『靈樞經』의 瀉血療法에 대한 考察 = (A) study on the blood-letting therapy of spiritual pivot classic

다국어 초록 (Multilingual Abstract)

Yellow Emperor's Inner Canon is an ancient medical text that has been treated as the fundamental doctrinal source for Korean medicine for more than two millennia and until today. The work is composed of two texts each of eighty-one chapters or treatises in a question-and-answer format between the mythical Yellow Emperor and six of his equally legendary ministers.
The first text, the Elementary Questions, covers the theoretical foundation of Korean Medicine and its diagnostic methods. The second and generally less referred-to text, the Spiritual Pivot, discusses acupuncture therapy in great detail. And there are many aspects in the book devoted to acupuncture, especially acupuncture description is rather and more organized. The book establishes the theory of meridians which explains the roots of meridians in details, and points out the location of acupoints and describes the standard of how to locates acupoints, sets forth nine kinds of needles and their uses. It lays the theoretical foundation of Korean Medicine.
This dissertation is to focus on 'Bloodletting' that is the withdrawal of often considerable quantities of blood from a patient to cure or prevent illness and disease. According to the classical text Spiritual Pivot, certain diseases are caused by vitiation of the blood. These can be treated effectively by letting out the vitiated blood.
'Discriminative Treating for Patients of Different Regions' in Elementary Questions says “In the eastern district, where the weather is warm like spring time, and the district is near the sea and water. As the district is rich in producing fish and salt, the local people like to eat fish and salt, and they are accustomed to live in the district and enjoy their food. But when fish is excessively taken, it will cause the heat-evil to retain in the stomach and intestine; when salt is excessively taken, it will hurt the blood of a man. Most of the local people there are black in skin and loose in straire, and their diseases are mostly of carbuncle kind. It is suitable to treat the disease with stone needle therapy (to prick with stone), so, the stone needle therapy is transmitted from the east."
The stone radical of Chapter 9 of the Explaining Simple and Analyzing Compound Characters says that "the stone needle is used for treating the disease." Like this, it may be inferred that the therapeutic bleeding through puncturing or cutting is practiced by most ancient people in the treatment of the disease.
"In the southern district of mostly lowland where the weather is hot like summer with abundant Yang Gi to breed all things, due and rain are plenty and climate is delicate. The people there prefer to eat sour and stinking food; their skin are dense and red, and they often contract the disease of spasm and wet-type arthralgia. In treating the disease, acupuncture therapy of nine kinds of needle is suitable. So, the acupuncture therapy of nine kinds of needle is transmitted from the south." From this fact I deduced that nine needles are transmitted from the south.
As mentioned above, among nine kinds of needle, sharp-edged needle and sword needle are used for bleeding.
According to the Spiriual Pivot, needle stone(or piercing stone) sharp-edged needle, and sword needle as tools of bloodletting are used, and there are twelve methods in pricking to treat the various diseases of the twelve channels, and there are nine kinds of needling to suit the nine kinds of pathological change as well.
This dissertation is to lay emphasis on the purpose of bloodletting therapy, the methods in pricking, kinds of needle, disease patterns, side effect, and contraindication. The results of the study are as follows:
1. Bloodletting (or blood-letting) is the withdrawal of often considerable quantities of blood from a patient to cure or prevent illness and disease.
Certain diseases are caused by vitiation of the blood due to blood stasis, lodged blood, exuberent vessel, blood vessel, blood network vessel, and bound vessel. These can be treated effectively by letting out the vitiated blood.
2. There are five criterions in pricking. the therapy that removes the edema is to prick the vessels of the joints.
3. The needles used for pricking are needle stone(or piercing stone) sharp-edged needle, and sword needle.
4. Bloodletting is used to treat certain types of health issues; snivel mucus, intractable impediment, impediment pattern, puffy swelling, massive pus, heavy tongue, leprosy, muscle pain, sudden loss of voice, agitated racing pulse (madness pulse), mania, wind tetany, febrile disease, reversal headache, spontaneous external bleeding, reversal cold of the limbs, edema, and swelling etc.
5. In Spiritual Pivot, because the weathers in the four seasons are different and the diseases affected by the weathers of the various seasons are different, the principle of bloodletting therapy should be set at the standard of getting the needle sensation.
6. When the treating the patient of leprosy, prick the swelling location frequently. After pricking, press around the pricking hole to squeeze out the malicious blood. The patient should take some proper food often and avoid to take the food disadvantageous to the recuperation of the disease.
7. When using a small needle to treat a small site, its effect will be small, When using a large needle to treat a large site, its effect will be large, thus, when the carbuncle is suppurated with pus, it is advisable to apply the stone needle, the sword needle to remove the pus.
This dissertation could help improve the understanding of the blood-letting therapy in Spiritual Pivot and also paves the way for applying the therapy to treatment of the various diseases.

국문 초록 (Abstract)

韓醫學 最古의 經典인『黃帝內經』은 『素問』과 『靈樞』 두 종류의 책으로 분류되어 『素問』은 有機體와 그것의 根本的인 特徵에 관한 問題를 주로 다루고,『靈樞』는 『鍼經』이라고 하여 鍼術과 뜸, 人體의 解剖 그리고 診脈에 대한 技術的인 내용들을 다루고 있는데, 『素問』이 總論이라면 『靈樞』는 各論이라고 말할 수 있으며, 또 經絡의 흐름과 臨床에 곧바로 應用할 수 있는 刺法에 관한 내용이 상세히 記錄되어 있다. 그리고 『靈樞』는 鍼刺手法의 핵심을 자세히 논하고 있을 뿐만 아니라, 十數種의 刺法을 소개하고 아울러 鍼灸使用, 鍼刺部位, 鍼刺深度, 鍼刺禁忌, 鍼刺와 四時의 關係 등의 문제에 대하여 記述하고 있다.

『素問ㆍ異法方宜論』에 “東方之域은 天地之所始生也라 … 其民이 皆黑色疏理요 其病이 皆爲癰瘍이니 其治는 宜砭石이라 故로 砭石者는 亦從東方來라” 하여 砭石이 동방지역에서 유래하였다고 하였으며, 『說文解字ㆍ九下石部』에서도 “砭 以石刺病也”라고 하여 砭石으로써 病을 治療한다고 하였다. 또한 砭石은 形狀에 따라 穿刺 혹은 切割에 使用되는데 鋒 혹은 刃이 있어서 古代에는 砭石을 鍼石(有鋒) 또는 鑱石(有刃)이라고 하였는데, 이러한 記錄들을 根據로 본다면 砭石은 古代의 出血道具로써 破開膿腫과 排膿放血에 使用된 것임을 알 수 있다.
또 “南方者는 … 其病이 攣痺니 其治는 宜微針이라 故로 九針者는 亦從南方來라”고 하여, 九鍼이 南方에서 由來하였으며, 그 가운데 鋒鍼과 鈹鍼이 瀉血療法에 사용되었음을 알 수 있다.

『靈樞』에는 瀉血療法의 道具로써 砭石이나 鋒鍼, 鈹鍼 등을 使用하였으며, 刺鍼法으로는 刺有三變･九變刺･十二節刺･五刺･五節刺 등에서 瀉血을 하여 疾病을 治療한 記錄들이 있으며, 現在에도 臨床에 많이 使用하고 있음에도 불구하고, 旣存의 연구들이 부분적이어서 『靈樞』 全般에 걸친 瀉血療法에 대한 實體 파악이 필요하다고 생각되어 『靈樞硏究集成』을 底本으로 하여 原文을 정독하여 瀉血과 關聯있는 내용을 拔萃하고, 瀉血療法의 目的ㆍ刺法ㆍ鍼의 種類ㆍ治療한 病症ㆍ副作用과 注意事項 등으로 分類하여 硏究한 결과 다음의 結論을 얻었다.

1. 瀉血療法의 目的은 宛陳･留血･盛絡･血脈･血絡･結絡 등의 鬱滯되거나, 留滯된 惡血을 出血시켜서 疾病을 治療하는 것이다.
2. 瀉血療法의 刺法은 刺有三變 중에서는 刺營者, 九變刺 중에서는 絡刺･大瀉刺, 十二節刺 중에서는 贊刺, 五刺 중에서는 豹文刺, 五節 중에서는 去爪가 있다.
3. 瀉血療法에 使用된 鍼의 種類는 砭石과 第4鍼인 鋒鍼･第5鍼인 鈹鍼이다.
4. 瀉血療法을 使用하여 治療한 疾病은 다음과 같다.
1) 膿血･米疽･疵癰･走緩 등은 砭石으로 治療한다.
2) 痼疾･痼痹･五臟固居･熱病･膿血･大邪･痼病･癰熱 등은 鋒鍼으로 治療한다.
3) 大膿･重舌･徒㽷･癘風･膿血･去爪･癰邪･癰膿 등은 鈹鍼으로 治療한다.
4) 久痹(不去身者)･膚脹(風㽷)･脈癲疾者(肌痛 毛髮焦而唇槁腊 不得汗)･(暴仆 四肢之脈 皆脹而縱:昏厥) 등은 血絡･血者･脈滿이 보이면 盡出其血･盡取之･盡刺之出血한다.
5) 暴瘖氣鞕･風痙(身反折)･癃(小便不通)･顑痛･男子如蠱女子如怚(身體腰脊如解 不欲飮食) 등은 經脈과 穴자리를 取하여 瀉血한다. (取扶突與舌本出血･血絡出血･出血･見血立已･先取湧泉見血)
6) 小腹痛腫不得小便･陰痹(邪在腎)･肌寒熱者･狂而新發(未應如此者)･衄而不止 등은 經脈과 穴자리를 先取한 이후에 瀉血한다. (視其絡脈與厥陰小絡結而血者･視有血者盡取之･以去其血者･盛者見血有頃已･ 不已刺膕中出血)
7) 厥頭痛(頭脈痛心悲善泣視頭動脈反盛者)･(頭痛甚耳前後脈湧有熱)･四厥(亂于臂脛)은 먼저 瀉血하고 經脈과 穴자리를 後取한다. (脈反盛者刺盡去血･耳前後脈湧有熱寫出其血)
8)「玉版」의 “成膿血者 其唯砭石鈹鋒之所取”에서는 같은 疾病이라도 砭石･鈹 鍼･鋒鍼 등으로 治療한다.
膿血 또는 大膿･痼痺･痺證･重舌･癘風･浮腫･肌痛･暴瘖氣鞕･脈癲疾･狂而新發･風痙･癃･熱病･男子如蠱 女子如怚･厥頭痛･顑痛･衄血･四厥･去爪･癰疽 등을 치료한다.

5. 注意事項으로 痼病은 四時刺法에 따라서 瀉하고, 肌寒熱은 惡血을 除去한 뒤에 땀을 내고, 癘風은 腫氣를 除去한 후에 올바른 食事를 하고, 腫氣와 膿과 癰의 경우에는 大小에 따라 適當한 크기의 鍼을 취하되 반듯이 부드러워진 후에 破腫해야 한다.

本 硏究는 󰡔黃帝內經･靈樞󰡕의 瀉血療法에 대한 전반적인 이해에 도움을 주어 󰡔靈樞󰡕에서 사용되던 瀉血療法을 現在 活用할 수도 있을 것이며, 또한 疾病의 治療術이 發展한 現在에 이르러 그대로 사용할 수는 없다고 하더라도 응용 할 수 있는 溫故而知新의 계기가 되었으면 한다.

목차 (Table of Contents)

• Ⅰ. 緖論 1
• Ⅱ. 硏究方法 4
• 1. 底本
• 2. 檢索
• 3. 分類
• Ⅲ. 本論 5
• 1. 瀉血療法의 目的 5
• 2. 瀉血療法에 使用된 刺法 7
• 1) 刺有三變 중 刺營者 7
• 2) 九變刺 중 絡刺·大瀉刺 8
• 3) 十二節刺 중 贊刺 9
• 4) 五刺 중 豹文刺 10
• 5) 五節刺 중 去爪 12
• 3. 瀉血療法에 使用된 鍼의 種類 14
• 1) ?石 14
• 2) 鋒鍼 17
• 3) ?鍼 20
• 4. 瀉血療法을 使用하여 治療한 疾病 24
• 1) 膿血 또는 大膿 24
• 2) 痼痺 26
• 3) 痺證 28
• 4) 重舌 29
• 5) ?風 30
• 6) 浮腫 31
• 7) 肌痛 33
• 8) 暴?氣? 34
• 9) 脈癲疾 35
• 10) 狂而新發 36
• 11) 風痙 37
• 12) ? 38
• 13) 熱病 38
• 14) 男子如蠱 女子如? 39
• 15) 厥頭痛 40
• 16) ?痛 41
• 17) ?血 42
• 18) 四厥 43
• 19) ?疝 44
• 20) 癰疽 45
• 5. 瀉血療法에 副作用과 注意事項 50
• 1) 血絡을 잘못 刺絡하여 생긴 副作用 50
• 2) 注意事項 51
• Ⅳ. 結論 54
• 參考文獻 56
• 參考論文 56
• 參考辭典 57