基于医案分析的三焦不畅相关病机、证候及治法研究
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摘要
目的：
收集古代近代三焦论治的医案及导师三焦论治的医案,通过对所收集医案中的证候表现、药物的数理统计分析,得出证候和药物的分布规律,推断三焦相关的病机规律。为中医临床从三焦整体辨治一类以三焦不畅为基本病机的复杂疾病提供参考。
方法：分别建立导师三焦论治医案证候数据库、导师三焦论治医案药物数据库、古代近代三焦论治医案证候数据库、古代近代三焦论治医案药物数据库。通过计算机统计软件对导师160个三焦论治医案及341个古代近代三焦论治医案的证候表现和药物进行频数分析、聚类分析、因子分析,并运用中医药理论,重点以三焦相关的理论分析统计结果。
结果：
1.导师三焦论治医案证候表现聚类分析结果可分为5个代表不同病机的组合类型,分别为：①三焦气郁,气津失布②肝阳上亢,经络不通③气血不足,三焦气郁④三焦不畅,郁热在里⑤三焦不畅,肝火犯胃。因子分析共提取了14个公因子,以三焦相关理论按病机相近的原则合并为6类,分别为：①三焦元气虚②三焦火郁、肝胆气郁③三焦气郁,肝经火旺④三焦气郁,上下不通⑤三焦气郁,营卫不和⑥三焦气郁,表里不通。对应核心病机的主要证候表现为：疲乏、背痛、腰酸腰痛、胸闷胸痛、舌淡红,齿痕舌、苔薄白、脉沉细、头痛、耳鸣耳聋、眼干眼胀、心慌心悸、口干口渴、腹胀腹痛、夜寐不安、舌暗红、胃胀、暖气、反酸烧心、舌红、脉滑、头晕、口苦、脉弦细。
2.导师三焦论治医案药物聚类分析结果可分为7个代表不同病机的组合类型分别为：①三焦气郁,枢机不利②三焦不畅,营卫不和③三焦不畅,肺胃蕴邪④肝阳上亢,经络不通⑤肝经火旺,肝火扰心⑥元气不足,湿热下注⑦肝气犯胃,气滞血瘀。因子分析共提取了19个公因子,以三焦相关理论按病机相近的原则合并为11类,分别为：①三焦气滞,肝火犯胃②三焦气滞,营卫不和③三焦气滞,经络不通④胃气瘀滞⑤三焦气滞,肝阳化风⑥三焦热盛,肝火扰心⑦肺胃蕴邪⑧三焦气郁⑨枢机不利⑩三焦气滞,腑气不通(11)三焦气虚,下焦湿热。对应核心病机的药物是：柴胡、桂枝、白芍、赤芍、枳壳、枳实、黄芩、大枣、党参、生姜、姜半夏、厚朴、瓜萎、郁金、虎杖、茯苓、生白术、川楝子、元胡、苏梗、山药、生麦芽、全蝎、羚羊角粉。
3.古代近代三焦论治医案证候表现聚类分析结果可分为7个代表不同病机的组合类型：①三焦气郁②三焦热郁③三焦湿阻,表里不和④三焦水溢⑤三焦湿阻,脏腑失和⑥热郁心营⑦三焦气逆。因子分析共提取了22个公因子,以三焦相关理论按病机相近的原则合并为10类：①三焦湿阻②三焦气滞③水溢三焦④三焦热盛⑤热入心营⑥经络不通⑦三焦湿热⑧三焦气逆⑨营卫不和⑩元气不足。对应核心病机的主要证候表现为：头胀、耳聋失聪、胸闷、脘中痞闷、食减纳呆、恶心、呕吐、便溏不爽、腹痛、腹泻、发热、口干口渴、多饮欲饮、烦渴、苔腻、苔白、苔黄、脉滑、脉濡、脉细、脉弦、四肢厥冷、咳嗽、咳痰、浮肿、气急喘促、不得卧。
4.古代近代三焦论治医案药物聚类分析结果可分为6个组合类型,可代表7个不同病机,分别为：①三焦湿阻②水溢三焦③三焦火旺④热入心营⑤三焦寒湿⑥气津两伤⑦气滞三焦,肺胃蕴邪。因子分析共提取了21个公因子,以三焦相关理论按病机相近的原则合并为9类分别为：①三焦热郁②三焦水溢③三焦湿阻④三焦湿热⑤热入心营⑥三焦寒湿⑦肺胃蕴邪⑧三焦气虚⑨三焦气滞。对应核心病机的药物是：杏仁、白豆蔻、厚朴、半夏、滑石、泽泻、猪苓、赤茯苓、通草、陈皮、大腹皮、藿香、黄芩、郁金、枳实、黄连、菖蒲、芦根、瓜蒌、金银花、犀牛角、枳壳、连翘、鲜生地、山栀、淡豆豉。
结论：
1.导师三焦论治医案的分析结果反映了内伤病三焦不畅证候、病机、治法的某些特点。古代近代三焦论治医案反映了外感病三焦不畅证候、病机、治法的某些特点。
2.内伤病三焦不畅的病机特点是：以三焦气郁为核心,多见营卫不和,脏腑失和,上下不通,表里不通,经络不通。且因气津失布而有湿郁、热郁的潜在病机。关联最密切的脏是肝,易出现肝经火旺、肝阳上亢等病机变化。关联较明显的腑是胃、大肠、膀胱。元气虚可能是内伤病三焦不畅的基础,与三焦虚证有关联的脏是脾和肾。胆经气郁多见,提示胆与三焦在病机意义上关系密切,三焦不畅可能是三焦腑、三焦经、胆腑、胆经整个少阳系统的不畅。
3.内伤病三焦不畅的证候特点是：气滞证候多见、火热证候多见、伴随肝经病变多见,表现为心肝火旺、肝阳上亢、肝气郁滞。
4.内伤病三焦不畅的治法特点是：以“通调”为基本治疗思想,主要运用八法中的“和”法,配合运用清法、补法、下法。针对不同的病机变化,常用理气疏肝、清肝泻火,平肝通络、行气活血、宣降肺胃、通腑泻热、补虚培元等具体治法。所用核心药物组合类似于柴胡桂枝汤与四逆散的合方。
5.外感病三焦不畅的病机特点是：以湿阻气机致三焦不畅为主,常见病机变化是气滞、湿阻、热郁、水停,脏腑病机的关联以中焦脾不健运,胃气不降为主,常涉及上焦肺失宣降及下焦膀胱气化不利。病势演变规律是邪气离三焦后易入心营,还存在三焦元气不足及寒湿阻滞三焦的病机类型。
6.外感病三焦不畅的证候特点是：以三焦气滞湿阻的证候为主,多见脾不健运、胃气不降、肺气失宣及膀胱气化不利的证候。易出现三焦湿热的证候。
7.外感病三焦不畅的治法特点是：以行气化湿的治法为主导,芳香宣化、淡渗利湿、清热利湿、健脾化湿等多种治湿法配合。具体以开宣肺气,和降胃气,健运脾气、渗利膀胱等方法以助湿化气行。清热药较常使用。邪热重需预护心营。所用核心药物组合类似甘露消毒丹与三仁汤合方。
8.三焦气滞是外感病与内伤病三焦不畅的共同病机基础,三焦气津失布对应的证候与病机在外感病与内伤病中均存在。
9.外感病与内伤病在病机和证候特点上也存在不同：外感病三焦不畅关联密切的脏腑主要与水液代谢相关,内伤病三焦不畅关联密切的脏腑主要与阳气衰旺相关。其原因可能是：外感病主要影响三焦气化功能,导致气津输布异常为主；内伤病在影响三焦气化同时还影响了三焦对脏腑阳气的调节功能,导致元气、三焦、脏腑间阳气输布调节异常。
创新点：
1.收集了古代近代从三焦论治的大量医案,以数理统计分析的方法系统总结了医案中三焦不畅相关的证候特点、治法特点,总结了可作为基本方参考的药物组合。阐明了外感病三焦不畅相关病机的特点,并探讨了与内伤病三焦不畅病机的异同及可能原因。为传统三焦辨证运用的范围从外感温病向内伤杂病延伸提供依据。
2.首次用数理统计分析的方法总结了导师三焦论治临床复杂疾病的医案。此类疾病以三焦不畅为基本病机,病位涉及广泛,证候表现复杂,病机复合多元,单一脏腑辨证治疗效果不佳,中医临床虽多见,而普遍不被重视。从三焦整体论治则效果明显。通过医案分析,确立了其证候特点、治法特点和病机特点,总结了可作为基本方参考的药物组合。为临床提供了诊治参考依据,有利于提高中医内科临床对此类疾病的诊治水平不足点：
所选古代近代三焦论治医案范围还欠广,因此结果仅反映出了外感病三焦不畅在证候、病机、治法上的部分特点,虽然反映了三焦理论在临床运用中的客观情况,但不全面。有待于今后收集更多的资料,进行更大范围的医案统计以得到更全面结论。
Objective:Collect ancient and modern Sanjiao medical records and mentor's Sanjiao medical records. Through analyzing these records' syndromes and mathematical statistical analysis of the drug, to derive regularity of distribution about the syndromes and drug,and then from it can decuce Sanjiao to relate in pathogenesis law. Provide a reference for TCM Clinical Diagnosis and Treatment from the Sanjiao Qi movement be obstructed as the basic pathogenesis of complex diseases.
Methods:To separately establish the mentor's Sanjiao syndrome database on the Treatment of Medical Records, the mentor's Sanjiao drug database on the Treatment of Medical Records, the Ancient and Modern Sanjiao syndromes database on the Treatment of medical records, the Ancient and Modern Sanjiao drug database on the Treatment of Medical Records.160 records of the mentor Sanjiao on the Treatment of Medical records and 341 records of the Ancient and Modern Sanjiao on the Treatment of Medical records syndromes and drugs are to be processed in frequency analysis, cluster analysis, factor analysis by using the computer statistical software. Apply Chinese medicine theory, especially the Sanjiao the theories to analyze the statistical results.
Results:1.Mentor's Sanjiao on the Treatment of medical records syndromes performance cluster analysis results can be divided into 5 representatives of the different pathogenesis of the combination of type.:①Sanjiao Qi depression,Qi and clear fluid not diffusion②upper hyperactivity of liver yang, channel barrier③deficiency of both Qi and blood, Sanjiao Qi depression④Sanjiao, heat being obstructed interior⑤, Qi stagnated in Sanjiao, liver fire invading stomach.The factor analysis extracted common factor of 14. Sanjiao theories similar pathogenesis basis consolidated into six categories:①primordial Qi deficiency in Sanjiao,②fire stagnated in Sanjiao, Qi depressionin liver and gallbladder③Qi stagnated in Sanjiao hyperactivity of fire in liver channel④Qi stagnated in Sanjiao, the upper and lower barrier⑤Qi stagnated in Sanjiao, incoordination between ying and wei⑥Qi stagnated in Sanjiao, superficies and interior barrier. Corresponding to the main card of the core pathogenesis as follows:fatigue, back pain, chest tightness, chest pain, pink tongue. Tongue, thin white fur, thin pulse, headache, tinnitus, dry eyes, eye swelling, palpitation palpitations, dry mouth, thirst, abdominal distension, abdominal pain, disturbed sleep soundly at night, dark red tongue, bloating, belching, acid regurgitation, heartburn, red tongue, slippery pulse, dizziness, mouth pain, pulse wiry.
2. Mentor's Sanjiao on the Treatment of Medical Records Drug clustering analysis of the results can be divided into 7 types which represent in different pathogenesis of types:①Qi stagnated in Sanjiao, stagnant pathogen of Shaoyang②Qi stagnated in Sanjiao, incoordination between ying and wei③Qi stagnated in Sanjiao, pathogenic Qi accumulated in lung and stmach.,④upper hyperactivity of liver yang, channel barrier⑤hyperactivity of liver fire, liver fire invading hear⑥primordial Qi deficiency, dampness-heat diffused downward,⑦liver Qi invading stomach, Qi stagnation and blood stasis.Factor analysis to extract the common factor of 19, according to the principles of pathogenesis similar Sanjiao related theory combined into 11 categories:①Qi stagnated in Sanjiao, liver fire invading stomach②Qi stagnated in Sanjiao, incoordination between ying and wei③Qi stagnation in Sanjiao, channel stoppage④Qi stagnation and blood stasis in stomach⑤Qi stagnated in Sanjiao, hyperactivity liver yang causing wind⑥intense heat in Sanjiao, liver fire invading heart⑦pathogenic Qi accumulated in lung and stomach⑧Qi stagnated in Sanjiao⑨tagnant pathogen of Shaoyang⑩Qi stagnated in Sanjiao. Qi accumulated in large intestineO Qi deficiency in Sanjiao, dampness-heat in lower jiao.Corresponding to the core pathogenesis of drugs are:Bupleurum, Cinnamon Twig, white peony root, peony root, Citrus aurantium, Citrus aurantium, skullcap, Jujube, Codonopsis, ginger, ginger Pinellia, Magnolia, Trichosanthes root, turmeric, Polygonum cuspidatum, Poria the Atractylodes Toosendan, Yuan Hu, the Soviet Union stems, yams, raw malt, Scorpio, the powder of antelope's horn
3.Ancient Modern Sanjiao on the Treatment of medical records syndromes performance cluster analysis can be divided into 7 types of combination of different pathogenesis.:①Qi stagnated in Sanjiao②heat stagnated in Sanjiao③dampness hampering Sanjiao Qi movement,incoordination between superficies and interior④water diffusion in Sanjiao⑤dampness hampering Sanjiao Qi movement, incoordination between zang-fu viscera⑥heat stagnation in heart nutriment⑦eversed flow of Qi in Sanjiao.The factor analysis extracted 22 common factors. According to The Sanjiao theories similar pathogenesis principle, they can be merged into 10 categories:①ampness hampering Sanjiao Qi movement②Qi stagnated in Sanjiao③water diffusion in Sanjiao④intense heat in Sanjiao⑤invasion of heart nutriment by heat⑥channel barrier⑦diffusive dampness-heat in Sanjiao⑧reversed flow of Qi in Sanjiao⑨ncoordination between ying and wei⑩primordial Qi deficiency.Corresponding to the main syndrome performance of the core pathogenesis:stretching, deafness, hearing loss, chest tightness, abdominal swelling of the liver nausea, the appetite to be lessen and digest to be bad. nausea, vomiting, the stools not to be completely, abdominal pain, diarrhea, fever, dry mouth, thirst, and desire to more drinking, greasy fur, white fur, yellow tongue coating, slippery pulse, pulse thin, thready pulse, the pulse string Jueleng limbs, cough, expectoration, edema, shortness of breath, breathlessness, not lying
4.Ancient and Modern Sanjiao on the Treatment of medical records drug cluster analysis results can be divided into 6 types of the different pathogenesis combinations. On behalf of 7 types:①dampness hampering Sanjiao Qi movement②water diffusion in Sanjiao③hyperactivity of fire in Sanjiao④invasion of heart nutriment by heat⑤cold-dampness disturbing Sanjiao⑥deficiency of both Qi and clear liquid⑦Qi stagnated in Sanjiao, pathogenic Qi accumulated in lung and stmach.The factor analysis to extract the common factor of 21, Sanjiao theories similar pathogenesis basis consolidated into 9 categories:①heat depression in Sanjiao②water diffusion in Sanjiao③dampness hampering Sanjiao Qi movement④diffusive dampness-heat in Sanjiao⑤invasion of heart nutriment by heat⑥cold-dampness disturbing Sanjiao⑦pathogenic Qi accumulated in lung and stmach⑧Qi deficiency in Sanjiao⑨Qi stagnated in Sanjiao.Correspond ing to the core pathogenesis of drugs are:almonds, cardamom, magnolia bark. Pinellia. talc. Alisma. Polyporus, Poria red, through the grass. orange peel, Dafu Pi, rugosa. skullcap, turmeric, citrus aurantium. berberinecalamus, reed, Trichosanthes, honeysuckle, rhino horn, Citrus aurantium, forsythia, fresh raw land, black bean sauce. Conclusion:1.A mentor Sanjiao on the Treatment of Medical Records analysis results reflect certain characteristics within the Qi movement be obstructed sick Sanjiao syndromes, pathogenesis, therapy. Ancient and Modern Sanjiao on the Treatment of medical records reflect certain characteristics of exogenous disease Sanjiao Qi movement be obstructed syndrome, pathogenesis and therapy.
2.The pathogenesis characteristics of internal injuries Sanjiao Qi movement be obstructed are:for Sanjiao Qi as the core, often see incoordination between ying and we, incoordination between zang and fu viscera, upper and lower barrier.superficies and interior barrier, channel barrier. And because of Qi and clear fluid not diffusion, dampness hampering Sanjiao Qi movement, heat depression in Sanjiao potential pathogenesis.The most closest conjunction of viscera are liver and are prone to have changes in the pathogenesis of the liver by fire, liver yang. The most associated obvious internal organs are the stomach, colon, and bladder. The weakness of Yuan Qi could be the foundation within injury Sanjiao Qi movement be obstructed and the associated internal organs with the Sanjiao deficiency are kidneys. The Qi depression frequently appears in Shaoyang Gallbladder Channel of Foot suggesting the close relationship of gall bladder and Sanjiao in the pathogenesis sense, Sanjiao Qi movement be obstructed could be Sanjiao internal organs, Sanjiao, gall internal organs, gall bladder through the Shaoyang system as a whole Qi movement not be fluently.
3. The syndrome's characteristics of injuries Sanjiao Qi movement be obstructed are: Qi stagnation syndrome are more commonly, fiery syndrome more common, along with the liver channel disease more common, performance is hyperactivity of heart-liver fire upper hyperactivity of liver yang. stagnation of liver Qi.
4. The therapy's characteristics of injuries Sanjiao Qi movement be obstructed are: "dredging and coordinating method" as the basic treatment of ideas, mainly using of the law "harmony" from "8 methods of treatment", cooperated with the use of a clear method, fill method, dismount. For different pathogenesis, often use Qi liver Qi and Liver purging fire, soothe the liver meridians, Qi and blood circulation, declared down the lung and stomach, catharsis and purging heat, tonic Pei-yuan, and the specific treatment method. The used Core of drug combinations are similar to Chaihuguizhi decoction and Sini powder.
5.The pathogenesis characteristics of exogenous disease of the Qi movement be obstructed Sanjiao are:the main air-caused by the Sanjiao Qi movement be obstructed moisture resistance, common pathogenesis is stagnation of Qi, dampness, heat Yu, the water stopped. the association of Visceral pathogenesis in focus the spleen is not health movement Stomach does not fall mainly, often involving with coke lung declared down and the next focus bladder gasification unfavorable. Disease potential evolution of the law is evil from the Sanjiao easily into the heart of the camp. There is lack of vitality, Sanjiao and alpine block Sanjiao the pathogenesis of type.
6. The syndrome characteristics of the exogenous disease Sanjiao are:based on the principle of syndrome-based Sanjiao stagnation of dampness, common spleen health movement, not fall Stomach, lung Vision loss and bladder gasification adverse syndromes. Prone to have Sanjiao damp heat syndrome
7.The therapy's characteristics of exogenous disease Sanjiao Qi movement be obstructed are:based on the principle of treatment of activating Qi and removing dampness, resolving of dampness with aromatics, promoting diuresis with drugs of tasteless flavor, invigorating spleen for eliminating dampness and sorts of eliminating dampness methods Mainly use the methods of dispersing lung Qi, regulating stomach descending adverse Qi invigorating spleen and replenishing Qi, promoting diuresis with drugs of tasteless flavor and other methods to help removing dampness and activating Qi.The heat-clearing formula are more often used.When intense heat in Sanjiao, need to pre-heart nutriment The taken core drug combinations are similar to ganlu xiaodu micropills and sanren decoction.
8.Qi stagnation in Sanjiao is the common pathogenesis base of exogenous disease and the injury the Sanjiao Qi movement be obstructed. The corresponding syndromes and pathogenesis of Qi and clear fluid not iffusion exist in both exogenous disease and internal injuries
9.Exogenous disease and internal injuries have differences between the characteristics of pathogenesis and the characteristics of syndromes:Qi movement be obstructed correlation of the exogenous disease Sanjiao organs injury in the pathogenesis of the syndrome characteristics are related to water metabolism. The closes of the organs within the injury Sanjiao Qi movement be obstructed correlation wang yang decline are related. The reason may be that exogenous disease mainly affects the Sanjiao function, abnormal,Qi and clear fluid not diffusion main; within the injury affected the Sanjiao organs yang regulatory function, resulting in strength, Sanjiao, organs yang not diffusion.
Innovation:1. Collecting a large number of medical records about Sanjiao treatment from Ancient to Modern. Using mathematical statistics analysis system to summarize Sanjiao related to Qi movement be obstructed medical records syndrome characteristics, governance characteristics of the method. To sum up, the combination of drugs can be used as a basic reference. To clarify the characteristics of the exogenous disease Sanjiao Qi movement be obstructed pathogenesis. and to explore the similarities and differences between and within the pathogenesis of injury Sanjiao Qi movement be obstructed and possible causes. Providing the basis for the dialectical use of the traditional Sanjiao range from exogenous febrile disease extends to the internal injuries and Miscellaneous Disease.
2. For the first time we use the mathematical statistics analyzing method to conclude mentor's Sanjiao on the Treatment of clinical medical records of complex diseases. Such kind of diseases are the basic pathogenesis of Sanjiao Qi movement be obstructed. Diseases locations cover a wide range. The performance of syndrome is complex. Pathogenesis is composite by diverse factors. The treatment of single viscera is very well. more common in clinical medicine, but generally not attach importance to it. The overall theory of governance from the Sanjiao can have a good effect. Through the analysis of medical records, to establish the syndrome characteristics. governance characteristics of the method and pathogenesis characteristics and to sum up as a basic reference for drug combinations. For clinical diagnosis and treatment provided a reference, help to improve the TCM internal medicine clinical diagnosis and treatment levels for such diseases.
Insufficient:The range of selected Ancient and Modern Sanjiao on the treatment of medical records have a little disadvantges so the results only reflect some of the features among exogenous disease Sanjiao Qi movement be obstructed in the syndrome, pathogenesis, on the therapy. Although reflecting the objective situations of Sanjiao theory in clinical use, then more one-sided. Subject to gather more information in the future and a wider range of statistics of medical cases to get a more comprehensive conclusion.
收集古代近代三焦论治的医案及导师三焦论治的医案,通过对所收集医案中的证候表现、药物的数理统计分析,得出证候和药物的分布规律,推断三焦相关的病机规律。为中医临床从三焦整体辨治一类以三焦不畅为基本病机的复杂疾病提供参考。
方法：分别建立导师三焦论治医案证候数据库、导师三焦论治医案药物数据库、古代近代三焦论治医案证候数据库、古代近代三焦论治医案药物数据库。通过计算机统计软件对导师160个三焦论治医案及341个古代近代三焦论治医案的证候表现和药物进行频数分析、聚类分析、因子分析,并运用中医药理论,重点以三焦相关的理论分析统计结果。
结果：
1.导师三焦论治医案证候表现聚类分析结果可分为5个代表不同病机的组合类型,分别为：①三焦气郁,气津失布②肝阳上亢,经络不通③气血不足,三焦气郁④三焦不畅,郁热在里⑤三焦不畅,肝火犯胃。因子分析共提取了14个公因子,以三焦相关理论按病机相近的原则合并为6类,分别为：①三焦元气虚②三焦火郁、肝胆气郁③三焦气郁,肝经火旺④三焦气郁,上下不通⑤三焦气郁,营卫不和⑥三焦气郁,表里不通。对应核心病机的主要证候表现为：疲乏、背痛、腰酸腰痛、胸闷胸痛、舌淡红,齿痕舌、苔薄白、脉沉细、头痛、耳鸣耳聋、眼干眼胀、心慌心悸、口干口渴、腹胀腹痛、夜寐不安、舌暗红、胃胀、暖气、反酸烧心、舌红、脉滑、头晕、口苦、脉弦细。
2.导师三焦论治医案药物聚类分析结果可分为7个代表不同病机的组合类型分别为：①三焦气郁,枢机不利②三焦不畅,营卫不和③三焦不畅,肺胃蕴邪④肝阳上亢,经络不通⑤肝经火旺,肝火扰心⑥元气不足,湿热下注⑦肝气犯胃,气滞血瘀。因子分析共提取了19个公因子,以三焦相关理论按病机相近的原则合并为11类,分别为：①三焦气滞,肝火犯胃②三焦气滞,营卫不和③三焦气滞,经络不通④胃气瘀滞⑤三焦气滞,肝阳化风⑥三焦热盛,肝火扰心⑦肺胃蕴邪⑧三焦气郁⑨枢机不利⑩三焦气滞,腑气不通(11)三焦气虚,下焦湿热。对应核心病机的药物是：柴胡、桂枝、白芍、赤芍、枳壳、枳实、黄芩、大枣、党参、生姜、姜半夏、厚朴、瓜萎、郁金、虎杖、茯苓、生白术、川楝子、元胡、苏梗、山药、生麦芽、全蝎、羚羊角粉。
3.古代近代三焦论治医案证候表现聚类分析结果可分为7个代表不同病机的组合类型：①三焦气郁②三焦热郁③三焦湿阻,表里不和④三焦水溢⑤三焦湿阻,脏腑失和⑥热郁心营⑦三焦气逆。因子分析共提取了22个公因子,以三焦相关理论按病机相近的原则合并为10类：①三焦湿阻②三焦气滞③水溢三焦④三焦热盛⑤热入心营⑥经络不通⑦三焦湿热⑧三焦气逆⑨营卫不和⑩元气不足。对应核心病机的主要证候表现为：头胀、耳聋失聪、胸闷、脘中痞闷、食减纳呆、恶心、呕吐、便溏不爽、腹痛、腹泻、发热、口干口渴、多饮欲饮、烦渴、苔腻、苔白、苔黄、脉滑、脉濡、脉细、脉弦、四肢厥冷、咳嗽、咳痰、浮肿、气急喘促、不得卧。
4.古代近代三焦论治医案药物聚类分析结果可分为6个组合类型,可代表7个不同病机,分别为：①三焦湿阻②水溢三焦③三焦火旺④热入心营⑤三焦寒湿⑥气津两伤⑦气滞三焦,肺胃蕴邪。因子分析共提取了21个公因子,以三焦相关理论按病机相近的原则合并为9类分别为：①三焦热郁②三焦水溢③三焦湿阻④三焦湿热⑤热入心营⑥三焦寒湿⑦肺胃蕴邪⑧三焦气虚⑨三焦气滞。对应核心病机的药物是：杏仁、白豆蔻、厚朴、半夏、滑石、泽泻、猪苓、赤茯苓、通草、陈皮、大腹皮、藿香、黄芩、郁金、枳实、黄连、菖蒲、芦根、瓜蒌、金银花、犀牛角、枳壳、连翘、鲜生地、山栀、淡豆豉。
结论：
1.导师三焦论治医案的分析结果反映了内伤病三焦不畅证候、病机、治法的某些特点。古代近代三焦论治医案反映了外感病三焦不畅证候、病机、治法的某些特点。
2.内伤病三焦不畅的病机特点是：以三焦气郁为核心,多见营卫不和,脏腑失和,上下不通,表里不通,经络不通。且因气津失布而有湿郁、热郁的潜在病机。关联最密切的脏是肝,易出现肝经火旺、肝阳上亢等病机变化。关联较明显的腑是胃、大肠、膀胱。元气虚可能是内伤病三焦不畅的基础,与三焦虚证有关联的脏是脾和肾。胆经气郁多见,提示胆与三焦在病机意义上关系密切,三焦不畅可能是三焦腑、三焦经、胆腑、胆经整个少阳系统的不畅。
3.内伤病三焦不畅的证候特点是：气滞证候多见、火热证候多见、伴随肝经病变多见,表现为心肝火旺、肝阳上亢、肝气郁滞。
4.内伤病三焦不畅的治法特点是：以“通调”为基本治疗思想,主要运用八法中的“和”法,配合运用清法、补法、下法。针对不同的病机变化,常用理气疏肝、清肝泻火,平肝通络、行气活血、宣降肺胃、通腑泻热、补虚培元等具体治法。所用核心药物组合类似于柴胡桂枝汤与四逆散的合方。
5.外感病三焦不畅的病机特点是：以湿阻气机致三焦不畅为主,常见病机变化是气滞、湿阻、热郁、水停,脏腑病机的关联以中焦脾不健运,胃气不降为主,常涉及上焦肺失宣降及下焦膀胱气化不利。病势演变规律是邪气离三焦后易入心营,还存在三焦元气不足及寒湿阻滞三焦的病机类型。
6.外感病三焦不畅的证候特点是：以三焦气滞湿阻的证候为主,多见脾不健运、胃气不降、肺气失宣及膀胱气化不利的证候。易出现三焦湿热的证候。
7.外感病三焦不畅的治法特点是：以行气化湿的治法为主导,芳香宣化、淡渗利湿、清热利湿、健脾化湿等多种治湿法配合。具体以开宣肺气,和降胃气,健运脾气、渗利膀胱等方法以助湿化气行。清热药较常使用。邪热重需预护心营。所用核心药物组合类似甘露消毒丹与三仁汤合方。
8.三焦气滞是外感病与内伤病三焦不畅的共同病机基础,三焦气津失布对应的证候与病机在外感病与内伤病中均存在。
9.外感病与内伤病在病机和证候特点上也存在不同：外感病三焦不畅关联密切的脏腑主要与水液代谢相关,内伤病三焦不畅关联密切的脏腑主要与阳气衰旺相关。其原因可能是：外感病主要影响三焦气化功能,导致气津输布异常为主；内伤病在影响三焦气化同时还影响了三焦对脏腑阳气的调节功能,导致元气、三焦、脏腑间阳气输布调节异常。
创新点：
1.收集了古代近代从三焦论治的大量医案,以数理统计分析的方法系统总结了医案中三焦不畅相关的证候特点、治法特点,总结了可作为基本方参考的药物组合。阐明了外感病三焦不畅相关病机的特点,并探讨了与内伤病三焦不畅病机的异同及可能原因。为传统三焦辨证运用的范围从外感温病向内伤杂病延伸提供依据。
2.首次用数理统计分析的方法总结了导师三焦论治临床复杂疾病的医案。此类疾病以三焦不畅为基本病机,病位涉及广泛,证候表现复杂,病机复合多元,单一脏腑辨证治疗效果不佳,中医临床虽多见,而普遍不被重视。从三焦整体论治则效果明显。通过医案分析,确立了其证候特点、治法特点和病机特点,总结了可作为基本方参考的药物组合。为临床提供了诊治参考依据,有利于提高中医内科临床对此类疾病的诊治水平不足点：
所选古代近代三焦论治医案范围还欠广,因此结果仅反映出了外感病三焦不畅在证候、病机、治法上的部分特点,虽然反映了三焦理论在临床运用中的客观情况,但不全面。有待于今后收集更多的资料,进行更大范围的医案统计以得到更全面结论。
Objective:Collect ancient and modern Sanjiao medical records and mentor's Sanjiao medical records. Through analyzing these records' syndromes and mathematical statistical analysis of the drug, to derive regularity of distribution about the syndromes and drug,and then from it can decuce Sanjiao to relate in pathogenesis law. Provide a reference for TCM Clinical Diagnosis and Treatment from the Sanjiao Qi movement be obstructed as the basic pathogenesis of complex diseases.
Methods:To separately establish the mentor's Sanjiao syndrome database on the Treatment of Medical Records, the mentor's Sanjiao drug database on the Treatment of Medical Records, the Ancient and Modern Sanjiao syndromes database on the Treatment of medical records, the Ancient and Modern Sanjiao drug database on the Treatment of Medical Records.160 records of the mentor Sanjiao on the Treatment of Medical records and 341 records of the Ancient and Modern Sanjiao on the Treatment of Medical records syndromes and drugs are to be processed in frequency analysis, cluster analysis, factor analysis by using the computer statistical software. Apply Chinese medicine theory, especially the Sanjiao the theories to analyze the statistical results.
Results:1.Mentor's Sanjiao on the Treatment of medical records syndromes performance cluster analysis results can be divided into 5 representatives of the different pathogenesis of the combination of type.:①Sanjiao Qi depression,Qi and clear fluid not diffusion②upper hyperactivity of liver yang, channel barrier③deficiency of both Qi and blood, Sanjiao Qi depression④Sanjiao, heat being obstructed interior⑤, Qi stagnated in Sanjiao, liver fire invading stomach.The factor analysis extracted common factor of 14. Sanjiao theories similar pathogenesis basis consolidated into six categories:①primordial Qi deficiency in Sanjiao,②fire stagnated in Sanjiao, Qi depressionin liver and gallbladder③Qi stagnated in Sanjiao hyperactivity of fire in liver channel④Qi stagnated in Sanjiao, the upper and lower barrier⑤Qi stagnated in Sanjiao, incoordination between ying and wei⑥Qi stagnated in Sanjiao, superficies and interior barrier. Corresponding to the main card of the core pathogenesis as follows:fatigue, back pain, chest tightness, chest pain, pink tongue. Tongue, thin white fur, thin pulse, headache, tinnitus, dry eyes, eye swelling, palpitation palpitations, dry mouth, thirst, abdominal distension, abdominal pain, disturbed sleep soundly at night, dark red tongue, bloating, belching, acid regurgitation, heartburn, red tongue, slippery pulse, dizziness, mouth pain, pulse wiry.
2. Mentor's Sanjiao on the Treatment of Medical Records Drug clustering analysis of the results can be divided into 7 types which represent in different pathogenesis of types:①Qi stagnated in Sanjiao, stagnant pathogen of Shaoyang②Qi stagnated in Sanjiao, incoordination between ying and wei③Qi stagnated in Sanjiao, pathogenic Qi accumulated in lung and stmach.,④upper hyperactivity of liver yang, channel barrier⑤hyperactivity of liver fire, liver fire invading hear⑥primordial Qi deficiency, dampness-heat diffused downward,⑦liver Qi invading stomach, Qi stagnation and blood stasis.Factor analysis to extract the common factor of 19, according to the principles of pathogenesis similar Sanjiao related theory combined into 11 categories:①Qi stagnated in Sanjiao, liver fire invading stomach②Qi stagnated in Sanjiao, incoordination between ying and wei③Qi stagnation in Sanjiao, channel stoppage④Qi stagnation and blood stasis in stomach⑤Qi stagnated in Sanjiao, hyperactivity liver yang causing wind⑥intense heat in Sanjiao, liver fire invading heart⑦pathogenic Qi accumulated in lung and stomach⑧Qi stagnated in Sanjiao⑨tagnant pathogen of Shaoyang⑩Qi stagnated in Sanjiao. Qi accumulated in large intestineO Qi deficiency in Sanjiao, dampness-heat in lower jiao.Corresponding to the core pathogenesis of drugs are:Bupleurum, Cinnamon Twig, white peony root, peony root, Citrus aurantium, Citrus aurantium, skullcap, Jujube, Codonopsis, ginger, ginger Pinellia, Magnolia, Trichosanthes root, turmeric, Polygonum cuspidatum, Poria the Atractylodes Toosendan, Yuan Hu, the Soviet Union stems, yams, raw malt, Scorpio, the powder of antelope's horn
3.Ancient Modern Sanjiao on the Treatment of medical records syndromes performance cluster analysis can be divided into 7 types of combination of different pathogenesis.:①Qi stagnated in Sanjiao②heat stagnated in Sanjiao③dampness hampering Sanjiao Qi movement,incoordination between superficies and interior④water diffusion in Sanjiao⑤dampness hampering Sanjiao Qi movement, incoordination between zang-fu viscera⑥heat stagnation in heart nutriment⑦eversed flow of Qi in Sanjiao.The factor analysis extracted 22 common factors. According to The Sanjiao theories similar pathogenesis principle, they can be merged into 10 categories:①ampness hampering Sanjiao Qi movement②Qi stagnated in Sanjiao③water diffusion in Sanjiao④intense heat in Sanjiao⑤invasion of heart nutriment by heat⑥channel barrier⑦diffusive dampness-heat in Sanjiao⑧reversed flow of Qi in Sanjiao⑨ncoordination between ying and wei⑩primordial Qi deficiency.Corresponding to the main syndrome performance of the core pathogenesis:stretching, deafness, hearing loss, chest tightness, abdominal swelling of the liver nausea, the appetite to be lessen and digest to be bad. nausea, vomiting, the stools not to be completely, abdominal pain, diarrhea, fever, dry mouth, thirst, and desire to more drinking, greasy fur, white fur, yellow tongue coating, slippery pulse, pulse thin, thready pulse, the pulse string Jueleng limbs, cough, expectoration, edema, shortness of breath, breathlessness, not lying
4.Ancient and Modern Sanjiao on the Treatment of medical records drug cluster analysis results can be divided into 6 types of the different pathogenesis combinations. On behalf of 7 types:①dampness hampering Sanjiao Qi movement②water diffusion in Sanjiao③hyperactivity of fire in Sanjiao④invasion of heart nutriment by heat⑤cold-dampness disturbing Sanjiao⑥deficiency of both Qi and clear liquid⑦Qi stagnated in Sanjiao, pathogenic Qi accumulated in lung and stmach.The factor analysis to extract the common factor of 21, Sanjiao theories similar pathogenesis basis consolidated into 9 categories:①heat depression in Sanjiao②water diffusion in Sanjiao③dampness hampering Sanjiao Qi movement④diffusive dampness-heat in Sanjiao⑤invasion of heart nutriment by heat⑥cold-dampness disturbing Sanjiao⑦pathogenic Qi accumulated in lung and stmach⑧Qi deficiency in Sanjiao⑨Qi stagnated in Sanjiao.Correspond ing to the core pathogenesis of drugs are:almonds, cardamom, magnolia bark. Pinellia. talc. Alisma. Polyporus, Poria red, through the grass. orange peel, Dafu Pi, rugosa. skullcap, turmeric, citrus aurantium. berberinecalamus, reed, Trichosanthes, honeysuckle, rhino horn, Citrus aurantium, forsythia, fresh raw land, black bean sauce. Conclusion:1.A mentor Sanjiao on the Treatment of Medical Records analysis results reflect certain characteristics within the Qi movement be obstructed sick Sanjiao syndromes, pathogenesis, therapy. Ancient and Modern Sanjiao on the Treatment of medical records reflect certain characteristics of exogenous disease Sanjiao Qi movement be obstructed syndrome, pathogenesis and therapy.
2.The pathogenesis characteristics of internal injuries Sanjiao Qi movement be obstructed are:for Sanjiao Qi as the core, often see incoordination between ying and we, incoordination between zang and fu viscera, upper and lower barrier.superficies and interior barrier, channel barrier. And because of Qi and clear fluid not diffusion, dampness hampering Sanjiao Qi movement, heat depression in Sanjiao potential pathogenesis.The most closest conjunction of viscera are liver and are prone to have changes in the pathogenesis of the liver by fire, liver yang. The most associated obvious internal organs are the stomach, colon, and bladder. The weakness of Yuan Qi could be the foundation within injury Sanjiao Qi movement be obstructed and the associated internal organs with the Sanjiao deficiency are kidneys. The Qi depression frequently appears in Shaoyang Gallbladder Channel of Foot suggesting the close relationship of gall bladder and Sanjiao in the pathogenesis sense, Sanjiao Qi movement be obstructed could be Sanjiao internal organs, Sanjiao, gall internal organs, gall bladder through the Shaoyang system as a whole Qi movement not be fluently.
3. The syndrome's characteristics of injuries Sanjiao Qi movement be obstructed are: Qi stagnation syndrome are more commonly, fiery syndrome more common, along with the liver channel disease more common, performance is hyperactivity of heart-liver fire upper hyperactivity of liver yang. stagnation of liver Qi.
4. The therapy's characteristics of injuries Sanjiao Qi movement be obstructed are: "dredging and coordinating method" as the basic treatment of ideas, mainly using of the law "harmony" from "8 methods of treatment", cooperated with the use of a clear method, fill method, dismount. For different pathogenesis, often use Qi liver Qi and Liver purging fire, soothe the liver meridians, Qi and blood circulation, declared down the lung and stomach, catharsis and purging heat, tonic Pei-yuan, and the specific treatment method. The used Core of drug combinations are similar to Chaihuguizhi decoction and Sini powder.
5.The pathogenesis characteristics of exogenous disease of the Qi movement be obstructed Sanjiao are:the main air-caused by the Sanjiao Qi movement be obstructed moisture resistance, common pathogenesis is stagnation of Qi, dampness, heat Yu, the water stopped. the association of Visceral pathogenesis in focus the spleen is not health movement Stomach does not fall mainly, often involving with coke lung declared down and the next focus bladder gasification unfavorable. Disease potential evolution of the law is evil from the Sanjiao easily into the heart of the camp. There is lack of vitality, Sanjiao and alpine block Sanjiao the pathogenesis of type.
6. The syndrome characteristics of the exogenous disease Sanjiao are:based on the principle of syndrome-based Sanjiao stagnation of dampness, common spleen health movement, not fall Stomach, lung Vision loss and bladder gasification adverse syndromes. Prone to have Sanjiao damp heat syndrome
7.The therapy's characteristics of exogenous disease Sanjiao Qi movement be obstructed are:based on the principle of treatment of activating Qi and removing dampness, resolving of dampness with aromatics, promoting diuresis with drugs of tasteless flavor, invigorating spleen for eliminating dampness and sorts of eliminating dampness methods Mainly use the methods of dispersing lung Qi, regulating stomach descending adverse Qi invigorating spleen and replenishing Qi, promoting diuresis with drugs of tasteless flavor and other methods to help removing dampness and activating Qi.The heat-clearing formula are more often used.When intense heat in Sanjiao, need to pre-heart nutriment The taken core drug combinations are similar to ganlu xiaodu micropills and sanren decoction.
8.Qi stagnation in Sanjiao is the common pathogenesis base of exogenous disease and the injury the Sanjiao Qi movement be obstructed. The corresponding syndromes and pathogenesis of Qi and clear fluid not iffusion exist in both exogenous disease and internal injuries
9.Exogenous disease and internal injuries have differences between the characteristics of pathogenesis and the characteristics of syndromes:Qi movement be obstructed correlation of the exogenous disease Sanjiao organs injury in the pathogenesis of the syndrome characteristics are related to water metabolism. The closes of the organs within the injury Sanjiao Qi movement be obstructed correlation wang yang decline are related. The reason may be that exogenous disease mainly affects the Sanjiao function, abnormal,Qi and clear fluid not diffusion main; within the injury affected the Sanjiao organs yang regulatory function, resulting in strength, Sanjiao, organs yang not diffusion.
Innovation:1. Collecting a large number of medical records about Sanjiao treatment from Ancient to Modern. Using mathematical statistics analysis system to summarize Sanjiao related to Qi movement be obstructed medical records syndrome characteristics, governance characteristics of the method. To sum up, the combination of drugs can be used as a basic reference. To clarify the characteristics of the exogenous disease Sanjiao Qi movement be obstructed pathogenesis. and to explore the similarities and differences between and within the pathogenesis of injury Sanjiao Qi movement be obstructed and possible causes. Providing the basis for the dialectical use of the traditional Sanjiao range from exogenous febrile disease extends to the internal injuries and Miscellaneous Disease.
2. For the first time we use the mathematical statistics analyzing method to conclude mentor's Sanjiao on the Treatment of clinical medical records of complex diseases. Such kind of diseases are the basic pathogenesis of Sanjiao Qi movement be obstructed. Diseases locations cover a wide range. The performance of syndrome is complex. Pathogenesis is composite by diverse factors. The treatment of single viscera is very well. more common in clinical medicine, but generally not attach importance to it. The overall theory of governance from the Sanjiao can have a good effect. Through the analysis of medical records, to establish the syndrome characteristics. governance characteristics of the method and pathogenesis characteristics and to sum up as a basic reference for drug combinations. For clinical diagnosis and treatment provided a reference, help to improve the TCM internal medicine clinical diagnosis and treatment levels for such diseases.
Insufficient:The range of selected Ancient and Modern Sanjiao on the treatment of medical records have a little disadvantges so the results only reflect some of the features among exogenous disease Sanjiao Qi movement be obstructed in the syndrome, pathogenesis, on the therapy. Although reflecting the objective situations of Sanjiao theory in clinical use, then more one-sided. Subject to gather more information in the future and a wider range of statistics of medical cases to get a more comprehensive conclusion.
引文
[1]王志红.“三焦”概念的再认识—与新世纪规划教材《中医基础理论》商榷[J].云南中医学院学报,2004,27：20-21
[2]秦越人.难经[M].北京：科学技术文献出版社,1996：16
[3]汉·华佗.中藏经[M].南通：江苏科学技术出版社,1985：39
[4]宋·陈言.三因极一病症方论[M].北京：人民卫生出版社,2007：143
[5]明·张景岳.类经[M].北京：学苑出版社,2005：49,50
[6]明·虞抟.医学正传[M].北京：中医古籍出版社,2002：7
[7]清·唐宗海.血证论[M].北京：人民卫生出版社,2005：15
[8]苏云放.论膜原的中介效应[J].中国中医基础医学杂志,2003,9(6)：20
[9]杨一工.三焦实质初探[J].天津中医,4：34
[10]平男君.关于三焦心包的解剖学研究[J].中国医药学报,2002,17(11)：699
[11]章太炎.章太炎医论[M].著者铅印本,1913：34.
[12]陈亨平.“三焦一受体说”之我见[J].黑龙江中医药,1997,4：55
[13]陈亨平.再谈“三焦一受体说”[J].黑龙江中医药,1998,5：3
[14]章恪.三焦实质探讨[J].中医药学报,1999,27(5)：7
[15]田在善,方步武.将腹腔丛视作中焦[J].天津中医,2002,19(4)：31
[16]烟建华.略论《难经》命元三焦系统[J].北京中医学院学报,1987,5：19
[17]烟建华.太极与命元三焦系统[J].中国医药学报,1990,6：11
[18]杜廷贵.从“三焦出气”谈宗气、营气、卫气[J].北京中医学院学报,1992,6：19
[19]黄海龙.关于中医理论中气的几个问题[J].中国医药学报,1991,6：8
[20]龙瑞敏.“卫出三焦”及其临床应用[J].贵阳中医学院学报,1989,2：4
[21]李其忠.气门、玄府、腠理、三焦联考[J].上海中医药杂志,1998,3：1
[22]凌耀星.论三焦的两个系统[J].上海中医药杂志.1981,10：48
[23]杨通金,平立仙.三焦之争的我见[J].贵阳中医学院学报,1996,4：5
[24]刘联群.论三焦属水及其实质[J].河南中医,1993,3：125
[25]吴雄志.从三焦气化看水液代谢[J].中国中医基础医学杂志,2000,3：6
[26]吴雄志.中医脾胃病学[M].北京：中医古籍出版社,2001.1：25
[27]韩平常,徐健.浅谈三焦与循环系统的相似性.[J].吉林中医药,1995,5：45
[28]苏云放.少阳三焦膜原系统论[J].浙江中医药大学学报,2009,33(4)：459-463
[29]王智明.脂肪组织的内分泌功能与三焦实质[J].中医药学刊,2003,21(8)：1312.
[30]杜梦玄.用系统论原理剖析三焦实质之谜[J].中医药信息,2007,24：6,7
[31]清·章楠.灵素节注类编[M].杭州：浙江科学技术出版社,1986：373
[32]清·高士宗.黄帝素问直解[M].北京：科学文献出版社,1980：144
[33]清·黄元御.黄元御医学全书[M].太原：山西科学技术出版社,20 10：319
[34]元·滑寿.准经本义[M].北京：中国中医药出版社,1990：126
[35]清·叶霖.难经正义[M].北京：人民卫生出版社,1990：126
[36]清·潘楫.医灯续焰[M].北京：人民卫生出版社,1988：491
[37]清·尤怡.金匮要略心典[M].北京：中国中医药出版社,1992：35,36
[38]清·李彣.金匮要略广注校诠[M].海口：海南出版社,2010：176
[39]清·钱潢.伤寒溯源集[M].北京：学苑出版社,2009：48,49
[40]清·方有执.伤寒来苏集[M].北京：中国中医药出版社,2009：63
[41]清·柯琴.伤寒来苏集[M].北京：学苑出版社,2009：255
[42]清·喻嘉言.尚论篇[M].北京：学苑出版社,2009：170,171
[43]清·王清任.医林改错[M].北京：人民卫生出版社,2005：19
[44]凌耀星.凌耀星内经讲稿[M].北京：人民卫生出版社,2008：159,160,174,183
[45]清·吴瑭.温病条辨[M].北京：人民卫生出版社,1996：10
[2]秦越人.难经[M].北京：科学技术文献出版社,1996：16
[3]汉·华佗.中藏经[M].南通：江苏科学技术出版社,1985：39
[4]宋·陈言.三因极一病症方论[M].北京：人民卫生出版社,2007：143
[5]明·张景岳.类经[M].北京：学苑出版社,2005：49,50
[6]明·虞抟.医学正传[M].北京：中医古籍出版社,2002：7
[7]清·唐宗海.血证论[M].北京：人民卫生出版社,2005：15
[8]苏云放.论膜原的中介效应[J].中国中医基础医学杂志,2003,9(6)：20
[9]杨一工.三焦实质初探[J].天津中医,4：34
[10]平男君.关于三焦心包的解剖学研究[J].中国医药学报,2002,17(11)：699
[11]章太炎.章太炎医论[M].著者铅印本,1913：34.
[12]陈亨平.“三焦一受体说”之我见[J].黑龙江中医药,1997,4：55
[13]陈亨平.再谈“三焦一受体说”[J].黑龙江中医药,1998,5：3
[14]章恪.三焦实质探讨[J].中医药学报,1999,27(5)：7
[15]田在善,方步武.将腹腔丛视作中焦[J].天津中医,2002,19(4)：31
[16]烟建华.略论《难经》命元三焦系统[J].北京中医学院学报,1987,5：19
[17]烟建华.太极与命元三焦系统[J].中国医药学报,1990,6：11
[18]杜廷贵.从“三焦出气”谈宗气、营气、卫气[J].北京中医学院学报,1992,6：19
[19]黄海龙.关于中医理论中气的几个问题[J].中国医药学报,1991,6：8
[20]龙瑞敏.“卫出三焦”及其临床应用[J].贵阳中医学院学报,1989,2：4
[21]李其忠.气门、玄府、腠理、三焦联考[J].上海中医药杂志,1998,3：1
[22]凌耀星.论三焦的两个系统[J].上海中医药杂志.1981,10：48
[23]杨通金,平立仙.三焦之争的我见[J].贵阳中医学院学报,1996,4：5
[24]刘联群.论三焦属水及其实质[J].河南中医,1993,3：125
[25]吴雄志.从三焦气化看水液代谢[J].中国中医基础医学杂志,2000,3：6
[26]吴雄志.中医脾胃病学[M].北京：中医古籍出版社,2001.1：25
[27]韩平常,徐健.浅谈三焦与循环系统的相似性.[J].吉林中医药,1995,5：45
[28]苏云放.少阳三焦膜原系统论[J].浙江中医药大学学报,2009,33(4)：459-463
[29]王智明.脂肪组织的内分泌功能与三焦实质[J].中医药学刊,2003,21(8)：1312.
[30]杜梦玄.用系统论原理剖析三焦实质之谜[J].中医药信息,2007,24：6,7
[31]清·章楠.灵素节注类编[M].杭州：浙江科学技术出版社,1986：373
[32]清·高士宗.黄帝素问直解[M].北京：科学文献出版社,1980：144
[33]清·黄元御.黄元御医学全书[M].太原：山西科学技术出版社,20 10：319
[34]元·滑寿.准经本义[M].北京：中国中医药出版社,1990：126
[35]清·叶霖.难经正义[M].北京：人民卫生出版社,1990：126
[36]清·潘楫.医灯续焰[M].北京：人民卫生出版社,1988：491
[37]清·尤怡.金匮要略心典[M].北京：中国中医药出版社,1992：35,36
[38]清·李彣.金匮要略广注校诠[M].海口：海南出版社,2010：176
[39]清·钱潢.伤寒溯源集[M].北京：学苑出版社,2009：48,49
[40]清·方有执.伤寒来苏集[M].北京：中国中医药出版社,2009：63
[41]清·柯琴.伤寒来苏集[M].北京：学苑出版社,2009：255
[42]清·喻嘉言.尚论篇[M].北京：学苑出版社,2009：170,171
[43]清·王清任.医林改错[M].北京：人民卫生出版社,2005：19
[44]凌耀星.凌耀星内经讲稿[M].北京：人民卫生出版社,2008：159,160,174,183
[45]清·吴瑭.温病条辨[M].北京：人民卫生出版社,1996：10