“枢机”探析  

Analysis on“Pivot”

作　　者：朱杰 叶婷[2] 宋晓晨 王雪华[1] 陈晶[1] ZHU Jie;YE Ting;SONG Xiaochen;WANG Xuehua;CHEN Jing(School of Basic Medicine,Heilongjiang University of Chinese Medicine,Harbin 150040,China;Second Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin 150001,China)

机构地区：[1]黑龙江中医药大学基础医学院,黑龙江哈尔滨150040 [2]黑龙江中医药大学附属第二医院,黑龙江哈尔滨150001

出　　处：《山东中医药大学学报》2024年第6期664-670,共7页Journal of Shandong University of Traditional Chinese Medicine

基　　金：王雪华全国名老中医药专家传承工作室建设项目(批文号:国中医药人教函〔2022〕75号)。

摘　　要：“枢机”最早起源于北斗七星之天枢,门户枢是其形象化的表现。在《黄帝内经》中应用有三,一是指关节,二是指穴位,三是指三阴三阳“开阖枢”理论。后者被运用到《伤寒论》六经辨证中,其中少阳枢机历代医家关注最多。后世医家在实践中丰富了“枢机”内涵,提出了脾胃枢机、玄府枢机、卫气营血枢机、三焦枢机、膜原枢机、脏腑枢机、枢经学说等,并在枢机病变的治疗中提出了枢机之剂,对枢机病变治疗的方药进行初步总结。枢机不仅是阴阳表里、寒热内外、上下气血出入的通道,更是正气与邪气斗争进出的场所,是疾病转归的关键。枢机宜调、宜和,在扶正的同时祛邪,给邪气以出路。调枢的过程可能会伴随瞑眩反应,临床需注意鉴别。“Pivot”originated from the celestial pivot of the Big Dipper,and the portal pivot is its visualization.There are three applications in the Huangdi’s Canon of Internal Medicine:The first refers to joints,the second refers to the acupoints,and the third refers to the theory of“opening and closing pivot”of the three yin and three yang.The latter was applied to syndrome differentiation based on six meridians of the Treatise on Cold Damage,in which the Shaoyang pivot has received the most attention from successive generations of medical practitioners.Later generations of doctors enriched the connotation of the“pivot”in practice,put forward the spleen-stomach pivot,Xuanfu pivot,defense-qi-nutrient-blood pivot,triple energizer pivot,pleurodiaphragmatic interspace pivot,viscera pivot and pivot meridian theory,etc.,and proposed the pivot formulas in the treatment of pivot diseases,and preliminarily summarized the formulas and medication for the treatment of pivot diseases.The pivot is not only the pathway of yin and yang,exterior and interior,cold and heat,inside and outside,ascending and descending,entering and exiting of qi and blood,but also the place where the healthy qi and pathogenic factors struggle,and is the key to the disease prognosis.The pivot should be regulated and harmonized to expel the pathogenic factors while reinforcing the healthy qi and give pathogenic factors a way out.It is worth noting that in the process of regulating pivot,it may be accompanied with dizziness,which should be clinically differentiated.

关 键 词：枢机 脾胃 玄府 卫气营血 膜原 三焦 经络 

分 类 号：R221[医药卫生—中医基础理论]