本文選題：唐容川 + 血證��； 參考：《北京中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：本論文共由三部分組成,第一部分綜述,第二部分血證的古代學(xué)術(shù)源流,第三部分以唐容川《血證論》為基礎(chǔ)的中醫(yī)血證診斷特色研究,探析中醫(yī)血證辨證論治的傳承演變過程。中醫(yī)血證古代學(xué)術(shù)源流,從目前所見的史料記載,是由公元前第5-6世紀(jì)的《五十二病方》,以頭發(fā)蒲席炒炭治療外傷出血以及內(nèi)服外洗治療痔血的臨床開始萌芽�！秲�(nèi)經(jīng)》對(duì)血證的望診與脈診,寒熱虛實(shí)陰陽的辨證,六淫辨證,七情證候、外傷、飲食勞傷的病因辨證,氣血津液辨證,臟腑辨證等論述,奠定了后世醫(yī)家在血證辨證的基礎(chǔ)。兩漢時(shí)期,《史記·扁鵲倉公列傳》多次以“血脈病”稱呼“血證”,其所敘述的血證診治書寫方式,被視為現(xiàn)代醫(yī)案撰寫的鼻祖。 《傷寒雜病論》以理、法、方、藥結(jié)合的形式,提升了血證辨證論治的思維,包括提出血證的“以方測(cè)證”,辨別血證的虛實(shí)寒熱、病因病機(jī)與病位。重視“和解法”如少陽熱入血室證以小柴胡湯和解之法。注重“血汗同源”,婦科治療重視水血兼病,并提示注意與雜病治法的差異等。魏晉南北朝時(shí)期,《中藏經(jīng)》、《脈經(jīng)》與《王叔和脈訣》等,以脈證為中心,分述五臟六腑病證的寒熱虛實(shí),形成有系統(tǒng)的臟腑辨證理論,并將之應(yīng)用于對(duì)血證的論述與提出治療方藥等。隋唐五代時(shí)期,《諸病源候論》在《內(nèi)經(jīng)》與《傷寒雜病論》的基礎(chǔ)上,結(jié)合臨床的實(shí)踐經(jīng)驗(yàn),對(duì)中醫(yī)各種血證的病因、病機(jī)、病位與臨床診治,都有詳細(xì)的記載,應(yīng)是我國(guó)論述血證證候較完整的醫(yī)著。兩宋時(shí)期,《三因極一病證方論》首次提出血證的三因總論與個(gè)別血證的三因,N&與南宋陳自明都提出“瘀蓄冷血”之說。金元時(shí)期,劉完素強(qiáng)調(diào)臟腑功能的協(xié)調(diào),并提出“六氣皆能化火”之說,重視“火熱為病”的病機(jī)；張從正主張“出血所以養(yǎng)血”的論點(diǎn)；李杲提出“內(nèi)傷脾胃,百病由起”的脾胃論學(xué)說；朱丹溪進(jìn)一步發(fā)展了“濕熱相火為病甚多”的觀點(diǎn),重視脾土之陰,強(qiáng)調(diào)養(yǎng)陰補(bǔ)血的重要性。明清時(shí)期,繆希雍提出“吐血三要”與“治血三要”：蕭京提出“治血貴靜說”的論點(diǎn)；李中梓明確提出“腎為先天,脾為后天”,同時(shí)強(qiáng)調(diào)“治先天根本,則有水火之分”、“治后天之本,則有飲食勞倦之分”的觀點(diǎn)；張景岳進(jìn)一步闡述“血”對(duì)人身、精神、意志的重要性,提出“火盛”與“氣傷”為血證的最主要病因病機(jī),“血證反證甚多”的經(jīng)驗(yàn)。喻嘉言重視從四診探究病機(jī)的“識(shí)病議藥”過程,提出“急重緩治”的創(chuàng)新論點(diǎn)；傅青主提出“火之所以妄者,皆由于血之衰,補(bǔ)血即足以制火”、“治血?jiǎng)t濕除,利濕反引火下行”、“平肝正所以扶脾”的婦科血證創(chuàng)新思維；葉天士總結(jié)“失血三因”與相應(yīng)治法,認(rèn)為“外因者,必先有感候；內(nèi)因者,必有內(nèi)證可據(jù)；不內(nèi)外因,治有臟腑經(jīng)絡(luò)之異”；陳修園從脈象論“血分病”的虛實(shí),強(qiáng)調(diào)六經(jīng)氣化說,為唐容川的“陰陽水火論”與“臟腑病機(jī)論”立下基礎(chǔ)。王清任提出氣門、衛(wèi)總管、榮總管、氣府與血府、髓府、津門、津管的解剖位置與功能路徑,解釋了氣血津液彼此流通的關(guān)系。重視瘀血的病因病機(jī),并將久治不愈之各種癥狀歸于血瘀為病,具有臨床指導(dǎo)意義；朱沛文在《醫(yī)林改錯(cuò)》的基礎(chǔ)上,提出“血經(jīng)運(yùn)行,中有炭氣,故色紫”的缺氧血。認(rèn)為“氣津液血四者,皆由后天水谷一源所生”“種種津液賴血以生”唐容川《血證論》的內(nèi)容特色包括該書在血證基礎(chǔ)理論與血證診斷學(xué)兩方面的創(chuàng)新特色。就血證基礎(chǔ)理論而言,在遵《內(nèi)經(jīng)》與法仲景的基礎(chǔ)上,結(jié)合“醫(yī)易”與“六經(jīng)氣化”作為《血證論》“陰陽水火氣血論”與“臟腑病機(jī)論”的血證理論基礎(chǔ)。內(nèi)容包括：呼應(yīng)陰陽互根的“天人相應(yīng)”的哲學(xué)思維、以“醫(yī)易”發(fā)揚(yáng)創(chuàng)新“陰陽理論”、重構(gòu)水火相濟(jì)化氣化血的氣化理論、水火氣血相成相制病因病機(jī),并以“六經(jīng)氣化理論”將“陰陽水火氣血論”與“臟腑病機(jī)論”整合重構(gòu),成為血證的基礎(chǔ)理論與辨證論治的血證診斷學(xué)特色。作為清末匯通學(xué)派的代表醫(yī)家,唐容川諳熟當(dāng)時(shí)西醫(yī)知識(shí),并深受西醫(yī)解剖、生理知識(shí)的影響,其著述中,也多試圖以古文經(jīng)旨解釋西醫(yī)的解剖形質(zhì)。唐容川提出的中醫(yī)血證診斷學(xué)的特色包括三方面：重視病位、結(jié)合各種辨證于一體與以六經(jīng)六氣與臟腑經(jīng)絡(luò)標(biāo)本中氣整合相關(guān)辨證等。唐容川于《傷寒論淺注補(bǔ)正》提出“上中下本標(biāo)中氣圖”與“臟腑應(yīng)天本標(biāo)中氣圖”,針對(duì)六經(jīng)之氣本標(biāo)中氣與臟腑經(jīng)絡(luò)本標(biāo)中氣,在陳修園的六經(jīng)六氣理論的基礎(chǔ)上,做了進(jìn)一步的闡發(fā)。唐容川解釋“上中下本標(biāo)中氣圖”,系以六經(jīng)之氣以風(fēng)寒熱濕燥火為本,三陰三陽為標(biāo),本標(biāo)之中,見者為中氣,中氣如少陽厥陰為表里,陽明太陰為表里,太陽少陰為表里,表里相通則彼此互為中氣。而“臟腑應(yīng)天本標(biāo)中氣圖”以臟腑為本,居里；十二經(jīng)為標(biāo),居表；表里相絡(luò)者為中氣,居中。所謂絡(luò)者乃表里相互維絡(luò),如足太陽膀胱經(jīng)絡(luò)于腎,足少陰腎經(jīng)亦絡(luò)于膀胱等。在《傷寒論淺注補(bǔ)正》的六經(jīng)病脈證篇中,可以更清楚與明確的看到有關(guān)陰陽水火氣血與臟腑經(jīng)絡(luò)之間的生理與病機(jī)關(guān)系。例如《傷寒論淺注補(bǔ)正·辨太陽病脈證篇》中,唐容川提出以小腸與膀胱統(tǒng)稱為太陽經(jīng),膀胱為寒水之府,小腸導(dǎo)心火下腎系,抵氣海血室,化膀胱之水為氣,“人必知小腸膀胱交通之道,又必知心腎水火相蒸之理,尤必知兩腑兩臟,其聯(lián)絡(luò)全在三焦�！敝赋隽诵∧c、膀胱為主的水、火、氣之間的生理與病機(jī)關(guān)系�？偨Y(jié)：在血證診斷方面,唐容川重構(gòu)了臟腑經(jīng)絡(luò)與陰陽水火氣血之間相互維系的作用與變化。唐容川也將“陰陽水火氣血論”與“臟腑病機(jī)論”,引入并融入血證傳統(tǒng)診斷體系,建構(gòu)了以辨病為綱,辨證與辨病相結(jié)合的特色診斷體系。唐容川所提及的與血水相關(guān)的“水瘀病”,是中醫(yī)瘀血辨證論治的新方向。
[Abstract]:This paper consists of three parts, the first part is a summary, the second part of the ancient academic origin of blood syndrome, the third part of the study on the diagnosis of TCM Blood Syndrome Based on Tang Rongchuan's "blood syndrome theory", and the analysis of the inheritance and evolution process of TCM Blood Syndrome Differentiation and treatment. In the 5-6 century, "fifty-two cases of disease", the treatment of hemorrhoids and haemorrhoids in the treatment of bleeding and the treatment of hemorrhoids with internal and external washing with charcoal in the hair cattail. < < internal classics > > for the inspection and pulse diagnosis of blood syndrome, syndrome differentiation of cold and heat deficiency and Yin and Yang, six types of syndrome differentiation, seven feelings syndrome, trauma, etiological syndrome differentiation, syndrome differentiation of Qi and blood body fluid and syndrome differentiation of viscera, etc. Later generations of doctors in the syndrome differentiation of blood syndromes. During the Han Dynasty, "historical records, Bian Que storehouse biography", "blood syndrome" called "blood syndrome" many times, the way of writing the diagnosis and treatment of blood syndrome is regarded as the ancestor of modern medical cases. < treatise on typhoid fever > with the form of theory, law, prescription and drug combination, raising the thinking of syndrome differentiation and treatment of blood syndrome, including the suggestion Blood syndrome of the "prescription test" to identify the deficiency and real cold and heat of the blood syndrome, etiology, pathogenesis and disease position. Pay attention to the "reconciliation method", such as the method of reconciliation of small Bupleurum soup, such as Shaoyang heat entry, pay attention to "blood and sweat homology", pay attention to the difference between water and blood and disease in gynecological treatment, and prompt attention to the difference between the treatment method of miscellaneous diseases. "Uncle" and "pulse formula >" and so on, taking pulse syndrome as the center, describing the deficiency and truth of the cold and heat of the five viscera and six organs disease syndrome, forming a systematic syndrome differentiation theory of viscera, and applying it to the exposition of blood syndrome and the treatment prescription. On the basis of the Sui, Tang and Five Dynasties, "the origin of the disease", on the basis of the "inner meridian >" and the theory of typhoid miscellaneous diseases, combined with the clinical practice experience, the various kinds of traditional Chinese Medicine The cause of the blood syndrome, the pathogenesis, the position of the disease and the clinical diagnosis and treatment have been recorded in detail. It should be a complete medical work on the syndrome of blood syndrome in China. During the two Song period, "three because of the theory of extremely one disease," the three cause of the blood syndrome and the three cause of the individual blood syndrome, N& and the Southern Song Dynasty Chen Ziming put forward the "blood stasis and cold blood". The coordination of the function of the Fu organs, and put forward the theory that "all six Qi can turn the fire", and pay attention to "the fever is the disease". Zhang Congzheng advocates the argument of "bleeding so the blood nourishing"; Li Gao puts forward the theory of spleen and stomach theory of "internal injury and spleen and stomach, all kinds of diseases rise"; and Zhu Danxi further develops the view that "hot and damp heat is a lot of disease", and attaches importance to the Yin of the spleen and soil. The importance of Nourishing Yin enriching blood. Ming and Qing Dynasties, Miao Xi Yong put forward "three to vomit blood" and "cure blood Three": Xiao Jing put forward the argument of "treating blood and Quietness"; Li Zhongzi made clear that "kidney is congenital, spleen is the day after", while emphasizing "cure congenital root, there is water and fire division", "cure the day, there are dietetic tiredness". Zhang Jingyue further expounds the importance of "blood" to human body, spirit and will, and puts forward the experience of "fire flourishing" and "Qi injury" as the most important pathogenesis of blood syndrome and "many blood evidence". "The reason why the cause of fire, all because of blood failure, the blood is enough to make fire", "blood is dampness, the wet anti fire down", "the liver is thus helping the spleen" of gynecologic blood syndrome innovation thinking; ye Tian Shi summed up the "three causes of blood loss" and the corresponding treatment, "external causes, must have the first sense; internal factors, must have internal evidence; no internal and external causes. On the basis of Tang Rongchuan's theory of "Yin and Yang water fire" and "viscera pathogenesis theory", Chen Xiuyuan put forward the foundation of Tang Rongchuan's theory of "Yin and Yang water fire" and "viscera disease machine theory" from the pulse image theory of "blood separation disease". Wang Qingren proposed the anatomic position and function path of the Qi gate, the general management, the Rong chief, the Qi Fu and the Xuefu, the mansion, the Jinmen and the Tianjin Pipe, and explained the Qi and blood Tianjin The relationship between the circulation of the liquid, the pathogenesis of the cause of blood stasis, and the clinical guiding significance of treating all the symptoms of the prolonged treatment to the blood stasis is of clinical guiding significance. On the basis of "the medical and forest modification", Zhu Peiwen put forward the anoxic blood of "blood menstruation, carbon gas and color purple". On the basis of the basic theory of blood syndrome, on the basis of the basic theory of blood syndrome, on the basis of the basic theory of "internal classics >" and "six meridians" as "blood syndrome theory >" "Yin and Yang water fire and blood circulation theory" and "Zang Fu organs" on the basis of the basic theory of blood syndrome, the basic theory of the two aspects of the basic theory of blood syndrome. On the basis of the theory of blood syndrome in the theory of "pathogenesis", the content includes the philosophical thinking of "the corresponding nature and human being" that echoes the mutual root of yin and Yang, developing the theory of "Yin and Yang" with "Yi Yi", reconstructing the gasification theory of the vaporization blood of water and fire, making the pathogenesis of the cause and disease of water, fire, blood and blood, and taking "the theory of six meridians" to "the Yin and Yang fire and the blood and the blood and the blood and blood theory" and " The theory of viscera disease machine theory "integrated reconstruction, become the basic theory of blood syndrome and the characteristic of diagnosis of blood syndrome of syndrome differentiation. As the representative doctor of the school of the Hui Tong School in the late Qing Dynasty, Tang Rongchuan was familiar with the knowledge of Western medicine, and was deeply influenced by the anatomy of Western medicine and physiological knowledge. In his writings, many attempts were made to explain the anatomy of Western medicine with the purpose of ancient Chinese medicine." Tang Rongchuan proposed that. The characteristics of the diagnosis of TCM blood syndrome include three aspects: attaching importance to the disease position, combining the syndrome differentiation in one body and the syndrome differentiation related to the Qi and Zang Fu meridians and collaterals in the six meridians and the Zang Fu meridians and collaterals. Tang Rongchuan proposed the "middle and the middle and the middle and the lower standard medium gas map" and the "Zang Fu and the Tian Ben standard gas map" in "the shallow injection of the typhoid fever". On the basis of the six Qi theory of the six meridians of the Zang Fu organs and meridians, Tang Rongchuan explained the theory of "six meridians" in Chen Shiyuan, explaining the "middle and lower middle and lower standard gas map", which is based on the gas of the six meridians with the wind cold and hot wet heat, and the three yin and three yang as the standard. In the form of Yin, the interconnecting of the inner and the inside is medium Qi. And "the viscera should be in the sky map" with the viscera as the basis, Curie; twelve as the standard, the living table; the form and collaterals are middle Qi and middle. The so-called collaterals are interrelated with each other, such as the meridians of the sun bladder meridians to the kidney, the foot less Yin kidney meridian also on the bladder, etc. In the vein of the disease, the relationship between the physiology and the pathogenesis between yin and Yang, water, fire, Qi and blood and viscera meridians can be seen clearly and clearly. For example, Tang Rongchuan proposed that the small intestine and bladder is the sun meridian, the bladder is the house of cold water, the kidney of the small intestine, the blood chamber of the Qi sea, the bladder and the bladder. The water is Qi, "people must know the way of the small intestine and bladder traffic, but also know the kidney water and fire steam, especially the two Zang Fu two dirty, the contact is all in three jiao." points out the relationship between the physiology and the pathogenesis between the small intestine, the water, the fire and the gas. Tang Rongchuan also introduced and integrated into the traditional diagnosis system of blood syndrome, and constructed the characteristic diagnosis system of combining the disease as the outline, the syndrome differentiation and the disease discrimination. The "water stasis" related to the blood and water in Tang Rong Sichuan is a new direction of TCM syndrome differentiation and treatment.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R241
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本文編號(hào)：1848159