以唐容川《血证论》为基础探讨中医血证的诊断学特色

发布时间：2018-05-05 15:05

  本文选题：唐容川 + 血证　； 参考：《北京中医药大学》2016年博士论文

【摘要】：本论文共由三部分组成,第一部分综述,第二部分血证的古代学术源流,第三部分以唐容川《血证论》为基础的中医血证诊断特色研究,探析中医血证辨证论治的传承演变过程。中医血证古代学术源流,从目前所见的史料记载,是由公元前第5-6世纪的《五十二病方》,以头发蒲席炒炭治疗外伤出血以及内服外洗治疗痔血的临床开始萌芽。《内经》对血证的望诊与脉诊,寒热虚实阴阳的辨证,六淫辨证,七情证候、外伤、饮食劳伤的病因辨证,气血津液辨证,脏腑辨证等论述,奠定了后世医家在血证辨证的基础。两汉时期,《史记·扁鹊仓公列传》多次以“血脉病”称呼“血证”,其所叙述的血证诊治书写方式,被视为现代医案撰写的鼻祖。 《伤寒杂病论》以理、法、方、药结合的形式,提升了血证辨证论治的思维,包括提出血证的“以方测证”,辨别血证的虚实寒热、病因病机与病位。重视“和解法”如少阳热入血室证以小柴胡汤和解之法。注重“血汗同源”,妇科治疗重视水血兼病,并提示注意与杂病治法的差异等。魏晋南北朝时期,《中藏经》、《脉经》与《王叔和脉诀》等,以脉证为中心,分述五脏六腑病证的寒热虚实,形成有系统的脏腑辨证理论,并将之应用于对血证的论述与提出治疗方药等。隋唐五代时期,《诸病源候论》在《内经》与《伤寒杂病论》的基础上,结合临床的实践经验,对中医各种血证的病因、病机、病位与临床诊治,都有详细的记载,应是我国论述血证证候较完整的医著。两宋时期,《三因极一病证方论》首次提出血证的三因总论与个别血证的三因,N&与南宋陈自明都提出“瘀蓄冷血”之说。金元时期,刘完素强调脏腑功能的协调,并提出“六气皆能化火”之说,重视“火热为病”的病机；张从正主张“出血所以养血”的论点；李杲提出“内伤脾胃,百病由起”的脾胃论学说；朱丹溪进一步发展了“湿热相火为病甚多”的观点,重视脾土之阴,强调养阴补血的重要性。明清时期,缪希雍提出“吐血三要”与“治血三要”：萧京提出“治血贵静说”的论点；李中梓明确提出“肾为先天,脾为后天”,同时强调“治先天根本,则有水火之分”、“治后天之本,则有饮食劳倦之分”的观点；张景岳进一步阐述“血”对人身、精神、意志的重要性,提出“火盛”与“气伤”为血证的最主要病因病机,“血证反证甚多”的经验。喻嘉言重视从四诊探究病机的“识病议药”过程,提出“急重缓治”的创新论点；傅青主提出“火之所以妄者,皆由于血之衰,补血即足以制火”、“治血则湿除,利湿反引火下行”、“平肝正所以扶脾”的妇科血证创新思维；叶天士总结“失血三因”与相应治法,认为“外因者,必先有感候；内因者,必有内证可据；不内外因,治有脏腑经络之异”；陈修园从脉象论“血分病”的虚实,强调六经气化说,为唐容川的“阴阳水火论”与“脏腑病机论”立下基础。王清任提出气门、卫总管、荣总管、气府与血府、髓府、津门、津管的解剖位置与功能路径,解释了气血津液彼此流通的关系。重视瘀血的病因病机,并将久治不愈之各种症状归于血瘀为病,具有临床指导意义；朱沛文在《医林改错》的基础上,提出“血经运行,中有炭气,故色紫”的缺氧血。认为“气津液血四者,皆由后天水谷一源所生”“种种津液赖血以生”唐容川《血证论》的内容特色包括该书在血证基础理论与血证诊断学两方面的创新特色。就血证基础理论而言,在遵《内经》与法仲景的基础上,结合“医易”与“六经气化”作为《血证论》“阴阳水火气血论”与“脏腑病机论”的血证理论基础。内容包括：呼应阴阳互根的“天人相应”的哲学思维、以“医易”发扬创新“阴阳理论”、重构水火相济化气化血的气化理论、水火气血相成相制病因病机,并以“六经气化理论”将“阴阳水火气血论”与“脏腑病机论”整合重构,成为血证的基础理论与辨证论治的血证诊断学特色。作为清末汇通学派的代表医家,唐容川谙熟当时西医知识,并深受西医解剖、生理知识的影响,其著述中,也多试图以古文经旨解释西医的解剖形质。唐容川提出的中医血证诊断学的特色包括三方面：重视病位、结合各种辨证于一体与以六经六气与脏腑经络标本中气整合相关辨证等。唐容川于《伤寒论浅注补正》提出“上中下本标中气图”与“脏腑应天本标中气图”,针对六经之气本标中气与脏腑经络本标中气,在陈修园的六经六气理论的基础上,做了进一步的阐发。唐容川解释“上中下本标中气图”,系以六经之气以风寒热湿燥火为本,三阴三阳为标,本标之中,见者为中气,中气如少阳厥阴为表里,阳明太阴为表里,太阳少阴为表里,表里相通则彼此互为中气。而“脏腑应天本标中气图”以脏腑为本,居里；十二经为标,居表；表里相络者为中气,居中。所谓络者乃表里相互维络,如足太阳膀胱经络于肾,足少阴肾经亦络于膀胱等。在《伤寒论浅注补正》的六经病脉证篇中,可以更清楚与明确的看到有关阴阳水火气血与脏腑经络之间的生理与病机关系。例如《伤寒论浅注补正·辨太阳病脉证篇》中,唐容川提出以小肠与膀胱统称为太阳经,膀胱为寒水之府,小肠导心火下肾系,抵气海血室,化膀胱之水为气,“人必知小肠膀胱交通之道,又必知心肾水火相蒸之理,尤必知两腑两脏,其联络全在三焦。”指出了小肠、膀胱为主的水、火、气之间的生理与病机关系。总结：在血证诊断方面,唐容川重构了脏腑经络与阴阳水火气血之间相互维系的作用与变化。唐容川也将“阴阳水火气血论”与“脏腑病机论”,引入并融入血证传统诊断体系,建构了以辨病为纲,辨证与辨病相结合的特色诊断体系。唐容川所提及的与血水相关的“水瘀病”,是中医瘀血辨证论治的新方向。
[Abstract]:This paper consists of three parts, the first part is a summary, the second part of the ancient academic origin of blood syndrome, the third part of the study on the diagnosis of TCM Blood Syndrome Based on Tang Rongchuan's "blood syndrome theory", and the analysis of the inheritance and evolution process of TCM Blood Syndrome Differentiation and treatment. In the 5-6 century, "fifty-two cases of disease", the treatment of hemorrhoids and haemorrhoids in the treatment of bleeding and the treatment of hemorrhoids with internal and external washing with charcoal in the hair cattail. < < internal classics > > for the inspection and pulse diagnosis of blood syndrome, syndrome differentiation of cold and heat deficiency and Yin and Yang, six types of syndrome differentiation, seven feelings syndrome, trauma, etiological syndrome differentiation, syndrome differentiation of Qi and blood body fluid and syndrome differentiation of viscera, etc. Later generations of doctors in the syndrome differentiation of blood syndromes. During the Han Dynasty, "historical records, Bian Que storehouse biography", "blood syndrome" called "blood syndrome" many times, the way of writing the diagnosis and treatment of blood syndrome is regarded as the ancestor of modern medical cases. < treatise on typhoid fever > with the form of theory, law, prescription and drug combination, raising the thinking of syndrome differentiation and treatment of blood syndrome, including the suggestion Blood syndrome of the "prescription test" to identify the deficiency and real cold and heat of the blood syndrome, etiology, pathogenesis and disease position. Pay attention to the "reconciliation method", such as the method of reconciliation of small Bupleurum soup, such as Shaoyang heat entry, pay attention to "blood and sweat homology", pay attention to the difference between water and blood and disease in gynecological treatment, and prompt attention to the difference between the treatment method of miscellaneous diseases. "Uncle" and "pulse formula >" and so on, taking pulse syndrome as the center, describing the deficiency and truth of the cold and heat of the five viscera and six organs disease syndrome, forming a systematic syndrome differentiation theory of viscera, and applying it to the exposition of blood syndrome and the treatment prescription. On the basis of the Sui, Tang and Five Dynasties, "the origin of the disease", on the basis of the "inner meridian >" and the theory of typhoid miscellaneous diseases, combined with the clinical practice experience, the various kinds of traditional Chinese Medicine The cause of the blood syndrome, the pathogenesis, the position of the disease and the clinical diagnosis and treatment have been recorded in detail. It should be a complete medical work on the syndrome of blood syndrome in China. During the two Song period, "three because of the theory of extremely one disease," the three cause of the blood syndrome and the three cause of the individual blood syndrome, N& and the Southern Song Dynasty Chen Ziming put forward the "blood stasis and cold blood". The coordination of the function of the Fu organs, and put forward the theory that "all six Qi can turn the fire", and pay attention to "the fever is the disease". Zhang Congzheng advocates the argument of "bleeding so the blood nourishing"; Li Gao puts forward the theory of spleen and stomach theory of "internal injury and spleen and stomach, all kinds of diseases rise"; and Zhu Danxi further develops the view that "hot and damp heat is a lot of disease", and attaches importance to the Yin of the spleen and soil. The importance of Nourishing Yin enriching blood. Ming and Qing Dynasties, Miao Xi Yong put forward "three to vomit blood" and "cure blood Three": Xiao Jing put forward the argument of "treating blood and Quietness"; Li Zhongzi made clear that "kidney is congenital, spleen is the day after", while emphasizing "cure congenital root, there is water and fire division", "cure the day, there are dietetic tiredness". Zhang Jingyue further expounds the importance of "blood" to human body, spirit and will, and puts forward the experience of "fire flourishing" and "Qi injury" as the most important pathogenesis of blood syndrome and "many blood evidence". "The reason why the cause of fire, all because of blood failure, the blood is enough to make fire", "blood is dampness, the wet anti fire down", "the liver is thus helping the spleen" of gynecologic blood syndrome innovation thinking; ye Tian Shi summed up the "three causes of blood loss" and the corresponding treatment, "external causes, must have the first sense; internal factors, must have internal evidence; no internal and external causes. On the basis of Tang Rongchuan's theory of "Yin and Yang water fire" and "viscera pathogenesis theory", Chen Xiuyuan put forward the foundation of Tang Rongchuan's theory of "Yin and Yang water fire" and "viscera disease machine theory" from the pulse image theory of "blood separation disease". Wang Qingren proposed the anatomic position and function path of the Qi gate, the general management, the Rong chief, the Qi Fu and the Xuefu, the mansion, the Jinmen and the Tianjin Pipe, and explained the Qi and blood Tianjin The relationship between the circulation of the liquid, the pathogenesis of the cause of blood stasis, and the clinical guiding significance of treating all the symptoms of the prolonged treatment to the blood stasis is of clinical guiding significance. On the basis of "the medical and forest modification", Zhu Peiwen put forward the anoxic blood of "blood menstruation, carbon gas and color purple". On the basis of the basic theory of blood syndrome, on the basis of the basic theory of blood syndrome, on the basis of the basic theory of "internal classics >" and "six meridians" as "blood syndrome theory >" "Yin and Yang water fire and blood circulation theory" and "Zang Fu organs" on the basis of the basic theory of blood syndrome, the basic theory of the two aspects of the basic theory of blood syndrome. On the basis of the theory of blood syndrome in the theory of "pathogenesis", the content includes the philosophical thinking of "the corresponding nature and human being" that echoes the mutual root of yin and Yang, developing the theory of "Yin and Yang" with "Yi Yi", reconstructing the gasification theory of the vaporization blood of water and fire, making the pathogenesis of the cause and disease of water, fire, blood and blood, and taking "the theory of six meridians" to "the Yin and Yang fire and the blood and the blood and the blood and blood theory" and " The theory of viscera disease machine theory "integrated reconstruction, become the basic theory of blood syndrome and the characteristic of diagnosis of blood syndrome of syndrome differentiation. As the representative doctor of the school of the Hui Tong School in the late Qing Dynasty, Tang Rongchuan was familiar with the knowledge of Western medicine, and was deeply influenced by the anatomy of Western medicine and physiological knowledge. In his writings, many attempts were made to explain the anatomy of Western medicine with the purpose of ancient Chinese medicine." Tang Rongchuan proposed that. The characteristics of the diagnosis of TCM blood syndrome include three aspects: attaching importance to the disease position, combining the syndrome differentiation in one body and the syndrome differentiation related to the Qi and Zang Fu meridians and collaterals in the six meridians and the Zang Fu meridians and collaterals. Tang Rongchuan proposed the "middle and the middle and the middle and the lower standard medium gas map" and the "Zang Fu and the Tian Ben standard gas map" in "the shallow injection of the typhoid fever". On the basis of the six Qi theory of the six meridians of the Zang Fu organs and meridians, Tang Rongchuan explained the theory of "six meridians" in Chen Shiyuan, explaining the "middle and lower middle and lower standard gas map", which is based on the gas of the six meridians with the wind cold and hot wet heat, and the three yin and three yang as the standard. In the form of Yin, the interconnecting of the inner and the inside is medium Qi. And "the viscera should be in the sky map" with the viscera as the basis, Curie; twelve as the standard, the living table; the form and collaterals are middle Qi and middle. The so-called collaterals are interrelated with each other, such as the meridians of the sun bladder meridians to the kidney, the foot less Yin kidney meridian also on the bladder, etc. In the vein of the disease, the relationship between the physiology and the pathogenesis between yin and Yang, water, fire, Qi and blood and viscera meridians can be seen clearly and clearly. For example, Tang Rongchuan proposed that the small intestine and bladder is the sun meridian, the bladder is the house of cold water, the kidney of the small intestine, the blood chamber of the Qi sea, the bladder and the bladder. The water is Qi, "people must know the way of the small intestine and bladder traffic, but also know the kidney water and fire steam, especially the two Zang Fu two dirty, the contact is all in three jiao." points out the relationship between the physiology and the pathogenesis between the small intestine, the water, the fire and the gas. Tang Rongchuan also introduced and integrated into the traditional diagnosis system of blood syndrome, and constructed the characteristic diagnosis system of combining the disease as the outline, the syndrome differentiation and the disease discrimination. The "water stasis" related to the blood and water in Tang Rong Sichuan is a new direction of TCM syndrome differentiation and treatment.

【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】：R241
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本文编号：1848159