巢氏《諸病源候論》「癥徵瘕假」立論的探討－評諸原典差異

Investigation Chao's views of 'Zheng is symbol and Jia is false' in the Book of ＂Zu Bing Yuan Hou Lung＂

闕麗敏(Li-Min Chueh)；周淑媚(Shu-Mei Chou)；周珮琪(Pei-Chi Chou)；孫茂峰(Mao-feng Sun)

癥瘕 ； 積聚 ； 腹診 ； Zheng-jia ； Ji-ju ； Abdominal diagnosis

臺灣中醫醫學雜誌

16卷1期（2018 / 03 / 30）

21 - 32

繁體中文

癥瘕積聚是臨床常見疾病，《難經》以積聚分臟腑，諸有形而堅著不移者為「積」，諸無形而留止不定者為「聚」。巢氏《諸病源候論》別立癥瘕之名，以「盤牢不動者為癥、可推移者為瘕」、又「癥，言其形狀，可徵驗也。瘕者，假也，謂虛假可動也。」區分之。本研究旨在探討巢氏「癥徵瘕假」這一論述對於後世醫家在臨床診斷的影響。結果顯示從文字意象上「癥瘕積聚」各自的形音義即含有疾病的特質在其中。癥瘕與積聚並非相同，而是異病異名；癥與瘕則是同病而異名，都是腹内「有形可癓，有塊可切」之腫塊。腹部之積塊除癥瘕積聚外，還有所謂的「疝」、「痃」、「癖」、「痞」的證狀，積聚痃癖癥瘕在臨床上按其病之淺深與所出現的部位，而分屬於三焦。希望探討結果對於混淆的概念得以澄清，以便於臨床的應用。

Zheng, jia, Ji, and Ju are common clinical diseases in clinical medicine. The book ＂Classic on Medical Problems＂ says, ＂Ji belong to viscera, is tangible and unswerving. Ju belong to bowels, is invisible and indefinite.＂ But ＂Zu Bing Yuan Hou Lung＂ has different views and says, ＂Those touch cannot move is called Zheng, and those can move is called Jia. Zheng has its shape and can also check. Jia is invisible and movable.＂ The purpose of the present will discuss the effects of Doctor Chao's views and how about the impact on clinical diagnosis. A content analysis of 'Zheng, jia, Ji, and Ju' in the ＂Canon of Internal Medicine＂ and ＂Zu Bing Yuan Hou Lung＂ was conducted. In addition, recent related medical literature on modern day was examined. The results showed that ＂Zheng＂, ＂Jia＂, ＂Ji＂, and ＂Ju＂ have their own phonetic meaning that contains the characteristics of the disease from the text image. Zheng-jia and Ji-ju is not the same, but different disease. Zheng and Jia are similar, the intra-abdominal tangible disease that have a block can be deducted. In addition to Zheng-jia and Ji-ju, there are so-called ＂hernia＂, ＂hypochondrium lump＂, ＂lump in the abdomen＂. According to the depth of the disease and the emergence of the site, they can be subdivided into The Triple Warmer in the clinical medicine of TCM. We hope the concept of confused to be clarified and the results could be facilitated the clinical application.

1. 闕麗敏,周淑媚,周珮琪,孫茂峰(2016)。《諸病源候論》以腹為診之探討。台灣中醫醫學雜誌，14(1)，23-37。
   連結：
2. (1988).漢語大字典.湖北:辭書出版社.
3. （元）滑壽(1984).難經本義.台北:文光圖書有限公司.
4. （宋）陳自明（編輯）,（明）薛己（補註）(1990).校註婦人良方.台北:牛頓出版股份有限公司.
5. （明）武之望(1977).濟陰綱目.台北:旋風出版社.
6. （東漢）張機(1973).金匱要略方論.台北:台聯國風出版社.
7. （東漢）張機(1973).金匱要略方論.台北:台聯國風出版社.
8. （東漢）華佗(1986).中藏經.台北:自由出版社.
9. （唐）王冰(1974).重廣補注黃帝內經.台北:旋風出版社.
10. （唐）王冰(1974).重廣補注黃帝內經.台北:旋風出版社.
11. （唐）王冰(1974).重廣補注黃帝內經.台北:旋風出版社.
12. （唐）王冰(1974).重廣補注黃帝內經.台北:旋風出版社.
13. （唐）王冰(1974).重廣補注黃帝內經.台北:旋風出版社.
14. （清）沈金鱉(2006).雜病源流犀燭.北京:人民衛生出版社.
15. （清）沈金鱉(2012).女科玉尺.太源:山西科學技術出版社.
16. （清）俞根初(2005).通俗傷寒論.北京市:中醫古籍出版社.
17. （隋）巢元方(1990).巢氏諸病源候總論.台北:牛頓出版股份有限公司.
18. （隋）巢元方(1990).巢氏諸病源候總論.台北:牛頓出版股份有限公司.
19. （隋）巢元方(1990).巢氏諸病源候總論.台北:牛頓出版股份有限公司.
20. （隋）巢元方(1990).巢氏諸病源候總論.台北:牛頓出版股份有限公司.
21. （漢）許慎,（清）段玉裁（注）(2003).說文解字注.台北:鼎淵文化事業有限公司.
22. 丁光迪（編）(1994).諸病源候論校注（上）.北京:人民衛生出版社.
23. 張延昌（編）(2006).武威漢代醫簡注解.北京:中醫古籍出版社.
24. 張綱.中醫百病名源考.台北:文光圖書有限公司.
25. 郭穎(2010).諸病源候論詞語研究.上海:上海人民出版社.
26. 裘鍚圭(1994).文字學概要.台北:萬卷樓圖書公司.
27. 薛梅,張建偉(2014)。胞宮源流淺考。江蘇中醫藥，46(3)，71-72。