中医学“燥”的理论研究

发布时间：2018-04-25 04:35

本文选题：燥 + 燥证　；参考：《中国中医科学院》2010年博士论文

【摘要】： 燥,是中医理论的重要概念,涉及五运六气、病因病机、治则治法、药性理论等诸多方面。早在《黄帝内经》中就有关于“燥”的论述,其后通过历代医家的继承与创新,使得中医学“燥”的理论内容和临床积淀日益丰富。本研究旨在比较系统地整理和总结历代医家关于“燥”的学术思想和诊疗经验,梳理中医学燥的学术源流,阐明中医学关于燥的基础理论。 1中医学“燥”的学术源流先秦两汉是中医学燥的理论肇始时期。这一时期的医家,通过长期的医学实践,在当时哲学、文化思想的影响下,以援物类比的思维方式,从燥气对自然界的影响,推演出作为致病邪气的“燥”作用于人体后的表现,从而形成了燥的医学概念和理论,集中表现于《黄帝内经》当中,初步建立了中医学燥的理论框架。东汉末年,张仲景在《伤寒杂病论》中对燥的病机阐发尤详,并针对性地提出了治则治法,为后世内燥理论的发展奠定了基础。晋唐是中医学燥的理论继承时期。这一时期的医学著作,在继承《黄帝内经》病机理论的基础上,提出“津伤成燥”和“肾虚致燥”的观点；在继承《伤寒杂病论》治燥之法的基础上,提出了一些新的治法和方药。宋金元是中医学燥的理论创新时期。宋代在运气理论的影响下,燥的病因理论得到了一定的发展。燥的病机理论方面也出现了许多新观点。如注重立足脏腑讨论燥的病机变化、“阴燥”理论的提出等。治燥思想日益丰富,如在五运六气理论指导下研究燥邪为患的治法、注重运用脏腑辨证针对燥的病机进行治疗等。金元时期,诸家争鸣,对燥的理论发展贡献最大的当属刘完素。他在《黄帝内经》运气理论的基础上,重新认识和完善了中医学六气病因病机学说,并在这一理论框架内,对燥的含义、性质、燥类病症的成因、种类、治则治法等内容进行了系统的阐发。明清是中医学燥的理论成熟时期。明代对外燥、内燥的认识开始分别开来,燥的病因理论开始独立发展,病机理论的发展中出现了“血燥说”、“燥痰论”等新的理论,这一时期“养脾阴”、“养肾阴”等思想对内燥的治法产生了重要影响。清代,燥的病因理论,伴随温病学派的崛起得以迅速发展,并形成了以温燥、凉燥为纲领的外燥辨治理论。立足脏腑对燥的病机探讨日趋完善、深入,并在此基础上形成了系统的内燥脏腑辨治理论。经历了清代之后,中医学燥的理论之外燥、内燥两大理论框架比较明确,理论内容也日渐完善。 2中医学“燥”的基础理论基于对“燥”的学术源流的深入梳理,认为中医学“燥”的基础理论,主要包括外燥与内燥两部分内容。 2.1外燥理论外燥是一种病因概念,是指自然界燥气的变化超过人体适应能力所致的,以耗伤津液、滞涩气机、克肝伤肺为主要致病特点的一种致病因素。外燥理论则是研究这种致病因素的产生、性质、致病特点、传变规律、所导致疾病的临床表现及治则治法的理论。燥邪的产生有以下三个条件：一是燥气与其相应的季节变化没有同时更迭；二是燥气发生过于强烈或变化过于急骤,超过了机体的适应能力；三是尽管燥气的变化正常,但是人体的抵抗能力降低。燥邪的产生与年份、季节、地域有密切的关系。燥邪的性质燥邪的性质取决于燥气,燥气在五行属性为金,如果在五行胜复变化中是作为“克”的一方时,以金行的特点为主,称为燥之胜气、燥之本气,“其性为凉”；当作为被克的一方时,它会与火气交争,称为燥之复气,有温热之性。燥邪的致病特点有以下四点：燥性干涸,易伤津液；燥邪上受,首伤肺金；燥性肃杀,克伐肝气；燥性坚敛,滞涩气机。燥邪传变规律燥邪自口鼻而入,先侵入上焦、波及气分,然后逐渐走入中焦、由气及血,最后深入下焦、累及血分。燥邪致病的治疗总的原则就是要秉承“燥淫所胜,平以苦温”和“燥者润之”两大原则,以燥之“胜气之邪”和“复气之邪”为纲,分别以温润和凉润为法度。具体还要按照上、中、下三焦的传变次序,明辨在表在里、在气在血的不同阶段,针对具体的证候随证治之。 2.2内燥理论内燥是一种病机概念,是指在疾病的发生发展变化中,由于各种原因导致的类似于燥邪伤津耗液致病特点的一种病机变化。内燥理论是研究这种病机的产生、演变、导致的证候表现及其治疗的理论。内燥成因内燥病机形成的关键是阴津的亏损不足,造成阴津亏损不足的原因有两类：一类是疾病过程中各种原因所致的阴津异常地、过量地损耗,使得阴津绝对不足；另一类是疾病过程中因脏腑功能虚损,体内有病理产物积聚,使得水液的输布出现障碍,造成阴津相对不足。内燥形成后的病机演变主要有血燥生风、血燥致瘀、燥从火化、燥极化湿等。内燥证的临床表现分为内燥本证和变证两大类。内燥本证是各种原因导致的内燥本体证候,按照形成的原因不同分为津伤内燥证和津郁内燥证。津伤内燥证按累及脏腑不同,表现各异。津郁内燥证依寒闭、阳虚、湿郁、瘀阻等病机不同表现不同。内燥变证是内燥病机进一步演变形成的证候,主要有血燥生风证、血燥成瘀证、燥极化湿证等。内燥证的治则治法治则依据“燥者濡之”、“燥者润之”原则。治法分为内燥本证的治法、内燥变证的治法两类。前者又包括滋阴润燥法、流湿润燥法、化瘀润燥法等三类具体治法。后者依据变证的具体病机,随证治之。内燥与外燥的区别和联系二者的区别主要表现在：(1)概念属性不同：外燥是一种病因概念,内燥是一种病机概念。(2)证候性质不同：外燥所形成的证候属于外感疾病范畴,内燥所致的病证主要属于内伤疾病的范畴。(3)临床表现不同：二者都有对方所不具备的临床表现,彼此不能完全包容。二者的联系主要表现在：发病过程中相互影响、临床表现上相互关联。中医学“燥”的理论在形成之初,是基于取象比类的思维,结合五运六气理论建立起燥的病因理论及相关治则治法理论(后世称外燥理论)。其后,这一理论又一次被取象比类,应用到内伤疾病中出现类似燥邪某些致病特点的病症诊治中,也就产生了燥的病机理论及相关治则治法理论(后世称内燥理论)。但是在发展过程中,由于后世医家认识“燥”的思维与《黄帝内经》有所差异,对燥邪的致病特点的认识不够全面,造成燥的病因概念内涵变小。笔者的研究工作,正是将后世医家外燥理论研究成果有机地统一到《黄帝内经》确立的外燥理论框架中来,并系统归纳、总结内燥理论,从而建立前后统一、内容完整的中医学“燥”的理论框架,并深刻阐述其理论内涵,为当代与“燥”相关疾病的临床诊疗实践提供有益的借鉴与参考。
[Abstract]:Dryness is an important concept in the theory of traditional Chinese medicine. It involves many aspects, such as five transport and six gas, etiology and pathogenesis, treatment and treatment, and the theory of drug property. The "dryness" was discussed in the Yellow Emperor's internal classics. After the succession and innovation of the doctors of the past dynasties, the theory of "dryness" and clinical accumulation were enriched. This study aims to compare the system with the system. To collate and summarize the academic thoughts and diagnosis and treatment experience of "dryness" in the past dynasties, comb the academic origin of dryness of Chinese medicine, and clarify the basic theory of dryness in traditional Chinese medicine.
1 the academic origin of "dryness" in traditional Chinese Medicine
The pre Qin and Han Dynasties were the beginning period of the theory of Chinese medicine dryness. Through long medical practice, the doctors of this period, under the influence of philosophy, culture and thought, influenced by the analogy of the aid and material, from the influence of the dry gas on the nature, and the performance of the "dryness" acting as the "dryness" of the pathogenic pathogenic Qi, thus forming a dryness medical probability. In the middle of the Yellow Emperor, the theoretical framework of Chinese medicine dryness was set up in the middle of the Huangdi Neijing. In the last year of the Eastern Han Dynasty, Zhang Zhongjing expounded the pathogenesis of dryness in the theory of "the disease of typhoid fever", and put forward the rule of rule, which laid the foundation for the development of the theory of dryness in the later generations.
The Jin and Tang Dynasties were the period of theoretical inheritance of traditional Chinese medicine dryness. On the basis of inheriting the theory of "Huangdi Neijing", the medical works of the period of Tang Dynasty put forward the viewpoint of "Jin injure to become dryness" and "kidney deficiency induced dryness", and put forward some new methods and prescriptions on the basis of inheriting the method of treating dryness with the theory of "typhoid miscellaneous disease" and "treating dryness".
Song Jinyuan is a period of theoretical innovation of dryness of traditional Chinese medicine. Under the influence of the theory of luck in the Song Dynasty, the theory of the cause of dryness has been developed. The theory of dryness has also appeared in many new views, such as the change of the pathogenesis of the Zang Fu and the theory of "Yin dryness", etc.. The idea of dryness is increasingly rich, such as the five transport and six gases. Under the guidance of the guidance of the study of dryness evil as the treatment method, pay attention to the use of viscera syndrome differentiation for the treatment of dryness. During the Jin Yuan period, the greatest contribution to the development of the theory of dryness was Liu completion. On the basis of the theory of luck of the yellow emperor, he reunderstood and perfected the theory of the pathogenesis of the six Qi disease in traditional Chinese medicine, and in this theory Within the framework, the meaning and nature of dryness, the causes and types of dryness disorders, and the principles and methods of treatment are systematically elucidated.
Ming and Qing Dynasties are the mature period of the theory of Chinese medicine dryness. The understanding of dryness in the Ming Dynasty began to begin separately, and the theory of dryness began to develop independently. In the development of pathogenesis theory, new theories such as "blood dryness theory", "dry phlegm theory" were appeared, and the thought of "nourishing the spleen yin" and "nourishing the kidney yin" had produced important shadow on the treatment of internal dryness. In the Qing Dynasty, the etiological theory of dryness in the Qing Dynasty developed rapidly with the rise of the school of febrile diseases, and formed a theory of external dryness differentiation and treatment based on warm dryness and cold dryness. Based on the viscera, the theory of internal Zang Fu organs differentiation and treatment was formed on the basis of the further improvement and deepening of the pathogenesis of dryness.
After the Qing Dynasty, the two major theoretical frameworks of dryness theory and dryness in Chinese medicine are clearer and the theoretical contents are gradually improving.
2 basic theory of "dryness" in traditional Chinese Medicine
Based on the in-depth analysis of the academic origin of "dryness", it is considered that the basic theory of "dryness" in Chinese medicine mainly includes two parts: external dryness and internal dryness.
2.1 external dryness theory
External dryness is a kind of etiological concept. It refers to the cause of the change of the natural gas in the nature, which is caused by the adaptability of the human body. It is a pathogenic factor for the injury of body fluid, the stagnating air machine and the liver injury of the liver. The theory of external dryness is the study of the occurrence, nature, pathogenicity and transmission of the pathogenic factors, the clinical manifestation and treatment of the disease. The theory of the rule of law.
There are three conditions in the production of dryness: one is that the dry gas is not changed at the same time with the corresponding seasonal changes; the two is that the dryness gas is too strong or the change is too rapid, and the adaptation ability of the body is exceeded; and the three is that although the change of the dry gas is normal, the resistance of the human body is reduced. The production of dryness is closely related to the years, seasons and regions. The relationship.
The nature of dryness evil depends on the nature of dryness and dryness, and the dry gas is gold in the five line of nature. If it is a party of "gram" in the five line of victories and changes, it is characterized by the characteristics of gold line, which is called dryness to win the gas, and it is "cool". When it is used as a party, it will fight with the fire, and it is called the complex gas of dryness, and it has warm heat.
The pathogenic characteristics of dryness evil include the following four points: dryness dryness, easy damage to body fluid; dry evil on top, first lung injury; dry dryness, Kevin liver qi; dryness and strong convergence, stagnation of Qi.
Dryness evil changes the law, dry evil enters from the mouth and nose, invades the upper energizer first, spreads to the gas, then gradually enters the middle Jiao, by Qi and blood, finally goes deep into the lower Jiao, and involves the blood.
The general principle for the treatment of dryness pathogenic factors is to adhere to the two principles of "the victory of dryness, the level of bitter temperature" and "the moistening of the dryness", with the principle of "the evil of winning the Qi" and "the evil of the Qi" as the outline, respectively, with warm and cool moisture. To treat specific syndromes with the evidence.
2.2 internal dryness theory
Internal dryness is a kind of concept of pathogenesis. It refers to a variety of pathogenesis, which are caused by various reasons, which are similar to the pathogenic characteristics of dryness injures. The theory of internal dryness is to study the emergence and evolution of the pathogenesis, the manifestation of syndrome and the theory of treatment.
The key to the formation of internal dryness internal dryness pathogenesis is the deficiency of Yin Jin, which causes the deficiency of yin and Tianjin in two categories: one is the abnormal loss of yin and Tianjin caused by various causes in the disease process, excessive loss, and the absolute deficiency of yin and Tianjin; the other is the deficiency of the function of the viscera, the accumulation of pathological products in the body, and the water of the body. There is an obstacle in the distribution of liquid, which causes the relative deficiency of yin and Tianjin.
The pathogenesis of endogenous dryness is mainly caused by blood dryness, wind generating, blood dryness causing stasis, dryness from cremation, dryness and polarization.
The clinical manifestations of internal dryness syndrome are divided into two categories: internal dryness and change of syndrome. Internal dryness is an internal dryness syndrome caused by various reasons. According to the causes of formation, it is divided into internal dryness syndrome and zinyu internal dryness syndrome. The syndrome of internal dryness in Tianjin is different. Different internal dryness syndrome is the syndrome of further development of internal dryness pathogenesis. It mainly includes blood dryness and wind generating syndrome, blood dryness and stasis syndrome, dryness polarization and dampness syndrome.
The treatment of internal dryness is based on the principle of "dryness" and "moistening the dryness". The treatment is divided into two types of internal dryness and internal dryness syndrome. The former includes three kinds of specific treatments, such as nourishing yin and moistening dryness, flow wetting dryness, removing blood stasis and moistening dryness. The latter is based on the specific pathogenesis of the syndrome.
The difference and connection between dryness and internal dryness
The difference between the two are as follows: (1) the concept attribute is different: dryness is a kind of etiological concept, and internal dryness is a kind of concept of pathogenesis. (2) the syndrome nature is different: the syndrome of external dryness belongs to the category of exogenous disease, and the syndrome caused by internal dryness is mainly in the category of internal injury. (3) the clinical manifestations are different: the two all have the other party does not possess The clinical manifestation can not be completely inclusive.
The connections between the two are mainly manifested in the interaction of the pathogenesis and the correlation of clinical manifestations.
At the beginning of the formation of the theory of "dryness" in traditional Chinese medicine, it is based on the thinking of taking image ratio and combining the theory of five transport and six gas to establish the theory of cause of dryness and the theory of related rule of treatment (the theory of later age called dryness). After that, this theory is once again taken as the image ratio class, and is applied to the diagnosis and treatment of some diseases which are similar to the pathogenic characteristics of dryness. In the process of development, the understanding of "dryness" and "Huangdi Neijing" are different in the process of development, but the understanding of the pathogenic characteristics of dryness is not comprehensive enough, and the concept of dryness is becoming smaller. The research results of the theory of external dryness of the doctors are organically unified into the framework of the theory of external dryness established by the Huangdi Neijing, and systematically summed up and summarized the theory of internal dryness, thus establishing a unified and complete theoretical framework of "dryness" of traditional Chinese medicine, and deeply explaining its theoretical connotation, providing the clinical diagnosis and treatment practice of contemporary and "dryness" related diseases. Useful reference and reference.

【学位授予单位】：中国中医科学院
【学位级别】：博士
【学位授予年份】：2010
【分类号】：R255

【参考文献】