本文選題：葉天士 + 雜病��； 參考：《廣州中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：臟腑學(xué)說是中醫(yī)基礎(chǔ)理論的核心,臟腑經(jīng)絡(luò)辨證、氣血津液辨證及八綱辨證是中醫(yī)臨床辨治體系的主要內(nèi)容,《傷寒論》六經(jīng)辨治體系即本于此。葉氏將氣血津液辨證發(fā)展為衛(wèi)氣營血辨證,揭示了新感溫病及伏氣溫病的傳變規(guī)律。在雜病辨治上,提出臟屬陰、腑屬陽、初病在經(jīng)屬氣、久病入絡(luò)屬血、久損入奇經(jīng)八脈的學(xué)說觀點,并擬定相應(yīng)的治法治則,一定程度上揭示了雜病發(fā)展規(guī)律及證治特點,值得臨床借鑒。葉天士依據(jù)《內(nèi)經(jīng)》五臟藏精氣不瀉、六腑傳化物不藏的基點,意識到臟腑陰陽藏瀉屬性的不同,提出臟腑分治說,其中最突出的是脾胃分治說,筆者認為還有腎、膀胱、三焦分治觀。治臟病多用收澀固攝,治腑病多用通泄。善用麥門冬湯通補胃陰,大半夏湯通補胃陽,復(fù)脈湯滋水涵木,腎氣丸通陽攝陰,五苓散通暢三焦、淡以通陽。葉天士繼承《內(nèi)經(jīng)》、《難經(jīng)》關(guān)于絡(luò)病的記載,提出久病入絡(luò)說,發(fā)展了經(jīng)絡(luò)辨證,揭示了雜病傳變的淺深層次,豐富了中醫(yī)治法理論。絡(luò)病分虛實兩端,而多屬實證。絡(luò)實輕證治以旋覆花湯法辛潤通絡(luò),絡(luò)實重證治以大黃蟄蟲丸蟲蟻搜埸；絡(luò)虛證主要治以桂枝湯及當(dāng)歸生姜羊肉湯的辛香甘溫法,并與奇經(jīng)病相結(jié)合來論治。葉天士對奇經(jīng)八脈的論述是與絡(luò)病結(jié)合在一起的。奇經(jīng)病多由臟陰虛損、肝血腎精久虛不復(fù)而來,屬于絡(luò)虛證的進一步發(fā)展。治療主要以血肉有情、柔劑通陽,選藥重視辛香入絡(luò)、穢濁入陰。葉天士治療雜病雖然博采眾方,但經(jīng)方卻是他最常選用的,而且在化裁使用經(jīng)方的基礎(chǔ)上,創(chuàng)造性地提出諸多學(xué)說,如陽化內(nèi)風(fēng)說、養(yǎng)胃陰說、絡(luò)病學(xué)說及奇經(jīng)八脈說,論述葉氏雜病辨治思想,經(jīng)方是繞不開的話題,因葉氏最善用古方,經(jīng)方的使用集中體現(xiàn)了他的雜病辨治觀。綜上,筆者根據(jù)葉案體現(xiàn)的臨床治療思想,認為葉天士治療雜病有“臟陰一腑陽—經(jīng)氣—絡(luò)血一奇經(jīng)八脈”五個辨治系統(tǒng),有其各自的治療特點,有助于辨別病位、病勢,一定程度上反映了雜病的傳變過程,或?qū)⒂欣谥嗅t(yī)臨床。故欲總結(jié)闡述這五個系統(tǒng),以期總結(jié)葉氏雜病辨治整體觀和恒動觀,以指導(dǎo)日后的臨床實踐。
[Abstract]:The theory of zang-fu organs is the core of the basic theory of traditional Chinese medicine, and the differentiation of zang-fu meridians and collaterals, qi, blood and body fluid and the eight principles of syndrome differentiation are the main contents of the clinical differentiation and treatment system of TCM, and the system of differentiation and treatment of the six meridians is based on this. Ye developed the syndrome differentiation of qi, blood and body fluid into the differentiation of Wei Qi and Ying blood, and revealed the law of transmission of new temperature sickness and latent temperature disease. In the treatment of miscellaneous diseases, it is put forward that the viscera belong to yin, the viscera to yang, the first disease to Qi, the long illness to collateral blood, the long damage to the eight meridians of Qijing, and the corresponding principles of treatment are drawn up. To a certain extent, the law of development and the characteristics of syndrome and treatment of miscellaneous diseases are revealed. It is worthy of clinical reference. Ye Tianshi, on the basis of the fact that the essence of the five viscera and the essence of the qi were not purged and the six fu-organs were transferred from the body to the ground, and realized the difference in the attributes of the zang-fu organs, Yin and Yang, he put forward the theory of dividing the zang-fu organs, the most prominent of which was the theory of dividing the spleen and stomach. The author believed that there were also the kidneys and the bladder. The view of division and rule of the three-coke. The treatment of visceral diseases is used to collect astringent fixation, the treatment of internal organs more use of catharsis. Make good use of Maimen Dong Tang tonifying stomach yin, big Banxia decoction tonifying stomach Yang, Fumai decoction Zishui Han wood, Kidney Qi pills Tongyang Yin, Wuling scattered unobstructed Sanjiao, light to Tongyang. Ye Tianshi inherits the records of collateral disease in "Internal Classic" and "difficult Classic", puts forward the theory of long illness into collateral, develops the syndrome differentiation of meridian, reveals the shallow and deep level of the spread of miscellaneous diseases, and enriches the theory of TCM treatment method. Collateral disease is divided into two ends of deficiency and reality, and most of them belong to empirical evidence. The deficiency syndrome of collaterals was mainly treated by cinnamon decoction and Angelica ginger mutton soup by Xin-Xiang Gan Wen method, and was treated by combination of Qi Jing disease and Qi Jing disease. Ye Tianshi's exposition on the eight veins of Qijing is combined with collateral disease. Qi-Jing disease is caused by viscera-yin deficiency and liver-blood-kidney essence-deficiency, which belongs to the further development of collaterals deficiency syndrome. Treatment mainly with blood and flesh, soften agent Tongyang, drug selection attention to Xin Xiang into the collateral, turbidity into the yin. Although Ye Tianshi used to treat miscellaneous diseases, he chose the prescription most frequently, and creatively put forward many theories, such as Yanghua Inner Wind Theory, Yanghua Inner Wind Theory, collateral Disease Theory, and Qi Ba-mai theory. It is an inextricable topic to discuss Yeh's thought of differentiating and treating miscellaneous diseases, because Ye's best use of ancient prescriptions embodies his view of differentiation and treatment of miscellaneous diseases. In summary, according to the clinical treatment thought embodied in Ye's case, the author thinks that Ye Tianshi's treatment of miscellaneous diseases has five treatment systems: "Zang Yin, Fu Yang, Meridian Qi, collaterals and Blood Qi, Qi and Qi Meridian Meridians", and has its own therapeutic characteristics, which is helpful to distinguish the disease position and disease potential. To some extent, it reflects the process of transmission of miscellaneous diseases, or will be beneficial to the clinical practice of traditional Chinese medicine. So we want to summarize the five systems in order to sum up the whole view and constant motion view of the differentiation and treatment of Ye's miscellaneous disease, so as to guide the clinical practice in the future.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R249.2

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