical analysis parts: we did a theoretical approach and analysis on relations between the climate, geographical environment, constitution of the people and living habits in south China and arrived at the objective evidence for the existence of Yang deficiency syndrome in south China as well as the production of assisting Yang characteristics among the representative doctors of theory on exogenous febrile disease in south China in modern times. 4. Theory educing and clinical practice part: (1) Recognition and clinical practice of Pro. Zhang heng-liu (instructor of the author) on theory of ying and wei as well as theory of liver Yang. (2) Clinical practice of the assisting Yang thoughts and experience of the TCM masters specializing on exogenous febrile disease in the modern times in south China, verified by 10 typical medical records among 430 medical cases collected. 5. Problem solutions and prospects.
Conclusions: 1. There are commonness and local characteristics in the academic thoughts of the four TCM doctors specialized in exogenous febrile disease in modern times in south China. We arrived at that the four masters paid much attention to "assisting Yang" thoughts and were good at protecting Yang Qi of the body when giving prescriptions from study on more than 130 medical records. (1)Succeeded the thoughts of "Yang the primary Ying secondary" from the school of theory on exogenous febrile disease in central China: Among the concrete treating methods of "assisting Yang", warming Yang method takes 52.27% in all medical cases and mostly warming kidney Yang and spleen Yang, other includes warming the middle Jiao replenishing deficiency, benefiting vital Qi and warming Yang, warming menstruation to stop pains, warming menstruation and activating blood flow etc.... (2) Paid much attention to the original formula, rarely use non-classical formula or local herbs. (3) assisting Yang method has been used widely and covered all severe cases in internal medicine, surgery, gynecology and pediatrics. (4) The four doctors were good at interpreting theory of exogenous febrile disease with classical quotations of TCM.
Compared with other TCM doctors in south China, these four masters have following features: (1)the dosage of the herbs is larger then normal in south China, especially hot-natured herbs. (2) Paid much attention to the assisting Yang method when treating severe cases.(3) Created the method of invigorating YANG and disintoxication when treating plague. (4)Good at using assisting Yang method, especially warming Yang method in treating bleeding cases. (5) Pay much attention to warm spleen and kidney Yang in diet therapies.
2. The assisting Yang thoughts and characteristics of the school of theory in exogenous febrile disease in modern times in south China had connections with many objective factors. Firstly, objective factors existed in south China which can damage Yang Qi of the body:(1)The climate and geographical environment is likely to cause Yang deficiency: the climate feature in south China is very hot, rainy and moist, and people lives in such an environment are intent to have "interspaces of skin and muscles being loose", "dampness in middle Jiao" and "heat in upper jiao, dampness in middle jiao and coldness in lower jiao", but normal treatment paid much attention to flame evil in the upper jiao but neglected spleen yang deficiency with damp-heat in middle Jiao, kidney yang deficiency with cold-damp in lower jiao. (2) Dampness is more likely to damage spleen and stomach Yang in south China. (3)The living habits in south China are easy to cause Ying essence damage, yin impairment involving yang. (4) Some eating habits in south China have disadvantage in preserving spleen and stomach Yang. Secondly, warming yang methods had been used for a long time in south China, and thoughts of "assisting Yang" were succeeded by some TCM doctors in south China area. Thirdly, approaches on the generation of "assisting Yang" features among the doctors specializing in exogenous febrile disease in south China modern time, (1)advocating classical books of TCM. (2) Assisting yang method can solve many problems clinically. (3) Assisting yang method has its own characteristics because of more compound syndromes in south China area.
3. Theory of assisting Yang in south China will show its values on disease such as sub-health, depression along the change of clinical diseases.
The prospect of assisting yang method will be in treating diseases caused by exogenous pathogenic factor and various sub-health disease mainly caused by incoordination between nutrient QI and defensive QI, defensive Yang deficiency. Accompanied with the acceleration of the living rhythm in city, mental illness and mental disorder such as depression increased, treatment principles of warming liver Yang and dispersing the depressed liver-Qi has been used very often gradually.
4. The doctors of school of theory on exogenous febrile disease in south china in modern times were good at using cold-natured herbs also which proved "assisting Yang" has practical importance.
Four masters of TCM in south China in modern times used cold-natured herbs distinguished, which proved they were not just knew "warming method" but involved determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs. And the general features of using cold-natured or yin-nourished herbs or formula includes: (l)Takes a lower proportion in all medical records except treating plague. (2) The cold-natured or ying-nourished herbs or formula are originated from book on exogenous febrile disease, not non-classical prescriptions. (3) Aim to relieve the patients' condition temporarily when using cold-natured herbs.
由于诸多原因,晚清至今岭南中医学常被等同于岭南温病学,甚至等同于岭南中草药、岭南凉茶,形成所谓“温证十有六七,伤寒十无一二”,重温热病尚寒凉药以至过于偏颇的观点。其实,岭南伤寒也是客观存在的。历史上岭南名医治疗疑难杂病,多崇尚仲景,妙用经方,善用温法救人无算,对仲景学说研究得心应手者不乏其人。岭南近代专研仲景经方之新会陈伯坛、顺德黎庇留、鹤山易巨荪、南海谭星缘,同生活在清末民初,最具有代表性,被后人合称为“四大金刚”。
一、抢救岭南近代伤寒派代表医家之学术经验,迫在眉睫,再过几年收集更加困难,有散失危险。
二、填补岭南近代伤寒医家学术思想专题汇编缺少有分量研究的空白。从实用角度出发,以汇编形式整理出其学术思想内核,能较快地指导和服务临床。
三、找出岭南近代伤寒四家学术思想的共性和特色,有助于客观地看待岭南地方疾病的中医辨证分型,并在一定程度上完善岭南中医学的辨证论治体系。
方法:
本研究综合运用文献调查、统计分析、历史研究、中医学术研究、医案研究、横向汇编比较、纵向师承考察等研究方法,通过收集整理岭南近代伤寒四家的《读过伤寒论》、《读过金匮卷十九》、《麻痘蠡言》、《伤寒论崇正编》、《黎庇留医案》、《集思医案》等6部医学著作,参阅《广州近代老中医医案医话选编》、《程祖培先生医学遗著》等2部著作和临证132例医案,以“扶阳”专题汇编的形式,对扶阳病案进行初步分类和统计分析,结合医论医著中的“扶阳思想”,对岭南近代伤寒代表名家学术思想和临床经验的内核,进行了较详实的整理和挖掘,并分析了岭南“阳亏现象”产生的客观原因,以期寻找其中对岭南医学同道较有借鉴意义的思想和经验。
内容:
共分五个部分:
一、绪论部分之相关研究现状:对近年来涉及近代岭南伤寒四家的研究、岭南瘟疫史中有关港粤甲午鼠疫的研究、建国后岭南伤寒学派学术思想和临床经验继承与发展等进行了初步梳理和回顾。
二、岭南近代伤寒四家生平简介、扶阳学术思想与临床经验总结:每位医家的临床经验又包括医案、医话、验方、总结与讨论四部分,并将收集到的各医家现存病案某方面的代表方剂进行证治分型,找出其中共性规律和特色,展示岭南近代伤寒四家扶阳的学术特色等。
三、理论分析部分:先试从岭南气候、地理环境、人群体质、生活习惯等与阳气的关系,展开理论探讨和分析,得出阳虚证型存在的客观依据;次则探讨了岭南近代伤寒学派代表医家扶阳特色产生原由。
四、理论发挥和临床运用部分:包括两部分:一是伤寒教研室张横柳教授(笔者导师)对营卫学说和肝阳学说的认识和临床发挥,对未来“扶阳思想”在治疗一些现代疾病中具有一定的启发意义。二是运用岭南近代伤寒家扶阳的思想和经验于临床,从收集到的430例典型病案中,列举10例典型医案,以示验证与运用。
五、问题解答与前景展望:解答了在课题主体部分未探讨的一些问题;突出“扶阳思想”对岭南中医临床的纠偏、救误作用及扶阳思想对临床的指导意义。
结论:
一、岭南近代伤寒四家学术思想具有共性和特色
从132例医案和案中寓有的学术思想上,可以得出岭南近代伤寒四家重视扶阳观点和善从保护人体阳气角度出发遣方用药。其有四大共性:
(一)继承了中原伤寒学派“阳主阴从”思想:几位医家扶阳的具体治法中,温阳属于第一位,占总病例之52.27%。其中温肾阳、温脾阳又占温阳法之大部分,为95.65%。余扶阳思想还体现在温中补虚、益气温阳、温经止痛、温经活血、升阳托毒凉血等具体治法中;另外对许多兼夹证的处理,如夹虚、夹瘀、夹痰、夹湿、夹毒等,多在以扶阳为先导的基础上兼治夹杂证,且终多以温复先后天脾肾之阳为根本落脚点。(二)重视经方的运用,且药味精专,合方或加减有度,使用时方和地方草药甚少。(三)扶阳运用范围广泛,涉及阴阳欲绝、昏迷、血证等急危重证及内、外、妇、儿各科。(四)善于以经解经,以论解论,或结合临床分析《伤寒论》中各方方规,扩大临床运用范围。
与岭南医家相比,岭南近代伤寒四家更有以下特色:
(一)岭南之地,所用药物剂量偏大,尤其是温热药剂量惊人。以陈伯坛为例“附子常用三两、甚至六两;干姜经常用二两,甚至四两,桂枝亦常用至一两以上。”(二)皆极重视温法在急、危、重证中的运用。(三)创大剂升阳托毒活血法治疗港粤甲午鼠疫。(四)善用温法,尤其是温阳法在急、重出血证中的运用。(五)注重温法在饮食疗法中的运用。
二、岭南近代伤寒四家扶阳思想及其特色与诸多客观因素有关
首先,岭南损害人体阳气的因素客观存在:
(一)气候及地理环境所致阳易亏损:岭南的气候特点是天气炎热、雨湿偏盛,在这种特定环境生活的岭南人,由于多种因素的综合作用,形成了“腠理不密”、“阳不下降”、“阴不上腾”、“中焦多湿”、“上热中湿下寒”的体质特点,而在治疗上易侧重上焦多火,而忽略中焦多脾阳虚夹湿,下焦多肾阳虚夹寒湿的特点。(二)岭南湿气更易损伤脾胃之阳。(三)岭南生活方式易致阴损及阳。(四)岭南部分饮食习惯不利于顾护脾胃之阳。
其次,滥用寒凉现象存在是损阳的人为因素:
(一)过于注重标病导致滥用寒凉。(二)虚火、郁火、实火辨识含糊导致过用寒凉。(三)岭南寒邪直中三阴证最易被忽视。
岭南近代伤寒四家扶阳特色产生原由探讨:
(一)与中原伤寒医家具有共性,崇尚经典,重视人体阳气,临证“法在救阳”。(二)重视扶阳代表经方经旨发挥,扩大运用范围,提供扶阳的具体理论支持。(三)岭南地区兼夹证偏多又使岭南近代伤寒四家温法上较中原医家丰富而自具特色。(四)善用温阳大剂、重剂与病种及四大家对中药性味的认识有关。(五)岭南近代伤寒四家使用凉性药及其规律能反衬其扶阳特色。(六)注重变换剂型、药食并用、寓扶阳于食疗中,适应岭南饮食文化。
三、岭南近代伤寒四家扶阳思想随着病种的变化将在亚健康、抑郁证等疾病的治疗上有一定启发意义
岭南近代伤寒四家扶阳学术思想,尤其是其温阳法在急、危、重证中的运用,由于纯中医治疗阵地大块丧失,未来扶阳学派运用前景将在阳气微虚、营卫不调所导致的岭南反复性外感、各类亚健康疾病上;随着城市生活节奏加快,肝阳虚所致的神经症、抑郁证、各类精神性疾病增多,疏解肝气、温补肝阳也日渐受到重视,故在理论探讨部分结合门诊所见病种,进一步挖掘了营卫学说和肝阳学说。引用经典和导师观点阐明:提倡卫主营从,调和营卫,以建中为本,顾护卫阳之根在于肾阳等学术观点;温肝阳在治疗精神类现代疾病的重要意义。
四、岭南近代伤寒四家使用凉性药及其规律对扶阳思想的反证意义
岭南近代伤寒四家寒凉之药的出色运用,证明其不是温法偏家,而是以辨证论治为基础的,更进一步证明扶阳病案所占比例过重,是基于临床,从而反证扶阳学术思想在岭南具有现实指导意义。另外其用寒凉或滋阴药的总体特点:一是除治疗鼠疫外在所有医案中占的比例较低。二是所使用之寒凉或滋阴方药多为仲景经方,而非后世温病方或时方。三是服寒凉药中病即止,以暂时性缓解病情为多,较之愈后用法中以温补法居多形成宣明对比。从另一面增加了“阳主阴从”思想在岭南适用的可行性。
五、岭南近代伤寒四家治学经验给后人的启迪
岭南近代伤寒四家扶阳学术思想和治学经验对本人收获很大的尚有:一是课题研究对本人学习经典著作之启示。二是结合营卫学说对人体阳气之运行的一些认识。三是结合伏寒学说认识到太阳与少阴之关系在六经中具有显著地位。
Aim:
Due to various reasons, TCM in south China has been identified as seasonal febrile disease, or south China herbs or even herbal tea since the end of Qing dynasty. And doctors laid excessive stress on seasonal febrile disease and cold-natured herbs. Actually, the Cold-induced febrile diseases objectively existed in south China. Most notable TCM doctors in south China advocated classical prescriptions and were good at using method of replenishing Yang when treating difficult miscellaneous diseases historically. Representative TCM doctors Chen bo-tan in Xinhui, Li bi-liu in Shunde, Yi ju-shun in Heshan and Tan xin-yuan in Nanhai who lived at the end of Qing dynasty and the beginning of China Republic focused on studying classical prescriptions were named "Four Masters".
1.To rescue the academic experience of the south China representative TCM doctors in the modern times.
2.To make up a deficiency on the blank area on symposium study on academic thoughts of south China Cold-induced febrile diseases doctors . Practically, to guide and serve for TCM clinic.
3. Sorting for the commonness and characteristics of south China school of theory on exogenous febrile disease in the modern times, which will help to understand the differentiation of symptoms and signs for classification of syndrome in south China spectrum of disease and correct the bias of emphasizing warm disease and cold -natured herbs, so as to consummate south China TCM" the system of determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs to some extent.
Methods: this study synthetically used methods of literatures investigation, statistic analysis, historical study, TCM academic research, medical records research, transversal assembly comparison, instructor inheriting investigation etc. Though collecting and sorting 5 medical books of the south China notable TCM doctors in modern times as well as consulting books of "selections of medical records and talks of Guangzhou notable TCM doctors in modern times ", "posthumous medical work of Mr. Chen zhu-pei ", classified and analyzed the medical records with assisting Yang method with the symposium about "assisting Yang".
We did an initial classification and statistic analysis, summarized and dig the detailed academic thoughts and clinical experience of the south China representative TCM doctors. Also analyzed the objective reasons of "Yang deficiency" in south China, so as to search useful medical thoughts and experience for south China medical doctors.
Contents:
Five chapters: 1 .Introduction part: major point is about relative research status: Reviewed and combed the recent studies on south China school of theory on exogenous febrile disease in modern times, plague in the south China pest history, inheritance and development of academic thoughts and clinical experience about "assisting Yang" in south China after 1949. 2. Introductions to the four TCM masters specializing on exogenous febrile disease in the modern times in south China, summary of the "assisting Yang" medical thoughts and clinical experience: Clinical experience of each doctor consists of medical records, medical talks, effective prescriptions and discussions. Classified the existed medical records and formulas according to different syndromes and found out the common principles and characteristics of "assisting Yang" of the school of theory of exogenous febrile disease in south China in modern times. 3. Theoretical analysis parts: we did a theoretical approach and analysis on relations between the climate, geographical environment, constitution of the people and living habits in south China and arrived at the objective evidence for the existence of Yang deficiency syndrome in south China as well as the production of assisting Yang characteristics among the representative doctors of theory on exogenous febrile disease in south China in modern times. 4. Theory educing and clinical practice part: (1) Recognition and clinical practice of Pro. Zhang heng-liu (instructor of the author) on theory of ying and wei as well as theory of liver Yang. (2) Clinical practice of the assisting Yang thoughts and experience of the TCM masters specializing on exogenous febrile disease in the modern times in south China, verified by 10 typical medical records among 430 medical cases collected. 5. Problem solutions and prospects.
Conclusions: 1. There are commonness and local characteristics in the academic thoughts of the four TCM doctors specialized in exogenous febrile disease in modern times in south China. We arrived at that the four masters paid much attention to "assisting Yang" thoughts and were good at protecting Yang Qi of the body when giving prescriptions from study on more than 130 medical records. (1)Succeeded the thoughts of "Yang the primary Ying secondary" from the school of theory on exogenous febrile disease in central China: Among the concrete treating methods of "assisting Yang", warming Yang method takes 52.27% in all medical cases and mostly warming kidney Yang and spleen Yang, other includes warming the middle Jiao replenishing deficiency, benefiting vital Qi and warming Yang, warming menstruation to stop pains, warming menstruation and activating blood flow etc.... (2) Paid much attention to the original formula, rarely use non-classical formula or local herbs. (3) assisting Yang method has been used widely and covered all severe cases in internal medicine, surgery, gynecology and pediatrics. (4) The four doctors were good at interpreting theory of exogenous febrile disease with classical quotations of TCM.
Compared with other TCM doctors in south China, these four masters have following features: (1)the dosage of the herbs is larger then normal in south China, especially hot-natured herbs. (2) Paid much attention to the assisting Yang method when treating severe cases.(3) Created the method of invigorating YANG and disintoxication when treating plague. (4)Good at using assisting Yang method, especially warming Yang method in treating bleeding cases. (5) Pay much attention to warm spleen and kidney Yang in diet therapies.
2. The assisting Yang thoughts and characteristics of the school of theory in exogenous febrile disease in modern times in south China had connections with many objective factors. Firstly, objective factors existed in south China which can damage Yang Qi of the body:(1)The climate and geographical environment is likely to cause Yang deficiency: the climate feature in south China is very hot, rainy and moist, and people lives in such an environment are intent to have "interspaces of skin and muscles being loose", "dampness in middle Jiao" and "heat in upper jiao, dampness in middle jiao and coldness in lower jiao", but normal treatment paid much attention to flame evil in the upper jiao but neglected spleen yang deficiency with damp-heat in middle Jiao, kidney yang deficiency with cold-damp in lower jiao. (2) Dampness is more likely to damage spleen and stomach Yang in south China. (3)The living habits in south China are easy to cause Ying essence damage, yin impairment involving yang. (4) Some eating habits in south China have disadvantage in preserving spleen and stomach Yang. Secondly, warming yang methods had been used for a long time in south China, and thoughts of "assisting Yang" were succeeded by some TCM doctors in south China area. Thirdly, approaches on the generation of "assisting Yang" features among the doctors specializing in exogenous febrile disease in south China modern time, (1)advocating classical books of TCM. (2) Assisting yang method can solve many problems clinically. (3) Assisting yang method has its own characteristics because of more compound syndromes in south China area.
3. Theory of assisting Yang in south China will show its values on disease such as sub-health, depression along the change of clinical diseases.
The prospect of assisting yang method will be in treating diseases caused by exogenous pathogenic factor and various sub-health disease mainly caused by incoordination between nutrient QI and defensive QI, defensive Yang deficiency. Accompanied with the acceleration of the living rhythm in city, mental illness and mental disorder such as depression increased, treatment principles of warming liver Yang and dispersing the depressed liver-Qi has been used very often gradually.
4. The doctors of school of theory on exogenous febrile disease in south china in modern times were good at using cold-natured herbs also which proved "assisting Yang" has practical importance.
Four masters of TCM in south China in modern times used cold-natured herbs distinguished, which proved they were not just knew "warming method" but involved determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs. And the general features of using cold-natured or yin-nourished herbs or formula includes: (l)Takes a lower proportion in all medical records except treating plague. (2) The cold-natured or ying-nourished herbs or formula are originated from book on exogenous febrile disease, not non-classical prescriptions. (3) Aim to relieve the patients' condition temporarily when using cold-natured herbs.
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