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1、從《金匱要略》初探背寒辨析治與防3600字
本文從《金匱要略》中,背寒冷如掌大的溫顧,對背部有較新的認識;背部通過經(jīng)絡(luò)的連屬,成為五臟反主應(yīng)于體表的生理系統(tǒng),又是防御系統(tǒng)。通過對背寒的范圍、程度、真假等的辨析,認為背寒雖然常以兼證出現(xiàn),而背寒冷為:畏寒、惡寒、微惡寒,存在于不同的病證中,其治法也有輕重緩急,內(nèi)溫補,外宣散之殊,背寒已成為對相關(guān)病證辨證與防治的重要標志,對背寒實質(zhì)的了解很有必要,還望同道們共同探討。
背寒;辨析; 治療 ;預防 畢業(yè)
[Abstract] From review of “the c
2、old in the back is as big as a hand” in “The Concise Golden Therapeutics”,this article has some new understandings of the back; as the connection of meridians,the back is not only a physiological system of body surface,which works as the reflection of the entrails,but also a defensive system.Through
3、 examining and discerning the extent,degree and truth of the coldness in the back,it is recognized that cold-feeling in the back,fear of coldness,bad cold,and slight back cold appear as symptoms in various diseases,although cold in the back appear usually as the minor symptom.The therapy also varies
4、 according to the degree of the cold,as it can be light or heavy,acute or chronic,and there has therapeutic difference between interior warming and exterior vent; cold in the back has become an important sign for diagnosis,prevention and cure for certain diseases.It is necessary to know the nature o
5、f the cold in the back,and I wish that my colleagues will corporate to have an in-depth research. 畢業(yè)
[Key words] cold of back;analysis;treatment;prevention
背寒見于《金匱要略痰飲咳嗽脈證并治第十二》,篇中所言:“夫心下有留飲,其人背寒冷如掌大?!敝倬把源思氨?,不言自破,即其他相關(guān)病證中實有癥狀背寒。同時又用取類比象的方法對其飲證“背寒冷如掌大”作出了相對部位、范圍、性質(zhì)、程度的精確度量。為何“其人背寒冷如掌大”。全國《金
6、匱師資班講稿》[1]中用了四句精辟術(shù)語作了很好的注釋,即“心之俞在于背,心陽行于背,寒飲注其俞,陽氣所不入”。解析了心陽、寒飲、陽氣、俞穴互結(jié)于背而成飲證背寒的病因病機。并且還強調(diào)了“背寒冷如掌大,屬背之局部與太陽外感整個背部惡寒有區(qū)別”。別于眾多病證中均有背寒而同中有異,怎樣才能做到正確的辨治與防呢?只有對背寒有更深化的認識。
1 組織結(jié)構(gòu)的劃分
早在《內(nèi)經(jīng)》中就以陰陽為人體背部、方位、屬性與臟腑經(jīng)絡(luò)的關(guān)系等作了明確的劃分,如《內(nèi)經(jīng)、金匱真言論》認為:“故背為陽、陽中之陽、心也,背為陽,陽中之陰肺也。”《內(nèi)難經(jīng)選釋》中更明釋為:“心肺同居膈上而連背,其性屬陽,但
7、心屬火為陽中之陽,……肺屬金為陽中之陰”[2],而五臟之主俞穴,即肺俞、心俞、肝俞、脾俞、腎俞成為五臟在背部的對應(yīng)點,由經(jīng)絡(luò)之聯(lián)系縱貫珠串于背部, 自然 形成了反應(yīng)于體表的一個整體生理系統(tǒng)。正如清薛生白說:“臟腑者,經(jīng)絡(luò)之根本,經(jīng)絡(luò)者臟腑之枝葉?!?
2 功能定位
如《內(nèi)經(jīng)、脈要精微論》說:“背者胸中之腑、背曲肩隨腑將壞矣。”由于五臟之主俞穴縱貫于背,形成了元陽內(nèi)潛五臟,相對集中于背部而衛(wèi)外的一個標志性的防御系統(tǒng)。如《傷寒集注》也明確認為:“背乃人生經(jīng)氣而各部,太陽分部于背[3]?!碧柋巢恐饕簧碇恚c表氣相通而護外,人身背部陽氣所踞,加之督脈乃諸陽之匯而過背,于是背部之陽氣則成衛(wèi)外之本,也是陽氣固護之部,更是外邪入侵之首,成為正邪交爭之地。 畢業(yè)
3 背寒成因
3.1 外邪入侵 背部首遭風寒之邪,風易犯人之上,寒多傷人之陽,如清柯琴認為:“風為寒之帥,寒隨風來?!憋L寒二邪合二為一,首先犯背傷人迅捷直達病所,正如柯琴所言:“蓋太陽經(jīng)部位最高”[4]。風寒之邪傷人陽氣,陽氣被遏不得宣發(fā)而成外感背寒。 畢業(yè)