“灸疮”考辩
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摘要
古人有"灸必发疮"方能奏效之说,本文通过考辩灸疮出处、医理及其坏证以明辩真伪。灸疮最早出自汉代《武威汉代医简》《金匮要略》,本义为灸后灼伤疮疡,至晋代《针灸甲乙经》始有用草鞋热烫促使灸疮感染化脓的记载,"发灸疮"法成为化脓灸的标志。考化脓灸须在辨证选穴正确前提下,兼气血充盛、取穴准、灸量足三因素方可得效;若艾灸过度、选穴不准、触犯外邪、护养不当则易产生坏证。历代医家对灸疮安全性和疗效提出质疑,提出禁用八木之火、设禁灸穴以防其害。临床证实灸感"气至"为灸法得效标志,"灸必发疮"之说多系古人为加强灸量刺激达到"气至"得效标准,而过度艾灸所致,非特指灸法得效标志。
There is an old saying that moxibustion,leading to sore,is effective. This paper investigated the source of post-moxibustion sore,principal of medical science and the bad disease to testify the old saying. Post-moxibustion sore was firstly recorded in Wuwei Medical Bamboo Slips of Han Dynasty and Synopsis of Golden Chamber written in Han Dynasty. The original meaning was ulceration from burning by post-moxibustion. Post-moxibustion sores have been perceived as the sign of the moxibustion of resolving pus since A-B Classic of Acupuncture and Moxibustion and has the records of purulent infection on moxibustion sore resulted by hot straw sandals in Jin dynasty. With syndrome differentiation and acupoints selection principles,the moxibustion of resolving pus can be effective on the basis of sufficient qi and blood,correct acupoints selection,enough quantitative moxibustion. Otherwise it may result in bad symptoms,if it is with the excessive moxibustion,incorrect acupoints selection,and improper nursing. The safety and efficacy of post-moxibustion sore has been questioned by the later medical master in every dynasty. It was suggested that 8 kinds of wood fire were forbidden. Acupoints that were forbidden to do acupuncture,were set to prevent the harmfulness. It was proved by clinical practice that moxibustion sensation of"Arrival of Qi"has proved the sign of moxibustion effects. Therefore,the old saying that moxibustion must lead to sore,meant that acupuncture quantity were strengthened in order to meet the standard of qi arrival,but not the result of excessive moxibustion. It was not the sign of effective moxibustion therapy.
There is an old saying that moxibustion,leading to sore,is effective. This paper investigated the source of post-moxibustion sore,principal of medical science and the bad disease to testify the old saying. Post-moxibustion sore was firstly recorded in Wuwei Medical Bamboo Slips of Han Dynasty and Synopsis of Golden Chamber written in Han Dynasty. The original meaning was ulceration from burning by post-moxibustion. Post-moxibustion sores have been perceived as the sign of the moxibustion of resolving pus since A-B Classic of Acupuncture and Moxibustion and has the records of purulent infection on moxibustion sore resulted by hot straw sandals in Jin dynasty. With syndrome differentiation and acupoints selection principles,the moxibustion of resolving pus can be effective on the basis of sufficient qi and blood,correct acupoints selection,enough quantitative moxibustion. Otherwise it may result in bad symptoms,if it is with the excessive moxibustion,incorrect acupoints selection,and improper nursing. The safety and efficacy of post-moxibustion sore has been questioned by the later medical master in every dynasty. It was suggested that 8 kinds of wood fire were forbidden. Acupoints that were forbidden to do acupuncture,were set to prevent the harmfulness. It was proved by clinical practice that moxibustion sensation of"Arrival of Qi"has proved the sign of moxibustion effects. Therefore,the old saying that moxibustion must lead to sore,meant that acupuncture quantity were strengthened in order to meet the standard of qi arrival,but not the result of excessive moxibustion. It was not the sign of effective moxibustion therapy.
引文
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[20]谢波,王玲玲.灸疮促发的意义及方法[J].江苏中医药,2013,45(12):53-54,55.
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[32]张庆萍,杨骏,黄学勇.论“灸误”[J].中医文献杂志,1999,17(1):17-18.
[33]巢元方.诸病源候论[M].北京:北京科学技术出版社,2016:354-355.
[34]闻人耆年.备急灸法[M].太原:山西科学技术出版社,2012:48.
[35]吴亦鼎.神灸经纶[M].北京:中国中医药出版社,2015:6.
[36]王玲玲.麦粒灸传薪集[M].北京:人民卫生出版社,2012:34.
[37]张子和.儒门事亲[M].上海:上海卫生出版社,1958:15.
[38]脱脱.宋史[M].北京:中华书局,1977:9021.
[39]赵佶.圣济总录[M].北京:人民卫生出版社,2013:1539.
[40]陈士铎.洞天奥旨[M].北京:中国中医药出版社,2015:1103.
[41]太平惠民和剂局编.太平惠民和剂局方[M].北京:中国社会科学出版社,2007:203.
[42]徐灵胎.医学源流论[M].北京:中国中医药出版社,2015:142.
[43]宋慈.《洗冤集录》今译[M].福州:福建科学技术出版社,2006:182-183.
[44]于赓哲.唐宋民间医疗活动中灸疗法的浮沉-一项技术抉择的时代背景分析[J].清华大学学报:哲学社会科学版,2006,21(1):62.
[45]张仁.针灸意外事故的历史与现状[J].中西医结合学报,2004,2(4):306-313.
[46]王耀帅.艾灸以温促通效应与TRPV1的相关性研究[D].南京:南京中医药大学,2012.
[47]丁沙沙,尚秀葵.健康人足三里穴灸感感传现象的初步研究[J].针灸临床杂志,2011,27(12):24-26.
[48]姜劲峰.承淡安先生灸法观阐微[J].新中医,2012,44(11):142-144.
[49]谢丁一.陈日新教授论灸感[J].中国针灸,2016,36(8):789-792.
[50]熊俊,陈日新.热敏灸循证评价与临床转化[J].世界中医药,2017,12(6):1248-1252,1257.
[51]谢锡亮.谢锡亮灸法[M].北京:人民军医出版社,2009:33.
[52]赤羽活也,刘公望.中日灸疗比较研究[J].天津中医药,2006,23(2):166-167.
[2]廖润鸿.勉学堂针灸集成[M].北京:北京科学技术出版社,2013:7.
[3]孙思邈.千金翼方[M].太原:山西科学技术出版社,2013:518.
[4]吴涣淦.古今医家论灸法[M].上海:上海科学技术文献出版社,2013:10.
[5]齐丽珍,马晓芃,洪珏.古今灸材及灸法的比较[J].中华中医药学刊,2013,31(11):2349-2354.
[6]张奇文.中国灸法[M].北京:北京中医药出版社,2016:14.
[7]张延昌.《武威汉代医简》中的外治疗法[J].甘肃中医,1991,4(2):32-33.
[8]吕有强,扈小健,唐鹏.武威汉代医简“骆苏”考辨[J].西部中医药,2015,28(10):69-71.
[9]张仲景.金匮要略方论[M].北京:人民卫生出版社,2012:7.
[10]灵枢经[M].北京:人民卫生出版社,2012:41.
[11]黄元御.金匮悬解[M].北京:中国中医药出版社,1999:604.
[12]张延昌,孙其斌,杨扶德,等.《武威汉代医简》与《伤寒杂病论》方药渊源[J].中华医史杂志,2006,36(2):72-74.
[13]孙思邈.备急千金要方[M].北京:中医古籍出版社,1997:799.
[14]丹波康赖.医心方[M].高文柱,校注.北京:华夏出版社,2011:71.
[15]徐家淳,李岩,赵祥斐,等.浅谈灸法禁忌的历史沿革[J].中华针灸(连续型电子期刊),2013,2(5):238-240.
[16]欧阳八四.灸法的起源与发展运用[J].针灸临床杂志,1998,14(12):3-6.
[17]皇甫谧.针灸甲乙经[M].北京:人民卫生出版社,2006:100.
[18]张仲源,秦璞,刘燕.化脓灸的免疫机理探讨[J].中医外治杂志,1995,4(1):3-4.
[19]王执中.针灸资生经[M].北京:人民卫生出版社,2007:103.
[20]谢波,王玲玲.灸疮促发的意义及方法[J].江苏中医药,2013,45(12):53-54,55.
[21]王焘.外台秘要[M].北京:中国中医药出版社,2006:453.
[22]杨继洲.针灸大成[M].2版.天津:天津科学技术出版社,2004:423.
[23]王寿椿.施延庆化脓灸法的经验[J].浙江中医杂志,1994,29(6):269-270.
[24]罗天益.卫生宝鉴[M].北京:中国中医药出版社,2007:12.
[25]吴谦.医宗金鉴[M].北京:人民卫生出版社,1995:2272.
[26]庄绰.灸膏肓俞穴法[M].上海:上海中医学院出版社,1989:125.
[27]王玲玲.艾灸的特点及温通效应[J].中国针灸,2011,31(10):865-868.
[28]陈延之.小品方[M].北京:中国中医药出版社,1995:243.
[29]翁瑜君.浅谈瘢痕灸[J].河南中医,2009,29(3):289-290.
[30]于赓哲.唐代疾病、医疗史初探[M].北京:中国社会科学出版社,2011:163.
[31]汪石山.针灸问对[M].北京:中国中医药出版社,2015:335.
[32]张庆萍,杨骏,黄学勇.论“灸误”[J].中医文献杂志,1999,17(1):17-18.
[33]巢元方.诸病源候论[M].北京:北京科学技术出版社,2016:354-355.
[34]闻人耆年.备急灸法[M].太原:山西科学技术出版社,2012:48.
[35]吴亦鼎.神灸经纶[M].北京:中国中医药出版社,2015:6.
[36]王玲玲.麦粒灸传薪集[M].北京:人民卫生出版社,2012:34.
[37]张子和.儒门事亲[M].上海:上海卫生出版社,1958:15.
[38]脱脱.宋史[M].北京:中华书局,1977:9021.
[39]赵佶.圣济总录[M].北京:人民卫生出版社,2013:1539.
[40]陈士铎.洞天奥旨[M].北京:中国中医药出版社,2015:1103.
[41]太平惠民和剂局编.太平惠民和剂局方[M].北京:中国社会科学出版社,2007:203.
[42]徐灵胎.医学源流论[M].北京:中国中医药出版社,2015:142.
[43]宋慈.《洗冤集录》今译[M].福州:福建科学技术出版社,2006:182-183.
[44]于赓哲.唐宋民间医疗活动中灸疗法的浮沉-一项技术抉择的时代背景分析[J].清华大学学报:哲学社会科学版,2006,21(1):62.
[45]张仁.针灸意外事故的历史与现状[J].中西医结合学报,2004,2(4):306-313.
[46]王耀帅.艾灸以温促通效应与TRPV1的相关性研究[D].南京:南京中医药大学,2012.
[47]丁沙沙,尚秀葵.健康人足三里穴灸感感传现象的初步研究[J].针灸临床杂志,2011,27(12):24-26.
[48]姜劲峰.承淡安先生灸法观阐微[J].新中医,2012,44(11):142-144.
[49]谢丁一.陈日新教授论灸感[J].中国针灸,2016,36(8):789-792.
[50]熊俊,陈日新.热敏灸循证评价与临床转化[J].世界中医药,2017,12(6):1248-1252,1257.
[51]谢锡亮.谢锡亮灸法[M].北京:人民军医出版社,2009:33.
[52]赤羽活也,刘公望.中日灸疗比较研究[J].天津中医药,2006,23(2):166-167.