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內傷伏氣致病學術流派

佚名 2023-11-11 04:37:40

伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)致(zhi)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)說肇始于(yu)《內(nei)(nei)(nei)(nei)經(jing)(jing)》。《素問(wen)﹒陰陽應象大(da)論(lun)》所(suo)(suo)論(lun)春(chun)夏秋冬(dong)(dong)四時(shi)之(zhi)(zhi)傷(shang),所(suo)(suo)致(zhi)以(yi)(yi)(yi)后(hou)發生(sheng)溫(wen)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)、飧泄(xie)、痎瘧(nve)、咳(ke)嗽等病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing),可謂(wei)伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)致(zhi)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)學(xue)說之(zhi)(zhi)源。其中以(yi)(yi)(yi)“冬(dong)(dong)傷(shang)于(yu)寒(han)(han)、春(chun)必病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)溫(wen)”最(zui)(zui)先(xian)引(yin)發醫家關注,伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)溫(wen)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)說成為(wei)(wei)(wei)醫家研究的重點課題。東漢張仲景著《傷(shang)寒(han)(han)論(lun)﹒傷(shang)寒(han)(han)例》曰(yue)(yue):“伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)之(zhi)(zhi)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing),以(yi)(yi)(yi)意候之(zhi)(zhi)。今(jin)(jin)月之(zhi)(zhi)內(nei)(nei)(nei)(nei),欲(yu)(yu)有伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)。”宋代成無己注:“冬(dong)(dong)時(shi)感(gan)寒(han)(han),伏(fu)(fu)(fu)(fu)(fu)藏(zang)于(yu)經(jing)(jing)中,不(bu)即(ji)(ji)發者,謂(wei)之(zhi)(zhi)伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)。至(zhi)(zhi)(zhi)(zhi)(zhi)春(chun)分(fen)之(zhi)(zhi)時(shi),伏(fu)(fu)(fu)(fu)(fu)寒(han)(han)欲(yu)(yu)發,故(gu)云今(jin)(jin)月之(zhi)(zhi)內(nei)(nei)(nei)(nei),欲(yu)(yu)有伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)”(《注解傷(shang)寒(han)(han)論(lun)》)。其所(suo)(suo)論(lun)伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)即(ji)(ji)《內(nei)(nei)(nei)(nei)經(jing)(jing)》經(jing)(jing)義也(ye)。張又曰(yue)(yue):“以(yi)(yi)(yi)傷(shang)寒(han)(han)為(wei)(wei)(wei)毒(du)者,以(yi)(yi)(yi)其最(zui)(zui)成殺(sha)厲之(zhi)(zhi)氣(qi)(qi)(qi)也(ye)。中而即(ji)(ji)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)者,名曰(yue)(yue)傷(shang)寒(han)(han)。不(bu)即(ji)(ji)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)者,寒(han)(han)毒(du)藏(zang)于(yu)肌(ji)(ji)膚(fu),至(zhi)(zhi)(zhi)(zhi)(zhi)春(chun)變(bian)為(wei)(wei)(wei)溫(wen)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing),至(zhi)(zhi)(zhi)(zhi)(zhi)夏變(bian)為(wei)(wei)(wei)暑病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)。”論(lun)述伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)溫(wen)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)乃冬(dong)(dong)時(shi)傷(shang)于(yu)寒(han)(han)毒(du),并(bing)伏(fu)(fu)(fu)(fu)(fu)藏(zang)于(yu)肌(ji)(ji)膚(fu)之(zhi)(zhi)中,至(zhi)(zhi)(zhi)(zhi)(zhi)次年春(chun)陽引(yin)發,認(ren)識(shi)到伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)致(zhi)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)因病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)機(ji)還包括毒(du)邪(xie)及邪(xie)伏(fu)(fu)(fu)(fu)(fu)之(zhi)(zhi)所(suo)(suo),是對(dui)《內(nei)(nei)(nei)(nei)經(jing)(jing)》伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)致(zhi)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)說的弘揚。宋代朱肱《傷(shang)寒(han)(han)類(lei)證(zheng)活人書》曰(yue)(yue):“伏(fu)(fu)(fu)(fu)(fu)寒(han)(han)化溫(wen)而發病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)”,不(bu)能一(yi)成不(bu)變(bian)的運(yun)用辛溫(wen)發表劑,需(xu)酌情加入寒(han)(han)涼清(qing)熱(re)(re)藥(yao)。元(yuan)代劉河間在伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)致(zhi)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)治法上創(chuang)新(xin),首以(yi)(yi)(yi)寒(han)(han)涼清(qing)熱(re)(re)法為(wei)(wei)(wei)主(zhu)治療。至(zhi)(zhi)(zhi)(zhi)(zhi)王(wang)安(an)道(dao)、明喻嘉言、吳又可,清(qing)以(yi)(yi)(yi)后(hou)葉子雨(yu)、劉吉人等于(yu)伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)各(ge)有發揮(hui)。然(ran)若深究經(jing)(jing)文,病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)溫(wen)屬(shu)于(yu)傷(shang)寒(han)(han)范(fan)疇(chou),飧泄(xie)、痎瘧(nve)、咳(ke)嗽皆為(wei)(wei)(wei)雜病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)范(fan)疇(chou)。可見(jian)伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)既是某些(xie)熱(re)(re)性傳染性疾病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)的病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)因,同時(shi)也(ye)是某些(xie)內(nei)(nei)(nei)(nei)科(ke)、兒科(ke)疾病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)的病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)因。清(qing)葉天士(shi)充分(fen)認(ren)識(shi)到這一(yi)點。伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)致(zhi)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)說流衍于(yu)歷代,至(zhi)(zhi)(zhi)(zhi)(zhi)葉天士(shi)可謂(wei)漸(jian)趨豐富。伏(fu)(fu)(fu)(fu)(fu)氣(qi)(qi)(qi)致(zhi)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)學(xue)說發展至(zhi)(zhi)(zhi)(zhi)(zhi)今(jin)(jin),已引(yin)起有識(shi)之(zhi)(zhi)士(shi)的充分(fen)關注。如(ru)今(jin)(jin)賢(xian)任繼學(xue)提(ti)出外感(gan)伏(fu)(fu)(fu)(fu)(fu)邪(xie)與(yu)雜病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)伏(fu)(fu)(fu)(fu)(fu)邪(xie)之(zhi)(zhi)分(fen),具有重要學(xue)術意義。

湖北省中醫(yi)(yi)名(ming)(ming)師(shi)朱祥(xiang)麟(lin)主任(ren)醫(yi)(yi)師(shi)在(zai)繼承前賢與(yu)家(jia)(jia)傳(chuan)理論的基礎之上,倡言內(nei)傷伏氣(qi)致病的學(xue)術(shu)思想,并對相關(guan)疾病總結出系統的證治(zhi)方法(fa),應用于臨床實踐,從而提高醫(yi)(yi)療(liao)效果,促進中醫(yi)(yi)學(xue)術(shu)之發展,在(zai)本地區(qu)享有盛名(ming)(ming)。朱老一族,名(ming)(ming)醫(yi)(yi)世家(jia)(jia),家(jia)(jia)學(xue)淵博,至今已(yi)歷五世。

“內傷伏氣致病”流派學術思想

朱慶甲

朱慶甲

朱氏中醫世家重視伏(fu)(fu)(fu)(fu)氣(qi)致病(bing)(bing)理論。朱氏一世慶甲(jia)先生(sheng)(sheng)(sheng)一生(sheng)(sheng)(sheng)精勤(qin)力學(xue),治學(xue)態度嚴謹,廣收博采(cai),宗古(gu)不(bu)泥。對《內(nei)(nei)經(jing)》、《傷(shang)寒(han)(han)(han)(han)論》研(yan)究頗精,對后世諸多(duo)醫家著作亦廣為(wei)涉獵(lie),并提(ti)出自己獨(du)特(te)的(de)見解(jie)。嘗論:經(jing)謂“春(chun)傷(shang)于風,夏為(wei)飧泄(xie);夏傷(shang)于暑,秋為(wei)痃瘧;秋傷(shang)于濕,冬(dong)必(bi)咳嗽;冬(dong)傷(shang)于寒(han)(han)(han)(han),春(chun)必(bi)病(bing)(bing)溫(wen)(wen),”此(ci)系伏(fu)(fu)(fu)(fu)邪(xie)過時(shi)發(fa)病(bing)(bing),后世所謂伏(fu)(fu)(fu)(fu)氣(qi)病(bing)(bing)也。張仲景《傷(shang)寒(han)(han)(han)(han)論?傷(shang)寒(han)(han)(han)(han)例》曰:“伏(fu)(fu)(fu)(fu)氣(qi)之病(bing)(bing),以(yi)(yi)意(yi)候之。今月之內(nei)(nei),欲有(you)伏(fu)(fu)(fu)(fu)氣(qi)。”又(you)曰:“以(yi)(yi)傷(shang)寒(han)(han)(han)(han)為(wei)毒(du)者,以(yi)(yi)其(qi)最成殺厲之氣(qi)也。中而即病(bing)(bing)者,名日傷(shang)寒(han)(han)(han)(han)。不(bu)即病(bing)(bing)者,寒(han)(han)(han)(han)毒(du)藏于肌膚,至春(chun)變為(wei)溫(wen)(wen)病(bing)(bing),至夏變為(wei)暑病(bing)(bing)。”其(qi)所論即《內(nei)(nei)經(jing)》“冬(dong)傷(shang)于寒(han)(han)(han)(han),春(chun)必(bi)病(bing)(bing)溫(wen)(wen)”之伏(fu)(fu)(fu)(fu)氣(qi)經(jing)義。慶甲(jia)先生(sheng)(sheng)(sheng)認為(wei),此(ci)種變生(sheng)(sheng)(sheng)的(de)伏(fu)(fu)(fu)(fu)氣(qi)溫(wen)(wen)熱病(bing)(bing)較(jiao)之時(shi)行溫(wen)(wen)病(bing)(bing)危害重篤(du),尤(you)需詳察,以(yi)(yi)免(mian)治誤(《醫學(xue)入門?元(yuan)部(bu)?四時(shi)辨(bian)證》。他的(de)這一論述對于家學(xue)傳承以(yi)(yi)深(shen)遠(yuan)影響。

二世彝亭先生繼承(cheng)乃父衣缽,視(shi)病以陰(yin)陽(yang)為(wei)(wei)總(zong)綱(gang),首重人體陽(yang)氣(qi);治療以八法為(wei)(wei)總(zong)綱(gang).而尤重祛(qu)邪(xie)(xie)。嘗謂仲(zhong)(zhong)景(jing)曰:“脈數而滑者(zhe),實也(ye),此有(you)宿(su)食,當(dang)下之(zhi)(zhi)(zhi),宜大承(cheng)氣(qi)湯(tang)”。其認(ren)為(wei)(wei):宿(su)食當(dang)下之(zhi)(zhi)(zhi),仲(zhong)(zhong)景(jing)用(yong)大承(cheng)氣(qi)湯(tang),乃速祛(qu)邪(xie)(xie)之(zhi)(zhi)(zhi)意。受(shou)乃父重視(shi)伏氣(qi)致(zhi)病說影響,其認(ren)為(wei)(wei)不(bu)獨風(feng)寒暑濕可為(wei)(wei)伏邪(xie)(xie),宿(su)食亦(yi)是伏邪(xie)(xie)。故無論風(feng)寒暑濕外感邪(xie)(xie)氣(qi)在(zai)于皮膚之(zhi)(zhi)(zhi)間(jian)而未(wei)深(shen)入(ru)者(zhe),或(huo)內(nei)傷所致(zhi)臟腑氣(qi)血失調產(chan)生之(zhi)(zhi)(zhi)氣(qi)血痰食壅(yong)結者(zhe),其未(wei)發生病癥者(zhe)皆可視(shi)為(wei)(wei)伏邪(xie)(xie),或(huo)汗之(zhi)(zhi)(zhi),或(huo)泄之(zhi)(zhi)(zhi),邪(xie)(xie)去則正安,具有(you)祛(qu)邪(xie)(xie)務盡的學術(shu)思路。

三(san)世瀛洲先生其(qi)臨床治病(bing)(bing)重視臟腑、氣血、六淫(yin)辨證,亦(yi)注重伏(fu)(fu)邪為(wei)患,形(xing)成自我診治的心(xin)法(fa)程式與思路(lu)。其(qi)運(yun)用外感伏(fu)(fu)氣致病(bing)(bing)理論治療伏(fu)(fu)暑、溫(wen)病(bing)(bing)發痙等病(bing)(bing)(見《瀛洲醫案》),得心(xin)應手療效顯(xian)著(zhu)。同時繼承乃父(fu)彝(yi)亭先生視一切尚未(wei)發生病(bing)(bing)癥(zheng)潛伏(fu)(fu)于(yu)人體之(zhi)風寒痰瘀等皆為(wei)伏(fu)(fu)邪,力(li)主(zhu)祛之(zhi)。并將這一觀點(dian)應用于(yu)雜病(bing)(bing)、婦科病(bing)(bing)之(zhi)中(zhong)。

四世英航先(xian)生承習家(jia)傳(chuan),推重(zhong)藏象(xiang)理(li)論,強調(diao)診治(zhi)急危重(zhong)病(bing)取效(xiao)貴(gui)速,發明用生綠豆漿防(fang)治(zhi)農藥中毒,擅用活(huo)血化瘀(yu)法。其重(zhong)視伏(fu)氣(qi)致病(bing)論,贊同潛(qian)伏(fu)于人體之(zhi)風寒痰(tan)瘀(yu)等皆為伏(fu)邪,力主祛之(zhi)的學術觀點(dian)。臨床治(zhi)療內傷雜病(bing),如蓄血、臌脹、失眠等病(bing),運用活(huo)血祛邪,每收(shou)捷效(xiao)。

朱祥麟

朱祥麟

五世祥麟精研(yan)醫(yi)典,傳承先(xian)賢理論(lun)(lun)和經(jing)驗(yan),對(dui)伏(fu)(fu)(fu)氣(qi)致(zhi)(zhi)(zhi)(zhi)病(bing)(bing)(bing)(bing)理論(lun)(lun)進行(xing)了長期深入(ru)的(de)研(yan)究。他認(ren)為(wei)(wei)《內(nei)(nei)經(jing)》“冬(dong)傷(shang)(shang)于(yu)寒,春(chun)必(bi)病(bing)(bing)(bing)(bing)溫”,已開伏(fu)(fu)(fu)氣(qi)致(zhi)(zhi)(zhi)(zhi)病(bing)(bing)(bing)(bing)之(zhi)先(xian)河。祥麟在(zai)研(yan)究經(jing)典著作(zuo)并繼承家學視(shi)(shi)一(yi)切尚未發(fa)生病(bing)(bing)(bing)(bing)癥(zheng)潛伏(fu)(fu)(fu)于(yu)人(ren)體之(zhi)風(feng)寒痰(tan)(tan)瘀(yu)等(deng)皆為(wei)(wei)伏(fu)(fu)(fu)邪(xie)致(zhi)(zhi)(zhi)(zhi)病(bing)(bing)(bing)(bing)說的(de)影響下,特倡言內(nei)(nei)傷(shang)(shang)伏(fu)(fu)(fu)氣(qi)致(zhi)(zhi)(zhi)(zhi)病(bing)(bing)(bing)(bing)說。其認(ren)為(wei)(wei),伏(fu)(fu)(fu)氣(qi)亦(yi)即(ji)伏(fu)(fu)(fu)邪(xie),其由外感淫邪(xie)侵入(ru)人(ren)體,潛藏(zang)于(yu)機體之(zhi)內(nei)(nei),過(guo)時而(er)引發(fa)相關疾(ji)病(bing)(bing)(bing)(bing),是(shi)(shi)為(wei)(wei)外感伏(fu)(fu)(fu)氣(qi)致(zhi)(zhi)(zhi)(zhi)病(bing)(bing)(bing)(bing),是(shi)(shi)其內(nei)(nei)函。若(ruo)此(ci)推(tui)論(lun)(lun)之(zhi),則(ze)凡臟(zang)腑功能失調(diao)所產生之(zhi)留滯(zhi)于(yu)人(ren)體內(nei)(nei)的(de)諸如滯(zhi)氣(qi)、瘀(yu)血、痰(tan)(tan)飲、枳食、蟲(chong)積、結(jie)石(shi)、內(nei)(nei)寒、內(nei)(nei)熱、內(nei)(nei)毒(du)等(deng)繼發(fa)致(zhi)(zhi)(zhi)(zhi)病(bing)(bing)(bing)(bing)因(yin)素,乃至潛伏(fu)(fu)(fu)之(zhi)腫(zhong)瘤基因(yin)等(deng)等(deng),皆可稱(cheng)之(zhi)為(wei)(wei)內(nei)(nei)傷(shang)(shang)伏(fu)(fu)(fu)邪(xie)。是(shi)(shi)為(wei)(wei)伏(fu)(fu)(fu)氣(qi)致(zhi)(zhi)(zhi)(zhi)病(bing)(bing)(bing)(bing)之(zhi)外延(yan)。其未發(fa)現明顯臨床證(zheng)狀前已經(jing)潛伏(fu)(fu)(fu)或滋生于(yu)肌體內(nei)(nei),可用傳統(tong)四(si)診(zhen)方法診(zhen)斷(duan)(duan)之(zhi)。如外感伏(fu)(fu)(fu)氣(qi)溫熱病(bing)(bing)(bing)(bing),葉(xie)天士(shi)之(zhi)診(zhen)治(zhi);又如內(nei)(nei)傷(shang)(shang)伏(fu)(fu)(fu)氣(qi)所致(zhi)(zhi)(zhi)(zhi)雜病(bing)(bing)(bing)(bing),張仲景之(zhi)診(zhen)斷(duan)(duan)伏(fu)(fu)(fu)飲、宿食、干血、癥(zheng)固害等(deng)病(bing)(bing)(bing)(bing)。亦(yi)可借助血液、尿液等(deng)化驗(yan)或影像(xiang)檢查,應用中醫(yi)宏觀(guan)(guan)辨證(zheng)并結(jie)合微觀(guan)(guan)辨證(zheng),早期發(fa)現,從(cong)而(er)確定診(zhen)斷(duan)(duan)。伏(fu)(fu)(fu)邪(xie)潛伏(fu)(fu)(fu)致(zhi)(zhi)(zhi)(zhi)病(bing)(bing)(bing)(bing),有(you)表(biao)現為(wei)(wei)陰陽氣(qi)血之(zhi)不足者(zhe),有(you)表(biao)現為(wei)(wei)寒熱痰(tan)(tan)瘀(yu)毒(du)邪(xie)等(deng)有(you)余者(zhe),以(yi)及(ji)正虛(xu)邪(xie)實或邪(xie)少虛(xu)多(duo)等(deng)等(deng),亦(yi)可參照患者(zhe)體質,確立治(zhi)則(ze),運用八法適時調(diao)治(zhi),相機而(er)行(xing),使陰陽歸(gui)于(yu)平秘,消(xiao)除(chu)疾(ji)病(bing)(bing)(bing)(bing),以(yi)保健康。強調(diao)消(xiao)除(chu)伏(fu)(fu)(fu)氣(qi)于(yu)萌芽,注重先(xian)期防(fang)治(zhi)的(de)學術(shu)觀(guan)(guan)點,此(ci)乃《內(nei)(nei)經(jing)》“圣(sheng)人(ren)不治(zhi)已病(bing)(bing)(bing)(bing)治(zhi)未病(bing)(bing)(bing)(bing)”之(zhi)精神(shen)。由于(yu)朱氏世家重視(shi)(shi)風(feng)病(bing)(bing)(bing)(bing)的(de)治(zhi)療(liao),內(nei)(nei)傷(shang)(shang)伏(fu)(fu)(fu)氣(qi)致(zhi)(zhi)(zhi)(zhi)病(bing)(bing)(bing)(bing)這一(yi)學術(shu)觀(guan)(guan)點便應用于(yu)風(feng)病(bing)(bing)(bing)(bing)以(yi)及(ji)多(duo)種相關疾(ji)病(bing)(bing)(bing)(bing)的(de)防(fang)治(zhi)過(guo)程之(zhi)中,從(cong)而(er)形成朱氏世家的(de)醫(yi)學理論(lun)(lun)與臨證(zheng)特色。

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