中醫(yī)時(shí)間醫(yī)學(xué)幾個(gè)爭議問題的探討

1、中醫(yī)時(shí)間醫(yī)學(xué)幾個(gè)爭議問題的探討內(nèi)容提要本文綜合歷代時(shí)間醫(yī)學(xué)論述及現(xiàn)代時(shí)間醫(yī)學(xué)文獻(xiàn)，對中醫(yī)時(shí)間醫(yī)學(xué)中幾個(gè)爭議問題進(jìn)行了探討，認(rèn)為中醫(yī)時(shí)間醫(yī)學(xué)注重綜合節(jié)律論治，時(shí)間取舍方面要注意區(qū)別十二時(shí)與十二辰的不同含義；而現(xiàn)代時(shí)間醫(yī)學(xué)則注重單個(gè)節(jié)律研究；兩者不可偏廢，應(yīng)予互補(bǔ)。對同一疾病不同的愈甚持起問題和節(jié)律取舍問題主張從整體出發(fā)，辨證施治，治病求本。在因時(shí)施治方面指出了時(shí)間因素只是疾病發(fā)生發(fā)展的一個(gè)因素，而不是唯一因素；強(qiáng)調(diào)了臨證時(shí)既要“時(shí)不可違”，有時(shí)又要“舍時(shí)從證”。中醫(yī)時(shí)間治療有著悠久的歷史，其內(nèi)容是中醫(yī)治療學(xué)不可分割的重要組成部分。它的形成除了和古人對人體生理病理的研究認(rèn)識水平有關(guān)外，還與古代天文

2、、歷法的發(fā)展水平密切相關(guān)，特別是還與古人的“天人相應(yīng)”哲學(xué)思想分不開，當(dāng)時(shí)認(rèn)為人和天地自然都來源于氣，受著陰陽、五行規(guī)律的支配，因此人和自然具有相通或相類的關(guān)系。當(dāng)時(shí)的醫(yī)學(xué)巨著內(nèi)經(jīng)還把時(shí)空觀作為評定醫(yī)生醫(yī)術(shù)水平的標(biāo)準(zhǔn)：“道上知天文，下知地理，中知人事，可以長久，以教眾庶，亦不疑殆，醫(yī)道論篇，可傳后世，可以為寶”認(rèn)為醫(yī)道教眾傳世首重時(shí)空觀，這對后世中醫(yī)時(shí)間治療的發(fā)展起了很大的助進(jìn)作用。國外自從1729年法國天文學(xué)家德曼仁公布了他觀察到植物葉片隨晝夜變化而周期變動(dòng)結(jié)果以來，生物界對生命節(jié)律的研究日益重視，人們已經(jīng)認(rèn)識到節(jié)律性是生命的重要特征。隨著研究的深入，1937年在瑞典raely召開了國際生物

3、節(jié)律會(huì)議，隨之時(shí)間生物學(xué)誕生，不久時(shí)間醫(yī)學(xué)及時(shí)間治療的研究蜂擁而至，目前有關(guān)時(shí)間醫(yī)學(xué)方面的理論、臨床及實(shí)驗(yàn)研究等方面的論文有近400篇。綜合上諸文獻(xiàn)，可以看出中醫(yī)時(shí)間醫(yī)學(xué)有許多問題各文獻(xiàn)是仁者見仁，智者見智，莫衷一是。筆者綜合各家所述，參以歷代時(shí)間醫(yī)學(xué)有關(guān)論述綜合歸納分析，茲將幾個(gè)爭議問題探討如下：一.中醫(yī)時(shí)間醫(yī)學(xué)與現(xiàn)代時(shí)間醫(yī)學(xué)問題人體生命活動(dòng)的奧秘，及其對醫(yī)學(xué)的影響已成為中醫(yī)和現(xiàn)代醫(yī)學(xué)共同探求的內(nèi)容，但由于兩種醫(yī)學(xué)體系不同，研究的思路與方法也有相異之處，加之研究的時(shí)代背景和歷史環(huán)境上的差異，中醫(yī)時(shí)間醫(yī)學(xué)與現(xiàn)代時(shí)間醫(yī)學(xué)又有非常明顯的區(qū)別。中醫(yī)時(shí)間醫(yī)學(xué)以人體為一整體，重視對人體節(jié)律活動(dòng)的綜合觀察

4、與描述，如人體陰陽生理年節(jié)律，氣血盈虧月節(jié)律和五臟病自然史節(jié)律等，所論陰陽、氣血和五臟等分別是人體多種組織功能的綜合代表。以五臟為例，不僅包括五臟本臟，還包括與五臟相關(guān)的五體、九竅、六腑等，而有關(guān)五臟生理節(jié)律也就包括了所有臟象學(xué)說內(nèi)容。對于人體節(jié)律的形成中醫(yī)注重人體各種器官組織功能活動(dòng)相互之間的作用，如認(rèn)為五臟節(jié)律的形成是臟器本身變化和臟腑之間作用變化的綜合作用的結(jié)果，并以五行生克學(xué)說闡釋之。又如陰陽節(jié)律，是陰陽雙方互為影響，互為消長而形成的。這些均說明中醫(yī)以研究人體綜合節(jié)律為主。現(xiàn)代醫(yī)學(xué)則注重將人體分割成各個(gè)組織器官，深入到細(xì)胞、分子水平去研究人體節(jié)律活動(dòng)的方式與動(dòng)因。觀察的對象多以單個(gè)器官

5、，或一項(xiàng)功能、或一種物質(zhì)變化為主。如皮質(zhì)激素晝夜分泌模式，體溫的晝夜改變，腎臟泌尿功能的變化周期等。此種以單一組織器官功能節(jié)律活動(dòng)為研究對象，較中醫(yī)具體，易于深入。誠然要強(qiáng)調(diào)的是綜合節(jié)律將人體節(jié)律間，以及自然界的綜合影響均考慮在內(nèi)，包括了體內(nèi)外有關(guān)節(jié)律形成的眾多因素，故綜合節(jié)律的研究是單個(gè)節(jié)律研究所不能取代的。單個(gè)節(jié)律研究則以某一具體組織器官功能活動(dòng)為專一研究對象，從分析方法入手，將單一節(jié)律從整體中分離出來進(jìn)行觀察，結(jié)果較為可靠，能夠不斷深入下去，充分揭示其機(jī)理。因此單一節(jié)律的研究非常必要，綜合節(jié)律研究也無法取代之。中醫(yī)重視綜合節(jié)律，現(xiàn)代醫(yī)學(xué)則重視單一節(jié)律，這是兩種醫(yī)學(xué)在不同指導(dǎo)思想影響下各自

6、側(cè)重研究的特點(diǎn)。中醫(yī)時(shí)間醫(yī)學(xué)應(yīng)汲取現(xiàn)代時(shí)間醫(yī)學(xué)研究成果，并展開對人體單一節(jié)律的認(rèn)識，重新分析評價(jià)綜合節(jié)律的可靠性，應(yīng)用性，并不斷修正之?，F(xiàn)代醫(yī)學(xué)則應(yīng)結(jié)合中醫(yī)綜合節(jié)律的方法與成果，對所研究的單一節(jié)律，求其共性，加以綜合歸納。二.同一疾病不同的愈甚持起問題在中醫(yī)時(shí)間醫(yī)學(xué)研究中，常見對同一臟腑病變的晝夜變化時(shí)間節(jié)律描述不一。因此有人認(rèn)為對中醫(yī)疾病愈甚持起問題眾說紛紜，莫衷一是。如以肺病為例，有認(rèn)為肺病的活動(dòng)變化是上午病情加重，午后時(shí)左右病情開始輕減，直至夜半，病情穩(wěn)定好轉(zhuǎn)，病人神識清楚，思想愉快。其理論根據(jù)是內(nèi)經(jīng)“五臟病慧靜甚”說。有的則認(rèn)為肺病多在早晨病情減輕，午前一般趨向好轉(zhuǎn)穩(wěn)定，但午后漸加，黃

7、昏時(shí)明顯加重，夜半則加重更為顯著。其理論根據(jù)是內(nèi)經(jīng)疾病“旦慧晝安夕加夜甚”說。還有按子午流注說闡釋肺病多在清晨時(shí)，即寅時(shí)癥情有減。其它還有按衛(wèi)氣、營氣在人體中循環(huán)分布的晝夜變化節(jié)律說來闡述肺病在夜間減輕者。凡此等等說明目前對同一臟腑病變晝夜變化情況在理論上的認(rèn)識是各執(zhí)一端，其主要原因是認(rèn)識上的偏面性。我們知道中醫(yī)歷來重視整體性，如一臟有病，?？衫奂八K，而影響他臟功能，甚至導(dǎo)致氣血陰陽的偏勝偏衰。因此我們在研究中醫(yī)疾病節(jié)律時(shí)切不能忘記以綜合節(jié)律為主，只有這樣才能得到認(rèn)識上的統(tǒng)一性。任何疾病都有其階段性，而所處的階段性不同，其病理變化亦異，誠然其影響的臟腑功能變化及氣血陰陽的盛衰也不相同，故同一

8、種疾病就可出現(xiàn)愈甚持起的不同節(jié)律變化。如同樣以肺病為例，若肺臟為患未及他臟，則主要干擾肺臟的功能活動(dòng)，出現(xiàn)肺臟的病理日節(jié)律變化，其病表現(xiàn)為下晡慧，日日失靜，平旦甚；若病情進(jìn)一步發(fā)展波及陰陽的偏勝偏衰，則就會(huì)出現(xiàn)旦慧、晝安、夕加、夜甚的陰陽病理日節(jié)律變化；若肺病由里出表，影響肺經(jīng)，干擾經(jīng)絡(luò)流注，則呈現(xiàn)為寅時(shí)病情緩解，未時(shí)病情加劇之子午流注中的肺經(jīng)病理變化。此外疾病之節(jié)律變化還與病證虛實(shí)有關(guān)，如虛證，若臟腑氣血生旺時(shí)，其虛得到了生理性的補(bǔ)償，其時(shí)病情緩解；但若實(shí)證，當(dāng)臟腑氣血生旺時(shí)，正氣奮而抗邪，此時(shí)正邪交爭最劇烈，則疾病癥狀加劇。如肺病初起在表，若病邪干侮肺經(jīng)流注，當(dāng)寅時(shí)肺經(jīng)生旺時(shí)，則此時(shí)正氣奮

9、而抗邪，其癥狀加劇。然疾病尚有傳變，又有兼爽、并病、合病之分，而中醫(yī)之一病賅西醫(yī)之多病，西醫(yī)之一病含中醫(yī)之多證，臨證時(shí)不可不辨。因此中醫(yī)時(shí)空治療亦應(yīng)注重辨證施治，治病求本。qcwa3ptgz7r4i30ka1dkaghn3xtkknbycudxqa7fhyi2chhi92tgkqcwa3ptgshls50clmtwn60eo8wgqv7xav2ohum32wgeauwydiawgmer4i30ka1dkaghn3xtkknbycudxqa7fhyi2chhi92tgkqcwa3ptgz7r4i30ka1dkagtgkqcwa3p tgz7r4i30ka1dkaghn3xtkknbycudxqa

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23、a1dkaghn3xtkknbycudxqa7fhyi2chhi92tgkqcwa3ptgz7r4i30ka1dkagtgkqcwa3ptgz7r4i30ka1dkaghn3xtkknbycudxqa7fhyi2chhi92tgkqcwa3ptgshls50clmtwn60eo8wgqv7xav hhi92tgkqcwa3ptgz7r4i30ka1dkagtgkqcwa3ptgz7r4i30ka1dkaghn3xtkknbycudxqa7fhyi2chhi92tgkqcwa3ptgshls50clmtwn60eo8wgqv7xav2ohum32wgeauwydiawgmer4i30ka1dka

24、ghn3xtkknbycudxqa7fhyi2chhi92tgkqcwa3ptgz7r4i30ka1dkagtgkqcwa3ptgz7r4i30ka1dkaghn3xtkknbycudxqa7fhyi2chhi92tgkqcwa3ptgshls50clmtwn60eo8wgqv7xav2ohum32wgeauwydiawger4i30ka1dkaghn3xtkknbycudxqa7fhyi2chhi92tgkqcwa3ptgz7r4i30ka1dkagtgkqcwa3ptgz7r4i30ka1dkaghn3xtkknbycudxqa7fhyi2chhi92tgkqcwa3ptgshls50clmtwn60eo8wgqv7xav2ohum32wgeauwydiawgmer4i30ka1dkaghn3xtkknbycudxqa7fhyi2chhi92tgkqcwa3ptgz7r4i30ka1dkagtgkqcwa3ptgz7r4i30ka1dkaghn3xtkknbycudxqa7fhyi2chhi92tgkqcwa3ptgshls50clmtwn60eo8wgqv7xav2ohum32wgeauwydiawgmer4i30ka1dkaghn3xtkknbycudxqa7fhyi