《金匱要略》五臟死脈條文釐定與闡釋

Proofreading and Clinical Interpretation of the Death Pulses of the Five Viscera in 《Synopsis of Golden Chamber》

陳志昇(Chin-Sheng Chen) ； 蔡金川(Chin-Chuan Tsai) ； 許偉宸(Wei-Cheng Hsu) ； 張永明(Yung-Ming Chang)

《臺灣中醫醫學雜誌》 12卷2期 (2014/09) Pp. 73-88

摘要

藉由《內經》、《脈經》與《傷寒論》等相關典籍將《金區要略‧五臟風寒積聚病脈證並治第十一》（以下簡稱《五臟風寒積聚》篇）中的五臟死脈原文重新釐定與補正缺漏後，結果如下：「肝死臟，浮之弱，按之緊，如索，不來或曲如蛇行者，死。」「心死臟，浮之實，按之短，如麻豆，擊手益躁疾者，死。」「脾死臟，浮之大堅，按之革，如覆杯，潔潔狀如搖者，死。」「肺死藏，浮之虛，按之弱，如蔥葉，下無根者，死。」「腎死藏，浮之堅，按之亂，如轉丸，益下入尺中者，死。」如此，能夠完整地反映出東漢‧張仲景時代對五臟死脈的臨床觀察紀錄，也進一步讓這些條文的內涵與意義更加清晰並被後學所認同。

關鍵字

《金區要略》 ； 《脈經》 ； 五臟死脈 ； 死臟

並列摘要

Chapter XI of the ＂Synopsis of Golden Chamber, On Pulse, Symptom Complex and Treatment Of Accumulation of Pathologenic Wind and Cold in the Five Viscera＂ hereinafter referred to as ＂Wind and Cold in the Five Viscera＂ states ＂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.＂, ＂Pulse of the Dead Liver is weak when pressed lightly. When pressed deeply, pulse is as stale as a rope or moves like a snake. Such pulsation is an indication of a fatal case.＂, ＂Pulse of a Dead Heart is excessive when pressed lightly, resembling the feeling of beans. When pressed deeply, the pulse becomes restless and swift. Such pulse suggests a fatal case.＂, ＂Pulse of a Dead Spleen is huge and strong when pressed lightly. When pressed deeply, it feels like an inverted empty cup, with swirling and restless pulsation. This indicates a fatal case.＂, ＂Pulse of a Dead Kidney is mighty and hard when pressed lightly. When pressed deeply, it feels like a swirling ball with an irregular movement. If this pulsation is more apparent in the Cubit, the case will be fatal.＂ This section we will abbreviate as the death pulses of the five viscera. Written by Zhang Zhong-Ji during the Eastern Han dynasty (25-220 A.D.), records and summarizes his method of the dying viscus pulse pattern from his clinical treatment and experience. Although, the text describes the structure and manner of speaking in great detailed, there are many sections that are questionable with gaps and omission. Therefore, the most impotant step is to re-determine the original content of the death pulses of the five viscera so that can reflect the clinical observation by Zhang Zhong-Ji. Finally, combine the integration perspective of modem medicine, giving them a corect pathological diagnosis and clinical significance.

並列關鍵字

《Synopsis ofGolden Chamber》 ； 《Maijing (The Pulse classic)》 ； Death Pulses of the Five Viscera ； Dead viscus