《金匮要略》百合病“得药则剧吐利”句读质疑

The Questioning of the Sentence Segmentation of "De Yao Ze Ju Tu Li" in the Chapter of Lily Disease in the Synopsis of Golden Chamber

《金匮要略》百合病篇条文中有"得药则剧吐利,如有神灵者"一句,其中"剧+症状"的表达在仲景医书中仅此一处。本文通过对《伤寒论》《金匮要略》《黄帝内经》及其他非医上古汉语文献的整理分析,考证了"剧"字在东汉时期的用法和含义。发现"剧"作为"严重"或"加重"的含义时,其用法多为单用,或连接在某一症状之后,即"症状+剧",而非"剧+症状",由此认为"得药则剧吐利"句读可能存在问题。综合《外台秘要》《医心方》中本条文的不同版本记载及明清注家观点,认为该句的断句或应改为"得药则剧,吐利如有神灵者"。二者的区别是:前者意为服药后吐利十分剧烈,而后者意为服药后病情反而加重。"吐利如有神灵"则可能是形容一种时呕时愈、时泻时止的状态,与上下文描述的似有似无而不甚剧烈的症状更相符合。

In the Synopsis of Golden Chamber,there is a sentence in the chapter of lily disease that reads "De Yao Ze Ju Tu Li, Ru You Shen Ling Zhe".The expression of " Ju + symptoms" is only seen in Zhang Zhongjing′s medical books.Through the collation and analysis of Shanghan Lun,Synopsis of Golden Chamber,Huangdi Neijing and other non-medical ancient Chinese documents, this paper examines the usage and meaning of the word "Ju" in the Eastern Han Dynasty.It is found that when " Ju " is used as the meaning of "serious" or "aggravating",its usage is mostly single use, or connected after a certain symptom, that is, "symptom+Ju",rather than "Ju+symptom".Therefore, it is considered that there may be a problem in the sentence segmentation of "De Yao Ze Ju Tu Li".Based on the records of different versions of this article in Waitai Miyao and Yixin Fang and the views of commentators in the Ming and Qing Dynasties, it is considered that the segmentation of this sentence should be changed to "De Yao Ze Ju, Tu Li Ru You Shen Ling Zhe".The difference between the two is: the former means that vomiting is very severe after taking medicine, while the latter means that the condition is aggravated after taking medicine. "Tu Li Ru You Shen Ling Zhe" may describe a state of vomiting, healing and diarrhea, which is more consistent with the seemingly non-severe symptoms described in the context.