《金匮要略》水液失常相关病变的辨证思想与方法
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摘要
目的通过对《金匮要略》中水液失常相关病变的研究,深化对痰饮病的理解,更进一步探讨仲景辨证论治思想与方法。
方法研读《金匮要略》与水液失常相关病变的条文,讨论辨病和辨证的关系,运用以疾病为核心的角度对《痰饮病篇》及其他相关条文进行重新分析。
结果①疾病与证候二者如影随形而不相离,辨证是为了认识疾病过程,若能在过程中确认患者所得的是何种具体疾病,则能更准确地了解证候在当下的意义及病机。②证候和“阶段性病机”并不是辨证的重点,更重要的是在关注动态整体的基础上,了解不同疾病发生变化的规律,推断病的发展趋势,才能为更全面准确的判断当下的治疗策略。③痰饮病以人体水液运化能力与饮邪二者的关系为发病主线,而因饮留之部位、饮结之深浅、发病的趋向等均有很大变化,故没有固定的简单规律可循。不过仲景对痰饮病的具体变化规律,作出了高度概括④“温药和之”作为痰饮病的治疗大原则,指治疗的过程总以回复人体水液正常运化为务,这是在整个治疗痰饮病的动态过程中而言,而非指某一次的治法。
结论仲景书最为可贵之处,并非仅仅在于书中对疾病表现的描述和方药记载,而是透过对疾病辨证论治的具体描述,让医者掌握其辨证论治的思维和方法。《金匮要略》论述了不同疾病的复杂变化规律,更示人辨治杂病的思维和方法。
Objective To find out the principle and method of diagnosing and treating fluid-related disorders used by Zhang Zhong-jing in the "Golden Chamber" and deepen the understanding towards "Fluid Retention Diseases"
Methods The articles in the "Golden Chamber" which concerning fluid-related disorders and clarify the relationships between symptoms and disease during diagnosis were studied and the Chapter of Fluid Retention Disease and articles related were reviewed using "disease centered approach".
Results①The concept "symptom" and "disease"could not be saperated. Symptom analyze was the only method to understand disease. If the pattern of particular disease was considered during diagnosis, disease mechanism would be revealed with higher accuracy.②Partial disease mechanism was not the main focus by Zhang Zhong-jing when diagnosing, instead, observe the disease process in dynamic way would help to increase the clarity and accuracy of deciding treatment method.③The pattern of Fluid-retention Disease was affected by the relationships between Vital energy and Evil. However, the excessive fluid could stay at any part of the body with various depth, which give out a complex pattern of change. In the Chapter of Fluid-retention Disease, Zhang Zhong-jing revealed the pattern in a highly conclusive manner.④"Harmonizing with drugs of warm in nature" was the principle of treating Fluid-retention disease. But it did not only refer to the treating method in one particular phase or moment. It was in fact the overall principle of treating Fluid-retention in the whole process.
Conclusion Formulae and treatment methods were not the most valuable part in the "Golden Chamber", through studying in a right angle, the mind set of how Zhang Zhong-jing consider to diagnose and treat disease would be shown.
方法研读《金匮要略》与水液失常相关病变的条文,讨论辨病和辨证的关系,运用以疾病为核心的角度对《痰饮病篇》及其他相关条文进行重新分析。
结果①疾病与证候二者如影随形而不相离,辨证是为了认识疾病过程,若能在过程中确认患者所得的是何种具体疾病,则能更准确地了解证候在当下的意义及病机。②证候和“阶段性病机”并不是辨证的重点,更重要的是在关注动态整体的基础上,了解不同疾病发生变化的规律,推断病的发展趋势,才能为更全面准确的判断当下的治疗策略。③痰饮病以人体水液运化能力与饮邪二者的关系为发病主线,而因饮留之部位、饮结之深浅、发病的趋向等均有很大变化,故没有固定的简单规律可循。不过仲景对痰饮病的具体变化规律,作出了高度概括④“温药和之”作为痰饮病的治疗大原则,指治疗的过程总以回复人体水液正常运化为务,这是在整个治疗痰饮病的动态过程中而言,而非指某一次的治法。
结论仲景书最为可贵之处,并非仅仅在于书中对疾病表现的描述和方药记载,而是透过对疾病辨证论治的具体描述,让医者掌握其辨证论治的思维和方法。《金匮要略》论述了不同疾病的复杂变化规律,更示人辨治杂病的思维和方法。
Objective To find out the principle and method of diagnosing and treating fluid-related disorders used by Zhang Zhong-jing in the "Golden Chamber" and deepen the understanding towards "Fluid Retention Diseases"
Methods The articles in the "Golden Chamber" which concerning fluid-related disorders and clarify the relationships between symptoms and disease during diagnosis were studied and the Chapter of Fluid Retention Disease and articles related were reviewed using "disease centered approach".
Results①The concept "symptom" and "disease"could not be saperated. Symptom analyze was the only method to understand disease. If the pattern of particular disease was considered during diagnosis, disease mechanism would be revealed with higher accuracy.②Partial disease mechanism was not the main focus by Zhang Zhong-jing when diagnosing, instead, observe the disease process in dynamic way would help to increase the clarity and accuracy of deciding treatment method.③The pattern of Fluid-retention Disease was affected by the relationships between Vital energy and Evil. However, the excessive fluid could stay at any part of the body with various depth, which give out a complex pattern of change. In the Chapter of Fluid-retention Disease, Zhang Zhong-jing revealed the pattern in a highly conclusive manner.④"Harmonizing with drugs of warm in nature" was the principle of treating Fluid-retention disease. But it did not only refer to the treating method in one particular phase or moment. It was in fact the overall principle of treating Fluid-retention in the whole process.
Conclusion Formulae and treatment methods were not the most valuable part in the "Golden Chamber", through studying in a right angle, the mind set of how Zhang Zhong-jing consider to diagnose and treat disease would be shown.
引文
1. 金寿山.辨病和辨证辨脉和辨因一《金匮》教学浅谈.上海中医药杂志,1980,2：38-39,28)
2. 卢如玲,郑泳霞.《伤寒杂病论》是辨证辨病相结合的典范.中医药临床杂志,2007,19(4)：325-326
3. 范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.3
4. 徐木林.《伤寒论》与《金匮要略》中病、证、症的关系问题.新医药通讯,1979(S1)：3-8
5. 成肇仁.略论《金匮要略》的辨病论治.河南中医,1984(4)：3-5
6. 范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.4
7. 范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.37
8. 耿义勤.论《金匮》辨病.山东中医学院学报,1989,13(5)：57-59
9. 林宗广.中医辨病论治探讨.中医药研究,1992,4：34-35
10.韦黎.证、证、症、候的沿革和证候定义的研究.中国医药学报,1996,11(2)：68-73
11.范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.189
12.李克光主编.高等医药院校教材《金匮要略讲义》.上海：上海科学技术出版社,1985.129
13.范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.190
14.张家礼.张家礼金匮要略讲稿.北京：人民卫生出版社,2009.242-243
15.魏荔彤.金匮要略方论本义.北京.人民卫生出版社,1997.160)
16.李克光主编.高等医药院校教材《金匮要略讲义》.上海：上海科学技术出版社,1985.130
17.陈纪藩主编.中医药学高级丛书《金匮要略》第2版.北京：人民卫生出版社,2000.367
18.尤怡.《金匮要略心典》.北京：中国中医药出版社,1992.91
19.尤怡.《金匮要略心典》.北京：中国中医药出版社,1992.92
20.程门雪.金匮篇解.北京：人民卫生出版社,1986.76
21.范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.192
22.魏荔彤.金匮要略方论本义.北京：人民卫生出版社,1997.163
23.魏荔彤.金匮要略方论本义.北京：人民卫生出版社,1997.164
24.何任.金匮要略新解.浙江：浙江科学技术出版社,1982.89
25.范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.193
26.范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.194
27.连建伟.连建伟金匮要略方论讲稿.北京：人民卫生出版社,2008.184
28.魏荔彤.金匮要略方论本义.北京：人民卫生出版社,1997.165
29.魏荔彤.金匮要略方论本义.北京：人民卫生出版社,1997.166
30.吴谦等.医宗金鉴.北京：人民卫生出版社.
31.范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.202
32.尤怡.《金匮要略心典》.北京：中国中医药出版社,1992.97-98
33.孙思邈.备急千金要方.北京：人民卫生出版社,1955.331
34.尤怡.《金匮要略心典》.北京：中国中医药出版社,1992.98
35.尤怡.《金匮要略心典》.北京：中国中医药出版社,1992.99
36.魏荔彤.金匮要略方论本义.北京：人民卫生出版社,1997.172
37.赵以德.金匮玉函经二注.北京：人民卫生出版社,1990.199-201
38.尤怡.《金匮要略心典》.北京：中国中医药出版社,1992.104
1.刘宝奇,刘国柱.“病痰饮者,当以温药和之”初探.天津中医学院学报.1983,Z1：8-10
2.陈凡,宣丽华.“病痰饮者,当以温药和之”的认识与运用.江西中医学院学报.2012,24(5)：6-9
3.周衡.也谈“病痰饮者,当以温药和之”.云南中医学院学报.1982,4：24-26)4.黄晓华,汪震,敖丽英等.《金匮要略》中“病痰饮者,当以温药和之”原意浅析.2011,17(4)：374,378
4.姜寅光.病痰饮者当以温药和之再思考.世界中西医结合杂志.2010,5(12)：1079-1080
5.王新佩.试谈痰饮病的“温”“和”法则.中国自然医学杂志.2000,2(1)：36-38
6.桑红灵.论《金匮》痰饮病治则.湖北中医学院金匮教研究.2009,24(4)：614-615
7.谢立奎.对仲景痰饮病“和之”含义之研讨.北京中医杂志.1987,3：12-14
8.黄晓华,汪震,敖丽英等.《金匮要略》中“病痰饮者,当以温药和之”原意浅析.2011,17(4)：374,378
9.汤川安,樊巧玲.“病痰饮者,当以温药和之”论.天津中医药.2009,26(4)：306-307
10.张维才.浅谈《金匮》痰饮病的治法.湖北中医杂志,1985,5：7-9,31
11.胡翊健.《金匮》痰饮病治则探析.江西中医学院学报,1999,12(4)：172
12.陈桂敏.《金匮要略》痰饮总治则新释.国医论坛,1996,11(3)：2
2. 卢如玲,郑泳霞.《伤寒杂病论》是辨证辨病相结合的典范.中医药临床杂志,2007,19(4)：325-326
3. 范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.3
4. 徐木林.《伤寒论》与《金匮要略》中病、证、症的关系问题.新医药通讯,1979(S1)：3-8
5. 成肇仁.略论《金匮要略》的辨病论治.河南中医,1984(4)：3-5
6. 范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.4
7. 范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.37
8. 耿义勤.论《金匮》辨病.山东中医学院学报,1989,13(5)：57-59
9. 林宗广.中医辨病论治探讨.中医药研究,1992,4：34-35
10.韦黎.证、证、症、候的沿革和证候定义的研究.中国医药学报,1996,11(2)：68-73
11.范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.189
12.李克光主编.高等医药院校教材《金匮要略讲义》.上海：上海科学技术出版社,1985.129
13.范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.190
14.张家礼.张家礼金匮要略讲稿.北京：人民卫生出版社,2009.242-243
15.魏荔彤.金匮要略方论本义.北京.人民卫生出版社,1997.160)
16.李克光主编.高等医药院校教材《金匮要略讲义》.上海：上海科学技术出版社,1985.130
17.陈纪藩主编.中医药学高级丛书《金匮要略》第2版.北京：人民卫生出版社,2000.367
18.尤怡.《金匮要略心典》.北京：中国中医药出版社,1992.91
19.尤怡.《金匮要略心典》.北京：中国中医药出版社,1992.92
20.程门雪.金匮篇解.北京：人民卫生出版社,1986.76
21.范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.192
22.魏荔彤.金匮要略方论本义.北京：人民卫生出版社,1997.163
23.魏荔彤.金匮要略方论本义.北京：人民卫生出版社,1997.164
24.何任.金匮要略新解.浙江：浙江科学技术出版社,1982.89
25.范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.193
26.范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.194
27.连建伟.连建伟金匮要略方论讲稿.北京：人民卫生出版社,2008.184
28.魏荔彤.金匮要略方论本义.北京：人民卫生出版社,1997.165
29.魏荔彤.金匮要略方论本义.北京：人民卫生出版社,1997.166
30.吴谦等.医宗金鉴.北京：人民卫生出版社.
31.范永升主编.新世纪全国高等中医药院校规划教材《金匮要略》.北京：中国中医药出版社,2003.202
32.尤怡.《金匮要略心典》.北京：中国中医药出版社,1992.97-98
33.孙思邈.备急千金要方.北京：人民卫生出版社,1955.331
34.尤怡.《金匮要略心典》.北京：中国中医药出版社,1992.98
35.尤怡.《金匮要略心典》.北京：中国中医药出版社,1992.99
36.魏荔彤.金匮要略方论本义.北京：人民卫生出版社,1997.172
37.赵以德.金匮玉函经二注.北京：人民卫生出版社,1990.199-201
38.尤怡.《金匮要略心典》.北京：中国中医药出版社,1992.104
1.刘宝奇,刘国柱.“病痰饮者,当以温药和之”初探.天津中医学院学报.1983,Z1：8-10
2.陈凡,宣丽华.“病痰饮者,当以温药和之”的认识与运用.江西中医学院学报.2012,24(5)：6-9
3.周衡.也谈“病痰饮者,当以温药和之”.云南中医学院学报.1982,4：24-26)4.黄晓华,汪震,敖丽英等.《金匮要略》中“病痰饮者,当以温药和之”原意浅析.2011,17(4)：374,378
4.姜寅光.病痰饮者当以温药和之再思考.世界中西医结合杂志.2010,5(12)：1079-1080
5.王新佩.试谈痰饮病的“温”“和”法则.中国自然医学杂志.2000,2(1)：36-38
6.桑红灵.论《金匮》痰饮病治则.湖北中医学院金匮教研究.2009,24(4)：614-615
7.谢立奎.对仲景痰饮病“和之”含义之研讨.北京中医杂志.1987,3：12-14
8.黄晓华,汪震,敖丽英等.《金匮要略》中“病痰饮者,当以温药和之”原意浅析.2011,17(4)：374,378
9.汤川安,樊巧玲.“病痰饮者,当以温药和之”论.天津中医药.2009,26(4)：306-307
10.张维才.浅谈《金匮》痰饮病的治法.湖北中医杂志,1985,5：7-9,31
11.胡翊健.《金匮》痰饮病治则探析.江西中医学院学报,1999,12(4)：172
12.陈桂敏.《金匮要略》痰饮总治则新释.国医论坛,1996,11(3)：2