【作者】 郭镇宇；

【导师】 李万瑶；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2012， 博士

【摘要】 针灸是中医的重要组成部份,其历史攸久,适应症多种多样。长期经验的累积,历代医家对其有多部经典著作,其内容精辟,是前人经验提炼而成的精华,在中医学中担当承先启后的角色,可指导临床和启发创新研究。本文试图整理历代被命名“鬼穴”的针灸治疗相关记载。虽然这些穴位源自古代,但现代针灸治疗精神神志疾病仍广泛使用,尤以“孙思邈十三鬼穴”最为常用。其临床研究亦逐渐增多。但由于古今相关记载内容有着版本的差异,使很多时候治疗的选穴操作不一,不利于进一步研究和推行,鉴于现今社会精神神志病发病日益严重,医疗压力激增的情况下,剖析中医“鬼穴”对精神神志疾病的特异性,和其介入治疗的操作和可行性有一定意义。“鬼穴”始于唐代孙思邈在《千金要方》,《千金翼方》记载,一般用以治疗精神神志疾患为主,故命名,及后历代对“鬼穴”有不同的描述和发挥,有些探求孙氏原文,有些从穴性着手,有些从自己,他人的临床经验发展,在原有孙氏“鬼穴”的基础上进行研究,修改,或自行订立使用规律,虽然各自对“孙氏十三鬼穴”原文有不同的理解,甚至有人创立新的一套穴位,并同样以“鬼穴”命名,各家著者都相信和认为人身有一些穴位可专治精神神志疾患,故都以“鬼穴”命名。搜寻发现；在古代对“鬼穴”的记载多为对其的主治功效的纪录,和相关穴位的命名纪录,施针的次序等。但历代记载不尽相同。就连“鬼穴”相对的穴位或定位也可有出入,而且未见有对穴位的特异性,穴位配伍的解释,适应症型进行讨论,校正或注解。在现代方面,对“鬼穴”的研究多集中在“鬼穴”相对穴位的针刺治疗,对精神神志疾病的临床疗效和适应症,虽然临床研究不少,但未有考究各现存“鬼穴”版本取穴对治病效果的差异和个中的中医理论的合理性。另外,在使用“鬼穴”时,多单个或按个人经验零散选用,同时还有使用其他配穴,而且为数众多,并未有说明只单用“鬼穴”但仍声称“鬼穴”研究的因由,又另外,原文针法基本没有人在使用。以上均造成不同作者所撰的“鬼穴”的研究之间没可比性。再加上随机对照的实验或临床不多,这一切使研究者难于以现行的方法如循证医学方法作回顾分析或制订“鬼穴”用穴指引,使其未能推广。但“鬼穴”的研究和临床在现代中医仍广泛使用,特别是在精神神志疾病上有一定贡献,这说明有可能各个版本的“鬼穴”,或者单个使用“鬼穴”,或与其他用穴配伍使用时,均可对精神神志疾病有一定疗效。虽然如此,在各个版本的“鬼穴”的基础上选辑但未有解说的情况下再作研究似乎有点混乱。本文将包罗这些的数据,整理历代记载,并试图探求“鬼穴”在中医学的理论和临床价值。希望藉此对中医针灸在治疗精神神志疾病的临床和未来的研究提供资料。研究目的：本文是一篇文献研究,研究工作的目的是为了整理历代中医针灸学中的“鬼穴”的记载和使用。所以对象是古今历代对“鬼穴”的一切现存的描述记载和临床使用。研究方法：是次研究查考现存古代经典,以及现代已刊登的文献。古代文献方面,以查考原文为主,每乎合纳入标准者即查其源头究竟,比较历代描述的异同。现代文献方面,按其记载引用,比较异同,并在选穴,主治,适应症,针刺手法等20项以上的指标将其分类。最终发现“鬼穴”的记载主要有五个版本。其中最为后世引用的为《千金要方》的“治百邪癫狂十三穴”,和《针灸大成》的“孙思邈十三鬼穴”研究结果：本次研究成果为经过搜索,查考,校对等工作后,有六方面的新见解。第一,命名方面,发现命名“鬼穴”的有29个,有的命名更在不同定位上重复使用,当中双侧穴位如曲池算1个,组合穴位如十宣也算1个。成套“鬼穴”有五套,分别有古代的《千金要方》,《干金翼方》,《针灸大成》所描述的“孙思邈十三鬼穴”,《针灸聚英。宋徐秋夫鬼病十三穴歌》的“徐秋夫十三鬼穴”,和现代的李仲愚十鬼穴主治神志病,精神病。而且历代临床和研究发挥以“孙氏十三鬼穴”为主。虽然描述“孙氏十三鬼穴”的版本各有所不同,但多数穴位相同,针法类似,应该是同出一宗。第二,“鬼穴”选用之意义,是以调整任督二脉之气和刺激四肢末端较突出。第三,选穴和所用穴位数量方面,由于古代文献无完整而可相互比较“鬼穴”使用病例,在考证“孙思邈十三鬼穴”(参照《干金要方》,《千金翼方》,和《针灸大成》版本)的选穴是否必须遵照古代原文的问题上,包括选穴数量和进针次序,针法等,统计上只纳入现代文章。发现在170篇纳入文章中,有32篇选用单用人中穴或作主穴,51篇选用人中穴加上其他“鬼穴”同用,由合共2到12个不等,其中有27篇是13鬼穴全用的;另外有44篇是人中以外的鬼穴的单用或为主穴使用,即包括少商,隐白,大陵,申脉,风府,颊车,承浆,间使或劳宫,上星,会阴,舌下中缝,即除曲池以外的所有孙思邈十三鬼穴。并以大陵为最多,有17篇,但仍然在临床上有良好疗效,不过在单用穴位或作主穴者“第二针的鬼信和第三针的鬼垒”则只各有一篇。而人中以外,以其他“鬼穴”多用为主穴者,有3篇,分别用两个,三个,和五个“鬼穴”作主穴治疗神志病,精神病。由此可见,在选穴方面,原文所描述的“凡针之体,先从鬼宫始,次针鬼信,便至鬼垒,又至鬼心,未必须并针,止五六穴即可知矣”。或者现代使用时可以理解为,凡是针刺神志病,精神病,大多数的情况,人中(鬼宫)都可以用作主穴,或单用。而大陵穴(鬼心)也可以有相类似的效果,全套针法不一定要全部用上,可能其中选五到六个以内的”鬼穴”作主穴已经可以治疗神志病,精神病了。第四,进针次序方面,近代研究虽然少有(纳入本文的只有1篇)讲究进针次序,所以本文并未有显示某种进针次序在利用“鬼穴”治疗神志病,精神病时有显着优势,不过170篇纳入文章中,有169篇未有特别说明讲究进针次序对针刺效果的影响,而且其他未有讲究进针次序的文章仍有有意义的疗效,所以在进针次序对疗效影响上可说没有太大意义。第五,至于针法方面,原文虽然记载火针灸法,并说“依诀而行,针灸等处,并备主之…。万不失一”也可能是个人经验或说明用各种针法的意思,因为似乎现代各家所遵只有穴位而非针法当然,如果要再考究原文针法,可能只有再进行临床试验。第六,鬼穴定位方面,虽然历代一直将孙思邈所描述的鬼穴的定位定作与固有穴位相同,但本文在这方面认为在某几个穴位的定位可能有商榷之处。结论：历代“鬼穴”是命名有关治疗神志精神疾病的特异穴位,其作用主要是通过刺激任督二脉,四肢末端来调整全身阴阳,传说是扁鹊所创,首先由唐代孙思邈在《千金要方》记载“鬼穴”三十一个,并整理了一套十三个的穴位用法,各穴冠以“鬼穴”命名,当中有些数据在《千金翼方》中修改重写,其后《针灸大成》加以整理,成为现代最多用的“十三鬼穴”版本。另外,现存较少研究和使用的”鬼穴”套穴有宋代徐秋夫十三鬼穴和现代李仲愚十鬼穴等。“鬼穴”的命名历代各有不同,有些不同的穴位更有重复使用,但治疗机理均以通过刺激任督二脉,四肢末端来调整一身阴阳。临床上使用鬼穴治疗神志病,精神病时,不应拘泥原文,可根据病情,选用单个“鬼穴”,数个“鬼位”,或单个“鬼穴”为主穴,或数个“鬼穴”为主穴,随症配穴,或“十三鬼穴”全套用上,均有可靠疗效。研究结论：中医历代“鬼穴”有七种版本,均以治疗精神疾患为主。临床使用上版本主要遵照《针灸大成》,此外各家针法多样,而鬼穴的第一至第四针使用率最高。人中(48.82%),少商(35.88%),隐白(27.65%),大陵(27.65%)。更多还原

【Abstract】 Acupuncture is an important component of traditional Chinese medicine, which has a long history. Long-term accumulation of experience, doctors in the past on several classics, which brilliantly, is the essence of people experience refine but, assumes the role of continuity in traditional Chinese medicine, to guide clinical and inspire innovation. This article tries to collate the articles about "ghost points" available from ancient to modern time. Although the’points are derived in ancient time, they, are still widely used in modern. Chinese acupuncture treatment, especially Sun Si-miao’s13ghosts points are most commonly used. Clinical researches are also done. However, the content recorded are different betweeen ancient and modern time, including the acupoint selection and operation, which is no good for further study and implementation. In view of today’s increasing burden of some mental diseases to our medical resources. The collation of information about traditional Chinese medicine "Ghost point" on the treatment of mental disease may help us to understand more about the specificity of the "Ghost point"; the feasibility and their intervention."Ghost points" was firstly recorded in the Tang Dynasty, in the book called Qian Jing Yao Fang of Sun Si-miao’s and another book call Qian Jing Yi Fang. Which is mainly for the treatment of mental disorders, and so named, and the time after that, different description on "ghost points" was suggested. Some may quest Sun’s original, some built up from the idea before, some from self clinical experiencet of which are developed from the original Sun’s "ghost points" Although some people may have different understanding, even the acupoints suggested were totally different, the authors believed that there were acupoints that can give special treatment effect on mental illnesses, so all of them tended to name the acupoints selected as "ghost points"We found from search that in the ancient time,"ghost points" records mainly indicate the efficacy, and the naming of the related acupoints. But along the history, the records vary. Even the "ghost points" relative points or orientation can also be different among the different editions in different dynasty. But there is no discussion of the specificity of the "ghost points", nor explanation of acupoint compatibility, indication-type for treatment discussion, corrections and notes.In the modern context, the focus of the "ghost point" study is on "ghost points" relative point acupuncture treatment effect for clinical psychiatric problem and mental illness, although there are many clinical researches, there is no indication of difference of curing effect among the existing "ghost point" versions and also the traditional Chinese medicine theories used. In addition, there is no much description on the trend of "ghost point" usage, including the number of ghost selected, some of them may include single use of "ghost point", while some may claimed the treatment effect is due to the usage of "ghost point" but of which included many other acupoints at the same time, the situation makes the comparison among the researches impossible, including those of higher level such as the production of guidelines or evidence-based medicine review analysis. So that the usage of "ghost points" fails to promote.However, the "ghost points" and is still widely used in clinical research in modern Chinese medicine, especially on mental illness suggesting possible versions of "ghost points", or a single Ghost point, or when mixed with other points, may have a certain effect on mental illness. Nevertheless, in various versions of the "ghost points" Allied but not on the basis of interpretation of the case further research seems to be a bit confusing. This article will cover these data, collating ancient records, and try to explore "ghost points" in the theory of traditional Chinese medicine and their clinical value. We hope that the research can help providing data for future researches.Objective:This article was a literature study, purpose is to collate of ancient Chinese medicine acupuncture and moxibustion "ghost points" records and use. So the object is the ancient and modern history "Ghost points" description for all existing records and clinical use.Methods:research study is extant in ancient classical and modern literature that are published. For ancient literature, it mainly includes original researches, which meet the inclusion criteria with their sources checked, also the similarities and differences recorded along the history.For modern literature, referenced by its records, similarities and differences, and point selection, acupuncture manipulation and others around more than20categories are used. Finally, there are five major versions "ghost points" recorded. Most frequently referenced ones include 《Qian Jing Yao Fang》"managing hundreds of evil madness13needles", and 《Zhen Jiu Da Cheng》"Sun Si-miao’s point13ghosts".Results:After searching, proofreading, there are six new insights.Firstly,for naming, there are29acupoints are named as "ghost-point", including some are of same relative point location but of different "ghost point" name. Here, we count double-sided acupoints as one. Combo points, such as ten vision, as one single acupoint. There are five complete set of "Ghost point". Including the ancient ones appeared in 《Qian Jing Yao Fang》,《Qian Jing YI Fang》,《Zhen Jiu Da Cheng》 Sun Si-miao’s13ghosts points,《Zhen Jiu Zu Ying》, Xu Qiufu of point13ghosts, and modern Li Zhongyu ten demons of acupoint indications of mental psychosis. Clinical and research and history play in Sun’s13ghosts point. Describes Sun’s version of point13ghosts is different, but most of the points of the same, similar to acupuncture, are actually unique and believed from the same origin.Secondly, the "ghost point" selection of meaning, is to adjust the flowing of Qi in Ren and Du meridian and stimulate outstanding at the end of limbs.Thirdly, for the selection of acupoints and the total number of acupoints selected, due to the absence of complete description in ancient literature, there are170articles included. Within which,32articles use DU26as main acupoint or as single use.51articles use DU26together with other2to12"ghost points".27articles use all of the13"ghost points"; There are44articles showing usage of ghost points other than DU26, of single use or as main acupoints in treatment. That is, LU11, SP1, PC7, BL62, DU16, ST6, RN24, PC5(or PC8), DU23, RN1and EX-HN11, but except LI11. And more articles,17articles, describes PC7. It is interesting that the clinical treatment effect is still good, although the main acupoints of the original prescription by Sun is not used.So, it can be seen that, in terms of point selection, the selection of "ghost point" may not be followed all the time, but the description of the amount of needle needed is around5to6seems to be rather accurate.Fourthly, for the order of insertion of needles, it is rarely discussed,(only1article of this is found). So it is still not confirmed if the treatment effect will be better when using special sequence of insertion of needles. However, within the170included articles, there are169never talked about the sequence but which still provide significant clinical treatment effect. We, up to now, may say that no significant difference if we just forget about the order of insertion of needles when using "ghost points".Fifthly, for the method of acupuncture, although the original recorded include fire-acupuncture, and said that "if method of acupuncture and moxibustion is followed, and preparation is well... it will be absolutely safe", practically, methods may vary from experience of different Doctors and still could help treating metal illness well. Of course, if one wants to research the original ghost point acupuncture method, only by further clinical trials.Sixthly, for location of the "ghost point" as recorded in ancient books. Although the ghosts of past dynasties had been described by Sun Si-miao’s point location and natural point of the same, it is still an open discussion for some "ghost points"Conclusions:"ghost points" are named and used for treatment of mental disease since long time ago in China. Its mechanism is believed by stimulation of Qi in DU and REN maridian. any also Qi in at extremities of limbs, which all together will adjust Yin and Yang of the whole body, and is created by Bian Que in legend, firstly introduced by a Chinese medicine doctor in Tang Dynasty, Sun Si-miao’s in 《Qian Jin Yao Fang》. After that and by others contribution, such as 《Qian Jin Yi Fang》 and 《Zhen Jiu Da Cheng》. There are29"ghost points" recorded in the ancient time, and full set of conventional use consist of13acupoints. Which later becomes the most modern of "13ghosts point" version. In addition, other existing "ghost points" set include Xu Qiufu13ghosts in the Song dynasty and the modern ten Li Zhongyu ghost points. The naming of Ghost point is different along the history, there are some names used repeatedly for different points, but.the idea and proposed mechanisms are the same, adjusting the Yin and Yang in the body, by stimulating acupoints on Du and Ren meridian and at extremites. In clinical use, when using the ghost points, one may not always follow the original set, but can use anyone, or some of the ghost points, according to the severity and situation, which is the golden idea in Chinese medicine. If so, the ghost points can provide reliable effect on treating mental diseases.There are totally seven major types of ghost point sets and are mainly for the treatment of mental illnesses. Clinically ghost points suggested in "Zhen Jiu Da Cheng" are the most commonly used which include the first four ghost points, with frequency, namely, DU26(48.82%), LU11(35.88%), SP1(27.65%), PC7(27.65%).更多还原