针灸诊查之要,贵在医患共“知”——再论“以知为数,以痛为输”  

The key to acupuncture-moxibustion diagnosis and examination lies in the“knowledge”of both doctors and patients-revisiting the“Yi Zhi Wei Shu,Yi Tong Wei Shu”

作　　者：李昕蔚 刘璐[2] 游伟[2] 魏嘉[2] 程金莲[2] 李彬[2] 闫世艳 李子祎 邵冰 高帆 刘慧林[2] LI Xin-wei;LIU Lu;YOU Wei;WEI Jia;CHENG Jin-lian;LI Bin;YAN Shi-yan;LI Zi-yi;SHAO Bing;GAO Fan;LIU Hui-lin(Beijing University of Chinese Medicine,Beijing 100029,China;Acupuncture and Moxibustion Center of Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University,Beijing 100010;Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing 100102;China Rehabilitation Research Center of Beijing Boai Hospital,Beijing 100068;Ningxia Hospital of Traditional Chinese Medicine&Institute of Traditional Chinese Medicine,Yinchuan 750021)

机构地区：[1]北京中医药大学,北京100029 [2]首都医科大学附属北京中医医院针灸中心,北京100010 [3]中国中医科学院望京医院,北京100102 [4]中国康复研究中心北京博爱医院,北京100068 [5]宁夏中医医院暨中医研究院,银川750021

出　　处：《针刺研究》2025年第2期224-231,共8页Acupuncture Research

基　　金：北京市医院管理中心“扬帆”计划临床技术创新项目(No.ZLRK202324);北京市医院管理中心“登峰”人才培养计划团队项目(No.DFL20241001);首都卫生发展科研专项项目(No.首发2024-2-2235)。

摘　　要：正确的针灸施术部位是针灸起效的关键,本文强调经筋病针灸施术部位应在诊查中确定,而非固定穴位,“以知为数,以痛为输”是确定经筋病针灸施术部位的原则和方法。古今医家对于“以知为数,以痛为输”的认识未达成共识。文中首次结合《伤寒杂病论》方后注中“以知为度”中“知”的含义,阐明“以知为数,以痛为输”的“知”体现了医生对疾病诊治规律的把握能力,即医生的专业化“认知”。明确提出“以知为数,以痛为输”旨在指导经筋病治疗前如何确定针灸施术部位,不是选择患者诉说的痛处,而是医生根据患者对于循切按压等查体操作过程中产生压痛的“感知”,即患者的“知痛”部位而判定。“以知为数,以痛为输”可理解为经筋病的施术部位的确定应以医生专业化“认知”为基础,在查体过程中医生对患者的“知痛”部位做出判断,从而确定针灸施术部位的过程,即需做到医患共“知”。本文进一步结合针灸治疗经筋病、紧张型头痛、带状疱疹后神经痛、原发性三叉神经痛等疾病及热敏灸理论,说明“以知为数,以痛为输”的内涵及临床拓展应用价值,以期为针灸施术部位的确定提供启示。The correct selection of the stimulated site is the key to the effectiveness of acupuncture and moxibustion.In the present paper,we propose that in the treatment of Jingjin(muscle,tendon,fascia,ligament,etc.)disease,the stimulated position of acupuncture or moxibustion should be determined by careful examination,rather than only selection of the fixed acupoints.The“Yi Zhi Wei Shu”(以知为数“Zhi”i.e.”knowledge”),means:the limit of the number of acupuncture or moxibustion treatment sessions is according to the therapeutic effect(improvement or cured)of a disease achieved,while the“Yi Tong Wei Shu”(“以痛为输”)refers to needling the site where the pain is,i.e.Ashi point,recorded in book Lingshu.Jingjin(Miraculous Pivot:Aponeurotic Structure along Meridians),are the basic principles and methods for the treatment of Jingjin disease.The ancient physicians and modern doctors have different understandings on the selection of number of treatment sessions,and the stimulation of Ashi-points.Combining the meaning of“Zhi”of“Yi Zhi Wei Du”(“以知为度”meaning that the herb-medicines can be taken until the clinical condition has been improved to a certain extent,and it is not necessary to stop the medicines until it is completely cured)in Shang Han Za Bing Lun(Treatise on Febrile and Miscellaneous Diseases)for the first time,we hold that the“Zhi”of“Yi Zhi Wei Shu”reflects the doctors’ability to grasp the rules of diagnosis and treatment of diseases,that is,doctors’professional“cognition”.We also propose that the saying“Yi Zhi Wei Shu,Yi Tong Wei Shu”refers to guiding how to determine the stimulated spots of acupuncture or moxibustion for Jingjin disease.It is by no means to choose the pain site complained by the patient,but the doctor’s judgement is according to the patient’s perception of tenderness proposed during physical examination such as touching and pressing,which is the patient’s“Zhi”.The saying“Yi Zhi Wei Shu,Yi Tong Wei Shu”could be understood

关 键 词：针刺 艾灸 以知为数 以痛为输 经筋病 

分 类 号：R245[医药卫生—针灸推拿学]