脾咳“咳则右胁下痛”新解

New Interpretation of the Pain in Right-hypochondrium about Spleen Cough

历代对《素问·咳论》脾咳"咳则右胁下痛"注解主要有三种:王冰、高士宗、张介宾等认为脾气主(在)右;马莳、张志聪等认为脾居于右;姚止庵认为脾病及肺,肺治于右;无论从脏之所在实位还是从天地气交,或从后天卦象方位相应等解释脾咳其痛在右实有牵强。《黄帝内经》深受中国古代哲学影响,尤其是作为群经之首的《周易》,《内经》以四时五脏阴阳为代表的医学模型就是用"易"的象数思维创建的;既然《周易》是观天地、类万物、言大道,中医自然也在其中。从医易角度分析脾咳,"右胁下痛"应为脾病及胆,与现代医学基本吻合;以实体解剖来看亦是胆居于右胁下,故其位痛,应之;"阴阴引肩背"乃经络所过,从现代医学角度看应是神经之属,为放射痛;"动则咳剧"是虚虚实实之象。脾咳右胁下痛为脾病及胆;"阴阴引肩背"是经络所过,亦可说是神经之属,疼痛为放射性;因虚虚实实之理,故有"甚则不可以动,动则咳剧"。

There are three interpretations about the spleen cough＇s symptoms of cough-pain in right- hypochondrium in On Cough of Su Wen in all ages： first, Yao Zhi＇an considers that the symptom causes are illness of spleen affecting lung and lung governing right part of body. Second, Wang Bing, Gao Shizong and Zhang Jiebin et al.consider that spleen qi governs（in） right part of body. Last, Ma Shi and Zhang Zhicong et al.consider that spleen is in right part of body. But these interpretations is so farfetched in all respects such as position of internal organ or the coition of celestial qi and earth qi and the correspondences of postnatal EightTrigrams and directions.Huangdi Neijing is heavily influenced by Ancient Chinese philosophy and Zhou yi is most important. The most typical medical model in Nei jing is the ＂four season-five zang viscera-yin and yang＂ model which is established with Xiang-Shu thinking of Yi. Zhou yi contains the traditional Chinese medicine （TCM） because it is all-inclusive about the whole universe. So the interpretation of spleen cough from the TCM-I Ching point could draw the following conclusions. First, ＂the symptom of cough-pain in right-hypochondrium＂ is caused by gallbladder and the basic cause is illness of spleen affecting gallbladder. Also this conclusion is basically consistent with modern medicine. Second, ＂ the dull pain in shoulder and back＂ is caused by the main and collateral channels. To explain by modern madicine, it is caused by nerves.And the pain property is rediating pain. Last, the basic cause of ＂move could induce worse cough＂ is that if entrench upon the Tao, it will letthe deficiency more deficient and the excess more excessive.