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【中國中醫藥報】張俊智:內和外通,治病養生

作者:張俊智 發表時間:2019年04月25日  

    在中醫整體觀、辨證論治觀之外,筆者認為,尚有一種內和外通觀。

  內和觀

  內和即中和。“中和”指中正平和,是儒家中庸之道的主要內涵。儒家認為中和則天地萬物均能各得其所,達于和諧境界。中者,不偏不倚,無過與不及之名矣。一指中間、中等、兩者之間之意;二指適宜、合適、合乎一定標準;三指人心、內心,即人的內在精神。中和之“中”取意合乎其宜之意,宋之理學家程頤稱之為“天下之道”也。和者,相應也(《說文解字》),其義有二:一指調和,二指和諧,表示協調、均衡、統一的狀態。中和之“和”,二者之意均有。和之內容,包羅萬象,可大可小,無處不有和。中醫內和觀指臟腑、氣血、陰陽調和。

  從陰陽學說談內和:“陰陽者,一分為二也”(《類經·陰陽類》)。陰陽學說屬于中國古代唯物論和辯證法范疇。中醫學把陰陽學說應用于醫學,形成了中醫學的陰陽學說。中醫學用陰陽學說闡明生命起源和本質、人體的生理功能、病理變化、疾病診斷和防治的根本規律,并將之貫穿于中醫理、法、方、藥中。

  陰陽的互根互用、陰陽的消長平衡為和諧之態。在正常情況下,陰陽雙方應是長而不偏盛,消而不偏衰,即內和之態。若超過了這一限度,出現了陰陽的偏盛或偏衰,是為異常的消長變化,即內失和,則生疾病。陰陽互根,是指相互對立的陰陽雙方,相互依存、相互化生、相互為用、相互吸引地共處于一個統一體中。陰陽消長,是指對立互根的陰陽雙方的量和比例不是一成不變的,而是處于不斷地增長或消減的運動變化之中。

  從五行理論談內和:五行學說是用木、火、土、金、水及其生克制化規律來認識、解釋人體內臟之間的相互關系、臟腑組織器官的屬性、運動變化及人體與外界環境的關系。五行之間具有相生相克的生理關系,五行相生相克生理平衡則內和,反之當五行不能維持相生相克生理平衡狀態時,生克關系即轉為相乘相侮的病理關系,產生相應的關聯性病變。

  從氣的升降理論談內和:升降出入出自《素問·六微旨大論》,指氣自下向上、自上向下、由內向外、由外向內的四種基本運動形式。存在于自然界和人體的氣,都處在不斷的運動之中,這就是氣的升降出入。這種運動是一切變化的由來。人體氣的升降出入,既體現在氣及由氣推動的血、津液的運行不息,也體現在臟腑、經絡等組織器官的功能活動中。升降出入促進了機體的新陳代謝,維持了正常的生命活動。氣的升、降、出、入運動,是人體生命活動的根本,是萬物變化的根本,是生命活動的體現。《素問·六微旨大論》指出:“故非出入,則無以生長壯老已;非升降,則無以生長化收藏。”氣升降有序,升降和諧則為內和之態,一旦升降出入失去協調平衡,就會出現各種病理變化;而升降出入止息,則生命活動也就終止。

  從五臟六腑功能談內和:臟腑雖存于體內,但其生理、病理方面的變化,都有征象表現在外。所以中醫學的臟腑學說,是通過觀察人體外部征象來研究內臟活動規律及其相互關系的學說。臟和腑是根據內臟器官的功能不同而加以區分的。五臟即心、肝、脾、肺、腎;六腑即胃、大腸、小腸、三焦、膀胱、膽。五臟六腑功能正常,則為內和之態,反之則為失和為內不和。如若某臟腑內不和,則株連其他臟腑,使之陰陽失和。

  《素問》云:“五臟者,藏精氣而不泄,故滿而不能實。六腑者,傳化物而不藏,故實而不能滿。”臟和腑的生理功能必須平衡和諧,藏和泄才能有內和之度。

  五臟六腑生理功能首先是整體統一,在這種狀態中完成著每個臟腑各自的生化收藏出入。五臟六腑之間關系在《內經》主要是以五行生克乘侮來闡明。肝主木,心主火,脾主土,肺主金,腎主水。五行相生分別為:木生火,火生土,土生金,金生水,水生木。五行相克分別為:木克土,土克水,水克火,火克金,金克木。

  臟腑生理功能正常與否,要取決于三焦的氣機正常,三焦氣機正常同時又依賴于五臟六腑生理功能的正常與否。

  從治療疾病求中和:和則生萬物,不和則害萬物。百病生于氣。因為氣具有恒溫性、運動性、穿透性、控攝性、記憶性,而中醫治病要依溫度、壓力、速度、時間,要動、要行、要和。要行中有和,和寓行中,而達和生萬物。和而原,和而壽。中州者,脾胃也。脾胃正常則氣機升降正常;升降正常則人身之諸氣則動則行,水液則運,氣血則生,人身之諸氣的升降要和,要有升有降有度。中和還要達到出入平衡。出指二便、汗,入指攝入食物。要求隨年齡的不同,疾病的不同,季節的不同,地域的不同有相應的飲食、生活習慣,二便和汗的排出有數和量。

  外通觀

  外通觀指十二正經、奇經八脈、十二經筋、十二皮部經氣暢通。

  有諸內者必形諸外:語出自《丹溪心法》,源于《靈樞·外揣》中的“司外揣內,司內揣外”思想,“欲知其內者,當以觀乎外;診于外者,斯以知其內。蓋有諸內者,必形諸外。”意思是說,人體是一個有機的整體,體外與體內有著密切聯系。

  經脈暢通,百病不生:經脈是指人體內氣血運行的通路。《靈樞·本藏》曰:“經脈者,所以行血氣而營陰陽,濡筋骨,利關節者也。”經脈可分為正經和奇經兩類。正經有十二條,即手足三陰經和手足三陽經,合稱十二經脈,是氣血運行的主要通道。奇經有八條,即督、任、沖、帶、陰蹺、陽蹺、陰維、陽維,合稱奇經八脈,有統率、聯絡和調節十二經脈的作用。十二經別,是從十二經脈別出的經脈,主要是加強十二經脈中相為表里的兩經之間的聯系,還由于它通達某些正經未循行到的器官與形體部位,因而能補正經之不足。因此針刺經脈可以達到疏通經絡,解除病痛的目的。《靈樞》曰:“經脈者,所以能決生死,處百病,調虛實,不可不通。”意思是說經脈的功能正常與否,決定了人的生與死,經脈運行正常對于疾病的治療與康復起著重要作用,暢通的經絡可以起到調整虛與實的作用,通則不痛,不能不通。

  人體是個統一的整體,各個系統之間存在著密切的聯系。如若內不和,則相對應的經脈就不通,進而可株連其相應臟腑,即所謂內不和則外不通,外不通則內不合。

  人宗岐黃道,心法陰陽平,外通筋骨氣,內調臟腑和。將針灸與藥有效結合,應用于臨床,調氣血,運中州,平升降,恒出入,從而達到內和外通之意。

  外通的治法主要是應用傳統針灸理論、平衡針灸理論、董氏奇穴理論疏通經絡。應用黃帝內經古法九針通經絡、通經筋、通皮部而通五痹。根據疏、運、行理論,應用不同針具,治療不同的疾病。

  內和外通的意義

  在內和外通觀點的指導與辨證論治的基礎上,內外同治,針藥并用,相得益彰。這可以使臨床療程縮短,提高有效率、治愈率。內和外通相輔相成,外不通則內不和,內不和則外不通。根據筆者近三十年的研究,只要將內治外治、針藥并用結合的妙,結合的正確,就能取得準、穩、快之桴鼓之效。(張俊智 寧夏回族自治區人民醫院)

  (注:文中所載藥方和治療方法請在醫師指導下使用。)

 

來源:中國中醫藥報4版2019-01-07 

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