癃闭的古代文献研究与学术源流探讨

发布时间：2018-07-27 13:31

【摘要】：癃闭的定义：癃闭是以排尿困难、小便量少、点滴而出,甚则闭塞不通为主的病证。一般以小便不利、点滴而短少、病势较缓者称为癃,而以小便闭塞、点滴不通、病势较急者称为闭。病位在肾与膀胱,因两者功能失调,三焦气化不能宣行所致。本病证相当于西医学中因各种原因所致的尿潴留和无尿症,如肾前性、肾后性及肾实质病变所致的急慢性肾功能衰竭的少尿或无尿症,以及尿路结石、尿路肿瘤、尿道狭窄、尿路损伤、前列腺增生、膀胱括约肌痉挛、神经性尿闭、脊髓炎所致的尿潴留。1.研究目的：①厘清“癃”在古代文献中的多重涵义以及与癃闭相关病名的历史沿革；②按照时间脉络,挖掘、整理、剖析重要医家及论著辨治癃闭的学术观点,理清学术上的继承性和发展性；③探讨脉诊在癃闭五脏辨治中应用的相关问题。2.研究方法：本课题采用传统文献学研究方法,以先秦到清代各个时期与癃闭相关的文献为研究对象,主要从病因病机、辨证分型、治则治法、处方用药、预防调摄等方面整理分析。具体操作方案：通过《中国中医古籍总目》筛选出与癃闭相关的古籍,再结合《中华医典》检索书籍中的内容,机检与手检相结合,确定最终选用的医籍；图书自北京中医药大学图书馆、中国中医科学院图书馆、中国国家图书馆获取。3.研究结果：①“癃”在古代文献中的涵义：“小便不利或尿闭”、“不能行走”、“疲病”,中医学主要取第一个含义。②癃闭相关病名的历史沿革：“癃”与“淋”一直混淆不清,到了明代,癃、淋的含义得到厘清,才被作为独立的病症分而论治。③各个时期对癃闭的认识：先秦两汉至魏晋南北朝时期,药物学、方剂学、治疗学都处于摸索的状态,但《黄帝内经》对其病位、病因、病机、治则皆有论述；隋唐时期,癃闭辨治最大的进展为外治法中导尿术的创新、方剂的辑录及癃闭严重性的提出；宋金元时期,对癃闭的研究各家争鸣,许多医家提出了卓越性见解,此期官修医书中关于小便不通的辨治文献十分可观；明代,癃闭的辨治体系趋于完善,对并发症、诊断分型、治则治法、药物方剂皆有极大地发展,并理清了癃闭淋的区别；到了清代,癃闭的辨治已经成熟,尤其是提出了辨证中的六大误区,四大最危急症,处方用药也有提升。④脉诊在癃闭五脏辨治中的应用：心肝脾肺肾五脏的功能紊乱皆可导致癃闭的发生,当病患症状表现过于单一或者杂乱难于辨证时,脉诊有利于分析癃闭发病的根源,更有针对性地指导处方用药,从而增强疗效。
[Abstract]:The definition of dysphagia: dysuria is dysuria, urination is less, dripping out, and even block the main symptoms. Generally to urinate unfavorable, drip and short, the disease is called longer, and to urinate obliterate, drip impassable, the disease is more urgent called closed. The disease is located in the kidney and bladder, due to the dysfunction of the two, three-coke gasification can not be declared. This syndrome is equivalent to oliguria or anuria caused by various causes in western medicine, such as acute and chronic renal failure caused by prerenal, postrenal and renal parenchymal lesions, as well as urinary calculi, urinary tract tumors, and urethral strictures. Urinary tract injury, Prostatic Hyperplasia, sphincter of bladder spasm, Neurostatic urinary obturation, Myelitis induced urinary retention. 1. 1. Objective: to clarify the multiple meanings of "longong" in ancient literature and the historical evolution of the name of the disease associated with dystopia. [2] to explore, sort out and analyze the academic viewpoints of important doctors and books on the treatment of dystopia according to the time context. To study the application of pulse diagnosis in the treatment of dysphoria. Research methods: this topic adopts the traditional philology research method, taking the literature related to dysphoria from pre-Qin to Qing Dynasty as the object of study, mainly from etiology and pathogenesis, syndrome differentiation, treatment method, prescription drug use. Prevention adjustment and other aspects of analysis. The concrete operation plan: through "Chinese traditional Chinese Medicine Ancient Books General catalogue" to screen out the ancient books related to dysphagia, then combined with the "Chinese Medical Code" to retrieve the contents of the books, machine examination and hand examination to determine the final selection of medical books; Books from Beijing University of traditional Chinese Medicine Library, the Chinese Academy of traditional Chinese Medicine Library, the National Library of China access. 3. The results showed that the meaning of "long" in ancient literature: "unfavorable urination or obstruction of urine", "inability to walk", "fatigue", Traditional Chinese medicine mainly takes the first meaning of the historical evolution of the name of Longobu related diseases: "long" and "Lin" have been confused, by the Ming Dynasty, the meaning of Longlin has been clarified, It was treated as an independent disease. 3. The understanding of dystopia in every period: from the pre-Qin and Han dynasties to the Wei, Jin and Southern and Northern dynasties, pharmacology, prescriptions, and therapeutics were all in a groping state, but Huangdi Neijing was concerned about the location, etiology, and pathogenesis of the disease. During the Sui and Tang dynasties, the greatest progress in the treatment of dysphoria was the innovation of catheterization, the compilation of prescriptions and the presentation of the severity of dysphoria. Many physicians have put forward outstanding opinions, and the literature on distinguishing and treating impassable urination in this period of the official medical book is quite considerable. In the Ming Dynasty, the system of distinguishing and treating dysphagia tended to be perfect, and the complications, diagnosis, classification, and treatment were treated according to the law. Drug prescriptions have greatly developed and sorted out the difference between dysphoria and dysphoria. By the Qing Dynasty, the differentiation and treatment of dysphoria had matured, especially six major misunderstandings in syndrome differentiation and four of the most critical diseases. Prescription medication also promoted the use of .4 pulse diagnosis in the treatment of dysphoria: the dysfunction of heart, liver, spleen, lung, kidney and five viscera could lead to dysphonia, and when the symptoms of patients were too single or confused, it was difficult to differentiate symptoms. Pulse diagnosis is helpful to analyze the root causes of dysphagia and to guide prescriptive medication to enhance the curative effect.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R256.53

【参考文献】