【作者】 李素云；

【导师】 赵京生； 黄龙祥；

【作者基本信息】 中国中医科学院 ， 针灸推拿学， 2009， 博士

【摘要】 明清西学东渐时期,是我国历史上一个重要的转型阶段。明末清初和鸦片战争以后的两次西医东渐,打破了中医学原本封闭、独立的发展空间,西方解剖生理学知识和方法对中医学的发展产生了一定影响。中西汇通中,医家和学者开始参照西医知识,重新认识和阐发传统中医理论,引发了中医学术内部的重要变化,成为促使中医由传统形态向近现代演变的主要原因。针灸学是中医学的组成部分,同样经历了这一特殊转变时期,考察其在这一时期的发展状况以及对当代针灸学产生了怎样的影响,是理清针灸学术发展脉络的重要课题。以往的研究较少关注这方面,尤其对明清针灸理论和人们对其认识的变化,从未有过专门、系统的梳理,而这正是本文所关注的内容。因此,本研究属于首次系统研究明清西医东渐背景下,人们如何认识和解读传统针灸理论,分析其对后世产生的影响,总结期间人们认识、传承针灸理论的经验和教训。本研究首先对明末清初与鸦片战争以后两次西医东渐的背景做了简要回顾,并分别考察了其对中医学产生的主要影响,以及接受西医的代表医家及其相关著作。研究表明,针灸学中的经络理论是明清医家中西汇通时较早关注的内容之一,西医东渐对针灸学的影响,主要体现在参合西医知识,对经络理论进行了有别于传统的解读和阐释,对经络理论的理解和认识发生了明显变化。这些变化主要集中于中西汇通的综合性医籍中,针灸专著中尚未见体现,这可能是由于当时针灸医家较少受到西医影响,或是有受影响的针灸医家也未见相关著述。明清中医医家中受西医影响较大,并参合西医解剖生理知识,对经络理论进行阐发的有:王宏翰、王学权、王清任、陈定泰、唐宗海、朱沛文等代表医家。王宏翰在《医学原始》中阐释经脉时兼采了许多西学知识,是中医著作中最早受西医影响的经脉观念,他较认同经络理论与血液循环两者之间的联系,从胚胎血络、脉络的发育解释经脉的发生与形成,采用动静脉血管阐释经络形质,并明确经络运行西方四液中的血液,将西医心血运动论与经脉营卫运行相结合。王学权认为西医解剖对人体结构的论述很详细,但经络偏于气化功用,不能对应于尸体解剖所得“有形之死质”,而其孙王升则比较注重脏腑经络的解剖形态。王清任在解剖观察尸体时见动脉管中无血,误认为动脉只行气,为“气管”,并误认为人体气、血运行分成两大系统,经络是气管,又称卫总管,属于行气系统,由“丝络”、“阳络”、“经”、“卫总管”、“气管”等组成,并按表里次序相互贯通,沟通内外。清代学者也有一些类似的错误认识,如:俞正燮认为经与络分别是脉络与血络;胡琨也认为营、卫分别对应血络、脉络。陈定泰受西医解剖实证思维和王清任的错误认识影响很深,希望从解剖的角度弄清经络本质,他提出了“二经”、“二络”观点,并认为二经分别为行血与行气的营、卫两管,二络分别是血络、精络。唐宗海是清代受西医影响较大的医家之一,他在《中西汇通医经精义》中参合中西医知识,将血管与经脉互参,认为有些经脉(如任脉)可以对应为血管,且营卫循环实迹也即为血液循环与肺呼吸气体交换。但他又指出,经脉有主气与主血之别,是脏腑气化的路径,又不能单指血管。唐宗海所提出的“气化”实际上强调的是中医经典中一贯记载的经脉既行血又行气的功用,以此与西方纯粹解剖结构进行区分。朱沛文也采用血管解读中医经络,他认为经络大约如血管,其中经脉、络脉、孙络分别对应动脉、静脉、毛细血管,但他又提出经络运行需要“生气鼓舞”,如果“呼吸一绝”经络也随即看不见,可见他对经络是有形还是无形,仍左右不定。朱沛文还试图采用循环与呼吸生理过程,解释中医营卫循行的实际轨迹。另外,刘钟衡与唐宗海相似,也认为经络偏于气化功用;高思敬则将经络与血管、筋脉等混为一谈。可见,明清西医东渐时期,受西医知识影响的医家,对经络理论的解读不论是内容上,还是方法上都出现了有别于既往传统形式的特点。多数医家有意识地采用血管形态来比附解释经络,并将血液循环、肺呼吸换气与经络气血运行、营卫交会进行参合与沟通,个别医家还用西医肉筋(今肌肉)阐释十二经筋的形质。在方法上,受西方解剖、实证等思维的影响,加上王清任亲自观察人体解剖结构,试图找到对应经络的管状结构的影响,这些医家改变了以往以经解经、传统思辨的解读模式,千方百计想从解剖形态、生理现象中寻求对经络的目测和实证,但最终这一愿望未能如愿。在面对这种汇而难通的尴尬状况时,有些医家,如唐宗海、刘钟衡等,又提出了经络气化特点,以概括中医经典中所记载的经络“行气血”的功能特点,并作为对西医解剖刀下找不到经络特定结构的一种解释方法。在上述基础上,本研究还初步比较了明清与民国时期的针灸理论认识变化。受日本针灸医学近现代发展的影响,民国时期认识、研究经络的视角更宽,针灸理论认识变化也更明显,更注重从神经生理角度对经络的形质及其功能进行阐发,并在腧穴定位中增加了肌肉、神经、血管等局部解剖知识,这些都与明清医家对西医的接受有一定延续性。明清医家尝试最多的是将血管解剖与经络对照研究,这种尝试是引发经络形质近现代研究的重要因素,并使之成为长期以来针灸科研中的重要课题之一。因此,不论明清医家重新解读和认识传统经络理论的观点正确与否,客观上都成为了近现代针灸学术演变的前奏。明清西医东渐背景下,人们解读经络理论的这些“前理解”、“前认识”以及由此引发的针灸理论认识方法、思路等的转变,对当代如何正确理解和传承针灸理论提供了许多有意义的启迪和借鉴。明清医家反复对经络理论与血液循环进行了参合与剖析,两者在对照研究中必然存在一些可参、可比性,否则也不会引起这么多医家的反复论述,在这种对照和比较中,进一步深化了我们对经络与血脉相关性的认识。从早期十一脉到十二经脉循环流注以及《内经》很多经络与血脉相关性的论述,也证实经络理论包含一部分血脉形态与功能的观察和总结,明清医家对经络理论与血管、血液循环等的互释和沟通确实有其内在根源。但通过血管解剖、血液循环实际上还是无法圆满解读经络理论的本质,这是因为经络理论它原本就不是通过解剖方式构建的,而是古人通过长期观察和医疗实践,对人体不同部位间相互联系的现象与规律的总结与理论解释。中西方两种医学体系的思想观念和对人体的认知方法完全不同,因此两者必然出现汇而难通的情况,此时经络气化的特点被唐宗海等明清医家提出,以强调中医经典所记述的经脉既行气又行血的功用,并作为西医解剖看不到经络的一种解释。气、血一直是古人论述经络时不可缺少的两种物质,尤其经脉营、卫循环流注模式更是中医经典一贯强调的经脉运行规律与功能现象,所以经络气化从来就是传统经络理论内容之一,只不过以往没有明确出现这一提法,而在与外来西医的对比分析中,经络气化才被明确提出,以更好地与西医形质概念进行区分。重温明清医家对经络与西医解剖生理之间的汇通实践,用事实又一次证明了经络理论不能等同于单纯的解剖形质概念,明清医家在与西医的对比中所明确提出的经络气化观点进一步提示要重视经络的整体性、功能性的特点。笔者认为,在古人的观念中经络是人体运行气血的通道,是整个人体上下、内外相互沟通联系的路径。经络理论的建立不是通过解剖方法实现的,而是长期医疗实践中观察到人体不同部位间特异性联系现象、规律、经验的总结,并掺杂运用了许多中国传统哲学文化观念对这些经验、规律进行了理论解释和提升。经络虽然包含血管、神经、淋巴管乃至组织液等人体多种形态结构及其功能,但它又不能直接对应某种形质,因为经络是人体综合、整体性联系功能的体现,另外经络理论中还包含有很多说理的成分。综合以上原因,经络必然不能等同于西医纯粹、孤立的形态结构,近现代开展的经络对应结构的探索也注定不能如愿以偿。正确分辨经络理论中的客观规律和说理成分,挖掘、提炼出经络理论中那些人体特定部位间特异的联系规律对临床治疗是非常有价值的,并借助西医解剖生理知识,进一步探索这些客观规律得以产生的生物学基础及其机制,从而更好地认识其中所包含的那些能被现代医学解释和印证的客观规律,更为深入地认知传统经络理论中所蕴含的人体生命奥秘,这才是今后经络研究发展的正确方向。总之,明清至民国西医东渐时期,是针灸理论认识形态由传统向近现代转变的重要阶段,本研究仅对明清针灸理论变化以及人们参合西医知识,对经络理论有别于传统的理解和认识进行了考察和分析,民国针灸理论及人们对其认识的演变将是下一步研究的重点。受本人学识水平所限,本研究肯定存在一些错误和不足,有待今后进一步完善。更多还原

【Abstract】 Cognition and Explanation of Meridian and Collateral Theory under the Background of Western Medicine Propagation to the East in Ming-qing DynastyThe time in which Western Culture Propagation to the East in Ming-qing dynasty is an important transition stage in China history.Twice Western Culture Medicine to the East broke China medicine’s original close and unattached development space,the west anatomy and physiology knowledge and method made great impact to China medicine.Chinese doctors and scholars began referring to western medicine,rediscoverring and developing traditional China medicine,which brought internal great changes in China medicine and was a main reason that prompted China medicine to change from traditional type to modern one.Acupuncture and moxibustion is a part of China medicine,also experienced this special stage.Inspecting its development condition in that time and what impact it made on modern acupuncture is an important task for studying the process of acupuncture learning development.Past studies didn’t pay attention to this aspect,especially there isn’t special and system research to the changes of Ming-qing acupuncture theory and people’s ideas,but this article pay close attention to it.Therefore,this research will have following innovations:the first time to system study the changes of acupuncture theory and people’s understanding of it in the back ground of western medicine spreading into China and analyze its influence on morden and summary people’s experiences and lessons in this course.At first,this research reviewed twice background of western medicine propagation to the east,the influence of western medicine to China medicine and the representative doctors and their literatures which had been influenced by the west medicine.The research indicates that meridian and collateral theory was one main part of which doctors pay early interesting to communicate with western medicine,and the influence of western medicine on acupuncture chiefly reflected on that people had referred western medicine to make new-type explanation of meridian and collateral theory and there had appeared great changes in people’s cognitions. These changes almost focused on synthesis medical literatures,not on acupuncture monograph.The reason might be that few acupuncture doctors in that time had been influenced by west medicine,or there hadn’t appeared correlative acupuncture literatures.The Chinese doctors in Ming-qing dynasty who referred more western anatomy and physiology to study meridian and collateral theory are:Wang-honghan、Wang-xuequan、Wang-qingren、Chen-dingtai、Tang-zonghai、Zhu-peiwen,etc.Wang-honghan adopted much western medicine knowledge to interpret meridians and identify meridian and collateral theory with blood circle.Wang-xuequan believed western anatomy discribes body structure in details,but meridian belonged to gasfication and function concept,so it couldn’t be found by corpse anatomy,while his grandson more emphasized viscera and meridian anatomy shape. Wang-qingren wrongly considered artery as windpipe and there were two independent systems to carry Qi and Blood,he thought meridians and collaterals belonged to the system of Qi and were the windpipes.The scholars in Qing dynasty had some similar ideas,for example: Yu-zhengxie took meridians as blood small nets and vessels,Hu-kun also thought Ying-wei corresponding to blood small nets and vessels.Chen-dingtai put forward "two meridians" and "two nets"opinion,he thought "two meridians" were the pipes of Ying and Wei,two nets were blood and spirit.Tang-zonghai thought some meridians could correspond with vessesls,but others couldn’t do,because meridians were the paths of viscera function,and they had the distinctions of managing Qi or Blood,so they couldn’t only be vessels.Zhu-peiwen also considered meridians mostly equal to vesssels and adopted western blood circle and respiration to explain Ying-wei circle in China medicine.But he still had no definite answer to whether meridians have anatomy special structure or not.Besides,Liu-zhongheng thought meridians had gasfication function,and Gao-sijing mixed up meridians,vessels and muscles.Above all,with the influences of western medicine,in Ming-qing dynasty,people’s cognition to meridian and collateral theory had great difference from tradition.Almost doctors adopted the structure of vessels to explain meridians and used blood circle and respiration to explain Yin-wei circle,several doctors used west muscles to explain twelve aponeurotic channels.In methods,effected by western anatomy and demonstration and Wang-qingren’s anatomic practices,these doctors changed past methods of following classics,traditional speculation.They adopted every conceivable means to study and look for anatomy structures of meridians,but the purpose didn’t be realized.In the condition of communicating not smoothly,some doctors put forward gasfication feature of meridians,in order to explain why they could never find the special structure excellently corresponding to meridians. Ming-qing doctors’ new idea and explanation of meridian theory made crucial use of matting and promoting for the modern transfer of acupuncture.They made great efforts to look for the structures of meridians,their demonstration ideas induced the modern research of meridian’s truth,and made it become an important research item for a long time in home. Whatever their opinions were correct or wrong,in fact,it became the preface of the acupuncture modern transformations.Following,this research also compare the cognitions of acupuncture theory in Ming-qing dynasty and in Min Guo.By the influence of Japanese acupuncture’s modern developments, Chinese doctors in Minguo paid more attention to nerve physiology to explain the structure and function of meridians and added muscle、nerve、vessel anatomy knowledge in acupoint’ locations.The new opinions、methods and the changes in cognition of meridian theory brought much meaningful reference and enlightenment:their attempt of using vessels to explain meridians deepened the cognition of the contacts between meridians and vessels.But in fact, meridian theory couldn’t be equal to blood circle,meridians also couldn’t be equal to blood pipes,because the meridian theory wasn’t constructed by anatomy methods.Therefore,some doctors put up meridian’s gasfication feature as the reason of why the meridians couldn’t be equal to the blood pipes and it has certain rationality.At last,western medicine made people understand meridian theory in a more wide scope and help people realize its biological truth and base better,moreover,understand deeply the sciencific meaning in meridian theory.To summarize,from Ming-qing to Minguo dynasty is a special and important stage, during which acupuncture theory transferred from traditional form to modern one.This research only has paid attention to Ming-qing dynasty,Minguo is the next research content. Limited by my scholar level,this reseach must have much insufficient and shortcoming, which I hope will be improved in future research.更多还原