張介賓 鬱證論治 연구 (Zhang Jiebin(張介賓)’s Discussion and Treatment of the Depressive Pattern)

서지정보

· 발행기관 : 대한한의학원전학회
· 수록지 정보 : 대한한의학원전학회지 / 35권 / 4호 / 77 ~ 96페이지
· 저자명 : 배정운, 박기호, 류정아

초록

Objective : 鬱證에 대한 張介賓의 醫論과 治法을 고찰하고, 특징과 의의를 알아서 현대 임상에 참고하고자 하였다.
Method : 『景岳全書』 「雜證模･鬱證」 원문, 鬱證 관련 『黃帝內經』의 원문 및 주석 그리고 金元四大家 醫書의 내용을 분석하고, 醫論의 발전과정을 살피며 비교･고찰하였다.
Result : 張介賓은 情志로 인한 氣의 변화가 병리 상태를 초래한 기전에 주목해 鬱을 怒鬱, 思鬱, 憂鬱 세 가지로 분류하였다. 『素問･六元正紀大論篇』의 五鬱과 治法에 관해 王冰, 滑壽, 王安道의 주석을 대조하며 實證 위주로 보던 관점을 虛證으로 확장하였고, 瀉法 위주의 治法도 손상된 精氣를 회복시키는 補法으로 확장하였다. 怒鬱, 思鬱, 憂鬱을 虛實로 세분화해 神香散, 壽脾煎, 歸脾湯 등의 처방을 제시하고, 鬱證이 情志 즉 心에서 기인함으로 情을 직접 다스리는 移情變氣療法을 제시하였다. 張介賓은 鬱의 범주를 확장시킨 朱震亨의 의견을 채택하였으며 虛實의 관점에서는 李東垣과 가장 유사하였다.
Conclusion : 張介賓 이전의 鬱證은 實證의 측면에서 언급되어왔던 반면 張介賓의 怒鬱, 思鬱, 憂鬱 중심 鬱證은 情志의 鬱에 주목하는 동시에 虛證의 鬱의 가능성을 제시했다는 점에서 기존의 관점이 확장되었다. 鬱을 다스리는 治法 또한 虛證에 대한 補法을 더하였으며, 情志 자체에 대한 치료적 접근이 필수적이게 되었다.

영어초록

Objectives : This paper examines the medical treatise and treatment methods of Zhang Jiebin on the depressive pattern, for clinical application today.
Methods : The Zazhengmo/Yuzheng chapter of the Jingyue Quanshu, related texts and annotations of the Huangdineijing, and related contents among the medical texts of the JinYuan masters were analyzed. Developmental process of the medical theories were compared and examined.
Results : Zhang focused on the mechanism in which emotion affects Qi leading to a disease state, and categorized Yu[鬱, depressed state] into three: anger depression, contemplative depression and comprehensive depression. The concept of the Five Depressive Patterns and its treatment from the Huangdineijing·Suwen which was considered as excess pattern was expanded to include deficiency pattern based on comparison with annotations of Wangbing, Hwashou, and Wang Andao. Treatment methods centered on purging was also expanded to include tonifying to restore the damaged Jing Qi. The depressive patterns anger depression, contemplative depression and comprehensive depression were subdivided according to excess and deficiency, for which formulas such as Shenxiangsan, Shoupijian, Guipitang were suggested. As the depressive pattern is caused by emotions and thus the Heart, the Yiqingbianqi method that directly deals with emotions was suggested. Zhang adopted Zhu Zhenheng's opinion which expands the category of Yu, and in the perspective of excess/deficiency, it is most similar to that of Li Dongyuan.
Conclusions : Before Zhang, the depressive pattern was discussed in terms of it being excess pattern. However, Zhang's discussion on depressive pattern based on anger depression, contemplative depression and comprehensive depression focuses on emotional stagnation while suggesting the possibility of deficient stagnation, expanding previous understanding. In terms of treatment, tonifying methods for deficiency pattern was added, while consideration of emotion itself became necessary in treatment.

참고자료

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