本文選題：針藥結(jié)合 + 辨證論治�。� 參考：《廣州中醫(yī)藥大學》2016年博士論文

【摘要】：臨床醫(yī)學的主要任務之一是對疾病進行診斷,然后根據(jù)診斷結(jié)果進行治療。因此正確的診斷是使治療產(chǎn)生效果的前提。在長期的醫(yī)療活動過程中,歷代醫(yī)家積累了豐富的診斷疾病的經(jīng)驗,形成了我國特有的完整的診病體系,即四診(望診、聞診、問診、切診)和辨證,從而建立了中醫(yī)診斷學這門學科。至古至今,中醫(yī)診斷學一直在臨床上發(fā)揮著作用。中醫(yī)對疾病情況進行判斷,可分“辨病”與“辨證”兩個方面。鑒于辨證是中醫(yī)學的獨特之處與精華所在,為臨床各科診斷疾病時普遍使用的方法,因此,本論文是在辨證方法研究的基礎上,進行中醫(yī)診斷治療模式的嘗試性探索。在長期的醫(yī)療實踐過程中,古代醫(yī)家創(chuàng)造了多種辨證方法,如八綱辨證、經(jīng)絡辨證、臟腑辨證、六經(jīng)辨證；衛(wèi)氣營血辨證、三焦辨證及氣血津液辨證等。這些辨證方法,從不同的方面總結(jié)了認識疾病癥候的規(guī)律。他們各有特點,在診斷證候時各有側(cè)重,但又相互聯(lián)系補充。其中,八綱辨證用于確定疾病性質(zhì)；經(jīng)絡臟腑辨證能夠落實病變部位；六經(jīng)辨證是系統(tǒng)的疾病診斷方法；衛(wèi)氣營血辨證及三焦辨證,則用于診斷外感熱��；氣血津液辨證則是分析人體生理功能與水液、營養(yǎng)物質(zhì)等的異常變化。目的：本論文的目的是通過整理四種主要的辨證方法(八綱辨證、經(jīng)絡辨證、臟腑辨證和六經(jīng)辨證),研究它們之間的相互關系和在疾病診療中的作用,嘗試建立一套實用的中醫(yī)診斷治療模式(簡稱“診療模式”)。方法：本論文前半部分采用文獻研究方法,對中醫(yī)辨證論治的相關內(nèi)容進行了詳細的整理歸納。論文的后半部分在中醫(yī)辨證論治方法的基礎研究上,通過縱向橫向比對,以六經(jīng)辨證(即“三陰三陽”辨證)體系為經(jīng),具體的病證為緯,通過整合八綱辨證、經(jīng)絡臟腑辨證來構(gòu)建中醫(yī)的診斷治療模式。內(nèi)容：論文的主體分為六大部分：第一部分主要介紹了中醫(yī)辨證論治的源流,并簡單的介紹了四種辨證論治方法。辨證論治是中醫(yī)學之精髓,辨證論治諸法各具特點,運用各有側(cè)重,但就學術(shù)淵源及理論內(nèi)容而論,經(jīng)絡辨證是基礎,臟腑辨證是核心,八綱辨證是綱紀,而六經(jīng)辨證在臨床中應用廣泛且療效顯著。第二部分詳細論述六經(jīng)辨證方法。結(jié)合文獻對六經(jīng)辨證進行了源流等詳細的研究,六經(jīng)辨證實際上更應該稱為“三陰三陽”辨證,只是后人已經(jīng)習慣于“六經(jīng)辨證”的叫法,但在臨床應用中應該將“六經(jīng)辨證”回歸到“三陰三陽”辨證,這樣才能更合理、更貼切地理解張仲景《傷寒論》中的“六經(jīng)辨證”體系,才能更深刻的認識到六經(jīng)辨證(即“三陰三陽”辨證體系)不僅是傷寒外感的辨證方法,也是內(nèi)科雜病的辨證體系,這也是完成針藥結(jié)合診療模式的思想基礎。第三部分比較了四種辨證方法的相互關系：八綱辨證和六經(jīng)辨證方法都源于《傷寒論》,經(jīng)絡臟腑辨證方法也是《傷寒論》的辨證基礎,八綱辨證是整個中醫(yī)辨證的總綱,是中醫(yī)診斷治療的方向,而經(jīng)絡臟腑辨證在臨床中可操作性強。而六經(jīng)辨證(即“三陰三陽”辨證)和八綱、經(jīng)絡臟腑辨證有著密不可分的關系,六經(jīng)辨證體系是可以統(tǒng)籌、整合八綱、經(jīng)絡臟腑辨證來高效、準確地進行中醫(yī)診斷治療的。第四部是在前三章的基礎上,進行六經(jīng)辨證(“三陰三陽”)診療模式的構(gòu)建,六經(jīng)辨證診療模式是以《傷寒論》為基礎,整合八綱辨證、經(jīng)絡臟腑辨證,通過六經(jīng)辨證(即“三陰三陽”辨證)體系來統(tǒng)領各種辨證方法來實現(xiàn)中醫(yī)的全面、系統(tǒng)的診斷治療。在六經(jīng)辨證(“三陰三陽”辨證)診療模式體系中,通過《傷寒論》原文提取太陽病、少陽病、陽明病、太陰病、少陰病、厥陰病的診斷要素,并且制作了六經(jīng)辨證問診單來實現(xiàn)有效、全面、準確的中醫(yī)診斷治療模式。第五部分是通過前面構(gòu)建的六經(jīng)辨證(即“三陰三陽”辨證)診療模式和對應病證的針灸治療相結(jié)合,完成了以“三陰三陽”為框架的中醫(yī)針藥結(jié)合診斷治療模式(簡稱“針藥診�！�)可行性研究,該診療模式通過“六經(jīng)”問診單,在臨床上能夠高效、準確地完成中醫(yī)的診斷治療。本論文還對六經(jīng)(“三陰三陽”)辨證診療模式中所選用的所有腧穴進行了統(tǒng)計分析,統(tǒng)計結(jié)果有以下兩點值得思考：十二經(jīng)絡雖然不能等同于“三陰三陽”辨證體系中的“六經(jīng)”,但是二者在六經(jīng)辨證診療模式中,不論是診斷還是治療都有著非常密切的聯(lián)系；對六經(jīng)整體取穴情況的統(tǒng)計,可以看出在《傷寒論》六經(jīng)辨證(即“三陰三陽”辨證)體系中,針灸治療多取足太陽膀胱經(jīng)、任脈、足陽明胃經(jīng)、足少陰腎經(jīng)和足太陰脾經(jīng)上的穴位,因此通過《傷寒論》“六經(jīng)”(即“三陰三陽”)辨證診療模式的構(gòu)建,本文也提出了中醫(yī)診斷治療預防疾病的思想即：“防外感,護脾胃,固腎氣,調(diào)情志”。本論文的最后部分介紹了六經(jīng)(“三陰三陽”)辨證診療模式在臨床中的實際應用,并且給出了臨床應用中的幾點體會：“知常察變”；“通陽能扶陽,清腸才滋陰；通陽陽自發(fā),清腸陰自足”；“實則陽明,虛則太陰”,“實則太陽,虛則少陰”、“病愈防外感”,期望有助于臨床診斷治療。成果：本論文的主要成果有以下四點：完成了中醫(yī)辨證方法(主要是八綱辨證、經(jīng)絡辨證、臟腑辨證、六經(jīng)辨證)的系統(tǒng)研究和綜合歸納；嘗試性的構(gòu)建綜合八綱、經(jīng)絡臟腑辨證的六經(jīng)(即“三陰三陽”)辨證的診療模式；給出了六經(jīng)辨證診療模式的針藥結(jié)合模式并且根據(jù)統(tǒng)計學結(jié)果提出了中醫(yī)診斷治療疾病的重要思想；最后對六經(jīng)辨證診療模式進行了臨床實踐。結(jié)論：本論文完成了六經(jīng)(“三陰三陽”)辨證診療模式及針藥結(jié)合模式的構(gòu)建,并給出了該診療模式的臨床應用,雖然幾則病案比較簡單,但是可以展望針藥結(jié)合六經(jīng)(“三陰三陽”)辨證診療模式在臨床中將會有廣闊的應用空間。該診療模式還存在很多不足,希望在以后的臨床實踐中不斷地完善。
[Abstract]:One of the main tasks of clinical medicine is to diagnose the disease and then to treat it according to the results of the diagnosis. Therefore, the correct diagnosis is the prerequisite for the effect of the treatment. In the course of long-term medical activities, the doctors of all ages have accumulated a rich experience of diagnosing the disease, and formed a complete and complete diagnosis system in our country, that is, four diagnoses. The medical diagnostics of traditional Chinese medicine has been established in the field of TCM diagnostics. Since ancient times, traditional Chinese medicine has been playing a role in clinical diagnosis. It can be judged by traditional Chinese medicine, which can be divided into two aspects: "disease discrimination" and "syndrome differentiation". In view of the uniqueness and essence of traditional Chinese medicine, diagnosis of diseases in various clinical subjects In the course of long-term medical practice, the ancient doctors created a variety of dialectical methods, such as eight class syndrome differentiation, meridian syndrome differentiation, viscera differentiation, six meridian syndrome differentiation, Wei Qi camp blood syndrome differentiation, triple focus syndrome differentiation and Qi and blood. These syndrome differentiation methods summarize the rules of understanding the symptoms of disease from different aspects. They have their own characteristics and each have their own emphasis on the diagnosis and syndrome, but they are complementary to each other. Among them, the eight class syndrome differentiation is used to determine the nature of the disease; the syndrome differentiation of meridians and collaterals can implement the lesion location; the six meridian syndrome differentiation is a systematic diagnosis method of disease. Wei Qi camp blood syndrome differentiation and triple focus syndrome differentiation are used to diagnose exogenous fever; Qi and blood body fluid syndrome differentiation is an analysis of abnormal changes of human physiological function and water and nutrients. The purpose of this paper is to study the four main methods of syndrome differentiation (eight outline syndrome differentiation, meridian syndrome differentiation, viscera syndrome differentiation and six meridian syndrome differentiation). The relationship and the role in the diagnosis and treatment of disease, try to establish a set of practical diagnosis and treatment mode of traditional Chinese medicine ("diagnosis and treatment mode"). Method: the first half of the thesis adopts the literature research method, and summarizes the related contents of TCM syndrome differentiation and treatment in detail. The second half of the thesis is in TCM syndrome differentiation and treatment methods. On the basis of the basic research, through the vertical and horizontal alignment, the system of six meridians syndrome differentiation ("three yin and three yang" syndrome differentiation) system is taken as the meridian, and the specific syndrome is weft, through the integration of the eight outline syndrome differentiation and the syndrome differentiation of the meridians and organs to construct the TCM diagnosis and treatment mode. Content: the main body of the thesis is divided into six parts: the first part mainly introduces the origin of TCM syndrome differentiation and treatment. And briefly introduces the four methods of syndrome differentiation and treatment. Syndrome differentiation and treatment is the essence of traditional Chinese medicine. The syndrome differentiation and treatment of various methods have their own characteristics, and each has their own characteristics. But on the basis of academic origin and theoretical content, the syndrome differentiation of meridians and collaterals is the basis, the syndrome differentiation of the viscera is the core, the eight class syndrome differentiation is the outline, and the six meridian syndrome differentiation is widely used in clinical and effective curative effect. Second Some detailed studies on the syndrome differentiation of the six meridians are discussed in detail. The origin and flow of the six meridians are studied in detail. In fact, the syndrome differentiation of the six meridians should be called the "Three Yin three yang" syndrome differentiation, but the later generations have been used to the "six meridian syndrome differentiation", but in the clinical application, the "six meridian syndrome differentiation" should be returned to the "Three Yin three yang" syndrome differentiation. It is more reasonable and more reasonable to understand the system of "the syndrome differentiation of six meridians" in Zhang Zhongjing's theory of typhoid fever more deeply to realize that the syndrome differentiation of the six meridians ("three yin and three yang" syndrome differentiation system) is not only a dialectical method of exogenous febrile exogenous disease, but also a dialectical system of internal medical miscellaneous diseases. This is also the ideological basis for the completion of the combination of acupuncture and medicine and the mode of diagnosis and treatment. The relationship between the four methods of syndrome differentiation is compared: the eight principles of syndrome differentiation and the six meridian syndrome differentiation are derived from the theory of typhoid fever, and the methods of syndrome differentiation of the meridians and collaterals are also the basis for the syndrome differentiation of the theory of typhoid fever. The eight outline syndrome differentiation is the general outline of the whole TCM syndrome differentiation, and the direction of the TCM diagnosis and treatment, while the syndrome differentiation of the meridians and collaterals is strong in clinical practice. That is, "three yin and three yang" syndrome differentiation) and eight classes, the meridian viscera syndrome differentiation has an inseparable relationship. The six meridian syndrome differentiation system is an integrated, integrated eight class, the meridian viscera syndrome differentiation to the high efficiency, accurate diagnosis and treatment of traditional Chinese medicine. On the basis of the first three chapters, the six meridian syndrome differentiation ("Three Yin three yang") diagnosis and treatment mode construction, six meridians The pattern of diagnosis and treatment is based on the theory of "Treatise on typhoid fever", integrating the syndrome differentiation of eight classes, syndrome differentiation of meridians and viscera, and through the system of syndrome differentiation of the six meridians ("Three Yin three yang" syndrome differentiation) to realize the comprehensive and systematic diagnosis and treatment of traditional Chinese medicine. In the system of diagnosis and treatment of the syndrome differentiation of the six meridians ("Three Yin three yang" syndrome differentiation), the text of "the theory of typhoid fever" is proposed. Taking the diagnosis factors of sun disease, shaoyang disease, Yangming disease, Taiyin disease, Shaoyin disease and Jue yin disease, and making a six meridian dialectical inquiry sheet to achieve effective, comprehensive and accurate diagnosis and treatment mode of traditional Chinese medicine. The fifth part is the combination of the six meridian syndrome differentiation (namely "three Yin three yang" syndrome differentiation) and the combination of the corresponding acupuncture and moxibustion treatment. It has completed the feasibility study of the combination of "three yin and three yang" as the framework of Chinese medicine combined with diagnosis and treatment of acupuncture and medicine (referred to as "needle medicine diagnosis model"). Through the "six meridian" inquiry form, the mode of diagnosis and treatment can effectively and accurately complete the diagnosis and treatment of traditional Chinese medicine in the clinical. This paper also selected the mode of diagnosis and treatment of the six meridians ("Three Yin three yang"). All acupoints are statistically analyzed, and the following two points are worth thinking: Although the twelve meridians can not be equal to the "six meridians" in the "Three Yin three yang" syndrome differentiation system, the two are closely related to the diagnosis and treatment in the diagnosis and treatment of the six meridian syndrome differentiation and treatment. As a result, we can see that in the system of syndrome differentiation of "the theory of typhoid fever" ("three yin and three yang" syndrome differentiation), the treatment of acupuncture and moxibustion is taken to take the foot of the sun bladder meridian, Ren pulse, Foot Yangming stomach meridian, foot less Yin kidney meridian and foot Taiyin spleen meridian, so the TCM syndrome differentiation and treatment mode is constructed by "the theory of typhoid fever", "six meridians" ("Three Yin three yang"), and the Chinese medicine is also put forward in this article. The last part of this paper introduces the practical application of the mode of diagnosis and treatment of the six meridians ("three yin and three yang") in the clinical application, and gives some experience in clinical application: "know Chang Yang to change the Yang" and "clear the intestine" to nourish the Yin; There are four points in this paper: eight class syndrome differentiation, syndrome differentiation of meridians, syndrome differentiation of meridians, syndrome differentiation of viscera, syndrome differentiation of six meridians, and syndrome differentiation of traditional Chinese medicine. Systematic research and comprehensive induction, and try to construct a comprehensive eight class, the syndrome differentiation pattern of the six meridians ("Three Yin three yang"), the combination mode of the acupuncture and medicine of the diagnosis and treatment pattern of the six meridians and the important thought of the diagnosis and treatment of the disease according to the statistical results; finally, the diagnosis and treatment model of the six meridian syndrome differentiation and treatment is put forward. Clinical practice. Conclusion: This paper completed the construction of the mode of diagnosis and treatment of the syndrome differentiation of the six meridians ("three yin and three yang") and the combination mode of acupuncture and medicine, and gave the clinical application of the mode of diagnosis and treatment. Although several cases are simple, it can be expected to be widely used in clinical diagnosis and treatment of the combination of acupuncture and medicine and six meridians ("Three Yin three yang"). Wide application space. There are still many deficiencies in the diagnosis and treatment mode, which is expected to be perfected in future clinical practice.

【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R241

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