. 從厥談雷諾氏現象

第八章辨厥陰病脈證並治

第九節 . 從厥談雷諾氏現象

仲景是這樣定義厥：「凡厥者，陰陽氣不相順接，便為厥。厥者，手足逆冷是也」。臨床上是四肢冰冷的現象，在現代醫學可以雷諾氏現象的表現最為傳神，厥陰病以厥為名自然厥症為多，其次當以少陰症為主。雷諾氏現象是因暫時性血流減少流向四肢末端的現象，通常會有３個 phase 的顏色變化（White phase，Cyanotic phase，red phase）。這是因為血管收縮，到擴張的過程所造成，雷諾氏現象可能是 Primary 也可以是 Secondary to Systemic disease，如全身性硬化症，冷凝球蛋白血症等。造成雷諾氏現象的原因，而造成雷諾氏現象的機轉到目前為止並不完全清楚，這２０幾年對雷諾氏現象的研究，可歸納為三個可能機轉(1)Vascular (2)neural (3)intravascular

(Rheuma to lagy 2005)。(1)Vascular 指的是血管內層 endothelium 構造及功能方面的異常(2)neural 指的是神經系統對血管張力的控制，包括缺少血管擴張性的 Calcitonin gene-related peptide（由感覺神經釋出）或 L2-adreno receptor activation (3) Intvavascular 指的是血小板的活化，血栓溶解的異常，血漿黏稠度增度或是氧化的壓力 (Oxidant stress)⁹¹，當我們細述上面三種可能的機轉

，發現正好與仲景對厥症的觀察一致，neural 方面的缺乏某些神經傳導物質是少陰之厥，而 Vascular 及 intravasular 則與厥陰病的原理一樣，再一次我們再次看到中西醫學思想的殊途同歸。

第九章結論

仲景的《傷寒雜病論》問世已歷經長遠的時代考驗，古今之醫者皆認為仲景方不僅可用，且常有驚人的療效，此為時方所不及。但可惜的是經方的精神已漸漸不為現代醫者所明暸，所以漢醫常有經方不好用之歎。更何況西醫訓練背景者。故此篇論文嘗試已最新的現代醫學論文來架構《傷寒雜病論》。歷代注解者對《傷寒雜病論》的保存及發揚有不可磨滅之貢獻

。但現代醫學如何認識傷寒論的智慧，並進一步對現代醫學有所貢獻，將是所有有志於中西醫結合的有志之士所不可不戮力以赴。但縱觀今日仲景學術的研究仍停留在以仲景方充為西醫藥理的研究素材，又或以古論古，

窮究考證之學。這兩者雖不失為中醫藥研究途徑，但皆有陷仲景之學於泥淖之憂。前者遠離中醫的整體觀哲學，後者則棄現代醫學的發展不用，專研文史而無所俾益於臨床。

筆者雖才力有所不逮，但認為唯有以更貼近現代醫學的理論來從新詮釋《

傷寒雜病論》方能發揚仲景之學。

本論文並非醫經醫史著作，而是從西方醫學已知的學術理論出發，為

《傷寒雜病論》的整體觀醫學，提出合理的架構。此理論架構為前人所未曾提出，亦是通篇論文唯一的價值，是非對錯尚待時日檢驗，但求拋磚引玉，希望中醫學的精妙處早為世人所認識。

本論文定義太陽少陰系統是 Neuro-endocrine Immune System(詳見第三章) 不僅圓滿解釋太陽為一身的綱領，也是外邪侵犯人體的第一層次與現代醫學病原從口鼻侵犯人體非從皮膚而來的矛盾。也突顯了何為治病之先，治病在表，為何仲景反覆在《傷寒論》中強調解表的重要性，及表未解而妄下的錯誤。借由這個架構本論文成功的詮釋太陽中風及太陽傷寒。

對少陰病本文將之定義為神經傳導物質之病，從 Septic encephalopathy 來看少陰病。我們可以看出仲景智慧所總結出來的少陰病提綱：「脈微細，

但欲寐」確實是正確且具有臨床指導意義。

太陰－陽明系統筆者從物種的演化，胚胎發育的角度來看，將太陰－陽明系統歸類於一個包含著運動（纖毛運動及收縮蠕動）及分泌吸收能力的系統，陽明代表著這個系統的運動能力，而太陰指的是分泌及吸收的能力

。並進一步將之歸類於 Common mucosa and duct system 這也是現代醫學的新發現。如此則太陰－陽明系統擴大到整個肺的系統。而避免傷寒論研究一直將肺歸入太陽系統而造成與經絡系統的矛盾。

從 Motility Dysfunction 看胃家實，借由 Serotonin signaling System 及 Enteric Mast cell 等腸道的神經傳導物質，詮釋陽明病的各種特殊症狀如陽明脈大

、大汗、色赤、膚黃、心煩、潮熱、小便不利等(詳第六章)

筆者歸類少陽為營養血管淋巴系統，厥陰系統指的是營養血管及淋巴管內的血液及淋巴液。我們為少陽病提綱及厥陰病提綱提出較為現代的解釋。筆者就現代血液疾病的角度從新詮釋少陽病及厥陰病。如此則足少陽膽腑為何封為「中正之官，決斷出焉」，為何「凡十一官，皆取決於膽」，

為何稱三焦為：「決瀆之官，水道出焉。」，少陽病咽乾在那裡，食則吐蛔的臨床意義，為何厥陰病不可下，都有了科學化的解釋。

著名的物理學家霍金(Stephen Hawking)說: “就實證主義觀點而言不同的問題可以選取不同的解釋以便呈現最適合的物理圖像＂，當科學尤其是現代物理學突飛猛進之時，量子理論諸如量子纏繞，波函數理論已漸漸引進意識作為研究目標，我們有理由相信在未來五十年內漢醫的天地人整體觀的系統將會得到十足的進展。

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在文檔中傷寒論六經病的現代理論探討; The modern medical theory study of the six meridians diseases from Shang Han Za Bing Lun (頁 71-0)

第八章 辨厥陰病脈證並治

第九節 . 從厥談雷諾氏現象

第八章辨厥陰病脈證並治