基于气血阴阳并倾探讨虚实病机及其对针刺治则的指导意义

Discussion on Deficiency and Excess Pathogenesis from the Perspective of Disordered Distribution of Qi,Blood,Yin and Yang and Its Guiding Significance for Therapeutic Principle of Acupuncture

虚实是辨证中的重要一环。历代所论虚实均以《黄帝内经》中的“邪气盛则实,精气夺则虚”(简称“邪正说”)为纲,但“邪气盛则实,精气夺则虚”的应用有其局限性。《素问·调经论》的“气血以并,阴阳相倾,气乱于卫,血逆于经,血气离居,一实一虚。……有者为实,无者为虚”(简称“有无说”)亦是有关虚实重要的论述。“邪正说”反映的是疾病发生与发展过程中外邪与人体正气的关系,“有无说”主要描述人体气血阴阳的循行、分布和配置情况,二者在阐释虚实病机内涵方面可互相补充。“有无说”在实践上也已有诸多应用,可有效指导临床针刺治则的选择及施治。

Deficiency and excess is an important part of syndrome differentiation in the field of traditional Chinese medicine(TCM). The physicians of past generations all differentiated the deficiency and excess based on the exposition of “predomination of pathogenic-qi resulting into excess and insufficiency of essence-qi resulting into deficiency”(hereinafter referred to as“pathogenic-qi and healthy-qi theory”)recorded in Yellow Emperor’s Canon of Medicine. However, the clinical application of“pathogenic-qi and healthy-qi theory”has its limitations.Another exposition is that“the disordered distribution of qi, blood, yin and yang results into the absence of defensive qi and meridian blood and then causes the excess and the deficiency. The presence(of disordered distribution of qi,blood,yin and yang)means the excess,and the absence(of qi,blood,yin and yang)means the deficiency”(hereinafter referred to as“presence or absence theory”). It is recorded in the chapter of Discussion on Regulating Meridians in Plain Conversation of Yellow Emperor’s Canon of Medicine and is also important for probing into the pathogenesis of deficiency and excess. The “pathogenic-qi and healthy-qi theory” emphasizes the relationship of pathogenic-qi and healthy-qi during the occurrence and development of the disease,and the“presence or absence theory” focuses on the flow,distribution and allocation of qi,blood,yin and yang. The“pathogenic-qi and healthy-qi theory”and“presence or absence theory”can complement each other in explaining the connotation of the pathogenesis of deficiency and excess. Till now,widely clinical application of“presence or absence theory” has shown in modern medical practice,and the“presence or absence theory”is effective for guiding the selection of therapeutic principle and performance of acupuncture in the clinic.