芍藥的配伍運用
芍藥加桂枝
代表(biao)方(fang)桂(gui)(gui)枝(zhi)(zhi)(zhi)湯(tang)。方(fang)中(zhong)(zhong)芍(shao)(shao)(shao)藥(yao)(yao)(yao)、桂(gui)(gui)枝(zhi)(zhi)(zhi)各三兩，《醫(yi)宗金鑒》：“桂(gui)(gui)枝(zhi)(zhi)(zhi)辛溫(wen)，辛能發(fa)散，溫(wen)通衛陽(yang)(yang)(yang)；芍(shao)(shao)(shao)藥(yao)(yao)(yao)酸寒，酸能收(shou)(shou)斂(lian)(lian)，寒走陰(yin)營(ying)(ying)。桂(gui)(gui)枝(zhi)(zhi)(zhi)君芍(shao)(shao)(shao)藥(yao)(yao)(yao)，是于(yu)(yu)發(fa)汗(han)中(zhong)(zhong)寓斂(lian)(lian)汗(han)之(zhi)(zhi)旨(zhi)；芍(shao)(shao)(shao)藥(yao)(yao)(yao)臣(chen)桂(gui)(gui)枝(zhi)(zhi)(zhi)，是于(yu)(yu)和(he)(he)營(ying)(ying)中(zhong)(zhong)有(you)(you)調衛之(zhi)(zhi)功。” “芍(shao)(shao)(shao)藥(yao)(yao)(yao)配桂(gui)(gui)枝(zhi)(zhi)(zhi)，以桂(gui)(gui)枝(zhi)(zhi)(zhi)發(fa)汗(han)，散太(tai)(tai)陽(yang)(yang)(yang)之(zhi)(zhi)風，芍(shao)(shao)(shao)藥(yao)(yao)(yao)和(he)(he)營(ying)(ying)兼以斂(lian)(lian)汗(han)，使不(bu)(bu)致發(fa)散太(tai)(tai)過，一(yi)散一(yi)收(shou)(shou)，剛(gang)柔互濟，相須(xu)為用(yong)，以達(da)解(jie)肌表(biao)而(er)通陽(yang)(yang)(yang)氣，和(he)(he)營(ying)(ying)衛而(er)不(bu)(bu)傷陰(yin)。”桂(gui)(gui)枝(zhi)(zhi)(zhi)是辛溫(wen)陽(yang)(yang)(yang)藥(yao)(yao)(yao)，辛甘(gan)通陽(yang)(yang)(yang)；芍(shao)(shao)(shao)藥(yao)(yao)(yao)是酸甘(gan)化陰(yin)，和(he)(he)其(qi)營(ying)(ying)衛。戴北山《廣(guang)瘟疫論(lun)》云：“寒熱并用(yong)之(zhi)(zhi)謂(wei)和(he)(he)。” 芍(shao)(shao)(shao)藥(yao)(yao)(yao)配桂(gui)(gui)枝(zhi)(zhi)(zhi)，一(yi)陰(yin)一(yi)陽(yang)(yang)(yang)，相反相成，極盡和(he)(he)法之(zhi)(zhi)道(dao)。其(qi)類方(fang)有(you)(you)桂(gui)(gui)枝(zhi)(zhi)(zhi)加芍(shao)(shao)(shao)藥(yao)(yao)(yao)湯(tang)，治療“太(tai)(tai)陽(yang)(yang)(yang)病，醫(yi)反下之(zhi)(zhi)，因(yin)爾腹滿時痛(tong)者(zhe)，屬太(tai)(tai)陰(yin)也，桂(gui)(gui)枝(zhi)(zhi)(zhi)加芍(shao)(shao)(shao)藥(yao)(yao)(yao)湯(tang)主之(zhi)(zhi)”。太(tai)(tai)陽(yang)(yang)(yang)病應用(yong)解(jie)表(biao)，不(bu)(bu)該用(yong)下法，誤(wu)用(yong)下法導致腹痛(tong)，用(yong)桂(gui)(gui)枝(zhi)(zhi)(zhi)湯(tang)加芍(shao)(shao)(shao)藥(yao)(yao)(yao)，這里(li)的(de)芍(shao)(shao)(shao)藥(yao)(yao)(yao)主要是止痛(tong)。
芍藥加甘草
代表方芍藥(yao)甘草湯(tang)。從頭痛(tong)(tong)(tong)到腳痛(tong)(tong)(tong)，可(ke)以治(zhi)療一切(qie)疼痛(tong)(tong)(tong)。程(cheng)鐘齡《醫學(xue)心悟》說：“芍藥(yao)甘草湯(tang)治(zhi)腹痛(tong)(tong)(tong)如神(shen)”，各種腹痛(tong)(tong)(tong)，包(bao)括婦科(ke)腹痛(tong)(tong)(tong)，內外科(ke)的(de)腹痛(tong)(tong)(tong)，神(shen)經(jing)科(ke)的(de)腹痛(tong)(tong)(tong)，精神(shen)性的(de)疼痛(tong)(tong)(tong)，肢(zhi)體的(de)疼痛(tong)(tong)(tong)，頭痛(tong)(tong)(tong)和(he)腳痛(tong)(tong)(tong)，都可(ke)以用(yong)此(ci)止(zhi)痛(tong)(tong)(tong)。類方包(bao)括芍藥(yao)甘草附子(zi)湯(tang)，用(yong)來治(zhi)療風濕(shi)病屬于陰(yin)陽兩虛(xu)經(jing)脈(mo)失養者。
原(yuan)來此(ci)方(fang)是治療陰虛引(yin)起的(de)足(zu)攣(luan)急，若陽(yang)虛引(yin)起的(de)足(zu)攣(luan)急可(ke)以(yi)(yi)配用(yong)(yong)桂(gui)枝、附子等(deng)。 現代臨床甘酸(suan)化陰緩急止痛(tong)(tong)(tong)廣泛應用(yong)(yong)于(yu)各(ge)個系統(tong)的(de)病癥(zheng)，不管(guan)痛(tong)(tong)(tong)在表面，痛(tong)(tong)(tong)在里面，不管(guan)是平(ping)滑(hua)肌(ji)(ji)腸(chang)痙攣(luan)，或是肌(ji)(ji)肉痛(tong)(tong)(tong)、神經(jing)痛(tong)(tong)(tong)，都可(ke)以(yi)(yi)用(yong)(yong)。現代臨床報道芍(shao)(shao)藥可(ke)以(yi)(yi)用(yong)(yong)于(yu)腓腸(chang)肌(ji)(ji)痙攣(luan)、三叉神經(jing)痛(tong)(tong)(tong)、血管(guan)性疼痛(tong)(tong)(tong)等(deng)。筆者曾(ceng)治療一腹(fu)型癲(dian)癇患者，重(zhong)用(yong)(yong)芍(shao)(shao)藥至45克，佐(zuo)以(yi)(yi)甘草(cao)(cao)而(er)得以(yi)(yi)控制癲(dian)癇的(de)發作。實驗(yan)研究證明(ming)芍(shao)(shao)藥甘草(cao)(cao)湯有明(ming)顯的(de)鎮痛(tong)(tong)(tong)作用(yong)(yong)，芍(shao)(shao)藥甘草(cao)(cao)比例為2：1。若方(fang)中(zhong)炙甘草(cao)(cao)用(yong)(yong)生(sheng)甘草(cao)(cao)代替，則鎮痛(tong)(tong)(tong)作用(yong)(yong)消(xiao)失。
芍藥加大黃
代(dai)(dai)(dai)表(biao)方大(da)(da)柴胡湯(tang)。少(shao)陽(yang)(yang)陽(yang)(yang)明合病，既(ji)(ji)有寒熱往來，又有陽(yang)(yang)明腑實(shi)(shi)痛(tong)。小柴胡湯(tang)加(jia)(jia)枳實(shi)(shi)、大(da)(da)黃，加(jia)(jia)重芍藥(yao)的劑量，芍藥(yao)既(ji)(ji)可(ke)通(tong)便(bian)，又可(ke)止(zhi)痛(tong)。其(qi)類方有柴胡加(jia)(jia)芒硝(xiao)湯(tang)，治(zhi)療少(shao)陽(yang)(yang)經陽(yang)(yang)明腑實(shi)(shi)證，其(qi)大(da)(da)便(bian)干結(jie)更(geng)加(jia)(jia)嚴重，用芒硝(xiao)咸寒軟(ruan)堅，通(tong)便(bian)的作用更(geng)強(qiang)。現(xian)代(dai)(dai)(dai)臨床大(da)(da)柴胡湯(tang)可(ke)以治(zhi)療肝炎(yan)(yan)、膽囊炎(yan)(yan)、胰(yi)腺炎(yan)(yan)、腸胃炎(yan)(yan)、膽道蛔蟲、膽石癥(zheng)、痢疾(ji)等。胰(yi)腺炎(yan)(yan)疼(teng)痛(tong)劇烈，芍藥(yao)可(ke)以重用。大(da)(da)便(bian)通(tong)、膽汁(zhi)排泄流(liu)暢，胰(yi)管的水腫、痙攣都可(ke)以緩解。實(shi)(shi)驗(yan)證明，大(da)(da)柴胡湯(tang)可(ke)以調(diao)節脂(zhi)質代(dai)(dai)(dai)謝，改善血液流(liu)變(bian)，尚有抗炎(yan)(yan)、利膽、解痙的作用。
芍藥加附子
代表方芍藥甘草附子湯，針對寒性腹痛。腹痛屬陰陽兩虛者，芍藥甘草加附子一起用。筆者曾治一患者，夏天怕熱，但是肚子怕冷，一冷就痛，用芍藥甘草加附子一起用，效果很好。南方醫生夏天不太敢用干姜、附子、肉桂。筆者發現夏天用干姜、附子、肉桂、蓽拔治療因冷飲、空調引起的胃痙攣、腸痙攣腹痛、腹瀉效果很好，不過劑量要適可而止。如果既有熱郁、又受寒疼痛，可以黃連與干姜、肉桂一起用。《黃帝內(nei)經》講春(chun)夏(xia)要(yao)養陽，春(chun)夏(xia)要(yao)保護(hu)人體(ti)的陽氣(qi)，為(wei)什么(me)？春(chun)夏(xia)最容易損傷(shang)陽氣(qi)。人體(ti)代謝，氣(qi)化(hua)功(gong)能依靠(kao)陽氣(qi)來溫煦推動，保護(hu)好陽氣(qi)，很(hen)重要(yao)。因此，芍(shao)藥、甘(gan)草甘(gan)酸化(hua)陰，附子(zi)、甘(gan)草辛甘(gan)通陽，一個(ge)化(hua)陰，一個(ge)通陽，兩(liang)者相互制(zhi)約(yue)，相反(fan)相成(cheng)，對于胃(wei)腸(chang)(chang)病效果(guo)很(hen)好。臨(lin)床(chuang)運用(yong)治療(liao)外感汗多陽虛惡寒(han)者，或用(yong)于治療(liao)風寒(han)濕(shi)痹陽氣(qi)虛弱關節酸痛者，或用(yong)于腸(chang)(chang)痙攣、腓腸(chang)(chang)肌痙攣等(deng)有良效。
芍藥加黃芩
代表方黃(huang)芩(qin)湯(tang)(tang)。治(zhi)療太陽少陽合病下利，如(ru)夏天(tian)受暑熱(re)(re)之邪，容易(yi)腹(fu)痛(tong)、腹(fu)瀉，用(yong)芍藥(yao)(yao)、黃(huang)芩(qin)，如(ru)稍有寒(han)邪，加肉桂、干(gan)姜，效(xiao)果(guo)很(hen)好(hao)。黃(huang)芩(qin)湯(tang)(tang)是下利的祖方，黃(huang)芩(qin)清熱(re)(re)治(zhi)利，芍藥(yao)(yao)酸(suan)甘化陰，緩急止(zhi)痛(tong)。可以治(zhi)療細菌性(xing)(xing)痢(li)疾(ji)、阿(a)米巴痢(li)疾(ji)、急慢性(xing)(xing)腸炎(yan)(yan)、胃炎(yan)(yan)、傳染性(xing)(xing)單(dan)核(he)細胞(bao)增(zeng)多癥等。藥(yao)(yao)理研究證(zheng)明，黃(huang)芩(qin)甙具有非常明顯的抗炎(yan)(yan)、解痙、鎮(zhen)靜、止(zhi)痛(tong)的作用(yong)。筆者體會到治(zhi)療胃腸病黃(huang)芩(qin)、黃(huang)連、干(gan)姜、肉桂一起用(yong)，既不會太苦(ku)寒(han)傷陽，又不會太熱(re)(re)傷陰，寒(han)熱(re)(re)并(bing)用(yong)，相反(fan)相成(cheng)，相得(de)益彰。
芍藥加半夏
代表方(fang)黃(huang)芩加半(ban)夏生姜(jiang)湯(tang)。《傷寒(han)論》：“太陽少陽合病(bing)，自下利者(zhe)，與黃(huang)芩湯(tang)，若(ruo)嘔吐者(zhe)，黃(huang)芩加半(ban)夏生姜(jiang)湯(tang)主之(zhi)。”黃(huang)芩、芍藥、甘草，加半(ban)夏、生姜(jiang)，這(zhe)是(shi)太陽少陽合病(bing)中(zhong)的變(bian)證(zheng)(zheng)(zheng)。筆者(zhe)認為，辨六(liu)經(jing)就是(shi)辨病(bing)，然后(hou)再(zai)辨經(jing)證(zheng)(zheng)(zheng)、腑證(zheng)(zheng)(zheng)、變(bian)證(zheng)(zheng)(zheng)、壞(huai)證(zheng)(zheng)(zheng)。整個《傷寒(han)論》就是(shi)一部(bu)醫案(an)(an)，六(liu)經(jing)病(bing)就講了(le)六(liu)個病(bing)。六(liu)個病(bing)當中(zhong)有經(jing)證(zheng)(zheng)(zheng)、腑證(zheng)(zheng)(zheng)，這(zhe)是(shi)我(wo)們現代講的辨證(zheng)(zheng)(zheng)論治的方(fang)案(an)(an)，然后(hou)講變(bian)證(zheng)(zheng)(zheng)和(he)壞(huai)證(zheng)(zheng)(zheng)怎么處理，可以說是(shi)辨病(bing)與辨證(zheng)(zheng)(zheng)相(xiang)結合的典范(fan)，故可示人(ren)以規矩。
芍藥加當歸
代表方(fang)當歸(gui)芍(shao)(shao)(shao)藥(yao)(yao)湯。有養血(xue)(xue)和(he)營(ying)作(zuo)用，《金(jin)匱要略》治療(liao)妊娠(shen)(shen)胎動不安(an)(an)，辨(bian)證屬于肝(gan)脾(pi)失(shi)和(he)者。方(fang)中(zhong)用當歸(gui)、芍(shao)(shao)(shao)藥(yao)(yao)、茯苓、白(bai)術、澤(ze)瀉(xie)、川(chuan)芎，川(chuan)芎要用的少一點，川(chuan)芎有活血(xue)(xue)作(zuo)用，要注意。芍(shao)(shao)(shao)藥(yao)(yao)斂養肝(gan)血(xue)(xue)，緩(huan)急止痛，當歸(gui)補養肝(gan)血(xue)(xue)。有安(an)(an)胎和(he)營(ying)止痛，對妊娠(shen)(shen)胎動不安(an)(an)有腹痛者，用當歸(gui)芍(shao)(shao)(shao)藥(yao)(yao)湯。另一方(fang)當歸(gui)芍(shao)(shao)(shao)藥(yao)(yao)散，《金(jin)匱要略》：“婦人妊娠(shen)(shen)，宜服(fu)當歸(gui)散主之。”婦科如胎位不正(zheng)，加川(chuan)斷、菟絲子、桑(sang)寄(ji)生、大腹皮、蘇葉、陳皮等(deng)；先兆流產加川(chuan)斷、菟絲子、桑(sang)寄(ji)生、苧麻(ma)根(gen)；功(gong)能性子宮出血(xue)(xue)加茜(qian)草、仙鶴草、蒲黃炭等(deng)。
芍藥加柴胡
代表方四(si)逆(ni)散。由于氣(qi)(qi)機(ji)被陽氣(qi)(qi)所郁遏(e)，氣(qi)(qi)機(ji)不(bu)(bu)暢，而導致(zhi)的(de)(de)四(si)肢(zhi)厥冷。此四(si)肢(zhi)厥冷不(bu)(bu)是虛證(zheng)是實(shi)證(zheng)。仲景(jing)書中(zhong)的(de)(de)厥癥都是實(shi)證(zheng)，一是氣(qi)(qi)機(ji)不(bu)(bu)能(neng)舒展，外邪侵犯，氣(qi)(qi)機(ji)不(bu)(bu)暢，用(yong)四(si)逆(ni)散。如果外邪侵犯導致(zhi)上下(xia)不(bu)(bu)通(tong)暢，上下(xia)氣(qi)(qi)不(bu)(bu)想順接，用(yong)三承氣(qi)(qi)湯。四(si)逆(ni)散中(zhong)用(yong)甘草、枳(zhi)實(shi)、柴胡、芍藥疏理氣(qi)(qi)機(ji)，它(ta)是調理氣(qi)(qi)機(ji)的(de)(de)祖方。柴胡疏肝(gan)解(jie)郁，透達郁陽，芍藥苦泄破結(jie)，通(tong)絡止痛(tong)(tong)。四(si)逆(ni)散現代臨床用(yong)于治療膽囊炎(yan)、肋(lei)間神經痛(tong)(tong)、肝(gan)炎(yan)、過(guo)敏性結(jie)腸(chang)炎(yan)、慢(man)性胃炎(yan)、便秘、月經不(bu)(bu)調、乳腺炎(yan)等(deng)。
芍藥加枳實
代表(biao)方(fang)枳實(shi)(shi)芍藥(yao)散(san)。《金匱要略(lve)·婦人篇》中講到(dao)，產后腹痛，煩滿不得臥，枳實(shi)(shi)芍藥(yao)散(san)主之。產婦腹痛，法當枳實(shi)(shi)芍藥(yao)散(san)。用枳實(shi)(shi)、芍藥(yao)理氣緩急止痛。枳實(shi)(shi)要燒(shao)黑，芍藥(yao)要等分。臨床(chuang)對(dui)氣滯血凝(ning)，惡露不盡，產后郁滯腹痛者(zhe)有效。《金匱要略(lve)·瘡(chuang)(chuang)癰(yong)腸癰(yong)篇》有排膿散(san)（枳實(shi)(shi)、芍藥(yao)、桔(jie)梗(geng)等），現代治療疔瘡(chuang)(chuang)癰(yong)瘍及各種無名腫塊等，有一定療效。
筆者(zhe)經(jing)驗，白(bai)芍(shao)加(jia)(jia)川芎，治療(liao)各(ge)種原因的頭痛(tong)(tong)(tong)，包括三叉神(shen)經(jing)痛(tong)(tong)(tong)，效果(guo)很好(hao)。芍(shao)藥(yao)可以(yi)用(yong)(yong)到30~50克，川芎可以(yi)用(yong)(yong)到12~30克。白(bai)芍(shao)加(jia)(jia)防風，治療(liao)各(ge)種過敏性(xing)結腸(chang)炎，這是(shi)(shi)取痛(tong)(tong)(tong)瀉(xie)要方意，對腸(chang)易激綜合癥(zheng)(zheng)這一類效果(guo)很好(hao)。白(bai)芍(shao)和(he)赤芍(shao)一起用(yong)(yong)，治療(liao)各(ge)種原因引起的疼痛(tong)(tong)(tong)，活血加(jia)(jia)養陰柔肝一起用(yong)(yong)。白(bai)芍(shao)加(jia)(jia)蓽菝，治療(liao)脘腹(fu)(fu)(fu)(fu)疼痛(tong)(tong)(tong)，脾胃病用(yong)(yong)得比較多。芍(shao)藥(yao)加(jia)(jia)黃連，腹(fu)(fu)(fu)(fu)痛(tong)(tong)(tong)腹(fu)(fu)(fu)(fu)瀉(xie)，是(shi)(shi)黃芩湯的用(yong)(yong)法。芍(shao)藥(yao)加(jia)(jia)白(bai)術(shu)，治療(liao)脘腹(fu)(fu)(fu)(fu)疼痛(tong)(tong)(tong)、泄瀉(xie)。白(bai)芍(shao)加(jia)(jia)木香、檳(bin)榔，治療(liao)腹(fu)(fu)(fu)(fu)痛(tong)(tong)(tong)腹(fu)(fu)(fu)(fu)瀉(xie)、里急(ji)后重，用(yong)(yong)于(yu)直腸(chang)炎，乙狀結腸(chang)炎，或者(zhe)是(shi)(shi)結腸(chang)癌手(shou)術(shu)后的后遺癥(zheng)(zheng)，里急(ji)后重，用(yong)(yong)木香、檳(bin)榔、青陳皮、黃連再加(jia)(jia)白(bai)芍(shao)，效果(guo)滿(man)意。白(bai)芍(shao)加(jia)(jia)干(gan)姜(jiang)，治療(liao)胃寒腹(fu)(fu)(fu)(fu)痛(tong)(tong)(tong)。白(bai)芍(shao)加(jia)(jia)麻(ma)仁，治療(liao)便秘效好(hao)。
赤芍的運用
以上重點談白芍的功效(xiao)與(yu)配伍運用(yong)(yong)(yong)，現代用(yong)(yong)(yong)赤芍主(zhu)要在以下三種情(qing)況(kuang)：①赤芍與(yu)生(sheng)地、丹(dan)皮(pi)合(he)用(yong)(yong)(yong)，清熱(re)涼血(xue)解(jie)毒(du)，如犀角(jiao)地黃湯，犀角(jiao)可以用(yong)(yong)(yong)水牛角(jiao)來代替。溫病熱(re)毒(du)深入(ru)營血(xue)，血(xue)熱(re)妄(wang)行，出現吐血(xue)，出血(xue)，斑疹，舌絳起刺的情(qing)況(kuang)。筆者經(jing)驗治(zhi)療糖尿病足、丹(dan)毒(du)、亞急性甲狀腺炎等效(xiao)果(guo)很好(hao)。②赤芍與(yu)桃仁、紅花同用(yong)(yong)(yong)，活血(xue)化瘀(yu)，通暢血(xue)脈(mo)，治(zhi)療經(jing)閉(bi)、痛(tong)經(jing)。③赤芍與(yu)金(jin)銀花、菊花同用(yong)(yong)(yong)，清肝熱(re)，風(feng)熱(re)，治(zhi)療風(feng)熱(re)頭痛(tong)。
芍藥的劑量
仲景在(zai)54個用(yong)(yong)(yong)(yong)芍(shao)藥方(fang)中注明用(yong)(yong)(yong)(yong)量的(de)(de)(de)有(you)(you)42方(fang)，用(yong)(yong)(yong)(yong)三(san)兩的(de)(de)(de)9方(fang)，用(yong)(yong)(yong)(yong)二兩的(de)(de)(de)2方(fang)，六兩、五兩、四(si)(si)兩各1個方(fang)。用(yong)(yong)(yong)(yong)于(yu)(yu)桂枝湯調和營(ying)衛的(de)(de)(de)用(yong)(yong)(yong)(yong)3兩，用(yong)(yong)(yong)(yong)于(yu)(yu)養(yang)血養(yang)陰的(de)(de)(de)如當歸四(si)(si)逆湯有(you)(you)3兩到4兩，用(yong)(yong)(yong)(yong)于(yu)(yu)止(zhi)(zhi)痛(tong)的(de)(de)(de)當歸芍(shao)藥散湯劑用(yong)(yong)(yong)(yong)6兩。古今(jin)劑量有(you)(you)別，一般用(yong)(yong)(yong)(yong)量在(zai)9~15克(ke)，***用(yong)(yong)(yong)(yong)于(yu)(yu)止(zhi)(zhi)痛(tong)可(ke)稍增加，特(te)別是嚴重的(de)(de)(de)疼痛(tong)，如三(san)叉神經痛(tong)、血管性疼痛(tong)、腹型(xing)癲癇、坐骨神經痛(tong)等，可(ke)用(yong)(yong)(yong)(yong)30~60克(ke)。加甘草(cao)，既(ji)加強緩急止(zhi)(zhi)痛(tong)作用(yong)(yong)(yong)(yong)，又(you)有(you)(you)監(jian)制其(qi)陰柔(rou)之性，沒有(you)(you)發現有(you)(you)副作用(yong)(yong)(yong)(yong)。
用芍藥禁忌
凡(fan)是(shi)胸陽(yang)(yang)不(bu)(bu)(bu)(bu)足(zu)引(yin)起(qi)的(de)(de)胸滿、驚悸、臥起(qi)不(bu)(bu)(bu)(bu)安者禁忌，如胸痹(bi)桂枝(zhi)生姜枳(zhi)實湯，烏(wu)頭赤石脂丸不(bu)(bu)(bu)(bu)用(yong)芍藥。引(yin)起(qi)胸痹(bi)的(de)(de)主要原因是(shi)心陽(yang)(yang)微(wei)，陰(yin)邪上乘，故陰(yin)藥慎用(yong)。由(you)此反(fan)推(tui)，胸陽(yang)(yang)不(bu)(bu)(bu)(bu)振(zhen)，不(bu)(bu)(bu)(bu)用(yong)白芍，可用(yong)赤芍。里(li)寒過甚的(de)(de)，如真武湯，方后(hou)有一句話，若下利(li)者去(qu)芍藥加干姜2兩。真武湯本身用(yong)于(yu)腎(shen)陽(yang)(yang)不(bu)(bu)(bu)(bu)足(zu)，陽(yang)(yang)虛水泛引(yin)起(qi)的(de)(de)水腫(zhong)，用(yong)陰(yin)藥不(bu)(bu)(bu)(bu)合適，要去(qu)芍藥加干姜。
芍藥的炮制
仲景對芍(shao)(shao)藥(yao)未論炮制(zhi)。現代(dai)用(yong)炒(chao)白(bai)(bai)(bai)芍(shao)(shao)加(jia)(jia)水炒(chao)，酒白(bai)(bai)(bai)芍(shao)(shao)加(jia)(jia)酒炒(chao)，醋白(bai)(bai)(bai)芍(shao)(shao)加(jia)(jia)醋炒(chao)。酒白(bai)(bai)(bai)芍(shao)(shao)藥(yao)止(zhi)中寒腹(fu)痛(tong)，醋白(bai)(bai)(bai)芍(shao)(shao)藥(yao)斂血(xue)止(zhi)血(xue)，土(tu)炒(chao)白(bai)(bai)(bai)芍(shao)(shao)，健(jian)脾(pi)止(zhi)血(xue)。《藥(yao)性切(qie)用(yong)》：“瀉火(huo)生(sheng)用(yong)，斂陰炒(chao)用(yong)，酒炒(chao)和血(xue)，醋炒(chao)止(zhi)血(xue)。”概括得很好。張錫純在《醫學衷中參西錄》生(sheng)用(yong)芍(shao)(shao)藥(yao)，反對濫加(jia)(jia)炮制(zhi)。
病案舉例
季某(mou)某(mou)，女，56歲。有(you)偏頭(tou)(tou)痛(tong)(tong)史多年(nian)，經(jing)常(chang)發作，尤其是在月經(jing)期或(huo)者(zhe)疲勞(lao)過度(du)時容易發作。近值更年(nian)期，頭(tou)(tou)痛(tong)(tong)發作頻(pin)繁，伴潮(chao)熱汗出，煩躁易怒，心(xin)緒不(bu)寧，睡眠不(bu)佳(jia)，胸(xiong)悶嘆(tan)息，口干舌燥，大便干結不(bu)爽。來(lai)診(zhen)(zhen)時頭(tou)(tou)痛(tong)(tong)劇烈，嘔吐2次(ci)，眩暈不(bu)支，診(zhen)(zhen)舌質微(wei)(wei)(wei)紅，苔薄微(wei)(wei)(wei)膩，脈來(lai)微(wei)(wei)(wei)數(shu)。患者(zhe)平素經(jing)常(chang)服用西藥止痛(tong)(tong)藥緩(huan)解頭(tou)(tou)痛(tong)(tong)，故胃中經(jing)常(chang)不(bu)舒。此心(xin)火旺、肝陽亢(kang)、陰分虧。治宜清心(xin)火、平肝陽、滋腎(shen)水(shui)、止頭(tou)(tou)痛(tong)(tong)。處方(fang)：知母(mu)12克(ke)(ke)(ke)(ke)(ke)，黃連6克(ke)(ke)(ke)(ke)(ke)，山梔12克(ke)(ke)(ke)(ke)(ke)，天麻12克(ke)(ke)(ke)(ke)(ke)，赤白芍（各）20克(ke)(ke)(ke)(ke)(ke)，珍珠母(mu)30克(ke)(ke)(ke)(ke)(ke)，麥冬(dong)12克(ke)(ke)(ke)(ke)(ke)，玉竹(zhu)12克(ke)(ke)(ke)(ke)(ke)，柏子(zi)仁(ren)(ren)15克(ke)(ke)(ke)(ke)(ke)，女貞子(zi)15克(ke)(ke)(ke)(ke)(ke)，遠志9克(ke)(ke)(ke)(ke)(ke)，7劑。藥后頭(tou)(tou)痛(tong)(tong)稍(shao)緩(huan)解，不(bu)再嘔吐，上方(fang)白芍改30克(ke)(ke)(ke)(ke)(ke)，加(jia)羚羊(yang)角粉***×2支（分2次(ci)早晚沖服），14劑。三診(zhen)(zhen)頭(tou)(tou)痛(tong)(tong)平定，潮(chao)熱汗出好轉，睡眠改善，再以滋水(shui)涵木、清心(xin)安神法(fa)善后。生熟(shu)地12克(ke)(ke)(ke)(ke)(ke)，知母(mu)12克(ke)(ke)(ke)(ke)(ke)，黃連6克(ke)(ke)(ke)(ke)(ke)，天麻12克(ke)(ke)(ke)(ke)(ke)，赤白芍（各）15克(ke)(ke)(ke)(ke)(ke)，珍珠母(mu)30克(ke)(ke)(ke)(ke)(ke)，麥冬(dong)12克(ke)(ke)(ke)(ke)(ke)，柏子(zi)仁(ren)(ren)15克(ke)(ke)(ke)(ke)(ke)，女貞子(zi)15克(ke)(ke)(ke)(ke)(ke)，酸(suan)棗(zao)仁(ren)(ren)15克(ke)(ke)(ke)(ke)(ke)，藿(huo)蘇梗(geng)（各）12克(ke)(ke)(ke)(ke)(ke)，14劑。隨訪：近半(ban)年(nian)來(lai)頭(tou)(tou)痛(tong)(tong)未再大發。
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