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针灸典籍,歌赋名篇——《席弘赋》浅解-
针灸典籍,歌赋名篇——《席弘赋》浅解

针灸典籍,歌赋名篇——《席弘赋》浅解

《席弘赋》为针灸医家席弘所著,是席氏临床经验之总结,极受明代针灸名家汪机之推祟。

《席弘赋》篇幅不大,赋中仅就头痛、痹证、心痛、癫痛等21个病证进行辨证用穴,而赋中用穴亦只有50多个。但此赋却充分地反映了元明时代,针灸治疗的特点。

现根据经络腧穴的理论,结合临床实践择其要对《席弘赋》作以解释.

头痛

“列缺头痛及正偏,重泻太渊无不应运”。

头痛分外感、内伤。歌赋提出的处方,应为治疗外感头痛而设。列缺为肺经络穴,专治头项病症;太渊为原穴。二穴相配,为原络配穴法之变化,可宣肺,疏风泄邪,外感风热或风寒之头痛均可用。临床上配伍风池穴效更佳,既可增强疏风泄邪的功效,又可疏通头部经络而止痛。

耳疾

“耳聋气痞听会针,迎香穴泻功如神”。

“但患伤寒两耳聋,金门听会疾如风”。

气痞,指耳内气满、闭塞无闻。“疾如风”,指疗效迅速。治疗耳疾,席氏提出听会配迎香及听会配金门两组处方,均为用于邪阻经络者。听会为胆经腧穴,又是三焦脉气所发之处。胆经、三焦经均行于耳前、耳中、耳后,故听会为治疗耳疾之常用穴。迎香属大肠经而位于鼻旁,鼻为肺之外窍,大肠与肺相表里,取迎香以宣通肺气泄邪,消除咽鼓管之炎症。太阳主一身之表,取足太阳经郄穴金门,可清热泄邪通窍。赋中虽强调“伤寒两耳聋”用金门,以区别于配迎香之症,但两组处方还是以治风热邪袭。临床可配外关,以增强疏风泄邪之功效。

咳嗽、哮喘

“虚喘须寻三里中”

赋中仅提出哮喘虚证的治疗处方。独取足三里,是因为足三里为土经土穴,具有较强的培土生金的功效。用于肺脾两虚为好。

“冷嗽先宜补合谷,却须针泻三阴交”。

冷嗽,指寒咳而言。成因于风寒外袭,或因于寒痰内扰,导致肺气失宣而咳。补合谷、泻三阴交是赋中提出的特殊处方之一肺主皮毛,肺气不足,卫外失固,外邪易犯。肺与大肠相表里,取大肠经原穴,补之以固表,宣通肺气而止咳。咳嗽者,与痰浊有关,多因脾失健运而聚湿生痰,取三阴交,实为调理脾胃,助运化水湿以除痰。固表宣肺、健脾利湿化痰,即取合谷、三阴交治咳之意义。《标幽赋》中亦提出列缺治寒痰咳嗽,实为异曲同工之处方。临床上治寒咳,加灸肺俞、风门为常用。

心痛

“心疼手额少海间,若要除根觅阴市”。

“妇人心痛心俞穴”

胸阳不振,络脉瘀阻,筋脉失养,即可见心痛、手震颤之症。赋中选用少海、心俞、阴市三穴,少海为心经合穴,心俞为心之俞穴,均可调理心之功能,祛瘀通经止痛。心俞非妇人专用,近代已被广泛用于治疗心纹痛。根治用阴市,当是席氏经验之谈。

痫证

“鸠尾能治五般痛,若下涌泉人不死”

痛证历代医家有不同的分型,如钱乙氏根据症状表现不同,分为犬、羊、牛、鸡、猪五种痫证,《诸病源候论》分为阳、阴、风、湿、马五种痛证,《千金方》又分为五脏痫和六畜痫。“五般痫”实指不同分型,痰浊内阻,气机逆乱为痛证之主要病机。张景岳指出:“凡气有所逆,痰有所滞,皆能塞闭经络,格塞心窍。因此,治疗亦以清心豁痰、镇心安神定惊搐为主。鸠尾穴被众多医家认为是治痛之要穴,《玉龙赋》、《玉龙歌》、《胜玉歌》等,均提到鸠尾治痫,针鸠尾,可清心开窍宁神,散导气郁。

涌泉,能开窍醒神,为回阳九针穴之一。痛证发作时,针涌泉可令人神清,即赋中之“人不死”的含义。鸠尾宁心安神,涌泉醒脑开窍,二穴相配,实为治痫良方。


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