以手太陰肺經穴位主治為例探析「離穴不離經」

An Analysis of '' Missing the Acupoints without Missing the Meridians '' based on the indications of acupoints on the Lung Meridian of Hand-Taiyin

目的：以手太陰肺經穴位主治為例，探析「離穴不離經」在運用上成立的條件，並比較「離穴不離經」與「寧失其穴，勿失其經」的文獻出處，以及二者的差異性。方法：本文查詢相關電子資料庫，並透過《標幽賦》及《針灸大成》中楊繼洲對其註解，與漢墓出土文獻《刺數》探究「離穴不離經」與「寧失其穴，勿失其經」的文獻出處，以及分析幾位學者提出「寧失其穴，勿失其經」的思想源頭來自《傷寒論》的可能性。結論：本文發現《傷寒論》與「寧失其穴，勿失其經」思想源頭並無關聯。另本文透過《標幽賦》及其楊氏註解，與後世醫家文獻比較「寧失其穴，勿失其經」與「離穴不離經」的差別是，前者較具下針前因病、擇經再選穴的大局觀；後者則偏向下針時針刺穴位準確與否的局部觀。此外，以「手太陰肺經」為例，「離穴不離經」係指醫者欲運用肺經腧穴進行治療，且治療目的是「咳嗽或短氣喘息等呼吸道疾病」時，才有可能成立。

Objective: Compare the literature sources of ''missing the acupoints without missing the meridians'' and ''rather losing the acupoints than losing the meridians'' and take the Lung Meridian of the Hand Taiyin as an example to analyze the application of ''missing the acupoints without missing the meridians''. Method: This article searches databases, and explores the definition of '' missing the acupoints without missing the meridians '' and '' rather losing the acupoints than losing the meridians '' through ''Biaoyou Fu'' and Yang's annotations, as well as the unearthed document ''Chishu'' from the ''Han Tombs''. This study also analyzes the possibility that several scholars proposed that '' rather losing the acupoints than losing the meridians '' originated from ''Shang Han Lun''. Conclusion: The results show that the origin of the thought of '' rather losing the acupoints than losing the meridians '' seem irrelevant to ''Shang Han Lun''. In addition, this article uses ''Biaoyou Fu'' and Yang's annotations to compare the difference between '' rather losing the acupoints than losing the meridians '' and '' missing the acupoints without missing the meridians '' and finds that the former has a more overview before acupuncture; the latter prefers a local view of the accuracy of acupoints while acupuncture. Taking the Lung Meridian for instance, this study also finds '' missing the acupoints without missing the meridians '' is only possible when treatment is carried out and the purpose of treatment is ''respiratory diseases such as cough or shortness of breath and wheezing''.