李素云

（1中国中医科学院针灸研究所，北京100700）

摘要：补泻刺法在古代文献中记载较丰富，自《内经》《难经》以来至明清时期，不仅补泻刺法的内涵发生了许多变化，也出现了多种不同的补泻手法。重视调气是促使其理法发生变化的关键因素，气一元论思想和经脉气血循环理论对此产生了重要影响。补泻对象由有形之瘀血、结络等转变为无形之“气”，使补泻操作更具发挥空间，促成其理法丰富、发展，并变得抽象和繁复。通过对相关文献较全面地整理、分析，笔者将其特点归纳为以下六个方面：（1）针刺对象：补即益，泻即损，针刺补泻总的指导原则为调整人体的虚实偏颇状态，虚者补之，实者泻之，故补泻对象适用于在阴阳、气血、正邪、寒热等方面已出现平衡失调的患者，目的在于纠正阴阳、寒热、虚实的失衡。（2）补泻工具：泻有形之邪实，如泻热出血、排脓、泻水等，《内经》一般使用锋针、铍针、大针等较为锋利的针具，调无形之气则多用形制小、创伤小的毫针或末端圆形的鍉针。因毫针操作安全且易于患者接受，后来逐渐成为临床中最广泛使用的针具。（3）针刺部位：根据不同情况，针刺补泻的刺激部位有所不同，泻有形之实多刺取邪实处、病脉处、结络处，调无形之气则多刺取腧穴处，如五输穴、下合穴、八脉交会穴等。（4）补泻时机：《内经》记载针刺补泻主要有两种判断操作时机的方法，“候呼吸之气”和“候针下气至”。“候呼吸之气”主要出现在《素问》，“候针下气至”主要见于《灵枢》。《难经》“得气”时是施行补泻的前提和开始时机。金元医家强调“得气即泻”、“气至病所”，出现“气至病所”是出针之时。无论“气至”，还是“得气”，都反映针刺对象的身体机能发生了变化。依据补泻操作目的和方式的不同，对补或泻时机的判断方法也不同。（5）操作特征：无论哪一种补泻操作手法，其共同特点是：医者将针具作为手指的延伸，通过它在患者体内进出、提插、捻转等，调整患者的虚实，补法多强调针具由外向内的过程，泻法则相反。（6）疗效的影响因素：补泻刺法的疗效受治疗时机体的阴阳、寒热、虚实状态以及病因病机，还有刺激部位、补泻时机、操作手法等多重因素的综合影响。补泻手法只是其中的影响因素之一。补泻时医患双方的专注（守神）和互动、配合也是必不可少的因素。

关键词：针灸；补泻刺法；古代文献

Study on General Characteristics of Traditional Reinforcing and Reducing Acupuncture Manipulations

LI Suyun¹

（1 Institute of Acupuncture and Moxibustion，China Academy of Chinese Medical Sciences, Beijing 100700）

Abstract: There are abundant record of reinforcing and reducing acupuncture manipulations in ancient literatures. Their connotation and methods had a lot of changes from Nei Jing, Nan Jing to dynasty of Ming and Qing. Attaching importance to regulating qi was key factor of urging them to change. Qi-monism and blood circulation theory have great influence. The author summarized the characteristics to six aspects. The first：acupuncture objects were patients who were disequilibrium in Ying and Yang，qi and blood，vital energy and evil qi，cold and hot，etc. The second： when reducing acupuncture manipulations were used，ensiform needle，beryllium needle，large needle were adopted；when regulating qi manipulations were used, filiform needle and di needle were often adopted. Afterwards, filiform needle is used in the most wide range gradually. The third：acupuncture position is different according to different object，reducing acupuncture manipulation often stimulates the location of evil gathering，disease veins，and knot collaterals. Regulating intangible qi often stimulates location of acupoints. The fourth：opportunity of reinforcing and reducing acupuncture manipulation changes according to its aim and method. The fifth is the operating characteristics: the reinforcing manipulations emphasized the process from outside to inside，the reducing ones were on the contrary. The sixth：there are many influencing factors of curative effect, such as patient condition, etiology and pathogenesis, stimulate location, handling opportunity and technique. Handling technique is only one influencing factor. In the course of reinforcing and reducing acupuncture，concentration，interaction and cooperation between doctor and patient also is indispensable effective factor.

Key words: Acupunctureand moxibustion, Bu Xie method, Ancient literature