中醫藥研究論叢

252.4 《金匱要略》婦人「陷經」「腹中有乾血」「臟堅癖」校訂與臨床關係闡釋
  TJ TCM.25(2) : 51-68, 2022
《金匱要略》婦人「陷經」「腹中有乾血」
「臟堅癖」校訂與臨床關係闡釋
Revising and Clarifying Clinical Relationship of “Menstrual Blood Flows Back into the
Uterus”, “Dry Blood Stasis in abdomen”,“Formation of A Hard Mass in the Viscera”in the Synopsis of the Golden Chamber
張永明1,2,3 呂平安4 陳季襄5 黃軒5 李伊婷6 林淑鑾7*
一品堂豐原中醫診所,台中,台灣
義守大學醫學院學士後中醫學系,高雄,台灣
義守大學義大醫院中醫部,高雄,台灣
彰化基督教醫院中醫部,彰化,台灣
中國醫藥大學中醫學系,台中,台灣
秀傳紀念醫院中醫部,彰化,台灣
一品堂鹿港中醫診所,彰化,台灣
【摘要】
背景:《金匱要略》婦人雜病篇中「陷經」、「腹中有乾血」和「臟堅癖」等名詞與相關經文存在諸多疑點,後世醫家詮釋紛亂,進而影響中醫理論發展和臨床實用性。
目的:釐訂名詞本義、經文缺漏和錯簡。
方法:以文字學為基石和經文比對。
結果:校訂後名詞與經文:1.「陷經」本義為「經血逆流」,並非「漏下崩中」、「經脈下陷」或「經氣下陷」;2.「乾血」正確病位在「腹中」,而非「臍下」,重訂為「腹」中有乾血;3. 經文語句重訂:「婦人,經水閉不利,腹中有乾血,臟堅癖,白物下不止,礬石丸主之。」
結論:1. 藉由「陷經」、「腹中有乾血」和「臟堅癖」三者臨床先後發生的病理關係,詮釋現代醫學子宮內膜異位症,因經血逆流造成巧克力囊腫、子宮腺肌症和骨盆腔發炎等疾病。2. 重新探討古典中醫治療子宮內膜異位症的相關處方思路。
【關鍵詞】陷經、乾血、臟堅癖、下白物、礬石丸
Yung-Ming Chang1,2,3Ping-An Lu4Chi-Hsiang Chen5Hsuan Huang5
I-Ting Lee6Shu-Luan Lin7*
1PT Fengyuan Chinese Medicine Clinics, Taichung, Taiwan
2The School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan
3Chinese Medicine Department, E-Da Hospital, Kaohsiung, Taiwan
4Department of Chinese Medicine, Changhua Christian Hospital (CCH), Changhua, Taiwan
5School of Chinese Medicine, China Medical University, Taichung, Taiwan
6Department of Chinese Medicine, SHOW-CHWAN Memorial Hospital, Changhua, Taiwan
7PT Lukang Chinese Medicine Clinics, Changhua, Taiwan
【Summary】
Background: The contents of “Menstrual blood flows back into the uterus”, “Dry blood stasis in abdomen”, “Formation of a hard mass in viscera” in chapter XXII, Miscellaneous Gynecological Diseases of the Synopsis of the Golden Chamber are considerably confusing thus made clinical interpretations and practicing difficult and inconsistent.
Purpose: To identify the original meaning of the terms and missing words and recompose the misplaced paragraphs.
Methods: Analyzing articles by grammatology and comparing syntax and grammar between similar sentences.
Result:
1. The original meaning of “Menstrual blood flows back into the uterus” ( 陷經) is retrograde menstruation instead of menorrhagia, metrorrhagia, meridian sinking,or channel qi sinking.
2. The location of “Dry blood stasis in abdomen” is in abdomen rather than below the umbilicus. The paragraph is revised as “Dry blood stasis in the abdomen”.
3. Revised the paragraph as “Women experiences menolipsis, scanty menstruation, and the formation of a hard mass in the uterus, ovary and abdominal cavity which remains there for a long time. Dry blood stasis is also presented in the abdomen. Leukorrhea is also presented. Pills of Alumen can be adopted to cure these syndrome.”
Conclusion:
1. Identify the clinical presentation orders and pathological relations of “Retrograde menstruation”, “Dry blood stasis in abdomen” and “Formation of a hard mass in viscera” to interpret Endometriosis which causes chocolate cysts, adenomyosis and pelvic inflammatory disease by retrograde menstruation.
2. Re-discuss the thinking process of related formulas used to treat endometriosis in Traditional Chinese Medicine.
 
【Keywords】“Retrograde menstruation”(陷經); “Dry blood stasis”(乾血);“Formation of a hard mass in viscera”(臟堅癖); “Leukorrhea”(下白物); “Pills of Alumen”(礬石丸)