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

DOI : 10.6516/TJTCM.202206_25(2).0004

《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�罘enstrual Blood Flows Back into the Uterus��,�籺ry Blood Stasis in abdomen��,�籹ormation 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*

1 一品堂豐原中醫診所,台中,台灣

2 義守大學醫學院學士後中醫學系,高雄,台灣

3 義守大學義大醫院中醫部,高雄,台灣

4 彰化基督教醫院中醫部,彰化,台灣

5 中國醫藥大學中醫學系,台中,台灣

6 秀傳紀念醫院中醫部,彰化,台灣

7 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
【Summary】
Background: The contents of�罘enstrual blood flows back into the uterus��,�籺ry blood stasis in abdomen��,�籹ormation 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�罘enstrual 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�籺ry blood stasis in abdomen�� is in abdomen rather than below the umbilicus. The paragraph is revised as�籺ry blood stasis in the abdomen��. 3. Revised the paragraph as�胇omen 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�耎etrograde menstruation��,�籺ry blood stasis in abdomen�� and�籹ormation 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)