內經脈診探討──以太素〈陰陽大論〉一段經文為例

《黃帝內經》記載了診斷方法的操作，然而經過長時間流傳，已非原貌，本文以《太素》仁和寺本為材料，探討其中之「善診者按脈，先別陰陽，審清濁而知部候，視喘息，聽音聲而知所苦；觀權衡規矩，而知病所在；按尺寸而觀浮沉滑澀，而知病所生。以治無過，以診則不失矣。」透過總結歷代研究、文義考察、比較研究，嘗試建立診斷流程。結果發現，「知部候」一句爭議較多，因太素原文在「分」字旁書一「候」字，使得傳世版本有「分」、「候」之不同，在文義詮釋方面歷代注者及醫家亦各有取向。其中，若該處文字作「知部候」，可將「部候」解釋為三部九候，進一步建立符合歷代流傳脈絡以及太素前後文義的診斷模式，即「按脈」先注意辨別三部九候皆異常的死證，或病變的位置，再透過比較虛實、找出獨者確認病位。討論部分，第一我們比較與現行本內經的異同，發現版本文字的不同影響了後代注家詮釋，提示了典籍善本的重要性。第二則與現代醫家經驗連結，以臨床診治驗證典籍中遍診法的記載。第三則探索現今醫療環境下遍診法的價值。

關鍵字

內經；太素；脈診；三部九候；遍診法

並列摘要

As one of the four classics of Chinese medicine, "Huangdi Neijing" describes diagnostic methods and procedures. However, over the course of time, it has undergone changes and is no longer in its original form. Previous studies have pointed out that the literature value of "Huangdi Neijing Taisu" is high, especially the ancient edition of Ninnaji Temple. In this article, we attempt to interpret a paragraph from the "Great Theory of Yin and Yang" in "Huangdi Neijing Taisu", summarize previous studies, examine its meaning, and conduct comparative studies to establish a diagnostic process. For example, the sentence "zhibuhou" has been controversial in the past because the original text of Taisu has a "hou" in the book next to the word "fen". If it is "zhibuhou", we can interpret it as "three positions and nine indicators". Thus, the diagnostic process that conforms to the historical context of the three positions and nine indicators can be established by distinguishing between the three positions and nine indicators with different abnormalities in the pulse to confirm the location of disease. In the discussion section, by comparing the differences between this passage and the same passage of "Huangdi Neijing", we found that the inconsistent versions and texts make clinical practitioners develop different diagnostic processes based on their experience, suggesting the importance of better versions of classics. Furthermore, we link our results to modern medical practitioners' experiences and verify the recorded diagnostic methods in the ancient texts through clinical practice. By doing so, we explore the value and feasibility of whole-body diagnostic methods in today's medical environment.