对《金匮要略》中血液运行障碍病证的研究

发布时间：2018-10-05 18:54

【摘要】：关于血液运行障碍病证的相关记载出现很早,现知最早的医书《五十二病方》中有对血运失常疾病“血癃”病名及治法的记载;近几年出土的《武威汉代医简》中,记载了具有温阳活血功效的“瘀方”;《黄帝内经》对血液运行障碍病证的记载颇详,认为外受风寒之邪乃发病的重要原因,治疗时,应待“天温冻解”使其得温而自行;《难经》在相关病机的论述上更是切中血液运行障碍病证的根本,并举例论述了由气滞、寒凝、气血虚等致病的基础病机。东汉末年,张仲景著《伤寒杂病论》,而《金匮要略》乃为后人对其杂病部分的整理,其中虽未对血液运行障碍病证进行专论,但散在各篇的论述繁多,且理法方药俱全,并首次提出“瘀血”一词,对后世“瘀血”相关理论的形成影响甚大。张仲景对以血液运行障碍为病机特点的病证有其独到的认识。病因上多因于寒,外感风寒之邪导致血液运行不畅,甚至停聚留著,最终可导致“瘀血”或“干血”之证。针对病因病机,张仲景对活血化瘀药物的应用很少,拟定的多首方剂均以温阳为大法,使得阳气温通而血运得畅;若疾病发展到了停聚留著的阶段,则以峻猛虫类药以求速下“瘀血”、“干血”之类。后世医家在继承《金匮要略》相关论述的基础之上,亦对相关理论进行了发展:除了内科疾病,开始重视外科疾病导致的血运停滞;不仅补充了治疗胸痹心痛的活血化瘀法之外,还补充以清热、凉血止血等治法治疗其他相关疾病;重视血液运行停滞阶段的病机表现,并随着多部血液运行障碍病证专著的形成,治疗用药上逐渐确立了活血化瘀药物在方剂中的主导地位。随着近现代血液生化检查及中药药理研究的发展,各医家的研究重点更多地放在了血运停滞的“瘀血”及“活血化瘀”之上,而在一定程度上忽略了病证发展的动态性与整体性,使得对血液运行障碍病证的研究逐步发展成为对“血瘀”证的研究。
[Abstract]:It is known that the earliest medical book < 52 patient's prescription > has a record of the name and treatment of "blood longong", a disease of abnormal blood circulation, which was unearthed in recent years in the "Wuwei Medical slips of the Han Dynasty," which was unearthed in recent years. It records the "blood stasis prescription" which has the effect of warming yang and activating blood, and the Huangdi Internal Classic, which has quite detailed records of the disease syndrome of blood movement obstacle, and thinks that the pathogenic factor of external wind and cold is an important cause of the disease, when it is treated, It is necessary to wait for "days of warming and freezing" to make it warm and self, and to discuss the basic pathogenesis of qi stagnation, cold coagulation and deficiency of qi and blood on the discussion of the related pathogenesis, which is the root of the disease syndrome of blood operation obstacle, and some examples have been given to illustrate the basic pathogenesis of the disease caused by qi stagnation, cold coagulation and deficiency of qi and blood. At the end of the Eastern Han Dynasty, Zhang Zhongjing wrote on typhoid fever and miscellaneous diseases, and synopsis of the Golden Chamber was arranged for later generations. Although there is no special discussion on the syndrome of blood dysfunction, there are many discourses scattered in various articles, and the prescription and prescription are all available. The term "blood stasis" is proposed for the first time, which has a great influence on the formation of the theory of blood stasis. Zhang Zhongjing has a unique understanding of the pathogenesis characterized by blood dysfunction. The etiology is mostly due to cold, the exogenous pathogenic wind and cold cause the blood to run unobstructed, even stop gathering, and eventually lead to the syndrome of "blood stasis" or "dry blood". According to the etiology and pathogenesis, Zhang Zhongjing's application of drugs to promote blood circulation and remove blood stasis is rare. The formulation of many prescriptions is based on warming Yang as the major method, which makes the Yang temperature flow and blood flow smoothly. If the disease develops to the stage of stopping gathering and remaining, In order to quickly reduce "blood stasis", "dry blood" and so on. On the basis of inheriting the related argumentation of synopsis of the Golden Chamber, the physicians of later generations also developed the relevant theories: apart from internal diseases, they began to attach importance to the stagnation of blood circulation caused by surgical diseases; It not only supplements the method of promoting blood circulation and removing blood stasis in treating chest arthralgia, but also supplements the treatment of other related diseases with the methods of clearing heat, cooling blood and stopping bleeding, and attaches importance to the pathogenesis of the stage of blood stagnation. And with the formation of several monographs on the syndrome of blood circulation disorder, the dominant position of the drugs for promoting blood circulation and removing blood stasis was gradually established. With the development of blood biochemical examination and pharmacological study of traditional Chinese medicine in modern and modern times, the research focus of various doctors is more on the stagnation of blood circulation "blood stasis" and "promoting blood circulation to remove blood stasis". To a certain extent, the dynamics and integrity of the development of disease and syndrome were ignored, which made the study of blood circulation disorder gradually develop into the study of "blood stasis" syndrome.
【学位授予单位】：长春中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R222.3

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