本文關(guān)鍵詞： 舍時(shí)從證 王孟英 醫(yī)案　出處：《南京中醫(yī)藥大學(xué)》2016年博士論文　論文類(lèi)型：學(xué)位論文

【摘要】：“舍時(shí)從證”思想濫觴于《黃帝內(nèi)經(jīng)》。其與“因時(shí)制宜”既相互對(duì)立,又互為補(bǔ)充,共同組成了中醫(yī)時(shí)間醫(yī)學(xué)體系的核心內(nèi)容。但目前,中醫(yī)學(xué)界對(duì)“舍時(shí)從證”還沒(méi)有給予明確的定義,各類(lèi)中醫(yī)詞典甚至未將“舍時(shí)從證”作為詞條收入其中。目前,無(wú)論是理論還是臨床,對(duì)“舍時(shí)從證”都缺少深入的研究和應(yīng)用。這種情況嚴(yán)重影響了“舍時(shí)從證”的理論價(jià)值和對(duì)臨證指導(dǎo)的實(shí)踐價(jià)值。自元代醫(yī)家羅天益在《衛(wèi)生寶鑒·舍時(shí)從證》篇中明確提出“舍時(shí)從證”的原則以后,后世雖然對(duì)其時(shí)有闡發(fā),但主要是在研究中醫(yī)時(shí)間醫(yī)學(xué)時(shí),將其作為“因時(shí)制宜”、“時(shí)不可違”的補(bǔ)充而略微涉及。研究范圍也只是對(duì)羅天益的“舍時(shí)從證”思想進(jìn)行闡述,即當(dāng)病證與季節(jié)氣候不一致時(shí),不能拘泥于時(shí)令氣候因素對(duì)疾病的影響,而要根據(jù)證候來(lái)決定治法。研究的內(nèi)容也以《衛(wèi)生寶鑒》中記載的醫(yī)案為主,即夏季用干姜、附子等藥組成的托里溫中湯治療寒性瘡瘍,強(qiáng)調(diào)夏季出現(xiàn)寒證也需要用溫?zé)崴庍M(jìn)行治療。進(jìn)入現(xiàn)代以來(lái),相對(duì)于“因時(shí)制宜”如火如荼的研究狀況,對(duì)“舍時(shí)從證”的研究則略顯冷清。經(jīng)檢索,以“舍時(shí)從證”為篇名的文獻(xiàn)也僅有發(fā)表于上世紀(jì)九十年代初的一篇論文,即北京中醫(yī)學(xué)院醫(yī)88級(jí)學(xué)生張向群在《北京中醫(yī)學(xué)院學(xué)報(bào)》發(fā)表的《淺論“時(shí)不可違”和“舍時(shí)從證”》。其認(rèn)為“舍時(shí)從證”的原則,正是“時(shí)不可違”在臨證治療中的靈活應(yīng)用。但并未對(duì)“舍時(shí)從證”進(jìn)行更深層次的研究,同樣只是引用羅天益在《衛(wèi)生寶鑒》中記載的醫(yī)案來(lái)進(jìn)行說(shuō)明。王孟英是晚清時(shí)期著名溫病學(xué)家,作為“溫病學(xué)派四大家”之一,其對(duì)溫病學(xué)的發(fā)展做出了巨大的貢獻(xiàn)。作為溫病學(xué)家的王孟英可謂深得“舍時(shí)從證”思想精髓。即當(dāng)病證與各種時(shí)間因素不符時(shí),王氏能夠不拘泥于“時(shí)”,而是堅(jiān)持以“證”為主,隨證施治。通過(guò)對(duì)王孟英醫(yī)案深入研究發(fā)現(xiàn),王氏對(duì)“舍時(shí)從證”的運(yùn)用主要體現(xiàn)在三大方面：“不為時(shí)氣節(jié)律所拘堅(jiān)持以證為本；不為人體節(jié)律所困堅(jiān)持以證為本；不為即時(shí)客邪所惑堅(jiān)持以證為本”。通過(guò)既遵守“因時(shí)制宜”,又堅(jiān)持“舍時(shí)從證”,王孟英實(shí)現(xiàn)了溫病學(xué)理論和辨證施治理論的完美結(jié)合。從“舍時(shí)從證”視角對(duì)王孟英醫(yī)案進(jìn)行研究,為深入研究挖掘王孟英醫(yī)學(xué)思想開(kāi)辟了新途徑,也為多視角研究中醫(yī)學(xué)醫(yī)案提供了新模式和新范本。同時(shí),結(jié)合王孟英醫(yī)案對(duì)“舍時(shí)從證”進(jìn)行研究,可以更準(zhǔn)確地理解“舍時(shí)從證”的內(nèi)涵,有助于對(duì)其含義進(jìn)行界定。結(jié)合王孟英醫(yī)案,綜合前賢研究成果,可以對(duì)“舍時(shí)從證”這樣進(jìn)行定義：當(dāng)時(shí)間因素與疾病證候不一致時(shí),不能局限于時(shí)間因素對(duì)疾病的影響,要堅(jiān)持以證為主,隨證施治。其內(nèi)涵主要有三個(gè)方面：舍時(shí)氣節(jié)律從證、舍人體節(jié)律從證、舍即時(shí)客邪從證。
[Abstract]:The thought of "giving away time from syndrome" originated in "Huangdi's Internal Classic". It and "taking measures according to the circumstances" are both opposite and complementary to each other, which together form the core content of the time medicine system of traditional Chinese medicine. However, at present, The Chinese medicine profession has not yet given a clear definition of "giving time from syndrome", and all kinds of Chinese medicine dictionaries have not even included "giving time from syndrome" as an entry. At present, whether it is theoretical or clinical, This situation has seriously affected the theoretical value and practical value of the guidance of temporary certificate. Luo Tianyi, a doctor of the Yuan Dynasty, followed the certificate in the "Health Po Jian 路she". After putting forward the principle of "giving up time according to evidence" clearly in the article, Although later generations have elucidated their time, they are mainly used in the study of time medicine of traditional Chinese medicine as a supplement to "taking measures according to the circumstances" and "cannot be violated when the time is not violated." the scope of the research is only to expound Luo Tianyi's thought of "passing time from syndrome". That is, when the disease syndrome is not consistent with the seasonal climate, the effect of seasonal climatic factors on the disease should not be confined to seasonal climate factors, but the treatment method should be determined according to the syndrome. The contents of the study are also based on the medical records recorded in the "Sanitary Treasure", that is, dry ginger is used in summer. Toriwenzhong decoction, composed of aconite and other drugs, is used to treat cold sore, emphasizing that cold syndrome also needs to be treated with warm medicine in summer. Since entering modern times, the research situation of "taking measures according to the times" is in full swing. The research on "Shishuozou syndrome" is slightly desolate. After searching, there is only one paper published in the beginning of -10s under the title of "Sheshe Shi Zong Zheng". That is, Zhang Xiangqun, a medical student of Grade 88 of Beijing Institute of traditional Chinese Medicine, published in the Journal of Beijing Institute of traditional Chinese Medicine, "on the principle of" not disobeying "and" giving time according to syndromes ">. It is the flexible application of "time must not disobey" in the treatment of clinical syndrome. However, no further research has been done on "giving time from syndrome". Wang Mengying, a famous febrile scientist in the late Qing Dynasty, was one of the "four major schools of febrile disease". Wang Mengying, a febrile scientist, has made a great contribution to the development of febrile disease. Wang was able not to stick to "time", but to stick to "syndrome" as the main treatment. Through an in-depth study of Wang Mengying's medical case, he found that. Wang's application of "giving away time from the card" is mainly reflected in three aspects: "the law firm does not stick to the evidence as the basis, not the human body to adhere to the rhythm of the card as the basis;" Not bewildered by instant guest evil, insist on taking syndrome as the basis ". By adhering to both" taking measures according to the circumstances "and" giving away time according to syndrome ", Wang Mengying realized the perfect combination of febrile disease theory and syndrome differentiation and treatment theory. From the angle of" giving time from syndrome ", Wang Mengying realized the perfect combination of febrile disease theory and syndrome differentiation theory. Meng Ying's medical records were studied. It opens up a new way for further research and excavation of Wang Mengying's medical thought, and also provides a new model and a new model for the study of traditional Chinese medicine cases from multiple perspectives. We can have a more accurate understanding of the connotation of "giving up time and following the card," which will help us to define its meaning. Combined with Wang Mengying's medical case, we can synthesize the research results of the former sages. It can be defined as follows: when the time factor is not consistent with the disease syndrome, it should not be limited to the influence of the time factor on the disease. There are three main aspects of its connotation: the rhythm of Qi, the rhythm of the human body, and the syndrome of instant guest evil.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R249;R242

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