明清学术视野下的伤寒学研究

发布时间：2018-06-18 05:54

本文选题：明清 + 学术　；参考：《中国中医科学院》2016年博士论文

【摘要】：自宋至清的一千多年里,儒医的数量不断增长,其临床声誉和学术影响力都日趋增大,逐渐成为中医史上的重要群体。由于大量传世医著出自儒医之手,显然,儒学的学术思想、研究方法发展,与时代思潮的流变,会对中医思想学术的发展产生重要影响。这种影响在明清时期的儒医著作中表现的尤为明显。从1368年洪武开国,到1911年辛亥革命,明清两朝544年历史,是我国古代思想文化史极大繁荣,学术辉煌发展的时代。这五百余年中,不但经史之学成就斐然,中医学也取得了长足的进展。《伤寒论》作为中医史领域的重要经典,其至高无上的学术地位即奠定于明清时期,而关于伤寒学的理论和临床研究也在这时达到了极大繁荣。本文根据明清时期的伤寒学研究的内在学术理路变迁,将这五百余年的《伤寒论》研究情况大致划分为明前期、明中晚期、清初、乾嘉时期四个阶段,通过以儒学为代表的中国传统学术史视角,对每个阶段的代表医家及其学术思想做出内史层面的归纳总结,考察阶段之间的内在承接与转折关系,亦尝试从外史的角度分析其学术成就与当时主流学术风气、社会思潮及社会文化现象之间的关系及相互影响情况。明前期是伤寒学术研究的整理与开创阶段。这一时期的医家继承了“金元四大家”的学术思路影响,同时探索并开辟了明清伤寒学术的新思路。从《伤寒论》的学术研究理路看,王履可谓是金元与明清的“承上启下人”。他较早提出“以法类证”研究《伤寒论》,并对王叔和、林亿等人整理编校的《伤寒论》原文内容、顺序提出质疑,开创了明清伤寒学派“错简重订”与“维护旧论”的数百年争鸣。许宏的《金镜内台方议》,是对《伤寒论》做出方剂学研究的重要尝试,通过以方类证的体裁对经方做了详细的分类和阐述,通过探讨经方的组成特点,阐释《伤寒论》的辨证用药规律。其严整的理论性建立在追本溯源、联系临床的基础上,与金元诸医的学术风格迥然不同。刘纯师将宋儒精研易学的理论成就引入医理考述,形成了自己独特的学术体系。他重视医案,以临床病情和方药运用为例,阐述方证关系,对明代以后的医学理论和实践有重要影响。总体上,这一时期的《伤寒论》研究体现出承上启下的特点,一方面对金元时期诸医家争鸣做出归纳总结,一方面产生新的学术关注点,尝试新的研究思路,从方法上和观点上,都开辟了后世伤寒学研究的先河。明中晚期是伤寒学术研究的重构与变革时期。《伤寒论》的学术地位进一步提高,医家在语句注疏、文义考证之外,对其内在逻辑系统的解释和重构产生浓厚兴趣。这一时期,主流学术史上的重大事件是“心学”对“理学”的对抗和消解。儒学中的质疑与重构之风影响到医家,促进了医家对《伤寒论》的归纳、质疑和深入探讨。方有执提出“错简论”,并创三纲鼎立说,影响极大。其观点在后世医家中引起了巨大的争论,掀起了伤寒学研究的新高潮。王肯堂的《伤寒证治准绳》对伤寒学的补充主要体现在疾病、症状、诊断、方剂四个方面。王肯堂的《伤寒证治准绳》乃至整个“准绳”系列丛书,是以伤寒方为主来讨论、整理内科学的尝试,将《伤寒论》条文和证治的内容丰富化、充实化。张介宾的《景岳全书·伤寒典》见解独到,以阴阳虚实的多层次、多角度反复论述,深化并完善伤寒学的理论体系研究,并将温病热病、补法温法等充实到伤寒学的诊疗体系中,丰富和发展伤寒学的诊疗思路。这一时期的伤寒学研究,以理论化、系统化追求为主要特点,在临床运用方面则呈现出丰富与多元的尝试。清初是伤寒学研究的反思与深入期,明清鼎革后,许多士人遁迹山林,他们对明末学风的反思也体现在这一时期的医学研究中,注重实学,开辟求知新路径,经世守身并重,理学回归等学术思潮对《伤寒论》理论研究的进一步深化有积极影响。同时这一时期《伤寒论》文字考据研究也发展起来。《尚论篇》是喻昌最重要的伤寒学术成果,其主要学术贡献是对伤寒学术理论系统化,清初《伤寒论》在中医思想学术领域地位达到空前高度,与喻昌的努力分不开。张志聪十分注重传统哲学的思辨分析,以阴阳虚实,经气交会,上下调和等方式来建立病机病因辨析。黄元御的将伤寒中的六经病分为太阳经络表病与其它五经脏腑里病两部分,同时又以六气统一营卫气血与六经辨证,将五运六气与伤寒六病的紧密结合,较为系统的整理出一套在临床上行之有效的理论学说,其对于纠正金元以来中医门派林立、各执一端的时弊有重要意义。乾嘉时期的《伤寒论》研究,随着考据学风的兴盛达到了全盛,并很快衰退。《医宗金鉴》是清代官修钦定的医学丛书,由清高宗倡议,官方主导,汇集百余位医家编纂而成,是清代最重要的医学成就之一。该书旗帜鲜明地提出,医生教学应当也只能以《伤寒论》为最基本、最重要的经典。这是对《伤寒论》学术地位的极大肯定。徐大椿的《伤寒类方》对《伤寒论》按照“不类经而类方”的原则重加整理,比柯琴更彻底地摆脱了六经分类,直接以方类证,阐发经旨。陈念祖在伤寒学术研究上的主张,主要是肯定王叔和编订的《伤寒论》原貌,认同成无己的注释具有高度学术价值。《伤寒医诀串解》是他一生精研伤寒学术的精要。在“维护旧论”的大背景下,对伤寒论的理论脉络做了学术梳理,形成自己独有的伤寒学术体系。中医伤寒一脉至此蔚为大观。
[Abstract]:In the one thousand years of the song and Qing Dynasties, the number of Confucian doctors has been increasing, its clinical reputation and academic influence are increasing, and gradually become an important group in the history of traditional Chinese medicine. Because of the large number of doctors from Confucianism, it is obvious that the academic thought of Confucianism, the development of research methods and the evolution of the trend of thought of the times will develop the academic development of traditional Chinese medicine. The influence of this influence was particularly evident in the Confucian classics of the Ming and Qing Dynasties. From the opening of Hongwu in 1368 to the revolution of 1911 in 1911 and the two dynasties of Ming and Qing Dynasties, the history of Chinese ancient thought and culture was flourishing and the academic brilliance developed. In these five hundred years, not only the achievements of history and traditional Chinese medicine have been achieved, but the traditional Chinese medicine has also been obtained. As an important classic in the history of traditional Chinese medicine, the supreme academic status of the theory of typhoid fever is established in the Ming and Qing Dynasties, and the theoretical and clinical studies on typhoid fever have also reached a great prosperity. This article, based on the internal learning of the study of typhoid fever in the Ming and Qing Dynasties, has made these five hundred years of "the theory of typhoid fever" The research situation is divided into four stages in the early Ming Dynasty, the late Ming and the late Ming Dynasty, the early Qing Dynasty and the Qianlong and Jiaqing period. Through the traditional Chinese academic history, represented by Confucianism, the author sums up the internal history level of the representative doctors and their academic thoughts in each stage. The relationship between the academic achievements and the prevailing academic atmosphere, the social trend of thought and the social and cultural phenomena and the interaction between them. The early stage was the arrangement and initiation stage of the academic research on typhoid fever. The doctors of this period inherited the influence of the academic thought of "Jin Yuan four", and explored and opened new ideas for the learning of typhoid fever in the Ming and Qing Dynasties. In view of the academic study of the theory of "Treatise on typhoid fever", Wang Lv is a "inheriting man" in Jin Yuan and Ming and Qing Dynasty. He earlier proposed the study of "the theory of law of law", "Treatise on typhoid fever", and questioned the order of the original content of "the treatise of Typhon", which was compiled and edited by Wang Shuhe, Lin Yi and others, and created the "reordering of the error reduction" and "maintaining the old theory" of the Ming and Qing School of typhoid fever. For hundreds of years, Xu Hong's "TaiFang discussion in the golden mirror" is an important attempt to make a prescription for the study of the theory of "Treatise on typhoid fever". Through a detailed classification and exposition of the prescriptions based on the genre of square syndrome, by discussing the composition characteristics of the classics, the law of the syndrome differentiation of "the theory of typhoid fever" is explained. On the basis of this, it is quite different from the academic style of Jin and Yuan Zhu. Liu Chun Shi introduced the theoretical achievements of the song Jing Jing Jing Yi Xue to the medical science examination and formed his own unique academic system. He paid attention to the medical case, took the clinical condition and the prescription of prescription as an example, expounded the relation of the prescription, and had an important influence on the medical theory and practice after the Ming Dynasty. The study of "the theory of typhoid fever" in the first period embodies the characteristics of the preceding and the following. On the one hand, it makes a summary of the contention of all the doctors in the Jin and Yuan Dynasties. On the one hand, it produces a new academic concern and attempts a new research idea. Both methods and views have opened up the first river of research on typhoid fever. The middle and late Ming Dynasty is the reconstruction and reform of the academic research of typhoid fever. The academic status of the theory of "typhoid fever" has been further improved. In addition to the annotation of sentences and textual textual criticism, doctors have a strong interest in the interpretation and reconstruction of the internal logic system. In this period, the major event in the mainstream academic history is the confrontation and digestion of "the philosophy" to "science". We have entered into the induction, question and deep discussion of the theory of "the theory of typhoid fever". Fang has put forward the theory of "error reduction", and creates a three outline and great influence. Its viewpoint has caused great controversy in later physicians and set off a new climax in the study of typhoid fever. Four aspects: Wang Ketang's < typhoid syndrome and treatment guidelines > and even the whole "line" series of books, which are mainly discussed by the typhoid party, collate the attempts of the internal medicine, enrich and enrich the contents of the treatise on typhoid fever and the treatment of the syndrome. Zhang Jiebin's "Jing Yue whole book, typhoid code >" is unique in many levels and multiple angles of yin and Yang. To deepen and improve the study of the theoretical system of typhoid fever, and to enrich and develop the diagnosis and treatment of typhoid fever in the diagnosis and treatment system of typhoid fever, and enrich and develop the diagnosis and treatment of typhoid fever. The study of typhoid fever in this period is characterized by theoretical and systematic pursuit, and presents rich and diverse attempts in clinical application. In the early Qing Dynasty, the study of typhoid fever was reflected and deepened. After the Ming and Qing Dynasties, many scholars fled to the mountain forest. Their reflection on the study style of the late Ming Dynasty was also reflected in the medical research of this period. At the same time, "Shang Han theory > text textual research also developed." Shang Wen > is the most important febrile academic achievement of Yu Chang. Its main academic contribution is to systematize the academic theory of typhoid fever. The position of "Shang Han theory >" in the academic field of traditional Chinese medicine has reached an unprecedented height in the early Qing Dynasty. It is inseparable from the efforts of Yu Chang. Zhang Zhicong pays great attention to the tradition. The speculative analysis of philosophy is to distinguish between yin yang deficiency and reality, the meridian intersection, the down regulation and the way to establish the pathogenesis of the disease. The six meridian diseases of Huang Yuan Royal are divided into two parts of the sun meridian surface disease and the other five meridian viscera diseases. At the same time, the six Qi and the Qi and Wei Qi blood and the six meridians are identified, and the five transport and six gas and the typhoid six diseases are closely combined. A set of theoretical theories which were effective in clinical practice had been made for the system. It was of great significance to the correction of the traditional Chinese medicine school since the Jin Yuan Dynasty. The study of "the theory of typhoid fever" in the period of Qianlong and Jiaqing has reached its heyday with the prosperity of the study style. It is one of the most important medical achievements of the Qing Dynasty, which is one of the most important medical achievements in the Qing Dynasty. The principle of "no analogy" and "class square" was put forward to get rid of the classification of the six classics more thoroughly than that of the six classics. Under the background of "maintaining the old theory", the theoretical context of the theory of typhoid fever was combed and the unique academic system of typhoid fever was formed.
【学位授予单位】：中国中医科学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R222.2

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