桂枝麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)葛(ge)(ge)根(gen)湯(tang)會上火(huo)麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)每每先(xian)(xian)煎,且必(bi)言“去(qu)(qu)(qu)(qu)沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)”,仲(zhong)師(shi)(shi)未(wei)(wei)(wei)述其(qi)(qi)(qi)理(li)(li)(li),古書不(bu)(bu)(bu)(bu)見(jian)(jian)旁證(zheng),雖(sui)屬小題(ti)(ti),竟成千(qian)古疑案(an)。由于(yu)(yu)(yu)(yu)(yu)(yu)牽扯到邏輯思維問(wen)(wen)(wen)(wen)題(ti)(ti),略作(zuo)分(fen)(fen)析。考(kao)證(zheng)前(qian)人(ren)注解,頗具影響者(zhe)(zhe)有兩(liang)說(shuo)(shuo):一是(shi)(shi)陶(tao)弘景(jing)認(ren)為“沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)令(ling)人(ren)煩”。二是(shi)(shi)張錫純(chun)指(zhi)出“沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)中(zhong)含有發(fa)(fa)(fa)(fa)表(biao)(biao)(biao)(biao)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)猛(meng)力(li)(li)(li)”。陶(tao)氏(shi)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)說(shuo)(shuo)可(ke)(ke)能(neng)(neng)屬親歷(li)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)談(tan),因(yin)為麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)湯(tang)證(zheng)多(duo)是(shi)(shi)寒(han)邪(xie)閉(bi)(bi)表(biao)(biao)(biao)(biao),均有不(bu)(bu)(bu)(bu)同程度的(de)(de)(de)(de)陽(yang)氣(qi)(qi)郁(yu)(yu)遏因(yin)素(su),而(er)麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)又性(xing)屬辛溫,汗中(zhong)助(zhu)熱,在(zai)(zai)(zai)服藥(yao)(yao)(yao)(yao)將汗未(wei)(wei)(wei)汗之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)時,由于(yu)(yu)(yu)(yu)(yu)(yu)郁(yu)(yu)熱擾(rao)及(ji)心神,也(ye)可(ke)(ke)能(neng)(neng)會出現“令(ling)人(ren)煩”的(de)(de)(de)(de)現象。然而(er),這里尚(shang)存在(zai)(zai)(zai)三個問(wen)(wen)(wen)(wen)題(ti)(ti):其(qi)(qi)(qi)一,即(ji)是(shi)(shi)邏輯思維問(wen)(wen)(wen)(wen)題(ti)(ti),用(yong)(yong)(yong)(yong)麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)的(de)(de)(de)(de)方(fang)(fang)證(zheng)可(ke)(ke)謂(wei)多(duo)矣,不(bu)(bu)(bu)(bu)屬表(biao)(biao)(biao)(biao)證(zheng)、不(bu)(bu)(bu)(bu)具陽(yang)郁(yu)(yu)病機者(zhe)(zhe),難(nan)能(neng)(neng)生(sheng)煩,何以(yi)治表(biao)(biao)(biao)(biao)治里之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)皆“去(qu)(qu)(qu)(qu)沫(mo)(mo)(mo)(mo)(mo)(mo)(mo),’?其(qi)(qi)(qi)二,“令(ling)人(ren)煩”是(shi)(shi)否(fou)當(dang)責之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)于(yu)(yu)(yu)(yu)(yu)(yu)“沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)”,證(zheng)據尚(shang)嫌(xian)不(bu)(bu)(bu)(bu)足(zu)。其(qi)(qi)(qi)三,今人(ren)煎服麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)諸湯(tang),皆不(bu)(bu)(bu)(bu)去(qu)(qu)(qu)(qu)沫(mo)(mo)(mo)(mo)(mo)(mo)(mo),也(ye)未(wei)(wei)(wei)見(jian)(jian)每每令(ling)人(ren)煩者(zhe)(zhe)。可(ke)(ke)見(jian)(jian),陶(tao)氏(shi)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)說(shuo)(shuo)難(nan)以(yi)令(ling)人(ren)信服。張氏(shi)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)說(shuo)(shuo),則(ze)更是(shi)(shi)于(yu)(yu)(yu)(yu)(yu)(yu)理(li)(li)(li)不(bu)(bu)(bu)(bu)通。麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)湯(tang)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)所(suo)以(yi)用(yong)(yong)(yong)(yong)麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang),就是(shi)(shi)針對(dui)寒(han)閉(bi)(bi)肌表(biao)(biao)(biao)(biao)的(de)(de)(de)(de)太陽(yang)病機開膜發(fa)(fa)(fa)(fa)汗.換言之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi),正(zheng)(zheng)是(shi)(shi)用(yong)(yong)(yong)(yong)的(de)(de)(de)(de)麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)“發(fa)(fa)(fa)(fa)表(biao)(biao)(biao)(biao)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)猛(meng)力(li)(li)(li)”.若果然“沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)中(zhong)含有發(fa)(fa)(fa)(fa)表(biao)(biao)(biao)(biao)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)猛(meng)力(li)(li)(li)”的(de)(de)(de)(de)話,豈(qi)不(bu)(bu)(bu)(bu)正(zheng)(zheng)應(ying)其(qi)(qi)(qi)治?怎能(neng)(neng)去(qu)(qu)(qu)(qu)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)呢?或(huo)曰:去(qu)(qu)(qu)(qu)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)以(yi)防麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)發(fa)(fa)(fa)(fa)表(biao)(biao)(biao)(biao)太過(guo),那么,治寒(han)閉(bi)(bi)尤甚乃至遏陽(yang)生(sheng)熱的(de)(de)(de)(de)大青龍湯(tang),為了峻(jun)汗開表(biao)(biao)(biao)(biao),麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)一舉用(yong)(yong)(yong)(yong)至六兩(liang),可(ke)(ke)謂(wei)正(zheng)(zheng)需“猛(meng)力(li)(li)(li)”,為何也(ye)“去(qu)(qu)(qu)(qu)上沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)”呢?可(ke)(ke)見(jian)(jian),張氏(shi)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)說(shuo)(shuo)也(ye)屬臆斷.麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)先(xian)(xian)煎去(qu)(qu)(qu)(qu)沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)問(wen)(wen)(wen)(wen)題(ti)(ti),應(ying)結合《內經》歷(li)史地看(kan)(kan)待。仲(zhong)師(shi)(shi)《傷(shang)(shang)寒(han)論(lun)(lun)》“撰(zhuan)用(yong)(yong)(yong)(yong)素(su)問(wen)(wen)(wen)(wen)九卷(juan)”,這說(shuo)(shuo)明在(zai)(zai)(zai)理(li)(li)(li)論(lun)(lun)上《傷(shang)(shang)寒(han)論(lun)(lun)》與(yu)《內經》有著(zhu)千(qian)絲萬縷的(de)(de)(de)(de)聯(lian)系(xi),《素(su)問(wen)(wen)(wen)(wen)·陰陽(yang)應(ying)象大論(lun)(lun)》中(zhong)說(shuo)(shuo):“清(qing)(qing)陽(yang)發(fa)(fa)(fa)(fa)滕理(li)(li)(li),濁(zhuo)陰走五臟”.又說(shuo)(shuo):“陰味(wei)出下竅,陽(yang)氣(qi)(qi)出上竅”。仲(zhong)師(shi)(shi)把這種(zhong)藥(yao)(yao)(yao)(yao)物(wu)氣(qi)(qi)味(wei)陰陽(yang)、清(qing)(qing)濁(zhuo)升(sheng)(sheng)降的(de)(de)(de)(de)理(li)(li)(li)論(lun)(lun)運(yun)用(yong)(yong)(yong)(yong)于(yu)(yu)(yu)(yu)(yu)(yu)經方(fang)(fang)的(de)(de)(de)(de)證(zheng)治之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)中(zhong),由此(ci)推論(lun)(lun),麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)的(de)(de)(de)(de)先(xian)(xian)煎去(qu)(qu)(qu)(qu)沫(mo)(mo)(mo)(mo)(mo)(mo)(mo),首先(xian)(xian)是(shi)(shi)麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)在(zai)(zai)(zai)煎煮過(guo)程中(zhong)出現“沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)”,而(er)仲(zhong)師(shi)(shi)(或(huo)仲(zhong)師(shi)(shi)前(qian)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)醫(yi)家)憑(ping)直觀認(ren)為沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)乃屬濁(zhuo)物(wu),必(bi)有礙于(yu)(yu)(yu)(yu)(yu)(yu)升(sheng)(sheng)發(fa)(fa)(fa)(fa),去(qu)(qu)(qu)(qu)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)以(yi)取(qu)麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)氣(qi)(qi)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)輕清(qing)(qing),而(er)有利于(yu)(yu)(yu)(yu)(yu)(yu)發(fa)(fa)(fa)(fa)腆理(li)(li)(li)、出上竅。誠(cheng)如(ru)柯韻伯所(suo)云:“去(qu)(qu)(qu)(qu)沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)者(zhe)(zhe),止取(qu)其(qi)(qi)(qi)清(qing)(qing)陽(yang)發(fa)(fa)(fa)(fa)膝(xi)理(li)(li)(li)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)義也(ye)。”可(ke)(ke)謂(wei)一語(yu)中(zhong)的(de)(de)(de)(de)。聯(lian)系(xi)整個《傷(shang)(shang)寒(han)論(lun)(lun)》的(de)(de)(de)(de)用(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao),也(ye)可(ke)(ke)以(yi)證(zheng)實仲(zhong)師(shi)(shi)對(dui)《內經》的(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)物(wu)清(qing)(qing)濁(zhuo)升(sheng)(sheng)降理(li)(li)(li)論(lun)(lun)十(shi)分(fen)(fen)重視,不(bu)(bu)(bu)(bu)唯(wei)麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)的(de)(de)(de)(de)“去(qu)(qu)(qu)(qu)沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)”問(wen)(wen)(wen)(wen)題(ti)(ti)。在(zai)(zai)(zai)桂枝加葛(ge)(ge)根(gen)湯(tang)、葛(ge)(ge)根(gen)湯(tang)及(ji)葛(ge)(ge)根(gen)琴(qin)連湯(tang)中(zhong),葛(ge)(ge)根(gen)均強調先(xian)(xian)煎去(qu)(qu)(qu)(qu)沫(mo)(mo)(mo)(mo)(mo)(mo)(mo),道理(li)(li)(li)也(ye)在(zai)(zai)(zai)于(yu)(yu)(yu)(yu)(yu)(yu)此(ci).葛(ge)(ge)根(gen)在(zai)(zai)(zai)這幾個方(fang)(fang)中(zhong)均有解散(san)表(biao)(biao)(biao)(biao)邪(xie)、升(sheng)(sheng)提(ti)(ti)津(jin)液的(de)(de)(de)(de)作(zuo)用(yong)(yong)(yong)(yong),而(er)發(fa)(fa)(fa)(fa)揮這些外散(san)上達的(de)(de)(de)(de)作(zuo)用(yong)(yong)(yong)(yong)正(zheng)(zheng)需要葛(ge)(ge)根(gen)的(de)(de)(de)(de)輕清(qing)(qing)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)氣(qi)(qi),所(suo)以(yi)也(ye)同樣(yang)去(qu)(qu)(qu)(qu)除了有礙升(sheng)(sheng)發(fa)(fa)(fa)(fa)的(de)(de)(de)(de)重濁(zhuo)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)。再聯(lian)系(xi)大黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)連瀉(xie)心湯(tang)的(de)(de)(de)(de)用(yong)(yong)(yong)(yong)“麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)沸湯(tang)漬之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)”,就能(neng)(neng)進(jin)一步說(shuo)(shuo)明仲(zhong)師(shi)(shi)是(shi)(shi)極善于(yu)(yu)(yu)(yu)(yu)(yu)運(yun)用(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)物(wu)的(de)(de)(de)(de)清(qing)(qing)濁(zhuo)升(sheng)(sheng)降理(li)(li)(li)論(lun)(lun)指(zhi)導處方(fang)(fang)用(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)的(de)(de)(de)(de)。大黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)連瀉(xie)心湯(tang)所(suo)“瀉(xie)”的(de)(de)(de)(de)是(shi)(shi)“氣(qi)(qi)痞”,“氣(qi)(qi)痞”就是(shi)(shi)無形之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)氣(qi)(qi)熱11聚心下所(suo)致,邪(xie)結當(dang)“瀉(xie)”,無形之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)邪(xie)又不(bu)(bu)(bu)(bu)當(dang)“瀉(xie)、邪(xie)結當(dang)治用(yong)(yong)(yong)(yong)大黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)連,無形之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)熱又不(bu)(bu)(bu)(bu)當(dang)徑(jing)用(yong)(yong)(yong)(yong)大黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)連。于(yu)(yu)(yu)(yu)(yu)(yu)是(shi)(shi)仲(zhong)師(shi)(shi)活(huo)用(yong)(yong)(yong)(yong)氣(qi)(qi)味(wei)厚(hou)薄升(sheng)(sheng)降出人(ren)的(de)(de)(de)(de)理(li)(li)(li)論(lun)(lun),從而(er)采取(qu)這種(zhong)不(bu)(bu)(bu)(bu)煎而(er)漬的(de)(de)(de)(de)特殊辦法,一方(fang)(fang)面取(qu)大黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)連輕清(qing)(qing)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)氣(qi)(qi),以(yi)上行瀉(xie)心消痞;另(ling)一方(fang)(fang)面又可(ke)(ke)避免大黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)連之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)厚(hou)味(wei)致寒(han)中(zhong)傷(shang)(shang)正(zheng)(zheng)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)弊,可(ke)(ke)謂(wei)用(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)巧,與(yu)麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)葛(ge)(ge)根(gen)“去(qu)(qu)(qu)(qu)沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)”異曲同工。除《金Ui》的(de)(de)(de)(de)厚(hou)樸麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)湯(tang)方(fang)(fang)后注未(wei)(wei)(wei)提(ti)(ti)及(ji)先(xian)(xian)煎去(qu)(qu)(qu)(qu)沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)外(恐屬遺漏),其(qi)(qi)(qi)他用(yong)(yong)(yong)(yong)麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)、葛(ge)(ge)根(gen)者(zhe)(zhe),無一例外,足(zu)見(jian)(jian)仲(zhong)師(shi)(shi)對(dui)此(ci)問(wen)(wen)(wen)(wen)題(ti)(ti)的(de)(de)(de)(de)重視.那么我們今天應(ying)如(ru)何看(kan)(kan)待這個問(wen)(wen)(wen)(wen)題(ti)(ti)呢?首先(xian)(xian),應(ying)該(gai)承認(ren)并搞清(qing)(qing)《傷(shang)(shang)寒(han)論(lun)(lun)》麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)、葛(ge)(ge)根(gen)去(qu)(qu)(qu)(qu)沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)的(de)(de)(de)(de)客觀存在(zai)(zai)(zai)及(ji)其(qi)(qi)(qi)涵義。至于(yu)(yu)(yu)(yu)(yu)(yu)麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)、葛(ge)(ge)根(gen)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)“沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)”,是(shi)(shi)否(fou)屬于(yu)(yu)(yu)(yu)(yu)(yu)濁(zhuo)物(wu)?是(shi)(shi)否(fou)有礙于(yu)(yu)(yu)(yu)(yu)(yu)升(sheng)(sheng)清(qing)(qing)?當(dang)結合現代藥(yao)(yao)(yao)(yao)理(li)(li)(li)進(jin)一步探討。就目前(qian)的(de)(de)(de)(de)麻(ma)(ma)(ma)(ma)(ma)(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)(huang)(huang)、葛(ge)(ge)根(gen)用(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)經驗來看(kan)(kan),對(dui)去(qu)(qu)(qu)(qu)沫(mo)(mo)(mo)(mo)(mo)(mo)(mo)與(yu)否(fou),不(bu)(bu)(bu)(bu)必(bi)斤(jin)斤(jin)計較、泥古不(bu)(bu)(bu)(bu)化。
桂枝麻黃葛根湯會上(shang)火
麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)每每先煎(jian),且必言“去(qu)(qu)(qu)沫(mo)(mo)”,仲(zhong)(zhong)師未述其(qi)理(li)(li),古(gu)書不(bu)(bu)(bu)見旁證(zheng)(zheng),雖屬小(xiao)題,竟成(cheng)千古(gu)疑案。由于(yu)(yu)(yu)牽扯到邏(luo)輯(ji)思(si)維(wei)問(wen)(wen)(wen)題,略作(zuo)(zuo)分(fen)析。考證(zheng)(zheng)前(qian)(qian)人(ren)(ren)注解(jie),頗(po)具影響者有(you)(you)兩(liang)說(shuo)(shuo)(shuo)(shuo)(shuo):一是(shi)(shi)陶(tao)弘景認為(wei)(wei)“沫(mo)(mo)令人(ren)(ren)煩(fan)”。二是(shi)(shi)張(zhang)(zhang)錫純指(zhi)出(chu)“沫(mo)(mo)中(zhong)(zhong)(zhong)含有(you)(you)發(fa)(fa)(fa)(fa)表之(zhi)(zhi)猛力(li)(li)(li)”。陶(tao)氏(shi)(shi)之(zhi)(zhi)說(shuo)(shuo)(shuo)(shuo)(shuo)可(ke)(ke)(ke)能(neng)屬親歷(li)之(zhi)(zhi)談,因(yin)為(wei)(wei)麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)湯(tang)證(zheng)(zheng)多(duo)是(shi)(shi)寒邪(xie)閉表,均(jun)(jun)有(you)(you)不(bu)(bu)(bu)同(tong)程(cheng)度(du)的(de)(de)(de)(de)陽(yang)氣(qi)(qi)(qi)郁(yu)(yu)遏(e)因(yin)素,而麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)又性(xing)屬辛溫(wen),汗(han)中(zhong)(zhong)(zhong)助熱(re)(re),在(zai)服藥將汗(han)未汗(han)之(zhi)(zhi)時,由于(yu)(yu)(yu)郁(yu)(yu)熱(re)(re)擾及(ji)心神,也(ye)(ye)可(ke)(ke)(ke)能(neng)會出(chu)現(xian)(xian)“令人(ren)(ren)煩(fan)”的(de)(de)(de)(de)現(xian)(xian)象。然而,這(zhe)里(li)尚存在(zai)三個問(wen)(wen)(wen)題:其(qi)一,即是(shi)(shi)邏(luo)輯(ji)思(si)維(wei)問(wen)(wen)(wen)題,用(yong)(yong)(yong)(yong)(yong)(yong)麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)的(de)(de)(de)(de)方(fang)(fang)證(zheng)(zheng)可(ke)(ke)(ke)謂(wei)(wei)(wei)多(duo)矣,不(bu)(bu)(bu)屬表證(zheng)(zheng)、不(bu)(bu)(bu)具陽(yang)郁(yu)(yu)病(bing)機者,難能(neng)生煩(fan),何以(yi)(yi)治表治里(li)之(zhi)(zhi)麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)皆(jie)“去(qu)(qu)(qu)沫(mo)(mo),’?其(qi)二,“令人(ren)(ren)煩(fan)”是(shi)(shi)否(fou)當(dang)(dang)責(ze)之(zhi)(zhi)于(yu)(yu)(yu)“沫(mo)(mo)”,證(zheng)(zheng)據尚嫌不(bu)(bu)(bu)足。其(qi)三,今人(ren)(ren)煎(jian)服麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)諸湯(tang),皆(jie)不(bu)(bu)(bu)去(qu)(qu)(qu)沫(mo)(mo),也(ye)(ye)未見每每令人(ren)(ren)煩(fan)者。可(ke)(ke)(ke)見,陶(tao)氏(shi)(shi)之(zhi)(zhi)說(shuo)(shuo)(shuo)(shuo)(shuo)難以(yi)(yi)令人(ren)(ren)信服。張(zhang)(zhang)氏(shi)(shi)之(zhi)(zhi)說(shuo)(shuo)(shuo)(shuo)(shuo),則更是(shi)(shi)于(yu)(yu)(yu)理(li)(li)不(bu)(bu)(bu)通(tong)。麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)湯(tang)之(zhi)(zhi)所以(yi)(yi)用(yong)(yong)(yong)(yong)(yong)(yong)麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang),就是(shi)(shi)針對(dui)寒閉肌表的(de)(de)(de)(de)太(tai)陽(yang)病(bing)機開膜發(fa)(fa)(fa)(fa)汗(han).換言之(zhi)(zhi),正是(shi)(shi)用(yong)(yong)(yong)(yong)(yong)(yong)的(de)(de)(de)(de)麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)“發(fa)(fa)(fa)(fa)表之(zhi)(zhi)猛力(li)(li)(li)”.若果然“沫(mo)(mo)中(zhong)(zhong)(zhong)含有(you)(you)發(fa)(fa)(fa)(fa)表之(zhi)(zhi)猛力(li)(li)(li)”的(de)(de)(de)(de)話,豈不(bu)(bu)(bu)正應其(qi)治?怎能(neng)去(qu)(qu)(qu)之(zhi)(zhi)呢?或曰:去(qu)(qu)(qu)之(zhi)(zhi)以(yi)(yi)防麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)發(fa)(fa)(fa)(fa)表太(tai)過,那么,治寒閉尤甚乃至遏(e)陽(yang)生熱(re)(re)的(de)(de)(de)(de)大(da)(da)青龍湯(tang),為(wei)(wei)了峻汗(han)開表,麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)一舉(ju)用(yong)(yong)(yong)(yong)(yong)(yong)至六兩(liang),可(ke)(ke)(ke)謂(wei)(wei)(wei)正需(xu)“猛力(li)(li)(li)”,為(wei)(wei)何也(ye)(ye)“去(qu)(qu)(qu)上(shang)沫(mo)(mo)”呢?可(ke)(ke)(ke)見,張(zhang)(zhang)氏(shi)(shi)之(zhi)(zhi)說(shuo)(shuo)(shuo)(shuo)(shuo)也(ye)(ye)屬臆(yi)斷.麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)先煎(jian)去(qu)(qu)(qu)沫(mo)(mo)問(wen)(wen)(wen)題,應結合《內經》歷(li)史地看待。仲(zhong)(zhong)師《傷(shang)寒論(lun)(lun)》“撰用(yong)(yong)(yong)(yong)(yong)(yong)素問(wen)(wen)(wen)九卷(juan)”,這(zhe)說(shuo)(shuo)(shuo)(shuo)(shuo)明在(zai)理(li)(li)論(lun)(lun)上(shang)《傷(shang)寒論(lun)(lun)》與《內經》有(you)(you)著(zhu)千絲萬(wan)縷(lv)的(de)(de)(de)(de)聯(lian)(lian)系(xi)(xi),《素問(wen)(wen)(wen)·陰陽(yang)應象大(da)(da)論(lun)(lun)》中(zhong)(zhong)(zhong)說(shuo)(shuo)(shuo)(shuo)(shuo):“清(qing)陽(yang)發(fa)(fa)(fa)(fa)滕理(li)(li),濁(zhuo)(zhuo)陰走五臟”.又說(shuo)(shuo)(shuo)(shuo)(shuo):“陰味出(chu)下(xia)竅(qiao),陽(yang)氣(qi)(qi)(qi)出(chu)上(shang)竅(qiao)”。仲(zhong)(zhong)師把這(zhe)種藥物(wu)氣(qi)(qi)(qi)味陰陽(yang)、清(qing)濁(zhuo)(zhuo)升(sheng)(sheng)(sheng)(sheng)降的(de)(de)(de)(de)理(li)(li)論(lun)(lun)運用(yong)(yong)(yong)(yong)(yong)(yong)于(yu)(yu)(yu)經方(fang)(fang)的(de)(de)(de)(de)證(zheng)(zheng)治之(zhi)(zhi)中(zhong)(zhong)(zhong),由此推論(lun)(lun),麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)的(de)(de)(de)(de)先煎(jian)去(qu)(qu)(qu)沫(mo)(mo),首先是(shi)(shi)麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)在(zai)煎(jian)煮過程(cheng)中(zhong)(zhong)(zhong)出(chu)現(xian)(xian)“沫(mo)(mo)”,而仲(zhong)(zhong)師(或仲(zhong)(zhong)師前(qian)(qian)之(zhi)(zhi)醫(yi)家)憑直觀認為(wei)(wei)沫(mo)(mo)乃屬濁(zhuo)(zhuo)物(wu),必有(you)(you)礙于(yu)(yu)(yu)升(sheng)(sheng)(sheng)(sheng)發(fa)(fa)(fa)(fa),去(qu)(qu)(qu)之(zhi)(zhi)以(yi)(yi)取(qu)麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)氣(qi)(qi)(qi)之(zhi)(zhi)輕清(qing),而有(you)(you)利于(yu)(yu)(yu)發(fa)(fa)(fa)(fa)腆(tian)理(li)(li)、出(chu)上(shang)竅(qiao)。誠(cheng)如柯韻伯所云:“去(qu)(qu)(qu)沫(mo)(mo)者,止取(qu)其(qi)清(qing)陽(yang)發(fa)(fa)(fa)(fa)膝(xi)理(li)(li)之(zhi)(zhi)義也(ye)(ye)。”可(ke)(ke)(ke)謂(wei)(wei)(wei)一語中(zhong)(zhong)(zhong)的(de)(de)(de)(de)。聯(lian)(lian)系(xi)(xi)整(zheng)個《傷(shang)寒論(lun)(lun)》的(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)(yong)藥,也(ye)(ye)可(ke)(ke)(ke)以(yi)(yi)證(zheng)(zheng)實(shi)仲(zhong)(zhong)師對(dui)《內經》的(de)(de)(de)(de)藥物(wu)清(qing)濁(zhuo)(zhuo)升(sheng)(sheng)(sheng)(sheng)降理(li)(li)論(lun)(lun)十分(fen)重視(shi),不(bu)(bu)(bu)唯(wei)麻(ma)(ma)黃(huang)(huang)(huang)(huang)(huang)的(de)(de)(de)(de)“去(qu)(qu)(qu)沫(mo)(mo)”問(wen)(wen)(wen)題。在(zai)桂(gui)枝(zhi)加(jia)葛(ge)(ge)根(gen)湯(tang)、葛(ge)(ge)根(gen)湯(tang)及(ji)葛(ge)(ge)根(gen)琴連湯(tang)中(zhong)(zhong)(zhong),葛(ge)(ge)根(gen)均(jun)(jun)強調(diao)先煎(jian)去(qu)(qu)(qu)沫(mo)(mo),道理(li)(li)也(ye)(ye)在(zai)于(yu)(yu)(yu)此.葛(ge)(ge)根(gen)在(zai)這(zhe)幾個方(fang)(fang)中(zhong)(zhong)(zhong)均(jun)(jun)有(you)(you)解(jie)散表邪(xie)、升(sheng)(sheng)(sheng)(sheng)提(ti)津(jin)液(ye)的(de)(de)(de)(de)作(zuo)(zuo)用(yong)(yong)(yong)(yong)(yong)(yong),而發(fa)(fa)(fa)(fa)揮(hui)這(zhe)些外散上(shang)達的(de)(de)(de)(de)作(zuo)(zuo)用(yong)(yong)(yong)(yong)(yong)(yong)正需(xu)要(yao)葛(ge)(ge)根(gen)的(de)(de)(de)(de)輕清(qing)之(zhi)(zhi)氣(qi)(qi)(qi),所以(yi)(yi)也(ye)(ye)同(tong)樣(yang)去(qu)(qu)(qu)除(chu)了有(you)(you)礙升(sheng)(sheng)(sheng)(sheng)發(fa)(fa)(fa)(fa)的(de)(de)(de)(de)重濁(zhuo)(zhuo)之(zhi)(zhi)沫(mo)(mo)。再聯(lian)(lian)系(xi)(xi)大(da)(da)黃(huang)(huang)(huang)(huang)(huang)黃(huang)(huang)(huang)(huang)(huang)連瀉心湯(tang)的(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)(yong)“麻(ma)(ma)沸湯(tang)漬之(zhi)(zhi)”,就能(neng)進一步說(shuo)(shuo)(shuo)(shuo)(shuo)明仲(zhong)(zhong)師是(shi)(shi)極善(shan)于(yu)(yu)(yu)運用(yong)(yong)(yong)(yong)(yong)(yong)藥物(wu)的(de)(de)(de)(de)清(qing)濁(zhuo)(zhuo)升(sheng)(sheng)(sheng)(sheng)降理(li)(li)論(lun)(lun)指(zhi)導(dao)處方(fang)(fang)用(yong)(yong)(yong)(yong)(yong)(yong)藥的(de)(de)(de)(de)。大(da)(da)黃(huang)(huang)(huang)(huang)(huang)黃(huang)(huang)(huang)(huang)(huang)連瀉心湯(tang)所“瀉”的(de)(de)(de)(de)是(shi)(shi)“氣(qi)(qi)(qi)痞(pi)”,“氣(qi)(qi)(qi)痞(pi)”就是(shi)(shi)無形之(zhi)(zhi)氣(qi)(qi)(qi)熱(re)(re)11聚(ju)心下(xia)所致,邪(xie)結當(dang)(dang)“瀉”,無形之(zhi)(zhi)邪(xie)又不(bu)(bu)(bu)當(dang)(dang)“瀉、邪(xie)結當(dang)(dang)治用(yong)(yong)(yong)(yong)(yong)(yong)大(da)(da)黃(huang)(huang)(huang)(huang)(huang)黃(huang)(huang)(huang)(huang)(huang)連,無形之(zhi)(zhi)熱(re)(re)又不(bu)(bu)(bu)當(dang)(dang)徑用(yong)(yong)(yong)(yong)(yong)(yong)大(da)(da)黃(huang)(huang)(huang)(huang)(huang)黃(huang)(huang)(huang)(huang)(huang)連。于(yu)(yu)(yu)是(shi)(shi)仲(zhong)(zhong)師活用(yong)(yong)(yong)(yong)(yong)(yong)氣(qi)(qi)(qi)味厚薄(bo)升(sheng)(sheng)(sheng)(sheng)降出(chu)人(ren)(ren)的(de)(de)(de)(de)理(li)(li)
論,從(cong)而(er)采取(qu)這種不煎(jian)而(er)漬(zi)的特殊辦法,一方面取(qu)大黃(huang)黃(huang)連(lian)輕清(qing)(qing)(qing)之氣,以上行瀉心(xin)消痞;另一方面又可避免(mian)大黃(huang)黃(huang)連(lian)之厚味致(zhi)寒(han)中(zhong)傷正之弊,可謂用藥(yao)之巧,與(yu)麻(ma)黃(huang)葛(ge)(ge)根(gen)“去(qu)沫(mo)(mo)(mo)”異(yi)曲(qu)同(tong)工。除《金(jin)Ui》的厚樸麻(ma)黃(huang)湯(tang)方后注未提及(ji)先煎(jian)去(qu)沫(mo)(mo)(mo)外(wai)(恐屬遺漏),其他(ta)用麻(ma)黃(huang)、葛(ge)(ge)根(gen)者,無一例外(wai),足見仲師對(dui)此問題(ti)的重視.那么我(wo)們今天應如何看待這個(ge)問題(ti)呢?首先,應該(gai)承(cheng)認并搞清(qing)(qing)(qing)《傷寒(han)論》麻(ma)黃(huang)、葛(ge)(ge)根(gen)去(qu)沫(mo)(mo)(mo)的客觀存在及(ji)其涵義。至于(yu)麻(ma)黃(huang)、葛(ge)(ge)根(gen)之“沫(mo)(mo)(mo)”,是(shi)否(fou)屬于(yu)濁物?是(shi)否(fou)有礙于(yu)升清(qing)(qing)(qing)?當結合現代藥(yao)理進一步(bu)探討。就目(mu)前(qian)的麻(ma)黃(huang)、葛(ge)(ge)根(gen)用藥(yao)經驗(yan)來看,對(dui)去(qu)沫(mo)(mo)(mo)與(yu)否(fou),不必斤(jin)斤(jin)計較、泥古不化。
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上(shang)一(yi)篇: 麻杏甘石湯(tang)、麻黃湯(tang)證(zheng)、桂枝加厚樸杏子(zi)···
下(xia)一(yi)篇: 有沒有類似麻黃成(cheng)分的(de)藥物?