《金匱要略．水氣病》五種水病釐定與重新詮釋

背景：《金匱要略．水氣病》將水氣病分成五類型：「師曰：病有風水，有皮水，有正水，有石水，有黃汗。風水其脈自浮，外證骨節疼痛，惡風；皮水其脈亦浮，外證跗腫，按之沒指，不惡風，其腹如鼓，不渴，當發其汗；石水其脈自沉，外證腹滿不喘；正水其脈沉遲，外證自喘；黃汗其脈沉遲，身發熱，胸滿，四肢頭面腫，久不愈，必致癰膿。」，經文簡短錯簡，造成解讀各異，尤以正水、石水和黃汗疑義甚多，影響「水氣病」診斷和運用。目的：五種水病相關經文釐訂與重新詮釋。方法：中醫典籍考證並結合西醫水腫病理表現。結果：「風水其脈自浮，外證骨節疼痛，按其手足上，陷而不起，惡風。」「皮水其脈亦浮，外證跗腫，按之沒指，不惡風。」「石水其脈自沉，外證腹滿不喘。」「正水其脈沉遲，外證腹滿自喘。」「黃汗其脈沉遲，外證身發熱，腹滿，四肢頭面腫，汗沾衣，色正黃如柏汁。」結論：「風水」：人體外感風邪氣所致。「皮水」：外感風邪解除後，水氣仍停留皮膚下層。「石水」：人體服用礦石藥物後，致腹腔臟腑功能下降或衰竭，引發腹水腫脹。「正水」：水分沿著人體中央軸線頭、頸、背、腹，腳堆積水腫。「黃汗」：服用硫磺類礦石藥後致身體燥熱，腹部四肢水腫，汗出如黃柏汁。

關鍵字

風水；正水；石水；黃汗；皮水

並列摘要

Background: There are five major types edema in Synopsis of the Golden Chamber, "Master: Edema can be classified into five categories: Wind-edema, Skin-edema, Midline-edema, Stone-edema and Yellow-sweat. Wind-edema is characterized by a floating pulse and external symptoms of pain in the bones and joints and aversion to wind. Skin-edema also has a floating pulse and external symptoms of swelling in the instep that can be pressed down with a finger. The patient does not have an aversion to wind and their abdomen is drum-like without thirst. Treatment should be diaphoresis. Stone-edema has a sinking pulse and external symptoms of abdominal fullness without wheezing. Midline-edema has a deep-slow pulse with external symptoms of wheezing. Yellow-sweat has a deep-slow pulse with fever, chest fullness, swelling in the limbs, head and face. If it is not cured for a long time, it will inevitably lead to abscesses." The scripture is brief and some characters are wrongly simplified or misprinted, resulting in different interpretations of the meaning. There are many doubts about Midline-edema, Stone-edema and Yellow-sweat, which affect the clinical diagnosis and treatment of edema. Objective: To collate and reinterpret the scriptures related to the five types of edema. Method: Verification of traditional Chinese medical literature combined with the pathological manifestations of edema in Western medicine. Results: "Wind-edema has a floating pulse and external symptoms of pain in the bones and joints. When pressing on the hands and feet, they sink and do not rise, and there is an aversion to wind." "Skin-edema also has a floating pulse and external symptoms of swelling in the instep that can be pressed down with a finger. The patient does not have an aversion to wind." "Stone-edema has a sinking pulse and external symptoms of abdominal fullness without panting." "Midline-edema has a deep-slow pulse with external symptoms of abdominal fullness and wheezing." "Yellow-sweat has a deep-slow pulse with external symptoms of fever, abdominal fullness, swelling in the limbs, head and face. The sweat soaks the clothes and is yellow like cypress juice. " Conclusion: 'Wind-edema' is caused by the external invasion of wind and cold evil in the human body. 'Skin-edema' refers to the residual water remaining in the subcutaneous layer after the external invasion of wind and cold evil has been resolved. 'Stone-edema' refers to the decline or failure of visceral function in the abdominal cavity after taking mineral drugs, leading to abdominal swelling and fullness. 'Midline-edema' originally refers to edema caused by water accumulation along the central axis of the human body, including the head, face, neck, back, abdominal cavity and toes. 'Yellow-sweat' refers to the dry heat in the body and swelling of the head, face, abdomen and limbs caused by taking yellow sulfuric mineral drugs in ancient times. The body sweats like yellow cypress juice and the skin is yellowish.