本文關(guān)鍵詞：從圓運(yùn)動(dòng)氣機(jī)升降理論探討桂枝湯類(lèi)方的證治規(guī)律　出處：《廣州中醫(yī)藥大學(xué)》2017年博士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 桂枝湯類(lèi)方 圓運(yùn)動(dòng) 氣機(jī)升降 傷寒論

【摘要】：《傷寒論》作為中醫(yī)界最重要的經(jīng)典著作之一,自成書(shū)以來(lái),一直都是歷代醫(yī)家學(xué)習(xí)和研究的熱點(diǎn)。從理論到臨床,從考據(jù)到藥理,《傷寒論》幾乎每個(gè)字都被學(xué)者研究過(guò),隨著研究方法的更新及研究思路的拓展,大家仍在孜孜不倦的挖掘著,以期更好的理解和闡述這一中醫(yī)學(xué)的寶貴財(cái)富,更好的指導(dǎo)臨床;盡管如此,我們?nèi)圆荒芡笍氐睦斫庠摃?shū)的每一個(gè)問(wèn)題。對(duì)于《傷寒論》中的方藥,用"類(lèi)方"的方法,可以劃分為桂枝湯類(lèi)、麻黃湯類(lèi)、承氣湯類(lèi)、柴胡湯類(lèi)、四逆湯類(lèi)等十余種,桂枝湯作為《傷寒論》的第一方,盡管人們對(duì)桂枝湯類(lèi)方做了大量的研究,但筆者仍希望能從一個(gè)新的角度來(lái)研究它,以期有不一樣的發(fā)現(xiàn),能更好的解讀并應(yīng)用于臨床。近年來(lái)"圓運(yùn)動(dòng)"理論越來(lái)越受到中醫(yī)學(xué)者的重視,本文試圖以圓運(yùn)動(dòng)的氣機(jī)升降理論作為切入點(diǎn)來(lái)解析桂枝湯類(lèi)方的證治規(guī)律。本文采用文獻(xiàn)研究的方法,以圓運(yùn)動(dòng)氣機(jī)升降理論作為切入點(diǎn),用氣機(jī)升降的理論來(lái)分析總結(jié)桂枝湯類(lèi)方的證治規(guī)律。本文搜集了與圓運(yùn)動(dòng)理論相關(guān)的研究文獻(xiàn),對(duì)其理論進(jìn)行概括、分析、提煉、總結(jié),重點(diǎn)闡述圓運(yùn)動(dòng)的氣機(jī)升降理論。結(jié)合圓運(yùn)動(dòng)理論來(lái)分析《傷寒論》桂枝湯類(lèi)方的方義、原文、應(yīng)用等,并系統(tǒng)總結(jié)現(xiàn)代中醫(yī)學(xué)者運(yùn)用桂枝湯類(lèi)方(從圓運(yùn)動(dòng)理論切入)的臨床經(jīng)驗(yàn),分析他們的典型醫(yī)案,以期得出圓運(yùn)動(dòng)理論指導(dǎo)下桂枝湯類(lèi)方的證治規(guī)律。本論文分為四部分,分別為圓運(yùn)動(dòng)理論研究、氣機(jī)升降理論研究、桂枝湯類(lèi)方研究及當(dāng)代醫(yī)家應(yīng)用桂枝湯類(lèi)方的經(jīng)驗(yàn)及典型醫(yī)案分析。第一部分是圓運(yùn)動(dòng)理論研究,旨在探討研究圓運(yùn)動(dòng)理論認(rèn)識(shí)源流及主要學(xué)術(shù)觀點(diǎn)。圓運(yùn)動(dòng)理論源于《周易》的河圖、洛書(shū)、先天八卦、后天八卦;此后的《黃帝內(nèi)經(jīng)》(以下簡(jiǎn)稱(chēng)《內(nèi)經(jīng)》)及《傷寒論》均有圓運(yùn)動(dòng)理論的繼承;到清代的黃元御和鄭欽安,本理論得到進(jìn)一步發(fā)展;至民國(guó)名醫(yī)彭子益撰寫(xiě)成《圓運(yùn)動(dòng)的古中醫(yī)學(xué)》,正式提出"圓運(yùn)動(dòng)"一詞,標(biāo)志著圓運(yùn)動(dòng)理論的成熟。需要指出的是,黃元御和鄭欽安的圓運(yùn)動(dòng)理論的立足點(diǎn)不同,黃氏側(cè)重于中土圓運(yùn)動(dòng),鄭氏則側(cè)重水火圓運(yùn)動(dòng)。彭子益汲取歷代醫(yī)家的的研究經(jīng)驗(yàn)和學(xué)術(shù)精華,著有《圓運(yùn)動(dòng)的古中醫(yī)學(xué)》,著中用圓運(yùn)動(dòng)理論闡述天地的圓運(yùn)動(dòng)規(guī)律,并推及人體生理及病理,涵蓋陰陽(yáng)、五行、六氣、十二經(jīng)絡(luò)、二十四節(jié)氣圓運(yùn)動(dòng)理論,創(chuàng)立以五臟為核心的圓運(yùn)動(dòng)體系,并用圓運(yùn)動(dòng)理論解析《傷寒論》的六經(jīng)用藥。第二部分是氣機(jī)升降理論研究,旨在對(duì)氣機(jī)的升降理論進(jìn)行系統(tǒng)研究。氣機(jī)升降浮沉理論是圓運(yùn)動(dòng)理論的重要組成部分,"浮"是氣"升"至極,"沉"為氣"降"至極。升降出入,作為人體氣機(jī)運(yùn)行的主要形式,如果明白氣機(jī)升降的道理,同樣可以明白人身的生理,也可以明白人身的病理。氣機(jī)升降浮沉理論起源于先秦時(shí)期的《內(nèi)經(jīng)》。中醫(yī)先哲認(rèn)為,物質(zhì)組成宇宙,物質(zhì)存在之根本形式為運(yùn)動(dòng)。氣是宇宙最原始的物質(zhì),是構(gòu)成天地萬(wàn)物的最小單元。把宇宙物質(zhì)的運(yùn)動(dòng)變化歸于一氣的升降,這是氣機(jī)升降理論樸素的唯物觀。醫(yī)圣張仲景繼承并發(fā)展《內(nèi)經(jīng)》的基本學(xué)術(shù)觀點(diǎn),在《傷寒論》中記載較多的由氣機(jī)升降失常導(dǎo)致的各種病證。時(shí)至金元時(shí)期,名醫(yī)輩出,開(kāi)創(chuàng)中醫(yī)學(xué)術(shù)爭(zhēng)鳴的繁榮局面,對(duì)氣機(jī)升降理論的闡述,則是見(jiàn)仁見(jiàn)智,各位醫(yī)家從不同的角度發(fā)展氣機(jī)升降理論的主要內(nèi)容。其中,張子和以吐法來(lái)論氣機(jī)升降,臨證以攻邪為主,倡導(dǎo)吐汗下法,而其吐法,尤有創(chuàng)見(jiàn)。到了明清時(shí)期,對(duì)氣機(jī)升降理論的發(fā)揮運(yùn)用頗多,從而推動(dòng)了氣機(jī)升降理論的普及與發(fā)展。在《傷寒論》中,氣機(jī)升降理論的應(yīng)用包括:脾胃升降、心腎升降、肝膽升降、肺腎升降、脾肺升降。氣機(jī)升降理論與六經(jīng)病的關(guān)系如下:太陽(yáng)病側(cè)重于營(yíng)衛(wèi)出入之失調(diào),陽(yáng)明病側(cè)重于陽(yáng)土(戊土)之氣的失降,少陽(yáng)病側(cè)重于樞機(jī)不暢,太陰病側(cè)重于陰土(己土)之氣的不升,少陰病側(cè)重于水火升降之失常,厥陰病側(cè)重于氣血升降之逆亂。第三部分是桂枝湯類(lèi)方研究,旨在對(duì)桂枝湯類(lèi)方的證治規(guī)律進(jìn)行系統(tǒng)研究。首先對(duì)桂枝湯類(lèi)方進(jìn)行梳理,以確定本文研究的桂枝湯類(lèi)方范圍,本課題中,選擇與大多數(shù)醫(yī)家相一致的觀點(diǎn),在劉渡舟教授和熊曼琪教授所選擇的21方的基礎(chǔ)上,選用臨床最常見(jiàn)最典型的十個(gè)方劑作為研究對(duì)象。此次所選十個(gè)方劑的組方中均包含了桂枝湯中的桂枝、芍藥、生姜、大棗、炙甘草五味基本藥物,而去桂枝、去芍藥之類(lèi)方并未納入研究,十個(gè)方劑分別為:桂枝湯、桂枝加葛根湯、桂枝加附子湯、桂枝加厚樸杏子湯、桂枝加芍藥生姜各一兩人參三兩新加湯、桂枝加桂湯、桂枝加芍藥湯、桂枝加大黃湯、小建中湯、桂枝麻黃各半湯。本部分主要運(yùn)用圓運(yùn)動(dòng)理論對(duì)桂枝湯類(lèi)方從方義及條文兩部分進(jìn)行論述。桂枝湯是桂枝湯類(lèi)方的基礎(chǔ)方,桂枝辛溫,升人體之陽(yáng),主升;芍藥酸苦寒,主收斂,主降;桂枝、芍藥一升一降,自成一圓運(yùn)動(dòng),生姜、大棗、甘草同主中州,顧護(hù)中土,穩(wěn)固圓運(yùn)動(dòng)之中軸;桂枝、芍藥一升一降,輔助中土調(diào)暢氣機(jī),調(diào)和營(yíng)衛(wèi)。桂枝加厚樸杏子湯,桂枝加厚樸杏子湯證主要是斂降之力不足,故加厚樸,厚樸對(duì)應(yīng)于西方的肅降之性;杏仁,其色白,味苦,主入肺、大腸經(jīng),苦則降泄,可助西方金氣下降,兼有潤(rùn)腸通便之效。一方面可以肅降西方上沖之氣,另一方面可以調(diào)理胃氣,中土氣機(jī)升降調(diào)和,有助于東方之氣的上升與西方之氣的下降。一方面調(diào)暢圓運(yùn)動(dòng)之軸的氣機(jī),一方面順應(yīng)于西方氣機(jī)的肅降,以制約氣機(jī)上沖之勢(shì)。桂枝新加湯,桂枝新加湯證為氣血不足,營(yíng)陰消耗之后,可知身疼痛為氣血不足以濡養(yǎng)經(jīng)脈所致,在桂枝湯原方基礎(chǔ)上加人參,人參有"補(bǔ)五臟"之功(《神農(nóng)本草經(jīng)》),增強(qiáng)補(bǔ)中之力,可使圓運(yùn)動(dòng)之軸更加穩(wěn)固,將生姜、芍藥的用量從三兩增加到四兩,加重生姜的用量可以提高中焦脾胃的運(yùn)化之力,穩(wěn)定圓運(yùn)動(dòng)之軸,以化生氣血;增加芍藥的用量則加強(qiáng)了收斂的功效,以養(yǎng)陰生津。小建中湯,小建中湯證主東方木氣疏泄不利,中央脾土虛弱,木氣橫犯中土,倍用芍藥,一方面可以柔肝緩急,另一方面芍藥與炙甘草、大棗相配,酸甘化陰,以養(yǎng)血和營(yíng)。飴糖氣味甘溫,歸脾、胃、肺經(jīng),具有補(bǔ)中益氣、緩急止痛、潤(rùn)肺止咳的功效。方中加入飴糖一升,以補(bǔ)中益氣,恢復(fù)中氣,固護(hù)中央土氣,調(diào)和東方木氣的疏泄。桂枝加葛根湯,桂枝加葛根湯證中加用的葛根為陽(yáng)明經(jīng)主藥,可宣達(dá)陽(yáng)明中土之氣,而又外合于太陽(yáng)經(jīng)脈,足陽(yáng)明胃經(jīng)主降濁,經(jīng)氣降則熱氣降;足太陰脾經(jīng)主升清,葛根可助人體陰氣的上升,恢復(fù)軸樞的升清降濁功能,解除陽(yáng)明經(jīng)氣不利的情況。桂枝加附子湯,桂枝加附子湯證中加用的附子主溫陽(yáng),可溫散人體一切陰寒之氣,溫養(yǎng)心腎,恢復(fù)身體左升的功能,陽(yáng)氣能自東方左升,就能在西方肅降;此外,附子溫脾陽(yáng)、散寒濕,可恢復(fù)四維和軸樞之力。桂枝加桂湯,桂枝加桂湯證中重用桂枝至五兩,主要是取其"降逆氣、降沖氣"的作用。加之芍藥收斂的功用,人體陽(yáng)氣才能有序下降,肝氣條達(dá),上逆之氣也終得復(fù)歸其位。另外,方中生姜、大棗、炙甘草三味藥同主中洲,增強(qiáng)中焦脾胃之氣,中焦斡旋之力得以復(fù)原,從而共同平復(fù)沖氣。桂枝加芍藥湯,桂枝加芍藥湯證乃太陽(yáng)病誤下所致,芍藥可以"主邪氣腹痛",本方中增加了芍藥的用量,增強(qiáng)了右降的力量,用于收斂橫逆中土的肝木之氣,使逆氣循正道而行。桂枝加大黃湯,桂枝加大黃證是太陽(yáng)病誤下寒入太陰之后,形成有形之實(shí)邪結(jié)聚之腹痛。本方在桂枝加芍藥湯基礎(chǔ)上加用大黃二兩,增加大黃以后,圓運(yùn)動(dòng)右方收斂收藏之力進(jìn)一步加強(qiáng)。與芍藥不同的是,大黃所降所收則更側(cè)重于有形之實(shí)邪。在桂枝湯的基礎(chǔ)上,大黃祛除有形之實(shí)邪,與方中芍藥斂降逆亂之氣相配合,可用于太陽(yáng)中風(fēng)表證未解,肝木之氣橫逆中土導(dǎo)致的腹部大實(shí)痛。桂枝麻黃各半湯,桂枝麻黃各半湯證為太陽(yáng)中風(fēng)和太陽(yáng)傷寒兼具之輕證。桂枝麻黃各半湯為桂枝湯原方的藥量和麻黃湯原方的藥量各取三分之一,兩者合二為一,各占一半,故名為桂枝麻黃各半湯。麻黃助陽(yáng)氣上升,更側(cè)重作用于機(jī)體之表皮,可助正氣沖破表皮寒邪之閉郁;表寒破除,隨之汗出癥減。方中杏仁色白入肺,味苦可助肺氣之收斂,條暢氣機(jī)之逆亂,與麻黃一升一降,形成麻黃湯中的圓運(yùn)動(dòng)。在本方中,桂枝湯與麻黃湯減量后各取一半,可用于太陽(yáng)中風(fēng)與太陽(yáng)傷寒兼有之輕證。第四部分是當(dāng)代醫(yī)家應(yīng)用桂枝湯類(lèi)方的經(jīng)驗(yàn)及典型醫(yī)案分析,從當(dāng)代傷寒大家劉渡舟教授、梅國(guó)強(qiáng)教授、陳亦人教授、黃煌教授的傷寒學(xué)術(shù)思想及桂枝湯的應(yīng)用進(jìn)行論述。劉渡舟教授推崇經(jīng)方,經(jīng)方與時(shí)方有機(jī)結(jié)合,不薄時(shí)方,提倡古今接軌;并提出方證相對(duì),精研類(lèi)方,對(duì)經(jīng)方運(yùn)用有獨(dú)到認(rèn)識(shí),善用桂枝劑、苓桂劑類(lèi)方,積累了寶貴的臨床經(jīng)驗(yàn)和診治特色。梅國(guó)強(qiáng)教授融會(huì)傷寒和溫病學(xué)說(shuō),認(rèn)為傷寒外感病遣方須辨表里緩急、重視陰津,發(fā)揚(yáng)張仲景六經(jīng)辨證之論,潛心研究擴(kuò)大《傷寒論》諸方的臨床運(yùn)用途徑;梅老認(rèn)為,桂枝湯配伍嚴(yán)謹(jǐn),有主有從,臨床療效顯著。桂枝湯作為《傷寒論》的群方之首,主要在于調(diào)和營(yíng)衛(wèi)之氣,重在斂肝,辛甘化陽(yáng),解決脾胃虛弱的問(wèn)題。陳亦人教授致力于《傷寒論》教學(xué)和研究,頗多創(chuàng)見(jiàn),他主編的《傷寒論譯釋》和《傷寒論求是》,在全國(guó)影響較大,陳老用主方增減的類(lèi)比法將以桂枝湯類(lèi)方分為21方進(jìn)行研究。黃煌教授注重經(jīng)方研究,倡導(dǎo)方證研究,并開(kāi)創(chuàng)體質(zhì)辨證,提出了 "方人""藥人"的新概念,歸納總結(jié)出"桂枝體質(zhì)"。本文通過(guò)對(duì)圓運(yùn)動(dòng)理論、氣機(jī)升降理論、桂枝湯類(lèi)方進(jìn)行系統(tǒng)研究,得出以下結(jié)論:桂枝湯類(lèi)方組成藥物主要以桂枝湯原方中的五味藥物為基礎(chǔ),其它類(lèi)方在此基礎(chǔ)上加味衍生而成;在組方、藥量及病機(jī)上,同主中洲、顧護(hù)中土的三味藥物生姜、大棗、炙甘草,其藥量基本不變,也體現(xiàn)了中土厚重淳和、承載萬(wàn)物、不易變動(dòng)的特點(diǎn),是桂枝湯類(lèi)方之中軸。其它根據(jù)病機(jī)需要可分為兩類(lèi),或增加桂枝、葛根、附子等升散之性藥物用量來(lái)加強(qiáng)辛溫升達(dá)之力,或增加芍藥、厚樸、杏子、大黃等苦寒性味藥物增強(qiáng)收斂下降之力。桂枝湯類(lèi)方,"在外解肌和營(yíng)衛(wèi),在內(nèi)化氣調(diào)陰陽(yáng)",既可用于外感熱病,亦能用于內(nèi)傷雜病。圓運(yùn)動(dòng)理論認(rèn)為,中土如軸,四維如輪,輪軸互應(yīng),疾無(wú)所依;一切外感、內(nèi)傷諸病,皆因"中軸失靈、四維倒作"而起;醫(yī)道雖繁,實(shí)"軸輪"而已。桂枝湯類(lèi)方有機(jī)融合了 "運(yùn)軸行輪"、"運(yùn)輪復(fù)軸"、"軸輪并運(yùn)"三法。本文的創(chuàng)新點(diǎn)在于:1、以《傷寒論》中最具代表性的十個(gè)桂枝湯類(lèi)方為研究對(duì)象,用圓運(yùn)動(dòng)的氣機(jī)升降理論來(lái)分析桂枝湯類(lèi)方的組方、方義、應(yīng)用和醫(yī)案,并初步從圓運(yùn)動(dòng)的氣機(jī)升降理論得出了桂枝湯類(lèi)方的證治規(guī)律。2、首次提出了桂枝湯的中和理論。
[Abstract]:< > treatise on as one of the most important Chinese Medicine Classics, since the book has always been a hot spot of ancient physicians to learn and study. From theory to clinical practice, from the textual treatise on < > to pharmacological, almost every word by scholars, with the idea of expanding the research methods and research updates. We are still diligently mining, in order to better understand and explain the TCM valuable wealth, better clinical guidance; nevertheless, we still cannot understand every problem in the book thoroughly. For < treatise on Medicine >, "method", can divided into Guizhi Decoction group, ephedra decoction, Dachengqi Decoction, Radix Bupleuri decoction, four inverse soup more than ten kinds of Guizhi Decoction as < > treatise on the first party, although people of Guizhi Decoction has done a lot of research, but I still hope from a new angle study on it, in order not to As the discovery, better interpretation and clinical application in recent years. "The circle movement" theory has attracted more and more attention of Chinese scholars, this paper attempts to gas lift theory of circular motion as a starting point to analyze the class Guizhi Decoction Treatment of the law. By using literature research, with a circular motion of gas lift theory as a starting point, with the lifting of the law theory to analyze and summarize the syndrome and treatment of Guizhi Decoction group. This paper collects the related literature and circular motion theory, the theoretical analysis, refining, summary, focuses on the circular air lift movement. Combined with the theory of circular movement theory to analyze the "Treatise on Febrile Diseases > Guizhi Decoction group square, the original application, etc., and summarize modern Chinese scholars use Guizhi Decoction (starting from the circular movement theory) clinical experience, analysis of typical cases of them, in order to circular motion theory The law under the guidance of Guizhi Decoction treatment class. This thesis is divided into four parts, respectively for the theoretical research of circular movement, gas lift theory research, analysis of Guizhi Decoction and application of Guizhi Decoction of modern doctors' experience and typical cases. The first part is the theory of circular movement, in order to understand the origin of and the main academic point of view of circular motion theory. The theory of circular motion in the river, the source of the book < > Luoshu, congenital, acquired gossip; since the "Yellow Emperor" (hereinafter referred to as the "Neijing > < >) inheritance and treatise on both circular motion theory of the Qing Dynasty; Huang Yuan Yu and Zheng Qinan this theory, further to the Republic of China; the famous doctor Peng Ziyi write a" circular motion of the ancient Chinese medicine ", formally proposed the" circular movement ", marks the maturity of the theory of circular motion. It is necessary to point out that Huang Yuan and Zheng Qinan's theory of imperial circle movement footholddifferent, Huang side In the middle of circular motion, circular motion and Zheng is focused on. Peng Ziyi from the ancient physicians research experience and academic essence, the author of "circular motion of the ancient Chinese medicine", with the circular motion law of circular motion theory in the world, and then human physiology and pathology, including Yin and Yang, five lines, six gas. Twelve channels, twenty-four solar term circular motion theory, the creation of circular motion system with internal organs as the core, and use the circular motion theory analytic < treatise on > six medication. The second part is the theoretical study of gas lift, aimed at lifting theory of gas machine system. Research of gas lifting machine is an important part of the theory circle theory of the motion, "floating" gas "or" extremely, "sink" gas "drop" extremely. Lift access, as the main form of body qi movement, if that lifting the truth, also can understand the physiology of the human body, also can understand human body disease Daniel. Air lifting theory originated in the pre Qin period. In that the Chinese sages ", composition of the universe, the fundamental form of material existence for the movement. Gas is the universe's original material, which is the smallest unit of the universe. The movement of the substance of the universe to a lift, this is the materialism of Qi the simple concept of lifting theory. San Zhang Zhongjing inherits and develops the basic < > in < treatise on the academic point of view, > recorded in more machine caused by abnormal movements of gas diseases. Up to the Jin and Yuan Dynasties, Chinese doctors come forth in large numbers, creating academic contending prosperity situation of Qi theory, is the main content of each Different people, different views., doctors from different angles the development of Qi theory. Among them, Zhang Zi and spit on gas lift, clinical to attack evil, advocate the sweat vomit down, vomiting, especially invasive. To the Ming and Qing Dynasties During the period, on the gas lift theory use a lot, so as to promote the popularization and development of gas lift theory. In "Treatise on Febrile Diseases", including the application of gas lift Theory: the spleen and stomach, heart and kidney lifting, lifting the lifting of lung and kidney, liver, spleen and lung. The lifting gas lift theory and the following relationship six: the sun disease focus on Ying Wei access disorders, Yangming disease focuses on Yang (E soil) soil gas loss drop, shaoyang disease focus on cardinal poor, Taiyin disease focus on soil Yin (f soil) of the gas does not rise, Shaoyin disease focus on arrhythmia and lifting. Jueyin disease focuses on the movements of the blood against the chaos. The third part is the study of Guizhi Decoction, Guizhi Decoction for the treatment of the law system research. We first analyzed Guizhi Decoction, Guizhi Decoction to determine the scope of the research, this paper, choice is consistent with the most medical opinion, in Based on Professor Liu Duzhou and Professor Xiong Manqi selected 21 party on the selection of the most common clinical ten most typical prescription as the research object. The selected ten prescription prescription were included in Guizhi Decoction of cassia twig, peony, ginger, jujube, licorice five kinds of essential drugs, and go to twig, peony such parties are not included in the study, ten prescriptions were: Guizhi Decoction, Guizhi Gegen decoction, Guizhi Fuzi decoction, Guizhi Houpu Xingzi decoction, Guizhi Shaoyao ginger one or two ginseng 32 new Guangxi soup, Guizhi Decoction, Guizhi Shaoyao decoction, Guizhi Decoction plus rhubarb, Xiaojianzhong decoction, Guizhi Mahuang each this part mainly uses the Bantang circular motion theory of Guizhi Decoction was discussed from two parts of Fang Yi, and provisions. Guizhi Decoction is the foundation, side Guizhi soups Guizhi Xin, Yang l body, or the main peony; acid bitter cold, the main convergence, Lord; cassia twig, peony 涓，

本文編號(hào)：1370146