【作者】 马力群；

【导师】 许能贵；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2009， 博士

【摘要】 艾灸疗法是我国传统针灸医学的一个重要组成部分,而医案则是古今中医临床家们灵活地将中医理论应用于临床的一种智慧的结晶,历代的艾灸疗法医案是艾灸疗法发展过程中凝结的精华,能够集中体现各个时期艾灸疗法理论及临床发展水平,能够体现艾灸疗法在各科疾病中的诊治规律。在艾灸疗法医案的收集上,对清代及清代以前艾灸疗法医案的收集本着全面的原则,以彭建中主编的《中国古今医案精粹选评》所附录的《历代医案书目提要》为基础进行收集;而对于现代艾灸疗法医案,则本着精选的原则,在现代著作的选择方面,只选取新中国成立以后较有代表性的灸疗专著两本,一本为医家周楣生所著的《灸绳》,一本为医家谢锡亮所著的《谢锡亮灸法》作为重点研究对象,此外还选取发表于学术期刊中较有代表性的文章作为研究材料,以弥补研究中的不足。在收集整理基础上总结艾灸疗法医案中所体现的历代艾灸疗法在不同时期的发展特色;总结艾灸疗法医案中所体现的中医常见疾病灸疗规律;总结医案所涉及的一些艾灸疗法中较有争议性问题。其目的在于:对典型艾灸疗法医案进行系统的整理;归纳艾灸疗法的发展历程,为艾灸疗法的发展提供参考;从分散的材料中找出其中共性,提炼临床思维方法,为提高临床水平及开拓科研思路提供宝贵的材料;吸取理论应用于临床的经验,促进艾灸疗法理论水平的提高。对历代典型艾灸疗法进行整理、归纳和研究,得出了下面结果:一、从艾灸疗法医案在各个历史时期所出现的数量和学术价值等方面得出艾灸疗法的发展规律:(1)晋唐时期没有艾灸疗法的医案流传,可以说,晋唐时期是艾灸疗法理论的探索、发展和完善期。这一时期所作的积累,对后来宋代艾灸疗法的发展做出了很好的铺垫。(2)宋代是艾灸疗法高度发展的时期。出现了一批以王执中、窦材等为代表的艾灸疗法专家。宋代的艾灸疗法医案显示,当时的医家运用艾灸疗法治证相当广泛,医案内容涉及内、外、妇、儿各科。(3)金元时期是理论与实践进一步融合的时期,这一时期,医家开始对艾灸疗法进行反思。(4)明代的内科灸法更加重视脉诊、辩证和与其它如针、药、熨等治疗方法相结合,各取所长,治疗更加灵活。而在外科灸法方面,更加重视得气,并发展隔物灸法。(5)清代中期以后,统治者阻碍针灸医学的发展,使得清代艾灸疗法医案在数量上较明代有较为明显的减少,但在辨证思路及创新性上都显示了其成就。(6)民国时期,一方面,民国政府阻碍针灸医学发展,而另一方面,热爱中医事业的有志之士,为保存和发展针灸医学而积极奔走。(7)1949年中华人民共和国诞生。在党中央的深切关怀和人民政府的大力支持下,针灸医学得到了普及和提高,艾灸疗法医案在数量上和质量上都有了突飞猛进的进展。二、通过对内、外、妇、儿、五官各科艾灸疗法医案的整理,得出如下艾灸疗法在各科常见疾病中的应用规律:(1)内科疾病主要整理及研究艾灸疗法在水肿、哮喘、虚劳、肺痨、汗症、痞满、中风、腰痛、泄泻、疟疾、流行性出血热、乙型肝炎等疾病当中的应用。从内科艾灸疗法医案来看:水肿的治疗常选择水分穴及使用温补脾肾法以化气行水;哮喘的治疗依虚实的不同分别采用温补脾肾和理气化痰之法;虚劳的治疗,常用穴位为关元、气海、膏肓、足三里等;膏肓穴是艾灸疗法治疗肺痨的常用有效穴,血愁穴为治疗肺结核的经验穴,癸亥日亥时灸腰眼治疗肺痨有效;汗证的艾灸治疗,根据症状和起病原因,主要从心、脾、肾论治,依法选择不同经络上的穴位进行治疗;痞满的艾灸治疗从脾胃入手,需分清虚实,分别采用补虚和泻实的方法;腰痛的治疗以温肾强腰为出发点,常选择肾俞、督脉穴位及神阙及脐周穴位治疗;泄泻的艾灸治疗以分利小便、升阳举陷为主要原则;通过补虚、健脾来治疗疟疾是艾灸疗法在疟疾治疗上的优势;流行性出血热:主要总结现代艾灸家周楣声在艾灸治疗流行性出血热方面的贡献;乙型肝炎:主要总结现代艾灸家谢锡亮在艾灸治疗乙型肝炎方面的贡献。(2)外科疾病主要整理及研究艾灸疗法在疮疡(包括疔疮、痈、发背、瘰疬)、脱疽、痔疾、虫兽伤等疾病当中的应用。主要采用局部取穴,直接或隔蒜、豆豉等材料艾灸疮口,以达到温通气血、拔毒外出的效果,促进伤口的愈合。(3)妇科疾病主要整理及研究艾灸疗法在女性产后血晕、胎位不正、崩漏、痛经、妇女乳房病症等疾病上的应用。从艾灸疗法医案来看:产后血晕的实证以行血逐瘀为主,虚症以益气摄血为主;艾灸至阴穴可纠正胎位,也可治疗胎位不正所引起的难产;崩漏的艾灸治疗以温补脾肾为主,隐白穴、断红穴为艾灸治疗崩漏的有效穴;艾灸疗法对寒凝胞宫所致的痛经效果最好;对于乳房疾病,乳痈的治疗以清热散邪为主;乳癖的治疗以疏肝健脾、软坚散结为主;乳痨的治疗以调理肝肾、理气化痰为主;乳岩的治疗以扶正祛邪为主。(4)儿科疾病主要整理及研究艾灸疗法在小儿遗尿、惊风、水痘等疾病上的应用。小儿遗尿的艾灸治疗以补肾固摄、补肺健脾为主;小儿急惊风多从心论治,慢惊风多用温补法;艾灸疗法多针对小儿水痘恶候,于患处作隔蒜灸,起到拔毒外出的作用。(5)五官科疾病主要整理及研究艾灸疗法在牙痛、鼻衄等疾病上的应用。牙痛的艾灸治疗常选择手阳明大肠经的穴位,吕细穴是艾灸治疗龋齿的经验穴;鼻衄的艾灸治疗常选择头部督脉或足太阳膀胱经的穴位,也可选择手阳明大肠经的穴位。三、通过相关医案的整理,从医家实践经验的角度出发,对艾灸疗法较有争议的几点问题进行研究:(1)误灸:对脉象不平者、火气盛者、阴虚挟热者、年少气弱者,不宜使用艾灸疗法。当出现灸误引起变症时,可用养阴清热药进行补救。(2)热证是否可灸:艾灸疗法医案用事实证明热证可灸,但这是建立在辩证准确、治疗方法得当基础上的。如有必要,可与其他中医治疗方法同用。(3)艾灸壮数及艾炷大小:大补元气者艾炷宜大,壮数宜多;病位较深者宜多灸,较浅者不宜多灸;急症施灸不计壮数;头不宜多灸。(4)补泻:清代及清代以前医案中没有涉及艾灸补泻手法。现代艾灸家周楣声将《黄帝内经》中所描述的补泻手法应用于临床,取得理想效果。(5)灸疮:化脓灸为古代常用的艾灸方法,古代医家认为化脓灸可达到一定的治疗量。但由于会引起剧痛及留下疤痕,现代临床治疗不常用。灸疮的愈合情况可作为疾病预后的参考。医案中还涉及灸疮的调护方法。综上所述,艾灸疗法医案作为灸疗文献的一个重要组成部分,具有很高的研究价值。不同时代流传下来的艾灸疗法医案会带有较为明显的时代烙印,能够体现当时艾灸疗法理论和临床发展水平。不同医家的医案能够体现医家的临床思路,在这些医案中,还出现了许多医家使用灸法治病的独特方法和经验,另外,从古今各科艾灸疗法医案中可以总结出对同一疾病,不同医案在辩证施治上的相通之处,体现了艾灸治疗的规律性,具有较高的参考价值,值得在临床和科研方面作进一步的探索和研究。艾灸疗法医案是艾灸疗法应用于临床的实践证明,通过这些实践,可以进一步论证艾灸疗法理论,并且帮助解决艾灸疗法长期存在的一些有争议性的问题。更多还原

【Abstract】 Moxibustion is an important component of Acupuncture and Moxibustion in Traditional Chinese Medicine(TCM),while case histories are the wisdom of clinical practitioners,who integrated TCM theory and practice effectively. Moxibustion case histories can reflect the level of Moxibustion theory and practice development in all ages,and the therapy pattern of Moxibustion used in different kind of diseases.The moxibustion case histories,which is created before and during Qing dynasty,were collected in an all-round manner.The rule is based on the <Bibliographical Summary of Case Histories in All Dynasties>,the addendum of <Selection and Comment on Case Studies of Ancient and Modern Chinese Medicine> edited by Peng Jianzhong.For those created in modern time,are well chosen.As a result,two monographs are selected as the major study object. They are <Moxibustion Rules>(edited by Zhou Meisheng) and <Xie Xiliang Moxibustion Therapy>(edited by Xie Xiliang).In addition,some representative medical literatures that published in professional periodicals are chosen as supplementary.The objectives of this paper is to collect and arrange typical moxibustion cases,generalize developing process of moxibustion,provide useful experience and lessons for moxibustion development,find the general characteristics of moxibustion treatment,extract the clinical thinking and valued materials for clinic and scientific research,to apply theories to practice and eventually improve the moxibustion theoretical level.On the basis of case collection,the paper would summarize the moxibustion development distinctness at different stages,the moxibustion therapy regulation to common diseases and some controversial questions that those cases dealing with.After the collection、analysis and study of classical cases,the result shown below:1、Investigate the pattern of moxibustion development from quantity and academic value of moxibustion cases in all ages:●There is no moxibustion case was descended from Jin and Tang dynasty, this is the stage of theory exploration、development and improvement. Experience accumulation in this stag is of benefit to moxibustion development of posterity.●Moxibustion was high developed in Song dynasty.Some specialist in moxibustion such as Wang Zhizhong and Doucai were born.Cases showed that moxibustion was used to treat a wide range of disease,involving department of internal medicine、surgery、gynecology and pediatrics.●Jin and Yuan dynasty is a stage that moxibustion theory and experiment were blended together further.Practitioners began to reflect upon moxibustion.●In the Ming dynasty,moxibustion in internal medicine placed importance on pulse diagnosis、zheng differentiation-treatment,and used moxibustion together with acupuncture、traditional Chinese medicinal herbs and rubbing hot medicated compress as treatments, using their excellences.For surgical disease,moxibustion accords importance to needling response and indirect moxibustion.●During the mid-and-late Qing dynasty,the government held back moxibustion development.Caused a reduction in the amount of moxibustion case studies.However,the achievement in zheng-differentiation and creativity was obvious.●During the period of the republic of china,the government held back the development of acupuncture and moxibustion.On the other hand, persons with lofty ideals that devoted to traditional Chinese medicine worked for reservation and development of acupuncture and moxibustion.●After the founding of the People’ s Republic of China in 1949,with the deeply concern from the Party’ s Central Committee and supports from the government,acupuncture and moxibustion have been popularized and improved.Quality and quantity of moxibustion cases studies have made an enormous progress.2、After the collection of moxibustion cases that belong to department of internal disease、surgery、gynecology and pediatrics respectively,come to a conclusion about law of moxibusion usage:(1) Department of internal diseaseMainly collect and study the usage of moxibustion in edema、asthma、deficiency、consumption、hidrosis syndrome、stuffiness in chest and abdomen、apoplexy、lumbago、diarrhea、malaria、epidemic hemorrhagic fever(EnF) and hepatitis B(HB).From the cases,we found:Adding heat moxibustion to Shuifen(RN9) is often used to treat edema,pyretic tonification of spleen and kidney to resolve qi and move water is a commonly used method;In accordance with deficiency or excess to asthma,the treatments are pyretic tonification of spleen and kidney, regulating qi to dissipate phlegm respectively;Guanyuan(RN4)、Qihai(RN6)、Gaohuang(BL43)、Zusanli(ST36) are commonly used in the moxibustion treatment of deficiency;Gaohuang(BL43) is the effective acupoint to consumption’s cure with moxibustion and Xuechou is an experience acupoint,adding heat moxibustion to Yaoyan at 9 to 11 o’ clock at night on Gui-hai day is an effective method in the treatment of pulmonary tuberculosis;Moxibustion to hidrosis syndrome,according to symptom and pathogeny,is mainly treated from the heart, from the spleen and the kidney,chose acupoints on the three lines(the heart Channel of Hand-Shaoyin、the spleen Channel of Food-Taiyin and the kidney Channel of Food-Shaoyin) respectively;Moxibustion to stuffiness in chest and abdomen should start with regulate spleen and stomach,should separate excess and deficiency,threat with moxibustion reinforcement and reduction;Warming the kidney and strenthening the waist is the point of departure to therapy of lumbago,moxibustion chose Shenshu(BL23)、acupionts of Du Channel and acupoints around the navel;Diuresis,ascending up yang and rise descents are chief principles to diarrhea moxibustion;By reinforcement and strengthening the spleen to cure malaria is an advantage in moxibustion;To EHF,mainly summarize the contributions of moxibustion specialist Zhou Meisheng to EHF moxibustion;To HB,mainly summarize the contributions of moxibustion specialist Xie Xiliang to HB moxibustion.(2) Department of SurgeryMainly collect and study the usage of moxibustion in pyocutaneous disease (include furuncle、carbuncle、carbuncle of the back、crewels)、gangrene、haemorrhoids、injury by animal.Selection of nearby points is commonly used, moxibustion directly or indirectly separate by garlic、lobster sauce on the opening of sore,the treatment effects are warming and smoothing qi and blood、take poison out,promote the wound healing.(3) Department of GynecologyMainly collect and study the usage of moxibustion in postpartum anemic fainting、malposition、uterine bleeding、algomenorrhea and diseases of breast.The moxibustion cases showed:promoting blood circulation by removing blood stasis is the chief therapeutic principle to sthenia syndrome of postpartum anemic fainting,and supplementing qi to control blood is used to the asthenia syndrome;Add heat moxibustion to Zhiyin(BL67) could correcting the position of fetus,and could cure dystocia that caused by malposition also; To the therapy of uterine bleeding mainly use the principle of pyretic tonification of spleen and kidney,Yinbai(SP1) and Duanhong are effective acupoints to uterine bleeding moxibustion.Moxibustion is more effective to algomenorrhea caused by coagulated cold in uterus;To the therapy of breast diseases,heat-cleaning and pathogen-eliminating is the main principle to mammary abscess moxibustion;Dispersing the depressed liver-energy and strengthening the spleen、soften hard lumps and dispel nodes are the main principles to hyperplasia of mammary glands moxibustion;Regulating the liver and kidney、regulating qi to dissipate phlegm are the main principles to tuberculosis of breast moxibustion;Strenthening healthy qi to eliminate pathogens is the main principle to mammary carcinoma moxibustion.(4)PediatricsMainly collect and study the usage of moxibustion in infantile enuresis、infantile convulsion、varicella.Tonifying kidney to reduce urination、strengthening the lungs and spleen are the main principle to infantile enuresis moxibustion;Acute convulsion is mostly treated from the heart,chronic convulsion is mostly treated by warm tonic method;moxibustion mainly treat the severity of varicella,garlic moxibustion on the opening of sore to take poison out.(5) OtorhinolaryngologyMainly collect and study the usage of moxibustion in toothache and nosebleed.Moxibustion to toothache mainly chose the acupoint of the Large Intestine Channel of Hand-Yangming;Lvxi is an experience acupoint. Moxibustion to nosebleed often chose the acupoints of Du channel on the head or the acupoints of the Urinary Bladder Channel of Foot-Taiyang,usage of the acupoints of the Large Intestine Channel of Hand-Yangming is another effective way.3、By the collection of moxibustion cases,in the point of view of practical experience of practitioner,study some controversial questions of moxibustion:●Moxibustion Mistreatment:moxibustion is not suitable to the patients who have irregular pulse,who have extra fire-qi,who have the syndrome of asthenic yin causing excessive pyrexia,who are young and weak.If negative consequences are caused,Chinese medicine of eliminating heat by nourishing yin can be used as a redemption.●Whether moxibustion can treat pyretic syndrome or not:the evidence from moxibustion cases show that moxibustion could be used to pyretic syndrome if and only if the overall analysis of the illness and the patient’s condition are correct.If necessary,moxibustion could be used with other treatment of chinese medicine.●Number and size of the moxa corn:The moxa corn should be big to great nourishment of renal qi;it need more moxa corn for the illness at inner position,and less for illness at shallow position;To emergency cases, use moxibustion until it is relieved;Use less moxa corn on head.●Reinforcing and reducing method:there is no moxibustion cases about reinforcing and reducing method in the books before and during the Qing dynasty,modern moxibustion expert Zhou Meisheng make reference to the description of reinforcing and reducing method in <The Yellow Emperor’s Inner Canon of Medicine> and use them in clinic.The curative effect is good.●Sore caused by burning moxa corn:The ancient practitioners believed that festering moxibustion could get enough amount of cure.But this method accompany with acute pain and sore,so it is not commonly used in modern clinical therapy.The recovery of the sore suggest the prognosis of disease.There are some nurse methods to the sore are found in the cases.To sum up the above arguments,moxibustion case history is the important component in moxibustion document and have high research value.Moxibustion cases in different periods have the distinct brand of the stage,and mean the theoretical and practical development level of moxibustion in different periods.Cases of different practitioners could reflect the different clinical thinking.In these cases,we could found some peculiar ways of treatment and effective acupoints that used in moxibustion.Meanwhile,there is similarity in clinical analysis found in various cases when encountering an identical disease.It is worth to have further works on the exploration in clinical and scientific research.Moxibustion cases are the proofs of moxibustion usage to clinical.By the practical experiences, the moxibustion theory is demonstrated and the controversial questions,which exist for a long time,are resolved.更多还原