《黄帝内经》虚里诊辨析

Analysis of Xuli Diagnosis in The Inner Canon of Huangdi

通过整理历代注家及各版教材对《素问·平人气象论篇》中“盛喘数绝者,则病在中;结而横,有积矣;绝不至,曰死”一句所描述关于虚里诊病情况的注释,发现对此经文的理解诸家注释观点不一,教材解读亦略有不同。遂从中西医不同角度分析医理,并联系西医心功能不全、风湿性心脏病发展到心力衰竭的过程,认为“盛喘数绝者,则病在中”之“中”病位在胸中,“结而横,有积矣”之“积”病变脏腑在心。联系现代医学认为,该句经文写实地论述了心系疾病进展中病情逐渐加重的三个阶段,对目前中西医临床诊断及治疗有较大的指导意义,并提示后学在研习《黄帝内经》理论时定需旁求博考,批判性地继承诸家注释,并将理论与临床相互佐证,使经典理论真正回归并指导临床。

This paper sorts out experts’annotations of“those whose Xu-li beat fast and intermittent,the nidus is in the middle;those whose xu-li beat slowly and intermittent with position moving,it means there is accumulation in the body;those whose xu-li stop beating,it means the man is dead”in《Su Wen·Ping Ren Qi Xiang Lun Pian》,this sentence is about xu-li diagnosis.Author finds out that experts’annotations are not the same,and the textbooks’explanations are inconsistent.By analyzing the sentence from different perspectives of Chinese and Western medicine,and contact cardiac insufficiency、rheumatic heart disease develops into heart failure,author thinks the location of the disease is in the chest,and the zang-fu organ involved is the heart.Contact with modern medicine,this sentence realistically describes three pathological processes of heart disease,and it’s of great significance to the clinical diagnosis and treatment of both Traditional Chinese medicine and Western medicine.It also reminds the later scholars should read widely,critically inherit the annotations,and prove the theory with the clinic so as to make the classical theory return to guide the clinic.