尤怡对《金匮要略》痰饮理论的阐发及其证治思想研究

发布时间：2018-03-04 10:09

  本文选题：《金匮要略》　切入点：痰饮　出处：《广州中医药大学》2016年博士论文　论文类型：学位论文

【摘要】：目的：痰饮乃是中医临床常见病证,首见于张仲景《金匮要略·痰饮咳嗽病脉证并治第十二》篇。痰饮证治理论是张仲景学说重要组成部分,其影响巨大,为后世医家对痰饮的诊断、治疗开了理法方药的先河。中医痰饮病的理论和治法方药,经过历代医家的实践运用、理论总结而不断地发展。《金匮要略·痰饮咳嗽病脉证并治第十二》篇所述痰饮证治体系,全面系统论述了痰饮病因病机、治法、方药。张仲景理论在唐、宋、金、元时期受到重视,痰饮理论也随之不断发展。各医家逐渐加深对痰饮的认识,扩展了痰饮理论的研究范围,从专注研究痰饮病的治疗扩大到研究其它杂病病种的痰饮证,也就是病因病机学范畴的痰饮。宋金元时期内科杂病理论得到大力发展,逐渐形成诊治杂病的痰理论；到了明清时期痰饮和痰理论被不断深化和归纳,并且有不少新发现；现代中医学者逐渐将痰饮理论研究应用于病因病机学和临床诊治,促进了现代中医的发展。在整个痰饮理论的发展过程中,尤怡是清代深化、归纳痰饮理论的集大成者,其对痰饮辨证论治的思想有突出的特点。尤怡毕生致力于古代医典研究与临床实践,其著作对后世医家影响深远。其代表作有《金匮要略心典》、《金匮翼》、《伤寒贯珠集》、《医学读书记》和《静香楼医案》。尤氏在阐发《金匮要略》的基础上,总结了“治痰七法”,对痰饮证的诊治在医学理论和临床实践两方面都有深远意义。本研究的目的之一是探索尤怡对《金匮要略》痰饮理论学术思想的发展成就。尤怡集十年寒暑研究《金匮要略》心得以成《金匮要略心典》,其观点独具慧眼而行文简洁扼要,对后人研读《金匮要略》产生了深刻的影响。本研究根据尤怡《金匮要略·痰饮咳嗽病脉证并治第十二》篇注文,分析《金匮要略》的痰饮理论体系,探究尤怡对张仲景痰饮证治理论的继承和研究的成就。本研究的目的之二是探索尤怡独创的治痰七法,总结尤氏独特的痰饮证治思想。治痰七法是尤怡痰饮辨证论治体系的集中体现,出现在其晚年著作《金匮翼》。尤怡为增补《金匮要略》而作《金匮翼》,该书是对张仲景杂病治疗体系的继承与发扬,是尤氏学术思想成熟之作。书中将内伤杂病分门别类,论述理法方药,参考前人医论、方药以完整阐述的杂病治疗方案,在临床中有较高实用价值。书中,治痰七法综合了三方面的成就,包括《金匮要略》痰饮理论；后世医家痰饮各论和尤怡自身的理论与实践经验。尤怡将治痰七法分为攻逐、消导、和、补、温、清、润,是7种不同辨证情况下的痰饮的治疗手段,每法还根据病情轻重缓急使用不同的方剂。本研究探索治痰七法的源头,分析治痰七法细微的治法方药,梳理尤怡证治痰饮的学术脉络,总结尤怡对《金匮要略》痰饮理论的发展和补充。本研究的目的之三是分析尤怡《静香楼医案》中的痰饮证治,归纳总结尤氏在临床中应用张仲景痰饮理论的心得和治痰七法的实用价值。本文深入分析《静香楼医案》痰饮证医案,追溯尤怡诊断、立法、处方、选药的历史渊源,以明了其深意。研究过程中,紧密结合《金匮要略心典》和《金匮翼》的论述,旁参历代医家的方药,探讨尤怡临床处方的历史源流,总结其临床实践与理论研究的一致性。综上所述,本研究旨在以《金匮要略·痰饮咳嗽病脉证并治第十二》为出发点,研究挖掘尤怡的痰饮证治思想。通过展现尤怡《金匮要略心典·痰饮》篇所发挥的张仲景痰饮学说、《金匮翼》的痰饮证治理论和《静香楼医案》治痰七法的实际应用,为现代中医临床辨证论证开拓新思路和方药提供借鉴。方法：本论文研究方法,采用中医文献研究,医史研究,古籍文本内容分析,古籍文献对比分析,结合现代中医理论发展成果加以适当的评按,挖掘古代医籍理论对现代中医理论和临床的意义。本研究对张仲景至尤怡的痰饮理论进行源流考究,梳理痰饮理论的学术发展历程,挖掘不同历史时期痰饮证治方法的演变和时代特点。本文结合现代中医学理论进行适当的发挥,参照不同的学说进行对比、鉴别,力求相对客观的评价古代医家的成就,以获得相对合理的结论。《金匮要略》痰饮理论是本研究的基础。在此基础上,参考历代相关古医籍文献,集中分析《金匮要略心典》、《金匮翼》、《静香楼医案》三部著作,对有关痰饮理论的命名、分类、辨证、病因病机、治疗进行系统的整理、分析和归纳,总结出尤怡痰饮证的辨证论治体系。本研究包含四部分：第一部分,以《金匮要略》为主线,分析历代8家《金匮要略》著名的注家(含尤怡)的注文,深入探讨尤怡《金匮要略心典》对痰饮理论的注疏和阐发的成就。这些注家大多生活在尤怡同时代或时期相近,其中一位注家生活时代较晚于尤怡,所选注家皆为临床名家,也是《金匮要略》著名的研究者。所选注家有：1、赵以德,著有《金匮方论衍义》,是最早全面注疏《金匮要略》的医家；2、沈明宗,著有《金匮要略编注》,其善于用自身体会进行注疏原文；3、徐彬,著有《金匮要略论著》,其师承于李中梓、喻昌,学术观点和源流与尤怡相近；4、魏荔彤,著有《金匮要略方论本义》,其研究《金匮要略》长达40余年,注疏严谨而详尽；5、程林,著有《金匮要略直解》,其为明末清初新安学派医家,其注疏采用“以经证经”之法,颇有特色；6、李_c,著有《金匮要略广注》,其注疏主要依据《黄帝内经》理论,参考历代医论；7、高学山,著有《高注金匮要略》,生活年代较晚于尤怡,其注本是稀缺的版本,该书是高氏临床心得和《金匮要略》研究的紧密结合,较有临床实用性。第二部分,以《金匮翼》文本为中心,紧密联系《金匮要略》的医学思想,追溯《金匮翼》中治法处方的渊源,分析尤怡治痰七法。通过考证和分析《金匮翼·痰饮》篇所,发现该篇引用历代27本著作的痰饮医论和方药,可见尤怡集历代所长而选方有深意。对治痰七法医理的研究,本文应用中医方剂学理论,深入分析《金匮翼》痰饮证所采用的方剂配伍意义和药物使用方法。对治痰七法分析表明,尤怡辨证准确,立法慎密,所选方剂实用,对现代中医有临床借鉴价值。第三部分,分析《静香楼医案》中痰饮证临床治疗方药,深入讨论尤怡临床辨证论治和立法处方的特点。本部分对《静香楼医案》进行筛选分析。被选用医案必须符合两个条件中的一个：第一,题目明显体现痰饮病因病机的；第二,诊治手法属于典型的治痰七法范畴的。对于部分医案与痰饮相关,但是诊疗的主要方面并不属于从痰饮论治的,给予排除。对筛选后的医案,采用中医学理论,从痰饮的病因病机,辨证论治,立法处方等角度进行分析。根据尤怡临证处方,寻找其在古代医籍的根源,参照历代医家相近的方论,探讨尤氏应用古方治今病之路。对痰饮证医案,结合《金匮要略心典》、《金匮翼》论述,展示三者的关联性,总结尤氏理论与实践的高度一致性。第四部分,深入讨论尤怡痰饮证治思想在临床中的应用,参考现代痰饮研究和临床家的经验,发现治痰七法对现代中医临床辨证论证的意义。本文的第5章讨论了研究对象和结果,总结出尤怡阐发张仲景痰饮理论的成就；分析挖掘治痰七法的学术特色以及尤怡的临床特色；启发尤怡痰饮证治思想对现代中医临床的理论价值和实践价值,以扩展现代中医临床应用其医学思想的思路与方法。结果：1.《金匮要略心典·痰饮》注疏阐明张仲景痰饮理论四饮体系,对“水在五脏”、留饮的发挥,是尤氏痰饮医学思想发展的基础；注文以“温药和之”治则为中心,阐述归纳多种治法,包括“温药和之”法、消法、攻逐法三大法。尤怡从理论、治法和方剂解析三个不同角度论述以上三法,发展成为《金匮翼》治痰七法的基础。2.《金匮翼》继承了《金匮要略》医学思想,通过研究历代痰饮证治大成,创立治痰七法。治痰七法包含了攻逐、消导、和、补、温、清、润。其中攻逐、消导、和、补、温等法多来源于《金匮要略》治法；清、润二法则是尤怡自身学验和后世发展总结而成。治痰七法辨证思路清晰、方药实用,便于指导痰饮证临床治疗。3.《静香楼医案》痰饮证医案是尤怡痰饮证治理论应用到各门杂病的临床治疗范例。本研究发现,在尤怡的临床痰饮证治中,诊断分析和立法多以张仲景《金匮要略》为基础；选方多用经典方剂,加以化裁,少数情况自拟方药。尤氏娴熟应用古方治今病(当时之病),是对古代医籍的实用性的肯定和价值的彰显。尤怡医案体是《金匮要略心典》、《金匮翼》的实际应用,也是在临床上对其理论的实践验证。4.尤怡的治痰七法体系与临床应用对现代医学治疗具有重大的理论意义和实践意义。其理论意义在于,尤怡以辨证论证和临床应用的角度阐发张仲景学术思想,以促进经典方药在其所在时代乃至现代临床中使用；治痰七法在理论上有鲜明的继承性和独创性,尤怡将其应用到临床的诊疗过程中,是理论到实践的高度统一。其对现代中医临床的实践价值在于,治痰七法可以给现代中医临床带来慎密的方法和丰富的方药,拓展了临床的治疗手段；临床应用治痰七法对痰饮病和痰饮病之外的杂病治疗都有良好的治疗效果,无论是现代中医病种还是西医病种都可以加以借鉴。结论：尤怡的痰饮证治思想体系,包括了对张仲景经典学说的继承；治痰七法理论；尤氏务实效临床应用治痰七法的经验。此三者是尤怡的痰饮医学证治理论与临床实际紧密联系的体现。以治痰七法为核心的尤怡的痰饮证治思想对现代中医临床立法论治有重大现实意义,其临床根据辨证化裁古方以治今病对现代中医药临床应用有借鉴意义。
[Abstract]:Objective: phlegm is a common clinical symptom, first seen in Zhang Zhongjing "Jinkui yaolue. Phlegm cough syndromes and treatment twelfth. Treatment of phlegm syndrome theory" is an important part of Zhang Zhongjing theory, its great influence, for physicians in diagnosis of phlegm, the treatment prescription of phlegm disease precedent. The theory of traditional Chinese medicine and herbs, through the practice of the ancient physicians use theoretical summary and developing constantly. Jinkui yaolue. Phlegm cough syndromes and treatment of the treatment system twelfth > phlegm card, comprehensively and systematically discusses the phlegm etiology and pathogenesis, treatment, prescription. Zhang Zhongjing theory in the Tang, song, Jin the Yuan Dynasty, attention, phlegm theory develops continuously. The doctors gradually deepen the understanding of phlegm, phlegm theory expands the research scope, research focus from the treatment of phlegm disease to study other diseases disease of phlegm syndrome of Yin, that is Etiology and pathogenesis of phlegm category Song Jinyuan miscellaneous diseases theory development, phlegm theory gradually formed to the diagnosis and treatment of diseases; phlegm and phlegm theory was deepened and summarized in the Ming and Qing Dynasties, and there are a lot of new discoveries; modern Chinese scholars gradually phlegm theory applied to pathogeny and clinical diagnosis and treatment, to promote the development of modern Chinese medicine. In the process of development of the theory of phlegm, especially Yi Qing Dynasty is deepening, synthesizer induction phlegm theory, its outstanding characteristics of phlegm syndrome differentiation thought. You Yi devoted his life to the ancient medical research and clinical practice, the profound influence on the later generations on behalf of the doctors. As a "jinkuiyaolue heart code >, < < > golden wing, Shang Han Guan Zhu Ji > > and < < medical record reading medical records. Especially in Shizuka building based on the analysis of < jinkuiyaolue >, summed up the" phlegm seven "of phlegm Certificate of diagnosis and treatment have far-reaching significance in two aspects of medical theory and clinical practice. One of the purposes of this study is to explore the You Yi of < > phlegm theory Jinkui yaolue academic development achievements. Especially the study of Yi set ten years experience with jinkuiyaolue > < < code > jinkuiyaolue heart, the view of discerning and the terse, has a profound influence on the later study. This study jinkuiyaolue > < < jinkuiyaolue according to You Yi - phlegm cough syndromes and treatment of twelfth > text annotation, analysis of the theoretical system of jinkuiyaolue > < phlegm, explore You Yi to inherit and study of Zhang Zhongjing's theory of phlegm retention syndrome governance achievements. The purpose of this study is to explore the two original You Yi phlegm seven method, summarize the uilenbergi unique thought of treatment. The treating phlegm phlegm retention syndrome seven method is the concentrated reflection of you Yi phlegm syndrome differentiation system, appear in his later works. "Golden wing for the addition of" You Yi Jin Or slightly as < > > golden wing, the book is to inherit and develop Zhang Zhongjing disease treatment system, is uilenbergi academic thoughts and mature work. The book will be arranged on internal diseases, prescription, medicine on previous treatment prescription, miscellaneous to fully elaborate the clinical in the higher practical value. In the book, seven methods of phlegm treatment combined with the three achievements, including the "Golden Chamber > phlegm theory; on the later doctors and phlegm You Yi own theory and practice experience. You Yi will be divided into seven phlegm Purgating, digestion, and complement, warm, clear, run, 7 different cases of phlegm syndrome differentiation treatment, each method also uses different prescriptions according to the condition of order of priority. This study explores the source of phlegm treatment of seven methods of analysis, treatment and prescription subtle phlegm phlegm treatment method seven, combing the context of academic certificate you Yi Yi, especially on" jinkuiyaolue summary the theory of phlegm. The exhibition and supplement. The purpose of this study is the analysis of the three floor You Yi < > in the medical records of Shizuka phlegm syndrome treatment, summarized the application of Zhang Zhongjing's theory of phlegm especially in clinical experiences in treating phlegm and seven practical value. This paper makes a deep analysis on building medical records > < Shizuka phlegm retention syndrome cases, retrospective diagnosis prescription You Yi broken, legislation, historical origin, drug selection, to understand its meaning. In the course of the study, combined with < jinkuiyaolue heart code > and < > this golden wing, next to participate in the ancient physicians prescription, to explore the historical origin of you Yi clinical prescription, consistency and summarize the clinical practice and theoretical research. In summary, this study aims to "Jinkui yaolue. Phlegm cough syndromes and treatment > twelfth as the starting point, study the phlegm syndrome mining You Yi thoughts. By showing you Yi" Jinkui yaolue heart code - > phlegm article played by Zhang Zhongjing phlegm phlegm retention syndrome theory, < > governance golden wing The practical application and theory building case > phlegm Shizuka < seven law, develop new ideas and provide reference for modern Chinese medicine clinical dialectical argumentation. Methods: in this paper, research methods, research history of Chinese literature, the ancient text analysis, literature analysis, comparative ancient books, combined with the theory of modern Chinese medicine development results properly according to the review, the excavation of ancient medical books theoretical significance for modern Chinese medicine theory and clinical research. The phlegm theory of Zhang Zhongjing to the You Yi origin research, combing the theory of academic development and mining, evolution and characteristics of the times in different historical periods. The phlegm retention syndrome treatment methods combined with the modern theory of traditional Chinese medicine appropriate play according to different theories, comparison, identification, in order to objectively evaluate the achievements of ancient physicians, to obtain a relatively reasonable conclusion. Jinkuiyaolue theory is the study on Phlegm 鐨勫熀纭，

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