关于金元以前脏腑辨证理论及体系建立的探析

On the establishment of the theory and system of syndrome differentiation of viscera before Jinyuan

脏腑辨证在中医临床诊断及治疗过程中占据着较为重要的地位,医家学者欲在临床疗效中有所精进,关于脏腑辨证理论内涵及体系则不可不明。本文主要采用文献学研究法、史学研究法等方法,从历史时期、医家著作和研究内容三个角度着手,以期能厘清金元以前脏腑辨证内容、理论形成及体系建立之脉络,明确脏腑辨证的发展阶段和特点,并对脏腑辨证理论体系形成的时间和阶段进行进一步的明确和阐释。通过比较分析,可以得出以下结论:首先,脏腑辨证理论经历了不同时期、不同医家的补充和完善,其体系的建立在先秦两汉到金元的漫长发展过程中存在明确的继承和发展关系,脉络清晰。其次,关于脏腑辨证理论体系的建立,具体分法有三种:(一)按时期划分:先秦两汉、晋隋唐宋和金元时期。(二)按医家著作分:(1)《黄帝内经》《难经》《金匮要略》《中藏经》等;(2)《脉经》《诸病源候论》《备急千金要方》《小儿药证直诀》等;(3)《素问病机气宜保命集》《医学启源》等。(三)按研究内容及特点分:(1)内容零散局限不成体系期;(2)内容丰富体系初步建立期;(3)内容成熟体系完备,研究方向由系统转向专题为主。最后,脏腑辨证理论体系的建立最终完备成熟于张元素所撰写的《医学启源》,该医著完善了中医辨证论治体系,并对易水学派及后世医家进行专题研究发挥了重要作用。

Visceral syndrome differentiation comparatively plays an important role in the clinical diagnosis and treatment by traditional Chinese medicine. TCM masters and scholars wanted to be more refined in clinical efficacy. The theory and system of visceral syndrome differentiation and visceral syndrome should be more clear. This paper mainly adopted the methods of philological research and historical research. From the historical perspective, the medical masterpieces and the research content, we hope to clarify the context of the syndrome differentiation, the formation of the theory and the establishment of the system before the Jinyuan , and to clarify the development characteristics and features of the syndrome differentiation, and to further clarify and explain the time and stage of the formation of the theory system of visceral syndrome differentiation. By comparative analysis, the following conclusion can be drawn: First, the theory of visceral syndrome differentiation has experienced the supplement and improvement by different TCM masters in different periods. The establishment of its system has a clear inheritance and development relationship in the long development from Pre-Qin and Han to Jinyuan dynasties. Second, there are 3 specific methods for the establishment of the system of visceral syndrome differentiation: 1 According to the period, namely, Pre-Qin and Han , Jin and Sui , Tang and Song , Jin and Yuan Dynasties. 2 According to the works of TCM masters (1) Huangdi’s Canon of Medi-cine, Nan Jing, Synopsis of Golden Chamber, Treasured Classic etc.;(2) Synopsis of Golden Chamber, Zhu Bing Yuan Hou Lun, Invaluable Formulas for Emergencies, Key to the Therapeutics of Children's Diseases etc.;(3) Su Wen Bing Ji Qi Yi Bao Ming Ji, Medicine Origin , etc. 3 According to the research content and characteristics:(1) the period of content fragmentation, without systemic period;(2) the preliminary establishment period of system with rich content;(3) The content is mature and the system is complete. And the research field is mainly from the system to specific subjects. Finally, the establishment of the theory system of visceral syndrome differentiation is finally completed and matured in Medicine Origin written by Zhang Yuansu , which has perfected the TCM syndrome differentiation system and played an important role in the special research by Yishui school and by later TCM masters.