《内经》针灸辨证方法研究

【作者】 王宝华；

【导师】 赵京生；

【作者基本信息】 中国中医科学院 ， 针灸推拿学， 2010， 博士

【摘要】 辨证论治,是指导针灸临床的重要思路与方法。然而在多重因素的影响下,今天的针灸辨证体系,逐渐趋同于现代中医以辨病性为核心的脏腑辨证体系。这与针灸学自身重辨部位的特点不相符合,使得针灸理论与实践之间表现出一定程度的脱节现象,对针灸学术发展造成了较大的不良影响。要解决这一问题,首先需要对针灸辨证方法进行深入的理论研究。《内经》是针灸学的奠基之作,其中绝大部分病证均采用针灸方法来治疗。深入分析《内经》针灸辨证方法,总结其辨证特点,对今天的针灸辨证方法研究有重要的参考价值。本论文基于病证的代表性、辨证内容的丰富性以及辨证方法的典型性等方面的考虑,选择《内经》中头痛、腰痛、心痛、咳、热病、疟、痹证等七病的针灸辨证方法作为主要研究对象,在《内经》整体的理论框架内探求具体病证的辨证依据。辨证方法解析之前,首先将《内经》中对该病病因病机的论述加以整理,分析其与经络、脏腑的关系,作为辨证的前提和基础。辨证方法阐释之后,又对其与针灸治疗之间的关系作了一定的评述,借以明确辨证结果的实践指导价值。具体而言,《内经》七病证所采用的辨证方法互有异同,其各自特点如下：1头痛,首先根据病机和病势的不同,区别为厥头痛、真头痛二证,其辨证的重点在于对厥头痛的足六经辨证。从其各证型的辨证依据来看,足三阳经之头痛,皆以其循行部位为据；阴经之证,则主要从经脉病候中求其依据。2腰痛,是典型的从经络辨证论述的病证之一。其辨证依据主要来自于经脉的病候,而经脉病候的范围并不局限于《灵枢·经脉》。对于《素问·刺腰痛》中提到的解脉、昌阳脉等诸脉证,因其有自己独立的名称、辨证要点和取治部位,是相对独立“脉”体系,无须过分强调其脉与十二经脉体系的对应关系。3心痛,亦有厥、真之辨,与头痛相似。对于厥心痛诸证,虽然形式上属典型的脏腑辨证,其实则主要来自于对经脉辨证的改编。经脉辨证是此病的主要辨证方法,经脉及脏腑病候是其主要的辨证依据。4咳,是从脏腑角度进行辨证的典型案例。《内经》中分从五脏六腑而论其咳证之状,以脏腑病候作为其主要辨证依据。5热病的辨证在《内经》中论述详细,不但从经脉、脏腑辨证,还论及形体辨证和以诊法为核心的辨证方法等,内容十分丰富。其经脉辨证在形式上十分强调循行的价值,然其所述经脉的循行部位,更接近于简帛书中的某些经脉的特征。热病的脏腑辨证,主要是以五脏的病候,及其相应经脉和表里经脉的循行、病候为依据,二者并重,而以经脉为据者略多。6疟,主要采用了经脉辨证与脏腑辨证两种方法,二者并举于同一篇中。经脉辨证中呈现出阳经证以外经病为主,阴经证以内脏病为主的特点,经脉病候仍作为主要的辨证依据。脏腑辨证则以典型的脏腑病候作为依据。7痹证,与其余诸病证的辨证方法区别较大,注重从形体和病症特点的辨证,而不强调经络、脏腑辨证的方法,其辨证依据主要在于形体病候。通过对七病证辨证方法的分析,将《内经》针灸辨证方法的特点总结为：《内经》病证所用的辨证方法以经络辨证、脏腑辨证和形体辨证三者为主。经络辨证多集中在十二经脉辨证方面,以经脉的循行、病候为主要依据。进行脏腑辨证的主要依据是脏腑的生理与病候,其内容散见于《内经》诸篇。就经脉辨证与脏腑辨证的关系而言,二者是分别从经脉理论和脏腑理论的视角下,.对病证所作的不同的分类方法。经脉辨证的结果与针灸治疗之间存在直接的对应关系,其特征为重经脉、重部位而轻腧穴。通过脏腑辨证得出相应的脏腑病位后,主要从其相合之经或表里经治疗,且往往明确该经的原穴、荥穴等作为治疗点。形体辨证与治疗的关系则更多体现在针具和刺法的选择上。本论文从《内经》具体病证的辨证方法入手,深入分析其对各种病证的辨证过程,总结各种辨证方法的运用规律,对今天针灸辨证研究,有重要的参考价值。对探索针灸学自身发展的规律,提高针灸的临床疗效,也都有明显的积极意义。更多还原

【Abstract】 Treatment according to pattern identification (Bianzheng Lunzhi) is the important method for both TCM and acupuncture. Today, the method mostly focuses on the nature of disease, instead of the place. This character is more compatible for TCM than for acupuncture, and makes the gap between the theory and clinic in acupuncture finally. To solve the problem, research in the theory of pattern identification is necessary at first. In Huangdineijing, the most important classic of TCM, hundreds of diseases are discussed, and pattern identification methods are the important parts in these discussion. What significant is, most of the diseases are treated by acupuncture. That means we can find ample evidence to rebuilt the pattern identification method for acupuncture in Huangdineijing.In this article,7 diseases, including headache, lumbar pain, cardiac pain, cough, fever diseases, malaria and arthromyodynia, are chosen for the research to find out the Bianzheng method, which is obscure in Huangdineijing. At the same time, the reason, process and treatment of theses diseases are mentioned, as the assistant parts for the pattern identification method. In Huangdineijing, these diseases are analyzed in the follow ways:1. Headache. The most important way to identify patterns for headache is the foot-6-meridian method. By the meridian’s position, foot-3-yang-meridian headaches can be told from each other. To differentiate foot-3-yin-meridian headaches, symptoms and signs are the better evidences.2. Lumbar pain. It is a typical disease to make use of the meridian pattern identification method. The division of different patterns of lumbar pain relies on the symptoms and signs too.3. Cardiac pain. Also the zangfu-vicera pattern identification method is used in the first eye, this disease adopts the meridian pattern identification method mostly. The evidence for pattern identification is the symptoms of zangfu-vicera and meridians.4. Cough. It is a typical use of zangfu-vicera pattern identification method. Cough is separated into 5-zang-patterns and 6-fu-patterns by the zangfu-vicera symptoms.5. Fever diseases. At least 4 methods are used in these diseases, such as meridian, zangfu-vicera and body-structure pattern identification methods etc. The division based on the position and symptoms mostly. 6. Malaria. Meridian and zangfu-vicera pattern identification methods are the 2 main methods used in malaria. Mostly, the body symptoms belong to the yang-meridian patterns, and the viscera symptoms pertain to the yin-meridian patterns.7. Arthromyodynia. It is greatly different from other diseases. The body-structure pattern identification method has more use than other methods in Arthromyodynia.Through the research above, meridian pattern identification is based on the position and symptoms of meridians. The symptoms of zangfu-viscera can be used as the evidence sometimes too. For the zangfu-vicera pattern identification method, all the symptoms of zangfu-viscera, the position and symptoms of meridians are important evidence.The meridian pattern identification can be used in clinic straightly. It pays more attention to the meridian and position, instead of the acupoints. On the other hand, the result of zangfu-vicera pattern identification needs to convert into meridian disease firstly. Then some specific acupoints are used to treat the disease. In some sense, meridian pattern identification is more useful than the zangfu-vicera pattern identification method.This article has a deeply analysis to the pattern identification method of 7 diseases in Huangdineijing. It is valuable for the pattern identification research of acupuncture today. At the same time, it will help to find the rule of acupuncture development, and enhance to improve the effect of acupuncture in clinic.更多还原