本文選題：燥 + 燥證　； 參考：《中國中醫(yī)科學(xué)院》2010年博士論文

【摘要】： 燥,是中醫(yī)理論的重要概念,涉及五運(yùn)六氣、病因病機(jī)、治則治法、藥性理論等諸多方面。早在《黃帝內(nèi)經(jīng)》中就有關(guān)于“燥”的論述,其后通過歷代醫(yī)家的繼承與創(chuàng)新,使得中醫(yī)學(xué)“燥”的理論內(nèi)容和臨床積淀日益豐富。本研究旨在比較系統(tǒng)地整理和總結(jié)歷代醫(yī)家關(guān)于“燥”的學(xué)術(shù)思想和診療經(jīng)驗(yàn),梳理中醫(yī)學(xué)燥的學(xué)術(shù)源流,闡明中醫(yī)學(xué)關(guān)于燥的基礎(chǔ)理論。 1中醫(yī)學(xué)“燥”的學(xué)術(shù)源流 先秦兩漢是中醫(yī)學(xué)燥的理論肇始時(shí)期。這一時(shí)期的醫(yī)家,通過長期的醫(yī)學(xué)實(shí)踐,在當(dāng)時(shí)哲學(xué)、文化思想的影響下,以援物類比的思維方式,從燥氣對(duì)自然界的影響,推演出作為致病邪氣的“燥”作用于人體后的表現(xiàn),從而形成了燥的醫(yī)學(xué)概念和理論,集中表現(xiàn)于《黃帝內(nèi)經(jīng)》當(dāng)中,初步建立了中醫(yī)學(xué)燥的理論框架。東漢末年,張仲景在《傷寒雜病論》中對(duì)燥的病機(jī)闡發(fā)尤詳,并針對(duì)性地提出了治則治法,為后世內(nèi)燥理論的發(fā)展奠定了基礎(chǔ)。 晉唐是中醫(yī)學(xué)燥的理論繼承時(shí)期。這一時(shí)期的醫(yī)學(xué)著作,在繼承《黃帝內(nèi)經(jīng)》病機(jī)理論的基礎(chǔ)上,提出“津傷成燥”和“腎虛致燥”的觀點(diǎn)；在繼承《傷寒雜病論》治燥之法的基礎(chǔ)上,提出了一些新的治法和方藥。 宋金元是中醫(yī)學(xué)燥的理論創(chuàng)新時(shí)期。宋代在運(yùn)氣理論的影響下,燥的病因理論得到了一定的發(fā)展。燥的病機(jī)理論方面也出現(xiàn)了許多新觀點(diǎn)。如注重立足臟腑討論燥的病機(jī)變化、“陰燥”理論的提出等。治燥思想日益豐富,如在五運(yùn)六氣理論指導(dǎo)下研究燥邪為患的治法、注重運(yùn)用臟腑辨證針對(duì)燥的病機(jī)進(jìn)行治療等。金元時(shí)期,諸家爭鳴,對(duì)燥的理論發(fā)展貢獻(xiàn)最大的當(dāng)屬劉完素。他在《黃帝內(nèi)經(jīng)》運(yùn)氣理論的基礎(chǔ)上,重新認(rèn)識(shí)和完善了中醫(yī)學(xué)六氣病因病機(jī)學(xué)說,并在這一理論框架內(nèi),對(duì)燥的含義、性質(zhì)、燥類病癥的成因、種類、治則治法等內(nèi)容進(jìn)行了系統(tǒng)的闡發(fā)。 明清是中醫(yī)學(xué)燥的理論成熟時(shí)期。明代對(duì)外燥、內(nèi)燥的認(rèn)識(shí)開始分別開來,燥的病因理論開始獨(dú)立發(fā)展,病機(jī)理論的發(fā)展中出現(xiàn)了“血燥說”、“燥痰論”等新的理論,這一時(shí)期“養(yǎng)脾陰”、“養(yǎng)腎陰”等思想對(duì)內(nèi)燥的治法產(chǎn)生了重要影響。清代,燥的病因理論,伴隨溫病學(xué)派的崛起得以迅速發(fā)展,并形成了以溫燥、涼燥為綱領(lǐng)的外燥辨治理論。立足臟腑對(duì)燥的病機(jī)探討日趨完善、深入,并在此基礎(chǔ)上形成了系統(tǒng)的內(nèi)燥臟腑辨治理論。 經(jīng)歷了清代之后,中醫(yī)學(xué)燥的理論之外燥、內(nèi)燥兩大理論框架比較明確,理論內(nèi)容也日漸完善。 2中醫(yī)學(xué)“燥”的基礎(chǔ)理論 基于對(duì)“燥”的學(xué)術(shù)源流的深入梳理,認(rèn)為中醫(yī)學(xué)“燥”的基礎(chǔ)理論,主要包括外燥與內(nèi)燥兩部分內(nèi)容。 2.1外燥理論 外燥是一種病因概念,是指自然界燥氣的變化超過人體適應(yīng)能力所致的,以耗傷津液、滯澀氣機(jī)、克肝傷肺為主要致病特點(diǎn)的一種致病因素。外燥理論則是研究這種致病因素的產(chǎn)生、性質(zhì)、致病特點(diǎn)、傳變規(guī)律、所導(dǎo)致疾病的臨床表現(xiàn)及治則治法的理論。 燥邪的產(chǎn)生有以下三個(gè)條件：一是燥氣與其相應(yīng)的季節(jié)變化沒有同時(shí)更迭；二是燥氣發(fā)生過于強(qiáng)烈或變化過于急驟,超過了機(jī)體的適應(yīng)能力；三是盡管燥氣的變化正常,但是人體的抵抗能力降低。燥邪的產(chǎn)生與年份、季節(jié)、地域有密切的關(guān)系。 燥邪的性質(zhì)燥邪的性質(zhì)取決于燥氣,燥氣在五行屬性為金,如果在五行勝復(fù)變化中是作為“克”的一方時(shí),以金行的特點(diǎn)為主,稱為燥之勝氣、燥之本氣,“其性為涼”；當(dāng)作為被克的一方時(shí),它會(huì)與火氣交爭,稱為燥之復(fù)氣,有溫?zé)嶂浴?燥邪的致病特點(diǎn)有以下四點(diǎn)：燥性干涸,易傷津液；燥邪上受,首傷肺金；燥性肅殺,克伐肝氣；燥性堅(jiān)斂,滯澀氣機(jī)。 燥邪傳變規(guī)律燥邪自口鼻而入,先侵入上焦、波及氣分,然后逐漸走入中焦、由氣及血,最后深入下焦、累及血分。 燥邪致病的治療總的原則就是要秉承“燥淫所勝,平以苦溫”和“燥者潤之”兩大原則,以燥之“勝氣之邪”和“復(fù)氣之邪”為綱,分別以溫潤和涼潤為法度。具體還要按照上、中、下三焦的傳變次序,明辨在表在里、在氣在血的不同階段,針對(duì)具體的證候隨證治之。 2.2內(nèi)燥理論 內(nèi)燥是一種病機(jī)概念,是指在疾病的發(fā)生發(fā)展變化中,由于各種原因?qū)е碌念愃朴谠镄皞蚝囊褐虏√攸c(diǎn)的一種病機(jī)變化。內(nèi)燥理論是研究這種病機(jī)的產(chǎn)生、演變、導(dǎo)致的證候表現(xiàn)及其治療的理論。 內(nèi)燥成因內(nèi)燥病機(jī)形成的關(guān)鍵是陰津的虧損不足,造成陰津虧損不足的原因有兩類：一類是疾病過程中各種原因所致的陰津異常地、過量地?fù)p耗,使得陰津絕對(duì)不足；另一類是疾病過程中因臟腑功能虛損,體內(nèi)有病理產(chǎn)物積聚,使得水液的輸布出現(xiàn)障礙,造成陰津相對(duì)不足。 內(nèi)燥形成后的病機(jī)演變主要有血燥生風(fēng)、血燥致瘀、燥從火化、燥極化濕等。 內(nèi)燥證的臨床表現(xiàn)分為內(nèi)燥本證和變證兩大類。內(nèi)燥本證是各種原因?qū)е碌膬?nèi)燥本體證候,按照形成的原因不同分為津傷內(nèi)燥證和津郁內(nèi)燥證。津傷內(nèi)燥證按累及臟腑不同,表現(xiàn)各異。津郁內(nèi)燥證依寒閉、陽虛、濕郁、瘀阻等病機(jī)不同表現(xiàn)不同。內(nèi)燥變證是內(nèi)燥病機(jī)進(jìn)一步演變形成的證候,主要有血燥生風(fēng)證、血燥成瘀證、燥極化濕證等。 內(nèi)燥證的治則治法治則依據(jù)“燥者濡之”、“燥者潤之”原則。治法分為內(nèi)燥本證的治法、內(nèi)燥變證的治法兩類。前者又包括滋陰潤燥法、流濕潤燥法、化瘀潤燥法等三類具體治法。后者依據(jù)變證的具體病機(jī),隨證治之。 內(nèi)燥與外燥的區(qū)別和聯(lián)系 二者的區(qū)別主要表現(xiàn)在：(1)概念屬性不同：外燥是一種病因概念,內(nèi)燥是一種病機(jī)概念。(2)證候性質(zhì)不同：外燥所形成的證候?qū)儆谕飧屑膊》懂?內(nèi)燥所致的病證主要屬于內(nèi)傷疾病的范疇。(3)臨床表現(xiàn)不同：二者都有對(duì)方所不具備的臨床表現(xiàn),彼此不能完全包容。 二者的聯(lián)系主要表現(xiàn)在：發(fā)病過程中相互影響、臨床表現(xiàn)上相互關(guān)聯(lián)。 中醫(yī)學(xué)“燥”的理論在形成之初,是基于取象比類的思維,結(jié)合五運(yùn)六氣理論建立起燥的病因理論及相關(guān)治則治法理論(后世稱外燥理論)。其后,這一理論又一次被取象比類,應(yīng)用到內(nèi)傷疾病中出現(xiàn)類似燥邪某些致病特點(diǎn)的病癥診治中,也就產(chǎn)生了燥的病機(jī)理論及相關(guān)治則治法理論(后世稱內(nèi)燥理論)。但是在發(fā)展過程中,由于后世醫(yī)家認(rèn)識(shí)“燥”的思維與《黃帝內(nèi)經(jīng)》有所差異,對(duì)燥邪的致病特點(diǎn)的認(rèn)識(shí)不夠全面,造成燥的病因概念內(nèi)涵變小。筆者的研究工作,正是將后世醫(yī)家外燥理論研究成果有機(jī)地統(tǒng)一到《黃帝內(nèi)經(jīng)》確立的外燥理論框架中來,并系統(tǒng)歸納、總結(jié)內(nèi)燥理論,從而建立前后統(tǒng)一、內(nèi)容完整的中醫(yī)學(xué)“燥”的理論框架,并深刻闡述其理論內(nèi)涵,為當(dāng)代與“燥”相關(guān)疾病的臨床診療實(shí)踐提供有益的借鑒與參考。
[Abstract]:Dryness is an important concept in the theory of traditional Chinese medicine. It involves many aspects, such as five transport and six gas, etiology and pathogenesis, treatment and treatment, and the theory of drug property. The "dryness" was discussed in the Yellow Emperor's internal classics. After the succession and innovation of the doctors of the past dynasties, the theory of "dryness" and clinical accumulation were enriched. This study aims to compare the system with the system. To collate and summarize the academic thoughts and diagnosis and treatment experience of "dryness" in the past dynasties, comb the academic origin of dryness of Chinese medicine, and clarify the basic theory of dryness in traditional Chinese medicine.
1 the academic origin of "dryness" in traditional Chinese Medicine
The pre Qin and Han Dynasties were the beginning period of the theory of Chinese medicine dryness. Through long medical practice, the doctors of this period, under the influence of philosophy, culture and thought, influenced by the analogy of the aid and material, from the influence of the dry gas on the nature, and the performance of the "dryness" acting as the "dryness" of the pathogenic pathogenic Qi, thus forming a dryness medical probability. In the middle of the Yellow Emperor, the theoretical framework of Chinese medicine dryness was set up in the middle of the Huangdi Neijing. In the last year of the Eastern Han Dynasty, Zhang Zhongjing expounded the pathogenesis of dryness in the theory of "the disease of typhoid fever", and put forward the rule of rule, which laid the foundation for the development of the theory of dryness in the later generations.
The Jin and Tang Dynasties were the period of theoretical inheritance of traditional Chinese medicine dryness. On the basis of inheriting the theory of "Huangdi Neijing", the medical works of the period of Tang Dynasty put forward the viewpoint of "Jin injure to become dryness" and "kidney deficiency induced dryness", and put forward some new methods and prescriptions on the basis of inheriting the method of treating dryness with the theory of "typhoid miscellaneous disease" and "treating dryness".
Song Jinyuan is a period of theoretical innovation of dryness of traditional Chinese medicine. Under the influence of the theory of luck in the Song Dynasty, the theory of the cause of dryness has been developed. The theory of dryness has also appeared in many new views, such as the change of the pathogenesis of the Zang Fu and the theory of "Yin dryness", etc.. The idea of dryness is increasingly rich, such as the five transport and six gases. Under the guidance of the guidance of the study of dryness evil as the treatment method, pay attention to the use of viscera syndrome differentiation for the treatment of dryness. During the Jin Yuan period, the greatest contribution to the development of the theory of dryness was Liu completion. On the basis of the theory of luck of the yellow emperor, he reunderstood and perfected the theory of the pathogenesis of the six Qi disease in traditional Chinese medicine, and in this theory Within the framework, the meaning and nature of dryness, the causes and types of dryness disorders, and the principles and methods of treatment are systematically elucidated.
Ming and Qing Dynasties are the mature period of the theory of Chinese medicine dryness. The understanding of dryness in the Ming Dynasty began to begin separately, and the theory of dryness began to develop independently. In the development of pathogenesis theory, new theories such as "blood dryness theory", "dry phlegm theory" were appeared, and the thought of "nourishing the spleen yin" and "nourishing the kidney yin" had produced important shadow on the treatment of internal dryness. In the Qing Dynasty, the etiological theory of dryness in the Qing Dynasty developed rapidly with the rise of the school of febrile diseases, and formed a theory of external dryness differentiation and treatment based on warm dryness and cold dryness. Based on the viscera, the theory of internal Zang Fu organs differentiation and treatment was formed on the basis of the further improvement and deepening of the pathogenesis of dryness.
After the Qing Dynasty, the two major theoretical frameworks of dryness theory and dryness in Chinese medicine are clearer and the theoretical contents are gradually improving.
2 basic theory of "dryness" in traditional Chinese Medicine
Based on the in-depth analysis of the academic origin of "dryness", it is considered that the basic theory of "dryness" in Chinese medicine mainly includes two parts: external dryness and internal dryness.
2.1 external dryness theory
External dryness is a kind of etiological concept. It refers to the cause of the change of the natural gas in the nature, which is caused by the adaptability of the human body. It is a pathogenic factor for the injury of body fluid, the stagnating air machine and the liver injury of the liver. The theory of external dryness is the study of the occurrence, nature, pathogenicity and transmission of the pathogenic factors, the clinical manifestation and treatment of the disease. The theory of the rule of law.
There are three conditions in the production of dryness: one is that the dry gas is not changed at the same time with the corresponding seasonal changes; the two is that the dryness gas is too strong or the change is too rapid, and the adaptation ability of the body is exceeded; and the three is that although the change of the dry gas is normal, the resistance of the human body is reduced. The production of dryness is closely related to the years, seasons and regions. The relationship.
The nature of dryness evil depends on the nature of dryness and dryness, and the dry gas is gold in the five line of nature. If it is a party of "gram" in the five line of victories and changes, it is characterized by the characteristics of gold line, which is called dryness to win the gas, and it is "cool". When it is used as a party, it will fight with the fire, and it is called the complex gas of dryness, and it has warm heat.
The pathogenic characteristics of dryness evil include the following four points: dryness dryness, easy damage to body fluid; dry evil on top, first lung injury; dry dryness, Kevin liver qi; dryness and strong convergence, stagnation of Qi.
Dryness evil changes the law, dry evil enters from the mouth and nose, invades the upper energizer first, spreads to the gas, then gradually enters the middle Jiao, by Qi and blood, finally goes deep into the lower Jiao, and involves the blood.
The general principle for the treatment of dryness pathogenic factors is to adhere to the two principles of "the victory of dryness, the level of bitter temperature" and "the moistening of the dryness", with the principle of "the evil of winning the Qi" and "the evil of the Qi" as the outline, respectively, with warm and cool moisture. To treat specific syndromes with the evidence.
2.2 internal dryness theory
Internal dryness is a kind of concept of pathogenesis. It refers to a variety of pathogenesis, which are caused by various reasons, which are similar to the pathogenic characteristics of dryness injures. The theory of internal dryness is to study the emergence and evolution of the pathogenesis, the manifestation of syndrome and the theory of treatment.
The key to the formation of internal dryness internal dryness pathogenesis is the deficiency of Yin Jin, which causes the deficiency of yin and Tianjin in two categories: one is the abnormal loss of yin and Tianjin caused by various causes in the disease process, excessive loss, and the absolute deficiency of yin and Tianjin; the other is the deficiency of the function of the viscera, the accumulation of pathological products in the body, and the water of the body. There is an obstacle in the distribution of liquid, which causes the relative deficiency of yin and Tianjin.
The pathogenesis of endogenous dryness is mainly caused by blood dryness, wind generating, blood dryness causing stasis, dryness from cremation, dryness and polarization.
The clinical manifestations of internal dryness syndrome are divided into two categories: internal dryness and change of syndrome. Internal dryness is an internal dryness syndrome caused by various reasons. According to the causes of formation, it is divided into internal dryness syndrome and zinyu internal dryness syndrome. The syndrome of internal dryness in Tianjin is different. Different internal dryness syndrome is the syndrome of further development of internal dryness pathogenesis. It mainly includes blood dryness and wind generating syndrome, blood dryness and stasis syndrome, dryness polarization and dampness syndrome.
The treatment of internal dryness is based on the principle of "dryness" and "moistening the dryness". The treatment is divided into two types of internal dryness and internal dryness syndrome. The former includes three kinds of specific treatments, such as nourishing yin and moistening dryness, flow wetting dryness, removing blood stasis and moistening dryness. The latter is based on the specific pathogenesis of the syndrome.
The difference and connection between dryness and internal dryness
The difference between the two are as follows: (1) the concept attribute is different: dryness is a kind of etiological concept, and internal dryness is a kind of concept of pathogenesis. (2) the syndrome nature is different: the syndrome of external dryness belongs to the category of exogenous disease, and the syndrome caused by internal dryness is mainly in the category of internal injury. (3) the clinical manifestations are different: the two all have the other party does not possess The clinical manifestation can not be completely inclusive.
The connections between the two are mainly manifested in the interaction of the pathogenesis and the correlation of clinical manifestations.
At the beginning of the formation of the theory of "dryness" in traditional Chinese medicine, it is based on the thinking of taking image ratio and combining the theory of five transport and six gas to establish the theory of cause of dryness and the theory of related rule of treatment (the theory of later age called dryness). After that, this theory is once again taken as the image ratio class, and is applied to the diagnosis and treatment of some diseases which are similar to the pathogenic characteristics of dryness. In the process of development, the understanding of "dryness" and "Huangdi Neijing" are different in the process of development, but the understanding of the pathogenic characteristics of dryness is not comprehensive enough, and the concept of dryness is becoming smaller. The research results of the theory of external dryness of the doctors are organically unified into the framework of the theory of external dryness established by the Huangdi Neijing, and systematically summed up and summarized the theory of internal dryness, thus establishing a unified and complete theoretical framework of "dryness" of traditional Chinese medicine, and deeply explaining its theoretical connotation, providing the clinical diagnosis and treatment practice of contemporary and "dryness" related diseases. Useful reference and reference.

【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2010
【分類號(hào)】：R255

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