从气机升降理论探讨岭南医家论治温病经验
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摘要
目的：
通过收集近、现代岭南医家的医著、医案、医话及有关学术经验。运用统计方法分析与文献研究相结合,归纳岭南医家们的用药规律和特点,从气机升降理论的角度与药物的气味厚薄、寒热属性、升降浮沉等方面探讨岭南医家们对温病的防治经验,以期对近年来在岭南地区爆发的急性传染疾病的治疗总结出一些有意义的方药和治疗方法。
方法：
本文通过医家学术专著、中文期刊数椐库(CNKI)及其它资料文献收集到15位岭南医家的医案、医话及有关学术经验,辑录整理成数椐库。运用(Microsoft excel2007软件)统计方法分析与文献研究相结合,归纳岭南医家的用药规律和特点。
研究内容与结果：
内容：
本文以“气”为出发点,探讨气其哲学慨念,及其与中医学的关系。以及《内经》中有关“百病皆生于气”及天人合一的整体观医学理论。疏理归纳气机升降运动的各种不同方式,及其与人体脏腑器官的生理、病理关系。
疏理归纳气机升降理论的历史源流,以及气机升降理论历代的发展传承。重点疏理归纳明清时期医家应用气机升降理论在温病治疗中的论述,以及气机升降理论与中药升降浮沉的关系,探讨以气机升降理论为依椐的温病方剂用药特点。
从三因制宜思想,分析地理气候环境对岭南人体质的影响,以及岭南医家因应地理气候条件等因素辨证论治温病之理论阐发及有关用药经验。
本文通收集岭南医家论治温病的医案,运用统计分析方法对常用药物,药性、药味、功效、归经和升降浮沉等各项属性,进行统计分析。结合文献疏理归纳,从气机升降理论探讨岭南医家论治温病的处方思想和用药经验。
结果：
《内经》“气”的思想源自中国古代哲学,用于分析研究人体的生理、病理,强调气机对生命及健康的重要性,而气机维护人体健康的关键是升降出入协调。历代医家由此将气机升降广泛应用到临床各科疾病的诊治当中,发展了《内经》学术理论,形成了很多新的理论学说,至明清时期的温病家,他们尤其重视升降理论在温病论治中的应用,在处方、药物配伍方面无不考虑调动人体之气机,以斡旋枢转、辛开苦降等方药用之临床而取得疗效。
近现代岭南医家承明清温病学医家之学术思想,从岭南地域特点出发,进一步发挥和发展了升降理论在温病治疗中的应用,经对他们临床用方的统计分析,结果得出：
1.岭南医家治疗温病时首要重视调理肺经(药物使用频率为：肺经20.65%),其次在整体调治过程中,以调理脾胃(脾、胃两经药物使用频率分别为16.13%、21.94%)为中心,协同配入调理其它脏腑的药物。
2.岭南医家重视运用药物性味及升降浮沉之理配伍使用药物以调畅气机。其中“甘、苦、辛”三种药味使用频率最高(分别为：甘味32.22%,苦味26.67%、微苦味8.89%,辛味18.89%)。因于岭南温病临床见症以阳热偏盛的特点。用药多为辛凉(寒)之品(药物使用频率分别为：寒药31.67%,微寒药25.00%,凉药3.33%,大寒药1.67%)。另者,岭南温病临床多见挟湿证候。医家在配伍用药时多会少许加入辛温或辛微温之药,寒温并用(药物使用频率,温药1].67%,微温药5.00%)。
结论：
1.承继《内经》气机升降理论要旨,接受明清医家论治温病的学术思想,岭南医家在温病的论治方面有所发挥。
2.岭南温病主要病机表现,是湿热纠缠郁遏气机。岭南医家注重运用药物气味升降浮沉之理,配伍处方用药以调理机体阴阳平衡复常以为治,故在论治之时首要使气机调畅复常,故必先调气。肺主气司呼吸,关乎一身气机,气机通调其它治疗方法方可以行。岭南医家在调肺气的前提下,注重运用药物气味升降浮沉之理,以调理脾胃为重点,综合调理其它脏腑气机(如：肝、胆、肾等脏腑),配伍处方用药以复常机体阴阳平衡以为治,在用药过程中常喜用轻清芳香透动的花、叶类药物以醒脾化湿。
3.在调理脾胃气机的常法前提下,配入调肝经之药(诸如：菊花,蝉蜕,白薇,青蒿,红条紫草,白芍,溪黄草、生香附等,此等药物多为辛、微苦,微寒,归肝经之药。其中青蒿,得春升之气,阴中有阳,降中有升；白薇：苦、咸,寒。凉肝退热。白芍：苦、酸,微寒。归肝经,能补肝阴不足,平抑肝阳：香附：辛、微苦、甘,平.能疏肝理气)。这正符合气机升降理：
4.在论治温病时,如能把“升降出入”的方剂配伍思想应用于“卫气营血”、“三焦”辨证,则可做到未病先防,截断病邪发展深入,先步用药,控制病情。掌握病位、病性、病势,更能有效指导用药,防止过用寒凉以冰遏邪气。
Qi is the basic element that makes up everything in the universe. Qi of yin and qi of yang interact to yield everything in the universe including human. The five zang-organs, the six fu-organs, the four limbs and the numerous bones form an organic whole through the meridian system. Qi is constantly circulating inside the human body. Movement of qi is called qi activities. If qi activities are normal, human body will be in harmony; otherwise, it will be subject to illness. Th ere is a saying "all diseases originated from qi" in Huangdi Neijing, it points out that dysfunction of qi activities is an important pathogenesis. The theory of falling and rising of qi activities has been elaborated and enhanced by many doctors in the past through their clinical experiences.
Seasonal febrile disease is another type of exogenous diseases and its onset, etiology, pathogenesis are different from that of febrile diseases." Yang-heat stagnation" and "qi stagnation" is the basic pathogenesis of seasonal febrile diseases. Detail analysis of the application of the theory of falling and rising of qi activities turns out to be a good method for clinical guidance. Since1840(Opium War), the Lingnan region has been increasingly open to the world including the acute season febrile diseases. Lingnan doctors were able to cure these diseases successfully using local herbs according to the foundation theory of Chinese medicine and the theory of seasonal febrile disease. Unfortunately, writings on these experiences were either few due to heavy clinical load or lost due to warfare.
The theory of seasonal febrile diseases of Lingnan is a combination of three-causes thinking and clinical application. Due to its different and special geography, climate and people's constitution, Lingnan seasonal febrile diseases have unique characteristics like hyperfunction of heat or qi stagnation caused by dampness-heat over the entire course of the diseases. As a result, Lingnan doctors are good at using treatment principles such as qing, xuan and tong.
Objective
This study attempts to summarize clinical experiences and the prescription pattern from the Lingnan doctor'sclinical records on season febrile diseases. The result of this study could guide prescription treatment on tackling new seasonal febrile diseases happened lately in the region.
Methods
This study collected62medical cases with145medical records from18Lingnan doctors from all sorts of journals and clinical literatures from sources such as CNKI. It then applies statistical analysis (using Microsoft Excel2007software) and literature research method to generalize prescription patterns and characteristics of the Lingnan doctor's clinical experiences.
Content
The study begins with qi, the philosophy of qi, and its relationship to Chinese medicine, especially on the saying "all diseases originated from qi" in Huangdi Neijing and the holistic view about the Heaven and Human. It also analyzes and summarizes types of rising and falling of qi activities, and its relationship with human body in physiological and pathological terms.
The study looks at the origin and development of the theory of rising and falling of qi activities with an emphasis on its application on seasonal febrile diseases from the doctors of the Ming and Qing periods, its relationship with the rising, falling, floating and sinking properties of Chinese medicine, and the characteristics of the related prescriptions.
According to the three-causes principle, the study analyzes how geography and climate factors affects the constitution of people in the Lingnan region, and how Lingnan doctors developed their method on differentiation of syndromes and the selection of herbs in their treatment based on these factors.
Through collection of the clinical records of the Lingnan doctors on seasonal febrile diseases, statistics method is applied to summarize the common herbs used including their properties, flavors, functions, meridian system belonged, etc. With these results and the review of the related literatures from these doctors, experiences and thinking are concluded from them.
Results
The thinking of qi in Huangdi Nei jing is originated in the ancient Chinese philosophy. It applies to human physiology and pathology and the attainment of healthy state, and focuses on the concept of rising and falling of qi. The past.doctors applied this thinking in clinical treatment and further developed the thinking of qi in Huangdi Nei jing by forming many innovating theories. In the Ming and Qing period, doctors of the seasonal febrile diseases stressed heavily on the theory of rising and falling of qi activities on their clinical applications, especially on the prescriptions and herbs used.
Contemporary Lingnan doctors adopted the thinking of these doctors from the Ming and Qing period based on the characteristics of the geography of the Lingnan region, further developed the theory of rising and falling of qi activities on their clinical applications. Based on statistic analysis on these clinical applications, results are as follows:
1. On treatment, Contemporary Lingnan doctors heavily stressed on regulating the lung meridian system (application%:20.65%), then on spleen and stomach meridian system (application%:16.13%and21.94%respectively.) with use of other minor Chinese medicine.
2. Contemporary Lingnan doctors were good at applying the properties and flavors of Chinese medicine and the theory of rising and fall of qi activities to regular the qi mechanism of the human body. Among them, Chinese medicine with sweet, bitter and spicy flavors were used the most (application%: sweet:32.22%, bitter:26.67%, slightly bitter:8.89%, spicy:18.89%). Since hyperfunction of heat is usually resulted in Lingnan's seasonal febrile diseases, Chinese medicine with spicy and cold properties were heavily used (application%:cold:31.67%, slightly cold:25.00%, cool:3.33%, extremely cold:1.67%). Be sides, since Lingnan's seasonal febrile diseases are usually seen with dampness, Chinese medicine with spicy warm or spicy slightly warm properties was used selectively (application%:warm:11.67%, slightly warm:5.00%).
Conclusion
1. To inherit the essence of the theory of rising and falling of qi activities in Huangdi Neijing and follow the thinking of Lingnan doctors on seasonal febrile diseases, contemporary Lingnan doctors were good at treating seasonal febrile diseases.
2. Seasonal febrile diseases in the Lingnan region are mainly caused by qi stagnation by dampness-heat. The Lingnan doctors on seasonal febrile diseases were good at applying the properties and flavors of Chinese medicine such as rising, falling, floating and sinking properties in their prescriptions to restore the balanced state of yin and yang of the human body. In fact, regulating the qi mechanism is the first priority of treamtment on seasonal febrile diseases in the Lingnan region. Lung presides over breathing and breathing is crucial to the entire body. As such, regulating the qi mechanism must be addressed first before any other method. To regulate lung's qi, Lingnan doctors applies the rising, falling, floating and sinking properties of Chinese medicine, focuses on the stomach and spleen together with the qi mechanism of other zangfu-organs like liver, gallbladder and kidney, selects prescription and Chinese medicine that can restore the balanced state of yin and yang of the human body and likes to use herbs with lightness and fragrance properties in order to remove dampness caused by the spleen.
3. To regulate the qi mechanism of the stomach and spleen, Chinese medicine of the liver branch of the meridian system is usually used such as Flos Chrysanthemi, Periostracum Cicadae, Radix Cynanchi Atrati, He bra Artemisiae Annuae and Radix Paeoniae Alba. This Chinese medicine is usually spicy, slightly bitter, slightly cold and belonged to the liver meridian systm. Th is follows the theory of the rising and fall of qi activities such that the rising of the liver and the falling of the lung are harmonized.
4. With regard to the treatment on the seasonal febrile diseases, if differentiation of syndromes based on Wei-qi-ying-xue, the triple jiao and the rising-falling-out-in principles is used skillfully, the result would be promising because, for example,further development of the diseases would be halt and overuse of Chinese medicine with cold property would be safeguarded.
通过收集近、现代岭南医家的医著、医案、医话及有关学术经验。运用统计方法分析与文献研究相结合,归纳岭南医家们的用药规律和特点,从气机升降理论的角度与药物的气味厚薄、寒热属性、升降浮沉等方面探讨岭南医家们对温病的防治经验,以期对近年来在岭南地区爆发的急性传染疾病的治疗总结出一些有意义的方药和治疗方法。
方法：
本文通过医家学术专著、中文期刊数椐库(CNKI)及其它资料文献收集到15位岭南医家的医案、医话及有关学术经验,辑录整理成数椐库。运用(Microsoft excel2007软件)统计方法分析与文献研究相结合,归纳岭南医家的用药规律和特点。
研究内容与结果：
内容：
本文以“气”为出发点,探讨气其哲学慨念,及其与中医学的关系。以及《内经》中有关“百病皆生于气”及天人合一的整体观医学理论。疏理归纳气机升降运动的各种不同方式,及其与人体脏腑器官的生理、病理关系。
疏理归纳气机升降理论的历史源流,以及气机升降理论历代的发展传承。重点疏理归纳明清时期医家应用气机升降理论在温病治疗中的论述,以及气机升降理论与中药升降浮沉的关系,探讨以气机升降理论为依椐的温病方剂用药特点。
从三因制宜思想,分析地理气候环境对岭南人体质的影响,以及岭南医家因应地理气候条件等因素辨证论治温病之理论阐发及有关用药经验。
本文通收集岭南医家论治温病的医案,运用统计分析方法对常用药物,药性、药味、功效、归经和升降浮沉等各项属性,进行统计分析。结合文献疏理归纳,从气机升降理论探讨岭南医家论治温病的处方思想和用药经验。
结果：
《内经》“气”的思想源自中国古代哲学,用于分析研究人体的生理、病理,强调气机对生命及健康的重要性,而气机维护人体健康的关键是升降出入协调。历代医家由此将气机升降广泛应用到临床各科疾病的诊治当中,发展了《内经》学术理论,形成了很多新的理论学说,至明清时期的温病家,他们尤其重视升降理论在温病论治中的应用,在处方、药物配伍方面无不考虑调动人体之气机,以斡旋枢转、辛开苦降等方药用之临床而取得疗效。
近现代岭南医家承明清温病学医家之学术思想,从岭南地域特点出发,进一步发挥和发展了升降理论在温病治疗中的应用,经对他们临床用方的统计分析,结果得出：
1.岭南医家治疗温病时首要重视调理肺经(药物使用频率为：肺经20.65%),其次在整体调治过程中,以调理脾胃(脾、胃两经药物使用频率分别为16.13%、21.94%)为中心,协同配入调理其它脏腑的药物。
2.岭南医家重视运用药物性味及升降浮沉之理配伍使用药物以调畅气机。其中“甘、苦、辛”三种药味使用频率最高(分别为：甘味32.22%,苦味26.67%、微苦味8.89%,辛味18.89%)。因于岭南温病临床见症以阳热偏盛的特点。用药多为辛凉(寒)之品(药物使用频率分别为：寒药31.67%,微寒药25.00%,凉药3.33%,大寒药1.67%)。另者,岭南温病临床多见挟湿证候。医家在配伍用药时多会少许加入辛温或辛微温之药,寒温并用(药物使用频率,温药1].67%,微温药5.00%)。
结论：
1.承继《内经》气机升降理论要旨,接受明清医家论治温病的学术思想,岭南医家在温病的论治方面有所发挥。
2.岭南温病主要病机表现,是湿热纠缠郁遏气机。岭南医家注重运用药物气味升降浮沉之理,配伍处方用药以调理机体阴阳平衡复常以为治,故在论治之时首要使气机调畅复常,故必先调气。肺主气司呼吸,关乎一身气机,气机通调其它治疗方法方可以行。岭南医家在调肺气的前提下,注重运用药物气味升降浮沉之理,以调理脾胃为重点,综合调理其它脏腑气机(如：肝、胆、肾等脏腑),配伍处方用药以复常机体阴阳平衡以为治,在用药过程中常喜用轻清芳香透动的花、叶类药物以醒脾化湿。
3.在调理脾胃气机的常法前提下,配入调肝经之药(诸如：菊花,蝉蜕,白薇,青蒿,红条紫草,白芍,溪黄草、生香附等,此等药物多为辛、微苦,微寒,归肝经之药。其中青蒿,得春升之气,阴中有阳,降中有升；白薇：苦、咸,寒。凉肝退热。白芍：苦、酸,微寒。归肝经,能补肝阴不足,平抑肝阳：香附：辛、微苦、甘,平.能疏肝理气)。这正符合气机升降理：
4.在论治温病时,如能把“升降出入”的方剂配伍思想应用于“卫气营血”、“三焦”辨证,则可做到未病先防,截断病邪发展深入,先步用药,控制病情。掌握病位、病性、病势,更能有效指导用药,防止过用寒凉以冰遏邪气。
Qi is the basic element that makes up everything in the universe. Qi of yin and qi of yang interact to yield everything in the universe including human. The five zang-organs, the six fu-organs, the four limbs and the numerous bones form an organic whole through the meridian system. Qi is constantly circulating inside the human body. Movement of qi is called qi activities. If qi activities are normal, human body will be in harmony; otherwise, it will be subject to illness. Th ere is a saying "all diseases originated from qi" in Huangdi Neijing, it points out that dysfunction of qi activities is an important pathogenesis. The theory of falling and rising of qi activities has been elaborated and enhanced by many doctors in the past through their clinical experiences.
Seasonal febrile disease is another type of exogenous diseases and its onset, etiology, pathogenesis are different from that of febrile diseases." Yang-heat stagnation" and "qi stagnation" is the basic pathogenesis of seasonal febrile diseases. Detail analysis of the application of the theory of falling and rising of qi activities turns out to be a good method for clinical guidance. Since1840(Opium War), the Lingnan region has been increasingly open to the world including the acute season febrile diseases. Lingnan doctors were able to cure these diseases successfully using local herbs according to the foundation theory of Chinese medicine and the theory of seasonal febrile disease. Unfortunately, writings on these experiences were either few due to heavy clinical load or lost due to warfare.
The theory of seasonal febrile diseases of Lingnan is a combination of three-causes thinking and clinical application. Due to its different and special geography, climate and people's constitution, Lingnan seasonal febrile diseases have unique characteristics like hyperfunction of heat or qi stagnation caused by dampness-heat over the entire course of the diseases. As a result, Lingnan doctors are good at using treatment principles such as qing, xuan and tong.
Objective
This study attempts to summarize clinical experiences and the prescription pattern from the Lingnan doctor'sclinical records on season febrile diseases. The result of this study could guide prescription treatment on tackling new seasonal febrile diseases happened lately in the region.
Methods
This study collected62medical cases with145medical records from18Lingnan doctors from all sorts of journals and clinical literatures from sources such as CNKI. It then applies statistical analysis (using Microsoft Excel2007software) and literature research method to generalize prescription patterns and characteristics of the Lingnan doctor's clinical experiences.
Content
The study begins with qi, the philosophy of qi, and its relationship to Chinese medicine, especially on the saying "all diseases originated from qi" in Huangdi Neijing and the holistic view about the Heaven and Human. It also analyzes and summarizes types of rising and falling of qi activities, and its relationship with human body in physiological and pathological terms.
The study looks at the origin and development of the theory of rising and falling of qi activities with an emphasis on its application on seasonal febrile diseases from the doctors of the Ming and Qing periods, its relationship with the rising, falling, floating and sinking properties of Chinese medicine, and the characteristics of the related prescriptions.
According to the three-causes principle, the study analyzes how geography and climate factors affects the constitution of people in the Lingnan region, and how Lingnan doctors developed their method on differentiation of syndromes and the selection of herbs in their treatment based on these factors.
Through collection of the clinical records of the Lingnan doctors on seasonal febrile diseases, statistics method is applied to summarize the common herbs used including their properties, flavors, functions, meridian system belonged, etc. With these results and the review of the related literatures from these doctors, experiences and thinking are concluded from them.
Results
The thinking of qi in Huangdi Nei jing is originated in the ancient Chinese philosophy. It applies to human physiology and pathology and the attainment of healthy state, and focuses on the concept of rising and falling of qi. The past.doctors applied this thinking in clinical treatment and further developed the thinking of qi in Huangdi Nei jing by forming many innovating theories. In the Ming and Qing period, doctors of the seasonal febrile diseases stressed heavily on the theory of rising and falling of qi activities on their clinical applications, especially on the prescriptions and herbs used.
Contemporary Lingnan doctors adopted the thinking of these doctors from the Ming and Qing period based on the characteristics of the geography of the Lingnan region, further developed the theory of rising and falling of qi activities on their clinical applications. Based on statistic analysis on these clinical applications, results are as follows:
1. On treatment, Contemporary Lingnan doctors heavily stressed on regulating the lung meridian system (application%:20.65%), then on spleen and stomach meridian system (application%:16.13%and21.94%respectively.) with use of other minor Chinese medicine.
2. Contemporary Lingnan doctors were good at applying the properties and flavors of Chinese medicine and the theory of rising and fall of qi activities to regular the qi mechanism of the human body. Among them, Chinese medicine with sweet, bitter and spicy flavors were used the most (application%: sweet:32.22%, bitter:26.67%, slightly bitter:8.89%, spicy:18.89%). Since hyperfunction of heat is usually resulted in Lingnan's seasonal febrile diseases, Chinese medicine with spicy and cold properties were heavily used (application%:cold:31.67%, slightly cold:25.00%, cool:3.33%, extremely cold:1.67%). Be sides, since Lingnan's seasonal febrile diseases are usually seen with dampness, Chinese medicine with spicy warm or spicy slightly warm properties was used selectively (application%:warm:11.67%, slightly warm:5.00%).
Conclusion
1. To inherit the essence of the theory of rising and falling of qi activities in Huangdi Neijing and follow the thinking of Lingnan doctors on seasonal febrile diseases, contemporary Lingnan doctors were good at treating seasonal febrile diseases.
2. Seasonal febrile diseases in the Lingnan region are mainly caused by qi stagnation by dampness-heat. The Lingnan doctors on seasonal febrile diseases were good at applying the properties and flavors of Chinese medicine such as rising, falling, floating and sinking properties in their prescriptions to restore the balanced state of yin and yang of the human body. In fact, regulating the qi mechanism is the first priority of treamtment on seasonal febrile diseases in the Lingnan region. Lung presides over breathing and breathing is crucial to the entire body. As such, regulating the qi mechanism must be addressed first before any other method. To regulate lung's qi, Lingnan doctors applies the rising, falling, floating and sinking properties of Chinese medicine, focuses on the stomach and spleen together with the qi mechanism of other zangfu-organs like liver, gallbladder and kidney, selects prescription and Chinese medicine that can restore the balanced state of yin and yang of the human body and likes to use herbs with lightness and fragrance properties in order to remove dampness caused by the spleen.
3. To regulate the qi mechanism of the stomach and spleen, Chinese medicine of the liver branch of the meridian system is usually used such as Flos Chrysanthemi, Periostracum Cicadae, Radix Cynanchi Atrati, He bra Artemisiae Annuae and Radix Paeoniae Alba. This Chinese medicine is usually spicy, slightly bitter, slightly cold and belonged to the liver meridian systm. Th is follows the theory of the rising and fall of qi activities such that the rising of the liver and the falling of the lung are harmonized.
4. With regard to the treatment on the seasonal febrile diseases, if differentiation of syndromes based on Wei-qi-ying-xue, the triple jiao and the rising-falling-out-in principles is used skillfully, the result would be promising because, for example,further development of the diseases would be halt and overuse of Chinese medicine with cold property would be safeguarded.
引文
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