1.談補藥
補(bu)(bu)(bu)藥(yao)多(duo)屬(shu)(shu)本經上品(pin)，人(ren)(ren)(ren)(ren)(ren)每喜用(yong)(yong)，但藥(yao)以(yi)(yi)救偏(pian)，補(bu)(bu)(bu)藥(yao)亦以(yi)(yi)其性之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)偏(pian)而(er)(er)具補(bu)(bu)(bu)性，故使用(yong)(yong)得當(dang)，則有(you)益(yi)于(yu)人(ren)(ren)(ren)(ren)(ren)體，使用(yong)(yong)不當(dang)，非特不能補(bu)(bu)(bu)益(yi)，適足以(yi)(yi)害人(ren)(ren)(ren)(ren)(ren)。聞一(yi)醫生(sheng)，得山參(can)一(yi)支，喜而(er)(er)頓服之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)，竟致(zhi)殞命，應引(yin)為濫補(bu)(bu)(bu)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)戒(jie)。南方(fang)人(ren)(ren)(ren)(ren)(ren)每喜用(yong)(yong)人(ren)(ren)(ren)(ren)(ren)參(can)進補(bu)(bu)(bu)，如廣州(zhou)冬月，街頭(tou)常(chang)有(you)參(can)杞雞湯(tang)等，頗受(shou)歡迎，此與南方(fang)氣(qi)候(hou)溫熱，陽(yang)氣(qi)疏泄過當(dang)，常(chang)感(gan)不足有(you)關，故用(yong)(yong)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)恰補(bu)(bu)(bu)其不足。而(er)(er)京華等地，盛年(nian)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)人(ren)(ren)(ren)(ren)(ren)，飲(yin)人(ren)(ren)(ren)(ren)(ren)參(can)酒(jiu)經常(chang)致(zhi)頭(tou)暈、耳鳴、鼻衄，即與南北方(fang)體質(zhi)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)不同有(you)關。用(yong)(yong)以(yi)(yi)治療虛(xu)證，個人(ren)(ren)(ren)(ren)(ren)的體會是：北方(fang)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)人(ren)(ren)(ren)(ren)(ren)，喜食辛熱，氣(qi)候(hou)凜冽，常(chang)致(zhi)內熱陰虛(xu)，故人(ren)(ren)(ren)(ren)(ren)參(can)反需慎用(yong)(yong)。確屬(shu)(shu)氣(qi)虛(xu)者(zhe)(zhe)，一(yi)般以(yi)(yi)黨參(can)為宜，以(yi)(yi)其性平味甘，擅補(bu)(bu)(bu)脾(pi)肺之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)氣(qi)，用(yong)(yong)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)補(bu)(bu)(bu)脾(pi)，可(ke)投(tou)四君，用(yong)(yong)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)補(bu)(bu)(bu)心，可(ke)配寸冬、五味取(qu)生(sheng)脈義，余如補(bu)(bu)(bu)腎(shen)，陰虛(xu)者(zhe)(zhe)多(duo)配熟(shu)地、枸杞子(zi)、女貞(zhen)子(zi)、山藥(yao)等藥(yao)，陽(yang)虛(xu)者(zhe)(zhe)常(chang)伍(wu)用(yong)(yong)羊藿葉、仙茅、沙菀子(zi)等品(pin)，黨參(can)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)用(yong)(yong)量，則輕者(zhe)(zhe)15g，重(zhong)者(zhe)(zhe)可(ke)逾50g，凡脈弱、脈虛(xu)、苔薄、中脘無滯悶之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)象者(zhe)(zhe)，每喜用(yong)(yong)黨參(can)于(yu)25-50g之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)間，反應頗好。氣(qi)虛(xu)皮如蟲(chong)行者(zhe)(zhe)，亦黨參(can)與黃(huang)(huang)芪(qi)并用(yong)(yong)而(er)(er)重(zhong)投(tou)，偏(pian)枯萎廢(fei)者(zhe)(zhe)則視(shi)其情，有(you)時(shi)亦取(qu)王(wang)清任之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)逐瘀(yu)湯(tang)法或補(bu)(bu)(bu)陽(yang)還五湯(tang)法重(zhong)投(tou)黃(huang)(huang)芪(qi)，但張老對(dui)黃(huang)(huang)芪(qi)常(chang)慎，因(yin)臨床用(yong)(yong)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)常(chang)易滯氣(qi)，故表虛(xu)者(zhe)(zhe)自(zi)當(dang)用(yong)(yong)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)，而(er)(er)氣(qi)機不利者(zhe)(zhe)則宜慎之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)，而(er)(er)虛(xu)不受(shou)補(bu)(bu)(bu)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)人(ren)(ren)(ren)(ren)(ren)，多(duo)屬(shu)(shu)陰虛(xu)者(zhe)(zhe)，故又須加以(yi)(yi)注(zhu)意。
補(bu)血：古來(lai)以(yi)四物(wu)為(wei)(wei)(wei)主(zhu)，四物(wu)湯(tang)確為(wei)(wei)(wei)治(zhi)血之(zhi)祖方。其(qi)中，歸(gui)、地(di)(di)(di)、芍偏(pian)(pian)補(bu)而(er)川(chuan)芎偏(pian)(pian)散，具配伍(wu)(wu)之(zhi)妙。但用(yong)(yong)(yong)(yong)時又(you)不(bu)(bu)(bu)可拘泥而(er)宜(yi)靈活，如血虛而(er)無出(chu)血象(xiang)(xiang)者(zhe)(zhe)(zhe)(zhe)，四物(wu)同用(yong)(yong)(yong)(yong)，若稍兼滯象(xiang)(xiang)者(zhe)(zhe)(zhe)(zhe)，酌(zhuo)增(zeng)川(chuan)芎之(zhi)量或(huo)(huo)(huo)伍(wu)(wu)用(yong)(yong)(yong)(yong)坤草(cao)、雞血藤等品，血虛而(er)有(you)出(chu)血象(xiang)(xiang)者(zhe)(zhe)(zhe)(zhe)，則宜(yi)少用(yong)(yong)(yong)(yong)或(huo)(huo)(huo)不(bu)(bu)(bu)用(yong)(yong)(yong)(yong)川(chuan)芎，視其(qi)寒熱而(er)分(fen)別佐以(yi)三(san)七(qi)、花蕊石或(huo)(huo)(huo)阿(a)(a)膠(jiao)、茅根等藥。阿(a)(a)膠(jiao)尤為(wei)(wei)(wei)補(bu)血養血止(zhi)血之(zhi)佳品，古出(chu)山(shan)東者(zhe)(zhe)(zhe)(zhe)良，吾省白城地(di)(di)(di)區驢(lv)多，故亦(yi)(yi)(yi)有(you)生產，今則國(guo)內遍地(di)(di)(di)開花，但其(qi)中不(bu)(bu)(bu)少系(xi)屬偽品，應(ying)予剔除。陰虛不(bu)(bu)(bu)足而(er)有(you)出(chu)血象(xiang)(xiang)者(zhe)(zhe)(zhe)(zhe)，用(yong)(yong)(yong)(yong)之(zhi)多效(xiao)。諸如咯血、尿血、衄血、崩漏等均可用(yong)(yong)(yong)(yong)之(zhi)。其(qi)性(xing)(xing)甘平，與(yu)三(san)七(qi)不(bu)(bu)(bu)同，三(san)七(qi)雖(sui)亦(yi)(yi)(yi)為(wei)(wei)(wei)止(zhi)血佳品而(er)性(xing)(xing)稍偏(pian)(pian)熱，不(bu)(bu)(bu)宜(yi)于血分(fen)有(you)熱者(zhe)(zhe)(zhe)(zhe)。《本草(cao)綱(gang)目》論阿(a)(a)膠(jiao)“大(da)要只是(shi)補(bu)血與(yu)液”誠為(wei)(wei)(wei)至(zhi)論，故吳(wu)鞠通治(zhi)下焦溫病之(zhi)定風珠、復脈湯(tang)諸方中均用(yong)(yong)(yong)(yong)之(zhi)。張老治(zhi)血熱出(chu)血者(zhe)(zhe)(zhe)(zhe)，常(chang)使阿(a)(a)膠(jiao)與(yu)生地(di)(di)(di)、白薇、丹皮等配用(yong)(yong)(yong)(yong)，頗為(wei)(wei)(wei)應(ying)手。但畢竟由其(qi)為(wei)(wei)(wei)驢(lv)皮熬制，從膏狀(zhuang)凝(ning)結而(er)成，黏膩之(zhi)性(xing)(xing)，可以(yi)礙脾，可以(yi)滯邪(xie)(xie)。胃(wei)逆嘔吐者(zhe)(zhe)(zhe)(zhe)，脾虛或(huo)(huo)(huo)脾運不(bu)(bu)(bu)佳，食(shi)不(bu)(bu)(bu)消谷者(zhe)(zhe)(zhe)(zhe)皆宜(yi)慎用(yong)(yong)(yong)(yong)。《本草(cao)述》曾言“暴熱為(wei)(wei)(wei)患者(zhe)(zhe)(zhe)(zhe)，或(huo)(huo)(huo)外感抑郁為(wei)(wei)(wei)患者(zhe)(zhe)(zhe)(zhe)，或(huo)(huo)(huo)怒氣初盛(sheng)為(wei)(wei)(wei)患者(zhe)(zhe)(zhe)(zhe)，亦(yi)(yi)(yi)當慎用(yong)(yong)(yong)(yong)”，即是(shi)恐其(qi)黏膩戀(lian)邪(xie)(xie)，確宜(yi)注意。
又，鹿茸亦(yi)為(wei)補(bu)血佳品，且屬東北特產，但價格(ge)昂貴，故臨床少用(yong)。而其效果確實(shi)，若經濟(ji)條件允許者，對(dui)癥用(yong)之(zhi)，遠勝一(yi)般草木之(zhi)品。性(xing)略偏溫(wen)，功(gong)能補(bu)元陽(yang)、填精髓(sui)、益(yi)氣血。張老用(yong)治(zhi)血虛頭痛，與川芎合(he)用(yong)，效果甚好，但實(shi)證(zheng)、熱證(zheng)之(zhi)頭痛則絕對(dui)禁用(yong)，故須辨證(zheng)準確。男子陽(yang)痿，屬腎虛而非相火旺或(huo)(huo)濕熱盛者，研(yan)面配湯(tang)劑同服，或(huo)(huo)配成藥丸亦(yi)可，但獨用(yong)之(zhi)治(zhi)陽(yang)痿則效不顯。
2.論瀉藥
瀉(xie)(xie)指泄下，使胃(wei)腸(chang)(chang)積(ji)(ji)滯(zhi)從速排出(chu)。有人(ren)每將(jiang)泄下與清熱(re)(re)混(hun)為(wei)一談，系屬誤解。吳又可(ke)(ke)(ke)(ke)曾說黃(huang)(huang)連(lian)清熱(re)(re)而(er)不(bu)(bu)(bu)(bu)瀉(xie)(xie)實，里熱(re)(re)者(zhe)用(yong)(yong)(yong)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)佳，里實者(zhe)用(yong)(yong)(yong)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)誤，非大(da)(da)(da)(da)(da)黃(huang)(huang)推蕩積(ji)(ji)滯(zhi)不(bu)(bu)(bu)(bu)可(ke)(ke)(ke)(ke)，即是(shi)講的此理。故(gu)雖有里熱(re)(re)，但(dan)腸(chang)(chang)胃(wei)并無(wu)積(ji)(ji)滯(zhi)糟粕(po)，則宜審其(qi)(qi)熱(re)(re)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)所在(zai)(zai)而(er)以三黃(huang)(huang)分別(bie)應之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)，若(ruo)(ruo)大(da)(da)(da)(da)(da)腸(chang)(chang)結(jie)(jie)滯(zhi)，腑(fu)氣(qi)(qi)(qi)不(bu)(bu)(bu)(bu)通，化(hua)熱(re)(re)成實者(zhe)，則非承氣(qi)(qi)(qi)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)攻下不(bu)(bu)(bu)(bu)可(ke)(ke)(ke)(ke)。三承氣(qi)(qi)(qi)以大(da)(da)(da)(da)(da)黃(huang)(huang)為(wei)主(zhu)(zhu)藥(yao)(yao)，因大(da)(da)(da)(da)(da)黃(huang)(huang)推蕩積(ji)(ji)滯(zhi)，迅猛如將(jiang)，故(gu)有將(jiang)軍(jun)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)稱(cheng)，史載金元時大(da)(da)(da)(da)(da)兵(bing)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)后，瘟疫流行(xing)(xing)，用(yong)(yong)(yong)大(da)(da)(da)(da)(da)黃(huang)(huang)治(zhi)(zhi)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)，全活甚(shen)眾。故(gu)吳又可(ke)(ke)(ke)(ke)贊大(da)(da)(da)(da)(da)黃(huang)(huang)為(wei)治(zhi)(zhi)瘟疫之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)起(qi)死神丹，并用(yong)(yong)(yong)為(wei)治(zhi)(zhi)疫主(zhu)(zhu)藥(yao)(yao)，實有所本(ben)。芒硝(xiao)咸寒潤下，能聚(ju)水入腸(chang)(chang)，使腸(chang)(chang)道(dao)潤滑，則結(jie)(jie)糞(fen)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)輸送順(shun)暢，故(gu)大(da)(da)(da)(da)(da)熱(re)(re)大(da)(da)(da)(da)(da)實之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)結(jie)(jie)非硝(xiao)黃(huang)(huang)合用(yong)(yong)(yong)不(bu)(bu)(bu)(bu)可(ke)(ke)(ke)(ke)。滯(zhi)熱(re)(re)行(xing)(xing)則上焦之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)火清，故(gu)瀉(xie)(xie)法還(huan)可(ke)(ke)(ke)(ke)用(yong)(yong)(yong)于(yu)口瘡(chuang)、咽痛、咯(ge)(ge)血(xue)、肺(fei)家痰阻(zu)等癥(zheng)。對經常(chang)(chang)咽痛、便秘之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)口瘡(chuang)患者(zhe)，屬胃(wei)腑(fu)結(jie)(jie)熱(re)(re)上炎(yan)，清之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)常(chang)(chang)不(bu)(bu)(bu)(bu)能奏效(xiao)，以其(qi)(qi)結(jie)(jie)未(wei)去，滯(zhi)未(wei)行(xing)(xing)，熱(re)(re)源不(bu)(bu)(bu)(bu)除所致。若(ruo)(ruo)用(yong)(yong)(yong)瀉(xie)(xie)法使腸(chang)(chang)胃(wei)通暢，結(jie)(jie)熱(re)(re)不(bu)(bu)(bu)(bu)生，口瘡(chuang)等可(ke)(ke)(ke)(ke)自(zi)愈。西醫稱(cheng)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)為(wei)誘導消炎(yan)作(zuo)用(yong)(yong)(yong)。大(da)(da)(da)(da)(da)黃(huang)(huang)又可(ke)(ke)(ke)(ke)降氣(qi)(qi)(qi)，故(gu)咯(ge)(ge)血(xue)屬熱(re)(re)迫近血(xue)，氣(qi)(qi)(qi)逆不(bu)(bu)(bu)(bu)降者(zhe)用(yong)(yong)(yong)大(da)(da)(da)(da)(da)黃(huang)(huang)使氣(qi)(qi)(qi)機通暢下行(xing)(xing)，不(bu)(bu)(bu)(bu)上逆則血(xue)自(zi)止(zhi)(zhi)。肺(fei)癆大(da)(da)(da)(da)(da)咯(ge)(ge)血(xue)者(zhe)亦每用(yong)(yong)(yong)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)，所謂(wei)氣(qi)(qi)(qi)降則血(xue)降，較用(yong)(yong)(yong)鴉片之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)類收斂，常(chang)(chang)令(ling)積(ji)(ji)熱(re)(re)不(bu)(bu)(bu)(bu)去，小愈必大(da)(da)(da)(da)(da)發(fa)者(zhe)，其(qi)(qi)效(xiao)要理想得(de)多了。大(da)(da)(da)(da)(da)黃(huang)(huang)既能降氣(qi)(qi)(qi)止(zhi)(zhi)血(xue)，又可(ke)(ke)(ke)(ke)破瘀通經，觀抵當丸(wan)、桃核承氣(qi)(qi)(qi)湯之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)組合可(ke)(ke)(ke)(ke)知，近代藥(yao)(yao)理學則謂(wei)其(qi)(qi)有泄下、抗菌、抗腫瘤，及(ji)止(zhi)(zhi)血(xue)、降壓、降血(xue)脂等諸多作(zuo)用(yong)(yong)(yong)，可(ke)(ke)(ke)(ke)知古(gu)人(ren)重(zhong)視(shi)大(da)(da)(da)(da)(da)黃(huang)(huang)絕非偶然。但(dan)其(qi)(qi)本(ben)身尚含(han)有鞣質，故(gu)酒大(da)(da)(da)(da)(da)黃(huang)(huang)宜用(yong)(yong)(yong)開水泡服，生大(da)(da)(da)(da)(da)黃(huang)(huang)宜煎(jian)服，但(dan)速煎(jian)力(li)強，久煎(jian)力(li)緩，以煎(jian)久則具(ju)瀉(xie)(xie)下作(zuo)用(yong)(yong)(yong)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)蒽醌類破壞而(er)鞣質仍存，大(da)(da)(da)(da)(da)、小承氣(qi)(qi)(qi)煎(jian)法的區別(bie)，道(dao)理即在(zai)(zai)于(yu)此，此又不(bu)(bu)(bu)(bu)可(ke)(ke)(ke)(ke)不(bu)(bu)(bu)(bu)知。
泄下之(zhi)(zhi)證，熱實者(zhe)多而(er)寒(han)實者(zhe)少，故(gu)(gu)巴(ba)豆很少應用(yong)(yong)(yong)，其(qi)(qi)性(xing)峻猛，逾于牽(qian)、黃、硝(xiao)、戟之(zhi)(zhi)上(shang)。李時珍說巴(ba)豆“不(bu)(bu)去(qu)膜則傷(shang)胃，不(bu)(bu)去(qu)心則作嘔，以沉香水浸能升能降(jiang)”，故(gu)(gu)臨床只去(qu)油后以巴(ba)豆霜入散(san)劑(ji)用(yong)(yong)(yong)之(zhi)(zhi)，方如三(san)(san)物(wu)瀉(xie)白散(san)治寒(han)實結(jie)胸，取(qu)其(qi)(qi)散(san)腫排(pai)疾之(zhi)(zhi)效，瀉(xie)而(er)不(bu)(bu)峻，三(san)(san)物(wu)備急丸(wan)治中(zhong)下焦寒(han)實里結(jie)，取(qu)其(qi)(qi)攻逐(zhu)推(tui)蕩之(zhi)(zhi)功。具強烈(lie)刺(ci)激性(xing)，亦用(yong)(yong)(yong)作發泡(pao)劑(ji)，敷穴位處(chu)，效類瘢痕(hen)灸。此(ci)外，古人尚用(yong)(yong)(yong)以止瀉(xie)，治冷積凝滯，脈沉滑(hua)，肉食(shi)油膩生冷食(shi)則作痛(tong)，溏瀉(xie)而(er)百藥(yao)不(bu)(bu)愈者(zhe)，可(ke)以試投。但此(ci)類藥(yao)物(wu)，性(xing)毒力猛，于老(lao)人，血虛(xu)、體弱等患(huan)者(zhe)，終不(bu)(bu)宜(yi)輕用(yong)(yong)(yong)。故(gu)(gu)全(quan)對此(ci)類患(huan)者(zhe)每(mei)喜(xi)以蓯(cong)蓉、當歸之(zhi)(zhi)屬潤腸通便，一(yi)般當歸15~25g即可(ke)奏效，遇便結(jie)較(jiao)甚，潤之(zhi)(zhi)不(bu)(bu)行(xing)者(zhe)配(pei)大(da)黃5~10g同(tong)用(yong)(yong)(yong)。總之(zhi)(zhi)，腸胃結(jie)滯者(zhe)，每(mei)令寢不(bu)(bu)安席，食(shi)不(bu)(bu)甘昧，必用(yong)(yong)(yong)通降(jiang)泄其(qi)(qi)結(jie)滯則諸癥俱(ju)消(xiao)。故(gu)(gu)瀉(xie)藥(yao)之(zhi)(zhi)功，不(bu)(bu)可(ke)忽視(shi)，畏而(er)不(bu)(bu)用(yong)(yong)(yong)或(huo)濫用(yong)(yong)(yong)均屬失當，妙在配(pei)合得宜(yi)，藥(yao)病相對耳。
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