【作者】 金钊；

【导师】 宋兴；

【作者基本信息】 成都中医药大学 ， 中医医史文献， 2009， 博士

【摘要】 《脾胃论》是东垣学说中理论最集中的一部分。《脾胃论》的出现,标志着脾胃学说的创立,是补土学派的学术之源。本书丰富了中医学理论和临床内容,开辟了中医认识、治疗内伤杂病的新途径,促进了当时医学的飞跃发展,是中医学宝库中的重要文献之一。结合时令用药即在辨证论治基础上,结合季节气候特点选择方药,确定剂量,以便更好地把时空因素对病体的影响考虑到中医的临床治疗方案中去,从而提高临床治疗效果,是中医因时制宜治疗原则的具体体现,也是历代医家遵循《黄帝内经》“必先岁气,无伐天和”,“用寒远寒,用热远热”的治疗原则的具体运用。东垣在《脾胃论》中记载了大量的按时令用药的内容和相应的医案。后世医家也尊内经之旨,循东垣之法,进行了相应的继承和发扬。但是,李杲立此法之后,后世医家仅用其法,而未进一步阐发其深刻内涵。所以,有必要对李氏《脾胃论》中按时令用药的心法进行归纳、总结、提炼,并阐释其内在联系和含义,以便于学习其心法,为中医临床工作提供更为清晰的用药参考。本文围绕金代著名脾胃专家李杲的代表作《脾胃论》按时令用药经验的研究,主要阐明了以下几个问题：一、以古今大量文献资料为依据,在天人合一大整体观指导下,中医治疗学指导思想是因时、因地、因人制宜。其中,因时制宜本质上是一个体现时间医学复杂内涵的科学命题。时间医学的内在理论依托则是阴阳的运动变化。正如吾师在研究陈潮祖教授“五脏宜通论”时所阐明的那样：“自然万物和人体自身都处在永恒运动之中,正是由于运动不息,决定了寒暑交替,春秋往来,朝暮移易,以及植物生、长、化、收、藏,动物生、长、壮、老、已的变化发展……。四时中的阴阳消长,和一日中的阴阳转化,都是阴阳运动变化在气候、气象等方面的生动体现。”二、以大量古今文献资料为依据,阐明了中医按时令用药的研究由来己久,是一个时间跨度千年,空间跨度涉及临床各科的学术大课题,早在中医基础理论著作《黄帝内经》中就已经有了十分丰富的展示,后世有关这个课题的研究,可以说都是以此为起点的,汉晋隋唐代有发展,至金而盛,在内伤脾胃病研究中突出这一课题的,则以李杲《脾胃论》最具有代表性。三、以《脾胃论》中的具体见解及医案,阐明了李杲《脾胃论》按时令用药的原则是：1.结合时令气候特征选方择药。2.结合时令气机升降选方择药。3.结合时令脏腑的五行关系选方择药。其按时令用药的具体体现是：1.针对同一个体,不同季节选方用药不同。2.针对同一个体,同一病症,不同季节药物加减不同。同时还阐明了这样的用药对提高临床疗效是大有助益的。四、以后世传承李杲学术经验的医家的医案为依据,阐明了李杲按时令用药经验对后世中医临床治疗学的深远影响。五、分析阐明了李氏按时令用药心法在现实临床上的体现并不那么生动丰富的原因主要在于：高明医家已融会在辨证论治中,体现微妙,形迹不彰；一般医家则难以捉摸,无从把握,因而需要大力继承发扬。本课题的研究目的正在于此。所以,学习李杲关于时令用药的心法,不仅仅要研究具体应用,还要学习李杲在临床运用这些心法时的整体、恒动思维特点,才是在临床上辨证论治的精髓所在。更多还原

【Abstract】 In Dongyuan School, Treatise on Spleen and Stomach is one of the parts which contains the most centralized academic theories. The advent of Treatise on Spleen and Stomach marked the establishing of Spleen and Stomach School and was the academic source of Spleen and Stomach School. This book, one of the important literature in the treasure of Traditional Chinese Medicine, played extremely significant role in enriching the theory of Traditional Chinese Medicine and the content of clinic, pioneering the new approach through which Traditional Chinese Medicine comprehend and cure Internal Damage miscellaneous disease, as well as advancing the dramatic development of medicine at that time.Based on the Determining treatment by Patterns identified, using medicine combined with seasons means choosing formula and herb as well as confirming dosage according to the characteristics of weather and season, by which the space-time aspects have been better considered in the clinic treatment project of Traditional Chinese Medicine, therefore improving the effect of clinic treatment, materializing the principle of taking measures suited to the time in Traditional Chinese Medicine, and concretely exerting the treatment principle of using herbs according to the seasonal Qi. Using Cold herbs needs avoiding Cold, and Using Hot herbs needs avoiding Hot by which doctor abide from the past.In Treatise on Spleen and Stomach, Li Gao recorded an ocean of the contents of using medicine combined with seasons and corresponding medical cases. Although doctors after Li Gao, who followed the aim of Inner Canon of Yellow Emperor and the treatment principle of his, did inherit and develop it, after this treatment principle established by Li Gao, doctors in aftertime merely using this method, and had no further explaining its profound connation. Therefore, it is necessary to conclude, summarize, abstract the experience of using medicine combined with seasons in Li Dongyuan’s Treatise on Spleen and Stomach and explain its internal connection and meaning, which is benefic to learn its experience and provide more lucid reference for the clinic work.This article based on the research of using medicine combined with seasons from Li Gao’s magnum opus Treatise on Spleen and Stomach, the famous doctor in Jin dynasty, primarily explains the following questions:The first, according to a large numbers of literatures and data, directed by the whole theory of correspondence of human body and natural environment, the thought of TCM therapeutics is the one suits its measures to different conditions in terms of time, locality and persons involved. In fact, the essence of taking measures suited to each person is a scientific proposition embodying the complicated connotation of chronomedicine. Moreover, the dynamic waxing and waning of Yin and Yang is the carrier of the inner theory of chronomedicine. just as my advisor once explained, when he studied professor Cheng Chaozu’s All Organs need freeing Treatise, that everything on earth and human body are in the permanently dynamic condition, it is the immortally dynamic waxing and waning that decides alternation of seasons, and the all steps in plant’s and animal’s development. All the waxing and waning of Yin and Yang in the four seasons and the alternation of Yin and Yang in one day are the vivid embodiment of the dynamic waxing and waning of Yin and Yang reflected in weather and climate, and so on.The second, according to a large number of literatures from the past, this article explains that using medicine combined with seasons in Traditional Chinese Medicine is long-standing, which is a big academic project spans thousands years and involves various fields in clinic. As early as Inner Canon of Yellow Emperor, the basic theory literature of Traditional Chinese Medicine, has abundantly exhibited that, which become the start point for future generations’research. And the research on this academic had developed in Han, Jin, Sui, Tang dynasty, reached its zenith in Jin Dynasty, among that, Li Gao’s Treatise on Spleen and Stomach is the most representative one highlights this project in the research of internal damage spleen and stomach diseases. The third, according to Treatise on Spleen and Stomach’s specific view and medicine cases, this article illustrates the principle of using medicine combined with seasons in Li Gao’s Treatise on Spleen and Stomach:1. suiting formula and herb in the term of the climatic characteristic of four seasons,2. suiting formula and herb in the term of upward and downward of seasonal Qi’s flow, 3. suiting formula and herb in the term of the relation between seasonal Organs and Five Elements. The concrete embodiment of using medicine combined with seasons is that:1. using different medicine in accordance with different season to the exact one person,2. modifying medicine in accordance with different season to exact one person and one disease, meanwhile, to explain this experience, which is instructive to improve the clinic’s effect.The forth, according to the medicine cases of doctors after him who inherit Li Gao’s academic experience, this article explains the profound influence of Li Gao’s experience on using medicine combined with seasons to the clinic treatment theory of Traditional Chinese Medicine after him.The fifth, this article analyzed the reason why the embodiment of Li Gao’s experience on using medicine combined with seasons is not so much vivid in practical clinic:brilliant doctors have blend it harmoniously in Determining treatment by Patterns identified, which makes it become subtle and hard to be traced; therefore, it is difficult to ascertain and master by ordinary doctors, that’s why we should make great efforts to inherit and develop it, and that’s the article’s aim.To sum up, learning Li Gao’s experience on using medicine combined with seasons is not only studying its concrete exertion, but also its holistic and dynamic balance thought characteristic which Li Gao used in clinic treatment. Only in this way, one can realize the soul of the Determining treatment by Patterns identified of clinic treatment.更多还原