《黄帝内经》“血脉”“经脉”概念辨析

Discrimination of the concepts of‘blood vessels'and‘meridians’in Huangdi Neijing

经脉与血脉皆是中医学核心概念。目前的针灸学理论未对二者有明确界定与区分,经常混同使用。本研究通过梳理相关文献,发现二者在起源、属性以及临床运用上皆存有差异。“血脉”概念出现较早,为有形可见的脉管,其内运行血液,应是源自解剖学知识;基于其解剖学关联,《黄帝内经》多论“心主血脉”;同时因其为实体性存在,故有察色与放血等直接的诊疗意义。经脉虽运行气血,但《黄帝内经》对其功能的界定更侧重于气,具体呈现:对于经脉与腧穴皆强调其无形可见;经脉上的腧穴被称之为气穴、气府;诊察经脉主体是诊候气的变化;针刺首重调气,以气至为针刺目的等。二者的概念有时又有混同,无法截然分开,经脉的概念是血脉的扩展与延伸,络脉即二者重合之处。

Meridians and blood vessels are the core concepts of traditional Chinese medicine.The current acupuncture theory does not clearly define and distinguish them,so they are often confused.Through combing the relevant literature,this study found that there are differences in the origin,attribute,and clinical application of the two concepts.The concept of‘blood vessel'appeared earlier and originated from anatomical cognition.It is a visible vessel in which blood runs.Based on its anatomic relationship,Huangdi Neijing mainly discusses ‘heart dominates blood vessels'.Meanwhile,because of its solid existence,it has the direct diagnosis and treatment significance of color inspection and bloodletting.Although meridians run both qi and blood,it is obvious that the definition of them in Huangdi Neijing focuses more on qi:Both meridians and acupoints emphasize their invisibility,and emptiness is their uses.Acupoints on meridians are called qi acupoints and qi fu.The main idea of meridian diagnosis is the change of qi.Acupuncture first focuses on regulating qi and takes qi to the balance as the purpose of acupuncture.The concepts of the two are sometimes confused and cannot be completely separated.The concept of meridians is the expansion and extension of blood vessels,and collaterals are where the two overlap.