《灸膏肓腧穴法》膏肓灸法的特色探讨
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摘要
研究目的
以《灸膏肓腧穴法》一书作者庄绰受争议的生卒年、及其籍贯“清源”探索,另外查找庄绰的一般著作、医学著作。主要梳理《灸膏肓腧穴法》的成书背景,归纳、汇总庄绰的文学诗作和医学著作,辩章其学术观点,考镜膏肓灸法的历史源流,为传统中医“膏肓灸”学术思想的传承与创新提供文献理论依据,拓宽人们对膏肓灸的理解思路,宣扬膏肓灸法在现代生活、临床诊疗、防病治病等领域应用,希望抛砖引玉,为膏肓灸法繁荣昌盛开展基础的古文献研究作出铺垫。
研究方法
运用中医历史学、文献学、古代文学、及社会文化的角度,探索《灸膏育腧穴法》作者、源流、引文出处、学术观点及有关膏肓灸等古文献史料的搜集,从古代秦、汉时期起至明、清时期对膏肓灸法、膏肓灸等的应用主治、功效等报道汇集,采用定性的分析和系统归纳法,追溯其历史沿革,归类、汇总、评述将古代文献中与膏肓灸法相关的内容,按不同的历史时期分别论述、分析,了解灸法、膏肓、膏肓灸等相关文献的历史分布情况,提炼出膏肓灸法在每个历史时期的治疗特点,研究表明”膏肓灸“奠基于秦、汉《内经》的基础理论指导；继而魏晋发展出化脓灸始见于《小品方》、葛洪《肘后备急方》,发展于唐《千金方》指出“膏肓无所不治”为膏肓灸之滥觞；盛极于宋《针灸神书》、《针灸资生经》、《圣济总录》、《世医得效方》的临床应用,到庄绰《灸膏肓腧穴法》总结宋以前各家膏肓揣穴方法、灸疗壮数、灸后补养,成熟地奠定了“膏肓灸”为中医的特色治疗方法；普及于明、清各个医家及医著《景岳全书》、《类经图翼》、《普济方》、《古今医鉴》、《杂病广要》、《医学入门》、《孙文垣医案》、《寿世保元》、《痰火点雪》、《医学纲目》、《神灸经纶》、《针灸逢源》、《针灸大成》、《针灸大全灵光赋》、《百症赋》、《医统大全》、《针灸聚英》、《急救广生集》、《医学实在易》、《医宗金鉴·刺灸心法要诀》的阐发。从收集的文献中,理清了我国膏肓灸的发展脉络。利用中医古籍数据库、中国古籍全录数据库及《中国医籍考》、《地方志》考证该书作者里籍,从纵观的各代医家、医著的历史沿革和治疗疾病分类横向汇总,将该书内容与其相关古籍有关灸疗的文献,从纵深的个角度进行系统的梳理。另外探讨现代文献膏肓灸法与针法对比统计图表分析、了解膏肓灸临床应用范围,以《中国期刊数据库网络资源》查找膏肓灸法等现代期刊文献,应用统计学的频数、图、表等方法呈现研究结果。
研究结果
《灸膏肓腧穴法》是宋·庄绰在前人应用膏肓灸的基础上,整理汇总记录各种膏肓穴的取法差异。目前对于膏肓灸法的古代文献研究还是比较薄弱的。该书是第一本研究单一腧穴：膏肓穴的书。作者重视传承孙真人对膏肓穴的认真揣位,并保存多位临床”膏肓灸“的验案,以及作者的切身膏肓灸疗的体验,对膏肓穴的取穴法有13种记录图形18幅,将各个流派的不同定位揣取膏肓的方法仔细记录,是集宋代之前灸膏肓的重要医籍资料。论文研究从对《灸膏肓腧穴法》作详细精读将灸法-膏肓灸的历史发展源流作系统全面的研究；从数据库搜集古代文献史料充实膏肓灸法应用的学术内容。在对传统灸法古今文献进行深入了解、探索与呈现的同时、继承古人和前人的膏肓灸疗的基础上希冀有所发现和提高,主要是希望发扬中医宝贵的膏肓灸,应用于现代各种慢性病和疑难杂病等的绿色疗法。同时也宣扬重要灸法古籍《灸膏肓腧穴法》一书,让医学界、学术界甚至普通大众,更明白和了解该书在中医灸法的地位。通过选题查新,发现该书还没有被深刻的研究过,只有几篇对庄绰里籍的考证,至于对《灸膏肓腧穴法》一书,尚无全面的系统论述,在此基础之上,对庄绰及《灸膏肓腧穴法》的学术研究从古今历史发展纵深视角探索,从时间的跨度能看出膏肓灸法发展演变的面貌。以及对膏肓灸法对现今临床的适应症作出归纳总结,希望对膏肓灸的广泛应用,在古文献理论方面作出绵薄之力。
结论：
本研究具有以下特点和创新
1、运用“辨章学术的文献学研究方法,全面探讨《灸膏肓腧穴法》的膏肓灸法源流和收集汉及汉以前至今的膏肓灸法相关文献,可说对膏肓灸法的历史沿革有一个全面的认识。
2、运用中医文献学的方法,对历代膏肓灸法进行断代分析和整体分析,研究了历代膏肓灸法的应用规律和特点。
研究中发现,现代临床应用膏肓灸首先在期刊的发表上,为数不多,其中对膏肓选穴定位也存在轻忽,正印了孙真人所言选穴不准,不独疗效不显,可能徒伤皮肉,这是对《灸膏肓腧穴法》一书研究最重要的体会。
3、强调必定对膏肓的选位准确,操作上做到分离两肩胛骨,然后灸之,才能效如桴鼓。孙真人：“若能用心方便,必得灸之,无疾不愈矣”、“不尔,即胛骨覆其穴,灸之无验”。
4、.膏肓灸必定要重灸,也就是至少500壮以上,对虚劳等消耗性疾病,才能达到最低治疗量,如果灸不到位,只会损气耗气,可能还会造成气机壅滞等变证,这也是施行膏肓灸必须要注意的,所谓”七年之病求三年之艾“说的三年之艾有两层意思,一是用三年陈艾,减少艾的燥热性,二是指要治疗七年之久的慢性病、久病之类消耗性虚证,要灸疗到三年以上才能根治的意思。
5、必要遵循孙真人的灸后补养遗训,做到灸前操作选位正确,灸后调理完善,从而达到“膏肓无所不治,无所不疗的至善境地。
本研究重点表明了,通过古代文献《灸膏肓腧穴法》著作的精读,参照历代有关膏肓灸法的文献分析探索,了解膏肓灸法的临床应用范围以及注意事项,希望膏肓灸法能在现代临床实际广泛运用,让医者在揣穴要点上明白了解到：必要分离两肩胛骨然后才对准膏肓穴正确施灸!如此才能提高灸疗效果,这些都是有积级的临床意义。
总之,本文献的研究给我们提供可行性借鉴,在临床采用膏肓灸,必定做到揣穴准确,万分强调要分离两肩胛骨,实施多壮重灸,以及灸后必定提醒患者作出应有的补养,才能起沉疴去痼疾,最终能达到、治病、防病、养生的目的,这也是研究《灸膏肓腧穴法》一书最重要的积极意义。
Objective
Regarding the book of Gaohuang Acupoint Moxibustion(GAM)as the major research subject, this paper examined author's disputed birth time, native place"Qing Yuan"and his various works, sort-ted out the historic backgrounds of the writing, summarized the author's life-long study and medical works, explored his academic thought and GAM's origin and history, all in an effort to provide a solid documentary and theoretical basis for the inheritance and innovation of traditional GAM, to broaden people's understanding, and to advocate GAM therapy in today's daily life, clinical treatment, disease prevention areas and so forth, to attract necessary attention from professionals and experts in the related areas, contributing itself as a fundamental historic documentary study serving the ever growing development and application of GAM.
Contents and Methods
An over view on the book of Guanghuang Acupoint Moxibustion, in this paper, approaches of medical history, philology, traditional literature, and cultural sociology were combined, to study the book of GAM's author, origin, quotation, academic thoughts and data collection of Gaohuang acupoint and moxibustion.This paper used qualitative analysis and inductive research methods to study the records and documents on GAM therapy and its major functions from Qin, Han through Ming, Qing dynasties, exploring its historic development. By classifying, collecting, criticizing related information, the paper discussed and analyzed the GAM relating contents in ancient documents of different historical times, gaining a full view on the historic layouts of documentaries related to moxibustion, Gaohuang acupoint and GAM, summarizing moxibustion features of different historic periods as follows:
1.A history of Moxibustion
Moxibustion came from the north, originated from the use of fire."Su Wen, Prescription and Therapy":North is the place for storage, mountains and highlands are everywhere, winds are cold and freezing, its people live in the country and drink milk. It's easy to catch coldness, moxibustion and warming-therapy are often used, therefore, moxibustion comes from the north.
In the famous dictionary compiled by Xun Shen, East Han Dynasty it says: Jiu, moxibustion, quick burning, using fire.
The book of Zhuang Zi is the earliest to mention the Chinese character of Jiu. For example, In "Zhuang Zi, Bandit Zhi" Confucian said to Zeuxian Zhi:I use moxibustion as a daily therapy even without illness. However, the character of Jiu was originated from the character of Jiu, namely long time. As mentioned in the bamboo book discovered in the year of1975from Shuihu, Yunmeng, Hubei Province:the dead man is white skin,7.1chi tall, hair2chi long, on his belly there are traces of Jiu (long time). This Jiu means moxibustion.
In Tang Dynasty, Wang Bing said in his interpretation of "Su Wen" Burning Moxa Therapy is called Moxibustion. This therapy was used to treat coldness diseases successfully, later it was developed to treat various diseases including internal, external, autecology, paediatrist, and so forth. In ancient times, direct skin moxibustion was first used, indirect moxibustion was developed later. In AC.581, namely10th Year of Chenggong,"Zuo Zhuan " recorded that Duke Jing of Jin Kingdom invited imperial physician Huan from Qin Kingdom to treat his disease, and doctor Huan said:This disease cann' t be cured. The illness stays above Gao and under Huang, it could n't be att-acted, could't be reached, herbals don't work. In this paragraph,"attack" means moxibustion,"reach" means acupuncture. This means moxibustion was widely used in Chunqiu Zhanguo tims. As recorded in Caige, Shi Jing:collect thy moxa. In West Han Dynasty, Mao Heng and Mao Geng interpreted:Moxa is used to treat disease.
In Tang Dynasty, Sun Simiao's Golden Prescription says:Officials in Wu and Shu areas, shall use moxibustion to treat2to3acupoints on their bodies,... then they will stay away from various diseases. This means moxibustion could not only used to treat diseases but also to prevent diseases. In Song Dynasty, Shen Kuo recorded Western Nationalist'fortune telling method in his "Conversation at Meng Brook ", chapter18:the fortune teller shall use moxa to burn goat bone, and check the sign on the bone. This proves that as early as Shang Dynasty, moxa was used to burn bones and shells for fortune telling purposes. In the book of Mendacious, Lilo u Captor:Nowadays, those who want to become kings, act just like those patients with7year disease looking for3year moxa. As illustrated by Chinese traditional medicine theories, Moxibustion uses moxa hairs and other materials to burn acupoints, using moxa's warmth to facilitate body channels, to balance physiology functions, for the purpose of treating and preventing diseases. The therapy of moxibustion has the functions of warming up body channels, harmonizing Qi and blood, upgrading the vital qi, retrieving Yang and strengthening the loosing part, activating blood flow and removing stagnation, dispersing numbness and coldness, preventing diseases and strengthening body functions.
In Qing Dynasty, Wu Yiding's book of Holy Moxibustion says:Moxibustion is originated from fire, as the nature of fire is warm and fast, its body is soft and its function is tough, so Yin disease could be cured. It moves fast and doesn't stay in one place, it enters internal organs of the body easily. The doctor shall use moxa's spiciness and fragrancy, to facilitate12channels, and enter3Yin, to sort out vital Qi and blood. A good doctor could cure all the diseases easily with moxibustion. This explains moxibustion's nature and result in treating diseases. In recent times a Japanese doctor used moxibustion in a whole factory and a school covering everyone there, for the purpose of disease prevention. The experiment proves moxibustion is really good at strengthening bodies and preventing diseases.
In Chunqiu times,"Shi Jing", Chaptor Caige:Collecting those moxa, as interpreted in Wester Han Dynasty by Mao Heng and Mao Geng:Moxa is used to treat diseases. In the book of Mencious, Chaptor Lilou:Nowadays those who want to become kings, act just like those patients with7year diseases, looking for moxa of3years. From these record we could see moxibustion was widely used in Chunqiu and Zhanguo periods. Therefore, moxibustion therapy must be originated earlier than Western Zhou Dynasty. The remaining moxibustion documents include silk book "Leg and arm11channel moxibustion" and "Yinyang11channels Moxibustion";"New Collection of Moxibustion Therapies" of Dunhuang Stone Chamber, medical prescriptions.
Pre-Qin Dynasty and Two Han Dynasties cover the historical periods when most important moxibustion theory of Chinese traditional medicine was established. The great medical work of "Huang Di Nei Jing" written between Qin and Han Dynasties, introduced moxibustion therapy as an important systematic part, emphasizing that "Moxibustion could also compliment acupuncture therapy in various diseases". In "Ling Shu", Chaptor" Function", it mentioned first that "Moxibustion comes from north". As mentioned in "Su Wen", Therapy and Prescription,"In the north,... there are mountains and highlands everywhere, winds are cold and freezing," its people live in the country and drink milk. It is easy to catch coldness, moxibustion shall used as treatment." This means that moxibustion therapy was originated from and related to Chinese northern people's living conditions and customs, natures of diseases. Moxibustion therapy could be used to treat external diseases, internal diseases, organic diseases, cold and hot diseases, ulcers, madness, and so forth. The function of moxibustion therapy includes lifing sagging, strengthening Yinyang, dispersing wicked coldness, facilitating body channels, vital Qi and blood flow, and so forth. In "Huang Di Nei Jing" it also mentioned moxibustion's strengthening and letting-out functions:" Moxibustion is used for strengthening purpose, don't blow out the fire, wait until the fire goes out; When moxibustion is used for letting-out purpose, blow the fire as quickly as possible, enhance the warmth of moxa, and wait until the fire goes out."("Lingshu, Back Acupoints") Finally, it pointed out that moxibustion should stay away from the following diseases:Both Yin and Yang are weak, or both Yin and Yang are over strong, or Yang is over strong and hot, or having difficulty in breathing. Somehow "Huang Di Nei Jing " laid a found basis for moxibustion therapy.
In Eastern Han Dynasty, Zhang Zhongjing wrote the book of Treatise on Febrile and Miscellaneous Diseases. The book focused on using herbal medicines and prescriptions to diagnose and treat febrile and miscellaneous diseases. Though acupuncture and moxibustion was not mentioned a lot, there are7articles discussing moxibustion in "Febrile Theory",2articlesin "Golden Chamber Theory ". These articles contribute to the applications and taboos of moxibustion therapy. Zhong Jing pointed out that moxibustion should be applied to treat3Yin diseases, or when Shao Yin Disease just begins, when Yang is weak and Yin is strong, moxibustion could be used to assist Yang and restrain Yin; Shao Yin Diarrhea and vomiting; when pulse is weak and hard going, moxibustion could be used to upgrade Yang and strengthening Yin; or in Jue Yin disease, when hand and leg feeling cold, when pulse is short-going, moxibustion could be used to facilitate Yang to reach out. All these have important influences on the doctors of later times.
In Chinese history the first work dedicated to moxibustion was Cao Xi' s "Cao's moxibustion prescription", totally7volumes, unfortunately the book is lost today. In Jin Dynasty, Chen Yan Zhi wrote "Small Prescription" though lost today, it is also one of the earliest book advocating moxibustion. He mentioned that "Acupuncture could only be used but professional doctors, but moxibustion could be carried out by ordinary people themselves." This means moxibustion is easy to promote. As found in the various books recording30some Chen's prescriptions, we find that he advocates that acupoints of moxibustion shall be as few as possible, he emphasizes that before moxibustion, wicked blood shall be pricked and taken away, moxibustion shall be used as many as50-100zhuang, the quantity could also be used as based on the patients' ages. Especially on moxibustion taboos, he points out that18taboos in "Huang Di Nei Ting" was not absolutely correct,"Direct moxibustion shall avoid unclothed parts of arms and legs, scars shall be considered as harmful" He has many innovative views for us to learn.
In Jin Dynasty, Ge Hong wrote "Elbow Prescription". He collected and recorded lots of moxibustion prescriptions of his concurrent and earlier times. The book has109articles discussing acupuncture and moxibustion, out of which moxibustion counts for94articles. Apart from inheriting direct moxibustion from "Huang Di Nei Jing" and "Acupuncture and Moxibustion Jia Yi Classics", the book innovates indirect moxibustion with materials put between moxa and skin, including salt, garlic, hot pepper, and so forth. Besides, apart from moxa, wax candle, pottery with burning herbals, and moxa pipe are also used in the therapy. Regarding the diseases, the book recorded prescriptions covering sudden death, diarrhea, apoplectic and28urgent diseases.
In Tang Dynasty, the famous doctor Sun Si Miao, in his great work Golden Prescription and Golden Prescription for Urgent Diseases, wrote lots about moxibustion therapy. He even added more indirect moxibustion materials, such as bean pastry, mud pastry, Fuzi, Shanglu, and so forth. Scope of moxibustion therapy was also developed, not only for treatment, but also for prevention. Doctor Sun was also the first one in history to advocate Guanghuang Acupoint Moxibustion, he proposed theorematic basis by using Guanghuang Acupoint Moxibustion to treat miscellaneous difficult diseases.
As moxibustion developed, professional moxibustion doctors came into being in Tang and Song Dynasties. For example, Han Yu of Tang Dynasty wrote a poem named "Driving away diarrhea ghosts":Moxibustion doctors work like hunters besieging their preys. This also means that moxibustion was widely used at the time.
Qing Dynasty could be considered as concluding period for ancient moxibustion therapy. Out of the documentaries, Wu Yiding's the book of Holy Moxibustion was most famous. The book summarized moxibustion theories and practices until Qing Dynasty, plus author's own clinical experiences, the book epitomized moxibustion therapy in history.
At the end of Qing Dynasty, the imperial hospital illegalized acupuncture and moxibustion therapy, this leads to the declination of moxibustion. However, acupuncture and moxibustion works still develop among the ordinary peoples. As moxibustion in highly efficient and low cost, it is still popular today.
2. A overview on Gaohuang Acupoint Moxibustion
The paper found that GAM was originated from theoretic basic of Neijing of Qin and Han dynasties;then in Wei and Jin Dynasties Fester Moxibustion was developed, recorded in Gehong' s Pre-emergency Prescription, Chapter Light Prescription;And then in Tang dynasty further developed as pointed out in Golden Prescription"it is a cure for all diseases";GAM's peak time came in Song dynasty as its application and function cited in most top prescription works of the time, and Zhuang Chuo's book of GAM summarized all the Ways of acupoint anatomic positioning, quantity of moxibustion, and follow-up nutrition, laying a solid foundation for featured traditional GAM;His work led to GAM's wide application in Ming and Song dynasties, as recorded and researched in various medical works of the time. Based on its wide range of collected documents,the paper sorted out the developing history of Chinese GAM.By using TCM ancient literature data base, Chinese ancient documentary all-in-one data base and Chinese Medical Document Research, Local Chronicles the paper pinpointed GAM author's hometown. Through comparing between doctors and medical works of various historic eras, applications and treatments of different diseases, the paper carried out an in-depth and systematic study on the book of GAM and its relating ancient works. By using statistic charts and graphs of modern GAM and acupuncture comparison,the paper provided an understanding of the GAM clinical application scope. The paper also used"China Academic Journal Network Publishing Data Base"to search GAM magazine documentaries, and engaged statistic frequency, charts and graphs for presentation of the research result.
Result
The book of Gaohuang Acupoint Moxibustion was written by Zhuang Chuo of Song Dynasty, recording and summarizing the different methods of Gaohuang acupoint anatomic-positioning, based on the application practice of earlier times. So far study on GAM ancient literatures has been weak. GAM is the first book ever in history dedicated to the research of a single acupoint, Gaohuang. The author inherited and focused on Sun Zhen Ren's fine anatomic positioning, and recorded many successful GAM clinical cases, as well as his own GAM experiences. The book includes18drawings depicting13ways of acupoint anatomic positioning,recording details of acupoint positioning methods of different schools,which made the book an important documentary covering GAM until Song Dynasty. This paper carried out a systematic and overall research on the origin and history on both generic moxibustion and Gaohuang Acupoint Moxibustion, starting from perusal of the book;collecting ancient documents from various data bases to strengthen GAM application's academic contents. While being focused on understanding, exploring,and presenting ancient and modern documentaries relating traditional moxibustion, this paper scrived not only to inherit but also to shed a new light on and further develope Chinese traditional GAM, to promote GAM as a valuable part of TCM system and apply it to modern multivarious chronic and difficult diseases, as a organic treatment. Meanwhile, this paper also dedicated to promote the book of GAM as an important ancient moxibustion work, to deliver a better understanding of the book' s value in moxibustion history to the medicals, academics and ordinary people as well. When selecting this research topic, it was found that this book had never been seriously and deeply studied, only several articles covering Zhuang Chuo's home place had been written. There had been no systematic and overall discussion on the book of GAM.This paper explored on Zhuang Chuo and his book of GAM, taking a historic point o"f view, aiming to give a clear picture of GAM development through the time. This paper also collected records on and gave a conclusion to GAM's application of modern times,all in an effort to promote GAM's application in the area of ancient documentary theories.
Conclusion
This study has the innovating features as follows:
1.This is the first paper combining academic debating and documentary studying approaches to discuss the book of GAM's origin and history, collecting relating documents dating from HAN Dynasty and earlier times until the present days.As a result,it presents an overall understanding on moxibustion development through the history.
2. This is the first paper using TCM documentary studying method,to carry out an history period division and overall research, exploring moxibustion historic application laws and features.
3. During the study, it was found that modern journal publications relating to GAM therapy was quite limited, while the importance on its anatomic-positioning had been ignored. As pointed out by Sun Zhen Ren, if the acupoint could not been accurately located, the patient's body would get further hurt, instead of get cured. This is the most important experience through the book of GAM's study.
1. Anatomic-positioning plays a major role in GAM therapy, two scapula's must be separated before moxibustion, for an effective and positive treatment. Sun Zhen Ren:If the moxibustion is delivered professionally and accurately, it could cure all the diseases... otherwise, if the acupoint is covered by the scapula, there will be no positive result.
2.GAM must be carried out heavily, at least500zhuang and above, only in this way, the lightest positive results could be achieved on patients of consumptive diseases. If not, the GAM would only consume the patentability energy and Qi, even causing Qi stagnation and other syndromes, for which doctors must be most careful during the operation. As the proverb says:A7year disease needs3year moxa. There are2meanings of it:1st the treatment shall use3year old moxa to avoid its dryness-heat,2nd it means a7year long consumptive disease takes moxibustion over3-year-time for a through curing.
3. Sun Zhen Ren's after-moxibustion nutrition rules must be followed. Only when accomplishing both before-GAM anatomic-positioning and after rest and "nutrition, the most desirable aim of"curing all the diseases with one treatment" could be reached.
Through perusal reading of the book of GAM, as well as referring to historic GAM documentaries, this paper aimed to provide a better understanding of GAM's clinical application scope and points for notice, to promote further GAM application in modern clinic treatment, to make the doctors master clearly the point of anatomic-positioning:two scapula s must be separated before moxibustion, for an effective and positive treatment. All in all, this gives the doctors a reference when delivering GAM therapy, two scapula's must be separated before moxibustion for the purpose of accurate anatomic-positioning, and heavy quantity must be taken, and rest-nutrition advice must be followed by the patients, only with the above serious diseases could be finally cured for the purpose of positive treatment, prevention of disease and a happier life. This is also the utmost purpose of this paper.
以《灸膏肓腧穴法》一书作者庄绰受争议的生卒年、及其籍贯“清源”探索,另外查找庄绰的一般著作、医学著作。主要梳理《灸膏肓腧穴法》的成书背景,归纳、汇总庄绰的文学诗作和医学著作,辩章其学术观点,考镜膏肓灸法的历史源流,为传统中医“膏肓灸”学术思想的传承与创新提供文献理论依据,拓宽人们对膏肓灸的理解思路,宣扬膏肓灸法在现代生活、临床诊疗、防病治病等领域应用,希望抛砖引玉,为膏肓灸法繁荣昌盛开展基础的古文献研究作出铺垫。
研究方法
运用中医历史学、文献学、古代文学、及社会文化的角度,探索《灸膏育腧穴法》作者、源流、引文出处、学术观点及有关膏肓灸等古文献史料的搜集,从古代秦、汉时期起至明、清时期对膏肓灸法、膏肓灸等的应用主治、功效等报道汇集,采用定性的分析和系统归纳法,追溯其历史沿革,归类、汇总、评述将古代文献中与膏肓灸法相关的内容,按不同的历史时期分别论述、分析,了解灸法、膏肓、膏肓灸等相关文献的历史分布情况,提炼出膏肓灸法在每个历史时期的治疗特点,研究表明”膏肓灸“奠基于秦、汉《内经》的基础理论指导；继而魏晋发展出化脓灸始见于《小品方》、葛洪《肘后备急方》,发展于唐《千金方》指出“膏肓无所不治”为膏肓灸之滥觞；盛极于宋《针灸神书》、《针灸资生经》、《圣济总录》、《世医得效方》的临床应用,到庄绰《灸膏肓腧穴法》总结宋以前各家膏肓揣穴方法、灸疗壮数、灸后补养,成熟地奠定了“膏肓灸”为中医的特色治疗方法；普及于明、清各个医家及医著《景岳全书》、《类经图翼》、《普济方》、《古今医鉴》、《杂病广要》、《医学入门》、《孙文垣医案》、《寿世保元》、《痰火点雪》、《医学纲目》、《神灸经纶》、《针灸逢源》、《针灸大成》、《针灸大全灵光赋》、《百症赋》、《医统大全》、《针灸聚英》、《急救广生集》、《医学实在易》、《医宗金鉴·刺灸心法要诀》的阐发。从收集的文献中,理清了我国膏肓灸的发展脉络。利用中医古籍数据库、中国古籍全录数据库及《中国医籍考》、《地方志》考证该书作者里籍,从纵观的各代医家、医著的历史沿革和治疗疾病分类横向汇总,将该书内容与其相关古籍有关灸疗的文献,从纵深的个角度进行系统的梳理。另外探讨现代文献膏肓灸法与针法对比统计图表分析、了解膏肓灸临床应用范围,以《中国期刊数据库网络资源》查找膏肓灸法等现代期刊文献,应用统计学的频数、图、表等方法呈现研究结果。
研究结果
《灸膏肓腧穴法》是宋·庄绰在前人应用膏肓灸的基础上,整理汇总记录各种膏肓穴的取法差异。目前对于膏肓灸法的古代文献研究还是比较薄弱的。该书是第一本研究单一腧穴：膏肓穴的书。作者重视传承孙真人对膏肓穴的认真揣位,并保存多位临床”膏肓灸“的验案,以及作者的切身膏肓灸疗的体验,对膏肓穴的取穴法有13种记录图形18幅,将各个流派的不同定位揣取膏肓的方法仔细记录,是集宋代之前灸膏肓的重要医籍资料。论文研究从对《灸膏肓腧穴法》作详细精读将灸法-膏肓灸的历史发展源流作系统全面的研究；从数据库搜集古代文献史料充实膏肓灸法应用的学术内容。在对传统灸法古今文献进行深入了解、探索与呈现的同时、继承古人和前人的膏肓灸疗的基础上希冀有所发现和提高,主要是希望发扬中医宝贵的膏肓灸,应用于现代各种慢性病和疑难杂病等的绿色疗法。同时也宣扬重要灸法古籍《灸膏肓腧穴法》一书,让医学界、学术界甚至普通大众,更明白和了解该书在中医灸法的地位。通过选题查新,发现该书还没有被深刻的研究过,只有几篇对庄绰里籍的考证,至于对《灸膏肓腧穴法》一书,尚无全面的系统论述,在此基础之上,对庄绰及《灸膏肓腧穴法》的学术研究从古今历史发展纵深视角探索,从时间的跨度能看出膏肓灸法发展演变的面貌。以及对膏肓灸法对现今临床的适应症作出归纳总结,希望对膏肓灸的广泛应用,在古文献理论方面作出绵薄之力。
结论：
本研究具有以下特点和创新
1、运用“辨章学术的文献学研究方法,全面探讨《灸膏肓腧穴法》的膏肓灸法源流和收集汉及汉以前至今的膏肓灸法相关文献,可说对膏肓灸法的历史沿革有一个全面的认识。
2、运用中医文献学的方法,对历代膏肓灸法进行断代分析和整体分析,研究了历代膏肓灸法的应用规律和特点。
研究中发现,现代临床应用膏肓灸首先在期刊的发表上,为数不多,其中对膏肓选穴定位也存在轻忽,正印了孙真人所言选穴不准,不独疗效不显,可能徒伤皮肉,这是对《灸膏肓腧穴法》一书研究最重要的体会。
3、强调必定对膏肓的选位准确,操作上做到分离两肩胛骨,然后灸之,才能效如桴鼓。孙真人：“若能用心方便,必得灸之,无疾不愈矣”、“不尔,即胛骨覆其穴,灸之无验”。
4、.膏肓灸必定要重灸,也就是至少500壮以上,对虚劳等消耗性疾病,才能达到最低治疗量,如果灸不到位,只会损气耗气,可能还会造成气机壅滞等变证,这也是施行膏肓灸必须要注意的,所谓”七年之病求三年之艾“说的三年之艾有两层意思,一是用三年陈艾,减少艾的燥热性,二是指要治疗七年之久的慢性病、久病之类消耗性虚证,要灸疗到三年以上才能根治的意思。
5、必要遵循孙真人的灸后补养遗训,做到灸前操作选位正确,灸后调理完善,从而达到“膏肓无所不治,无所不疗的至善境地。
本研究重点表明了,通过古代文献《灸膏肓腧穴法》著作的精读,参照历代有关膏肓灸法的文献分析探索,了解膏肓灸法的临床应用范围以及注意事项,希望膏肓灸法能在现代临床实际广泛运用,让医者在揣穴要点上明白了解到：必要分离两肩胛骨然后才对准膏肓穴正确施灸!如此才能提高灸疗效果,这些都是有积级的临床意义。
总之,本文献的研究给我们提供可行性借鉴,在临床采用膏肓灸,必定做到揣穴准确,万分强调要分离两肩胛骨,实施多壮重灸,以及灸后必定提醒患者作出应有的补养,才能起沉疴去痼疾,最终能达到、治病、防病、养生的目的,这也是研究《灸膏肓腧穴法》一书最重要的积极意义。
Objective
Regarding the book of Gaohuang Acupoint Moxibustion(GAM)as the major research subject, this paper examined author's disputed birth time, native place"Qing Yuan"and his various works, sort-ted out the historic backgrounds of the writing, summarized the author's life-long study and medical works, explored his academic thought and GAM's origin and history, all in an effort to provide a solid documentary and theoretical basis for the inheritance and innovation of traditional GAM, to broaden people's understanding, and to advocate GAM therapy in today's daily life, clinical treatment, disease prevention areas and so forth, to attract necessary attention from professionals and experts in the related areas, contributing itself as a fundamental historic documentary study serving the ever growing development and application of GAM.
Contents and Methods
An over view on the book of Guanghuang Acupoint Moxibustion, in this paper, approaches of medical history, philology, traditional literature, and cultural sociology were combined, to study the book of GAM's author, origin, quotation, academic thoughts and data collection of Gaohuang acupoint and moxibustion.This paper used qualitative analysis and inductive research methods to study the records and documents on GAM therapy and its major functions from Qin, Han through Ming, Qing dynasties, exploring its historic development. By classifying, collecting, criticizing related information, the paper discussed and analyzed the GAM relating contents in ancient documents of different historical times, gaining a full view on the historic layouts of documentaries related to moxibustion, Gaohuang acupoint and GAM, summarizing moxibustion features of different historic periods as follows:
1.A history of Moxibustion
Moxibustion came from the north, originated from the use of fire."Su Wen, Prescription and Therapy":North is the place for storage, mountains and highlands are everywhere, winds are cold and freezing, its people live in the country and drink milk. It's easy to catch coldness, moxibustion and warming-therapy are often used, therefore, moxibustion comes from the north.
In the famous dictionary compiled by Xun Shen, East Han Dynasty it says: Jiu, moxibustion, quick burning, using fire.
The book of Zhuang Zi is the earliest to mention the Chinese character of Jiu. For example, In "Zhuang Zi, Bandit Zhi" Confucian said to Zeuxian Zhi:I use moxibustion as a daily therapy even without illness. However, the character of Jiu was originated from the character of Jiu, namely long time. As mentioned in the bamboo book discovered in the year of1975from Shuihu, Yunmeng, Hubei Province:the dead man is white skin,7.1chi tall, hair2chi long, on his belly there are traces of Jiu (long time). This Jiu means moxibustion.
In Tang Dynasty, Wang Bing said in his interpretation of "Su Wen" Burning Moxa Therapy is called Moxibustion. This therapy was used to treat coldness diseases successfully, later it was developed to treat various diseases including internal, external, autecology, paediatrist, and so forth. In ancient times, direct skin moxibustion was first used, indirect moxibustion was developed later. In AC.581, namely10th Year of Chenggong,"Zuo Zhuan " recorded that Duke Jing of Jin Kingdom invited imperial physician Huan from Qin Kingdom to treat his disease, and doctor Huan said:This disease cann' t be cured. The illness stays above Gao and under Huang, it could n't be att-acted, could't be reached, herbals don't work. In this paragraph,"attack" means moxibustion,"reach" means acupuncture. This means moxibustion was widely used in Chunqiu Zhanguo tims. As recorded in Caige, Shi Jing:collect thy moxa. In West Han Dynasty, Mao Heng and Mao Geng interpreted:Moxa is used to treat disease.
In Tang Dynasty, Sun Simiao's Golden Prescription says:Officials in Wu and Shu areas, shall use moxibustion to treat2to3acupoints on their bodies,... then they will stay away from various diseases. This means moxibustion could not only used to treat diseases but also to prevent diseases. In Song Dynasty, Shen Kuo recorded Western Nationalist'fortune telling method in his "Conversation at Meng Brook ", chapter18:the fortune teller shall use moxa to burn goat bone, and check the sign on the bone. This proves that as early as Shang Dynasty, moxa was used to burn bones and shells for fortune telling purposes. In the book of Mendacious, Lilo u Captor:Nowadays, those who want to become kings, act just like those patients with7year disease looking for3year moxa. As illustrated by Chinese traditional medicine theories, Moxibustion uses moxa hairs and other materials to burn acupoints, using moxa's warmth to facilitate body channels, to balance physiology functions, for the purpose of treating and preventing diseases. The therapy of moxibustion has the functions of warming up body channels, harmonizing Qi and blood, upgrading the vital qi, retrieving Yang and strengthening the loosing part, activating blood flow and removing stagnation, dispersing numbness and coldness, preventing diseases and strengthening body functions.
In Qing Dynasty, Wu Yiding's book of Holy Moxibustion says:Moxibustion is originated from fire, as the nature of fire is warm and fast, its body is soft and its function is tough, so Yin disease could be cured. It moves fast and doesn't stay in one place, it enters internal organs of the body easily. The doctor shall use moxa's spiciness and fragrancy, to facilitate12channels, and enter3Yin, to sort out vital Qi and blood. A good doctor could cure all the diseases easily with moxibustion. This explains moxibustion's nature and result in treating diseases. In recent times a Japanese doctor used moxibustion in a whole factory and a school covering everyone there, for the purpose of disease prevention. The experiment proves moxibustion is really good at strengthening bodies and preventing diseases.
In Chunqiu times,"Shi Jing", Chaptor Caige:Collecting those moxa, as interpreted in Wester Han Dynasty by Mao Heng and Mao Geng:Moxa is used to treat diseases. In the book of Mencious, Chaptor Lilou:Nowadays those who want to become kings, act just like those patients with7year diseases, looking for moxa of3years. From these record we could see moxibustion was widely used in Chunqiu and Zhanguo periods. Therefore, moxibustion therapy must be originated earlier than Western Zhou Dynasty. The remaining moxibustion documents include silk book "Leg and arm11channel moxibustion" and "Yinyang11channels Moxibustion";"New Collection of Moxibustion Therapies" of Dunhuang Stone Chamber, medical prescriptions.
Pre-Qin Dynasty and Two Han Dynasties cover the historical periods when most important moxibustion theory of Chinese traditional medicine was established. The great medical work of "Huang Di Nei Jing" written between Qin and Han Dynasties, introduced moxibustion therapy as an important systematic part, emphasizing that "Moxibustion could also compliment acupuncture therapy in various diseases". In "Ling Shu", Chaptor" Function", it mentioned first that "Moxibustion comes from north". As mentioned in "Su Wen", Therapy and Prescription,"In the north,... there are mountains and highlands everywhere, winds are cold and freezing," its people live in the country and drink milk. It is easy to catch coldness, moxibustion shall used as treatment." This means that moxibustion therapy was originated from and related to Chinese northern people's living conditions and customs, natures of diseases. Moxibustion therapy could be used to treat external diseases, internal diseases, organic diseases, cold and hot diseases, ulcers, madness, and so forth. The function of moxibustion therapy includes lifing sagging, strengthening Yinyang, dispersing wicked coldness, facilitating body channels, vital Qi and blood flow, and so forth. In "Huang Di Nei Jing" it also mentioned moxibustion's strengthening and letting-out functions:" Moxibustion is used for strengthening purpose, don't blow out the fire, wait until the fire goes out; When moxibustion is used for letting-out purpose, blow the fire as quickly as possible, enhance the warmth of moxa, and wait until the fire goes out."("Lingshu, Back Acupoints") Finally, it pointed out that moxibustion should stay away from the following diseases:Both Yin and Yang are weak, or both Yin and Yang are over strong, or Yang is over strong and hot, or having difficulty in breathing. Somehow "Huang Di Nei Jing " laid a found basis for moxibustion therapy.
In Eastern Han Dynasty, Zhang Zhongjing wrote the book of Treatise on Febrile and Miscellaneous Diseases. The book focused on using herbal medicines and prescriptions to diagnose and treat febrile and miscellaneous diseases. Though acupuncture and moxibustion was not mentioned a lot, there are7articles discussing moxibustion in "Febrile Theory",2articlesin "Golden Chamber Theory ". These articles contribute to the applications and taboos of moxibustion therapy. Zhong Jing pointed out that moxibustion should be applied to treat3Yin diseases, or when Shao Yin Disease just begins, when Yang is weak and Yin is strong, moxibustion could be used to assist Yang and restrain Yin; Shao Yin Diarrhea and vomiting; when pulse is weak and hard going, moxibustion could be used to upgrade Yang and strengthening Yin; or in Jue Yin disease, when hand and leg feeling cold, when pulse is short-going, moxibustion could be used to facilitate Yang to reach out. All these have important influences on the doctors of later times.
In Chinese history the first work dedicated to moxibustion was Cao Xi' s "Cao's moxibustion prescription", totally7volumes, unfortunately the book is lost today. In Jin Dynasty, Chen Yan Zhi wrote "Small Prescription" though lost today, it is also one of the earliest book advocating moxibustion. He mentioned that "Acupuncture could only be used but professional doctors, but moxibustion could be carried out by ordinary people themselves." This means moxibustion is easy to promote. As found in the various books recording30some Chen's prescriptions, we find that he advocates that acupoints of moxibustion shall be as few as possible, he emphasizes that before moxibustion, wicked blood shall be pricked and taken away, moxibustion shall be used as many as50-100zhuang, the quantity could also be used as based on the patients' ages. Especially on moxibustion taboos, he points out that18taboos in "Huang Di Nei Ting" was not absolutely correct,"Direct moxibustion shall avoid unclothed parts of arms and legs, scars shall be considered as harmful" He has many innovative views for us to learn.
In Jin Dynasty, Ge Hong wrote "Elbow Prescription". He collected and recorded lots of moxibustion prescriptions of his concurrent and earlier times. The book has109articles discussing acupuncture and moxibustion, out of which moxibustion counts for94articles. Apart from inheriting direct moxibustion from "Huang Di Nei Jing" and "Acupuncture and Moxibustion Jia Yi Classics", the book innovates indirect moxibustion with materials put between moxa and skin, including salt, garlic, hot pepper, and so forth. Besides, apart from moxa, wax candle, pottery with burning herbals, and moxa pipe are also used in the therapy. Regarding the diseases, the book recorded prescriptions covering sudden death, diarrhea, apoplectic and28urgent diseases.
In Tang Dynasty, the famous doctor Sun Si Miao, in his great work Golden Prescription and Golden Prescription for Urgent Diseases, wrote lots about moxibustion therapy. He even added more indirect moxibustion materials, such as bean pastry, mud pastry, Fuzi, Shanglu, and so forth. Scope of moxibustion therapy was also developed, not only for treatment, but also for prevention. Doctor Sun was also the first one in history to advocate Guanghuang Acupoint Moxibustion, he proposed theorematic basis by using Guanghuang Acupoint Moxibustion to treat miscellaneous difficult diseases.
As moxibustion developed, professional moxibustion doctors came into being in Tang and Song Dynasties. For example, Han Yu of Tang Dynasty wrote a poem named "Driving away diarrhea ghosts":Moxibustion doctors work like hunters besieging their preys. This also means that moxibustion was widely used at the time.
Qing Dynasty could be considered as concluding period for ancient moxibustion therapy. Out of the documentaries, Wu Yiding's the book of Holy Moxibustion was most famous. The book summarized moxibustion theories and practices until Qing Dynasty, plus author's own clinical experiences, the book epitomized moxibustion therapy in history.
At the end of Qing Dynasty, the imperial hospital illegalized acupuncture and moxibustion therapy, this leads to the declination of moxibustion. However, acupuncture and moxibustion works still develop among the ordinary peoples. As moxibustion in highly efficient and low cost, it is still popular today.
2. A overview on Gaohuang Acupoint Moxibustion
The paper found that GAM was originated from theoretic basic of Neijing of Qin and Han dynasties;then in Wei and Jin Dynasties Fester Moxibustion was developed, recorded in Gehong' s Pre-emergency Prescription, Chapter Light Prescription;And then in Tang dynasty further developed as pointed out in Golden Prescription"it is a cure for all diseases";GAM's peak time came in Song dynasty as its application and function cited in most top prescription works of the time, and Zhuang Chuo's book of GAM summarized all the Ways of acupoint anatomic positioning, quantity of moxibustion, and follow-up nutrition, laying a solid foundation for featured traditional GAM;His work led to GAM's wide application in Ming and Song dynasties, as recorded and researched in various medical works of the time. Based on its wide range of collected documents,the paper sorted out the developing history of Chinese GAM.By using TCM ancient literature data base, Chinese ancient documentary all-in-one data base and Chinese Medical Document Research, Local Chronicles the paper pinpointed GAM author's hometown. Through comparing between doctors and medical works of various historic eras, applications and treatments of different diseases, the paper carried out an in-depth and systematic study on the book of GAM and its relating ancient works. By using statistic charts and graphs of modern GAM and acupuncture comparison,the paper provided an understanding of the GAM clinical application scope. The paper also used"China Academic Journal Network Publishing Data Base"to search GAM magazine documentaries, and engaged statistic frequency, charts and graphs for presentation of the research result.
Result
The book of Gaohuang Acupoint Moxibustion was written by Zhuang Chuo of Song Dynasty, recording and summarizing the different methods of Gaohuang acupoint anatomic-positioning, based on the application practice of earlier times. So far study on GAM ancient literatures has been weak. GAM is the first book ever in history dedicated to the research of a single acupoint, Gaohuang. The author inherited and focused on Sun Zhen Ren's fine anatomic positioning, and recorded many successful GAM clinical cases, as well as his own GAM experiences. The book includes18drawings depicting13ways of acupoint anatomic positioning,recording details of acupoint positioning methods of different schools,which made the book an important documentary covering GAM until Song Dynasty. This paper carried out a systematic and overall research on the origin and history on both generic moxibustion and Gaohuang Acupoint Moxibustion, starting from perusal of the book;collecting ancient documents from various data bases to strengthen GAM application's academic contents. While being focused on understanding, exploring,and presenting ancient and modern documentaries relating traditional moxibustion, this paper scrived not only to inherit but also to shed a new light on and further develope Chinese traditional GAM, to promote GAM as a valuable part of TCM system and apply it to modern multivarious chronic and difficult diseases, as a organic treatment. Meanwhile, this paper also dedicated to promote the book of GAM as an important ancient moxibustion work, to deliver a better understanding of the book' s value in moxibustion history to the medicals, academics and ordinary people as well. When selecting this research topic, it was found that this book had never been seriously and deeply studied, only several articles covering Zhuang Chuo's home place had been written. There had been no systematic and overall discussion on the book of GAM.This paper explored on Zhuang Chuo and his book of GAM, taking a historic point o"f view, aiming to give a clear picture of GAM development through the time. This paper also collected records on and gave a conclusion to GAM's application of modern times,all in an effort to promote GAM's application in the area of ancient documentary theories.
Conclusion
This study has the innovating features as follows:
1.This is the first paper combining academic debating and documentary studying approaches to discuss the book of GAM's origin and history, collecting relating documents dating from HAN Dynasty and earlier times until the present days.As a result,it presents an overall understanding on moxibustion development through the history.
2. This is the first paper using TCM documentary studying method,to carry out an history period division and overall research, exploring moxibustion historic application laws and features.
3. During the study, it was found that modern journal publications relating to GAM therapy was quite limited, while the importance on its anatomic-positioning had been ignored. As pointed out by Sun Zhen Ren, if the acupoint could not been accurately located, the patient's body would get further hurt, instead of get cured. This is the most important experience through the book of GAM's study.
1. Anatomic-positioning plays a major role in GAM therapy, two scapula's must be separated before moxibustion, for an effective and positive treatment. Sun Zhen Ren:If the moxibustion is delivered professionally and accurately, it could cure all the diseases... otherwise, if the acupoint is covered by the scapula, there will be no positive result.
2.GAM must be carried out heavily, at least500zhuang and above, only in this way, the lightest positive results could be achieved on patients of consumptive diseases. If not, the GAM would only consume the patentability energy and Qi, even causing Qi stagnation and other syndromes, for which doctors must be most careful during the operation. As the proverb says:A7year disease needs3year moxa. There are2meanings of it:1st the treatment shall use3year old moxa to avoid its dryness-heat,2nd it means a7year long consumptive disease takes moxibustion over3-year-time for a through curing.
3. Sun Zhen Ren's after-moxibustion nutrition rules must be followed. Only when accomplishing both before-GAM anatomic-positioning and after rest and "nutrition, the most desirable aim of"curing all the diseases with one treatment" could be reached.
Through perusal reading of the book of GAM, as well as referring to historic GAM documentaries, this paper aimed to provide a better understanding of GAM's clinical application scope and points for notice, to promote further GAM application in modern clinic treatment, to make the doctors master clearly the point of anatomic-positioning:two scapula s must be separated before moxibustion, for an effective and positive treatment. All in all, this gives the doctors a reference when delivering GAM therapy, two scapula's must be separated before moxibustion for the purpose of accurate anatomic-positioning, and heavy quantity must be taken, and rest-nutrition advice must be followed by the patients, only with the above serious diseases could be finally cured for the purpose of positive treatment, prevention of disease and a happier life. This is also the utmost purpose of this paper.
引文
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