硕士学位论文：中医心肾相关理论源流梳理及其临床应用探讨

硕士学位论文中医心肾相关理论源流梳理及其临床应用探讨学位申请人指导教师姓名专业名称中医学申请学位类型科学学位论文提交日期年月广州中医药大学GuangzhouUniversityofChineseMedicine广州中医药大学学位论文原创性声明本人郑重声明：所呈交的学位论文，是个人在导师的指导下，独立进行研究工作所取得的成果。除文中已经特别加以注明引用的内容外，本论文不含任何其他个人或集体已经发表或撰写过的作品成果。对本文的研究做出重要贡献的个人和集体，均已在文中以明确方式标明并致谢。本人完全意识到本声明的法律结果由本人承担。学位论文作者签名＿＿＿＿＿日期：年月日关于学位论文使用授权的声明本人完全了解广州中医药大学有关保留使用学位论文的规定，同意学校保留或向国家有关部门机构送交论文的复印件和电子版，允许被查阅和借阅。本人授权广州中医药大学可以将本学位论文的全部或部分内容编入有关数据库进行检索，可以采用影印、缩印或其他复印手段保存和汇编本学位论文。（保密论文在解密后应遵守此规定）论文作者签名＿＿＿＿＿论文导师签名＿＿＿＿＿日期：年月日中文摘要本论文主要从古代中医文献梳理、理论内涵探讨、常见证型提炼、医案分析和现代文献综述等方面对中医心肾相关理论进行了初步的探讨、总结和归纳。中医心肾相关的理论离不开阴阳五行，可追溯到《易传》、《洪范》，而《内经》及《难经》则将阴阳五行理论应用于阐释人体的生理病理，并增加了解剖学的基础，奠定了该理论的基本框架。至后世，唐宋医家逐渐将“水火”理论落实于脏腑进行阐释，并且开始用于阐释相关的疾病；金元医家对心肾的升降理论进行了详细的阐发，李东垣的脾胃论为脾胃是心肾升降枢纽的学说奠定了基础，明清是心肾相关学说发展的全盛时期，医家在临床总结经验的同时从脏腑角度对心肾之间的生理、病理联系，相关疾病的病因、病机、诊断、治法及方药等方面进行论述，提出了心肾相关重要理论，如君火相火论、真阴真阳论、脾胃中枢论、心肾精血同源论等，逐步完善心肾相关理论。近现代学者一方面对心肾相关的理论进行了梳理、总结、提炼和归纳，另外在临床实践、实验研究等方面也进行了许多的研究，促使心肾相关理论不断的发展和完善。中医五脏相关学说是邓铁涛教授继承和发扬中医理论的核心之一。该学说是邓氏基于中医五行学说，总结历代医家的临床经验及学术思想，结合自身多年的临床实践而作出的一种理论学说。其深刻的理论内涵及临床实践价值在近几年得到充分的认同和发展。中医心肾相关理论正是作为中医五脏相关学说的子系统而被提出的，它是以阐发心肾之间生理、病理的相关机理及其指导临床辨证治疗为主要内容的理论学说，是对五脏相关理论的细化、充实和补充，有其丰富的理论内涵和临床指导意义。对心肾相关的具体内涵，主要从以下几个层面进行探讨。首先，阐述心与肾之间在生理上的密切联系，归纳起来主要有经络通联，阴阳相生互用（包括了精血互化、阳气互用、神志互现）和君相安位；在病机上，传统认识心肾之间的病机主要归为心肾不交，但因其概念模糊，后世医家多存争议，本文在梳理历代医论结合临床实践的基础上尝试理清心肾病机之间的内涵，重新定义其主要的概念，并认为心肾之间的病机应包括心肾之间病邪的传变，阴阳互损（包括精血互损、阳气互损、神志病变）及君相失位等三个方面。在临床运用上，一方面梳理了心肾疾病相互传变及心肾失交的常见证型，并列举典型医案进行论证。另一方面，从肾病治心、心病治肾、心肾同治三个角度进行文献的查找，选取临床上常见的病种，进一步筛选和综述其核心内容，通过临床实践来检验医学理论，它验证了心肾相关理论对现代疾病诊疗的指导作用同样是积极有效的，同时也为心肾相关理论在指导现代疾病的临床诊治和研究方面提供思路和借鉴。关键词：心肾相关；阴阳；精血；君火相火TheoriginofheartandkidneycorrelationtheoryinTCManddiscussionsonclinicalpracticeSpeciality:MedicalHistoryandLiteraturesofTCMAuthor:LiWeiNanTutor:Prof.QiuShijunAbstractThispapertriestodiscuss、summarizeandinducethetheoryaboutcorrelationbetweenheartandkidneysofTraditionalChineseMedicine(TCM).Fivepartsareincluded:sortingtheancientliterature,explorationofthetheory,selectingcommonpatternsofsyndrome,casesanalysisandreviewingmoderndocuments.ThetheoryofcorrelationbetweenheartandkidneysiscloselyrelatedwithYin-YangandTheFiveElements,theChineseancientnaturalphilosophywhichcanbetracedbacktoYiZhuanandHongFan.However,fromtheHuangdi'sInternalClassicandTheClassiconMedicalProblems,Yin-YangandFiveElementsareusedtoexplainhumanphysiologyandpathology,addingthecontentofanatomy,whilethebasicframeworkofthistheorywasestablished.Thereafter,doctorsofTangDynastyandtheSonggraduallydiscussedaboutthevisceraandassociateddiseasesusingthetheoryofWaterandFire.DoctorsintheJinandYuandynastyelaboratedontheAscending-descendingTheoryofheartandkidneys,LiDongYuan'sTreatiseonSpleenandStomachlaidthefoundationforthetheoryofspleenandstomacharethehubofmovementsofheartandkidneys.TheMingandQingdynastiesaretheheydayofthecorrelationbetweenheartandkidneystheorydevelopingprocess,doctorsdiscussedmanyaspectsacademiccontentsaccordingtheviscera,suchasthelinksofphysiologyandpathologybetweenheartandkidneys,andelateddisease'setiology、pathogenesis、diagnosis、treatmentandChineseherbalformulasandmedicines.Minewhile,someveryimportanttheorieshadbeenproposed,suchasSovereignFireandMinisterialFiretheory、genuine-Yinandgenuine-Yangtheory、theSpleenandStomachactionsasthehubofmovementstheory、essenceandbloodsharingwithasameorigintheory.Thesetopicsbetteredthecorrelationbetweenheartandkidneystheorygradually.Scholarsinmodernandcontemporarytimeshavedonemanyworkstoreview、summarize、refineandclassifythetheoriesofcorrelationbetweenheartandkidneysontheonehand,besideshavedonenumbersofstudiesonexperimentsandclinicalresearchesontheotherhand.Theseeffortspromotethedevelopmentandperfectionofthetheory.InfieldoftraditionalChinesemedicine,theliver,heart,spleen,lungs,kidneysinhumanbodyaregroupedtogether,theyareacollectivetermknownasfivezang-organs.Thetraditionaltheorythatfivezangorgansarethecommanderofthefunctioninthewholebodyandtheyarecorrelatingwitheachotherclosely,isproposedbyProfessorDengTietao.ThetheorydevelopsfromtheclassicaltheoryofFiveElements,hassummarizeddoctors'clinicalexperienceandacademicthoughtsofallthepastChinesedynasties.ProfessorDengputforththetheorybasedonhislong-termclinicalpractice.Withitsprofoundconnotationandclinicalvalue,thetheoryhasgotfullyrecognitionanddevelopmentinrecentyears.ThecorrelationbetweenheartandkidneystheorywascomeupjustasonesubsystemoftheFiveZangOrgansCorrelationtheoryinTraditionalChineseMedicine,itisatheorymainlydiscussesthecontactsofphysiologyandpathologybetweenheartandkidneys,withtheaimtodirectclinicinstructivetreatmentaccordingtherequirementofmedicalpractice.Atthebaseofthefivezangorganstheory,theheartandkidneyscorrelationtheoryismoredetailed、moresubstantial,itisalsolookedonasasupplementtothefivezangorganscorrelationtheory,ownsplentyoftheoreticalimplicationandclinicalinstructivesignificance.Thispaperdiscussestheconcreteconnotationoftheheartandkidneyscorrelationfromthefollowingseverallevels.Firstly,heartandkidneysarecloselyassociatedwitheachotherinphysiology.Ingenerally,theseformsareincluded:meridianscommunications,synergismbetwee