本文選題：藏醫(yī)　切入點：水腫　出處：《北京中醫(yī)藥大學(xué)》2017年博士論文　論文類型：學(xué)位論文

【摘要】：水腫是當(dāng)今臨床很常見和難愈的疾病之一,肝硬化腹水更是在西藏地區(qū)呈現(xiàn)發(fā)病率日趨增多的高危態(tài)勢,現(xiàn)代醫(yī)學(xué)的利尿劑和穿刺療法對其療效平淡且易復(fù)發(fā)。藏醫(yī)水腫治療理論隨博大精深、治療手段豐富,但目前對此的研究和應(yīng)用力度嚴(yán)重不足。我認(rèn)為在藏醫(yī)水腫理論研究中最重要的兩個內(nèi)容是秘藥理論研究與證型理論研究。在《四部醫(yī)典》之秘訣部(臨床集)的第八、九、十章分別載述了三種不同程度的體液代謝紊亂癥--即浮腫(skyarbab)、墜積水腫(,or)和大癆水臌癥(gcong chen dmu chu)。這三種病癥是水腫發(fā)生時的三個階段性體現(xiàn),但從分型上又有所區(qū)別。在《四部醫(yī)典》中,浮腫又分為肺性,肝性,脾性,隆性,黃水性五種。墜積水腫分為隆性,赤巴性,培根性,血性,外傷性,中毒性六種。腹水被概括為潴積('khyims)、擴散(byer)、滲漏(zags)、穿孔(rdol)等四種類型。且又可細(xì)分為尿液潴積性腹水1種;血液擴散性腹水、膽汁擴散性腹水、黃水?dāng)U散性腹水3種擴散型;胃漏性腹水、大腸滲漏性腹水、肝漏性腹水、脾漏性腹水、肺漏性腹水、脈瘤漏性腹水、血瘤漏性腹水、黃水瘤漏性腹水8種滲漏型;小腸穿孔性腹水1種;中毒性腹水1種;癔癥性腹水1種,共15種病證。治療水腫的內(nèi)容是《四部醫(yī)典》秘訣部九十二個章節(jié)中篇幅最大的章節(jié)之一。但是,當(dāng)前藏醫(yī)臨床上鑒別水腫類型時則以肝腎心肺等病變部位來診斷,使得《四部醫(yī)典》中的水腫證型理論無法結(jié)合到實踐應(yīng)用當(dāng)中。在本課題的研究中通過采用文獻(xiàn)對比、專家采訪、統(tǒng)計分析、臨床總結(jié)、規(guī)律解析、推理闡微等研究方法,對藏醫(yī)水腫證型理論發(fā)展的歷史沿革,《四部醫(yī)典》所記載的水腫證型理論總綱及《秘訣紅卷》所述十二種不同的腹水證型、藏醫(yī)水腫療法三大流派的證型理論,以及證型間彼此的所屬關(guān)系,可導(dǎo)致水腫的其他病癥等進(jìn)行了深入的比較和研究。對《藏醫(yī)藥大典》全冊(共六十卷)所記載的156個治療水腫的藥方進(jìn)行了挖掘和整理,并通過數(shù)據(jù)統(tǒng)計方法對水腫藥方配伍規(guī)律進(jìn)行了分析和討論。并對阿輸吠陀水腫理論對藏醫(yī)水腫理論的影響和現(xiàn)代醫(yī)學(xué)與藏醫(yī)學(xué)水腫理論的結(jié)合思路進(jìn)行了探討。通過研究本課題所獲得的結(jié)果有:一、不僅通過對《四部醫(yī)典》所記載的水腫理論和《貢珠札記》所載述的臨床診療方法的探討外,在全面挖掘與整理現(xiàn)存所有藏醫(yī)典籍中所涉及的水腫證型理論之基礎(chǔ)上,對與其相關(guān)的"三因"、臟腑病癥、內(nèi)外傷、中毒、方劑學(xué)等方面進(jìn)行了全面和系統(tǒng)的分析和研究。二、全面揭示了藏醫(yī)水腫學(xué)的基本理論特點。三、較清晰地剖析和比較了水腫各證型的病理機制與診療原則。四、使形成對臨床具有指導(dǎo)意義的藏醫(yī)水腫各證型的診療理論體系奠定了基礎(chǔ),并對改變藏醫(yī)水腫理論與實踐無法結(jié)合的現(xiàn)狀進(jìn)行了思考和探討。
[Abstract]:Edema is one of the most common and difficult diseases in clinical practice today, and ascites with liver cirrhosis is showing a high risk situation of increasing incidence in Tibet. The therapeutic effect of diuretics and puncture therapy in modern medicine is dull and easy to recur. I think the two most important contents in the theoretical study of edema in Tibetan medicine are the theory of secret medicine and the theory of syndromes. In 8th and 9 of the secret section (clinical collection) of the "four Medical Codex", The ten chapters respectively describe three kinds of humoral metabolic disorders of different degrees, that is, bloated skyarbabia, dropsy and dropsy) and large tuberculosis and dropsy, Gcong chen dmu, which are the three stages of the occurrence of edema. However, there are differences in classification. In the "four Medical examples", edema is divided into five types: lung, liver, spleen, Carina and yellow water. Dropsy edema is divided into Carina, red bar, bacon, blood, traumatic. The ascites were classified into four types, I. e., the hydrocephalus hyimsm, the diffusion byerg, the percolation zagsl, the perforated rdol. and the ascites were divided into three types: hematogenous ascites, bile diffuse ascites, yellow water diffusive ascites, and urine hydrocephalic ascites, which were divided into three types: hematogenous ascites, bile diffusive ascites, yellow water diffusive ascites. Gastric leakage ascites, large intestine leakage ascites, liver leakage ascites, splenic leakage ascites, lung leakage ascites, vein tumor leakage ascites, hemangioma leakage ascites, xanthomatous ascites 8 kinds of leakage type, small intestine perforation ascites 1 type, toxic ascites 1 type; Hysterical ascites, a total of 15 disease syndromes. The treatment of edema content is the secret of the "four medical code" 92 chapters of the largest chapter. However, At present, the clinical diagnosis of edema in Tibetan medicine is based on liver, kidney, heart, lung and other pathological changes, which makes it impossible to combine the theory of edema syndrome type in "four medical codes" into practical application. Expert interviews, statistical analysis, clinical summary, law analysis, reasoning and other research methods, With regard to the history of the development of the theory of edema syndrome in Tibetan medicine, the general outline of the theory of edema syndrome type recorded in the four Medical Codex, the 12 different ascites syndrome types described in the Red Book of Secrets, and the syndromes theory of three major schools of edema therapy in Tibetan medicine, As well as the relationship between syndromes and types, other diseases that can lead to edema are compared and studied in depth. The 156 prescriptions for treating edema recorded in the whole Book of Tibetan Medicine (60 volumes) have been excavated and sorted out. The compatibility law of edematous prescription was analyzed and discussed by statistical method. The influence of the theory of Aveda edema on the theory of edema in Tibetan medicine and the thought of combining modern medicine with the theory of edema of Tibetan medicine were discussed. The results obtained from the research on this subject are as follows:. Not only through the discussion of the theory of edema recorded in the four Medical codes and the methods of clinical diagnosis and treatment contained in the Notes of Gongzhu, but also on the basis of comprehensively excavating and sorting out the theory of edema syndrome type involved in all the existing books of Tibetan medicine. The related aspects of "three causes", viscera diseases, internal trauma, poisoning, prescriptions and so on are comprehensively analyzed and studied. Secondly, the basic theoretical characteristics of edematology in Tibetan medicine are fully revealed. The pathological mechanism and principles of diagnosis and treatment of each syndrome type of edema were analyzed and compared clearly. Fourthly, the theoretical system of diagnosis and treatment of each syndrome type of edema in Tibetan medicine, which has guiding significance in clinical practice, was formed, which laid a foundation for the formation of a theoretical system for the diagnosis and treatment of each syndrome type of edema. At the same time, the author thinks and discusses the current situation that the theory and practice of Tibetan medicine edema can not be combined.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R29
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本文編號：1576648