摘要
《神灸经纶》(以下简称《神灸》)是清代古歙吴亦鼎所著,成书于咸丰辛亥年间(1851年),距今不到160年。吴氏精医理,慨叹当时医者多以汤液为主,灸法旁落,云：“灸疗亦与针并重,而其要在审穴,审得其穴,立可起死回生”,遂篇着《神灸经纶》四卷,约20余万字。全面总结了清代以前有关灸疗灸法的理论和临床实践。全书专论灸法,详列蓄艾、用艾、灸忌以及十二经、奇经八脉的循行经络、全身诸病之证与治、特殊灸法,如“骑竹马灸法”、“四花穴灸法”、“秦承祖灸鬼法”和各种隔物灸等,是近代灸疗灸法专着中的专着。
一、吴氏主要强调的基础理论
《神灸》“蓄艾”篇全文不过88字,指出：“凡物多用新鲜惟艾取陈久者良”,明示用艾以陈旧者为佳,因艾性纯阳,气味辛烈,新用恐伤血脉肌肤,必待三年,候其燥气降解,性温和方可取用
《神灸》第一卷之十八“灸疮候发”。主要论述和强调艾炷灸的着肤灸,即“瘢痕灸”所产生的“灸疮”。并且对其灸后饮食、意外情况等处理都有详尽论述,值得进一步研究和探讨。
《神灸》全书,立“男左女右”度量取穴与施灸方法共10条,可见吴氏特别重视此临床法则。本文试图透过现代解剖学、分子学、能量学分析,并对比古代文献,辨明“男左女右”在医学上的意义和临床价值,从而移除中医科学化、现代化的伴脚石。
二、吴氏对于临床上的灸法以及处方
《神灸》第三卷详论全身证与治的灸法灸疗首章,论述精详,用穴处方简单,其它专着鲜能出其右,往下之治疗篇乃作者毕生的临床施治的总结,值得深入探讨。
《神灸》灸疗伤寒项目不过21条,首6条属阴阳二经同时受寒,病情严重,灸多详明壮数,而且用穴精简,可见吴氏在救急之时,须一矢中的,不容虚发。第7至21条属伤寒初起,病情较轻,灸不限壮数而且处方用穴较阔,是施术的神髓,后学不容忽视。《神灸》灸疗两感、合病及过经不解等严重症候以阴经为主,尤重用足太阴肾经之太溪。以远程取穴为主,发挥扛杆作用,而壮数亦不过三、五、七而矣,提示点到即止。伤寒轻症处方为复合式,以局部及远程取穴兼营,而且不壮数,提示医者可临床制宜。
《神灸》对中风病因的观点：《神灸》第三卷第十节之“中风证治”,吴氏结合《内经》等文献,详论“气虚”乃中风病的主要病因。一身之气不足,是谓胃气虚,在先天,主要责之肾,在后天,主要责之脾胃。《内经》曰：“邪之所凑,其气必虚”。吴氏所言“气虚”乃指中气之虚,所谓“中气”是指中焦脾胃气化升降的功能。《医家秘奥》言：“按阳气有三名,一曰宗气,即膻中之阳,一曰胃中之阳,又曰中气。……一曰肾中之阳,又曰命门真火。”气的作用历来被医家重视。中风选穴上根据“治痿独取阳明”,常取手足阳明经腧穴为主,临床时随症加减施治。吴氏在中风急性期(卒中)主张灸神厥穴,曰：“凡卒中风者,此穴最佳”。罗天益云：“中风服药只可扶持,要收全功,灸火为良。盖不惟追散风邪,宣通血脉,其于回阳益气之功,真有莫能尽述者。”查神厥位居脐中,为先天之根蒂,又为五脏六腑之本,气血归藏之根,灸之可以培本固元,温阳益气。其实在临床上“卒中”除灸神厥外,关元、气海、丹田皆一脉相承,操作一气呵成,亦可一并灸之。关元可补“脐下肾间动气”,来达到固护的目的。
《神灸》在十三条灸治中风组方中,有五条言明所灸壮数,由二、三、五、七以致百壮不等,明显强调应以化脓灸为主。有研究证明,化脓灸可以降低高血压患者的血压,降低“血液粘稠度”和“纤维蛋白降解产物”,改善脑血流图,从而起到活血化瘀的作用。但目前化脓灸疗法在中风的临床运用尚未受欢迎,所以取而代之,可以大剂量而持续施灸,从量变而达质变的效果。
《神灸》第三卷之十二有厥逆证略及十三有厥逆证治二篇。“厥逆证略”全篇仅二百余字,宗《内经》以定分型,精简而握要。一语道出,救治厥逆重在元气之固护,并与伤寒之厥鉴别。至于文中有“四时不正之气及山魔、土煞、五尸、魔魅(古代迷信用语)”中人可至厥之说,近乎迷信,无须深究。吴氏又推崇灸疗厥逆莫如秦承祖灸鬼法及华佗救阳脱法,前者史有记载,而且近代亦应用于急慢性焦虑证,后者则无从稽考矣。“厥逆证治”全篇分型九类,看似杂乱无章,惟已涵盖诸般致厥病因,其用穴少而炷数多,动辄几十壮甚至百壮不等,皆以灸至患者苏醒为度。
《神灸》第四卷未为“外科证治”,是全书精华所在,所涉症状无有不包,几乎涵盖通身,其中有关疽病35例、痈病13例、疠病6例、瘿瘤赘疣疹疥等15例(尚有3例因言语不详,无从分类),由深层病至浅表病,共68例,而且以较严重的疽病着墨较多,是吴氏用心之处。古代临床灸疗痈疽大都在病灶部位(肿块高耸之处)直接着艾下火或在痈疽表面隔物灸,而《神灸》以穴配症,辨证施治,从整体出发,尝以远端取穴；经验穴；局部取穴,合乎“系统扶正”原则,是《神灸》之重点。其灸疗用穴简单而奇特,多一症配一二穴,临床上容易掌握,易于操作,是其可贵之处。从上诸家灸疗厥证观察,《神灸》明显类症分型较详细,取穴较多,可集前圣之大成。观察表明,灸疗厥逆证取壮数偏多,动辄几十壮甚至过百壮,但至《神灸》在壮数方面已无明言,大概已体会救人以回阳复苏为务,壮数多寡已无实际意义。而且古人所言“百壮”非实数也,言其多也,不可泥于数字,但视乎临床患者反应,其它有明示多少壮者亦如是观。
《神灸》在“外科证略”一卷中,尝引《内经》、薛立斋痈(疽之五善七恶)、元戎(元·王好古之《医垒元戎》)、《精要》等,在痈疽辨证论治上多所发明。在灸量方面,吴氏宗陈实功法,曰：“一切疮毒大痛或不痛,或麻木,如痛者,灸至不痛,不痛者,灸至痛,其随火而散,此从治之法也。”
《神灸》外科证型及治法共72种,第三十二证坐马疽、五十九证身面赘疣、七十一证腋气、七十二证毒疮久不收口,无言明专穴,但灸患处便是,不列入统计范围,所以以68证为基数。目的：将《神灸》外科证治灸疗用穴,分六类,由A至F,归纳其用穴的共性和必然性,从而得出用穴规律,给临床灸疗在灸治肿瘤时较明确的指引。A.手足三阳经B.手足三阴经C.任脉D.督脉E.经外奇穴F.特定穴
三、特殊灸法
吴亦鼎氏在《神灸》卷四“外科证治”中有三例应用骑竹马灸法以灸治痈疽病：第一条“骑竹马灸法主治一切痈疽恶疮发背,妇人乳痈”；第二十一条“背疽当观其色,赤肿痛易治,……春黄夏黑不治……急以骑竹马法灸之”；第五十六条“瓜藤疠,胸前生者。肘尖、少海、骑竹马灸。”骑竹马灸法乃古代治疗外科痈疽病的一种特殊灸法,病人须由两人参扶,骑在竹杠上,两脚悬空,在背上施灸,对治疗恶性痈疽疮疡病变有特殊疗效。但今人对此法的应用与源流已不甚了解。据史料所载,此法首载于南宋,闻人耆年所著《备急灸法》中。宋.陈自明《外科精要》有录“骑竹马灸法”,文中提到“叶丞相方、洪内翰方、陈日华方、郭知县方,皆云：自得此,救人不可胜计。”叶丞相、郭知县灸方均见于现存北宋洪内翰《洪氏集验方》一书中,而叶、郭二氏的取穴法相同,却又与宋以后的通行骑竹马灸法取穴法有所不同,可见前者为其雏形、宋至清为成熟期。近代在取穴方面又有所变通(见下文),可视为褪变期,但无论如何,其取穴部位总不离人体的背部,背部是最接近五脏六腑的神经反射区,灸疗背部腧穴可直接调节内环境的平衡。古为今用,作为发掘前贤宝藏的同时,探究骑竹马灸法的实用价值是急切而必然的。
秦承祖灸鬼法属另类特殊灸法,临床报导较为少见,但临床实践证明,在治疗慢性焦虑证,躁郁证等神经性疾病,疗效甚佳。一些神经易激性病患者,大都对针刺治疗有抗拒。秦承祖灸鬼法以取鬼哭穴为主,取穴既简单、灸治过程短、痛苦轻,而且起效快,主要适应证是深夜神志异常、哭闹惊惧的患者。由于“病时”多在晚上,又病无常态,所以冠以“鬼”字。《神灸》第三卷十二之“厥逆证略”中有载“……飞尸卒厥……莫如秦承祖灸鬼法为妙。”特别指出“四时不正之气及山魔、土煞、五尸、魇魅”等引起“尸厥”都可以用此法灸治。
近世代社会发达,大部分国家都从农转工、转商、转高新科技的发展,人与人之间的关系压缩至近乎零的空间,人性疏离,“工作压力”、“情志病”,成为头号致病源。有报导,一些先进国家的精神科个案每年以双位百分点暴升,以“灸鬼法”灸治癫、狂、痫、精神分裂、焦虑症、躁郁症等功能障碍症,既安全、疗效高,又无药物毒副作用和依赖性,是“古为今用”的经典,值得推广和深层次研究。
四：数据库
灸疗灸法用穴是防病治病的关键,即吴氏所云：“审得其穴,立可起死回生。”但历代医家各有体验,灸疗灸法适应症和用穴屡多增补,为免沧海遗珠,本文利用电子计算器,建构两软件：
软件A：以《神灸》诸证治为主导,与历代有代表性文献(29种)对比,得出《神灸》用穴的认受性,从而确定“有是证,用是穴”,的概念,为灸疗处方奠立基础。
软件B：以腧穴为主导,详列人体诸穴灸疗所主治,快速展示历代医家对该穴的应用率,加强使用该穴的灵活性和信心,有助灸疗灸法的临床应用。
上述软件查找方便,可以作为灸疗电子字典。为供诸同好,有利临床应用,增强使用灸法者的信心,希望为灸法天地跨出新的一步,所以上述软件,不作注册专利,欢迎复制使用。
"Shenjiujinglun" (hereinafter referred to as "Shenjiu") is the ancient Qing Xi Wuyi Ding's book, written in between Xianfeng Xinhai (1851), less than 160 years ago. Wu Jing medical knowledge, doctors who lament was based mostly soup liquid, moxibustion changed hands, saying:"moxibustion and acupuncture both are, and its point in the trial, the trial obtaining the point, can stand back from the dead", then chapter of "Shenjiujinglun" four volumes, about 20 million words. For a comprehensive summary of the Qing Dynasty before moxibustion moxibustion theory and clinical practice. Monograph book moxibustion, Ai build detailed, with Ai, moxibustion bogey and twelve, eight extra meridians through the line, the body and treatment of various diseases of the card, special moxibustion, such as "riding a bamboo horse moxibustion" "Four Flowers points moxibustion", "Qin Chengzu moxibustion ghost Law" and various other partitioned moxibustion, moxibustion moxibustion in modern monograph monograph.
First, Wu stressed that some of the basic theory mainly has the following
"God Moxibustion", "build Ai" chapter 88 text characters, however, pointed out:"Where things get more fresh but Ai Chen Jiujin are good," Viagra for the express use of the old preferred, because of Ai Shun Yeung, smell Xinlie, new blood with the fear of skin injury, will stay for three years, waiting for the dry air degradation of moderate access only
" Shenjiu " VolumeⅠof the eighteen "moxibustion sore waiting development." Mainly discussed and stressed skin with moxa cone moxibustion, moxibustion, or "scar Moxibustion" generated "moxibustion sore. " After their diet and moxibustion, such as handling unexpected situations are discussed in detail, worthy of further study and discussion.
"Shenjiu" book, legislation "Nanzuonvyou" acupoints and moxibustion methods measure a total of 10, see Wu particular attention to the clinical rule. This paper attempts to make use of modern anatomy, molecular, energy analysis and comparison of ancient literature, identify "Nanzuonvyou" the meaning in medicine and clinical value, and thus remove the Chinese scientific and modern rock with feet.
Second, Wu and moxibustion for clinical prescription of the following main diseases
"Shenjiu" the third volume of the body card details and moxibustion moxibustion treatment of the first chapter discusses the fine detail, using simple point prescription, and other monographs can match his fresh, down to the treatment of life-long papers are clinical differentiation of summary, worthy of further exploration.
"Shenjiu" cold moxibustion healing items, but 21, the first six are yin and yang by both cold and serious condition, the number of moxibustion and more full and clear strong and streamlined with a hole can be seen in the emergency of the Wu, it should be in a vector, should not be in vain. Section 7-21 is typhoid fever since the beginning of mild, moxibustion not limited to a few strong points, and a wider use of prescription, is the essence of the treatments, after the school can not be ignored. "Shenjiu" both a sense of moxibustion, combined disease and other serious symptoms have been puzzled by the yin-based, especially the reusability of the kidney was too full moon river. The main acupoints to remote play the role of a lever, and strong, but also the number three, five, seven and men, and cue point to the last. Mild typhoid fever as a compound prescription to the local and remote acupoints concurrently, and the number is not strong, suggesting that doctors who may be of clinical benefit and development.
"Shenjiu" perspective on the etiology of stroke:"Shenjiu" section X of VolumeⅢ, "Treatment of Stroke", Wu with "via" and other documents, details of "Qi" is a major cause of stroke. One of the gas shortage, is that the stomach qi deficiency in the innate, the main responsibilities of the kidney, the day after tomorrow, the main responsibility of the spleen and stomach. "Nei Jing" said:"The evil Minato, the gas will empty. " Wu said, "Qi" means in the empty air, so-called "in the air" refers to movements in the function of coke gasification stomach. "Doctors Secret" words:"Three by yang, said cases of a gas, that is the smell of mutton yang, the yang of a stomach said, again, he said in the gas.……A kidney yang said, again, he really Vital the fire. "The role of gas has always been doctors attention. Stroke selection of points on the basis of "treating atrophy was given Yangming", often hand-foot-Yangming Meridian points to take the main addition and subtraction with the disease when clinical and treatment. Wu in the acute phase of stroke (stroke) advocates point moxibustion God Jue, said:"Where the wind stroke, the hole the best." Luo Tianyi says:"stroke medication can only support, to receive full power, moxibustion fire for good. Cover Bu Wei chase San Feng Xie, Xuan-blood, its back to the Yang Qi of the work, who really exemplifies the best of the above. " Investigation of God Jue among the navel, for the birth of the pedicle, but also for the internal organs of the country, the root of blood return reservoir, moxibustion can be training the solid element, yang qi. In fact, the clinical "stroke" In addition to moxibustion God Jue, the related element, air sea, pubic region are the same strain, operating at one go, can be incorporated in moxibustion. Guanyuan can make up "below the belly button kidney angry", to achieve the purpose of solid protection.
"Shenjiu" in the stroke group of thirteen moxibustion prescription, there are five strong implicit that the number of moxibustion, by two, three, five, seven hundred strong that range, obviously the main emphasis should be purulent moxibustion. Studies have shown, suppurative moxibustion can reduce blood pressure in hypertensive patients, reduce the "blood viscosity" and "fibrin degradation products", to improve cerebral blood flow map, which play a role in blood circulation. But festering moxibustion clinical application in stroke has not yet popular, so instead, you can high-dose and sustained moxibustion, up from the quantitative and qualitative results.
"Shenjiu" the third volume of twelve and thirteen have Jueni card has Jueni slightly Treatment of two. "Jueni Card Strategy," the whole chapter is only two hundred words, were "via" to set type, lean and grip to. A way to explain, where Jueni focusing strength of the solid protection, and the dedication with the identification of typhoid fever. As for the article in the "four o'clock unjust gas and mountain magic, evil earth, five dead, magic charm (the ancient superstition term)" to the dedication of the human can be said, almost superstitious, do not get to the bottom. Wu and respected moxibustion moxibustion Jueni ghost method and nurturing Qincheng Zu Yang Hua save off method, the former recorded history, but also applies to acute and chronic anxiety of modern cards, which carry no from ascertained. "Jueni Treatment of" The complete classification of nine categories, seemingly chaotic, but has covered all sorts of causes induced Jue, the cone with the number of points less and more easily tens or even hundreds Zhuang Zhuang, ranging from patients begin with moxibustion for the degree of awakening.
"Shenjiu" fourth volume is not as "Surgical Treatment" is the essence of the book, covering the symptoms are not included free, almost covering Tongshen, including 35 cases of illness related to anthrax, carbuncle disease in 13 cases, Pandora disease in 6 cases, scabies rash wart gall tumors in 15 patients (3 patients are still unknown because of language, no categories), from deep to superficial disease patients, a total of 68 patients, and patients with more severe gangrene dwell more, is the heart of the Wu Department. Ulcer clinic moxibustion Ancient mostly in the lesion site (mass towering place) directly under the fire with AIDS or ulcer surface of Indirect Moxibustion, and "Shenjiu" to point with disease, syndrome differentiation, starting from the whole, try to remote acupoints; experience points; local acupoints, in line with "the system righting" principle is "Shenjiu" in focus. Moxibustion with its simple and exotic points, with more than one disease or two points, the clinical easy to grasp, easy to operate, is the valuable point. Moxibustion from the various home Jue permit observation, "Shenjiu" significantly more detailed classification of disease categories, more acupoints, can set the culmination of the former St. Observations showed that moxibustion Jueni card-number to take strong ones, easily tens or even hundreds strong and strong, but to "Shenjiu" is no longer made it clear that several aspects in strong, probably have already experienced life-saving service recovery, to the return Yang, Zhuang numbers are small moot. And the ancients said, "the hundred strong" non-real also, words and more also, not mud in the figures, but depending on the clinical response of patients, how many other have expressed strong Zheyi agree.
"Shenjiu" in the "Surgical Strateg" a roll, the taste of lead "via", Xue Li Zhai carbuncle (gangrene of the five good seven evil), Yuan Rong (Yuan·Wang Hao ancient "medical barrier Yuanrong"), "Essentials "and so on in ulcer diagnosis and treatment more than invention. In moxibustion quantity, Wu Chen Shi Gong cases, said:"All sore big pain or no pain, or numbness, such as the pain person, moxibustion to no pain, no pain were, moxibustion to the pain, its with the fire and dispersed, this also from the rule of the law. Shenjiu "Surgical Treatment of Points Rule:"Shenjiu" surgery syndrome and a total of 72 kinds of therapies, the thirty-second ride horses gangrene certificate, identity card Fifty-nine face wart, Seventy-one card axillary gas, eventually becoming heal canker seventy cards, no implicit special points, but moxibustion affected area is not included in the statistics, so the 68 permit the base. Objective:The "Shenjiu" Surgical Treatment of moxibustion with points, six points from A to F, summarized the common use of point and necessity to arrive at Points Rule, to clinical moxibustion moxibustion tumors than in clear guidelines. A. Sanyang hand, foot and hand, foot and three yin channels by B. Du C. Ren D. E. F. The specific points outside the singular point
Third, special moxibustion
Wuyi Ding's "Shenjiu" volume IV, "Surgical Treatment" in the bamboo horse riding, three patients were treated with moxibustion moxibustion ulcer disease: the first "bamboo horse riding moxibustion treating all ulcer malignant sore hair back, the woman breast carbuncle"; Article a "back gangrene when the concept of the color, red throat and easy administration, Yellow Spring Summer…………radical black dead riding a bamboo horse law in moxibustion"; Fifty-sixth of "melon vine Pandora, chest living. Zhou Jian, a small sea, riding a bamboo horse moxibustion. "riding a bamboo horse moxibustion is the surgical treatment of ulcer disease in ancient a special moxibustion, and help patients by two parameters, riding on a bamboo bar, feet dangling in the back of moxibustion, Sores on the treatment of malignant ulcer disease with special effects. However, application of modern people and the origins of this law has been poorly understood. According to historical data contained in this Act first set out in the Southern Song Dynasty, famous person for the Elderly [] "written emergency preparedness moxibustion" in the. Song. Chen Ziming "Essentials of Surgery, " has recorded a "bamboo horse riding moxibustion, " in which refers to "Ye Chengxiang Fang, Fang Hong Lenehan, Chen Japan-China party, the magistrate Fang Guo, Jie Yun:contented of this, to save not win total." Leaf prime minister, Guo Fang are found in the existing magistrate moxibustion Lenehan Hong Song, "Hung set prescription," a book, and leaves, Guo Ershi the same point selection method, but with the passage of riding a bamboo horse after the Song moxibustion point selection method has The difference shows that the former is its shape, Song to Qing was mature. Modern aspects of the acupoints have the modifications (see below), can be regarded as Fading period, but in any case, the total area separated from the body's acupoints back, back is the closest to the internal organs of the nervous reflex, moxibustion and acupoints back can directly regulate the balance within the environment. Past serve the present, as a treasure to explore worthies, while riding a bamboo horse to explore the practical value of moxibustion is urgent and inevitable.
Qin Chengzu ghosts of the French alternative special moxibustion moxibustion, clinical reports are rare, but clinical practice has proved, in the treatment of chronic anxiety card, manic depression syndrome and other neurological diseases, very good effect. Some patients with sexually transmitted diseases, nervous bowel, most of the acupuncture treatment resistance. Qin Chengzu law to take ghost moxibustion Guiku acupoint, acupoints is simple, the process of short-moxibustion, pain, and rapid onset, the main indication is the abnormal state of mind at night, crying and frightened patients. As the "sick time" and more in the evening, and a disease is not normal, so as a "ghost" characters. "Shenjiu" Twelve of the third volume, "Jueni card slightly" in the set [] "…………flying dead death dedication equal to the union Qin Chengzu moxibustion method for the wonderful ghost." Highlighted the "Four Seasons of errors of the gas and the Magic Mountain, soil evil, five dead, Nightmare Enchantment "and cause" dead Jue "moxibustion can this method.
Social development in recent generations, most countries are from rural to change jobs, switch providers, the development of high technology transfer, human relations compressed to almost zero space, human alienation, "work pressure" and "emotional illness", become the number one source of disease. It has been reported, a number of psychiatric cases in the advanced countries to double-digit percentage points every year shot up to "Ghost moxibustion Law" moxibustion insane, crazy, epilepsy, schizophrenia, anxiety disorders, bipolar disorder and other functions, both safe and effective high, nor of drug side effects and dependence, is the "past serve the present" a classic, worthy of promotion and deep research.
Fourth, moxibustion moxibustion prevent and cure diseases with the key point is that Ng says:"Examination of obtaining the point, can stand back from the dead. " But the ancient physicians have experience, and the use of moxibustion moxibustion points repeated indications many additions, the Pearl of the sea to avoid, this use of electronic calculators, construction of two software:
Software A:the "Shenjiu" all evidence-led government, a representative with the ancient literature (29 species) compared draw "Shenjiu" the acceptability of using points to determine "There is evidence, with a hole", the concept for the foundation laid moxibustion prescription.
Software B:acupoints led to set out the body by attending various points moxibustion, ancient physicians quickly demonstrate the application rate of the cavity to enhance the flexibility of using the points and confidence will help the clinical application of moxibustion moxibustion.
The software is easy to find, moxibustion can be used as electronic dictionaries. For its various enthusiasts, favorable clinical applications, and enhance the confidence of those who use moxibustion, moxibustion world want to step farther, so the above software, do not make up for patent, please copy to use.
引文
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