甄别与还原——论《黄帝内经》两种不同的医学体系

Identification and restoration:a study of two distinct medical systems in Huangdi Neijing

目前的中医学框架,是将中医学视为以脏腑为核心,外合体、窍、华、时的一种医学体系,药物、针石、按蹻等治病方法是涵摄于理论体系下的具体临床应用。但对《黄帝内经》医学理论进行还原与解析则会发现,《黄帝内经》早期的医学理论是基于针石外治与药物内治不同医学实践方法的发育。与后世所倡导的药物内治之脏腑医学不同,《黄帝内经》医学理论主体是基于针石外治形成的身形医学。这一体系除经脉、腧穴、针刺疗法等理论外,尚包括五体核心论、表里层次疾病传变论、营卫理论、虚实病机论、补泻治病法等,与脏腑医学理论存在着一定的差异性。笼统地将两种体系下的理论归纳为一体,导致了理论自身的冲突及与临床的脱节,需要甄别与还原。

The current framework of traditional Chinese medicine is regarded as a medical system that places the zang-fu viscera at its core,encompassing external pathways,physical aspects,orifices,manifestation(hua),and the seasonal influence.Treatment modalities,such as pharmaceuticals,acupuncture and stone-needle,and moxibustion,are considered specific clinical applications encapsulated within this theoretical system.However,a closer examination of the medical theories within Huangdi Neijing reveals that the early medical theories in the Huangdi Neijing were developed based on external treatments using acupuncture and moxibustion,as well as internal treatments with pharmaceuticals.These early theories differ from the emphasis on internal treatment of zang-fu organs advocated in subsequent periods.The primary body of medical theory in the Huangdi Neijing is rooted in somatological medicine,which was primarily formed through external treatments,including theories related to meridians,acupoints,acupuncture,and encompassing theories such as the theory of five body constituents,the theory of the transformation of exterior and interior diseases,the theory of nutrient qi and defensive qi,the theory of deficiency and excess pathogensis,and therapeutic method involving tonification and purgation.These theories exhibit certain differences from the later dominant zang-fu viscera medicine theories.The oversimplification of amalgamating these two systems′theories has result mistakes in inherent conflicts within the theory itself and a detachment from clinical practice.Thus,there is a pressing need for differentiation and a return to the original sources to reestablish a more coherent theoretical foundation.