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医之门户分於金元，金元医学又以河间为首，其理法对後世有很大影响。本文以河
间晚年专着《三消论》为据，简述「理法」辨证思维，这与时下「辨证论治」思考模式
有所不同。河间勤求素问玄机，尽用平生所学，推陈「天地六位脏象图」此图亦是运气
七篇大论之精髓，理论体系恢宏，临床是经验，医理是活法，其玄妙之处在於：「知常
达变」。天水散全方仅有两种药物，中医治病岂有如此简陋法门？不会如此简单，本文
将分析其义。医者面对病患，当因时因地因人而制宜，进行辨证论治，临证时「脉因症
治」存乎一心，心中了然为治病必要条件；处方用药，不在乎拘束於滑石、甘草二药。
刘氏以「肠胃之外燥热太甚」、又以「寒物属阴，能养水而泻心」，此二者立论为「消
渴症」理法之依据，於是滑石成生津治消渴之首选用药，相对合理。然而辨证是施治的
依据，亦是理所当然，至於如何运用「医理」的考量来治病？本文用河间《三消论》医
理以为法及医案一则以为范本，浅析其理，并述其要。
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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( 证) 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 河间天水散治消渴症理法辨思暨临床经验
