古脉诊法的演变及与针灸的关系

【作者】 郑志杰；

【导师】 李志刚；

【作者基本信息】 北京中医药大学 ， 针灸推拿学， 2008， 博士

【摘要】 古脉诊法指的是从我们发现的最早的脉诊法以来至《脉经》成书之前的时期,人们诊治疾病时所用的脉诊法。自《脉经》以降,人多只知有寸关尺分候脏腑的寸口诊法。但《脉经》的寸口诊法又一直受到历代医家的质疑,不同医家在运用此诊法时,对六部分候脏腑的理论又有不同的理解,对疾病的解释也是百花齐放,莫衷一是。重温经典,我们发现经典古籍中蕴含着许多当时就已广泛运用的古脉诊法,如《黄帝内经》中还有十二经遍诊法、三部九候法、人迎寸口诊法等,《伤寒杂病论》还有趺阳诊法、少阴诊法,而《难经》的寸口诊法与《脉经》之寸口诊法也有明显区别。另外,在一些非医学典籍中也发现了一些古医家运用的脉诊法,在一些托名所作而未明作者的医学著作中也可见到当时医家的脉诊特点。本文试图勾勒出一幅关于脉诊法的发展与演变的较为细致的曲线,并探讨脉诊法的演变对针灸的影响,以期从脉诊法的演变过程中找到最适合针灸的脉诊法,完善针灸的诊治体系。笔者研究认为脉诊在中医的早期即已产生,起源于对全身经脉的检查。然而更准确地说,应当是对血脉的检查。脉诊在此后不同时期各有不同的特点。早期的脉诊法是与望诊密不可分的。马王堆医书时代采用的是原始的遍诊法,对脉的检查应当不仅有手指的触诊,而且人们通过眼睛观察到了脉动与络色。这一捆绑诊断方法延续到了《内经》时代,不但有色脉合诊,还有寸(口)尺(肤)合参。但自《内经》开始,脉诊法已经逐渐独立出来。如《内经》中的三部九候诊法与人迎寸口诊法就是单纯诊脉动,而没有掺入诊络脉了。《内经》的脉诊法都是对比诊法,其中最重要的是人迎寸口诊法。笔者在《史记·扁鹊仓公列传》及《脉经》中发现扁鹊脉法的部分特点,认为扁鹊脉法重视时间因素。仓公诊法仅在《史记·扁鹊仓公列传》中见到,其采用的应该是寸口诊法,诊断的依据是脉象。《难经》脉法是在四维时空背景下诊察脉象的诊法,在笔者看来是所有脉诊法中最完善的诊法。在四季基本脉象的基础上,根据寸尺、脉位的上下浮沉、脉象的微甚的阴阳辨证做出诊断,并配套相应的针法,形成一个理、法、方、术有机结合的诊治体系。仲景脉法则是张仲景将医经家的脉诊法引入经方家的辨证之中,张仲景勤求古训,博采众长,所运用的寸口脉诊法很好的保留了古脉诊法的精华。此外,张仲景还发展了趺阳脉法、少阴脉法。《脉经》为西晋王叔和编撰,收录了一些古脉诊法,包括脉法赞脉法、四时经脉诊法、奇经八脉脉诊法,但都比较简略。但王叔和对其中“脉法赞”脉法的发挥所形成的寸口诊法成为了后世脉法之源。由于人们的理解不同,对寸口分候脏腑的争论一直没有停息。在脉诊演变的过程中,从遍诊法到人迎寸口对比诊法是一次理论的大胆改进。肺经与胃经皆赖胃气的推动,二者一源二歧,息息相关。这是产生人迎寸口诊法的哲学理论和内在机理。独取寸口诊法的形成是更大的一次理论突破,其产生的根本原因是十二经脉循环流注理论。后世脉法替代古脉诊法成为脉诊法主流主要是由于《脉经》的影响力。在寸口诊法中,寸关尺的分配以难经的方式最为合理。关于脉诊与针灸的关系,笔者认为内、难二经论述最详。《内经》时代最重视脉诊对针灸的指导,脉诊贯穿了针灸的整个过程,一直发挥着指导作用。扁鹊根据时间与脉象、仓公根据症状针刺。《难经》独重五输穴,根据阴阳脉诊判断虚实,以五行针法补虚泻实,二者配合默契。张仲景、华佗及此后的王叔和多为方药,少用针灸,但多以症状结合脉象判断阴阳证候与虚实证候,仍遵阳证宜针、阴证宜灸及补虚泻实的基本原则。更多还原

【Abstract】 The ancient pulse-taking methods mean those pulse-taking methods utilized in diagnosing and treating disease during the period from the oldest one we found to the outcome of the book ’Mai Jing’ . People usually know only the wrist pulse-taking with cun,guan&chi admeasuring different zangfu in ’Mai Jing’. But this method has long been oppugned since its beginning. Different doctor has different apprehension about the theory, which affected different explanations about disease.When recovering the classics, we find that many ancient pulse-taking methods which had been used widely at that time hidden in the books. For example, there’re overall pulse-taking method, three portions and nine pulse-takings, comparing renying pulse and wrist pulse,etc in Huang Di Nei Jing; taking fuyang pulse & taking shaoyin pulse in Shang Han Za Bing Lun. And the wrist pulse-taking between Nan Jing and Mai Jing is quite different. What’s more, the author find some pulse-taking methods of several ancient doctors in non-medical books, some in medical books written by dubious authors.This paper try to figure out a curve about the development and evolvement of pulse-taking methods, and discuss its effect on the acupuncture, thus we can find the best pulse-taking method to fit acupuncture, and perfect the diagnosis and treating system.Through studying, the author draw a conclusion that pulse-taking method came out at the beginning of TCM(Traditional Chinese Medicine). It originated from the checking of pulse in whole body, accurately speaking, including the checking of blood vessel.The pulse-taking method had different characteristic in different periods later.The early pulse-taking method was combined by inspection.During the period of Mawangdui medical books, the pulse-taking method was raw overall pulse-taking method.Doctor checked the pulse not only with fingers but also with eye to see the pulse’s activation and the color of skin. This combining method continued in Nei Jing period. Beside the combining of color-diagnosis and pulse-taking,Nei Jing has also the combining of pulse-taking and chi-skin touching.But the pulse-taking method gradually came to its independence since Nei Jing. For instance, the three portions and nine pulse-takings, comparing renying pulse and wrist pulse were both pure pulse-taking method without the combining of checking others. The pulse-taking methods in Nei Jing are all comparing method, and the comparing renying pulse and wrist pulse were the most important one.The author find some characteristic of Bianque pulse-taking method in ’ the biographies of Bianque and Canggong’ in Shiji and Mai Jing. He considers that Bianque used yinyang pulse-taking method and recognised the time, while the Canggong pulse-taking method can only be seen in ’ the history of Bianque and Canggong’, it shoud be a kind of writst pulse-taking method, and the gist was the pulse condition.Nan Jing’s pulse-taking method was under the background of space-time. In the author’s eyes, it is the best in all pulse-taking methods. On the foundation of basic pulse condition in every season, it draw a conclusion through checking yinyang such as the cun & chi, the site of the pulse, the minor or intensity, and then cooperated with relative acupuncture. Thus organised a diagnosis-treating system combining theory and method.Zhang Zhongjing brought the pulse-taking method from Yijing genre into Jingfang genre. He studied the ancient methods and regarded them, his pulse-taking method keeped the soul of the ancient pulse-taking methods, and it was also a kind of yinyang pulse-taking method. What’s more, Zhang Zhongjing developed the method of taking fuyang pulse and taking shaoyin pulse .Mai Jing was compiled by Wang Shuhe in Xijing dynasty. Wang Shuhe excerpted some ancient pulse-taking method, such as Four-season pulse-taking method and Eight extra-meridians pulse-taking method, but they are all very simple. Wang Shuhe explained the Praise to pulse-taking method ,Which is the origin of aftertime pulse-taking method. But the dispute about the zangfu arranging on the wrist pulse’s sites never came to a conclusion because of different apprehension.During the process of the evolvement of pulse-taking method, it’s a bold amelioration that overall pulse-taking method evolve to the comparing of renying pulse and wrist pulse. The lung meridian and stomach meridian both depend on the push of stomach qi,they come from the same resource, so they are combined together.This is the philosophic theory and inner mechanism. And the forming of writst pulse-taking method is a greater breakthrough in theory, and the ultimate causion of the forming is the theory of the circulationg of the twelve meridians.Nowadays pulse-taking method became the main method of pulse-taking instead of ancient pulse-taking method mainly because of the great influence of ’Maijing’.The distribution of Zangfu on the wrist pulse in Nanjing is the most reasonable.The author regard that Nei Jing and Nan Jing discussed most about the relationship between pulse-taking and acupuncture. Nei Jing most emphasized on the direction of acupuncture by pulse-taking , which go through the whole process of acupuncture. While Bianque acupunctured with the direction of time and pulse condition,Canggong acupunctured with the direction of syndrome.Nan Jing emphasized on the five Shu-points,it judged deficiency and excess by yinyang pulse-taking method,and then reinforced deficiency & reduced excess by wuxing acupuncture, the cooperation of the pulse-taking method and acupuncture were perfect. Zhang Zhongjing , Huatuo and Wang Shuhe used mostly herb and only a few acupuncture. In using acupuncture, they often judged yin and yang, deficiency and excess by syndrome and pulse condition, and abided by the basic principle that yang syndrome shoud be acupunctured and yin syndrome be moxibusted , deficiency shoud be reinforced and excess be reduced.更多还原