《伤寒杂病论》下利与《中医内科学》泄泻辨治规律的比较研究

发布时间：2018-03-19 23:07

  本文选题：伤寒杂病论　切入点：泄泻　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的本文拟从病名、病因、病机、治法、方药等几个方面对《伤寒杂病论》下利和《中医内科学》泄泻进行比较,探讨《中医内科学》泄泻与《伤寒杂病论》下利之间的关系;通过对《中医内科学》泄泻与《伤寒杂病论》下利进行比较,并结合历代医家对泄泻的认识,梳理泄泻辨治规律的发展与演变。方法本文采用文献研究法、比较研究法等方法,通过对《伤寒杂病论》下利相关的方证进行梳理,对下利的病名、病因、病机、治法、方药等方面进行归纳总结,并与《中医内科学》泄泻的病因、病机、治法、方药等方面进行比较,结合历代医家对泄泻的认识,探讨《中医内科学》泄泻对《伤寒杂病论》下利的继承与发展,梳理泄泻辨治规律的发展与演变。结果通过对《伤寒杂病论》下利与《中医内科学》泄泻的比较可以得出:①在病名方面,《伤寒杂病论》下利是包括泄泻与痢疾而言;《中医内科学》是泄泻与痢疾分开论治,这是对泄泻与痢疾认识的提高,便于更好的把握泄泻的辨治规律。②在病因方面,《中医内科学》与《伤寒杂病论》都论述了感受外邪、饮食不慎、脾胃虚弱、肾阳不振等病因,但对外邪的认识不太一致,《中医内科学》强调外邪以湿邪为主,而《伤寒杂病论》则以寒邪、热邪为主,可挟湿邪而为患。此外,两者对泄泻病因的认识也有不一致的地方,如情志失调,虽始于《内经》,但《伤寒杂病论》并无记载,后经历代发展,《中医内科学》继承了下来;又如水饮内停与误下,《伤寒杂病论》论之颇详,《中医内科学》却没有记载。③在病机方面,《伤寒杂病论》下利病机基本包含了《中医内科学》泄泻病机。唯有寒湿泄泻一证,《伤寒杂病论》虽有提及,但与《中医内科学》所论并不一样。《伤寒杂病论》所论寒湿或由外感寒湿直中太阴,或由脾阳虚、寒湿内生,虽外感、内伤不同,但皆有阳气亏虚、寒湿内盛之表现,而以阳虚为主。《中医内科学》所论寒湿泄泻以湿邪为本,或夹外感寒邪,或湿盛寒微,而无阳虚之表现,与《伤寒杂病论》所论并不完全相同。此外,《伤寒杂病论》有大量下利病机是《中医内科学》泄泻没有涉及到的,如表里合病、协热而利;肾水不足、阴虚火旺、迫津下泄;里实燥热内结、热结旁流;少阳阳明合病、胆热移胃、迫液下注等。这些病机有的属于泄泻,有的不属于泄泻,但都可见下利的症状,都是对泄泻病机的补充,对这些病机的认识有助于对泄泻辨治规律的全面把握,值得进一步探讨。④在治法方面,《中医内科学》泄泻治法与《伤寒杂病论》治法都含有汗法、和法、补法、清法、温法、消法、下法、固涩法等基本治法,《中医内科学》泄泻治法基本未出《伤寒杂病论》下利治法的范围,但除固涩法两者基本一致外,其具体治法则不尽相同。《伤寒杂病论》以温法之温脾及温肾、清法之清热解毒及清热祛湿为主,而《中医内科学》则是以运脾化湿为基本大法。《中医内科学》泄泻治法是在《伤寒杂病论》下利治法基础上有所发展,但同时也有一些不完善的地方。⑤在方药方面,《中医内科学》泄泻有部分用方与《伤寒杂病论》治泻方相同,如赤石脂禹余粮汤、桃花汤、诃黎勒散、葛根芩连汤、理中汤、五苓散、乌梅丸等;《中医内科学》有一些治泻方与《伤寒杂病论》部分方主治相近,如藿香正气散与葛根汤、四神丸与四逆辈、痛泻要方与四逆散、保和丸与大承气汤、胃苓汤与五苓散等;《伤寒杂病论》尚有一些治泻方是《中医内科学》没有选用的。而在药物方面,一方面《中医内科学》在每首方下面都有加减法,所加减药物种类繁多,数量比较大,所用药物已不局限于治疗泄泻;另一方面,因法选方,因方用药,药物随着治法及方剂的不同所用药物也不同,而治法与方剂前面已经进行比较,因此在药物方面并未进行比较。结论通过对《中医内科学》泄泻与《伤寒杂病论》下利的病名、病因、病机、治法、方药等方面进行比较,认为《中医内科学》泄泻是在《伤寒杂病论》下利基础上,经后世医家的不断补充发展而来,《伤寒杂病论》奠定了泄泻辨证论治的基础。但《中医内科学》泄泻并未完全继承《伤寒杂病论》,《伤寒杂病论》对泄泻的论治还有值得挖掘的地方。这样的深入挖掘有利于完善泄泻的辨证论治规律,并对临床实践有一定的指导意义。从《伤寒杂病论》到《中医内科学》,泄泻的辨治发生了很多变化,说明泄泻的辨治规律是不断发展与完善的,泄泻辨治规律的发展与完善深受医学流派及各家学说的影响。
[Abstract]:The purpose of this paper from the name of disease, etiology, pathogenesis, treatment, and > and < > diarrhea medicine of traditional Chinese medicine to compare the < Shanghanzabinglun several aspects of medicine, Chinese medicine "on the relationship between profit and diarrhea > > < typhoid; according to the < > diarrhea medicine of traditional Chinese Medicine" typhoid and miscellaneous diseases theory > comparison, combined with the ancient physicians understanding of diarrhea, combing the development and evolution of diarrhea treatment rule. This method adopts the literature research method, comparative research method and other methods, based on < Shanghanzabinglun > and related side comb, disease name, etiology, disease the method of machine, and the medicine and other aspects were summarized, and the "Chinese Medicine > diarrhea etiology, pathogenesis, treatment, prescription and other aspects were compared, combined with the ancient physicians understanding of diarrhea, to explore the Chinese medicine for diarrhea > < < Shanghanzabinglun > inheritance and development Lee, comb The development and evolution of the law of treating diarrhea. By comparing the results of < < Shanghanzabinglun and Chinese Medicine > under the Science > diarrhea in the name of disease, < Shanghanzabinglun > is including diarrhea and dysentery; "Chinese medicine" is separated on the treatment of diarrhea and dysentery, this is to improve the understanding of the diarrhea and dysentery, in order to better grasp the law of treating diarrhea. The etiology, "Chinese medicine" and "Shanghanzabinglun > have discussed Waixie, eating carelessly, spleen and stomach, kidney yang malaise and other causes, but external evil is not consistent," Chinese medicine learn > that external pathogens to dampness, and < Shanghanzabinglun > in Hanxie, heat evil, evil and wetness can be affected. In addition, the understanding of the etiology of diarrhea have inconsistencies, such as emotional disorders, although in the < >, and < Shanghanzabinglun > no records, after issuing 灞，

本文编号：1636421