【摘要】：病因是研究和闡明疾病發(fā)生的原理,發(fā)病機(jī)制是研究在病因作用下疾病發(fā)生發(fā)展的過(guò)程,;兩者都是藏醫(yī)學(xué)基礎(chǔ)理論即藏醫(yī)病機(jī)學(xué)內(nèi)容的重要組成部分,亦是連接理論與實(shí)踐的橋梁和臨床診治疾病的主要依據(jù)。自藏醫(yī)經(jīng)典《月王藥珍》和《四部醫(yī)典》成書(shū)至今,歷代藏醫(yī)學(xué)家對(duì)病機(jī)重視有加,代有發(fā)展,但見(jiàn)仁見(jiàn)智,尚缺乏系統(tǒng)的理論研究與整理,對(duì)病機(jī)的定義未發(fā)掘藏醫(yī)學(xué)的獨(dú)特之處,并含義模糊,界限不清,內(nèi)涵局限,指導(dǎo)臨床存在普適性不足,對(duì)正確理解、解釋與應(yīng)用藏醫(yī)病機(jī)理論造成困難。本文以整理、歸納藏醫(yī)對(duì)疾病發(fā)展過(guò)程的認(rèn)知為研究目的,整理藏醫(yī)古籍文獻(xiàn),辨析病機(jī)含義,對(duì)藏醫(yī)古典中提出的“出處”(s Kye m CHed)和“蓄(g Sog)、發(fā)(l Dang)、息(zhi)”以及“誘因”(s Long r Kyen)等病機(jī)構(gòu)詞進(jìn)行對(duì)比和解讀,辯證三者之間的關(guān)系;通過(guò)“比較異同、梳理嬗變”的縱向與橫向比較研究方法,探討疾病的發(fā)生和演變規(guī)律,結(jié)合藏醫(yī)內(nèi)因(也稱(chēng)三因)的“二十特性”和外緣之時(shí)辰、飲食等的“十七效”之間的生克關(guān)系,進(jìn)一步對(duì)疾病過(guò)程進(jìn)行考證,分析其理論在臨床實(shí)踐中的應(yīng)用價(jià)值,為后繼研究藏醫(yī)發(fā)病機(jī)制提供本底資料;通過(guò)專(zhuān)家訪(fǎng)談、病理分析,對(duì)“赤占”(m KHris s Kran)病的發(fā)病過(guò)程、臨床診斷、治療實(shí)踐等進(jìn)行整理和總結(jié),得出結(jié)果并與文獻(xiàn)綜述的研究結(jié)果相結(jié)合,從而間接證實(shí)“蓄、發(fā)、息”發(fā)病機(jī)制理論能夠指導(dǎo)臨床疾病診治。藏醫(yī)學(xué)認(rèn)為一切疾病的發(fā)生由外緣和內(nèi)因所決定,外緣即疾病發(fā)生的外在條件;內(nèi)因即“隆”、“赤巴”、“培根”在體內(nèi)互相協(xié)調(diào),維持整個(gè)機(jī)體處在一種相對(duì)平衡的狀態(tài),保證生理活動(dòng);如內(nèi)因的平衡狀態(tài)發(fā)生紊亂就會(huì)引起疾病。各種病因作用于機(jī)體后可引起內(nèi)因的平衡紊亂導(dǎo)致疾病,而內(nèi)因本身的平衡紊亂又可以作為新的病因引起繼發(fā)的疾病,故研究藏醫(yī)學(xué)的疾病過(guò)程和發(fā)病機(jī)制,必須正確理解內(nèi)因的“二十特性”與外緣的“十七效”之間生克關(guān)系的變化,正是因?yàn)榇朔N生克關(guān)系,引起了“隆”、“赤巴”、“培根”由平息狀態(tài)轉(zhuǎn)化為疾病時(shí)的“出處”、“蓄、發(fā)、息”的發(fā)生和發(fā)展的過(guò)程。在《月王藥珍》中最早提出了“蓄”、發(fā)、息”的概念,但未完全指出其含義。在《四部醫(yī)典》的病機(jī)學(xué)中提出了“蓄、發(fā)、息”的概念以及其病因、病位、病性等的變化機(jī)理;在診斷學(xué)中指出按“蓄、發(fā)、息”發(fā)生發(fā)展的變化機(jī)理診斷疾病的方法;在治療學(xué)中指出疾病處在“蓄”階段應(yīng)采用調(diào)理的藥物治療,“發(fā)”階段應(yīng)采用“峻瀉”(s Byong Byed)的方法治療,“息”即疾病緩和后應(yīng)注意飲食行為,防止疾病再次被誘發(fā)。故此推斷,“蓄、發(fā)、息”詮釋了藏醫(yī)學(xué)發(fā)病機(jī)制即發(fā)病過(guò)程。筆者參考藏醫(yī)病機(jī)學(xué)、診斷學(xué)、治療學(xué)、藥理學(xué)等相關(guān)資料,鉆研病機(jī)的含義,并將疾病的“發(fā)”與疾病“初期”、“中期”、“晚期”等概念相結(jié)合,細(xì)化疾病過(guò)程理論,挖掘藏醫(yī)病機(jī)學(xué)的深層含義。因此正確理解藏醫(yī)“蓄、發(fā)、息”發(fā)病機(jī)制的理論含義,有助于正確認(rèn)識(shí)藏醫(yī)對(duì)健康與亞健康、健康與疾病之間的區(qū)分,有助于指導(dǎo)臨床疾病診斷、對(duì)癥治療等。
[Abstract]:Etiology is to study and clarify the principle of disease occurrence, pathogenesis is to study the process of disease occurrence and development under the effect of etiology, both of which are important components of basic theory of Tibetan medicine, i.e. the content of pathogenesis of Tibetan medicine, and also the bridge connecting theory with practice and the main basis of clinical diagnosis and treatment of diseases. Up to now, Tibetan medical scholars have paid more attention to pathogenesis than ever before, and have developed from generation to generation. However, they have different opinions, and lack of systematic theoretical research and collation. This paper aims at sorting out and summarizing the cognition of Tibetan medicine on the process of disease development, sorting out the ancient Tibetan medical literature, distinguishing the meaning of pathogenesis, and comparing the words of "origin" (s Kye m CHed) and "storage" (g Sog), hair (l Dang), zhi) and "inducement" (s Long R Kyen) in the classical Tibetan medicine. Through the longitudinal and horizontal comparative research methods of "comparing similarities and differences, combing transmutation", the occurrence and evolution of diseases are discussed, and the relationship between the "twenty characteristics" of internal causes (also called three causes) and the "seventeen effects" of diet, etc., is further improved. By conducting textual research, analyzing the application value of its theory in clinical practice, providing background information for the follow-up study of the pathogenesis of Tibetan medicine; through expert interviews and pathological analysis, sorting out and summarizing the pathogenesis, clinical diagnosis and treatment practice of "Chizhan" (m KHris s Kran) disease, the results are combined with the results of literature review. Tibetan medicine holds that the occurrence of all diseases is determined by external and internal causes, that is, the external conditions for the occurrence of the disease; and that the internal causes are "uplift", "chiba" and "bacon" coordinate each other in the body to maintain a relatively balanced state of the whole body. The disorder of the balance of internal causes can lead to the disorder of the balance of internal causes, and the disorder of the balance of internal causes can be used as a new cause to cause secondary diseases. It is precisely because of the change of the relationship between the "twenty characteristics" of the internal cause and the "seventeen effects" of the external cause that the "longing", "chiba" and "bacon" are transformed from the state of subsidence into the "origin" of the disease, and the occurrence and development of "reserve, hair, breath". In the etiology of the Four Medical Books, the concept of "accumulation, hair and rest" and the change mechanism of its etiology, disease location and disease etc. are put forward; in the diagnosis, the method of diagnosing disease according to the change mechanism of "accumulation, hair and rest" is pointed out; in the treatment, the disease is in the "accumulation" stage. It is concluded that the pathogenesis of Tibetan medicine, i.e. pathogenesis, diagnostics and therapeutics of Tibetan medicine, is interpreted by "storing, sending and breathing". Pharmacology and other relevant information, study the meaning of pathogenesis, and combine the concepts of "hair" and "early", "middle" and "late" of the disease, refine the theory of disease process, excavate the deep meaning of pathogenesis of Tibetan medicine. The distinction between health and sub-health, health and disease helps to guide clinical diagnosis and symptomatic treatment.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R29

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