中(zhong)藥(yao)(yao)(yao)的(de)(de)(de)性(xing)能,是(shi)指藥(yao)(yao)(yao)物(wu)(wu)的(de)(de)(de)性(xing)味和功能,也就是(shi)中(zhong)藥(yao)(yao)(yao)的(de)(de)(de)藥(yao)(yao)(yao)性(xing)理論。每(mei)一種(zhong)(zhong)藥(yao)(yao)(yao)物(wu)(wu)都(dou)具有一定的(de)(de)(de)性(xing)能,把(ba)各種(zhong)(zhong)中(zhong)藥(yao)(yao)(yao)的(de)(de)(de)性(xing)能歸納(na)起來(lai),主要有四氣(qi)、五味,升降浮(fu)沉及歸經(jing)等(deng)方面。對中(zhong)藥(yao)(yao)(yao)性(xing)能的(de)(de)(de)認識(shi),是(shi)歷(li)代醫家在醫療實(shi)踐中(zhong)逐步探索出(chu)來(lai)的(de)(de)(de)。如藥(yao)(yao)(yao)性(xing)的(de)(de)(de)寒、熱(re)(re)、補(bu)、瀉(xie)、升、降、浮(fu)、沉,就是(shi)依據疾病性(xing)質的(de)(de)(de)寒、熱(re)(re)、虛、實(shi)和臟(zang)腑(fu)功能的(de)(de)(de)升、降變化等(deng)總結出(chu)來(lai)的(de)(de)(de)。藥(yao)(yao)(yao)物(wu)(wu)的(de)(de)(de)歸經(jing)是(shi)依據藥(yao)(yao)(yao)物(wu)(wu)對不同臟(zang)腑(fu)經(jing)絡的(de)(de)(de)病變起著選擇性(xing)作用歸納(na)出(chu)來(lai)的(de)(de)(de)。藥(yao)(yao)(yao)性(xing)理論是(shi)以(yi)陰(yin)陽、臟(zang)腑(fu)、經(jing)絡等(deng)學說(shuo)為基礎(chu)的(de)(de)(de)。
中(zhong)(zhong)(zhong)醫(yi)學認為(wei),一(yi)切疾病(bing)(bing)的(de)(de)發展變(bian)化過程,實際上都是(shi)人體陰(yin)陽邪正(zheng)(zheng)的(de)(de)相互(hu)消長(chang),是(shi)臟腑(fu)經(jing)絡功(gong)能失調后,反(fan)映出來的(de)(de)陰(yin)陽偏勝偏衰(shuai)的(de)(de)狀態。而(er)中(zhong)(zhong)(zhong)藥(yao)(yao)治病(bing)(bing)的(de)(de)基本(ben)作(zuo)用,就在于消除致(zhi)病(bing)(bing)因(yin)素,恢復(fu)和(he)調整臟腑(fu)的(de)(de)功(gong)能,糾正(zheng)(zheng)陰(yin)陽偏勝偏衰(shuai)的(de)(de)病(bing)(bing)理現象。因(yin)此,中(zhong)(zhong)(zhong)藥(yao)(yao)治病(bing)(bing),就是(shi)利用每(mei)種藥(yao)(yao)物不(bu)(bu)(bu)(bu)(bu)同(tong)(tong)(tong)(tong)的(de)(de)偏性(xing)。如(ru)不(bu)(bu)(bu)(bu)(bu)同(tong)(tong)(tong)(tong)的(de)(de)氣,不(bu)(bu)(bu)(bu)(bu)同(tong)(tong)(tong)(tong)的(de)(de)味(wei)(wei)和(he)不(bu)(bu)(bu)(bu)(bu)同(tong)(tong)(tong)(tong)的(de)(de)歸經(jing)等(deng)(deng),以及味(wei)(wei)同(tong)(tong)(tong)(tong)氣不(bu)(bu)(bu)(bu)(bu)同(tong)(tong)(tong)(tong),或氣同(tong)(tong)(tong)(tong)而(er)味(wei)(wei)不(bu)(bu)(bu)(bu)(bu)同(tong)(tong)(tong)(tong),或氣味(wei)(wei)相同(tong)(tong)(tong)(tong)而(er)歸經(jing)又不(bu)(bu)(bu)(bu)(bu)同(tong)(tong)(tong)(tong),等(deng)(deng)等(deng)(deng)。必須熟悉(xi)這(zhe)些性(xing)能,并掌握每(mei)一(yi)種藥(yao)(yao)物特點,才能在“辨(bian)證(zheng)”明確(que)的(de)(de)基礎上,恰當地(di)處(chu)方用藥(yao)(yao)。可見,運用中(zhong)(zhong)(zhong)藥(yao)(yao)治療疾病(bing)(bing),如(ru)果離開(kai)了中(zhong)(zhong)(zhong)醫(yi)藥(yao)(yao)學理論的(de)(de)指導,是(shi)不(bu)(bu)(bu)(bu)(bu)可能達到預期療效的(de)(de)。
1.四氣五味
四(si)氣、五(wu)味(wei)就是藥物(wu)(wu)的(de)性(xing)味(wei),每(mei)一種藥物(wu)(wu)都具有性(xing)和味(wei)兩個方面。這是說明藥物(wu)(wu)功效的(de)主要(yao)依據,也是構成藥物(wu)(wu)性(xing)能(neng)的(de)重要(yao)部分,對臨床實踐具有重要(yao)的(de)指導意義。
(1)四氣
氣(qi)(qi)(qi)(qi),是指藥(yao)物的性(xing)(xing)質,四(si)氣(qi)(qi)(qi)(qi)就是寒(han)(han)、熱(re)(re)、溫(wen)(wen)、涼(liang)(liang)四(si)種(zhong)不同(tong)的藥(yao)性(xing)(xing)。所以四(si)氣(qi)(qi)(qi)(qi),又(you)稱(cheng)四(si)性(xing)(xing)。而溫(wen)(wen)與(yu)熱(re)(re)、寒(han)(han)與(yu)涼(liang)(liang)僅僅是程度上(shang)的差異,溫(wen)(wen)次于(yu)熱(re)(re),涼(liang)(liang)次于(yu)寒(han)(han),微(wei)寒(han)(han)相當于(yu)涼(liang)(liang),大溫(wen)(wen)相當于(yu)熱(re)(re),因(yin)此(ci),寒(han)(han)涼(liang)(liang)和溫(wen)(wen)熱(re)(re)實質上(shang)是寒(han)(han)熱(re)(re)兩類藥(yao)性(xing)(xing)。此(ci)外,還有(you)平(ping)性(xing)(xing)藥(yao),是指寒(han)(han)涼(liang)(liang)和溫(wen)(wen)熱(re)(re)性(xing)(xing)質不甚(shen)明顯(xian),作用比較平(ping)和的藥(yao)物,但實質上(shang)仍有(you)偏(pian)溫(wen)(wen)、偏(pian)涼(liang)(liang)的不同(tong),仍然屬于(yu)四(si)氣(qi)(qi)(qi)(qi)的范圍(wei),所以不稱(cheng)五氣(qi)(qi)(qi)(qi),而仍稱(cheng)四(si)氣(qi)(qi)(qi)(qi)。四(si)氣(qi)(qi)(qi)(qi)之中,寒(han)(han)涼(liang)(liang)屬陰,溫(wen)(wen)熱(re)(re)屬陽。
藥性(xing)的寒(han)、熱、溫、涼(liang),是根據藥物(wu)(wu)(wu)作用于(yu)人體所發生的反應和(he)治療(liao)效果而歸納(na)出來的。凡是能(neng)夠治療(liao)熱性(xing)病證(zheng)的藥物(wu)(wu)(wu),便認為是寒(han)性(xing)或涼(liang)性(xing);能(neng)夠治療(liao)寒(han)性(xing)病證(zheng)的藥物(wu)(wu)(wu),便認為是熱性(xing)或溫性(xing)。
四氣(qi)的作用(yong)(yong):一般地說,寒(han)(han)(han)涼(liang)性藥物(wu)大(da)(da)多(duo)具有清(qing)熱、瀉火、解毒等作用(yong)(yong),常(chang)用(yong)(yong)于大(da)(da)熱煩渴,面(mian)紅目(mu)赤(chi),脈洪數等熱證(zheng)(zheng)(zheng)陽證(zheng)(zheng)(zheng)患者,如(ru)石(shi)膏、知(zhi)母(mu)、黃連等;溫(wen)熱性藥物(wu)大(da)(da)多(duo)具有溫(wen)中、助陽、散寒(han)(han)(han)等作用(yong)(yong),常(chang)用(yong)(yong)于畏寒(han)(han)(han)肢冷,面(mian)色蒼白,大(da)(da)便(bian)清(qing)稀(xi),脈微弱等寒(han)(han)(han)證(zheng)(zheng)(zheng)陰(yin)證(zheng)(zheng)(zheng)患者,如(ru)附子、干(gan)姜、肉桂(gui)等。由(you)此可知(zhi),如(ru)果不(bu)明四氣(qi),不(bu)分陰(yin)陽,治療陽證(zheng)(zheng)(zheng)熱證(zheng)(zheng)(zheng)用(yong)(yong)熱藥,陰(yin)證(zheng)(zheng)(zheng)寒(han)(han)(han)證(zheng)(zheng)(zheng)用(yong)(yong)寒(han)(han)(han)藥,藥證(zheng)(zheng)(zheng)不(bu)合,則勢(shi)必促使病情(qing)惡化(hua),甚至造成(cheng)死(si)亡。
(2)五味
味(wei),是(shi)指藥(yao)(yao)物(wu)的(de)味(wei)道(dao),五(wu)味(wei)就是(shi)辛、甘、酸、苦(ku)、咸五(wu)種不(bu)(bu)同(tong)(tong)的(de)味(wei)道(dao)。此外,還有淡味(wei),因(yin)(yin)其藥(yao)(yao)味(wei)不(bu)(bu)甚明顯,前(qian)人將(jiang)它附屬于甘,常(chang)甘淡并稱。因(yin)(yin)此,一般仍(reng)稱五(wu)味(wei)。這些味(wei)道(dao),主要是(shi)由昧覺(jue)器官辨別出來的(de),或是(shi)根據臨床(chuang)治療反映出來的(de)效(xiao)果(guo)而確定的(de)。前(qian)人在(zai)長期醫療實(shi)踐中,發現不(bu)(bu)同(tong)(tong)味(wei)道(dao)的(de)藥(yao)(yao)物(wu)具有不(bu)(bu)同(tong)(tong)的(de)治療作用,因(yin)(yin)而總(zong)結了五(wu)味(wei)的(de)用藥(yao)(yao)理論,對(dui)于臨床(chuang)用藥(yao)(yao)有重要指導意義(yi)。現將(jiang)五(wu)味(wei)的(de)作用分述如下:
辛:能散能行(xing),具有發(fa)散、行(xing)氣、活血(xue)的作(zuo)用,常用于外感表證(zheng)和氣血(xue)阻滯的病證(zheng)。如(ru)蘇(su)葉發(fa)表,木香(xiang)行(xing)氣,川芎活血(xue)等。
甘:能補(bu)能緩,具有(you)補(bu)養、緩和的作用。常用于虛(xu)證(zheng)(zheng)或拘急疼痛等病(bing)證(zheng)(zheng)。如人參補(bu)氣,熟地補(bu)血,甘草和中、緩急止痛等。
酸:能收能斂(lian),具有(you)收斂(lian)固澀的(de)作用(yong)。常用(yong)于(yu)虛(xu)汗外泄、遺精帶下、久瀉(xie)不止等病證。如五味子收斂(lian)止汗,金櫻子固精止遺,訶(he)子澀腸止瀉(xie)等。
苦:能(neng)瀉(xie)能(neng)降能(neng)燥,具有瀉(xie)火(huo)(huo)、瀉(xie)下、降逆及(ji)燥濕(shi)(shi)的作(zuo)用(yong)(yong)。常用(yong)(yong)于熱性病,大便不(bu)通,氣逆脹滿等病證。如黃(huang)連瀉(xie)火(huo)(huo),大黃(huang)瀉(xie)下通便,杏(xing)仁降逆平喘,厚(hou)樸燥濕(shi)(shi)散滿等。
咸:能下能軟(ruan),具有潤下軟(ruan)堅(jian)的作用。常用于瘰疬痰(tan)核、大便(bian)燥結(jie)等(deng)病證。如牡蠣軟(ruan)堅(jian)散結(jie),芒硝潤下通便(bian)等(deng)。
淡:能(neng)滲(shen)能(neng)利,具(ju)有滲(shen)濕(shi)利水(shui)的作用(yong)。常(chang)用(yong)于濕(shi)邪阻滯,小便不利等病證(zheng)。如茯苓、通草,既能(neng)滲(shen)濕(shi)又能(neng)利水(shui)等。
五味之中(zhong),辛甘淡為陽,酸苦咸為陰。
氣和(he)味(wei)是(shi)構成藥(yao)性的(de)主要依(yi)據,它們(men)之間的(de)關系是(shi)非常密切(qie)的(de)。每(mei)一種藥(yao)物都(dou)具有氣和(he)味(wei)兩方面,必須把兩方面綜合(he)起來(lai),才能(neng)比較全面地掌握(wo)藥(yao)性。例如紫(zi)蘇(su)味(wei)辛性溫(wen)(wen),辛能(neng)發散,溫(wen)(wen)可散寒(han),所(suo)以,紫(zi)蘇(su)主要有發散風寒(han)作用;蘆(lu)根味(wei)甘性寒(han),甘能(neng)生津,寒(han)能(neng)清熱,所(suo)以,蘆(lu)根主要有清熱生津功效等(deng)。
一般(ban)說來,氣(qi)(qi)(qi)(qi)味(wei)(wei)相同(tong)的(de)(de)藥(yao)(yao)(yao)(yao)物(wu)(wu),其主要(yao)作(zuo)(zuo)(zuo)用(yong)(yong)大致相同(tong),例(li)如(ru)辛(xin)(xin)(xin)溫(wen)藥(yao)(yao)(yao)(yao)物(wu)(wu)大都具有(you)(you)發(fa)表散(san)寒(han)的(de)(de)作(zuo)(zuo)(zuo)用(yong)(yong),苦寒(han)藥(yao)(yao)(yao)(yao)物(wu)(wu)大都具有(you)(you)清熱(re)瀉(xie)火的(de)(de)作(zuo)(zuo)(zuo)用(yong)(yong)。氣(qi)(qi)(qi)(qi)味(wei)(wei)不同(tong)的(de)(de)藥(yao)(yao)(yao)(yao)物(wu)(wu),作(zuo)(zuo)(zuo)用(yong)(yong)也就有(you)(you)所不同(tong),如(ru)氣(qi)(qi)(qi)(qi)同(tong)味(wei)(wei)異,同(tong)是溫(wen)性(xing)(xing)藥(yao)(yao)(yao)(yao),具有(you)(you)溫(wen)里散(san)寒(han)的(de)(de)共性(xing)(xing),但(dan)(dan)麻黃(huang)辛(xin)(xin)(xin)溫(wen)發(fa)汗(han),黃(huang)芪甘(gan)溫(wen)補(bu)氣(qi)(qi)(qi)(qi),厚樸苦溫(wen)燥濕,烏梅(mei)酸溫(wen)收斂,蛤蚧咸溫(wen)補(bu)腎;又(you)味(wei)(wei)同(tong)氣(qi)(qi)(qi)(qi)異,同(tong)是辛(xin)(xin)(xin)味(wei)(wei)藥(yao)(yao)(yao)(yao),具有(you)(you)發(fa)散(san)行(xing)氣(qi)(qi)(qi)(qi)的(de)(de)共性(xing)(xing),而(er)(er)(er)薄荷辛(xin)(xin)(xin)涼(liang)發(fa)散(san)風熱(re),紫(zi)蘇辛(xin)(xin)(xin)溫(wen)發(fa)散(san)風寒(han),石(shi)膏辛(xin)(xin)(xin)寒(han)能除(chu)大熱(re),附子辛(xin)(xin)(xin)熱(re)可祛陰寒(han)等。還有(you)(you)些藥(yao)(yao)(yao)(yao)物(wu)(wu),一氣(qi)(qi)(qi)(qi)兼有(you)(you)兩(liang)種以上(shang)的(de)(de)味(wei)(wei),其作(zuo)(zuo)(zuo)用(yong)(yong)范(fan)圍也就相應擴大,而(er)(er)(er)有(you)(you)多種作(zuo)(zuo)(zuo)用(yong)(yong),如(ru)當(dang)歸甘(gan)辛(xin)(xin)(xin),甘(gan)既能補(bu)辛(xin)(xin)(xin)又(you)能行(xing)等。凡氣(qi)(qi)(qi)(qi)味(wei)(wei)相同(tong)的(de)(de)藥(yao)(yao)(yao)(yao)物(wu)(wu),作(zuo)(zuo)(zuo)用(yong)(yong)一般(ban)也相類似,這是共性(xing)(xing),但(dan)(dan)每(mei)種藥(yao)(yao)(yao)(yao)物(wu)(wu)又(you)各有(you)(you)特(te)(te)性(xing)(xing),如(ru)紫(zi)蘇、生(sheng)姜(jiang)氣(qi)(qi)(qi)(qi)味(wei)(wei)均為辛(xin)(xin)(xin)溫(wen),具有(you)(you)發(fa)汗(han)散(san)寒(han)的(de)(de)共性(xing)(xing),但(dan)(dan)紫(zi)蘇發(fa)汗(han)功效較(jiao)(jiao)強(qiang),并有(you)(you)行(xing)氣(qi)(qi)(qi)(qi)安胎作(zuo)(zuo)(zuo)用(yong)(yong),生(sheng)姜(jiang)發(fa)汗(han)功效較(jiao)(jiao)弱,另(ling)有(you)(you)溫(wen)胃止嘔作(zuo)(zuo)(zuo)用(yong)(yong),這說明藥(yao)(yao)(yao)(yao)物(wu)(wu)的(de)(de)性(xing)(xing)能在相同(tong)之中又(you)各有(you)(you)不同(tong)的(de)(de)特(te)(te)點。由(you)此可見,藥(yao)(yao)(yao)(yao)物(wu)(wu)的(de)(de)氣(qi)(qi)(qi)(qi)味(wei)(wei)比較(jiao)(jiao)復(fu)雜(za)。因此,我們不但(dan)(dan)要(yao)熟(shu)悉(xi)四氣(qi)(qi)(qi)(qi)、五味(wei)(wei)的(de)(de)一般(ban)規律和藥(yao)(yao)(yao)(yao)物(wu)(wu)的(de)(de)共性(xing)(xing),還必須(xu)掌握(wo)每(mei)一藥(yao)(yao)(yao)(yao)物(wu)(wu)的(de)(de)特(te)(te)性(xing)(xing),才能較(jiao)(jiao)為全面而(er)(er)(er)正(zheng)確地指導臨床運用(yong)(yong)。
2.升降浮沉
升(sheng)(sheng)降浮沉是(shi)指藥(yao)物(wu)作(zuo)用(yong)于(yu)(yu)(yu)人體上、下(xia)(xia)、表(biao)、里的四種趨(qu)(qu)向(xiang)(xiang)而言(yan)。升(sheng)(sheng)是(shi)上升(sheng)(sheng)舉陷(xian),趨(qu)(qu)向(xiang)(xiang)于(yu)(yu)(yu)上;降是(shi)下(xia)(xia)降平逆,趨(qu)(qu)向(xiang)(xiang)于(yu)(yu)(yu)下(xia)(xia);浮是(shi)上行發散(san),趨(qu)(qu)向(xiang)(xiang)于(yu)(yu)(yu)表(biao);沉是(shi)下(xia)(xia)行泄利,趨(qu)(qu)向(xiang)(xiang)于(yu)(yu)(yu)里;升(sheng)(sheng)與浮、沉與降,其趨(qu)(qu)向(xiang)(xiang)是(shi)類似的。升(sheng)(sheng)浮藥(yao)主(zhu)上升(sheng)(sheng)而向(xiang)(xiang)外,具(ju)有升(sheng)(sheng)陽、發表(biao)、散(san)寒和催(cui)吐等作(zuo)用(yong);沉降藥(yao)主(zhu)下(xia)(xia)行而向(xiang)(xiang)內,具(ju)有清熱、瀉下(xia)(xia)、利水(shui)、潛陰、降逆、收斂和止(zhi)吐等作(zuo)用(yong)。
升(sheng)(sheng)降浮(fu)(fu)(fu)(fu)沉(chen)(chen)4種藥(yao)(yao)性,也是臨(lin)床(chuang)用(yong)(yong)(yong)藥(yao)(yao)原則之一(yi)。因為體發生(sheng)病(bing)變的(de)部位,有上(shang)(shang)下(xia)表(biao)里的(de)不(bu)同,病(bing)勢(shi)有上(shang)(shang)逆下(xia)陷的(de)差別,在(zai)(zai)治療(liao)上(shang)(shang)就需要針對病(bing)情選(xuan)用(yong)(yong)(yong)藥(yao)(yao)物。病(bing)邪(xie)在(zai)(zai)上(shang)(shang)在(zai)(zai)表(biao)的(de),宜(yi)(yi)(yi)(yi)用(yong)(yong)(yong)升(sheng)(sheng)浮(fu)(fu)(fu)(fu)而不(bu)用(yong)(yong)(yong)沉(chen)(chen)降,如(ru)外(wai)感風(feng)寒(han)之表(biao)證(zheng),用(yong)(yong)(yong)麻黃(huang)、紫蘇等(deng)升(sheng)(sheng)浮(fu)(fu)(fu)(fu)藥(yao)(yao)以(yi)發散風(feng)寒(han);病(bing)邪(xie)在(zai)(zai)下(xia)在(zai)(zai)里的(de),宜(yi)(yi)(yi)(yi)用(yong)(yong)(yong)沉(chen)(chen)降而不(bu)用(yong)(yong)(yong)升(sheng)(sheng)浮(fu)(fu)(fu)(fu),如(ru)腸燥便(bian)秘之里實證(zheng),當用(yong)(yong)(yong)大黃(huang)、枳實等(deng)沉(chen)(chen)降藥(yao)(yao)以(yi)攻里通便(bian);病(bing)勢(shi)上(shang)(shang)逆的(de)宜(yi)(yi)(yi)(yi)降不(bu)宜(yi)(yi)(yi)(yi)升(sheng)(sheng),如(ru)肝(gan)(gan)火上(shang)(shang)升(sheng)(sheng)、肝(gan)(gan)陽上(shang)(shang)亢(kang)引起(qi)的(de)頭痛(tong)、眩暈、目赤等(deng),用(yong)(yong)(yong)黃(huang)連、決明子(zi)、石決明和牡蠣等(deng)沉(chen)(chen)降藥(yao)(yao)以(yi)清熱降火、平肝(gan)(gan)潛陽;若(ruo)病(bing)勢(shi)下(xia)陷的(de)宜(yi)(yi)(yi)(yi)升(sheng)(sheng)不(bu)宜(yi)(yi)(yi)(yi)降,如(ru)久瀉脫(tuo)肛、婦女(nv)陰挺,用(yong)(yong)(yong)黃(huang)芪、升(sheng)(sheng)麻等(deng)升(sheng)(sheng)浮(fu)(fu)(fu)(fu)藥(yao)(yao)以(yi)益氣升(sheng)(sheng)陽。這(zhe)是用(yong)(yong)(yong)藥(yao)(yao)治病(bing)的(de)規律。如(ru)違背(bei)這(zhe)一(yi)規律,就會產生(sheng)不(bu)良后果(guo),如(ru)肝(gan)(gan)陽上(shang)(shang)亢(kang)之頭痛(tong),若(ruo)用(yong)(yong)(yong)升(sheng)(sheng)浮(fu)(fu)(fu)(fu)藥(yao)(yao)治療(liao),則陽升(sheng)(sheng)無制,易引起(qi)痙厥(jue)之證(zheng);脾氣下(xia)陷的(de)久瀉,若(ruo)用(yong)(yong)(yong)沉(chen)(chen)降藥(yao)(yao)治療(liao),則下(xia)陷更甚,必導致洞泄不(bu)禁。
藥(yao)物(wu)(wu)升(sheng)降浮(fu)沉的(de)不同作用,與四氣(qi)(qi)五味(wei)(wei)、質地輕重(zhong)以及炮制(zhi)等都(dou)(dou)有(you)(you)密切聯系。凡(fan)是味(wei)(wei)辛(xin)甘、氣(qi)(qi)溫熱的(de)藥(yao)物(wu)(wu),大都(dou)(dou)能升(sheng)浮(fu),如(ru)麻(ma)黃(huang)、黃(huang)芪等;味(wei)(wei)酸(suan)苦咸、氣(qi)(qi)寒涼的(de)藥(yao)物(wu)(wu),大都(dou)(dou)能沉降,如(ru)大黃(huang)、芒(mang)硝等。凡(fan)花葉(xie)(xie)(xie)及質輕的(de)藥(yao)物(wu)(wu),大多能升(sheng)浮(fu),如(ru)辛(xin)夷(yi)、蘇葉(xie)(xie)(xie)、升(sheng)麻(ma)和桔梗(geng)等;子(zi)(zi)實及質重(zhong)的(de)藥(yao)物(wu)(wu)大多能沉降,如(ru)紫蘇子(zi)(zi),枳實、石(shi)決明和代赭(zhe)石(shi)等。但其中也有(you)(you)一(yi)些例外情(qing)況,如(ru)旋覆花、番瀉葉(xie)(xie)(xie)等花葉(xie)(xie)(xie)類(lei)(lei)藥(yao)物(wu)(wu),其性(xing)應(ying)升(sheng)而反(fan)降;蔓(man)荊(jing)子(zi)(zi)、蒼耳子(zi)(zi)等果實類(lei)(lei)藥(yao)物(wu)(wu),其性(xing)應(ying)降而反(fan)升(sheng),這說明藥(yao)物(wu)(wu)在一(yi)般(ban)規(gui)律中各有(you)(you)其特性(xing)。
藥(yao)(yao)物的升(sheng)(sheng)降(jiang)(jiang)浮沉(chen)(chen),雖(sui)是以氣味和質輕重為依據,但由于中藥(yao)(yao)的運用(yong),多(duo)以復方出現,故(gu)其(qi)性(xing)能每隨著配伍、炮(pao)制而(er)有所轉(zhuan)化。如沉(chen)(chen)降(jiang)(jiang)藥(yao)(yao)經酒制或(huo)與(yu)較多(duo)、較強的升(sheng)(sheng)浮藥(yao)(yao)同用(yong),也能隨之(zhi)而(er)上(shang)升(sheng)(sheng);升(sheng)(sheng)浮藥(yao)(yao)經鹽制或(huo)與(yu)較多(duo)、較強的沉(chen)(chen)降(jiang)(jiang)藥(yao)(yao)同用(yong),也可隨之(zhi)而(er)下降(jiang)(jiang)。因此(ci),在臨床(chuang)用(yong)藥(yao)(yao)時(shi),除掌握(wo)一般(ban)原則外,還要知其(qi)中的變化,才能達到準確運用(yong)中藥(yao)(yao)的目的。
3.歸經
歸(gui)經(jing),是(shi)說明某種藥(yao)物對某些臟腑(fu)(fu)經(jing)絡(luo)的(de)病(bing)(bing)變(bian)起著主要治療作(zuo)(zuo)用(yong)(yong)。藥(yao)物對人體所(suo)起的(de)作(zuo)(zuo)用(yong)(yong),都有一定的(de)適應(ying)范(fan)圍(wei),如寒性藥(yao)物,雖同(tong)(tong)樣具有清熱(re)作(zuo)(zuo)用(yong)(yong),但其適應(ying)范(fan)圍(wei):有的(de)偏清肺(fei)熱(re),有的(de)偏清肝熱(re),有的(de)偏清胃火,各有所(suo)專;同(tong)(tong)一補藥(yao),也(ye)有補肺(fei)、補脾、補腎的(de)不同(tong)(tong)。因此,祖(zu)國(guo)醫學便(bian)根據臟腑(fu)(fu)經(jing)絡(luo)學說,結(jie)合藥(yao)物對不同(tong)(tong)臟腑(fu)(fu)經(jing)絡(luo)的(de)病(bing)(bing)變(bian)發(fa)揮不同(tong)(tong)的(de)治療作(zuo)(zuo)用(yong)(yong)進(jin)行(xing)了歸(gui)納(na),得出某藥(yao)能治某經(jing)的(de)病(bing)(bing),某藥(yao)歸(gui)入某經(jing)的(de)結(jie)論(lun)(lun),這(zhe)就(jiu)形成藥(yao)物的(de)歸(gui)經(jing)理論(lun)(lun)。
藥(yao)物的歸經(jing)(jing)(jing),主要是(shi)以臟(zang)(zang)腑(fu)經(jing)(jing)(jing)絡(luo)理論為(wei)基礎的。因為(wei)經(jing)(jing)(jing)絡(luo)能(neng)(neng)溝通(tong)人體(ti)(ti)內外表(biao)(biao)里,在(zai)病(bing)理狀態(tai)下,體(ti)(ti)表(biao)(biao)的病(bing)變(bian)可以通(tong)過經(jing)(jing)(jing)絡(luo)而影響(xiang)內在(zai)的臟(zang)(zang)腑(fu),臟(zang)(zang)腑(fu)的病(bing)變(bian)也可通(tong)過經(jing)(jing)(jing)絡(luo)而反映到體(ti)(ti)表(biao)(biao)。因此,人體(ti)(ti)各部(bu)分發(fa)生病(bing)變(bian)時,所(suo)(suo)出現的證(zheng)候,可以通(tong)過經(jing)(jing)(jing)絡(luo)而獲得系(xi)統的認(ren)識。如肺(fei)經(jing)(jing)(jing)病(bing)變(bian),每(mei)見(jian)喘(chuan)咳(ke)、胸痛(tong)(tong)(tong)等證(zheng);肝經(jing)(jing)(jing)病(bing)變(bian),每(mei)見(jian)脅(xie)痛(tong)(tong)(tong)、抽搐等證(zheng);心經(jing)(jing)(jing)病(bing)變(bian),每(mei)見(jian)神昏(hun)、心悸等證(zheng);脾經(jing)(jing)(jing)病(bing)變(bian),每(mei)見(jian)腹瀉、水(shui)腫等證(zheng);腎(shen)(shen)經(jing)(jing)(jing)病(bing)變(bian),每(mei)見(jian)腰痛(tong)(tong)(tong)、遺精等證(zheng)。我們(men)根據(ju)藥(yao)物的功效與臟(zang)(zang)腑(fu)經(jing)(jing)(jing)絡(luo)的密切關系(xi),就可以說(shuo)明(ming)某藥(yao)對某些臟(zang)(zang)腑(fu)、經(jing)(jing)(jing)絡(luo)的病(bing)變(bian)起著主要作用(yong)。如桔(jie)梗(geng)、杏(xing)仁能(neng)(neng)治咳(ke)嗽(sou)、氣(qi)喘(chuan),故(gu)(gu)歸肺(fei)經(jing)(jing)(jing);香附、羚羊角(jiao)能(neng)(neng)治抽搐、脅(xie)痛(tong)(tong)(tong),故(gu)(gu)歸入肝經(jing)(jing)(jing);菖(chang)蒲、朱砂能(neng)(neng)治心悸、神昏(hun),故(gu)(gu)入心經(jing)(jing)(jing);白術、山藥(yao)能(neng)(neng)治腹瀉、水(shui)腫,故(gu)(gu)入脾經(jing)(jing)(jing);菟絲子、補骨脂能(neng)(neng)治腰痛(tong)(tong)(tong)、遺精,故(gu)(gu)歸入腎(shen)(shen)經(jing)(jing)(jing)等。由此可見(jian),歸經(jing)(jing)(jing)的理論,具體(ti)(ti)指出藥(yao)效的所(suo)(suo)在(zai),也是(shi)人們(men)長(chang)期從臨床療效觀察中總結出來(lai)的用(yong)藥(yao)規(gui)律。
藥(yao)物(wu)的五(wu)(wu)味與五(wu)(wu)臟也(ye)有一定的關系。一般來講,辛入(ru)(ru)(ru)肺、甘入(ru)(ru)(ru)脾、酸入(ru)(ru)(ru)肝、苦入(ru)(ru)(ru)心、咸入(ru)(ru)(ru)腎,這是(shi)根據藥(yao)物(wu)五(wu)(wu)味對(dui)疾病(bing)治(zhi)療作用而作出的歸納,是(shi)歸經用藥(yao)的一般規(gui)律。
至于一種藥物可以歸(gui)數(shu)(shu)經的(de)(de),是(shi)說(shuo)明對數(shu)(shu)經都有(you)治(zhi)療作用(yong),例如杏仁(ren)歸(gui)肺、大腸二經,是(shi)說(shuo)杏仁(ren)既能平喘止咳,又能潤腸通(tong)便;石(shi)膏歸(gui)肺、胃二經,是(shi)說(shuo)石(shi)膏既能清肺熱(re),又能清胃熱(re)。不過,在具體(ti)運用(yong)時,對一藥入數(shu)(shu)經應分清主次(ci),才(cai)能收(shou)到更(geng)好的(de)(de)效果。
歸(gui)(gui)經(jing)雖具體指出了藥(yao)(yao)效所(suo)在,便(bian)于(yu)臨(lin)床(chuang)應(ying)用。但人體的(de)(de)疾病是(shi)復雜(za)多變的(de)(de),臟腑(fu)經(jing)絡(luo)的(de)(de)功(gong)能(neng)是(shi)互(hu)相影響的(de)(de)。因(yin)此,在臨(lin)床(chuang)用藥(yao)(yao)時不能(neng)單純地(di)使(shi)用一經(jing)藥(yao)(yao)物。如肺病日久,必影響到脾,除用治肺的(de)(de)藥(yao)(yao)物外,還應(ying)配伍補脾的(de)(de)藥(yao)(yao)物,因(yin)脾主健(jian)運(yun),可(ke)以促進肺病的(de)(de)痊愈。所(suo)以,既要(yao)了解每一藥(yao)(yao)物的(de)(de)歸(gui)(gui)經(jing),又要(yao)掌握臟腑(fu)經(jing)絡(luo)間的(de)(de)相互(hu)關(guan)系,才(cai)能(neng)更(geng)好地(di)運(yun)用歸(gui)(gui)經(jing)理論指導臨(lin)床(chuang)用藥(yao)(yao)。
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