本文選題：《金匱要略》　切入點：痰飲　出處：《廣州中醫(yī)藥大學(xué)》2016年博士論文　論文類型：學(xué)位論文

【摘要】：目的：痰飲乃是中醫(yī)臨床常見病證,首見于張仲景《金匱要略·痰飲咳嗽病脈證并治第十二》篇。痰飲證治理論是張仲景學(xué)說重要組成部分,其影響巨大,為后世醫(yī)家對痰飲的診斷、治療開了理法方藥的先河。中醫(yī)痰飲病的理論和治法方藥,經(jīng)過歷代醫(yī)家的實踐運用、理論總結(jié)而不斷地發(fā)展�！督饏T要略·痰飲咳嗽病脈證并治第十二》篇所述痰飲證治體系,全面系統(tǒng)論述了痰飲病因病機(jī)、治法、方藥。張仲景理論在唐、宋、金、元時期受到重視,痰飲理論也隨之不斷發(fā)展。各醫(yī)家逐漸加深對痰飲的認(rèn)識,擴(kuò)展了痰飲理論的研究范圍,從專注研究痰飲病的治療擴(kuò)大到研究其它雜病病種的痰飲證,也就是病因病機(jī)學(xué)范疇的痰飲。宋金元時期內(nèi)科雜病理論得到大力發(fā)展,逐漸形成診治雜病的痰理論；到了明清時期痰飲和痰理論被不斷深化和歸納,并且有不少新發(fā)現(xiàn)；現(xiàn)代中醫(yī)學(xué)者逐漸將痰飲理論研究應(yīng)用于病因病機(jī)學(xué)和臨床診治,促進(jìn)了現(xiàn)代中醫(yī)的發(fā)展。在整個痰飲理論的發(fā)展過程中,尤怡是清代深化、歸納痰飲理論的集大成者,其對痰飲辨證論治的思想有突出的特點。尤怡畢生致力于古代醫(yī)典研究與臨床實踐,其著作對后世醫(yī)家影響深遠(yuǎn)。其代表作有《金匱要略心典》、《金匱翼》、《傷寒貫珠集》、《醫(yī)學(xué)讀書記》和《靜香樓醫(yī)案》。尤氏在闡發(fā)《金匱要略》的基礎(chǔ)上,總結(jié)了“治痰七法”,對痰飲證的診治在醫(yī)學(xué)理論和臨床實踐兩方面都有深遠(yuǎn)意義。本研究的目的之一是探索尤怡對《金匱要略》痰飲理論學(xué)術(shù)思想的發(fā)展成就。尤怡集十年寒暑研究《金匱要略》心得以成《金匱要略心典》,其觀點獨具慧眼而行文簡潔扼要,對后人研讀《金匱要略》產(chǎn)生了深刻的影響。本研究根據(jù)尤怡《金匱要略·痰飲咳嗽病脈證并治第十二》篇注文,分析《金匱要略》的痰飲理論體系,探究尤怡對張仲景痰飲證治理論的繼承和研究的成就。本研究的目的之二是探索尤怡獨創(chuàng)的治痰七法,總結(jié)尤氏獨特的痰飲證治思想。治痰七法是尤怡痰飲辨證論治體系的集中體現(xiàn),出現(xiàn)在其晚年著作《金匱翼》。尤怡為增補《金匱要略》而作《金匱翼》,該書是對張仲景雜病治療體系的繼承與發(fā)揚,是尤氏學(xué)術(shù)思想成熟之作。書中將內(nèi)傷雜病分門別類,論述理法方藥,參考前人醫(yī)論、方藥以完整闡述的雜病治療方案,在臨床中有較高實用價值。書中,治痰七法綜合了三方面的成就,包括《金匱要略》痰飲理論；后世醫(yī)家痰飲各論和尤怡自身的理論與實踐經(jīng)驗。尤怡將治痰七法分為攻逐、消導(dǎo)、和、補、溫、清、潤,是7種不同辨證情況下的痰飲的治療手段,每法還根據(jù)病情輕重緩急使用不同的方劑。本研究探索治痰七法的源頭,分析治痰七法細(xì)微的治法方藥,梳理尤怡證治痰飲的學(xué)術(shù)脈絡(luò),總結(jié)尤怡對《金匱要略》痰飲理論的發(fā)展和補充。本研究的目的之三是分析尤怡《靜香樓醫(yī)案》中的痰飲證治,歸納總結(jié)尤氏在臨床中應(yīng)用張仲景痰飲理論的心得和治痰七法的實用價值。本文深入分析《靜香樓醫(yī)案》痰飲證醫(yī)案,追溯尤怡診斷、立法、處方、選藥的歷史淵源,以明了其深意。研究過程中,緊密結(jié)合《金匱要略心典》和《金匱翼》的論述,旁參歷代醫(yī)家的方藥,探討尤怡臨床處方的歷史源流,總結(jié)其臨床實踐與理論研究的一致性。綜上所述,本研究旨在以《金匱要略·痰飲咳嗽病脈證并治第十二》為出發(fā)點,研究挖掘尤怡的痰飲證治思想。通過展現(xiàn)尤怡《金匱要略心典·痰飲》篇所發(fā)揮的張仲景痰飲學(xué)說、《金匱翼》的痰飲證治理論和《靜香樓醫(yī)案》治痰七法的實際應(yīng)用,為現(xiàn)代中醫(yī)臨床辨證論證開拓新思路和方藥提供借鑒。方法：本論文研究方法,采用中醫(yī)文獻(xiàn)研究,醫(yī)史研究,古籍文本內(nèi)容分析,古籍文獻(xiàn)對比分析,結(jié)合現(xiàn)代中醫(yī)理論發(fā)展成果加以適當(dāng)?shù)脑u按,挖掘古代醫(yī)籍理論對現(xiàn)代中醫(yī)理論和臨床的意義。本研究對張仲景至尤怡的痰飲理論進(jìn)行源流考究,梳理痰飲理論的學(xué)術(shù)發(fā)展歷程,挖掘不同歷史時期痰飲證治方法的演變和時代特點。本文結(jié)合現(xiàn)代中醫(yī)學(xué)理論進(jìn)行適當(dāng)?shù)陌l(fā)揮,參照不同的學(xué)說進(jìn)行對比、鑒別,力求相對客觀的評價古代醫(yī)家的成就,以獲得相對合理的結(jié)論�！督饏T要略》痰飲理論是本研究的基礎(chǔ)。在此基礎(chǔ)上,參考?xì)v代相關(guān)古醫(yī)籍文獻(xiàn),集中分析《金匱要略心典》、《金匱翼》、《靜香樓醫(yī)案》三部著作,對有關(guān)痰飲理論的命名、分類、辨證、病因病機(jī)、治療進(jìn)行系統(tǒng)的整理、分析和歸納,總結(jié)出尤怡痰飲證的辨證論治體系。本研究包含四部分：第一部分,以《金匱要略》為主線,分析歷代8家《金匱要略》著名的注家(含尤怡)的注文,深入探討尤怡《金匱要略心典》對痰飲理論的注疏和闡發(fā)的成就。這些注家大多生活在尤怡同時代或時期相近,其中一位注家生活時代較晚于尤怡,所選注家皆為臨床名家,也是《金匱要略》著名的研究者。所選注家有：1、趙以德,著有《金匱方論衍義》,是最早全面注疏《金匱要略》的醫(yī)家；2、沈明宗,著有《金匱要略編注》,其善于用自身體會進(jìn)行注疏原文；3、徐彬,著有《金匱要略論著》,其師承于李中梓、喻昌,學(xué)術(shù)觀點和源流與尤怡相近；4、魏荔彤,著有《金匱要略方論本義》,其研究《金匱要略》長達(dá)40余年,注疏嚴(yán)謹(jǐn)而詳盡；5、程林,著有《金匱要略直解》,其為明末清初新安學(xué)派醫(yī)家,其注疏采用“以經(jīng)證經(jīng)”之法,頗有特色；6、李_c,著有《金匱要略廣注》,其注疏主要依據(jù)《黃帝內(nèi)經(jīng)》理論,參考?xì)v代醫(yī)論；7、高學(xué)山,著有《高注金匱要略》,生活年代較晚于尤怡,其注本是稀缺的版本,該書是高氏臨床心得和《金匱要略》研究的緊密結(jié)合,較有臨床實用性。第二部分,以《金匱翼》文本為中心,緊密聯(lián)系《金匱要略》的醫(yī)學(xué)思想,追溯《金匱翼》中治法處方的淵源,分析尤怡治痰七法。通過考證和分析《金匱翼·痰飲》篇所,發(fā)現(xiàn)該篇引用歷代27本著作的痰飲醫(yī)論和方藥,可見尤怡集歷代所長而選方有深意。對治痰七法醫(yī)理的研究,本文應(yīng)用中醫(yī)方劑學(xué)理論,深入分析《金匱翼》痰飲證所采用的方劑配伍意義和藥物使用方法。對治痰七法分析表明,尤怡辨證準(zhǔn)確,立法慎密,所選方劑實用,對現(xiàn)代中醫(yī)有臨床借鑒價值。第三部分,分析《靜香樓醫(yī)案》中痰飲證臨床治療方藥,深入討論尤怡臨床辨證論治和立法處方的特點。本部分對《靜香樓醫(yī)案》進(jìn)行篩選分析。被選用醫(yī)案必須符合兩個條件中的一個：第一,題目明顯體現(xiàn)痰飲病因病機(jī)的；第二,診治手法屬于典型的治痰七法范疇的。對于部分醫(yī)案與痰飲相關(guān),但是診療的主要方面并不屬于從痰飲論治的,給予排除。對篩選后的醫(yī)案,采用中醫(yī)學(xué)理論,從痰飲的病因病機(jī),辨證論治,立法處方等角度進(jìn)行分析。根據(jù)尤怡臨證處方,尋找其在古代醫(yī)籍的根源,參照歷代醫(yī)家相近的方論,探討尤氏應(yīng)用古方治今病之路。對痰飲證醫(yī)案,結(jié)合《金匱要略心典》、《金匱翼》論述,展示三者的關(guān)聯(lián)性,總結(jié)尤氏理論與實踐的高度一致性。第四部分,深入討論尤怡痰飲證治思想在臨床中的應(yīng)用,參考現(xiàn)代痰飲研究和臨床家的經(jīng)驗,發(fā)現(xiàn)治痰七法對現(xiàn)代中醫(yī)臨床辨證論證的意義。本文的第5章討論了研究對象和結(jié)果,總結(jié)出尤怡闡發(fā)張仲景痰飲理論的成就；分析挖掘治痰七法的學(xué)術(shù)特色以及尤怡的臨床特色；啟發(fā)尤怡痰飲證治思想對現(xiàn)代中醫(yī)臨床的理論價值和實踐價值,以擴(kuò)展現(xiàn)代中醫(yī)臨床應(yīng)用其醫(yī)學(xué)思想的思路與方法。結(jié)果：1.《金匱要略心典·痰飲》注疏闡明張仲景痰飲理論四飲體系,對“水在五臟”、留飲的發(fā)揮,是尤氏痰飲醫(yī)學(xué)思想發(fā)展的基礎(chǔ)；注文以“溫藥和之”治則為中心,闡述歸納多種治法,包括“溫藥和之”法、消法、攻逐法三大法。尤怡從理論、治法和方劑解析三個不同角度論述以上三法,發(fā)展成為《金匱翼》治痰七法的基礎(chǔ)。2.《金匱翼》繼承了《金匱要略》醫(yī)學(xué)思想,通過研究歷代痰飲證治大成,創(chuàng)立治痰七法。治痰七法包含了攻逐、消導(dǎo)、和、補、溫、清、潤。其中攻逐、消導(dǎo)、和、補、溫等法多來源于《金匱要略》治法；清、潤二法則是尤怡自身學(xué)驗和后世發(fā)展總結(jié)而成。治痰七法辨證思路清晰、方藥實用,便于指導(dǎo)痰飲證臨床治療。3.《靜香樓醫(yī)案》痰飲證醫(yī)案是尤怡痰飲證治理論應(yīng)用到各門雜病的臨床治療范例。本研究發(fā)現(xiàn),在尤怡的臨床痰飲證治中,診斷分析和立法多以張仲景《金匱要略》為基礎(chǔ)；選方多用經(jīng)典方劑,加以化裁,少數(shù)情況自擬方藥。尤氏嫻熟應(yīng)用古方治今病(當(dāng)時之病),是對古代醫(yī)籍的實用性的肯定和價值的彰顯。尤怡醫(yī)案體是《金匱要略心典》、《金匱翼》的實際應(yīng)用,也是在臨床上對其理論的實踐驗證。4.尤怡的治痰七法體系與臨床應(yīng)用對現(xiàn)代醫(yī)學(xué)治療具有重大的理論意義和實踐意義。其理論意義在于,尤怡以辨證論證和臨床應(yīng)用的角度闡發(fā)張仲景學(xué)術(shù)思想,以促進(jìn)經(jīng)典方藥在其所在時代乃至現(xiàn)代臨床中使用；治痰七法在理論上有鮮明的繼承性和獨創(chuàng)性,尤怡將其應(yīng)用到臨床的診療過程中,是理論到實踐的高度統(tǒng)一。其對現(xiàn)代中醫(yī)臨床的實踐價值在于,治痰七法可以給現(xiàn)代中醫(yī)臨床帶來慎密的方法和豐富的方藥,拓展了臨床的治療手段；臨床應(yīng)用治痰七法對痰飲病和痰飲病之外的雜病治療都有良好的治療效果,無論是現(xiàn)代中醫(yī)病種還是西醫(yī)病種都可以加以借鑒。結(jié)論：尤怡的痰飲證治思想體系,包括了對張仲景經(jīng)典學(xué)說的繼承；治痰七法理論；尤氏務(wù)實效臨床應(yīng)用治痰七法的經(jīng)驗。此三者是尤怡的痰飲醫(yī)學(xué)證治理論與臨床實際緊密聯(lián)系的體現(xiàn)。以治痰七法為核心的尤怡的痰飲證治思想對現(xiàn)代中醫(yī)臨床立法論治有重大現(xiàn)實意義,其臨床根據(jù)辨證化裁古方以治今病對現(xiàn)代中醫(yī)藥臨床應(yīng)用有借鑒意義。
[Abstract]:Objective: phlegm is a common clinical symptom, first seen in Zhang Zhongjing "Jinkui yaolue. Phlegm cough syndromes and treatment twelfth. Treatment of phlegm syndrome theory" is an important part of Zhang Zhongjing theory, its great influence, for physicians in diagnosis of phlegm, the treatment prescription of phlegm disease precedent. The theory of traditional Chinese medicine and herbs, through the practice of the ancient physicians use theoretical summary and developing constantly. Jinkui yaolue. Phlegm cough syndromes and treatment of the treatment system twelfth > phlegm card, comprehensively and systematically discusses the phlegm etiology and pathogenesis, treatment, prescription. Zhang Zhongjing theory in the Tang, song, Jin the Yuan Dynasty, attention, phlegm theory develops continuously. The doctors gradually deepen the understanding of phlegm, phlegm theory expands the research scope, research focus from the treatment of phlegm disease to study other diseases disease of phlegm syndrome of Yin, that is Etiology and pathogenesis of phlegm category Song Jinyuan miscellaneous diseases theory development, phlegm theory gradually formed to the diagnosis and treatment of diseases; phlegm and phlegm theory was deepened and summarized in the Ming and Qing Dynasties, and there are a lot of new discoveries; modern Chinese scholars gradually phlegm theory applied to pathogeny and clinical diagnosis and treatment, to promote the development of modern Chinese medicine. In the process of development of the theory of phlegm, especially Yi Qing Dynasty is deepening, synthesizer induction phlegm theory, its outstanding characteristics of phlegm syndrome differentiation thought. You Yi devoted his life to the ancient medical research and clinical practice, the profound influence on the later generations on behalf of the doctors. As a "jinkuiyaolue heart code >, < < > golden wing, Shang Han Guan Zhu Ji > > and < < medical record reading medical records. Especially in Shizuka building based on the analysis of < jinkuiyaolue >, summed up the" phlegm seven "of phlegm Certificate of diagnosis and treatment have far-reaching significance in two aspects of medical theory and clinical practice. One of the purposes of this study is to explore the You Yi of < > phlegm theory Jinkui yaolue academic development achievements. Especially the study of Yi set ten years experience with jinkuiyaolue > < < code > jinkuiyaolue heart, the view of discerning and the terse, has a profound influence on the later study. This study jinkuiyaolue > < < jinkuiyaolue according to You Yi - phlegm cough syndromes and treatment of twelfth > text annotation, analysis of the theoretical system of jinkuiyaolue > < phlegm, explore You Yi to inherit and study of Zhang Zhongjing's theory of phlegm retention syndrome governance achievements. The purpose of this study is to explore the two original You Yi phlegm seven method, summarize the uilenbergi unique thought of treatment. The treating phlegm phlegm retention syndrome seven method is the concentrated reflection of you Yi phlegm syndrome differentiation system, appear in his later works. "Golden wing for the addition of" You Yi Jin Or slightly as < > > golden wing, the book is to inherit and develop Zhang Zhongjing disease treatment system, is uilenbergi academic thoughts and mature work. The book will be arranged on internal diseases, prescription, medicine on previous treatment prescription, miscellaneous to fully elaborate the clinical in the higher practical value. In the book, seven methods of phlegm treatment combined with the three achievements, including the "Golden Chamber > phlegm theory; on the later doctors and phlegm You Yi own theory and practice experience. You Yi will be divided into seven phlegm Purgating, digestion, and complement, warm, clear, run, 7 different cases of phlegm syndrome differentiation treatment, each method also uses different prescriptions according to the condition of order of priority. This study explores the source of phlegm treatment of seven methods of analysis, treatment and prescription subtle phlegm phlegm treatment method seven, combing the context of academic certificate you Yi Yi, especially on" jinkuiyaolue summary the theory of phlegm. The exhibition and supplement. The purpose of this study is the analysis of the three floor You Yi < > in the medical records of Shizuka phlegm syndrome treatment, summarized the application of Zhang Zhongjing's theory of phlegm especially in clinical experiences in treating phlegm and seven practical value. This paper makes a deep analysis on building medical records > < Shizuka phlegm retention syndrome cases, retrospective diagnosis prescription You Yi broken, legislation, historical origin, drug selection, to understand its meaning. In the course of the study, combined with < jinkuiyaolue heart code > and < > this golden wing, next to participate in the ancient physicians prescription, to explore the historical origin of you Yi clinical prescription, consistency and summarize the clinical practice and theoretical research. In summary, this study aims to "Jinkui yaolue. Phlegm cough syndromes and treatment > twelfth as the starting point, study the phlegm syndrome mining You Yi thoughts. By showing you Yi" Jinkui yaolue heart code - > phlegm article played by Zhang Zhongjing phlegm phlegm retention syndrome theory, < > governance golden wing The practical application and theory building case > phlegm Shizuka < seven law, develop new ideas and provide reference for modern Chinese medicine clinical dialectical argumentation. Methods: in this paper, research methods, research history of Chinese literature, the ancient text analysis, literature analysis, comparative ancient books, combined with the theory of modern Chinese medicine development results properly according to the review, the excavation of ancient medical books theoretical significance for modern Chinese medicine theory and clinical research. The phlegm theory of Zhang Zhongjing to the You Yi origin research, combing the theory of academic development and mining, evolution and characteristics of the times in different historical periods. The phlegm retention syndrome treatment methods combined with the modern theory of traditional Chinese medicine appropriate play according to different theories, comparison, identification, in order to objectively evaluate the achievements of ancient physicians, to obtain a relatively reasonable conclusion. Jinkuiyaolue theory is the study on Phlegm 鐨勫熀紜，

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