姜老(lao)臨證治療痹證,注重(zhong)以(yi)(yi)腎為本.善用(yong)大劑量生(sheng)地(di)黃于溫散蠲痹、祛風通絡藥之(zhi)中(zhong),以(yi)(yi)涼血清營、養血補腎、滋陰潤絡,尤其治療反復發作(zuo)之(zhi)頑痹,每獲良效,現介(jie)紹如下。
姜老認為生地川烏合用治療痹證能相輔相成:根據痹證的病因病機與臨床表現,大體包括西醫的風濕熱、風濕性關節炎、類風濕性關節炎、痛風、坐骨神經痛、骨質增生性疾病等。先生積幾十年治療痹證的經驗,在辨證論治的基礎上,主張扶正固本,強調以腎為本,運用補腎法為主治療各種類型痹證,并結合中西醫結合科研實驗研究,將大量具有祛風除濕,散寒止痛,補益肝腎,強筋健骨功效的中藥廣泛地運用于臨床,勤于實踐,勇于探索,地烏蠲痹湯就是先生自擬的一個治療風寒濕熱痹的有效方。方中,以大劑量生地黃為君藥,生地黃具有滋陰潤絡,涼血清營,補益肝腎之功,《神農本(ben)草經(jing)》有其“逐(zhu)血(xue)(xue)(xue)痹(bi)(bi)(bi)”、“除(chu)(chu)寒熱(re)積(ji)聚”、“除(chu)(chu)痹(bi)(bi)(bi)”的(de)(de)(de)記(ji)載(zai)。先生(sheng)用(yong)生(sheng)地黃(huang)治(zhi)療頑痹(bi)(bi)(bi)一般用(yong)量在(zai)60~90g之(zhi)(zhi)間(jian),最多可用(yong)至150g。其用(yong)意有三(san):第一,生(sheng)地甘(gan)寒,入肝腎經(jing),可滋(zi)養陰(yin)(yin)血(xue)(xue)(xue),補(bu)(bu)肝益(yi)腎,得酸平(ping)之(zhi)(zhi)淮(huai)牛(niu)膝,辛(xin)(xin)溫之(zhi)(zhi)五加(jia)皮(pi)協助,共同發揮補(bu)(bu)益(yi)肝腎,扶助正氣(qi)的(de)(de)(de)作用(yong)。第二,風(feng)寒濕三(san)痹(bi)(bi)(bi)中(zhong)寒痹(bi)(bi)(bi)和(he)濕痹(bi)(bi)(bi)均需(xu)辛(xin)(xin)溫或燥烈之(zhi)(zhi)品(pin)(pin)方可消除(chu)(chu),然(ran)辛(xin)(xin)溫燥烈之(zhi)(zhi)品(pin)(pin)無不有傷陰(yin)(yin)耗血(xue)(xue)(xue)之(zhi)(zhi)弊。方中(zhong)的(de)(de)(de)川烏、蠶砂、威靈仙(xian)、獨活便是此(ci)類藥物,得大劑量之(zhi)(zhi)生(sheng)地,可緩和(he)它(ta)們(men)的(de)(de)(de)燥烈之(zhi)(zhi)性,雙(shuang)向(xiang)調(diao)節(jie),取利祛(qu)弊。第三(san),根(gen)據《神(shen)農本(ben)草經(jing)》記(ji)載(zai),地黃(huang)有除(chu)(chu)痹(bi)(bi)(bi)作用(yong),生(sheng)者尤良,風(feng)寒濕三(san)痹(bi)(bi)(bi)中(zhong)行痹(bi)(bi)(bi)需(xu)以散(san)風(feng)為(wei)主,佐以祛(qu)寒理(li)濕,但古有“治(zhi)風(feng)先治(zhi)血(xue)(xue)(xue),血(xue)(xue)(xue)行風(feng)自(zi)(zi)滅”的(de)(de)(de)理(li)論,更須參以補(bu)(bu)血(xue)(xue)(xue)之(zhi)(zhi)劑,血(xue)(xue)(xue)不足者痹(bi)(bi)(bi)著不行,生(sheng)地黃(huang)補(bu)(bu)血(xue)(xue)(xue)養血(xue)(xue)(xue),補(bu)(bu)養充足,自(zi)(zi)然(ran)流通洋(yang)溢(yi)而痹(bi)(bi)(bi)行矣。藥理(li)實(shi)驗證實(shi):生(sheng)地黃(huang)有延(yan)長抗(kang)體存在(zai)時間(jian)的(de)(de)(de)作用(yong),是促(cu)進(jin)免(mian)疫功(gong)能的(de)(de)(de)藥物,且又可調(diao)節(jie)抑(yi)制(zhi)性T細胞的(de)(de)(de)功(gong)能,從而阻抑(yi)自(zi)(zi)身抗(kang)體的(de)(de)(de)形成(cheng),具(ju)有保護(hu)腎上(shang)腺(xian)皮(pi)質功(gong)能的(de)(de)(de)雙(shuang)向(xiang)調(diao)節(jie)作用(yong)。茲舉例如下(xia):
楊某(mou),男,46歲。3年(nian)多來腰痛如折,右腿冷(leng)(leng)痛,腫脹麻木(mu),屈伸不(bu)利(li),艱于行走(zou),得溫則(ze)減,遇寒則(ze)甚,氣候交變尤易(yi)發作:化驗:抗(kang)“O”750u,血沉(chen)15mm/h,診斷為風濕(shi)性關(guan)節(jie)炎。平素惡寒怯冷(leng)(leng),口淡不(bu)渴,舌苔(tai)白(bai)而(er)厚(hou)膩,脈象按之沉(chen)細。證屬寒濕(shi)入絡(luo),凝滯(zhi)經脈,閉阻營衛。治(zhi)擬溫經散寒,活血鎮痛。藥用制附(fu)子(zi)9g,桂枝9g,生(sheng)地黃50g,威靈仙15g,晚蠶砂30g,秦艽9g,蘄蛇9g,當歸(gui)9g,赤(chi)芍9g。7劑(ji)藥后,關(guan)節(jie)疼(teng)痛、麻木(mu)、發冷(leng)(leng)好(hao)轉。守上方加黃芪30g,乳香、沒藥各(ge)6g,再(zai)進(jin)14劑(ji),病人(ren)下肢(zhi)活動自如,后用上法(fa)調治(zhi)月(yue)余(yu)而(er)愈,隨訪1年(nian)未發。
按:本(ben)案為(wei)“痛(tong)痹(bi)”,系由寒(han)濕(shi)(shi)之(zhi)(zhi)邪(xie)外襲,凝(ning)滯經(jing)脈,不通(tong)(tong)則痛(tong)。綜觀(guan)本(ben)方(fang)配(pei)伍,妙在重用(yong)(yong)(yong)生地(di)一味(wei),生地(di)味(wei)苦甘性寒(han),滋(zi)(zi)陰(yin)(yin)養血(xue)(xue)而補益肝腎(shen),臨(lin)床多用(yong)(yong)(yong)于熱(re)痹(bi)之(zhi)(zhi)熱(re)灼營陰(yin)(yin),或陰(yin)(yin)虛內熱(re),耗血(xue)(xue)傷津之(zhi)(zhi)證(zheng)。今(jin)先生通(tong)(tong)權達變,用(yong)(yong)(yong)以治療(liao)(liao)寒(han)濕(shi)(shi)痹(bi)證(zheng),是(shi)取其滋(zi)(zi)陰(yin)(yin)補腎(shen),鼓舞正(zheng)氣之(zhi)(zhi)用(yong)(yong)(yong)也(ye)。正(zheng)氣乃固衛御邪(xie)之(zhi)(zhi)動(dong)力,但必(bi)以陰(yin)(yin)精為(wei)之(zhi)(zhi)糧資,地(di)黃(huang)(huang)滋(zi)(zi)補腎(shen)陰(yin)(yin),則一身活力由之(zhi)(zhi)振奮,祛(qu)邪(xie)乃能得(de)力,此(ci)其一也(ye)。且地(di)黃(huang)(huang)能通(tong)(tong)利血(xue)(xue)脈,《名醫別(bie)錄》云“生地(di)為(wei)散血(xue)(xue)之(zhi)(zhi)專(zhuan)藥(yao)”。蓋通(tong)(tong)脈之(zhi)(zhi)品(pin)都具有(you)破瘀攻伐之(zhi)(zhi)性,而生地(di)散血(xue)(xue)通(tong)(tong)脈,既無燥烈傷正(zheng)之(zhi)(zhi)害,又有(you)滋(zi)(zi)柔潤脈之(zhi)(zhi)用(yong)(yong)(yong),并具通(tong)(tong)中(zhong)(zhong)寓通(tong)(tong)補之(zhi)(zhi)功效,乃寓通(tong)(tong)以于養血(xue)(xue)之(zhi)(zhi)中(zhong)(zhong),盡其祛(qu)邪(xie)之(zhi)(zhi)能,正(zheng)如《本(ben)經(jing)逢原(yuan)》所曰:“統領他藥(yao),共襄(xiang)破宿生新之(zhi)(zhi)功。”此(ci)其二也(ye)。又據現代藥(yao)理研究,大劑量(liang)應用(yong)(yong)(yong)地(di)黃(huang)(huang)有(you)激素(su)(su)樣作用(yong)(yong)(yong)而無激素(su)(su)的副(fu)作用(yong)(yong)(yong)。方(fang)中(zhong)(zhong),威(wei)靈仙與(yu)當歸、桂心配(pei)伍為(wei)《證(zheng)治準繩》神(shen)應丸(wan),更加血(xue)(xue)肉有(you)情之(zhi)(zhi)品(pin)蘄蛇,故治療(liao)(liao)風(feng)濕(shi)(shi)腰痛(tong)尤佳。
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