《内经》治则治法学说的渊源与形成研究
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摘要
《黄帝内经》为中医治则治法学说的形成奠定了理论基础，其理论来源于实践，是前人的经验积累和总结，并经过归纳整理而形成的独具特色的治疗学理论。目前，《内经》治则治法学说的研究尚处于初步阶段，存在着很大的研究空间，因此通过对先秦及汉初医学文献、非医学文献以及《内经》之中相关内容的整理、研究，从学术史角度探寻治则治法学说的渊源及形成的脉络，有着极其现实的学术意义。
本课题主要采用文献研究的方法搜集、整理出先秦汉初有关治则治法内容的文献资料；归纳整理《内经》有关治则治法学说的内容，探求其学术渊源关系；最后，系统整理出《内经》治则治法学说渊源及其形成、演变的脉络，并简单分析其原因。
在治则方面，马王堆、江陵张家山、安徽阜阳等汉简都没有记载用于指导治疗疾病的治则；《周易》、《老子》、《孙子》等哲学思想对《内经》治则学术思想的形成影响较大。《内经》基于先秦汉初哲学思想并结合其医疗实践形成了中医学治则理论。
在“治未病”治则方面，《内经》“未病先防”“既病防变”起源于《周易》、《老子》、《孙子》等避祸防患、“有备无患”的思想；而《内经》“治未病”原则中的“瘥后防复”是先秦汉初避祸防患思想的进一步发展完善，显然“瘥后防复”治则产生的时间较晚。
在“因势利导”治则方面，《内经》这一治则是《易经》、《老子》、古代军事思想中“顺势而治”思想与医疗实践的结合与发展。
“治病求本、标本缓急”治则则是《内经》对哲学范畴中的“标”“本”的辩证关系的发展和创新。
“协调阴阳，扶正祛邪”治则中的“协调阴阳”是《内经》在阴阳哲学中“和”观念的影响下而成形。至于“扶正祛邪”治则则是《内经》基于“邪气”和“正气”辩证关系的深刻认识而提出。
“因时因地因人制宜”治则方面，从《孟子》有关天时、地利、人和的论述，《孙子》强调军事作战天地人的整体观，到《淮南子》重视天文、地理、人事相结合，构建了天人感应的理论体系，都是“因时因地因人制宜”治则的理论基础，《内经》体现了古代哲学中天地人的和谐统一。
纵观先秦汉初到《内经》的文献，治则的形成有着一条在内容上由粗略到详尽、由简单到丰富，治则理论由模糊到明确，一步步发展完善的比较清晰的脉络。
关于治法内容包括两方面，一为治病理法，包括基本治法、一般治法和具体治法等，是基于治则理论所形成的治病机理及效果划分的各种方法；二为治疗手段。前者以汗法为例，在《史记·扁鹊仓公列传》、《五十二病方》中都有其雏形，而《内经》则把汗法升华到了理论。
治疗手段内容较为庞杂。《内经》所载的针刺、灸法、药物、导引、按摩、手术、精神疗法及饮食疗法等至今还指导着临床实践。
关于针刺，马王堆简帛医书《五十二病方》有“砭法”无针法，《脉法》中“用砭启脉”。《山海经》、《战国策》、《韩非子》等先秦著作中载有砭石、箴石等，而《内经》中不同篇章或有砭石或有九针或有砭石九针共论，说明当时医家各有师承，而《内经》则非一人一时之作。《内经》对针刺，包括针具、针刺法则、针刺部位、针刺时机和针刺手法等都有详尽论述，说明《内经》对这一治病方法已经有了相当系统、深刻而完善的掌握，奠定了后世针灸治疗学说的基础。
关于灸法，从《五十二病方》火炙疗法与灸法并存，到《内经》焫、灸的并载，以灸法为主。至于《庄子》提出“艾”为烟熏之用，《孟子》指出艾在灸疗中的主要作用，而《内经》提到灸法时未言艾，则说明艾已成为灸法的主要用材故略其不言。
从学术发展规律进行分析，关于针灸部位，马王堆、《史记·仓公传》记载的刺灸经脉方法，在《内经》中亦有记载，但《内经》尚记载了刺腧穴而不论经脉以及循经取穴的针灸方法，这三种方法体现了针灸治病方法由粗到精的发展过程。值得注意的是该三种针灸法《内经》均有载述，说明并非一种方法消失后，另一种方法才出现，而是几种针灸法逐渐交替发展。
关于药物治病，从《尚书·说命》的“若药弗瞑眩，厥疾弗瘳”，《周礼》“聚毒药以供医事”等，人们首先是对药物毒性的认识；《诗经》、《尔雅》、《楚辞》载药品种很多，但未言药物功效；《山海经》指出了多种药物的功效和使用方法；《史记·扁鹊仓公列传》提到的古代药物学书中有《药论》：阜阳汉简《万物》，长沙马王堆出土帛书《五十二病方》药物由单效向复方发展，其内容逐渐丰富；《内经》仅载有十三方，药物品种少，这十三方也由单方向复方的发展。这些都说明先秦药物治疗尚处于起步阶段。《内经》其他篇章如《阴阳应象大论》、《至真要大论》等有用药法度、组方制度的内容，不仅显现出药物学发展的清晰脉络，而且亦说明《内经》本身包含由粗略到详尽、由简单到丰富的学术发展史料。
饮食疗法，早在《周礼·疾医》中就有：“以五味五谷五药养其病”，《素问·金匱真言论》、《素问·藏气法时论》、《灵枢·五味》、《灵枢·五音五味》等中都有食养五味之说，说明此四篇传承的一致性，而且与《周礼·食医》、《淮南子·时则训》等所言的四季饮食调养法则密切相关。
精神疗法，先秦汉初的诸多文献如《庄子·达生》、《吕氏春秋·志忠》都有典型的例子，《素问·阴阳应象大论》结合当时盛行的阴阳五行学说指出了五志相胜和以情胜情精神疗法的理论。同时《内经》亦指出祝由应属于精神疗法的范畴。
关于导引按摩，《庄子·刻意》、《吕氏春秋·古乐》都载有导引疗法，马王堆出土的《导引图》、江陵张家山医简《引书》都为导引专著；《史记·扁鹊仓公列传》、《说苑》、《韩诗外传》等书中载有上古医生俞跗运用按摩治病。《内经》则明确了导引按摩的理论依据，使实践升华到了理论的高度。
手术疗法，《管子》、《尸子》及《五十二病方》提出以“割痤疽”、“祛痔”为主的手术。《灵枢·痈疽》篇记载了切开排脓术、截趾术；《灵枢·四时气》载有放腹水法。《内经》中手术工具也有砭石向铍针、锋针的发展。
通过以上研究，治则治法的内容在《内经》成书之前的古籍文献中有着大量的记载，但是零散而不成体系，亦未上升到理论高度，然而通过归纳整理，仍可以探寻到一条比较清晰的发展脉络。而在《内经》之中的某些篇章之间也存在着学术上的继承和发展关系，再次证明了《内经》“非一人一时之手笔”的成书特点。同时说明《内经》确实是一部当之无愧的中医理论的奠基之作，治则治法的大部分理论、方法都是在《内经》时代逐步成熟并确立下来了，为后世中医治则治法学说的发展奠定了理论基础。
本课题的创新之处在于：
1．通过整理、分析先秦及汉初非医学文献和医学文献，以及《内经》的相关资料，归纳出《内经》治则治法学说如何从先秦零散的治病方法，到西汉中前期，经过加工整理，形成《内经》系统的治则治法学说，从而在理论和方法上为后世治则治法学说的进一步发展完善奠定了基础。而本文的资料整理及相关的分析推论亦为中医学术史提供新的参考资料。
2．本研究从学术发展规律进行分析发现：针刺的工具从砭石到九针，针刺部位从针刺患处到针刺经脉，再到针刺不以经脉描述的特定穴位，最后发展为循经取穴的针刺法，这一由粗略到精确的发展过程。《左传·襄公二十二年》提到药石为针刺的王具的最早记载。针刺经脉法最早见于《史记·扁鹊仓公列传》，但针刺穴位未出现。说明当时医家各有传承，而《内经》对砭石、九针及针刺患处、经脉、穴位均有载述，则非一人一时之作；两种工具、三种针刺法并非一种方法消失后，另一种方法才出现，而是几种针刺法逐渐交替发展。
3．本研究发现《内经》记载的药物疗法有两个特点：其一为《内经》十三方由单方向复方的发展，说明《内经》“非一人一时之手笔”的成书特点；其二为记载的药物气味阴阳的《素问·阴阳应象大论》成篇于战国末期至汉初阴阳五行说最兴旺的时期，其与《素问·至真要大论》关于药物气味阴阳分类的思想一致，说明两篇传承的一致性。此外，《五十二病方》等无组方制度，《至真要大论》却有方剂组织法度的内容，显然其成篇的时间较晚。
4．本研究发现《素问·阴阳应象大论》所载的精神疗法的五志相胜治病法，是据董仲舒确立的今文经五行说，说明《阴阳应象大论》成篇的时间亦较晚。还发现《素问·金匮真言论》、《素问·藏气法时论》、《灵枢·五味》、《灵枢·五音五味》等中的食养五味之说的思想是一致的，说明此四篇传承的一致性。
Yellow Emperor's Internal Classic(or Neijing, or Huangdi's Canon of Medicine, or Canon of Internal Medicine) is the splendid traditional culture of the Chinese nation, which has made outstanding contributions to the formation of the theory of therapeutic principles and methods. The theories of Yellow Emperor's Internal Classic had originated from practice, which had been the empirical summation and theoretical generalization of the Chinese people's long-time fighting against diseases, and the theory of the characteristic therapeutics had been formed through inducing and summarizing. At present, the researches on the theory of therapeutic principles and methods of Yellow Emperor's Internal Classic have been on the early stage, and there are far more researching space. So through having research the medical and non-medical writings of all the pre-Qin times and the early years of the Han Dynasty and Yellow Emperor's Internal Classic, it is of great significance for probing on the thread of the origin and formation of the theory of therapeutic principles and methods.
This research subject has systematically collected and assorted the literature data with literature research, and at the same time the contents relating the theory of therapeutic principles and methods of Yellow Emperor's Internal Classic have been condcing and assorting and analysing the internal relationship; and then the related data of the pre-Qin times and the early years of the Han Dynasty and the contents relating the theory of therapeutic principles and methods of Yellow Emperor's Internal Classic have been compared to probe the relationship of academic origin; lastly the thread of the origin and formation and evolvement of the theory of therapeutic principles and methods in Yellow Emperor's Internal Classic have been assorted systematically, which have analvsed the cause simply.
In the aspect of therapeutic principles(or principles of treatment), the therapeutic principles leading to the principles in treatment of a disease had not been recorded in Han Dynasty Grave of Mawangdui, Han Dynasty Grave of Jiangling Zhangjia Mount or Anhui Fuyang. However the philosophy's thinking of Zhou Yi, Lao Zi, Sun Zi, etc had a great influence upon the academic the thinking of therapeutic principles of Yellow Emperor's Internal Classic. Fellow Emperor's Internal Classic had been forming and even creating the theory of therapeutic principles relating to the medical pratice based on philosophy's thinkings of the pre-Qin times and the early years of the Han Dynasty.
In the aspect of therapeutic principle's thought of treating disease before its onset, "taking preventive measures before a disease comes" and "taking precautions against the progression of a disease" of Yellow Emperor's Internal Classic had originated from the thought of avoiding disaster and preventing anxiety of Zhou H, Lao Zi, Sun Zi, Huai Nan Zi and so on. However, "taking measures against recrudescence after recovery", one of the three aspects of therapeutic principle's thought of treating disease before its onset in Yellow Emperor's Internal Classic, had been developed the thought of avoiding disaster and preventing anxiety, and obviously the thought of taking measures against recrudescence after recovery had formed far more lately.
In the aspect of therapeutic principle of improving the occasion, therapeutic principle of improving the occasion in Yellow Emperor's Internal Classic had combined and developed the thought of administering nation by taking advantage of an opportunity in Yi Jing, Lao Zi, ancient thought of military affairs and medical practice.
Therapeutic principle of "searing for the primary cause of a disease in treatment" and "taking appropriate measures in consideration of the urgency and severity of fundamental and the incidental in treatment" in Yellow Emperor's Internal Classic had developed the relationship of "biao" and "ben" of philosophy's area and had created the medical meaning.
In the aspect of therapeutic principle of "regulation of Yin and Fang" and "strengthening the body resistance and eliminating pathogenic factors", the former had originated from the philosophy of Yin and Yang during the pre-Qin times and the early years of the Han Dynasty. From Lao Zi, Yi Jing, Xunkuang to the Yin and Yang researcher, Zouyan, especially Dong Zhongshu, they had applied the theory of Yin and Yang to philosophy, science, politics, and so on. Yellow Emperor's Internal Classic had inherited the connotation of the theory of Yin and Yang and created the therapeutic principle of "regulation of Yin and Fang". The therapeutic principle of "strengthening the body resistance and eliminating pathogenic factors" had also been created and developed the dialectic relationship of "pathogenic factors" and "the body resistance".
In the aspect of therapeutic principle of "treating in accordance with seasonal condtions, local condtions and the physique of an individual", from Meng Zi having recorded climate timeliness, favourable geographical position and support of people; Sun Zi having had emphasis on the conception of the whole of climate, geography and people in military affairs' campaign; to Huai ivan Zi having attached importance to the systemic theory integrating weather, terra and human to construct the telepathy of nature and man; therapeutic principle of "treating in accordance with seasonal condtions, local condtions and the physique of an individual" had reflected harmonious unification of weather, terra and human in the ancient philosophy.
Having reviewed the literature of pre-Qin times and the early years of the Han Dynasty, the formation of the therapeutic principles has the much clearer thread, whose content is from cursoriness to detail, from simpleness to abundance, and the theory of therapeutic principles has developed to perfectness gradually from mistiness to definitude.
On the therapeutic methods, there are two aspects. On the one hand, the logos of treating diseases is the several methods according to the mechanism of treating diseases and effect based on the theory of therapeutic principles. On the other hand, the means to treat the diseases. The former is the example of diaphoresis, whose rudiment had lied in Shiji-BianqueCanggong-Biography and Fifty-two Prescription, and Yellow Emperor's Internal Classic had sublimed diaphoresis to the height of the theory.
There are much more contents of the means to treat the diseases. The means to treat the diseases in Yellow Emperor's Internal Classic, for example, the acupuncture therapy, moxibustion techique, drugs, physical and breathing exercises, massage, mind cure, dietetic therapy, etc have still directed clinical practice to this day.
About acupuncture therapy, there was the means of flint stone to the disease in Fifty-two Prescription of Han Dynasty Grave of Mawangdui, but no needling therapy; and there was the needling the channels with flint stone in Mai Fa of Han Dynasty Grave of Mawangdui. There were flint stone and needles stone in Shan Hai Jing, Han Fei Zi, Strategy of the Warring States, etc. However, the different chapters in Yellow Emperor's Internal Classic have recorded the flint stone or nine needles. That means different doctors had different inherit, and Yellow Emperor's Internal Classic hadn't been written by only one person during only one period. Yellow Emperors Internal Classic have recorded the acupuncture including acupuncture instruments, acupuncture principles, acupuncture methods detailedly. It also means that the recognition of Huangdi's Canon of Medicine for acupuncture is systemic, perfect, and deeply meaningful and flawless. And it explains that it is of significance for Huangdi's Canon of Medicine as a classical works conducting the theory.
About moxibustion techique, from both spitchcock therapy and moxibustion techique having existed in Fifty-two Prescription to both roasting therapy and moxibustion techique having existed in Huangdi's Canon of Medicine, and mainly moxibustion techique is in it. Zhuang Zi had recorded "argy wormwood leaf" as sootines; Meng Zi had recorded "argy wormwood leaf" as mostly function of moxibustion techique; Huangdi's Canon of Medicine had recorded moxibustion techique but had not put forward the "argy wormwood leaf" clearly, that means "argy wormwood leaf" had already the main body of moxibustion techique.
From the analysis of academic development rule, the part of acupuncture and moxibustion have had a process of development, which is from acupuncture and moxibustion the affected part to acupuncture and moxibustion the channels and lastly to acupuncture and moxibustion acupoint, and the procedure is from coarseness to extract in the science of acupuncture and moxibustion. Remarkablely, the three means of acupuncture and moxibustion hadn't that another means had appeared after one means having disappearing, but several means had alternated to develop gradually.
About drugs treating the diseases, drugs efficacy because of vertigo altering taking in Shang Shu-Shuo Ming, gathering toxicant for medicine in Zhou Li, etc accounted for the recognition of drugs' toxicity. Shi Jing, Er Ya, Chu Ci had recorded much more variety of drugs but hadn't drugs efficacy. Shan Hai Jing had indicated the efficacy and ways and means of hundreds of drugs. The Theory of Drugs had ever existed in Shiji-BianqueCanggong-Biography but were lost. The drugs of Wan Wu in bamboo slips for writing on of Anhui FuYang and Fifty-two Prescription of Han Dynasty Grave of Mawangdui had developed from single efficacy to compound recipe, whose content had also grudually developed to the abundance. However, there are traditionally thirteen prescriptions of TCM in Canon of Internal Medicine, of which the breed is few. And the traditionally thirteen prescriptions of TCM have been recorded different chapters. Furthermore, other chapters in Yellow Emperor's Internal Classic, for example the Chapter" Great Topic on Supreme Truth and Importance"(chapter 74 in Plain Questions), have recorded the rule of Medication and the system of Prescription. It explains not only the clear thread of drugs' development during the pre-Qin times and the early years of the Han Dynasty but also that Yellow Emperor's Internal Classic itself is a academic history of development from superficiality to exactitude and from simpleness to enrichment.
Dietetic therapy had firstly existed in "the recuperate depending on five kinds of flavours, five kinds of paddy, five kinds of drugs" of Zhou Li. The Chapter "On the Relation Between Energies of Five Viscera and the Four Seasons"(chapter 22 in Plain Questions), the Chapter" The Five Tastes"(chapter 56 in Spiritual Pivot) and the Chapter" The Five Tons and Five Tastes"(chapter 65 in Spiritual Pivot) have all recorded the theory of dietetic therapy's five tastes, that shows the three chapters had come down in one continuous line. And at the same time dietetic therapy of Yellow Emperor "s Internal Classic had influenced and instructed the dietetic disaffinity of the four seasons in Huai Nan Zi .
Among writings of all the pre-Qin times and the early years of the Han Dynasty, for example, Zhuang Zi-Dasheng, Lu Shi Chun Qiu-Zhihong, there are representative examples of mind cure. The Chapter"Grand Discussion on the Concept of Yin and Yang Reflected by Various Natural and Life Phenomena" (chapter 5 in Plain Questions) combining the theory of five elements prevailing at that time have pointed out the theory of psychotherapy on five emotions conquering each other. And at the same time Yellow Emperor's Internal Classic had indicated that incantations and prayer belongs to the category of psychotherapy.
On physical and breathing exercises and massage, Zhuang Zi-Keyi, Lu Shi Chun Qiu-Gule have all recorded the therapy of physical and breathing exercises. Drawing of physical and breathing exercises in Mawangdui Hart tombs and the Book of physical and breathing exercises in Jiangling Zhangjia Mount Han tombs are all the monograph of physical and breathing exercises. Shiji-BianqueCanggong-Biography, Shuo Yan and Han Shi Wai Zhuan, etc have all recorded that Yufu, a ancient doctor, treated the diseases adopting massage. Yellow Emperor's Internal Classic have definited the theory of physical and breathing exercises and massage and sublimed to the height of the theory from practice.
On surgical therapy, Guan Zi, Shi Zi, and Fifty-two Prescription had brought forward the surgery mainly concluding the removal of celluiitis and haemorrhoids. The Chapter"On Carbuncle and Deep-rooted Carbuncle" (chapter 81 in Spiritual Pivot) have recorded the technique of sundering to purulent discharge and amputated extremity, and the Chapter"Application of Different Pricking Therapies in Different Seasons " (chapter 19 in Spiritual Pivot) have recorded the means of discharging peritoneal fluid. Surgical instrument had developed from flint stone to a sharp three-edged needle and a sword-like needle.
From above researching, we find that the content of therapeutic principles and methods had been recorded massly in the ancient literature before Yellow Emperor's Internal Classic had been published in book form. But it was unsystemlly scattering and didn't go up to the theory altitude. However, through inducing and trimming, we could search an more limpid thread of development. Moreover, some chapters among Yellow Emperor's Internal Classic exist the technical relationship having inherited and developed, which once again has demonstrated that the characteristic of Yellow Emperor's Internal Classic hadn't written by only one person during only one period. At the same time, it is believed that Yellow Emperor's Internal Classic is really worthy of a foudational writing of TCM's theory. The much theory and many methods of therapeutic principles and methods have all had been maturing and establing gradually in the period of Yellow Emperor's Internal Classic had been published in book form. It could settle the rational for the development of the theory of therapeutic principles and methods for the later ages.
The new ideas in the research subject are following:
1. Through trimming and analysing the medical and non- medical literature during the pre-Qin days and the early years of Han Dynasty and the relevant information of Yellow Emperor's Internal Classic, we can draw up how the theory of the therapeutic principles and methods in Yellow Emperor's Internal Classic had been forming by elaborating and trimming from the scattering methods of treating diseases in the pre-Qin days to mid-prophase Xi-Han Dynasty. And it was settled the foudation on the theory and method for the theory of therapeutic principles and methods having developed later ages. And at the same time, the article having sorting of data and related analysis' deducement is provided original reference information for the study of academic history in TCM.
2. We analyse the subject from academic development, and we discover acupuncture instrument from flint stone to nine needles, and the part of acupuncture have had a process of development, which is from acupuncturing the affected part to acupuncturing the channels and lastly to acupuncturing acupoint, and the procedure is from coarseness to extract. Medical stone was brought forward as the first recordation of acupuncture instrument in Zuo Zhuan-Xianggong22-year. Acupuncturing the channels have been firstly recorded in Shiji-BianqueCanggong-Biography which hadn't recorded acupuncturingcupoint. That means different doctors had different inherit, and Yellow Emperor's Internal Classic have recorded not only flint stone but also nine needles, and it have discussed not onlv acupuncturing the affected part but also acupuncturing the channels and acupuncturing acupoint, and it explains that Yellow Emperor's Internal Classic hadn't been written by only one person during only one period. The two acupuncture instrument and the three means of acupuncture weren't that another means had appeared after one means having disappearing, but several means had alternated to develop gradually.
3.We find there are two characteristic having been recorded about drugs in Yellow Emperor's Internal Classic. Firstly there are traditionally thirteen prescriptions of TCM in different chapters of Canon of Internal Medicine, and the traditionally thirteen prescriptions of TCM have been recorded during different period. It shows that the different chapters of Canon of Internal Medicine had come into being during different period. Secondly, the Chapter"Great Topic on Supreme Truth and Importance" (chapter 74 in Plain Questions), have recorded the vin and yang of five-kind flavors that had based on the Yin-vang and five elements theory having been established by Dong Zhongshu. And the rule of Medication and the system of Prescription didn't exist in Fifty-two Prescription but had existed in "Great Topic on Supreme Truth and Importance". Remarkablely, "Great Topic on Supreme Truth and Importance" had been come into being for more lateness.
4. We find that the Chapter"Grand Discussion on the Concept of Yin and Yang Reflected by Various Natural and Life Phenomena" (chapter 5 in Plain Questions) has pointed out the theory of psychotherapy on five emotions conquering each other that originated from the theory of five elements having been established by Dong Zhongshu. And this Chapter has recorded the yin and yang of drugs' flavors that originated from the theory of Yin-yang having been established by Dong Zhongshu too. Remarkablely, the Chapter"Grand Discussion on the Concept of Yin and Yang Reflected by Various Natural and Life Phenomena" had been come into being after Chun Qiu Fan Lu.
本课题主要采用文献研究的方法搜集、整理出先秦汉初有关治则治法内容的文献资料；归纳整理《内经》有关治则治法学说的内容，探求其学术渊源关系；最后，系统整理出《内经》治则治法学说渊源及其形成、演变的脉络，并简单分析其原因。
在治则方面，马王堆、江陵张家山、安徽阜阳等汉简都没有记载用于指导治疗疾病的治则；《周易》、《老子》、《孙子》等哲学思想对《内经》治则学术思想的形成影响较大。《内经》基于先秦汉初哲学思想并结合其医疗实践形成了中医学治则理论。
在“治未病”治则方面，《内经》“未病先防”“既病防变”起源于《周易》、《老子》、《孙子》等避祸防患、“有备无患”的思想；而《内经》“治未病”原则中的“瘥后防复”是先秦汉初避祸防患思想的进一步发展完善，显然“瘥后防复”治则产生的时间较晚。
在“因势利导”治则方面，《内经》这一治则是《易经》、《老子》、古代军事思想中“顺势而治”思想与医疗实践的结合与发展。
“治病求本、标本缓急”治则则是《内经》对哲学范畴中的“标”“本”的辩证关系的发展和创新。
“协调阴阳，扶正祛邪”治则中的“协调阴阳”是《内经》在阴阳哲学中“和”观念的影响下而成形。至于“扶正祛邪”治则则是《内经》基于“邪气”和“正气”辩证关系的深刻认识而提出。
“因时因地因人制宜”治则方面，从《孟子》有关天时、地利、人和的论述，《孙子》强调军事作战天地人的整体观，到《淮南子》重视天文、地理、人事相结合，构建了天人感应的理论体系，都是“因时因地因人制宜”治则的理论基础，《内经》体现了古代哲学中天地人的和谐统一。
纵观先秦汉初到《内经》的文献，治则的形成有着一条在内容上由粗略到详尽、由简单到丰富，治则理论由模糊到明确，一步步发展完善的比较清晰的脉络。
关于治法内容包括两方面，一为治病理法，包括基本治法、一般治法和具体治法等，是基于治则理论所形成的治病机理及效果划分的各种方法；二为治疗手段。前者以汗法为例，在《史记·扁鹊仓公列传》、《五十二病方》中都有其雏形，而《内经》则把汗法升华到了理论。
治疗手段内容较为庞杂。《内经》所载的针刺、灸法、药物、导引、按摩、手术、精神疗法及饮食疗法等至今还指导着临床实践。
关于针刺，马王堆简帛医书《五十二病方》有“砭法”无针法，《脉法》中“用砭启脉”。《山海经》、《战国策》、《韩非子》等先秦著作中载有砭石、箴石等，而《内经》中不同篇章或有砭石或有九针或有砭石九针共论，说明当时医家各有师承，而《内经》则非一人一时之作。《内经》对针刺，包括针具、针刺法则、针刺部位、针刺时机和针刺手法等都有详尽论述，说明《内经》对这一治病方法已经有了相当系统、深刻而完善的掌握，奠定了后世针灸治疗学说的基础。
关于灸法，从《五十二病方》火炙疗法与灸法并存，到《内经》焫、灸的并载，以灸法为主。至于《庄子》提出“艾”为烟熏之用，《孟子》指出艾在灸疗中的主要作用，而《内经》提到灸法时未言艾，则说明艾已成为灸法的主要用材故略其不言。
从学术发展规律进行分析，关于针灸部位，马王堆、《史记·仓公传》记载的刺灸经脉方法，在《内经》中亦有记载，但《内经》尚记载了刺腧穴而不论经脉以及循经取穴的针灸方法，这三种方法体现了针灸治病方法由粗到精的发展过程。值得注意的是该三种针灸法《内经》均有载述，说明并非一种方法消失后，另一种方法才出现，而是几种针灸法逐渐交替发展。
关于药物治病，从《尚书·说命》的“若药弗瞑眩，厥疾弗瘳”，《周礼》“聚毒药以供医事”等，人们首先是对药物毒性的认识；《诗经》、《尔雅》、《楚辞》载药品种很多，但未言药物功效；《山海经》指出了多种药物的功效和使用方法；《史记·扁鹊仓公列传》提到的古代药物学书中有《药论》：阜阳汉简《万物》，长沙马王堆出土帛书《五十二病方》药物由单效向复方发展，其内容逐渐丰富；《内经》仅载有十三方，药物品种少，这十三方也由单方向复方的发展。这些都说明先秦药物治疗尚处于起步阶段。《内经》其他篇章如《阴阳应象大论》、《至真要大论》等有用药法度、组方制度的内容，不仅显现出药物学发展的清晰脉络，而且亦说明《内经》本身包含由粗略到详尽、由简单到丰富的学术发展史料。
饮食疗法，早在《周礼·疾医》中就有：“以五味五谷五药养其病”，《素问·金匱真言论》、《素问·藏气法时论》、《灵枢·五味》、《灵枢·五音五味》等中都有食养五味之说，说明此四篇传承的一致性，而且与《周礼·食医》、《淮南子·时则训》等所言的四季饮食调养法则密切相关。
精神疗法，先秦汉初的诸多文献如《庄子·达生》、《吕氏春秋·志忠》都有典型的例子，《素问·阴阳应象大论》结合当时盛行的阴阳五行学说指出了五志相胜和以情胜情精神疗法的理论。同时《内经》亦指出祝由应属于精神疗法的范畴。
关于导引按摩，《庄子·刻意》、《吕氏春秋·古乐》都载有导引疗法，马王堆出土的《导引图》、江陵张家山医简《引书》都为导引专著；《史记·扁鹊仓公列传》、《说苑》、《韩诗外传》等书中载有上古医生俞跗运用按摩治病。《内经》则明确了导引按摩的理论依据，使实践升华到了理论的高度。
手术疗法，《管子》、《尸子》及《五十二病方》提出以“割痤疽”、“祛痔”为主的手术。《灵枢·痈疽》篇记载了切开排脓术、截趾术；《灵枢·四时气》载有放腹水法。《内经》中手术工具也有砭石向铍针、锋针的发展。
通过以上研究，治则治法的内容在《内经》成书之前的古籍文献中有着大量的记载，但是零散而不成体系，亦未上升到理论高度，然而通过归纳整理，仍可以探寻到一条比较清晰的发展脉络。而在《内经》之中的某些篇章之间也存在着学术上的继承和发展关系，再次证明了《内经》“非一人一时之手笔”的成书特点。同时说明《内经》确实是一部当之无愧的中医理论的奠基之作，治则治法的大部分理论、方法都是在《内经》时代逐步成熟并确立下来了，为后世中医治则治法学说的发展奠定了理论基础。
本课题的创新之处在于：
1．通过整理、分析先秦及汉初非医学文献和医学文献，以及《内经》的相关资料，归纳出《内经》治则治法学说如何从先秦零散的治病方法，到西汉中前期，经过加工整理，形成《内经》系统的治则治法学说，从而在理论和方法上为后世治则治法学说的进一步发展完善奠定了基础。而本文的资料整理及相关的分析推论亦为中医学术史提供新的参考资料。
2．本研究从学术发展规律进行分析发现：针刺的工具从砭石到九针，针刺部位从针刺患处到针刺经脉，再到针刺不以经脉描述的特定穴位，最后发展为循经取穴的针刺法，这一由粗略到精确的发展过程。《左传·襄公二十二年》提到药石为针刺的王具的最早记载。针刺经脉法最早见于《史记·扁鹊仓公列传》，但针刺穴位未出现。说明当时医家各有传承，而《内经》对砭石、九针及针刺患处、经脉、穴位均有载述，则非一人一时之作；两种工具、三种针刺法并非一种方法消失后，另一种方法才出现，而是几种针刺法逐渐交替发展。
3．本研究发现《内经》记载的药物疗法有两个特点：其一为《内经》十三方由单方向复方的发展，说明《内经》“非一人一时之手笔”的成书特点；其二为记载的药物气味阴阳的《素问·阴阳应象大论》成篇于战国末期至汉初阴阳五行说最兴旺的时期，其与《素问·至真要大论》关于药物气味阴阳分类的思想一致，说明两篇传承的一致性。此外，《五十二病方》等无组方制度，《至真要大论》却有方剂组织法度的内容，显然其成篇的时间较晚。
4．本研究发现《素问·阴阳应象大论》所载的精神疗法的五志相胜治病法，是据董仲舒确立的今文经五行说，说明《阴阳应象大论》成篇的时间亦较晚。还发现《素问·金匮真言论》、《素问·藏气法时论》、《灵枢·五味》、《灵枢·五音五味》等中的食养五味之说的思想是一致的，说明此四篇传承的一致性。
Yellow Emperor's Internal Classic(or Neijing, or Huangdi's Canon of Medicine, or Canon of Internal Medicine) is the splendid traditional culture of the Chinese nation, which has made outstanding contributions to the formation of the theory of therapeutic principles and methods. The theories of Yellow Emperor's Internal Classic had originated from practice, which had been the empirical summation and theoretical generalization of the Chinese people's long-time fighting against diseases, and the theory of the characteristic therapeutics had been formed through inducing and summarizing. At present, the researches on the theory of therapeutic principles and methods of Yellow Emperor's Internal Classic have been on the early stage, and there are far more researching space. So through having research the medical and non-medical writings of all the pre-Qin times and the early years of the Han Dynasty and Yellow Emperor's Internal Classic, it is of great significance for probing on the thread of the origin and formation of the theory of therapeutic principles and methods.
This research subject has systematically collected and assorted the literature data with literature research, and at the same time the contents relating the theory of therapeutic principles and methods of Yellow Emperor's Internal Classic have been condcing and assorting and analysing the internal relationship; and then the related data of the pre-Qin times and the early years of the Han Dynasty and the contents relating the theory of therapeutic principles and methods of Yellow Emperor's Internal Classic have been compared to probe the relationship of academic origin; lastly the thread of the origin and formation and evolvement of the theory of therapeutic principles and methods in Yellow Emperor's Internal Classic have been assorted systematically, which have analvsed the cause simply.
In the aspect of therapeutic principles(or principles of treatment), the therapeutic principles leading to the principles in treatment of a disease had not been recorded in Han Dynasty Grave of Mawangdui, Han Dynasty Grave of Jiangling Zhangjia Mount or Anhui Fuyang. However the philosophy's thinking of Zhou Yi, Lao Zi, Sun Zi, etc had a great influence upon the academic the thinking of therapeutic principles of Yellow Emperor's Internal Classic. Fellow Emperor's Internal Classic had been forming and even creating the theory of therapeutic principles relating to the medical pratice based on philosophy's thinkings of the pre-Qin times and the early years of the Han Dynasty.
In the aspect of therapeutic principle's thought of treating disease before its onset, "taking preventive measures before a disease comes" and "taking precautions against the progression of a disease" of Yellow Emperor's Internal Classic had originated from the thought of avoiding disaster and preventing anxiety of Zhou H, Lao Zi, Sun Zi, Huai Nan Zi and so on. However, "taking measures against recrudescence after recovery", one of the three aspects of therapeutic principle's thought of treating disease before its onset in Yellow Emperor's Internal Classic, had been developed the thought of avoiding disaster and preventing anxiety, and obviously the thought of taking measures against recrudescence after recovery had formed far more lately.
In the aspect of therapeutic principle of improving the occasion, therapeutic principle of improving the occasion in Yellow Emperor's Internal Classic had combined and developed the thought of administering nation by taking advantage of an opportunity in Yi Jing, Lao Zi, ancient thought of military affairs and medical practice.
Therapeutic principle of "searing for the primary cause of a disease in treatment" and "taking appropriate measures in consideration of the urgency and severity of fundamental and the incidental in treatment" in Yellow Emperor's Internal Classic had developed the relationship of "biao" and "ben" of philosophy's area and had created the medical meaning.
In the aspect of therapeutic principle of "regulation of Yin and Fang" and "strengthening the body resistance and eliminating pathogenic factors", the former had originated from the philosophy of Yin and Yang during the pre-Qin times and the early years of the Han Dynasty. From Lao Zi, Yi Jing, Xunkuang to the Yin and Yang researcher, Zouyan, especially Dong Zhongshu, they had applied the theory of Yin and Yang to philosophy, science, politics, and so on. Yellow Emperor's Internal Classic had inherited the connotation of the theory of Yin and Yang and created the therapeutic principle of "regulation of Yin and Fang". The therapeutic principle of "strengthening the body resistance and eliminating pathogenic factors" had also been created and developed the dialectic relationship of "pathogenic factors" and "the body resistance".
In the aspect of therapeutic principle of "treating in accordance with seasonal condtions, local condtions and the physique of an individual", from Meng Zi having recorded climate timeliness, favourable geographical position and support of people; Sun Zi having had emphasis on the conception of the whole of climate, geography and people in military affairs' campaign; to Huai ivan Zi having attached importance to the systemic theory integrating weather, terra and human to construct the telepathy of nature and man; therapeutic principle of "treating in accordance with seasonal condtions, local condtions and the physique of an individual" had reflected harmonious unification of weather, terra and human in the ancient philosophy.
Having reviewed the literature of pre-Qin times and the early years of the Han Dynasty, the formation of the therapeutic principles has the much clearer thread, whose content is from cursoriness to detail, from simpleness to abundance, and the theory of therapeutic principles has developed to perfectness gradually from mistiness to definitude.
On the therapeutic methods, there are two aspects. On the one hand, the logos of treating diseases is the several methods according to the mechanism of treating diseases and effect based on the theory of therapeutic principles. On the other hand, the means to treat the diseases. The former is the example of diaphoresis, whose rudiment had lied in Shiji-BianqueCanggong-Biography and Fifty-two Prescription, and Yellow Emperor's Internal Classic had sublimed diaphoresis to the height of the theory.
There are much more contents of the means to treat the diseases. The means to treat the diseases in Yellow Emperor's Internal Classic, for example, the acupuncture therapy, moxibustion techique, drugs, physical and breathing exercises, massage, mind cure, dietetic therapy, etc have still directed clinical practice to this day.
About acupuncture therapy, there was the means of flint stone to the disease in Fifty-two Prescription of Han Dynasty Grave of Mawangdui, but no needling therapy; and there was the needling the channels with flint stone in Mai Fa of Han Dynasty Grave of Mawangdui. There were flint stone and needles stone in Shan Hai Jing, Han Fei Zi, Strategy of the Warring States, etc. However, the different chapters in Yellow Emperor's Internal Classic have recorded the flint stone or nine needles. That means different doctors had different inherit, and Yellow Emperor's Internal Classic hadn't been written by only one person during only one period. Yellow Emperors Internal Classic have recorded the acupuncture including acupuncture instruments, acupuncture principles, acupuncture methods detailedly. It also means that the recognition of Huangdi's Canon of Medicine for acupuncture is systemic, perfect, and deeply meaningful and flawless. And it explains that it is of significance for Huangdi's Canon of Medicine as a classical works conducting the theory.
About moxibustion techique, from both spitchcock therapy and moxibustion techique having existed in Fifty-two Prescription to both roasting therapy and moxibustion techique having existed in Huangdi's Canon of Medicine, and mainly moxibustion techique is in it. Zhuang Zi had recorded "argy wormwood leaf" as sootines; Meng Zi had recorded "argy wormwood leaf" as mostly function of moxibustion techique; Huangdi's Canon of Medicine had recorded moxibustion techique but had not put forward the "argy wormwood leaf" clearly, that means "argy wormwood leaf" had already the main body of moxibustion techique.
From the analysis of academic development rule, the part of acupuncture and moxibustion have had a process of development, which is from acupuncture and moxibustion the affected part to acupuncture and moxibustion the channels and lastly to acupuncture and moxibustion acupoint, and the procedure is from coarseness to extract in the science of acupuncture and moxibustion. Remarkablely, the three means of acupuncture and moxibustion hadn't that another means had appeared after one means having disappearing, but several means had alternated to develop gradually.
About drugs treating the diseases, drugs efficacy because of vertigo altering taking in Shang Shu-Shuo Ming, gathering toxicant for medicine in Zhou Li, etc accounted for the recognition of drugs' toxicity. Shi Jing, Er Ya, Chu Ci had recorded much more variety of drugs but hadn't drugs efficacy. Shan Hai Jing had indicated the efficacy and ways and means of hundreds of drugs. The Theory of Drugs had ever existed in Shiji-BianqueCanggong-Biography but were lost. The drugs of Wan Wu in bamboo slips for writing on of Anhui FuYang and Fifty-two Prescription of Han Dynasty Grave of Mawangdui had developed from single efficacy to compound recipe, whose content had also grudually developed to the abundance. However, there are traditionally thirteen prescriptions of TCM in Canon of Internal Medicine, of which the breed is few. And the traditionally thirteen prescriptions of TCM have been recorded different chapters. Furthermore, other chapters in Yellow Emperor's Internal Classic, for example the Chapter" Great Topic on Supreme Truth and Importance"(chapter 74 in Plain Questions), have recorded the rule of Medication and the system of Prescription. It explains not only the clear thread of drugs' development during the pre-Qin times and the early years of the Han Dynasty but also that Yellow Emperor's Internal Classic itself is a academic history of development from superficiality to exactitude and from simpleness to enrichment.
Dietetic therapy had firstly existed in "the recuperate depending on five kinds of flavours, five kinds of paddy, five kinds of drugs" of Zhou Li. The Chapter "On the Relation Between Energies of Five Viscera and the Four Seasons"(chapter 22 in Plain Questions), the Chapter" The Five Tastes"(chapter 56 in Spiritual Pivot) and the Chapter" The Five Tons and Five Tastes"(chapter 65 in Spiritual Pivot) have all recorded the theory of dietetic therapy's five tastes, that shows the three chapters had come down in one continuous line. And at the same time dietetic therapy of Yellow Emperor "s Internal Classic had influenced and instructed the dietetic disaffinity of the four seasons in Huai Nan Zi .
Among writings of all the pre-Qin times and the early years of the Han Dynasty, for example, Zhuang Zi-Dasheng, Lu Shi Chun Qiu-Zhihong, there are representative examples of mind cure. The Chapter"Grand Discussion on the Concept of Yin and Yang Reflected by Various Natural and Life Phenomena" (chapter 5 in Plain Questions) combining the theory of five elements prevailing at that time have pointed out the theory of psychotherapy on five emotions conquering each other. And at the same time Yellow Emperor's Internal Classic had indicated that incantations and prayer belongs to the category of psychotherapy.
On physical and breathing exercises and massage, Zhuang Zi-Keyi, Lu Shi Chun Qiu-Gule have all recorded the therapy of physical and breathing exercises. Drawing of physical and breathing exercises in Mawangdui Hart tombs and the Book of physical and breathing exercises in Jiangling Zhangjia Mount Han tombs are all the monograph of physical and breathing exercises. Shiji-BianqueCanggong-Biography, Shuo Yan and Han Shi Wai Zhuan, etc have all recorded that Yufu, a ancient doctor, treated the diseases adopting massage. Yellow Emperor's Internal Classic have definited the theory of physical and breathing exercises and massage and sublimed to the height of the theory from practice.
On surgical therapy, Guan Zi, Shi Zi, and Fifty-two Prescription had brought forward the surgery mainly concluding the removal of celluiitis and haemorrhoids. The Chapter"On Carbuncle and Deep-rooted Carbuncle" (chapter 81 in Spiritual Pivot) have recorded the technique of sundering to purulent discharge and amputated extremity, and the Chapter"Application of Different Pricking Therapies in Different Seasons " (chapter 19 in Spiritual Pivot) have recorded the means of discharging peritoneal fluid. Surgical instrument had developed from flint stone to a sharp three-edged needle and a sword-like needle.
From above researching, we find that the content of therapeutic principles and methods had been recorded massly in the ancient literature before Yellow Emperor's Internal Classic had been published in book form. But it was unsystemlly scattering and didn't go up to the theory altitude. However, through inducing and trimming, we could search an more limpid thread of development. Moreover, some chapters among Yellow Emperor's Internal Classic exist the technical relationship having inherited and developed, which once again has demonstrated that the characteristic of Yellow Emperor's Internal Classic hadn't written by only one person during only one period. At the same time, it is believed that Yellow Emperor's Internal Classic is really worthy of a foudational writing of TCM's theory. The much theory and many methods of therapeutic principles and methods have all had been maturing and establing gradually in the period of Yellow Emperor's Internal Classic had been published in book form. It could settle the rational for the development of the theory of therapeutic principles and methods for the later ages.
The new ideas in the research subject are following:
1. Through trimming and analysing the medical and non- medical literature during the pre-Qin days and the early years of Han Dynasty and the relevant information of Yellow Emperor's Internal Classic, we can draw up how the theory of the therapeutic principles and methods in Yellow Emperor's Internal Classic had been forming by elaborating and trimming from the scattering methods of treating diseases in the pre-Qin days to mid-prophase Xi-Han Dynasty. And it was settled the foudation on the theory and method for the theory of therapeutic principles and methods having developed later ages. And at the same time, the article having sorting of data and related analysis' deducement is provided original reference information for the study of academic history in TCM.
2. We analyse the subject from academic development, and we discover acupuncture instrument from flint stone to nine needles, and the part of acupuncture have had a process of development, which is from acupuncturing the affected part to acupuncturing the channels and lastly to acupuncturing acupoint, and the procedure is from coarseness to extract. Medical stone was brought forward as the first recordation of acupuncture instrument in Zuo Zhuan-Xianggong22-year. Acupuncturing the channels have been firstly recorded in Shiji-BianqueCanggong-Biography which hadn't recorded acupuncturingcupoint. That means different doctors had different inherit, and Yellow Emperor's Internal Classic have recorded not only flint stone but also nine needles, and it have discussed not onlv acupuncturing the affected part but also acupuncturing the channels and acupuncturing acupoint, and it explains that Yellow Emperor's Internal Classic hadn't been written by only one person during only one period. The two acupuncture instrument and the three means of acupuncture weren't that another means had appeared after one means having disappearing, but several means had alternated to develop gradually.
3.We find there are two characteristic having been recorded about drugs in Yellow Emperor's Internal Classic. Firstly there are traditionally thirteen prescriptions of TCM in different chapters of Canon of Internal Medicine, and the traditionally thirteen prescriptions of TCM have been recorded during different period. It shows that the different chapters of Canon of Internal Medicine had come into being during different period. Secondly, the Chapter"Great Topic on Supreme Truth and Importance" (chapter 74 in Plain Questions), have recorded the vin and yang of five-kind flavors that had based on the Yin-vang and five elements theory having been established by Dong Zhongshu. And the rule of Medication and the system of Prescription didn't exist in Fifty-two Prescription but had existed in "Great Topic on Supreme Truth and Importance". Remarkablely, "Great Topic on Supreme Truth and Importance" had been come into being for more lateness.
4. We find that the Chapter"Grand Discussion on the Concept of Yin and Yang Reflected by Various Natural and Life Phenomena" (chapter 5 in Plain Questions) has pointed out the theory of psychotherapy on five emotions conquering each other that originated from the theory of five elements having been established by Dong Zhongshu. And this Chapter has recorded the yin and yang of drugs' flavors that originated from the theory of Yin-yang having been established by Dong Zhongshu too. Remarkablely, the Chapter"Grand Discussion on the Concept of Yin and Yang Reflected by Various Natural and Life Phenomena" had been come into being after Chun Qiu Fan Lu.
引文
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[6] 陶功定．生态医学思想是贯穿《黄帝内经》的主线．山西中医，2004，20(3)：36～40．
[7] 陈国信，吴元黔．从临床治“气反”谈《内经》治病求本的思想．云南中医学院学报，1981，(4)：4～6．
[8] 刘绍辉．略谈《内经》治病求本．新中医，1989，(2)：2～4．
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[10] 何凡夫．《内经》“因势制宜”学术思想探讨．国医论坛，2000，15(6)：17～18．
[11] 烟建华．《内经》因势利导治疗原则及其临床应用研究．中国医药学报，2002，17(10)：582～585．
[12] 杨晓林．《内经》中因时针刺初探．湖南中医学院学报，1995，15(2)：13～14．
[13] 尹雪萍．论《内经》治未病之预防观．中医函授通讯，1993，(3)：11～13．
[14] 王非，杨旭，刘林．《内经》“治未病”的基本含义．中医药学报，1996，(1)：6～7．
[15] 朴元林．《内经》巨刺与“治未病”思想．吉林中医药，1997，(3)：45～46．
[16] 蒋瑞．论《内经》“治未病”及其与未来中医走向的关系．光明中医，2000，15(2)：9～13．
[17] 苏颖．《内经》运气治则探析．长春中医学院学报，2002，18(3)：1～2．
[18] 吴缉庵．关于《内经》中“反治”涵义的我见．中医杂志，1981，(3)：76～77．
[19] 刘涛．《内经》反治法在温病治疗中的应用．南京中医药大学学报，1998，14(5)：260～261．
[20] 吴勇，王继仙．理汗以治病是《内经》治疗学的重要思想．辽宁中医杂志，1995，22(4)：151～153．
[21] 刘国祥，刘勇．论《内经》中传统治法及临床应用．河北中医，1994，16(2)：41～42．
[22] 周学牲．《内经》非药物疗法的防病治病机理初探．南京中医药大学学报，2000， 16(1)：8～10·
[23] 辛军．《内经》时期药物治疗的三个发展层次．陕西中医，2002，23(4)：373～374．
[24] 程士德主编．内经讲义．上海：上海科技出版社，1984年，第一版：206～210．
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