李东垣治喘学术思想研究

发布时间：2018-05-09 02:09

本文选题：李东垣 + 学术思想　；参考：《广州中医药大学》2017年博士论文

【摘要】：研究背景:喘证在中医学中既可单独作为一个病证,也可作为其他疾病的伴随症状出现。临床上多表现为呼吸困难,严重者可伴有张口抬肩、鼻翼煽动、不能平卧等临床表现。在西医学中很多疾病都可出现喘证,如慢性阻塞性肺病、肺源性心脏病、哮喘、喘息性支气管炎、重症肺炎、肺气肿、肺癌及癔病等疾病。临床上中医多按喘证辨证治疗。喘证病机复杂,治疗上较为棘手,严重影响患者身心健康,给国家、人民带来沉重经济负担,是临床常见的难治和危重病之一。中医药在治疗疾病上讲究辨证施治,注重整体原则。如《黄帝内经》就对喘证的病因病机作出了相关阐述,张仲景在内经理论的基础上,亦对喘证作出相关论述,不仅在六经辨证中论及喘证,在杂病中对喘证的论述更为详尽。后世医家对喘证也多有论治,有着丰富的临床经验。因此,加强对古医家治疗喘证经验的整理与研究,具有重要现实意义。李东垣,本名李杲,字明之。其年少时拜易水先生张元素为师,与刘完素、张从正、朱震亨齐名,史称"金元四大家"。其以脾胃立论,认为许多疾病皆由"脾胃内伤"所致。强调外感与内伤的鉴别,提出了益气升阳、甘温除热、甘寒泻火等治疗原则,形成了较为完整的脾胃内伤辨治体系。李东垣认为脾主四肢,胃主受纳腐熟水谷,劳役过度、饮食不节可直接损伤脾胃,引起喘证。如其在《脾胃论》中提到"脾胃一虚,肺气先绝",因虚作喘。在《兰室秘藏》中提到外感风寒可导致肺气闭郁,上逆作喘。同时指出内伤脾胃导致肺卫不固,容易使人感受风寒邪气,体现了邪之所凑,其气必虚的指导思想。在《活法机要》中提到脾虚不运,痰浊内生,上犯于肺,会引起严重的咳喘疾病,并且迁延难愈。在《内外伤辨惑论》中指出脾胃虚损,浊阴不降,导致大便艰涩,肺与大肠相表里,腑气不通,肺气上逆亦可作喘。可见脾胃虚损,可直接或间接影响肺的宣发肃降功能,导致喘证。目前国内学者对李东垣学术思想的研究大多集中在脾胃、五官和疮疡病上,对其治喘学术思想的研究较少,国内尚未见针对其治喘经验的相关学术报道。因此,加强对李东垣治喘学术思想的研究,对喘证治疗无疑有重要现实意义。目的:总结李东垣内伤学术思想,在此基础上深入剖析其治喘经验,探索其临证证治规律,为临床治疗喘证提供理论支持。结合现代中医临床经验,探讨李东垣治喘学术思想对现代临床辨治喘证的指导意义。方法:运用中医文献研究、医史研究、古籍文本内容分析等理论研究方法,通过收集整理李东垣相关学术著作,结合现代中医理论,对其治喘学术思想进行系统的整理和研究。总结孙志佳教授"培土生金法"辨治慢性阻塞性肺病的临床经验,探讨李东垣治喘学术思想对现代临床辨治喘证的指导意义。结果:本研究主要分为四部分:第一部分:简述李东垣的医学生涯与主要著作李东垣年少时素有盛名,《李濂医史·东垣老人传》中说他为人忠义,讲信誉,实事求是,与人交往很重注礼节。遇到饥荒,更是积极救助灾民。可见其宅心仁厚,拥有一颗博爱之心。此时虽未有学医之心,却已是初具孙思邈《大医精诚》中所提倡的大慈恻隐之心。东垣20岁时,母亲病逝,东垣痛心疾首,始立志学医。花重金拜河间张元素为师,学数年,尽得其法。此时东垣虽学医有成,却未有行医之心,而是走上仕途。虽身在官海,东垣在百姓遭受瘟疫之苦时,亦是寻求古训,终自创普济消毒饮,救人无数。后金元交战,东垣为避战乱,南下至临安。此时,正式开始行医生涯。在行医过程中,多从脾胃论治,疗效显著,自此名声大噪。并在此阶段,开始整理其内伤思想,并开始着手自己的第一本医学专著《内外伤辨惑论》的写作。其晚年,则在河北老家一边授徒,一边整理自己的医学经验。据现代学者考据认为《内外伤辨惑论》是李东垣生前唯一一部著作,《脾胃论》为其晚年之作,刊行于其身后。《医学发明》、《活法机要》、《东垣试效方》、《兰室秘藏》多认为是其弟子罗天益整理之作。第二部分:对李东垣的内伤思想进行总结李东垣认为外感风寒皆有余之病,当泻不当补。脾胃内伤皆属不足,当补不当泻。饮食过饥过饱,形劳太过,导致脾胃之气不足,营卫失和,其人亦恶风寒。世人大多将内伤不足之恶风寒误认为外感有余之邪,虚虚实实,杀人而不自知。东垣从辨阴证阳证开始,从十三个方面对外感内伤进行鉴别。认为人以胃气为本,火与元气不两立。脾胃虚弱,导致阴火内生,提出甘温除大热的观点,并根据《内经》相关理论,自创补中益气汤。通过五行生克制化学说,将脾胃和其他脏腑有机结合起来,形成了以脾胃为核心的五脏传变理论。其处方用药注重药物性味与归经,强调结合四时气候阴阳变化合理用药。药味虽多,但都谨遵法度、条理井然。注重养生摄养,讲究未病先防。第三部分:对李东垣治喘学术思想进行系统的整理和研究李东垣认为喘证的成因不外外感与内伤两端。外感多为风寒、暑热或疫疠乘袭,内伤可由饮食、劳役、久病所致。外感与内伤并不孤立,气虚易感风寒,暑热亦可伤气。喘证的病理性质多为虚实夹杂,或兼痰饮,或兼气乱,或兼阴火,或兼宿食,或兼积聚。发病机理与肺、脾、肾三脏脏腑功能失调密切相关。肺主气的宣发肃降,开窍于鼻,外合皮毛。若外邪侵袭,或它脏病气上犯,皆可导致肺气不利而致喘满。脾胃为气血生化之源,脾虚则营卫不调,易感外邪,导致肺失宣降作喘。脾气虚则阴火内生,阴火可直接耗伤元气,使肺虚作喘,又可直接上乘迫肺导致肺痿作喘。脾为湿土,主水液代谢,脾虚则易生痰积饮,痰饮阻滞气机,肺气上逆作喘。脾主升清,脾不升清,浊阴不降,清浊相干,三焦气乱作喘。脾阳不足,中焦虚寒,肠外血与津液凝结成积,迫肺作喘。肾为气之根,肾阳衰惫,摄纳失常则气不归元,上逆作喘。肾司二便,肾水不足,大便坚涩,肺与大肠相表里,腑气不通,肺失肃降作喘。在治疗风寒致喘或暑热致喘时不忘顾护胃气。对于内伤致喘,在补中益气的基础上,或是清热,或是滋阴,或是行气,或是化痰,或是逐饮,或是行瘀,或是温里,形成了以脾胃为核心的治喘理论体系。第四部分:李东垣治喘学术思想临床应用探究李东垣基于《内经》,从脾胃立论,形成了以脾胃为核心的治喘理论,补充和丰富了现代辨治喘证的理论体系,有助于临床工作者把握喘证虚实缓急,指导合理用药。慢性阻塞性肺病是一种常见的呼吸系统疾病,它以不完全可逆的气流受限为主要临床特点。中医临床上多将慢性阻塞性肺病归结为"肺胀"、"喘证"。孙志佳教授在慢性阻塞性肺病的治疗中主张"急则治标,缓则治本"的治疗原则,在急性期或是解表,或是化痰,或是逐瘀,或是行气,以祛邪为主,不忘兼顾脾胃。在缓解期注重温补脾肾,尤重脾胃,以固本培元。同时建议结合患者自身体质和季节变化,制定合理养生方案,力求阴阳平衡。其辨治慢性阻塞性肺病的临床经验,从某种程度上来讲,既是对李东垣治喘学术思想的继承,又是对李东垣治喘学术思想的发展。在一定程度上说明李东垣以脾胃为核心的治喘学术思想,在现代临床实践中具有理论指导意义。结论:李东垣治喘,不离外感、内伤两大端。认为邪之所凑,其气必虚。治疗外感不忘顾护脾胃。对于内伤致喘,多是从肺、脾、肾三脏入手,其中脾胃是关键。通过脾胃将肺、肾有机联系起来,临证多虚实夹杂。其以脾胃为核心的治喘学术思想,对现代临床治疗喘证具有重要指导意义。
[Abstract]:Background: asthma can be used as a syndrome in traditional Chinese medicine as a syndrome or as an accompanying symptom of other diseases. Many clinical manifestations are dyspnea, serious patients can be accompanied by mouth lifting, nasal alar incitement, and no supine clinical manifestations. In western medicine, many diseases can appear asthma, such as chronic obstructive pulmonary disease and pulmonary origin. Heart disease, asthma, asthmatic bronchitis, severe pneumonia, emphysema, lung cancer and hysteria. The clinical traditional Chinese medicine is treated with asthma syndrome differentiation and treatment. Asthma pathogenesis is complicated and the treatment is more difficult. It seriously affects the physical and mental health of the patients and brings heavy economic burden to the country and the people. It is one of the common difficult and critical diseases in the clinic. Chinese medicine is treated in the treatment of traditional Chinese medicine. On the basis of the theory of Zhang Zhongjing's internal meridian, we also make a related exposition of asthma, not only in the syndrome differentiation of the six meridians and asthma, but also in the discussion of the asthma in the miscellaneous diseases. It has a lot of clinical experience. Therefore, it is of great practical significance to strengthen the collation and research of ancient doctors' experience in treating asthma. Li Dongyuan, the present name, Li Gao, is clear. When he was young, Mr. Yi Shui, Zhang Yuansu, was named as Liu finished, Zhang Congzheng and Zhu Zhenheng, and the history called "Jin Yuan four people". It is caused by "internal injury of spleen and stomach". It emphasizes the differentiation of external and internal injuries, and puts forward the principle of improving Qi and Yang, removing heat from the heat of the spleen and reducing fire and so on, and forming a more complete system of differentiation and treatment of spleen and stomach internal injury. Li Dongyuan thinks that the spleen and stomach are the main limbs of the spleen, the main stomach of the stomach is absorbed by the decomposed water valley, the labor is overworked, and the drinking and feeding can directly damage the spleen and stomach and cause asthma. It mentioned "spleen and stomach deficiency, Lung Qi first", because of asthenia and asthenia. In the theory of differentiation of internal and external injuries, the deficiency of spleen and stomach, cloudy and cloudy and cloudy and difficult, the lung and the large intestine, the inflow of the organs and the Qi, the asthenia of the spleen and stomach can be seen. The research on Li Dongyuan's academic thought is mostly concentrated on the spleen and stomach, the five senses and the sore diseases, and less research on the academic thought of the treatment of asthma. There is no relevant academic report on the treatment of asthma in China. Therefore, it is of great practical significance to strengthen the study on the academic thought of Li Dongyuan's treatment of asthma. On this basis, we deeply analyze the experience of treating asthma, explore the rule of the treatment of its syndromes, provide theoretical support for clinical treatment of asthma, and combine the clinical experience of modern Chinese medicine to explore the guiding significance of Li Dongyuan's academic thought on modern clinical diagnosis and treatment of asthma. By collecting and sorting out the relevant academic works of Li Dongyuan and combining the theory of modern Chinese medicine, this paper systematically collates and studies the academic thought of treating asthma by combining the theory of modern Chinese medicine. It summarizes the clinical experience of Professor Sun Zhijia's "PEX Sheng Jin method" in the treatment of chronic obstructive pulmonary disease (COPD), and probes into the diagnosis and treatment of asthma by Li Dongyuan's academic thought on modern clinical treatment. The study is divided into four parts: the first part is divided into four parts: the first part is a brief description of the medical career and the main works of Li Dong Yuan. At 20 years old, Dongyuan was 20 years old, the mother died, and the East yuan was very sad, and began to study medicine. Heart, but walking on an official career. Although he was in the official sea, Dongyuan was also seeking ancient training in the suffering of plague in the people, and at the end of the war, he created Puji disinfection drink and saved countless people. After the war of gold and yuan, Dongyuan avoided war and south to Ling'an. At this time, it began to practise medical career. In the process of practicing medicine, the curative effect was remarkable. He began to organize his internal injury thought and began to write his first medical monograph, "internal and external injury discrimination theory". In his later years, he taught the apprentice on the side of Hebei's home and arranged his own medical experience. According to modern scholars, it was considered that the theory of internal and external injury differentiation was the only work before Li Dongyuan, and the spleen and stomach theory was the work of his later years. The second part: the second part: a summary of Li Dongyuan's Thoughts on internal injury: Li Dongyuan thinks that there is a disease that Li Dongyuan thinks that the external feeling is cold and cold. Too much, resulting in the spleen and stomach qi deficiency, the camp and the disharmony, the people also evil wind cold. Most of the world has mistaken the evil wind and cold of the internal injury, mistaken the external sense of the evil, the false and the murderous and unknowable. The East yuan from the Yin Syndrome from thirteen aspects of internal injury to identify. It leads to the endogenous growth of the Yin Fire, puts forward the idea of "Gan Wen" and "great heat". According to the theory of "internal meridian >", we set up the decoction of replenishing qi and replenishing qi. Through the five lines, the spleen and stomach and other viscera are organically combined together to form the theory of five Zang Zang organs transfer with the spleen and stomach as the core. The prescription drugs pay attention to the drug taste and the return of the meridian, emphasizing the combination of the climate Yin and Yang at the time of four. The third part: the third part: a systematic arrangement and Research on the academic thought of Li Dongyuan's treatment of asthma. Li Dongyuan thinks that the causes of asthma are not outside the external feeling and internal injury. It is caused by the long illness. The external and internal injuries are not isolated, the Qi deficiency and the cold and the heat can also hurt the Qi. The pathological nature of the asthma syndrome is mostly false and solid, or cum phlegm drink, or concurrently with Yin Fire, or concurrently with the three dirty viscera and concurrently accumulation. The pathogenesis of the lung, spleen and kidney is closely related to the dysfunction of the lungs and the nose and outer fur. The spleen and stomach are the source of Qi and blood biochemistry, the spleen and stomach are the source of Qi and blood biochemistry, the spleen deficiency is not adjusted in the camp and Wei, and the external evil is easy to feel. Metabolism, spleen deficiency is easy to produce phlegm, Qi block Qi machine, Lung Qi reverse asthma. Spleen main rise clear, spleen does not rise clear, cloudy Yin does not descend, cloudy and cloudy to make asthma, spleen yang deficiency, middle coke deficiency cold, intestinal blood and body fluid condense formation, lung make wheezing. Kidney is gas root, kidney yang decay, upper and reverse asthma. Kidney division two stool kidney, kidney kidney Water is not enough, the stool is hard, the lung and the large intestine are in the form of the stomach and the intestine, the organs and the air are not clear, the lung is lost and the stomach is breathed. In the treatment of the wind and cold and the heat caused by the asthma, it does not forget to care for the stomach qi. The fourth part: the fourth part: the clinical application of the academic thought of treating asthma by Li Dongyuan, based on the theory of spleen and stomach, it has formed the theory of treating asthma with spleen and stomach as the core, supplementing and enriching the theory system of modern diagnosis and treatment of asthma. It is helpful for clinical workers to make the deficiency and real urgency of the syndrome and guide the rational use of drugs. Sexual lung disease is a common respiratory disease, which is mainly characterized by incomplete and reversible airflow limitation. In clinical Chinese medicine, chronic obstructive pulmonary disease is mostly attributed to "lung distention" and "asthma". In the treatment of chronic obstructive pulmonary disease, Professor Sun Zhijia advocates the principle of "urgent rule treatment, slow rule" treatment, in acute period or to solve the table, Or to eliminate phlegm, or to remove stasis, or do Qi, to dispel evil spirits, not forget the spleen and stomach. In the remission period, pay attention to the spleen and kidney, especially the spleen and stomach, to fix this element. At the same time, it suggests combining the patient's own physique and seasonal change, making a reasonable regimen of health keeping and striving for the balance of yin and Yang. Speaking, it is not only the inheritance of Li Dongyuan's academic thought of treating asthma, but also the development of the academic thought of Li Dongyuan's treatment of asthma. To a certain extent, it shows that Li Dongyuan's thought of treating asthma with spleen and stomach as its core has theoretical guiding significance in modern clinical practice. Deficiency in the treatment of external sensation does not forget to care for the spleen and stomach. In the case of internal injury, it is mostly from the lung, the spleen and the kidney three organs, among which the spleen and stomach are the key. Through the spleen and stomach, the lung and kidney are linked together, and many deficiency and real inclusions are faced. The treatment of asthma with the spleen and stomach as the core is of important guiding significance for the modern clinical treatment of asthma.

【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R256.12

【参考文献】