寸關尺分候臟腑之診係由易學竄入而非臨床驗得

The Concept of Cun Guan Chi Represented Viscera and Bowels Derived from I Ching Instead of Clinical Practice

五行學說與易學皆曾竄入中醫，中醫須與爾等脫鉤而回歸於臨床實證。中醫診斷大家習以寸關尺分候五臟（右寸肺、左寸心、右關脾、左關肝、尺脈候腎）之疾。但是我們甚少去追問此對應之臨床證據與文獻之本貌。追溯《難經》寸關尺是先分候經脈，再透過經脈各自內屬其臟腑。“經脈示意線”並非恆定存在之解剖組織，當行以針灸刺激時則呈現，針灸一結束則“經脈示意線”多隨即消失。其暫時存在之特性類如候鳥之飛行途徑，當氣溫下降（刺激出現）時則自然呈現，氣候一回溫則候鳥飛行途徑多隨即消失。血則為恆定之解剖組織而異於“經脈示意線”。先賢當初應能辨清兩者之差異而分別創有「脈」與「□」字。如病人未同步施予針灸之條件下，醫師所診之寸關尺是橈動脈之血而非經脈，自必須符合心臟血液動力學等機轉；故寸關尺三部皆能候得心律不整而非侷限於左寸。解剖寸關尺處並無各自內屬臟腑，推知寸關尺「血」處沒有內屬臟腑。又病人如未同步施予針灸之條件下，“經脈示意線”根本沒有被激發出，其內服湯藥自無“經脈示意線”可歸屬，此時之寸關尺「經脈」亦無內屬臟腑。所謂藥物歸“經”、入臟腑之理論者錯誤。本文考證出《難經》寸關尺分候五臟是源自易學四象竄入之類比規範，非關臨床。針灸療法屬外科，湯方療法屬內科，兩者不容混淆。《難經》寸關尺既曰分候「經脈」，其對象自是指針灸，不可訛移作湯方。一連串錯誤卻奉為今日湯方療法之診斷理論。《靈樞．九鍼十二原》：「凡將用鍼，必先診脈。」被訛解作“凡將開方，必先診脈。”按針灸著於診脈，湯方則著於證候。漢代醫家開方多無需診脈，或藉用手太陰脈口整體佐作開方之診斷參考。仲景脈學不分寸關尺，不分左右手。113首湯方僅33首附有脈象，其餘80首湯方則無脈象。故診脈並非開方之必要條件。脈診儀不能分候臟腑之疾。

The theories of the Five Elements and I Ching (Classic of Changes) had been introduced to TCM for thousands of years, but TCM should be separated from them.TCM doctors used cun (inch) guan (bar) chi (cubit) wrist pulse-taking method for diagnosing disease corresponded to five viscera (right cun indicates lung, left cun indicates heart, right guan indicates spleen, left guan indicates liver, and both chi indicate kidney) , but we rarely question about the literature and their clinical evidence. Cun guan chi method described from Nan Jing (Classic of Difficult Issues) was originally developed on the basis of differentiating meridians rather than blood vessels, and their meridian linkage to viscera and bowels. ”Meridian schematic line” is not a constant anatomical structure. The line appeared when a patient stimulated by acupuncture, and disappeared in the end of the procedure. Its characteristics of temporary existence resemble the flight paths of migratory birds, which appeared when temperature dropped (stimulus), and disappeared when getting warmer. On the other hand, blood vessels are constant in anatomy. Therefore the ancient Chinese doctors created different characters for separated meaning. In situation without acupuncture, TCM doctors detected the blood vessels instead of meridians by wrist pulse-taking method, most of the data acquired was related to hemodynamic mechanism. In this way, doctors can diagnose arrhythmia in all sections of wrist but not merely left cun. Since each ”Meridian schematic line” is not appeared by acupuncture, doctors cannot prescribe medicine with their corresponded ”meridian entry” defined by orientation of the medicinal action according to the meridian on which the therapeutic action is manifested. This study revealed the cun guan chi method described in Nan Jing was misunderstood and categorized through the concept of I Ching, which is not clinically oriented. Cun guan chi can only guide the clinical use of acupuncture (external medicine) instead of decotion therapy (internal medicine). Ling shu (Miraculous Pivot) had recorded ”take the pulse before acupuncture”, but misunderstood as ”take the pulse before decoction” in modern TCM. In internal medicine system, symptoms/signs are more significant than pulse condition. Physicians in Han Dynasty prescribing decoction without or with little concerned to pulse condition, such as Zhang Zhongjing. There is no difference between cun, guan, chi, left or right in his concepts of sphygmology. Only 33 of the 113 decoction described with a pulse condition. Therefore taking pulse is not necessary in prescribing decoction, and sphygmography cannot distinguish diseases of viscera and bowels.