《諸病源候論》以腹為診之探討

「切診」是中醫四診之一，包含脈診與腹診；中醫腹診起源於《黃帝內經》，《難經》、《傷寒論》、《金匱要略》均有記載，但是受封建禮教的影響，醫者不方便使用，一般多以脈診和舌診為主，較少使用腹診於臨床，使得腹診被遺忘。巢氏《諸病源候論》（610AD）是醫藥學史上第一部病理、病因與證候學專書，此書中不論方劑，所謂「湯熨鍼石，別有正方，補養宣導，今附於後」，重視導引、按摩、行氣或內視，將養生實踐與病源論和病理學配合。對唐以後的醫家及《干金方》、《外臺秘要〉、《太平聖惠方》、《普濟方》等醫學著作，均有很大影響。本研究皆在探討《諸病源候論》一書有關腹診之理論、方法、範園、應用，結果顯示全書67門，1739病候，除五官、四肢及外科瘡蕩的病候沒有涉及腹診外，大部分症候的診斷都是運用腹診，更有以腹證為病候者，書中所應用的腹診不是只有切診而已，而是包含望、聞、問、切四診，並且根據不同症候有所分類，增加了臨床應用的方法。本研究建議臨床時，可參考《諸病源候論》腹證的思維，以提高臨床診斷的準確。

關鍵字

《諸病源候論》；腹診；癥瘕；積聚

並列摘要

Palpation is one of the Traditional Chinese Medicine diagnosis, in which was the process of examining pulse and abdomen. TCM abdominal diagnosis originated in the ＂Canon of Internal Medicine＂ (Huang Di Nei ling). Influenced by the feudal ethics, most of the TCM doctors paid more attention to the pulse and tongue based examinations. With the progress of the times, less use in clinical make abdominal diagnosis to be neglect. ＂Zu Bing Yuan Hou Lung＂ is the earliest classic on etiology and symptomatology in China. It regardless of prescription, but emphasize traction, massage and qi. The book is not designed for abdominal diagnosis chapter discusses, but most of the symptoms are the use of it. The purpose of the present will discuss the abdominal consultation principle, methods, area and application of abdominal diagnosis in the book ＂Zu Bing Yuan Hou Lung＂. A content analysis of abdominal diagnosis in the ＂Canon of Internal Medicine＂ and ＂Zu Bing Yuan Hou Lung＂ was conducted. In addition, recent abdomen-related medicalliterature on modern day was examined. The result showed that abdominal diagnosis described in ＂Zu Bing Yuan Hou Lung＂ is not just about palpation. In fact it includes four examinations: inspection, olfaction, inquiry and palpation. It benefits the clinical medicine and enriches determination of treatment based on differentiation of syndromes and broadens four examinations. The study suggested that clinicians can follow the principle of abdominal diagnosis in ＂Zu Bing Yuan Hou Lung＂ to enrich their diagnosis effect.