《金匱要略》「婦人之病」經文釐定闡釋與篇章重構

背景：《金匱要略》婦人雜病篇總綱「婦人之病」經文，存在諸多疑點，使醫家詮釋紛亂，進而影響臨床實用。目的：釐訂經文缺漏和錯簡。方法：以原典文本詮釋與文字對稱分析兩種方法，進行經文分析。結果：校訂後經文：「婦人之病，因虛、積冷、結氣，至有歷年。血寒積結，胞門寒傷，為諸經水斷絕。在上凝滯，咳吐涎沫，久成肺癰，形體損分。在中盤結，繞臍寒疝，兩脇疼痛，與藏相連；在中結熱，痛在關元，脈數無瘡，肌若魚鱗。在下未多，少腹惡寒，氣衝急痛；或引脊腰，膝脛疼煩。時著男子，非止女身。下根氣街，經候不勻，令陰掣痛，奄忽眩冒，狀如厥癲，或有憂慘，悲傷多嗔，非有鬼神，此皆帶下。」結論：1.「婦人之病」核心理論在於探討除婦人專有疾病外，亦須注意全身系統疾病對婦人之影響。2.儘管經文出處仍具爭議，然此條文作為《金匱要略》婦人妊娠、產後、雜病三篇章之總綱，對於學習婦人病將有所助益。

關鍵字

婦人雜病；氣街；氣衝；胞門；帶下

並列摘要

Background: The contents of ＂Gynecologic diseases＂ in chapter XXII, Miscellaneous Gynecological Diseases of the Synopsis of the Golden Chamber are considerably confusing thus made clinical interpretations and practicing difficult and inconsistent. Purpose: To identify the missing words and recompose the misplaced paragraphs. Methods: Analyzing articles by comparing different former versions available from different time periods, and comparing syntax and grammar between similar sentences. Result: The pathogenic factors of ＂Gynecologic diseases＂ include deficiency of Qi and Blood, obstruction of pathogenic Cold and Qi, which may cause long-term interference with women's menstrual cycle thus leads to irregular menstruation or menopause. When the upper-thoracic cavity is influenced by pathogenic substances, it would result in coughing and sputum secretion, and then gradually lead to pulmonary abscesses and mental and physical health deterioration. When the mid-abdominal cavity is influenced by the pathogenic factors, it would cause intestinal entanglement and herniation pain resulting from Cold around the umbilicus that got transferred to the Viscus. If inflammation occurs, the patient's pulse rate accelerates and skin texture turns rough like fish scales, instead of skin sores. When the lower-abdominal cavity is invaded, patient may suffer from chills and acute pain on Qichong, lumbar spine, coccyx, knee and calf. Diseases of the upper, middle and lower parts of the body occur in both genders, not limited to women. If Qijie is invaded, when in women, it would result in irregular menstruation and dysmenorrhea. Syncope and vertigo may suddenly occur, accompanied by melancholy and irritability during the periods. These are not caused by ghosts or illusions, but symptoms related to gynecologic diseases. Conclusion: 1. ＂Gynecologic diseases＂ discuss not only the gynecopathy but the influence of diseases from other systems. 2. The outlines of the three chapters ＂Gynopathy during pregnancy＂, ＂Postpartum diseases＂, ＂Miscellaneous gynecological diseases＂ would still be beneficial for learning gynecopathy, despite that there are some controversies with regards to these articles in the former original book.