《金匱要略》「肺死臟」重新詮釋

Reinterpretation of "Dead Lung" in the Synopsis of Golden Chamber

10.6516/TJTCM.202403_27(1).0004

張永明(Yung-Ming Chang)；呂冠恩(Kuan-En Lu)；呂平安(Ping-An Lu)；陳冠宇(Kuan-Yu Chen)；張家誠(Chia-Cheng Chang)

肺死臟 ； 蔥葉 ； 特發性肺纖維化 ； Dead Lung ； The leaves of a Chinese onion ； Idiopathic Pulmonary Fibrosis ； IPF

中醫藥研究論叢

27卷1期（2024 / 03 / 30）

39 - 51

繁體中文;英文

背景：《金匱要略．五臟風寒積聚病脈證並治第十一》：「肺死藏，浮之虛，按之弱，如蔥葉，下無根者，死」，文僅17字，由於缺乏關鍵證候，導致醫家詮釋存在諸多疑點，影響「肺死臟」的診斷與臨床實用。目的：釐訂並重新詮釋「肺死臟」。方法：典籍考證，結合西醫解剖、影像學。結果：1.「肺死臟」記錄肺臟由正常生理轉變為死臟的病理過程，並非僅描述脈象變化。2.「浮之虛」指肺臟在正常生理狀態之下會充滿氣體，呈現空虛狀態，可飄浮在水面上。3.「按之弱」是從解剖角度觀察肺臟組織，指性質按壓脆弱的特色。4.「如蔥葉」描述「肺死臟」的病理型態，相當於西醫特發性肺纖維化在高解析度肺部電腦斷層下呈現的「蜂窩肺」特徵，顯示當時醫家有觀察到「肺死臟」之肺部解剖病理構造，才能精準描繪「如蔥葉」。5.「下無根」指肺泡間質纖維化後導致肺泡逐漸喪失氣體交換的功能，最後因肺功能衰竭而死亡。6.以王叔和《脈經・熱病五藏氣絕死日證第二十二》中「熱病，肺氣絕……肺先死」六大證候：（1）喘逆，（2）欬，（3）唾血，（4）手足腹腫，（5）面黃，（6）振慄不能言語，彌補未臻完整的「肺死臟」症狀表現。結論：《金匱要略》「肺死臟」記錄肺臟由正常生理轉變成特發性肺纖維化的病理過程。

Background: Chapter XI of the Synopsis of Golden Chamber: "Pulse of Dead Lung is deficient when pressed lightly and as weak and rootless as the leaves of a Chinese onion when pressed deeply. This indicates a fatal case." Only 17 words, but the lack of critical syndrome has led to many doubts in the interpretation, which affects the diagnosis of the "Dead Lung" and therapeutic usefulness. Purpose: Define and reinterpret the "Dead Lung". Methods: Classics research and integration of anatomy and Radiology. Results: 1. "Dead Lung" describes the pathological transformation of the lungs from normal to failure, not just a description of pulse changes. 2. "Deficient when pressed lightly" means that the lungs in physiological state are full of gas and appear to be empty, floating on the water surface. 3. "Weak when pressed deeply" is an anatomical view of the lung tissue, which is fragile. 4. "As the leaves of a Chinese onion" describes the pathological pattern of "Dead Lung" as comparable to the "honeycomb lung" characteristic of Idiopathic Pulmonary Fibrosis (IPF) under high resolution computed tomography, indicating that doctors at that time had observed the anatomical pathology of "Dead Lung" in order to accurately depict the term. 5. "Rootless when pressed deeply" refers to the gradual loss of gas exchange following interstitial fibrosis of the lung and eventual death from lung failure. 6. Chapter XXII of the Maijing written by Wang Shuhe, the six symptoms of "The Lung Qi is exhausted due to febrile illness......the Lung Failure first" are: (1) wheezing, (2) cough, (3) spitting blood, (4) swelling of the hands, feet and abdomen, (5) yellow face, and (6) shivering and inability to speak, to make up for the lack of symptoms of "Dead Lung". Conclusion: The term "Dead Lung" in the Synopsis of the Golden Chamber describes the pathological transformation of the lungs from normal to IPF.