中医药研究论丛

271.3《金匮要略》妇人「伤胎」厘定与重新诠释

TJ TCM.27(1) : 27-37, 2024

DOI : 10.6516/TJTCM.202403_27(1).0003

《金匮要略》妇人「伤胎」厘定与重新诠释

Revision and Reinterpretation of the Pregnancy Women’s Fetal Injury in Synopsis of the Golden Chamber

陈季襄1林淑銮2张永明3,4,5,*

1中国医药大学附设医院,中医部,台中

2一品堂鹿港中医诊所,彰化

3一品堂丰原中医诊所,台中

4义守大学医学院,学士後中医学系,高雄

5*义守大学医学院,中医部,高雄

【摘要】

背景:《金匮要略·妇人妊娠病脉证并治第二十》(以下简称《金匮·妊娠》):「妇人伤胎,怀身腹满,不得小便,从腰以下重,如有水气状。怀身七月,太阴当养不养,此心气实,当刺泻劳宫及关元。小便微利则愈 见《玉函》」,言简意赅而艰涩,历代医家或保留原文,或如清·吴谦《医宗金鉴·金匮要略注》按语曰:「文义未详,此穴刺之落胎,必是错简,不释。」,导致医家对妇人「伤胎」存在诸多疑点,影响後世对於「伤胎」诊断和治疗。

目的:藉由「怀身腹满」、「不得小便」和「从腰以下重,如有水气状」等关键语句,厘订妇人「伤胎」,并重新诠释。

方法:中医典籍考证并结合西医妇人妊娠後期病理状态表现。

结果:

1.妇人「伤胎」主要纪录妊娠七个月後所妇人所出现的病理表现。

2.妇人「伤胎」临床表现「腹满」、「腰以下水肿」和「不得小便」。

结论:妇人「伤胎」依照孕妇出现症状之时间轴和临床表现,相当於现代医学「子癫前症(Preeclampsia)」。

【关键词】妇人伤胎、怀身、子癫前症
【Summary】
Background: The chapter 20 on Pulse Diagnosis and Treatment of gynopathy during pregnancy in Synopsis of the Golden Chamber define “Pregnant Women’s Fetal Injury” : ‘when a pregnancy woman suffering from fullness in the abdomen, inability to urinate, heaviness below the waist, as if she has fluid-retention syndrome. In the seventh month of pregnancy, the Taiyin (spleen) channel should be nourishing the fetus, but it fails to do so. The heart qi is in an excessive state. She should be treated by acupuncture at Lao Gong(PC 8) and Guan Yuan(RN 4). When urination is slightly relieved, the syndrome will recover. See Jīn guì yù hán jīng’. The clause is simple and concise but difficult to understand. Medical practitioners of past dynasties either retained the original text or, as Wu Qian of the Qing Dynasty said in his commentary on the Golden Mirror of Medical Ancestry: Essential
【Keywords】
Pregnant Women’s Fetal Injury, Pregnancy, Preeclampsia