基于系统辨证脉学探讨《伤寒杂病论》仲景脉法  

Discussion on ZHANG Zhongjing’s Pulse Examination Method in Treatise on Cold Pathogenic and Miscellaneous Diseases Based on Systematic Sphygmology for Syndrome Differentiation

作　　者：卜瑞琪 韩宇 闫伟[3] 滕晶[3] 齐向华[3] BU Ruiqi;HAN Yu;YAN Wei;TENG Jing;QI Xianghua(Shandong University of Traditional Chinese Medicine,Jinan 250355,China;Dongying Shengli Oilfield Central Hospital,Dongying 257034,China;Shandong Provincial Hospital of Traditional Chinese Medicine,Jinan 250014,China)

机构地区：[1]山东中医药大学,山东济南250355 [2]东营胜利油田中心医院,山东东营257034 [3]山东省中医院,山东济南250014

出　　处：《山东中医药大学学报》2025年第1期6-11,35,共7页Journal of Shandong University of Traditional Chinese Medicine

基　　金：国家重点研发计划中医药现代化研究专项(编号:2018YFC1707500)。

摘　　要：系统辨证脉学从位、数、形、动、质五个维度描述了脉体、脉管壁、血流和脉搏波方面的脉象信息,脉象要素耦合形成脉象系统,进而各系统间形成网络化的疾病发生发展的动态逻辑,形成中医脉诊的“心智模型”。《伤寒杂病论》强调“脉”在辨证识病中的重要性,将脉形、脉位、脉势分别辨阴阳,以分析疾病之病性与动态转归。通过系统辨证脉学的视角,将仲景脉法分为阴阳、五脏、六经辨证脉法三大方面。结合五带六区七层理论阐释的“部位阴阳”,结合“太过不及”重新解构传统脉象的“脉象阴阳”,结合不同疾病阴阳属性与特定病脉的“疾病阴阳”;结合系统论、全息理论重新阐释“五脏脉法”;结合疾病过程及脉象要素客观阐释“六经辨证脉法”。据此,进一步还原张仲景《伤寒杂病论》的脉诊模式。仲景阴阳脉法、五脏脉法、六经辨证脉法三者实质上相互融合,对于疾病的定位、定性诊断可互为补充,从而可发掘人体系统出现病理变化背后的真正病机。Systematic sphygmology for syndrome differentiation describes the pulse information of pulse body,vascular wall,blood flow and pulse wave from the five dimensions of position,rate,shape,movement and quality.Pulse elements are coupled to form the pulse system,and then a networked dynamic logic of disease occurrence and development is formed among the various systems,forming a“men⁃tal model”of pulse diagnosis of traditional Chinese medicine.The importance of“pulse”in syndrome differentiation is emphasized in Treatise on Cold Pathogenic and Miscellaneous Diseases,stating pulse shape,pulse position and pulse tendency should be differentiated based on yin and yang to analyze the pathogenicity and dynamic outcomes of diseases.From the perspective of systematic sphygmology for syndrome differentiation,ZHANG Zhongjing’s pulse examination method is divided into three pulse examination methods based on yin-yang,five Zang-organs and six meridians for syndrome differentiation.For pulse examination method based on yin-yang,“yin and yang in position”is explained according to the theory of five belts,six zones and seven layers,traditional“yin and yang pulse”has been reconstructed according to“excess or deficiency”,and“yin and yang in disease”is diagnosed according to the yin and yang attributes of different diseases and the specific disease pulse.For“pulse examination method based on five Zang-organs”,it has been reinterpreted according to system theory and holographic theory.For“pulse examination method based on six meridians”,it has been interpreted objectively according to disease process and pulse elements.Therefore,ZHANG Zhongjing’s pulse examination pattern in Treatise on Cold Pathogenic and Miscellaneous Diseases is further restored.ZHANG Zhongjing’s pulse examination methods based on yin-yang,five Zang-organs and six meridians for syndrome differentiation are essentially integrated,which can complement each other in the localization and qualitative diagnosis of diseases,so as to e

关 键 词：系统辨证脉学 《伤寒杂病论》 仲景脉法 定位诊断 定性诊断 客观阐释 

分 类 号：R241.1[医药卫生—中医诊断学] R222[医药卫生—中医临床基础]