《金匮要略》积聚“终不移”与“展转痛移”释义

Interpretation of Ji-Ju‘zhong bu yi’and‘zhan zhuan tong yi’in Synopsis of the Golden Chamber

对于《金匮要略·五藏风寒积聚病脉证并治第十一》中积“终不移”与聚“展转痛移”的记载,历代医家多将“终不移”解释为“痛有定处”,而将“展转痛移”解释为“痛无常处”,但现实中却难以找到临床表现能与“痛无常处”相符合的积聚类疾病。文章从梳理历代注家观点入手,通过文字考证,结合《黄帝内经》及张仲景的相关论述,认为“终不移”所描述的是一种持续性疼痛,而“展转痛移”描述的是一种非持续性的、可自行缓解的疼痛,并非传统解释的“痛有定处”或“痛无定处”之意。

According to the records of‘zhong bu yi’and‘zhan zhuan tong yi’in Synopsis of the Golden Chamber·DiseasePulse-Syndrome Combined Treatment of Wind Cold and Ji-Ju in the Five Viscera at No.11’,most of the physicians in past dynasties interpreted‘zhong bu yi’as‘pain has a fixed place’,while‘zhan zhuan tong yi’as‘pain has no fixed place’,but in reality,it is difficult to find Ji-Ju with clinical manifestations consistent with‘pain has no fixed place’.This paper,started with the viewpoint of the ancient annotators,through textual research,combined with Huangdi Neijing and ZHANG Zhong-jing’s related discussion,holds that‘zhong bu yi’describes a kind of persistent pain,while‘zhan zhuan tong yi’describes a kind of nonpersistent and self-relieving pain,rather than the traditional interpretation of‘pain has a fixed place’or‘pain has no fixed place’.