痿证理论的源流梳理

Origin of theory of atrophy syndrome

中医痿证包括手足痿软无力为主要特征的诸多疾病,病因有外感六淫、内伤七情、饮食劳倦,古有痿躄、痿痹、痿易、痿厥、解亦相关名称。《内经》立"痿论"专篇,突出五脏,强调病始于肺热叶焦,而治疗则"独取阳明"。后世医家对此理论有所发展,主要观点有3:其一,遵循"独取阳明",但重心从针灸移向药物;其二,以补肾为要,盖肾总司筋骨;其三,痿证、痹症治疗有别,痿证以补益为要,不可祛风,痹症以祛风为主,不宜补虚。《内经》"独取阳明"强调针刺阳明经,"调其荥而补其俞",可以调节全身的气血,助"宗筋束骨而利机关";后世"独取阳明"多用药物调理脾胃脏腑,扶正气,祛湿热,助纳运,复升降,则气血生化有源;补益肝肾更是药物治疗痿证的主要方法,补益肝肾可以强筋壮骨。总之,治疗痿证宜针药结合,取长补短;取阳明与补肝肾不可偏废,应当以辨证为主;痿痹、痿厥等名称源于临床实践,迄今仍有现实意义,所谓痿证宜补、痹症当泻,有失偏颇。

Atrophy syndrome in Chinese medicine consists of a variety of diseases characterized by flaccidity of hands and feet.The causes include six excesses,seven emotions,improper diet and overstrain.Atrophy syndrome is also named Weibi,Weiyi,Weijue and Jieyi in ancient time.There is a specific chapter-Weilun in Neijing,which emphasizes five zang-viscera,and underlines atrophy syndrome originating from scorched lung and the therapeutic method being to needle only in Yangming Meridians.The doctors of later ages have developed the above-mentioned theory and they focused on three opinions： the first one moved the main point from acupuncture to Chinese medicinal though they abiding by the therapeutic method of needling only in Yangming Meridians.The second one took the therapy of tonifying kidney as core because kidney governing tendons and bones.The third one differentiated the therapeutic methods for atrophy syndrome from impediment syndrome.The essential of treatment of atrophy syndrome is invigoration but not dispelling wind and the essential of treatment of impediment syndrome is dispelling wind but not tonifying deficiency.The therapeutic method of needling only in Yangming Meridians in Neijing stressed acupuncture in Yangming Meridians for clearing Ying and tonifying Shu,regulating qi and blood of the whole body,and helping ancestral sinew to control bones and joints.The doctors of later ages have paid more attention to administrating medicinal for regulating spleen and stomach,strengthening healthy qi,removing dampness and heat,helping transportation and transformation,recovering ascending and descending movement of qi,and supplying more resources for qi and blood.The method of tonifying liver and kidney is a major one in the treatment of atrophy syndrome with medicinal,which can strength tendons and bones.The author believed that acupuncture and medicinal should be integrated in the treatment of atrophy syndrome,i.e.needling in Yangming Meridians combining with tonifying liver and kidney according to syndrome differentiation.The names of Weibi or Weijue were all originated from clinical practice and still have practical significance nowadays.So the opinion that atrophy syndrome should be tonified while impediment syndrome should be purged is improper.