基于古代文献的中医骨伤诊疗理论研究

发布时间：2018-09-14 08:50

【摘要】：本文为国家重点基础研究发展计划(973计划)“中医理论体系框架结构研究”(2013CB532004)子课题“中医骨伤诊疗理论框架结构研究”(2013CB532004-2-3)研究内容的一部分。基于中医古代文献及现代研究进展与成果,以逻辑思维为主导,遵循“集成”“归真”和“纳新”的原则,采用文献学、诠释学、术语学及理论研究等方法,对我国古代骨伤相关文献进行系统梳理,提取中医骨伤诊疗理论的基本概念,明确概念内涵,确立中医骨伤诊疗理论概念体系,探究中医骨伤理论的形成与发展,搭建中医骨伤诊疗理论框架结构。从而,为完成国家973项目打下坚实基础,同时也能为骨伤科的临床实践提供更多的理论指导。首先确定研究书目并且制定中医骨伤诊疗理论基本概念的筛选原则与方法。其次,从“时间”和“空间”两个维度探讨中医骨伤理论体系的规律与本质,既从历史进程的角度研究理论概念的源流演变,又从空间定位的角度钻研同时代的医家在讨论相同概念的学术见解,从而全面提炼出中医骨伤理论概念。共梳理总结出中医骨伤诊疗理论概念402条,参照《中医大辞典》《中医药学名词》和全国高等院校《中医骨伤科学》教材等现代研究成果,选取有代表性的、较早出现的或出现频率较高的概念为正名,其余为异名,共收集病因概念89条(正名30条,异名59条)、病机概念75条(正名41条,异名34条)、病名病证概念159条(正名93条,异名66条)、治则治法概念79条。概念的释义是对该概念的定义,以《中医大辞典》《汉语大词典》等辞书为准。概念未见于辞书者,依据上下文义,拟定概念释义。用例部分选取该概念正名和异名首见于古籍中的例句,明确概念的源头,同时酌情选用体现概念发展的例句。病因、病机、病名病证和治则治法概念体系由若干不同层次分属的概念组成,每一概念词条下有异名、释义、用例条目,力求构建层次分明、结构合理的中医骨伤诊疗理论概念体系。围绕因机证治,按照时间顺序,自上而下系统梳理并深入探讨从秦汉到明清时期的中医骨伤理论形成与发展的历史源流。认为战国至秦汉间是骨伤科诊疗理论的初步形成期,为后世医家重视整体观念和辨证论治,以及损伤后的气血病机以及脏腑功能失调等提供了扎实的理论依据。三国、两晋南北朝时期是骨伤科临床医学的兴起阶段,该时期出现了专治创伤疾病的“折伤医”。隋唐时期是骨伤科的形成时期,出现了第一部骨伤科专著以及系统阐述其病因证候学专著,该时期将伤损疾病分为“外损”和“内伤”两类。宋金元时期是骨伤科成长的时期,此时骨伤科诊疗理论更加丰富,伤损后的症状描述更为详细,将骨折和关节脱位归纳为“六出臼”和“四折骨”。明清是骨伤科发展的时期,该时期强调伤损损于外,则气血伤于内,出现了我国第一部伤科内伤专著。关于中医骨伤的病因,自古以来较为明确,多来自于外力作用,即为金疮、坠堕、跌磕、压迮、击打、挫闪。此外,由于人体是一个有机的整体,情志不畅或劳倦所伤会影响脏腑功能,加重伤损后的病情变化。外力作用于人体导致骨断、筋伤必然会累及气血,引起气血病变,而脏腑功能活动的物质基础是气血津液,经络能够联系并濡养全身的皮肉、筋骨,同时也是气血运行的通道,故局部皮肉、筋骨的损害会伤及气血、脏腑、经络。因此,中医骨伤病机主要分为伤及气血、犯伤五脏及内动经络三大类。中医骨伤病名病证主要包括骨折、筋伤、筋骨俱伤、脱臼、跌闪伤、金疮及内伤杂证。中医骨伤治则分为骨折筋伤治则、脱臼治则、跌打损伤治则、金疮治则及伤损内证治则,主要包括散瘀血、止疼痛、续筋骨、通经络、和肝补肾、调补脾气等。骨伤科治法除了用药外,还有外治法、隔纸灸法、雷火针法等治法。系统梳理了我国古代中医骨伤文献既有的理论框架,发现《外台秘要》《圣济总录》《世医得效方》《正体类要》《伤科汇纂》中的骨伤诊疗理论框架最具有代表性。《外台秘要》将骨伤疾病框架与骨伤方证框架整合在一起,《圣济总录》对骨伤理论阐述较为详备,因、机、证、治的理论框架初步形成,《世医得效方》首次将骨伤科疾病总结为“手(脚)六出臼四折骨”,《正体类要》确立了从内治伤的诊疗理论框架。《伤科汇纂》主要从病因学角度将损伤类疾病分成金刃伤、箭镞伤、磁锋伤、签刺伤、坠堕伤、跌磕伤、挫闪伤、压迮伤、铁器伤、砖石伤、木器伤11大类,再以病机结合病证、提出相应治则为其细类,并附诸多相关治法方药为其框架填充内容,这种因机证治的诊疗理论框架模式既是对前人经验的继承也是对后世医家的启迪。通过对中医骨伤共性的、实用性的、代表性的诊疗理论加以分析、比较、提炼与集成,结合论文对中医骨伤病因、病机、病名病证、治法治则等方面的概念梳理,以瘀血内停和亡血过多为总纲,以气血辨证为主,同时结合八纲辨证,以出现频次较多并且因机证治完备的诊疗理论搭建中医骨伤外伤病框架和内伤病框架。外伤病诊疗理论框架主要以伤折、闪伤、金疮、脱臼所致气血瘀滞、出血或亡血过多为纲目,采用整骨续筋、导气行血、止血定痛等治则进行治疗。内伤病诊疗理论框架主要以恶血留内、血虚或血脱、气血亏虚所致病证为纲目,采用活血化瘀、补气养血、兼以滋阴、健壮脾胃、疏肝理气等治则进行治疗。初步构建了中医骨伤共性诊疗理论的框架结构,以期能为骨伤科的临床实践提供更多的理论指导。
[Abstract]:This paper is a part of the research contents of the sub-project of the National Key Basic Research and Development Program (973 Program) "Research on the Framework of the Theoretical System of Traditional Chinese Medicine" (2013 CB532004) "Research on the Theoretical Framework of Bone and Wound Diagnosis and Treatment of Traditional Chinese Medicine" (2013 CB532004-2-3). The principles of "integration", "simplification" and "acceptance of new ideas" are adopted to systematically sort out the related literature on bone injury in ancient China by means of philology, hermeneutics, terminology and theoretical research, extract the basic concepts of bone injury diagnosis and treatment theory of traditional Chinese medicine, clarify the conceptual connotation, establish the conceptual system of bone injury diagnosis and treatment theory of traditional Chinese medicine, and explore the shape of bone injury theory of traditional Chinese medicine. In order to lay a solid foundation for the completion of the National 973 Project and provide more theoretical guidance for the clinical practice of orthopedics and traumatology, the author first determines the research bibliography and formulates the screening principles and methods of the basic concepts of the theory of orthopedics and trauma diagnosis and treatment of traditional Chinese medicine. The two dimensions of "space" discuss the law and essence of the theory system of bone injury in TCM. It not only studies the origin and evolution of the theory concept from the perspective of historical process, but also explores the academic opinions of contemporary physicians in discussing the same concept from the perspective of spatial positioning, so as to refine the concept of bone injury theory in TCM comprehensively. Referring to the modern research results of "Dictionary of Traditional Chinese Medicine", "Terms of Traditional Chinese Medicine" and the textbooks of "Orthopedics and Injury of Traditional Chinese Medicine" in Colleges and universities of China, 402 concepts of therapeutic theory were selected as normal names, while the others were anonymous names. A total of 89 concepts of etiology and 75 concepts of pathogenesis were collected. There are 41 proper names, 34 different names, 159 concepts of disease and syndrome (93 proper names, 66 different names) and 79 concepts of treatment principles and methods. The conceptual system of etiology, pathogenesis, disease name, syndrome and treatment principles and methods is composed of several different levels of subordinate concepts, each of which has different names, definitions and use case entries, and strives to construct a well-structured and well-structured bone injury diagnosis in traditional Chinese medicine. Conceptual System of Therapeutic Theory. Around the opportunity of treatment, according to the chronological order, this paper systematically combs and probes into the historical origin of the formation and development of the theory of orthopedics and traumatology from Qin-Han Dynasty to Ming-Qing Dynasty. The three kingdoms, the Jin Dynasty and the Southern and Northern Dynasties were the rising stages of orthopedics and traumatology clinical medicine, during which the "traumatology doctor" specializing in traumatic diseases appeared. The Sui and Tang Dynasties were the formation period of orthopedics and traumatology, and the first monograph on orthopedics and traumatology appeared. The Song, Jin and Yuan Dynasties were the growing period of orthopedics and traumatology. At this time, the theory of orthopedics and traumatology diagnosis and treatment was more abundant, and the symptoms after trauma were described in more detail. Fractures and joint dislocations were classified as "six dislocations" and "four broken bones". Ming and Qing Dynasties were the development of orthopedics and traumatology. In this period, the first monograph on internal injuries in traumatology appeared in China. The etiology of bone injuries in traditional Chinese medicine has been relatively clear since ancient times, mostly due to external forces, that is, golden ulcer, falling, falling, stumbling, striking, and flashing frustration. In addition, because the human body is an organic whole, the mood is not good or tired. Injury can affect the function of the viscera and aggravate the changes of the condition after injury.External force on the human body leads to bone fracture, tendon injury will inevitably involve Qi and blood, causing Qi and blood lesions, and viscera function of the material basis is qi, blood and fluid, meridians and collaterals can contact and nourish the body's flesh, tendons and bones, but also the channel of Qi and blood movement, so local skin, flesh, tendons and bones Damage can damage Qi and blood, viscera, meridians and collaterals. Therefore, the pathogenesis of bone injury in traditional Chinese medicine can be divided into three categories: injury of Qi and blood, injury of five viscera and internal action of meridians and collaterals. Orthopedics treatments include external treatment, paper-separated moxibustion, thunder-fire needle therapy, etc. Besides medication, it systematically combs the existing theoretical framework of ancient Chinese medical literature on bone injuries, and finds that < Outdoor Secrets > < Shengji General Records > The theoretical framework of bone injury diagnosis and treatment in < Zheng Tie Lei Ya > < Traumatology Collection > is the most representative. < Outdoor Secret Ya > integrates the framework of bone injury disease with the framework of bone injury prescription and syndrome. < Sheng Ji Zhu Lu > elaborates on the theory of bone injury in detail. The theoretical framework of cause, mechanism, syndrome and treatment is preliminarily formed. Summarized as "six out of the acetabulum and four broken bones", "orthodoxy" established a theoretical framework for the diagnosis and treatment of internal injuries. Syndrome, put forward the corresponding treatment principles for its detailed categories, and attached a lot of relevant treatment prescriptions and medicines as its framework filling content, this kind of syndrome-based diagnosis and treatment theoretical framework model is not only the inheritance of previous experience but also inspiration for future generations of physicians. Cheng, combing the concepts of etiology, pathogenesis, disease name and syndrome, treatment and rule of law of traditional Chinese medicine bone injury in this paper, taking stasis and excessive blood loss as the general program, Qi and blood syndrome differentiation as the main component, and combining eight principles of syndrome differentiation, the frame of internal injury and internal injury of traditional Chinese medicine bone injury is established with the theory of more frequent occurrence and complete treatment of pathogenesis. The theoretical framework of the diagnosis and treatment of internal injury mainly focuses on the treatment of trauma, flash injury, golden ulcer, dislocation caused by Qi and blood stasis, hemorrhage or excessive blood loss. Qi nourishing blood, nourishing Yin, strengthening spleen and stomach, soothing liver and regulating qi, etc. were used to treat the disease.
【学位授予单位】：辽宁中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R274
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本文编号：2242189

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