藏医水肿证型理论研究

发布时间：2018-03-06 22:00

  本文选题：藏医　切入点：水肿　出处：《北京中医药大学》2017年博士论文　论文类型：学位论文

【摘要】：水肿是当今临床很常见和难愈的疾病之一,肝硬化腹水更是在西藏地区呈现发病率日趋增多的高危态势,现代医学的利尿剂和穿刺疗法对其疗效平淡且易复发。藏医水肿治疗理论随博大精深、治疗手段丰富,但目前对此的研究和应用力度严重不足。我认为在藏医水肿理论研究中最重要的两个内容是秘药理论研究与证型理论研究。在《四部医典》之秘诀部(临床集)的第八、九、十章分别载述了三种不同程度的体液代谢紊乱症--即浮肿(skyarbab)、坠积水肿(,or)和大痨水臌症(gcong chen dmu chu)。这三种病症是水肿发生时的三个阶段性体现,但从分型上又有所区别。在《四部医典》中,浮肿又分为肺性,肝性,脾性,隆性,黄水性五种。坠积水肿分为隆性,赤巴性,培根性,血性,外伤性,中毒性六种。腹水被概括为潴积('khyims)、扩散(byer)、渗漏(zags)、穿孔(rdol)等四种类型。且又可细分为尿液潴积性腹水1种;血液扩散性腹水、胆汁扩散性腹水、黄水扩散性腹水3种扩散型;胃漏性腹水、大肠渗漏性腹水、肝漏性腹水、脾漏性腹水、肺漏性腹水、脉瘤漏性腹水、血瘤漏性腹水、黄水瘤漏性腹水8种渗漏型;小肠穿孔性腹水1种;中毒性腹水1种;癔症性腹水1种,共15种病证。治疗水肿的内容是《四部医典》秘诀部九十二个章节中篇幅最大的章节之一。但是,当前藏医临床上鉴别水肿类型时则以肝肾心肺等病变部位来诊断,使得《四部医典》中的水肿证型理论无法结合到实践应用当中。在本课题的研究中通过采用文献对比、专家采访、统计分析、临床总结、规律解析、推理阐微等研究方法,对藏医水肿证型理论发展的历史沿革,《四部医典》所记载的水肿证型理论总纲及《秘诀红卷》所述十二种不同的腹水证型、藏医水肿疗法三大流派的证型理论,以及证型间彼此的所属关系,可导致水肿的其他病症等进行了深入的比较和研究。对《藏医药大典》全册(共六十卷)所记载的156个治疗水肿的药方进行了挖掘和整理,并通过数据统计方法对水肿药方配伍规律进行了分析和讨论。并对阿输吠陀水肿理论对藏医水肿理论的影响和现代医学与藏医学水肿理论的结合思路进行了探讨。通过研究本课题所获得的结果有:一、不仅通过对《四部医典》所记载的水肿理论和《贡珠札记》所载述的临床诊疗方法的探讨外,在全面挖掘与整理现存所有藏医典籍中所涉及的水肿证型理论之基础上,对与其相关的"三因"、脏腑病症、内外伤、中毒、方剂学等方面进行了全面和系统的分析和研究。二、全面揭示了藏医水肿学的基本理论特点。三、较清晰地剖析和比较了水肿各证型的病理机制与诊疗原则。四、使形成对临床具有指导意义的藏医水肿各证型的诊疗理论体系奠定了基础,并对改变藏医水肿理论与实践无法结合的现状进行了思考和探讨。
[Abstract]:Edema is one of the most common and difficult diseases in clinical practice today, and ascites with liver cirrhosis is showing a high risk situation of increasing incidence in Tibet. The therapeutic effect of diuretics and puncture therapy in modern medicine is dull and easy to recur. I think the two most important contents in the theoretical study of edema in Tibetan medicine are the theory of secret medicine and the theory of syndromes. In 8th and 9 of the secret section (clinical collection) of the "four Medical Codex", The ten chapters respectively describe three kinds of humoral metabolic disorders of different degrees, that is, bloated skyarbabia, dropsy and dropsy) and large tuberculosis and dropsy, Gcong chen dmu, which are the three stages of the occurrence of edema. However, there are differences in classification. In the "four Medical examples", edema is divided into five types: lung, liver, spleen, Carina and yellow water. Dropsy edema is divided into Carina, red bar, bacon, blood, traumatic. The ascites were classified into four types, I. e., the hydrocephalus hyimsm, the diffusion byerg, the percolation zagsl, the perforated rdol. and the ascites were divided into three types: hematogenous ascites, bile diffuse ascites, yellow water diffusive ascites, and urine hydrocephalic ascites, which were divided into three types: hematogenous ascites, bile diffusive ascites, yellow water diffusive ascites. Gastric leakage ascites, large intestine leakage ascites, liver leakage ascites, splenic leakage ascites, lung leakage ascites, vein tumor leakage ascites, hemangioma leakage ascites, xanthomatous ascites 8 kinds of leakage type, small intestine perforation ascites 1 type, toxic ascites 1 type; Hysterical ascites, a total of 15 disease syndromes. The treatment of edema content is the secret of the "four medical code" 92 chapters of the largest chapter. However, At present, the clinical diagnosis of edema in Tibetan medicine is based on liver, kidney, heart, lung and other pathological changes, which makes it impossible to combine the theory of edema syndrome type in "four medical codes" into practical application. Expert interviews, statistical analysis, clinical summary, law analysis, reasoning and other research methods, With regard to the history of the development of the theory of edema syndrome in Tibetan medicine, the general outline of the theory of edema syndrome type recorded in the four Medical Codex, the 12 different ascites syndrome types described in the Red Book of Secrets, and the syndromes theory of three major schools of edema therapy in Tibetan medicine, As well as the relationship between syndromes and types, other diseases that can lead to edema are compared and studied in depth. The 156 prescriptions for treating edema recorded in the whole Book of Tibetan Medicine (60 volumes) have been excavated and sorted out. The compatibility law of edematous prescription was analyzed and discussed by statistical method. The influence of the theory of Aveda edema on the theory of edema in Tibetan medicine and the thought of combining modern medicine with the theory of edema of Tibetan medicine were discussed. The results obtained from the research on this subject are as follows:. Not only through the discussion of the theory of edema recorded in the four Medical codes and the methods of clinical diagnosis and treatment contained in the Notes of Gongzhu, but also on the basis of comprehensively excavating and sorting out the theory of edema syndrome type involved in all the existing books of Tibetan medicine. The related aspects of "three causes", viscera diseases, internal trauma, poisoning, prescriptions and so on are comprehensively analyzed and studied. Secondly, the basic theoretical characteristics of edematology in Tibetan medicine are fully revealed. The pathological mechanism and principles of diagnosis and treatment of each syndrome type of edema were analyzed and compared clearly. Fourthly, the theoretical system of diagnosis and treatment of each syndrome type of edema in Tibetan medicine, which has guiding significance in clinical practice, was formed, which laid a foundation for the formation of a theoretical system for the diagnosis and treatment of each syndrome type of edema. At the same time, the author thinks and discusses the current situation that the theory and practice of Tibetan medicine edema can not be combined.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R29
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本文编号：1576648