《金匮要略》“气分”“旋杯”“旋盘”考释

Textual Study on“Qi Aspect”“Rotating Cup”and“Rotating Dish”in Synopsis of Golden Chamber

历代医家对《金匮要略·水气病脉证并治第十四》中“气分”“边如旋杯”“边如旋盘”“水饮所作”争论不休。通过考证文字、文物、历代医家文献记述以及临床观察,否定了后世有关《金匮要略》错简及旋杯、旋盘等同论,并阐明桂枝去芍药加麻黄细辛附子汤条文与枳术汤条文之差异在于“气分”及“边如旋杯”“边如旋盘”之体征,虽同为心下胃脘坚大如盘之痞块,边界规则如圆盘,按之不痛,然前者边高出皮面而中凹平,后者边低中凸如覆盘,及前者有阳虚寒凝血不足之诸证,而后者只有气滞水积之态。

The doctors of the past dynasties have been controversial about the“qi aspect”,“the edge felt like a rotating cup”,“the edge felt like a rotating dish”and“caused by retention of fluid”in the Chapter 14 of Water Qi Disease:Pulses,Syndromes and Treatment of Synopsis of Golden Chamber.Through textual study on characters,cultural relics,medical records and clinical observation,the author denied the later statements about the mistakes of Synopsis of Golden Chamber and the equivalence of the rotating cup and the rotating dish.The difference between the items of Guizhi Qu Shaoyao Jia Mahuang Xixin Fuzi Decoction(桂枝去芍药加麻黄细辛附子汤)and Zhizhu Decoction(枳术汤)lies in the signs of the“qi aspect”,“the edge felt like a rotating cup”,“the edge felt like a rotating dish”.Although they are the same as epigastric stuffiness and hardness below the heart like a dish,the edge of which felt like a round dish,without pain when pressed,the edge of the former is higher than the skin surface with the depressed and flat center while the edge of the latter is lower with the raised center like a covered dish.Syndrome of yang deficiency,congealing cold and insufficiency of blood can be seen in the former while the latter only has the state of qi stagnation and fluid accumulation.