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醫之門戶分於金元，金元醫學又以河間為首，其理法對後世有很大影響。本文以河
間晚年專著《三消論》為據，簡述「理法」辨證思維，這與時下「辨證論治」思考模式
有所不同。河間勤求素問玄機，盡用平生所學，推陳「天地六位臟象圖」此圖亦是運氣
七篇大論之精髓，理論體系恢宏，臨床是經驗，醫理是活法，其玄妙之處在於：「知常
達變」。天水散全方僅有兩種藥物，中醫治病豈有如此簡陋法門？不會如此簡單，本文
將分析其義。醫者面對病患，當因時因地因人而制宜，進行辨證論治，臨證時「脈因症
治」存乎一心，心中了然為治病必要條件；處方用藥，不在乎拘束於滑石、甘草二藥。
劉氏以「腸胃之外燥熱太甚」、又以「寒物屬陰，能養水而瀉心」，此二者立論為「消
渴症」理法之依據，於是滑石成生津治消渴之首選用藥，相對合理。然而辨證是施治的
依據，亦是理所當然，至於如何運用「醫理」的考量來治病？本文用河間《三消論》醫
理以為法及醫案一則以為範本，淺析其理，並述其要。
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Yee-Guang Chen 1,2* Chien-Lin Chen 1,2
1 TCM Department of IHMED
2 School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Taiwan
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Prestigious medical master LiuWanSu(Hejian) ,who had led the historical reform in the
Jen-Yuan dynasty (1200AD) and traditional Chinese medicine(TCM) lineage was subdivided since then, he made a revolutionary theoretical approach in the medical world by giving affluent teachings and documentations based on Huangdi-Neijing. A teaching of San-Shoa-Lun(diabetic syndrome) thesis ,which was edited by Hejian’s late age, was elicited to explain the concept of Zheng( 證) differentiation correlated with principal and methodological( 理法) approaches. His teaching had been summarized in a pictorial table “Heaven Earth Six levels simulate Six Organs” whilst it was originated from classical seven-doctrines of Neijing. TCM always emphasis on theoretical approach in addition to empirical practice which intervene abnormal changes from normal. The formula Tien-Shiu-San, which was introduced to treat diabetic syndrome, composed only two herbal medicine Talcum(hydrous magnesium silicate) and Glycyrrhiza which are the remedies still use today extensively. Firstly, Hejian explained the mechanism of polyphagia-polyuria-polydipsia which was occurred due to hotness redundancy over the exterior gastrointestinal tract. Secondly, based on his theoretical thinking he formulated this remedy to target on hotness by elimination with coldness medication Tien-Shiu. Thirdly, diseases which used to be different from person to person, must come up with Zheng differentiation by Pulse-Etiology-Zheng-Treatment strategy. In conclusion, this study gives the idea of theoretical Zheng
differentiation based on Hejian which was an old idea but new to us today. Finally, a successful clinical example was edited to explain the whole picture of diabetes (NIDDM) treatment affiliated the concept of theoretical Zheng approach.
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105.1 河間天水散治消渴症理法辨思暨臨床經驗
