中医阴阳的本质及相关问题研究

【作者】 王正山；

【导师】 张其成；

【作者基本信息】 北京中医药大学 ， 中医医史文献， 2014， 博士

【摘要】 阴阳是中医基础理论中最核心的概念,贯穿于中医理论体系的方方面面。本论文从三个方面对中医阴阳学说进行研究：上篇集中讨论中医阴阳的本质及数学特性。这是本论文最核心的内容。其中又分为四章：第1章讨论中医阴阳的本质及基本数学特性。论文从阴阳的本义出发出发,区分了“抽象阴阳”与“具体阴阳”。其中,“抽象阴阳”是抽象意义上的阴阳,所指无定在,比较模糊笼统；“具体阴阳”是具体属性上的阴阳,所指明确,可以测量,具有确定性和可判定性。阴阳是相对的,互为前提而存在,在这个角度上说,阴阳是一种二元关系。作为二元关系,阴阳具有反自反性、反对称性和可传递性等数学特性。事物的属性可划分为两种类型,一种数值大者为阳(比如温度),可称之为“阳属性”；一种数值大者为阴(比如湿度),可称之为“阴属性”。基于此,本文详细讨论了中医阴阳虚实的含义及度量方法。第2章对经典中医体系中最重要的几种“具体阴阳”进行深入分析。(1)寒热之阴阳。寒热是中医“八纲辨证”中的两纲,也是中医临床最关注的症候之一。中医学中的寒热,主要包括气候的寒热、症状的寒热和药性的寒热。而这些“寒热”概念,有时候是客观的温度冷热(如气温高低,体温高低),而更多的时候则是指医者或病者的主观感觉。由于主观感觉与客观温度的不一致性,导致了“寒热真假”及“药性悖论”等问题。文章还探讨了各种寒热的测量方法。(2)空间之阴阳。空间位置之阴阳,主要考虑四种位置关系：左右、前后、上下、外内。文中详细讨论了这四种位置阴阳及“左血右气”、“男左女右”、“左升右降”等说法之间存在的逻辑问题。文中还给出了空间阴阳的数学表示。(3)气味之阴阳。气味是传统中医药性理论中最核心的概念。以气味分阴阳,则有气与气相对之阴阳、有味与味相对之阴阳、也有气味相对之阴阳。气味各有厚薄,气味因其厚薄又可以各分阴阳。这些问题盘根错节,又十分重要。经典中医理论中关于气味阴阳理论的论述中存在着众多的问题。其中,气、味之阴阳方面的问题主要有四个；气味之厚薄及其阴阳方面的问题主要有八个。这些问题长期未能引起学术界应有的关注。(4)清浊之阴阳。清浊是经典中医里非常重要的概念。清升浊降,从类比自然界中的浮力现象而来。根据浮力原理,药物在人体里上升还是下降,应该只与该药物的密度(轻重)有关,而跟用量无关；而升提或下降之(?)的大小,则与该药物的密度和用量有关。而根据清轻者为阳主升的假设,药物在人体里上升还是下降,不仅与该药物的密度有关,还取决于用量,二者产生了矛盾。本文对此矛盾进行了深入分析。除此以外,本章还讨论了营卫阴阳和脏腑阴阳中的问题。第3章把阴阳的二元关系进行了扩展,讨论集合之间阴阳的判定方法,并讨论了“一分为二”和“一分为三’’的异同。研究表明,“一分为二”是“一分为三”的一种特例。第4章把用于描述单个属性的“具体阴阳”进行扩展,提出了“复合阴阳”和“属性向量”的概念,用于描述一个具有多个属性的事物的整体阴阳。并初步讨论了“复合阴阳”在描述人体健康、单味中药药性和药方功用上的应用。到此,我们实现了三个目标：1)给出对阴阳的严格数学定义。2)由阴阳的数学定义,推导出阴阳的数学特性。3)建立一个能够同时用于描述人体阴阳、疾病模型、药物模型和药方模型的数学模型。中篇讨论中医阴阳的相互关系。具体分两章：第5章,讨论阴阳的相互关系。阴阳的相互关系是阴阳学说的核心内容。由于对阴阳的实质认识不清,未能区分“抽象阴阳”与“具体阴阳”,故学术界对阴阳的关系认识至今仍然属于比较“混沌”的状态。本章从四个方面对阴阳的关系进行了分析。(1)单个属性上的阴阳关系。传统所说的对立制约、互根互用、相互转化一般都是单个属性上阴阳双方之间的关系。(2)不同属性间的阴阳关系。事物的多个属性之间,可能存在正相关、逆相关、函数相关和不相关关系。文中指出,“阳生阴长”和“阳杀阴藏”只是不同属性间的一种可能的正相关关系。同样地“阳长阴消”和“阳消阴长”也是只是不同属性间的一种可能的逆相关关系。故不能简单地认为,人体里任何两种阴阳会存在“阳生阴长”或“阳长阴消”的规律,而需要在实际情况中具体分析。(3)人体阴阳与外界阴阳的关系。人体阴阳与外界阴阳,既可能同步消长,也可能反向消长；同样地,人体阴阳与药物阴阳,既可能同步消长,也可能反向消长。这些都要求我在运用阴阳学说时,具体情况具体分析。(4)阴阳平衡。所谓的阴阳平衡,在单一属性上看,就是该属性既不是阳虚,也不是阳实,既不是阴虚,也不是阴实的状态。所谓事物A的阴阳平衡,就是指事物A的每个独立的属性皆处于阴阳平衡的状态。第6章,讨论扶阳与滋阴学派之争。阴阳是中医学的根本,而扶阳与滋阴,也是中医学界永恒的争论。本章中,我们对扶阳和滋阴二派进行了界定,并详细讨论了二派的主要源流、主要医家及其特色。归纳起来,两派论争的焦点有三：1)阴阳贵贱与主从关系；2)阳虚与阴虚之病孰少孰多?3)阳虚和阴虚之病该如何调治?本研究认为,这些问题之所以长期争论不休,无法达成一致,主要原因有二：1)是论证问题的方法有误。古代医家论证问题,主要采用如下几种方式：取类比象、诉诸权威、诉诸实例、诉诸中庸、诉诸情绪、人身攻击等等。这些都不是科学和有效的论证方式,当然也就无法得到可靠的结论。2)是二派对阴阳内涵的认识不清,未能区分“抽象阴阳”和“具体阴阳”。由于抽象阴阳“所指无定在”,容易“蒙混”,故二派之间的争论,往往也是蒙混不清的。如果能够区分“具体阴阳”,将不难发现,在人体的任何一个属性上,唯有阴阳平衡,才是健康状态,偏阴偏阳,皆属病态。另外,本文还提出四种假说,来解释为何两种相反的意见能够常期并存：(1)病人正反馈说。(2)病人选择说。(3)师承授受说。(4)同病异治说。下篇讨论了与阴阳相关的三个重要概念：气、四象和五行。相对上篇和中篇来说,下篇相对次要一些。本篇有几个地方值得关注：第7章,讨论气与阴阳相关的问题。第7.2节专门讨论气化学说的气化动力问题。“气化”不会无缘无故的发生,它需要动力,这就是所谓的“气化动力”问题。这个问题,以前很少有学者注意,更没有系统研究。本论文对此问题进行了较深入的探讨。第8章讨论阴阳与四象相关的问题。提出了四季配四象分太少阴阳的两种方式：“正统四象说”和“医家四象说”。因为对阴阳的定义不同,故二者所描述的阴阳变化规律有异。另外,本文还探讨了《内经》五脏与“四象”的两种配属方式背后的逻辑,从而证明,基于“正统四象说”的配属方法更为本源。第9章中,讨论阴阳与五行相关的问题。最值得关注的是有关五行生克内涵的辨析。目前中医学界的主流认识,倾向于把相生定义为促进作用,把相克定义为制约作用。这种定义并不完全合理。相生的涵义有两层：第一层,是时间、空间和属性上的相续；第二层,才是促进作用。相克的涵义也有两层：第一层,是时间、空间和属性上的相离和对待；第二层,才是抑制作用。第一层涵义是本质的、绝对的,第二层涵义则是派生的、相对的。相生强调的是相续和同一,而相克强调的则是相离和差别。正确认识相生相克的涵义,对完善中医基础理论,避免逻辑混乱具有重要意义。更多还原

【Abstract】 Yin and Yang is the core concepts in Basic Theory of TCM, Which was penetrated in all aspects of the TCM theory. This paper studies the theory of yin and yang from three aspects:Part I discusses the nature and mathematical properties of yin and yang. This is the most important part of the paper. We discuss in Four chapters:Chapters1discusses the nature and basic mathematical properties of yin and yang. We first define the basic meaning of yin and yang, then we distinguish concrete Yin and Yang from abstract Yin and Yang. Abstract Yin and Yang is an abstract concept, have no fixed meaning, rather vague and general. Concrete Yin and Yang is of specific properties, have fixed object, with observability, certainty and decidability.Yin and Yang is a relative concept, depend on the existence of each other, and so can be considered as a binary relation. Being a binary relation, Yin and Yang have mathematical properties such as anti-reflexive, anti-symmetry and transitivity.Attributes of an object can be divided into two types:Yang attributes and Yin attributes. Based on this understanding, we discuss the meaning and measurement of deficiency or sufficiency of Yin and Yang.Chapters2discusses six important types of Concrete Yin and Yang in TCM theory in great details.(1) Cold and heat. Cold and heat are two important syndromes of "eight principal syndromes" in TCM, and they are most important two syndromes for TCM doctors in their clinical practice. The meaning of cold and heat in TCM theory include the temperature of climate, cold and heat of the syndromes, as well as the cold and heat of the drugs. Cold and heat sometimes refer to as the objective temperature, but in most cases, they are subjective feelings of the patients or the doctors. The differences between the objective temperature of the patients and their feelings lead to the problems of true-false of cold and heat in TCM theory. The differences between the feelings of different people lead to the paradox on Traditional Chinese Herbalism theory. We also discuss the temperature measurement method in this paper.(2) Position. We discuss four types of Yin and Yang about position:left and right, front and rear, upper and lower, outside and inside. We analysis the Yin and Yang about position with blood left and Qi right theory, male left and female right theory, Qi ascend at left and descend at right theory, and find out many logical problems. We also discuss the mathematical representation of Yin and Yang about position. (3) Flavors and tastes. Flavors and tastes are core concepts of the theory of drug property in TCM. Our research has shown that, there are twelve logical problems in the theory of drug property in TCM. These issues should attract more academic attention.(4) Clear Qi and impure Qi. Clear Qi and impure Qi are core concepts of the theory of TCM. Analogy with buoyancy phenomenon, TCM have a theory of light, clear Qi tend to ascend and weightier, impure Qi tend to descend. This is an important theory of drugs in TCM; Unfortunately, this theory have logical problems. In this section, we discuss the problems in great detail.We also discuss the problems in the Yin and Yang theory of Ying and Wei, Zang and Fu in this chapter.Chapters3discusses Yin and Yang of the set. We give determination method of Yin and Yang of the set. We also discuss the differences and similarities of a whole divided into two and a whole divided into three.Chapters4discusses Yin and Yang of an object. We extended the concrete Yin and Yang from an attribute to an object. We define the concepts of compound Yin and Yang and attribute vector, which were used to describe the integrated Yin and Yang of an object with more than one attributes. We also use the compound Yin and Yang and attribute vector to describe the human health, drug attribute and prescription functionalities.Part II discusses the relation of yin and yang. This is the second important part of the paper. We discuss in two chapters:Chapters5discuss the relation of yin and yang. The relation of yin and yang is the core content of the theory of Yin and Yang. Related researches before are totally vague and general as their researchers haven’t distinguished concrete Yin and Yang from abstract Yin and Yang. We study the subject in four aspect:(1) The relation of yin and yang on a single attribute. We find that the traditional concepts, such as opposing and constraints, mutual root and interoperability, mutual transformation, are relations of yin and yang on a single attribute.(2) The relation of yin and yang between two attributes. Relation between attributes of an object may be positive correlation, inverse correlation, functional correlation or simply irrelevant. So, the theory that "yin grows while yang is generating, yang restrained and yin concealed" is simply a possible positive correlation between a yang attribute and a yin attribute. Also, the theory that "yin is decreasing while yang is generating, yang is decreasing while yin is generating" is simply a possible negative correlation between a yang attribute and a yin attribute. We can’t simply take any one of them as a truth and we need carefully analysis based on concrete conditions.(3) The relation of yin and yang between human beings and the outer environment. Yin and yang of human beings can be synchronously growth and decline with outer environment. They can also reverse ebb and flow with outer environment. Which mean that we need carefully analysis on concrete conditions when we use the theory of yin and yang.(4) The balance of yin and yang. The balance of yin and yang on a single attribute means that the attribute is in a condition of neither deficiency or sufficiency of Yin and Yang. The balance of yin and yang on object A means that all attributes of A are in the condition of balance of yin and yang.Chapters6discusses the debate between Zi yin School and and Fu yang School. We give definition of Zi yin School and and Fu yang School and then we make a detailed discussion on the origins, evolutions, primary physicians and their main points of each school.To sum up, There are three major issues in the two schools’controversy:1) the priority of Yin and Yang.2) The two main diseases, deficiency of Yin and deficiency of Yang, which is more general?3) How to treat the two diseases, deficiency of Yin and deficiency of Yang?Why these issues had been long debated, but cannot be solved until now? We think there are two main reasons for this question:1) The demonstration method is wrong. Ancient TCM physicians solve a controversy usually use such methods:analogy, appeal to authority, resorting to a special case, resorting to moderation, resorting to emotions, or even use personal attacks. These methods are not scientific and so ineffective.2) Neither of them have a clear understanding on the connotation of Yin and Yang. They haven’t distinguished concrete Yin and Yang from abstract Yin and Yang. And so the debate is vague and abstract.We propose four hypotheses to explain why the two opponent schools can coexist in long history:1) the positive feedback of patient.2) The active choice of patient.3) Master’s influence.4) One disease can have multiple treatments.Part III discusses three important concepts related to yin and yang:Qi, Si Xiang and Wu Xing. This is the third important part of the paper. This part has some sections that deserve attention:Chapters7discuss Qi theory. In section7.2, we discuss the motive force of Qi transformation in classical Qi transformation Theory.Chapters7discuss the Si Xiang Theory. Si Xiang is a subdivision of Yin and Yang. There are two method in how Si Xiang match four seasons:1) orthodox Si Xiang theory, which matches spring with Shao yang, summer with Tai yang, autumn with Shao yin, winter with Tai yin. This method was widely used in ancient books.2) TCM Si Xiang theory, which matches spring with Shao yang, summer with Tai yang, autumn with Tai yin, winter with Shao yin. This method was widely used in ancient TCM books. The two methods are based on different view of Yin and Yang and so be reasonable in different ways. Based on the two Si Xiang theories, there are two methods on how the Si Xiang matches with the five viscera in TCM theory. Chapters9discuss the Wu Xing Theory. In this section, our most important devotions are the new interpretation on Xiang-Sheng and Xiang-Ke of Wu-Xing. Current TCM academia tends to define Xiang-Sheng as Mutual generation and define Xiang-ke as Mutual restriction. This definition is not entirely reasonable. Xiang-Sheng has two level meanings:1. Continuous and extend of the time, space and attribute;2. the effect of promotion and facilitation. Xiang-Ke also has two meanings:1. Separation and difference of the time, space and attribute;2. the effect of suppression and obstruction. The first meaning is essential and absolute; the second meaning is derived and relative. A correct understanding of the meaning of Xiang-Sheng and Xiang-Ke has significance effects on avoiding logical confusion and improving the basic theory of TCM.更多还原