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《难经》医学体系解读

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《难经》认为,饮食五谷是维持人体生命活动的基本物质来源,六腑负责受盛水谷,并将其转化为精微物质,而五脏负责储藏精微物质以舍神.在五脏六腑对精微物质生成与储存的中间环节,还需要三焦对其运输.疾病的生成与传变有"七传",第一步是外感六淫,《难经》称之为伤寒,第二步为邪气侵袭五脏,若不治则按照相克的方向传变,心传肺为第三步,肺传肝为第四步,肝传脾为第五步,脾传肾为第六步,肾传心为第七步.在疾病传变期间,若出现"王者不受邪"情况,则会发生积聚.《难经》采取"病、脉、诊"并参的诊法系统,病与脉、内外证相参,医者通过脉诊诊断出其相应的五脏脉,之后通过问诊、望诊、闻诊等得出相应的症状(病)、体征(诊、内外证),将五脏脉应有的内外证、病与所得的内外证、病进行比对,相符说明脉诊正确,不相符则需要重新诊断.在邪气初犯人体之时,《难经》以汗法、下法治疗,若有虚损脏腑,祛邪的同时辅以补益,以防外邪入里.针刺多参考卫气针法,以脉诊确定邪气侵犯部位,依据"卫气分部,营气循经",择而针之.《难经》以"肾间命门"为人体元动力,三焦为运行通道,阴阳、五行为指导诊断与治疗的方法论,形成了独具特色的"命门-三焦-五行"医学体系.
Interpretation of the Medical System in Classic of Difficulties
According to Classic of Difficulties,grains and other foods are the fundamental sources of nourishment for human life activi-ties.The six fu organs are responsible for receiving and digesting these grains,transforming them into refined substances,while the five zang organs store these refined substances to house the spirit.The transportation of these refined substances between their generation and storage is carried out by the triple energizer.The development and transmission of diseases follow the principle of"seven transmis-sions."The first stage involves the external invasion of the six pathogenic factors,which Classic of Difficulties refers to as"cold dam-age".The second stage involves the invasion of the five zang organs by pathogenic qi.If untreated,the disease progresses following the control cycle:from the heart to the lungs(which is the third stage),the lung to the liver(the fourth stage),the liver to the spleen(the fifth stage),the spleen to the kidney(the sixth stage),and finally,from the kidney back to the heart(the seventh stage).If the trans-mission is interrupted by"the ruling organ not receiving evil"condition,accumulations or masses may form.Classic of Difficulties em-ploys a diagnostic system integrating"disease,pulse,and diagnosis".It cross-references pulse diagnosis with both internal and external manifestations of disease.Physicians diagnose the corresponding pulse of the five zang organs and confirm the diagnosis through inquiry,inspection,and listening.If the internal and external symptoms match the expected organ pulse,the pulse diagnosis is considered accu-rate;otherwise,re-diagnosis is required.When pathogenic qi first invades the body,Classic of Difficulties advocates treatments using sweating and purging methods.If there is deficiency or damage to the internal organs,the dispelling of the pathogenic qi is supplemented with tonification to prevent the external pathogens from penetrating deeper into the body.Acupuncture often follows the defense qi acu-puncture method,where pulse diagnosis is used to determine the area of the body affected by pathogenic qi.Based on the principle of"the division of defense qi and the circulation of nutrient qi along the meridians,"specific acupuncture points are selected accordingly for treatment.Classic of Difficultie regards the"Mingmen(GV4)between the kidneys"as the primary source of vital energy in the hu-man body,with the triple energizer acting as the pathway for its circulation.Guided by the theories of yin-yang and the five elements,it establishes a unique medical system centered around the"Mingmen(GV 4)-the triple energizer-five elements"framework for diagnosis and treatment.

Classic of Difficultiesmovement of qi between the kidneystriple energizerfive elementsmedical system

蔡超产、徐峰

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北京中医药大学第三附属医院,北京 100020

《难经》 肾间动气 三焦 五行 医学体系

2024

河南中医
河南省中医药学会 河南中医学院

河南中医

影响因子:0.968
ISSN:1003-5028
年,卷(期):2024.44(10)