【作者】 吕金山；

【导师】 赵京生；

【作者基本信息】 中国中医科学院 ， 针灸推拿学， 2010， 硕士

【摘要】 经络理论不仅指导针灸临床实践,同时也不同程度指导着中医其他各科临床,是中医理论重要组成部分,历来受到医家重视。药物归经就是以经络理论指导用药的一种理论方法。药物归经的方法和内容,蕴含着前人对经络的理解认识。站在针灸学的研究角度,探讨药物归经中对经络的运用,以及这种方法的形成及影响因素,将更全面地展现古人所认识的经络理论,深化今人对经络理论的理解认识,拓展经络理论研究的范围。同时,也是全面认识中医理论必不可少的一个重要方面。以往对药物归经的研究,多是站在中药学的角度,研究重点几乎全部放在中药功效方面：而针灸界又将药物归经视为中药研究领域,所以,对古代药物归经所相关的经络理论认识的研究几乎是空白,影响我们对经络内涵、经络理论的全面认识。本研究的目的是：了解药物归经方法中蕴含的前人对经络理论的理解认识,为深入理解和正确解释经络理论,提供更宽阔视野和文献基础。因此,涉及药物归经的文献收集范围下限为清代,主要集中在从金元到清朝的重要本草文献,唐宋及以前的主要运用经络脏腑辨证的文献。本研究主要以文献、医史、理论研究方法为基础。从文献、医家和时代背景的角度,以药物归经的有关经络内容为研究重点,通过比较分析,探讨药物归经的经络理论运用及认识。论文内容主要有三大部分：1.药物归经的主要文献与方法比较基于三十余部主要相关医药古籍分析,认识经络与药物运用的关系：早在《神农本草经》成书时代,已有用脏腑经络来表达药物主治功效部位的意识。东汉《伤寒杂病论》、唐代《千金要方》《千金翼方》等著作所建立起的用药体系中均十分重视经络的意义,这对后世药物归经的的形成,有深远的潜在影响。宋代《和剂局方》《证类本草》《本草衍义》和《小儿药证直诀》中,用经脉概括方药功效的现象已经出现,尽管这种对经脉的运用多数仍较笼统,但已开始有所细化,如阳经、足三阴经,具体如肾经、膀胱经、肺经、脾经、肝经等,并出现“脏腑气——脏腑经”这样涉及对方剂和药物作用的经脉表达形式。金元医家张元素临床用药言及藏象时刻不离经络,所认为的“药物归经”是根据藏象经络系统辨证,归纳病因病机而来,这种用经络理论对药物主治功效进行归类的思想,被后世一些医家高度重视和进一步归纳发展完善,最终成为专门药性理论。其徒弟李东垣,以脾胃之气为理论核心,借助经络影响着其他脏腑的功能,直接应用经络理论概述方药主治,按照气口与人迎对比脉诊分“经”用药。王好古师承张元素和李东垣,这些学术传承特色在其所撰《汤液本草》中多能有所体现,而在“药物归经”方面成就比起张元素更是显而易见的,对更多的药物配合三阴三阳及十二经脉,归纳阐述这些药物的归经认识,从而反映其在中药运用中对于经络理论的理解程度和运用方法。明清时期,《玉机微义》以脏腑经络定位方剂主治,更能体现的是“方剂归经”与“药物归经”之间的相互影响。《银海精微》根据“五轮八廓学说”和瞳神大小选方用药等眼科特色理论,重视“目为五脏之精华,一身之要系”的认识,以及在这种认识基础上所设立的通过调理治疗全身来达到治疗眼睛疾病的方药,对于理解经络理论在眼科临床上运用特色有着不可忽视的价值。叶天士在其多年临床实践中,形成了自己独特的“药物归络”的络病诊疗理论。沈金鳌第一次把“归经”作为一个药性名词提出来,并总结了历代本草书中有关论述归经的内容,把“引经”、“向导”、“行经”、“入”、“走”、“归”等名词统称为“归经”,进一步模糊了前人归经概念。《得配本草》中存在药物归“奇经”和归“十二经”等多种经脉认知方式,提示中医在临床中应用经络理论辨证选方用药时候,不同医家侧重理论思考角度不同,会出现不同的认识。徐大椿在应用经络理论时候,主要沿着张仲景三阴三阳病的认识,将经络作为一种受邪传变的部位,用以概述疾病的发展阶段,进而为选方用药作准备。王清任通过解剖实证,努力改正古人对于脏腑经络认识错误及矛盾,对于经络理论认识有其独特之处,创立的方剂不多,至今应用甚广,体现了其对于经络理论的独特认识和运用方法。包诚首先按照手足三阴三阳脏腑经(包括手少阴肾经分出的命门)对药物主要趋向性进行归类,然后针对每一味药物又同时按照性味、所入脏腑及功效进行概述,从药物“归经”与“归脏”结合,并以经络统脏腑,对药物主要功效特点进行药性理论探索,该过程很好地解决了药物归经从其产生发展过程中在归经与归脏之间一直存在的混乱模糊状态,应该说属于一种将经络理论及所属脏腑广泛应用到药物分类概述中的一种较为理性思考,该方法确实从某种程度上,体现了当时医家在临床上重视经络理论指导用药的思路,类似还可结合同时代《本草分经》。张鲁峰结合自己临床实践,除了将十二经与五脏五行八卦结合以外,还同时更加重视肝经和阴阳营卫气血升降理论证论治,对于张仲景六经亦采取的是经络与阴阳表里分部认识结合的方法,从某种程度上加强了藏象经络理论的整体关系性。《喉科秘诀》所体现的有关“方药归经”的经络理论运用,主要表现在对于四张方剂的归属经络上面,极具有喉科临床代表性。莫文泉从药物作用机制考虑对“药物归经”的概念提出质疑,强调“汤液治病,分气味不分经络,与针法大异”,在《研经言》中并没有认可药物归经理论,并为此提出一些理由,这些理由至今仍然存在,值得思考。周岩对药物所归属经络进行适当阐释思辨,有些认识限于时代背景虽然存在牵强之处,但还是体现了作者在西学东渐时期,对于传统经络理论更深刻的认识体会。2.药物归经形成的影响因素通过对唐以前、宋金元、明清等中医历史上三个主要不同时期,以及药物归经形成以后不同医家之间相关学术思想的比较分析,归纳“药物归经”中经络运用的影响因素主要包括：《伤寒论》“六经”辨证的方药运用启发；方剂归经对于药物归经形成的影响；特殊时代背景的影响；腧穴归经的启迪等四大主要因素。3.经络理论的运用方法及其经络认识并进而对古代医家在药物临床中运用经络理论的方法,主要从四个方面进行了探讨：以经典的经脉循行和病候为归经依据,药物作用的说明——由血气而经脉,方证对应及经脉脏腑关系推论,及引经药意义与所引之经等。对药物归经中所反映的经络理论认识,主要从药物与“脏腑系”关系、对奇经八脉的运用与认识、经脉与脏腑的关系认识等三个角度予以分析。总之,经络理论与药物运用关系,早期主要应用在方证、药证分析上面,而药物归经的出现,体现了经络理论在临床用药上面的新的应用价值。以往对于药物归经之“经”的认识,多是建立在将脏腑与经络理论孤立的基础上去进行对比,难免会产生药物“归经”和“归脏”之辨,药物所归之经,已不完全基于经络循行部位和主治症候。更多还原

【Abstract】 Acupuncture meridian theory, an important part of Chinese medicine theory, not only guide clinical practice, but also guide other branches of clinical medicine from different degrees, and pays attention by doctors. Meridian tropism theory is a theoric method to guide the administration of a meridian.The method and content of classifying drugs contains the understanding of previous knowledge of the meridian. From acupuncture research perspective, studying the application of meridians in meridian tropism, and the formation and effective factor of this method, it can make people comprehensively demonstrate the theory of meridians, deepen the known of meridians, and expand the scope of the study of meridians. At the same time, it is also an important aspect in understanding the theory of TCM.Previous studies on the drug meridial distribution mostly relied on a view from pharmaceutical,and the researches focused entirely on the effectiveness of the traditional Chinese medicine;however, for the acupuncture field, the drug meridial distribution was also considered to the pharmaceutical research. So nothing was researched on the understanding of the meridian theory related to ancient pharmaceuticals, which caused not to comprehensively know the connotation and theory of meridian.The purpose of this study is:to understand meridial thory the ancients considered in the method of drug meridial distribution.and it provide a more broad based perspective and literature for in-depth understanding and correctly interpreting the meridian theory.So, the limit of literature relating to drug was up to Qing Dynasty, mainly the literatures from herbal Jin and Yuan to the Qing Dynasty, and from the Tang Dynasty, Song Dynasty and previous literature about meridian syndrome differentiation.This study mainly based on the literatures, medical history,and theory research methods. From the perspective of the literature, medicine and background, the keys to the reseach was acupuncture on basis of drug meridian, and to disscuss the application and deep understanding of drug meridian by comparative analysis. The paper mainly contained three parts:1.The ancient "medicinal herb’s meridian tropism" the main documents and MethodsCorrelation based on three major ancient Chinese medicine Shi Yubu analysis, understanding the relationship between the meridian and drug use: Back in "Shen Nong Ben Cao Jing" a book of the times, organs and meridians have been used to express the awareness part of drug efficacy indications. Eastern Han Dynasty, "zabzabinglun" Tang "Prescriptions", "Qian Jin Yi Fang" and other works by both established medication system is still great importance attaches great importance to the significance of the meridian, which is owned by the later formation of drugs have far-reaching the potential impact.Song "and the agent the Council" "Syndrome of Materia Medica," "Ben Cao Yan Yi" and "pediatric drug card straight tactic" in the efficacy of using prescription meridian general phenomenon has emerged, although the majority still use on the meridians general, but has begun to refine, such as yang, full of Yin Meridian, concrete, such as kidney, the bladder, lung, spleen and liver, etc., and a "gas organs-organs by" such other agents and related drugs expression of the role of the meridians. Zhang Jin and Yuan physician clinical drug Speaking of hidden elements separated from the meridian as the moment, the view that "drug owned by the" possession, as the meridian system is based on differentiation, induction pathogenesis from that meridian theory with the effectiveness of the drug are classified attending thought, was later a number of physicians attached great importance to and developed further summarized and eventually become specialized medicinal theory. Expelling his disciples, to the theoretical core of the spleen and stomach, with the meridians affect the function of other organs, the direct application of meridian theory outlined prescription indications, in accordance with the air intake and the people welcome contrast pulse points "after" medication. Wang Hao Zhang ancient modeled elements and Expelling those written by the academic heritage features in its "Herbal Decoction" in more than can be reflected in the "meridian tropism" of success than Zhang element is obvious, for more drugs with the three Yin Sanyang and 12, in turn, summarized to elaborate on these drugs go through awareness, to reflect its use in traditional Chinese medicine meridian theory in understanding the extent and use them.Ming and Qing Dynasties, "Yu-machine micro-justice" in order to locate meridians prescription indications, better reflects the "Prescription Meridian" and "Drugs go through" the interaction between. "Silver Sea subtle" under "5 8 profiles Doctrine" and Tong Shen sizing for drugs and other eye characteristics theory, emphasis on "eye for the essence of the five internal organs, one of the to line" understanding of, and established on the basis of this understanding The treatment of the body through the conditioning used to treat eye diseases, herbs, meridian theory for understanding the use of clinical features in the eye has a value can not be ignored. Ye Tianshi in its many years of clinical practice, formed its own unique "drugs go over" the theory of collateral disease clinics. Shen Jin Ao for the first time to "go after" as a medicinal term up to, and summarizes the book discusses the ancient herbal owned by the content, "cited by", "Wizard", "walking", "into", "Walk" "return" and other terms referred to as "Meridian", further blurring the previous meridian concept. "Get with herbal medicine," drugs classified in the existence of "extraordinary meridian" and return "twelve" and many other passages of cognitive style, suggesting the application of Chinese meridian theory in the clinical syndrome election time for drugs, physicians focus on theoretical thinking in different point of view different will lead to different understanding. XU Da-chun meridian theory in the application of the time, mainly along the Zhongjing three Yin Sanyang awareness of the disease, will pass the meridian as a change of position by the evil, for an overview of the disease stage, and then prepare for the election administration side. Wang Qing Ren by anatomical evidence, to correct the ancients for the understanding of errors and contradictions meridians, meridian theory has its unique understanding of the creation of the recipe much, has a very wide application, reflecting its unique understanding of the meridian theory and application Methods. Package in accordance with the first hand-foot-3 Yinsan Yang Cheng organs by (including ceded Hand Shao Yin Kidney Meridian Gate of Life) on the main trends of drugs are classified, and then blindly drugs for each hand and in accordance with the nature of taste, into the organs and the efficacy of the overview, from the drugs "go after" and "go dirty," combined with the meridian system and organs, the main effect of drug medicinal characteristics of theoretical exploration, the process solves the drugs go through the process of development from its creation in Meridian return dirty and there has been confusion between the fuzzy state, we should say is a form of meridian theory, and their organs will be widely applied to drug classification outlined in a more rational thinking, this method does to some extent, reflects the physician was importance in clinical medicine meridian theory to guide the thinking of a similar combination of his contemporaries can be "divided by the herbal medicine." Zhang Lufeng conjunction with our own clinical practice, in addition to 12 combined with the five internal organs other than the five elements gossip, but also at the same time pay more attention to the liver and the theory of Yin and Yang Ying and Wei Qi and blood and treatment based on movements for Zhongjing Six has taken the meridians and the yin and yang, exterior and interior points the method of combining the Department of understanding, to some extent strengthened the meridian theory of viscera of the overall relationship. "Throat secret" embodied in the "Prescriptions go through" the use of the meridian theory, mainly in four prescriptions for the attribution of the meridian above the pole with throat clinical representative. Mo spring mechanism of drug action from the consideration of "Drugs go through," questioned the concept, stressing that "soup liquid treatment, odor, regardless of the meridian points, and the needle big differences" in the "Research by the words," There was no recognition of drug meridian theory and put forth some reasons, these reasons still exist, worth considering. Zhou Yan ownership of the drug by proper interpretation of the meridian speculative, and some background knowledge is limited although there are far-fetched, it nevertheless still reflects the period of westernization, traditional meridian theory for a better understanding of experience.2. Drugs classified by the formation of factorsBy Don ago, Song Yuan, Ming and Qing dynasties such as Chinese history, three main different times and different drugs classified by the physician after the formation of an association between the comparative analysis of academic thought, summed up "drugs go through" meridians used in the main influencing factors include:"Treatise on" "Six," the use of proof is inspired by prescription; prescription meridian tropism for the formation of drugs; special background effects; inspiration meridian acupoints four major factors.3. Meridian and the meridian theory of understanding of the use of methodsThus the ancient physicians used the drug in the meridian theory of clinical methods, mainly from four aspects were discussed:the classic meridian tropism and disease signs as the basis for description of drug action-by blood, in turn, side relationship between the corresponding organs and meridians permits inference, and the introduction of meaning and cited by the drug-tested and so on.Owned by the drug, as reflected in the meridian theory of knowledge, mainly from the drugs and the "Department of organs," the relationship between the use and understanding of the kidneys, the relationship between the understanding of meridians and organs be analyzed from three perspectives.In short, the meridian theory and drug use relationship, in the early days used in square card, drug card of the above, the drug owned by the emergence reflects the clinical application of meridian theory in the new value of the above. In the past for drugs go through, "after" knowledge, mostly based on the theory of isolated organs and meridians the basis of comparison up, inevitably produce drugs "go after" and "go dirty," Debate, the return of drugs by, no longer based entirely on the meridian and the main symptom site.更多还原