本文關鍵詞： 舍時從證 王孟英 醫(yī)案　出處：《南京中醫(yī)藥大學》2016年博士論文　論文類型：學位論文

【摘要】：“舍時從證”思想濫觴于《黃帝內經》。其與“因時制宜”既相互對立,又互為補充,共同組成了中醫(yī)時間醫(yī)學體系的核心內容。但目前,中醫(yī)學界對“舍時從證”還沒有給予明確的定義,各類中醫(yī)詞典甚至未將“舍時從證”作為詞條收入其中。目前,無論是理論還是臨床,對“舍時從證”都缺少深入的研究和應用。這種情況嚴重影響了“舍時從證”的理論價值和對臨證指導的實踐價值。自元代醫(yī)家羅天益在《衛(wèi)生寶鑒·舍時從證》篇中明確提出“舍時從證”的原則以后,后世雖然對其時有闡發(fā),但主要是在研究中醫(yī)時間醫(yī)學時,將其作為“因時制宜”、“時不可違”的補充而略微涉及。研究范圍也只是對羅天益的“舍時從證”思想進行闡述,即當病證與季節(jié)氣候不一致時,不能拘泥于時令氣候因素對疾病的影響,而要根據證候來決定治法。研究的內容也以《衛(wèi)生寶鑒》中記載的醫(yī)案為主,即夏季用干姜、附子等藥組成的托里溫中湯治療寒性瘡瘍,強調夏季出現(xiàn)寒證也需要用溫熱藥進行治療。進入現(xiàn)代以來,相對于“因時制宜”如火如荼的研究狀況,對“舍時從證”的研究則略顯冷清。經檢索,以“舍時從證”為篇名的文獻也僅有發(fā)表于上世紀九十年代初的一篇論文,即北京中醫(yī)學院醫(yī)88級學生張向群在《北京中醫(yī)學院學報》發(fā)表的《淺論“時不可違”和“舍時從證”》。其認為“舍時從證”的原則,正是“時不可違”在臨證治療中的靈活應用。但并未對“舍時從證”進行更深層次的研究,同樣只是引用羅天益在《衛(wèi)生寶鑒》中記載的醫(yī)案來進行說明。王孟英是晚清時期著名溫病學家,作為“溫病學派四大家”之一,其對溫病學的發(fā)展做出了巨大的貢獻。作為溫病學家的王孟英可謂深得“舍時從證”思想精髓。即當病證與各種時間因素不符時,王氏能夠不拘泥于“時”,而是堅持以“證”為主,隨證施治。通過對王孟英醫(yī)案深入研究發(fā)現(xiàn),王氏對“舍時從證”的運用主要體現(xiàn)在三大方面：“不為時氣節(jié)律所拘堅持以證為本；不為人體節(jié)律所困堅持以證為本；不為即時客邪所惑堅持以證為本”。通過既遵守“因時制宜”,又堅持“舍時從證”,王孟英實現(xiàn)了溫病學理論和辨證施治理論的完美結合。從“舍時從證”視角對王孟英醫(yī)案進行研究,為深入研究挖掘王孟英醫(yī)學思想開辟了新途徑,也為多視角研究中醫(yī)學醫(yī)案提供了新模式和新范本。同時,結合王孟英醫(yī)案對“舍時從證”進行研究,可以更準確地理解“舍時從證”的內涵,有助于對其含義進行界定。結合王孟英醫(yī)案,綜合前賢研究成果,可以對“舍時從證”這樣進行定義：當時間因素與疾病證候不一致時,不能局限于時間因素對疾病的影響,要堅持以證為主,隨證施治。其內涵主要有三個方面：舍時氣節(jié)律從證、舍人體節(jié)律從證、舍即時客邪從證。
[Abstract]:The thought of "giving away time from syndrome" originated in "Huangdi's Internal Classic". It and "taking measures according to the circumstances" are both opposite and complementary to each other, which together form the core content of the time medicine system of traditional Chinese medicine. However, at present, The Chinese medicine profession has not yet given a clear definition of "giving time from syndrome", and all kinds of Chinese medicine dictionaries have not even included "giving time from syndrome" as an entry. At present, whether it is theoretical or clinical, This situation has seriously affected the theoretical value and practical value of the guidance of temporary certificate. Luo Tianyi, a doctor of the Yuan Dynasty, followed the certificate in the "Health Po Jian 路she". After putting forward the principle of "giving up time according to evidence" clearly in the article, Although later generations have elucidated their time, they are mainly used in the study of time medicine of traditional Chinese medicine as a supplement to "taking measures according to the circumstances" and "cannot be violated when the time is not violated." the scope of the research is only to expound Luo Tianyi's thought of "passing time from syndrome". That is, when the disease syndrome is not consistent with the seasonal climate, the effect of seasonal climatic factors on the disease should not be confined to seasonal climate factors, but the treatment method should be determined according to the syndrome. The contents of the study are also based on the medical records recorded in the "Sanitary Treasure", that is, dry ginger is used in summer. Toriwenzhong decoction, composed of aconite and other drugs, is used to treat cold sore, emphasizing that cold syndrome also needs to be treated with warm medicine in summer. Since entering modern times, the research situation of "taking measures according to the times" is in full swing. The research on "Shishuozou syndrome" is slightly desolate. After searching, there is only one paper published in the beginning of -10s under the title of "Sheshe Shi Zong Zheng". That is, Zhang Xiangqun, a medical student of Grade 88 of Beijing Institute of traditional Chinese Medicine, published in the Journal of Beijing Institute of traditional Chinese Medicine, "on the principle of" not disobeying "and" giving time according to syndromes ">. It is the flexible application of "time must not disobey" in the treatment of clinical syndrome. However, no further research has been done on "giving time from syndrome". Wang Mengying, a famous febrile scientist in the late Qing Dynasty, was one of the "four major schools of febrile disease". Wang Mengying, a febrile scientist, has made a great contribution to the development of febrile disease. Wang was able not to stick to "time", but to stick to "syndrome" as the main treatment. Through an in-depth study of Wang Mengying's medical case, he found that. Wang's application of "giving away time from the card" is mainly reflected in three aspects: "the law firm does not stick to the evidence as the basis, not the human body to adhere to the rhythm of the card as the basis;" Not bewildered by instant guest evil, insist on taking syndrome as the basis ". By adhering to both" taking measures according to the circumstances "and" giving away time according to syndrome ", Wang Mengying realized the perfect combination of febrile disease theory and syndrome differentiation and treatment theory. From the angle of" giving time from syndrome ", Wang Mengying realized the perfect combination of febrile disease theory and syndrome differentiation theory. Meng Ying's medical records were studied. It opens up a new way for further research and excavation of Wang Mengying's medical thought, and also provides a new model and a new model for the study of traditional Chinese medicine cases from multiple perspectives. We can have a more accurate understanding of the connotation of "giving up time and following the card," which will help us to define its meaning. Combined with Wang Mengying's medical case, we can synthesize the research results of the former sages. It can be defined as follows: when the time factor is not consistent with the disease syndrome, it should not be limited to the influence of the time factor on the disease. There are three main aspects of its connotation: the rhythm of Qi, the rhythm of the human body, and the syndrome of instant guest evil.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R249;R242

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