惲鐵樵(1875-1935),名樹(shu)玨,江蘇武(wu)進人。早(zao)年(nian)曾在商務印書(shu)館主編《小說月報》,以譯筆而聲于(yu)文壇。同(tong)時(shi),他又(you)精(jing)研醫(yi)經,數問業(ye)于(yu)上海傷寒(han)名家(jia)汪蓮(lian)石。中年(nian)改操醫(yi)業(ye),行(xing)道二十年(nian),其挽救(jiu)危逆甚眾(zhong),以膽識兼(jian)優為(wei)同(tong)道稱(cheng)評。
惲(yun)氏以時(shi)醫(yi)多崇(chong)尚(shang)葉(xie)(xie)(xie)天(tian)士《溫(wen)熱論(lun)》、吳鞠通《溫(wen)病條(tiao)辨(bian)》,與(yu)《傷(shang)寒(han)論(lun)》分庭抗(kang)禮,另(ling)辟門經(jing),遂注意研究三焦(jiao)(jiao)學(xue)(xue)說(shuo)(shuo).研究《溫(wen)病條(tiao)辨(bian)》、《臨(lin)證指(zhi)南醫(yi)案(an)》、《溫(wen)熱經(jing)緯》等書中(zhong)的(de)用藥規律,并(bing)留心觀察崇(chong)葉(xie)(xie)(xie)、吳之(zhi)(zhi)學(xue)(xue)的(de)醫(yi)生的(de)治病效果,發現溫(wen)病學(xue)(xue)說(shuo)(shuo)中(zhong)“有(you)未(wei)發明之(zhi)(zhi)學(xue)(xue)理(li),有(you)江湖術之(zhi)(zhi)黑幕”,遂著《溫(wen)病明理(li)》辟葉(xie)(xie)(xie)吳諸家學(xue)(xue)說(shuo)(shuo)之(zhi)(zhi)非,追(zhui)尋仲景學(xue)(xue)說(shuo)(shuo)之(zhi)(zhi)古義。他(ta)認為,《溫(wen)病條(tiao)辨(bian)》之(zhi)(zhi)三焦(jiao)(jiao),非《內(nei)經(jing)》之(zhi)(zhi)三焦(jiao)(jiao),而溫(wen)病從口鼻(bi)(bi)而入,始(shi)于(yu)手(shou)太陰之(zhi)(zhi)說(shuo)(shuo)亦不能(neng)成立。他(ta)說(shuo)(shuo):《內(nei)經(jing)》言(yan)凡熱病傷(shang)寒(han)之(zhi)(zhi)類,凡邪風之(zhi)(zhi)害人,皆始(shi)于(yu)皮毛,今言(yan)從口鼻(bi)(bi)入,由里出(chu)外,是(shi)必溫(wen)病在《內(nei)經(jing)》‘凡熱病’,三字范圍之(zhi)(zhi)外而后(hou)可”。又謂:“既(ji)(ji)言(yan)從口鼻(bi)(bi)入,鼻(bi)(bi)通于(yu)肺,故在手(shou)太陰,然則(ze)口通千脾,不在足太陰乎?”認為葉(xie)(xie)(xie)、吳于(yu)《傷(shang)寒(han)論(lun)》六(liu)經(jing)之(zhi)(zhi)外別創一三焦(jiao)(jiao)之(zhi)(zhi)說(shuo)(shuo),是(shi)“既(ji)(ji)未(wei)懂(dong)得六(liu)經(jing),尤未(wei)懂(dong)得三焦(jiao)(jiao)”,基本上(shang)否定(ding)了溫(wen)熱派(pai)的(de)學(xue)(xue)說(shuo)(shuo)。
歷史(shi)上(shang)的(de)傷(shang)寒(han)(han)與溫(wen)(wen)(wen)(wen)病(bing)(bing)(bing)(bing)之(zhi)(zhi)(zhi)(zhi)(zhi)爭,頗為(wei)(wei)(wei)(wei)激烈,惲(yun)氏(shi)認(ren)(ren)為(wei)(wei)(wei)(wei)關鍵在于(yu)(yu)(yu)(yu)病(bing)(bing)(bing)(bing)名(ming)(ming)混淆,概念不(bu)(bu)消,故(gu)首先為(wei)(wei)(wei)(wei)之(zhi)(zhi)(zhi)(zhi)(zhi)正名(ming)(ming)。他認(ren)(ren)為(wei)(wei)(wei)(wei):“溫(wen)(wen)(wen)(wen)病(bing)(bing)(bing)(bing)本(ben)是傷(shang)寒(han)(han),因時令(ling)之(zhi)(zhi)(zhi)(zhi)(zhi)異,六(liu)氣之(zhi)(zhi)(zhi)(zhi)(zhi)殊,病(bing)(bing)(bing)(bing)形之(zhi)(zhi)(zhi)(zhi)(zhi)變而別名(ming)(ming)為(wei)(wei)(wei)(wei)風溫(wen)(wen)(wen)(wen)、暑(shu)溫(wen)(wen)(wen)(wen)、濕(shi)(shi)(shi)(shi)溫(wen)(wen)(wen)(wen)。溫(wen)(wen)(wen)(wen)病(bing)(bing)(bing)(bing)之(zhi)(zhi)(zhi)(zhi)(zhi)來路(lu),因傷(shang)于(yu)(yu)(yu)(yu)寒(han)(han),與傷(shang)寒(han)(han)同一(yi)方式,故(gu)假定為(wei)(wei)(wei)(wei)傷(shang)寒(han)(han)系之(zhi)(zhi)(zhi)(zhi)(zhi)溫(wen)(wen)(wen)(wen)病(bing)(bing)(bing)(bing),即仲(zhong)景所(suo)(suo)言之(zhi)(zhi)(zhi)(zhi)(zhi)溫(wen)(wen)(wen)(wen)病(bing)(bing)(bing)(bing)也(ye)。其(qi)夏秋(qiu)間(jian)習見之(zhi)(zhi)(zhi)(zhi)(zhi)熱(re)病(bing)(bing)(bing)(bing),不(bu)(bu)因傷(shang)于(yu)(yu)(yu)(yu)寒(han)(han),因于(yu)(yu)(yu)(yu)濕(shi)(shi)(shi)(shi)者,曰濕(shi)(shi)(shi)(shi)溫(wen)(wen)(wen)(wen),因于(yu)(yu)(yu)(yu)暑(shu)者,曰暑(shu)溫(wen)(wen)(wen)(wen),與前條(tiao)之(zhi)(zhi)(zhi)(zhi)(zhi)濕(shi)(shi)(shi)(shi)溫(wen)(wen)(wen)(wen).暑(shu)溫(wen)(wen)(wen)(wen),病(bing)(bing)(bing)(bing)理病(bing)(bing)(bing)(bing)形絕不(bu)(bu)相同,故(gu)另名(ming)(ming)為(wei)(wei)(wei)(wei)非傷(shang)寒(han)(han)系之(zhi)(zhi)(zhi)(zhi)(zhi)溫(wen)(wen)(wen)(wen)病(bing)(bing)(bing)(bing),相當(dang)于(yu)(yu)(yu)(yu)仲(zhong)景所(suo)(suo)言之(zhi)(zhi)(zhi)(zhi)(zhi)濕(shi)(shi)(shi)(shi)、暍(he),亦《難(nan)經》所(suo)(suo)言之(zhi)(zhi)(zhi)(zhi)(zhi)“四日熱(re)病(bing)(bing)(bing)(bing)五日濕(shi)(shi)(shi)(shi)溫(wen)(wen)(wen)(wen)之(zhi)(zhi)(zhi)(zhi)(zhi)名(ming)(ming)”。這個濕(shi)(shi)(shi)(shi)與暍(he),惲(yun)氏(shi)解(jie)釋(shi)道(dao):兩病(bing)(bing)(bing)(bing)多(duo)發(fa)在夏秋(qiu)之(zhi)(zhi)(zhi)(zhi)(zhi)交、溽暑(shu)之(zhi)(zhi)(zhi)(zhi)(zhi)時。暑(shu)病(bing)(bing)(bing)(bing)汗多(duo),舌(she)絳邊潤(run),脈數(shu);濕(shi)(shi)(shi)(shi)病(bing)(bing)(bing)(bing)舌(she)白(bai)潤(run),口渴(ke)脈軟汗多(duo)。無(wu)論濕(shi)(shi)(shi)(shi)、暍(he)必(bi)胸(xiong)悶(men)。兩病(bing)(bing)(bing)(bing)還多(duo)發(fa)于(yu)(yu)(yu)(yu)都會人(ren)煙(yan)稠密之(zhi)(zhi)(zhi)(zhi)(zhi)處。基于(yu)(yu)(yu)(yu)以(yi)上(shang)認(ren)(ren)識,惲(yun)氏(shi)認(ren)(ren)為(wei)(wei)(wei)(wei)舉世(shi)聚訟,繳繞不(bu)(bu)巳(si)的(de)溫(wen)(wen)(wen)(wen)病(bing)(bing)(bing)(bing)不(bu)(bu)過濕(shi)(shi)(shi)(shi)、暍(he)而巳(si),而吳(wu)鞠通(tong)等必(bi)著為(wei)(wei)(wei)(wei)專(zhuan)書,妄(wang)引經文,不(bu)(bu)肯直載爽快(kuai)說出,致后人(ren)不(bu)(bu)得要領。
關(guan)于治療,惲(yun)氏認為(wei)凡(fan)傷寒(han)(han)系的(de)疾病(bing),皆(jie)以(yi)(yi)《傷寒(han)(han)論(lun)》為(wei)準(zhun)則,“傷寒(han)(han)以(yi)(yi)《傷寒(han)(han)論(lun)》為(wei)準(zhun),溫(wen)病(bing)亦當以(yi)(yi)《傷寒(han)(han)論(lun)》為(wei)準(zhun)。凡(fan)《傷寒(han)(han)論(lun)》中祖方,用(yong)辛涼(liang)不(bu)參(can)以(yi)(yi)溫(wen)藥者(zhe)、皆(jie)是(shi)治溫(wen)病(bing)之方”,他遵陸九(jiu)芝之說,視葛根芩(qin)連(lian)(lian)湯(tang)(tang)為(wei)治傷寒(han)(han)系溫(wen)病(bing)的(de)主方。如(ru)溫(wen)病(bing)初起發(fa)熱,唇紅(hong),舌(she)(she)燥(zao)渴(ke),不(bu)惡寒(han)(han),煩(fan)躁,無汗而喘者(zhe),用(yong)麻杏石(shi)甘湯(tang)(tang);不(bu)煩(fan)躁,指(zhi)尖微(wei)涼(liang),舌(she)(she)質紅(hong)、邊尖光,下利者(zhe),用(yong)葛根芩(qin)連(lian)(lian)加麻黃湯(tang)(tang);如(ru)初起發(fa)熱形(xing)寒(han)(han)喉痛,扁桃腺有白點,而有汗者(zhe),可用(yong)葛根芩(qin)連(lian)(lian)加石(shi)膏(gao)合(he)普濟消毒飲;若發(fa)熱有汗,初起微(wei)形(xing)寒(han)(han),須臾(yu)即罷,骨楚頭(tou)痛,或咳或否,或自利者(zhe),用(yong)葛根芩(qin)連(lian)(lian)湯(tang)(tang)。
關于濕(shi)溫(wen)(wen)(濕(shi))、暑(shu)溫(wen)(wen)(暍)的治法(fa),惲氏認(ren)為(wei)比較(jiao)簡單,遠不(bu)如傷寒復雜,但要辨準,否則誤治而成壞病(bing),通常號稱(cheng)難治的濕(shi)溫(wen)(wen),實皆(jie)壞病(bing)。如發熱(re)(re)形寒,脈緩,熱(re)(re)不(bu)甚高,肌膚(fu)津潤,舌苔純白,舌面潤,味蕾粒粒聳起,口(kou)味淡(dan),欲渴而引飲。躁(zao)煩畏光,是真濕(shi)溫(wen)(wen),用(yong)茅術白虎湯(tang)主(zhu)之(zhi);形寒甚,汗出津潤者加桂枝,筋骨(gu)疼痛(tong)者加防己(ji)、秦(qin)艽;嘔吐(tu)或胸(xiong)悶,加川(chuan)連、半夏。若此法(fa)不(bu)誤,可以(yi)弭患(huan)無形,隨手(shou)而愈。暑(shu)溫(wen)(wen)病(bing)勢急暴(bao),多見(jian)壯熱(re)(re)無汗,唇舌紅(hong)(hong)絳,銀翹散(san)、香薷飲皆(jie)效(xiao),又以(yi)香薷、銀花為(wei)要。若立(li)秋后天氣初涼,感冒發熱(re)(re)骨(gu)楚頭(tou)痛(tong),熱(re)(re)有起伏,往(wang)往(wang)如癥,一日二三度發,舌紅(hong)(hong)者為(wei)伏暑(shu),當以(yi)青蒿(hao)白薇湯(tang)主(zhu)之(zhi)。
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