【作者】 赵令竹；

【导师】 鞠宝兆；

【作者基本信息】 辽宁中医药大学 ， 中医基础理论， 2017， 博士

【摘要】 目的:本项研究通过对散在于《黄帝内经》162篇中因寒邪所致疾病或与寒相关等寒性疾病的系统梳理,从考辨这些疾病之病名,明确其含义入手,探讨《内经》寒性疾病的发生、发展及治疗规律,初步形成系统的寒性疾病因机证治理论,以规范病名、促进对寒性疾病的全面认识,从而为中医术语的规范化和临床诊疗提供理论支持。研究方法与内容:本研究以人民卫生出版社1963年版《黄帝内经素问》与1956年版《灵枢经》为底本,参考历代《内经》注家的注释,同时参考张登本《内经词典》及郭霭春《黄帝内经词典》,亦参读《尔雅》《说文解字》《说文解字注》等字辞书及其它相关书籍,运用文献学研究方法,借助发生学、诠释学及分析归纳和演绎等逻辑方法,对《内经》寒性疾病进行全面探讨。全文共分三部分:第一部分为《黄帝内经》寒性疾病理论概述。首先对《内经》中与“寒”相关的16个字词进行释义,辨析其寒冷程度的差异,明确其在《内经》中的用法;其次分别从理论方面阐述了寒性疾病的病因有内外寒之分,病机有阴寒至盛、阳虚生寒,特点为季节性与地域性、易感人群特定,诊断以望诊与脉诊为主,治疗分内治法、外治法及情志疗法等,预防以防寒为要。第二部分为《黄帝内经》寒性疾病要览。包括因寒邪所致疾病及与寒相关疾病两类。其中因寒邪致所致疾病又有外寒所致、阳虚(内寒)所致及内外之寒共致之分,与寒相关疾病又有寒湿之邪所致、风寒之邪所致、风寒湿之邪所致及水病之别。对本部分所选疾病的病名及因机证治进行了概要论述。第三部分为《黄帝内经》寒性疾病研究举隅。针对该类疾病中重要疾病,就后世有争议的问题进行源流梳理,形成清晰的临证理论框架。对“肺咳”、“寒厥”、“寒痹”、“洞泄”从病名及其衍化、病因病机及主症、治疗等方面进行重点研究,深化对相关疾病的认识。研究结果:1.《内经》中与“寒”相关的词语有:冷、凉、清、凊、凄、凝、冽、凓、冻、洒淅、洒洒、洒然、淅淅、泝泝等16个。2.通过对《内经》162篇全部原文的逐一查找及筛选,得到因寒邪所致及与寒相关疾病病名90个,分别为:真心痛,心痛,厥心痛,脾心痛,肾心痛,胃心痛,心疝,隔中,惊骇,善畏,肺消,肺疝,大肠胀,?胀,噫,哕,寒下,积,厥逆,头半寒痛,?疝,颓疝,痈肿,肤胀,石瘕,肠覃,大偻,四厥,清病,寒病,寒清,狂,洞泄,后泄,满病,真头痛,腰痛,瘘,肺咳,鹜溏,濡泄,濡泻,寒中,痞逆,胕肿,寒疡,皮,肉苛,霍乱,寒疾,腹满,飧泄,目风,齿寒,痹厥,胃风,痹,肝痹,肠痹,骨痹,筋痹,脉痹,肌痹,皮痹,行痹,痛痹,著痹,寒痹,风痹,仲春痹,孟春痹,季春痹,仲夏痹,孟夏痹,季夏痹,仲秋痹,孟秋痹,季秋痹,仲冬痹,孟冬痹,季冬痹,阴痹,肉痹,大痹,周痹,血痹,蹠跛,水,石水,涌水。结论:1.《内经》中“寒”为冷,也有捍格之义。“凉”“冷”“清”三字在冷的程度上要轻于寒,而“凄”“凝”“凛”“冽”“凓”(今简化为“栗”)更与寒字相近。以上诸字,散文可通,对文有别。“洒淅、洒洒、洒然、淅淅(另有作“泝泝”者,当是“淅淅”之俗体)”,多用于形容寒冷的状态。2.《内经》寒性疾病的病因有内外寒之分,病机有阴寒至盛、阳虚生寒之不同,有季节性、地域性、易感人群特定等特点,主要借助望诊与脉诊来诊断,治疗分内治法、外治法及情志疗法,预防上以主动御寒为主。3.《内经》因寒所致及与寒相关疾病共有90个。其中因寒邪所致疾病共计39个,分外寒、阳虚(内寒)及内外之寒合邪三类。外寒致病计31种,阳虚(内寒)致病计7种,内外之寒合邪致病有1种。与寒相关疾病共计51个,分寒湿、风寒、风寒湿及水病四类。寒湿致病计12种,风寒致病计5种,风寒湿致病计31种,水病计3种。4.《内经》寒性疾病研究举隅的主要结论有:(1)《素问》之“肺咳”,本指因寒所致肺气上逆的咳嗽,后世演变或指外感咳嗽中寒咳、冷嗽(亦称寒嗽),或指内伤咳嗽,或指过忧所致的咳嗽。(2)《内经》之“寒厥”,以手足逆冷为特征,以房事过度,肾阳虚损为主要病因病机,亦称冷厥。后世又补充寒邪直中阴经这一重要病机,“寒厥”的症状出现转变。《内经》倡用针法治疗,后世以温补肾阳的内治法为主。(3)《内经》之“寒痹”,为风寒湿杂至而导致的血气凝结之病。后世在遵从《内经》针刺、药熨法的基础上,创立了辛温散寒、温肾祛寒等有效方剂,且重视补益气血之法。(4)《内经》之“洞泄”,有风寒湿侵袭所致者,亦有因脾肾虚弱所致者。后世医家重视温补祛邪与酸涩固脱之法的应用。此病与飧泄、濡泄的不同在于,前者以食入即下、泄泻势急得名,后两种则以排泄物的性质命名,即便质清稀如水者为濡泄,水谷不分者为飧泄。本研究的创新性体现在以下三个方面:1.系统收集并详细辨析了《内经》与“寒”相关的诸多字词,明确其本义及在《内经》中的含义用法,为深入理解原文提供了帮助。2.提出了“寒性疾病”的纳入标准有三,满足其中两个则可判定为寒性疾病。3.全面系统梳理出《内经》因寒所致疾病及与寒相关疾病共有90个,并首次对此进行了概要论述。更多还原

【Abstract】 Objective:The purpose is to preliminarily form the systematic theory of etiology,pathogenesis,diagnosis and treatment,to standardize the disease names,and to promote a comprehensive understanding of cold diseases,so as to provide a theoretical support for the standardization of TCM terminology and clinical diagnosis and treatment.It is conducted by discussing the cold diseases which scattered in the 162 chapters of The Inner Canon of Huangdi.Methods and Contents:Methods and Contents:The study takes The Inner Canon of Huangdi Su Wen(1963)and Ling Shu Jing(1956)published by the People’s medical publishing house as the master copy,with the main reference to the annotations of The Inner Canon of Huangdi,The Inner Canon of Huangdi Dictationary(1990)edited by Dengben Zhang,The Inner Canon of Huangdi Dictationary(2000)edited by Aichun Guo,some ancient books such as Er Ya,Shuo Wen Jie Zi,Shuo Wen Jie Zi Zhu,etc.The method of literature research and textual research is applied,as well as philology,generation science,hermeneutics,calibration method,deduction and induction,to fully recognize cold diseases in The Inner Canon of Huangdi.The paper is divided into three parts:The first part is the theory summary of cold diseases in The Inner Canon of Huangdi.First,sixteen characters and words related to cold in The Inner Canon of Huangdi are explained,differentiated in cold degree and clarified in terms of their usages in the book.Second,causes of disease,pathogenesis,features,diagnosis,prognosis,treatment and prevention are illustrated respectively in theory.The cause of disease includes endogenous cold and exdogenous clod;the pathogenesis includes yin cold exuberance,cold caused by yang deficiency.The features includes seasonality,regionalism and susceptible population.The diagnosis includes inspection diagnosis and pulse-taking.Cold-proof is mainly of prevention.The treatment includes internal therapy,external therapy and mental therapy.The second part is the general survey about cold diseases in The Inner Canon of Huangdi,including two types of diseases: the cold-caused diseases and the cold-related diseases.Cold-caused diseases can be divided into three types: the one caused by exogenous cold,the one caused by yang deficiency(endogenous cold)and the one caused by both endogenous cold and exdogenous cold.Cold-related diseases can be divided into four types: the one caused by cold-damp pathogen,the one caused by wind-cold pathogen,the one caused by wind-cold-damp pathogen and water natured diseases.There are brief descriptions of the diseases chosen in the part in terms of disease names,etiology and pathogenesis,syndrome and treatments.The third part gives examples of the disease caused by cold in The Inner Canon of Huangdi.It forms a clear theorical framework by studying these important cold dieases and the controversial problems: fei ke(肺咳),,han jue(寒厥),han bi(寒痹),and dong xie(洞泄).And it focuses studying on their disease names,derivations,etiology and hepathogenesis,main symptoms,and treatment to deepen the understanding of their relavant diseases.Results:1.There are 16 characters and words related to “han”(寒)in The Inner Canon of Huangdi which are leng(冷),liang(凉),qing(清),qing(凊),qi(凄),ning(凝),lie(冽),li(凓),dong(冻),sa xi(洒淅),sa sa(洒洒),sa ran(洒然),xi xi(淅淅),su su(泝泝),etc.2.Through thoroughlly searching the 162 chapters of The Inner Canon of Huangdi,we get90 names of cold diseases : zhen xin tong(真心痛),xin tong(心痛),jue xin tong(厥心痛),pi xin tong(脾心痛),shen xin tong(肾心痛),wei xin tong(胃心痛),xin shan(心疝),ge zhong(隔中),jing hai(惊骇),shan wei(善畏),fei xiao(肺消),fei shan(肺疝),da chang zhang(大肠胀),chen zhang(?胀),yi(噫),yue(哕),han xia(寒下),ji(积),jue ni(厥逆),tou ban han tong(头半寒痛),tui shan(?疝),tui shan(颓疝),yong zhong(痈肿),fu zhang(肤胀),shi jia(石瘕),chang xun(肠覃),da lou(大偻),si jue(四厥),qing bing(清病),han bing(寒病),han qing(寒清),kuang(狂),dong xie(洞泄),hou xie(后泄),man bing(满病),zhen tong tou(真头痛),yao tong(腰痛),lou(瘘),fei ke(肺咳),wu tang(鹜溏),ru xie(濡泻),han zhong(寒中),pi ni(痞逆),fu zhong(胕肿),han yang(寒疡),pi qun(皮),rou ke(肉苛),cholera(霍乱),han ji(寒疾),fu man(腹满),sun xie(飧泄),mu feng(目风),chi han(齿寒),bi jue(痹厥),wei feng(胃风),bi(痹),gan bi(肝痹),chang bi(肠痹),gu bi(骨痹),jin bi(筋痹),mai bi(脉痹),ji bi(肌痹),pi bi(皮痹),xing bi(行痹),tong bi(痛痹),zhuobi(著痹),han bi(寒痹),feng bi(风痹),zhong chun bi(仲春痹),meng chun bi(孟春痹),ji chun bi(季春痹),zhong xia bi(仲夏痹),meng xia bi(孟夏痹),ji xia bi(季夏痹),zhong qiu bi(仲秋痹),meng qiu bi(孟秋痹),ji qiu bi(季秋痹),zhong dong bi(仲冬痹),meng dong bi(孟冬痹),ji dong bi(季冬痹),yin bi(阴痹),rou bi(肉 痹),da bi(大 痹),zhou bi(周 痹),xue bi(血 痹),zhi bo(蹠跛),water(水),shishui(石水),yong shui(涌水).Conclusions:1.“Han”(寒)in The Inner Canon of Huangdi means a low temperature and it also means declining strongly.“liang”(凉),“leng”(冷),“qing”(清)are less colder than “han”(寒).“qi”(凄),“ning”(凝),“lin”(凛),“lie”(冽),“li”(凓)are much similar to “han”(寒).The words are always used to describe the state of cold like “sa xi”(洒淅),“sa sa”(洒洒),“sa ran”(洒然),“xi xi”(淅淅),and “su su”(泝泝).2.The causes of disease in The Inner Canon of Huangdi include endogenous cold and exdogenous clod.The pathogenesis includes yin cold exuberance,cold caused by yang deficiency.The features includes seasonality,regionalism and susceptible population.The diagnosis includes inspection diagnosis and pulse-taking.Cold-proof is mainly of prevention.The treatment includes internal therapy,external therapy and mental therapy.3.There are 90 diseases caused by cold or related to cold in The Inner Canon of Huangdi,among which 39 species are caused by cold,and 51 species are related to cold.Cold-caused diseases could be divided into three types: the ones caused by exogenous cold,the ones caused by yang deficiency and the ones caused by in-outside cold pathogens.Amoung the cold-caused diseases,31 species are caused by exogenous cold.,7 species by yang deficiency,and 1 specie by in-outside cold pathogens.Cold-related diseases could be divided into four types: cold-dampness type,wind-cold type,wind-cold-dampness type and water disease.The cold-dampness type of diseases are 12 species.The wind-cold type of diseases are 5 species.The wind-cold-dampness type are 31 species.And water diseases are3 species.4.The conclusions of examples of the cold disease are as follows:(1)“Feike”(肺咳)in Su Wen originally refers to cough caused by cold and manifestated by upward counterflow of lung qi,and evolves into han ke or leng ke(also named han shou)of exogenous cough or into endogenous cough or into cough caused by much worry.(2)“Han jue”(寒厥)in The Inner Canon of Huangdi is featured by cold extremities.Its pathogenesis are sexual strain and deficiency of kidney-yang.It is also called leng jue.Doctors later added pathogenesis of cold direct attacking yin channels and symptoms of “han jue”(寒 厥)changed.It is advocated in The Inner Canon of Huangdi to use acupuncture treatment and doctors of later generations mainly use internal treatment of tonifying kidney yang.(3)“Han bi”(寒 痹)in The Inner Canon of Huangdi is a disease characterized by condensation of qi and blood caused by wind,cold and dampness.Based on the treatments of acupuncture and medicated iron in The Inner Canon of Huangdi,doctors of later generations not only invent effective prescriptions of dispersing cold with pungent-warm and warming the kidney to dispel cold but also pay attention to the therapeutic method of tonyfying qi to generate blood.(4)The pathogenesis of “dong xie”(洞泄)in The Inner Canon of Huangdi inlclude wind-cold-dampness type and deficiency of kidney and spleen.Doctors of the later generations pay much attention to eliminate pathogen by warming and to consolidate by using astringent and sour drugs.It is diffrent from sun xie and ru xie in that the former is featured by its eating-defecating and quick diarrhea and the latter two are named by the property of defecate.The ruxie’s property of defecate is watery.And the sunxie’s property of defecate is the mixture of water and uncompletely digested food.The three innovative aspects of this study are as follows:1.A large number of characters and words about “han”(寒)in The Inner Canon of Huangdi have been collected systematically,deferentiated in detail,and clearified with the original meaning and the usages in The Inner Canon of Huangdi,which is helpful to deepen the understanding of the disease.2.Standard of cold diseases has been proposed.If satisfying two of the three conditions,it is a cold disease.3.Ninety diseases caused by cold and related to cold in The Inner Canon of Huangdi have been teased out fully and systematically and illustrated briefly for the first time.更多还原