病机辨识理论源流考
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摘要
先秦两汉时期已将审察病机作为诊疗的核心,并形成以辨病机为核心的疾病诊断和论治体系,以《黄帝内经》中"病机十九条"为典范,《黄帝内经》及《伤寒杂病论》中具有丰富的辨识病机论治病证的实践范例。隋代《诸病源候论》系统整理各病的病因病机病症,便于临床病机辨识。金元时期刘完素著《素问病机气宜保命集》《素问玄机原病式》,从运气的角度专篇阐发病机,对"病机十九条"进行增补,并以其为纲,继承与发展了病机辨识体系。明清时期病机的概念变得宽泛,四诊以察病机为目的,治法方药基于病机拟定,外感病的辨识病机论治的体系进一步完善,病机在诊治中的重要性成了更多医家的共识。
During pre-Qin and Han Dynasties,observation of pathogenesis has already been the core of diagnosis and treatment process,and a relevant system with pathogenesis differentiation as the core has been established,with"Nineteen Items of Pathogenesis"in Inner Canon of Yellow Emperor(《黄帝内经》) as a model and plenty practical examples with pathogenesis differentiation in Inner Canon of Yellow Emperor and Treatise on Cold Pathogenic and Miscellaneous Diseases( 《伤寒杂病论》). In Sui Dynasty,General Treatise on the Cause and Symptoms of Diseases( 《诸病源候论》) systematically arranged the etiology,pathogenesis and symptoms of various diseases,so that clinical application of pathogenesis differentiation became convenient. During the times of the Jin and Yuan Dynasties,LIU Wansu wrote Suwen Bingji Qiyi Baoming Ji( 《素问病机气宜保命集》) and Suwen Xuanji Yuanbingshi( 《素问玄机原病式》),in which he focused on pathogenesis and explained pathogenesis with"five evolutive phases and six climates factors".He supplemented the "Nineteen Items of Pathogenesis"and took it as the outline to develop the system of pathogenesis differentiation,promoting the pathogenesis differentiation system. During the period of the Ming and Qing Dynasties,the concept of pathogenesis covered a wider range. The four diagnostic methods were for pathogenesis differentiation,and treatment therapy and prescription were decided based on pathogenesis,and improved the system for treating exogenous disease based on pathogenesis differentiation. The importance of the pathogenesis in the diagnosis and treatment has become the consensus of more doctors.
During pre-Qin and Han Dynasties,observation of pathogenesis has already been the core of diagnosis and treatment process,and a relevant system with pathogenesis differentiation as the core has been established,with"Nineteen Items of Pathogenesis"in Inner Canon of Yellow Emperor(《黄帝内经》) as a model and plenty practical examples with pathogenesis differentiation in Inner Canon of Yellow Emperor and Treatise on Cold Pathogenic and Miscellaneous Diseases( 《伤寒杂病论》). In Sui Dynasty,General Treatise on the Cause and Symptoms of Diseases( 《诸病源候论》) systematically arranged the etiology,pathogenesis and symptoms of various diseases,so that clinical application of pathogenesis differentiation became convenient. During the times of the Jin and Yuan Dynasties,LIU Wansu wrote Suwen Bingji Qiyi Baoming Ji( 《素问病机气宜保命集》) and Suwen Xuanji Yuanbingshi( 《素问玄机原病式》),in which he focused on pathogenesis and explained pathogenesis with"five evolutive phases and six climates factors".He supplemented the "Nineteen Items of Pathogenesis"and took it as the outline to develop the system of pathogenesis differentiation,promoting the pathogenesis differentiation system. During the period of the Ming and Qing Dynasties,the concept of pathogenesis covered a wider range. The four diagnostic methods were for pathogenesis differentiation,and treatment therapy and prescription were decided based on pathogenesis,and improved the system for treating exogenous disease based on pathogenesis differentiation. The importance of the pathogenesis in the diagnosis and treatment has become the consensus of more doctors.
引文
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[34]丹波元简.伤寒论辑义[M].北京:人民卫生出版社,1983:117.
[35]程杏轩.杏轩医案[M].储全根,李董男,校注.北京:中国中医药出版社,2009:99.
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[38]张振鋆.厘正按摩要术[M].曲祖贻,点校.北京:人民卫生出版社,1990:21.
[39]缪希雍.神农本草经疏[M].北京:中医古籍出版社,2002.
[40]刘利娟,童东昌,周德生.清末民初医家“三张”治疗脑出血学术思想探析及其影响[J].中国中医急症,2016,25(4):616-618,660.
[41]叶桂.温证论治[M]//唐笠山.吴医汇讲.丁光迪,点校.北京:中国中医药出版社,2013:7-8.
[42]黄玉燕.中医疫病发病理论源流[J].时珍国医国药,2013,24(5):1209-1210.
[43]黄玉燕.中医疫病传变规律探讨[J].中医杂志,2014,55(2):157-160.
[44]蔡定芳,孟澍江.温疫病学的学术体系探讨[J].中国医药学报,1990,5(4):11-16.
[45]余师愚.疫疹一得[M].郭谦亨,孙守才,点校.北京:人民卫生出版社,1996:17-18.
[2]胡镜清,江丽杰.从病机原义解析辨证识机论治[J].中医杂志,2015,56(24):2098-2100,2103.
[3]于智敏,卢红蓉,赵凯维,等.中医病机新论[M].北京:化学工业出版社,2011.
[4]佚名.黄帝内经素问[M].王冰,注.北京:人民卫生出版社,1963.
[5]张灿岬.黄帝内经文献研究[M].上海:上海中医药大学出版社,2005:95.
[6]马继兴.神农本草经辑注[M].北京:人民卫生出版社,2013:21.
[7]夏小军.从“病机十九条”谈中医辨证的基本方法[J].中医研究,2006,19(3):3-5.
[8]卢红蓉,李海玉,孙谊.《内经》中病机内涵析义[J].世界科学技术-中医药现代化,2009,11(1):26-28,35.
[9]周仲瑛,周学平.中医病机辨证学[M].北京:中国中医药出版社,2013:2.
[10]邢玉瑞.内经选读[M].北京:人民卫生出版社,2012:152-153.
[11]唐雪梅,梅晓云.《内经》疾病传变理论探析[J].南京中医药大学学报,2004,20(1):17-19.
[12]岳振松,姜战胜,欧阳华强,等.辨病与辨证相结合的“病机辨证”源流考[J].辽宁中医杂志,2016,43(2):278-281.
[13]徐姗姗,郑丰杰,姜冬云.浅述《伤寒论》以病机为核心的辨证观[J].时珍国医国药,2013,24(2):455-456.
[14]刘渡舟.“辨证论治”的历史和方法[J].北京中医药大学学报,2000,23(2):1-2.
[15]孙思邈.备急千金要方[M].高文柱,沈澍农,校注.北京:华夏出版社,2008:24.
[16]南京中医学院.诸病源候论校释:上册[M]. 2版.北京:人民卫生出版社,2009:392.
[17]姚洁敏,严世芸.《诸病源候论》文献研究思路述评与展望[J].中华中医药学刊,2011,29(3):480-483.
[18]刘完素.素问病机气宜保命集[M].鲍晓东,校注.北京:中医古籍出版社,1998:31.
[19]刘完素.素问玄机原病式[M].北京:人民卫生出版社,2005.
[20]朱震亨.丹溪心法[M].王英,竹剑平,江凌圳,整理.北京:人民卫生出版社,2005.
[21]毛德西.刘完素对《素问》病机十九条的发挥[J].河南中医,2004,24(10):5-7.
[22]聂金娜,苏颖.刘完素识病之法归于五运六气之化[J].上海中医药杂志,2014,48(1):30-31.
[23]李培生.柯氏伤寒论翼笺正[M].北京:人民卫生出版社,1965:142.
[24]罗浩.罗浩医书二种:医经余论[M].王兴伊,干旦峰,王丽丽,校注.北京:中国中医药出版社,2015:38.
[25]张介宾.类经[M].范志霞,校注.北京:中国医药科技出版社,2011.
[26]周学海.内经评文灵枢[M].李海峰,陈正,刘庆宇,等,校注.北京:中国中医药出版社,2015:177.
[27]李培生.柯氏伤寒附翼笺正[M].北京:人民卫生出版社,1986:92.
[28]周学海.脉简补义[M].傅海燕,战佳阳,校注//周学海医学全书.郑洪新,李敬林,主编.北京:中国中医药出版社,1999:543.
[29]汤尔群,张立平,黄玉燕.病机概念演化与中医原创思维[J].时珍国医国药,2015,26(12):2977-2978.
[30]徐春甫.古今医统大全:下册[M].崔仲平,王耀廷,主校.北京:人民卫生出版社,1991:858-859.
[31]喻昌.医门法律[M].张晓梅,肖培新,袁尚华,校注.北京:中国中医药出版社,2002:5.
[32]陈修园.长沙方歌括[M].武跃进,校注.上海:上海中医药大学出版社,2006:33.
[33]沈金鳌.伤寒论纲目[M].蔡永敏,刘文礼,王铭,等,校注.北京:中国中医药出版社,2015:336.
[34]丹波元简.伤寒论辑义[M].北京:人民卫生出版社,1983:117.
[35]程杏轩.杏轩医案[M].储全根,李董男,校注.北京:中国中医药出版社,2009:99.
[36]顾世澄.疡医大全[M].北京:人民卫生出版社,1987:77.
[37]龚信.古今医鉴[M].达美君,王荣根,周金根,等,校注.北京:中国中医药出版社,1997:14.
[38]张振鋆.厘正按摩要术[M].曲祖贻,点校.北京:人民卫生出版社,1990:21.
[39]缪希雍.神农本草经疏[M].北京:中医古籍出版社,2002.
[40]刘利娟,童东昌,周德生.清末民初医家“三张”治疗脑出血学术思想探析及其影响[J].中国中医急症,2016,25(4):616-618,660.
[41]叶桂.温证论治[M]//唐笠山.吴医汇讲.丁光迪,点校.北京:中国中医药出版社,2013:7-8.
[42]黄玉燕.中医疫病发病理论源流[J].时珍国医国药,2013,24(5):1209-1210.
[43]黄玉燕.中医疫病传变规律探讨[J].中医杂志,2014,55(2):157-160.
[44]蔡定芳,孟澍江.温疫病学的学术体系探讨[J].中国医药学报,1990,5(4):11-16.
[45]余师愚.疫疹一得[M].郭谦亨,孙守才,点校.北京:人民卫生出版社,1996:17-18.