从《临证指南医案》研究叶天士的杂病辨治理论

发布时间：2018-07-03 14:27

本文选题：叶天士 + 杂病　；参考：《广州中医药大学》2016年硕士论文

【摘要】：脏腑学说是中医基础理论的核心,脏腑经络辨证、气血津液辨证及八纲辨证是中医临床辨治体系的主要内容,《伤寒论》六经辨治体系即本于此。叶氏将气血津液辨证发展为卫气营血辨证,揭示了新感温病及伏气温病的传变规律。在杂病辨治上,提出脏属阴、腑属阳、初病在经属气、久病入络属血、久损入奇经八脉的学说观点,并拟定相应的治法治则,一定程度上揭示了杂病发展规律及证治特点,值得临床借鉴。叶天士依据《内经》五脏藏精气不泻、六腑传化物不藏的基点,意识到脏腑阴阳藏泻属性的不同,提出脏腑分治说,其中最突出的是脾胃分治说,笔者认为还有肾、膀胱、三焦分治观。治脏病多用收涩固摄,治腑病多用通泄。善用麦门冬汤通补胃阴,大半夏汤通补胃阳,复脉汤滋水涵木,肾气丸通阳摄阴,五苓散通畅三焦、淡以通阳。叶天士继承《内经》、《难经》关于络病的记载,提出久病入络说,发展了经络辨证,揭示了杂病传变的浅深层次,丰富了中医治法理论。络病分虚实两端,而多属实证。络实轻证治以旋覆花汤法辛润通络,络实重证治以大黄蛰虫丸虫蚁搜埸；络虚证主要治以桂枝汤及当归生姜羊肉汤的辛香甘温法,并与奇经病相结合来论治。叶天士对奇经八脉的论述是与络病结合在一起的。奇经病多由脏阴虚损、肝血肾精久虚不复而来,属于络虚证的进一步发展。治疗主要以血肉有情、柔剂通阳,选药重视辛香入络、秽浊入阴。叶天士治疗杂病虽然博采众方,但经方却是他最常选用的,而且在化裁使用经方的基础上,创造性地提出诸多学说,如阳化内风说、养胃阴说、络病学说及奇经八脉说,论述叶氏杂病辨治思想,经方是绕不开的话题,因叶氏最善用古方,经方的使用集中体现了他的杂病辨治观。综上,笔者根据叶案体现的临床治疗思想,认为叶天士治疗杂病有“脏阴一腑阳—经气—络血一奇经八脉”五个辨治系统,有其各自的治疗特点,有助于辨别病位、病势,一定程度上反映了杂病的传变过程,或将有利于中医临床。故欲总结阐述这五个系统,以期总结叶氏杂病辨治整体观和恒动观,以指导日后的临床实践。
[Abstract]:The theory of zang-fu organs is the core of the basic theory of traditional Chinese medicine, and the differentiation of zang-fu meridians and collaterals, qi, blood and body fluid and the eight principles of syndrome differentiation are the main contents of the clinical differentiation and treatment system of TCM, and the system of differentiation and treatment of the six meridians is based on this. Ye developed the syndrome differentiation of qi, blood and body fluid into the differentiation of Wei Qi and Ying blood, and revealed the law of transmission of new temperature sickness and latent temperature disease. In the treatment of miscellaneous diseases, it is put forward that the viscera belong to yin, the viscera to yang, the first disease to Qi, the long illness to collateral blood, the long damage to the eight meridians of Qijing, and the corresponding principles of treatment are drawn up. To a certain extent, the law of development and the characteristics of syndrome and treatment of miscellaneous diseases are revealed. It is worthy of clinical reference. Ye Tianshi, on the basis of the fact that the essence of the five viscera and the essence of the qi were not purged and the six fu-organs were transferred from the body to the ground, and realized the difference in the attributes of the zang-fu organs, Yin and Yang, he put forward the theory of dividing the zang-fu organs, the most prominent of which was the theory of dividing the spleen and stomach. The author believed that there were also the kidneys and the bladder. The view of division and rule of the three-coke. The treatment of visceral diseases is used to collect astringent fixation, the treatment of internal organs more use of catharsis. Make good use of Maimen Dong Tang tonifying stomach yin, big Banxia decoction tonifying stomach Yang, Fumai decoction Zishui Han wood, Kidney Qi pills Tongyang Yin, Wuling scattered unobstructed Sanjiao, light to Tongyang. Ye Tianshi inherits the records of collateral disease in "Internal Classic" and "difficult Classic", puts forward the theory of long illness into collateral, develops the syndrome differentiation of meridian, reveals the shallow and deep level of the spread of miscellaneous diseases, and enriches the theory of TCM treatment method. Collateral disease is divided into two ends of deficiency and reality, and most of them belong to empirical evidence. The deficiency syndrome of collaterals was mainly treated by cinnamon decoction and Angelica ginger mutton soup by Xin-Xiang Gan Wen method, and was treated by combination of Qi Jing disease and Qi Jing disease. Ye Tianshi's exposition on the eight veins of Qijing is combined with collateral disease. Qi-Jing disease is caused by viscera-yin deficiency and liver-blood-kidney essence-deficiency, which belongs to the further development of collaterals deficiency syndrome. Treatment mainly with blood and flesh, soften agent Tongyang, drug selection attention to Xin Xiang into the collateral, turbidity into the yin. Although Ye Tianshi used to treat miscellaneous diseases, he chose the prescription most frequently, and creatively put forward many theories, such as Yanghua Inner Wind Theory, Yanghua Inner Wind Theory, collateral Disease Theory, and Qi Ba-mai theory. It is an inextricable topic to discuss Yeh's thought of differentiating and treating miscellaneous diseases, because Ye's best use of ancient prescriptions embodies his view of differentiation and treatment of miscellaneous diseases. In summary, according to the clinical treatment thought embodied in Ye's case, the author thinks that Ye Tianshi's treatment of miscellaneous diseases has five treatment systems: "Zang Yin, Fu Yang, Meridian Qi, collaterals and Blood Qi, Qi and Qi Meridian Meridians", and has its own therapeutic characteristics, which is helpful to distinguish the disease position and disease potential. To some extent, it reflects the process of transmission of miscellaneous diseases, or will be beneficial to the clinical practice of traditional Chinese medicine. So we want to summarize the five systems in order to sum up the whole view and constant motion view of the differentiation and treatment of Ye's miscellaneous disease, so as to guide the clinical practice in the future.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R249.2

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