“舍时从证”理论及王孟英相关医案研究

发布时间：2018-02-15 05:48

本文关键词： 舍时从证王孟英医案　出处：《南京中医药大学》2016年博士论文　论文类型：学位论文

【摘要】：“舍时从证”思想滥觞于《黄帝内经》。其与“因时制宜”既相互对立,又互为补充,共同组成了中医时间医学体系的核心内容。但目前,中医学界对“舍时从证”还没有给予明确的定义,各类中医词典甚至未将“舍时从证”作为词条收入其中。目前,无论是理论还是临床,对“舍时从证”都缺少深入的研究和应用。这种情况严重影响了“舍时从证”的理论价值和对临证指导的实践价值。自元代医家罗天益在《卫生宝鉴·舍时从证》篇中明确提出“舍时从证”的原则以后,后世虽然对其时有阐发,但主要是在研究中医时间医学时,将其作为“因时制宜”、“时不可违”的补充而略微涉及。研究范围也只是对罗天益的“舍时从证”思想进行阐述,即当病证与季节气候不一致时,不能拘泥于时令气候因素对疾病的影响,而要根据证候来决定治法。研究的内容也以《卫生宝鉴》中记载的医案为主,即夏季用干姜、附子等药组成的托里温中汤治疗寒性疮疡,强调夏季出现寒证也需要用温热药进行治疗。进入现代以来,相对于“因时制宜”如火如荼的研究状况,对“舍时从证”的研究则略显冷清。经检索,以“舍时从证”为篇名的文献也仅有发表于上世纪九十年代初的一篇论文,即北京中医学院医88级学生张向群在《北京中医学院学报》发表的《浅论“时不可违”和“舍时从证”》。其认为“舍时从证”的原则,正是“时不可违”在临证治疗中的灵活应用。但并未对“舍时从证”进行更深层次的研究,同样只是引用罗天益在《卫生宝鉴》中记载的医案来进行说明。王孟英是晚清时期著名温病学家,作为“温病学派四大家”之一,其对温病学的发展做出了巨大的贡献。作为温病学家的王孟英可谓深得“舍时从证”思想精髓。即当病证与各种时间因素不符时,王氏能够不拘泥于“时”,而是坚持以“证”为主,随证施治。通过对王孟英医案深入研究发现,王氏对“舍时从证”的运用主要体现在三大方面：“不为时气节律所拘坚持以证为本；不为人体节律所困坚持以证为本；不为即时客邪所惑坚持以证为本”。通过既遵守“因时制宜”,又坚持“舍时从证”,王孟英实现了温病学理论和辨证施治理论的完美结合。从“舍时从证”视角对王孟英医案进行研究,为深入研究挖掘王孟英医学思想开辟了新途径,也为多视角研究中医学医案提供了新模式和新范本。同时,结合王孟英医案对“舍时从证”进行研究,可以更准确地理解“舍时从证”的内涵,有助于对其含义进行界定。结合王孟英医案,综合前贤研究成果,可以对“舍时从证”这样进行定义：当时间因素与疾病证候不一致时,不能局限于时间因素对疾病的影响,要坚持以证为主,随证施治。其内涵主要有三个方面：舍时气节律从证、舍人体节律从证、舍即时客邪从证。
[Abstract]:The thought of "giving away time from syndrome" originated in "Huangdi's Internal Classic". It and "taking measures according to the circumstances" are both opposite and complementary to each other, which together form the core content of the time medicine system of traditional Chinese medicine. However, at present, The Chinese medicine profession has not yet given a clear definition of "giving time from syndrome", and all kinds of Chinese medicine dictionaries have not even included "giving time from syndrome" as an entry. At present, whether it is theoretical or clinical, This situation has seriously affected the theoretical value and practical value of the guidance of temporary certificate. Luo Tianyi, a doctor of the Yuan Dynasty, followed the certificate in the "Health Po Jian 路she". After putting forward the principle of "giving up time according to evidence" clearly in the article, Although later generations have elucidated their time, they are mainly used in the study of time medicine of traditional Chinese medicine as a supplement to "taking measures according to the circumstances" and "cannot be violated when the time is not violated." the scope of the research is only to expound Luo Tianyi's thought of "passing time from syndrome". That is, when the disease syndrome is not consistent with the seasonal climate, the effect of seasonal climatic factors on the disease should not be confined to seasonal climate factors, but the treatment method should be determined according to the syndrome. The contents of the study are also based on the medical records recorded in the "Sanitary Treasure", that is, dry ginger is used in summer. Toriwenzhong decoction, composed of aconite and other drugs, is used to treat cold sore, emphasizing that cold syndrome also needs to be treated with warm medicine in summer. Since entering modern times, the research situation of "taking measures according to the times" is in full swing. The research on "Shishuozou syndrome" is slightly desolate. After searching, there is only one paper published in the beginning of -10s under the title of "Sheshe Shi Zong Zheng". That is, Zhang Xiangqun, a medical student of Grade 88 of Beijing Institute of traditional Chinese Medicine, published in the Journal of Beijing Institute of traditional Chinese Medicine, "on the principle of" not disobeying "and" giving time according to syndromes ">. It is the flexible application of "time must not disobey" in the treatment of clinical syndrome. However, no further research has been done on "giving time from syndrome". Wang Mengying, a famous febrile scientist in the late Qing Dynasty, was one of the "four major schools of febrile disease". Wang Mengying, a febrile scientist, has made a great contribution to the development of febrile disease. Wang was able not to stick to "time", but to stick to "syndrome" as the main treatment. Through an in-depth study of Wang Mengying's medical case, he found that. Wang's application of "giving away time from the card" is mainly reflected in three aspects: "the law firm does not stick to the evidence as the basis, not the human body to adhere to the rhythm of the card as the basis;" Not bewildered by instant guest evil, insist on taking syndrome as the basis ". By adhering to both" taking measures according to the circumstances "and" giving away time according to syndrome ", Wang Mengying realized the perfect combination of febrile disease theory and syndrome differentiation and treatment theory. From the angle of" giving time from syndrome ", Wang Mengying realized the perfect combination of febrile disease theory and syndrome differentiation theory. Meng Ying's medical records were studied. It opens up a new way for further research and excavation of Wang Mengying's medical thought, and also provides a new model and a new model for the study of traditional Chinese medicine cases from multiple perspectives. We can have a more accurate understanding of the connotation of "giving up time and following the card," which will help us to define its meaning. Combined with Wang Mengying's medical case, we can synthesize the research results of the former sages. It can be defined as follows: when the time factor is not consistent with the disease syndrome, it should not be limited to the influence of the time factor on the disease. There are three main aspects of its connotation: the rhythm of Qi, the rhythm of the human body, and the syndrome of instant guest evil.
【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R242

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