【摘要】：本文為國(guó)家重點(diǎn)基礎(chǔ)研究發(fā)展計(jì)劃(973計(jì)劃)“中醫(yī)理論體系框架結(jié)構(gòu)研究”(2013CB532004)子課題“中醫(yī)骨傷診療理論框架結(jié)構(gòu)研究”(2013CB532004-2-3)研究?jī)?nèi)容的一部分�；谥嗅t(yī)古代文獻(xiàn)及現(xiàn)代研究進(jìn)展與成果,以邏輯思維為主導(dǎo),遵循“集成”“歸真”和“納新”的原則,采用文獻(xiàn)學(xué)、詮釋學(xué)、術(shù)語(yǔ)學(xué)及理論研究等方法,對(duì)我國(guó)古代骨傷相關(guān)文獻(xiàn)進(jìn)行系統(tǒng)梳理,提取中醫(yī)骨傷診療理論的基本概念,明確概念內(nèi)涵,確立中醫(yī)骨傷診療理論概念體系,探究中醫(yī)骨傷理論的形成與發(fā)展,搭建中醫(yī)骨傷診療理論框架結(jié)構(gòu)。從而,為完成國(guó)家973項(xiàng)目打下堅(jiān)實(shí)基礎(chǔ),同時(shí)也能為骨傷科的臨床實(shí)踐提供更多的理論指導(dǎo)。首先確定研究書(shū)目并且制定中醫(yī)骨傷診療理論基本概念的篩選原則與方法。其次,從“時(shí)間”和“空間”兩個(gè)維度探討中醫(yī)骨傷理論體系的規(guī)律與本質(zhì),既從歷史進(jìn)程的角度研究理論概念的源流演變,又從空間定位的角度鉆研同時(shí)代的醫(yī)家在討論相同概念的學(xué)術(shù)見(jiàn)解,從而全面提煉出中醫(yī)骨傷理論概念。共梳理總結(jié)出中醫(yī)骨傷診療理論概念402條,參照《中醫(yī)大辭典》《中醫(yī)藥學(xué)名詞》和全國(guó)高等院�！吨嗅t(yī)骨傷科學(xué)》教材等現(xiàn)代研究成果,選取有代表性的、較早出現(xiàn)的或出現(xiàn)頻率較高的概念為正名,其余為異名,共收集病因概念89條(正名30條,異名59條)、病機(jī)概念75條(正名41條,異名34條)、病名病證概念159條(正名93條,異名66條)、治則治法概念79條。概念的釋義是對(duì)該概念的定義,以《中醫(yī)大辭典》《漢語(yǔ)大詞典》等辭書(shū)為準(zhǔn)。概念未見(jiàn)于辭書(shū)者,依據(jù)上下文義,擬定概念釋義。用例部分選取該概念正名和異名首見(jiàn)于古籍中的例句,明確概念的源頭,同時(shí)酌情選用體現(xiàn)概念發(fā)展的例句。病因、病機(jī)、病名病證和治則治法概念體系由若干不同層次分屬的概念組成,每一概念詞條下有異名、釋義、用例條目,力求構(gòu)建層次分明、結(jié)構(gòu)合理的中醫(yī)骨傷診療理論概念體系。圍繞因機(jī)證治,按照時(shí)間順序,自上而下系統(tǒng)梳理并深入探討從秦漢到明清時(shí)期的中醫(yī)骨傷理論形成與發(fā)展的歷史源流。認(rèn)為戰(zhàn)國(guó)至秦漢間是骨傷科診療理論的初步形成期,為后世醫(yī)家重視整體觀念和辨證論治,以及損傷后的氣血病機(jī)以及臟腑功能失調(diào)等提供了扎實(shí)的理論依據(jù)。三國(guó)、兩晉南北朝時(shí)期是骨傷科臨床醫(yī)學(xué)的興起階段,該時(shí)期出現(xiàn)了專治創(chuàng)傷疾病的“折傷醫(yī)”。隋唐時(shí)期是骨傷科的形成時(shí)期,出現(xiàn)了第一部骨傷科專著以及系統(tǒng)闡述其病因證候?qū)W專著,該時(shí)期將傷損疾病分為“外損”和“內(nèi)傷”兩類(lèi)。宋金元時(shí)期是骨傷科成長(zhǎng)的時(shí)期,此時(shí)骨傷科診療理論更加豐富,傷損后的癥狀描述更為詳細(xì),將骨折和關(guān)節(jié)脫位歸納為“六出臼”和“四折骨”。明清是骨傷科發(fā)展的時(shí)期,該時(shí)期強(qiáng)調(diào)傷損損于外,則氣血傷于內(nèi),出現(xiàn)了我國(guó)第一部傷科內(nèi)傷專著。關(guān)于中醫(yī)骨傷的病因,自古以來(lái)較為明確,多來(lái)自于外力作用,即為金瘡、墜墮、跌磕、壓迮、擊打、挫閃。此外,由于人體是一個(gè)有機(jī)的整體,情志不暢或勞倦所傷會(huì)影響臟腑功能,加重傷損后的病情變化。外力作用于人體導(dǎo)致骨斷、筋傷必然會(huì)累及氣血,引起氣血病變,而臟腑功能活動(dòng)的物質(zhì)基礎(chǔ)是氣血津液,經(jīng)絡(luò)能夠聯(lián)系并濡養(yǎng)全身的皮肉、筋骨,同時(shí)也是氣血運(yùn)行的通道,故局部皮肉、筋骨的損害會(huì)傷及氣血、臟腑、經(jīng)絡(luò)。因此,中醫(yī)骨傷病機(jī)主要分為傷及氣血、犯?jìng)迮K及內(nèi)動(dòng)經(jīng)絡(luò)三大類(lèi)。中醫(yī)骨傷病名病證主要包括骨折、筋傷、筋骨俱傷、脫臼、跌閃傷、金瘡及內(nèi)傷雜證。中醫(yī)骨傷治則分為骨折筋傷治則、脫臼治則、跌打損傷治則、金瘡治則及傷損內(nèi)證治則,主要包括散瘀血、止疼痛、續(xù)筋骨、通經(jīng)絡(luò)、和肝補(bǔ)腎、調(diào)補(bǔ)脾氣等。骨傷科治法除了用藥外,還有外治法、隔紙灸法、雷火針?lè)ǖ戎畏�。系統(tǒng)梳理了我國(guó)古代中醫(yī)骨傷文獻(xiàn)既有的理論框架,發(fā)現(xiàn)《外臺(tái)秘要》《圣濟(jì)總錄》《世醫(yī)得效方》《正體類(lèi)要》《傷科匯纂》中的骨傷診療理論框架最具有代表性�！锻馀_(tái)秘要》將骨傷疾病框架與骨傷方證框架整合在一起,《圣濟(jì)總錄》對(duì)骨傷理論闡述較為詳備,因、機(jī)、證、治的理論框架初步形成,《世醫(yī)得效方》首次將骨傷科疾病總結(jié)為“手(腳)六出臼四折骨”,《正體類(lèi)要》確立了從內(nèi)治傷的診療理論框架�！秱茀R纂》主要從病因?qū)W角度將損傷類(lèi)疾病分成金刃傷、箭鏃傷、磁鋒傷、簽刺傷、墜墮傷、跌磕傷、挫閃傷、壓迮傷、鐵器傷、磚石傷、木器傷11大類(lèi),再以病機(jī)結(jié)合病證、提出相應(yīng)治則為其細(xì)類(lèi),并附諸多相關(guān)治法方藥為其框架填充內(nèi)容,這種因機(jī)證治的診療理論框架模式既是對(duì)前人經(jīng)驗(yàn)的繼承也是對(duì)后世醫(yī)家的啟迪。通過(guò)對(duì)中醫(yī)骨傷共性的、實(shí)用性的、代表性的診療理論加以分析、比較、提煉與集成,結(jié)合論文對(duì)中醫(yī)骨傷病因、病機(jī)、病名病證、治法治則等方面的概念梳理,以瘀血內(nèi)停和亡血過(guò)多為總綱,以氣血辨證為主,同時(shí)結(jié)合八綱辨證,以出現(xiàn)頻次較多并且因機(jī)證治完備的診療理論搭建中醫(yī)骨傷外傷病框架和內(nèi)傷病框架。外傷病診療理論框架主要以傷折、閃傷、金瘡、脫臼所致氣血瘀滯、出血或亡血過(guò)多為綱目,采用整骨續(xù)筋、導(dǎo)氣行血、止血定痛等治則進(jìn)行治療。內(nèi)傷病診療理論框架主要以惡血留內(nèi)、血虛或血脫、氣血虧虛所致病證為綱目,采用活血化瘀、補(bǔ)氣養(yǎng)血、兼以滋陰、健壯脾胃、疏肝理氣等治則進(jìn)行治療。初步構(gòu)建了中醫(yī)骨傷共性診療理論的框架結(jié)構(gòu),以期能為骨傷科的臨床實(shí)踐提供更多的理論指導(dǎo)。
[Abstract]:This paper is a part of the research contents of the sub-project of the National Key Basic Research and Development Program (973 Program) "Research on the Framework of the Theoretical System of Traditional Chinese Medicine" (2013 CB532004) "Research on the Theoretical Framework of Bone and Wound Diagnosis and Treatment of Traditional Chinese Medicine" (2013 CB532004-2-3). The principles of "integration", "simplification" and "acceptance of new ideas" are adopted to systematically sort out the related literature on bone injury in ancient China by means of philology, hermeneutics, terminology and theoretical research, extract the basic concepts of bone injury diagnosis and treatment theory of traditional Chinese medicine, clarify the conceptual connotation, establish the conceptual system of bone injury diagnosis and treatment theory of traditional Chinese medicine, and explore the shape of bone injury theory of traditional Chinese medicine. In order to lay a solid foundation for the completion of the National 973 Project and provide more theoretical guidance for the clinical practice of orthopedics and traumatology, the author first determines the research bibliography and formulates the screening principles and methods of the basic concepts of the theory of orthopedics and trauma diagnosis and treatment of traditional Chinese medicine. The two dimensions of "space" discuss the law and essence of the theory system of bone injury in TCM. It not only studies the origin and evolution of the theory concept from the perspective of historical process, but also explores the academic opinions of contemporary physicians in discussing the same concept from the perspective of spatial positioning, so as to refine the concept of bone injury theory in TCM comprehensively. Referring to the modern research results of "Dictionary of Traditional Chinese Medicine", "Terms of Traditional Chinese Medicine" and the textbooks of "Orthopedics and Injury of Traditional Chinese Medicine" in Colleges and universities of China, 402 concepts of therapeutic theory were selected as normal names, while the others were anonymous names. A total of 89 concepts of etiology and 75 concepts of pathogenesis were collected. There are 41 proper names, 34 different names, 159 concepts of disease and syndrome (93 proper names, 66 different names) and 79 concepts of treatment principles and methods. The conceptual system of etiology, pathogenesis, disease name, syndrome and treatment principles and methods is composed of several different levels of subordinate concepts, each of which has different names, definitions and use case entries, and strives to construct a well-structured and well-structured bone injury diagnosis in traditional Chinese medicine. Conceptual System of Therapeutic Theory. Around the opportunity of treatment, according to the chronological order, this paper systematically combs and probes into the historical origin of the formation and development of the theory of orthopedics and traumatology from Qin-Han Dynasty to Ming-Qing Dynasty. The three kingdoms, the Jin Dynasty and the Southern and Northern Dynasties were the rising stages of orthopedics and traumatology clinical medicine, during which the "traumatology doctor" specializing in traumatic diseases appeared. The Sui and Tang Dynasties were the formation period of orthopedics and traumatology, and the first monograph on orthopedics and traumatology appeared. The Song, Jin and Yuan Dynasties were the growing period of orthopedics and traumatology. At this time, the theory of orthopedics and traumatology diagnosis and treatment was more abundant, and the symptoms after trauma were described in more detail. Fractures and joint dislocations were classified as "six dislocations" and "four broken bones". Ming and Qing Dynasties were the development of orthopedics and traumatology. In this period, the first monograph on internal injuries in traumatology appeared in China. The etiology of bone injuries in traditional Chinese medicine has been relatively clear since ancient times, mostly due to external forces, that is, golden ulcer, falling, falling, stumbling, striking, and flashing frustration. In addition, because the human body is an organic whole, the mood is not good or tired. Injury can affect the function of the viscera and aggravate the changes of the condition after injury.External force on the human body leads to bone fracture, tendon injury will inevitably involve Qi and blood, causing Qi and blood lesions, and viscera function of the material basis is qi, blood and fluid, meridians and collaterals can contact and nourish the body's flesh, tendons and bones, but also the channel of Qi and blood movement, so local skin, flesh, tendons and bones Damage can damage Qi and blood, viscera, meridians and collaterals. Therefore, the pathogenesis of bone injury in traditional Chinese medicine can be divided into three categories: injury of Qi and blood, injury of five viscera and internal action of meridians and collaterals. Orthopedics treatments include external treatment, paper-separated moxibustion, thunder-fire needle therapy, etc. Besides medication, it systematically combs the existing theoretical framework of ancient Chinese medical literature on bone injuries, and finds that < Outdoor Secrets > < Shengji General Records > The theoretical framework of bone injury diagnosis and treatment in < Zheng Tie Lei Ya > < Traumatology Collection > is the most representative. < Outdoor Secret Ya > integrates the framework of bone injury disease with the framework of bone injury prescription and syndrome. < Sheng Ji Zhu Lu > elaborates on the theory of bone injury in detail. The theoretical framework of cause, mechanism, syndrome and treatment is preliminarily formed. Summarized as "six out of the acetabulum and four broken bones", "orthodoxy" established a theoretical framework for the diagnosis and treatment of internal injuries. Syndrome, put forward the corresponding treatment principles for its detailed categories, and attached a lot of relevant treatment prescriptions and medicines as its framework filling content, this kind of syndrome-based diagnosis and treatment theoretical framework model is not only the inheritance of previous experience but also inspiration for future generations of physicians. Cheng, combing the concepts of etiology, pathogenesis, disease name and syndrome, treatment and rule of law of traditional Chinese medicine bone injury in this paper, taking stasis and excessive blood loss as the general program, Qi and blood syndrome differentiation as the main component, and combining eight principles of syndrome differentiation, the frame of internal injury and internal injury of traditional Chinese medicine bone injury is established with the theory of more frequent occurrence and complete treatment of pathogenesis. The theoretical framework of the diagnosis and treatment of internal injury mainly focuses on the treatment of trauma, flash injury, golden ulcer, dislocation caused by Qi and blood stasis, hemorrhage or excessive blood loss. Qi nourishing blood, nourishing Yin, strengthening spleen and stomach, soothing liver and regulating qi, etc. were used to treat the disease.
【學(xué)位授予單位】：遼寧中醫(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)】：R274
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本文編號(hào)：2242189

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