張子和의 醫學思想에 關한 硏究 = A Study on Zhang Zi He(張子和)'s Medical Thought

다국어 초록 (Multilingual Abstract)

The period of Jin-Yuan(金元) Dynasty was an era of rapid change historically. Many people suffered a series of wars and epidemics. But, the existing medical community did not only respond to the change of the times but prefer to warm-dry herbs and tonics(Bu-Yao 補̌藥). Zhang Zi He(張子和) recognized exactly problems at that times and made his own theory with criticism to existing medical tendency. Subsequently, he created a school of medicine that is called ‘Gong-Xia-Pai(攻下派)’. Today, he is said to be one of the Jin-Yuan-Si-Da-Jia(金元四大家 ; means four great masters of O. M. D in Jin-Yuan age.)
He treated patients from his youth because he was born in the family of medical doctor. Thus, he could accumulate rich clinical experience throughout his life. His creative medical theory is based on his clinical practice. He was one of the most famous doctors at that time, and became to the royal physician. But he resigned before long because of his liberal personality and vilifiers and discussed medicine with his students and treated patients out of office. As a result of that, 󰡔Ru-Men-Shi-Qin(儒門事親)󰡕 was written at that time.
󰡔Ru-Men-Shi-Qin󰡕 is a very important work that contains everything of Zhang's medical thought. The book was made into present form after the process of change several times. These days the printed book is consist of 10 classes and 15 volumes that combine several books. Original 󰡔Ru-Men-Shi-Qin󰡕 was the name of volume 1, 2, 3, 󰡔Zhi-Bing-Bai-Fa(治病百法)󰡕 volume4, 5, 󰡔Shi-Xing-San-Liao(十形三療)󰡕 volume 6, 7, 8, 󰡔Za-Ji-Jiu-Men(雜記九門)󰡕 volume 9, 󰡔Cuo-Yao-Tu(撮要圖)󰡕 volume 10, 󰡔Zhi-Bing-Za-Lun(治病雜論)󰡕 volume 11, 󰡔San-Fa-Liu-Men(三法六門)󰡕 volume 12, 󰡔San-Xiao-Lun(三消論)󰡕 volume 13, 󰡔Zhi-Fa-Xin-Yao(治法心要)󰡕 volume 14, and 󰡔Shen-Xiao-Ming-Fang(神效名方)󰡕 volume 15.
󰡔Ru-Men-Shi-Qin󰡕 is a collection of a few books so, the literary style isn't uniform. The unconformity show that 󰡔Ru-Men-Shi-Qin󰡕 was not written by one person. The problem who is the writer of each volume remains controversial. But most scholars recognize that volume 1, 2, 3, original 󰡔Ru-Men-Shi-Qin󰡕 and was written by Zhang Zi He, embellished by Ma-Zhi-Ji(麻知幾). Also, it is recognized that 󰡔San-Xiao-Lun󰡕 was collected by Ma-Zhi-Ji and inserted by posterity, and that Chang-Zhong-Ming(常仲明) and Luan-Qi(欒企) who were Mr. Zhang's disciples participated in compilation of 󰡔Ru-Men-Shi-Qin󰡕. Therefore, it is sure that the contents of the book express Zhang Zi He's medical thought.
He was influenced by 󰡔Huang-Di-Nei-Jing(黃帝內經)󰡕 and Liu-He-Jian(劉河間)'s theory, and other classics. Also, his clinical experience was helpful to theorize his thought. Thus, he improved medical theory by combining previous medical theory and his own experience.
The essence of his thought is the importance of Xie-Qi(邪氣) as the cause of disease and is San-Fa(三法) of Han-Tu-Xia(汗, 吐, 下) as the methodology for removing Xie-Qi(邪氣) away. He regarded Xie-Qi as the cause of disease, and eliminated Xie-Qi for the remedy. Namely, San-Fa of Han-Tu-Xia(汗, 吐, 下) was selected as the best efficient method for driving Xie-Qi away.
San-Fa of Zhang Zi He have different meaning from previous one. Traditionally, Han-Fa(汗法) was regarded as therapy for Wai-Gan-Bing(外感病), and its effect was regarded as Fa-Han-Jie-Biao(發汗解表). Tu-Fa(吐法) was throwing up Tan-Yin-Xiu-Shi(痰飮宿食) of stomach and above diaphragm. Xia-Fa(下法) means Tong-Bian(通便), Xia-Ji(下積), Xie-Shi(瀉實), Zhu-Shui(逐水) were regarded as therapy for Yang-Ming-Shi-Zheng(陽明實證) of Shang-Han(傷寒).
He submitted a new extensive concept of San-Fa adding traditional one, and expanded the application range of San-Fa. All methods, can cause circulation of Qi-Xie(氣血) by opening the 'Xuan-Fu(玄府)', like Jin, Xun, Zheng, Xi, Yu, Lao, Zhen-Zi, Bian-Xie, Dao-Yin, An-Ma(灸薰、蒸、洗、熨、烙、針刺、砭瀉、導引、按摩: moxa, fumigation, washihg, iron, breaking a boil with a red-hot needle, acupuncture, venesection, stretching, massage) were regarded as Han-Fa(汗法). Especially, he thought that Han-Fa(sweating) and Xie-Xie(瀉血, venesection) have same medical implication. Similarly, all means that can cause going up Qi-Yun(氣運) were considered as Tu-Fa(吐法), like Yin-Xian, Lu-Xian, Ti-Qi, Zhu-Lei(引涎、漉涎、嚔氣、追淚: to cause drivel, sneezing, tear), and all treatments that can cause going down Qi-Yun were thought as Xia-Fa(下法), like Cui-Sheng, Xia-Ru, Mo-Ji, Zhu-Shui, Po-Jing, Xie-Qi(崔生、下乳、磨積、逐水、破經、泄氣; to cause an easy delivery, lacteal secretion, menstruation, breaking wind). So, the San-Fa was redefined as the wide-range concept, can include most of treatments.
If we examine the process of pushing out Xie-Qi by means of San-Fa, we can find the intermediation, that is circulation of Qi-Xie. Its meaning is implied in the word of 'opening Xuan-Fu'. He thought that the circulation of Qi-Xie is the key to control health. Qi-Xie was circulated well under the physiological balance, but it was not circulated well under the invasion of Xie-Qi. In other words, Xie-Qi is the immediate cause of bad circulation of Qi-Xie and disease.
Naturally, the doctor must remove Xie-Qi that cause bad circulation for healing by means of San-Fa. In my opinion, because the ultimate goal of Zhang Zi He was circulation of Qi-Xie by removing Xie-Qi, the concept of San-Fa could be expanded widely.
Some people criticize his thought. They says that his therapy is too drastic to apply and he have a low opinion of toning up health. But I disagree in the critic. He did know San-Fa can be harmful to Zheng-Qi(正氣) or Wei-Qi(胃氣), obviously, and apply San-Fa to patients under the very strict rule. We can make sure that by checking the truth that he emphasize careful application and taboo. He could apply too drastic remedies, because his correct judgement on patient and disease was preceeded.
Also, he presented the theory of ‘Yao-Xie(藥邪)’, abuse and misuse of medicine can cause another disease. He was careful to protect Wei-Qi and had his own view point to 'Bu-Fa(補法)'. It is unique to apply 'Bu-Fa' after removing Xie-Qi and to emphasize ‘Shi-Bu(食補; toning up patient's health by feeding food not medicine)’. His therapy with food is in the line with the theory of ‘Yao-Xie(藥邪)’ against abuse of medicine.
Thus, it is considered as proper to say that he didn't insist unreasonable Gong-Xie-Liao-Fa(攻邪療法) and he had well balanced view. Nevertheless, it is sure that the core of his medical thought is Xie-Qi as the cause of disease, and San-Fa of Han-Tu-Xia(汗, 吐, 下) for removing Xie-Qi. His remedies in 󰡔Ru-Men-Shi-Qin󰡕 were surprisingly bold and creative. He used San-Fa quite freely. These tell us that he mastered and practiced his own theory completely.
Today's situation is similar to the past medical community criticized by him. Now, drastic remedy that can cause strong effect like Tu-Fa is not applied, but tendency of preference to Bu-Fa is continued. There are many differences between today and Jin-Yuan age, but his medical thought is very influential today.
Finally, I expect that the effective therapy that kept in dead storage gets to be alive, and then our oriental medical world develops with new vitality.

목차 (Table of Contents)

• I. 序論 = 1
• Ⅱ. 本論 = 4
• 제1장 張子和의 生涯와 門人들 = 4
• 제1절 張子和의 生涯 = 4
• 제2절 張子和의 門人들 = 6
• 1. 麻知幾 = 6
• 2. 常仲明 = 6
• 3. 欒企 = 7
• 4. 越君玉 = 7
• 제2장 張子和의 著作 = 8
• 제1절 『儒門事親』 = 8
• 1. 張子和의 自撰내용과 自撰에 대한 논란 = 9
• 1) 「蟲닉之生濕熱爲主訣」 = 10
• 2) 「補論」 = 11
• 3) 「水解」 = 11
• 2. 麻知幾, 常仲明 등이 기록 정리한 내용 = 13
• 1) 강의 내용에 대한 기록 = 14
• (1) 『治病百法』과 『治病雜論』 = 14
• (2) 『撮要圖』 = 15
• ① 『難素撮要究治識病用藥圖』와 『天地六位臟象圖』 = 16
• ② 『撮要圖』 = 17
• ③ 『六門病證藥方圖』 = 17
• ④ 『五泄圖』와 『金궤十全之法圖』 = 18
• ⑤ 『金궤十全五泄法後論』 = 18
• 2) 張氏의 臨床經驗의 記錄 = 18
• (1) 『十形三療』 = 19
• (2) 『雜記九門』 = 21
• 3) 張氏의 方劑 수집 = 22
• (1) 『三法六門』 = 22
• 4) 古人들의 經驗 方藥 수집 = 23
• (1) 『神效名方』 = 23
• 3. 常仲明 보유 내용 = 24
• (1) 『治法心要』 = 24
• 4. 麻知幾와 후인의 수집과 보충 = 25
• (1) 『三消論』 = 26
• 제2절 『心鏡別集』 = 28
• 제3절 『儒門事親』의 판본 = 29
• 1. 金代 刻本 = 29
• 2. 元代刻本 = 30
• 3. 明代 刻本 = 31
• 1) 『醫方類聚』輯錄本 = 31
• 2) 邵輔(柏涯)本과 『醫統正脈』本 = 32
• 4. 淸代 刻本 = 33
• 5. 近代 刊刻本 = 34
• 제3장 張氏의 의학사상 = 36
• 제1절 學術思想의 淵源 = 36
• 1. 『黃帝內經』 = 36
• 2. 劉河間의 영향 = 37
• 3. 새로운 지식의 융합 = 39
• 1) 옛 것에 구애되지 않음 = 39
• 2) 迷信을 반대 = 39
• 3) 민간요법을 중시 = 41
• 제2절 학술 사상 = 43
• 1. '病因'에 대한 관점 = 43
• 2. 汗、吐、下 三法 = 44
• 2-1. '汗法' = 44
• 1) '汗法'의 개념 = 44
• 2) '汗法'의 방법과 종류 = 47
• (1) 藥物療法 = 47
• (2) 물리적 요법인 外治發汗 = 48
• ① 九曲玲瓏조 = 48
• ② 溫室發汗 = 49
• ③ 폄刺發汗 = 49
• ④ 조浴發汗 = 49
• ⑤ 導引按摩發汗 = 50
• (3) 變法 = 50
• 3) '汗法'의 활용범위 = 52
• 4) '汗法'의 규율 = 53
• 5) 發汗禁忌 = 53
• 6) 汗法의 치료 기전 = 54
• 2-2. '吐法' = 57
• 1) '吐法'의 개념 = 57
• (1) 病因의 근원을 제거 = 58
• (2) 先急後緩 = 58
• (3) 주理를 열어 邪氣를 외부로 제거함 = 58
• 2) '吐法'의 방법과 종류 = 59
• (1) 藥物催吐 = 59
• (2) 療痰 = 60
• (3) 旋轉取吐法 = 61
• (4) 기타 外用吐法 = 61
• ① 引涎法 = 61
• ② 록涎法 = 61
• ③ 체氣 = 62
• ④ 追淚 = 62
• 3) '吐法'의 규율 = 62
• 4) 禁忌 = 63
• 5) 調宜 = 63
• 6) 涌吐의 치료 기전 = 64
• 2-3. '下法' = 65
• 1) '下法'의 개념 = 66
• 2) '下法'의 구체적 방법과 종류 = 67
• 3) '下法'의 범위 = 68
• 4) '下法'의 규율 = 70
• (1) 實證、熱症에 국한되지 않음 = 70
• (2) 峻下法은 暴病卒痛、邪實에 多用 = 70
• (3) 濕邪、積聚에는 반복하여 攻下함 = 71
• (4) '下法' 가운데 '緩法'이 있음 = 71
• (5) '下法' 方劑의 배합과 단계 = 71
• (6) '下法'과 '汗法' 및 '吐法'과 연관성 = 72
• (7) 病情과 체질적 특성에 근거하여 '下法'을 사용함 = 73
• 5) '下法'의 禁忌 = 73
• (1) 表症에는 '下法'을 금함 = 73
• (2) 순수한 虛症으로 邪氣가 없는 때는 '下法'을 금함 = 73
• (3) 老人、小兒、姙婦、虛弱者에는 '下法'을 신중하게 사용함 = 74
• 6) 調宜 = 74
• (1) 攻前先安胃吐 = 74
• (2) 下後當複胃氣 = 75
• (3) 약물 치료의 선후 = 75
• 7) 下法의 치료기전 = 76
• (1) "推陳致新"論 = 76
• (2) 인체에 대한 하법의 작용기전 = 77
• 3. 五志七情에 대한 관점 = 78
• 4. '藥邪'觀 = 80
• 1) '藥邪'의 개념 = 80
• 2) '藥邪'에 대한 張氏의 견해 = 81
• (1) 藥邪致病 = 81
• (2) 다른 질병을 발생시킴 = 81
• (3) 약물의 오용으로 죽음에 이를 수 있음 = 82
• 3) '藥邪'의 형성 = 82
• (1) 약물 자체의 '毒邪' = 82
• ① 過量 = 82
• ② 誤服 = 83
• ③ 泡制의 잘못 = 83
• (2) 약물의 오용 = 83
• ① 오용 燥熱藥 = 84
• ② 補法 濫用 = 84
• 5. '補論' = 85
• 1) 邪氣가 물러나기 전에는 補할 수 없다 = 85
• 2) 養生은 마땅히 食補, 治病은 藥攻 = 86
• 3) 張氏의 補法 方藥 = 87
• (1) 약물을 이용한 補法 = 87
• (2) 飮食을 이용한 補法 = 88
• Ⅲ. 結論 = 90
• Ⅳ. 參考文獻 = 94
• ABSTRACT = 96