【作者】 张树剑；

【导师】 赵京生；

【作者基本信息】 南京中医药大学 ， 针灸推拿学， 2009， 博士

【摘要】 《内经》是针灸理论成熟的标志,同时,《内经》的医学思想也是以针灸作为主要旨归的。然而,对于针灸经典理论的研究目前尚十分薄弱,尤其以及作为其基石的经典概念的系统研究更是阙如。鉴于此,本论文将《内经》经典针灸理论与概念作为研究对象,试图对经典针灸理论与概念的形成观念与演变规律作出解读。本论文上篇撷取了对针灸理论构建观念关系密切的八个概念范畴作了专题微观研究,由此对针灸经典理论的构建观念与思想内涵可窥一斑。上篇第一节:考察了在经脉的形成初期古人对经脉的认识方法与古人眼中的经脉形态。认为:实体组织解剖与观察是形成经脉概念的形态基础,实证的方法在中医学早期的经脉认识方法中占重要地位,然而古人自觉地将经脉与地脉互相比附,经水概念由此形成。本节旨在澄清古人的经脉形态观,有助于我们正确认识经脉的本质。第二节:以督脉为例阐释了古人经脉命名思想。认为:督脉的初始意义并无“督率”之意,仅指脊中之脉。与督脉相类,奇经八脉与十二经脉的命名意义亦较为直观朴素,由此可以看到经典概念在一开始是直观的,感性的,而概念的向前发展,有一个意义扩充或转化的累进过程。第三节:解析了镵针的由来,并由此追溯决脉通滞的针刺治疗观念的思维来源。认为:镵系尖锐的金属器具,其主要作用有两端,医者以刺脉,农者以刺土。由于经脉与地脉在形态上的相似性,刺脉与刺土亦存在理念上的内在关联,同时,“以泻阳气”的治疗观念也与农者及时耕作以疏泄地气的观念亦相似,从而可以推论决脉通滞的治疗观念或与农耕思想有关。第四节:探讨了针刺补泻观念的思维来源。认为:损益是古代观念中互相对立而又彼此统一的概念范畴,“损有余补不足”被古人视为“天之道”,其对中医学补虚泻实的治疗思想影响甚深。第五节:追溯了导气针法的思想观念来源。认为:导气是为了治乱,治乱是社会领域内的核心范畴,但是在古人自然界、人体与社会同构同理的观念影响下,治乱被认为是针刺疗疾的重要原则,并且为之专设了导气针法。第六节:通过对守机这一概念来源的分析,阐述了针刺驱邪观念的形成与变化。认为:古代巫者驱鬼、兵家制敌与医者治疗在攻邪这一理念层面有相关性,使用的工具亦有关联,医家以针疗疾的观念或与巫、兵有涉,但是随着朴素自然观的发展,鬼祟致病的病因论渐被医家摒弃,代之为进步的六气致病说,守机也转化为有着实际临床意义的技术。第七节:对针刺候气这一重要概念的观念来源作了上溯与解读。认为:候气本指古人用律管候四时八节之气,气与风异名而同类,八节之气即八节之风,风有正邪,邪风袭于虚乡而中人,则身疾病。风之出入与舍居之所即为风穴,是腧穴的观念来源之一。针刺治疗上的候气或与此观念有关。第八节:阐述了守神这一临床观念的形成历程。认为:“神”在哲学领域与一般观念中主要有三方面的涵义:变化、法则与主宰。守神之“神”来源于神的微妙的变化这一层涵义,守神其实就是通过脉诊体察脉的状态,以此来判断血气的有余不足。同时,本节还兼及治神、守神、本神,心神、五藏神等概念的形成与涵义。本论文下篇对经典针灸理论的思想观念作了总结性论述之后,重点对医学概念、术语的意义形成与演变规律作了分析。下篇第一节:结合上篇个案研究与多个个例例证,总结叙述了经典针灸理论中的四个核心观念:经脉观念、腧穴观念、病因观念与治疗观念。第二节:进一步总结了针灸理论构建与概念形成过程中遵循的基本规律:天道。符合天道是古人几乎在一切领域内的思维起点,在医学理论的构建之始也是如此。第三节:阐述了一般观念与语汇的医学化过程以及医学概念与语汇在语境变化与历代诠释的意义演变过程,这一过程中起决定因素是医学的实践特点。由是观之,经典针灸理论与概念所蕴含的思想观念与古代一般观念一脉相承,在医学理论构建与概念形成的初期,受到社会观念的影响颇深,诸多针灸理论中的重要概念范畴如守神、守机、补泻、导气等,都与早期社会观念,尤其是自然、人体与社会同构同理这一基本观念有着千丝万缕的联系。而针灸理论、概念等形成之后,在医学语境中不断地被重新理解与诠释,这一过程从《内经》经典理论、概念的形成之初就已经开始,概念的语境一旦变化,意义也随之变化了,至今依然。本论文在广阔的非医背景下,较多地运用了文字学、史学、诠释学的方法,证据材料重点选取自传世非医文献,展开针灸概念的微观研究,同时对针灸理论与概念形成的思想观念作了较为系统的研究,无论是研究方法还是内容与角度,都有一定的创新性。本论文的价值与意义在于:第一,正确阐释针灸经典理论的需要;第二,针灸经典理论现代表达的需要;第三,针灸学术史自身发展的需要;第四,为针灸实验与临床研究提供依据。更多还原

【Abstract】 HUANGDINEIJING is the symbol of theory maturity in acupuncture-moxibustion,where most essential points of acupuncture-moxibustion were discussed.While the study on classic theory of acupuncture-moxibustion was very weak,especially the systemic study on the classic conception was seldom. Therefore,this paper took the classic theory and conception of acupuncture-moxibustion in HUANGDINEIJING as research objects,tried to interpret the principles of their construction and evolution.Part One of this paper selected eight conceptions to do specific microstudy.In the 1st segment of Part One,how ancients had been understanding meridians in the initial stage of meridian construction,and their cognitive methodology were discussed.And it was concluded that,tangible anatomy and observation are morphologic basis in the construction of meridian conception;besides,concretely methods occupied an important place in the early stage of Chinese medicine.Thus, ancients compared the meridians with earth-channels self-consciously,and the conception of meridian-water was constructed.All of this helped us to recognize the nature of meridians correctly.In the 2nd segment of Part One,the paper took Governor Vessel as an example to interpret the nomenclature origin of meridians.And it was concluded that,the initial meaning of Governor Vessel only referred to the meridian on midline of the spine,with no sense of "govern or command".Similar to that,the nomenclature meaning of eight extra meridians and twelve meridians is also perceptual and intuitionistic.The development of conceptions will be a progressive procedure in meaning expansion and transformation.In the 3rd segment of Part One,the origin of Chan-needle was analyzed.On the basis of that,the acupuncture therapeutic idea of dredging the meridians was traced back.And it was concluded that,Chan refers to the sharp metal tool with two ends, one end is to acupuncture the meridians for doctors,and the other is to plough the soil.Because of the morphological similarity between the meridians and earth-channels,the internal relationship also exists between acupuncturing the meridians and ploughing the soil.Furthermore,the therapeutic idea of dispelling Yang-Qi also has the similarity with the idea of dredging earth-Qi in cultivating.So it can be deduced that,the therapeutic idea of dredging the meridians has something with cultivation idea.In the 4th segment of Part One,the thinking origin of acupuncture reinforcing-reducing theory was discussed.To reinforce and to reduce form a unity of opposites in ancient ideas,that was regarded as the essence of nature.And it has deeply influenced the therapeutic idea of reinforcing the deficiency and reducing the excess in Chinese medicine.In the 5th segment of Part One,the origin of inducing-Qi manipulation was traced back.The goal of inducing Qi is to control the disorders,which is regarded as the important principle in treating diseases with acupuncture.In the 6th segment of Part One,the construction and change of dispelling pathogenic Qi in acupuncture were expounded by analyzing the origin of conserving Qi-movement.Wizards dispel ghosts,military commanders fight their enemies, doctors treat diseases with needle,these three have relativity in tools used and the idea of dispelling evils.But with the development of initial natural viewpoint,the aetiology that ghosts and evils result in diseases was abandoned gradually,which was substituted by pathogenic theory of six climatic factors.Correspondingly, conserving qi-movement changed to a kind of needle manipulation with real clinical meaning.In the 7th segment of Part One,the origin of waiting for qi in acupuncture was studied.For Qi and wind belong to the same category,the places where wind goes out,enters,resides are the acupoint location.So it can be concluded that,the conception of waiting for Qi has something with the idea of Qi and wind.In the 8th segment of Part One,the construction process of keeping mind was elaborated.Mind has three meanings,change,principle and administration,here the mind refers to CHANGE.To keep mind refers to experience the pulse situation by pulse-taking,so as to judge the deficiency and excess of Qi and blood.In part Two of the paper,firstly,classic acupuncture-moxibustion theory was discussed conclusively;then,the evolution rules of medical conceptions and terminology were analyzed in detail.In the 1st segment of Part Two,four key conception ideas of classic acupuncture-moxibustion theory,meridians,acu-points,disease origin and acupuncture treatment,were summarized.In the 2nd segment of Part Two,the basic principles in the construction of acupuncture-moxibustion theory and conceptions were summarized further,which was called as the essence of nature.To follow it was the starting point of ancients’ thinking,just the same as that in the early stage of the construction of medical theory.In the 3rd segment of Part Two,the process that generic attitudes and vocabularies were transformed in medical language situations and the process that vocabularies and attitudes were given new meanings gradually,because of language situation’s change and further annotations during different dynasties.change were elaborated.It can be seen that,the ideas lying in acupuncture-moxibustion theory and conceptions had preserved continuity with general ideas in ancient times.In the early stage of construction of medical theory and conceptions,many important conceptions in acupuncture-moxibustion theory,e.g.keeping mind,conserving Qi-movement,reinforcing-reducing and inducing-Qi,had been influenced deeply by, and maintained manifold links with social attitudes in early stage,especially such a general conception as entity of nature,human body,and society.However,after their construction,acupuncture-moxibustion theory and conceptions had been re-understood and annotated again and again.This process had no sooner started than classic theory and conceptions were constructed in HUANGDINEIJING. Precisely speaking,once the language situation of conception changed,its meanings will change along with it;and until now,it still was. Against the wide nonmedical background,the paper selected the existing nonmedical literatures as the evidence to develop the microstudy on acupuncture-moxibustion conceptions with many research approaches,e.g.philology, historiography,and hermeneutics,etc.Furthermore,the author studied the construction ideas of acupuncture-moxibustion theory and conceptions systematically.The paper has some innovativeness whether in research approaches, or research contents and angles.The value of paper lies in the following aspects.Firstly,it is the need to interpret the classic theory of acupuncture-moxibustion correctly;secondly,it is the need to express the classic theory of acupuncture-moxibustion with modern styles; thirdly,it is the need of acupuncture-moxibustion self-development in academic history;fourthly,it will provide relative evidence for research on acupuncture-moxibustion experiences and clinic.更多还原