中醫藥研究論叢

271.3《金匱要略》婦人「傷胎」釐定與重新詮釋

TJ TCM.27(1) : 27-37, 2024

DOI : 10.6516/TJTCM.202403_27(1).0003

《金匱要略》婦人「傷胎」釐定與重新詮釋

Revision and Reinterpretation of the Pregnancy Women’s Fetal Injury in Synopsis of the Golden Chamber

陳季襄1林淑鑾2張永明3,4,5,*

1中國醫藥大學附設醫院,中醫部,台中

2一品堂鹿港中醫診所,彰化

3一品堂豐原中醫診所,台中

4義守大學醫學院,學士後中醫學系,高雄

5*義守大學醫學院,中醫部,高雄

【摘要】

背景:《金匱要略.婦人妊娠病脈證並治第二十》(以下簡稱《金匱.妊娠》):「婦人傷胎,懷身腹滿,不得小便,從腰以下重,如有水氣狀。懷身七月,太陰當養不養,此心氣實,當刺瀉勞宮及關元。小便微利則愈 見《玉函》」,言簡意賅而艱澀,歷代醫家或保留原文,或如清.吳謙《醫宗金鑑.金匱要略註》按語曰:「文義未詳,此穴刺之落胎,必是錯簡,不釋。」,導致醫家對婦人「傷胎」存在諸多疑點,影響後世對於「傷胎」診斷和治療。

目的:藉由「懷身腹滿」、「不得小便」和「從腰以下重,如有水氣狀」等關鍵語句,釐訂婦人「傷胎」,並重新詮釋。

方法:中醫典籍考證並結合西醫婦人妊娠後期病理狀態表現。

結果:

1.婦人「傷胎」主要紀錄妊娠七個月後所婦人所出現的病理表現。

2.婦人「傷胎」臨床表現「腹滿」、「腰以下水腫」和「不得小便」。

結論:婦人「傷胎」依照孕婦出現症狀之時間軸和臨床表現,相當於現代醫學「子癲前症(Preeclampsia)」。

【關鍵詞】婦人傷胎、懷身、子癲前症
【Summary】
Background: The chapter 20 on Pulse Diagnosis and Treatment of gynopathy during pregnancy in Synopsis of the Golden Chamber define “Pregnant Women’s Fetal Injury” : ‘when a pregnancy woman suffering from fullness in the abdomen, inability to urinate, heaviness below the waist, as if she has fluid-retention syndrome. In the seventh month of pregnancy, the Taiyin (spleen) channel should be nourishing the fetus, but it fails to do so. The heart qi is in an excessive state. She should be treated by acupuncture at Lao Gong(PC 8) and Guan Yuan(RN 4). When urination is slightly relieved, the syndrome will recover. See Jīn guì yù hán jīng’. The clause is simple and concise but difficult to understand. Medical practitioners of past dynasties either retained the original text or, as Wu Qian of the Qing Dynasty said in his commentary on the Golden Mirror of Medical Ancestry: Essential
【Keywords】
Pregnant Women’s Fetal Injury, Pregnancy, Preeclampsia