基于《太素·五脏脉诊》探析“尺肤分候”之经义  

Analysis of the Meaning of"Syndrome Differentiation by Palpation of Forearm Skin"based on the Text of Grand Simplicity·Five Viscera Pulse Diagnosis(《太素·五脏脉诊》)

作　　者：王娇 顾漫[2] 侯酉娟[3] 李楠[4] WANG Jiao;GU Man;HOU Youjuan;LI Nan(School of Basic Medical Sciences,Zhejiang Chinese Medical University,Hangzhou,310053;China Institute for History of Chinese Medicine and Medical Literature,China Academy of Chinese Medicine Sciences;Institute of Information on Traditional Chinese Medicine,China Academy of Chinese Medicine Sciences;Graduate School of China Academy of Chinese Medical Sciences)

机构地区：[1]浙江中医药大学基础医学院,浙江省杭州市310053 [2]中国中医科学院中国医史文献研究所 [3]中国中医科学院中医药信息研究所 [4]中国中医科学院研究生院

出　　处：《中医杂志》2024年第24期2497-2503,共7页Journal of Traditional Chinese Medicine

基　　金：国家资助博士后研究人员计划(GZC20241536);四川省社会科学重点研究基地(扩展)“中国出土医学文献与文物研究中心”委托项目(2020CW03);浙江中医药大学校级科研项目人才专项(2023RCZXSK02)。

摘　　要：《黄帝内经》中的尺诊是指通过诊察手腕至肘部之间的尺部皮肤以诊断疾病的方法,其中“尺肤分候”是尺诊的重要组成部分。然而随着寸口诊法盛行,后世医家或将《黄帝内经》之“尺”误注为寸口诊法之“尺部”,且历来医家多依据《素问·脉要精微论篇》解读“尺肤分候”之义,释疑不明,使“尺肤分候”长期未能在临床得到良好应用以致失传。使用文献学、史学以及理论研究相结合的方法,依据《太素·五脏脉诊》的“尺肤分候”文本对其进行了更契合临床的阐释,认为“尺肤分候”是在《灵枢·论疾诊尺》热病、虫病等诊断规律的基础上所建构的手臂肘与躯干的全息关联,关联中以“尺—腹”为核心,这个结论可在《黄帝内经》成书时期的两个尺诊案例“蛲瘕”与“狐筋”中进一步得到验证。通过对“尺肤分候”经义之释疑,为尺诊在现代临床应用拓宽思路。In The Inner Canon of Yellow Emperor(《黄帝内经》),the palpation of forearm skin usually refers to disease diagnosis by pulse diagnosis and observation of the forearm skin between the wrist and the elbow,in which"syndrome differentiation by palpation of forearm skin"is an important part of forearm diagnosis.However,with the popularity of palpation of the radial pulse,later generations of doctors may mismark the"forearm"of The Inner Canon of Yellow Emperor as the"chi part"of the radial pulse palpation.In addition,generations of doctors have relied on the Plain Questions·Treatise of the Essential Subtleties of the Pulse(《素问·脉要精微论篇》)to interpret the meaning of"syndrome differentiation by palpation of forearm skin",but still with doubts and unclear explanation,so that"syndrome differentiation by palpation of forearm skin"has not been well used in clinic for a long time and has been lost.Based on the text of"syndrome differentiation by palpation of forearm skin"in Grand Simplicity·Five Viscera Pulse Diagnosis(《太素·五脏脉诊》),this paper provided a new and more clinical interpretation by combining biblio⁃graphic,historical,and theoretical research methods."Syndrome differentiation by palpation of forearm skin"is a holographic correlation between arm,elbow and torso based on the diagnosis rules of fever and insect disease in Miraculous Pivot·Understanding Sickness by Examination of the Cubit Skin(《灵枢·论疾诊尺》).The core of the correla⁃tion is"forearm-abdomen",which can be further verified in the two disease cases by palpation of forearm skin,"Pinworm-induced conglomerations(蛲瘕)"and"Hujin(狐筋,also as疹筋)",when the Inner Canon of Yellow Emperor was written.Through the explanation of"syndrome differentiation by palpation of forearm skin",we can broaden the thinking for the modern clinical application of palpation of forearm skin.

关 键 词：尺诊 寸口诊法 《太素》 尺肤分候 

分 类 号：R241.1[医药卫生—中医诊断学]