摘要
叶天士是清代著名医家,温病学派的代表人物,在中医学历史上占有十分重要的地位,近年来对叶天士学术思想的研究十分广泛,涉及到治法研究、专病研究、古方运用规律等多个方面。在叶天士学术思想与仲景学术思想的继承和发展方面,部分学者也进行了对比。但这些研究在深度和广度方面都还不够,对《临证指南医案》当中运用经方的医案研究缺乏完整性,在叶天士对仲景学说的继承和发展方面缺乏系统性。
叶天士作为温病学派的医家对伤寒学术极为推崇,对经方谙熟,深得仲景心法,从《临证指南医案》中可以看出叶天士对仲景学说求真务实,敢于创新的学风,极大发展了《伤寒论》的学术思想。本文以《临证指南医案》当中运用经方的医案为研究对象,研究叶天士对经方化裁使用的一般规律和特殊规律,可以看出叶天士是师古而不泥古的典范。从医案中折射出叶天士的一些重要学术思想如：卫气营血辨证、脾胃学说、气味配伍组方经验、络病学说、阳化内风说,都是对仲景学说的继承和发展。
叶天士与张仲景都尊奉《内经》营卫学说,对心肺与营卫的关系上看法一致,只是感受外邪有寒热之分。叶氏在温邪传变过程中,在卫分证借鉴了河间辛凉解表的思想有独特发挥,在气分、营分、血分的辨证论治及邪留三焦、里结阳明等问题的处理上均受仲景之学的启发,在选方和治法上取法伤寒。
叶天士从脾胃分治、到顾护胃气、脾胃之气资助营卫、存胃阴、通补阳明治法、土虚木乘方面都对仲景学说有重要继承和发展,结合李东垣脾胃思想,最终形成了完备成熟的脾胃学说。
在气味配伍理论方面,叶天士与张仲景都以《内经》为本源。叶天士在四气五味的配伍方面,从经方的组方中得到启迪,对仲景气味配伍、不同药性的煎煮时间不同等方面都有继承发展,特别是为达到特殊疗效,对药物通过炮制,改变气味属性方面叶氏都有独特的创新和发展。
在络病学说方面,叶氏继承仲景之学,倡“外感、内伤皆致病,新病、久病皆入络”之说,并提出“久痛入络”、“络病有虚实之分”。在络病的治法上继承发扬仲景络病思想,以辛味药为主、善用虫蚁搜剔,发挥补虚通络、润药、秽药通络等诸多治法,丰富完善了络病学说。
在中风理论研究方面,叶天士遥承仲景之学,借鉴刘完素、李东垣、朱丹溪、张景岳等诸家思想,倡“肝阳化风”之说,以仲景复脉汤、黄连阿胶汤、甘麦大枣汤加减化裁,作为滋心、肝、肾三脏之阴的核心用药,强调肝肾阴虚、心营受损都是“肝阳化风”的重要因素。借鉴仲景土虚木乘理论,以麦门冬汤、酸枣仁汤加减作为底方,治疗胃阴不足,肝风内动而偏热证。
本文还以《临证指南医案》为媒介,再次探讨温病学派另一巨著——《温病条辨》与《伤寒论》的关系。研究表明,吴鞠通的《温病条辨》有对仲景学术的直接继承,也有通过叶天士《临证指南医案》的间接继承。得出结论,温病学派是对伤寒学派的继承发展,温病大家从不排斥伤寒论,在学术上有继承有发展,不必强分彼此。
本文对《临证指南医案》当中复脉汤、真武汤、泻心汤、小建中汤等叶天士化裁特色鲜明的几首经方进行了专题讨论,揭示了各方运用的特殊规律及其折射出的学术思想。本文总结了叶氏运用经方“宗于原意、精于变通”、“善抓病机,一方多用”的一般规律,对《临证指南医案》中运用经方的医案,按方剂归类,以供研究者参考。
总之,叶天士对仲景学说全面继承,在运用发展仲景方剂、发挥仲景学术思想方面独辟蹊径,大胆创新。我们有理由认为叶天士不但是温病大家,同时也是伤寒学术史上的伤寒大家,可以作为清代经方临床运用的杰出代表。
Ye Tian-shi was an outstanding physician in Qing dynasty. One of the most important representatives of the school of warm disease. In recent years, his academic thoughts have been widly researched. Scolars have been comparing the academic thoughts between Ye Tianshi and Zhang Zhongjing. But the Completeness in researching of Lin Zheng Zhi Nan Yi AN (Medical Records for Clinical Guidance) and the systematicness of Ye Tianshi's Inheriting and developing of Zhang Zhongjing is obvious not enough.
As a scolar in school of warm disease, Ye Tianshi was very admiring the theory of Shanghan. He also could master the theory precisely. From Lin Zheng Zhi Nan Yi AN(Medical Records for Clinical Guidance), we could tell that Pragmatism and creativity. He inherited the academic thoughts in Shang Han Lun, and developed it to a new level.
Both Ye Tianshi and Zhang Zhongjing admire the NeiJing's Ying-wei theory. Their ideas about the relationship between the heart-lung and the Ying-Wei are the same excepting resuming whethere the pathogenic qi is cold or hot. Ye Tianshi came up with an idea about the transfer of heat pathogen.He drawn on the experience of Liu Wansu's theory of Weifen pattern. On the same time, his creative idea about the treatment according to syndrome differentiation and the therapy of phthogens libngering in triple energizer and retention of heat-evil is inspired by Zhang Zhongjing. So he selected formula and therapy from the Shang Hanlun. Ye tianshi have a great inheritance and development from Zhang zhongjing's theory of divide-and-conquer spleen and stomach、stomach's protection stomach-yin's saving、completion of yangming and so on, also reference the spleen and stomach of Li dongyuan, then finally transform into the spleen and stomach of his own.
Ye tianshi and Zhang zhongjing both have Internal Classic as the origin of their theorys of properties and tastes. Enlightened from the classical prescription, Ye tianshi both developed Zhang zhongjing's ways'of brew and theory of properties and tastes, and has his unique innovation and development about how to change the properties and tastes, and how to process the herbal for special curative effect.
In terms of collateral disease, YE Tian-shi carry on Zhongjing's theory advocate that both exopathy and internal injury can Cause disease, neopathy and Chronic Diseases Transforming to Collaterals, In addition, he Proposed that Chronic Pain Transforming to Collaterals, collateral disease has deficiency and excess. In the treatment, YE Tian-shi carry on and develop Zhongjing's theory, the based drug is acrid, being good at using Pests to remove obstruction in the meridians, exerting treatment methods of Tonic tonify to expel wind to dredge collateral, Dampness medicine and drugs of sweet flavor with warm nature can dredge the collatera, enrich and complete the theory of collateral disease.
In terms of Stroke(TCM), YE Tian-shi carrys on Zhongjing's theory and draws lessons from thought of Liu Wan-su, ZHU Dan-xi and Zhang Jing-yue, advocating the of liver-yang cause wind syndrome, the based Prescriptions are Zhongjing's Fumai Decoction, rhizoma coptidis ejiao decoction and Ganmai Dazao Decoction, the based drug is nourishing yin of heart, liver and kidney, stressing that yin deficiency of liver and kidney and over consumption of heart nutriment are important facts of liver-yang cause wind syndrome. Drawing lessons from the theory of liver invading deficient spleen, using Maimendong Decoction and Suan Zao Ren decoction as based drug to treat Asthenia of Gastroyin, up-stirring of the liver, fever of deficiency type.
This paper bases on Lin Zheng Zhi Nan Yi An, again Discussion on Different and Same Place of Idea of Physical Capacity of Treatise on Febrile Diseases and WenBingTiaoBian. The researching shows that Wen Bing Tiao Bian has not only inherited the idea of Shang Han Lun, but also used for reference of Lin Zheng Zhi Nan Yi An. So, the theory of Wenbing inherits and develops the theory of shanghan, they are not Conflicted from each other.
This paper focuses on some formula such as Fu Mai Decoction, Zhen Wu Decoction, Xie Xin Decoction, and Xiao Jian Zhong Decoction. Which show some special law in his accommodation that could tell Ye's academic thoughts. The researching shows the regular rule of his experience in using classic formula is discovering the essence of diseases, and expending the indication of the same fomular, and building a new kind of category that separates cases in Lin Zheng Zhi NanYi An by the name of formula.
After all, YeTianshi had clearly mastered the academic thoughts in Shang Han Lun, inherited and developed it to a new level. His thoughts and his success in clinic not only proved his important place in the school of Shang Han, but also made him one of the best clinicians in Qing Dynasy.
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