發(fā)布時間：2018-03-19 23:07

  本文選題：傷寒雜病論　切入點：泄瀉　出處：《北京中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的本文擬從病名、病因、病機、治法、方藥等幾個方面對《傷寒雜病論》下利和《中醫(yī)內科學》泄瀉進行比較,探討《中醫(yī)內科學》泄瀉與《傷寒雜病論》下利之間的關系;通過對《中醫(yī)內科學》泄瀉與《傷寒雜病論》下利進行比較,并結合歷代醫(yī)家對泄瀉的認識,梳理泄瀉辨治規(guī)律的發(fā)展與演變。方法本文采用文獻研究法、比較研究法等方法,通過對《傷寒雜病論》下利相關的方證進行梳理,對下利的病名、病因、病機、治法、方藥等方面進行歸納總結,并與《中醫(yī)內科學》泄瀉的病因、病機、治法、方藥等方面進行比較,結合歷代醫(yī)家對泄瀉的認識,探討《中醫(yī)內科學》泄瀉對《傷寒雜病論》下利的繼承與發(fā)展,梳理泄瀉辨治規(guī)律的發(fā)展與演變。結果通過對《傷寒雜病論》下利與《中醫(yī)內科學》泄瀉的比較可以得出:①在病名方面,《傷寒雜病論》下利是包括泄瀉與痢疾而言;《中醫(yī)內科學》是泄瀉與痢疾分開論治,這是對泄瀉與痢疾認識的提高,便于更好的把握泄瀉的辨治規(guī)律。②在病因方面,《中醫(yī)內科學》與《傷寒雜病論》都論述了感受外邪、飲食不慎、脾胃虛弱、腎陽不振等病因,但對外邪的認識不太一致,《中醫(yī)內科學》強調外邪以濕邪為主,而《傷寒雜病論》則以寒邪、熱邪為主,可挾濕邪而為患。此外,兩者對泄瀉病因的認識也有不一致的地方,如情志失調,雖始于《內經》,但《傷寒雜病論》并無記載,后經歷代發(fā)展,《中醫(yī)內科學》繼承了下來;又如水飲內停與誤下,《傷寒雜病論》論之頗詳,《中醫(yī)內科學》卻沒有記載。③在病機方面,《傷寒雜病論》下利病機基本包含了《中醫(yī)內科學》泄瀉病機。唯有寒濕泄瀉一證,《傷寒雜病論》雖有提及,但與《中醫(yī)內科學》所論并不一樣�！秱s病論》所論寒濕或由外感寒濕直中太陰,或由脾陽虛、寒濕內生,雖外感、內傷不同,但皆有陽氣虧虛、寒濕內盛之表現,而以陽虛為主。《中醫(yī)內科學》所論寒濕泄瀉以濕邪為本,或夾外感寒邪,或濕盛寒微,而無陽虛之表現,與《傷寒雜病論》所論并不完全相同。此外,《傷寒雜病論》有大量下利病機是《中醫(yī)內科學》泄瀉沒有涉及到的,如表里合病、協(xié)熱而利;腎水不足、陰虛火旺、迫津下泄;里實燥熱內結、熱結旁流;少陽陽明合病、膽熱移胃、迫液下注等。這些病機有的屬于泄瀉,有的不屬于泄瀉,但都可見下利的癥狀,都是對泄瀉病機的補充,對這些病機的認識有助于對泄瀉辨治規(guī)律的全面把握,值得進一步探討。④在治法方面,《中醫(yī)內科學》泄瀉治法與《傷寒雜病論》治法都含有汗法、和法、補法、清法、溫法、消法、下法、固澀法等基本治法,《中醫(yī)內科學》泄瀉治法基本未出《傷寒雜病論》下利治法的范圍,但除固澀法兩者基本一致外,其具體治法則不盡相同�！秱s病論》以溫法之溫脾及溫腎、清法之清熱解毒及清熱祛濕為主,而《中醫(yī)內科學》則是以運脾化濕為基本大法�！吨嗅t(yī)內科學》泄瀉治法是在《傷寒雜病論》下利治法基礎上有所發(fā)展,但同時也有一些不完善的地方。⑤在方藥方面,《中醫(yī)內科學》泄瀉有部分用方與《傷寒雜病論》治瀉方相同,如赤石脂禹余糧湯、桃花湯、訶黎勒散、葛根芩連湯、理中湯、五苓散、烏梅丸等;《中醫(yī)內科學》有一些治瀉方與《傷寒雜病論》部分方主治相近,如藿香正氣散與葛根湯、四神丸與四逆輩、痛瀉要方與四逆散、保和丸與大承氣湯、胃苓湯與五苓散等;《傷寒雜病論》尚有一些治瀉方是《中醫(yī)內科學》沒有選用的。而在藥物方面,一方面《中醫(yī)內科學》在每首方下面都有加減法,所加減藥物種類繁多,數量比較大,所用藥物已不局限于治療泄瀉;另一方面,因法選方,因方用藥,藥物隨著治法及方劑的不同所用藥物也不同,而治法與方劑前面已經進行比較,因此在藥物方面并未進行比較。結論通過對《中醫(yī)內科學》泄瀉與《傷寒雜病論》下利的病名、病因、病機、治法、方藥等方面進行比較,認為《中醫(yī)內科學》泄瀉是在《傷寒雜病論》下利基礎上,經后世醫(yī)家的不斷補充發(fā)展而來,《傷寒雜病論》奠定了泄瀉辨證論治的基礎。但《中醫(yī)內科學》泄瀉并未完全繼承《傷寒雜病論》,《傷寒雜病論》對泄瀉的論治還有值得挖掘的地方。這樣的深入挖掘有利于完善泄瀉的辨證論治規(guī)律,并對臨床實踐有一定的指導意義。從《傷寒雜病論》到《中醫(yī)內科學》,泄瀉的辨治發(fā)生了很多變化,說明泄瀉的辨治規(guī)律是不斷發(fā)展與完善的,泄瀉辨治規(guī)律的發(fā)展與完善深受醫(yī)學流派及各家學說的影響。
[Abstract]:The purpose of this paper from the name of disease, etiology, pathogenesis, treatment, and > and < > diarrhea medicine of traditional Chinese medicine to compare the < Shanghanzabinglun several aspects of medicine, Chinese medicine "on the relationship between profit and diarrhea > > < typhoid; according to the < > diarrhea medicine of traditional Chinese Medicine" typhoid and miscellaneous diseases theory > comparison, combined with the ancient physicians understanding of diarrhea, combing the development and evolution of diarrhea treatment rule. This method adopts the literature research method, comparative research method and other methods, based on < Shanghanzabinglun > and related side comb, disease name, etiology, disease the method of machine, and the medicine and other aspects were summarized, and the "Chinese Medicine > diarrhea etiology, pathogenesis, treatment, prescription and other aspects were compared, combined with the ancient physicians understanding of diarrhea, to explore the Chinese medicine for diarrhea > < < Shanghanzabinglun > inheritance and development Lee, comb The development and evolution of the law of treating diarrhea. By comparing the results of < < Shanghanzabinglun and Chinese Medicine > under the Science > diarrhea in the name of disease, < Shanghanzabinglun > is including diarrhea and dysentery; "Chinese medicine" is separated on the treatment of diarrhea and dysentery, this is to improve the understanding of the diarrhea and dysentery, in order to better grasp the law of treating diarrhea. The etiology, "Chinese medicine" and "Shanghanzabinglun > have discussed Waixie, eating carelessly, spleen and stomach, kidney yang malaise and other causes, but external evil is not consistent," Chinese medicine learn > that external pathogens to dampness, and < Shanghanzabinglun > in Hanxie, heat evil, evil and wetness can be affected. In addition, the understanding of the etiology of diarrhea have inconsistencies, such as emotional disorders, although in the < >, and < Shanghanzabinglun > no records, after issuing 灞，

本文編號：1636421