《伤寒论》和《脉经》中10种脉象的比较研究

Abstract

本研究以《伤寒论》和《脉经》中所载“浮、沉、数、迟、紧、缓、法、涩”10 种脉象的原文为主要研究对象,运用传统中医学、文献学研究方法,以及“八钢辨证”中的“明、 阳、表、里、寒、热、虚、实”进分和归纳10种脉象的类型、形成各种脉象的重要临床因 素、病证、症状、治法等,以最终通过综合分析和比较后,可得出两书中形成10种脉象的基本 原理和临床意义之异同。研究结果显示,《伤寒论》和《脉经》对上述10种脉象的形态特征和 其基本形成机理未见明显的差异。不过“浮、紧、缓、洪、弦、涩”等脉的形成机制及临床意 义方面,在两书中存在一定的差异,例如,在《伤寒论》398条中明确记载,缓脉是太阳中风 证的主要脉象,但《脉经》反而认为,该脉常见于虚证。另外,只在《伤寒论·辨脉法》中指 出,“洪脉”可见于“阴阳离决之证”。由此可见,两书成书时间相去不远,均为收录早期脉学 理论内容的重要医籍。但深入研究后,反而发现两书在某种脉象形成机理及相关病症的论论述上 非完全一致。因此,后续在探究早期脉学,不宜仅据单一典籍作为当代脉学的基础依据,而应 结合多种文献进行综合考察。

This study focuses on the original descriptions of ten pulse types Floating Pulse (Fu Mai), Sunken Pulse (Chen Mai), Rapid Pulse (Shu Mai), Slow Pulse (Chi Mai), Tight Pulse (Jin Mai), Moderate Pulse (Huan Mai), Surging Pulse (Hong Mai), Stringlike Pulse (Xian Mai), Faint Pulse (Wei Mai) and Rough Pulse (Se Mai) as recorded in the "Treatise on Febrile Caused by Cold (Shang Han Lum)" and the "Maijing". Using traditional Chinese medicine and philological research methods and the diagnostic framework of the "Eight Principles Pattern Indentification" (Yin, Yang, Exterior, Interior, Cold, Heat, Deficiency and Excess), this study classifies and synthesizes relevant passages to examine the clinical factors, associated syndromes, symptoms, treatment methods and patterns underlying the formation of these pulse types. Through comprehensive analysis and comparison, the research aims to identify the similarities and differences in the fundamental mechanisms and clinical significance of the ten pulse types as presented in the two books. The results indicate that the "Treatise on Febrile Caused by Cold (Shang Han Lun)" and the "Maijing" show no substantial differences in the morphological features and basic formation mechanisms of the ten pulse types. However, the formation mechanisms and clinical significance of certain pulses such as Floating Pulse (Fu Mai), Tight Pulse (Jin Mai), Moderate Pulse (Huan Mai), Surging Pulse (Hong Mai), Stringlike Pulse (Xian Mai) and Rough Pulse (Se Mai) show some differences between the two books. For example, 398 rows in "Treatise on Febrile Caused by Cold (Shang Han Lun)", the Moderate Pulse (Huan Mai) is clearly identified as the primary pulse pattern in "Greater Yang wind stroke (Tai Yang Zhong Feng)", whereas the "Majing" instead regards it as a common manifestation of "Vacuity pattern". In addition, "The Bian Mai Fa" section of the "Treatise on Febrile Caused by Cold (Shang Han Lum)" is the only part that identifies the Surging Pulse (Hong Mai) as indicative of a syndrome characterized by the separation of Yin and Yang. This suggests that the two books were compiled around the same period and are both important medical classics that document early theories of pulse diagnosis. However, upon closer examination, it becomes evident that their interpretations of the formation mechanisms and related pathological interpretations of certain pulse types are not entirely consistent. Therefore, future research on early pulse theory should not rely solely on a single classical source as the foundation for modern pulse diagnostics, but should instead undertake a comprehensive analysis based on multiple historical texts.