交通心肾治法源流与应用规律研究

发布时间：2018-04-28 15:54

  本文选题：交通心肾 + 心肾相关　； 参考：《北京中医药大学》2016年博士论文

【摘要】：研究目的“交通心肾”治法是在“心肾相关”理论指导下的中医临床常用重要治法之一,“心肾相关”理论自先秦两汉时期萌芽,经历代医家从临床实践中的总结、提炼和升华,逐渐发展完善,“交通心肾”治法亦随之经历了发展和变化。本研究侧重历代相关重要中医古籍和医家学术思想,以中医基础理论、中医内科学以及相关医案类文献为主要研究对象,对“交通心肾”治法相关古今文献进行研究,以期勾勒该治法的历史发展脉络和古今临床应用的规律和特点。研究方法本研究将主要分为三篇进行阐述：上篇以“交通心肾”治法历史源流研究为主要内容。通过检索《中华医典》里“医经类”“内科类”“综合医书类”类目中相关内容,结合《中国医学史》《中医各家学说》和《中国中医古籍总目》,筛选出各个历史时期比较有影响力的文献著作,以计算机检索和手检结合的方式,收集与“交通心肾”治法和“心肾相关”理论相关的原始资料。按照先秦两汉时期、两晋至五代时期、宋金元时期、明代、清代和现代等六个不同历史阶段对检索资料进行分期,应用文献学一般研究方法,结合各个历史时期的社会背景及医学发展特点、主要医家学术观点、中医教材相关内容等,对资料进行系统整理与分析,探讨治法和相关理论源流。中篇基于文献研究内容需求,设计开发“名医名方中医药传承平台(V1.0)”,该平台通过对医疗信息进行采集、提取特征、综合管理和数据挖掘,可将中医病案独立分离的理、法、方、药等信息集成一个相互关联、完整和协调的综合系统。通过对中医临证诊疗中的四诊、处方等信息进行采集和储存,运用数据挖掘方法对相关信息进行深入挖掘分析,促进中医临证和传承中“隐性知识”的显性化。下篇主要从古代和现代相关医案入手,研究古今医案中该治法的临床应用特点与规律。在古代医案研究中,应用关键词检索古代医案数据库,从127本中医医案类古籍中,检索主要应用“交通心肾”治法治疗疾病的相关医案,严格纳入和排除标准,筛选出相关医案70篇,借助“名医名方中医药传承平台(V1.0)”建立古代医案数据库。基于古代医案数据库,对医案中出现的疾病和用药进行统计；应用数据挖掘技术,对用药内容进行关联规则分析,探讨总结古代医家在应用“交通心肾”治法中常见疾病分布和用药特点。现代医案研究部分主要从相关期刊论文、万方数据知识服务平台、中文科技期刊数据库等3个网络文献资料数据库中,检索近30年应用“交通心肾”治法治疗疾病的相关医案,严格纳入和排除标准,筛选出相关医案344篇,借助“名医名方中医药传承平台(V1.0)”建立现代医案数据库。基于现代医案数据库,对于医案中出现的疾病、症状、药物等内容进行统计；对症状、药物内容进行关联规则分析、因子分析；参考网络药理学研究方法,对相关方剂进行网络药理学分析,探讨现代临床在应用“交通心肾”治法的疾病、症状和用药特点。讨论部分主要从古今对“心”“肾”的认识演变和差异,以及“心肾交通”的途径和方式等方面内容入手,分析探讨“交通心肾”治法的内涵；探讨“心”“肾”概念的现代内涵；探讨古今应用“交通心肾”治法在临床上治疗的常见疾病、辨证、症状以及处方用药的特点与规律,并试从现行《中医诊断学》教材和相关“国标”的定义中出发,探讨古今临床处方用药差异的原因。研究结果1古代中医应用“交通心肾”治法以治疗肾系疾病、心系疾病、气血津液病证等系统疾病为主,常用于治疗遗精、不寐、心悸等病证。2古代中医应用“交通心肾”治法主要采用安神药、补虚药、清热药、收涩药等四大类药物；常用药物有茯神、酸枣仁、远志、麦冬、地黄等；常用药对有茯神-酸枣仁,酸枣仁-远志,茯神-远志等；常用药物的药性以平、温、寒为主,药味以甘、苦为主,归经以肾、心两经为主。3现代中医应用“交通心肾”治法以治疗心系疾病与肾系疾病为主,常用于治疗不寐、经断前后诸证、心悸、遗精等疾病；西医疾病以失眠、更年期综合征、病理性遗精、遗尿等疾病为主。4现代中医临床常见心肾不交证的症状有不寐、心悸、头晕、梦多、口干等；常见舌色以红色和淡红色为主,舌尖红为心肾不交证特异性舌色：常见苔质为薄苔和少苔；常见脉象为细数脉。5现代中医应用“交通心肾”治法主要采用补虚药、安神药、清热药、收涩药等四大类药物；常用药物有黄连、酸枣仁、地黄、肉桂、远志等；常用药对有黄连-肉桂、黄连-酸枣仁、地黄-黄连等；常用药物药性以平、寒、温为主,药味以甘、苦为主；归经以心、肾、肝经为主；6应用“交通心肾”治法时,在补益药的应用上,古代临床以补气和补阳药物的使用为主,现代临床以补阴和补血药物的使用为重。7现代中医临床治疗心肾不交证常用方剂有交泰丸、六味地黄丸、黄连阿胶汤、天王补心丹等4首,常在方剂中加入“龙骨、牡蛎”“地黄、牡丹皮、知母”等药物组合。研究结论1“心”“肾”的概念内涵丰富,中医在“心”“肾”的认识经历了从解剖意义上“心”“肾”到功能上的“心”“肾”的发展过程。目前,“心肾相关”理论中所指的“心”“肾”,主要代表“精神神经系统”、“生殖系统”和“内分泌系统”等的生理功能；心肾不交证常见于现代医学“精神和行为障碍”和“泌尿生殖系统”疾病中。2“交通心肾”及其相关理论在形成初期,深受古代哲学思想和道家丹道学说思想的影响,但在其后来发展过程中因中医和道家道教发展目标、理论体系以及研究与应用手段方法不同,自明清已降,“交通心肾”治法仅用于少部分疾病的治疗中。3心肾之间交通方式主要依靠心肾阴阳交感、经络、脾胃、肝胆、胞胎、三焦等,临床治疗心肾不交证常从“心肾阴阳失调”与“脾胃”两方面入手。4高等院校《中医诊断学》教材与《中华人民共和国国家标准·中医临床诊疗术语·证候部分》(GB/T 16751.2-1997),均将心肾不交证等同于心肾阴虚[阳亢]证；且《中医临床诊疗术语·治法部分》(GB/T 16751.3-1997)则仅提出滋阴潜阳之法以“交通心肾”。现行教材和“国标”并未对“心肾不交”内涵进行全面的分析和阐述,使得“交通心肾”治法在临床上应用范围较为局限。5数据挖掘技术可以有效的应用于中医医案的研究中,辅助挖掘潜在的、不易察觉的、有价值的症状和用药信息。
[Abstract]:This study focuses on the study of the historical development of TCM ancient books and traditional Chinese traditional Chinese medicine , which is based on the basic theory of traditional Chinese medicine , the contents of TCM teaching materials and so on . Through collecting and storing medical information , the platform collects and stores information such as four diagnostic , prescription and other information in the medical record of Chinese medicine .
Based on the database of Chinese periodical full - text database , universal data knowledge service platform and Chinese sci - tech periodicals database , the author searches for the related medical cases , which is based on the database of modern medical records , and makes statistics on the diseases , symptoms and drugs in medical cases .
The correlation rule analysis and factor analysis of the symptom and drug content are carried out .
With reference to the method of network pharmacology research , the related prescriptions are analyzed by network pharmacology , and the characteristics of diseases , symptoms and medication of modern clinical practice in the application of " traffic centers and kidneys " are discussed . The discussion is mainly based on the understanding and difference of " heart " and " kidney " in modern clinic , and the ways and ways of " heart and kidney transportation " .
To explore the modern connotation of " heart " " kidney " concept ;
This paper discusses the causes of common diseases , syndrome differentiation , symptoms and prescription drugs of traditional Chinese medicine in the treatment of common diseases , symptoms , symptoms and prescription drugs .
Common medicines include Poria , Semen Ziziphi Spinosae , Cortex et Radix Polygalae , Radix Ophiopogonis , Radix Rehmanniae , and the like ;
The common medicine is prepared from Poria , Semen Ziziphi Spinosae , Semen Ziziphi Spinosae , Cortex et Radix Polygalae , Poria , Radix Polygalae , and the like ;
The traditional Chinese medicine is mainly used for treating cardiovascular diseases and renal diseases , which are commonly used for treating insomnia , pre - and post - menopausal syndrome , palpitation , spermatorrhea , etc .
Western medicine diseases are mainly diseases such as insomnia , climacteric syndrome , pathological nocturnal emission , nocturnal urine , etc . The symptoms of the clinical common heart and kidney syndrome in modern Chinese medicine are insomnia , palpitation , dizziness , dream , mouth and dry , etc .
The common tongue color is mainly red and light red , and the tongue tip is red as the specific tongue color of the heart and kidney .
The common pulse is the fine pulse . The modern Chinese medicine is mainly applied to four drugs such as tonifying deficiency medicine , tranquilizing medicine , clearing away heat and astringent , etc .
commonly used medicines are coptis , wild jujube seed , rehmannia root , cinnamon , polygala root and the like ;
The common drug is prepared from Coptidis Rhizoma , Cortex Cinnamomi , Coptidis Rhizoma , Semen Ziziphi Spinosae , Radix Rehmanniae , Rhizoma Coptidis , and the like ;
Common drug resistance is mainly flat , cold and warm , and the medicine taste is mainly sweet and bitter ;
It is classified as heart , kidney and liver meridian ;
6 . In the application of " heart - kidney " method , the traditional Chinese medicine is mainly used for tonifying qi and tonifying yang , and the modern clinic is mainly used for tonifying yin and enriching the blood . The research conclusion is that the concept of " heart " kidney is rich , and the traditional Chinese medicine has experienced the development process of " heart " and " kidney " in the meaning of " heart " .
Heart and kidney syndrome is common in modern medicine " spirit and behavior disorder " and " urinary reproductive system " disease . " Traffic center kidney " and its related theory are influenced by ancient philosophy thought and Taoist Dandao theory thought in the early stage of formation .
Traditional Chinese medicine and GB / T 16751 . 3 - 1997 only put forward the method of nourishing yin and yang . The present teaching material and the national standard do not comprehensively analyze and expound the connotation of " heart and kidney " . The data mining technology can be applied to the research of traditional Chinese medicine to help excavate the latent , difficult , valuable symptom and medication information .

【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】：2016
【分类号】：R242
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本文编号：1815928