明代瘴病证治特色及对岭南医学的影响研究

发布时间：2018-08-27 07:20

【摘要】：目的：系统整理明代六本中医著作中的有关瘴病证治的文献,分析瘴病证治方、药数据,总结明代中医治疗瘴病的规律与特点,并探讨明代瘴病文献对岭南医学流派理论建设的价值及影响。方法：以文献研究法为主,对明代医著《普济方》、《明医杂著》、《古今医统大全》、《景岳全书》、《瘴疟指南》、《三合集》六书瘴病相关内容进行整理。对文献中有关瘴病的理论进行系统收集,分类进行梳理；从病因、病机、治法、方药等角度,总结明代的瘴病论治的规律特色。总结瘴病相关方药、方剂数据,并进行分析。将数据分析结果与理论研究进行对照分析,进一步归纳明清瘴病证治的规律与特色。结合天人合一和异病同治思想,探讨明代瘴病文献中的环境病理思想要素与体质病理思想要素及其对岭南医学理论研究的意义。成果：《普济方》论瘴病分为“山岚瘴气疟”和“时气瘴疫”,列治瘴方药共136条,集明以前医家之大成。病因理论,包括气候条件致病、“饥饱过伤”、“荣卫虚弱”、“山岚烟雾”、“蛇虺郁毒”、“涉溪涧”、“山溪毒气”、“风温痰饮”、“鬼疠”、“热毒”等,所论瘴病辨治主张以槟榔御瘴,重视瘴病合并泄痢的调理,主张瘴病愈后精心调理,待正气恢复。王纶《明医杂著·拟治岭南诸病篇》将瘴病分岭南伤寒、疟证、天行瘟疫热病、温黄四种论治。注重瘴病的愈后调摄。徐春甫《古今医统大全》将瘴病分“瘴疟”与“瘴气”两类,治疗与愈后调养都注重培补正气。《瘴疟指南》中,《辨证》章分别论述瘴病病因、症状、鉴别诊断、分型、脉象、预后判断、妇人小儿瘴病、调理方法、并发症处理等内容。《辨药》章按药性阐述升药、降药、平胃药,随后详列麻黄、柴胡、槟榔、附子、常山、黄芪、白术等药在治疗瘴病时的使用方法。卷下六章,将治瘴常用方按治法分六类述之。《景岳全书》作者张介宾认为岭南瘴病与岭北伤寒、疟疾无异,治瘴不离寒热虚实及有邪无邪。治瘴应重视内虚病机,随证补之。《三合集》引入六经、六气辨证,结合因地制宜等因素,提出瘴病虽因外感瘴气发病,但本因为内伤不足。治疗以“解外感”为主,间或辅以“扶内伤”。结论：明代医家在对瘴病的诊疗过程中明晰了瘴病的外感病内涵；完善了瘴病病机,对内虚病机的重视成为发展岭南特色杂病证治的重要理论基础；开始探寻了岭南外感病治疗体系,为岭南医学流派建设提供了理论基础。明代医家对瘴病的探索深化了人们对岭南体质的认识和岭南疾病的认识。从瘴病中分离出杂病部分,提高了岭南杂病证治水平。
[Abstract]:Objective: to systematize the literature on the syndromes and treatment of miasma in six books of the Ming Dynasty, analyze the prescriptions and data of the treatment of miasma, and summarize the law and characteristics of the treatment of miasma in the Ming Dynasty. The value and influence of the literature on miasma in Ming Dynasty on the theory construction of Lingnan medical school were discussed. Methods: the literature research method was used to sort out the related contents of the medical works of Ming Dynasty, such as Puji recipe, mixed Medical works of Ming Dynasty, General Collection of Ancient and Modern Medicine, Jingyue Guidebook, Guide to miasma and Malaria, and six Books of miasma. This paper systematically collects and classifies the theory of miasma in the literature, and summarizes the characteristics of the law of the treatment of miasma in Ming Dynasty from the angles of etiology, pathogenesis, treatment, prescription and medicine. To summarize and analyze the data of related prescriptions and prescriptions for miasma. The results of data analysis and theoretical study were compared and analyzed, and the law and characteristics of the treatment of miasma syndrome in Ming and Qing dynasties were further summarized. Combined with the thought of the unity of nature and human being and the same treatment of different diseases, this paper discusses the elements of environmental pathology and physique pathology in the literature of miasma in Ming Dynasty and their significance to the theoretical study of Lingnan medicine. Results: the miasma is divided into "Shan Lan miasma malaria" and "Shiqi miasma epidemic". There are 136 prescriptions for treating miasma. Etiological theories, including climatic conditions, "hunger and satiety injury", "Rongwei weakness", "mountain haze", "snake cobra depression", "wading stream", "mountain stream gas", "wind-warming phlegm drink", "ghost plague", "heat poison", etc. In this paper, the treatment of miasma disease is called betel nut imperial miasma, attention is paid to the management of miasma disease combined with diarrhea, and it is advocated that after the miasma disease is cured, the patient should be carefully treated, and the recovery of qi should be done. Wang Lun's "mingling Medicine to treat Lingnan Diseases" will be divided into four kinds of miasma: typhoid fever, malaria syndrome, plague fever and warm yellow. Pay attention to the recovery of miasma. Xu Chunfu divided the miasma disease into two types: "miasmatic malaria" and "miasma". Both the treatment and the recuperation after recovery pay attention to nourishing and nourishing the qi. In the Guide to Malaria, the chapter "Syndrome differentiation" discusses the etiology, symptoms, differential diagnosis, classification and pulse of miasma, respectively. Prognosis judgment, miasma of women and children, methods of nursing, management of complications, etc. According to the medicine, Zhang described the drugs of ascending, descending, leveling stomach medicine, then detailed listed ephedra, chaihu, areca nut, aconite, Changshan, astragalus, etc. Atractylodes macrocephala and other drugs used in the treatment of miasma. Zhang Jiabin, author of JingyueGuanshu, thinks that Lingnan miasma is no different from northern mountain typhoid, malaria, treatment of miasma, cold and heat deficiency and evil. In the treatment of miasma, we should pay attention to the pathogenesis of internal deficiency and supplement it with syndromes. The introduction of six meridians and six qi differentiation, combined with local conditions and other factors, suggests that although the miasma is caused by exogenous miasma, the internal injury is insufficient. The treatment was mainly "external feeling", sometimes supplemented by "internal injury." Conclusion: in the course of diagnosis and treatment of miasma, the doctors of Ming Dynasty made clear the connotation of external disease of miasma, perfected the pathogenesis of miasma, and attached importance to the pathogenesis of internal deficiency, which became the important theoretical basis for the development of syndrome and treatment of characteristic miscellaneous diseases in Lingnan. It begins to explore the treatment system of Lingnan exogenous disease, which provides a theoretical basis for the construction of Lingnan medical school. The exploration of miasma in Ming Dynasty deepened people's understanding of Lingnan physique and Lingnan disease. The miscellaneous diseases were isolated from the miasma disease, which improved the level of syndrome treatment of Lingnan miscellaneous disease.
【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;R254

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