《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

10.6516/TJTCM.202206_25(2).0004

張永明(Yung-Ming Chang)；呂平安(Ping-An Lu)；陳季襄(Chi-Hsiang Chen)；黃軒(Hsuan Huang)；李伊婷(I-Ting Lee)；林淑鑾(Shu-Luan Lin)

陷經 ； 乾血 ； 臟堅癖 ； 下白物 ； 礬石丸 ； ＂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)

中醫藥研究論叢

25卷2期（2022 / 06 / 30）

51 - 67

繁體中文

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。

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.

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