【作者】 刘耀岽；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2010， 博士

【摘要】 一、研究的意义、目的、方法针灸禁忌是针灸医学的重要组成部分,有必要对其进行整理。《内经》有关针灸禁忌的论述,已经基本完成了针灸禁忌理论体系的构建,对后世医家影响深远；《针灸大成》针灸禁忌,是对《内经》针灸禁忌的继承与发展,进一步丰富了古代针灸禁忌的内容。目前对《内经》与《针灸大成》针灸禁忌尚未见专题研究,有必要将分散于其中的针灸禁忌总结整理。古代针灸禁忌,多为古人针灸临床的经验教训总结,很多内容对现代临床仍然具有借鉴意义,对其进行研究,可以减少医疗事故,有利于针灸医学的健康发展；《内经》针灸禁忌是针灸禁忌之源,《针灸大成》针灸禁忌是针灸禁忌之流,将二者放在一起进行研究,有利于溯源穷流,探求针灸禁忌的历史演变。本文综合运用了文献研究、历史研究、比较研究、中医学术研究等方法。借鉴了张景岳编辑《类经》的方法,首先选取针灸经典名作《内经》作为古代早期针灸代表作,将《内经》针灸禁忌的内容分门别类,以此作为针灸禁忌内容的主体框架；再选取明代针灸巅峰之作《针灸大成》作为古代后期针灸代表作,将《针灸大成》的针灸禁忌按《内经》的分类法附在《内经》之后,以类相从,共归纳为五个层面二十四项内容,如此则《内经》与《针灸大成》针灸禁忌在结构上纲举目张,在时代上前后交相辉映。通过归类整理,初步构建《内经》与《针灸大成》针灸禁忌的理论框架,比较全面地了解针灸禁忌的主要构成与内容；通过分析对比,探求《内经》和《针灸大成》针灸禁忌的异同点、历史演变及其与现代针灸临床的关系。二、研究的内容与结论论文主要分为四部分：(一)针灸禁忌的研究状况与研究趋势；(二)《黄帝内经》与《针灸大成》针灸禁忌概述。这部分主要从宏观上描述《黄帝内经》与《针灸大成》针灸禁忌的总体情况;(三)《内经》与《针灸大成》针灸禁忌的五个层面与二十四项内容。这是本研究的主体部分,对二书的针灸禁忌整理分类,具体阐述针灸禁忌的各项内容。(四)《内经》与《针灸大成》针灸禁忌若干问题的探讨分析。操作技术层面的针灸禁忌是针灸禁忌最基础最直观的内容,至今对临床具有直接的指导作用；生理层面的针灸禁忌重视患者个体生理特点,辨证辨病论治层面的针灸禁忌重视患者个体病理特点,二者对预防医疗事故、提高疗效都具有重要的理论指导意义；时间禁忌层面的针灸禁忌以“天人合一”为理念,极具特色,然而古今争议不断；医生素质层面的针灸禁忌是预防医疗意外的重要保证。《内经》禁针穴记载的并不多,只有十个左右,《内经》倾向指出针刺的禁忌部位,警示在某一个区域针刺时应当慎针或禁针；《针灸大成》禁针穴则达三十多个,明显多于《内经》,由《内经》以指明禁针部位为主到《针灸大成》以记录禁针穴为主,提示随着临床实践的积累,针灸禁忌的内容在不断地具体化、细节化。《针灸大成》针灸部位禁忌虽不如《内经》详尽,但极为简明,具有高度概括性。《内经》既注重针刺深浅与疗效的关系,又注重针刺深浅与针刺安全性的关系。《内经》对针刺浅深的衡量比较模糊,很少对具体穴位的针刺深度进行量化,《针灸大成》“考正穴法”则对大部分腧穴都注明了针刺的安全深度,对针刺安全和针灸的发展无疑具有极其重要的作用。《内经》认为留针过长过短都有害；《针灸大成》则认为可以根据针感的松紧确定补泻及出针的时机,增强了针刺临床的可操作性。《内经》针刺消毒意识不强,《针灸大成》中的消毒意识明显增强,有选择制针材料以及药物煮针消毒的记载。《内经》已经注意采取一些针灸事故的预防措施,如防止滞针、折针的措施等,在针灸救误方面,《内经》只记载了晕针后“闷则急坐之”；《针灸大成》预防救误方面的内容则更为丰富,记载了多种晕针、断针之后的处理措施,还记载了防止灸疮感染的外敷药方。人处于大醉、大饥等异常生理状态下,此时人体“脉乱气散”,针后易引发晕针等不良后果。《内经》与《针灸大成》已经认识到针灸禁忌的性别与年龄差异,某些可以用于男患者的针灸治疗却不能用于女患者,尤其是孕期妇女；小儿囟门未合者,禁针灸囟门。疾病的病情往往错综复杂,如果离开了正确的诊断,就有可能出现重大的针刺事故。《内经》认为,针灸者首先必须明白针灸的适应症与禁忌症。还要辨明疾病的病位病性,针灸治疗才不会违背“以平为期”的治疗原则,才不会犯虚虚实实之戒,才不会补泻过度。与后世针灸古籍相比,《内经》在讨论针灸禁忌时,特别强调辨证辨病的准确性,并把辨证辨病误差作为导致的针灸不良后果的一个重要因素。《内经》在天人合一的理念下,强调“天忌不可不知也”,明确提出“因天时而调气血”的针刺原则。《内经》针灸时间禁忌内容十分丰富,有四时禁忌、月相禁忌、用天干地支表述的针灸忌日、根据昼夜时辰变化的针刺禁忌等,《针灸大成》的针灸时间禁忌大部分内容可以从《内经》上找到源头。《内经》针灸时间禁忌在后世发展过程中常被任意推衍,并不断地注入阴阳术数方面的内容,使得时间禁忌的内容越来越多,有些时间针灸禁忌甚至变得不可理喻,受到古今医家的质疑。《内经》和《针灸大成》都认识到：提高医德修养和医术水平,对于预防针灸意外具有重要作用。《内经》的艾灸禁忌、火针禁忌主要着眼于治疗大法；《针灸大成》则记载了一些操作细节方面的禁忌。《内经》列举了几种不可艾灸的情况；《针灸大成》的艾灸禁忌内容十分丰富,广泛涉及到禁灸穴,部位禁忌,刺激量的禁忌,时间禁忌,点火禁忌,体位禁忌,逆针灸禁忌,灸后调摄禁忌,艾灸顺序禁忌等多个方面。《内经》提出火针不能用于热痹证,火针不适于体弱者；《针灸大成》则提出不可以用没烧红的火针针刺治病,火针进针切忌太深等。《内经》刺络放血疗法禁忌内容也较为丰富。《内经》与《针灸大成》都非常重视针灸禁忌,《内经》与《针灸大成》五个层面二十四项针灸禁忌是一个有机的总体。二书中很多针灸禁忌内容在现代临床中仍然具有一定的指导意义,现代对针灸禁忌的研究主要集中在《内经》操作技术层面,并取得了很大进展,《内经》其它层面的针灸禁忌的研究则相对不足,尚有待加强。更多还原

【Abstract】 Objective and methods:Acupuncture taboo (AT) is an important part of the acupuncture medicine, so the collation on AT is necessary. The statement about AT in Neijing shows that it has basically formed the theoretical system of AT, and it has a far-reaching influence on the later physicians. Zhenjiu Dacheng enrichs the AT’s contents further and is recognized as Neijing’s inheritance and development. At present, specific study on AT in Neijing and Zhenjiu Dacheng has not been found yet. So the paper will collate all the statements on AT scattered in these two books so as to benefit future studies on this topic. The statements on AT in ancient times mostly came from ancient people’s clinical practice of acupuncture, and most of them are meaningful for reference to the acupuncture clinic at present. So the studies on the ancient taboos of acupuncture can reduce medical accidents and also are beneficial to the healthy development of acupuncture. Neijing’s AT is the origin and Zhenjiu Dachengs is its branch, so the study on AT in both the books is in favor of exploring the historical evolution of AT.Methods for literature study, history study, comparison study and Traditional Chinese Medicine academic study were used comprehensively. In reference to Zhang Jingyue Leij’ing’s frame, this paper select the acupuncture classics Neijing as a representative of early ancient acupuncture books; And Zhenjiu Dacheng, which stands for the culmination of Acupuncture, is selected as the late ancient masterpiece and its’statements on AT are arranged according to the classification of Neijingas the paper’s latitudes, and classify them into 5 levels and 24 parts as the paper’s meridians. So the statements in these two books crisscross in frame and contrast in the periods. Through the method, the paper intends to describe the theoretical framework of AT in the books, and to summarize the ancient taboo comprehensively so as to recognize AT’s development with the change of time. Main content of the study and conclusion:The paper is divided into four parts:(A) present research on AT and its trend (B) an overview of AT in Neijing and Zhenjiu Dacheng (C) 5 levels and 24 parts of the both books. This is the main part of the paper. (D) discussion on AT in Neijing and Zhenjiu Dacheng.There are about 10 contracupuncture points in Neijing, and most of them are recorded as some contracupuncture area; while the number of contracupuncture points in Zhenjiu Dacheng is up more than 30, and they are recorded as some contracupuncture points rather than some area, which suggests AT statements became more and more specific with the accumulation of acupuncture clinical practices. The discussion in Zhenjiu Dacheng are not as detailed as in Neijing, but extremely precise.As for the depth of acupuncture, Neijing, on the one hand, pays attention to the relations between depth and clinical efficacy; on the other hand, focuses on the relations between depth and safety. However, the depths described in Neijing are obscure, and few points’depths are quantified, while in Zhenjiu Dacheng Kaozhengxuefa, most safety depths of the acupoints are stated, which plays an important role in the development of acupuncture safety.Neijing stated that It is harmful if the retain time is too long or short. While Zhenjiu Dacheng believes that it is appropriate to determine the reinforcing and reducing time according to the doctor’s feeling under his finger, which is more practical for clinical application.In Neijing, awareness of sterilization was not strong, while that in Zhenjiu Dacheng was enhanced much. For example, it has stated that the way of selecting needle materials and cooking needles with drugs are used as sterilization.Neijing has taken note of prevention measures on acupuncture accidents. And when acupuncture accidence occurs, Neijing only states when the patient feel uneasy he should be made sit for rest at once, while Zhenjiu Dacheng records more ways to deal with on acupuncture accidents. It recorded a variety of measures to deal with needle faint, and needle breakage, and the external application to prevent the infection of moxibustion scars. When people are in great hunger or famine or other abnormal physiological state, qi in their body would become chaos, so acupuncture can not be applied, otherwise, it is easily to lead faint. Neijing and Zhenjiu Dacheng, has taken note of the gender and age differences in acupuncture. Men and women, due to the physical characteristics of the structural and physiological differences, some acupuncture treatment can be used to male patients but is not suitable for female patients, especially for pregnant women. As for the baby whose fontanel is not closed, his fontanel region is forbidden to be needled.There would bring forth serious accidents of acupuncture if the diagnosis is not correct, since the patients’conditions and the diseases are complicated and confused. Neijing argues that the doctor of acupuncture should clarify the indications and contraindications of acupuncture, and differentiate the locations and properties of diseases. It should be notified that the principle "taking balance as the treatment goal" can avoid evacuating the vacuity and replenishing the repletion, and over-reinforcing and over-reducing. Compared with the posterior classics of acupuncture, Neijing puts emphasis on the precise differentiation while discussing the contraindications of acupuncture, and regards the errors of differentiations of and syndromes and diseases as an important factor of the untoward effects resulting from acupuncture.Neijing thinks that the movements of qi and blood of human bodies are correlated with the time based on the conceptions of integrated nature and human beings, since human beings are influenced by the nature, the seasons and the climate. Neijing claims that "the nature’s AT can not be ignored", and mentions explicitly that the principle of acupuncture "regulating the qi and blood according to the rhythms of nature and time". The contents of temporal AT in Neijing are so fruitful that we can find the AT of four seasons, phases of the moon, particular days represented by Chinese Era (combination of the Heavenly Stems and Earthly Branches), and transitions caused by the day, night and hours. The major contents of temporal AT in Zhenjiu Dacheng can be traced to the source Neijing. The contents of the Yin-yang theory and the Shu-shu (Chinese divinations) studies are so continuously added to those of temporal AT in Neijing that some temporal AT can hardly be understood and reasoned by posterior physicians of Traditional Chinese Medicine.The medical ethics and the medical skills of physicians are so significant for the prevention of accident that they are highlighted in Neijing and Zhenjiu Dacheng.The taboo of moxibustion is limited to the principles of treatment as far as Neijing is concerned. In contrast, the taboo of moxibustion in Zhenjiu Dacheng is so fruitful that we can find not only contramoxi-points, but also the taboo of moxibustion of locations, quantity of stimulus, time, lighting, body postures, reverse manipulations, posterior regulating, and sequence or orders.The taboo of fire needle is limited to the principles of treatment as far as Neijing is concerned. Fire needles can not be used in the syndrome of heat impediment (bi), not applied to the weak patients either. Zhenjiu Dacheng focuses on some manipulation details of fire needles. Fire needles which are not heating enough can not be applied to the treatment, and fire needles can not be inserted pretty deep either. The contents of venesection and phlebotomy therapy are fruitful in Neijing.The acupuncture and moxibustion taboo are emphasized in Neijingand Zhenjiu Dacheng. the five dimensions of 24 acupuncture taboo parts are an organic whole. Many contents of the acupuncture and moxibustion taboo in Neijing and Zhenjiu Dacheng are so helpful for the clinic medical practice nowadays that the academic research on the acupuncture taboo and moxibustion taboo is furthered by the particular manipulations mentioned by Neijing. In addition, the studies of acupuncture and moxibustion taboo in other aspects mentioned by Neijing are to be strengthened.更多还原