六经辨证诊疗模式的构建及其针药结合的临床应用

发布时间：2018-04-28 03:22

本文选题：针药结合 + 辨证论治　；参考：《广州中医药大学》2016年博士论文

【摘要】：临床医学的主要任务之一是对疾病进行诊断,然后根据诊断结果进行治疗。因此正确的诊断是使治疗产生效果的前提。在长期的医疗活动过程中,历代医家积累了丰富的诊断疾病的经验,形成了我国特有的完整的诊病体系,即四诊(望诊、闻诊、问诊、切诊)和辨证,从而建立了中医诊断学这门学科。至古至今,中医诊断学一直在临床上发挥着作用。中医对疾病情况进行判断,可分“辨病”与“辨证”两个方面。鉴于辨证是中医学的独特之处与精华所在,为临床各科诊断疾病时普遍使用的方法,因此,本论文是在辨证方法研究的基础上,进行中医诊断治疗模式的尝试性探索。在长期的医疗实践过程中,古代医家创造了多种辨证方法,如八纲辨证、经络辨证、脏腑辨证、六经辨证；卫气营血辨证、三焦辨证及气血津液辨证等。这些辨证方法,从不同的方面总结了认识疾病症候的规律。他们各有特点,在诊断证候时各有侧重,但又相互联系补充。其中,八纲辨证用于确定疾病性质；经络脏腑辨证能够落实病变部位；六经辨证是系统的疾病诊断方法；卫气营血辨证及三焦辨证,则用于诊断外感热病；气血津液辨证则是分析人体生理功能与水液、营养物质等的异常变化。目的：本论文的目的是通过整理四种主要的辨证方法(八纲辨证、经络辨证、脏腑辨证和六经辨证),研究它们之间的相互关系和在疾病诊疗中的作用,尝试建立一套实用的中医诊断治疗模式(简称“诊疗模式”)。方法：本论文前半部分采用文献研究方法,对中医辨证论治的相关内容进行了详细的整理归纳。论文的后半部分在中医辨证论治方法的基础研究上,通过纵向横向比对,以六经辨证(即“三阴三阳”辨证)体系为经,具体的病证为纬,通过整合八纲辨证、经络脏腑辨证来构建中医的诊断治疗模式。内容：论文的主体分为六大部分：第一部分主要介绍了中医辨证论治的源流,并简单的介绍了四种辨证论治方法。辨证论治是中医学之精髓,辨证论治诸法各具特点,运用各有侧重,但就学术渊源及理论内容而论,经络辨证是基础,脏腑辨证是核心,八纲辨证是纲纪,而六经辨证在临床中应用广泛且疗效显着。第二部分详细论述六经辨证方法。结合文献对六经辨证进行了源流等详细的研究,六经辨证实际上更应该称为“三阴三阳”辨证,只是后人已经习惯于“六经辨证”的叫法,但在临床应用中应该将“六经辨证”回归到“三阴三阳”辨证,这样才能更合理、更贴切地理解张仲景《伤寒论》中的“六经辨证”体系,才能更深刻的认识到六经辨证(即“三阴三阳”辨证体系)不仅是伤寒外感的辨证方法,也是内科杂病的辨证体系,这也是完成针药结合诊疗模式的思想基础。第三部分比较了四种辨证方法的相互关系：八纲辨证和六经辨证方法都源于《伤寒论》,经络脏腑辨证方法也是《伤寒论》的辨证基础,八纲辨证是整个中医辨证的总纲,是中医诊断治疗的方向,而经络脏腑辨证在临床中可操作性强。而六经辨证(即“三阴三阳”辨证)和八纲、经络脏腑辨证有着密不可分的关系,六经辨证体系是可以统筹、整合八纲、经络脏腑辨证来高效、准确地进行中医诊断治疗的。第四部是在前三章的基础上,进行六经辨证(“三阴三阳”)诊疗模式的构建,六经辨证诊疗模式是以《伤寒论》为基础,整合八纲辨证、经络脏腑辨证,通过六经辨证(即“三阴三阳”辨证)体系来统领各种辨证方法来实现中医的全面、系统的诊断治疗。在六经辨证(“三阴三阳”辨证)诊疗模式体系中,通过《伤寒论》原文提取太阳病、少阳病、阳明病、太阴病、少阴病、厥阴病的诊断要素,并且制作了六经辨证问诊单来实现有效、全面、准确的中医诊断治疗模式。第五部分是通过前面构建的六经辨证(即“三阴三阳”辨证)诊疗模式和对应病证的针灸治疗相结合,完成了以“三阴三阳”为框架的中医针药结合诊断治疗模式(简称“针药诊模”)可行性研究,该诊疗模式通过“六经”问诊单,在临床上能够高效、准确地完成中医的诊断治疗。本论文还对六经(“三阴三阳”)辨证诊疗模式中所选用的所有腧穴进行了统计分析,统计结果有以下两点值得思考：十二经络虽然不能等同于“三阴三阳”辨证体系中的“六经”,但是二者在六经辨证诊疗模式中,不论是诊断还是治疗都有着非常密切的联系；对六经整体取穴情况的统计,可以看出在《伤寒论》六经辨证(即“三阴三阳”辨证)体系中,针灸治疗多取足太阳膀胱经、任脉、足阳明胃经、足少阴肾经和足太阴脾经上的穴位,因此通过《伤寒论》“六经”(即“三阴三阳”)辨证诊疗模式的构建,本文也提出了中医诊断治疗预防疾病的思想即：“防外感,护脾胃,固肾气,调情志”。本论文的最后部分介绍了六经(“三阴三阳”)辨证诊疗模式在临床中的实际应用,并且给出了临床应用中的几点体会：“知常察变”；“通阳能扶阳,清肠才滋阴；通阳阳自发,清肠阴自足”；“实则阳明,虚则太阴”,“实则太阳,虚则少阴”、“病愈防外感”,期望有助于临床诊断治疗。成果：本论文的主要成果有以下四点：完成了中医辨证方法(主要是八纲辨证、经络辨证、脏腑辨证、六经辨证)的系统研究和综合归纳；尝试性的构建综合八纲、经络脏腑辨证的六经(即“三阴三阳”)辨证的诊疗模式；给出了六经辨证诊疗模式的针药结合模式并且根据统计学结果提出了中医诊断治疗疾病的重要思想；最后对六经辨证诊疗模式进行了临床实践。结论：本论文完成了六经(“三阴三阳”)辨证诊疗模式及针药结合模式的构建,并给出了该诊疗模式的临床应用,虽然几则病案比较简单,但是可以展望针药结合六经(“三阴三阳”)辨证诊疗模式在临床中将会有广阔的应用空间。该诊疗模式还存在很多不足,希望在以后的临床实践中不断地完善。
[Abstract]:One of the main tasks of clinical medicine is to diagnose the disease and then to treat it according to the results of the diagnosis. Therefore, the correct diagnosis is the prerequisite for the effect of the treatment. In the course of long-term medical activities, the doctors of all ages have accumulated a rich experience of diagnosing the disease, and formed a complete and complete diagnosis system in our country, that is, four diagnoses. The medical diagnostics of traditional Chinese medicine has been established in the field of TCM diagnostics. Since ancient times, traditional Chinese medicine has been playing a role in clinical diagnosis. It can be judged by traditional Chinese medicine, which can be divided into two aspects: "disease discrimination" and "syndrome differentiation". In view of the uniqueness and essence of traditional Chinese medicine, diagnosis of diseases in various clinical subjects In the course of long-term medical practice, the ancient doctors created a variety of dialectical methods, such as eight class syndrome differentiation, meridian syndrome differentiation, viscera differentiation, six meridian syndrome differentiation, Wei Qi camp blood syndrome differentiation, triple focus syndrome differentiation and Qi and blood. These syndrome differentiation methods summarize the rules of understanding the symptoms of disease from different aspects. They have their own characteristics and each have their own emphasis on the diagnosis and syndrome, but they are complementary to each other. Among them, the eight class syndrome differentiation is used to determine the nature of the disease; the syndrome differentiation of meridians and collaterals can implement the lesion location; the six meridian syndrome differentiation is a systematic diagnosis method of disease. Wei Qi camp blood syndrome differentiation and triple focus syndrome differentiation are used to diagnose exogenous fever; Qi and blood body fluid syndrome differentiation is an analysis of abnormal changes of human physiological function and water and nutrients. The purpose of this paper is to study the four main methods of syndrome differentiation (eight outline syndrome differentiation, meridian syndrome differentiation, viscera syndrome differentiation and six meridian syndrome differentiation). The relationship and the role in the diagnosis and treatment of disease, try to establish a set of practical diagnosis and treatment mode of traditional Chinese medicine ("diagnosis and treatment mode"). Method: the first half of the thesis adopts the literature research method, and summarizes the related contents of TCM syndrome differentiation and treatment in detail. The second half of the thesis is in TCM syndrome differentiation and treatment methods. On the basis of the basic research, through the vertical and horizontal alignment, the system of six meridians syndrome differentiation ("three yin and three yang" syndrome differentiation) system is taken as the meridian, and the specific syndrome is weft, through the integration of the eight outline syndrome differentiation and the syndrome differentiation of the meridians and organs to construct the TCM diagnosis and treatment mode. Content: the main body of the thesis is divided into six parts: the first part mainly introduces the origin of TCM syndrome differentiation and treatment. And briefly introduces the four methods of syndrome differentiation and treatment. Syndrome differentiation and treatment is the essence of traditional Chinese medicine. The syndrome differentiation and treatment of various methods have their own characteristics, and each has their own characteristics. But on the basis of academic origin and theoretical content, the syndrome differentiation of meridians and collaterals is the basis, the syndrome differentiation of the viscera is the core, the eight class syndrome differentiation is the outline, and the six meridian syndrome differentiation is widely used in clinical and effective curative effect. Second Some detailed studies on the syndrome differentiation of the six meridians are discussed in detail. The origin and flow of the six meridians are studied in detail. In fact, the syndrome differentiation of the six meridians should be called the "Three Yin three yang" syndrome differentiation, but the later generations have been used to the "six meridian syndrome differentiation", but in the clinical application, the "six meridian syndrome differentiation" should be returned to the "Three Yin three yang" syndrome differentiation. It is more reasonable and more reasonable to understand the system of "the syndrome differentiation of six meridians" in Zhang Zhongjing's theory of typhoid fever more deeply to realize that the syndrome differentiation of the six meridians ("three yin and three yang" syndrome differentiation system) is not only a dialectical method of exogenous febrile exogenous disease, but also a dialectical system of internal medical miscellaneous diseases. This is also the ideological basis for the completion of the combination of acupuncture and medicine and the mode of diagnosis and treatment. The relationship between the four methods of syndrome differentiation is compared: the eight principles of syndrome differentiation and the six meridian syndrome differentiation are derived from the theory of typhoid fever, and the methods of syndrome differentiation of the meridians and collaterals are also the basis for the syndrome differentiation of the theory of typhoid fever. The eight outline syndrome differentiation is the general outline of the whole TCM syndrome differentiation, and the direction of the TCM diagnosis and treatment, while the syndrome differentiation of the meridians and collaterals is strong in clinical practice. That is, "three yin and three yang" syndrome differentiation) and eight classes, the meridian viscera syndrome differentiation has an inseparable relationship. The six meridian syndrome differentiation system is an integrated, integrated eight class, the meridian viscera syndrome differentiation to the high efficiency, accurate diagnosis and treatment of traditional Chinese medicine. On the basis of the first three chapters, the six meridian syndrome differentiation ("Three Yin three yang") diagnosis and treatment mode construction, six meridians The pattern of diagnosis and treatment is based on the theory of "Treatise on typhoid fever", integrating the syndrome differentiation of eight classes, syndrome differentiation of meridians and viscera, and through the system of syndrome differentiation of the six meridians ("Three Yin three yang" syndrome differentiation) to realize the comprehensive and systematic diagnosis and treatment of traditional Chinese medicine. In the system of diagnosis and treatment of the syndrome differentiation of the six meridians ("Three Yin three yang" syndrome differentiation), the text of "the theory of typhoid fever" is proposed. Taking the diagnosis factors of sun disease, shaoyang disease, Yangming disease, Taiyin disease, Shaoyin disease and Jue yin disease, and making a six meridian dialectical inquiry sheet to achieve effective, comprehensive and accurate diagnosis and treatment mode of traditional Chinese medicine. The fifth part is the combination of the six meridian syndrome differentiation (namely "three Yin three yang" syndrome differentiation) and the combination of the corresponding acupuncture and moxibustion treatment. It has completed the feasibility study of the combination of "three yin and three yang" as the framework of Chinese medicine combined with diagnosis and treatment of acupuncture and medicine (referred to as "needle medicine diagnosis model"). Through the "six meridian" inquiry form, the mode of diagnosis and treatment can effectively and accurately complete the diagnosis and treatment of traditional Chinese medicine in the clinical. This paper also selected the mode of diagnosis and treatment of the six meridians ("Three Yin three yang"). All acupoints are statistically analyzed, and the following two points are worth thinking: Although the twelve meridians can not be equal to the "six meridians" in the "Three Yin three yang" syndrome differentiation system, the two are closely related to the diagnosis and treatment in the diagnosis and treatment of the six meridian syndrome differentiation and treatment. As a result, we can see that in the system of syndrome differentiation of "the theory of typhoid fever" ("three yin and three yang" syndrome differentiation), the treatment of acupuncture and moxibustion is taken to take the foot of the sun bladder meridian, Ren pulse, Foot Yangming stomach meridian, foot less Yin kidney meridian and foot Taiyin spleen meridian, so the TCM syndrome differentiation and treatment mode is constructed by "the theory of typhoid fever", "six meridians" ("Three Yin three yang"), and the Chinese medicine is also put forward in this article. The last part of this paper introduces the practical application of the mode of diagnosis and treatment of the six meridians ("three yin and three yang") in the clinical application, and gives some experience in clinical application: "know Chang Yang to change the Yang" and "clear the intestine" to nourish the Yin; There are four points in this paper: eight class syndrome differentiation, syndrome differentiation of meridians, syndrome differentiation of meridians, syndrome differentiation of viscera, syndrome differentiation of six meridians, and syndrome differentiation of traditional Chinese medicine. Systematic research and comprehensive induction, and try to construct a comprehensive eight class, the syndrome differentiation pattern of the six meridians ("Three Yin three yang"), the combination mode of the acupuncture and medicine of the diagnosis and treatment pattern of the six meridians and the important thought of the diagnosis and treatment of the disease according to the statistical results; finally, the diagnosis and treatment model of the six meridian syndrome differentiation and treatment is put forward. Clinical practice. Conclusion: This paper completed the construction of the mode of diagnosis and treatment of the syndrome differentiation of the six meridians ("three yin and three yang") and the combination mode of acupuncture and medicine, and gave the clinical application of the mode of diagnosis and treatment. Although several cases are simple, it can be expected to be widely used in clinical diagnosis and treatment of the combination of acupuncture and medicine and six meridians ("Three Yin three yang"). Wide application space. There are still many deficiencies in the diagnosis and treatment mode, which is expected to be perfected in future clinical practice.

【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】：2016
【分类号】：R241

【相似文献】