“五经”、《尔雅》与《黄帝内经》病症名词的比较研究

【作者】 赵鸿君；

【导师】 郑洪新；

【作者基本信息】 辽宁中医药大学 ， 中医基础理论， 2009， 博士

【摘要】 目的:“五经”名称始于汉代,是五部儒家经典的总称,包括《周易》、《尚书》、《诗经》、《周礼》、《春秋》。《尔雅》是我国最早的一部词典,唐文宗刻石经时,将《尔雅》列入经部。本文所言“五经”是指《诗经》、《尚书》、《周易》、《周礼》、《春秋左氏传》。“五经”、《尔雅》中存有大量的病症名词,有的意义《内经》至今仍在使用,有的意义已经转移,产生了新的意义,有的意义未见于《内经》。本文通过对“五经”、《尔雅》病症名词的研究,确定其病症词意义,比照《内经》分析其发展演变的源流,探讨疾病的致病原因,完善普通词典以及专业词典的不足。方法:本文运用文献学、训诂学、逻辑学等方法,对“五经”、《尔雅》中的病症名词进行梳理。具体方法为:①数据库检索。通过《十三经索引》查找“五经”、《尔雅》中相关的病症词,通过《四库全书》电子版、《经史子集》电子版进行检索。②手工检索。通过阅读“五经”、《尔雅》找出相关病症名词。③病症名词筛选。一个词可能出现几十次,意义不同,通过阅读分析,选出与医学相关意义的句子。④文献分析。利用《十三经注疏》、《经典释文》、《故训汇纂》、《尔雅义疏》等工具书查找相关病症词的诸家注释,利用《说文解字》、《说文解字注》、《释名》、《广雅》、《集韵》、《广韵》、《玉篇》、《通训定声》、《正字通》等工具书分析病症词的本义及引申义。通过共时描写、历时比较和数理统计相结合的方法,分析、归纳、整理,提取出病症名词的本来意义及在具体语境中的意义,分析疾病的病因病机,与《内经》进行比较,梳理病症名词发展的源流,确定病症词义的变化与否。比照《中医大辞典》、《汉语大词典》,完善其中的不足,找出其中缺失的意义,考证其所用书证的早晚。结果:1.本文考证了59个病症名词,有5个词与《内经》比较无变化或变化微小,有6个词与《内经》比较产生新义,有48个病症名词未见于《内经》。《内经》未见分四种情况:一是完全未见于《内经》;二是虽然未见于《内经》,但《内经》中产生替代词,意义相同或相近;三是《内经》中产生替代词,词义变化;四是未见于《内经》的病症名词,在后世的医学古籍中出现,有的词义变化小,有的产生新义。(1)与《内经》比较无变化或变化微小的病症名词跛、矇、瘧、瘍、心病共5个。跛,义为瘸腿、足不能行,《内经》义为瘸腿;矇,意为有眸子而盲,《内经》用“蒙”代替矇,指目不明;瘧,义为瘧疾,《内经》指温瘧和寒瘧;瘍,指身疮,《内经》亦指身疮;心病,指过度忧虑而致的心脏疾病,《内经》指心脏疾病。(2)与《内经》比较产生新义的病症名词痱、痒、疵、瘨、狂、蛊等6个。痱,泛指病,《内经》指风病、痱疮;痒,义为头疮、瘙痒,《内经》义为疮痈、皮肤瘙痒症;疵,义为小毛病、小过失、小缺点,《内经》指疮痈;瘨,泛指病,《内经》与“癫”同,指癫病;狂,指精神昏乱之病,《内经》义为癫狂病;蛊,指腹中虫、心志惑乱之疾、久病,《内经》义为溲出白液。(3)未见于《内经》的病症名词有四种情况:一是未见于《内经》的病症名词:如瞽、瞍、眇、瘵、痁、微、疕、瘏、痡、虺颓、玄黄、劬劳、逐、咎、顇、瘽、瘉、鳏、戮、(?)、疷、闵、疚、痗、瘥、瘼、(?)、痯痯、瘐瘐、籧篨、邛、痻、札、梗、壞、心疾、无慧、蠢愚、沈溺、重膇等40个。如瞽、瞍义为盲;眇,义为目偏小不盲;瘵,义为劳病;痁,义为有热无寒之瘧;微,义为足胫生疮;疕,义为头疮、秃;瘏、痡、虺颓、玄黄、痯痯皆为因过度疲劳而生病;劬劳、顇、瘽、邛皆为因过度劳苦而病;咎、(?)、疷、闵、疚、痗、瘐瘐皆为因忧愁而病;痗、痻指因思念过度而病;梗,泛指病,《内经》描绘的是疾病的症状,象“草木刺人”的“梗状”;壞,义为木之内伤病,《内经》义为败坏;心疾,指心脏疾病,《内经》指“心嫉”,与疾病无关;蘧篨指只能仰而不能俯的疾病:无慧、蠢愚指白痴;沈溺指风湿病;重膇指脚肿病,(?)为身体瘦弱之病,瘼为方言词,泛指病。二是未见于《内经》的病症名词,《内经》产生替代词,意义相同或相近:如尰、癵、心荡、戚施、废疾等。尰,指足肿病,《内经》写作“瘇”,指足及小腿浮肿;心荡,指心跳异常、心慌,《内经》以“心悬”替代心荡之义;癵,《内经》用“挛”表示筋脉拘急;戚施指不能仰之疾,《内经》用“偻”、“偻附”、“伛偻”表示戚施之不能仰之疾;废疾指残疾,《内经》用“废”表示肢体残疾。三是未见于《内经》的病症名词,《内经》产生替代词,词义变化:如癙、疢、(?)。疢,义为热病,《内经》写作“疹”,久病;癙,义为忧虑愁苦之病或忧虑愁苦所致之病,《内经》鼠同癙,用“鼠瘘”表示瘘疮;(?),义为积劳成疾,《内经》写作“瘅”,指消中病。四是未见于《内经》的病症名词,在后世的医学古籍中出现,有的词义变化小,有的产生新义:如眇、微、痁、壊、札、瘥、瘵等。眇,义为目偏小不盲,《诸病源候论》指一目盲;瘵,义为劳病,《医宗金鉴》出现“癆瘵”,《杂病源流犀烛》指虚劳重症。微,义为足胫生疮,“足胫生疮”在《千金要方》中称为“胻疮”,《鸡肋编》中称为“臁疮”、“骭疮”;疕,义为头疮、秃,《证治准绳》称为“白疕”,《外科大成》称为“蛇虱”。札、瘥指疫病或遭疫病而早死,《外台秘要》中札、瘥皆指遭疫病而早死。痁,义为有热无寒之瘧,《丹溪心法》开始以痁表示瘧疾之总称。2.从致病原因上探讨疾病的发生,归纳为3类病因:外感病因类、内伤病因类、其它病因。外感病因包括六淫致病、疫疠;内伤病因包括三种情志致病、心理因素致病、饮食致病、过劳致病;其它病因包括毒虫致病、鬼神致病、灾难致病。(1)外感病因类:①六淫致病:本文有4个病症名词是因湿致病:如尰、微、沈溺、重膇;2个病症名词是因寒热失调致病:如瘧、瘥:1个病症名词因暑热致病:如瘼。可见,先秦时期只有寒、热、暑、湿四种外邪为病。②疫疠致病:1个病症名词因疫疠而早死:如札,大荒灾之年流行疫病。(2)内伤病因类:①三种情志致病:有19个病症词是忧愁致病:如癙、疢、痒、梗、壞、咎、心病、瘉、鳏、癵、(?)、闵、疚、痗、瘼、瘐瘐、邛、痻、疷等;13个病症词因思虑过度致病:如癙、痒、狂、梗、心病、心疾、瘉、鳏、癵、疷、痗、邛、痻等;2个病症词因悲伤致病,如闵、疚。可见先秦时期致病因素只有三种情志,即忧、思、悲,忧在三种情志中所占的比例最大。三种情志致病因素的特点是,一种病症常常有两种致病因素交叉,如忧思致病,癙、痒、梗、心病、瘉、鳏、癵、疷、痗、邛、痻等皆是;忧悲致病,如闵、疚等。②心理因素致病:有1个病症名词:如戮,指的是因羞辱、耻辱而病或羞辱、耻辱之病。③饮食致病:1个病症名词是饮食致病:如瘨。在“五经”、《尔雅》中饮食致病的意思是饥饿致病。④过劳致病:过劳致病包括劳力过度、房劳过度两种。有10个因过劳致病的病症名词:如(?)、虺颓、瘏、痡、玄黄、劬劳、顇、瘽、闵、痯痯等。过度辛劳导致的疾病往往很宽泛,只释为病,表现为疲劳、憔悴。房劳致病有1个病症词:如蛊,指的是纵欲过度而致心神惑乱疾病。(3)其它病因①毒虫致病:有1个病症名词:如蛊,指蛊毒害人致病。②鬼神致病:鬼神致病的病症名词有2个:如心荡、痁。③灾难致病:有1个病症名词:如瘉,指因灾难、危害而病。本文有17个病症名词没有涉及到致病因素,如跛、眇、瞽、矇、瞍、瘵、痱、疵、疕、疡、籧篨、戚施、逐、(?)、废疾、无慧、蠢愚等,皆以症状命名,如跛为足瘸,瞽、矇、瞍是目盲,眇是一目小而不盲,疕、疡是头疮或身疮,籧篨、戚施是能仰不能俯或能俯不能仰,废疾为残疾,无慧、蠢愚是痴呆或白痴。结论:1.在成书时间上,《内经》与“五经”、《尔雅》有交叉,又略晚于“五经”、《尔雅》。《周易》成书于西周末年;《尚书》反映的是虞、夏、商、周的史实;《诗经》创作于西周初期至春秋中叶;《周礼》成书于战国晚期;《左传》是记录我国春秋时代历史的史书,战国时流行;《尔雅》成书年代一般认为是在战国末年,后经秦汉学者增补;《内经》除去《七篇大论》、两个遗篇,大致成书于西汉,说明“五经”、《尔雅》对《内经》的影响是存在的。《内经》的作者既是医学家,又是语言学家,掌握先秦文献资料,使得医学名词得以延续;另外也有可能《内经》的作者看到了没有使用“五经”、《尔雅》的病症名词,或者没有看到。在考证“五经”、《尔雅》的59个病症词中,有48个病症词未见于《内经》,占81.3%;有6个病症词产生新义,占10.7%;有5个病症词无变化或变化小,占8.5%。2.从致病因素看,归纳为3类病因:外感病因、内伤病因和其它病因。外感病因包括六淫致病、疫疠:内伤病因包括三种情志致病、饮食致病、过劳致病、心理因素致病;其它病因包括毒虫致病、鬼神致病、灾难致病。六淫致病只有寒、热、暑、湿四种外邪;灾荒导致疫疠,疫疠又成为致病因素。现代的七情致病,在“五经”、《尔雅》中仅涉及到三种情志,即悲、忧、思,以忧致病为多;心理感受耻辱也成为致病因素之一,属于心理疾病:饮食致病主要指因饥饿致病,与现代的饮食失调不同;过劳致病有10个病症名词,说明先秦时期人们的生活困苦,心理压抑,躯体过劳,这也是古人平均寿命短的原因之一。但是,古代过劳致病在内涵上与现代过劳有所不同。“五经”首次提出纵欲过度导致心神惑乱疾病,这种疾病是国君所患的病,有其特殊的群体。毒虫致病特指蛊毒。鬼神致病,说明先秦时期人们崇尚鬼神,相信天命,一切解释不清的事物均以龟占卜,认为鬼神使然。更多还原

【Abstract】 Purpose:Five Classics,dating from Hun Dynasty,is the collection of five Confucian Classics.It includes Yijing("Classic of Changes"),the Shujing ("Classic of History"),the Classic of Poetry,the Collection of Rituals,and the Chunqiu("Spring and Autumn Annals").In Tang Dynasty,Nine Classics includes the Collection of Zhou Rituals,the Collection of Rituals,the Rituals, Chunqiu about Zuoshi Biography,Chunqiu about Gongyang Biography,Chunqiu about Giliang Biography,the Classic of Poetry,the Shujing and Yijing.The Erya is the oldest Chinese dictionary.When Emperor Tang Wenzong made the lection on the stone,the Erya was included.Five Classics here refers to the Classic of Poetry,the Shujing,Yijing,the Collection of Rituals and the Chunqiu about Zuoshi Biography(Zuo Biography in short term).There are lots of terms about illness in Five Classics and The Erya.Some of the significance in them is in use,some change to new one and some vanish.Through the research of the illness terms in the two books,this article is to ensure the significance of the illness terms,to find out the origins of the development by comparing with the Neijing, to study the reason for the illness and to perfect the common dictionary and the professional dictionary.method:By collecting the works,the article sorts the illness terms in Five Classics and The Erya.The detailed methods are as follows:①Database Search.It can find our the relevant illness terms in Five Classics and The Erya through Thirteen Jing Index.Also it can search through electronic versions of the Siku Quanshu and the Jingshi Ziji.②Manual Search.That is to find the relevant illness terms by reading the two books.③Screening.One word may appear for many times with different significance. We can select the sentences with medical significance by reading and illustrating.④Works Analysis.It can find the various definitions from some works like Comments to the Thirteen Classics,the Jingdian shiwen,the Guxun Huizhuan,the Erya Yishu,etc.Also it can analyze the original and extended meaning from works like Shuowen Jiezi,Shuowen Jiezi Notes,Shiming,Guangya,Jiyun,Guangyun, Yupian,Tongxun Dingsheng,Zhengzi Tong,etc.Through the combination of the contemporary description,the historical comparison and the data statistics, the purpose is to analyze,conclude,collect and extract the original meaning and the exact meaning in the concrete context,to analyze the etiology and pathogenesis of the illness,to find out the origins of the development by comparing with the Neijing,and to ensure the change and extinction of the illness. Also by comparing with the Dictionarv of Traditional Chinese Medicine and the Chinese Dictionary,it is to perfect the faulty points,to find the lost significance and to do textual research about the documentary evidence in it.Results:1.The article does the textual research for 59 illness terms,with 5 having no or tiny change comparing with Neijing,with 6 having new meanings comparing with Neijing,with 48 extinguishing comparing with Neijing.The extinction has four kinds:the first one refers to the whole extinction of the definition;the second refers to the term extinction which means the new one replaces the old one;the third is the term extinction which means the new one replaces the old one and the definition changes;the fourth refers to the situation that the extinct term appears in the latter medical works with tiny change or new meaning.(1) Terms with no or tiny change:Five terms like Bo,Meng,Nue,Yang and Xinbing.Bo means being lame or being unmovable with foot.It means being lame in Neijing;Meng means being blind, Meng is used in Neijing instead of Meng to refer to being blind:Nue means Malaria, while in Neijing it refers to the hot one and the cold one;Yang means the body illness,the same as in Neijing;Xinbing means the illness in heart because of excessive alysmus while any illness in heart in Neijing.(2) Terms with new meanings:Six terms like Fei,Yang,Ci,Dian,Kuang,and Gu.Fei refers to illness generally,while illness with the wind or Fei sore in Neijing;Yang refers to the head sore or itching,while carbuncle or itching in skins in Neijing;Ci refers to tiny illness or fault,while disability in limbs or carbuncle in shoulders in Neijing;Dian refers to illness generally,while epilepsy as the same as Dian in Neijing;Kuang refers to illness to be mild in spirit,while Mania in Neijing;Gu refers to the illness of having worms in the body or confusion in spirit for a long time,while having the white fluid in urine in Neijing.(3) Terms not used in Neijing:It has four situations.The first one is terms not used in Neijing,with the 40 examples like Gu, Sou,Miao,Zhai,Shan,Wei,Bi,Tu,Pu,Huitui,Xuanhuang,Qulao,Zhu,Jiu, Cui,Qin,Yu,Guan,Lu,Li,Zhi,Min,Jiu,Mei,Cuo,Mo,Qi,Guanguan,Yuyu,Quchu,Qiong,M in,Zha,Geng,Huai,Xinji,Wuhui,Yuchun,Chenni,Zhongzhui.Among them,Gu,Sou mean being blind:Miao means anorthopia without being blind;Zhaimeans being ill for tiredness;Shan means having hot symptom not cold one;Wei means sore in hind tibia;bi means sore and bald in head;Tu,Pu,Huitui,Xuanhuang,Guanguan all mean having illness for excess tiredness;Qulao,Cui,Qin,Qiong all mean having illness for excess labor:Jiu,Li,Zhi,Min,Jiu,Mei,Yuyu all mean having illness for alysmus;Mei,Min mean having illness for excess miss;Geng refers to illness generally,while the symptom of illness in Neijing,with the meaning of the shape of stalk like grass stabbing people;Huai means the inner illness of the wood while the inner illness in Neijing;Xinbing means the illness in heart because of excessive alysmus while any illness in heart in Neijing.Quchu mean the head only throwing back not throwing forward:Wuhui,Yuchun mean being an idiot;Chenni means rheumatology;Zhongzhui means the foot swelling; Qi means emaciation;Mo,the dialect,means illness generally. The second one is the replaced terms with same or similar meaning,not used the terms in Five Classics and Erya,like Zhong,Luan,Xindang,Qishi,Feiji,etc. Among them,Zhong refers to the foot swollen,while edema of the foot and cnemis with the writing as Zhong;Xindang refers to the irregular beating or the flustered feeling of heart,while it has the replaced term as Xinxuan or Xinji; Luan refers to limb spasm in muscle and vessel in Neijing with the writing as Luan;Qishi refers to the illness of disability of throwing back the head,with the replaced terms as Lou、Loufu、Yulou in Neijing to make the same meaning; Feiji refers to the disability,while the same meaning with the word of Fei.The third one is the replaced terms with changed meaning,not used the terms in Five Classics and Erya,with the example like Shu,Chen,Dan.Chen means calenture,while aeipathia with the word of Zhenin Neijing;Shu means the illness of alysmus,while in Neijing Shu is regarded as Shu,to refer to the sore of fistula with the word Shuliu;Dan means the breakdown from constant overwork, while in Neijing it is written as Dan with the meaning of Xiaozhong Illness.The fourth is the situation that the terms not used in Five Classics and Erya appear in the latter medical works with tiny change or new meaning,like Miao,Wei,Shan,Huai,Zha,Cuo,Zhaietc.Miao means anorthopia without being blind, while one-eye being blind in Treatise on the Causes and Manifestations of Diseases;Zhaimeans illness of tiredness,while is written as LaoZhai in Golden Mirror of Medicine and means the serious illness of deficiency for tiredness in Zabing Yuanliu Xizhu;Wei means sore in hind tibia,while called Hengchuang in Invaluable Prescriptions for Ready Reference and Lianchuang、Ganchuang in Jileibian;Bi means sore and bald in head,while Bai Bi in Zhenzhizunsheng,while Sheshi in Compendium of Surgery;Zha,Cuo refer to loemia or early death because of loemia,while early death because of loemia in Medical Secrets from the Royal Library;Shan means having hot symptom not cold one,while as a general term in Danxi Xinfa.2.There are three types of pathogeny according to the reasons to cause the illness,that is,the type of diseases caused by exogenous pathogenic factor, the type of diseases caused by internal injury,the type of diseases caused by other reasons.Diseases caused by exogenous pathogenic factor include illness for six evils and loemia;diseases caused by internal injury include illness for the three emotions,illness for diet and illness for excess tiredness; diseases caused by other reasons include illness for poisonous worm,illness for ghost,illness for disaster and illness for psychological elements.(1) Diseases caused by exogenous pathogenic factor:①Illness for six evils:Here it has 5 terms of illness for hygropathy like Zhong,Wei,Chenni,Zhongzhui;1 term of illness for disharmony of temperature and coldness like Nue,Cuo;1 term of illness for hotness like Mo.From this,we can see there are only four exogenous evils to be illness including coldness, temperature,hotness and hygropathy in Pre-Qin Period.②Loemia:one term for death for loemia,like Zha.Loemia is spreading in famine year.(2) Diseases caused by internal injury:①Illness for the three emotions:It includes 19 terms for the worried emotion like Shu,Chen,Yang,Geng,Huai,Jiu,Xinbing,Yu,Guan,Luan,Li,Min,Jiu, Mei,Mo,Yuyu,Qiong,Min,Zhi;13 terms for the excess thinking like Shu,Yang, Kuang,Geng,Xinbing,Xinji,Yu,Guan,Luan,Zhi,Mei,Qiong,Min;2 terms for sorrow like Min,Jiu.From this,we can see there are only three emotional elements to result in the illness in Pre-Qin Period,while sorrow makes the greatest ratio in these three.The feature in this part is that one illness often mixes with other two reasons like illness for thinking and worry.So doShu,Yang,Geng, Xinbing,Yu,Guan,Luan,Zhi,Mei,Qiong,Min.Also like illness for worry and sorrow.②Illness for diet:One term like Dian.It refers to illness for in Fivo Classics and Erya.③Illness for excess tiredness:It includes two kinds like excess labor and excess indulgence.There are 10 terms for the excess labor like Dan、Huitui、Tu、Pu、Xuanhuang、Qulao、Cui、Qin、Min、Guanguan.Such kind of illness is so general that we usually explain it as illness,with the symptom as being tired. There is one term for the excess indulgence like Gu,which means confusion in mind because of the excess indulgence.(3) Illness for other reasons:①Illness for parasitic tympanties:One term like Gu,which means the illness for the harm of poisonous worms.②Illness for ghost:It includes 2 terms like Xindang,Shan.③Illness for disaster:One term like Yu,refering to the illness for disaster or harm.It should be defined as the psychological term.④Illness for psychological elements:It has 1 term like Lu which means illness for shame.There are 17 terms without any relations to the pathogenic factors including Bo,Miao,Gu,Meng,Sou,Zhai,Fei,Ci,Bi,Yang,Quchu,Qishi,Zhu,Qi,Feiji,Wuhui,Yuch un.They can be classified to two types --- one is for the terms of physiological disease like Bo to be lame,Gu,Meng,Sou to be blind,Miao to be narrow in one eye not being blind,Bi,Yang to have sore in head and body,Quchu、Qishi to be throwing back not throwing forward or throwing forward not throwing back,Feiji to be disable,Wuhui,Yuchun to be an idiot.The other type is for the terms of being abnormal like Qi to be limp,Zhaito be tired,Fei to be regarded as the general illness,Ci to be faulty.Conclusion:1.In the point of time to finish the works,Neijing has crossing with Five Classics and Erya,while later than them.Yijing is finished in the late Xihan; Shujing shows the history of Dynasty of Yu,Xia,Shang and Zhou;the Classic of Poetry is made between the start of Xizhou Dynasty and the middle age of Spring and Autumn Period;the Collection of Rituals is finished in the late Warring States Period;Chunqiu about Zuoshi Biography is a history of Spring and Autumn Period and is popular in Warring States Period;Erya is regarded to be finished in the end of Warring States Period and then improved by the scholars in Qin and Han Dynasty;Neijing,except Qipian Dalun and two remains,is finished in Western Han Dynasty.It shows that the influence of Five Classics and Erya on Neijing really exists.The author of Neijing is both medical scientist and linguist.They collect the information of works in Pre-Qin Period,which makes the spreading of medical terms.In other points,the author of Neijing did not use the terms in Five Classics and Erya or did not see them.When we are doing the textual research on the 59 terms in Five Classics and Erya,there are 48 terms extinct in Neijing,which accounts for 81.3%;there are 6 terms with new meanings,which accounts for 10.7%;there are 5 terms with no or tiny change, which accounts for 8.5%.2.There are three types of pathogeny according to the reasons to causethe illness,that is,the type of diseases caused by exogenous pathogenic factor,the type of diseases caused by internal injury,the type of diseases caused by other reasons.Diseases caused by exogenous pathogenic factor include illness for six evils and loemia;diseases caused by internal injury include illness for the three emotions,illness for diet and illness for excess tiredness; diseases caused by other reasons include illness for poisonous worm,illness for ghost,illness for disaster and illness for psychological elements.Illness for six evils only include coldness,temperature,hotness and hygropathy.Famine results in the loemia while the loemia becomes the pathogeny.Among the seven emotions nowadays,there are only three to mention in Five Classics and Erya. And the most are sorrow,worry and thinking.Diet mainly refers to hunger,which is different from the definition of drinking and eating irregularly;excess tiredness has 10 terms,which means the life in Pre-Qin Period is so severe and people at that time have no personal freedom.The physiological and the psychological pressure result in the short-time life in the ancient time mainly. But the connotation of excess tiredness is quite different from the present one. It is the first time to mention the excess indulgence will result in the illness in confusion of mind.This illness is the one that the emperor has most,which is the special group.To feel ashamed becomes one of the pathogeny,belonging to the psychological illness;Poisonous worms refers to the Gu poison.Illness for ghost shows that people in Pre-Qin Period admire ghost and believe the fate. They will make augury with turtles to find out the fact of all the obscure things because they think the ghost makes it.更多还原