【作者】 潘大为；

【导师】 区永欣；

【作者基本信息】 广州中医药大学 ， 中医基础理论， 2008， 博士

【摘要】 研究目的:本研究的目的在于通过对《内经》形神理论内部不同方面的具体问题的研究,揭示《内经》对人的生命活动和精神活动、即对“神”的认识和对“形”“神”关系的认识的丰富层次和多重结构,从而获得对《内经》形神理论的渊源流变和理论本质的更深认识。研究方法:本文采用规范研究和历史研究相结合研究方法,也就是把对《内经》形神理论立论基础、论证逻辑和内部构成等的分析和对《内经》形神理论历史渊源的探索结合起来。选取这种研究方法的依据在于精神现象的研究特点和《内经》作为一个历史时段内(先秦至两汉)的医学文献汇编的篡述性质。研究成果:本文选取《内经》对人的生命活动和精神活动也就是对“神”及“形”“神”关系的认识为研究方向,选取这个大问题的六个不同方面的具体问题为具体研究对象,得出以下的结果:(1)《内经》所认识的外部因素对人精神状态的影响机制,以“酒悖”现象为例。“酒悖”指“怯士”即胆小的人酒后性情暂时改易,貌似“勇士”的现象。《灵枢·论勇》列举了“勇士”和“怯士”的种种形态学差异。分析表明,人的“勇怯”在实际上不取决于藏府形态,而取决于人体气和气机状况,该篇列举的判断“勇怯”的种种形态学指标,实质表征着人体气和气机状况。通过分析酒对人的影响机制表明,酒对人体气和气机的扰动是酒能暂时改变人“勇怯”的原因;脱离气和气机来讨论个别臧府对人精神状态(“勇怯”)的影响,不仅片面,而且直接导致对《内经》形神理论基本立场的偏离。(2)精神活动的生理影响机制,以《内经》对“人之哀而泣涕出”这个精神活动引起的生理现象的三种解释为例。“人之哀而泣涕出”,即为什么人悲哀时会流泪。《内经》对这个现象提供了三种深浅不同的解释。对这三种解释的模式和立论基础的分析展示了《内经》对七情生理影响机制的认识的演变轨迹,反映了早期中医对精神活动的生理影响机制的认识由以“形”的探索为主到“形”“神”并重这一隐晦但重要的转向。《素问·解精微论》对这个现象的解释,是“神”的抽象观念和对人体即“形”的认知结合的产物。(3)神志疾病的病理机制,以《内经》对一种急性发作性神志疾病“巅疾”的怖肀局实牟臀?《内经》对“巅疾”的认识包括三个层面:(一)以气的观念为基础的疾病观。认为“巅疾”的实质在于上部气实,下部气虚,厥气逆上。(二)阴阳观念的引入导致从“辨气机”转向“辨阴阳”。“巅疾”实质在于阴气偏衰,导致阳亢无制。(三)经脉学说的引入导致从“辨气机”转到“归经”再到“归藏”即“辨五藏”。指出逆气上行的通道是特定经脉,即“归经”,通过归经来实现“归藏”,把“巅疾”最终归结为肾病。三种解释并存于《内经》,是《内经》形神理论发展的历史过程的生动体现,也是早期中医理论演变的凝固缩影。(4)神志疾病的病理解释模式,以《素问·宣明五气》“五邪”的解释学为例。这一部分是承接前面对《内经》记载的神志疾病“巅疾”病理解释的讨论而来的。《素问·宣明五气》“五邪所乱”这段有一个问题,即“五邪”之名和其内容、即“搏(抟)阳则为巅疾”等六种病在数目和辨证标准上都存在矛盾。高世栻和森立之对这个名不副实的现象的解释有高下之别,但都体现出五行学说作为一种强力规范的影响。这种影响具体反映为两点:一是“神”。把神志症状的原因从整体性的“气”“阳气”缩小到具体的藏,提供了更确切的病理解释,弥补了气—阴阳辨证的不足,也在“神”和“形”(具体即五藏)间建立了一种具体而密切的联系,把“神”这个抽象概念具象化了。这是引入五行观念的正面效果。二是人体图式。从气和气机辨证依据的是“无中心”的人体图式,气象水一样流布人体,病理解释的重点在于指出气机异常的部位。《内经》对“巅疾”病机的论述所以着重描述部位和气行趋向,就在于病位在这种解释模式里的意义。阴阳辨证是气的辨证和阴阳观念的结合,所以要指出“阴”和“阳”的力量对比及相互关系。《素问·宣明五气》“抟阳则为巅疾”正是例子。五行观念的引入意味着新的人体图式和新的病理解释模式。建在以五藏为中心的、同心圆式的人体图式上的病理解释,重点不在病位,而在把疾病归结到某一个或某几个藏。这正是高世栻和森立之努力要把六种病归结到五藏的根本原因。从气机辨证,从阴阳辨证,从五行五藏辨证,在“巅疾”问题上《内经》主要采用了前两种。明清注家为了把“搏(抟)阳则为巅疾”等六病的病理解释“五行化”而不懈努力,造成这种局面的一个重要原因在于这些医家看待《内经》和中医理论的方式:一是《内经》正典化,二是五行观念教条化。运用历史眼光,摒除这类教条主义的影响,是准确理解《内经》思想的前提。(5)“神”的内部层次及其与“形”的相互关系,以五行学说对《内经》“神”和形神理论的具体影响(即五神藏理论)的内部结构为例。五神臧理论是《内经》形神理论的重要组成部分,把“神”一分为五,对生命现象和精神现象的解释、研究有什么影响?这一部分从《内经》对梦这一精神现象本质的认识入手探讨这个问题。《内经》对梦的认识展示了《内经》对“神”内部层次的认识:《内经》认为梦是病理现象。梦的发生机制归结为两条,一是睡眠时“志意”收摄“魂魄”功能弱化,造成“魂魄”易于散扬,这是梦发生的大前提;二是人体病理状态被处于这种易感、易“飞扬”状态下的“魂魄”所感,形成梦象,这是梦发生的直接原因,也是《灵枢·淫邪发梦》论述的重点。《内经》对梦的这种认识和道家思想“至人无梦”的观点是一贯的。心是“君主之官”,心神在五神里处于中枢地位,但其余四神间的关系历来少被注意。魂魄志意四神间的关系实质即“魂魄”和“志意”的关系。“魂魄”和“志意”构成了一个基本框架,这个框架是《内经》用来解释生命现象和(包括梦在内的)精神现象的重要工具之一:“魂魄”代表人的生命活动和精神活动里比较低级的部分,“志意”则是比较高级的部分。“志意”承上启下,一方面收摄“魂魄”,一方面是更复杂的精神意识思维活动即《灵枢·本神》说的“思”“虑”“智”的基础。“志意”对“魂魄”的收摄作用属于心——准确地说是心神——功能的一部分。人的理想状态是“志意”清明,“魂魄”不散,“精神”抟聚。“志意”蒙昧则“魂魄”失于收摄,“精神”不能抟聚。《内经》重视精神养生、强调“守神”和“形与神俱”的原因,也可以根据对五神内部层次和相互关系的这种认识得到一个比较深入的解释。(6)《内经》对精神现象的分类和解释体系,以《内经》的梦诊学说为例。梦是《内经》感兴趣的精神现象,《内经》有相当篇幅论述梦中境象即梦象的意义。分析表明,《内经》里不存在一个严格的梦象解释体系。《内经》的梦象解释思路主要有两个,一是比象,以《素问·脉要精微论》为代表,二是五行学说的不彻底运用,以《素问·方盛衰论》为代表。《灵枢·淫邪发梦》是两种思路的混合。对这三篇的梦象解释思路及体系的分析显示了《内经》梦诊理论的丰富角度、多歧来源和复杂层次,再次说明《内经》不是教条,不是神秘的天才的创造,而是复杂历史演变的产物。《内经》是静止的,但中医是向前发展的。中医对人的生命活动和精神活动的认识在现代要怎么样发展,本文末章着眼于这个问题,选取脑和“神”的关系这个来自西医的新问题为例子,分析了张山雷、王清任和张锡纯的三种不同做法的得失和启示。研究结论:以上的分析初步地展示出《内经》形神理论的丰富内容和层次,我们把这些内容和层次概括地称为《内经》形神理论的多重结构。包括两个意思:(一)《内经》形神理论的五个层次。从内容上看,影响并决定了《内经》形神理论最终面貌的是以下几个因素:气的观念、经脉学说、阴阳的观念和五行学说。这些因素先后作用,共同造成了《内经》形神理论的丰富层次和多重结构。《内经》形神理论包括以下五个层次:(1)《内经》对人的生命现象和精神现象的探索,是以对“形”的关注、即人体形态学研究作为逻辑上和事实上的起点的。这一点在今本《内经》里仍遗留有少量痕迹。(2)对“形”的研究和气的观念的结合,可以视为《内经》形神理论形成的预备阶段。对“形”的研究在非常早的阶段就和气的观念(气论)结合起来,成为后者在医学领域的运用的一部分,这使得早期中医对人的精神状况及其变化(例如“酒悖”现象)机制的探索没有停留在“形”或者说实体研究上,使得中医很早就脱离了还原论人体观,走上了注重从整体角度研究人及其状态变化(生理的和病理的)的道路。经脉学说作为气论的具体化精确化发展,在《内经》神志疾病病理解释的发展过程中也起了重要的作用。(3)“神”作为解释要素的出现,标志着《内经》形神理论初步形成,标志着《内经》形神理论的第一个层次。和有形的躯体相对的、无形的“神”的出现,表明《内经》对生命现象和精神现象本质的认识不再局限于个别的局部的现象,而有了更宏观更深入的思考和概括。(4)阴阳观念的运用,使得《内经》对精神现象的生理影响(例如“人之哀而泣涕出”现象)、以及神志疾病(例如“巅疾”)的病理本质的解释水平都出现了飞跃,使得《内经》形神理论在深度上大大前进。标志着《内经》形神理论的第二个层次。(5)五行学说的渗透和改造,使《内经》形神理论在体系化方面实现飞跃,标志着《内经》形神理论发展的第三个层次。五行学说在形神领域的具体运用即五神藏理论。五神藏理论把“神”一分为五,分解成为对应五藏的神魂魄志意五神,五神内部又有差等。其积极意义有两个,一是使抽象的“神”具象化,在抽象的“神”和实在的“形”之间建立起了一种具体而密切的联系;二是提供了新的和更确切的神志疾病病理解释模式和对精神活动、例如梦的发生机制的解释。这些更确切的认识,也正是《内经》推重“守神”“形与神俱”、重视精神养生的养生思想的基础。五行学说的进入也有其消极影响,即形式化、教条化倾向。这种消极影响在《内经》里比较隐晦,在后世注家对《内经》的注释里则充分暴露出来。(二)这五个层次的存在方式及其意义这五个层次的内容在《内经》里不是顺次分布的。相反地,它们表现为散见于《内经》各篇的、对形神理论内部不同方面的众多具体问题的具体论述。不同层面、不同角度的认识并存于《内经》,这种情形是《内经》成书和流变的复杂历史过程的有力证明。这种情形正象沉积在地层里的众多化石,随地壳运动叠压,移动,交错,但仍然呈现某种类型分布和演化序列,指示着环境变迁的趋向。所以说,《内经》形神理论的这五个层次,也可以视为是《内经》形神理论由浅到深发展过程的五个阶段。气的观念、经脉学说、阴阳的观念和五行学说这些因素先后作用,推动早期中医形神理论由浅到深、由粗到精、由零散到系统的逐渐发展,并共同造成了《内经》形神理论的丰富层次和多重结构。这种情形是《内经》作为历史产物、文献汇编的篡述性质所内在地决定的。这个性质决定了《内经》内部隐含的时间维度,也决定了运用历史眼光,把历史观念和规范研究相结合,对于研究《内经》、理解《内经》医学思想来说十分必要。《内经》对“神”、对形神问题的认识,是多层次多角度认识的累积和互相结合。这种情形揭示了中医学“形神合一”思想和中医整体观的丰富内涵和层次。不论是以气论为基础的人体图式、以阴阳观念为基础的人体图式还是以五行观念为基础的人体图式,都是从宏观的、整个人体的高度来探讨人体生理病理现象;它们以复杂的方式结合起来,共同构成了《内经》对“神”、对形神问题的深入认识和丰富洞见。更多还原

【Abstract】 Aim:This study was undertaken to show the rich content and context of understanding of human vitality and mental activity i.e.spirit of Chinese medicine in Yellow Emperor’s Canon of Internal Medicine and the clue to early evolution of Chinese medicine.Methods:The study is a combination of normative study and historical study,which means to unite method of systematic analysis i.e.analysis of the argumentation and mechanism of the ides of Spirit and the theory of integration of Body and Spirit with the method of philology and history focused on specific idea, physiological and pathological phenomena and correspondent explanation and paradigm.Results:The study concludes a series of related issues on which analyses were carried out and resulted asfollows:Issue 1 is the mechanism of external factor influencing human character i.e.mental condition exampled by "drunken stupor".This chapter focuses on the physiological basis of human courage and its changes caused by alcohol recorded in Miraculous Pivot.Analysis of alcohol’s functional mechanism attributes alcohol’s capacity of filling a coward with provisional bravery to its influence on Qi and Qi-transformation.Furthermore, researchers should owe human courage/cowardice to no specific organ(s),but Qi and Qi-transformation of human body,which was represented by anatomical indexes of courage/cowardice specified in Miraculous Pivot.An instance from Zhang Jiebin shows that argumentation on relation between anatomy and mentality leads to partial explanation inevitably without considering Qi and Qi-transformation.Issue 2 is the physiological effect of mental activity exampled by explanations of "sorrow brings tears". Aiming at absolute understanding of the explanative theory about seven emotions and their physical effects in Chinese medicine,this chapter focus on the similarities and differences among three explanations of "sorrow brings tears" in Yellow Emperor’s Canon of Internal Medicine.According to analysis on theoretical modes and acknowledge basics of the three explanations,the track of early-period evolution of Chinese medicine was uncovered which developed from physical-orientated to physical-idealistic-orientated gradually.Especially,it is argued that how the physical study and the idea of Spirit were integrated to reach an improved explanation..issue 3 is pathological mechanism of a kind of mental disease epilepsy.There ate three types of explanation of epilepsy in Yellow Emperor’s Inner Canon.The explanation of epilepsy in the Yellow Emperor’s Inner Canon includes three types.The first is regarding epilepsy as upper body exuberance and lower body vacuity which based on the idea of qi and similarity between epilepsy and reversal pattern.The second is developed explanation of hyperactivity of yang due to yin vacuity,which is the result of the introduction of the idea of yin and yang.The third is channel entry according channel theory and corresponding treatment of acupuncture,which connect epilepsy with kidney.The rich implication of the explanation shows the early evolution of Chinese medicine and the inner characteristic of it.Issue 4 is explanative mode of mental disease exampled by the hermeneutical problem of "five evils".Chapter 4 focuses on hermeneutics of"five evils" e.g."gathering of yang causes epilepsy".There is a strange contradiction between the name of "five evils" and its content which includes six kinds of diseases.Analyses of two explanations of the contradiction show the double effect of the theory of five elements as a new strong norm to Chinese medicine-- positive and negative:Positive effect:The application of theory of five elements in mental pathology leads to more exact explanation of mental disease and more specific relation of Spirit and Body.Furthermore,the entering of theory of five elements changes the paradigm of research of human from equalized mode to focused mode.Negative effect:There are two related preconceptions which are side-effects of the theory of five elements,which influenced the interpretation of the Yellow Emperor’s Inner Canon seriously and negatively:Dogmatizing the Yellow Emperor’s Inner Canon;dogmatizing the theory of five elements. Dogmatism due to the blind obedience to Yellow Emperor’s Inner Canon and prevents people to realize the fact that Yellow Emperor’s Inner Canon is historical assembly and demands historical study correspondently.Issue 5 is the inner mechanism of "Spirit" and its relevance to the "Body" exampled by the effect of the theory of five elements to the theory of Spirit in Chinese medicine i.e.the theory of five spirits.Study on dream in Yellow Emperor’s Inner Canon shows the innate gradates and interrelations of five spirits.Dream is regarded as pathological phenomena in Yellow Emperor’s Inner Canon.Will and reflection are the governor of the ethereal soul and corporeal soul.The government is weakened and the ethereal soul and corporeal soul are vulnerable in sleep.Pathological factor leads the condition of the ethereal soul and corporeal soul to float which is reflected in dream.The idea of dream’s mechanism in Yellow Emperor’s Inner Canon is correspondent to the idea that ideal man does not dream in Taoism.The ethereal soul and corporeal soul are primary part of human vitality and mental activity i.e.spirit. Will and reflection are higher part of spirit governing them and the basis of the most complicated mental activities,which is the reason why will and reflection are regarded as representative of spirit at all.Heart spirit supervises will,reflection,the ethereal soul and corporeal soul totally.It is explained by the innate gradates and interrelations of five spirits that why spiritual health care and congruence of body and spirit are valued in Yellow Emperor’s Inner Canon and Chinese medicine.Issue 6 is the classification and interpretative system of mental phenomena exampled by the dream-diagnosis theory of Yellow Emperor’s Inner Canon.Analysis shows that there is no exact classification and consistent logic and integrated system of dream interpretation but two different interpretative systems coexist in Yellow Emperor’s Inner Canon: Analogy and incomplete application of the theory of five elements in dream interpretation.The fact that Yellow Emperor’s Inner Canon is multi-originated and composed complicatedly is revealed by the way the two systems coexist and combine.Yellow Emperor’s Inner Canon is still,whilst Chinese medicine develops.The last part of this study examples and analyzes three opinions on the relation between spirit and brain as a prospective study on how Chinese medicine deals with challenge from western medicine.Conclusion:1.Studies above mentioned unfold the fivefold mechanism of the theory of Spirit and the integration of Body and Spirit in Yellow Emperor’s Inner Canon.Substantial factors influent the outlook of the theory of Spirit and the integration of Body and Spirit in Yellow Emperor’s Inner Canon are:the idea of qi;the channel theory;the idea of yin and yang;the theory of five elements.Theses factors acted on the study on human vitality and mental activity successively and formed the theory of Spirit and the integration of Body and Spirit in Yellow Emperor’s Inner Canon in common,which contains five gradates as follows:(1)The research on human vitality and mental activity begins with empirical study i.e.study on Body both actually and logically,which remains some indications in Yellow Emperor’s Inner Canon.(2)The combination of empirical study and the idea of qi is the preparation for the theory of integration of Body and Spirit to form.Empirical study combined with the idea of qi in early stage in Chinese medicine and was integrated as a part of its application in the field of medicine,which promote regarding the human body as a whole and the study on human vitality and mental activity e.g."drunken stupor" of Chinese medicine away from simple empirical study and reductionism.The channel theory performed as an important role in the development of pathological explanation of mental disease which can be regarded as improved and specified theory of qi.(3)Spirit occurs as a interpretative element indicates the theory of Body and Spirit of Yellow Emperor’s Inner Canon come into being and the first gradate of it.Invisible Spirit oppose the visible Body lead the study on human vitality and mental activity apart from local phenomenon to deeper and macroscopic viewpoint.(4)The application of the idea of yin and yang indicates the second gradate of the theory of Body and Spirit.in Yellow Emperor’s Inner Canon.The application of the idea of yin and yang improved the explanation of mental activity’s physiological effect and mental disease in Yellow Emperor’s Inner Canon.(5)The reconstructive power from the theory of five elements indicates the third gradate of of the theory of Body and Spirit.The application of the theory of five elements in the field of medicine is the theory of five spirits which divides Spirit into five segments corresponding to five viscera.The five spirits are not equal but in a rank according to their respective intension.The positive effects of the theory of five spirits are:first,it specified the abstract ides of Spirit and set exact and close relationship between Spirit and Body;second,it supplies more specific explanative mode of mental disease and more specific explanation on mental activity e.g.dream,which are the basis of the health cultivation viewpoint of Chinese medicine emphasizes on "guarding Spirit" and the congruence of body and spirit.The negative effects of the theory of five spirits are formalism and dogmatization which reflect obscurely in Yellow Emperor’s Inner Canon and obviously in the interpretation of Yellow Emperor’s Inner Canon from later scholars.2.Significance of the fivefold mechanismThe five gradates are not arranged in order but reflect in arguments of specific issues distributed in Yellow Emperor’s Inner Canon.We can draw an analogy between the fact that viewpoints in various perspectives about human vitality and mental activity coexist in Yellow Emperor’s Inner Canon with fossils deposit in layers in a long term,which accumulate,move and overlap but take on some type distribution and evolutionary series nevertheless,which is the reason why the fivefold mechanism above mentioned can be regarded as five stages of the evolution of the theory of integration of Body and Spirit in Yellow Emperor’s Inner Canon.too.It was decided that the fivefold mechanism and its appearance of the theory of integration of Body and Spirit by the fact that Yellow Emperor’s Inner Canon is time-orientated itself.It is necessary to study Yellow Emperor’s Inner Canon with the insight of history combined with normative study.更多还原