中医痛证理论发展之历程

Research Institute of Basic Theories,China Academy of Traditional Chinese Medicine

运用中医文献学研究方法，探讨痛证证治理论发展历程。认为痛证理论发展经历了以寒热病因、气血病机及作用于经脉、五脏类分为标志的《内经》时代；从外感、内伤分证，确立痛证辨证论治体系的仲景时代；以李东垣、朱丹溪为代表深化和创立痛证病机学说，从气、血、痰、郁立法论治的金元时代；突破“痛无补法”禁区，倡导温补治痛诸法明代的温补学派时代；以叶天士、王清任为代表的清代医家，提出“治有先后”、“治分内外”及活血化瘀法则等灼见的临床证治集大成者。近代以来开展了利用现代医学手段，对各种痛证病理及治疗方药的系统研究，其中尤以针刺镇痛机理的探讨最为深入。

The development history of the theory on pattern identification and treatment of pain syndrome was probed by the research methods of Chinese medical literature.The author believed that the development of the theory on pain syndrome underwent the “Inner Canon”period characterized by etiology of pathogenic cold and heat,pathogenesis of qi and blood,the meridians and classification of five zang organs,Zhang Zhongjing's period characterized by pattern classification of external factors and internal injuries and by creation of the theoretical and therapeutic system by pattern identification of pain syndrome,the Jing and Yuan periods characterized by creation of the theory of the pathogenesis in pain syndrome for establishment of the therapeutic methods from qi ,blood,phlegm and stagnation with Li Dongheng and Zhu Danxi as representatives,and the period of the warming and tonifying school characterized by proposal of the warming and tonifying methods for pain,after a breakthrough in taboo of “no tonifying method for pain”,and the period in which the medical practitioners of the Qing Dynasty,with Ye Tianshi and Wang Qingren as the representatives,propsed many clinical methods of “priority in treatments”,“internal and external therapies”and the treating principle of activating blood and dispersing stagnation.Since the modern times,the systematical study on pathology and herbal formulas and recipes of various pain syndromes has been conducted by the means of modern medicine,in which the study on mechanism of acupuncture anesthesia is most impressive.