Friday, March 27, 2009

Death of our mother Kam Agong - medical negligence

9th July 1957 - 19th March 2002

Mazmur 91:1-2 Orang yang duduk dalam lindungan Yang Mahatinggi dan bermalam dalam naungan Yang
Mahakuasa akan berkata kepada TUHAN: Tempat perlindunganku dan kubu
pertahananku, Allahku, yang kupercayai.

Psalms 91:1-2 Whoever goes to the LORD for safety, whoever remains under the protection of the
Almighty, can say to him: You are my defender and protector. You are my GOD, in you I trust.


This site was create with intention to highlight all the events that took place which lead to the death of our mother KAM AGONG. Cause of death: Secondary Postpartum Hemorrhage (SPPH) (Defination: Secondary PPH is defined as excessive blood loss from the genital tract after 24 hours following delivery, until six weeks post delivery. )

On 19th March 2002 Mr. Padan Labo and his eight children lost their mother (Kam Agong). She died of severe bleeding a month after the doctors have performed Caesarean Section (C-Section) at the Lawas District hospital on the 19th March 2002 at the age of 44.

The plaintiffs are the eldest daughter Ms. Agnes Padan and her husband represented the estate of Kam Agong.

The defendants are Dr. Jaya Purany, Dr. Lalitha, Dr. Hasimah Bt Basri, Dr. Fazilah Bt Azali, Jururawat Masyarakat Klinik Kesihatan Ibu dan Kanak-Kanak Long Semadoh Lawas, Pengarah Hospital Daerah Lawas Sarawak and the Government of Malaysia.

Our mother Kam Agong and her family are from Long Semadoh Lawas Sarawak. They belong to an ethnic group call Lun Bawang. According to Meechang Tuie the author of Masyarakat Lun Bawang Sarawak, the Lun Bawang tribes have been in Borneo Island many centuries ago. According to Tom Harrisson (1959) and S. Runciman (1960), the Lun Bawang tribes are the once who started settlements in the highlands in the centre of the Borneo Island. They are predominantly farmers and majority of them are of Christian faith belonging to the Borneo Angelical Church or (SIB).

Kam Agong – she is a God fearing person and loving mother of 8. She was the cornerstone of our family. She took care of her children and helped them with their studies. She worked with the husband in the paddy field and assisted her husband with some construction work in her village. She taught her children to sing and to play music.

She participated in the Church activities in the village. In the early years when there were no flights from Long Semadoh and no land transport from her village to the nearest town called Lawas.

She and the villagers use to walk for two to three weeks to Lawas from Long Semadoh carrying goods to sell in Lawas and with that money they will purchase some groceries and walk back all the way back to Long Semadoh. She was a strong lady and according to some villagers they have never seen her falling ill even after her normal delivery she recuperates very quickly.

Delivery, all her pervious deliveries were normal. Some of us were delivered at home and in the village clinic. Ironically the all seven previous deliveries very handled by mid wife and nurses except for the eighth child by doctors.

At the time of Kam Agong's death the children were:

Jonny Agong 1975 age 27 (delivered at Home mid wife)

Andy Padan 1977 age 25 (delivered at Clinic by mid wife)

Agnes Padan 1979 age 23 (delivered at Home by JD )

Danny Padan 1981 age 20 (delivered at Clinic by JD)

Kathy Busak Padan 1987 age 14 (delivered at Clinic byJD )

Alister Samuel Padan 1990 age 11 (delivered at Hospital Lawas mid wife)

Xtus Baru Padan 1992 age 9 (delivered at Home by Taya)

Jeremiah Jordan Padan 2002 30 days old infant (at Hospital Lawas with caesarian section by Doctors)

Sequence Events

18th February 2002, approximately seven to eight in the evening Kam Agong had her contraction and her husband took her to the Lawas District Hospital for delivery. She was admitted at 9.45 pm. At about 10.30 Dr Fazilah the fourth defendant produced a form for Mr. Padan Labo to sign. It was consent form for the perform a tubal ligation. However at around two in the morning the forth defendant have decided that she (Kam Agong) requires emergency C– Section and waited for the third defendant Dr. Hasimah until 4.30 in the morning. Our finding after going trough the case notes (hospital documents) obtained from the Federal Council.

18th February 2002 - The deceased had labour pain and she was taken to the Lawas District Hospital at 9.45pm. According to case note 7 at 12 midnight her OS has opened up 7 to 8 cm and the head in at station + 1. However the PARTOGRAPH indicates station + 2. After that they monitored the condition of her cervix dilation and it progressed according to the normal PARTOGRAPH. At this time after she was monitored they said that she has gone into obstructed labour.

2. There was no evidence of obstructed labour which has been recorded or indication of obstructed labour. At about at 10.30pm to 11pm they did artificial rupture of the membrane. They found that light meconium staining.

3. After the 10.30pm they suppose to monitor the fetal heart rate (FHR) between 10.30pm to 2am but there was no record, despite the fact that there was evidence that there was meconium staining at 10.30pm. But they have recorded the there was no fetal distress at 10.30pm because they have recorded FHR at 140.

4. After 2pm only then the realized that there was fetal distress and the FHR 80-90bpm but by this time the cervix has dilated to 9cm (as indicated), no CTG recording at all. Hence if the fetal distress was not there, labour would have continued until delivery could have been done through vaginal.

5. Even after 2.30am until the point when they went for the Em LSCS there was a delay of 3 hours. No monitoring done in between to see if the baby has gone down to station and could have been delivered earlier time then caesarian section . Caesarian was only done at 4.15am (no recordings of contraction and FHR since 12.30 on the PARTOGRAPH).

6. No indications of what time oxytocin was administed on the (PARTOGRAPH). – to be commented only if the defendant oxytocin given. The recording time of oxytocin drip is vital in the labour record and partograph (oxytocin will enhance the delivery process and should be monitored). And injudicial use of oxytocin when prolonged in labour is one of the causes of fetal distress (because of cord compression).

7. Before c-section that PH reading of the fetal blood from the scalp to determine if it is less then 7.25. This is the true indicator of less oxygen, was this done?

8. Question of c-section arised only after the normal labour had progressed, why there was fetal distress when there was no indication. The labour was considered normal because she had seven normal deliveries and PARTOGRAPH supports the progress of the cervical dilation. It is only recorded until 2am 19 February 2002.

9. Discharge summary and the post operative notes have noted obstructed labour when there are no specific reasons mentioned. Inaccurate diagnosis recorded. Diagnosis of obstructed labour was not mentioned in the case notes before post operative report.

10. Only one reading of fetal heart rate (FHR) was indicated when it was low. But there is no evidence and the Labour Chart is incomplete after 10.30pm.

11. Case note 34 indicates that the FHR was normal at 10.30pm on the 18th February 2002 but they also indicated the there was SMSL (slight meconium stain). This Labour Chart is not the original copy and it has been conveniently fabricated (case note 33).

12. The deceased husband stated when he was questioned by the defense lawyer, is that your signature on the consent form for the operation, he replied no, and if it was the deceased signature he replied no. But the Dr. Fazilah had asked the deceased husband to sign another document which was the consent form to perform tubal ligations (BTL) which should have been signed by both the deceased and her husband however it was only his signature that was required. Who signed on the consent for the operation form?

13. From 10.30pm to 2am there was no FHR recorded as it should have been.

14. Monitoring was neglected after 10.30pm and 2am on the condition of the fetus and the maternal vital signs. The only thing was recorded was the dilation.

15. The dilatation of cervix was normal.

16. Three hours later, the FHR was documented indicates 80bpm to 90bpm and they have decided to perform C-section. Is there a possibility that the heart rate obtained was maternal in origin? In this case the diagnosis of fetal distress and C-Section performed justified (no CTG recorded).

17. If the change in the FHR was detected earlier then the fetal distress would have been predicted earlier. But they did not monitor and did not do it. Should they have done this recording they could have done Em LSCS earlier.

18. Decision for C-Section was 2.30am and C-Section performed at 4.30am. Why was the delay? Em LSCS for fetal as per NIA (National Indicator Approach) should be performed within 30 minutes. Why were the fetus and the mother not monitored during this period?

19. The fetus may have been in distress for more then 3 hours. Within such time the baby could have been delivered or C-section could have been completed.

20. There was no monitoring after 2am and no record.

21. Case note 34 incomplete and not the general practice and it could have been written after delivery.

22. Two PATOGRAPH one was canceled. Indicates that they should go for C-section earlier. Case note 42. If this is the true PATOGRAPH then the labour was not proceeding.

23. We want to know why the there was a prolonged labour? Deceased admission date was 18 February 2002 at 9.45pm. There was contraction started at 7pm at home. We want to know if the hospital did an ultra sound to measure the head of the fetus for any possible obstructed labour. The child was only delivered at 4.38am.

24. We want to know what happen between 9.45pm 18 February 2002 till 4.38am February 2002.

25. We want to know the reason for caesarian either obstructed labour or fetal distress. The admission was 9.45pm but she has been having contraction since 7.00pm. The fetus head was engaged in position and the heart rate was 140 as indicated in the case note 1. Time not indicated on the case note 1 but on the PARTOGRAPH time indicated 10.30pm, 11.30pm and 12.30am but what was the following reading after 1.30am?

26. There was a trial of labour from 9.45pm until 2.00am when the FHR dropped to 80-90bpm. Only then the MO was called i.e. Dr Fazilah. What was the FHR reading before 2pm? Why it was not recorded in case note 34. Why did they wait till the FHR to drop before they could call Dr. Fazilah?

27. PARTOGRAPH and the Labour Chart (case note 33 and 34) only indicate the first hour 10.30pm on the 18th February 2002. We want to know why these two important documents are incomplete?

28. What caused the fetal distress? Even during surgery there was no abnormalities written except for TMSL. But the deceased lost 2 liters of blood?

During C-Section

29. Intra operative notes on condition BP 90/50 case note 39. The excessive blood lost during the surgery up to 2 liter what were the remedial measures taken to control blood lost?

30. Case note 37 only shows the plan post operatively and the earlier portion the page is blank on the operative notes. We want to know whether Dr. Hasimah is competent enough to perform the surgery. Is she credentialed to do so?

31. With regards to the doctor's decision to perform caesarian section. We want to know the type of caesarian section done. It is indicated that the doctors had performed a Lower caesarian section but one document indicated that it was a classical caesarian section this could have contributed to her blood lost. The indication c-section of the deceased does not justify a classical section (this is only performed on a very special circumstances). And why the doctors could not decide whether it was obstructed labour or fetal distress? If they were not competent why the doctors did not seek help from a gynecologist post surgery when complication arised?

32. We want to know since Dr. Hashima is not a Gynecologists she had a duty to refer the deceased to a Gynecologists when she encounter problems. Why this was not done? They had 30 days.

After the caesarian

33. What caused SEC PPH?

34. Syntometrine was ordered by Dr. Hasimah to be administrated at home on the 18th March 2002. So it is apparently evident that Dr. Hashimah noted that there was still bleeding. Is it a practice to give such medication without further investigation and assessment?

35. The management was, administration of Syntometrine in the hope that the hemorrhage will subside without further investigation and consultation with a proper Gynecologist: failure to diagnose the cause of the SEC PPH and no mention in the hospital notes.

36. Hysterectomy was an option and why it was not referred or considered, when there was a serious complication SEC PPH up to a month.

37. On follow up the baby Jeremiah Jordan Padan was treated repeatedly for excessive mucosa retention in the lungs. The doctor treated him with high dosages nebulizer and pediatric solution to remove the excessive

secretions. Had commented that his condition is continuing because of delayed delivery.

38. On the 14th march 2002 500ml of fresh blood – HB recorded 90/50, pale anemic indicated but HB recorded 10.2 does not make sense. Request for PER-OBST- 306 NOT AVAILABLE

39. Blood lost at PER-OBST-305 was 1.7liters but in the PER-OBST-304 indicated 200ml. and there are lots of discrepancies.

40. 1st March 2002 at the Clinic Kesihatan Long Semadoh the deceased was attended by JM Lily and Tia Tindin. According to them her wound was dirty and there was infection on her wound. The wound was still open and requires dressing and her uterus was bulky. They did not refer her to Lawas hospital. Refer to case note 13 on the Plaintiffs’ Bundle of Documents (PBD). Appointment set on 8th March 2002 according to the records. Why she was not referred to a gynecologist?

41. 8th March 2002 Dr. Hasimah has gone to Long Semadoh to give talk to ladies in the village. On this day the deceased when for her appointment at the Klinik Kesihatan Long Semadoh, where she was checked by the Dr. Hasimah and she was treated for infections on her wound and JM Lily was a witness to it and JM Lily said that “Fundal height was still high”. She also said that Dr. Hashimah told the deceased that her uterus was still bulky because of her age. On what basis and finding is this? JM Lily claims that Dr. Hashimah treated her with antibiotics. There no appointments given. Why she was not referred to a gynecologist?

42. Second Admission 14th March 2002

On the 14th March 2002 in the morning she started bleeding. In was indicated fresh blood in the case note 13 (PBD). There was a drip set and she was administered syncometrin an agent to contract the uterus hence it stops bleeding. Her vitals were bp 90/50, HB 10.2 (recorded at 12.25pm) according to record with pallor and pulse 78. On the way to the Lawas Hospital, JM Lily (nurse) stopped call to the Lawas Hospital to inform them that the deceased was in a state of shock and she has lost approximately 500ml of blood.

At Lawas Hospital she was received by Dr. Fazilah. The deceased was admitted and they placed a pad on her vaginal to see if she was still bleeding. According to the JM Lily there was very little bleeding but there are no records available to conform this. No records of her BP and HB after admission. The Discharge summary mentioned about ultrasound but no report in the case notes. According to witness there was no blood transfusion but given drips (IV) and blood request was send to the lab. There was no active management to monitor the deceased condition and the cause of her massive hemorrhage. She was merely kept under observation for less then 48 hours. No blood transfusion.Why she was not referred to a gynecologist?

43. 16th March 2002 What attempts made to consult a gynecologist? Who was the person made these attempts and which gynecologist did they consult at the material time? We have requested for her to be transferred to Miri Hospital but there was no reply on the part of the hospital staff. It is assumption that the condition will resolve and no need for further consultation.

44. Records (on the day of discharge, evidence to show that she has stopped bleeding, even her vitals was not given, was there any form of treatment administered on the wounds for infections).

45. They took blood for test, she appeared very weak, the hospital staff said that she was completely alright and no more bleeding and she can return home. The deceased continued to stay in Lawas at Minah Tagal’s home. She was even weaker and not well than the time of delivery. Appointment was given 1 month later on the 16 April 2002 Klinink Kesihatan. The HB has been altered from 8.0 to 9.4 on the discharge summary, what was the reason to do so and no official report on this HB. It is not normal for a person who had delivered one month ago to persistently bleed and have such low HB.

46. 18th March 2002 The deceased went up to Long Semadoh. Her daughter Ms Kathy Busak Padan has noted that her uterus was bulky, infections on her wound, there was pus and her pads were soaked with blood. This was noted in the evening. But in the discharge summary there was discrepancy about the infected wound. Which probably written routinely? And only observation stressed in the discharge summary dated 16th March was minimum lochia (with in 3 weeks discharge of lochia should have resolved). What was the reason to discharge her in such a hurry without appropriate, adequate assessment and consultation with a gynecologist? She was admitted in the late afternoon on the 14th March 2002 and discharged in the early afternoon on the 16th March 2002. She was only observed less than for 48 hours.

47. 19th March 2002

Our mother died of massive bleeding (Secondary Post partum Hemorrhage), on the way to Lawas District Hospital. No postmortem was done.

Probable causes of blood lost:

1. PPH primary and secondary

2. Retain products of conception

3. Uterine atony (not contracted well).

4. Uterine extended tear.

5. Lost coagulating factor with excessive blood lost during surgery? DIVC.

6. 11 pads fully soaked in 2 days not normal.

7. Egomatrin was given but not monitored in the hospital?

8. What is the protocol to investigate SEC PPH more than 3 weeks? – Blood investigations – clinical examination – ultra sound – consultation with O&G specialist.

9. For women at the age of 44 how long her uterus before involution? 2 weeks

10. Number of pads changed: before they called Dr. Lalitha to inform her of her HB level which was 8.9. Do you think in your opinion if they informed Dr. Lalitha that there was 6 ½ pads changed she would have discharged her any way. No (answered by a Gynecologist).

11. Entries by doctors in notes have lots of discrepancies.

12. 2 different Parthograph with different entries.

13. Blood lost in the operative notes, in the labour summary chart and discharge summary differs.

14. The indication for c-section differs in the 305 and the post operative review (case note 9 poor maternal effort).

15. Case note 37 post operative note blank.

16. The type of surgery on the 305 upper segment but 304 and case note 9 indicates lower segment.

Noted by a Gynecologist

Kam Agong could have been alive today but not so due to negligence of the concerned parties. From the beginning since admission in labour, management and monitoring was inappropriate.

i.e.

- the indication of C-Section

- the type of C-Section which is questionable

- intra partum management – with Primary Post Partum Hemorrhage

- post partum management

- finally management of Secondary Post Partum Hemorrhage

Noted by a Gynecologist

Signature on the Consent form for surgery - we found out during the trial that the signature on the consent form case note 26 defendants bundle of documents does not belong to Mr. Padan Labo. However it was allegedly singed by the Kam Agong. We the family member belief that the signature on the consent form does not belong to our mother and it has been falsified.

Defendant Case Notes: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57

Plaintiff Case Notes: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

2 comments:

  1. Thank you guys for commenting....

    ReplyDelete
  2. 悉怛多缽怛囉阿門
    不淨觀青黃赤白黑

    不淨觀(http://www.wretch.cc/blog/mod_cloak2.php黃 DSC-T9 誠實(國自 和-T9 前 是密碼))
    是對治淫欲和貪欲很殊勝的方式.
    http://big5.jiexieyin.org/show.aspx?id=961&cid=19
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    =>http://www.wretch.cc/album/album.php?id=zycxxcz1234&book=20
    www.wretch.cc/blog/zycxxcz1234&article_id=4325607
    http://www.wretch.cc/blog/zycxxcz1234&article_id=4325677
    ::::
    搜尋標題及內容: 不淨觀
    http://www.wretch.cc/blog/blog.php?id=zycxxcz1234&search=%E4%B8%8D%E6%B7%A8%E8%A7%80&search_title=1&search_content=1
    http://www.wretch.cc/blog/zycxxcz1234/4324016
    < h3 >*修身觀─不淨觀< /h3 > http://www.wretch.cc/blog/zycxxcz1234/4324018
    < h3 >*三種身至念< /h3 >
    不淨觀頌(並敘)

    佛為貪欲眾生說不淨觀,觀之既久,貪欲即除,可以越愛河而超苦海。余
    閒居閱《大智度論》,因取意而為之頌,以此自警,並以警世云。

    死想(先作此觀,為下九想張本):有愛皆歸盡,此身寧久長。替他空墮
    淚,誰解反思量?

    脹想:記得穠華態,俄成□脹軀。眼前年少者,容貌竟何如?

    青瘀想:紅白分明相,青黃瘀爛身。請君開眼看,不是兩般人。

    壞想:皮肉既墮落,五藏於中現。憑君徹底看,何處堪留戀。

    血塗想:無復朱顏在,空餘殷血塗。欲尋妍醜相,形質漸模糊。

    膿爛想:腐爛應難睹,腥臊不可聞。豈知膿潰處,蘭麝昔曾熏。

    啖想:羊犬食人肉,人曾食犬羊。不知人與畜,誰臭復誰香?

    散想:形骸一已散,手足漸移置。諦觀嫵媚姿,畢竟歸何處?

    骨想:本是骷髏骨,曾將誑惑人。昔時看是假,今日睹方真。

    燒想:火勢既猛烈,殘骸忽無有。試看煙焰中,著得貪心否?

    前詩粗示端緒,尚未諦審觀察,復作五言律,以廣之。

    死想:所愛竟長別,淒涼不忍看。識才離故體,屍已下空棺。夜火虛堂
    冷,秋風素幔寒。勸君身在日,先作死時觀。

    脹想:風大鼓其內,須臾□脹加。身如盛水袋,腹似斷藤瓜。垢膩深塗
    炭,蠅蛆亂聚沙。曾因薄皮誑,翻悔昔年差。

    青瘀想:風日久吹炙,青黃殊可憐。皮乾初爛橘,骨朽半枯椽。耳鼻缺還
    在,筋骸斷復連。石人雖不語,對此亦潸然。

    壞想:肌膚才脫落,形質便遭傷。瓜裂半開肉,蛇鑽欲出腸。枯藤纏亂
    髮,濕蘚爛衣裳。寄語嬋娟子,休將畫糞囊。

    血塗想:一片無情血,千秋不起人。淋漓塗宿草,狼藉汙埃塵。莫辨妍媸
    相,安知男女身。哀哉癡肉眼,錯認假為真。

    膿爛想:薄皮糊破紙,爛肉棄陳羹。膿血從中潰,蠅蛆自外爭。食豬腸易
    嘔,洗狗水難清。不是深憎惡,何由斷妄情?

    啖想:屍骸遭啖食,方寸少完全。不飽饑鳥腹,難乾饞狗涎。當年空自
    愛,此日有誰憐。不若豬羊肉,猶堪值幾錢。

    散想:四體忽分散,一身何所從。豈唯姿態失,兼亦姓名空。長短看秋
    草,穠纖問晚風。請君高著眼,此事細推窮。

    骨想:皮肉已銷鑠,唯餘骨尚存。雨添苔蘚色,水浸土沙痕。牽挽多蟲
    蟻,收藏少子孫。風流何處去,愁殺未歸魂。

    燒想:烈焰憑枯骨,須臾方熾然。紅飛天際火,黑透樹頭煙。妄念同灰
    盡,真心並日懸。欲超生死路,此觀要精研。 [img]bighug[/img]



    February 8, 2008
    < h3 >*修身觀─不淨觀< /h3 > 言自體不淨者即三十六物。一髮二毛三爪四齒五皮六肉七骨八髓九筋十脈十一脾十二腎十三心十四肝十五肺十六大腸十七小腸十八胃十九胞二十屎二十一尿二十二垢二十三汗二十四淚二十五浩二十六涕二十七唾二十八膿二十九血三十黃三十一白三十二肪三十三三十四腦三十五膜三十六精也。或論本九穴不淨名共相不淨。三十六物名自相不淨云云。又云何第五。終竟不淨者。謂是死後之九想之不淨是也云云。又云何云觀他不淨觀自不淨。答觀他身九相云觀他身不淨。問其他身九相者何。答他身九相者。一死相。二脹相。三瘀青相。四膿爛相。五壞相。六血塗相。七虫噉相。八骨鎖相。九離壞相也。

    三十六物:指構成人身之三十六種要素。然關於數目,多有異說。據大明三藏法數卷四十八所舉,三十六物分為外相、身器、內含三類:

    (一)外相十二物,髮、毛、爪、齒、眵、淚、涎、唾、屎、尿、垢、汗。

    (二)身器十二物,皮、膚、血、肉、筋、脈、骨、髓、肪、膏、腦、膜。

    (三)內含十二物,肝、膽、腸、胃、脾、腎、心、肺、生臟、熟臟、赤痰、白痰。

    雜阿含經卷四十三則列髮、毛、爪、齒、塵垢、流涎、皮、肉、白骨、筋、脈、心、肝、肺、脾、腎、腸、肚、生臟、熟臟、胞、淚、汗、涕、沫、肪、脂、髓、痰、膿、血、腦、汁、屎、溺等三十六種。南本涅槃經卷二十二(大一二‧七四九中):「見凡夫身,三十六物不淨充滿」故「不淨觀」,即是觀三十六物不淨(自體不淨)。﹝增一阿含經卷二十五、大品般若經卷五、坐禪三昧經卷上﹞p156



    (原經文)

    優波尼沙陀,即從座起,頂禮佛足,而白佛言:我亦觀佛最初成道。觀不淨相,生大厭離。悟諸色性。以從不淨白骨微塵,歸於虛空。空色二無,成無學道。如來印我名尼沙陀。塵色既盡,妙色密圓。我從色相,得阿羅漢。佛問圓通,如我所證,色因為上。

    (整段經文意思)

    優波尼沙陀此云塵性,以觀塵性空而得道故。譯曰近少,微細,因等微細分析至極之言也義譯為微細,極至鄰虛(新譯曰極微。色法之最極少分,鄰似虛空者,此為色法之根本 謂諸識色及定中色,無障無礙,似於虛空,而實非虛空,故名鄰虛也),立即從座位上站起來,頂禮(五體投地以吾頂禮尊者之足也)釋迦摩尼佛的腳後,向釋迦摩尼佛報告說道:觀見如來最初成道的時候。作意思惟觀想,一者觀自身之不淨,二者觀他身之不淨。觀自身不淨,有九相:一死想,二脹想,三青瘀想,四膿爛想,五壞想,六血塗想,七蟲噉想,八骨鎖想,九分散想。觀他身有五不淨:一種子不淨,是身以過去之結業為種,現以父母之精血為種。二住處不淨,在母胎不淨之處。三自相不淨,是身具有九孔,常流出唾涕大小便等不淨。四自體不淨,由三十六種之不淨物所合成。五終竟不淨,此身死竟,埋則成土,蟲噉成糞,火燒則為灰,究竟推求,無一淨相,而生起大厭離心(謂我等當觀生死之中,虛假不實,如水上泡,速起速滅,往來流轉,猶如車輪。此身眾苦所集,一切皆是不淨,甚可厭離。當以此心而行懺悔也。)。了悟一切色性。以從不淨觀白骨觀作意思惟觀想,乃至逐步微細分析微塵極至鄰虛塵,分析到最後則歸於虛空。當達到空色二者均歸於空無之境界,便成就斷三界諸惑已盡,證真諦之理,不更要學修之圓滿智慧,阿羅漢之無漏智。如來印證我名叫尼沙陀(此云塵性,以觀塵性空而得道故。譯曰近少,微細,因等微細分析至極之言也義譯為微細,極至鄰虛(新譯曰極微。色法之最極少分,鄰似虛空者,此為色法之根本 謂諸識色及定中色,無障無礙,似於虛空,而實非虛空,故名鄰虛也))。一切微塵及青黃赤白等顯色及男女形色等之染污情識既然滅盡,微妙不可思議色相周密圓融無礙遍一切處。我從作意思惟觀想分析一切色塵中,證得阿羅漢果位。佛問我們,我們最初發心證悟十八界,是以什麼圓融周遍一切處,通達無礙,為修學之所緣? 如以我所證到的而言,我認為以色塵為最上圓通。



    +_________________________*
    例如以五臟為例,腎屬水,會發黑光,腎臟不好,因土剋水,脾強腎弱,
    是脾害腎成病,當止腎病於脾,故以黑氣攝取黃氣,腎病者即能癒好。同
    樣道理,脾屬土,會發黃光,脾臟不好係木剋土,肝強脾弱,當止脾病於
    肝,以黃氣攝取青氣,脾病則癒好。心屬火,會發紅光,心臟不好,因水
    剋火,腎害心成病,因腎強心弱,當止心病於腎,以赤氣攝取黑氣,心病
    則癒好。肝屬木,會發青光,肝臟不好,因金剋木,肺害肝成病,因肺強
    肝弱,當止肝病於肺,以青氣攝取白氣,肝病則癒好。肺屬金,會發白
    光,肺臟不好,因火剋金,心害肺成病,因心強肺弱,當止肺病於心,以
    白氣攝取紅氣,肺病則癒好。在基礎篇裏有這些論述,你的哪種臟器有
    病,你就可觀想哪種光,是用物性轉你身體的狀況,萬法唯心造,有心人
    在本身內臟有毛病時,打坐到最好時機,要觀想:我哪個毛病沒有了,我
    那個有毛病的臟器發光了,一天想,二天想,想了一百次、一千次,想不
    發光也不行,所以那個病就沒有了。

    黑黃青白紅 赤氣攝取黑氣
    黑氣攝取黃氣
    黃氣攝取青氣
    以青氣攝取白氣
    白氣攝取紅氣

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