yunbox
/
hiu


			
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  </head>

  <body>
    <div class="markdown-body">
      <p>舒肺达肝法，是我多年来的医疗经验，肺主诸气，调节脏腑的功能，经云：“肺者相傅之官，制节生焉”。这说明了肺对人体活动的重要性。肝为藏血脏器，疏畅人身血液之流通，主管人们对事物的分析和判断，经云：“肝者将军之官，谋虑出焉”。这说明肝在人体中对人的思维和毅力是一个不可缺少的脏器。</p>
<p>在人的正常生理状态中，体内气血的活动能够保持一定的生理平衡，关系肝肺两个脏器的功能相互制约，这就是所谓相反相成之理。</p>
<p>01</p>
<p>（一）气乱生百病 调理寻肝肺</p>
<p>祖国医学十分重视气化，“生化之道，以气为本……人之有生，全赖此气”，气一乱，百病丛生。我本此思想在临床上，对疾病的发生，发展，转归，都注意脏腑的气化功能。所以，在治疗疾病时，强调展运气机，注重肝肺气机的宣降条达。</p>
<p>肺朝百脉，气贯五脏，为宗气出入之所，气机升降之枢。肺失宜降，内脏诸气无法升降，血液中的浊气无法排泄。血液的流行之所以能达周身，全靠肺气之输送。所以前人说：“肺主诸气，运行不息，如天行之健”。又说：“诸气贲郁皆属于肺”，这说明肺气关系人体的生理状态和病理变化至为重要。</p>
<p>肝主疏泄，性喜条达，主藏血液，为情志调节之枢。内脏之气的舒展，气血的和平，精神的活跃，水谷的代谢，皆有赖于肝气的条达疏泄。肝肺之气调，则诸气皆调；肝肺之气乱，则诸气皆乱。气乱生诸病，诸病在发生、发展、转归过程中，又易乱于气。</p>
<p>所以许多疾病，都与肝肺气机不达，有着这样或那样，间接或直接的密切关系。有些疾病，多方治疗无效，看来复杂，但若从舒肺达肝着手，把握应变，均能取得满意疗效。</p>
<p>02</p>
<p>（二）着眼通展药贵轻灵</p>
<p>气血以通行展运为顺，展运之法，不在重剂，妙在根据脏腑的生理特性，寻其郄窍，巧转千钧。特别是舒展肝肺气机，用药尤重轻灵。</p>
<p>盖肺为娇脏，不耐寒热，清肃之体，难任厚味；肝为刚脏，不胜燥烈，舒柔之质，难负滋腻，故凡大苦大寒，大温大热，大辛大燥，大甘大腻之药，皆非所宜。欲使肺舒肝达，必须注意寒温适中，宣补适中，滋养适中，疏利适中，才能遂其宣降条达之性。</p>
<p>在这方面，我是深有体会的。我日常治病，多用黄芪、北沙参、桔梗、甘草、桑叶、枇杷叶、银柴胡、浙贝母、青蒿草、白头翁、白芍、地骨皮、川楝、香附、防风、荆芥······等辛平甘润，轻清灵活之品。</p>
<p>方中黄芪、北沙参合用，不寒不热，味薄气清，补肺益气而不壅滞，桔梗、甘草苦甘合化，开提肺气而不耗散；白芍、地骨皮甘寒清润，养血柔肝而不滋腻；香附、川楝行血中气滞，气中血滞，疏肝解郁而不温燥；桑叶、枇杷叶、银柴胡、浙贝母、青蒿草、白头翁均皆清凉灵活，清肺凉肝而不遏郁；防风、荆芥辛平甘润，宣畅肝肺而不辛烈。药不在多，贵在精灵，识此妙法，泛应曲当。</p>
<p>03</p>
<p>（三）舒达肝肺 兼顾其它</p>
<p>百病生于气，以气郁为多，气郁诸病，又以肝郁不达者为多，肝郁不达，又以肺气不畅者为常见。肺气不畅，与肺虚无力有关，肝郁不达，与肺虚不宣有关；欲开肺气，必须补肺，欲达肝气，必先舒肺，补肺才能制肝，舒肺才能达肝。</p>
<p>所以我在舒展肝肺气机的处方中，几乎每方都是黄芪、北沙参、桔梗、甘草并用，一补一开，以舒张肺气。其中黄芪、北沙参均为等分，用量也较重，每剂从20~50克不等。由于平淡之药，非重用难建奇功。其它清肺、凉开、柔肝、疏肝诸药，则因证而施，不必悉用。并适当照顾兼证，根据病情，辅以它药，广泛用于许多病证。兹就治疗某些常见疾病的处方，例举数则，以示加减变通之法。</p>
<p>1.治妇科疾病，月经不调常用药</p>
<p>黄芪、北沙参、桔梗、甘草、青蒿、桑叶、白头翁、丹参、香附。</p>
<p>女子以血为本，治妇科诸病，以理血为主，故四物汤为妇科常用方。我意以调气为主，从肝肺着眼，制立此方以代逍遥散，因逍遥散药偏辛温，着重行气活血。妇科月经不调诸证，以肺虚肝郁，血热血滞者为多。此方以舒肺达肝，清肺凉肝为主。略佐丹参，活血行滞，用之临床，每收效验，这是在治妇科病中，另辟一法。</p>
<p>2.治痢疾，里急后重常用药</p>
<p>黄芪、北沙参、桔梗、甘草、青蒿、枇杷叶、白头翁、白芍、黄连、焦山楂。</p>
<p>肝热下迫，热痢下重，用黄连、白芍、白头翁、焦山楂，这是常法。伍以黄、北沙参、桔梗、甘草、青蒿、枇杷叶，舒肺达肝，清金平木，上下同治，古方新法，寓意其中。尿道感染、尿频尿急，与痢疾同源异流，亦守此法。去焦山楂、青蒿、枇杷叶，加桑白皮、地骨皮、银柴胡，清热熄风养肝肺之阴，白茅根清利湿热，制止频急。</p>
<p>3.治湿温，湿遏热伏常用药</p>
<p>黄苌、北沙参、桔梗、甘草、青蒿、浙贝母、栀子、原朴、石菖蒲、白茅根。</p>
<p>湿温病，一般多是以三仁汤、甘露消毒丹加减。从历年临床实践经验中，我认为：湿温病，湿遏热伏，气机不畅，三焦不利之证，不益气直肺，气机何以通展？湿热何以透达？不舒肺达肝，三焦何以通利？湿热何以下渗？因而制订此方，以治湿温病，湿遏热伏，肺虚不透及用三仁汤、甘露消毒丹无效之证。此方除有三仁汤开上、畅中、渗下和甘露消毒丹清热化湿之功外，还具有益气透达之力，用之得当，效若梓鼓。</p>
<p>4.治坐骨神经痛常用药</p>
<p>黄芪、北沙参、桔梗、甘草、桑寄生、玉竹、生地、熟地、龟胶、黄连、田三七粉。</p>
<p>肝主筋，肝郁化火，灼伤阴液；血不养筋，则筋脉痿痹疼痛，余对此证的治疗，首应开肺，肺气不开，则肝气不达，郁火不清，肺气不开，输泄无权，则津液不布，筋脉失养。余积四十余年的临床经验，以此加减，治疗某些已用祛风湿、利关节及舒筋活络之药无效的坐骨神经痛而收治效。喻嘉言治痰证，有“金代木荣”之法，着眼肺热。余侧重肺虚，源同流归，或可补前人不足。</p>
<p>5.治情志所伤，悲忧气消，精神委顿，神志昏愤，甚或惊恐易怒，烦躁闷乱方</p>
<p>青蒿、黄芪、北沙参、甘草、桔梗、黄连合甘麦大枣汤，酸枣仁汤加减。</p>
<p>悲忧伤肺，肺气无权，肝气不升，脾气不运，心气不调，五脏气馁，势所必然。但肺为主气之枢，肝为精神调节之所，肺运无权，肝气不达，肝郁化火，则情志暗伤。故治此证，当以宣畅肺气，条达肝气为主，适当辅以运输脾气、和调心气之品。肺气无权，肝气不达，专于安神镇静是无济于事的。故于甘麦大枣汤、酸枣仁汤醒牌养肝的基础上，重用川芎，振升肝气，配以黄连泻火平木，更加黄芪、北沙参、桔梗、甘草运输肺气，气机一转，五脏机能正常，精神自振。</p>
<p>04</p>
<p>病案举例</p>
<p>例一：虚弱性病证</p>
<p>徐××，女，60多岁，家庭妇女。身体虚弱，精神不振，经常感臂，咳嗽有淡，鼻塞流涕。每日下午七时，头面出汗，有时扩展到上半身。汗出时，全身烦躁发热，汗出后全身怕冷，整天畏寒，畏风，畏冷水，舌干口燥不欲饮，手心发热，一身酸痛，夜晚口干口苦，自觉有血腥气味，食纳无味，食甘发酸，少气懒言，四肢无力，面色白，形容憔悴，夜尿多，大便、体温无变化，舌苔白厚而粗糙，舌质淡，两脉沉细。西医检查，未发现异常，有时给点助消化药或营养药。中医有主气虚感冒的，用玉屏风散加味；气血两虚的，用八珍、十全加减；也有从阳虚或阴虚论治的。历经数年，久治不愈。</p>
<p>此证比较复杂。气虚有食滞，血虚有热，肺气无权，肝虚不达，脾虚不运等型。补气难用甘温，壅气助燥，补血难用滋腻，滞脾呆胃。补者，调其虚实，和其顺逆也。本证治疗，宜以益气舒肺，养血调肝，运输脾气为主。肺舒肝达，脾气运转，则气血有生化之源，郁热有透达之路，遮几热可清，汗可止，食可化，苔可退。</p>
<p>处方：黄芪30克，北沙参30克，桔梗10克，甘草3克，淅贝10克，白芍10克，地骨皮10克，淮山30克，神曲10克，炒谷芽10克。连服5剂，汗渐止，烦渐除，苔稍退，食稍进。二诊、三诊俱守原方加减，渐趋康复。后以参苓白术散加减收功。</p>
<p>此方黄芪、沙参补肺益气，桔梗、甘草舒肺达肝，淮山、神曲、谷芽，一补一消，运输脾气，白芍、地骨皮养血柔肝；浙贝母解郁散结。且白芍配桔梗，一敛一开，舒肺而不耗气；甘草合白芍，酸甘化阴。全方不寒不热，不磨不腻，补气养血，运脾达肝，主次分明，兼顾全面。补气不用党参者，嫌其甘壅，补血不用归、地，防其腻滞；补脾不用白术，恶其湿燥也。</p>
<p>例二：精神病证</p>
<p>陈××，男，28岁，工人。因受刺激，忧思成疾，遂成精神病症。神志紊乱，举动失常，食欲减退，夜寐不安，舌上无苔，脉象弦涩。经服中西药品，病仍不解，病情逐渐加重，不认亲疏，拒诊打人。</p>
<p>此证系属肝脾气郁，肺失制节。脾主思，思则气结，气结则清阳不升，浊阴不降。肺气不舒，肝气不达，郁而生热，心经受害，故症见食欲不振，夜寐不安，神志紊乱，举动失常等等。舌上无苔是里虚之象，脉弦涩是气郁血滞之证。本证治法，当以宜畅肺气，运行脾气，条达肝气，清泄心气为主。因肺舒肝达，脾气运转则心气和畅，气血流通无阻，郁热有透达之机，庶几情志清，烦可止，味口开，神可安。</p>
<p>处方：青蒿10克，黄芪30克，北沙参30克，桑叶10克，桔梗10克，甘草3克，厚朴10克，焦栀子10克，石菖蒲6克，黄连10克。只服两剂，神志清醒，要求服药，能自动散步。二诊按照原方加减，连服5剂，渐趋康复。后用清肺养肝之品，以善其后。</p>
<p>此方黄芪、北沙参一阴一阳，益气清肺，树其清肃之令。桔梗、甘草辛苦甘凉，开提上焦，解散肺郁，由此肝气能达，脾气能运。青蒿、桑叶轻清透达肝胆之气， 令郁热有放散之路。厚朴、栀子一升一降，运行脾气，清泄在里郁热。菖蒲、黄连芳香透络，除烦安神。本方是按脏腑机制之理组成，不是机械地专补耳。</p>
<p>例三：妇科病证</p>
<p>袁××，女，40岁，干部。原有胃溃疡病，不能食糖，食则泛酸。胃中嘈杂，喜暖畏寒，气力不足，易于感冒。1982年2月，经水适来，劳力过度，经水遂止，小腹作胀，净后四、五日，经水复至，量较多，延至十余日不净，间或下红黄水，气带腥臭。曾经他医给予补中益气汤，小腹反胀，饮食乏味，精神不振。西医疑为早期子宫肌瘤。</p>
<p>此证为肺虚肝热，瘀浊内阻，治以补肺平肝，清热化浊。</p>
<p>处方：黄芪30克，北沙参30克，白头翁20克，青蒿10克，桔梗10克，甘草3克，黄连10克，薏苡仁30克，焦山楂30克，石菖蒲6克。连服5剂，腹胀减轻，精神转振，口味转佳，红黄浊液、气味渐清。二诊、三诊均守原方加减，病情好转，现已康复。</p>
<p>此方治法仍以益气舒肺，条肝运脾为主，稍作变化，药症契合。盖湿浊瘀阻是由肺虚不能舒展，肝郁不能条达所致。特别是妇科病症多是心胸不舒，情志不遂的。所谓思则气结，忧则气郁，久则气郁血滞，气变为湿，血变为浊。此病如不舒肺达肝，则清气不升，浊气不降，单用升提，等于闭门留寇；专事攻逐则正气未免更伤，病反加重。是以制立此方，扶正而不碍邪，祛邪而不伤正，立法精当，自必有效。</p>
<p>例四：眼科病证</p>
<p>王××，女，45岁，干部。自诉两目模糊，视物不清，特别是左眼模糊尤甚，目眶作胀，心烦胸闷，左下肢浮肿，呼吸气少，小便有热感，并有痔疮，脉沉细，舌润无苔。西医诊为白内障。</p>
<p>此证系肺气不足，肝经有热所致。根据五行生克制化之理，属于金虚不能制木，水虚不能涵木。目为肝窍，肝血虚则虚火上升，目失所养，故视物不清。治法主以舒肺达肝，养阴明目。</p>
<p>处方：青蒿10克，黄芪30克，白头翁15克，北沙参30克，桑叶10克，桔梗10克，甘草3克，白芍10克，黄芩10克，生地30克，珍珠粉3分。连服5剂，两目清爽，下肢肿消，目眶胀减，气力较充，头亦不痛，但下肢仍有酸感。二诊、三诊俱照原方，共服10剂，两目重明，诸悉痊愈。以杞菊地黄丸巩固疗效。</p>
<p>为了开创中医学术交流新局面，促进中医事业的发展未敢嘱尔而息，特爱笔成编，提供读者参考。由于笔者学识空疏，不当之处敬请指教。</p>
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