中醫(yī)學(xué)教學(xué)課件：01 緒論

TraditionalChineseMedicine1IntroductionSectionⅠ

HistoricalevolutionofTCM

1.TheoriginofTCM

2.InitiationanddevelopmentoftheoreticalsystemofTCM

SectionⅡBasiccharacteristicsoftheoreticalsystemofTCM1.ConceptionofHolism

整體觀念2.TreatmentDeterminationBasedonSyndromeDifferentiation辨證施治2SectionⅠ

HistoricalevolutionofTCM1.TheoriginofTCM

Productionactivitiesandsocialpracticecreatthemedicine

Shennongtastedhundredsofgrassesandfoundherbs

神農(nóng)嘗百草一日而遇七十毒《淮南子·修務(wù)訓(xùn)》

Bianstoneisthesproutofacupuncture

砭石治病，即針刺萌芽，開創(chuàng)針刺療法

Inventionofthemetallurgyimprovetheneedlinginstrument

冶金術(shù)發(fā)明，針具不斷改進(jìn)

Thediscoveryandusingofthefireproducedthemoxibustion

火的發(fā)現(xiàn)與使用，產(chǎn)生灸法32.InitiationanddevelopmentoftheoreticalsystemofTCM

TheculturalandsocialbackgroundoftheformationofthetheoreticalsystemofTCM1)TheinfiltrationofancientphilosophyThetheoriesofYin-YangandtheFiveelementspenetratedintoallfieldsofthesociety,eveninmedicine

陰陽五行學(xué)說2)Theinfluenceoffarmingculture特定地理環(huán)境條件生產(chǎn)方式

生活方式文化形態(tài)

農(nóng)耕、放牧、航海世界文化原型農(nóng)耕放牧漁獵航海5TheculturalandsocialbackgroundoftheformationofthetheoreticalsystemofTCM

黃河及長江中下流域——適宜耕作

（中國古代文化特點(diǎn)）農(nóng)耕文化影響、滲透中醫(yī)學(xué)

長于觀察，經(jīng)世致用崇尚祖先，敬仰天地6TheculturalandsocialbackgroundoftheformationofthetheoreticalsystemofTCM3)Specificgeographicalenvironment

特定的地理環(huán)境東及東南瀕臨浩瀚太平洋西南高不可攀世界屋脊西及西北杳無人煙戈壁荒漠北部人跡罕至西伯利亞7TheculturalandsocialbackgroundoftheformationofthetheoreticalsystemofTCM

內(nèi)陸腹地，區(qū)域廣泛，土地遼闊交通極不發(fā)達(dá)，國際間文化交流困難避免固有文化間斷和異化得以沿著自身文化軌跡發(fā)展8EvolutionofTCM1Thefoundationoftheoreticalsystem理論體系奠基時期——春秋戰(zhàn)國至東漢《Huangdi'sInternalClassic》《黃帝內(nèi)經(jīng)》Theearliestextantmedicalmasterpiece.

PlainQuestions

素問MiraculousPivot靈樞9EvolutionofTCM1Thefoundationoftheoreticalsystem

《Huangdi'sInternalClassic》Systematicallyexpoundthehumanbodyphysiology、pathology、diagnosis、treatmentandprevention系統(tǒng)闡述人體生理、病理、診斷、治療乃至預(yù)防

PrimarilyestablishthetheoreticalsystemframeworkofTCM

初步確立中醫(yī)學(xué)理論體系框架

Combinethehumanbodyandthenature、socialenvironment、mentalactivitiestogether

將人體與自然、社會環(huán)境、心理活動等因素結(jié)合綜合考慮

Containtherudimentofthehumanbody-socal-psychologicalmedicalpatternsinthemodernworld

蘊(yùn)含當(dāng)今世界醫(yī)學(xué)人體—社會—心理醫(yī)學(xué)模式結(jié)構(gòu)的雛形1Thefoundationoftheoreticalsystem

理論體系奠基時期——春秋戰(zhàn)國至東漢《Shennong'sClassicofMedicinalHerbs》《神農(nóng)本草經(jīng)》

Theearliestextant

pharmacologymasterpieceRecord365medicines,252plantmedicines,67animalmedicines,46mineralmedicinesincluded

載藥365種，植物藥252種、動物藥67種、礦物藥46種Presentfourproperties,fiveflavorsandsevenrelationsofmedicinalcompatibilityetc.pharmaceuticaltheoriesforthefirsttime首次提出了四氣、五味和七情等藥物學(xué)理論FoundatethebasicframeofthetheoryofChinesemateriamedica

奠定了中藥學(xué)理論的基本框架11EvolutionofTCM1Thefoundationoftheoreticalsystem

理論體系奠基時期——春秋戰(zhàn)國至東漢《TreatiseonColdPathogenicandMiscellaneousdiseases》Theearliestextantclinicalmedicinemonograph

《傷寒雜病論》是目前我國現(xiàn)存最早的一部臨床醫(yī)學(xué)專著

Establishtheruleoftreatmentdeterminationbasedonsyndromedifferentiation確立辨證施治法則

SettlethefoundationforChineseMedicinetherapy奠定了中醫(yī)治療學(xué)的基礎(chǔ)12EvolutionofTCM1Thefoundationoftheoreticalsystem

理論體系奠基時期——春秋戰(zhàn)國至東漢《TreatiseonColdPathogenicandMiscellaneousdiseases》東漢張仲景《TreatiseonColdPathogenicDiseases》——《傷寒論》《SynopsisofGoldenChamber》——《金匱要略》Inthebook,thetheory,principle,formula,medicinalareallgiven.Itiscalled"theancestorofformula".理法方藥具備，為“方書之祖”EvolutionofTCM2.Developmentofclinicaldepartments臨證各科逐步完備時期——晉唐variousclinicalbranches分支學(xué)科出現(xiàn)Sphygmology:《PulseClassic》

byWangShuhe,theearliestmonographofpulseloreextant

脈學(xué)，王叔和《脈經(jīng)》現(xiàn)存最早脈學(xué)專著Thetheoryofetiologyandpathogenesis:《GeneraltreatiseonCausesandManifestationsofAllDiseases》byCaoYuanfang

病因病機(jī)學(xué)，巢元方《諸病源候論》14EvolutionofTCM針灸學(xué)，皇甫謐《針灸甲乙經(jīng)》婦產(chǎn)科學(xué)，昝(zan)殷《產(chǎn)寶》兒科學(xué)，太醫(yī)署設(shè)學(xué)制5年少小科，《顱囟經(jīng)》問世外科學(xué)，劉涓子《劉涓子鬼遺方》15EvolutionofTCM

專科蓬勃發(fā)展，專著相繼問世《備急千金要方》《千金翼方》《外臺秘要》形成世界醫(yī)學(xué)中心16EvolutionofTCM3.Contentionofahundredschoolsofthought學(xué)派涌現(xiàn)，理論提高時期——宋、金、元

兒科、婦科、針灸、法醫(yī)、免疫接種等學(xué)科日趨成熟陳無擇“三因觀點(diǎn)”《銅人腧穴針灸圖經(jīng)》

宋慈王唯一陳自明17EvolutionofTCMFourgreatphysiciansintheJinandYuandynasties金元“四大家”劉完素“寒涼派”張從正（子和）“攻下派”李東垣“補(bǔ)脾派”朱丹溪“滋陰派”朱丹溪18EvolutionofTCMFourgreatphysiciansintheJinandYuandynastiesLiuWansu——schoolofcoldmedicine

EnlightenedbytheoriesofpathomechanismandfivecircuitsandsixclimatesinPlainQuestions,heraisedthetheorythatdiseasesmostlyarisefrom"fire",believingthat"exogenouslycontractedsixclimaticagentswouldbetransformedintofire";"extremelyhyperactivityofthefiveemotionscanallleadtoproductionoffire".Sohepreferredtousecoldandcoolmedicinalsandprescriptionsintreatmentofdisease.EvolutionofTCMFourgreatphysiciansintheJinandYuandynastiesZhangCongzheng——schoolofeliminatingpathogen

Heheldthataperson'sillnessismainlycausedbyinvasionofpathogenicqi,oncethepathogenicqiwasdispelled,theillnesswilldisappear;soheadvocatedthateliminationofpathogenicqiisthekeymatterintreatmentofdisease.Histherapiesaremainlydiaphoresis,emesisandpurgationinordertogettheaimofeliminatingthepathogenandsafeguardingthevital.EvolutionofTCMFourgreatphysiciansintheJinandYuandynastiesLiDongyuan——schoolofstrengtheningthespleen

Hebelievedthattheoccurrenceofdiseaseismostlyrelatedtotheendogenousinjuryofthespleenandstomach.Heemphasizedthespleenandstomachbelongtotheearthinthefiveelementsthatisthemotherofeverything,serveasthesourceofgeneration;ifthespleenandstomachgetdisordered,manydiseaseswillappearconsequently.Healsoexpoundedalotthetheoryofascending-descendingofqidynamicofthespleenandstomach,andputfirstthenourishingthespleenandstomachintreatmentofdisease.EvolutionofTCMFourgreatphysiciansintheJinandYuandynastiesZhuDanxi——schoolofnourishingyin

HeblendedtheopinionsofthethreeschoolsofLiu,ZhangandLi,andhewasgoodatdiagnosisandtreatmentofmiscellaneousdiseases,withmanyoriginalideas.Hegavefurtherexplanationofministerialfire（相火）theory.Hebelievedthebasicpathologicalchangeofdiseaseisthat"yangiseverexcessivewhileyiniseverindeficiency",andadvocatedtheremediesofnourishingyinandreducingfire.EvolutionofTCM4.Theschoolofwarmdiseasesemerged溫病學(xué)崛起和成熟時期——明、清溫病學(xué)理論體系形成吳又可《瘟疫論》提出“戾氣”致病葉天士《溫?zé)嵴摗沸l(wèi)、氣、營、血辨證吳鞠通《溫病條辨》三焦辨證李時珍——《本草綱目》載藥1892種235.Mordentimes近代中醫(yī)學(xué)研究與發(fā)展時期——近代和現(xiàn)代民國時期，國民政府扼殺中醫(yī)，大批志士奮起抗?fàn)幮轮袊嗅t(yī)學(xué)事業(yè)飛躍發(fā)展，各種研究獲可喜成果24TheWHOTraditionalMedicineStrategy2014-2023ThegoalsofthestrategyaretosupportMemberStatesin:harnessingthepotentialcontributionofTMtohealth,wellnessandpeoplecentredhealthcare;promotingthesafeandeffectiveuseofTMbyregulating,researchingandintegratingTMproducts,practitionersandpracticeintohealthsystems,whereappropriate.1.ConceptionofHolism整體觀念

Socalled"wholeness"signifiestheunityandintegrityofathing.Chinesemedicineholdsthatthehumanbodyisanorganicwholeinwhichallconstituentpartsarestructurallyinseparable,functionallycoordinativeandinteractive,andpathologicallyinter-influencing.Anditalsorecognizesmaniscloselyrelatedwithnaturalandsocialenvironments,manmaintainsitsnormllifeactivityinthepracticeofactiveadaptingandtransformingnature.

Thiskindofthinkingoftheintegrityofthebodyitselfandtheunityofman'sinternalandexternalenvironmentsistheconceptionofholismofChinesemedicine.SectionⅡBasiccharacteristicsoftheoreticalsystemofTCM1)Humanbodyasanorganicwhole人是一個有機(jī)整體生理上相互聯(lián)系形神合一

fivezang-viscera以五臟為中心病理上相互影響組織結(jié)構(gòu)相互溝通精氣血物質(zhì)相同臟腑機(jī)能密切聯(lián)系心理與生理機(jī)能有機(jī)結(jié)合271.ConceptionofHolism

整體觀念2)Unityofmanandnature人與自然統(tǒng)一人與環(huán)境統(tǒng)一人與地域統(tǒng)一3)Closerelationofmantosociety人與社會統(tǒng)一

職業(yè)地位經(jīng)濟(jì)條件不同文化背景差異

天人合一身心機(jī)能差異勞心者中虛筋柔骨脆勞力者中實(shí)骨勁筋強(qiáng)281.ConceptionofHolism

整體觀念291.Terminology

專有名詞disease?。篴completemorbidprocessincludingspecificcause,modeofonset,typicalclinicalpresentation,developinglawandoutcome,forexample,commoncold,dysentery.symptom癥，癥狀：adiscomfortfeltsubjectivelybythepatient,suchaspain,dizziness,nauseaetc.患者主觀感覺到的不適sign征，體征：theabnormalchangespresentedobjectivelybythemorbidbody,forexample,maculeandpacule,redtongueetc.病體客觀表現(xiàn)出的異常變化2.TreatmentDeterminationBasedonSyndromeDifferentiation

辨證施治1.Terminology

專有名詞syndrome證(候)：apathologicalsummaryinagivenstageofadiseaseinitscoursemadebythedoctor,whichincludesthecauseofdisease(wind-cold,stagnantblood),focusofdisease(externally,internally,inaviscus,inameridian),natureofdisease(cold,heat),situationofdisease(mild,severe,chronicandacute),andrelationshipbetweenthepathogenicandthevital(deficiencyandexcess).Itmarkstheessenceofpathologicalchangeatpresent.疾病本質(zhì)，疾病過程中某一階段的病理性概括(病因、病機(jī)、病位、病性、病變趨勢)312.TreatmentDeterminationBasedonSyndromeDifferentiation

辨證施治Syndromedifferentiation

辨證：Toanalyze,differentiateandrecognizethesyndromeofadisease.辨，即甄別。證，即證候。所謂辨證，將四診所收集的癥狀、體征病史資料，進(jìn)行分析綜合，辨清疾病的原因、性質(zhì)、病位、以及邪正之間的關(guān)系，概括、判斷為某種性質(zhì)的證。Treatmentdetermination論治：Toconsiderandformulatethecorrespondingtherapeuticprincipleandmethodaccordingtotheresultofsyndromedifferentiation.根據(jù)辨證結(jié)果，確定治療方案。2.TreatmentDeterminationBasedonSyndromeDifferentiation

辨證施治Differenttreatmentsforthesamedisease同病異治：forthesamediseasebecauseofdifferenttimesandgeographicareasofattack,aswellasthepatient'sreactions,orbecauseofdifferentstagesofdevelopmentinwhichthediseaseis,theconclusion