ATCM JOURNAL September 2014 - 21

ISSN: 1745-6843
英 Volume 21 Issue 2
第 21 卷第 2 期
英国 The Journal of Chinese Medicine

ISSN: 1745-6843
Volume 21 Issue 2
第 21 卷第 2 期
中 And Acupuncture
国
医The Journal of Chinese Medicine
20th September 2014
中针
And Acupuncture
医灸
20th September 2014
针杂
灸志
杂
志
目录 Contents
理论与文献 Theory & Literature

Acupuncture Treatment for Parkinson’s Disease Bai-Yun Zeng, Kaicun Zhao 1
The Yin Yang of the Five Elements and their energetic Andreas Feyler 4
relationships in relation to levels of consciousness
Current opinion in acupuncture on stroke rehabilitation Maggie Ju 9
A Brief History of the Introduction of Chinese Kanwen Ma 11
Acupuncture to Britain – From Scepticism to Acceptance
对孙真人《养生铭》的现代诠释温长路 13
基于老中医经验对大肠癌癌毒病机的中层理论探讨闫晓天, 李雁 16
“一分为三”看“经络”（下部）王以胜 19
临诊经验 Clinical Experience

从痰辨证施治顽固性胃食管反流病体会刘汶 21
桂枝加葛根汤运用心得黄伟 25
中医研究 TCM Research

Is acupuncture effective in improving fertility in patients Guijie Wang 27
with polycystic ovary syndrome?
The latest research review on Chinese herbs of anti Tiejun Tang, Louise Helen Booker 34
myocardial ischemia
A comparative study of traditional Chinese and western Tiejun Tang, Jasmin Mulvey, Marcos 37
herb medicine Patchett
临床报告 Clinical Reports

观察关幼波益气活血化痰通络法治疗乙肝后肝硬化104例刘汶，李灼，李娟娟，冯金帅，龚然 41
不同取穴方法治疗腰椎间盘突出症190例观察周泼兰，靳勇 44
病案分析 Case Studies

The Treatment of Carpal Tunnel Syndrome with Alexander B. Mearns 46
Acupuncture: Five Case Studies
Case Histories from the files of Professor Shulan Tang Shulan Tang, Kathleen Dowd 49
中医药辨病辨证结合治疗痤疮及兼症体会袁炳胜 51
中药复方治疗痛经验案一则罗瑜，曲凡 53
征稿启事 54
Call for Papers 54
英国中医针灸杂志编辑委员会 Editorial Committee of JCMA

主编：赵丽琴，范安杰 Chief Editors: Liqin Zhao, Andreas Feyler
编辑：向阳，张超，George Cooper Editors: Yang Xiang, Chao Zhang, George Cooper
本期编辑：赵丽琴，沈惠军 Editors of this Issue: Liqin Zhao, Huijun Shen
版面设计：PCL Wollaston Print Graphics: PCL Wollaston Print
英国中医药学会 The Association of Traditional Chinese Medicine And Acupuncture UK

地址 Address: ATCM, Suite 12 Brentano House, Unit 5, The Exchange, Brent Cross Gardens,
London NW4 3RJ
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The Journal of Chinese Medicine And Acupuncture Volume 21 Issue 2 September 2014
Acupuncture Treatment for Parkinson’s Disease
Bai-Yun Zeng1 & Kaicun Zhao2

1
Neurodegenerative Disease Research Group, Institute of Pharmaceutical Science, School of
Biomedical Sciences, King’s College London, London, United Kingdom;
2
Department of Natural Sciences, Middlesex University London, The Burroughs, Hendon, London,
United Kingdom
Abstract: Parkinson’s disease (PD) Many patients with PD are reported using acupuncture as an alternative treatment at
some points of their life. This review summarise recent development in acupuncture research of Parkinson’s disease (PD), in
particular, focused on effects of acupuncture and its underline mechanisms on Parkinson’s disease.
Manual or electro-acupuncture treatment enhances motor function recovery and significantly relieves motor symptoms and
many non-motor symptoms. Recent studies have shown that acupuncture stimulation at the assigned acupoints protected
dopaminergic neurones. This action is mediated by stimulating expression of neurotrophic factors in the brain substantia
nigra and striatum. Acupuncture therapy was found to slow cell death process by acting as antioxidant to protect dopamine
neurones against oxidative stress-induced neurodegeneration.
Study also showed to relieve non-motor symptoms of PD. Significant improvement on Beck’s Depression Inventory (BDI),
an assessment about the depression, has been observed following acupuncture treatment.
Additionally, both preclinical and clinical studies suggest that acupuncture reduce the side effects of levodopa on motor
function and alleviates levodopa-induced motor complications by lowering the dose of levodopa and restoring neurochemical
imbalance in the brain.
Future studies needs to look other potential acupoints which modulate dopamine and other neurotransmitter transmissions in
the basal ganglia to enhance the efficacy of acupuncture treatment. More importantly we need to explore the acupoints that
improve motor function and enhance neurotrophic factors releasing to slow down dopaminergic degeneration in particular at
the early stage of the disease.
Introduction significantly improved the motor function of affected

hand following acupuncture treatment (Shulman et al.,
Parkinson’s disease (PD) is an age-related, 2002; Cristina et al., 2005; Eng et al., 2006). Here, we
progressive neurodegenerative disorder that affects summarise recent development in acupuncture research
approximately 1 in 1000 population over age of 60 years. of Parkinson’s disease, in particular, focused on effects of
PD is caused by inability of brain to produce dopamine, a acupuncture and its underline mechanisms on Parkinson’s
neurotransmitter that affects the regulation of movement disease.
and our mood as well. The main motor symptoms of PD
include slow movement, resting tremor, muscular rigidity, Potential mechanisms of acupuncture
postural imbalance (Jankovic, 2008). The non-motor treatment in Parkinson’s disease
symptoms are found in majority of PD patients and
consist of autonomic dysfunction, neuropsychiatric Recent studies on Parkinson’s models reported that
disturbance, sleep disorders and gastro-intestinal acupuncture stimulation at the assigned acupoints
symptoms and many others (Chaudhuri et al., 2006). protected dopaminergic neurones in the substantia nigra
Clinic treatment with levodopa, the precursor of in the middle brain against toxic insults and restored
dopamine, provides only a symptomatic relief with dopamine expression in the striatum, a brain area playing
limited time rather a cure. Long-term treatment with a pivotal role in modulating movement (Park et al., 2003;
levodopa induces adverse effects such as motor Kim et al., 2005; Yu et al., 2010). Further, acupuncture
fluctuation and dyskinesia within approximately 50% of stimulation enhanced motor function recovery in the PD
patients with PD within 3-5 years following medication models following acupuncture treatment (Park et al.,
(Ahlskog & Muenster, 2001; Stocchi et al., 2008). 2003; Kim et al., 2005). This suggested that acupuncture
Acupuncture is one of the most popular types of has neuroprotective property helping dopaminergic
complementary medicines because it has been reported to neurons against toxic insults (Liang et al., 2002; Jia et al.,
be very safe and well-tolerated treatment with only minor 2009). More studies revealed that the effects of
side effects (Shulman et al., 2002; Rabinstein & Shulman, acupuncture-induced neuroprotection are mediated by
2003). Many patients with PD are reported using stimulating expression of neurotrophic factors in the
acupuncture as an alternative treatment at some points of substantia nigra and striatum (Liang et al., 2002; Park et
their life. It has been estimated that more than a quarter of al., 2003). Acupuncture therapy slows cell death process
patients with PD in the United States (40%), Britain by acting as antioxidant agent to protect dopamine
(38.7%), Singapore (61%) and Argentina (25.7%) have neurones against oxidative stress-induced neuro-
used at least one form of complementary medicine for PD, degeneration (Choi et al., 2009). In addition, acupuncture
while 7-49% of them have used acupuncture as an stimulation inhibited expression of inflammation markers
alternative therapy (Rajendran et al., 2001; Tan et al., in the relevant brain regions and enhanced its protective
2006; Pecci et al., 2010). Recently it has been reported effects (Liu et al., 2004; Kang et al., 2007). Further,
that acupuncture treatment to patients with PD studies on neuronal activity of motor circuits in the brain
reported that acupuncture rebalanced output of neuronal
1
ATCM, Suite 12 Brentano House, Unit 5, The Exchange, Brent Cross Gardens, London NW4 3RJ
Tel/Fax: 020 8457 2560, Email: [email protected] Website: www.atcm.co.uk
activity and improved behavioural functions in effects than levodopa treatment alone. The combined
Parkinson’s models (Jia et al., 2009; 2010). The results of treatment showed prolonged and better alleviation of
those studies suggest that early application of motor symptoms and reduced the occurrence of motor
acupuncture treatment to PD patients may be helpful in complications, while reducing the effective dose of
slowing down cell death process in Parkinson’s disease. levodopa (Jiang et al., 2006; Chang et al., 2008; Sui et al.,
2010).
Clinical study of acupuncture therapy for Very recently a group of Korean scientists
Parkinson’s disease investigated the effects of combined acupuncture and
Acupuncture is effective in alleviating PD symptoms levodopa on adverse effects of levodopa treatment on PD
Acupuncture is an effective treatment for Parkinson’s model (Kim et al., 2014). They reported that the
disease. Manual- or electro-acupuncture treatment reliefs combined treatment maintained a comparable
both motor symptoms and many non-motor symptoms. improvement in motor function with half dosage
There have been a few clinical studies of acupuncture (7.5mg/kg) of levodopa compared levodopa treatment
therapy for Parkinson’s in the past 15 years (Shulman et alone group (15mg/kg), and a reduction in abnormal
al., 2002; Cristina et al., 2005; Eng et al., 2006). involuntary movement in PD model. Further they found
Although the results are encourage but remain that combination of acupuncture and levodopa
inconclusive due to many factors such as smaller number diminished levodopa-induced changes in biomarkers of
of patients recruited, study design with many flaws. motor complications in the brain. Their findings
Recently, a clinical study, aimed to investigate the confirmed the results of clinical studies in China (Jiang et
efficacy of acupuncture as an alternative therapy for al., 2006; Chang et al., 2008; Sui et al., 2010). Together,
Parkinson’s, was carried out, with 43 patients with PD, both preclinical and clinical studies suggest that
the largest number of patients recruited in a single study acupuncture enhances the benefits of levodopa on motor
so far (Cho et al., 2012). The patients in the treatment function with reduced dose of levodopa and alleviates
group underwent acupuncture treatment twice a week for levodopa-induced motor complications by restoring
8 weeks. The patients in control group did not receive any neurochemical imbalance in the brain.
treatment. The results showed that the PD patients in Acupuncture therapy for non-motor symptoms of
treatment group experienced significantly greater Parkinson’s disease
improvement on the Unified Parkinson’s disease rating Non-motor symptoms (NMS) of Parkinson’s disease
scales (UPDRS), including total UPDRS scores and part (PD) are common but often are not well recognized in
III scores which assess individual’s motor function such clinic practice due to the lack of spontaneous complaints
as rigidity, finger tapping, hand movements, arising from from patients and of effective procedures of identification.
chair and gait etc (Cho et al., 2012). In addition, patients NMS occurs throughout the course of the disease. Some
receiving acupuncture showed a significant improvement of them, such as depression, fatigue and smelling
on Beck’s Depression Inventory (BDI), an assessment dysfunction, may appear at the earliest stage of the
about the depression. However, patients in control groups disease in not treated patients. Others appear at the
did not show any significant changes in both UPDRS and advanced stage of the disease. At the time of diagnosis,
BDI assessments. Although the number of patients the prevalence of NMS among PD patients is 21% (pain,
participated in this clinical study is still quite smaller urinary symptoms, depression and anxiety) and goes up
compared the clinical studies of other subjects, its results to 88% after 7 years disease progression (Shulman et al.,
are promising, indicating acupuncture treatment is 2001; O’Sullivan et al., 2008). NMS of PD ranges from
effective in alleviating symptoms of patients with autonomic dysfunction, neuropsychiatric disorders, sleep
Parkinson’s disease. disturbance to gastrointestinal syndromes and many
Combination of acupuncture and levodopa alleviates others and are under-treated (Chaudhuri et al., 2006).
levodopa-induced adverse effects and reduces effective Indeed, non-motor aspects of PD have greater influence
dose of levodopa in Parkinson’s model on quality of life and institutionalization rates, and
Since its introduction in the 1970s, levodopa has healthcare cost (Chaudhuri et al., 2007). In general NMS
remained the most effective treatment for the motor of PD respond poorly if at all to dopaminergic treatment,
symptoms of PD (Stocchi et al., 2008). However, as PD indicating the involvement of other neurotransmitters
patients receive chronic treatment with levodopa they besides the dopamine.
gradually develop two main clinical phenomena: Acupuncture including manual and electro-
fluctuation in motor response and a variety of involuntary acupuncture is effective in treating depression, anxiety,
movements, known as levodopa-induced dyskinesia insomnia, pain, orthostasis, constipation, fatigue and
(Bargiotas & Konitsiotis, 2013). The frequency of these vomiting. Studies about the mechanisms of acupuncture
motor complications has been estimated between 40-60%, reported that acupuncture stimulation modulates the
after approximately 5 years of levodopa medication, but expression of neurotransmitters such as serotonin,
increase to 90% after 10 years of treatment (Ahlskog & glutamate and gammaaminobutyric acid etc in the brain
Muenster, 2001; Stocchi et al., 2008). Those adverse (Longhurst & Tjen-A-Looi, 2013; Takahashi, 2013; Zhao,
effects of levodopa medication are often disturbing and 2013).
have huge impact on quality of life of PD patients. In Depression is one of the most common NMS in
China, combination of acupuncture and levodopa is often patients with PD. Patients with depression feel sad,
used to treat patients with PD. Many clinical studies anxiety, irritable and restless, and may lose interest in
reported that combined treatment had better therapeutic activities once enjoyable etc. The causes of depression in
2
PD patients are not clear but the decreased levels of disease: A double-blind pilot study. Movement Disorders, 20,
serotonergic and noradrenergic and dopaminergic 1185–1188.
neurotransmission in brain are implicated as relevant Eng, M. L., Lyons, K. E., Greene, M. S., & Pahwa, R. (2006)
factors (Pilkington, 2013). In clinical studies, one of the Open-label trial regarding the use of acupuncture and yin tui na
in Parkinson’s disease outpatients: A pilot study on efficacy,
prominent responses to acupuncture treatment in PD tolerability, and quality of life. Journal of Alternative and
patients is the reported effect on depression (Shulman et Complementary Medicine, 12, 395–399.
al., 2002; Cristina et al., 2005; Eng et al., 2006). Many Jankovic J., (2008) Parkinson's disease: clinical features and
patients experienced great improvement in their diagnosis. J Neurol Neurosurg Psychiatry. 79(4):368-76.
symptoms and this is reflected on the results of Beck Jia, J., Sun, Z. L., Li, B., Pan, Y. L., Wang, H. M., Wang, X.
Depression Inventory, one of the most widely used (2009) Electroacupuncture stimulation improves motor
instruments for measuring severity of depression, which disorders in Parkinsonian rats. Behavioural Brain Research, 205,
showed a significant decrease in the scores in patients 214–218.
with acupuncture therapy compared with control Jiang XM, Huang Y, Zhuo Y, Gao YP. (2006) Therapeutic effect
of scalp electroacupuncture on Parkinson disease. Nan Fang Yi
treatment group (Shulman et al., 2002; Cristina et al., Ke Da Xue Xue Bao. 26(1):114-6.
2005; Eng et al., 2006). It has been reported that Kang, J. M., Park, H. J., Choi, Y. G., Choe, I. H., Park, J. H., et
acupuncture stimulation caused activation of serotonergic al. (2007) Acupuncture inhibits microglial activation and
neurons in the dorsal raphe neuclei in the midbrain inflammatory events in the MPTP-induced mouse model. Brain
leading to elevated levels of serotonin which is confirmed Research, 1131(1), 211–219.
by neuroimaging studies (Pilkington, 2013). Kim SN, Doo AR, Park JY, Choo HJ, Shim I, Park JJ, Chae Y,
So far the results from acupuncture studies in PD Lee B, Lee H, Park HJ, (2014) Combined treatment with
models suggest that acupuncture may act as neurotrophin acupuncture reduces effective dose and alleviates adverse effect
release enhancer, anti-oxidant and anti-inflammation of L-dopa by normalizing Parkinson's disease-induced
neurochemical imbalance, Brain Res.1544:33-44.
agents and the modulator of neuronal activity in the basal Kim, Y. K., Lim, H. H., Song, Y. K., Lee, H. H., Lim, S. (2005)
ganglia circuits which ultimately protects dopaminergic Effect of acupuncture on 6-hydroxy dopamine-induced
neurons against degenerative process and modulates the nigrostratal dopaminergic neuronal cell death in rats.
outcome of neuronal activity of basal ganglia circuit. Neuroscience Letters, 384(1–2), 133–138.
Future studies needed to look other potential acupoints Liang, X. B., Liu, X. Y., Li, F. Q., Luo, Y., Lu, J., Zhang, W. M.
which modulate dopamine and other neurotransmitter (2002) Long-term high-frequency electro-acupuncture
transmissions in the basal ganglia to enhance the efficacy stimulation prevents neuronal degeneration and up-regulates
of acupuncture treatment. More importantly we need to BDNF mRNA in the substantia nigra and ventral tegmental area
explore the acupoints that improve motor function and following medial forebrain bundle axotomy. Brain Research
Molecular Brain Research, 108:51–59.
enhance neurotrophic factors releasing to slow down Liu, X. Y., Zhou, H. F., Pan, Y. L., Liang, X. B., Niu, D. B., et al.
dopaminergic degeneration in particular at the early stage (2004) Electroacupuncture stimulation protects dopaminergic
of the disease. It is hopeful that translation of neurons from inflammation- mediated damage in medial
achievement in acupuncture research in animal models forebrain bundle-transected rats. Experimental Neurology,
into clinical treatment of Parkinson’s will maximise the 189:189–196.
effectiveness of acupuncture treatment. Longhurst JC, Tjen-A-Looi S. (2013) Acupuncture regulation of
blood pressure: two decades of research. In BY Zeng, K Zhao &
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Takahashi T (2013) Effect and mechanism of acupuncture on
The Yin Yang of the Five Elements and their energetic

relationships in relation to levels of consciousness
Andreas Feyler
(Lecturer of TCM at Shulan College in Manchester)
Abstract: The Theories of Chinese Medicine have evolved over the centuries to reflect the increasing awareness of
the natural world and the role human beings play within it. Comparing the Shang Han Lun Theory with the Pulse
Position Theory and Anatomy, some discrepancies can be found regarding the Yin-Yang relationships between
Kidney and Liver, Liver and Spleen, and Heart and Spleen. Analyzing the Five Element Zang Organs systematically,
the order from most Yang to most Yin is Lung, Spleen, Heart, Liver, Kidney. The implication proposed is that a
similar order exists in respect to the related levels of consciousness from Body, Intellect, Spirit, Soul, and Will.
Key words: Yin-Yang comparison of Five Elements, Order of levels of consciousness, comparing theories of TCM
Scholars, familiar with the various theories of Chinese Therefore, all the Fu Organ meridians of the Hand such
Medicine, are aware of various discrepancies in the as Large Intestine, San Jiao, and Small Intestine, and the
ancient theories, and how they were adjusted over the Fu Organ meridians of the Foot such as Stomach, Gall
centuries to accommodate new and improved levels of Bladder and Bladder can be found on the lateral or outer
awareness of the natural world. For example, prehistoric aspects of those limbs. Similarly and in typical Yin Yang
people were aware of the four seasons and directions, yet fashion, all the Zang Organ meridians of the Hand such
managed to implement a Five Element Theory by as Lung, Pericardium, and Heart, and the Zang Organ
introducing the concept of the Middle and Late Summer. meridians of the Foot such as Liver, Spleen and Kidney
Having the Earth as the Center is a sophisticated leap can all be found on the medial or inner aspects of those
towards recognizing the connection that human beings limbs.
play in the consciousness link between heaven and earth. Dividing the number of the 12 regular meridians,
The fifth direction indicates that we have a choice of not however, gives 6 Yin meridians and 6 Yang meridians.
only walking North, South, East or West, but also that we Apparently, the Five Element Theory avoided the
can remain in the center and do not walk at all. In contrast problem of the fifth direction by introducing the Middle
to this revolutionary idea, the introduction of a fifth or Center direction, as discussed above. A much greater
season called Late Summer strikes me as somewhat challenge posed the number 6 resulting from the 12 daily
arbitrary in particular in respect to the huge climatic segments to the Five Element theorists. The introduction
variations that exist in a large country such as China. of the somewhat mysterious concepts of the Pericardium
Furthermore, it was quickly recognized that the time and the San Jiao seems to me as a less convincing attempt
span called a day on earth has 24 hours, and can be to square the circle. It tries to emphasize the importance
subdivided into neat 12 two hour segments. A new theory of the Heart or Fire element in human existence by giving
of the Meridians tried to match this by postulating the it double the time in the 24 hour clock with the
existence of 12 regular acupuncture channels. This Pericardium channel, and it elevates the nebulous idea of
conveniently mapped the four limbs of the human being Qi with an overarching concept of the San Jiao or Triple
with 3 meridians on each aspect and even managed to Energizer neatly organized according to Yin and Yang
incorporate aspects of the ancient Yin Yang Theory in a with a Triple Energizer theory a few centuries later.
way that Yin Meridians would be on the inner aspect of Zhang Zhong Jing in his Treatise on the Treatment of
the limb and the Yang Meridians on the outer aspects. Diseases caused by Cold (Shang Han Lung) expanded on
4
this by organizing the 12 organs into a theory of disease simplicity, again, I will call the ethereal soul, simply soul
progression from the outside inwards or from superficial in this essay.
and less dangerous to the deep and life threatening. He In the analysis of Lung, Spleen, Heart, Liver and
postulated that the Taiyang Meridians of Bladder and Kidney I will use the anatomical positions of those organs
Small Intestine lie most superficial and guard against the known in medicine, the order proposed by Zhang Zhong
invasion of outside pathogenic factors with the help of Jing in his famous text, and the pulse positions of those 5
Wei Qi. The Yang Ming Meridians of Stomach and Large organs. Underlying my considerations will be the theory
Intestine symbolize the ability of the antipathogenic qi to of Yin and Ying in terms of external versus internal and
muster a strong defense by raising body temperature upper versus lower comparisons. It will be shown that
causing a fever in the patient. Zhang Zhong Jing further there are expected discrepancies and contradictions
suggests the pivoting role of the ShaoYang Meridians of between these theories as it is often the case in the
Gallbladder and San Jiao as being neither exterior nor evolution of Chinese Medicine.
interior completely. To establish some basic premises, the three
This brilliant theorist of Chinese medicine further parameters of Anatomy, Zhang Zhong Jing’s theory, and
explained a similar structure to the Yin meridians the Pulse positions need to be briefly explained. In terms
representing the Zang organs. The TaiYin Meridians of of anatomy, the lungs and the heart lie above the
Lung and Spleen seem to suggest the importance of air diaphragm, while the liver, spleen (pancreas), and
and food in the creation of post natal Qi. The Shao Yin kidneys lie below it. The lungs lie above and lateral to the
meridians of Heart and Kidney recognize the important heart, the spleen and liver lie above the kidneys. Spleen
duality of fire and water in typical Yin Yang style. Finally, and Liver could be viewed as lying at somewhat equal
the Jue Yin or terminal Yin meridians of Liver and height. Zhang Zhong Jing postulated that the lung and
Pericardium represent the final or end stage of the disease spleen (Taiyin) lie more superficial than the kidney and
progression in this famous textbook. heart (Shaoyin) which in turn lie more superficial than the
In the following analysis, I would like to build upon liver and pericardium (Jueyin). In terms of pulse
the theories of the Five Elements and the 12 regular reading, the left hand, containing heart, liver, and kidney
Meridian channels and examine them in light of the much yin pulses, is considered yin, while the right hand,
older theory of Yin and Yang. I would like to show a containing lung, spleen, and kidney yang pulses, is
structure of conceptual levels of the 5 organs associated considered yang.
with the five elements and their related consciousness The Lung is anatomically viewed the uppermost of
energies of Body, Intellect, Spirit, Soul and Will. In the those 5 organs, has the pulse position of most distal on
process of this, I will disregard the Pericardium as the the right wrist, and is part of the Taiyang concept by
sixth Zang organ as well as all Fu organs. I will limit Zhang Zhong Jing. Comparing the lung element to the
myself to the analysis of the Five Elements and their most other 4 elements in terms of YinYang Theory, the
directly related organs. For the purpose of simplicity, I following becomes apparent. The lung lies anatomically
will assume that the corporeal soul can be seen as the above all the others, can be found at the most distal (outer)
concept of body. Therefore, I will base my considerations pulse position of the right (yang) hand, and in Zhang
on the theory that the Lung houses the bodily soul, or Zhong Jing’s theory is the hand (or upper) meridian of
named Po in Chinese. In this essay I will call this simply Taiyang, while the spleen is the foot (or lower) meridian
body, yet recognizing additional explanations of what of Taiyang. Therefore, the following table summarizes
actually Po is. According to the same theory The Spleen the relationship of yin versus yang of the lung element to
houses the Intellect, or Yi in Chinese. The heart houses the other 4 elements as seen in the three different
Spirit, or Shen; the liver houses the ethereal soul, or Hun theories.
in Chinese; and the kidney houses the Will, or Zhi. For
Theories of TCM Yin Yang Comments

Anatomy: Lung versus Spleen Spleen Lung The lung lies above the diaphragm, the spleen below.
Anatomy: Lung versus Heart Heart Lung Although both lie above the diaphragm, the lung reaches higher
than the heart and surrounds it.
Anatomy: Lung versus Liver Liver Lung The lung lies above the diaphragm, the liver below.
Anatomy: Lung versus Kidney Kidney Lung The lung lies above the diaphragm, the kidney below.
Pulses: Lung versus Spleen Spleen Lung Although both lie on the right (yang) wrist, the lung is more
distal than the spleen.
Pulses: Lung versus Heart Heart Lung The Lung lies on the right (yang) wrist, while the heart lies on
the left (yin) wrist.
Pulses: Lung versus Liver Liver Lung The Lung lies on the right (yang) wrist, while the liver lies on
the left (yin) wrist.
Pulses: Lung versus Kidney Kidney Lung The Lung lies on the right (yang) wrist, while the kidney yin lies
on the left (yin) wrist, and the kidney yang lies more proximal
(more yin) than the lung on the right (yang) wrist.
Meridians: Lung versus Spleen Spleen Lung In Zhang Zhong Jing’s theory, both are considered Taiyin, but
5
lung is hand Taiyin and therefore above spleen, which is foot

Taiyin.
Meridians: Lung versus Heart Heart Lung Heart as hand Shaoyin is considered more interior (yin) than
lung as hand Taiyin.
Meridians: Lung versus Liver Liver Lung Lung as hand Taiyin is more exterior (yang) than liver as foot
Jueyin.
Meridians: Lung versus Kidney Kidney Lung Lung as hand Taiyin is more exterior (yang) than kidney as foot
Shaoyin.
Overall : Lung 0 12 Lung is most yang of all elements.
It can be seen, that all three theories agree, that the theories of TCM. Although the Heart lies anatomically
Lung is the outermost and uppermost of the five elements, above the Spleen, and would be considered yang, in terms
and would therefore be considered the most yang. of the pulses the Heart is yin, because it is found on the
By comparing the next element, the Spleen, it left wrist, while the Spleen is on the right.
becomes apparent, that discrepancies appear among the

Anatomy: Lung versus Spleen Spleen Lung The lung lies above the diaphragm, the spleen below.
Anatomy: Spleen versus Heart Spleen Heart The heart lies above the diaphragm, the spleen below.
Anatomy: Spleen versus Liver Spleen Liver The spleen lies on the left side, the liver on the right.
Anatomy: Spleen versus Kidney Kidney Spleen The spleen lies above the kidneys.
Pulses: Lung versus Spleen Spleen Lung Although both lie on the right (yang) wrist, the lung is
more distal than the spleen.
Pulses: Spleen versus Heart Heart Spleen The spleen lies on the right (yang) wrist, while the heart
lies on the left (yin) wrist.
Pulses: Spleen versus Liver Liver Spleen The spleen lies on the right (yang) wrist, while the liver
lies on the left (yin) wrist.
Pulses: Spleen versus Kidney Kidney Spleen The spleen lies on the right (yang) wrist, while the kidney
yin lies on the left (yin) wrist, and the kidney yang lies
more proximal (more yin) than the spleen on the right
(yang) wrist.
Meridians: Lung versus Spleen Spleen Lung In Zhang Zhong Jing’s theory, both are considered Taiyin,
but lung is hand Taiyin and therefore above spleen, which
is foot Taiyin.
Meridians: Spleen versus Heart Heart Spleen Heart as hand Shaoyin is considered more interior (yin)
than spleen as foot Taiyin.
Meridians: Spleen versus Liver Liver Spleen Spleen as foot Taiyin is more exterior (yang) than liver as
foot Jueyin.
Meridians: Spleen versus Kidney Kidney Spleen Spleen as foot Taiyin is more exterior (yang) than kidney
as foot Shaoyin.
Overall : Spleen 5 7 Spleen is more yang than yin.
Similarly, for the Heart follows this analysis. the left (yin) wrist pulse, and Heart foot Shaoyin is
Although Heart and Spleen have the same number of yin considered deeper (more yin) than Spleen foot Taiyin.
and yang points, 2 of the 3 theories agree that the Heart is
yin in respect to the Spleen, because it can be found on

Anatomy: Heart versus Spleen Spleen Heart The heart lies above the diaphragm, the spleen below.
Anatomy: Lung versus Heart Heart Lung Although both lie above the diaphragm, the lung
reaches higher than the heart and surrounds it.
Anatomy: Heart versus Liver Liver Heart The heart lies above the diaphragm, the liver below.
Anatomy: Heart versus Kidney Kidney Heart The heart lies above the diaphragm, the kidney below.
Pulses: Heart versus Spleen Heart Spleen The heart lies on the left (yin) wrist, while the spleen
lies on the right (yang) wrist.
6
Pulses: Lung versus Heart Heart Lung The Lung lies on the right (yang) wrist, while the
heart lies on the left (yin) wrist.
Pulses: Heart versus Liver Liver Heart The heart lies more distal (yang) than the liver on the
left wrist.
Pulses: Heart versus Kidney Kidney Heart The heart lies more distal (yang) than the kidney on
the left wrist.
Meridians: Heart versus Spleen Heart Spleen Heart as hand Shaoyin is considered more interior
(yin) than spleen as foot Taiyin.
Meridians: Lung versus Heart Heart Lung Heart as hand Shaoyin is considered more interior
(yin) than lung as hand Taiyin.
Meridians: Heart versus Liver Liver Heart Heart as hand Shaoyin is more exterior (yang) than
liver as foot Jueyin.
Meridians: Heart versus Kidney Kidney Heart Heart as hand Shaoyin is above (yang) kidney as foot
Shaoyin.
Overall : Heart 5 7 Heart is more yang than yin.
Similarly, for the Liver follows this analysis, showing Jing’s theory and the pulse positions clearly indicate that
that it is considered much more yin than yang among the the Liver is more yin than the Spleen. The Liver is found
theories. The interesting discrepancy here is that on the left (yin) wrist, and the Spleen on the right. The
anatomically the Liver lies on the right (yang) side of the Liver foot Jueyin is considered deeper (more yin) than the
body and the Spleen on the left, while Zhang Zhong Spleen foot Taiyin.

Anatomy: Liver versus Spleen Spleen Liver The liver lies on the right (yang) side of the body, the
spleen on the left (yin).
Anatomy: Liver versus Heart Liver Heart The heart lies above the diaphragm, the liver below.
Anatomy: Lung versus Liver Liver Lung The lung lies above the diaphragm, the liver below.
Anatomy: Liver versus Kidney Kidney Liver The liver lies above the kidneys.
Pulses: Liver versus Spleen Liver Spleen The liver lies on the left (yin) pulse, while the spleen
lies on the right (yang) pulse.
Pulses: Liver versus Heart Liver Heart The liver lies more proximal (yin) than the heart on
the left wrist.
Pulses: Lung versus Liver Liver Lung The Lung lies on the right (yang) wrist, while the
liver lies on the left (yin) wrist.
Pulses: Liver versus Kidney Kidney Liver The liver lies more distal (yang) than the kidney yin
pulse on the left wrist.
Meridians: Liver versus Spleen Liver Spleen Liver as foot Jueyin is considered more interior (yin)
than spleen as foot Taiyin.
Meridians: Liver versus Heart Liver Heart Heart as hand Shaoyin is considered more exterior
(yang) than liver as foot Jueyin.
Meridians: Lung versus Liver Liver Lung Lung as hand Taiyin is more exterior (yang) than liver
as foot Jueyin.
Meridians: Liver versus Kidney Liver Kidney Liver as foot Jueyin is more interior (yin) than kidney
as foot Shaoyin.
Overall : Liver 9 3 Liver is more yin than yang.
Similarly, for the Kidney follows this analysis. The however, that the Kidney is the most yin of all the five
interesting discrepancy here is that although anatomically elements.
the Liver lies above the Kidneys, and the Liver pulse is Although the 3 analyzed theories of TCM agree in
more proximal (yang) than the Kidney pulse, Zhang most yin-yang comparisons of the 5 element organs, they
Zhong Jing postulates that the Liver foot Jueyin lies disagree in the comparison of Heart versus Spleen, Liver
deeper than the Kidney foot Shaoyin. It is still clear, versus Spleen, and Liver versus Kidneys.
7
Anatomy: Kidney versus Spleen Kidney Spleen The spleen lies above the kidney.
Anatomy: Kidney versus Heart Kidney Heart The heart lies above the diaphragm, the kidney below.
Anatomy: Kidney versus Liver Kidney Liver The liver lies above the kidney.
Anatomy: Lung versus Kidney Kidney Lung The lung lies above the diaphragm, the kidney below.
Pulses: Kidney versus Spleen Kidney Spleen The kidney yang lies more proximal (yin) than the
spleen on the right wrist.
Pulses: Kidney versus Heart Kidney Heart The kidney yin lies more proximal (yin) than the heart
on the left wrist.
Pulses: Kidney versus Liver Kidney Liver The kidney yin lies more proximal (yin) than the liver
on the left wrist.
Pulses: Lung versus Kidney Kidney Lung The Lung lies on the right (yang) wrist, while the
kidney yin lies on the left (yin) wrist, and the kidney
yang lies more proximal (more yin) than the lung on
the right (yang) wrist.
Meridians: Kidney versus Spleen Kidney Spleen Kidney as foot Shaoyin is considered more interior than
spleen as foot Taiyin.
Meridians: Kidney versus Heart Kidney Heart Heart as hand (yang) Shaoyin is above kidney as foot
Shaoyin.
Meridians: Kidney versus Liver Liver Kidney Kidney as foot Shaoyin is more exterior (yang) than
liver as foot Jueyin.
Meridians: Lung versus Kidney Kidney Lung Lung as hand Taiyin is more exterior (yang) than
kidney as foot Shaoyin.
Overall : Kidney 11 1 Kidney is most yin of all elements.
Anatomy Pulse Position Zhang’s Meridians

Heart versus Spleen Heart yang, Spleen yin Heart yin, Spleen yang Heart yin, Spleen yang
Liver versus Spleen Liver yang, Spleen yin Liver yin, Spleen yang Liver yin, Spleen yang
Liver versus Kidney Liver yang, Kidney yin Liver yang, Kidney yin Liver yin, Kidney yang
From the analysis, it can be concluded, that despite (yin) aspect.

some discrepancies in the theories used to compare the 5 If those levels of consciousness can be thought of as
element organs in terms of yin and yang, the lungs are the yang contains yin, or outer levels contain inner levels, it
most yang, and the kidneys are the most yin. The Liver is would mean that the body contains the intellect (thinking)
almost as yin as the Kidneys. The Spleen and the Heart which contains the spirit (feeling) which contains the soul
are almost equal in terms of yin and yang, although a which contains the will. That is, when we become aware
majority of theories postulates that the Heart is somewhat of levels of realities, we sense with our bodies first. When
more yin than the Spleen. we think deeper, we understand more, but feelings of
Superimposing the theory of the related consciousness understanding come from deeper levels of consciousness
levels of Body (Po), Intellect (Yi), Spirit (Shen), Soul still. Yet, deeper levels of awareness exist in the levels of
(Hun), and Will (Zhi), some interesting aspects are the soul and the will, where the will can reach the deepest
revealed. The Body (Lung) is the most yang or most layers of existence.
exterior. The Will (Kidney) is the most yin or
most interior. The soul (Liver) is almost as yin
or interior as the Will. The Spirit (Heart) is
pretty much on equal footing with the Intellect
(Spleen), although some argument can be made
that the Spirit is slightly more interior (yin)
than the Intellect.
I propose therefore the following theory.
The Intellect or the thinking part of
consciousness is closer related to the body
(more exterior and yang), while the spirit or the
feeling part of consciousness is closer related to
the soul (more interior and yin). The body is
the most superficial (yang) aspect of
consciousness, while the will is the most deep
8
Current Opinion in Acupuncture on Stroke Rehabilitation

Maggie Ju
London
Email: [email protected]
Abstract: Disability rate is very high after stroke attack. Motor function deficits, aphasia, post stroke depression and
urinary incontinence are very common conditions in post stroke patients. To maximise recovery from stroke, reduce
disability, improve quality of life for post stroke patients, acupuncture is commonly used for stroke rehabilitation in
China. Usually acupuncture is one of approaches in combined rehabilitation programmes. Current research from
China also provided some evidences to support the effectiveness of acupuncture on post stroke complications.
Acupuncture improved motor function and helped with aphasia recovery. Also acupuncture was reported to effectively
treat post stroke depression and urinary incontinence which leads to better quality of life for post stroke patients. The
mechanisms of acupuncture treatments include that first acupuncture increased brain network connectivity and
increased brain network activity and second acupuncture improved blood supply to the brain.
Key words: Acupuncture, Stroke, Motor function deficits, aphasia, post stroke depression, urinary incontinence,
Stroke is a life threatening condition due to randomized controlled trials showing that acupuncture
disturbance of blood supply to the brain. It is the leading played a role in motor function recovery in patients with
cause of death and disability globally. The death rate stroke.
following stroke is up to 37% depending on different Acupuncture helps recovery of motor function in post
countries [1]. Stroke is divided into two types: ischemic stroke patients by adding on the routine rehabilitation
or hemorrhagic. Ischemic stroke is caused by either programme. For example, acupuncture points were
thrombosis (blood clotting) in the blood vessels of the prescribed at Taiyuan (LU 9), Zusanli (ST 36),
brain or arterial embolism in which clot is formed in the Xuanzhong (GB 39), Waiguan (TE 5), Shousanli (LI 10),
blood vessel elsewhere and travelled to the blood vessel Quchi (LI 11) and Jianyu (LI 15). 4 weeks of daily
of the brain. As a result the affected brain region is acupuncture at these points significantly improved the
damaged by lack of blood supply and is not working upper limb pain, the systematic motor function of the
properly. Hemorrhagic stroke is caused by rupture of a upper limbs, the nerve function defect, nailfold
blood vessel of the brain. The brain is damaged by microcirculation compared with that before the
compression of blood, loss of blood supply, toxic effect treatments [3]. Acupuncture had better effects on motor
of blood, and the inflammation surrounding the bleeding function recovery compared with that for routine
area. For stroke survivors, brain damage leads to rehabilitation only [3]. Adding acupuncture on the routine
impairment of brain function causing physical and mental rehabilitation also helps reduce limb spasticity. Tong et al
disabilities. Majority of stroke survivors experience studied the effect of acupuncture on spasticity in post
motor function deficits linked with lowering quality of stroke patients. They added acupuncture on routine
life. Aphasia is common if dominant hemisphere is rehabilitation and found that two course of 10
affected. Post stroke depression is usual. In 2010 there acupuncture treatments significantly improved motor
were 33 million stroke survivors worldwide [1]. function and reduced spasticity in post stroke patients
Functional recovery and improving quality of life remain with spasmodic hemiplegia [4] . Also a study has shown
challenging in the health care of post stroke patients. that acupuncture alone can improve spasticity in post
Stroke rehabilitation is aiming to achieve the maximal stroke patients. For this purpose four acupoints at
mental and physical function recovery. Most of the Neiguan (PC6), Shaohai (HT3), Zeqian (Ex-UE, A32),
neurological function recovers during the first 3 to 6 and Shounizhu (EX-UE), were selected near the motor
months after stroke and there is still continuing progress points of the muscles for elbow flexion, forearm
of recovery for years after stroke [2]. pronation, and finger flexion. After 6 weeks of
Motor function deficits are a common problem in acupuncture treatments muscle reaction (R1), passive
stroke survivors. Motor function is controlled by the range of motion (R2), and dynamic component (R2-R1)
frontal lobe of the brain. The motor function is damaged which is used to evaluate the joint spasticity for elbow
after stroke causing motor disability, weakness and joint was improved significantly [5]. Adding acupuncture
spasticity which is unusual increased muscle tone. To on a routine stroke rehabilitation programme achieved
improve motor functions many new rehabilitative equivalent improvement as adding massage on a routine
techniques have been developed in recent years which stroke rehabilitation programme in the aspects of limb
include constraint-induced movement therapy, mental motor function, the independent activity of life, the
practice, mirror therapy, virtual reality, robotics and brain activity of daily life and the quality of life [6].
stimulation techniques. Acupuncture is widely used in Within the brain there is wide range of network
stroke rehabilitation in China, though it is not broadly connectivity between different brain regions. This
accepted in Western countries and the efficacy is still in network connectivity of patients with stroke was
debate. There are many clinical trials of acupuncture on weakened and different brain regions lost interactions
stroke rehabilitation most of which were carried out in with each other compared with that of healthy subjects.
China. There are some promising results from these There was less communication between different brain
9
regions during motor task. A recent study with fMRI scan stroke depression. In these trials there were 1096 patients
has shown that acupuncture at Yanglinquan GB34 aged 38-79 with post stroke depression involved. The
enhanced the brain network connectivity between effect of acupuncture was compared with Western
different regions in the brain in post stroke patients with medicine used in the studies. It indicated that acupuncture
hemiparesis. Consequently, this could contribute to had better curative rate than Western medicine such as
improvement of movement coordination and motor fluoxetine hydrochloride used in the particular researches
learning in post stroke patients [7]. In patients with left [11].
hemiplegia in stroke recovery, needling at Yanglinquan Post stroke urinary incontinence is a common
GB34 acupoints induced passive finger movement. fMRI problem that can affect over 30% of post stroke patients
scan has shown that motor sensory cortex on the right [12]. Medications and application of catheter are
side was activated in these patients and brain acitivity commonly used to manage this condition. Acupuncture
was increased significantly [8]. Increasing brain network was reported effective in treating post stroke urinary
connectivity and increasing brain activities could be the incontinence. Song et al conducted a clinical trial which
mechanisms of the effect of acupuncture on motor was involved in 136 post stroke urinary incontinence
recovery after stroke. Animal experiments have suggested cases. These patients were treated with acupuncture [13].
that acupuncture improved cerebral blood flow and After 4 weeks of acupuncture treatments, the interval of
reduced moderate ischemic injury [9]. urination, nocturia frequency, urination difficulty, urinary
Aphasia is a condition in which language skill is incontinence severity, bladder capacity and patients'
impaired and patients with aphasia cannot use or satisfaction were all significantly improved. The efficacy
comprehend language as they used to. Stroke is a leading for acupuncture was better than that for indwelling
cause of aphasia which could affect up to about 30% catheter (68 cases). Another study was conducted by Chu
stroke survivors. The symptoms of aphasia include that et al. This study was involved in 111 post stroke urinary
patient has difficulty to speak, understand language, read, incontinence patients and the effect of acupuncture was
write or use numbers and calculate etc. Acupuncture is compared with medications control including calcium ion
also widely used in this condition to shorten recovery antagon, angiotensin-converting enzyme inhibitor,
time and maximise the degree of recovery of post stroke angiotensin II receptor antagonist, compound
aphasia in China. Clinical research on post stroke aphasia thromb-clearing agent [14]. These patients were allocated
developed in China from early stage of case study to into two groups acupuncture group 56 cases and control
recent clinical randomised controlled trials. Sun et al group 55 cases. Frequency of urination, urgency of
analysed 104 research studies on post stroke aphasia and urination and urinary incontinence were measured. 7.1%
the results were encouraging. Some controlled clinical patients were cured in acupuncture group compared with
studies with subjective measurements and large sample 0 in control group. Effectiveness rate was 62.5% for
size have shown positive therapeutic effects of acupuncture group compared with 36.4% for control
acupuncture on post stroke aphasia. To achieve best group. The infection rate for acupuncture group was
outcome, selection of acupoints was important. The ten much lower than that for control group.
most frequently used acupoints for aphasia were Due to improved diagnosis techniques and advanced
Lianquan (RN 23), Jinjin (EX-HN 12), Yuye (EX-HN 13), medical treatments, stroke surviving rates have increased
Tongli (HT 5), Fengchi (GB 20), Neiguan (PC 6), Baihui [1]. Post stroke medical care, reducing disability and
(DU 20), No. 1, 2 and 3 language sections, Sanyinjiao improving patient’s quality of life are very important in
(SP 6) and Yamen (DU 15). Styles of acupuncture were stroke rehabilitation. Current research shed a light on the
various including tongue, scalp, body and combination effectiveness of acupuncture on stroke recovery.
acupuncture. Acupuncture was recommended as an Acupuncture could potentially be a treatment option on
adjunct therapeutic approach to language training stroke rehabilitation, though there are more high quality
programme for patients with post stroke aphasia [10]. of clinical trials and evidences needed to support the
There were a few possible mechanisms of application.
acupuncture on post stroke aphasia. First, acupuncture
increased cortical blood flow, improved cortical oxygen References
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History in Brief: the Introduction of Chinese Acupuncture to Britain –

From Scepticism to Acceptance
Kan-Wen Ma
Acupuncture was a popular traditional therapy in European medicine by the likes of Bondit, ten Rhine and
China when it was introduced to neighbouring countries Kaempter, very little attention was paid to this therapy in
such as Korea and Japan in the 6th century AD. Later, in Europe until the end of the 18th century.
the 17th century, acupuncture was discovered and In Britain the negative descriptions of Chinese
described by surgeons working with the Dutch East India physicians’ practice of acupuncture by Western travellers
Company, who then brought this information to the West. contributed to a reluctance to adopt it. For example, Sir
The earliest such reference is by the Dane Jacob de Bondt John Staunton, a member of the first British official
who, in the last chapter from his Historia Naturalis et delegation to the Chinese Empire headed by George
Medica India Orientalis (1958) entitled “Certain Macartney in 1793, described acupuncture as a method
miraculous works of Nature which future medical which caused exquisite pains and suffering to the patient.
researchers must investigate further”, mentioned the The end of the 18th and the beginning of the 19th
miraculous cure resulting from acupuncture in the century saw changing attitudes to acupuncture in major
treatment of chronic head pain that he witnessed in Japan. European countries. Credit for the first clinical use of
This was followed by a more detailed description of acupuncture in Europe might be given to the French
acupuncture by William ten Rhine, a Dutch medical physician L.V.J. Berlioz who published reports for
officer of the East India Company in Deshima, Japan, in treating gastralgia, whooping cough, contusion, febrile
his work Dissertatio de Arthritide (1863), which is headaches, severe muscle aches, pains and other
considered the first detailed work on acupuncture in the conditions with good results. This was followed by
West. Engelbert Kaempter, a German naturalist and accounts by other French doctors in the use of
qualified doctor of medicine, who worked for the Dutch acupuncture for other kinds of diseases including asthma,
East India Company also observed the practice of various forms of paralysis, rheumatism and arthritis with
acupuncture in Deshima. In his work Amoenitaltum good effect. Here the emphasis was very much on
Exoticarum, he gave an excellent description of analgesic effects, including the relief of facial neuralgia
acupuncture in the treatment of illnesses such as arthritis. and other conditions of intractable pain as well as the
Both ten Rhine and Kaempter remarked on the gentle treatment of sciatica and arthritis. Furthermore,
character of acupuncture in comparison with the drastic acupuncture was quickly adopted by Cloquet and
therapeutic measures of the day in the West such as Sarlandiere in French hospital clinics. Similarly there
bleeding, purging, actual cautery and similar procedures. were clinical reports of acupuncture in Italy, Germany
However, despite these encouraging eye-witness and other parts of Europe.
accounts and the actual introduction of acupuncture to
11
Britain followed this trend in the first half of the 19th “The benefit of this treatment was apparent, and its
century. Acupuncture was even familiar to a country repetition still further continued to do good, this short
general practitioner like Coley who reported in 1802 on account of ‘needling’ may serve to bring up for
the performance of paracentesis on an infant with discussion a practice which has tradition – that is,
tympanites. Other reports were provided by James Morss experience – for its justification; and there can be no
Churchill, who published articles and two books doubt that as a rational treatment it has much to
describing his clinical experience with acupuncture. His recommend it”.
achievements were chiefly on the treatment of rheumatic Dr Cantlie’s article was published in parallel with an
conditions, sciatica, back pain, muscle strains and the like. editorial entitled “Chinese Medicine and Surgery” in the
He also had good results in treating dropsical states, same issue of the journal, which commented that Dr
oedema, anasarca and similar conditions. Cantlie’s interesting paper was a plea based on sound
Thus, as a result of its clinical efficacy, from the 19th reasoning for the increased use of acupuncture in certain
century onwards acupuncture gradually became a popular well-defined conditions.
therapy in Britain; however attitudes towards it varied, Moving on, acupuncture continued to hold its ground
particularly within the medical establishment. Some were in Britain. In the 1970s there was a new wave of
sceptical or even scornful, some were objective and acupuncture in Britain triggered by the eye-witness
positive. reports of American doctors visiting Beijing of the use of
British medical journals at first resisted publishing acupuncture as analgesia for surgical operations,
reports of acupuncture, because most British doctors, including major operations like open-heart surgery. This
especially those in China, viewed it as quackery. For boosted the popularity of acupuncture in the West, which
example, acupuncture was described in The Diseases of was furthered by experimental research on endogenous
China by the American medical missionary W. Hamilton peptides. In Britain, the British Medical Acupuncture
Jefferys and his British co-author James L. Maxwell as Society was founded in 1980, which was followed shortly
“the deadly acupuncture needle, which is the favourable afterwards by the appearance of its journal Acupuncture
Chinese instrument of professional torture.” in Medicine. Consequently practitioner numbers grew in
Things changed from the early 20th century onwards the UK. Several acupuncture organisations have been
and it is gratifying to see that within British medicine established and acupuncture training courses have been
more positive attitudes arose that were based on rational set up, and significant numbers of British doctors have
reasoning and practical experience. In the China Medical been to China to learn to practise. Estimates suggest that
Journal published in 1916 and edited by the China there are several thousand acupuncture practitioners in
Medical Missionary Association there was an article Britain who can be broadly divided into two types. One
written by Dr. James Cantlie, an eminent British consists of those who adhere to the traditional Chinese
physician entitled “Needling Painful Spots as Practised medical model of needle insertion and selection of
by the Chinese”. The article starts by saying: acupuncture points based on diagnostic methods and
“From the immemorial the Chinese have practised disease classification in accordance with traditional
‘needling’ the body for the relief of pain, of swelling, of Chinese medicine principles and theories. These include
stiffness, and the treatment of many ailments. The those who were trained in China and graduates from a
practice has become with them an art – an exact science, five or six year traditional Chinese medicine course in a
in fact, if the term science can be applied to such a university or college. The other consists of doctors
proceeding. trained in conventional medicine who adopt a modified
The model of the human body in brass, with its many version of acupuncture based on the understanding of
indicated puncture points, is a well-known feature of neurophysiology and anatomy rather than fundamental
wonder to the northern Chinese, and the pictures of the traditional Chinese theories such as Yin and Yang, Qi,
model are met with throughout the Empire. Channels and Collaterals in the clinical application and
To each one of the hundreds of puncture points interpretation of the effects of acupuncture.
indicated in the model a curative effect is attached, and Either way, acupuncture has been accepted in some
the modern student of surface anatomy may well stand parts of the British National Health Service, which is a
aghast when asked to interpret the several structures any good illustration of how it has been recognised and
particular puncture might traverse when pushed deeply; appreciated in this country, two centuries after it was first
and the clinician will be puzzled to explain the possible introduced, and despite consistent scorn and scepticism.
effect likely to be produced thereby. We may and do say:
‘There is something in it’; but we seldom if ever venture
to practise it, except occasionally in an experimental and
tentative fashion, as, for instance, by placing an electric
needle in the sciatic nerve.”
Dr Cantlie said that he was very impressed by the use
of “needling” for many ailments, such as rheumatic pains
in the gluteal region and in the neighbourhood of the
hip-joint when the pain was not relieved in any other way,
and also for lumbago due to injury or rheumatism and the
like. He concluded his article by saying:
12
对孙真人《养生铭》的现代诠释
温长路
中华中医药学会（100029）
在我国医学发展史上，孙思邈可谓一位集众多学说之大的都是情志对养生的决定性作用。
成者，除了传统意义上的医学理论和实践外，把养生防病纳就孙氏诗中所说之怒伤肝言，它是人情志受损的一种表
入人类的健康大系，并使他成为具有理论与实际一体的特色现。
《黄帝内经》中有明确地论述：
“大怒则形气绝，而血菀
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题（涌）于上。
”（《素问•生气通天论》
）“怒则气逆，甚则呕血
有过许多精辟的论述，并在《千金方》和《千金翼方》中两及飱泄。”（《素问•举痛论》）也就是说，怒因气生，气则怒
次作过专门总结，这是有典可据的。除此以外，有关孙思邈发，生气——发怒——生气，构成了一条恶性循环链。正如
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广，《淮南子》所言：“人之性，有所侵犯则怒，怒则血充，血
《养生铭》就是其中的一首。此文收于《全唐书》和后人整充则气激，气激则发怒”。唐代诗人白居易在他在一首制怒
理的孙氏的《摄生咏》中，也有称为《保生铭》和《孙真人诗中也阐明了雷同的观点：“自知气发每因情，情在何由气
铭》的。宋代温革的《琐碎录》和 14 世纪朝鲜出版的《医得平，若问病根深与浅，此身应与病齐生”
。
方类聚》及日本的相关著作中也都有反映。这些版本在文字怒气大发，相应的疾病就会因之而生，受害最直接的是
上虽然有些出入，但其基本内容是一致的。陕西耀县的药王肝胆系统。因怒导致的机体的气血逆乱，会使人出现头痛、
山上，也保存有这首诗的石刻件，还不时被中外游人转抄和目胀、面红、耳赤、呕血、憋气等症状。甚则使人昏厥卒倒，
效法。其诗全文如下：因此致死者也不罕见。《三国演义》中诸葛亮三气周瑜的故
事，就是一个典型的案例：血气方刚的周瑜性情急躁，容易
怒甚偏伤气，思多太损神。神疲心易疫，气弱病相因。
发怒。深谙心理学的诸葛亮故意用计让他动气，结果没有用
勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。
真枪实弹就放倒了这位年仅 36 岁的英雄汉。临床上遇到的
亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。
因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死
若要无诸病，常当节五辛。安神宜悦乐，惜气保和纯。
亡的病例，在国内外媒体上都不时有过报道。
“气是杀人贼”
，
寿夭休命论，修行本在人。若能遵此理，平地可朝真。
老百姓的说法一语道破了生气对人类健康的严重危害。
时过境迁，从公元 6 世纪至今，历史的隧道已经向前穿美国医学专家的一项调查说，一个人经常发怒或心身承
越了 15 个轮回，科学已经发展到了人类从地面走向太空的受的压力太大，机体会分泌出一种代谢类固醇──皮质醇，
时代，膏粱厚味之外，琳琅满目的各色保健品足以让人眼花它会直接损害人的记忆力和对事物的专注力。不良情绪还会
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是增加胃中盐酸的流量，影响人的食欲，使人发生胃痛、恶心，
需要科学者正面回答的问题，也正是本文要用现代观点诠释甚至导致溃疡病的发生。发怒和绝望的情绪是造成血压升高
孙真人《养生铭》的立意所在，相信事实会给人们一个有说的主要原因，引起血管收缩，导致舒张压明显上升。芬兰科
服力的答案。学家的研究证实了这一点，他们对 616 名男性对象的调查发
为了方便叙述，本文将孙真人的这首诗分为五段进行剖现，每发一次怒或绝望值增加 1 分，高血圧的危险性就增加
析，每两句为一节，先从第一节说起。 16%。而高血圧又可成为新的病因，引发其他更严重的疾病
发生。癌症的发生也与经常发怒有直接联系，有统计证实，
1. 怒甚偏伤气，思多太损神。神疲心易疫，癌症患者中易发怒的人明显高于性格温和的人。
气弱病相因再说孙氏诗中说的思伤神，神指的是人的精神意识，是
这一节总体上是讲精神养生的，怒之所伤，肝气也；思人类区别于其它动物、独具聪明智慧表现的主要指征之一。
之所伤，脾胃之气也；喜之所伤，心气也。气乃肺、肾所主，神志的主宰者是心，
《灵枢•大惑论》中有“心者，神之舍也”
神依气血所存，正气损伤，岂不心“疫”、病“因”吗！对的话。思为心所主，
《孟子•告子上》中有“心之官则思”的
于此，孙思邈在他的《千金方》中曾引用魏晋时期养生学家话。心的主神、主思功能处于正常状态，人就表现出聪明、
嵇康的话说：“养生有五难，名利不去为一难（实乃最大的理智、敏捷、灵活，健康长寿的机会相对就多；反之，人就
心病），喜怒不除为二难，声色不去为三难（确为耗心神、会表现出愚笨、粗鲁、迟钝、固执，疾病和灾难的发生率相
伤肾气之大虑）
，滋味不绝为四难（吃也是非常费脑筋的活）
，对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼人、豁达大度的人、善于处世的人，都是有“心计”的；而
英华，呼吸太阳，不能不回其操、不夭其年也。五者无于胸那些碌碌无为、傻头笨脑、鸡肠小肚、无朋无友的人，或多
中，则信顺日跻，道德日全，不祈善而有福，不求寿而自延，或少都缺了点“心眼”。很显然，心的这些功能里，包括了
此养生之大旨也。”在孙氏反复论证的这段话中，重点强调大脑的某些功能。把心与脑的部分功能混而谈之，不能片面
13
The Journal
The Journal of
of Chinese
Chinese Medicine
Medicine And
And Acupuncture
Acupuncture Volume
Volume 2121Issue
Issue
2 2 September 2014
地归结为古人认识上的局限性，重要的是如何透过这一现象林深远，固为佳境。
”“背山临水，气候高爽。
”“居处不得绮
去认真挖掘其中存在的必然性联系。在现代临床上，一些心靡华丽，令人贪，目禁无厌，乃患害之源。
”“衣食寝处，皆
脑疾患在发病机制上表现出的相关性和对心脑疾病同治收适能顺时气者，始尽养生之道”等。智者爱山，仁者爱水，
到的理想效果，越来越使人们认识到心与脑关系的不可分割
孙氏所倡，与现代人提出的居住要环境优雅、污染少、空气
性和中医认识的科学性。温长路
负粒子多、回归自然的标准如同出一辙。
在心境平和的状态下，充足的心血供应和灵活的神志发孙氏对饮食与养生的关系论述最多，也颇为精辟。如“勿
挥，使人的五脏六腑处于平稳运行中，人体这个小天地保持使脯肉丰盈，常令约俭为佳”
，说的是“食宜俭”
，荤食不可
着相对平衡的环境，疾病就很少发生。一旦人的这种平和心少，但要少而精；“所有资身，在药菜而已。料理如法，殊
境被打破，心理因素造成的机体失衡状态立即就会发生了。
在我国医学发展史上，孙思邈可谓一位集众多学说之大益于人”，说的是“食宜素”，“菹酱而已，其人少病而寿”；
的都是情志对养生的决定性作用。
各种不平静因素形成的兴奋灶不时成为人思维中的优势中
成者，除了传统意义上的医学理论和实践外，把养生防病纳 “若得肉，必须新鲜，似有气息，则不宜食” ，说的是“食
就孙氏诗中所说之怒伤肝言，它是人情志受损的一种表
心，并不断通过大脑皮层的作用操纵植物神经系统和内分泌
入人类的健康大系，并使他成为具有理论与实际一体的特色宜鲜”
现。，食用新鲜食物的营养、不新鲜食物的危害尽都说到
《黄帝内经》中有明确地论述： “大怒则形气绝，而血菀
系统发挥作用，使人生出多种疾病来。有人对应考的高中毕
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题了；“若贪味伤多，人肠胃皮薄，多则不消，彭亨短气，必
（涌）于上。”
（《素问•生气通天论》）
“怒则气逆，甚则呕血
业生进行了胆固醇浓度变化的系统测定，发现在高考前一年
有过许多精辟的论述，并在《千金方》和《千金翼方》中两致霍乱”
及飱泄。，说的是“食忌过量” ，暴饮暴食或过食肥腻必然伤
”（《素问•举痛论》）也就是说，怒因气生，气则怒
的平静状态下，其浓度处于最低值；在备考的一年中，处于
次作过专门总结，这是有典可据的。除此以外，有关孙思邈及脾胃，出现病变； “鱼脍、生菜、生肉、腥冷物多损于人，
发，生气——发怒——生气，构成了一条恶性循环链。正如
不断升高的变值；在参加高考的前夜，达到最高值；然后，
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广，宜常断之”
，说的是
《淮南子》所言：“食忌生冷”，背逆季节、背逆正常吃法，
“人之性，有所侵犯则怒，怒则血充，血
又逐渐下降。日常生活中这样的例子也不少见，当一个人心
《养生铭》就是其中的一首。此文收于《全唐书》和后人整一味吃生、吃冷是有害身体健康的； “咸则伤筋，酢（醋，
充则气激，气激则发怒”。唐代诗人白居易在他在一首制怒
情不好时，常表现出山珍海味也难下咽、暖床柔被也难入睡、
理的孙氏的《摄生咏》中，也有称为《保生铭》和《孙真人可引申为酸味）则伤骨，故每学淡食”
诗中也阐明了雷同的观点：，说的是“食忌咸酸”
，
“自知气发每因情，情在何由气
幽默逗笑也难开心等现象，由此引发的疾病就在所难免了。
铭》的。宋代温革的《琐碎录》和 14 世纪朝鲜出版的《医口味偏嗜都是对机体有害的，要养成以淡味为主的生活习惯。
得平，若问病根深与浅，此身应与病齐生”。
糟糕的心境轻则使人食欲减退、大便紊乱、月经不调、头痛
方类聚》及日本的相关著作中也都有反映。这些版本在文字凡此等等，无法将孙思邈对饮食科学的论述逐一进行列举，
怒气大发，相应的疾病就会因之而生，受害最直接的是
眩晕、心慌汗出、失眠健忘，重则形成神经官能症、胃及十
上虽然有些出入，但其基本内容是一致的。陕西耀县的药王仅透过以上说的“三宜”、“三忌”，不也足可以反映出他说
肝胆系统。因怒导致的机体的气血逆乱，会使人出现头痛、
二指肠溃疡、慢性结肠炎、高血压病、血管硬化症等疾病，
山上，也保存有这首诗的石刻件，还不时被中外游人转抄和的“饮食均”的广泛含义了吗？
目胀、面红、耳赤、呕血、憋气等症状。甚则使人昏厥卒倒，
其后果是不堪设想的。
效法。其诗全文如下：大家知道，机体需要包括蛋白质、脂肪、碳水化合物、
因此致死者也不罕见。《三国演义》中诸葛亮三气周瑜的故
对于这些由于心境不好造成的疾病，药物治疗是很难奏维生素、矿物质、水和纤维素在内的多种营养物质，这些物
效的，最好还是通过心理疗法。《黄帝内经》对这一问颇具质都是通过广义的“饭”——饮食物获得的，它们包括粮食、
高见，在它的第一篇《上古天真论》中就为人们开出了“恬蔬菜、肉类、豆类、蛋类、奶类、鱼类等食品。在通常情况
淡虚无，真气从之，精神内守，病安从来”的心理处方，让下，一般性食物在胃里只能停留 3～5 小时，高脂肪的肉类、
人们用平常心看待平常事，进而达到体健不病或少病的目的。油炸食物可能稍长一些，但最多在
亡的病例， 6 个小时内排空。此时，
在国内外媒体上都不时有过报道。“气是杀人贼”，
胃就开始收缩，饥饿感随之也就产生了。正常的进食时间大
2. 时过境迁，从公元
勿使悲欢极，当令饮食均。再三防夜醉，
6 世纪至今，历史的隧道已经向前穿 4～5 小时之间，一日三餐是比较科学的饮食模式。长
体在美国医学专家的一项调查说，一个人经常发怒或心身承
第一戒晨嗔
越了 15 个轮回，科学已经发展到了人类从地面走向太空的时间饥饿，会引起对胃粘膜的恶性刺激，影响胃的正常收缩
受的压力太大，机体会分泌出一种代谢类固醇──皮质醇，
时代，膏粱厚味之外，琳琅满目的各色保健品足以让人眼花功能，造成胃的病变，有可能导致胃痛、胃炎、胃溃疡、胃
它会直接损害人的记忆力和对事物的专注力。不良情绪还会
在这一节所谈的内容中，孙氏既说到了在上节中未说尽
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是癌等疾病的发生。如累及到肠、胆、肝、脾、胰等整个消化
增加胃中盐酸的流量，影响人的食欲，使人发生胃痛、恶心，
的情志因素“悲欢极”，又进一步强调了怒的危害，提出了
需要科学者正面回答的问题，也正是本文要用现代观点诠释系统，发生的疾病会更多、更严重。一次性进食过多或过食
甚至导致溃疡病的发生。发怒和绝望的情绪是造成血压升高
“戒晨嗔”的告诫。可以肯定地说，这些都是符合科学道理
孙真人《养生铭》的立意所在，相信事实会给人们一个有说鱼香肉美的油腻性食物，会加重胃肠的负担，造成消化过程
的主要原因，引起血管收缩，导致舒张压明显上升。芬兰科
的至理明言。“人有五脏化五气，以生喜怒悲恐惊。”
（《素问
服力的答案。的速度加快、质量下降，消化不良、急性胃肠炎、胰腺炎、
学家的研究证实了这一点，他们对 616 名男性对象的调查发
•阴阳应象大论》）情志为病多多，这里不再多费笔墨去全面
为了方便叙述，本文将孙真人的这首诗分为五段进行剖胆囊炎、泄泻、痛风等疾病都有随时发生的可能。还会使胃
现，每发一次怒或绝望值增加 1 分，高血圧的危险性就增加
论述它。而孙氏提出的另外两个问题“饮食均”和“防夜醉”
析，每两句为一节，先从第一节说起。在短时间内极度膨胀，导致急性胃扩张的出现，极有丧命的
16%。而高血圧又可成为新的病因，引发其他更严重的疾病
的问题，倒是需要我们重点加以论述一下的。
危险。有调查认为，50%以上的胃肠病患者与不良进食习惯
何谓“饮食均”？狭义地讲，就是饮食要合理。广义上
1. 怒甚偏伤气，思多太损神。神疲心易疫，有关，其中主要的就是时饥时饱和暴饮暴食。过食生冷和饮
癌症患者中易发怒的人明显高于性格温和的人。
说，是包括衣食住行在内的全方位科学。关于这一点，孙思
气弱病相因食不洁造成的危害显而易见，这里就不再陈述。
再说孙氏诗中说的思伤神，神指的是人的精神意识，是
邈在他的《千金方》和《千金翼方》中都有过相应的说法。
主副搭配，以主为主；荤素搭配，以素为主，是中国人
人类区别于其它动物、独具聪明智慧表现的主要指征之一。
这一节总体上是讲精神养生的，怒之所伤，肝气也；思
如说到穿衣，孙氏说：“衣服但粗缦，可御寒暑而已，第一
在长期生活实践中总结出的科学饮食规则，也是孙思邈反复
神志的主宰者是心，《灵枢•大惑论》中有“心者，神之舍也”
之所伤，脾胃之气也；
勤洗浣，以香霑之。” 喜之所伤，心气也。气乃肺、肾所主，
“湿衣及汗衣，皆不可久着，令人发疮
强调的养生法则，与《黄帝内经》中提出的“五谷为养，五
的话。思为心所主，《孟子•告子上》中有“心之官则思”的
神依气血所存，正气损伤，岂不心“疫”、病“因”吗！对
及风瘙。大汗能易衣佳，不易者急洗之，不尔令小便不利。
果为助，五畜为益，五菜为充，气味合而服之，以补精益气”
话。心的主神、主思功能处于正常状态，人就表现出聪明、
于此，孙思邈在他的《千金方》中曾引用魏晋时期养生学家
凡大汗勿偏脱衣，喜得偏风、半身不遂。春天不可薄衣，令
（《灵枢•五味》）的原则一脉相承，与现代研究得出的结论
理智、敏捷、灵活，健康长寿的机会相对就多；反之，人就
嵇康的话说：“养生有五难，名利不去为一难（实乃最大的
人伤寒、霍乱、食不消”等。其义非常明确，衣料是棉织的
是完全一致的。素食的构成主要是指粮食、蔬菜、水果、豆
会表现出愚笨、粗鲁、迟钝、固执，疾病和灾难的发生率相
心病），喜怒不除为二难，声色不去为三难（确为耗心神、
好，勤洗换是卫生的基本要求，在衣物上用点芳香之品对机
制品类，它们含有丰富的维生素、不饱和脂肪酸、纤维素、
对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
伤肾气之大虑），滋味不绝为四难（吃也是非常费脑筋的活）
体有利，汗出时要及时换衣、防止受风吹，春天的棉衣不能，
果胶和微量元素，具有增强对肠蠕动的良性刺激、促使机体
人、豁达大度的人、善于处世的人，都是有“心计”的；而
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼
脱得过早，衣服不卫生或穿着不科学是许多疾病发生的根源，
排毒过程的顺利进行和卵磷质的充分合成、胆固醇的正常代
那些碌碌无为、傻头笨脑、鸡肠小肚、无朋无友的人，或多
英华，呼吸太阳，不能不回其操、不夭其年也。五者无于胸
这里孙氏所说的内容与现代人们追求的穿要纯棉，勤洗勤换，
谢等作用。以素食为主确实具有减少血管硬化、净化血液、
或少都缺了点“心眼”。很显然，心的这些功能里，包括了
中，则信顺日跻，道德日全，不祈善而有福，不求寿而自延，
以香料辟汗、杀菌及出汗时不要马上对着电扇、空调纳凉，
调整血脂和降低胆固醇、避免机体中毒的效果，从而使人们
大脑的某些功能。把心与脑的部分功能混而谈之，不能片面
此养生之大旨也。”在孙氏反复论证的这段话中，重点强调
春捂秋冻等穿着上的习惯有何两样？说到住处，孙氏说：
“山
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从中获得健康。但素食中缺乏含高热值的营养素——脂肪，新陈代谢的速度放慢，酒精进入人体后更不容易挥发，使人
它的缺乏和不足会严重影响人体的正常生长发育。从导致性中毒的程度会相应加重，死亡的几率自然会随之增大。
激素含量降低、影响性器官成熟开始，就为人的低质量种下现代研究指出，醉酒对消化系统的伤害是首当其冲的，
了祸根。同时，也影响蛋白质、维生素和其他营养物质的代
对心血管系统、中枢神经系统、呼吸系统、生殖系统和骨骼、
温长路
谢、吸收和利用，使机体无法得到充足的养分。如人体中的运动系统的危害也相当严重，是最终导致人生病、短命、死
铁质有 80%来自肉类和蛋黄，钙质 80%来自奶类食品，它们亡的原因之一。从许多疾病发病原因的调查中看，酗酒者的
都属于荤食的内容。孙思邈非常重视这类食物的摄入，指出：发病率明显高于不饮酒者或有节制的少量饮酒者。
“鱼酪酥等，常食之令人有筋力胆干，肌体润泽。
”“牛奶性当然，用辩证的观点看，把酒说得一无是处也是不公正
平，在我国医学发展史上，孙思邈可谓一位集众多学说之大
补血脉，益心长肌肉，令人身体康健，润泽，面目光锐，的。客观地说，酒具有扩张皮肤血管、增加胃液分泌、杀灭
志气不衰。故为人子者，须供之以常食。”
“此物胜肉远矣。
成者，除了传统意义上的医学理论和实践外，把养生防病纳” 病菌和加速热挥发的作用，并且能释放出一定热量，以加强
看来，提倡食素为主又同时适量配以荤食的思想是中医所倡
入人类的健康大系，并使他成为具有理论与实际一体的特色机体的新陈代谢。除了作为药物直接被运用之外，酒还经常
现。
导的一贯饮食模式。说白了，荤食长期摄入不足，人就不可
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题进入复方或作为辅料与其它药物一起，共同参与对多种疾病
（涌）于上。
”（《素问•生气通天论》）
能长出健壮的身体来。因此，必须保持荤食在饮食结构中的
有过许多精辟的论述，并在《千金方》和《千金翼方》中两的治疗。酒与药的这种有机结合，起码有五个方面的作用：
及飱泄。”（《素问•举痛论》）也就是说，怒因气生，气则怒
适当位置，使膳食中脂肪的含量控制在总热量的 25%左右，
次作过专门总结，这是有典可据的。除此以外，有关孙思邈一、改变药性，引药归经；二、增强温补肝肾的作用；三、
以维护机体运转的正常需要。权衡利弊，科学家们的结论性
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广，增强活血通络的作用；四、矫正药物的不良气味，降低药物
《淮南子》所言：“人之性，有所侵犯则怒，怒则血充，血
建议是：在合理安排好素食与荤食比例的前提下，限制荤食
《养生铭》就是其中的一首。此文收于《全唐书》和后人整的毒副作用；五、增加药物有效成分的析出。一句话，作为
的摄入量是必要的，鸡鸭鱼肉之类的动物性食品不仅含的脂
理的孙氏的《摄生咏》中，也有称为《保生铭》和《孙真人治病、健身之用，酒是具有一定益处的，问题的关键是如何
诗中也阐明了雷同的观点：“自知气发每因情，情在何由气
肪多、胆固醇高，而且大都属于酸性食物，食用过多势必会
铭》的。宋代温革的《琐碎录》和 14 世纪朝鲜出版的《医正确掌握饮酒的度和量了。孙思邈不反对适量饮酒，提出了
得平，若问病根深与浅，此身应与病齐生”。
导致机体肥胖，增加血管负担，使血液中的胆固醇增高、血
方类聚》及日本的相关著作中也都有反映。这些版本在文字 “饮酒不宜使多，多则速吐之为佳”和“适性服之，勿至醉
液粘稠度增大，从而导致高血圧、冠心病一类的疾病发生。
上虽然有些出入，但其基本内容是一致的。陕西耀县的药王吐”的观点。他还特别推荐以葡萄为基质的甜酒，赞“其酒
同时，会因血液酸碱度的改变，导致胃肠和肾脏的功能受损，
山上，也保存有这首诗的石刻件，还不时被中外游人转抄和常饮益人”
目胀、，这与现代研究得出的结论是不相悖的。他还强
面红、耳赤、呕血、憋气等症状。甚则使人昏厥卒倒，
使大量的氨基酸在腐败分解过程中产生的毒素危害机体，造
效法。其诗全文如下：调酒剂的防疫作用，说“一人饮，一家无疫；一家饮，一里
成人的疾病和短命。按照近期编制的《中国居民膳食指南》无疫”。在他的《千金方》和《千金翼方》中，除直接用酒
中建议的标准，营养全面的饮食比例是，每个成人每天应进送服丸、散剂和作为制作丸、散剂的原料外，所列举出的酒
食谷类食物 300～500 克、蔬菜 400～500 克、水果 100～200 剂方就有 90 余种。
克、鱼虾类 50 克、畜禽肉类 50～100 克、蛋类 25～50 克、（本文分两部分刊出，第二部请看下期）
奶类及奶制品 100 克、豆类及豆制品 50 克、油脂类 25 克。亡的病例，在国内外媒体上都不时有过报道。
，
我们在研究孙思邈养生思想之际，不妨把它再特色化一些。温长路，中医主任医师、教授、作家，享受国务院特殊津贴专家，
时过境迁，从公元 6 世纪至今，历史的隧道已经向前穿
孙氏诗中提出的“防夜醉”的观点，也是非常具有科学中华中医药学会学术顾问。国家中医药管理局中医药文化建设与科
美国医学专家的一项调查说，一个人经常发怒或心身承
越了 15 个轮回，科学已经发展到了人类从地面走向太空的
道理的经验之谈。醉酒就是酒精中毒，对人体的毒副作用是学普及委员会专家、科技期刊审读专家，中国科协精品期刊评审专
时代，膏粱厚味之外，琳琅满目的各色保健品足以让人眼花
人所共知的。明代医学家李时珍认真领会了孙思邈的思想，它会直接损害人的记忆力和对事物的专注力。不良情绪还会
家，中华中医药学会首席健康科普专家，科学技术进步奖评审专家，
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是
在他的《本草纲目》中一口气列举出了醉酒使人表里为病的增加胃中盐酸的流量，
《世界中西医结合》影响人的食欲，
、《环球中医药》使人发生胃痛、
、《西部中医药》、恶心，、
《中医研究》
15 大“罪状”
需要科学者正面回答的问题，也正是本文要用现代观点诠释
：“或呕吐，或自汗，或疮疥，或鼻齇，或泄利，甚至导致溃疡病的发生。发怒和绝望的情绪是造成血压升高
《中医药文化》、
《中医文献》、
《光明中医》
、《大众医学》
、《现代中
孙真人《养生铭》的立意所在，相信事实会给人们一个有说
或心脾痛，尚可散而去之。其久也病深，或消渴，或内疽，的主要原因，引起血管收缩，导致舒张压明显上升。芬兰科
医药》、
《中国中医药现代远程教育》、《陕西中医学院学报》等多家
服力的答案。
或肺痿，或鼓胀，或失明，或哮喘，或劳瘵，或癫痫，或痔学家的研究证实了这一点，他们对 616 名男性对象的调查发
期刊的编委、顾问。已公开发表学术论文 100 多篇，文史、政论、
为了方便叙述，本文将孙真人的这首诗分为五段进行剖
漏，难名之病”。为了加深人们的印象，李氏还特意在书中现，每发一次怒或绝望值增加 1 分，高血圧的危险性就增加
科普等各类文章 1000 余篇，出版著作 60 余种。主要事迹被国内外
析，每两句为一节，先从第一节说起。
写进了一则实例：过去有个叫周顗的人，非常好客。有一晚 16%。而高血圧又可成为新的病因，引发其他更严重的疾病
几十家媒体报道，并载入《英国剑桥名人录》
、《中国科学家传记》
他家来了一位朋友，他拿出两石美酒招待，结果把这位朋友发生。癌症的发生也与经常发怒有直接联系，有统计证实，
1. 怒甚偏伤气，思多太损神。神疲心易疫，
灌得酩酊大醉。第二天早上一看，这位朋友“已胁穿而死矣”
。
等 30 余种辞书。
气弱病相因
无独有偶，梁章钜在《归田琐记》中也记述了醉酒致死人的再说孙氏诗中说的思伤神，神指的是人的精神意识，是
故事：清•嘉庆年间，两江总督协办大学士松筠，与负责河人类区别于其它动物、独具聪明智慧表现的主要指征之一。
务的官员费淳聚饮，其副将“陪酒”，三人全部醉倒。那“副神志的主宰者是心，
之所伤，脾胃之气也；喜之所伤，心气也。气乃肺、肾所主，
将昨夜回署，即不言动，今晨已奄逝” 。的话。思为心所主，
上述两则饮酒夜醉导致死人的故事，与孙思邈提出的“防话。心的主神、主思功能处于正常状态，人就表现出聪明、
夜醉”的观点存在着必然的联系，或者说是对孙思邈“防夜理智、敏捷、灵活，健康长寿的机会相对就多；反之，人就
醉”理论的有力证明。这是因为，一、夜晚醉酒会造成对睡会表现出愚笨、粗鲁、迟钝、固执，疾病和灾难的发生率相
眠的直接影响，给机体健康带来危害，有可能诱发多种病变；对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
伤肾气之大虑），滋味不绝为四难（吃也是非常费脑筋的活），
二、夜晚是男女兴房事最多的时段，酒后又容易引起兴奋，人、豁达大度的人、善于处世的人，都是有“心计”的；而
而醉酒后进行房事既有损于男性正气，又会给未来胎儿的形那些碌碌无为、傻头笨脑、鸡肠小肚、无朋无友的人，或多
成埋下隐患，因此得畸形儿、痴呆儿者屡见不鲜。三、更重或少都缺了点“心眼”。很显然，心的这些功能里，包括了
要的是，夜晚人的机能活动状态处于相对平静的弱势，器官大脑的某些功能。把心与脑的部分功能混而谈之，不能片面
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IssueIssue
2 2 September 2014
September 2014
基于老中医经验对大肠癌癌毒病机的中层理论探讨
1 2
闫晓天，李雁＊
1
温长路
上海中医药大学国际教育学院（上海 201203）
2 中华中医药学会（100029）
上海中医药大学附属市中医医院肿瘤科（上海 200071）
＊[通讯作者]李雁，博士，主任医师，E-mail:[email protected]
摘要: 文章首先简述了《内经》对于肠中积聚“阳虚寒凝”的认识，进而尝试运用扎根理论方法，通过开放式编
码、主轴编码、选择性编码等三级编码过程，对32位老中医对于大肠癌病机的认识进行了理论研究，初步归纳出
入人类的健康大系，并使他成为具有理论与实际一体的特色现。《黄帝内经》中有明确地论述：“大怒则形气绝，而血菀
了大肠癌癌毒的中层理论。文章最后探讨了现代社会生活方式对癌毒病机的影响、脏气虚寒与大肠癌毒病机、大
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题（涌）于上。”
肠癌毒理论对于治疗的启示等问题。
[Abstract] The understandings
次作过专门总结，这是有典可据的。除此以外，有关孙思邈 of deficiency of Yang and accumulation of cold in the large intestine from Neijing were
described briefly in the first part of the article. Then, after open coding, axial coding and selective coding, the ground
theory method was used to study 32 veteran traditional Chinese doctors’ opinions on the pathogenesis of large intestine
《养生铭》就是其中的一首。此文收于《全唐书》和后人整
cancer, and sum up the middle-range theory of large intestine 充则气激，气激则发怒” 。唐代诗人白居易在他在一首制怒
cancerous toxin initially. The last part of the article
理的孙氏的《摄生咏》中，也有称为《保生铭》和《孙真人
discussed the effect of the modern lifestyle and deficiency of Yang in organs on the “自知气发每因情，情在何由气
诗中也阐明了雷同的观点： pathogenesis large intestine
cancerous toxin, and the treatment
铭》的。宋代温革的《琐碎录》和 based on this theory.
14 世纪朝鲜出版的《医得平，若问病根深与浅，此身应与病齐生” 。
关键词：老中医；大肠癌；癌毒；病机；中层理论
大肠癌是指包括盲肠、全部结肠、直肠等部位发生的恶之络伤，则血溢于肠外，肠外有寒汁沫与血相搏，则并合凝
性肿瘤。如今，结直肠发病现已居我国癌证发病的第三位 [1]。聚，不得散而积成矣”、“卒然外中于寒，若内伤于忧怒，
上海居民大肠癌发病数已从上世纪70年代初的第6位上升到则气上逆，气上逆则六腧不通，
真枪实弹就放倒了这位年仅 36温气不行，凝血蕴里而不散，
岁的英雄汉。临床上遇到的
目前的第2位 [2]。中医学对大肠癌的病因病机及其论治的理津液涩渗，著而不去，而积皆成矣。”《灵枢•五变》又谓
论与实践已有二千多年的历史，随着当代中医学对于大肠癌 “人之善病肠中积聚者……则肠胃恶，恶则邪气留止，积聚
“气是杀人贼”，
防治实践的不断深化，中医学对大肠癌病机的认识也更加深乃伤。脾胃之间，寒温不次，邪气稍至，蓄积留止，大聚乃
入。时过境迁，从公元 6 世纪至今，历史的隧道已经向前穿
有别于内经时代人们对肠中积聚多从 “阳虚寒积”认识，美国医学专家的一项调查说，一个人经常发怒或心身承
起。”《素问•风论》“久风入中，则为肠风飧泄。”
当代中医从上世纪90年代即提出了“癌毒”的概念 [3]，治受的压力太大，机体会分泌出一种代谢类固醇──皮质醇，
通过分析《内经》对相关病机的论述，可以看出，在秦
疗思路随之产生了较大的变化。为更加贴近当今肿瘤临床的它会直接损害人的记忆力和对事物的专注力。不良情绪还会
汉时期当时的历史环境和生活习惯条件下，古人认为肠中积
实践去归纳、理解大肠癌的病机，形成介于中医抽象理论与聚有一个缓慢的形成过程，其病因以感受邪气、饮食无度、
具体临床经验之间的关于大肠病机的中层理论，进而指导临起居不节、七情内伤为主，且以经络阳虚寒积、凝血汁沫蘊
床实践，我们尝试运用扎根理论方法，研究了一批老中医对结为病机要素。
大肠癌的认识和实践，借助三级编码研究过程，逐步理清了
为了方便叙述，本文将孙真人的这首诗分为五段进行剖 2 运用扎根理论方法探析老中医对大肠癌癌
其中的要素及其相互联系，较清晰地呈现了老中医对相关问
析，每两句为一节，先从第一节说起。毒病机认识
题的总体认识，并进而提出了大肠癌癌毒病机的中层理论，
希望能够对于探索肿瘤的中医临床基础理论有所帮助。 2.1研究资料的收集、整理与编码步骤
在CNKI以及万方等文献数据库中，通过“大肠癌”、“肠
气弱病相因
1 《内经》对大肠癌病机的认识简述再说孙氏诗中说的思伤神，神指的是人的精神意识，是
癌”、“老中医”、“中医”、“经验”等关键词搜索，收
大肠癌在临床上出现症状，多有大便习惯改变、便血、集近5年来国内学术期刊公开发表的传承人或学生介绍老中
之所伤，脾胃之气也；喜之所伤，心气也。气乃肺、肾所主，神志的主宰者是心，《灵枢•大惑论》中有“心者，神之舍也”
腹部肿块、局部症状等，《内经》对大肠癌的认识散见于对医的大肠癌治疗经验的文章，将其中有对大肠癌病因病机认
“肠中积聚”、“积”、“聚”以及“肠风”的讨论中。对识内容的文章纳入研究，共55篇；（2）从对治疗癌证有丰
其病因病机的认识主要可概括为因受虚邪贼风或暴饮暴食，富临床经验的老中医，如周仲瑛、刘嘉湘、周岱翰、庞德湘、
加之起居不节、七情忧怒等致气机不调、血脉不畅、阳气不孙桂芝等的大肠癌经验入手，提取文章中关于病因、病机、
行，寒凝日久而邪气留蓄、
伤肾气之大虑）汁沫或凝血留著，
，滋味不绝为四难积久成积。如：
（吃也是非常费脑筋的活），对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
病理因素等内容进行资料整理，并进行内容整合与归纳，必
《灵枢•百病始生》谓：“积之始生，得寒乃生，厥乃成积
要时再收集所需老中医的5年前相关资料作为补充。当老中
也”，“虚邪之中人也……留而不去，传舍于肠胃之外，募
医经验样本数达到32位时已近理论饱和，不再出现新的类别；
原之间，留著于脉，稽留而不去，息而成积。”又云：“卒
（3）运用扎根理论方法依次进行开放式编码（对收集到的
然多食饮则肠满，起居不节，用力过度，则络脉伤……肠胃大脑的某些功能。把心与脑的部分功能混而谈之，不能片面
资料进行逐字逐句分析与分解，进行初始概念化）、主轴编
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码（在从开放编码中得到范畴的基础上，找出范畴之间联系，经过选择性编码及不断补充完善范畴、分析隐含的相互
通过对比分析建立关联，确定主范畴）、选择性编码（选择关系，我们将大肠癌癌毒病机的核心问题范畴化为“邪气的
核心范畴把它系统地与其它范畴加以联系，验证其间的关系，对孙真人《养生铭》的现代诠释
产生”“邪气与癌毒”“癌毒与大肠癌的发生”，并进而进
补充完备范畴，初步形成相关理论）。行理论建构，初步阐发一些相比内经积聚理论更为贴近当今
温长路
中医肿瘤临床实践的中层理论。
2.2研究结果
2.2.1开放式编码中华中医药学会（100029）
3.大肠癌癌毒病机的中层理论及其探讨
首先对老中医的表述不断凝练、概括，然后运用开放性
诚如花宝金教授指出的，大肠癌的病机是多因素的复杂
编码对所得到的关键表述、句子进行概念化提练，进而进行
过程，当代关于大肠癌的病机有气滞学说、血瘀学说、热毒
概念化加工及其范畴的考察、归类，最终从资料中抽象出41
学说、湿聚学说、正虚学说等，均不免失于片面。[4] 我们
入人类的健康大系，并使他成为具有理论与实际一体的特色
个病机概括和6个范畴。现。
研究发现，老中医对大肠癌癌毒的病机从不同角度提出了许
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题
得出的6个范畴（A1～A6），分别为“外邪犯内产生癌（涌）于上。 ”
多看法，显示了癌毒病机多环节、多要素而又相互钩连的特
有过许多精辟的论述，并在《千金方》和《千金翼方》中两
毒的病机”、“始于内生湿（痰）邪的癌毒蘊迫大肠的病机”、及飱泄。”（《素问•举痛论》）也就是说，怒因气生，气则怒
点。经过三级编码过程，我们初步概括出了大肠癌癌毒病机
次作过专门总结，这是有典可据的。除此以外，有关孙思邈
“始于气滞血瘀的癌毒蘊迫大肠的病机”、“大肠传导失司发，生气——发怒——生气，构成了一条恶性循环链。正如
的中层理论。
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广，
自酿癌毒的病机”、“蘊结癌毒伤害大肠的病机”、“邪毒《淮南子》所言：“人之性，有所侵犯则怒，怒则血充，血
《养生铭》就是其中的一首。此文收于《全唐书》和后人整 3.1大肠癌癌毒病机的中层理论简述
充则气激，气激则发怒” 。唐代诗人白居易在他在一首制怒
复又伤正生毒的病机”。对大肠癌病机资料所进行的开放式
理的孙氏的《摄生咏》中，也有称为《保生铭》和《孙真人癌毒是形成恶性肿瘤的特异性病邪，具有猛烈、顽固、
诗中也阐明了雷同的观点： “自知气发每因情，情在何由气
编码如表1所示（限于篇幅，只截取部分编码表）。
铭》的。宋代温革的《琐碎录》和 14 世纪朝鲜出版的《医流窜、隐匿、损正等特性。[5] 大肠癌癌毒的主要病机有二：
得平，若问病根深与浅，此身应与病齐生” 。
2.2.2主轴编码
方类聚》及日本的相关著作中也都有反映。这些版本在文字（1）来自体内传毒：外邪来犯或缘起内因，五脏（脾肾肝
运用主轴编码对范畴进行关系归类并建立关联，形成了
为主）受伤，虚而不主，功能失调，内生痰、湿、瘀、热之
三大类主要的关系。具体见表2。
2.2.3 选择性编码
怒甚偏伤气，思多太损神。神疲心易疫，气弱病相因。表1 开放式编码表
概念化范畴化范畴的性质
a1 五脏失常，外邪入内，积聚于肠将 a1 、a8、a34、a36、a37 范畴
a2 五脏失常，湿邪内生，积聚于肠
若要无诸病，常当节五辛。安神宜悦乐，惜气保和纯。化为 A1“外邪犯内产生癌毒病机” 外邪与癌毒
a3 五脏失常，湿热痰结，阻络生瘀，痰瘀成癌毒，亡的病例，在国内外媒体上都不时有过报道。 “气是杀人贼”
，
毒侵大肠将 a2 、a3、a5、a9、a16、a17、
a4 体内瘀毒，久成癌毒，毒侵大肠
时过境迁，从公元 6 世纪至今，历史的隧道已经向前穿 a18、a19、a21、a22、a23、a35、
湿（痰）邪内生与癌毒迫于大肠
a5 体内痰湿，久成癌毒，毒侵大肠 a38、a41 范畴化为 A2 “始于内生
a6 气滞血瘀，久成癌毒，瘀毒侵犯大肠受的压力太大，机体会分泌出一种代谢类固醇──皮质醇，
湿（痰）邪的癌毒蘊积大肠的病机”
a7 癌毒滋增，瘀助癌毒，浸润转移它会直接损害人的记忆力和对事物的专注力。不良情绪还会
a8 外邪化火，火聚成癌毒，侵犯大肠将 a4 、a6、a7、a10、a13、a28、
a9 五脏失常，湿热内生，湿热邪毒侵，犯大肠 a30、a39 增加胃中盐酸的流量，
范畴化为 A3 “始于气滞影响人的食欲，使人发生胃痛、恶心，
a10 五脏失常，气滞血瘀，瘀结大肠甚至导致溃疡病的发生。发怒和绝望的情绪是造成血压升高
血瘀的癌毒蘊积大肠的病机”
气滞血瘀与癌毒迫于大肠
a11 邪毒侵肠，气血受阻，气滞血瘀，湿毒瘀滞凝结
a12 痰、湿、瘀互结久成癌毒，损害脏腑经络功能将 a14 、a15、a20、a24、a26、
服力的答案。 616 名男性对象的调查发
a13 五脏失常，虚而致积，气机不畅，毒邪蘊结脏腑， a31、a40学家的研究证实了这一点，他们对
范畴化为 A4“大肠传导
侵犯大肠失司自酿癌毒的病机”
大肠腑滞而自生癌毒
a14 腑气不通，关格壅塞，邪热下迫大肠
a15 五脏失常，大肠传导失司，湿热蘊毒
a16 五脏失常，湿邪内生，气机阻滞，络阻生瘀，发生。癌症的发生也与经常发怒有直接联系，有统计证实，
湿瘀犯肠…… 。。。。。。
（共计 6 个范畴）
气弱病相因（共计 41 种概括）再说孙氏诗中说的思伤神，神指的是人的精神意识，是
注：表中“a”表示从资料中提炼出概括表述的编码； “A”表示从概括中归纳出范畴的编码。
表 2 基于主轴编码的三大类关系
神志的主宰者是心，
编号关系类别影响关系的范畴
1 外邪与癌毒 “外邪犯内产生癌毒的病机”
“始于内生湿（痰）邪的癌毒蘊积大肠的病机”
2 内生癌毒蘊迫大肠会表现出愚笨、粗鲁、迟钝、固执，疾病和灾难的发生率相
“始于气滞血瘀的癌毒蘊积大肠的病机”
“邪毒复又伤正生毒的病机”
“大肠传导失司自酿癌毒的病机”
3 大肠失司自生癌毒 “外邪犯内产生癌毒的病机”
“蘊结癌毒伤害大肠的病机”
“邪毒复又伤正生毒的病机”
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温长路
。
图1 基于老中医经验的大肠癌癌毒病机理论示意图
邪，积久成毒，蘊成癌毒，毒迫大肠，大肠络伤湿滞，毒与津血调治；（2）针对大肠传导不利的调畅气机、通调腑气；
湿（痰）瘀胶结，终至大肠癌，大肠癌毒复再伤脏而益生毒；（3）针对体内蘊结之邪的清湿化痰、逐瘀散结；（4）针对
（2）本于大肠生毒：外邪来犯或邪起内因直害大肠，或五癌毒特别是大肠癌癌毒直接致病的抗癌解毒。这四个环节构
脏不调使大肠不利，大肠传导失司，实而失畅，湿瘀热结，成了治疗大肠癌的框架思路，至于到具体患者，又需根据其
蘊而成毒，久成癌毒，大肠癌毒益使络伤湿滞，复再伤腑益中西医治疗的阶段、病情的缓急、兼证的变化等灵活变化施
生毒，终至大肠癌。试以图1详示之。药，犹如毛笔虽同，但随立意不同而笔峰运用有异。
3.2几点讨论亡的病例，在国内外媒体上都不时有过报道。
，
寿夭休命论，修行本在人。若能遵此理，平地可朝真。参考文献
3.2.1现代社会生活方式对癌毒病机的影响老百姓的说法一语道破了生气对人类健康的严重危害。
“大肠者，传导之官，变化出焉”，大肠为六腑之一， [1] 美国医学专家的一项调查说，一个人经常发怒或心身承
曾红梅，陈万青，中国癌症流行病学与防治研究现状 [J]化学进
泻而不藏，具有排泄人体糟粕的作用。现代社会饮食习惯与展, 2013, 25(9):1415－1420
运动习惯出现较大变化，高脂、高蛋白、低纤维素、含化学 [2] 黄辛，专家呼吁重视大肠癌早期筛查 [N] 科学网资讯，2014年
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是 07月26日
物品饮食，缺少运动，以及排便不畅等均可直接造成大肠腑增加胃中盐酸的流量，影响人的食欲，使人发生胃痛、恶心，
[3] 赵智强，李嘉.略论周仲瑛教授的“癌毒”学说及其临床运用 [J]
气不通而糟粕久留、气血不畅、久而成毒。这一因素与内经甚至导致溃疡病的发生。发怒和绝望的情绪是造成血压升高
新中医，1998，30 (10)：6-8.
时代积聚发生的病因病机已有较大不同，老中医对此已有较的主要原因，引起血管收缩，导致舒张压明显上升。芬兰科
[4] 秦英刚，花宝金教授治疗大肠癌经验 [J] 中医学报, 2013，28
服力的答案。
普遍的认识，因此在理论中成为重要的病机之一。学家的研究证实了这一点，他们对 616 名男性对象的调查发
（177）：160－161
3.2.2为了方便叙述，本文将孙真人的这首诗分为五段进行剖
脏气虚寒与大肠癌毒病机现，每发一次怒或绝望值增加 1 分，高血圧的危险性就增加
[5] 周计春，邢风举，颜新.国医大师周仲瑛教授治疗癌毒五法及辨
人体中精气、津血的生成和运行无不靠阳气的化生与推 16%。而高血圧又可成为新的病因，引发其他更严重的疾病
病应用经验 [J].中华中医药杂志, 2014, 29(4):1112－1114
动，是以阳气在人体中“若天与日”般重要。在大肠癌的病发生。癌症的发生也与经常发怒有直接联系，有统计证实，
机中，凡内外因致病，或致脾肾阳气不足或不行，则易导致作者简介
气弱病相因
精气津血不生或不行，使人体气血亏虚并生湿生瘀，湿瘀又再说孙氏诗中说的思伤神，神指的是人的精神意识，是
闫晓天，医学硕士，1988 年毕业于河南中医学院内经专业，
成为蘊毒的所在。因此，大肠癌毒初期蘊生的阶段多有脏气人类区别于其它动物、独具聪明智慧表现的主要指征之一。
2001 年晋升教授。现任上海中医药大学国际教育学院院长，
虚寒的过程，这与内经关于阳虚寒凝积的理论是一致的。在神志的主宰者是心，《灵枢•大惑论》中有“心者，神之舍也”
之所伤，脾胃之气也；喜之所伤，心气也。气乃肺、肾所主，全国中医药高等教育学会对外教育研究会副理事长，中华中
湿瘀已蘊成癌毒的阶段，则癌毒成为致病的主要因素，癌毒的话。思为心所主，《孟子•告子上》中有“心之官则思”的
神依气血所存，正气损伤，岂不心“疫”、病“因”吗！对医药学会中医基础理论分会常务委员。主要从事中医基础理
并非简单的寒凝所能概括，而是多邪胶结、寒热相抟的过程，话。心的主神、主思功能处于正常状态，人就表现出聪明、
于此，孙思邈在他的《千金方》中曾引用魏晋时期养生学家论教学与研究、中医教育研究与管理工作，发表论文 70 余
这一点无疑是当代老中医对内经理论的发展之处。理智、敏捷、灵活，健康长寿的机会相对就多；反之，人就
嵇康的话说：“养生有五难，名利不去为一难（实乃最大的篇、学术著作 11 部，承担研究基金项目以及科技攻关项目 8
3.2.3大肠癌毒理论对于治疗的启示会表现出愚笨、粗鲁、迟钝、固执，疾病和灾难的发生率相
心病），喜怒不除为二难，声色不去为三难（确为耗心神、项，获国家级、省级和厅级成果奖 8 项，所参加的教学团队
《素问•至真要大论》言：“谨守病机，各司其属”。大对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
，
肠癌毒病机理论所揭示的病机要素及其联系，启示我们治疗 2009 年荣获国家级优秀教学团队。
大肠癌应重视四个环节，即（1）针对传邪而来的五脏调养、那些碌碌无为、傻头笨脑、鸡肠小肚、无朋无友的人，或多
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Issue2 September2014
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“一分为三”看“经络”（下部）
王以胜
北京同仁堂（英国伦敦）
温长路
四. 探讨“任督二脉” (一) 大体循行：起于胞中，出会阴绕前阴，沿腹、胸正中线上
行，至口唇内，环绕口唇，分二支至双目下。首穴会阴，末穴承
中医典籍以及中国中医高等教育教材，都是把“督脉、任脉”
浆。
划归于“奇经八脉”范畴。
(二) 基本功能：调节阴经气血；调节、促进生殖机能；宽胸理
前面“总论”提出： “督脉、任脉”都有自己的“穴位”和“络
入人类的健康大系，并使他成为具有理论与实际一体的特色现。《黄帝内经》中有明确地论述：
气，健脾和胃。 “大怒则形气绝，而血菀
脉” ，而其余“奇经六脉”则无自己的穴位，更别说“络脉”了。
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题 (三) 主要病症：疝气、癥瘕积聚。月经不调、带下、流产、不
（涌）于上。 ”
（《素问•生气通天论》）“怒则气逆，甚则呕血
显然“任督二脉”与“奇经六脉”有明显区别。
有过许多精辟的论述，并在《千金方》和《千金翼方》中两育不孕等。
及飱泄。 ”（《素问•举痛论》）也就是说，怒因气生，气则怒
元朝滑伯仁先生已经把“任脉、督脉”另列而与“十二正经”
次作过专门总结，这是有典可据的。除此以外，有关孙思邈督脉：督即总督一身阳气和阳经，故称“阳脉之海”
发，生气——发怒——生气，构成了一条恶性循环链。正如。
相提并论，著有《十四经发挥》（1341 年）一书。
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广， (一) 大体循行：
《淮南子》所言：起于胞中，出会阴后行于腰背正中，
经项入脑，
以胜主编的《针灸推拿学》于 1995 年出版时，用作国家中医
《养生铭》就是其中的一首。此文收于《全唐书》和后人整属脑，由项沿头正中线，经头顶、额、鼻到上唇系带处。并有支
药学校教材使用，为避免学术异议，还是沿用传统文献说法，把
脉络肾、贯心。首穴长强，末穴龈交。
“任督二脉”归入“奇经八脉”论述。诗中也阐明了雷同的观点：“自知气发每因情，情在何由气
(二) 基本功能：调节阳经气血；调节泌尿生殖功能；反映脊髓
铭》的。宋代温革的《琐碎录》和
实际上以胜是把“任脉、督脉”另列一类， 14 世纪朝鲜出版的《医
以示与“奇经六脉” 得平，若问病根深与浅，此身应与病齐生” 。
和脑功能。
有区别，表明“经脉”也是“一分为三”
方类聚》及日本的相关著作中也都有反映。这些版本在文字：分为“十二正经” 、
“任怒气大发，相应的疾病就会因之而生，受害最直接的是
(三) 主要病症：脊柱强直，角弓反张，脊背疼痛，惊厥，精神
督二脉” 、“奇经六脉” 。
失常。
在《黄帝内经•素问》 “骨空论篇第六十”有专门论述“任脉、
督脉”和“冲脉”的循行、主病的经文： “任脉者起于中极之下---
效法。其诗全文如下：五. 探讨“奇经六脉”
冲脉者起于气街---任脉为病男子内结七疝女子带下瘕聚冲脉为病
逆气里急督脉为病脊强反折” ，是把“任脉”放在“督脉”之前论按照“一分为三”看“经脉”理论框架， “经脉”分为“十二
述，叙述过“任脉” 、
“冲脉”之后，才叙述“督脉” 。完全符合春正经” 、
“任督二脉” 、
“奇经六脉”三部分。在探讨过“十二正经”
秋战国之前的哲学、文化习惯和行文风格，母系氏族遗风明显，
亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。和“任督二脉”之后，继续探讨“奇经六脉” 。
“奇经六脉”是指：冲脉；带脉；阴跷脉、阳跷脉；阴维脉、
先阴后阳，故称“阴阳学说”而不是“阳阴学说”
若要无诸病，常当节五辛。安神宜悦乐，惜气保和纯。。十二经脉也是
从手太阴经开始论述，到最后还是足厥阴经再注入手太阴经。所亡的病例，在国内外媒体上都不时有过报道。
阳维脉等“六脉” “气是杀人贼”
，因为这六条经脉与“十二正经”不同，在内不，
以在讨论“督脉、任脉”时，其顺序应当是“任督二脉” ，而非“督老百姓的说法一语道破了生气对人类健康的严重危害。
络属于脏腑，在外彼此不形成配偶关系；又与“任督二脉”不同。
时过境迁，从公元
任二脉” 。 6 世纪至今，历史的隧道已经向前穿美国医学专家的一项调查说，一个人经常发怒或心身承
“奇经六脉”在上肢没有本经分布。故称为“奇经” ，
“奇”而非
15 个轮回，科学已经发展到了人类从地面走向太空的
越了丹道家也是 “一分为三”理论，认为人体真气运行的经脉主要受的压力太大，机体会分泌出一种代谢类固醇──皮质醇，
“偶” ，又有“异”意。
有三条：一是赤道，即任脉；二是黑道，即督脉；三是黄道，即（一）冲脉：又叫“太冲脉” 。“冲”意指上冲，冲脉上走头，
中黄。他们认为“任督二脉”为“人道” ，可以兼容先、后天之精下走足，总领诸经的气血，故有“十二经之海”之称。
气运行，督脉运行是由脑向下到尾闾；任脉由会阴向上至天门。大体循行：冲脉与任脉、督脉都是起于胞中，下出会阴。
丹家逆“人道”而修炼“仙道” ，导真气逆行“任督二脉”
孙真人《养生铭》的立意所在，相信事实会给人们一个有说，此称冲脉“一分为三”分为三支而行：1、出会阴，环绕后阴，沿
为“河车搬运”或“小周天”
服力的答案。。督脉有尾闾、夹脊、玉枕三关，精腹腔后壁上行于脊柱内。2、出会阴，环绕前阴，沿腹腔前壁，挟
气过三关才能上入“泥丸宫” 。任脉有上田、中田、下田三窍；此
为了方便叙述，本文将孙真人的这首诗分为五段进行剖脐上行，经咽喉络口唇上至两目下。3、出会阴下行，沿股内侧下
外还有天门（眉心）、重楼（气管）、生门（脐门）等要穴。行经内踝后入足下，其别支经足背至足大趾、次趾之间。
“中黄”又称黄中、中道、黄道、正黄、正脉、黄脉、真黄等，基本功能：1、调节十二经气血，为“十二经脉之海” 。2、调
是处于人体正中的大脉，而通络于四肢，被丹家视为不传之秘。节月经，特别是初潮、绝经时期，以及月经的量的多少。因为冲
其特点是只有先天真精、真气可以通过，故称为“仙道” 。先天精脉与月经有关，又涵蓄十二经气血，所以又称冲脉为“血海” 。3、
调节气机升降。
气自“虚危穴” （即会阴穴，也称阴蹻、尾闾关、生死窍、复命关）
透入，过中黄，直达顶骨（即天灵盖、囟门）
这一节总体上是讲精神养生的，怒之所伤，肝气也；思。顶骨乃人身生气所人类区别于其它动物、独具聪明智慧表现的主要指征之一。
主要病症：1、妇科疾病：月经不调、崩漏、经闭、乳少等。2、
凝结，上应镇星，其光华称“意珠” ，可护卫婴儿，即未成熟之阳
泌尿、生殖系统疾病。3、气机升降失常病症，如吐血、气逆、上
神。黄道（黄脉）与佛教密宗中的“中脉”暗合，可见人体的奥
神依气血所存，正气损伤，岂不心“疫” 、病“因”吗！对的话。思为心所主，
呃等。《孟子•告子上》中有“心之官则思”的
秘是统一的。只是因为佛家、道家用各自不同的理论解释同一个（二）带脉：带脉起于季肋下，环行腰一周，状如束带，故称
“人体”而已。正如中医学、西医学哲学理念、基本理论和说理 “带脉”。有约束诸经之功能。带脉是唯一横行的经脉。其余都是
工具不同，但是研究的都是相同的“人体” 。纵行的经脉。
本文也遵循中医经典，把任脉放在督脉之前论述。大体循行：起于季肋（约在第十二肋骨端），斜向下行到带脉
“任脉、冲脉、督脉”都是“起于胞中” ，故有“一源三岐” 穴，横行绕腰一周复至季肋。并且于带脉穴处再向前下方沿髂骨
之说。临床实践证明，有关性功能、生殖系统、泌尿系统、妇科上缘斜行到少腹。
疾病都与“任脉、冲脉、督脉”有关。基本功能：1、约束纵行的所有经脉。2、主司带下。3、强壮
中，任脉：任即担任一身之阴气、阴经，故称“阴脉之海”
则信顺日跻，道德日全，不祈善而有福，不求寿而自延，或少都缺了点“心眼”。很显然，心的这些功能里，包括了
。任通腰部。
此养生之大旨也。 ”在孙氏反复论证的这段话中，重点强调大脑的某些功能。把心与脑的部分功能混而谈之，不能片面
妊，故有“任主胞胎”之说。主要病症：1、妇女带下病、子宫脱垂。2、腹部胀满。3、腰
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The
The Journal
Journal of
of Chinese
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Medicine And
And Acupuncture
Acupuncture Volume
|September 2014
软无力。（《难经•二十九难》“带之为病腰溶溶若坐水中” ）。足三阳经：胃经足阳明络丰隆；膀胱经足太阳络飞扬；胆经足

（三）阳跷脉、阴跷脉： “跷”原意是“脚向上抬” ，有轻灵矫少阳络光明。
健之意。因为阴跷脉、阳跷脉其功能是令人行动跷捷，故称跷脉。脾之大络大包；任脉之络鸠尾；督脉之络长强。
大体循行：阴跷脉是足少阴经之别脉，起于足中出然谷穴，经对孙真人《养生铭》的现代诠释
2、孙络：络脉最细小的分支称为“孙络” 。就如“经络”系统
照海穴上至内踝上二寸以交信为郗，沿下肢内侧后方上行，入阴是一个“大网络” ，一层一层细分下去，一直到最基层分支，就如
温长路
部，经腹部、胸部，出人迎，过喉结交叉到睛明，与手足太阳、 “愚公移山”寓言里“愚公”所说的“子又生子，子又生孙，子
足阳明、阳跷五脉相会。中华中医药学会（100029）
子孙孙，无穷匮也” 。所有的“子子孙孙，儿孙之辈”的最细小的
阳跷脉是足太阳之别脉，起于足跟中，出于外踝下申脉穴，经络脉，相当于西医学所说的“毛细血管” 、“神经末梢”之类都叫
仆参穴上行外踝上三寸以跗阳穴为郗，沿下肢外侧上行，经居窷 “孙络” ，“经络系统”正是通过这些“孙络”联系、滋养、调控
在我国医学发展史上，孙思邈可谓一位集众多学说之大
穴，沿胁后、胸部后外侧，上肩部过三穴（手太阳小肠经之臑俞的都是情志对养生的决定性作用。
机体五脏六腑、四肢百骸的阴阳气血。
成者，除了传统意义上的医学理论和实践外，把养生防病纳
穴；手阳明大肠经之肩髃、巨骨穴），经颈部上口，再向上经承泣就孙氏诗中所说之怒伤肝言，它是人情志受损的一种表
3、浮络：络脉之浮行于机体浅表部位者，叫做“浮络” ，
“浮
穴，过睛明穴、风池穴、风府穴入脑。现。
络”《黄帝内经》中有明确地论述：
是“孙络”的一部分，仅仅是因为其位于 “大怒则形气绝，而血菀
“浅表”“浮而可见”
基本功能：1、阴跷脉、阳跷脉主一身左右之阴阳，使身体左
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题而名之“浮络”
（涌）于上。 ”。
（
《素问•生气通天论》）“怒则气逆，甚则呕血
右阴阳趋于平衡。2、协调下肢肌肉运动。3、控制眼睑开阖。阴
有过许多精辟的论述，并在《千金方》和《千金翼方》中两（二）经属：经属也是“一分为三”
及飱泄。，分为“十二经别、十二
跷脉与阳跷脉交会于两目，属于脑，其功能与睡眠有关。阳跷阳
次作过专门总结，这是有典可据的。除此以外，有关孙思邈经筋、十二皮部” 。
气盛则躁动不安，目张，不寐。阴跷阴气盛则精神不振，目合，
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广， 1、十二经别：是十二经脉别行分出的一种循行于人体深部的
嗜睡。
《养生铭》就是其中的一首。此文收于《全唐书》和后人整经脉干线，也是十二经脉别出的正经，属于经脉范畴，其作用，
主要病症： 1、下肢运动不协调。阴跷病则会足内翻。阳跷病除了加强表里两经联系之外，并能通达某些正经未能行经的器官
则会足外翻。2、眼睑开阖异常：阴跷病则嗜睡，阳跷病则不寐。与形体部位，以补正经之不足。还有濡养脏腑的功能和作用。
铭》的。宋代温革的《琐碎录》和 14 世纪朝鲜出版的《医得平，若问病根深与浅，此身应与病齐生” 。
3、阴跷病则喉痛，阳跷病则癫狂、目内眦赤疼痛。过去的中医学高等教育教材，即全国中医药大学教材对于“十
（四）阴维脉、阳维脉： “维”即“维系”意。二经别”都是非常简单几句话表述，现代许多针灸学著作也没有
大体循行：阴维脉起于小腿内侧足三阴经交会处，沿下肢内侧认真讨论过“十二经别”有关知识，更没有认真告诉学生和读者
山上，也保存有这首诗的石刻件，还不时被中外游人转抄和
上行到腹部与脾经同行，到胁部与肝经相合，上行至咽喉与任脉目胀、面红、耳赤、呕血、憋气等症状。甚则使人昏厥卒倒，
有关“十二经别”的具体内容。实际上《黄帝内经•灵枢》 “经别
效法。其诗全文如下：
相合。阳阳维脉起于外踝下，与胆经并行，经躯干后外侧到肩、因此致死者也不罕见。
第十一”篇专门探讨“十二经别” 《三国演义》中诸葛亮三气周瑜的故
。例如“足太阳之正，别入于腘
颈、颊、额、项部，与督脉会合，循行期间与手足太阳、少阳、事，就是一个典型的案例：血气方刚的周瑜性情急躁，容易
中，其一道下尻五寸，别入于肛，属于膀胱，散之肾，循膂当心
阳跷等交会。发怒。深谙心理学的诸葛亮故意用计让他动气，结果没有用
入散；直者，从膂上出于项，复属于太阳，此为一经也。足少阴
基本功能：联络维系阴阳经脉。真枪实弹就放倒了这位年仅 36 岁的英雄汉。临床上遇到的
之正，至腘中，别走太阳而合，上至肾，当十四椎，出属带脉；
主要病症： “阳维为病苦寒热，阴维为病苦心痛” （难经•二十直者，系舌本，复出于项，合于太阳，此为一合。成以诸阴之别，
九难）。阳维脉病症为寒热表证。阴维脉病心、胃、胸腹疼痛等里皆为正也。
亡的病例， ”在国内外媒体上都不时有过报道。 “气是杀人贼” ，
证。寿夭休命论，修行本在人。若能遵此理，平地可朝真。 2、十二经筋：是十二经脉循行部位上分布的筋腱和肌肉系统
时过境迁，从公元 6 世纪至今，历史的隧道已经向前穿的总称，行于体表，不入内脏；有联缀四肢百骸、维络周身、主
六．探讨“络脉和经属”
越了 15 个轮回，科学已经发展到了人类从地面走向太空的管全身关节运动。《黄帝内经•灵枢》“经筋第十三”篇专门探讨“十
二经筋” 。
在“总论”里我们把“经络”一分为三： “经络”由“经脉” 、它会直接损害人的记忆力和对事物的专注力。不良情绪还会
3、十二皮部：是十二经脉在体表相应的皮肤部位的反应区域，
“络脉” 、
“经属” （以胜新拟名）三部分组成，各自又“一分为三”
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是：增加胃中盐酸的流量，影响人的食欲，使人发生胃痛、恶心，
即通过络脉把皮肤分为十二部，纳入十二经脉所支配的范围，十
“经脉”分为“十二正经” 、“任督二脉”、“奇经六脉”
需要科学者正面回答的问题，也正是本文要用现代观点诠释。甚至导致溃疡病的发生。发怒和绝望的情绪是造成血压升高
二经脉发生病变，在相应的皮部也会有所反应。
“络脉”分为“别络、孙络、浮络” 。
“经属”分为：
服力的答案。 “十二经别” 、“十二经筋”、“十二皮部” 。
前面我们分别讨论了“ 经脉命名、循行交接” 、
“经脉循行主
七．经络的生理功能
病”、探讨“任督二脉” 、探讨“奇经六脉” ，本文将《探讨“络按照“三元论”理论， “经络”由“经脉” 、
“络脉”、“经属”
脉和经属” 》。三部分组成， “经脉”是经络系统的主要组成部分。 “经络功能”
（一）络脉： “络脉”也是“一分为三” ，分为“别络、孙络、主要通过“经脉”体现出来，所以《黄帝内经•灵枢》 “经脉第十”
浮络”三部分。说： “经脉者，所以能决死生、处百病、调虚实，不可不通。 ”
气弱病相因
1、别络、十五络脉：通常说的“络脉” 、“别络”就是指“十再说孙氏诗中说的思伤神，神指的是人的精神意识，是
经络的生理功能活动称为“经气” ，平时人们在做“针灸、按
五络脉” ，又叫“十五别络” 。即十二正经、任督二脉各有一支别
摩”时所说的“得气” ，就是指激发的“经气” 。当针灸或按摩刺
络，再加上“脾之大络” ，合为“十五别络” 。
之所伤，脾胃之气也；喜之所伤，心气也。气乃肺、肾所主，神志的主宰者是心，《灵枢•大惑论》中有 “心者，
激经脉循行部位或穴位时，人体可以感觉到“经气”按一定方向神之舍也”
“十二正经”的“络脉”从一定部位发出，经过一定的循行路和路径传导，即表现为酸、麻、重、胀等感觉的传导。这种“经
线后，或从阳经入于相表里的阴经；或从阴经入于相表里的阳经，气”在经脉中的传导，是经络维持正常生理功能活动的动力，也
加强“十二经脉”在四肢的表里联系和十二经脉的循环传注。是实现经络功能活动的基础。
“十五络脉”是以发出的腧穴名称命名的，具体名称如下：《黄帝内经•灵枢》 “本脏第四十七”所说：
会表现出愚笨、粗鲁、迟钝、固执，疾病和灾难的发生率相 “经脉者，所以行
手三阴经：肺经手太阴络列缺；心经手少阴络通里；心包经手血气而营阴阳，濡筋骨，利关节者也” 。以胜认为，这就是告诉人
厥阴络内关。们有关“经脉的生理功能” 。
手三阳经：大肠经手阳明络偏历；小肠经手太阳络支正；三焦按照“一分为三看世界”方法论，经络生理功能也是大体分为
经手少阳络外关。三个方面，
中，足三阴经：
脾经足太阴络公孙；肾经足少阴络大钟；肝经足厥（一）沟通内外，网络周身：十二正经源于脏腑，通过络、属、
此养生之大旨也。
阴络蠡沟。 ”在孙氏反复论证的这段话中，重点强调大脑的某些功能。把心与脑的部分功能混而谈之，不能片面
贯、注等方式，把互为表里的脏腑联系在一起，并且使脏与脏、
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腑与腑、脏与腑之间互相联系，使各脏腑之间彼此协调，使“经有压痛点。
气”顺序传递，如环无端，周流不息，共同完成机体各种复杂的 3、脏腑病变互相影响的途径：如足厥阴肝经“属肝” 、
“挟胃”、
生理活动；达到“阴平阳秘，生命乃治”的健康状态。 “注肺中” ，故有“肝气犯胃”、
“肝火烁肺”等证候。足少阴肾经
由于“十二经脉”及其分支纵横交错，出表入里，通达上下， “属肾”对孙真人《养生铭》的现代诠释
、
“入肺”、
“络心”，所以“肾虚水泛”时，会“水气凌心”、
相互络属于脏腑之间；“任督二脉”和“奇经六脉”联系沟通于十 “水气射肺” ；足太阴脾经“属脾”、“络胃”、
“注心中”，所以会
温长路
二正经、十二经筋、十二皮部，联络筋脉皮肉，经络循行于身体 “胃热熏心” ，出现神志昏迷症状，如大热、大渴、大汗之阳明热
躯干、四肢、头面部位，联系到眼、耳、口、舌、咽、喉、二阴病。互为表里的两经联系更为密切，如“心火移热于小肠” ；大肠
以及所有脏腑器官。全身各个部位通过经络互相沟通，形成一个实热，腑气不通可以引起肺气不利而咳喘、胸满等。
有机整体。（二）诊断：经络有脏腑络属和循行部位，会反映相关证候，结
（二）运行气血，滋养全身：气血是脏腑生理活动的产物，又的都是情志对养生的决定性作用。
合“四诊”知识，就可以诊断疾病。
是机体脏腑器官、全身各类组织正常生理活动的物质基础。气血就孙氏诗中所说之怒伤肝言，它是人情志受损的一种表
1、分经辨证：根据经络理论，依据脏腑功能和病理变化特点，
的生化依赖脏腑生理功能正常而实现，但是气血的运行输布全靠现。《黄帝内经》中有明确地论述： “大怒则形气绝，而血菀
可以诊断属于何经脉病变。临床出现咳嗽、气喘、胸闷胀满、小
“经络”生理功能正常来完成。即“经脉者，所以行血气而营阴
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题便频数而量少等证，是肺主气、司呼吸、通调水道等功能失常的
（涌）于上。 ”
阳，濡筋骨，利关节者也” 。机体依靠网络周身、四通八达的“经
有过许多精辟的论述，并在《千金方》和《千金翼方》中两表现；再有缺盆疼痛、烦心、掌中热、挠侧臂痛、肩背痛等症，
络”，把气血输送到全身各处，滋养全身各种组织、器官、四肢百
次作过专门总结，这是有典可据的。除此以外，有关孙思邈是肺经循行部位病变。《伤寒杂病论》的“六经辨证”就是运用“经
骸；完成“行血气、营阴阳、濡筋骨、利关节”的生理功能。
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广，络理论”结合“藏象学说、病因学说、阴阳五行学说”建立的“辨
如果因为各种原因导致经络功能失常，气血运行发生障碍，经
《养生铭》就是其中的一首。此文收于《全唐书》和后人整证施治”理论体系。
脉阻滞不通，就会形成“气滞血瘀” ，机体会出现疼痛、肿胀、瘀 2、分部论经：依据病变部位，诊断何经病变。如头痛部位不
斑等实证；或者气虚血少，经脉失养，会出现局部麻木；或某些同，属于不同经脉病变：前额痛，属阳明头痛；头两侧疼痛，为
脏腑虚证；或血虚生内热，烁阴生风，出现筋脉拘急、抽掣。无少阳头痛；头后部痛，为太阳头痛；头顶疼痛，为厥阴头痛。再
论虚实，机体日久失去经络气血濡养，都会枯废。如牙痛，上牙痛与足阳明胃经有关，下牙痛，与手阳明大肠经有
（三）调节平衡，防护自身：经络对机体各组织器官的生理活关。
动具有调节作用，使彼此之间相互协调，保持阴阳气血相对平衡，目胀、面红、耳赤、呕血、憋气等症状。甚则使人昏厥卒倒，
3、经穴辨病：依据在经络循行通路和穴位周围，出现明显的
即“阴平阳秘，生命乃治” ，使机体处于健康状态。因此致死者也不罕见。《三国演义》中诸葛亮三气周瑜的故
压痛点、结节状或条索状反应物、或局部电位变化，进行诊断疾
“十二经脉”本身左右对称，也会互相调节；例如临床治疗偏事，就是一个典型的案例：血气方刚的周瑜性情急躁，容易
病。如上面所说“经络可以反映病候” ，胆囊炎患者在胆经的阳
瘫、面瘫，一边有病，可以通过针灸另一边进行治疗，即“左有发怒。深谙心理学的诸葛亮故意用计让他动气，结果没有用
陵泉穴位处有压痛点，肠痈（阑尾炎）在足三里穴下阑尾穴处有
病而右畔取”的治疗方法。压痛点。
“任督二脉”和“奇经六脉”对于“十二经脉”气血的调节功（三）治疗：
能，古人以“溢蓄”二字表述，用“湖泊” 、
“大海”、
“水库”与 1、循经取穴：经脉循行线上有穴位，针灸就是通过刺激穴位
亡的病例，在国内外媒体上都不时有过报道。 “气是杀人贼”
，
“河渠”形象比拟：例如“冲脉”能够调节十二经气血，故称“冲 “经气”，通过经络系统使机体相应的脏腑功能恢复正常而治疗疾
脉”为“十二经脉之海”
时过境迁，从公元。当“十二经脉”气血不足时， “任督二
6 世纪至今，历史的隧道已经向前穿病或养生保健、延年益寿。例如治疗头痛，除了取头痛局部穴位
脉”和“奇经六脉”会“溢出”气血而保障各经脉气血的供应；
越了 15 个轮回，科学已经发展到了人类从地面走向太空的外，一定要“循经取穴”：太阳经头痛，取手部后溪穴、足部昆仑
当“十二经脉”气血有余时，又能“蓄入” ，如此调节机体的气血穴；阳明经头痛，取手部合谷穴、足部内廷穴；太阳经头痛，取
在不同状态下的需要量，保持阴阳气血相对平衡，使机体处于健手部中渚穴、足部临泣穴。再如胃疼痛，取胃经的足三里穴；肝
康状态。病取肝经的期门穴。
经络能够“行血气、营阴阳” ，而且是“营行脉中，卫行脉外”， 2、药物归经：药物治疗也是以经络为通路，药物经过经络的
经络使“卫气”密布于皮毛肌肤，具有卫外功能。经络是运行气传导转输而发挥作用。古人经过长期使用和观察总结，推出了“药
血的通路，也是病邪入侵机体的通路。正如《黄帝内经•素问》 “皮物归经”理论。如太阳经头痛，可用羌活、藁本；阳明经头痛，
部论篇第五十六” 所说：
“邪客于皮则腠理开，开则邪入客于络脉，现，每发一次怒或绝望值增加 1 分，高血圧的危险性就增加
可用白芷；少阳经头痛，可用柴胡；厥阴经头痛，可用吴茱萸。
络脉满则注于经脉，经脉满则入舍于腑藏也” 。只要正气足，“正 16%。而高血圧又可成为新的病因，引发其他更严重的疾病
这些药物归属于相关的经脉，同时它们还能引导其它药物归入相
气存内，邪不可干” ，所以经络系统具有防护自身的功能。应的病变经脉，加强治疗作用，故又叫做“引经药” 。
1. 怒甚偏伤气，思多太损神。神疲心易疫， 3、六经论治：中医治疗和养生理论，是“灸法”在“针法”
八．经络的应用
气弱病相因前、“食物疗法”在“药物疗法”前，其发展顺序为：灸—针，食
疗—药疗；针灸治疗早于药物治疗。
按照“三元论”理论，“经络的应用”可归纳为“病理、诊断、
中医药学知识在汉朝之前已经处于比较完善状态，张仲景《伤
治疗”三部分论述。
寒杂病论》的“六经论治”就是把疾病分为三阴三阳“六经辨证”，
（一）病理：的话。思为心所主，《孟子•告子上》中有“心之官则思”的
神依气血所存，正气损伤，岂不心“疫”、病“因”吗！对概括了脏腑十二经的病变。太阳主表、阳明主里、少阳主半表半
1、经络是运行气血的通路，也是外邪入侵由表入里的通路；话。心的主神、主思功能处于正常状态，人就表现出聪明、
于此，孙思邈在他的《千金方》中曾引用魏晋时期养生学家里，而三阴统属于里。
还是正气逼迫邪气外出的通路。经络在病理方面的作用，主要是理智、敏捷、灵活，健康长寿的机会相对就多；反之，人就
嵇康的话说：“养生有五难，名利不去为一难（实乃最大的张仲景提出六经病“提纲证”，如太阳病“脉浮头项强痛而恶
关于“疾病的发生和传变” 。在张仲景《伤寒杂病论》体现最多。会表现出愚笨、粗鲁、迟钝、固执，疾病和灾难的发生率相
心病），喜怒不除为二难，声色不去为三难（确为耗心神、寒” 、阳明病“胃家实是也”、少阳病“口苦咽干目眩”等，建立
2、经络可以反映病候。脏腑病变通过经络会反映在五官九窍对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
伤肾气之大虑），滋味不绝为四难（吃也是非常费脑筋的活），了“六经辨证论治”体系。
或体表相应的区域和穴位。如肝火盛可见目赤；心火盛可见舌尖
（版面所限，参考文献略）
红、甚至溃疡疼痛；胃火可见牙龈肿痛；胆火可见耳暴鸣、暴聋
等。两胁疼痛多为肝胆疾病，肾病见腰痛，胆囊炎患者在胆经的
阳陵泉穴位处有压痛点，肠痈（阑尾炎）在足三里穴下阑尾穴处
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Acupuncture Volume21
Volume 21 Issue
Issue22 September 2014
September 2014
从痰辨证施治顽固性胃食管反流病体会
刘汶
温长路
首都医科大学附属北京中医医院
摘要: 胃食管反流病是指胃酸、胃蛋白酶、胰液、胆汁等胃及十二指肠内容物反流到食管中引起的疾病。本病病
程较长，容易反复发作，西医认为本病需长期治疗甚至需要终生服用抑酸剂维持治疗。笔者认为胃食管反流病病
因与七情失和、饮食不节、禀赋不足有关，顽固性胃食管反流病病机与脾虚痰阻有关，治疗时应健脾化痰，和胃
降逆。
关键词：胃食管反流病；顽固性；痰邪
1.胃食管反流病西医治疗概述
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广，酸，是吐酸水如醋，平时津液随上升之，气郁积而久，湿中
生热，故从火化，遂作酸味”。湿邪郁积化痰，日久化热，
胃食管反流病是指胃酸、胃蛋白酶、胰液、胆汁等胃及
理的孙氏的《摄生咏》中，也有称为《保生铭》和《孙真人诗中也阐明了雷同的观点：
遂生“嘈杂” “自知气发每因情，情在何由气
，临床上多见表现烧心为主，《丹溪心法》中
十二指肠内容物反流到食管中引起的疾病，常见的临床表现
说：“嘈杂是痰因火动，治痰为先。姜炒黄连入痰药，用炒
有反酸、烧心、胸骨后灼痛、反食、咽异物感以及食管外症
山栀子、黄芩为君，南星、半夏、陈皮为佐。热多加青黛。
状如咳嗽、哮喘等。胃食管反流病可分为内镜下阴性的胃食
嘈杂，此乃食郁有热，炒栀子、姜炒黄连不可无。肥人嘈杂，
管反流病、内镜下阳性的胃食管反流病和 Barrett’s 食管。
二陈汤少加抚芎、苍术、白术、炒山栀子。嘈杂若湿痰气郁，
内镜下阴性的胃食管反流病虽有胃食管反流的临床表现，但
不喜食，三补丸加苍术，倍香附子” 。饮食不节日久则伤
内镜检查食管黏膜未见异常，内镜下阳性的胃食管反流病可事，就是一个典型的案例：血气方刚的周瑜性情急躁，容易
怒甚偏伤气，思多太损神。神疲心易疫，气弱病相因。脾胃，导致脾失健运，脾不化湿，聚而生痰，痰凝气滞，从
见食管黏膜的炎症、糜烂、溃疡甚至食管狭窄等，Barrett’ 发怒。深谙心理学的诸葛亮故意用计让他动气，结果没有用
勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。而加重胃气上逆。
s 食管为食管黏膜正常的鳞状上皮细胞被胃的柱状上皮细胞真枪实弹就放倒了这位年仅 36 岁的英雄汉。临床上遇到的
亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。 2.2 七情失和，患者生气、抑郁、恼怒等，引起肝气郁结，
所替代，并伴有肠上皮化生，进一步发展可成为食管腺癌。因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死
肝气横逆犯胃，导致胃失和降，胃气上逆，出现反酸、
亡的病例，在国内外媒体上都不时有过报道。烧心、
，
胃食管反流液中胃酸、胃蛋白酶为酸性液体，胰液、胆
反食、胸骨后疼痛，伴嗳气，胃胀等症状。正如《寿世保
汁为碱性液体。所以反流有以混合型反流为主的，也有以酸
时过境迁，从公元 6 世纪至今，历史的隧道已经向前穿元•吞酸》曰：
“夫酸者肝木之味也，由火盛制金，不能平木，
性反流为主或碱性反流为主的。西医治疗多以碱性药物、抑
越了 15 个轮回，科学已经发展到了人类从地面走向太空的则肝木自甚，故为酸也”。肝气郁结日久，横逆克脾，脾失
酸剂、促动力剂以及保护食管黏膜剂为主。碱性药物有碳酸
健运，导致水湿阻滞，聚而成痰。
氢钠、碳酸钙、铝碳酸镁等，抑酸剂有质子泵抑制剂、H2
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是增加胃中盐酸的流量，影响人的食欲，
2.3 禀赋不足，劳倦内伤，使人发生胃痛、
大病久病之后，恶心，
导致脾胃虚弱，
受体拮抗剂，质子泵抑制剂有奥美拉唑、兰索拉唑、埃索美
脾虚气滞，土壅木郁，导致肝胃不和，胃失和降，胃气上逆，
拉唑、雷贝拉唑、泮托拉唑等等，组织胺 H2 受体拮抗剂有
导致反酸、烧心等症状。另外脾胃虚弱，水湿不化，聚而生
西咪替丁、雷尼替丁、法莫替丁、尼扎替丁、罗莎替丁等。
痰，导致痰湿阻滞，气机逆乱，胃气上逆，出现反酸、烧心、
黏膜保护剂有硫糖铝、枸橼酸铋钾、米索前列醇、麦滋林-S、
嗳气、胃胀等症状。
替普瑞酮、瑞巴派特、惠加强--G 等。胃食管反流病病程较
以上三种证型，如反复发作，都可导致脾胃虚弱，脾失
长，容易反复发作，故被认为是一种顽固性疾病。西医认为发生。癌症的发生也与经常发怒有直接联系，有统计证实，
需长期治疗甚至终生服用药物来抑制胃酸，但临床上可见长
健运，水湿不化，聚而生痰，痰气阻滞，中焦升降失常，胃
气弱病相因气上逆，加重反酸烧心。
期服用抑酸剂的患者可发生霉菌性食管炎、胃肠功能紊乱、再说孙氏诗中说的思伤神，神指的是人的精神意识，是
综上所述，可知胃食管反流病的发生与肝、脾、胃密切
肝功异常、白细胞减少、血小板减少等。
相关，病机多为肝胃不和、湿热中阻、痰湿阻滞，而气机逆
2.胃食管反流病中医病因病机、病“因”吗！对
神依气血所存，正气损伤，岂不心“疫”
乱，胃失和降是其基本病机
的话。思为心所主，。由于本病病程较长，病情易
反复发作，故本病多为本虚标实，本虚是指脾胃虚弱，标实
胃食管反流病属于中医“吐酸”、“嘈杂”范畴，与以下
嵇康的话说：“养生有五难，名利不去为一难（实乃最大的是指痰湿、气滞、热郁等。如反复发作，势必会导致水湿
几方面因素有关：
不化，聚而成痰，最后痰气交阻，脾胃升降失司，胃气上逆，
2.1 饮食不节，患者嗜食肥甘厚腻、辛辣刺激之品，如甜
伤肾气之大虑），滋味不绝为四难（吃也是非常费脑筋的活），对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
从而引起反酸烧心反复发作。顽固性胃食管反流，与脾虚痰
食、巧克力、韭菜、红薯、油煎油炸食物等，暴饮暴食、嗜人、豁达大度的人、善于处世的人，都是有“心计”的；而
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼阻有关，治疗时就应健脾化痰，和胃降逆。
烟、饮酒过度等也易导致脾胃受伤，脾失健运，水湿不化，那些碌碌无为、傻头笨脑、鸡肠小肚、无朋无友的人，或多
日久化热，导致湿热内阻，脾胃升降失常，胃失通降，胃气
中，则信顺日跻，道德日全，不祈善而有福，不求寿而自延， 3.痰邪在胃食管反流病中的临证表现及治疗
上逆而发生反酸烧心。正如朱丹溪在《丹溪心法》中说： “吐大脑的某些功能。把心与脑的部分功能混而谈之，不能片面
此养生之大旨也。”在孙氏反复论证的这段话中，重点强调痰邪是人体因感受外邪、饮食不节、七情失和、禀赋不
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7BJ. London NW4 3RJ
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8951 2560,
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AndAcupuncture
Volume 21 Issue
September 2014
足等原因导致的病理产物。在不同的部位表现则不一样。
“在姓名：孙某性别男 30 岁
肺则咳，在胃则呕，在头则眩，在心则悸，在背则冷，在胁
首诊：09-09-15
则胀，其变不可胜穷也。”痰病的性质可分为湿痰、热痰、对孙真人《养生铭》的现代诠释
主诉：剑突下疼痛 2 个月。
燥痰、寒痰、风痰等。在胃食管反流病中，在不同的部位则
现病史：剑突下疼痛，放射至周边，无明显反酸烧心，咳嗽
温长路
表现不一样，阻滞于经脉可影响气血运行和经络的生理功能，
（饭后），无痰，咽痒，纳可，二便调。
停滞于脏腑可影响脏腑的功能和气机升降。如痰停留在咽喉
检查：09-08-05 胃镜：反流性食管炎，Barrett’s 食管（片
部，则表现为咽异物感，咽中如有物堵，吞之不下，吐之不
状）慢性浅表性胃炎伴糜烂
出；停留在食管，则表现为反酸烧心、胸骨后疼痛；停留在
在我国医学发展史上，孙思邈可谓一位集众多学说之大病理：（窦）轻度慢性炎，腺体轻度萎缩，伴粘膜及小凹上
胃部，则表现为胃胀，胃痛，纳差，恶心，呕吐，嗳气，反
成者，除了传统意义上的医学理论和实践外，把养生防病纳皮增生，（食道）鳞-柱状上皮粘膜慢性炎，伴鳞状上皮单纯
酸、反食等；停留在胸胁，可见胸闷憋气，胸胁胀满；停留
性增生。 “大怒则形气绝，而血菀
在胸膈，则表现为胸闷，咳喘，不能平卧；停留在大小肠，
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题（涌）于上。 ”
望诊：舌淡红苔白。（
《素问•生气通天论》）
则肠间沥沥有声，大便秘结或大便稀溏，黏滞不爽。
闻诊：未闻异常口气及体气。
切诊：脉弱。
4.顽固性胃食管反流病的中医治疗
辨证分析：患者脾胃不和，脾属寒，胃属热，脾胃不和，寒
4.1 痰在咽喉：反酸，烧心，反食，咽部异物感，咽中如充则气激，气激则发怒”。唐代诗人白居易在他在一首制怒
热错杂。脾胃为人体升降之枢纽，升降不利，气机阻滞，故
有物堵，吞之不下，吐之不出；或咳嗽气急，咯痰不爽，涩诗中也阐明了雷同的观点：“自知气发每因情，情在何由气
出现胃脘部疼痛。脾失健运，水湿不化，痰湿内生。胃失和
铭》的。宋代温革的《琐碎录》和 14 世纪朝鲜出版的《医
而难出，胸膈满闷，苔白，脉弦缓或弦滑。贝母瓜蒌散合半得平，若问病根深与浅，此身应与病齐生” 。
降，气机上逆，故咳嗽、咽痒。舌淡红苔白，脉弱，为脾气
夏厚朴汤加减。虚弱之象。综上所述，本证为寒热错杂，痰瘀互阻，胃气上
4.2 痰在胸膈：反酸，烧心，反食，胸痛彻背，胸闷憋气，逆之证。
胸胁胀满，咳嗽痰多，色白难咯，恶心呕吐，胸膈满闷，肢中医诊断：胃痛（寒热错杂，痰瘀互阻）
体困重，或头眩心悸，舌苔白滑或腻，脉滑。瓜蒌薤白半夏西医诊断：反流性食管炎，Barrett’s 食管，功能性消化不
汤合二陈汤加减。良
4.3 痰留食管：胸骨后疼痛，反酸烧心，伴心下痞满，反 36 岁的英雄汉。临床上遇到的
治法：辛开苦降，健脾化痰，理气降逆
真枪实弹就放倒了这位年仅
食，或呕吐，肠鸣下利，舌苔腻而微黄，脉滑，偏于寒热错因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死
方药：泻心汤加减
杂者半夏泻心汤加减；伴头痛目赤，耳聋胁痛，口干口苦口亡的病例，在国内外媒体上都不时有过报道。
，
寿夭休命论，修行本在人。若能遵此理，平地可朝真。清半夏 10g 黄芩 10g 黄连 6g 干姜 3g
粘，舌红苔黄腻，脉弦滑，偏于肝胆湿热者龙胆泻肝汤加减。老百姓的说法一语道破了生气对人类健康的严重危害。
时过境迁，从公元 6 烧心，
4.4 痰在胸胁：反酸，世纪至今，历史的隧道已经向前穿
反食，胸闷憋气，胸胁胀满，吴茱萸 3g 浙贝母 10g 海螵蛸 30g
美国医学专家的一项调查说，一个人经常发怒或心身承瓦楞子 30g
心烦喜呕，不欲饮食，口苦，咽干，头晕目眩，头痛呕逆，青黛 10g 百合 20g 降香 10g 三七面 3g
咳嗽喘急，痰涎粘稠，舌苔厚腻，脉弦滑。导痰汤合小柴胡它会直接损害人的记忆力和对事物的专注力。不良情绪还会
旋覆花 10g 生赭石 10g 白蔹 10g 白及 10g
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是增加胃中盐酸的流量，
海浮石 30g 影响人的食欲，使人发生胃痛、恶心，
汤加减。
4.5 痰邪留胃：反酸，烧心，反食，心下痞闷，按之则痛，
孙真人《养生铭》的立意所在，相信事实会给人们一个有说中药：七剂日一剂水煎服，每日两次。
胃脘痞闷或胀满，纳差，恶心，呕吐，嗳气，反食或心胸闷
服力的答案。中成药：康复新液（100ml*1）X4
学家的研究证实了这一点，他们对瓶/15ML，口服，日
616 名男性对象的调查发
痛，或咳痰粘稠，舌苔白腻，脉缓或滑。旋覆代赭汤合小陷
为了方便叙述，本文将孙真人的这首诗分为五段进行剖三次；复方陈香胃片（0.56g*48 片）X2/4 片，口服，日三
胸汤加减。
次
4.6 痰在大小肠：反酸，烧心，反食，食少难消，脘腹胀
辅助治疗：穴贴神阙-化瘀清胃膏（本院自制）
满，肠间沥沥有声，大便秘结或大便稀溏，黏滞不爽。小便
二诊：09-9-24
气弱病相因
短赤，舌苔白腻或黄腻，脉滑。三子养亲汤合枳实导滞丸加再说孙氏诗中说的思伤神，神指的是人的精神意识，是
减。剑突下仍有疼痛，空腹时明显，嗳气，口干，晨起明显，
笔者在临床实践中，还总结出了一些用药小窍门。如常咳嗽消失，无咽痒，大便日一次，偏干，小便调，纳食可，
用治疗反酸烧心的对药有：乌贼骨、浙贝母，瓦楞子、海浮眠安。舌暗淡苔白，脉弦滑。
石，黄连、吴茱萸，黄连、干姜，煅龙骨、煅牡蛎，海藻、治疗：穴贴神阙-化瘀清胃膏
昆布，龙胆炭、黄芩炭等，可根据具体情况临证加减。中药：十四剂日一剂水煎服，每日两次。
清半夏 10g 黄芩 10g 黄连 6g 瓜蒌 20g
病案举例，滋味不绝为四难（吃也是非常费脑筋的活），
伤肾气之大虑）对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
吴茱萸 3g 浙贝母 10g 海螵蛸 30g 瓦楞子 30g
青黛 10g 百合 30g 降香 10g 三七面 3g
提要：本病例是一功能性消化不良伴有反流性食管炎、
Barrett’s 食管病例，采用《伤寒论》之半夏泻心汤辛开苦旋覆花 10g 生赭石 20g 白蔹 10g 白及 10g
降法治疗，明显缓解。海浮石 30g
13
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MedicineAnd
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Volume 21 Issue
September 2014
三诊：09-10-25 中药：七剂日一剂水煎服，每日两次。
胸骨后隐痛，饥饿时胃痛，进食油腻则大便稀，嗳气减康复新液（100ml*1）X4 瓶/15ML，口服，日三次
轻，口干，不苦，纳可，大便调。舌淡黯苔黄腻，脉沉细。对孙真人《养生铭》的现代诠释
治疗：穴贴神阙-化瘀清胃膏
清半夏 10g 黄芩 10g 醋柴胡 10g 北沙参 15g 七诊 09-12-24

温长路
麦冬 15g 浙贝母 10g 海螵蛸 30g 瓦楞子 30g 胃脘部不适，无疼痛，无反酸烧心，二便调，纳眠可。舌
淡苔白，脉弦滑。
青黛 10g 百合 30g 降香 10g 三七面 3g
旋覆花 10g 生赭石 20g 白蔹 10g 白及 10g 清半夏 10g 黄芩 10g 蒲公英 30g 北沙参 15g
海浮石 30g 的都是情志对养生的决定性作用。
麦冬 15g 浙贝母 10g 旋覆花 10g 生赭石 20g
中药：七剂日一剂水煎服，每日两次。五灵脂 10g 蒲黄炭 10g 黄连 3g 三七面 3g
中成药：康复新液（100ml*1）X2 瓶/10ML，口服，日
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题全蝎 3g”
（涌）于上。（蜈蚣 3 条白蔹
《素问•生气通天论》） 10g 白及 10g
三次
有过许多精辟的论述，并在《千金方》和《千金翼方》中两海浮石
及飱泄。 30g
辅助治疗：穴贴神阙-化瘀清胃膏发，生气——发怒——生气，构成了一条恶性循环链。正如
中药：七剂日一剂水煎服，每日两次。
四诊：09-10-22 康复新液（100ml*1）X4 瓶/15ML，口服，日三次
诸症状均有减轻，偶有进食不适时有胃脘部不适，隐痛，
伴有嗳气，纳可，二便调。舌红苔黄腻，脉弦滑。按语
方类聚》及日本的相关著作中也都有反映。这些版本在文字
清半夏 10g 黄芩 10g 醋柴胡 10g 北沙参 15g
本病例是一反流性食管炎、Barrett’s 食管伴有功能性消
化不良病例。因其症状以胃痛为主要表现，故中医诊断为“胃
麦冬 15g 浙贝母 10g 海螵蛸 30g 瓦楞子 30g
痛”。患者脉弱，是脾虚表现；胃痛，是胃失和降，气滞血
五灵脂 10g 蒲黄炭 10g 降香 10g 三七面 3g
瘀所致。脾虚痰湿不化，气滞血瘀，痰瘀互阻，导致血腐肉
旋覆花 10g 生赭石 20g 白蔹 10g 白及 10g
败，故形成反流性食管炎、Barrett’s 食管。由于脾属脏，
海浮石 30g 发怒。深谙心理学的诸葛亮故意用计让他动气，结果没有用
勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。属阴；胃属腑，属阳。脾虚多为脾阳不振，中焦虚寒，痰湿
中成药：七剂日一剂水煎服，每日两次。
亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。内阻；胃气不降，多郁而化热。故脾病多寒，胃病多热。脾
辅助治疗：穴贴神阙-化瘀清胃膏
若要无诸病，常当节五辛。安神宜悦乐，惜气保和纯。胃不和多为寒热错杂。故属于寒热错杂，脾胃不和，痰瘀互
亡的病例，在国内外媒体上都不时有过报道。 “气是杀人贼”，
寿夭休命论，修行本在人。若能遵此理，平地可朝真。阻。用《伤寒论》之半夏泻心汤寒热并用，辛开苦降，故能
五诊 09-10-29 老百姓的说法一语道破了生气对人类健康的严重危害。
时过境迁，从公元 6 世纪至今，历史的隧道已经向前穿起到较好疗效。用失笑散、全蝎、蜈蚣以活血通络止痛，用
胸骨后稍有隐痛，偶有嗳气，纳可，二便调。舌红苔黄，美国医学专家的一项调查说，一个人经常发怒或心身承
越了 15 个轮回，科学已经发展到了人类从地面走向太空的浙贝母、瓦楞子、海浮石等清化顽痰，用白蔹、白芨敛疮止
脉沉弦。受的压力太大，机体会分泌出一种代谢类固醇──皮质醇，
时代，膏粱厚味之外，琳琅满目的各色保健品足以让人眼花血，治疗反流性食管炎、Barrett’s 食管之粘膜充血糜烂，
清半夏 10g 黄芩 10g 蒲公英 30g
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是北沙参 15g 可谓古方今用。本病例是一辨证与辨病相结合的典型案例。
麦冬 15g 浙贝母 10g 海螵蛸 30g
需要科学者正面回答的问题，也正是本文要用现代观点诠释瓦楞子 30g 甚至导致溃疡病的发生。发怒和绝望的情绪是造成血压升高
五灵脂 10g 蒲黄炭 10g 黄连 3g 三七面 3g 作者简介
服力的答案。
旋覆花 10g 生赭石 20g 白蔹 10g 白及 10g 学家的研究证实了这一点，他们对 616教授，
名男性对象的调查发
刘汶，医学硕士。北京中医医院主任医师，硕士研究生导师，
海浮石 30g 感染科主任。长期从事消化系统胃肠及肝胆疾病的临床、科研及教
学。已发表学术论文 40 余篇，并参加了《实用中医消化病学》
、《中
中药：七剂日一剂水煎服，每日两次。发生。癌症的发生也与经常发怒有直接联系，有统计证实，
1. 治疗：穴贴神阙-化瘀清胃膏
怒甚偏伤气，思多太损神。神疲心易疫，医消化病诊疗指南》等书的编写，著有《刘汶脾胃病临证心悟》一
书。现为北京市突发公共事件中医药应急专家委员会专业组专家，
六诊 09-12-17 北京中西医结合学会临床营养治疗专业委员会副主任委员，北京市
饮食不慎后胸骨后疼痛，反酸烧心，时有嗳气，无恶心中西医结合消化病专业委员会秘书，北京市中医药学会肝胆病专业
之所伤，脾胃之气也；喜之所伤，心气也。舌红苔黄，脉弱。
气乃肺、肾所主，神志的主宰者是心，
呕吐，口干，无口苦，二便调，纳眠可。委员会秘书长，北京中西医结合学会第六届肝病专业委员会委员，
神依气血所存，正气损伤，岂不心“疫”、病“因”吗！对的话。思为心所主，《孟子•告子上》中有“心之官则思”的
北京中医药学会感染专业委员会委员，北京中医药学会心身医学（精
清半夏 10g 黄芩 10g 蒲公英 30g
于此，孙思邈在他的《千金方》中曾引用魏晋时期养生学家北沙参 15g
神与卫生）专业委员会委员，
《中华中医药杂志》
、《中国实验方剂学》
麦冬 15g“养生有五难，名利不去为一难（实乃最大的
嵇康的话说：浙贝母 10g 海螵蛸 30g 瓦楞子 30g
审稿专家，《光明中医》杂志社编委，《中国医药导报》特约专家，
五灵脂 10g 蒲黄炭 10g 黄连 3g 三七面 3g
《中国中医药现代远程教育杂志》特约专家，世界中联脾胃病专业
全蝎 3g ，滋味不绝为四难
蜈蚣 3 条（吃也是非常费脑筋的活）
白蔹 10g 白及 10g ，
委员会理事，世界中联亚健康专业委员会理事。
海浮石 30g
13
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House, Unit 5,Road,
London, HA8Gardens,
7BJ. London NW4 3RJ
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8951 2560,
The Journal
The Journal of
of Chinese
Chinese Medicine
MedicineAnd
AndAcupuncture
Acupuncture Volume 21
Volume 21 Issue
Issue 22 September 2014
September
桂枝加葛根汤运用心得
黄伟（Falkirk）
摘要: 桂枝加葛根汤见《伤寒杂病论》第十三篇，辩太阳病脉症并治上。桂枝加葛根汤用于太阳病，头项强痛，
温长路
项背强紧紧，有汗怕风的病人。太阳病，汗出恶风，是桂枝汤证。只用桂枝汤，仅能解肌祛风，调和营卫，对驱
除经脉中邪气力量不够，所以加葛根就成了桂枝加葛根汤。经方应用中，剂量问题一直有诸多争论，本文觉得必
须严格把握剂量。随着中医药学发展，桂枝加葛根汤的运用已经大大超过了“伤寒”的范畴，且得到了现代药理
学的广泛支持。的都是情志对养生的决定性作用。
关键词：太阳病；桂枝加葛根汤；心得；中医；现代药理就孙氏诗中所说之怒伤肝言，它是人情志受损的一种表
1.经文今悟
寒邪入经本来是无汗的，但病人却有汗，这就提示了寒邪在
经，经气不利。正因为外有风邪，风主疏泄，卫阳被伤，卫
1.1原文学习
外失司，所以有汗出。外有风邪，卫阳被伤，伤得较轻，所
桂枝加葛根汤见于《伤寒杂病论》第十三篇，辨太阳病
以有惡风——当风则恶，无风则缓，是畏寒比较轻的一个症
脉证并治上。
状。太阳病，汗出恶风，是桂枝汤证。但只用桂枝汤的话，
原文为：太阳之为病，脉浮，头项强痛而恶寒。太阳病，
仅能解肌祛风，调和营卫，对驱除经脉中的邪气力量不够，
项背强几几，反汗出恶风者，桂枝加葛根汤主之。（几音：
所以加一味葛根，于是就成了桂枝加葛根汤。桂枝加葛根汤
上虽然有些出入，但其基本内容是一致的。陕西耀县的药王
紧，紧固拘挛不柔和貌）方三。肝胆系统。因怒导致的机体的气血逆乱，会使人出现头痛、
山上，也保存有这首诗的石刻件，还不时被中外游人转抄和可以解肌驱风，疏通经脉。葛根在此有三个作用：1.升阳发
目胀、面红、耳赤、呕血、憋气等症状。甚则使人昏厥卒倒，
葛根四两麻黄二两（去节）芍药二两桂枝二两（去皮）
效法。其诗全文如下：表，助桂枝汤解肌驱风，
因此致死者也不罕见。并鼓舞胃气上行。桂枝汤养营力强，
《三国演义》中诸葛亮三气周瑜的故
甘草二两（炙）生姜三两（切）大枣十二枚（擘）右七味，
发汗力弱，发汗需要喝热稀粥200ml并盖被子，而加葛根就
以水一斗，先煮麻黄、葛根减二升，去上沫，内诸药，煮取
可以助桂枝汤发汗达表，故桂枝加葛根汤不需要再喝热稀粥；
三升，去滓，温服一升，覆取微似汗，不须啜粥，余如桂枝
2.疏通经脉，驱除经脉中的邪气；3.升津液，起阴气，滋润
法将息及禁忌。（仲景本论，太阳中风自汗用桂枝，伤寒无
经脉。
汗用麻黄，今证云汗出恶风，而方中有麻黄，恐非本意也。
，
第三卷有葛根汤证，云无汗、恶风，正与从方同，是合用麻
2.现代药理研究拾遗
黄也。此云桂枝加葛根汤，恐是桂枝中但加葛根耳）[1]
2.1葛根概览
1.2量效要领受的压力太大，机体会分泌出一种代谢类固醇──皮质醇，
时代，膏粱厚味之外，琳琅满目的各色保健品足以让人眼花现代药理研究证实，葛根具有显著的β受体阻滞效应。
正确运用经方，须把握剂量。按汉代度量衡：汉1斤＝250g；它会直接损害人的记忆力和对事物的专注力。不良情绪还会
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是葛根降低血压，减慢心率，扩张冠状动脉，降低心肌耗氧，
1两＝15.625g；汉1合＝20ml；1升＝200ml；1斗＝2000ml；增加胃中盐酸的流量，影响人的食欲，使人发生胃痛、恶心，
需要科学者正面回答的问题，也正是本文要用现代观点诠释与心得安等β受体阻滞剂作用相似，但无明显抑制心脏作用，
1斛＝20000ml[2]
孙真人《养生铭》的立意所在，相信事实会给人们一个有说能使β受体兴奋引起的心电图S - T段异常,得到改善或恢复
所以，桂枝加葛根汤方应为：葛根60g 芍药30g 桂枝30g
服力的答案。正常[3]。
炙甘草30g 生姜45g（切）大枣十二枚（擘）。加水2000ml，
为了方便叙述，本文将孙真人的这首诗分为五段进行剖研究表明葛根所含葛根素和葛根总黄酮有扩张脑血管,增
先煮葛根，去除泡沫后待水减少至1600ml时，加入其余五味，
加脑血流量,扩张冠状动脉,增加冠脉流量,抑制血小板聚集的
再煎至600ml，每次温服200ml。除不以热粥助药力外，其余
作用。尚有降低外周血管阻力，降低血压的作用。
注意事项同桂枝汤。癌症患者中易发怒的人明显高于性格温和的人。
研究发现,葛根煎剂具有降低家兔血糖的作用，改善脂肪
气弱病相因
身材魁梧的照此剂量，若身材娇小则取此方三分之一量，再说孙氏诗中说的思伤神，神指的是人的精神意识，是
细胞的胰岛素抵抗,从而增强脂肪细胞对葡萄糖摄取利用的
灵活掌握。人类区别于其它动物、独具聪明智慧表现的主要指征之一。
这一节总体上是讲精神养生的，怒之所伤，肝气也；思能力及改善Ⅱ型糖尿病患者胰岛素的抵抗和降低空腹血糖
1.3膀胱经生理复习
之所伤，脾胃之气也；喜之所伤，心气也。气乃肺、肾所主，的作用。
太阳膀胱经上连风府，与督脉相通；下络腰肾，和肾相葛根发汗解热的作用,不但可用于风寒感冒,同时也可用
连，可借助督脉和肾的阳气主管全身表阳。又有太阳膀胱经于风热感冒,尤对太阳表证项背强直、头痛疗效更好,同时还
散布于心，可影响心的功能。而且，膀胱在肾阳的温煦作用可治疗麻疹初起,疹出不畅之症。
下通过气化化生阳气后，通过太阳膀胱经脉和三焦经脉向体葛根提取物能促进未成熟大鼠乳腺、子宫发育,使其功能
表输布；膀胱还化生津液向全身输布并排泄水。正常发挥,从而使乳腺、子宫重量增加,同时又能增加血清E2、
FSH、LH水平表明其对垂体—卵巢轴具有兴奋作用[4]。
1.4膀胱经病理及桂枝加葛根汤的效用
葛根素能增加外周血内皮细胞(endothelial
或少都缺了点“心眼” 。很显然，心的这些功能里，包括了 progenitor cell，
中，风寒入侵太阳经脉会出现多种太阳病的临床症状。太阳
则信顺日跻，道德日全，不祈善而有福，不求寿而自延，
EPC) 数量,且能改善EPC增殖、迁移黏附和体外血管生成能
病本身有头项强痛，头痛，后项部肌肉拘紧不柔和。太阳病
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力。提示葛根素不但直接对内皮细胞具有保护作用，可能同煎剂灌胃，能增加正常大鼠足跖部的汗腺分泌，能抑制
时增加EPC的数量，并改善其功能从而促进内皮修复改善冠安痛定所致的汗腺分泌亢进和拮抗阿托品引起的汗腺分泌
心病患者的临床症状和预后。对孙真人《养生铭》的现代诠释
减少；灌胃，能抑制因注射新斯的明引起的小鼠肠蠕动亢进
葛根素具有保护鼻黏膜上皮细胞免受雌激素缺乏的损害和拮抗肾上腺素引起的肠蠕动抑制。桂枝汤煎剂灌胃对免疫
作用,葛根总黄酮对卵巢切除大鼠鼻黏膜的保护作用可能在温长路
功能已呈抑制的病毒感染小鼠，可提高其巨噬细胞吞噬功能、
于大豆黄酮的雌激素样作用,也可能与抗氧化等作有关[5]。血清凝集素、溶血素效价和外周血中T细胞百分率，使之恢
葛根素在机体缺血再灌注时通过抑制细胞内Ca2 + 的聚复到正常；而对免疫功能已增强的左旋咪唑处理小鼠，则降
集,减轻细胸损伤；葛根素上调BcL-2（B-细胞淋巴瘤基因2）低其血清凝集素、溶血素效价和外周血中T细胞百分率，使
蛋白的表达,下调Bax蛋白的表达,从而抑制神经细胞凋亡,发之接近或恢复到正常水平。
挥神经元保护作用。上述研究表明桂枝汤在体温、汗腺分泌、肠蠕动、免疫
葛根素可减轻缺血性大鼠脑细胞的损伤，提高其HSP70 等方面具有双向调节作用，为其调和营卫即补身救弊，调节
蛋白表达水平，通过诱导细胞表达HSP70,而对神经细胞的损
有过许多精辟的论述，并在《千金方》和《千金翼方》中两紊乱的内涵提供了一定的现代理解。
伤产生保护[6]
2.3桂枝汤配伍研究拾穗
高剂量葛根素对选模引起大鼠的全血过“浓”“黏”导
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广，《淮南子》所言： “人之性，有所侵犯则怒，怒则血充，血
配伍研究：以抑制流感病毒性肺炎、角叉菜胶性足肿胀、
致的全血高、中、低切黏度值异常升高,具有显著抑制作用。
碳末廓清（RES）功能为指标，利用正交设计实验，观察到
葛根素还可通过显著降低血液屈服应力起到改善血“凝”的诗中也阐明了雷同的观点：“自知气发每因情，情在何由气
全方抑制病毒性肺炎、增强RES功能的作用显著强于组成药
作用。而其对急性血瘀症大鼠过高的细胞聚集指数和血小板得平，若问病根深与浅，此身应与病齐生” 。
味的各种组合，全方减去任何一种药味都会影响疗效。对于
最大聚集率的双重降低作用，表明葛根素具有抑制血“聚” 怒气大发，相应的疾病就会因之而生，受害最直接的是
不同观察指标，方中各组成药味在全方中所起的作用不同：
的作用[5]。肝胆系统。因怒导致的机体的气血逆乱，会使人出现头痛、
桂枝以抗炎为主，芍药以抑制病毒为主，而大枣以提高RES
2.2桂枝汤新解
效法。其诗全文如下：功能为主。方中各组成药味间有协同、拮抗等不同关系：桂
现代药理研究表明：桂枝汤具有发汗解表，抗炎镇痛，枝伍芍药，其抗炎作用增强；桂枝伍生姜，其抗炎和RES功
抑制病毒，镇咳，祛痰，平喘，调节肠道、免疫功能和心脑能增强；芍药伍甘草，其抗病毒、抗炎和提高吞噬活性等功
血流等作用。真枪实弹就放倒了这位年仅 36 岁的英雄汉。临床上遇到的
能增强；芍药伍大枣，其抑制肺炎病变的作用增强，对RES
1.抗病毒、抗炎、镇静、镇痛等作用：桂枝汤煎剂灌胃能因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死
活性的提高有拮抗作用；甘草伍大枣，其抗炎和提高RES功
显著抑制小鼠流感病毒性肺炎的肺肿胀；经此方灌胃处理后亡的病例，在国内外媒体上都不时有过报道。
，
能增强。提示在抗病毒感染方面，桂枝汤方中诸药在配伍上
的兔、大鼠血清在体外能显著抑制副流感等病毒致细胞病变老百姓的说法一语道破了生气对人类健康的严重危害。
具有协同增效性，方中药物在配伍上的重要性与药理作用的
作用。灌胃能对抗小鼠皮肤毛细血管通透性增高，抑制角叉选择有关。
菜胶或甲醛性足肿胀的形成和发展；能显著减少小鼠的自主对大、小鼠的时间药理学研究表明，桂枝汤对活动期动
活动，可与巴比妥钠协同，提高入睡率，延长睡眠时间；能物的解热作用强于静止期动物，提示桂枝汤对人宜白昼服用。
降低醋酸刺激腹膜所致的扭体发生数；腹腔注射能提高小鼠提高环境温度并辅以药后灌服小米粥，能增强桂枝汤的抑制
对热刺激的拟疼痛阈值。煎剂灌胃能延长氨水诱致的小鼠咳病毒性肺炎和单核巨噬细胞吞噬功能，说明“啜热粥温覆以
嗽时间、提高气管内酚红排泌量；能延长组胺诱致豚鼠哮喘
服力的答案。助药力”的科学性。以小鼠巨噬细胞功能为指标，桂枝汤一
发生的潜伏期；灌胃后20分钟即能明显增加正常兔的心肌血
为了方便叙述，本文将孙真人的这首诗分为五段进行剖日2剂的作用强于一日1剂，连日服的作用强于非连日服。一
流量，作用持续达2小时。
析，每两句为一节，先从第一节说起。日总量分三次口服，每次间隔2.5小时，作用也明显强于总量
2.双向调节作用：桂枝汤煎剂灌胃可降低正常以及酵母所一次服，证明桂枝汤宜多次分服的合理性。[7]
致大鼠发热，对安痛定所致的大鼠体温降低有升温作用。进癌症患者中易发怒的人明显高于性格温和的人。
气弱病相因
一步研究发现，在体温升高的大鼠，桂枝汤煎剂灌胃可阻断 3.小结
发热激活物和白介素-1、干扰素、肿瘤坏死因子等内生致热
因而，在临床上以此方治疗“普通感冒、流行性感冒、
源的作用，降低前列腺素E2和环核苷酸（cAMP）等中枢发
面神经麻痹、原发性震颤、僵人综合征、乙脑后遗症、重症
热介质在下丘脑中的含量及作用，促进体温调节中枢神经递
肌无力、慢性多发性肌炎、高血压、脑动脉硬化、颈椎病”
质5-羟色胺的降解灭活、抑制乙酰胆碱的作用，激活致冷神
等有风寒入太阳，表虚的“头项强痛，项背强几几”症状者
经调质蛙皮素受体的活性，从而发挥其降温作用；在低体温理智、敏捷、灵活，健康长寿的机会相对就多；反之，人就
多可获良效。
机体，桂枝汤可提高前列腺素E2和cAMP等中枢发热介质在
下丘脑的含量，阻断发热神经递质5-羟色胺的降解灭活，提， 4.典型病例
高其在体温调节中枢中的含量，拮抗致冷神经递质去甲肾上
李某某，女，24岁，餐馆服务员。2010年4月26日诊。主
腺素作用，激活传出神经能受体，从而发挥其升温作用。
诉：咳嗽，高热，头痛，颈项强痛，恶风伴疲乏十多天。十
多天前患“感冒”，出现发热，咽喉痛，头痛，颈项强痛，
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身痛。服西药后出汗，咽喉痛，身痛好转，体温下降，但复参考文献
又出现咳嗽少痰，高热（39℃ --39.8℃ ），头痛，颈项强
[1] 刘渡舟主编《伤寒论校注》，人民卫生出版社 1991年6月；
痛，恶风伴全身疲乏。继续服“感冒药”“抗生素”一周多对孙真人《养生铭》的现代诠释
伤寒论卷第二五三 83
疗效不明显。经人介绍前来就诊。 [2] 郝万山《汉代度量衡制和经方药量的换算》，[J]中国中医药
温长路现代远程教育 2005：3（3）48-51
刻诊：面稍赤，覆厚衣戴帽，精神差。口唇稍干。咳嗽，
咯少许黄痰。头痛，颈项强痛，恶风，疲乏。无鼻塞，清涕 [3] 吕欣然，陈淑梅，孙塘《葛根对β-肾上腺素能受体阻滞作用
及咽喉疼痛。查：体温39.5℃，扁桃体无充血肿大及化脓，的研究》[J];药学学报，1980，15（4）：218-221.
舌微红苔薄黄稍干，脉浮稍数。诊断：1.呼吸道感染。2.流 [4] 郭建平，孙其荣，周全《葛根药理作用研究进展》〔J〕.中
感？辨证：太阳中风证兼经气不利。草药，1995,26(3):163—165.
治疗：当解肌祛风，升津舒筋，辅以清热解毒。予针刺。 [5] 崔树明《中药葛根的药理研究及进展》[J]内蒙古中医药，
入人类的健康大系，并使他成为具有理论与实际一体的特色现。《黄帝内经》中有明确地论述： “大怒则形气绝，而血菀
桂枝加葛根汤：葛根20g 芍药10g 桂枝10g炙甘草10g 生姜 1006-0979（2005）增：58-60
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题（涌）于上。 ”（《素问•生气通天论》）
[6] 张相彤等《葛根素对成年大鼠创伤性脑损伤神经细胞的保护
有过许多精辟的论述，并在《千金方》和《千金翼方》中两3
15g（切）大枣5枚（擘），二剂。“清肺口服液”20ml/次及飱泄。”（《素问•举痛论》）也就是说，怒因气生，气则怒
作用》〔J〕创伤外科杂志，2007（3）:241-244.
次/日。
[7] http://www.baike.com/wikdoc/sp/qr/history/version.do?ver=13&
4月28日复诊，头痛已瘥，颈项强痛，恶风，疲乏及咳嗽
hisiden=tBwREAw,
明显好转。体温37.3℃。续用前法，再予桂枝加葛根汤三剂，
生姜减量至9g。诗中也阐明了雷同的观点：“自知气发每因情，情在何由气
5月1日复诊，诸证已除，予加减八珍汤五剂调养。5月3 得平，若问病根深与浅，此身应与病齐生”
。
日电话告知体力睡眠已经恢复正常并开始正常工作。怒气大发，相应的疾病就会因之而生，受害最直接的是
Is Acupuncture Effective in Improving
勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。 Fertility in Patients with
Polycystic Ovary因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死
亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。 Syndrome?
Guijie Wang
，
EnLong Ltd, London. Email:
时过境迁，从公元 6 世纪至今，历史的隧道已经向前穿 [email protected]
Abstract: Polycystic ovary syndrome (PCOS) affects 5-15%受的压力太大，机体会分泌出一种代谢类固醇──皮质醇，
of women of reproductive age and causes 50-70% of
female infertility in anovulation. Many research studies showed
时代，膏粱厚味之外，琳琅满目的各色保健品足以让人眼花 the positive results on using acupuncture treatment
PCOS. In order to further assess the effectiveness, this study
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是 reviewed
增加胃中盐酸的流量， the published clinical treatments
影响人的食欲，使人发生胃痛、results 恶心，
between 1995 and 2014. Data from 6 research papers was further analysed. Results showed that 5 out of 6 study
results show that acupuncture treatment is effective in treating PCOS which showed significantly higher ovulation
rate and pregnancy rate compared to clomiphene treatment or的主要原因，引起血管收缩，导致舒张压明显上升。芬兰科
孙真人《养生铭》的立意所在，相信事实会给人们一个有说 in a self-controlled study. Another study did not show
服力的答案。its effect compared to sham control. In view of the absence of published research using patient sample size above
100 and less fully randomly controlled experiment and standard treatment procedure, a better RCT and standard
为了方便叙述，本文将孙真人的这首诗分为五段进行剖现，每发一次怒或绝望值增加
study is needed to further confirm the effectiveness of acupuncture treatment PCOS. 1 分，高血圧的危险性就增加
Key words: Polycystic ovary syndrome; Acupuncture; Ovulation rate and pregnancy rate
1. Introduction
气弱病相因 patients often suffer from menstrual abnormalities,
leading to difficulty in getting pregnant. Other common
Polycystic ovary syndrome (PCOS) affects 5-15% of 人类区别于其它动物、独具聪明智慧表现的主要指征之一。
这一节总体上是讲精神养生的，怒之所伤，肝气也；思 symptoms are excess hair growth on the lips and legs,
之所伤，of
women reproductive
脾胃之气也； age and 心气也。
喜之所伤， causes 50-70%
气乃肺、of female
肾所主，神志的主宰者是心，
facial acne, weight《灵枢•大惑论》
gain, et al 中有 “心者，神之舍也”
(Goodarzi, 2011). In
infertility in anovulation (Broekmans, et al., 2006). women in adolescence, infrequent or absent menstruation
Two-thirds of women with PCOS have metabolic may signal the signs and symptoms of PCOS. In women
dysfunction which increases risks of developing type 2 past adolescence, difficulty becoming pregnant or
diabetes mellitus
嵇康的话说： and cardiovascular disease (Goodarzi
“养生有五难，名利不去为一难（实乃最大的理智、敏捷、灵活，健康长寿的机会相对就多；反之，人就
unexplained weight gain may be the first sign (Dronavalli
and Azziz, 2006). In most PCOS cases, the ovaries
and Ehrmann, 2007).
become enlarged and contain numerous small, immature The aetiology of PCOS is unclear. The biochemical
follicles scattered along the outer edge of each ovary, this changes of the syndrome include elevated levels of
may cause failure to release eggs upon maturation. insulin and luteinizing hormone (LH), in about 70% of
PCOS is characterised by ovulatory dysfunction,
women with PCOS, there is lower or no effect on
oligo/amenorrhea, and polycystic ovaries不求寿而自延，
(Hull, 1987; 或少都缺了点“心眼”。很显然，心的这些功能里，包括了
中，则信顺日跻，道德日全，不祈善而有福， follicle-stimulating hormone (FSH) and this will cause
Jonard, 2005; Dronavalli
此养生之大旨也。 and Ehrmann, 2007). PCOS
”在孙氏反复论证的这段话中，重点强调大脑的某些功能。把心与脑的部分功能混而谈之，不能片面
the LH/FSH ratio increase to more than 2.5 (Ma et al.,
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of Chinese
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AndAcupuncture
Volume 21 Issue
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1996). Ovarian androgen production was increased in study (Shi et al., 2001). Clinical evidence also showed the
about 50–75% of women with PCOS, which impair effectiveness of acupuncture in assisting the reproductive
follicle development (Goodarzi, 2011). In the face of a treatment either in clinical trial (Zai et al., 2003; So et al.,
high LH/FSH ratio, more androsternedione is synthesized 2009; Moy et al., 2011) or in system meta-analyses
but not aromatised, thus perpetuating a vicious cycle (Zheng et al., 2012; ).
driving LH production and prolactin production which 温长路 Some research showed the benefit of acupuncture
induces granulose cell differentiation and subsequent treatment on PCOS. However, the true effectiveness
follicle growth (Franks, et al. 1999; Marx and Mehta,
中华中医药学会（100029）hasn’t been thoroughly analysed due to avoiding bias or
2003). Acupuncture treatment can reverse the increased poor design. The aim of the study was to review its
LH and decreased ratio of LH:FSH (Stener-Victorin and effectiveness by analysis the published data.
Manneras, 2008). Increased fat mass and central adiposity
are related to hyperinsulinaemia from prepuberty to 2. Methodology
postmenarche (Hasson et al., 2003). Weight gain worsens Papers published in English or Chinese with English
metabolic disorders, e.g. dyslipidemia, insulin resistance abstract from 1995 to 30th March 2014 have been
and hyperandrogenism et al., and reproductive （涌）于上。 ”（《素问•生气通天论》）“怒则气逆，甚则呕血
electronic searched. They were from: (1) PubMed and
abnormalities, e.g. menstrual irregularity and infertility in
有过许多精辟的论述，并在《千金方》和《千金翼方》中两及飱泄。 ” （《素问•举痛论》）也就是说，怒因气生，气则怒
Medline using key words: polycystic ovary syndrome and
obesity women with PCOS (Ciaraldi et al., 2009; Aroda
次作过专门总结，这是有典可据的。除此以外，有关孙思邈 acupuncture; 49 papers were found. 12 papers were found
et al., 2008). With 20–40% of first-degree female
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广， if further searched
《淮南子》所言： by using polycystic ovary syndrome,
relatives of women with PCOS affected by the PCOS acupuncture, and clinical trial. Among them, 3 papers
compared to the general population (prevalence 4–6%) were related to ovulation. Among them, 1 paper was on
(Vink et al., 2006)
both ovulation and pregnancy but it is written in Chinese
There is no golden standard
铭》的。宋代温革的《琐碎录》和 for the long-term
14 世纪朝鲜出版的《医得平，若问病根深与浅，此身应与病齐生”
with English abstract. (2). Electronic medical 。 database
treatment of women with PCOS. Treatment generally
方类聚》及日本的相关著作中也都有反映。这些版本在文字 from China National Knowledge Infrastructure (CNKI)
focuses on management of individual main concerns, as was searched. A total of 49 published papers were found
the medications may include ameliorating from 1995 until 30th March 2014, using key words: 多
hyperandrogenic symptoms, inducing ovulation, 目胀、面红、耳赤、呕血、憋气等症状。甚则使人昏厥卒倒，
囊卵巢综合征 (PCOS), 针灸 (acupuncture) or 针刺
regulating menstruation and preventing complications
(Marx and Mehta, 2003). Treatments include oral (needle pricking) and 临床观察 (clinical observation).
contraceptives (Banaszewska, 2011) containing synthetic Among them, 27 papers are clinical trials, and all studies
with words like "randomization" or "quasi-
estrogen and progesteronein; insulin sensitizers (Geller et
al., 2011), e.g. metformin, in order to decrease insulin randomization"
真枪实弹就放倒了这位年仅 in their abstracts, and only 4 papers meet
36 岁的英雄汉。临床上遇到的
levels; Clomiphene citrate, an oral anti-estrogen the selective criteria
因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死 (including one paper found in
若要无诸病，常当节五辛。安神宜悦乐，惜气保和纯。 PubMed). Articles that were deemed to provide the，
medication, should be taken in the first part of her 亡的病例，在国内外媒体上都不时有过报道。 “气是杀人贼”
menstrual cycle in order to help ovulation (Dronavalli greatest contributions to understanding acupuncture on
and时过境迁，从公元
Ehrmann, 2007; 6 McFarland, 2012); and lifestyle the ovulation and infertility research in human clinical
世纪至今，历史的隧道已经向前穿 trial.美国医学专家的一项调查说，一个人经常发怒或心身承
Four papers with clomiphene (a medicine used to
interventions, e.g. eating balanced diet with high in fibre
越了 15 个轮回，科学已经发展到了人类从地面走向太空的 improve ovulation) treatment as control group were
and do regular exercise to keep an ideal weight (Carmina
et al., 2003; Manneras et al., 2008). selected for statistical reanalysis. Numbers of non-
Chinese medicine has achieved some positive effects
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是 pregnancy and non-ovulation in treatment and control
in treatment of PCOS. According to TCM theories, PCOS groups were reanalysed based on previously published
is caused by the dysfunction in the Liver, Kidney and paper’s data.
孙真人《养生铭》的立意所在，相信事实会给人们一个有说 Selected criteria: randomly controlled trials that
Spleen systems, especially the imbalance and regulation
服力的答案。
of the kidney (Tiangui), Chong and Ren (Hou et al., studied the efficacy of acupuncture
学家的研究证实了这一点，他们对 616treatment
名男性对象的调查发 in infertile
2008). Acupuncture, an integral part of TCM, has been women with PCOS.
现，每发一次怒或绝望值增加 1 分，高血圧的危险性就增加 In this review, reanalysis papers
applied to the treatment of human diseases, e.g. pain,
析，每两句为一节，先从第一节说起。 with 1) controlled group treated with clomiphene and 2)
dating back 3000–5000 years. Acupuncture has been treatment group using acupuncture only. In other papers,
using self-control or control group with sham treatment.
widely
1. used by patients for infertility problems, although
怒甚偏伤气，思多太损神。神疲心易疫，
their efficacy has not yet been fully established. The exclusion criteria are 1) the trial with a group size
气弱病相因
Acupuncture treatments decrease total testosterone and below 10; 2) diseases, e.g. congenital disease, physical
other sex steroid levels, reduce the LH/FSH ratio, and defect, cancer; adrenal gland disease, thyroid disease, 3)
这一节总体上是讲精神养生的，怒之所伤，肝气也；思 acupuncture treatment combined with herbs or western
improve menstrual frequency without adverse effects. 神志的主宰者是心，《灵枢•大惑论》中有“心者，
Several randomized controlled trial (RCT) have been medicine, using hormone treatment within 神之舍也”
3 months
performed to evaluate the effects of acupuncture on
神依气血所存，正气损伤，岂不心“疫” 、病“因”吗！对 before
的话。思为心所主， trial. 《孟子•告子上》中有“心之官则思”的
hyperandrogenism and oligo/amenorrhoea in women with
All papers on acupuncture treatments related to
PCOS who do not attempt to conceive (Chen et al., 2007; pregnancy or ovulation have been considered and the
嵇康的话说： “养生有五难，名利不去为一难（实乃最大的 indices are: 1) For pregnancy test, the couples live
Pastro et al, 2011). Case-control studies suggest that 会表现出愚笨、粗鲁、迟钝、固执，疾病和灾难的发生率相
acupuncture has stronger effects than physical exercise on together for at least 2 years and having normal sexual life
without taken the contraception, and the ratio of LH to
these variables (Jedel et al., 2011). Acupuncture on Yishu
(also called Weiwangxiashu, EX B3) point also showed
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼 FSH is above 2-3. The volume of both ovaries is
significant improvements in ovulation rate in PCOS increasing under
那些碌碌无为、傻头笨脑、鸡肠小肚、无朋无友的人，或多the B-ultrasonic screen, the reflective
patients with non-insulin-resistance (Hu不求寿而自延，
et al., 2009). sound
或少都缺了点“心眼” increasing and anovulation; 2) Pregnancy
。很显然，心的这些功能里，包括了
中，则信顺日跻，道德日全，不祈善而有福， diagnosis: pregnancy should be recognised if following
Treatment on Yishu also showed the regulation of islet 大脑的某些功能。把心与脑的部分功能混而谈之，不能片面
function and reducing the hyperglycimia in an animal criteria are met: amenorrhea above 40 days, Konsuloff's
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reaction is positive and HCG concentration is above treatment); Polycystic ovary

3IU/L, and pregnant sac can be seen under obstetric syndrome; Clinical trial; Pregnancy
ultrasonography; 3) Definition of ovulation should be and ovulation (Chinese paper plus
based upon the following test: the basic body temperature
clomiphene)
wave is showing the biphasic pattern, the diameter of the
ovarian folicle is above 18 mm in the preovulatory phase 温长路Selected to meet the criteria 3 3
and the diameter is reduced in the postovulatory phase; 4)
Diagnostic criteria of PCOS: Menstrual abnormality
中华中医药学会（100029） The initial literature search identified 92 papers in
include menstrual intervals longer than 35 days; fewer total using the key word acupuncture and polycystic
than eight menstrual cycles a year; failure to menstruate ovary. With the key word of clinical trial added, it
for 在我国医学发展史上，孙思邈可谓一位集众多学说之大
four months or longer; and prolonged periods that narrowed the search to 39 papers and final reading and
may be scanty or heavy. selection to meet the criteria down to 6 papers used in this
study. Table 1 shows the flow of papers in the process.
Table 1 General information on depicting the selected papers
入人类的健康大系，并使他成为具有理论与实际一体的特色现。 Statistical difference between“大怒则形气绝，而血菀
《黄帝内经》中有明确地论述： treatment and control
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题 groups was analysed
（涌）于上。 ”（ using chi squared
《素问•生气通天论》） (X2) analysis.
PubMed
Key Words
有过许多精辟的论述，并在《千金方》和《千金翼方》中两 CNKI 及飱泄。”（《素问•举痛论》）也就是说，怒因气生，气则怒
/Medline
次作过专门总结，这是有典可据的。除此以外，有关孙思邈 3. Results
Acupuncture; Polycystic ovary; 49 49
Syndrome 3.1 The review “人之性，有所侵犯则怒，怒则血充，血
《淮南子》所言： papers were summarised in Table 2
Acupuncture; Polycystic ovary 27 12
and 3
Four papers tested the effect of acupuncture treatment
诗中也阐明了雷同的观点：“自知气发每因情，情在何由气
syndrome; Clinical trial
on PCOS compare with clomophene treatment. They are,
Acupuncture; Polycystic ovary
19 3 得平，若问病根深与浅，此身应与病齐生” 。 Ma R et al.,
Yuan L, et al., (2010); Yang Y et al., (2005);
syndrome; Clinical trial; Ovulation
方类聚》及日本的相关著作中也都有反映。这些版本在文字 (1996); Chen D et al., (2007). One paper used sham as
Acupuncture (no combined
上虽然有些出入，但其基本内容是一致的。陕西耀县的药王 3 1 control to observe the effects of acupuncture in treatment
Table 2 Basic information目胀、
山上，也保存有这首诗的石刻件，还不时被中外游人转抄和 in selected
面红、 papers
耳赤、呕血、憋气等症状。甚则使人昏厥卒倒，
Experimental
Method Treatment group事，就是一个典型的案例：血气方刚的周瑜性情急躁，容易
Control group (clomiphene control)
design
In Ma (1996)
Quasi-randomized Not clear
亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。 N = 50; Age: 22-39 years old N = 48; Age: 24-36 years; History of infertility or
controlled
若要无诸病，常当节五辛。安神宜悦乐，惜气保和纯。 History of infertility or irregular因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死
menstrual irregular menstrual 0.5-13 years; Among them,
8-13 years; Among them, wish 亡的病例， to be 在国内外媒体上都不时有过报道。
wish to be pregnancy: N = 29 “气是杀人贼” ，
pregnancy: N = 32 老百姓的说法一语道破了生气对人类健康的严重危害。
Yuan (2010)
In时过境迁，从公元 6 世纪至今，历史的隧道已经向前穿美国医学专家的一项调查说，一个人经常发怒或心身承
越了Quasi-
15 randomized Treatment order N = 30; Age: 20-40 years old; All
个轮回，科学已经发展到了人类从地面走向太空的 patients N = 30; Age: 20-40 years old; All patients wish
controlled
时代，膏粱厚味之外，琳琅满目的各色保健品足以让人眼花 wish to be pregnancy, but not mention to be pregnancy, but not mention infertility
infertility history in paper history in paper
In Yang (2005)
Quasi- randomized Not clear N = 66; Age: 21-35 years old 甚至导致溃疡病的发生。发怒和绝望的情绪是造成血压升高
N = 60; Age: 22-36 years old
controlled Infertility history: 2-8 years 的主要原因，引起血管收缩，导致舒张压明显上升。芬兰科
Infertility history: 2-7.5 years
In Chen (2007)
Randomized Random number N = 61; Age: 21-38 years old 现，每发一次怒或绝望值增加
为了方便叙述，本文将孙真人的这首诗分为五段进行剖 N = 60; Age: 22-391 years old
分，高血圧的危险性就增加
controlled
析，每两句为一节，先从第一节说起。 Infertility history: 2-12 years Infertility history: 2-12 years
In Pastroe (2011)
1.Randomized
怒甚偏伤气，思多太损神。神疲心易疫，Random number N = 40; Age: 18–43 years old; the presence N = 44; Age: 18-43 years old;
controlled of both oligomenorrhea and 癌症患者中易发怒的人明显高于性格温和的人。the presence of both oligomenorrhea and
气弱病相因 hyperandrogenism, at least one menses 再说孙氏诗中说的思伤神，神指的是人的精神意识，是
and hyperandrogenism, no more than eight periods in
这一节总体上是讲精神养生的，怒之所伤，肝气也；思 no more than eight periods in the most the most recent 12 months
recent 12 months 神志的主宰者是心，《灵枢•大惑论》中有“心者，神之舍也”
In Stener-Victorin (2000) 的话。思为心所主，《孟子•告子上》中有“心之官则思”的
Non-randomized N =、病“因”吗！对
24; Age: 20-40 years old; amenorrhea self-control
controlled or oligomenorrhea with no more than four
嵇康的话说：“养生有五难，名利不去为一难（实乃最大的 spontaneous bleedings per year 理智、敏捷、灵活，健康长寿的机会相对就多；反之，人就
伤肾气之大虑），滋味不绝为四难（吃也是非常费脑筋的活） Table 3 Basic information
， in treatment group
Acupuncture points Treatment method & Index of observation
In Ma (1996). 或少都缺了点“心眼”。很显然，心的这些功能里，包括了
Main points: Guanyuan (R4), Zhongji (R3), Zigong, After 5 days of menstrual, daily treatment, needles remain 20
Dahe (KI12), Sanyinjiao (SP6), and minutes, continual 20 days per cycle, take 5 day off treatment
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Volume 21 Issue
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 If weak of Spleen and Kidney qi, add Shenshu (BL23), after 20 days treatment, maximum continuous treatment for 6
Zusanli (ST36), Taibai (SP3), Gongsun (SP4) with cycles.
reinforcing method and moxibustion plus electronic Index of observation: Pregnancy rate; Ovulation rate; LH;
stimulation 对孙真人《养生铭》的现代诠释 FSH; LH/FSH; Testosterone
 If liver qi stagnation, add Ganshu (BL18), Jueyinshu
(BL14), Qimen (LR14), using reinforcing-reducing 温长路
method plus electronic stimulation
In Yuan (2010) 中华中医药学会（100029）
Zhongwan (R12), Xiawan (R10), Qihai (R6), Guanyuan After 5 days menstrual (or withdrawal bleeding after
(R4), Zhongji (R3), Zhigong, above point deep puncture; progesterone treatment), daily treatment for 3 days , after 3
Wailing midle puncture. times treatment, every other day for 3 times, needle retention
成者，除了传统意义上的医学理论和实践外，把养生防病纳 30 minutes, 就孙氏诗中所说之怒伤肝言，它是人情志受损的一种表
6 times treatment per cycle. Repeat the rule of the
入人类的健康大系，并使他成为具有理论与实际一体的特色 next cycle
现。if《黄帝内经》中有明确地论述：
no pregnancy, mmaximum continuous treatment
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题 for 3 cycles.
（涌）于上。 ”（《素问•生气通天论》）“怒则气逆，甚则呕血
有过许多精辟的论述，并在《千金方》和《千金翼方》中两 Index of及飱泄。
observation: Pregnancy rate;
”（《素问•举痛论》 Ovulation rate; LH;
）也就是说，怒因气生，气则怒
FSH; LH/FSH; Testosterone
In Yang (2005)
Selected three groups of points for alternative use: After 10 days of the menstrual or withdrawal bleeding of
Group I: Yinjiao (R7), Guanyuan (R4), Diji (SP8), progesterone 充则气激，气激则发怒” 。唐代诗人白居易在他在一首制怒
intramuscular injection, patients were given
Shuidao (ST28); Group II: Guilai (ST29), Dahe (KI12), treatment in turn to use 3 group points. “自知气发每因情，情在何由气
Needle retaintion 30
Qugu(R2), Xuehai (SP10); Group 14III:
铭》的。宋代温革的《琐碎录》和 Zhongji (R3), minutes.得平，若问病根深与浅，此身应与病齐生”
世纪朝鲜出版的《医 Continuous acupuncture 5-10 days. 。
Shuidao (ST28), Guilai (ST29), Shanyinjiao
方类聚》及日本的相关著作中也都有反映。这些版本在文字 Index of observation: Pregnancy rate; Ovulation rate
Acupuncture points
上虽然有些出入，但其基本内容是一致的。陕西耀县的药王 Treatment method & Index of observation
In Chen (2007) 目胀、面红、耳赤、呕血、憋气等症状。甚则使人昏厥卒倒，
效法。其诗全文如下： on the 1st clean day after
The main point: Paravertebral points (1.5 to 2 inch away Pricking因此致死者也不罕见。 menstrual, every 3 to 5 days
from 7th cervical Spinous process); The sacral plexus pricking,事，就是一个典型的案例：血气方刚的周瑜性情急躁，容易
and treatment of a total of 8 to 10 times. During
point (posterior superior iliac spine, To about 1 to 2 ovulation, every 3 to 5 days pricking. Mixmum treatment for 3
nd
Wang pointed at), 2 lumbar beside the point (in the mentrual真枪实弹就放倒了这位年仅
cycle. Locally anesthesia the36pick points, and then
lumbar 2, 3, the end of the bilateral transverse process of using specially designed stainless
因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死 steel pick-needle (National
the midpoint, and the Shenshu the same), Guilai (ST29) Patent number: the ZI 98,243,187.2) penetrate subcutaneous in
亡的病例，在国内外媒体上都不时有过报道。 “气是杀人贼” ，
Submain point: Qichong (ST30) and the point beside a the point, holding the needle, the needle to the rhythmic
lumbar (at the end of 6the
时过境迁，从公元 1st and 2nd lumbar bilateral traction action with medium stimulation frequency (80 to 120
世纪至今，历史的隧道已经向前穿美国医学专家的一项调查说，一个人经常发怒或心身承
transverse process of the midpoint, and the same lever as times / min), the intensity varies from person to person.
Sanjiaoshu (BL22)). Mixmium treatment for 6 mentrual cycle.
Index of它会直接损害人的记忆力和对事物的专注力。不良情绪还会
observation:
Pregnancy rate; Ovulation 影响人的食欲，
rate; LH; FSH; 使人发生胃痛、
LH/FSH; 恶心，
Testosterone
In Pastroe (2011) 的主要原因，引起血管收缩，导致舒张压明显上升。芬兰科
服力的答案。
Shensu (BL23), Pangguangsu (BL28), Sanyinjiao (SP6), 12 sessions of true or sham acupuncture (Park616
学家的研究证实了这一点，他们对 sham device) for
and Yinlinquan (SP9) use EA;
为了方便叙述，本文将孙真人的这首诗分为五段进行剖 8 weeks.现，每发一次怒或绝望值增加
Twice each week for the first 14分，高血圧的危险性就增加
weeks followed by
Shenmen (P6), triple energizer 5 (SJ5), and Baihui (Du once per16%。而高血圧又可成为新的病因，引发其他更严重的疾病
析，每两句为一节，先从第一节说起。 week for an additional 4 weeks.
20) use manual acupuncture Index of发生。癌症的发生也与经常发怒有直接联系，有统计证实，
observation: Ovulation rate; LH; FSH; LH/FSH
1.In Stener-Victorin
(2000) 癌症患者中易发怒的人明显高于性格温和的人。
Shensu (BL23), Pangguangsu (BL28), Yinlingquan EA was given
气弱病相因 twice a week for 2 weeks and then once a week,
(SP9), Sanyinjiao (SP6) use EA altogether 10–14 treatments. Needles remain 30 minutes.
Shenmen (P6), triple energizer 5 (SJ5), and Baihui (Du Maximum treatment for 3 months.
之所伤，神志的主宰者是心，《灵枢•大惑论》中有“心者，神之舍也”
20) use 脾胃之气也；喜之所伤，
manual acupuncture 心气也。气乃肺、肾所主，
by rotation Index of observation: Ovulation
Table 4. The effect of acupuncture treatment on pregnancy rate (%)
Treatment group
心病），喜怒不除为二难，声色不去为三难（确为耗心神、 Control group
伤肾气之大虑），滋味不绝为四难（吃也是非常费脑筋的活）对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
Pregnancy Non-pregnancy ， % Pregnancy Non pregnancy %
Yuan (2010) 13 17 43.4 11 19 36.6
Yang (2005) 40 26 61.2** 19 41 31.7
中，则信顺日跻，道德日全，不祈善而有福，
Ma (1996) 26 不求寿而自延，
8 81.3* 15 14 51.7
*
Chen (2007)
此养生之大旨也。 32
”在孙氏反复论证的这段话中，重点强调 29 52.5 23 37 38.3
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Total+ 111 80 58.1** 68 111 38.0

* ** * **
, : significantly different compared to control group; P<0.05, P<0.01.
+: data reanalyzed
Control group were all treated with clomiphene which seen on Tables 4 and 5.
温长路
used the following procedure. The control group, in 5th The results show that acupuncture treatments
day of the menstrual or withdraw bleeding 中华中医药学会（100029）
by progestrone significantly increase both pregnant rate (Table 4) and
intromuscluar injection. Patients begin serving daily ovulation rate (Table 5) in combined data of four studies.
doses of 50mg clomiphene for five consecutive days. Although one individual study did not show acupuncture
According to the results of the B-ultrasonic monitoring of
在我国医学发展史上，孙思邈可谓一位集众多学说之大 treatment significantly increase pregnant rate and the
follicular development,
when the follicular diameter ovulation rate from one study even lower than control
greater than 18mm, single intramuscular injection of group, acupuncture treatment shows its benefit higher
chorionic gonadotrophin (hCG, a hormone produced 现。
than《黄帝内经》中有明确地论述： “大怒则形气绝，而血菀
clomiphene treatment in improving pregnant rate.
during pregnancy that is made by the developing embryo
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题（涌）于上。 ”（《素问•生气通天论》）“怒则气逆，甚则呕血
3.1.2. EA treatments induced regular ovulations
after conception) 10000U;
Stener-Victorin et al (2000) has tested whether EA
The sham control used Park sham device was placed
could affect oligo-/anovulation in 24 women with PCOS
on the skin at standardized points on all four extremities
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广， and oligo-/amenorrhoea.
《淮南子》所言： They were treated by EA for 3
(Achilles tendon and lateral head of the triceps) chosen to
《养生铭》就是其中的一首。此文收于《全唐书》和后人整 months, 10-14 treatments
充则气激，气激则发怒”。唐代诗人白居易在他在一首制怒 in total. Nine women (38%)
avoid standard acupuncture meridians and acupuncture
had good effect of EA treatment and showed improve the
points (Stener-Victorin, et al., 2000).
ovulation and oligo/amenorrhoa by a mean of 0.66
3.1.1 Effect of acupuncture on14pregnancy
铭》的。宋代温革的《琐碎录》和世纪朝鲜出版的《医 rate and 得平，若问病根深与浅，此身应与病齐生” 。 after the EA
ovulations / woman in the period during and
ovulation rate (compared with clomiphene treatment)
方类聚》及日本的相关著作中也都有反映。这些版本在文字 period compared to a mean of 0.15 before the EA period.
Table 5. The effect of acupuncture treatment
上虽然有些出入，但其基本内容是一致的。陕西耀县的药王 on ovulation rate (%)
Treatment group Control group
Ovulation Non- ovulation % Ovulation Non ovulation %
Yuan (2010)
怒甚偏伤气，思多太损神。神疲心易疫，气弱病相因。 38 34 52.8 42 25 62.7
Yang (2005)
勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。 56 10 84.8** 19 60 24.0
Ma (1996)
亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。 49 1 98.0 44 4 91.7
Chen (2007)
若要无诸病，常当节五辛。安神宜悦乐，惜气保和纯。 51 10 83.6* 38 22 63.3
Total +
194 55 77.9 亡的病例，
** 在国内外媒体上都不时有过报道。
143 111 “气是杀人贼”
56.3 ，
* **
, : significantly difference compared to control group; * P<0.05, ** P<0.01.
+
6 世纪至今，历史的隧道已经向前穿美国医学专家的一项调查说，一个人经常发怒或心身承
: data reanalysed
Table 6. The change of LH and FSH lever and LH/FSH ration compared with before treatment
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是 Yuan (2010) Yuan (2005)增加胃中盐酸的流量， Ma (1996) 影响人的食欲， Pastore (2011)
使人发生胃痛、恶心，
Group: Treatment Control Treatment Control Treatment Control Treatment Sham
LH ↓* ↓ ↓* ↓ ↓* ↓ ↓ ↓
FSH - - - - - - - -
LH/FSH ↓* ↓ ↓* 现，每发一次怒或绝望值增加
↓ ↓* ↓ ↓1 分，高血圧的危险性就增加
↓
Testosterone ↓* ↓ ↓* ↓ ↓* ↓
Note: ↓: significantly decrease compared with pre-treatment (baseline);↓*: significantly decrease
compared with control group; -: no significantly change癌症患者中易发怒的人明显高于性格温和的人。
compared with before treatment (baseline)
These women also demonstrated significantly lower
这一节总体上是讲精神养生的，怒之所伤，肝气也；思 intervention 60 days before enrolment. Serum LH and
levels of body mass index, serum testosterone FSH were measured
神志的主宰者是心， at baseline, after
《灵枢•大惑论》 intervention,
中有“心者，神之舍也” and 3
concentration, serum testosterone/sex hormone binding months
的话。思为心所主， later. Ovulation was measured
《孟子•告子上》中有“心之官则思”的 with weekly urine
globulin ratio and serum basal insulin、病“因”吗！对
concentration or blood samples. Results show that true and sham
compared to those women with no effect.
于此，孙思邈在他的《千金方》中曾引用魏晋时期养生学家 acupuncture produced similar frequency of ovulation and
嵇康的话说： both groups had a similar improvement in their LH/FSH
3.1.3. True “养生有五难，名利不去为一难（实乃最大的
and sham acupuncture produced similar
ratio.
frequency
心病） of ovulation
，喜怒不除为二难，声色不去为三难（确为耗心神、
Pastore et ，
伤肾气之大虑） al (2011) recently
滋味不绝为四难 conducted a random，
（吃也是非常费脑筋的活）对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
3.1.4. Summary of the effect of acupuncture on LH,
control, double-blind, sham-controlled clinical trial using
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼 FSH and testosterone levels
12 sessions of true or sham acupuncture (Park sham In three clinical trials, the LH and testosterone level
device). The trial lasted 8 weeks. Eighty-four and LH/FSH ratio 。很显然，心的这些功能里，包括了
或少都缺了点“心眼” showed a significant decrease
中，则信顺日跻，道德日全，
reproductive-aged women 不祈善而有福，不求寿而自延，
with PCOS were involved in compared to pre-treatment and control group treated with
the study. They were not involved in hormonal
此养生之大旨也。 ”在孙氏反复论证的这段话中，重点强调 clomiphene. One clinical trial used sham control, LH
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lever and LH/FSH ratio in both group have significantly trial. However, they selected a variety of acupuncture
decreased compared with pre-treatment, and also LH points in these treatments (see Table 3). Treatments in all
level has significantly decreased compared with sham four studies: Ma et al, 1996; Yang et al, 2005; Chen 2007;
group, LH/FSH ratio has declined but there was no Yuan et al, 2010, selected the needle points based on their
significant difference compared with sham group. personal situation, however, the other two studies did not
温长路treat based on individual needs, and used acupuncture
4. DISCUSSION treatment in a consistent way to all participants in the
Acupuncture has been used for treatment 中华中医药学会（100029）
PCOS for whole treatment period, such as acupuncture points, the
many years, however, there is no inconclusive depth of the needle, the duration of stimulation and
confirmation about its effectiveness. This study focused intensity of the stimulation were all same. These ‘same
on a systematic review of published data on acupuncture
在我国医学发展史上，孙思邈可谓一位集众多学说之大 method’ is different from actual acupuncture practice
in the treatment of PCOS, the aim is to assess whether
成者，除了传统意义上的医学理论和实践外，把养生防病纳 which should be based on individual situation and
acupuncture is effective in improving fertility in patients symptoms to choose a variety of acupuncture points, time
with PCOS. 6 papers were selected for this review. course et al.
The Pastore ”（《素问•生气通天论》
et al (2011) study ） “怒则气逆，甚则呕血
used large random
4.1 Acupuncture treatment effectively increase
有过许多精辟的论述，并在《千金方》和《千金翼方》中两 controlled trails, following Stener-Victorin’s treatment
及飱泄。 ” （《素问•举痛论》）也就是说，怒因气生，气则怒
ovulation rate
次作过专门总结，这是有典可据的。除此以外，有关孙思邈 procedure, but the whole period (2 months treatment
The data showed ovulation rates in the treatment and 3 months follow up) is less than Stener-Victorin’s
group was higher (Yang et al, 2005; Chen 2007) than the 《淮南子》所言： “人之性，有所侵犯则怒，怒则血充，血
treatment which is a total of 8-9 months study period,
control group treated by clomiphene, a medicine used
thus studies showed different results. Pastore et al also
frequently to treat anovulation; ovulation rate in treatment
couldn’t “自知气发每因情，情在何由气
collect the basic information for EA treatment on
group was equal to the
铭》的。宋代温革的《琐碎录》和 14 世纪朝鲜出版的《医 control group (Ma et al, 1996; the menstrual and ovulation patterns before
得平，若问病根深与浅，此身应与病齐生” 。 treatment.
Yuan et al, 2010) and this shows clinical effectiveness of The怒气大发，相应的疾病就会因之而生，受害最直接的是
good thing is that the clinical trial size met the
acupuncture treatment; 38% of patients showed effect experiment requirement.
after treatment and ovulation rate has been increased in 肝胆系统。因怒导致的机体的气血逆乱，会使人出现头痛、
these patients by 4 times, but there is no difference
山上，也保存有这首诗的石刻件，还不时被中外游人转抄和 4.4
目胀、 Acupuncture
面红、耳赤、呕血、 treatments
憋气等症状。 show effectiveness in
甚则使人昏厥卒倒，
between
效法。其诗全文如下： after treatment and pre-treatment if the total recovering the imbalance
因此致死者也不罕见。《三国演义》中诸葛亮三气周瑜的故 of hypothalamus-pituitary-
group was considered (Stener-Victorin et al 2000). There ovary axis in some extent
is no怒甚偏伤气，思多太损神。神疲心易疫，气弱病相因。
effect of acupuncture treatment compared to sham These papers also tested the LH, FSH and testosterone
levels and found that after acupuncture treatment, LH
treatment (Pastore et al 2011), however, this is caused by
other亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。
components of sham acupuncture and the treatment significantly
真枪实弹就放倒了这位年仅 reduced and thus 36 reduced the LH/FSH ratio.
method’s difference. The four studies (Ma et al, 1996; Acupuncture treatments
因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死 also decreased testosterone and
Yang et al, 2005; Chen 2007; Yuan et al, 2010) used inhibited GnRH secretion and re-balanced the
participants from hospital patients with irregular
寿夭休命论，修行本在人。若能遵此理，平地可朝真。 hypothalamus-pituitary-ovary axis.
4.5 There is no effect in the Pastore et al (2011) study:
anovulation or infertility history. There is no detailed
时过境迁，从公元 6 世纪至今，历史的隧道已经向前穿 a randomized, double blind, sham-controlled clinical trial.
information on the patients whether they have
clomiphene resistance in the above 4 studies and in In this study, 84 reproductive-aged women with
Pastore et al (2011) study. In Stener-Victorin et al (2000)
时代，膏粱厚味之外，琳琅满目的各色保健品足以让人眼花 PCOS completed 60 day’s intervention and then they
study, 19 out of 24 participants are clomiphene resistant.
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是 were followed up for 3 months. Intervention included 12
sessions of true or sham acupuncture in the points (Table
4.2 Acupuncture treatment effectively increase
3) for 8 weeks. Results showed acupuncture produced a
pregnancy rate
孙真人《养生铭》的立意所在，相信事实会给人们一个有说 similar ovulation rate compared with sham control group.
The data showed acupuncture 1) significantly These non-effective results may be
服力的答案。学家的研究证实了这一点，他们对 616caused
名男性对象的调查发by not having
increases pregnancy rate (Ma et al, 1996; Yang et al, 2005; enough treatments and other factors in the sham control
Chen, 2007) in treatment group compared to control treatments.
group treated with clomiphene; 2) pregnancy rate with 16%。而高血圧又可成为新的病因，引发其他更严重的疾病
acupuncture treatment, 8% higher than the control group 5. CONCLUSION
treated with clomiphene (Yuan et al, 2010)
Among 6 papers analysed, 4 papers used case-control
气弱病相因
4.3 The strength and limitation in the studies studies which compared the acupuncture treatments to the
Published data has been searched thoroughly and control groups that were treated with clomiphene. 1 paper
这一节总体上是讲精神养生的，怒之所伤，肝气也；思 used no random self-control study and another one is a
there are not many well designed RCT studies. Among
之所伤，脾胃之气也；
the 6 papers selected,喜之所伤，心气也。
4 papers are written气乃肺、肾所主，
in Chinese and fully RCT study. 5 out of 6 study results show that
they have good case control studies:
神依气血所存，正气损伤，岂不心“疫” acupuncture
、病“因”吗！对的话。思为心所主，
acupuncture treatment 《孟子•告子上》中有“心之官则思”的
is effective in treating PCOS
treatment compared to
于此，孙思邈在他的《千金方》中曾引用魏晋时期养生学家 clomiphene treatment. In view of which showed significantly
话。心的主神、主思功能处于正常状态，人就表现出聪明、 higher ovulation rate and
the absence of published research using patient sample pregnancy rate compare to clomiphene treatment or in a
size no more than 80 participants - based on the power self-controlled study. Another study did not show its
calculated by Pastore (2011) plus it not being a fully effect compared to sham control. In view of the absence
randomly controlled
伤肾气之大虑），滋味不绝为四难 experiment, it shows interesting，
（吃也是非常费脑筋的活） of published research using patient sample size above 100
results but a better quality controlled and standard study
and less fully randomly controlled experiment and
is needed.
英华，呼吸太阳，不能不回其操、不夭其年也。五者无于胸 standard treatment procedure, results show limited
One study is self-controlled (Stener-Victorin et al, information.
或少都缺了点“心眼” Subsequently a better RCT and standard
2000) with small size participants. Another study (Pastore study is needed to further confirm the effectiveness of
et al, 2011) is a well-designed RCT with double blinded acupuncture treatment PCOS.
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6. Acknowledgements Jonard, S., Y. Robert and D. Dewailly. 2005. Revisiting the

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Zheng, C. H., G. Y. Huang, M. M. Zhang and W. Wang. 2012.
polycystic ovary syndrome from the theory of phlegm 神志的主宰者是心，
Effects of Acupuncture《灵枢•大惑论》 on Pregnancy中有“心者，Rates 神之舍也”
in Women
accumulating in uterus. Zhongguo Zhong Yi Ji Chu Yi Xue Za Undergoing in Vitro《孟子•告子上》中有“心之官则思”的
Fertilization: A Systematic Review and
Zhi. 14(10):725-726 Meta-Analysis. Fertility and sterility 97:599-611.
Hull, M. G. 1987. Epidemiology of Infertility and Polycystic
Ovarian Disease:
嵇康的话说： Endocrinological and Demographic Studies.
Gynecological endocrinology: the official journal of the 会表现出愚笨、粗鲁、迟钝、固执，疾病和灾难的发生率相
International Society of Gynecological Endocrinology 1:235-45.
Jedel, E., F. ，滋味不绝为四难
Labrie, A. Oden, （吃也是非常费脑筋的活）
et al. 2011. Impact of ，
Electro-Acupuncture
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼 and Physical Exercise on 人、豁达大度的人、善于处世的人，都是有“心计”的；而
Hyperandrogenism and
英华，呼吸太阳，不能不回其操、不夭其年也。五者无于胸 oligo/amenorrhea in Women with 那些碌碌无为、傻头笨脑、鸡肠小肚、无朋无友的人，或多
Polycystic Ovary Syndrome: A Randomized Controlled Trial. 或少都缺了点“心眼”。很显然，心的这些功能里，包括了
中，则信顺日跻，
American 道德日全，
journal of 不祈善而有福，不求寿而自延，
physiology.Endocrinology and metabolism
300:E37-45.
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The Latest Research Review on Chinese Herbs of Anti-myocardial

Ischemia
Tiejun Tang, Louise
温长路Helen Booker
Middlesex University
Key Words: Insomnia, Primary Insomnia, Acupuncture, Taiji, Chinese Medicine, Syndrome Pattern
Coronary heart disease (CHD) is the UK's biggest 的都是情志对养生的决定性作用。
Asperosaponin VI is a saponin from Chinese herb
killer. Although western medicine has achieved a lot
成者，除了传统意义上的医学理论和实践外，把养生防病纳 Xuduan (Dipsacus asper). A study investigated the
progress in treating CHD, it is still causing around 82,000
入人类的健康大系，并使他成为具有理论与实际一体的特色 anti-MI
现。 effects of Asperosaponin“大怒则形气绝，而血菀
《黄帝内经》中有明确地论述： VI both in vivo and in
deaths each year. About one in five men and one in eight
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题 vitro.
（涌）于上。 The ”results
（ suggested
《素问•生气通天论》 that
） it could provide
women die from the disease. In traditional Chinese significant cardioprotective effects against acute MI in
medicine many herbal remedies have showed a good rats. These mechanisms might be attributed to scavenging
effect on treating angina. Many laboratory studies have 发，生气——发怒——生气，构成了一条恶性循环链。正如
lipid peroxidation products and reactive oxygen species,
been done to investigate the mechanism of treating
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广， increasing antioxidant
《淮南子》所言： defence enzymes and preventing
myocardial ischemia (MI). I published a research review
《养生铭》就是其中的一首。此文收于《全唐书》和后人整 mitochondrial
充则气激，气激则发怒” damage (Chunmei Li, 2010).
。唐代诗人白居易在他在一首制怒
on this topic many years ago (Tang, T. 2003). Many
理的孙氏的《摄生咏》中，也有称为《保生铭》和《孙真人 Angelica sinensis
诗中也阐明了雷同的观点：“自知气发每因情，情在何由气 polysaccharides are an active
progressive new reports have been published in the last 5 ingredient extracted from Danggui (Angelica sinensis).
years. For a clinical practitioner these research updates The cardioprotective effects were evaluated by using
will provide a helpful reference in treatment of CHD. For 怒气大发，相应的疾病就会因之而生，受害最直接的是
MI/reperfusion rats. A sinensis polysaccharides treatment
researchers and students it can provide a useful reference
上虽然有些出入，但其基本内容是一致的。陕西耀县的药王 significantly reduced myocardial infarction size,
for future research projects. As for the general public, it
山上，也保存有这首诗的石刻件，还不时被中外游人转抄和 enhanced
目胀、面红、 CT-1
耳赤、 and
呕血、antioxidant
憋气等症状。 enzymes activity, down
has displayed some scientific evidence for Chinese herbs
regulated caspase-12
mRNA expression in rats (Song
in treating ischemic heart disease. Zhang, 2010).
Juemingzi (Semen Cassiae) was proved to reduce
1 Research on individual herb and plant monomer
blood lipid levels. A study investigated whether it can
Danshen (Salvia miltiorrhiza) is a very commonly reduce MI and reperfusion36injury.
真枪实弹就放倒了这位年仅 The results showed
used traditional Chinese herb in treating heart disease. It Juemingzi extract can
因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死 not only significantly reduce the
contains many sub fractions, which are mainly
若要无诸病，常当节五辛。安神宜悦乐，惜气保和纯。 plasma lipid level, but it can also improve the
TanshinoneⅠ, ⅡA, ⅡB, Salvianolic acid A (SAA), and
寿夭休命论，修行本在人。若能遵此理，平地可朝真。 instantaneous first derivation of left ventricle pressure
and reduce infarct size (Feng Fu, 2014).
Salvianolic acid B (SAB). In an in vivo study, rat MI
时过境迁，从公元 6 世纪至今，历史的隧道已经向前穿 Gegen (Lobed Kudzuvine Root) has been widely
model was induced by permanent left anterior descending
coronary
越了 artery ligation. The results showed Tanshinone used in the treatment of myocardial and cerebral ischemia.
IIA attenuates the MI pathological changes and improves
时代，膏粱厚味之外，琳琅满目的各色保健品足以让人眼花 Puerarin is a major active ingredient extracted from
heart function, and reduces expression of MCP-1,
Gegen. A study was designed to observe the effects of
TGF-β1 and macrophage infiltration. It could also puerarin on the signalling transmission mediated by
需要科学者正面回答的问题，也正是本文要用现代观点诠释 P2X3 receptor in stellate ganglia and cervical dorsal root
decrease the expression of TNF-α and activation of
nuclear transcription factor-kappa B (Z.H.Ren, 2010). ganglia after MI damage. The results suggested that
Researchers applied a myocardial infarct rats model. The
服力的答案。 Puerarin could reduce systolic blood
学家的研究证实了这一点，他们对 pressure and heart
rats为了方便叙述，本文将孙真人的这首诗分为五段进行剖
were given different concentrations of SAA. rate, relieved pain and decreased up-regulated expression
Immunohistological analysis was performed to measure of P2X3 mRNA and protein after MI. Puerarin was
vascular endothelial growth factor and vascular shown to inhibit the up-regulated ATP-activated currents
endothelial growth factor receptor-2 expressions. The after MI. This suggested that puerarin can relieve MI
secretion of matrix metalloproteinase type X was through blocking the P2X3 signalling transmission
气弱病相因
evaluated in serum of post-ischemic rats. The result (Shuangmei Liu, 2014).
showed SAA potentiated the ischemia induced Rougui (Cinnamomum cassia) is widely used for the
neovascularization. These findings show that SAA has treatment of ischemic heart disease. The active
potent 脾胃之气也；
之所伤， proangiogenic properties
喜之所伤，心气也。 by 气乃肺、
promoting
肾所主， the 神志的主宰者是心，
components, cinnamic 《灵枢•大惑论》中有“心者，
aldehyde and cinnamic神之舍也”
acid, can
expression of proangiogenic factors (Yujuan
神依气血所存，正气损伤，岂不心“疫” 、病“因”吗！对Li, 2014). be isolated from Rougui.
的话。思为心所主， A study has investigated the
Another study shows SAB also can markedly and effects of anti MI of Cinnamic aldehyde and cinnamic
dose-dependently reduce fibrinogen and malonaldehyde acid. The results showed these two extracts can decrease
嵇康的话说： “养生有五难，名利不去为一难（实乃最大的
levels, increase the HDL level, improve blood viscosity the ST elevation induced by acute MI, decreased serum
levels of CK-MB, LDH, TNF-α and IL-6, and increased
and plasma
心病） viscosity in MI rabbits (Qian Yang, 2010). A
，喜怒不除为二难，声色不去为三难（确为耗心神、
study applied ，
伤肾气之大虑） an RT-PCR and（吃也是非常费脑筋的活）
滋味不绝为四难 Western blot method to， serum NO activity, increased SOD activity and decreased
detect p38 MAPK gene
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼 expression. The result suggests MDA content in myocardial tissue (Fan Song,2013).
that Tanshinone IIA play a role in protection Shanzha (hawthorn) is commonly used Chinese
英华，呼吸太阳，不能不回其操、不夭其年也。五者无于胸 medicine. A study was designed to investigate the effects
cardiomyocytes from ischemic and hypoxic injury. The 或少都缺了点“心眼”。很显然，心的这些功能里，包括了
effect 道德日全，
is based on 不祈善而有福，
inhibiting 不求寿而自延，
miR-1 expression through and mechanisms of hawthorn leaf flavonoids on acute
MI/reperfusion in anesthetized dogs. The results indicated
p38 MAPK signal pathway (Zhang, Y. 2010).
此养生之大旨也。 ”在孙氏反复论证的这段话中，重点强调
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Volume 21 Issue
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that this flavonoid can significantly decrease the degree in vivo after reperfusion. The result showed pre-treatment
and scope of MI, markedly inhibit the increase of with CPT significantly attenuated myocardial
myeloperoxidase activity, and IL-1 and TNF-α content microcirculatory disturbance, including decreased
induced by MI/infarction. It can also increase G coronary blood flow and red blood cell velocity in
protein-coupled receptor kinase 2 expression and arterioles, increased expression of CD18 on neutrophils
inhibited NF-κB expression (Jianhua Fu, 2013). 温长路and intercellular adhesion molecule 1 on endothelial cells,
Tetramethylpyrazine, sodium ferulate and puerarin are and albumin leakage from venules. It was also shown that
extracts from Chinese herbs Chuangxiong,中华中医药学会（100029）
Danggui and it could significantly ameliorate the myocardial damage
Gegen respectively. Some research has shown that these and apoptosis, inhibitor-κBα degradation, and expression
three extracts can antagonize the nociceptive or pain of Bcl-2, Bax, and caspase-3 in myocardial tissues (Na
transmission mediated by P2X3 and/or P2X2/3 receptors
在我国医学发展史上，孙思邈可谓一位集众多学说之大 Zhao, 2010). A metabonomic study was conducted to
in primary afferent
成者，除了传统意义上的医学理论和实践外，把养生防病纳neurons. They could therefore be assess the effect of Danshen, Sanqi and their compound
considered as new methods for treating MI injury and formula for myocardial infarction in rats. As a result,
cardiac arrhythmia (Shangdong Liang, 2010). the compound was shown to exert synergistic therapeutic
Dracocephalum moldavica L is an extract from （涌）于上。
efficacies to ”（《素问•生气通天论》
exhibit a better effect ） “怒则气逆，甚则呕血
on MI when compared
Chinese herb Xiang Qing Lan. A study evaluates
有过许多精辟的论述，并在《千金方》和《千金翼方》中两 to singular herbs (Xiaoping Liang, 2011).
antioxidative and cardioprotective effects of total
次作过专门总结，这是有典可据的。除此以外，有关孙思邈 Gualou Xiebai Tang is composed of Gualou (fructus
flavonoids extracted
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广，from Xiang Qing Lan. It showed trichosanthis)
《淮南子》所言： Xiebai (macrostem onion). It was first
and“人之性，有所侵犯则怒，怒则血充，血
remarkable scavenging effects against 1, 1-diphenyl- recorded in JinGui YaoLue, and is one of the main
2-picrylhydrazyl, hydroxyl and superoxide anion radicals formulae to treat chest pain, used since the Han Dynasty
in vitro. It can improve the heart rate and coronary flow,
(A.D 206). A study aimed “自知气发每因情，情在何由气
to investigate the effect of
raise left ventricular developed 14
铭》的。宋代温革的《琐碎录》和 pressure and decrease
世纪朝鲜出版的《医 Gualou Xiebai Tang ethanol extract 。
得平，若问病根深与浅，此身应与病齐生” on myocardial
creatine kinase, lactate dehydrogenase levels in coronary
方类聚》及日本的相关著作中也都有反映。这些版本在文字 fibrosis. The mRNA levels of Collagen I and Collagen III
flow. It can also reduce the infarct size in ischemic area were detected by real-time PCR. The results showed that
of heart. (Jiangtao Jian, 2014). Gualou Xiebai Tang could significantly reduce the heart
山上，也保存有这首诗的石刻件，还不时被中外游人转抄和目胀、面红、耳赤、
weight/body weight呕血、憋气等症状。
ratio as well as甚则使人昏厥卒倒，
the left ventricle
2 Research on compound formulas
效法。其诗全文如下： weight/body
因此致死者也不罕见。 weight ratio. It also significantly alleviated
Apart from individual herb and plant monomers, the degree of inflammation, decreased myocardial
some怒甚偏伤气，思多太损神。神疲心易疫，气弱病相因。
studies have focused on compound formulas. Many collagen volume fraction, and markedly prevented the
traditional and modern formulas have been shown to be
勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。 up-regulations of Collagen I and Collagen III, down
effective in treating MI.
亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。 regulated expressions of TGF-β1, TGFβRI, TGFβRII in
Compound Danshen Tablets (CDT) are formulated 因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死
the rats with myocardial fibrosis (Yongfang Ding, 2013).
from a compound remedy. The ingredients are Danshen, 亡的病例， Buyang Huanwu Tang is a commonly
在国内外媒体上都不时有过报道。 used formula，
Sanqi, and Borneol. A study investigated therapeutic to
老百姓的说法一语道破了生气对人类健康的严重危害。 the
treat ischemic heart disease. A study investigated
mechanisms of CDT by
时过境迁，从公元 6 世纪至今，历史的隧道已经向前穿using a metabolomic approach. potential mechanism of this formula in alleviating MI in
Plasma extracts from sham, MI model, CDT and western rats. The expression of the cluster of differentiation 40
medicines were used in treating rats. Plasma was (CD40) in the mononuclear cells was measured using
analyzed by ultra-performance liquid chromatography/ flow cytometry, and the expressions of CD40 and its
quadruple. The orthogonal partial least square model was
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是 ligand
增加胃中盐酸的流量，(CD40L) in myocardial
影响人的食欲， tissues were determined
built, and found that metabolites were expressed in
需要科学者正面回答的问题，也正是本文要用现代观点诠释 by western blotting. The results showed that Buyang
significantly different amounts between MI and sham
孙真人《养生铭》的立意所在，相信事实会给人们一个有说 Huanwu Tang could decrease the expression of CD40 in
groups of rats. The results showed that CDT presented the mononuclear cells and the CD40 and CD40L
服力的答案。
protective effects on MI by reversing potential 学家的研究证实了这一点，他们对
expressions in myocardial tissues 616 (Yu 名男性对象的调查发
Liu, 2011).
biomarkers to sham levels, especially for the four Sini Tang is has been used1 to
现，每发一次怒或绝望值增加 treat MI for many years.
metabolites in the pathway of purine metabolism.
析，每两句为一节，先从第一节说起。 A lot of research has been done in the past two decades. A
(Yonghai Lv, 2010). recent study applied a urinary metabonomic method
Tanshinone IIA, SAB and ginsenoside
1. 怒甚偏伤气，思多太损神。神疲心易疫，癌症患者中易发怒的人明显高于性格温和的人。 Rb1 are the based on nuclear magnetic resonance and ultra
three major active ingredients of CDT. A report has found high-performance liquid chromatography coupled to mass
气弱病相因
that the combination of these three ingredients brings 再说孙氏诗中说的思伤神，神指的是人的精神意识，是
spectrometry in order to characterize MI related
nearly equal therapeutic
这一节总体上是讲精神养生的，怒之所伤，肝气也；思 effects on MI as CDT and it metabolic profiles and delineate the effect of Sini Tang on
plays more stable regulated action on those 22 identified MI. Nineteen
神志的主宰者是心， potential
《灵枢•大惑论》 biomarkers in rat urine
中有“心者，神之舍也” were
metabolites than single compound (Yonghai Lu, 2011). screened out, primarily related to myocardial energy
神依气血所存，正气损伤，岂不心“疫” 、病“因”吗！对的话。思为心所主，《孟子•告子上》中有“心之官则思”的
Another report uses an in vivo myocardial infarction metabolism, including the glycolysis, citrate cycle, amino
model mice; endothelial nitric oxide syntheses
acid metabolism, purine metabolism and pyrimidine
(eNOS)/nitric“养生有五难，名利不去为一难（实乃最大的
嵇康的话说： oxide (NO) pathway were detected. The metabolism. The results demonstrated that Sini Tang
results showed that both Tanshinone IIA and salvianolic could provide satisfactory effect on MI through partially
acid B have cardio protective function in certain levels regulating the perturbed myocardial energy metabolism
through multiple ，滋味不绝为四难
targets related（吃也是非常费脑筋的活）
with NO production, such， (Guangguo Tan, 2012).
as eNOS phosphorylation, L-arginine uptake (Chunshui
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼 Guanxin II is a relatively new formula, currently
Pan, 2011).
used to treat coronary heart disease. It contains 5
Another study applied
中，则信顺日跻，道德日全，不祈善而有福，不求寿而自延， an ischemia-reperfusion injury traditional
或少都缺了点“心眼” herbs. Akt is a key protein kinase in the
rat model to examine coronary blood flow, vascular processes of inhibition of apoptosis in cardiomyocytes.
diameter, velocity of red blood cells, and albumin leakage The results of a study found that Guanxin II can
13
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7BJ. London NW4 3RJ
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Volume 21 Issue
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significantly activate Akt kinase, increase the Bcl-2/Bax and myocardial damage in rats. American Journal of
ratio, inhibit cytochrome c release, reduced caspase-9 Physiology - Heart and Circulatory Physiology. 2010; 298.
activation, and attenuated subsequent caspase-3 H1166-H1176
[9] Qian Yang. Effect of Salvianolic Acid b and Paeonol on
activation. These results therefore suggest that Guanxin II
Blood Lipid Metabolism and Hemorrheology in Myocardial
ensures the survival of myocardium by enhancing the
Ischemia Rabbits Induced by Pituitruin. Int. J. Mol. Sci.
Akt-mediated antiapoptosis pathway (Xi Huang, 2010). 温长路 2010, 11(10), 3696-3704
Shen-fu injection is a modern formulation composed [10] Shangdong Liang. P2X receptors and modulation of pain
by Renshen (Ginseng) and Fuzi (Aconite).中华中医药学会（100029）
A study found transmission: Focus on effects of drugs and compounds
that this formula can significantly decrease infarct size, used in traditional Chinese medicine. Neurochemistry
apoptosis, caspase-3 protein expression in myocardial International. 2010; 57(7): 705-712.
tissues, and increase p-Akt, p-eNOS, bcl-2 protein
在我国医学发展史上，孙思邈可谓一位集众多学说之大 [11] Shuangmei Liu. Puerarin blocks the signalling
expression, compared to the control group (Yang Wu, transmission mediated by P2X3 in SG and DRG to relieve
myocardial ischemic damage. Brain Research Bulletin.
2011).
入人类的健康大系，并使他成为具有理论与实际一体的特色现。 2014; 101: 57-63.
In this field a large number of reports have been [12] Song Zhang. Extraction, chemical analysis of Angelica
published within the past 5 years. I have included some of （涌）于上。 ”（《素问•生气通天论》）“怒则气逆，甚则呕血
sinensis polysaccharides and antioxidant activity of the
the major ones here. From this review we can sum up a
有过许多精辟的论述，并在《千金方》和《千金翼方》中两及飱泄。 ”（《素问•举痛论》
polysaccharides ）也就是说，怒因气生，气则怒
in ischemia–reperfusion rats. International
number of points. Firstly,
次作过专门总结，这是有典可据的。除此以外，有关孙思邈 research methods have been Journal of Biological Macromolecules. 2010; 47(4):
updated. A large number of studies have applied the latest
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广， 546-550.
《淮南子》所言： “人之性，有所侵犯则怒，怒则血充，血
biomedical techniques, such as metabolomics, apoptosis, [13] Tiejun Tang. Experimental research progress on anti
《养生铭》就是其中的一首。此文收于《全唐书》和后人整充则气激，气激则发怒” 。唐代诗人白居易在他在一首制怒
myocardial ischemia herbs. Shenzhen Journal of Integrated
cellular signal transduction etc. These new molecular
biology techniques have been widely applied in the
理的孙氏的《摄生咏》中，也有称为《保生铭》和《孙真人 Traditional
诗中也阐明了雷同的观点： Chinese and Western Medicine 2003；13
research of Chinese herbs. Secondly,
铭》的。宋代温革的《琐碎录》和 14 Danshen and its sub
世纪朝鲜出版的《医 (2):111-113,118.
fractions have become a hot point in this field. There [14] Xiaoping Liang, Xi Chen, Qionglin Liang. Metabonomic
Study of Chinese Medicine Shuanglong Formula as an
have been approximately 4000-5000 reports conducted
上虽然有些出入，但其基本内容是一致的。陕西耀县的药王 Effective Treatment for Myocardial Infarction in Rats. J.
annually within the past 3 years. Thirdly, most reports are Proteome Res. 2011; 10憋气等症状。
(2): 790-799. 甚则使人昏厥卒倒，
conducted as laboratory research, and relatively few are 目胀、面红、耳赤、呕血、
[15] Xi Huang. Pretreatment with a Traditional Chinese
clinical reports. Finally, although all the papers are
效法。其诗全文如下：因此致死者也不罕见。
Formula, Guanxin II,《三国演义》中诸葛亮三气周瑜的故
Reduces Cardiac Apoptosis via the
published on formal academic journals, there is still an Akt Survival Pathway in Rats with Myocardial Ischemia.
unfortunate lack of papers from the core journals. As The Tohoku Journal of Experimental Medicine. 2010;
there勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。
is a lot of research in Chinese medicine still to be 220(2): 157-163.
[16] Yang Wu. Shen-Fu Injection36 岁的英雄汉。临床上遇到的
Preconditioning Inhibits
done,亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。
I believe there will be much progress in the future
of this field. Myocardial Ischemia-Reperfusion
因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死 Injury in Diabetic Rats:
若要无诸病，常当节五辛。安神宜悦乐，惜气保和纯。 Activation of eNOS via the PI3K/Akt Pathway. Journal of
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[1] 时过境迁，从公元
Chunmei Li. Protective roles of Asperosaponin VI, a
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Yongfang Ding. Gualou Xiebai Decoction prevents
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越了acute15 个轮回，科学已经发展到了人类从地面走向太空的
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[2] Chunshui Pan. Salvianolic acid B and Tanshinone IIA
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是 [18] Yonghai Lv. Metabolomic study of使人发生胃痛、
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attenuate myocardial ischemia injury in mice by NO 增加胃中盐酸的流量，影响人的食欲，恶心，
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[3] Fan Song. Protective effects of cinnamic acid and cinnamic
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[4] Feng Fu. Semen Cassiae Attenuates Myocardial Ischemia salvianolic acid B and ginsenoside Rb1 in myocardial
and Reperfusion Injury in High-Fat Diet 发生。癌症的发生也与经常发怒有直接联系，有统计证实，
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神依气血所存，正气损伤，岂不心“疫” 的话。思为心所主，《孟子•告子上》中有“心之官则思”的
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[7] Jiangtao
心病） Jiang. Ant oxidative and Cardioprotective Effects
，喜怒不除为二难，声色不去为三难（确为耗心神、 [22] Z.H. Ren. Tanshinone II A attenuates inflammatory
of Total Flavonoids Extracted from Dracocephalum 对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
伤肾气之大虑），滋味不绝为四难（吃也是非常费脑筋的活）， responses of rats with myocardial infarction by reducing
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Myocardial Injury in Isolated Rat Heart. Cardiovascular [23] Zhang Y. Tanshinone IIA Inhibits miR-1 Expression
Toxicology 2014.
英华，呼吸太阳，不能不回其操、不夭其年也。五者无于胸 through p38 MAPK Signal Pathway in Post-infarction Rat
中，Na
[8] Zhao, Yu-Ying
则信顺日跻，道德日全，Liu, Fang Wang. Cardio不求寿而自延，
不祈善而有福， tonic pills, a 或少都缺了点“心眼”。很显然，心的这些功能里，包括了
Cardiomyocytes. Cell Physiol Biochem 2010; 26:991–998.
compound Chinese medicine protects 大脑的某些功能。把心与脑的部分功能混而谈之，不能片面
ischemia-reperfusion-induced microcirculatory disturbance
13
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A Comparative Study of Traditional Chinese and Western Herb

Medicine
Tiejun Tang, Jasmin Mulvey, Marcos Patchett
Park Clinic, Middlesex
温长路 University
Herbs have been widely used to treat disease all over the world. In China, the use of herbal medicine (HM) became
an important part of Traditional Chinese Medicine (TCM). In Europe and America HM gradually developed into
Western Herbal Medicine (WHM). There are some commonalities and some differences between TCM and WHM. In
this study we compared the history, basic theory, function and clinic application of commonly used crossover herbs in
TCM and WHM. Through this comparison we hope to build的都是情志对养生的决定性作用。
在我国医学发展史上，孙思邈可谓一位集众多学说之大 a bridge between Chinese and western herbalists, to
exchange ideas and clinical applications of some crossover herbs. 就孙氏诗中所说之怒伤肝言，它是人情志受损的一种表
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题（涌）于上。 ”（
Method called ‘channel tropism’. For example, many herbs are
有过许多精辟的论述，并在《千金方》和《千金翼方》中两 described
及飱泄。 ”（as ‘heat clearing’,
《素问•举痛论》 but because channel tropisms
1. History comparison
次作过专门总结，这是有典可据的。除此以外，有关孙思邈 vary, Huanlian (Rhizoma Coptidis) is used to clear heart
Human use of natural plants to treat illness can be and stomach fire;“人之性，有所侵犯则怒，怒则血充，血
Longdancao (Radix Gentianae ) is used
traced back for thousands of years. Since the origin of 《淮南子》所言：
to clear liver and gallbladder fire; and Huangqin (Radix
humanity, our ancestors started to use herbs to relieve
Scutellariae) is used to clear lung heat.
certain symptoms. The first classic about TCM theory is
In TCM the 5 elements“自知气发每因情，情在何由气
are linked with internal organs,
Yellow Emperor's Canon of Traditional
铭》的。宋代温革的《琐碎录》和 Chinese Medicine
14 世纪朝鲜出版的《医 people’s emotions, seasons, weather and
得平，若问病根深与浅，此身应与病齐生” 。 environment.
(Huangdi Neijing). It was written during the Warring See怒气大发，相应的疾病就会因之而生，受害最直接的是
Table 1.
States Period (475 BC – 221 BC). Nearly at the same WHM is originally based on the theory of humoral
time, in ancient Greece Hippokrates (460 BC-370 BC) 肝胆系统。因怒导致的机体的气血逆乱，会使人出现头痛、
medicine, four elements, Physio-medicalism and the
published the humoral theory which became the basis of
山上，也保存有这首诗的石刻件，还不时被中外游人转抄和目胀、面红、
interaction 耳赤、
and 呕血、憋气等症状。
function 甚则使人昏厥卒倒，
of the entire body as a whole
WHM.
效法。其诗全文如下： terrain. A Holistic patient
因此致死者也不罕见。 oriented approach.
The first classic book about TCM herbs is Shennong's Very similar to TCM, in WHM 4 humours and 4
Herbal. It was written at early stage of Eastern Han
elements was also matched with internal organs,
Dynasty (AD25-220), 365 herbs were recorded in this
勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。 emotions, seasons, weather and environment. See Table
book.亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。
The first classic of western herbs is De Materia 真枪实弹就放倒了这位年仅 36 岁的英雄汉。临床上遇到的
2.
Medica which was written between 50 --70 AD by 因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死
若要无诸病，常当节五辛。安神宜悦乐，惜气保和纯。 3. Crossover herb comparison
Pedanius Dioscorides, a Greek origin Roman physician. 亡的病例，在国内外媒体上都不时有过报道。
，
About寿夭休命论，修行本在人。若能遵此理，平地可朝真。
600 plants were recorded. Both TCM and WHM A selection of nine herbs which are widely used in
both TCM and WHM. A comparison of their functions
have a long history, their basic philosophy was
时过境迁，从公元 6 世纪至今，历史的隧道已经向前穿 and美国医学专家的一项调查说，一个人经常发怒或心身承
indications, formulations and doses is presented in
established at nearly the same time – about 2400 years
ago. 15 个轮回，科学已经发展到了人类从地面走向太空的
越了 the tables below.
2. Basic theory comparison: Result
Eastern and western cultural differences determined The following results
增加胃中盐酸的流量， can be obtained
影响人的食欲， from the 恶心，
使人发生胃痛、 above
that from their inception TCM and WHM were based on
需要科学者正面回答的问题，也正是本文要用现代观点诠释 compare:
different theories. TCM is based on the theory of
孙真人《养生铭》的立意所在，相信事实会给人们一个有说 1) The origin and history of TCM and WHM is
Yin/Yang, five elements, Qi/blood, Zang Fu and
服力的答案。 similar. They both have a very long history.
meridians, and all the herbs are classified in Four Natures 2) Although they are based on different theories, TCM
(Cold, heat, warm and cool) and Five Flavours (sour, and WHM both believe the universe is composed of some
bitter, sweet, pungent and salty). The hot and warming basic elements. Compare TCM’s five elements and
herbs belong to yang, suitable to treat cold syndromes; WHM’s four elements: we find three elements are exactly
1.
the cold and cooling herbs belong to yin, suitable to treat
怒甚偏伤气，思多太损神。神疲心易疫， the same.
气弱病相因 The five flavours are matched to the five
heat syndromes. 3) TCM and WHM both believe these basic elements
elements and five zang organs (liver, heart, spleen, lung are connected to internal organs, and related to people’s
and这一节总体上是讲精神养生的，怒之所伤，肝气也；思
kidney). Each herb has a selective function to some 人类区别于其它动物、独具聪明智慧表现的主要指征之一。
moods or emotions, the seasons, weather and
part
之所伤， of the body. It may
脾胃之气也； have strong
喜之所伤，心气也。effect on one肾所主，
气乃肺、 or some environment.
meridians, but has little effect on other meridians. This is
Table 1 In TCM five elements links
于此，孙思邈在他的《千金方》中曾引用魏晋时期养生学家 human body and nature
5 Elements Zang Organs Fu organs
嵇康的话说：“养生有五难，名利不去为一难（实乃最大的 Sense organs Season Qualities
理智、敏捷、灵活，健康长寿的机会相对就多；反之，人就 Emotions
Wood Liver
心病），喜怒不除为二难，声色不去为三难（确为耗心神、 Gallbladder Eyes 会表现出愚笨、粗鲁、迟钝、固执，疾病和灾难的发生率相
Spring Wind Anger
伤肾气之大虑）Fire
，滋味不绝为四难 Heart（吃也是非常费脑筋的活）
Small intestine ， Tongue 对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
Summer Heat Joy
Earth Spleen
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼 Stomach Mouth Later summer Dampness
人、豁达大度的人、善于处世的人，都是有“心计”的；而 Anxiety
Metal Lung Larger intestine Nose 那些碌碌无为、傻头笨脑、鸡肠小肚、无朋无友的人，或多
Autumn Dryness Grief
Water Kidney Bladder Ears 或少都缺了点“心眼” Winter Cold Fear
Table 2 In WHM four humours and four elements links human body and nature
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Elements Humour Season Organ Qualities Ancient name Ancient characteristics

Air Blood Spring Liver Warm & moist Sanguine courageous, hopeful,
对孙真人《养生铭》的现代诠释 amorous
Fire Yellow bile Summer Gallbladder Warm & dry Choleric easily angered,
温长路 bad tempered
Earth Black bile Autumn Spleen Cold & moist Melancholic despondent,
中华中医药学会（100029） sleepless, irritable
Water Phlegm Winter Brain/ lung Cold & dry Phlegmatic calm, unemotional
4) TCM and WHM both incorporate holistic concepts,
成者，除了传统意义上的医学理论和实践外，把养生防病纳 found for most pharmaceutical drugs. Many drugs works
they agree that the entire body functions as an organic
入人类的健康大系，并使他成为具有理论与实际一体的特色 well《黄帝内经》中有明确地论述：
现。 to treat one disease but their“大怒则形气绝，而血菀
side effects may cause
whole. new diseases. In some conditions drug addiction and drug
5) TCM and WHM have many similar or exactly the resistance are difficult to avoid. Humans need an
same indications for some herbs. For example: Angelica 及飱泄。 ”（《素问•举痛论》
alternative ）也就是说，怒因气生，气则怒
approach to maintain their health and life.
(Danggui) was used as a blood nutrition agent and a
次作过专门总结，这是有典可据的。除此以外，有关孙思邈 Herbal medicine is a wise choice.
menstrual regulator and female tonic; Ephedra Ephedra
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广， Herbal medicine
《淮南子》所言： comes from natural plants; flowers,
sinica (Mahuang) was used to treat asthma.
《养生铭》就是其中的一首。此文收于《全唐书》和后人整 seeds, leaves, branches,
充则气激，气激则发怒”。唐代诗人白居易在他在一首制怒 roots and barks. Compared to
6) For some other herbs TCM and WHM have some chemical synthetic drugs they are much safer and cause
different indications. For example: In TCM Mint (Bohe) fewer side effects. Some herbs can reduce the side effects
is used to expel early stage measles,
but in WHM it was of chemical drugs when they are combined
得平，若问病根深与浅，此身应与病齐生” 。 together. The
used as a spasmolytic in some conditions; Ginger (Sheng
方类聚》及日本的相关著作中也都有反映。这些版本在文字 effect of herbs has been proved by countless cases
Jiang) is used to treat nausea & vomiting in both TCM &
上虽然有些出入，但其基本内容是一致的。陕西耀县的药王 through thousands of years’ practice. In the east and west
WHM, but it is also used as an anti-platelet and of the world, our ancestors leave us a great treasure –
antipyretic in WHM. In TCM’s opinion it is a pungent & herbal medicine. It is our inheritance and our
warm herb, only suitable for wind-cold syndrome, not 因此致死者也不罕见。《三国演义》中诸葛亮三气周瑜的故
responsibility to develop this treasure and hand it down to
suitable for wind-heat syndrome.
next generation.
7) To explain the functions of herbs, TCM uses more TCM and WHM are two main branches of natural
traditional theory and terminology like yin/yang; herbal therapy. From basic 36
真枪实弹就放倒了这位年仅 theory to clinical indications
cold/heat; deficiency/excess; qi and meridians; WHM
亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。 they have many similar opinions. For a long time, the
uses 若要无诸病，常当节五辛。安神宜悦乐，惜气保和纯。
more modern medicine terminology like practitioners of these two traditions lacked with
anti-inflammatory, anti-allergic, anti-microbial, anti-Ulcer, 亡的病例，在国内外媒体上都不时有过报道。
communication, they practiced separately,“气是杀人贼”
and did not，
etc. know much about each other. We hope this crossover
时过境迁，从公元 6 世纪至今，历史的隧道已经向前穿 study between two different subjects will bring about
Discussion some new ideas in both TCM and WHM.
Modern medicine mainly uses chemical synthetic
drugs to treat disease. A lot of side effects have been
Table 3.1.
Chinese medicine Western herbal medicine
Name Danggui 当归
为了方便叙述，本文将孙真人的这首诗分为五段进行剖 Angelica Angelica sinensis
Functions Nourishing blood; Remove the blood stasis; Anti-inflammatory; Uterine regulator; Anti-anaemic;
Regulating menstruation and release pain; Antiplatelet; Anti-arrythmic; Mild laxative; Female
Moisten larger intestine tonic
Indications Blood deficiency, Dysmenorrhoea; Irregular Dysmenorrhoea; Irregular menstruation;
气弱病相因 menstruation; Amenorrhoea; Infertility; 再说孙氏诗中说的思伤神，神指的是人的精神意识，是
Amenorrhoea; ;PMS; Infertility; Menopause;
Constipation due to the blood deficiency
CVS disorders
Formulations Decoction;
之所伤，脾胃之气也；喜之所伤，心气也。气乃肺、肾所主，Pills; Tablets Tincture
Doses 10-15g in decoction
神依气血所存，正气损伤，岂不心“疫” 、病“因”吗！对 As 1:3 tincture, 30-60ml
的话。思为心所主， / week
Table 3.2 理智、敏捷、灵活，健康长寿的机会相对就多；反之，人就
Chinese medicine Western herbal medicine
Name ，滋味不绝为四难
伤肾气之大虑） Bohe 薄荷（吃也是非常费脑筋的活）， Peppermint Mentha x piperita
Functions Expel wind
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼 heat; Cooling head and eyes; Carminative; Spasmolytic; Choleretic; Anti-emetic/
Expel measles anti-nausea; Disinfectant
Indications Common cold or flu due to wind- heat invade Dyspepsia; Nausea。很显然，心的这些功能里，包括了
或少都缺了点“心眼” or vomiting ; Flatulence; Biliary
Early stage of measles; Headache, red eyes disorders; Essential oil topically as mild anaesthetic
13
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London, HA8Gardens,
7BJ. London NW4 3RJ
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of Chinese
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MedicineAnd
AndAcupuncture
Volume 21 Issue
September
and sore throat due to the wind-heat

for headache and injury pain; Used as vapour
inhalation for colds/ catarrh etc
Formulations Decoction; Pills; Tablets Tincture; Infusion (tisane); Essential oil in enteric
对孙真人《养生铭》的现代诠释 coated capsules
Doses 3-6g in decoction
温长路 As infusion: 1 teaspoon per cup boiling water, infused
5 mins, drunk t.d.s / p.r.n.; As 1:3 tincture, 10-30ml /
week
Table 3.3
Chinese medicine 就孙氏诗中所说之怒伤肝言，它是人情志受损的一种表
Western herbal medicine
Name Sheng Di Huang 生地黄现。
Rehmannia Rehmannia glutinosa“大怒则形气绝，而血菀
Functions Clearing heat and promoting body fluid; （涌）于上。 ” （《素问•生气通天论》
Adrenal restorative; ）“怒则气逆，甚则呕血
Anti-inflammatory;
Nourishing Yin & blood; Cooling blood 及飱泄。 ”（《素问•举痛论》）也就是说，怒因气生，气则怒
Anti-haemorrhagic; Anti-pyretic
Indications Asthenia heat, hot flash; Diabetes;
次作过专门总结，这是有典可据的。除此以外，有关孙思邈 Adrenal exhaustion; As support for adrenals during
Hematemesis, metrorrhagia, purpura due to 《淮南子》所言：
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广， corticosteroid “人之性，有所侵犯则怒，怒则血充，血
treatment; General tonic
blood heat; Prevent miscarriage; Constipation充则气激，气激则发怒”
《养生铭》就是其中的一首。此文收于《全唐书》和后人整 Some skin and muscular skeletal inflammations
。唐代诗人白居易在他在一首制怒
due to Yin deficiency.
Formulations
铭》的。宋代温革的《琐碎录》和Decoction; Pills; Tablets
14 世纪朝鲜出版的《医 Tincture
Doses 10-15 g in
方类聚》及日本的相关著作中也都有反映。这些版本在文字 decoction As 1:2 tincture, 30-60ml/week
Table 3.4 目胀、面红、耳赤、呕血、憋气等症状。甚则使人昏厥卒倒，
Chinese medicine Western herbs medicine
Name Xiao Hui Xiang 小茴香
怒甚偏伤气，思多太损神。神疲心易疫，气弱病相因。 Fennel Seed Foeniculum vulgare
Functions Warming kidney and liver; Remove Qi
勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。 Carminative; Anti-spasmodic; Stomachic/ orexigenic;
stagnation and release pain; Benefit stomach.
亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。 Some use as anti-inflammatory; Expectorant, mild
若要无诸病，常当节五辛。安神宜悦乐，惜气保和纯。 anti-asthmatic
Indications Lower abdominal pain; Hernia pain; 亡的病例，
Testicle 在国内外媒体上都不时有过报道。
Colic; IBS; Flatulence; “气是杀人贼” ，
pain; Dysmenorrhea; Stomachache due to the 老百姓的说法一语道破了生气对人类健康的严重危害。
Poor appetite; Some use topically for rheumatism
时过境迁，从公元 6 cold世纪至今，历史的隧道已经向前穿美国医学专家的一项调查说，一个人经常发怒或心身承
越了 Formulations Decoction; Pills Tincture; Infusion (tisane)
Doses 10-15g in decoction Tincture: 1:2, 20-40ml / week
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是 As infusion: 1 teaspoon
增加胃中盐酸的流量， bruised/crushed
影响人的食欲， seed per cup
需要科学者正面回答的问题，也正是本文要用现代观点诠释 boiling water, infused 5 mins, drunk t.d.s / p.r.n.
Table 3.5
Chinese medicine
为了方便叙述，本文将孙真人的这首诗分为五段进行剖 Western herbs
现，每发一次怒或绝望值增加 medicine
1 分，高血圧的危险性就增加
Name Da Huang 大黄
析，每两句为一节，先从第一节说起。 Rhubarb Rheum palmatum
Functions Purge sthenia heat; Expel damp-heat Laxative; Astringent; Haemostatic; Stomachic;
Smoothing intestine; Cooling blood Anti-inflammatory;
癌症患者中易发怒的人明显高于性格温和的人。 Anti-microbial; Choleretic
气弱病相因 Detoxication; Remove blood stasis Antipyretic; Anti-uraemic; Antilipidaemic
Nephroprotective; Antineoplastic
Indications Constipation due to excess heat; Abdominal Constipation; Haemorrhoids; Diarrhoea;
pain due to food retention; Jaundice due to Gastroenteritis; Gastro-intestinal Haemorrhage
damp-heat; Bleeding due to blood heat Acute hepatitis/ pancreatitis/ cholecystitis
Carbuncles and boils; Red eyes, pain and
于此，孙思邈在他的《千金方》中曾引用魏晋时期养生学家 Hyperlipidaemia; Skin inflammation
swelling in the throat and gum.
As an adjunct in kidney problems and some cancers
Formulations Decoction;
心病），喜怒不除为二难，声色不去为三难（确为耗心神、 Pills; Tablets 会表现出愚笨、粗鲁、迟钝、固执，疾病和灾难的发生率相
Tincture; Powder; Decoction
Doses
伤肾气之大虑） 5-10 g in（吃也是非常费脑筋的活）
，滋味不绝为四难 decoction ，对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
As powder, ½ - 1 teaspoon per dose;
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼 As 1:2 tincture, 5-30ml / week
Table 3.6
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Name Renshen 人参 Korean Ginseng Panax ginseng
Functions Invigorating vital qi; Invigorating spleen
Adaptogen; Thymoleptic; Tonic; Stimulant/ anti-fatigue;
and benefiting lung; Promoting body fluid
Immunomodulator; Hypoglycaemic; Anti-inflammatory;
Hepatoprotective & Cardioprotective; Anti-arrhythmic
温长路
Indications Qi deficiency; Qi exhaustion Stress & tiredness (short-term); Convalescence;
Aging & Debility (long-term); Impotence, poor sperm
motility/ count; Menopause; Substance abuse
Poor immune function, as a prophylactic for cancers & a
treatment of immune related conditions like HIV
Formulations Decoction; Pills 就孙氏诗中所说之怒伤肝言，它是人情志受损的一种表
Tincture; Capsules or Tablets (containing powdered herb
or standardised extracts) “大怒则形气绝，而血菀
Doses 6-10 g in decoction
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题 As tincture:
（涌）于上。 ”（1:2, 7-40ml / week; As
《素问•生气通天论》） tablet, dose range
有过许多精辟的论述，并在《千金方》和《千金翼方》中两 equivalent
及飱泄。 to 300mg – 1.5g）也就是说，怒因气生，气则怒
”（《素问•举痛论》 daily.
Table 3.7
Chinese medicine
理的孙氏的《摄生咏》中，也有称为《保生铭》和《孙真人 Western herbs
诗中也阐明了雷同的观点： medicine
Name
铭》的。宋代温革的《琐碎录》和Wu Wei Zi 五味子 14 世纪朝鲜出版的《医 Schizandra Shisandra chinensis
Functions Astringing lung; Benefit Qi and promoting
方类聚》及日本的相关著作中也都有反映。这些版本在文字 Hepatic/ hepatoprotective; Detoxifying; Adaptogen;
fluid; Nourishing heart and kidney
上虽然有些出入，但其基本内容是一致的。陕西耀县的药王 Nervine Tonic; Antitussive; Oxytocic (Uterotonic)
Indications Chronic cough and asthma; Insomnia and
山上，也保存有这首诗的石刻件，还不时被中外游人转抄和 Liver面红、
目胀、 damage
耳赤、and 呕血、
toxicity憋气等症状。
related to poor liver function
palpitations; Nocturnal emission; Chronic and Acute liver disease; Nervous-system
Chronic diarrhea; Spontaneous sweating and disorders
night sweating; Diabetes due to internal heat
Formulations Decoction; Pills
勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。 Tincture
Doses 6-10 g in decoction
亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。 As 1:2 tincture, 25-60ml / week
Table 3.8 亡的病例，在国内外媒体上都不时有过报道。
，
Name 6 世纪至今，历史的隧道已经向前穿
Ma Huang 麻黄 Ephedra Ephedra sinica
Functions Inducing sweating to relieve superficies Anti-asthmatic; Bronchodilator; Central nervous
Dispersing lung relieving asthma
时代，膏粱厚味之外，琳琅满目的各色保健品足以让人眼花 system and cardiac stimulant; Sympathomimetic;
Promoting urination and expelling edema
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是 Diaphoretic; Mydriatic;
增加胃中盐酸的流量， Diuretic; Anti-allergic;
影响人的食欲，使人发生胃痛、恶心，
需要科学者正面回答的问题，也正是本文要用现代观点诠释 Decongestant
Indications Common cold or flu due to wind-cold
孙真人《养生铭》的立意所在，相信事实会给人们一个有说 Asthma; Hayfever & Allergies; Whooping Cough
服力的答案。 Asthma; Edema at up part of body (pertussis); Enuresis ; Some nervous system disorders
为了方便叙述，本文将孙真人的这首诗分为五段进行剖 including narcolepsy
Formulations Decoction; Pills; Tablets Tincture
Doses 6-9 g in decoction As 1:4 tincture, legal maximum 48ml / week
(Schedule III herb in the UK)
英国中医针灸杂志
The Journal of Chinese Medicine and Acupuncture

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This journal is free to ATCM members (one copy 人、豁达大度的人、善于处世的人，都是有“心计”的；而
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼 per member), and £4.00 plus £1.50 p&p for
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观察关幼波益气活血化痰通络法治疗乙肝后肝硬化104例
刘汶，李灼，李娟娟，冯金帅，龚然
温长路
首都医科大学附属北京中医医院感染科
摘要: 目的观察关幼波益气活血化痰通络方治疗乙肝后肝硬化疗效。方法选取乙肝后肝硬化患者104例，

随机分为治疗组和对照组，每组52例；两组均给予常规护肝治疗，同时治疗组给予关幼波益气活血化痰通络
方，对照组给予复方鳖甲软肝片。比较两组治疗前后证候积分、肝功能指标、血小板计数（PLT）、透明质
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题（涌）于上。”（《素问•生气通天论》
酸（HA）、III型前胶原肽（PCⅢ）、IV型胶原（IV－C）和层粘蛋白〔LN)、S指数及肝纤维化指数(FibroIndex)
值变化并综合评价疾病疗效。结果治疗后两组组内比较患者肝功能、PLT、肝纤维化四项、证候积分、S指
数及FibroIndex值比治疗前均有明显减少（P<0.05），两组组间比较除PLT无明显统计学差异（P>0.05），其
余指标治疗组与对照组相比有统计学差异（P<0.05）。结论通过本研究发现益气活血化痰通络方能够有效
助延缓肝脏纤维化进程，且有一定的保肝降酶作用。
摘要: 肝硬化；痰瘀理论；复方鳖甲软肝片
乙型病毒性肝炎是引起肝硬化的常见病因，疾病发展至
山上，也保存有这首诗的石刻件，还不时被中外游人转抄和 EpiCalc2000
目胀、面红、耳赤、软件，按照成组设计两样本率比较样本含量估
呕血、憋气等症状。甚则使人昏厥卒倒，
失代偿期则难以逆转。近期越来越多基于病理学研究的肝硬因此致死者也不罕见。《三国演义》中诸葛亮三气周瑜的故
计公式（参照刘建平.循证中医药临床研究方法.人民卫生出
化疗效评定研究证实，早期肝硬化可以逆转。肝硬化程度与事，就是一个典型的案例：血气方刚的周瑜性情急躁，容易
版社），计算得出样本量每组45例，考虑15%的脱落率。确
透明质酸（HA）、III型前胶原肽（PCⅢ）、IV型胶原（IV
勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。定本研究总例数为104例。
－C）和层粘蛋白〔LN)等多项指标密切相关，且与无创肝
1.3诊断标准及纳入标准
纤维模型S指数[1]及FibroIndex[2]成正相关，我们应用以关
1.3.1肝硬化诊断标准
：符合2003年中国中西医结合学会，
幼波痰瘀理论为基础拟定的益气活血化痰通络方联合常规老百姓的说法一语道破了生气对人类健康的严重危害。
消化系统疾病专业委员会重庆会议“肝硬化中西医结合诊治
护肝药物及抗病毒治疗，在延缓肝硬化进程上起到了一定作美国医学专家的一项调查说，一个人经常发怒或心身承
方案草案”拟定的肝硬化诊断标准 [3]。病因学诊断符合血
用，现将结果报道如下。受的压力太大，机体会分泌出一种代谢类固醇──皮质醇，
清学检查HBsAg（+）。
1.3.2中医证候诊断标准：符合中药新药临床指导原则拟
1.
材料与方法增加胃中盐酸的流量，影响人的食欲，使人发生胃痛、恶心，
需要科学者正面回答的问题，也正是本文要用现代观点诠释定的气虚痰瘀证标准，表现为乏力，腹胀，食欲下降，右胁
1.1一般资料
孙真人《养生铭》的立意所在，相信事实会给人们一个有说隐痛而胀，胸闷不舒，头昏而重，口干苦粘，肢体麻木，或
选择2011年10月 ~ 2012年10月就诊于我院肝病科门诊
易健忘，舌质紫黯，或有瘀点、瘀斑，或舌下静脉曲张，苔
的乙型病毒性肝炎后肝硬化患者104例，患者其中男性50例，现，每发一次怒或绝望值增加 1 分，高血圧的危险性就增加
腻，脉涩。
女性54例。年龄最大51岁，最小39岁，利用计算机伪随机数 16%。而高血圧又可成为新的病因，引发其他更严重的疾病
1.4排除标准
法随机分为2组，治疗组52例，男性24例，女性28例，平均
1. 怒甚偏伤气，思多太损神。神疲心易疫，（1）年龄18岁以下或65岁以上；
年龄44.96±3.50岁，对照组52例，男性26例，女性26例，44.88
气弱病相因（2）重型肝炎和/或肝衰竭；
±3.32岁，血清病原学检查HBV-DNA（+）病例总数23例。（3）冠心病、慢性肺心病、血液系统疾病；
治疗前，两组年龄、性别、Child-Pugh分级、肝功能、肝纤（4）伴有脑血管疾病、常规治疗未能控制的高血病及症
维化四项指标、PLT、超声检查、S指数及FibroIndex等资料状性高血压；
无明显差异（P>0.05），具有可比性。（5）呼吸衰竭、发热等可能影响观察结果者；
（6）食管胃底静脉曲张破裂所致的急性出血期；
1.2病例计算（7）妊娠或哺乳期妇女；
按照随机对照试验设计要求，根据相关文献报导及我院（8）精神障碍不能配合者。
临床治疗经验，复方鳖甲软肝片治疗肝硬化的有效率为人、豁达大度的人、善于处世的人，都是有“心计”的；而
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼 1.5治疗方法
59.8%。结合课题组的研究基础，估计常规中药辨证治疗肝那些碌碌无为、傻头笨脑、鸡肠小肚、无朋无友的人，或多
英华，呼吸太阳，不能不回其操、不夭其年也。五者无于胸治疗组按照关幼波益气活血化痰通络法予益气活血化痰
硬化的有效率为85.5%,
中，以a=0.05，β=0.1.根据统计软件
通络汤 [4] 加减治疗。
Epidemiological Calculator（流行病学计算器），简称
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基础方：生黄芪30g 生赭石10g，旋覆花10g，杏仁10g，所有数据输入电脑，用SPSS19.0软件包建立数据库并进

橘红10g，赤芍10g，白芍10g，丹参10g，香附10g，瓜蒌15g，行分析，计数资料用X2检验、秩和检验、Mann-Whitney U
小蓟10g，藕节10g，泽兰10g。对孙真人《养生铭》的现代诠释
检验，计量资料以均数±标准差表示，用 t 检验。P<0.05
加减：食欲不振加鸡内金30g，焦三仙30g，胃胀加旋复为有统计学意义。
温长路
花20g、生赭石30，乏力较重，加太子参30g、红景天30g，
2.结果
口干、眼干加女贞子30g、沙苑子30g。肝区疼痛加元胡10g、
川楝子10g，舌下系带紫暗，瘀血严重者加王不留行10g，穿 2.1两组中医证候积分比较
山甲5g。
两组组内治疗后积分均较治疗前明显减少（P<0.01），
服用方法：200ml/次，每日早晚2次，饭后1小时温服，就孙氏诗中所说之怒伤肝言，它是人情志受损的一种表
治疗后的治疗组中医证候积分较对照组明显减少（P<0.01）。
疗程6个月。对照组给予复方鳖甲软肝片，4片/次，每天3次，现。
（见表1）。
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题（涌）于上。”（
疗程6个月。表1 治疗组与对照组中医证候积分比较（Mean±SD）
两组均给予常规保肝治疗。HBV-DNA阳性患者同时给予
组别例数治疗前（分）治疗 6 个月后（分）
常规抗病毒治疗。
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广，《淮南子》所言：
治疗组 52 “人之性，有所侵犯则怒，怒则血充，血
19.06±2.73 7.13±4.20△▲
1.6观察方法充则气激，气激则发怒”
对照组 52 。唐代诗人白居易在他在一首制怒
18.31±2.39 9.55±4.63△
1.6.1中医临床证候观测利用症状体征量化表（依照《中 △
注：与治疗前相比 P<0.01，与对照组相比 P<0.01。
▲

。
药新药临床研究指导原则》拟定）[5] 记录中医临床症状，
方类聚》及日本的相关著作中也都有反映。这些版本在文字 2.2两组中医证候有效率比较
按无、轻、中、重分别记0、1、2、3分。
卡方检验结果提示治疗组中医证候治疗效果优于对照组
1.6.2理化指标检测观察治疗前后肝生化功能检测：血
（P<0.05）。（见表2）
清谷丙转氨酶(ALT)、血清谷草转氨酶(AST)、血清总胆红素因此致死者也不罕见。《三国演义》中诸葛亮三气周瑜的故
表 2 治疗组与对照组中医证候有效率比较
(TBil)、γ-谷氨酰转肽酶（GGT）、血清白蛋白（Alb）；事，就是一个典型的案例：血气方刚的周瑜性情急躁，容易
肝纤维化血清学指标：透明质酸（HA）、III型前胶原肽、IV 发怒。深谙心理学的诸葛亮故意用计让他动气，结果没有用
组别显效有效无效合计有效率(%)
22 24
治疗组 36 6岁的英雄汉。临床上遇到的
52 88.5
－C（IV型胶原）和层粘蛋白〔LN)；血常规：PLT；FibroIndex：
17 20 15 52 71.2
对照组
10×eD/(1+eD)[D=-6.29+1.678×ln(年龄)-1.786×
，
ln(PLT)+1.177×ln(GGT)+1.019×ln(HA)]。S指数：1000× 2.3两组疾病综合疗效比较
GGT/( PLT×Alb2)。（疗效评价标准以肝脏组织细胞学检查
结果如表3所示，治疗6个月后，治疗组疾病综合疗效明
为准，上述指标仅供参考）受的压力太大，机体会分泌出一种代谢类固醇──皮质醇，
显高于对照组（P<0.05）。
1.7中医证候疗效标准 [6] 表 3 治疗组与对照组疾病疗效比较
临床痊愈：症状、体征消失或基本消失，证候积分减少
需要科学者正面回答的问题，也正是本文要用现代观点诠释组别显效有效无效合计有效率(%)
≥95%
孙真人《养生铭》的立意所在，相信事实会给人们一个有说治疗组 22 21 9 52 82.7
服力的答案。
显效：症状、体征明显改善，证候积分减少≥70% 对照组 19 13 20 616 名男性对象的调查发
学家的研究证实了这一点，他们对 52 61.5
有效：症状、体征均有好转，证候积分减少≥30% 现，每发一次怒或绝望值增加 1 分，高血圧的危险性就增加
2.4治疗组与对照组肝功能、PLT及肝纤维化四项指标比较
无效：症状、体征无明显改善，甚或加重，证候积分减治疗6个月后，两组组内比较，上述各项指标治疗后与治
少不足30%
1. 怒甚偏伤气，思多太损神。神疲心易疫，疗前比较具有统计学差异（P<0.05）。治疗组与对照组组间
气弱病相因
1.8疾病疗效标准 [7] 比较，肝功能指标、肝纤维化四项指标有统计学差异
显效：症状消失;肝脾回复正常或回缩，无压痛及叩痛;
（P<0.05），两组组间PLT比较无统计学差异（P>0.05）(见
肝功指标复常; HA、LN、IV-C、PCIII四项指标中异常的指
表4) 《灵枢•大惑论》中有“心者，神之舍也”
标中有两项恢复正常。 2.5 两组治疗前后肝纤维化S指数与FibroIndex指数比较
有效：症状明显减轻或消失;肝脾肿大稳定不变，无明显结果显示两组在治疗后,治疗组S指数及FibroIndex指数比
压痛及叩痛;肝功能指标恢复正常或较治疗前异常值下降50% 会表现出愚笨、粗鲁、迟钝、固执，疾病和灾难的发生率相
心病），喜怒不除为二难，声色不去为三难（确为耗心神、较具有统计学差异（P<0.01）。（见图1、图2）
以上，HA、LN、IV-C、PCIII四项指标中异常的指标中有一对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
项以上恢复正常。
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼 3.讨论
无效：未达到上述标准。
关幼波益气活血化痰通络复方中，君药黄芪补益后天之
1.9统计学方法气以扶正祛邪，据关老多年的行医经验，臣药瓜蒌、杏仁、
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表 4 两组肝功能、肝纤维化四项指标及 PLT 比较（Mean±SD）
项目例数治疗前治疗后治疗前后比较 P 值
ALT（U/L）
治疗组 52 131.10±15.59 41.85±9.32 ★
P<0.05
对照组 52 131.99±18.95
温长路 50.08±6.02 P<0.05
★
AST（U/L）治疗组 52 52.27±13.01 35.53±6.81 P<0.05
对照组中华中医药学会（100029）
52 50.80±13.63 45.35±8.82 P<0.05
★
GGT（U/L）治疗组 52 184.70±21.50 154.60±17.64 P<0.05
对照组 52 188.32±18.87
在我国医学发展史上，孙思邈可谓一位集众多学说之大 165.24±16.31
的都是情志对养生的决定性作用。 P<0.05
★
TBIL(µmol/L) 治疗组 52
成者，除了传统意义上的医学理论和实践外，把养生防病纳 37.72±6.96 14.24±5.91 P<0.05
对照组 52
入人类的健康大系，并使他成为具有理论与实际一体的特色38.66±6.97
现。 18.98±4.63
《黄帝内经》中有明确地论述： P<0.05
★
ALB(g/L ) 治疗组 52
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题28.56±2.25 32.82±1.96
（涌）于上。 ”（ P<0.05
《素问•生气通天论》）“怒则气逆，甚则呕血
对照组 52
有过许多精辟的论述，并在《千金方》和《千金翼方》中两29.14±2.24 30.43±2.36
及飱泄。”（《素问•举痛论》 P<0.05
PLT（×109/L）治疗组 52
次作过专门总结，这是有典可据的。除此以外，有关孙思邈91.51±13.63 102.17±7.33 P<0.05
对照组 52 88.34±14.41
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广， 103.41±7.13
《淮南子》所言： P<0.05
★
HA（ng/mL）治疗组 52 426.7±59.8
《养生铭》就是其中的一首。此文收于《全唐书》和后人整充则气激，气激则发怒” P<0.05
196.9±36.2 。唐代诗人白居易在他在一首制怒
对照组 52 434.5±61.9
理的孙氏的《摄生咏》中，也有称为《保生铭》和《孙真人 298.0±39.7
诗中也阐明了雷同的观点： P<0.05
14 世纪朝鲜出版的《医
★
LN（μg/L）治疗组 52 得平，若问病根深与浅，此身应与病齐生”
141.7±44.7 95.3±9.8 P<0.05 。
对照组 52 133.0±45.9怒气大发，相应的疾病就会因之而生，受害最直接的是
104.6±14.8 P<0.05
PCⅢ（μg/L ）治疗组 52 肝胆系统。因怒导致的机体的气血逆乱，会使人出现头痛、
189.4±37.5 114.4±24.7★ P<0.05
对照组 52 目胀、面红、
196.0±40.6 耳赤、呕血、憋气等症状。
139.2±23.4 P<0.05 甚则使人昏厥卒倒，
IV-C (ug/L) 治疗组 52 因此致死者也不罕见。
192.5±27.9 113.3±30.8★《三国演义》中诸葛亮三气周瑜的故
P<0.05
对照组 52 事，就是一个典型的案例：血气方刚的周瑜性情急躁，容易
189.2±28.8 141.9±24.8 P<0.05
注：★与对照组相比 P<0.05。发怒。深谙心理学的诸葛亮故意用计让他动气，结果没有用
治疗组与对照组 S 指数与 FibroIndex 比较直方图
，
图1 图2
橘红相配伍后理气化痰效果甚佳，佐以旋复花、生赭石、化
肾之阴，既能防诸化痰药物劫伤肝阴，又可治疗湿热久稽耗
痰下气以除痞满治疗肝硬化之腹胀。赤芍、白芍、丹参既养
伤肝阴。肝区疼痛加元胡、川楝子加强活血行气。舌下系带
血柔肝，又化瘀以止疼痛，与理气药香附相伍可以理气而不紫暗，瘀血严重者加王不留行，穿山甲以破血通络，散结除
破气，活血而不伤血。因痰瘀互结，久病入络，佐以小蓟、痞。黄芪还可利水消肿，补而不滞，尤其对于肝硬化腹水者
藕节、泽兰既活血化瘀畅通络脉，缓消而散坚积，又引诸药疗效显著；现代药理学研究证实：益气药物黄芪可降低慢性
入于肝络而治络脉之疾。食欲不振加鸡内金，焦三仙配合旋乙型肝炎患者HA含量,降低血清TGF-β1及提高外周血单个
复花、生赭石消食下气除胀满；乏力较重，加太子参、红景核细胞产生干扰素(INF)γ的活性[8]，还可以促进肝脏合成
天佐黄芪以益气养血；口干、眼干加女贞子、沙苑子滋养肝
功能，提高血浆白蛋白水平；穿山甲、王不留能有效降低血
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House, Unit 5,Road,
London, HA8Gardens,
7BJ. London NW4 3RJ
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The Journal
The Journal of
of Chinese
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AndAcupuncture
Volume 21 Issue
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液粘度，改善肝硬化患者微循环障碍，促进肝细胞供血，帮对于肝硬化发生发展干预的具体机制尚未研究充分，还有待
助肝组织再生。进一步实验室基础研究讨论。
肝硬化患者体内星型胶质细胞分泌大量胶原蛋白等ECM，对孙真人《养生铭》的现代诠释
生成大于降解，稳定的胶原纤维含量增多。由肝星状细胞分参考文献
温长路
泌的HA、PCⅢ、LN、IV-C都是ECM或其代谢产物，在一定 [1] 周琨，郑瑞丹，咸建春等．从常规指标中建立肝纤维化非创伤
程度上反映肝硬化发展的快慢。在诊断方面，肝穿结果与模中华中医药学会（100029）
性诊断模型[J]．肝脏，2008，13(5)：263—267.
[2] 张文胜,王宝恩,王泰龄等.慢性乙型肝炎肝纤维化无创性诊断模
型研究证实，以乙肝病例构建的S指数[9]与肝穿刺结果纤维型的建立[J].中华肝脏病杂志 2006, 14(3)∶169-173.
化程度相关系数r=0. 602，具有良好的相关性，且预测肝硬
在我国医学发展史上，孙思邈可谓一位集众多学说之大 [3] 郑筱萸主编.中药新药临床研究指导原则[M],北京：中国医药科
成者，除了传统意义上的医学理论和实践外，把养生防病纳技出版社，2002.
化（S4期）的AUROC在0.881水平，特异度达到93.84%，包
[4] 赵伯智主编.关幼波肝病医案解读[M],北京：人民军医出版
含HA指标的 FibroIndex 值[10]与纤维化程度相关系数现。《黄帝内经》中有明确地论述： “大怒则形气绝，而血菀
社,2007.85-87.
r=0.718，相关度较高，灵敏度为71.3%。联合运用能够有效 [5-7]危北海，张万岱，陈治水，张育轩.肝硬化中西医结合诊治方案
有过许多精辟的论述，并在《千金方》和《千金翼方》中两及飱泄。 ”（《素问•举痛论》）也就是说，怒因气生，气则怒
[J].中国中西医结合杂志，2004，
提高肝脏硬度诊断水平并在一定程度上代替有创肝脏穿刺
[8] 程鹏,刘索侠.黄芪抗肝纤维化的作用与转化生长因子β1 及干扰
病理活检。益气活血，化痰通络治疗与复方鳖甲软肝片的活
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广，素γ的关系[J],临床军医杂志,2000,28(3)：32.
血化瘀解毒治疗相比较，前者更有助于肝纤维化四项指标改
《养生铭》就是其中的一首。此文收于《全唐书》和后人整 [9] 郑瑞丹,周琨,咸建春等.慢性乙型肝炎病毒感染患者肝纤维化非
创伤性诊断模型的应用评价[J]，肝脏,2008,13(6):451-455.
善，使S指数及FiborIndex有效降低，且有一定的保肝降酶作
[10] 朱现丽.无创模型的联合应用对慢性乙型肝炎纤维化诊断意义
用，在延缓肝硬化发生发展上疗效确切。本实验虽然从临床 14 世纪朝鲜出版的《医得平，若问病根深与浅，此身应与病齐生” 。
的研究[D],长沙：湖南中医药大学，2007.
角度证实了虚、痰、瘀与肝硬化发生发展密切相关，但本方怒气大发，相应的疾病就会因之而生，受害最直接的是
.
不同取穴方法治疗腰椎间盘突出症190例观察
周波兰，靳勇
，
深圳平乐骨伤科医院针灸理疗科（518010）
目的：观察不同取穴方法治疗腰椎间盘突出症的效果，以期为临床选穴提供参考。
方法：将190例腰椎间盘突出症患者随机分为围刺取穴组（观察组1）、夹脊取穴组（观察组2）、常规取穴组（对
照组）。观察组1取腰椎局部阿是点进行“围刺”(针刺前对患者进行细致检查，确定压痛或扣痛明显的腰椎节段，
如有明显肌肉呈条索样改变，则以条索样改变起始点为取穴范围，对应每一腰椎节段平棘突下外围阿是点为取穴
点，一侧腰痛者取同侧阿是穴与对侧L3、L4夹脊穴，双侧腰痛则按照上述方法取双侧阿是穴,以形成包围之势)，
下肢麻痛者配合秩边；观察组2取阿是点及上下椎体对应夹脊穴，下肢麻痛者配秩边、环跳、承扶、阳陵泉、昆
仑；对照组取膀胱经穴并循经取穴，根据不同经疼痛配肾俞、气海俞、大肠腧、关元俞、环跳、承扶、委中、承
山、昆仑等。
结果：观察组1总共64例，治愈39例，显效14例，有效5例，无效6例，总有效率90.6%；观察组2总共63例，治愈
34例，显效18例，有效3例，无效8例，总有效率87.3%；对照组总共20例，治愈20例，显效16例，有效6例，无效
21例，总有效率66.6%。观察组1与观察组2比较无统计学差异（p>0.05），观察组与对照组比较有统计学差异（p<0.05）。
关键词：腰椎间盘突出症、围刺法、夹脊穴
1.病例资料
于此，孙思邈在他的《千金方》中曾引用魏晋时期养生学家病情轻重、突出节段方面比较，差异无统计学意义，具有可
比性。
本实验所观察病例均明确诊断为腰椎间盘突出症，来自会表现出愚笨、粗鲁、迟钝、固执，疾病和灾难的发生率相
2009年8月至2011年8月本科室门诊病人。年龄14~71岁，病对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
伤肾气之大虑），滋味不绝为四难（吃也是非常费脑筋的活）， 2.诊断标准 [1]
程1天~10年，男124例，女66例。按照门诊先后顺序随机分
为观察组1、观察组2和对照组。观察组1病例64例，观察组2 （1）有腰部外伤、慢性劳损或受寒湿史。大部分患者在
病例63例，对照组63例。三组病例患者在年龄、性别、病程、发病前有慢性腰痛史。
（2）常发生于青壮年。
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（3）腰痛向臀部及下肢放射，腹压增加（如咳嗽、喷嚏）治疗效果比较见表1。“围刺法”针刺阿是穴与传统取穴
时疼痛加重。比较对于腰椎间盘突出症效果更佳。针刺夹脊穴治疗腰椎间
（4）脊柱侧弯，腰理理弧度消失，病变部位椎旁有压痛，对孙真人《养生铭》的现代诠释
盘突出症效果优于传统取穴。
并向下肢放射，腰部活动受限。
表 1 三组疗效比较
温长路
（5）下肢受累神经支配区有感觉过敏或迟钝，病程长都
可出现肌内萎缩直腿抬高或加强试验阳性，膝、跟腱反射减组别例数治愈显效有效无效有效率（%）
弱或消失，拇趾背伸力减弱。观察组 1 64 39 14 5 6 90.6*
（6）X线摄片检查：脊柱侧弯，腰生理前凸消失，相邻观察组 2 63 34 18 3 8 87.3*
边缘有骨赘增生。CT、MRI检查可显示椎间盘突出的部位及对照组 63 20 16 6 21 66.6*
程度。
*观察组 “大怒则形气绝，而血菀
1 与观察组 2 比较差异无统计学意义（p>0.05）；
*观察组 ”
2 与对照组比较差异有统计学意义（p<0.05）
。
3.疗效评定标准 [2]
（1）治愈：腰腿痛消失，直腿抬高70°以上，能恢复原 6.讨论
工作，能行走两公里以上。《淮南子》所言：“人之性，有所侵犯则怒，怒则血充，血
腰椎间盘突出症属中医学“腰痛”、“痹证”范畴。《素
（2）好转：腰腿痛减轻，腰部活动功能改善。充则气激，气激则发怒”。唐代诗人白居易在他在一首制怒
问.脉要精微论》记载：“腰者，肾之府，转摇不能，肾将惫
（3）未愈：症状、体征无改善。诗中也阐明了雷同的观点：“自知气发每因情，情在何由气
矣”，《丹溪心法》曰：“腰痛，血滞于下”，《诸病源候
论》：“劳损于肾，动伤经络，又为风冷所侵，气血击搏，
4.实验方法
故腰痛也”。其病因为外邪侵袭、体虚年衰、跌仆闪挫，基
取穴方法本病机为筋脉痹阻，腰府失养。是因“不通则痛，不荣则痛”，
观察组1 根据本人多年临床经验总结的“围刺法”取穴，
效法。其诗全文如下：治疗上以“补肾固本，祛邪通络”为其治疗原则。针灸具有
针刺前对患者进行细致检查，确定压痛或扣痛明显的腰椎节疏通经络，补肾益髓的作用，治疗腰腿痛历史悠久，《素问.
段，如有明显肌肉呈条索样改变，则以条索样改变起始点为刺腰痛第四十一》根据经络循行，阐述了各经络为病所出现
取穴范围，对应每一腰椎节段平棘突下外围阿是点为取穴点，真枪实弹就放倒了这位年仅 36 岁的英雄汉。临床上遇到的
的腰痛症状及相应的针刺方法和穴位： “足太阳脉令人腰痛，
一侧腰痛者取同侧阿是穴与对侧L3、L4夹脊穴，双侧腰痛则因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死
引项脊尻背如重状；刺其郄中。…少阳令人腰痛…刺少阳成
按照上述方法取双侧阿是穴，述下肢疼痛或麻木者配同侧秩亡的病例，在国内外媒体上都不时有过报道。
，
骨之端出血…”，《针灸大成》：“肾虚腰痛，举动艰难，
边穴。老百姓的说法一语道破了生气对人类健康的严重危害。
取足临泣、肾俞、脊中、委中”。
观察组2 以腰椎压痛或扣痛点为参照点，取疼痛侧其对围刺法，又称围针法，是一种在病变部位周围进行包围
应夹脊穴和上下夹脊穴，述下肢麻木者配同侧秩边、环跳、式针刺以达到提高疗效目的的针刺法。本实验与传统的围刺
承扶、阳陵泉、昆仑。法有所区别，《灵枢.经筋第十三》：“治在燔针劫刺，以知
对照组根据临床常用取穴方法，辩证取穴和循经取穴，为数，以痛为腧”。本实验即以病变周围的阿是点作为围刺
主穴：肾俞、气海俞、大肠腧、关元俞、秩边；下肢麻痛者，进针点，对病变的腰椎间盘进行围刺治疗。夹脊穴是人体常
循胆经疼痛者配环跳、风市、阳陵泉、丘墟穴；循膀胱经痛
服力的答案。用强壮穴位，而且神经干穿出皮下大部分是在夹脊穴附近，
者配秩边、承扶、委中、承山、昆仑。
为了方便叙述，本文将孙真人的这首诗分为五段进行剖因此刺激夹脊穴治疗腰椎间盘突出症能取得较为良好的效
析，每两句为一节，先从第一节说起。果。
针具及仪器
针灸针为苏州医用品有限公司生产的华佗牌一次性毫针，发生。癌症的发生也与经常发怒有直接联系，有统计证实，
1. 怒甚偏伤气，思多太损神。神疲心易疫，参考文献
规格30号，长短规格为1、1.5、2寸。电针仪为苏州华佗牌SDZ
气弱病相因 [1]再说孙氏诗中说的思伤神，神指的是人的精神意识，是
国家中医药管理局.中医病证诊断疗效标准.南京：南京大学出
－Ⅱ型电子针疗仪，选用连续波，频率90～100HZ。
版社，1994，P186。
操作方法神志的主宰者是心，《灵枢•大惑论》中有“心者，神之舍也”
之所伤，脾胃之气也；喜之所伤，心气也。气乃肺、肾所主， [2] 中华人民共和国卫生部.中药新药临床研究指导原则，1993，
穴位皮肤常规消毒，得气后通以持续电流连续波刺激30 的话。思为心所主，
P145。《孟子•告子上》中有“心之官则思”的
分钟。七天为一疗程，第一疗程每天针灸一次，休息两天后
进行第二疗程，第二疗程隔天一次，治疗两个疗程后观察效
果。
盲法
研究者、患者双盲。那些碌碌无为、傻头笨脑、鸡肠小肚、无朋无友的人，或多
5.结果大脑的某些功能。把心与脑的部分功能混而谈之，不能片面
13
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The Treatment of Carpal Tunnel Syndrome with Acupuncture:

Five Case Studies
Alexander B.温长路Mearns, Lic. Ac.
Private Clinic, Tain, Ross-Shire
Abstract: In this study five cases of Carpal Tunnel Syndrome (CTS) were treated by acupuncture. In all cases
there was significant improvement, and in four of the five cases就孙氏诗中所说之怒伤肝言，它是人情志受损的一种表
patients reported that their CTS discomfort was
either minor or alleviated completely. In view of the costs
入人类的健康大系，并使他成为具有理论与实际一体的特色现。 incurred by the NHS in treating“大怒则形气绝，而血菀
《黄帝内经》中有明确地论述： such a common
complaint, and the amount of work-days lost to employers, an effective treatment for CTS has enormous potential
cost benefits for the economy, and for personal well being of the individuals affected.
Key words: Acupuncture, Carpal Tunnel Syndrome, CTS
Introduction
《养生铭》就是其中的一首。此文收于《全唐书》和后人整 According to Flaws。唐代诗人白居易在他在一首制怒
充则气激，气激则发怒” and Sionneau (2002), CTS falls
理的孙氏的《摄生咏》中，也有称为《保生铭》和《孙真人 into three patterns.
诗中也阐明了雷同的观点： “自知气发每因情，情在何由气
According to NICE U.K. (National Institute for 1) Blood Vacuity not nourishing the Sinews and
Health and Care Excellence), Carpal 14 Tunnel
世纪朝鲜出版的《医Syndrome is 得平，若问病根深与浅，此身应与病齐生” 。
Vessels.
a peripheral nerve entrapment when there is compression
2) Qi Stagnation and Blood Stasis
of the median nerve in the carpal tunnel. It occurs more
3) Wind Damp Impediment
often in women than men and has no known cause,
although it is related to repetitive motion, vibration and As well as the usual treatment protocols associated
效法。其诗全文如下：因此致死者也不罕见。
with each pattern, it is《三国演义》中诸葛亮三气周瑜的故
also recommended that the patient
increased force in the use of the hands. It is
characterized stopped any activities which aggravated the condition,
怒甚偏伤气，思多太损神。神疲心易疫，气弱病相因。 the
by tingling, numbness or pain in
distribution of the median nerve (the thumb, index finger and that heat therapy with a TDP lamp will be helpful.
勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。 Other sources (Legge, 1997) focus solely upon local
and middle finger) and is often worse at night. (NICE 真枪实弹就放倒了这位年仅 36 岁的英雄汉。临床上遇到的
n.d.) 亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。 stagnation.
Diagnosis is based upon the physical symptoms and
simple tests although an electromyograph (EMG) of the
Case Studies
亡的病例， of treatment
在国内外媒体上都不时有过报道。 “气是杀人贼”
，
wrist showing compression of the medial nerve is 老百姓的说法一语道破了生气对人类健康的严重危害。
Case One
definitive.
时过境迁，从公元 (Flaws and6Sionneau, 2002). Treatment can
世纪至今，历史的隧道已经向前穿 Male, 38 years old, Garage Mechanic
be conservative;
越了 the use of a splint at night, avoidance of
15 个轮回，科学已经发展到了人类从地面走向太空的 This man had a history of injury on his hands and
aggravating factors, and advice that the problem may
时代，膏粱厚味之外，琳琅满目的各色保健品足以让人眼花 fingers owing to the nature of his work.. Consequently
resolve itself within six months. If there is no he has experienced pain in his hands and fingers for a
improvement within three months of conservative long time, but the pain影响人的食欲，使人发生胃痛、
had intensified 恶心，
so he consulted his
treatment, then the patient may be recommended for GP, who diagnosed CTS and advised an operation. Both
surgery. (ibid) Underlying conditions such as diabetes,
孙真人《养生铭》的立意所在，相信事实会给人们一个有说 hands were affected, but the right was much worse. He
rheumatoid arthritis and hypothyroidism must also be
服力的答案。 decided to try acupuncture before
学家的研究证实了这一点，他们对 616agreeing
名男性对象的调查发to surgery.
addressed.
为了方便叙述，本文将孙真人的这首诗分为五段进行剖 He also suffered from diverticulitis.
There does not appear to any clear figures for the Syndrome Diagnosis:
efficacy of surgery. At least one study has shown that 1) Liver Qi Stagnation
surgical methods “are probably” better than non-surgical 2) Heat in the Large Intestine
methods, but there were significantly more complications 3) Kidney Yang Deficiency
following surgery. The study applied only to severe
气弱病相因 Treatment Session 1
cases. (Verdugo et al., 2008)
In the UK it is estimated that at least 3 out of 100 men
Points selected: Liver 3, Large Intestine 4, Large
and 5 out脾胃之气也；
of 100 women will be心气也。
affected气乃肺、
by CTS肾所主，
at some Intestine 11, all were
神志的主宰者是心， retained for中有
《灵枢•大惑论》 about
“心者， forty minutes.
神之舍也”
之所伤，喜之所伤， Local Points were Pericardium 6, Large Intestine 6, and
point in their lifetime. (NHS n.d.) Up to date UK 的话。思为心所主，
神依气血所存，正气损伤，岂不心“疫”、病“因”吗！对 Large Intestine 5 on the right.
statistics are hard to find but in the US in 1994, CTS 话。心的主神、主思功能处于正常状态，人就表现出聪明、
accounted for 849,000 office based visits to physicians, Session 2
and involving
嵇康的话说： 260,000 operations. CTS results in the
“养生有五难，名利不去为一难（实乃最大的 After the first session, the patient reported a notable
highest
心病） median number of days of work lost (30 days)
，喜怒不除为二难，声色不去为三难（确为耗心神、会表现出愚笨、粗鲁、迟钝、固执，疾病和灾难的发生率相
improvement in his hands and especially in his right hand.
among all major
伤肾气之大虑） work-related injury
，滋味不绝为四难 or illness categories,，
（吃也是非常费脑筋的活） He had been on holiday, so two weeks had passed since
and of those cases nearly one half (47.5%) resulted in 31 his initial treatment.
days or more of loss of work. (Flaws and Sionneau, Points Selected: as Session 1, but this time Large
2002) Intestine 5 was used bilaterally.
Session 3
TCM Pattern”在孙氏反复论证的这段话中，重点强调
此养生之大旨也。 Differentiation 大脑的某些功能。把心与脑的部分功能混而谈之，不能片面
The patient reports that he was free from hand pain.
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September 2014
However, he had been feeling very hot and was Worker

constipated. This man came to the clinic because he has
Points Selected: Liver 3, Large Intestine 4, Large acquainted with the patient in Case 2. He had pain in
Intestine 11 to address heat issues. Locally only both hands diagnosed by his GP as CTS. His problems
Pericardium 6 was used. All were retained for about 40 started a number of years ago after a car accident, but the
minutes. At the end of the session Kidney 3 was pain had intensified recently. He experienced a tingly
温长路
tonified. sensation and then numbness in both his hands, and both
中华中医药学会（100029） were painful. His left hand was more painful than the
Result
right at night. He was quite a bit over weight.
Since the hand pain was not an issue, the patient
Syndrome Diagnosis:
discontinued treatment, electing not to address his other
在我国医学发展史上，孙思邈可谓一位集众多学说之大 1) Spleen Deficiency
issues for whatever reason. It has been over a year since
成者，除了传统意义上的医学理论和实践外，把养生防病纳 2) Damp-heat and Phlegm
his treatment and he is still free from pain.
3)) Liver Qi Stagnation
Case Two:
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题 Treatment:
（涌）于上。 ”（《素问•生气通天论》）“怒则气逆，甚则呕血
Female, 39 years old, Care Worker
Session 1:
This woman came to the clinic very reluctantly owing Points selected: Liver 3, Large Intestine 4, Large
Intestine 11, Spleen 6, Spleen 9, Stomach 40. Local
to a fear of needles. In fact her husband made the
appointment for her. She had a history of CTS problems.
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广， points: Pericardium
《淮南子》所言： 6, Large Intestine 6. All were
She had surgery for CTS on her left hand which reduced
《养生铭》就是其中的一首。此文收于《全唐书》和后人整 retained for about forty。唐代诗人白居易在他在一首制怒
充则气激，气激则发怒” minutes. They were removed,
the pain initially but it was returning. At the time of her
理的孙氏的《摄生咏》中，也有称为《保生铭》和《孙真人 and then Pericardium 7 was
诗中也阐明了雷同的观点： tonified, to test his Causative
visit to the clinic her right hand was very sore with a Factor according to Five Element theory..
weak grip. She decided to try to avoid further surgery by
方类聚》及日本的相关著作中也都有反映。这些版本在文字 Session 2:
trying acupuncture. She has a number of health issues
After Session One, the patient reported excellent
including diabetes for which she injects insulin.
progress. The tingling and numbness had gone entirely,
Syndrome Diagnosis:
山上，也保存有这首诗的石刻件，还不时被中外游人转抄和目胀、
and the面红、pain 耳赤、呕血、憋气等症状。
was significantly reduced.甚则使人昏厥卒倒，
1) Spleen Deficiency
效法。其诗全文如下： Points Selected: (as
因此致死者也不罕见。 with Session 1) Liver 3, Large
2) Damp and Damp-heat
Intestine 4, Large Intestine 11, Spleen 6, Spleen 9,
3)怒甚偏伤气，思多太损神。神疲心易疫，气弱病相因。
Liver Qi Stagnation
Stomach 40. Local points: Pericardium 6, Large
Treatment Session 1
勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。 Intestine 6. All were retained for about forty minutes.
Points selected: Liver 3, Large Intestine 4, Large
亥寝鸣云鼓，寅兴漱玉津。妖邪难犯己，精气自全身。 They were removed, and then Pericardium 7 was tonified.
Intestine 11, Spleen 9. Local points: Pericardium 6, Large 因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死
若要无诸病，常当节五辛。安神宜悦乐，惜气保和纯。 Session 3:
Intestine 6. All were retained for about forty minutes. 亡的病例，在国内外媒体上都不时有过报道。 “气是杀人贼” ，
寿夭休命论，修行本在人。若能遵此理，平地可朝真。 Owing to work schedules, it was over a month until
They were removed, and then Spleen 6 was tonified. 老百姓的说法一语道破了生气对人类健康的严重危害。
the patient returned for a follow-up treatment. He was
Session 2: 6 世纪至今，历史的隧道已经向前穿 still美国医学专家的一项调查说，一个人经常发怒或心身承
free of the tingling and numbness and the pain was
越了After15 个轮回，科学已经发展到了人类从地面走向太空的
Session One, the patient reported that the pain only slight.
was much less, particularly at night. It did return however
时代，膏粱厚味之外，琳琅满目的各色保健品足以让人眼花 Points Selected: (as with Session 1, and 2) Liver 3,
the night before her next treatment. Her grip strength
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是 Large Intestine 4, Large Intestine 11, Spleen 6, Spleen 9,
had improved as well. Stomach 40. Local points: Pericardium 6, Large
Points selected: Liver 3, Large Intestine 4, Large Intestine 6. All were retained for about forty minutes.
Intestine 11, Spleen 6 and Spleen 9. Local points: They were removed, and then Pericardium 7 was tonified.
Pericardium 6, Large Intestine 6. All were retained for
Result:
about forty minutes. They were removed, and then
为了方便叙述，本文将孙真人的这首诗分为五段进行剖 1 分，高血圧的危险性就增加
It has been nearly 3 months
现，每发一次怒或绝望值增加 since his treatment, and
Kidney 7 and Spleen 3 were tonified.
析，每两句为一节，先从第一节说起。 he is free from his symptoms.
Session 3: 发生。癌症的发生也与经常发怒有直接联系，有统计证实，
Case Four:
1. The patient reported an overall improvement in grip
怒甚偏伤气，思多太损神。神疲心易疫，癌症患者中易发怒的人明显高于性格温和的人。
strength and pain reduction. The pain, although much Male, 39 years old, Fabricator
气弱病相因
reduced, would return and then go away. The patient 再说孙氏诗中说的思伤神，神指的是人的精神意识，是
This man had a history of CTS problems, and had
was这一节总体上是讲精神养生的，怒之所伤，肝气也；思
satisfied with her progress and this was her last undergone surgery for CTS on both wrists, which he
treatment. described as partly《灵枢•大惑论》
神志的主宰者是心， successful. His中有
symptoms
“心者，were 神之舍也”worse
Points selected: Liver 3, Large Intestine 4, Large when he used a《孟子•告子上》中有“心之官则思”的
的话。思为心所主， machine called a grinder which,
Intestine 11. Local points: Pericardium 、病“因”吗！对 6, Large unfortunately, was part of his usual work duties. With
Intestine 6, Triple Burner 5. All were retained for about
于此，孙思邈在他的《千金方》中曾引用魏晋时期养生学家 regard to other health issues, he is an insulin dependent
forty minutes.
嵇康的话说： They were removed, and then Lung 7
diabetic.
and Pericardium 4 were
心病），喜怒不除为二难，声色不去为三难（确为耗心神、 tonified. 会表现出愚笨、粗鲁、迟钝、固执，疾病和灾难的发生率相
Syndrome Diagnosis:
Result:
1) Spleen Deficiency
It has been nearly six
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼 months since her treatment, and 2) Damp Heat
she has had only short term occurrences of minor pain. 3) Stomach Heat
4) Liver Qi Stagnation
Case
中， Three:
则信顺日跻，道德日全，不祈善而有福，不求寿而自延，或少都缺了点“心眼” 。很显然，心的这些功能里，包括了
5) Kidney Yang Deficiency
Male, 43 years
此养生之大旨也。 old, Bus Driver and Agricultural
”在孙氏反复论证的这段话中，重点强调
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Session 1: Session 2:
Points Selected: Liver 3, Large Intestine 4, Large The patient reported daily improvement, until the day
Intestine 11, Large Intestine 14. Local points: before treatment when the pain returned.
Pericardium 6, Large Intestine 6. All were retained for Points Selected: Liver 3, Gallbladder 34, Large
about forty minutes. They were removed, and then Intestine 4. Local Points: Pericardium 6, Small Intestine 6,
Lung 9 was tonified. 温长路Large Intestine 6. The needles were retained and then
Heart 7 and Small Intestine 4 were tonified according to
Session 2:
中华中医药学会（100029） Five Element practice.
The patient reported an improvement through
following the initial treatment, until he was engaged in Session 3:
the use of the grinding machine. This machine vibrates At this session the patient said that he was
strongly and this appears to aggravate the patient's experiencing no pain in his hands, but that there was
condition. some就孙氏诗中所说之怒伤肝言，它是人情志受损的一种表
numbness in his left hand.
Points Selected: Liver 3, Large Intestine 4, Large
入人类的健康大系，并使他成为具有理论与实际一体的特色现。 Points Selected:
《黄帝内经》中有明确地论述： (as per “大怒则形气绝，而血菀
Session 2) Liver 3,
Intestine 11. Local points:
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题 Pericardium 6, Large Gallbladder
（涌）于上。 ”（34, Large
《素问•生气通天论》 Intestine
） 4. Local Points:
Intestine 6. All were retained
for about forty minutes. Pericardium 6, Small Intestine
6, Large Intestine 6. The
They were removed, and then Lung 6 and then Lung 7 needles were retained and then Heart 7 and Small
were tonified. The tonifications however did not change 发，生气——发怒——生气，构成了一条恶性循环链。正如
Intestine 4 were tonified according to Five Element
the pulse condition.
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广， practice.
Session 3: Session 4:
The patient estimated a 40% improvement from his 诗中也阐明了雷同的观点： “自知气发每因情，情在何由气
The patient was still pain free, but there was still some
initial situation.
铭》的。宋代温革的《琐碎录》和 14 世纪朝鲜出版的《医 numbness in his left hand. A small swelling
得平，若问病根深与浅，此身应与病齐生” 。 was noted
Points Selected: Liver 3, Large Intestine 4, Large
方类聚》及日本的相关著作中也都有反映。这些版本在文字 at the base of his left palm.
Intestine 11, Spleen 6, Spleen 9. Local points:
Point Selection: Left side: Large Intestine 4, Large
Pericardium 6, Lung 9, Large Intestine 6 and Large Intestine 6, Lung 10, Pericardium 5. After retention for
Intestine 9. All were retained for about forty minutes. 目胀、
about 面红、耳赤、呕血、
forty minutes 憋气等症状。
the needles were 甚则使人昏厥卒倒，
removed and Heart
During this time the patient experienced a temporary
效法。其诗全文如下： 7 was tonified bilaterally.
feeling of dizziness but then he was fine. The needles 事，就是一个典型的案例：血气方刚的周瑜性情急躁，容易
Result:
were 怒甚偏伤气，思多太损神。神疲心易疫，气弱病相因。
removed, and then He 7 was tonified to test for his 发怒。深谙心理学的诸葛亮故意用计让他动气，结果没有用
It has been ten years since treatment and the patient
Five 勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。
Element Causative Factor, which brought about an
has been pain free and has36not
真枪实弹就放倒了这位年仅 had a recurrence of the
overall improvement in his pulse condition.
CTS. He did not need surgery.
Result:
The patient did not return for further treatment, so the
寿夭休命论，修行本在人。若能遵此理，平地可朝真。 Discussion
，
best that may be said is that there was a 40% 老百姓的说法一语道破了生气对人类健康的严重危害。

In all five cases there was an improvement, and in all
improvement, 6 世纪至今，历史的隧道已经向前穿
as estimated by the patient himself. four美国医学专家的一项调查说，一个人经常发怒或心身承
cases the length of treatment was short consisting of
越了 15 个轮回，科学已经发展到了人类从地面走向太空的 only three sessions and the fifth case involved four
Case Five:
时代，膏粱厚味之外，琳琅满目的各色保健品足以让人眼花 treatments. Further treatment is likely to have been
Male, 53 years old, Self-employed Joiner
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是 helpful for cases 1 to影响人的食欲，4. With regard to the patient in
增加胃中盐酸的流量，使人发生胃痛、恶心，
This patient is involved with physically demanding Case 4, the man's work duties aggravated his CTS.
work, and this probably has triggered his CTS. Its onset Without a significant time away from the aggravating
was gradual, starting with stiffness and swelling and by 的主要原因，引起血管收缩，导致舒张压明显上升。芬兰科
activity it is difficult to see a way ahead towards a cure.
the time he attended the clinic for acupuncture the pain
服力的答案。 It is also of note that when there was
学家的研究证实了这一点，他们对 initial improvement
was为了方便叙述，本文将孙真人的这首诗分为五段进行剖
severe. It was especially bad at night, and he had followed by a return of
现，每发一次怒或绝望值增加 1 分，高血圧的危险性就增加 the pain it was at about five or six
disturbed sleep for two weeks. The pain affected is his
析，每两句为一节，先从第一节说起。 days after the initial treatment. This suggests that an
two middle fingers and could shoot up his forearms. interval of a week is too long between treatments,
His GP diagnosed CTS, and prescribed 发生。癌症的发生也与经常发怒有直接联系，有统计证实，
particularly at the outset.
anti-inflammatory medication. The patient was also 癌症患者中易发怒的人明显高于性格温和的人。
The cases presented here, admittedly a small sample,
气弱病相因
placed on a waiting list for surgery. presented Syndromes somewhat different from those
Syndrome Diagnosis: published. These case studies emphasized underlying
1) Spleen Deficiency Spleen Deficiency with damp as well as Qi stagnation.
2) Dampness Patterns involving the Blood or Wind -damp impediment
did not feature. As 《孟子•告子上》中有“心之官则思”的
indicated in the published literature,
3) Liver Qi Stagnation
4) Kidney Yin Deficiency
于此，孙思邈在他的《千金方》中曾引用魏晋时期养生学家 Pericardium 6 was an important point in all the cases.
5) Kidney“养生有五难，名利不去为一难（实乃最大的
Yang Deficiency The use of a TDP lamp was not tried, but it would have
嵇康的话说：
been a good option in cases where dampness was a
Session
心病） 1:
，喜怒不除为二难，声色不去为三难（确为耗心神、 concern.
Points Selected: Liver 3, Gallbladder 34, Large，对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
伤肾气之大虑），滋味不绝为四难（吃也是非常费脑筋的活） The diagnostic approach involved standard TCM
Intestine 4. Local Points: Pericardium 6, Small Intestine 6,
syndrome differentiation, as well as the use of the Five
Large Intestine 6. The needles were retained and then Element theory. The Five Element approach was
the heart meridians were tonified to test the patient's especially important
或少都缺了点“心眼”。很显然，心的这些功能里，包括了 in the selection of points for
Causative 道德日全，
Factor., 不祈善而有福，
Pericardium 不求寿而自延，
7, Triple Burner 4, Heart tonification. In this
regard, intuitive techniques in point
7.
此养生之大旨也。 ”在孙氏反复论证的这段话中，重点强调 selection were also used (Mearns, 2013).
13
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314 Premier House,
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7BJ. London NW4 3RJ
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8951 2560,
TheJournal
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MedicineAnd
AndAcupuncture
Acupuncture Volume
Volume 21 21Issue
Issue
2 2 September 2014
September 2014
Overall, treatment was shown to be effective. NHS (n.d) Carpel Tunnel Syndrome. {online} Available from <
Effective treatment for such a common complaint has the http://www.nhs.uk/conditions/carpal-tunnel-syndrome
potential for enormous cost savings for the health system, /Pages/Whatisit.aspx> (accessed July 19, 2014)
and for a great reduction in the number of works days lost NICE (n.d.) Carpal Tunnel Syndrome. {online} Available from
<http://cks.nice.org.uk/carpal-tunnel-syndrome#!topic summary>
to employers. Effective treatment also, is a great relief
to those suffering from the condition. (accessed July 19, 2014)
温长路
Verdugo RJ, Salinas RA, Castillo JL, Cea JG. (2008), Surgical
References versus non-surgical treatment for carpal tunnel syndrome.
Cochrane Database of Systematic Review, {online} Issue 4. Art.
Flaws, B. and Sionneau, P. (2002) The Treatment of Modern No.: CD001552. DOI: 10.1002/14651858.CD001552.pub2.
Western Medical Diseases with Chinese Medicine. Boulder: Available from <http://onlinelibrary.wiley.com/doi/10.1002/
Blue在我国医学发展史上，孙思邈可谓一位集众多学说之大
Poppy Press. 的都是情志对养生的决定性作用。
14651858.CD001552.pub2/abstract> (accessed July 3, 2014)
Mearns, A. (2013) The Treatment of Postherpetic Pain with
Acupuncture – Two case studies in the clinical application of
Waveform. The Journal of Chinese Medicine and Acupuncture,
Vol.20. Issue 2, pp.42-44.
医学，不能不说是孙氏的一大功劳。孙思邈一生对养生问题（涌）于上。 ”（《素问•生气通天论》） “怒则气逆，甚则呕血
Case Histories
铭》的。宋代温革的《琐碎录》和 from the files 得平，若问病根深与浅，此身应与病齐生”
14 世纪朝鲜出版的《医 of Professor Shulan Tang。
方类聚》及日本的相关著作中也都有反映。这些版本在文字1 怒气大发，相应的疾病就会因之而生，受害最直接的是
Shulan Tang , Kathleen
上虽然有些出入，但其基本内容是一致的。陕西耀县的药王 Dowd2
1 2
Shulan TCM Clinic, Manchester, UK; MQP, Dip. Lic.目胀、
山上，也保存有这首诗的石刻件，还不时被中外游人转抄和 Acu.,面红、
GDCHM,
耳赤、 Woodlands
呕血、憋气等症状。 Health Centre,
Newcastle House, Newcastle, Co Dublin, Ireland
Case勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。
one Bei Sha Shen 8g, Zhu Ru 6g, Chi Shao 8g, Fo Shou 8g
Ban Lan Gen 10g, Dan Zhu
真枪实弹就放倒了这位年仅 36 Ye 8g, Yuan Zhi 8g, Huai
P.C., Male, 44 years old, Single, Civil Servant, Born Hua 8g, Jin Qian Cao 8g, Ma Chi Xian 8g, He Huan Pi
in the若要无诸病，常当节五辛。安神宜悦乐，惜气保和纯。
UK, Currently residing in Manchester 8g, Ye Jiao在国内外媒体上都不时有过报道。
Teng 8g
亡的病例， “气是杀人贼” ，
Disease Onset 04/2001, First Consultation 20/03/2008
寿夭休命论，修行本在人。若能遵此理，平地可朝真。 The formula was supplied in raw herbs, to be taken
Presenting Complaint: Depression of almost 10 years 老百姓的说法一语道破了生气对人类健康的严重危害。
for 7 days.
duration 美国医学专家的一项调查说，一个人经常发怒或心身承
Further advice to the patient: Stop smoking, avoid
越了 15 个轮回，科学已经发展到了人类从地面走向太空的 alcohol, pungent or spicy foods, get plenty of fresh air
History of Presenting Complaint
Almost 10 years ago, Mr. P.C. began suffering from and exercise.
extremely deep depression. He felt he was in a trance-like
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是 Further Visits
state. His feelings/emotions are abnormal and he believes
that life is passing him by. The patient is unable to 01/04/2008 - (2nd Consultation)
communicate effectively and there was little animation in The patient’s memory and attention span has very
服力的答案。 obviously improved. His mouth is616
学家的研究证实了这一点，他们对 no longer dry and there
his facial expression. His sleep is poor and he has profuse
nightmares. He is easily angered, his memory is
为了方便叙述，本文将孙真人的这首诗分为五段进行剖 is no feeling of body heat
现，每发一次怒或绝望值增加 1 分，高血圧的危险性就增加 or sweating. Sleep and bowel
deteriorating and his attention span is very low with no
析，每两句为一节，先从第一节说起。 movements have both improved
and the patients vitality
powers of concentration. In addition, the patient is or animation has increased. The patients tongue is red
with a yellow greasy coating and the pulse is soggy and
suffering
1. from headaches, dizziness, mental fatigue and
nervousness. His facial complexion and eyes are very red, rapid.
气弱病相因
the skin on his face is dry and itchy. His stool is dry and The above prescription was repeated for a further
his urine is yellow. week
Tongue: Red with a yellow coating, Pulse: Soggy, fast 08/04/2008
神志的主宰者是心， - (3rd Consultation)
之所伤，Other脾胃之气也；
Medical 喜之所伤，
History: 10心气也。
years气乃肺、肾所主，
previously, the Patient continues
的话。思为心所主， to show improvement. Body heat
patient had a viral infection and had a continuous low
神依气血所存，正气损伤，岂不心“疫” 、病“因”吗！对
has eased, but there is profuse sweating on the head.
fever for a number of weeks.
Sleep is again improved and the patient felt that it was
Chinese “养生有五难，名利不去为一难（实乃最大的
嵇康的话说： Medicine Diagnosis: 理智、敏捷、灵活，健康长寿的机会相对就多；反之，人就
returning to normal. The patient is now aware of normal
Disease name: Depression life. Memory and concentration have further improved
Pattern: Spleen Deficiency; Hyperactive Heart & and emotionally, the patient is happy. Both energy and
伤肾气之大虑），滋味不绝为四难
Liver Fire; Phlegm （吃也是非常费脑筋的活）
Heat Harassing the Heart. ，
appetite have increased, defecation and urination are
Treatment Principle: Strengthen the Spleen, Soothe
神虑精散为五难。五者必存，虽心希难老，口诵至言，咀嚼 regular. The patients tongue is red, with a thin yellow
the Liver, Clear the Heart, Transform Dampness.
coating and the pulse is rapid.
或少都缺了点“心眼” 。很显然，心的这些功能里，包括了
The above prescription was modified with the
Prescribed
中，则信顺日跻， Formula
道德日全，不祈善而有福，不求寿而自延，
Tai Zi Shen 8g,
此养生之大旨也。 Fu Shen10g, Dan Shen 8g, Yu Jin 8g,
”在孙氏反复论证的这段话中，重点强调 removal of Jin Qian Cao and the addition of
13
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314 Premier House,
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7BJ. London NW4 3RJ
Tel/Fax: 020 8951
8457 3030,
TheJournal
ChineseMedicine
MedicineAnd
AndAcupuncture
Volume 21 Issue
September 2014
Sang Ye 8gms. This modified prescription was which allowed the root of the condition to be eliminated
prescribed for one week. over time. The patients health, mentally, physiologically
and energetically all reached an overall balance and he is
15/04/2008 - (4th Consultation)
Patient reports continued improvement. Headaches
now able to function again in a demanding work
environment.
and dizziness are gone, and the itch on the skin has
completely receded. 温长路
Case two
Prescription from 08/04 was repeated for one week.
中华中医药学会（100029） Nancy, Female, 35yrs old, Married Housewife,
22/04/2008 - (5th Consultation) English, Currently residing in Manchester
There was continued improvement overall. The Disease Onset: 1993, First Consultation 11/01/2000
patient is smiling, his nightmares are gone, memory and
在我国医学发展史上，孙思邈可谓一位集众多学说之大 Presenting Complaint: Depression and nervous
concentration have further improved and he no longer
成者，除了传统意义上的医学理论和实践外，把养生防病纳 tension for the last 7 to 8 years
experiences feelings of anxiety. He reports that both of
History of Presenting Complaint “大怒则形气绝，而血菀
his hands feel as if they were in water. The patients
tongue is red with a thin yellow coating and his pulse is Nancy has
（涌）于上。 ”（ 3 sons under the age
《素问•生气通天论》） of 18. Her husband
rapid.
有过许多精辟的论述，并在《千金方》和《千金翼方》中两 works
及飱泄。 away
”（ from
《素问•举痛论》 home and has very
）也就是说，怒因气生，气则怒 little to do with
Prescription from 08/04
次作过专门总结，这是有典可据的。除此以外，有关孙思邈 was repeated for one week. Nancy and their children.
It has reached the point where
they are not getting on very well. Nancy constantly feels
15/05/2008 - (6th Consultation)
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广，《淮南子》所言：
emotionally unstable“人之性，有所侵犯则怒，怒则血充，血
and she cries easily. When she is
The patient reports feeling a greater sense of
《养生铭》就是其中的一首。此文收于《全唐书》和后人整 suffering from a severe 。唐代诗人白居易在他在一首制怒
充则气激，气激则发怒” attack, both her hands are tremble
relaxation. He feels as if his skin can breathe. His whole
理的孙氏的《摄生咏》中，也有称为《保生铭》和《孙真人 and shake. She has no appetite
诗中也阐明了雷同的观点： and finds it difficult to
body is relaxed and there is increased energy. He is happy. sleep at night. She has palpitations, headaches, severe
The patients tongue is red with a thin white coating and empty heat (baking heat) and acne.
the pulse is even and slightly wiry. 怒气大发，相应的疾病就会因之而生，受害最直接的是
Tongue: Red with little coating; Pulse: Wiry and
Prescription from 08/04 was repeated for one week.
rapid
The patient attended the clinic at weekly intervals for
山上，也保存有这首诗的石刻件，还不时被中外游人转抄和目胀、 Other
面红、 Medical
耳赤、呕血、 History: None 甚则使人昏厥卒倒，
憋气等症状。
the first
效法。其诗全文如下： three months. After this, consultations were Chinese Medicine《三国演义》中诸葛亮三气周瑜的故
因此致死者也不罕见。 Diagnosis:
reduced to fortnightly and over time to monthly visits, Disease name: Depression
culminating in visits at intervals of 6 to 12 months. The
怒甚偏伤气，思多太损神。神疲心易疫，气弱病相因。 Pattern: Liver Fire harassing the Heart
most 勿使悲欢极，当令饮食均。再三防夜醉，第一戒晨嗔。
recent of these visits occurred today 01/10/13. 发怒。深谙心理学的诸葛亮故意用计让他动气，结果没有用
Treatment Principle: Disperse the Liver, Regulate
Qi, Clear the Heart, Lower Fire 36 岁的英雄汉。临床上遇到的
01/10/13
The patient is in good health and spirits. Both eyes are Acupuncture: Qu Chi (LI 11), He Gu (LI 4), Lie
sparking. He has recommenced work as a civil servant, Que
亡的病例，(Lu 7),在国内外媒体上都不时有过报道。
Nei Guan (P 6), Shen Men (Ht“气是杀人贼”
7), San Yin，
working in a government department. His mood is Jiao (Sp 6), Tai Chong (Liv 3)
generally good. In recent days, he noticed that the skin on Prescribed Formula:
his head was becoming itchy and flaky and there is slight Jia Wei Xiao Yao Wan 2 bottles
越了 15 个轮回，科学已经发展到了人类从地面走向太空的 Zhi Bai Di Huang Wan 2 bottles
hair loss. His lumbar back is slightly sore. His sleep is
good and his appetite and defecation are regular. His Dosage of each formula - 8 tablets three times daily
tongue is red with a thin, yellow and slightly peeled
Further Visits 影响人的食欲，使人发生胃痛、恶心，
coating. Pulse is wiry and rapid.
Chinese Medicine Diagnosis: Kidney Yin Deficiency 25/01/2008 - (2nd Consultation)
with Empty Fire Harassing Upwards It is two weeks since the patient’s first visit. Her mood
服力的答案。 has improved and the nervous tension
学家的研究证实了这一点，他们对 has eased. The
Treatment Principle: Tonify the Kidneys, Support &
Nourish Yin, Clear Heat, Moisten the Skin trembling in both hands has 1stopped.
现，每发一次怒或绝望值增加 The patients sleep
析，每两句为一节，先从第一节说起。 and appetite have both improved and she is only smoking
Prescribed Formula 10 to 15 cigarettes a day. She would like to stop smoking.
Sang Ye 8g, Sheng Di Xuan Shen 8g, Xia Ku Cao 发生。癌症的发生也与经常发怒有直接联系，有统计证实，
Acupuncture: Qu Chi (LI 11),He Gu (LI 4), Lie
1.
8g, 怒甚偏伤气，思多太损神。神疲心易疫，
Fu Ling 8g, Bai Ju Hua 8g, Gou Qi Zi 8g, Di Fu Zi 癌症患者中易发怒的人明显高于性格温和的人。
Que (Lu 7), Nei Guan (P 6); Shen Men (Ht 7), San Yin
气弱病相因
8g, He Shou Wu 8g, Fo Shou 8g, Sang Shen Zi 8g, Mu Jiao再说孙氏诗中说的思伤神，神指的是人的精神意识，是
(Sp 6), Tai Chong (Liv 3)
Dan Pi 8g, Chi Shao 8g, Dan Shen 8g, Huai Hua 8g 人类区别于其它动物、独具聪明智慧表现的主要指征之一。
这一节总体上是讲精神养生的，怒之所伤，肝气也；思 28/01/2008 - (3rd Consultation)
Summary-Evaluation of Case Diagnosis and The patient has《灵枢•大惑论》
神志的主宰者是心， not smoked since
中有 the last visit.
“心者，神之舍也” Due to
Treatment the fact that her husband
的话。思为心所主， is abroad, emotionally she is
This patient had, for a long period 、病“因”吗！对
of time, been feeling low. She feels like sighing and crying. She is
consuming alcohol and spicy foods with very little
于此，孙思邈在他的《千金方》中曾引用魏晋时期养生学家 agitated and unsettled and at times feels nauseous. Her
exercise or fresh air. This led to Spleen deficiency with 理智、敏捷、灵活，健康长寿的机会相对就多；反之，人就
嵇康的话说： “养生有五难，名利不去为一难（实乃最大的 food intake is poor. The patients tongue is red with a
exuberance of Heart and Liver Fire and Phlegm Heat
greasy white coating and her pulse is wiry and slippery.
harassing the Heart. The Western Medicine treatment was Chinese Medicine Diagnosis: Liver Stagnation
to prescribe sleeping tablets and anti-depressants to treat overwhelming the Spleen, Liver and Stomach not
the outward signs. harmonised
Chinese Medicine treatment focused on the root of the 那些碌碌无为、傻头笨脑、鸡肠小肚、无朋无友的人，或多
英华，呼吸太阳，不能不回其操、不夭其年也。五者无于胸 Treatment Principle: Disperse the Liver, Strengthen
problem.
中，则信顺日跻， Treatment
道德日全，strengthened
不祈善而有福， the Spleen, dispersed
不求寿而自延，或少都缺了点“心眼” 。很显然，心的这些功能里，包括了
the Spleen, Regulate Qi, Harmonise the Stomach
the Liver, cleared the
Heart and transformed Phlegm Acupuncture: Shen Men (Ht 7), Nei Guan (P 6),
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San Yin Jiao (Sp 6), Tai Chong (Liv 3), Zu San Li (St 36), circumstance and temperament, the origin of these
Tian Shu (St 25) conditions is principally due to home and/or work life
Prescribed Formula pressures and conflicts. This illness often has its root in
Ban Xia 8g, Chen Pi 8g, Bai Zhu 10g, Zhen Zhu the emotional aspect of a female’s relationship with their
Mu 12g, Fu Ling 10g, Shen Qu 8g, Chai Hu 6g, Bai partner or husband. Apart from accurate pattern
Shao 8g, Dang Gui Wei 8g, Bo He 6g, He Huan Pi 8g, discrimination and treatment using acupuncture and
温长路
Dan Shen 8g Chinese Herbal Medicine, I personally believe that the
Above formula was made up in concentrate granules
中华中医药学会（100029） exchange between the patient and doctor is paramount.
100 gms, 2 level teaspoons to be taken three times daily. People are generally sociable animals. The doctor must
use their Heart to perceive the condition and must often
10/02/2000 - The patient phoned the clinic and postponed
在我国医学发展史上，孙思邈可谓一位集众多学说之大 listen attentively to and communicate with the patient
her next appointment due to family commitments and the
成者，除了传统意义上的医学理论和实践外，把养生防病纳 from the Heart. The doctor must comprehend the patient’s
necessity of having to travel 2 hours to the clinic.
life and environment, and from this understanding of the
Summary-Evaluation of Case Diagnosis and patient’s lifestyle, eating habits and pressures from home
or ”（《素问•生气通天论》
work, accurate treatment can）“怒则气逆，甚则呕血
be effected and the
Treatment
有过许多精辟的论述，并在《千金方》和《千金翼方》中两 imbalances
及飱泄。”（《素问•举痛论》within the patient can be regulated.
Nervous tension and depression are commonly seen in
women in the Western world. Apart from an individual’s
。
中医药辨病辨证结合治疗痤疮及兼症体会
袁炳胜（BingSheng Yuan,
上虽然有些出入，但其基本内容是一致的。陕西耀县的药王 Doncaster）
摘要: 各科临床病、证，常常相兼出现。医学教材，分别病、证，盖为易于讲述、示范其例而设。临床之际，单
一之病、单一之证，十无其一。新病旧病、表病里疾，虚实、寒热之证，同时并见于一人一时之案例，则十有其
九。此初涉临床者所以茫茫然、疑难顽杂病证之所以无从下手、危急重症之所以易致失误者也。本文以痤疮二案
为例，说明病、证同辨，不仅根据病、同时根据证的情况，来进行治疗选药，而为寒温补泻之治的临床运用。病
证同辨，一则可以提高临床疗效，二则同时有利于充分发挥每一味药物各方面的的性味功能，从而减少治疗所用
，
药物的不良反应。
关键词：痤疮中医药治疗 / 病证同辨兼症治疗 / 临床疗效副作用控制。
原腕部湿疹皮损已愈，仅见有皮损愈后之脱皮，完全不痒。
案一，痤疮兼湿疹增加胃中盐酸的流量，影响人的食欲，使人发生胃痛、恶心，
非常高兴。舌淡红偏暗，苔白薄，脉沉略弦缓。
D.V 女士, 26岁，立陶宛裔。2012年9月27日初诊。继用上方，加南沙参、薏苡仁6克，再服7剂巩固。
主诉：面部痤疮4-5年，双手腕部湿疹3年。现病史：面 10月20日，前症尽愈，皮肤除有轻微原皮损遗留印痕外，
部痤疮，4-5年前始发。头面部之额、颊、鼻旁等部痤疮密余与正常无异，因购物路过，特以相告。
集分布，新发者色红，表面或有白色脓点，陈旧者暗红，突小结：
起于皮肤表面，大小不一。久久为之苦恼，医与抗生素及外本例痤疮多年，久经其原籍（立陶宛）及英国医生诊治，
服用多种抗生素等疗效不佳。并不是所用抗生素不好，盖因
1.
用药膏治疗无效。并患双手腕及前臂内侧部湿疹3年，皮肤
怒甚偏伤气，思多太损神。神疲心易疫，癌症患者中易发怒的人明显高于性格温和的人。
因痒甚搔抓而破烂，有渗出。夜间多汗，抑郁紧张。眠纳可，此病，虽有炎症之表现，但细菌和炎症并非致病之最重要原
因。本病虽也有成年后仍长期不愈者，但多始发于青春期前
便调，经调。
后、生长发育旺盛之青少年。《内经.素问.上古天真论篇第
中医检查：舌暗红，苔白略腻、脉沉略弦。
一》说：女子“二七天癸至，任脉通，太冲脉盛，月事以时
中医诊断：痤疮、湿疹。肝郁脾虚、湿热内藴，郁积肺
下, 《孟子•告子上》中有“心之官则思”的
故有子；三七肾气平均（张志聪注曰：肾气者，肾藏所
胃二经、血气失和，外现于皮肤。
藏之气也。气生于精，故先天癸至，而后肾气平），是故真
治法：健脾除湿、疏肝理气，清热和血。
牙生而长（音掌）极，四七筋骨坚，发长极，身体盛壮”；
处方：丹参3克，连翘4克，桔梗3克，枳壳3克，薄荷3
男子“二八，肾气盛，天癸至，精气溢泻，阴阳和，故能有
克，黄柏3克，苍术3克，柴胡3克，紫草6克，地肤子10克，
子；三八肾气平均，筋骨劲强，故真牙生而长极”。本病的
紫花地丁6克，苦参2克，生甘草3克，白茅根6克，7剂。二
发生，是和青春期肾气、天癸、冲任气血、阴阳的变化密切
煎三服，一日一剂。
相关的,所以单从局部病理变化的角度,对病论治,效果不佳；
10月6日，复诊。经服前方7剂尽，面部痤疮大为好转，
即使暂时获效,也极易反复。
大部分疮疹已经消褪，原有之旧疮疹亦进一步缩减或消散；
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根据本例患者的舌脉症，局部表现，体质情况，认为系 6月10日，诉经前治疗，面部痤疮消除。未再有新发。仍
肝郁（舌暗，脉弦，抑郁、紧张）、脾虚（脉沉苔腻）、湿有瘢痕。近日经前服食辛辣食物，致面部有一二枚红疹出现，
热内藴（舌红苔腻，湿疹痤疮）、血气失和（湿疹痒甚），担心痤疮复发，希继续调治根除。继与疏肝宣肺，疏风清热
外现于皮肤，痤疮与湿疹并见。
除湿，兼佐活血调经治之。
故治疗以健脾（甘草苍术）、疏肝理气（柴胡枳壳），温长路柴胡6克，白芍6克，枳壳4克，甘草3克，黄芩6克，生地
清热除湿（紫草地丁、连翘、苦参、薄荷、黄柏、地肤子等）、 6克，川芎3克，荆芥6克，牛蒡子6克，苍耳子4克，连翘6克，
和血（丹参白茅根）。不仅清除湿热致病之标，且健脾除湿，桔梗4克，桑白皮6克，桑叶6克，薏苡仁10克，薄荷4克，香
疏肝解郁，和血利气，以调理脏腑功能及气血阴阳，使标本附3克，益母草6克，浓缩粉剂，摇匀为散，每次3克，一日3
内外同治而获痊愈。
在我国医学发展史上，孙思邈可谓一位集众多学说之大次。
疮疡为有形之病症，然有形生于无形。西医认为系有形
成者，除了传统意义上的医学理论和实践外，把养生防病纳 3月余后随访，痤疮愈，经调、经行不痛，头痛数月来亦
病原微生物所致，故皆主以抗菌抗病原微生物为治。然如此
入人类的健康大系，并使他成为具有理论与实际一体的特色未觉。
现。
例痤疮一类病症，抗菌抗病原微生物往往难以见到根本的效
小结
果，盖因于此也。中医辨病的同时，结合辨证，考虑到气血
本例痤疮，兼有月经失调，且经期加重。又兼花粉症，
的失调，阴阳的失和，导致湿热、邪毒产生的内在因素，使
遇凉则清涕喷嚏立作。痤疮与花粉症，均为1年半前来英后
用一系列不仅对应病、亦且对应证的治疗措施，所以取得了
发生。是脾虚肺郁，风寒湿热，滞郁于内外表里、皮腠官窍
较单一的对病治疗更好、更快捷、也更彻底、同时几乎没有
之间；又肾虚肝郁，气血不和、冲任失调，月经迟至。经期
见到明显治疗的副反应，同时全身健康情况还得到改善的疗
前后血气动荡，故痤疮加重。受风冷则肺卫之表郁更甚，则
效。
铭》的。宋代温革的《琐碎录》和 14 世纪朝鲜出版的《医得平，若问病根深与浅，此身应与病齐生”。祛其邪实，
涕、嚏顿发。总为虚实夹杂之证，宜乎补其所虚，
唯因缓急而消息用药。
案二，痤疮兼风疹、花粉症，月经不调。
前医治法，侧重于疏风清热解毒祛邪，以治痤疮之标，
曹女士，20岁。2013年3月25日初诊（电话及网络诊治，目胀、面红、耳赤、呕血、憋气等症状。甚则使人昏厥卒倒，
是一般治疗痤疮的通常习用之法，用药亦然。然此患者痤疮
其母及本人叙述病史，舌脉未诊）。因此致死者也不罕见。《三国演义》中诸葛亮三气周瑜的故
表现，多因月经将至而加重，故加丹参活血调经，疏其血气；
主诉：面部痤疮一年半。现症：面部痤疮，额、腮、下事，就是一个典型的案例：血气方刚的周瑜性情急躁，容易
肺与大肠互为表里，其人便微秘，肠道热郁，熏蒸于上；若
颌为甚，经期前后加重。疮疹色红，顶部有白色脓点，便不发怒。深谙心理学的诸葛亮故意用计让他动气，结果没有用
得知母之清疏宣导其下，则热郁于上之痤疮易治，前医诸药，
畅，口臭、纳差。经期延后4-5天，有时延后半月。经行次真枪实弹就放倒了这位年仅
更易建功矣。 36 岁的英雄汉。临床上遇到的
日腹痛，每6-7天而净。有时头痛、手足凉。因突然动怒而导致血压升高、不省人事，甚至发生脑溢血死
后因兼花粉症、身起红疹作痒，是有风寒湿热同时为患，
诊断：1.痤疮；2.月经不调。脾虚肝郁，内生湿热，藴郁亡的病例，在国内外媒体上都不时有过报道。
肺卫气分营分同病， “气是杀人贼”
则不可仅治其热，不见其寒；，
仅治其实，
肺胃，熏蒸于面部，伴冲任失调。老百姓的说法一语道破了生气对人类健康的严重危害。
不见其虚；仅见其卫、气，不见其营、血。故疏风散寒、清
因前此曾于国内就诊于某名中医，与处方：桑叶9克，菊美国医学专家的一项调查说，一个人经常发怒或心身承
热除湿、清宣表里营卫气血以祛其实（柴胡、桑叶、薄荷、
花9克，枇杷叶9克，桑白皮9克，黄芩6克，银花9克，蒲公受的压力太大，机体会分泌出一种代谢类固醇──皮质醇，
苍耳子、紫草、地肤子），健脾和中（苍术、茯苓、神曲、
英9克，连翘9克，薏苡仁12克，泽泻9克，车前子9克，因商它会直接损害人的记忆力和对事物的专注力。不良情绪还会
甘草）、疏肝理肺（柴胡、白芍、甘草、枳壳、桔梗）以安
于余。据其症每于经期加重，经迟、痛经、便秘诸证，加丹增加胃中盐酸的流量，影响人的食欲，使人发生胃痛、恶心，
其里、再佐理气和血（枳壳、当归、白芍、紫草）疏其壅遏，
参4，知母9克，稍佐之以活血清热，调经通便，诸味以浓缩甚至导致溃疡病的发生。发怒和绝望的情绪是造成血压升高
有是证用是药，又嘱清淡饮食、适寒温以杜绝风寒湿热之源、
药粉与之，每次2-3克，1日3次，开水冲服。的主要原因，引起血管收缩，导致舒张压明显上升。芬兰科
充分休息以助营卫气血之安定、助脏腑功能、体力正气之回
服力的答案。
4月11日，电话复诊。服上方一周，痤疮稍好转；近3-4 学家的研究证实了这一点，他们对 616 名男性对象的调查发
复，故获良效。
天不慎受凉，清涕、鼻塞、伴身起红色小痒疹。询知来英后现，每发一次怒或绝望值增加 1 分，高血圧的危险性就增加
因气候不同而患花粉症，亦一年半左右，每遇气候变化或受 16%。而高血圧又可成为新的病因，引发其他更严重的疾病
体会
凉则发清涕喷嚏，甚为不舒。发生。癌症的发生也与经常发怒有直接联系，有统计证实，
1. 兼感风寒，外郁于表，肺气不利；引动内郁之湿热，营
怒甚偏伤气，思多太损神。神疲心易疫，各科临床病、证，常常相兼。医学教材，盖为分别讲述、
气弱病相因示范其例而设。临床之际，单一之病、单一之证，十无其一。
卫不和，故身痒出疹。嘱前方暂停，宜宣通肺卫，清热利湿，再说孙氏诗中说的思伤神，神指的是人的精神意识，是
新病旧病、表疾里疾，虚实、寒热，同时相兼见于一人一时
兼和其营分。另为拟方：
之案例，比比皆是；而疑难顽杂之疾犹然。此初涉临床者所
苍耳子6克，甘草3克，紫草10克，薄荷6克，桑叶6克，
以茫茫然，久事临床者，遇多方诊治，难以获效之疑难顽杂
桔梗4克，地肤子10克，枳壳6克，柴胡6克，白芍10克，当
病证，所以无从下手者。
归6克，苍术6克，茯苓6克，神曲6克，服用法同前。
此两案例，皆以痤疮为患者来就诊的主要问题。医者常
4月22日，诉服用前方后，现面部痤疮已全部消失，身上
嵇康的话说： “养生有五难，名利不去为一难（实乃最大的理智、敏捷、灵活，健康长寿的机会相对就多；反之，人就
因患者之求治心切，欲求对症之治而不暇顾及其余之症，然
的痒疹亦全部消除；且服药1-2日即明显生效。现在面部仅
则往往欲速则不达。案一者，西医以痤疮之局部疮疡表现，
遗留原痤疮留下的瘢痕。嘱继续服完11日方巩固，并宜清淡
，滋味不绝为四难（吃也是非常费脑筋的活），对就要高些。实践证明，大凡有雄心壮志的人、聪颖灵透的
用抗生素及外用药膏对病治疗无效，但以中医辨病与辨证，
饮食，适当进食蔬果，少熬夜。
病、证兼顾治疗而获佳效；案二前医以面部痤疮，而从疮疡
30日，服完11日方，除面部遗留痤疮瘢痕外，仅偶遇凉
之治，用清热解毒，而未能兼顾患者其他情况。尤其痤疮常
轻微鼻塞。3月25日方尚余一半，予斯方加苍耳子4克，荆芥
因月经将来而加重，并伴便秘，认为在治疗中必须考虑这两
4克，牛蒡子4克，继续服完。
个与痤疮有高度相关性的问题，故于其方中加丹参、知母，
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September 2014
服药7天而稍觉好转；但因受凉而并发花粉症，遇冷则涕、者屡见不鲜。是故要求医者需望、闻、问、切，明辨病、证，
嚏并作、风疹身痒，遂转而更进一步辨病与辨证结合，整体了知虚、实所在、病、证所因，标本主次，因果关系，舌脉
治疗而迅速获效（1-2天）。可见，病辨与不辨、单纯辨病从舍、治证取舍；又需熟悉药物性能、寒温补泻、主治脏腑
与辨病辨证结合论治，其临床效果是不可同日而语的。
经络、升降浮沉燥润散敛之宜，尽可能有效利用药物的功能
如此二案，案一痤疮兼湿疹，案二痤疮兼风疹、更兼内温长路
作用，合理用之，人、病同治，才能既能迅速缓解病情，又
科或耳鼻喉科之花粉症（本患平常以过敏性鼻炎表现为主，尽可能将治疗的不良反应尽可能下降甚至于零，而利于病人
中医谓之鼻鼽）、妇科之月经不调；此仅其例也，临床类似整体的健康。
入人类的健康大系，并使他成为具有理论与实际一体的特色中药复方治疗痛经验案一则
现。
1 2*
罗瑜
有过许多精辟的论述，并在《千金方》和《千金翼方》中两，曲凡
1 发，生气——发怒——生气，构成了一条恶性循环链。正如
浙江大学医学院附属妇产科医院宁海分院
2
浙江大学医学院附属妇产科医院
*通信作者：浙江大学医学院附属妇产科医院, 学士路 2 号, 杭州市，浙江，中国邮编 310006,
E-mail：[email protected], 电话：13429119143
摘要: 痛经，是妇女正值经期或经行前后出现周期性小腹疼痛或痛引腰骶，甚至剧痛晕厥者，称为痛经。笔者跟
随曲凡医生出诊，现整理曲凡医生应用中药复方治疗痛经验案一则。
关键词：痛经；验案事，就是一个典型的案例：血气方刚的周瑜性情急躁，容易
痛经，是妇女正值经期或经行前后出现周期性小腹疼痛 4 月 18 日，三诊，患者服药后无明显不适，白带正常。
或痛引腰骶，甚至剧痛晕厥者，称为痛经。笔者跟随曲凡医舌红苔黄腻，
亡的病例，脉滑数。治以清热利湿，化瘀止痛。
在国内外媒体上都不时有过报道。金银花 30g
“气是杀人贼” ，
生出诊，收获良多。曲凡医生是医学博士，妇产科学博士后，老百姓的说法一语道破了生气对人类健康的严重危害。 g
茵陈 30 g 焦山栀 15 g 桑叶 25 g 青蒿 10 g 淡竹叶 15
副研究员，博士研究生导师，也是首届江浙沪中西医结合优
时过境迁，从公元 6 世纪至今，历史的隧道已经向前穿太子参 25 g 砂仁 3 g（后下）芡实 12 g
美国医学专家的一项调查说，一个人经常发怒或心身承苏梗 10 g 炙
秀青年人才奖获得者。现整理曲凡医生应用中药复方治疗痛
越了 15 个轮回，科学已经发展到了人类从地面走向太空的甘草 12 g 黄精 12 g 黄芩 25 g 垂盆草 10 g
受的压力太大，机体会分泌出一种代谢类固醇──皮质醇，竹茹 10
经验案一则，报道如下：
时代，膏粱厚味之外，琳琅满目的各色保健品足以让人眼花 g它会直接损害人的记忆力和对事物的专注力。不良情绪还会
柴胡 20g 泽泻 12g 猪苓 15g 元胡 10 g 益母草 30 g
患者，女，薛某某，37 岁，2013 年 3 月 29 日就诊。患
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是皂角刺 10 g 10 g，14 剂。使人发生胃痛、恶心，
乌梢蛇影响人的食欲，
增加胃中盐酸的流量，
者有 10 年痛经病史，经多方求治无效。平素月经规则，15
需要科学者正面回答的问题，也正是本文要用现代观点诠释 4 月 26 日，四诊，患者服药后无明显不适，白带正常。
7/25 2014 年 3 月 5 日，量中，色暗红，质稠月经第 1-2 天小
孙真人《养生铭》的立意所在，相信事实会给人们一个有说舌红苔薄黄，脉滑。治以清热利湿，化瘀止痛。金银花 25g 茵
腹疼痛，痛连腰骶，难忍，影响正常工作及生活。平素白带
服力的答案。陈 20 g 焦山栀 15 g 桑叶 25 g 616
学家的研究证实了这一点，他们对青蒿 10 g 淡竹叶 15 g
量多，色略偏黄。胃纳可，睡眠安，二便正常。舌红苔黄腻，
为了方便叙述，本文将孙真人的这首诗分为五段进行剖炒白术 20 g 白扁豆 10g 芡实
现，每发一次怒或绝望值增加 12 g 苏梗 10 g 炙甘草
1 分，高血圧的危险性就增加
脉滑数。妇科检查：外阴已婚式；阴道畅；宫颈光，激光术
析，每两句为一节，先从第一节说起。 12 g 黄精 12 g 竹茹 10 g 柴胡 20g 泽泻 12g 猪苓
后改变；宫体前位，常大，无压痛，双附件未及。白带检查 10g 元胡 10 g 益母草 30 g 皂角刺 10 g
发生。癌症的发生也与经常发怒有直接联系，有统计证实，乌梢蛇 10 g，
1.
正常。怒甚偏伤气，思多太损神。神疲心易疫，
证属湿热蕴结，治以补肾健脾，清热除湿。金银花 30g 14 剂。
气弱病相因
茵陈 30 g 焦山栀 15 g 桑叶 25 g 青蒿 10 g 淡竹叶 15 g 5 月 2 日，五诊，末次月经 2014 年 4 月 28 日，色暗红，
太子参 25 g 北沙参 20 g 芡实 12 g 苏梗 10 g 炙甘草量、质中等，痛经缓解。7 天经净。胃纳可，睡眠安，二便
12 g 黄精 12 g 黄芩 25 g 女贞子 20 g 覆盆子 15 g,7 正常。舌红苔薄白，脉滑。患者服药后无明显不适，白带正
剂。常。治以健脾清热利湿。金银花
的话。思为心所主， 25g 焦山栀 15 g 桑叶 25 g
4 月 12 日，二诊，末次月经 2014 年 3 月 31 日，性量无青蒿 10 g 炒白术 20 g 白扁豆 10g 芡实 12 g 苏梗 10 g
明显改变，痛经较前略缓解。7 天经净。白带量减少，色白。炙甘草 12 g 黄精 12 g 竹茹 10 g 柴胡 20g 7 剂。
胃纳可，睡眠安，二便正常。舌红苔黄腻，脉滑数。治以健体会：本例患者，为湿热蕴结型痛经。湿热之邪，盘踞
脾清热利湿。金银花 30g 茵陈 30 g 焦山栀 15 g 桑叶 25 冲任子宫，气血失畅，湿热与血互结壅滞不通，故腹痛，痛
g 青蒿 10 g 淡竹叶 15 g 太子参 25 g 砂仁 3 g（后下）连腰骶；湿热扰血，故经色暗红质稠；累及任带，则带下异
芡实 12 g 苏梗 10 g 炙甘草 12 g 黄精 12 g 黄芩 25 g 常。舌红、苔黄腻、脉滑数均为湿热蕴结之候。初诊，以金
垂盆草 10 g 竹茹 10 g 柴胡 20g 泽泻 12g 猪苓 15g，7 银花、焦山栀、桑叶、黄芩、
或少都缺了点“心眼” 青蒿清热；茵陈、淡竹叶利湿；
剂。太子参、芡实、苏梗、炙甘草、黄精、苏梗健脾利湿；月经
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Volume 21 Issue
September 2014
即将来潮，不忘同时以北沙参、女贞子护阴，覆盆子补肾填角刺、乌梢蛇行气活血止痛。四诊，患者舌红苔薄黄，脉滑。
精。二诊，患者白带转为正常，但舌红苔黄腻，脉滑数，湿湿热去之大半，前方金银花、茵陈减量；去垂盆草、黄芩；
热仍较重，以垂盆草、泽泻、猪苓利尿通淋；砂仁、竹茹清去人参、砂仁改为白扁豆，减少清热利湿之功。五诊，月经
中焦之湿热；柴胡和解表里，加强清热利湿之功效。三诊，
第 5 天，患者因湿热得利，淤血得痛，痛经缓解，去淡竹叶、
温长路
患者白带虽正常，但舌红苔黄腻，脉滑数。湿热仍重，继续泽泻、猪苓、元胡 10 g、益母草、皂角刺、乌梢蛇 10 g，继
原治疗，月经后期，前方之上加益母草活血化瘀，元胡、皂续清热化湿巩固治疗。
入人类的健康大系，并使他成为具有理论与实际一体的特色征稿启事
现。
《英国中医针灸杂志》为中英文双语学术期刊，每年三月和九月发行两期，并可在学会网上阅览。本会刊宗旨着重在于
为大家提供一个平台和论坛，借此互相沟通学习，不断提高学术水平和质量，从而推动中医针灸的发扬光大。欢迎诸位会员，
中医同仁及各界读者慷慨赐稿，与大家共同分享你们的临床经验，典型病例分析，行医心得，理论探讨，中医教育和发展，
文献综述和研究报告。并建议大家推荐本刊给病人及其周围之人阅读，让更多英国民众看到并亲身体验到中医之奇妙果效，
从而提高中医之声誉，扩大中医之影响。
来稿中文或英文均可，中英双语更受欢迎。字数中文 5000 字以内，英文 4000 字以内，并附 200 字以内摘要。文章必须
符合以下格式：标题，作者，摘要，关键词，概要，文章内容，综述/讨论或结论，以及参考文献。每篇文章也可附带一份单
独的作者简介。
所有来稿必须是尚未在其它杂志上发表过的文章，也不得同时投稿于其它杂志。若编辑审稿后认为需做明显改动，将会
与作者联系并征得同意。本会刊保留版权，未发表的文章将不退稿。投稿一律以电子邮件发往
怒甚偏伤气，思多太损神。神疲心易疫，气弱病相因。 [email protected].请注明“杂志
投稿”字样。
下期来稿截至日期为 2014 年 8 月 10 日。若来稿于此日期之后收到，我们会考虑在以后之期刊发表。
，
Call for Papers
The Journal of Chinese Medicine and Acupuncture
时代，膏粱厚味之外，琳琅满目的各色保健品足以让人眼花 (JCMA) is a bilingual TCM academic magazine, which
is published twice annually
缭乱，孙氏的这些原则还能够适应今人的养生需要吗？这是 in March and September. It is intended as a platform and a forum, where the
journal concerning the profession can be developed, debated and enhanced from the greatest variety of
perspectives. All of ATCM members, other TCM professionals and members of public are welcomed and
invited to contribute papers for publication. The journal may feature articles on varies of topics, which
including clinical experience, case studies, theory and literature, education and development, book reviews
为了方便叙述，本文将孙真人的这首诗分为五段进行剖 1
and research reports etc. 现，每发一次怒或绝望值增加分，高血圧的危险性就增加
Papers should be in Chinese or English, but preferably 16%。而高血圧又可成为新的病因，引发其他更严重的疾病
bilingual, with up to 5000 words in Chinese or 4000
words in English. An abstract of 150-200 words should 发生。癌症的发生也与经常发怒有直接联系，有统计证实，
also be attached. The article must comply with the
following format: Title, Author, Abstract, Key Words, Introduction, Text, Summary/Discussion or Conclusion
气弱病相因
and References. Each article may also be accompanied by a short biography on a separate page.
All the submitted articles or papers must not being simultaneously submitted to other journals, and also
have not been published in any other journals unless particularly
神志的主宰者是心， specified. Submitted articles
《灵枢•大惑论》中有“心者，are reviewed
神之舍也” by
our editors. If the editors suggest any significant changes的话。思为心所主，
to the article, their comments and
《孟子•告子上》中有“心之官则思”的 suggestions will
be passed on to the authors for approval and/or alteration.话。心的主神、主思功能处于正常状态，人就表现出聪明、
JCMA maintains copyright over published articles.
Unpublished articles will not be returned unless specifically arranged with the editors.
All the “养生有五难，名利不去为一难（实乃最大的
嵇康的话说： papers should be sent to the Editorial Committee via email [email protected]. Please indicate
"Paper for JCMA".
Deadline of
伤肾气之大虑） submission for
，滋味不绝为四难 next Issue (Volume 22
（吃也是非常费脑筋的活）， Issue 1) is 10th March 2015.
Papers received after the deadline may still be considered
for publication, but in the later issue.
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Volume 21 Issue
September 2014
Guideline of English standard for authors

(1) Please run a spell check on your computer before 温长路submitting.
(2) Only use sentences (NOT fragments) containing a subject, verb and object.
(3) Avoid long and confusing sentences with commas and semicolons.
(4) Double check that you use the proper tense. We would recommendto write case histories in past tense.eg,
the patient had... (NOT is...)
Use appropriate punctuation,there should be a space following
(5)在我国医学发展史上，孙思邈可谓一位集众多学说之大 a comma or full stop.
(6) Avoid phrases that
成者，除了传统意义上的医学理论和实践外，把养生防病纳 are difficult to express or translate in another language, or explain them properly.
(7) Use standard and
unified measures, eg, minutes (NOT 现。
mins), hours (NOT hrs) etc. “大怒则形气绝，而血菀
(8) All herbal names should have their proper Pin Yin and Latin name, and the measures of dosage must be
followed, eg, Shan Yao 10g (NOT 10).
有过许多精辟的论述，并在《千金方》和《千金翼方》中两及飱泄。 ”（《素问•举痛论》
(9) All acupuncture points need to be named according to convention (Ki 7, Taixi). ）也就是说，怒因气生，气则怒
numbered with a bracket, eg, [1] [2] [3].
(10) Illustrations/references from other sources should be 发，生气——发怒——生气，构成了一条恶性循环链。正如
(11) Referencing should be Harvard. Please ensure all dates
的养生著述以诗歌为载体在民间流行的内容也甚多、甚广， and publishers’
《淮南子》所言： details are correct.
It should comply with
《养生铭》就是其中的一首。此文收于《全唐书》和后人整the format as following: 充则气激，气激则发怒”。唐代诗人白居易在他在一首制怒
Books: Author (year), Title. City: Publisher. Eg, Lewis R. 诗中也阐明了雷同的观点：
(2004), The Infertility Cure. London: Little, Brown
and Company.
Articles: Author (year), Title. Journal, Volume (Issue), pages. eg, Lei Chen (2003). Prevalence of。metabolic
syndrome among Shanghai adults in China. Chinese Journal of Cardiology, 31 (12), 909-912.
，
13
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Company: TCM Hoffnung looking for TCM Therapists
Vacancy:
We offer job position in the field of TCM in Zurich area / Switzerland. Full time.
Availability: immediately or by arrangement
Your responsibilities:
Treatment of patients with TCM methods such as acupuncture, Tuina massage,
herbal therapy, moxibustion and cupping.
Your profile:
Completed TCM studies with work experience, Bachelor Degree
Good team skills, social competence, reliable, friendly and conscientious
Very good knowledge of pulse and tongue diagnosis, acupuncture, Tui-Na
massage, cupping, moxibustion and Chinese herbal medicine.
English and or German skills preferred
Work and residence permits in EU / Switzerland preferred
Please send your complete application with picture by e-mail:
[email protected]
诚聘中医大夫, 德语区工作, 全职.
工作:
通过四诊、推拿、针、灸、拔火罐、中药等方法治疗各种疾病，如颈肩腰疼痛、脊椎
疾病、各种痛症、失眠、呼吸道疾病、肠胃疾病、妇科病、皮肤病、抑郁症和其它疑
难杂症
要求:
本科以上学历
具有多年的中医从业经验
熟练掌握针灸按摩开药方等技术
工作认真负责, 态度友好，无不良嗜好
会德语或英语者优先
有欧盟/瑞士工作许可/居留许可者优先
有意者请把个人简历、毕业证书、医师资格证和医师执业证照片（扫描）发送到:
[email protected]
The Association of Traditional Chinese Medicine and Acupuncture UK
ATCM’s New Office Address

and Telephone Number
ATCM
Suite 12
Brentano House
Unit 5, The Exchange
Brent Cross Gardens
London NW4 3RJ
Tel: 0208 457 2560
Email: [email protected]
Website: www.atcm.co.uk
TCMswiss
TCMswiss
– Centre
– Centre
for Traditional
for Traditional TCMswiss – 瑞士中医中心
TCMswiss – 瑞士中医中心
，诚聘
，诚聘
Chinese
Chinese
Medicine
Medicine
(TCM)(TCM)
in Switzerland
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is looking
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for for
TCM
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Therapists
Therapists 中医师
中医师
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haveyou
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ATCM JOURNAL September 2014 - 21

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ISSN: 1745-6843

英 国 The Journal of Chinese Medicine

理论与文献 Theory & Literature

临诊经验 Clinical Experience

中医研究 TCM Research

临床报告 Clinical Reports

病案分析 Case Studies

英国中医针灸杂志编辑委员会 Editorial Committee of JCMA

英国中医药学会 The Association of Traditional Chinese Medicine And Acupuncture UK

Acupuncture Treatment for Parkinson’s Disease

Bai-Yun Zeng1 & Kaicun Zhao2

Introduction significantly improved the motor function of affected

The Yin Yang of the Five Elements and their energetic

Theories of TCM Yin Yang Comments

lung is hand Taiyin and therefore above spleen, which is foot

Theories of TCM Yin Yang Comments

Theories of TCM Yin Yang Comments

Theories of TCM Yin Yang Comments

Theories of TCM Yin Yang Comments

Anatomy Pulse Position Zhang’s Meridians

From the analysis, it can be concluded, that despite (yin) aspect.

Current Opinion in Acupuncture on Stroke Rehabilitation

History in Brief: the Introduction of Chinese Acupuncture to Britain –

软无力。 （《难经•二十九难》“带之为病腰溶溶若坐水中” ）。 足三阳经：胃经足阳明络丰隆；膀胱经足太阳络飞扬；胆经足

清半夏 10g 黄 芩 10g 醋柴胡 10g 北沙参 15g 七诊 09-12-24

reaction is positive and HCG concentration is above treatment); Polycystic ovary

Total+ 111 80 58.1** 68 111 38.0

6. Acknowledgements Jonard, S., Y. Robert and D. Dewailly. 2005. Revisiting the

The Latest Research Review on Chinese Herbs of Anti-myocardial

A Comparative Study of Traditional Chinese and Western Herb

Elements Humour Season Organ Qualities Ancient name Ancient characteristics

and sore throat due to the wind-heat

Chinese medicine Western herbs medicine

The Journal of Chinese Medicine and Acupuncture

摘要: 目的 观察关幼波益气活血化痰通络方治疗乙肝后肝硬化疗效。方法 选取乙肝后肝硬化患者104例，

基础方：生黄芪30g 生赭石10g，旋覆花10g，杏仁10g， 所有数据输入电脑，用SPSS19.0软件包建立数据库并进

铭》的。宋代温革的《琐碎录》和 14 世纪朝鲜出版的《医 得平，若问病根深与浅，此身应与病齐生”

表 4 两组肝功能、肝纤维化四项指标及 PLT 比较（Mean±SD）

项目 例数 治疗前 治疗后 治疗前后比较 P 值

The Treatment of Carpal Tunnel Syndrome with Acupuncture:

However, he had been feeling very hot and was Worker

best that may be said is that there was a 40% 老百姓的说法一语道破了生气对人类健康的严重危害。

Guideline of English standard for authors

诚聘中医大夫, 德语区工作, 全职.

ATCM’s New Office Address

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英国 The Journal of Chinese Medicine

软无力。（《难经•二十九难》“带之为病腰溶溶若坐水中” ）。足三阳经：胃经足阳明络丰隆；膀胱经足太阳络飞扬；胆经足

清半夏 10g 黄芩 10g 醋柴胡 10g 北沙参 15g 七诊 09-12-24

摘要: 目的观察关幼波益气活血化痰通络方治疗乙肝后肝硬化疗效。方法选取乙肝后肝硬化患者104例，

基础方：生黄芪30g 生赭石10g，旋覆花10g，杏仁10g，所有数据输入电脑，用SPSS19.0软件包建立数据库并进

铭》的。宋代温革的《琐碎录》和 14 世纪朝鲜出版的《医得平，若问病根深与浅，此身应与病齐生”

项目例数治疗前治疗后治疗前后比较 P 值