藏医“蓄、发、息”发病机制及“赤占”病的发病过程研究

发布时间：2018-08-16 14:44

【摘要】：病因是研究和阐明疾病发生的原理,发病机制是研究在病因作用下疾病发生发展的过程,;两者都是藏医学基础理论即藏医病机学内容的重要组成部分,亦是连接理论与实践的桥梁和临床诊治疾病的主要依据。自藏医经典《月王药珍》和《四部医典》成书至今,历代藏医学家对病机重视有加,代有发展,但见仁见智,尚缺乏系统的理论研究与整理,对病机的定义未发掘藏医学的独特之处,并含义模糊,界限不清,内涵局限,指导临床存在普适性不足,对正确理解、解释与应用藏医病机理论造成困难。本文以整理、归纳藏医对疾病发展过程的认知为研究目的,整理藏医古籍文献,辨析病机含义,对藏医古典中提出的“出处”(s Kye m CHed)和“蓄(g Sog)、发(l Dang)、息(zhi)”以及“诱因”(s Long r Kyen)等病机构词进行对比和解读,辩证三者之间的关系;通过“比较异同、梳理嬗变”的纵向与横向比较研究方法,探讨疾病的发生和演变规律,结合藏医内因(也称三因)的“二十特性”和外缘之时辰、饮食等的“十七效”之间的生克关系,进一步对疾病过程进行考证,分析其理论在临床实践中的应用价值,为后继研究藏医发病机制提供本底资料;通过专家访谈、病理分析,对“赤占”(m KHris s Kran)病的发病过程、临床诊断、治疗实践等进行整理和总结,得出结果并与文献综述的研究结果相结合,从而间接证实“蓄、发、息”发病机制理论能够指导临床疾病诊治。藏医学认为一切疾病的发生由外缘和内因所决定,外缘即疾病发生的外在条件;内因即“隆”、“赤巴”、“培根”在体内互相协调,维持整个机体处在一种相对平衡的状态,保证生理活动;如内因的平衡状态发生紊乱就会引起疾病。各种病因作用于机体后可引起内因的平衡紊乱导致疾病,而内因本身的平衡紊乱又可以作为新的病因引起继发的疾病,故研究藏医学的疾病过程和发病机制,必须正确理解内因的“二十特性”与外缘的“十七效”之间生克关系的变化,正是因为此种生克关系,引起了“隆”、“赤巴”、“培根”由平息状态转化为疾病时的“出处”、“蓄、发、息”的发生和发展的过程。在《月王药珍》中最早提出了“蓄”、发、息”的概念,但未完全指出其含义。在《四部医典》的病机学中提出了“蓄、发、息”的概念以及其病因、病位、病性等的变化机理;在诊断学中指出按“蓄、发、息”发生发展的变化机理诊断疾病的方法;在治疗学中指出疾病处在“蓄”阶段应采用调理的药物治疗,“发”阶段应采用“峻泻”(s Byong Byed)的方法治疗,“息”即疾病缓和后应注意饮食行为,防止疾病再次被诱发。故此推断,“蓄、发、息”诠释了藏医学发病机制即发病过程。笔者参考藏医病机学、诊断学、治疗学、药理学等相关资料,钻研病机的含义,并将疾病的“发”与疾病“初期”、“中期”、“晚期”等概念相结合,细化疾病过程理论,挖掘藏医病机学的深层含义。因此正确理解藏医“蓄、发、息”发病机制的理论含义,有助于正确认识藏医对健康与亚健康、健康与疾病之间的区分,有助于指导临床疾病诊断、对症治疗等。
[Abstract]:Etiology is to study and clarify the principle of disease occurrence, pathogenesis is to study the process of disease occurrence and development under the effect of etiology, both of which are important components of basic theory of Tibetan medicine, i.e. the content of pathogenesis of Tibetan medicine, and also the bridge connecting theory with practice and the main basis of clinical diagnosis and treatment of diseases. Up to now, Tibetan medical scholars have paid more attention to pathogenesis than ever before, and have developed from generation to generation. However, they have different opinions, and lack of systematic theoretical research and collation. This paper aims at sorting out and summarizing the cognition of Tibetan medicine on the process of disease development, sorting out the ancient Tibetan medical literature, distinguishing the meaning of pathogenesis, and comparing the words of "origin" (s Kye m CHed) and "storage" (g Sog), hair (l Dang), zhi) and "inducement" (s Long R Kyen) in the classical Tibetan medicine. Through the longitudinal and horizontal comparative research methods of "comparing similarities and differences, combing transmutation", the occurrence and evolution of diseases are discussed, and the relationship between the "twenty characteristics" of internal causes (also called three causes) and the "seventeen effects" of diet, etc., is further improved. By conducting textual research, analyzing the application value of its theory in clinical practice, providing background information for the follow-up study of the pathogenesis of Tibetan medicine; through expert interviews and pathological analysis, sorting out and summarizing the pathogenesis, clinical diagnosis and treatment practice of "Chizhan" (m KHris s Kran) disease, the results are combined with the results of literature review. Tibetan medicine holds that the occurrence of all diseases is determined by external and internal causes, that is, the external conditions for the occurrence of the disease; and that the internal causes are "uplift", "chiba" and "bacon" coordinate each other in the body to maintain a relatively balanced state of the whole body. The disorder of the balance of internal causes can lead to the disorder of the balance of internal causes, and the disorder of the balance of internal causes can be used as a new cause to cause secondary diseases. It is precisely because of the change of the relationship between the "twenty characteristics" of the internal cause and the "seventeen effects" of the external cause that the "longing", "chiba" and "bacon" are transformed from the state of subsidence into the "origin" of the disease, and the occurrence and development of "reserve, hair, breath". In the etiology of the Four Medical Books, the concept of "accumulation, hair and rest" and the change mechanism of its etiology, disease location and disease etc. are put forward; in the diagnosis, the method of diagnosing disease according to the change mechanism of "accumulation, hair and rest" is pointed out; in the treatment, the disease is in the "accumulation" stage. It is concluded that the pathogenesis of Tibetan medicine, i.e. pathogenesis, diagnostics and therapeutics of Tibetan medicine, is interpreted by "storing, sending and breathing". Pharmacology and other relevant information, study the meaning of pathogenesis, and combine the concepts of "hair" and "early", "middle" and "late" of the disease, refine the theory of disease process, excavate the deep meaning of pathogenesis of Tibetan medicine. The distinction between health and sub-health, health and disease helps to guide clinical diagnosis and symptomatic treatment.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R29

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