張錫純用藥思路：
一肺虛咳(ke)喘用(yong)五味(wei)子治療咳(ke)喘兼補腎，但是五味(wei)子外酸內辛(xin) 所以用(yong)時必須敲碎，使之酸能(neng)能(neng)收辛(xin)能(neng)開，常配牛蒡子。
二虛人咳喘(chuan)或者虛人失眠(mian)，陽氣浮于上(shang)，常(chang)配(pei)人參(can)與代(dai)石(shi)，人參(can)與代(dai)石(shi)配(pei)伍，使補益之氣直通涌泉，凡(fan)是咳喘(chuan)之病，都是寵(chong)胃(wei)之氣上(shang)逆，凡(fan)是失眠(mian)治病，都因為虛陽上(shang)逆不(bu)能下交(jiao)于腎，比用代(dai)石(shi)降(jiang)胃(wei)氣降(jiang)虛陽，
三 用(yong)人(ren)參(can)常(chang)配(pei)(pei)雞內金 因為虛人(ren)脈絡常(chang)用(yong)淤血(xue) 雞內金配(pei)(pei)人(ren)參(can) 是人(ren)吃了人(ren)參(can)不會產生悶氣，可花人(ren)參(can)之(zhi)膩，又可活血(xue)化瘀。（人(ren)參(can)補而升 所以配(pei)(pei)代石使之(zhi)降）凡咳(ke)喘病(bing) 不可盲目用(yong)人(ren)參(can)，必須配(pei)(pei)代石引下，氣歸于腎。
四補(bu)(bu)陰(yin)常(chang)大(da)劑(ji)量山藥 于肉 肺陰(yin)虛(xu)天冬 麥冬 沙(sha)參 陰(yin)虛(xu)常(chang)配元參代替之母 三伏(fu)天傷(shang)陰(yin)必用(yong)(yong)石膏 透熱(re)用(yong)(yong)連翹 和茅(mao)根 是熱(re)從皮(pi)膚散 熱(re)從小便(bian)處用(yong)(yong)白芍(shao)和滑(hua)石 白芍(shao) 利尿(niao)補(bu)(bu)陰(yin) 滑(hua)石利尿(niao)滑(hua)濕(shi)氣不傷(shang)陰(yin)。
五 三七(qi)活血通絡要要 又是止(zhi)血要藥 凡(fan)是虛人(ren)老咳喘 肺必然氣逆和血逆，用三七(qi)效果好。
咳喘兼腎(shen)(shen)虛者用配遠(yuan)志，遠(yuan)志苦能(neng)補(bu)腎(shen)(shen)酸能(neng)化痰理肺(fei) 多(duo)生肺(fei)中津液。
六氣血兩虧 與寒氣咳喘者 常用重山藥當歸 白芍 天冬 之類配干姜 桂枝五味子 細辛小青龍加補陰藥治療。
（小青(qing)龍湯(tang)喘(chuan)者(zhe)去麻(ma)黃(huang) 加杏仁 有外感加石膏 沒(mei)有外感加天冬 麥(mai)冬已(yi)解(jie)桂(gui)枝(zhi) 干姜(jiang)之熱）
七肺癆咳喘(chuan) 天氣熱 肺中(zhong)氣管(guan)(guan)松 咳喘(chuan)好轉 天氣冷肺中(zhong)氣管(guan)(guan)收縮 咳喘(chuan)重 此(ci)病常腎也(ye)虛(xu)
治(zhi)療必須宣通肺氣 麻(ma)黃配遠志加牛蒡子 再用細辛去寒配天冬 花粉 白芍補陰。
八 凡(fan)是失眠(mian) 咳喘 都(dou)是因為(wei)胃氣(qi)(qi)不(bu)降肝氣(qi)(qi)不(bu)升 麥芽吵(chao)消食 生 用(yong)升肝氣(qi)(qi) 人生之氣(qi)(qi)化
原是左升(sheng)右降 代石降胃 麥(mai)芽升(sheng)肝氣 氣化順其自然(ran)。
九伏氣(qi)化熱 串入陽明 不(bu)可亂用寒涼(liang) 是(shi)熱無出路 上之(zhi)肺(fei) 咳喘 肺(fei)結核治療用石膏清熱
元(yuan)參代之母清胃熱 三七 銀華解毒 蘆根(gen)連翹熱從(cong)皮膚(fu)處(chu)。
10凡是溫下焦之(zhi)(zhi)藥(yao)如附子 切不(bu)可用(yong)升提之(zhi)(zhi)藥(yao)升麻(ma) 柴(chai)胡之(zhi)(zhi)類 用(yong)之(zhi)(zhi)必火升上(shang)煩躁，氣虛之(zhi)(zhi)人黃芪配升麻(ma) 柴(chai)胡 升提之(zhi)(zhi)力很大
11 卑解之藥(yao) 能縮小(xiao)便 斷不能通小(xiao)便。不可盲用通利小(xiao)便之藥(yao)，凡是水腫 淋病不可盲目使用。
12大氣下(xia)陷 右部寸關脈(mo)必沉 肝(gan)部又熱 左(zuo)關脈(mo)弦補氣黃芪配柴胡 清肝(gan)熱白(bai)芍配龍膽(dan)草。
心陽虛(xu) 干姜(jiang)配桂枝。
13桂枝一(yi)藥 氣(qi)升者與升藥則升 氣(qi)降(jiang)者遇(yu)降(jiang)藥責降(jiang)，能(neng)升能(neng)降(jiang)
山藥 芡實(shi)不(bu)慎又能收(shou)斂下焦(jiao)氣化，龍骨 牡(mu)蠣 斂正氣不(bu)斂邪(xie)氣。
;14凡是食后氣上(shang)沖 都是胃(wei)氣不降，治療必(bi)須降胃(wei)氣用代石(shi)，泄肝(gan)(gan)氣，肝(gan)(gan)為(wei)將軍之官，內有相火，其性剛烈，不可強制，用藥用麥芽(ya) 茵陳 舒其肝(gan)(gan)氣不至于升提，順其肝(gan)(gan)木柔和。
凡(fan)是肝郁胃氣不降者(zhe)都(dou)用(yong)麥芽(ya) 茵陳(chen)升肝 代(dai)石 半(ban)夏 降胃氣。凡(fan)是病遇胃氣不降者(zhe) 往(wang)往(wang)不用(yong)柴胡，因為用(yong)柴胡 升提之力很大，是胃氣不降，用(yong)了恐怕下(xia)引(yin)之氣上逆。
張錫純用藥核心思維：
藥(yao)(yao)為(wei)治病(bing)者(zhe)設(she)，醫者(zhe)臨證，雖貴在辨證準確、方(fang)藥(yao)(yao)合拍，而藥(yao)(yao)物(wu)劑量(liang)(liang)之(zhi)多少亦至關重(zhong)(zhong)(zhong)要。藥(yao)(yao)輕(qing)(qing)(qing)病(bing)重(zhong)(zhong)(zhong)則藥(yao)(yao)不能勝(sheng)病(bing)，藥(yao)(yao)重(zhong)(zhong)(zhong)病(bing)輕(qing)(qing)(qing)則徒(tu)傷(shang)正氣。張(zhang)仲景用(yong)(yong)(yong)藥(yao)(yao)，尤為(wei)精(jing)當(dang)，同是大黃、厚(hou)樸、枳實，而劑量(liang)(liang)不同，方(fang)名為(wei)三，治證亦異。張(zhang)錫純深(shen)諳其道(dao)，在《醫學衷中(zhong)參西(xi)錄(lu)》中(zhong)謂“論(lun)用(yong)(yong)(yong)藥(yao)(yao)以(yi)勝(sheng)病(bing)為(wei)主，不拘分量(liang)(liang)之(zhi)多少”。其立方(fang)遣藥(yao)(yao)，或(huo)峻藥(yao)(yao)重(zhong)(zhong)(zhong)用(yong)(yong)(yong)，或(huo)峻藥(yao)(yao)輕(qing)(qing)(qing)用(yong)(yong)(yong)；或(huo)平藥(yao)(yao)重(zhong)(zhong)(zhong)用(yong)(yong)(yong)，或(huo)平藥(yao)(yao)輕(qing)(qing)(qing)用(yong)(yong)(yong)；或(huo)重(zhong)(zhong)(zhong)藥(yao)(yao)重(zhong)(zhong)(zhong)用(yong)(yong)(yong)，或(huo)重(zhong)(zhong)(zhong)藥(yao)(yao)輕(qing)(qing)(qing)用(yong)(yong)(yong)；或(huo)輕(qing)(qing)(qing)藥(yao)(yao)重(zhong)(zhong)(zhong)用(yong)(yong)(yong)，或(huo)輕(qing)(qing)(qing)藥(yao)(yao)輕(qing)(qing)(qing)用(yong)(yong)(yong)，總以(yi)藥(yao)(yao)病(bing)相(xiang)當(dang)。筆者(zhe)現就《醫學衷中(zhong)參西(xi)錄(lu)》相(xiang)關內容將(jiang)其用(yong)(yong)(yong)藥(yao)(yao)特點淺析如下(xia)
1 重藥(yao)重用(yong)，重藥(yao)輕用(yong)
所謂重(zhong)(zhong)藥(yao)(yao)(yao)，乃指藥(yao)(yao)(yao)質(zhi)沉重(zhong)(zhong)，如(ru)貝殼類、金石(shi)(shi)(shi)(shi)類，重(zhong)(zhong)藥(yao)(yao)(yao)多有(you)鎮降(jiang)作用(yong)(yong)(yong)。張(zhang)錫(xi)純(chun)(chun)用(yong)(yong)(yong)重(zhong)(zhong)藥(yao)(yao)(yao)治(zhi)(zhi)(zhi)病(bing)，其(qi)劑(ji)量輕重(zhong)(zhong)有(you)別(bie)，恰到好處。如(ru)代(dai)赭(zhe)(zhe)(zhe)石(shi)(shi)(shi)(shi)，張(zhang)錫(xi)純(chun)(chun)認為(wei)(wei)降(jiang)逆以代(dai)赭(zhe)(zhe)(zhe)石(shi)(shi)(shi)(shi)壓(ya)(ya)力(li)最甚，用(yong)(yong)(yong)治(zhi)(zhi)(zhi)氣(qi)逆重(zhong)(zhong)癥(zheng)，用(yong)(yong)(yong)量2～4兩(liang)(liang)(liang)(1兩(liang)(liang)(liang)＝30 g，下(xia)同)或(huo)更多。如(ru)《醫學衷中參西錄》中載(zai)其(qi)用(yong)(yong)(yong)代(dai)赭(zhe)(zhe)(zhe)石(shi)(shi)(shi)(shi)4兩(liang)(liang)(liang)煎湯(tang)(tang)(tang)、1兩(liang)(liang)(liang)為(wei)(wei)末服之(zhi)(zhi)(zhi)治(zhi)(zhi)(zhi)腸(chang)結(jie)而效。而治(zhi)(zhi)(zhi)周姓(xing)婦(fu)，年30許(xu)，妊(ren)娠(shen)(shen)劇(ju)吐便(bian)秘，單用(yong)(yong)(yong)代(dai)赭(zhe)(zhe)(zhe)石(shi)(shi)(shi)(shi)4兩(liang)(liang)(liang)，以3兩(liang)(liang)(liang)煎湯(tang)(tang)(tang)、1兩(liang)(liang)(liang)為(wei)(wei)末服之(zhi)(zhi)(zhi)，嘔吐乃止(zhi)，大(da)(da)便(bian)亦(yi)(yi)暢。代(dai)赭(zhe)(zhe)(zhe)石(shi)(shi)(shi)(shi)為(wei)(wei)妊(ren)娠(shen)(shen)禁忌(ji)，但(dan)有(you)故(gu)而亦(yi)(yi)無殞(yun)也(ye)；用(yong)(yong)(yong)治(zhi)(zhi)(zhi)癲狂之(zhi)(zhi)(zhi)劇(ju)證，亦(yi)(yi)常用(yong)(yong)(yong)至4兩(liang)(liang)(liang)；而治(zhi)(zhi)(zhi)虛(xu)勞喘逆、飲食減(jian)少之(zhi)(zhi)(zhi)滋培湯(tang)(tang)(tang)，生(sheng)(sheng)代(dai)赭(zhe)(zhe)(zhe)石(shi)(shi)(shi)(shi)只用(yong)(yong)(yong)3錢(1錢＝3 g，下(xia)同)，醴泉(quan)飲生(sheng)(sheng)代(dai)赭(zhe)(zhe)(zhe)石(shi)(shi)(shi)(shi)用(yong)(yong)(yong)4錢，急救回陽(yang)湯(tang)(tang)(tang)生(sheng)(sheng)代(dai)赭(zhe)(zhe)(zhe)石(shi)(shi)(shi)(shi)用(yong)(yong)(yong)4錢，因(yin)張(zhang)錫(xi)純(chun)(chun)認為(wei)(wei)代(dai)赭(zhe)(zhe)(zhe)石(shi)(shi)(shi)(shi)不(bu)但(dan)養氣(qi)、降(jiang)氣(qi)而不(bu)傷正，且“赭(zhe)(zhe)(zhe)石(shi)(shi)(shi)(shi)之(zhi)(zhi)(zhi)壓(ya)(ya)力(li)最勝者，可使人參補益之(zhi)(zhi)(zhi)力(li)，下(xia)行(xing)直至涌泉(quan)，而上(shang)焦(jiao)之(zhi)(zhi)(zhi)逆氣(qi)浮火，皆(jie)隨之(zhi)(zhi)(zhi)順流而下(xia)”，重(zhong)(zhong)藥(yao)(yao)(yao)輕用(yong)(yong)(yong)，以為(wei)(wei)佐(zuo)藥(yao)(yao)(yao)。張(zhang)錫(xi)純(chun)(chun)清(qing)熱習用(yong)(yong)(yong)生(sheng)(sheng)石(shi)(shi)(shi)(shi)膏。石(shi)(shi)(shi)(shi)膏味(wei)辛性寒，不(bu)但(dan)治(zhi)(zhi)(zhi)外(wai)(wai)感發(fa)熱，效比金丹，而內臟有(you)熱，如(ru)鼻淵、痔(zhi)疾、婦(fu)人熱入血室(shi)、外(wai)(wai)科瘡瘍等，石(shi)(shi)(shi)(shi)膏亦(yi)(yi)能清(qing)之(zhi)(zhi)(zhi)。外(wai)(wai)感大(da)(da)熱，生(sheng)(sheng)石(shi)(shi)(shi)(shi)膏每用(yong)(yong)(yong)4～8兩(liang)(liang)(liang)。如(ru)書中所載(zai)：趙某之(zhi)(zhi)(zhi)子(zi)，19歲，溫(wen)病(bing)熱厥，予大(da)(da)劑(ji)人參白虎(hu)湯(tang)(tang)(tang)，生(sheng)(sheng)石(shi)(shi)(shi)(shi)膏用(yong)(yong)(yong)至8兩(liang)(liang)(liang)；治(zhi)(zhi)(zhi)一7歲孺子(zi)，溫(wen)病(bing)高(gao)熱，單用(yong)(yong)(yong)生(sheng)(sheng)石(shi)(shi)(shi)(shi)膏6兩(liang)(liang)(liang)；
治(zhi)奉天(tian)劉(liu)某(mou)之(zhi)壯熱，生(sheng)(sheng)(sheng)石膏(gao)日用(yong)(yong)1斤(jin)(1斤(jin)＝480 g，下(xia)同)，共投(tou)8斤(jin)之(zhi)多。然張(zhang)(zhang)錫純用(yong)(yong)石膏(gao)亦不孟(meng)浪，加(jia)味越婢加(jia)半夏(xia)湯治(zhi)外感勞(lao)嗽石膏(gao)只用(yong)(yong)3錢(qian)(qian)；治(zhi)鄰(lin)村周某(mou)，年20余，溫病(bing)變(bian)證，投(tou)白虎湯，生(sheng)(sheng)(sheng)石膏(gao)只用(yong)(yong)5錢(qian)(qian)，因(yin)其能(neng)(neng)(neng)把握(wo)病(bing)情，善用(yong)(yong)石膏(gao)。張(zhang)(zhang)錫純認為，龍(long)(long)(long)骨(gu)(gu)、牡(mu)蠣既能(neng)(neng)(neng)斂(lian)(lian)補又能(neng)(neng)(neng)開通，補虛而不斂(lian)(lian)邪，治(zhi)諸虛不復，補藥之(zhi)中加(jia)龍(long)(long)(long)骨(gu)(gu)、牡(mu)蠣每能(neng)(neng)(neng)建(jian)功。故制十全(quan)育真湯中用(yong)(yong)生(sheng)(sheng)(sheng)龍(long)(long)(long)骨(gu)(gu)、生(sheng)(sheng)(sheng)牡(mu)蠣各4錢(qian)(qian)，佐人(ren)(ren)參、黃(huang)芪、山藥以(yi)扶(fu)正氣；治(zhi)婦女血崩之(zhi)固(gu)(gu)(gu)沖湯則重(zhong)用(yong)(yong)煅(duan)龍(long)(long)(long)骨(gu)(gu)、煅(duan)牡(mu)蠣各8錢(qian)(qian)以(yi)收斂(lian)(lian)固(gu)(gu)(gu)澀而救急(ji)。如(ru)書(shu)中載(zai)：治(zhi)一(yi)產后多汗(han)，以(yi)生(sheng)(sheng)(sheng)龍(long)(long)(long)骨(gu)(gu)、生(sheng)(sheng)(sheng)牡(mu)蠣各8錢(qian)(qian)伍(wu)生(sheng)(sheng)(sheng)山藥、凈吳茱萸各1兩(liang)，生(sheng)(sheng)(sheng)白芍藥4錢(qian)(qian)，止汗(han)固(gu)(gu)(gu)脫；從龍(long)(long)(long)湯治(zhi)虛喘，生(sheng)(sheng)(sheng)龍(long)(long)(long)骨(gu)(gu)、生(sheng)(sheng)(sheng)牡(mu)蠣皆用(yong)(yong)1兩(liang)；治(zhi)16歲童(tong)，溫病(bing)高熱，心(xin)中怔忡，精神恍惚，用(yong)(yong)人(ren)(ren)參白虎湯加(jia)生(sheng)(sheng)(sheng)龍(long)(long)(long)骨(gu)(gu)、生(sheng)(sheng)(sheng)牡(mu)蠣各1兩(liang)。因(yin)病(bing)有(you)輕重(zhong)，證有(you)緩急(ji)，用(yong)(yong)藥劑量自當有(you)別.
2 輕(qing)藥(yao)輕(qing)用，輕(qing)藥(yao)重用
所謂輕(qing)藥，系指藥物質輕(qing)，如(ru)植物藥之(zhi)(zhi)花、葉(xie)，動物之(zhi)(zhi)殼衣(yi)多為輕(qing)藥，輕(qing)藥多能升散。張(zhang)錫(xi)(xi)純(chun)用(yong)(yong)(yong)(yong)輕(qing)藥之(zhi)(zhi)劑(ji)量(liang)，或輕(qing)或重(zhong)，總視病(bing)證而(er)變。如(ru)紅(hong)(hong)花重(zhong)用(yong)(yong)(yong)(yong)能活血(xue)消(xiao)瘀(yu)(yu)，小劑(ji)則(ze)和(he)血(xue)養血(xue)。張(zhang)錫(xi)(xi)純(chun)治(zhi)(zhi)(zhi)產后受(shou)風(feng)發(fa)(fa)搐，制(zhi)和(he)血(xue)熄風(feng)湯(tang)，重(zhong)用(yong)(yong)(yong)(yong)當歸(gui)、黃(huang)芪、阿膠以(yi)養血(xue)，少佐(zuo)紅(hong)(hong)花1錢(qian)(qian)以(yi)助(zhu)補藥為功。如(ru)治(zhi)(zhi)(zhi)一64歲老年中風(feng)，平肝(gan)滋陰(yin)降逆方中紅(hong)(hong)花只(zhi)1錢(qian)(qian)以(yi)化腦中瘀(yu)(yu)血(xue)；治(zhi)(zhi)(zhi)鼠疫之(zhi)(zhi)重(zhong)癥，脈道阻滯，形容慘淡，神(shen)志模糊之(zhi)(zhi)解毒(du)活血(xue)湯(tang)，紅(hong)(hong)花則(ze)用(yong)(yong)(yong)(yong)5錢(qian)(qian)。薄(bo)荷(he)葉(xie)辛涼發(fa)(fa)散，常(chang)用(yong)(yong)(yong)(yong)于(yu)外感風(feng)熱(re)。張(zhang)錫(xi)(xi)純(chun)制(zhi)清(qing)解湯(tang)，治(zhi)(zhi)(zhi)溫病(bing)初(chu)起，薄(bo)荷(he)葉(xie)用(yong)(yong)(yong)(yong)4錢(qian)(qian)，蟬蛻用(yong)(yong)(yong)(yong)3錢(qian)(qian)；治(zhi)(zhi)(zhi)表(biao)里(li)同(tong)病(bing)之(zhi)(zhi)通變大(da)柴胡(hu)湯(tang)，薄(bo)荷(he)用(yong)(yong)(yong)(yong)3錢(qian)(qian)。而(er)治(zhi)(zhi)(zhi)其堂(tang)侄女口角(jiao)生疔(ding)用(yong)(yong)(yong)(yong)大(da)黃(huang)掃(sao)毒(du)湯(tang)，方中薄(bo)荷(he)葉(xie)為1錢(qian)(qian)；治(zhi)(zhi)(zhi)外感熱(re)病(bing)驚風(feng)之(zhi)(zhi)鎮風(feng)湯(tang)，薄(bo)荷(he)葉(xie)用(yong)(yong)(yong)(yong)量(liang)亦為1錢(qian)(qian)。前(qian)者薄(bo)荷(he)葉(xie)量(liang)大(da)是冀其得汗，后者量(liang)小則(ze)旨在發(fa)(fa)散。茵(yin)陳(chen)具升發(fa)(fa)之(zhi)(zhi)性既能利濕退黃(huang)，亦能升達(da)肝(gan)胃，張(zhang)錫(xi)(xi)純(chun)用(yong)(yong)(yong)(yong)茵(yin)陳(chen)每取小劑(ji)，以(yi)防茵(yin)陳(chen)升發(fa)(fa)太過而(er)害胃。如(ru)治(zhi)(zhi)(zhi)天津(jin)蘇媼之(zhi)(zhi)黃(huang)疸，茵(yin)陳(chen)用(yong)(yong)(yong)(yong)量(liang)2錢(qian)(qian)；治(zhi)(zhi)(zhi)天津(jin)李(li)氏婦肝(gan)火頭疼，生代赭(zhe)石用(yong)(yong)(yong)(yong)1.5兩，懷(huai)牛(niu)膝(xi)1兩而(er)佐(zuo)以(yi)茵(yin)陳(chen)1錢(qian)(qian)半(ban)。
張錫純認為(wei)“茵陳(chen)(chen)(chen)為(wei)青蒿(hao)之嫩者……與(yu)肝(gan)木同(tong)氣(qi)相(xiang)(xiang)求”，用茵陳(chen)(chen)(chen)者，因肝(gan)為(wei)將(jiang)(jiang)軍之官，其(qi)性(xing)(xing)(xing)剛果，且中(zhong)寄相(xiang)(xiang)火(huo)，若但(dan)用藥(yao)平之鎮(zhen)之，恒至(zhi)(zhi)起反(fan)動(dong)之力。茵陳(chen)(chen)(chen)最(zui)能將(jiang)(jiang)順肝(gan)木之性(xing)(xing)(xing)，且又善瀉(xie)肝(gan)熱，故張錫純治(zhi)腦(nao)充(chong)血之證，平肝(gan)鎮(zhen)降藥(yao)中(zhong)，每(mei)(mei)每(mei)(mei)少佐茵陳(chen)(chen)(chen)，以使升降相(xiang)(xiang)因，平衡有(you)序(xu)。以茵陳(chen)(chen)(chen)能順肝(gan)，張錫純治(zhi)天津年66歲徐某之不寐，心肝(gan)同(tong)治(zhi)，予養心安神藥(yao)對中(zhong)更加茵陳(chen)(chen)(chen)1錢(qian)(qian)至(zhi)(zhi)1.5錢(qian)(qian)，使母(mu)子平安；治(zhi)族嫂勞瘵，予資生湯(tang)方中(zhong)加茵陳(chen)(chen)(chen)1.5錢(qian)(qian)，舒肝(gan)之郁也。青黛性(xing)(xing)(xing)味咸寒，能清熱解毒(du)、涼血止血、清肝(gan)火(huo)，常用量0.5錢(qian)(qian)至(zhi)(zhi)1錢(qian)(qian)。若用量較(jiao)大時(shi)每(mei)(mei)可出現惡心嘔吐，腹部難受，腹脹，泄瀉(xie)。
張(zhang)錫(xi)純(chun)臨證，常用3錢(qian)，如(ru)制(zhi)安胃飲治(zhi)惡(e)(e)阻，方(fang)中(zhong)清(qing)半夏1兩，赤石脂(zhi)1兩，青黛(dai)3錢(qian)；治(zhi)天津(jin)王錫(xi)純(chun)婦之(zhi)(zhi)惡(e)(e)阻，予(yu)益(yi)氣養(yang)陰(yin)、健胃降(jiang)逆(ni)方(fang)中(zhong)，亦取青黛(dai)3錢(qian)，意(yi)在胎前(qian)多肝(gan)熱，藉青黛(dai)以(yi)清(qing)之(zhi)(zhi)涼之(zhi)(zhi)，使木(mu)火平斂(lian)。蟬蛻(tui)能散風熱，透(tou)疹(zhen)、止痙，張(zhang)錫(xi)純(chun)制(zhi)宣解(jie)湯(tang)治(zhi)感冒久(jiu)在太陽，蟬蛻(tui)用3錢(qian)；而(er)治(zhi)奉天年(nian)28歲(sui)王某之(zhi)(zhi)子，溫(wen)病白痧，外感與真陰(yin)不(bu)足相(xiang)兼(jian)，予(yu)生石膏、知母等清(qing)熱，天花粉、生地黃養(yang)陰(yin)，黨參、生山藥益(yi)氣，更用蟬蛻(tui)1錢(qian)，是欲(yu)輕散而(er)不(bu)欲(yu)太過之(zhi)(zhi)意(yi)
3 峻(jun)(jun)藥重用，峻(jun)(jun)藥輕用
峻藥(yao)(yao)是藥(yao)(yao)性(xing)峻烈或有毒之(zhi)(zhi)品，乃虎狼之(zhi)(zhi)師，祛邪傷正，只差毫厘，醫者用(yong)(yong)之(zhi)(zhi)，固宜(yi)審慎(shen)。張(zhang)錫純駕馭峻藥(yao)(yao)，常以(yi)常人不敢而(er)為(wei)之(zhi)(zhi)。如硫(liu)黃(huang)(huang)，性(xing)大(da)熱有毒，一(yi)般醫者多(duo)不敢重用(yong)(yong)，張(zhang)錫純以(yi)為(wei)硫(liu)黃(huang)(huang)本無毒，其毒即其熱力，其溫陽(yang)之(zhi)(zhi)功(gong)，更勝肉桂、附子，以(yi)治(zhi)沉(chen)寒(han)(han)痼冷，腎陽(yang)式微之(zhi)(zhi)重癥惡疾，常建(jian)奇功(gong)。張(zhang)錫純治(zhi)一(yi)青(qing)年(nian)，中寒(han)(han)嘔(ou)吐(tu)(tu)，用(yong)(yong)生(sheng)硫(liu)黃(huang)(huang)共4斤而(er)病除(chu)；治(zhi)鄰(lin)村(cun)張(zhang)氏婦，年(nian)20余，胃寒(han)(han)嘔(ou)吐(tu)(tu)，硫(liu)黃(huang)(huang)日用(yong)(yong)量達0.67兩，嘔(ou)吐(tu)(tu)乃止。而(er)治(zhi)一(yi)50余歲(sui)婦寒(han)(han)飲證(zheng)，硫(liu)黃(huang)(huang)僅(jin)用(yong)(yong)3分；治(zhi)一(yi)60余歲(sui)叟，陽(yang)虛(xu)水腫(zhong)，生(sheng)硫(liu)黃(huang)(huang)只用(yong)(yong)2分；治(zhi)一(yi)13歲(sui)少(shao)年(nian)，陽(yang)虛(xu)之(zhi)(zhi)證(zheng)，生(sheng)硫(liu)黃(huang)(huang)日用(yong)(yong)量為(wei)分許(xu)。病情重輕(qing)不同，體質強弱相(xiang)異，同一(yi)硫(liu)黃(huang)(huang)，用(yong)(yong)量重輕(qing)相(xiang)差懸殊。
附(fu)(fu)子(zi)(zi)(zi)辛熱有(you)(you)毒(du)，常(chang)用(yong)量(liang)(liang)為(wei)1～5錢(qian)(qian)。張(zhang)錫純(chun)(chun)治大(da)病后(hou)陰陽不相維系，制(zhi)既濟湯陰陽雙補，附(fu)(fu)子(zi)(zi)(zi)用(yong)量(liang)(liang)1錢(qian)(qian)，是以(yi)附(fu)(fu)子(zi)(zi)(zi)協同(tong)(tong)芍藥(yao)引浮(fu)越之(zhi)(zhi)陽下(xia)(xia)歸其宅，以(yi)小劑量(liang)(liang)為(wei)功。而(er)用(yong)大(da)劑附(fu)(fu)子(zi)(zi)(zi)8錢(qian)(qian)治一(yi)妊(ren)娠少婦(fu)中寒(han)證(zheng)，應手而(er)愈。更有(you)(you)案載治余某妻陰寒(han)證(zheng)，左邊少腹有(you)(you)塊，遍身冷汗，不省人(ren)事(shi)，附(fu)(fu)子(zi)(zi)(zi)用(yong)量(liang)(liang)4兩，藥(yao)后(hou)面熱如醉，手足拘攣，舌尖麻，而(er)痼疾乃瘥，此膽(dan)大(da)心(xin)細，中毒(du)與祛病，把握(wo)不當則僨(fen)事(shi)矣(yi)。大(da)黃(huang)(huang)有(you)(you)將軍之(zhi)(zhi)稱，攻下(xia)(xia)破結，藥(yao)性峻猛，雖為(wei)常(chang)用(yong)之(zhi)(zhi)藥(yao)，而(er)張(zhang)錫純(chun)(chun)對大(da)黃(huang)(huang)劑量(liang)(liang)之(zhi)(zhi)認(ren)識(shi)非(fei)同(tong)(tong)常(chang)人(ren)。張(zhang)錫純(chun)(chun)論治癲狂之(zhi)(zhi)實(shi)證(zheng)用(yong)大(da)黃(huang)(huang)2兩，疔毒(du)更可以(yi)大(da)劑治之(zhi)(zhi)，案載用(yong)生大(da)黃(huang)(huang)治瘡毒(du)以(yi)10斤水(shui)煎(jian)飲(yin)之(zhi)(zhi)而(er)愈。治吐血(xue)仿(fang)瀉(xie)心(xin)湯法(fa)，用(yong)大(da)黃(huang)(huang)細末(mo)合肉桂細末(mo)各6、7分(fen)，開(kai)水(shui)送(song)服；制(zhi)秘紅(hong)丹治吐血(xue)大(da)黃(huang)(huang)亦用(yong)1錢(qian)(qian)。同(tong)(tong)一(yi)味藥(yao)，用(yong)量(liang)(liang)相差多矣(yi)。樸硝咸苦寒(han)，功能瀉(xie)下(xia)(xia)、清熱軟堅。張(zhang)錫純(chun)(chun)制(zhi)赭遂攻結湯治宿食結于腸間，用(yong)生赭石2兩，樸硝5錢(qian)(qian)、干姜2錢(qian)(qian)、甘(gan)遂末(mo)1.5錢(qian)(qian)，以(yi)樸硝助甘(gan)遂通下(xia)(xia)；
制(zhi)硝(xiao)菔(fu)通(tong)結湯(tang)，取單(dan)味樸硝(xiao)4兩(liang)(liang)，鮮萊菔(fu)子5斤同煎頓服，治(zhi)氣血凝(ning)滯(zhi)諸證(zheng)。案載其治(zhi)奉(feng)天劉某(mou)之結證(zheng)，樸硝(xiao)6兩(liang)(liang)與鮮萊菔(fu)子同煮，服之得通(tong)下而(er)愈。乳(ru)香、沒(mei)藥能(neng)行氣活血，張錫純(chun)多用(yong)(yong)(yong)生(sheng)(sheng)品，其用(yong)(yong)(yong)量(liang)大小各別(bie)，案載用(yong)(yong)(yong)加味補(bu)血湯(tang)治(zhi)痿證(zheng)，乳(ru)香、沒(mei)藥用(yong)(yong)(yong)量(liang)6錢(qian)；而(er)定(ding)心湯(tang)、氣淋湯(tang)用(yong)(yong)(yong)生(sheng)(sheng)乳(ru)香、生(sheng)(sheng)沒(mei)藥各1錢(qian)；治(zhi)表侄(zhi)劉某(mou)之瘡瘍、乳(ru)香沒(mei)藥亦用(yong)(yong)(yong)1錢(qian)。張錫純(chun)降逆止(zhi)嘔，習用(yong)(yong)(yong)自(zi)制(zhi)生(sheng)(sheng)半(ban)夏。如治(zhi)奉(feng)天王(wang)姓婦妊娠惡(e)阻，用(yong)(yong)(yong)自(zi)制(zhi)半(ban)夏2兩(liang)(liang)配生(sheng)(sheng)代赭石8兩(liang)(liang)，生(sheng)(sheng)懷(huai)山藥2.5兩(liang)(liang)，2日而(er)愈。其他如案載用(yong)(yong)(yong)麻(ma)黃去節(jie)2兩(liang)(liang)，熟(shu)附子2兩(liang)(liang)2錢(qian)，炙甘草(cao)2錢(qian)治(zhi)臌(gu)脹(zhang)無汗；用(yong)(yong)(yong)蝎子末2兩(liang)(liang)治(zhi)鄰莊馬(ma)姓壯年中風(feng)無汗；以鴉膽子50～60粒(li)，甚至日用(yong)(yong)(yong)100粒(li)治(zhi)熱(re)痢等，皆(jie)膽識(shi)過人之舉。
4 平(ping)藥(yao)重用，平(ping)藥(yao)輕用
所謂平(ping)(ping)(ping)(ping)藥(yao)(yao)(yao)(yao)是其(qi)味較淡，藥(yao)(yao)(yao)(yao)性平(ping)(ping)(ping)(ping)和之(zhi)(zhi)(zhi)品，多有(you)(you)補(bu)(bu)(bu)益(yi)調(diao)理(li)之(zhi)(zhi)(zhi)功，乃王者(zhe)(zhe)(zhe)之(zhi)(zhi)(zhi)師，醫(yi)者(zhe)(zhe)(zhe)最(zui)為常(chang)用(yong)(yong)(yong)(yong)(yong)。平(ping)(ping)(ping)(ping)藥(yao)(yao)(yao)(yao)雖藥(yao)(yao)(yao)(yao)性平(ping)(ping)(ping)(ping)和無毒，其(qi)用(yong)(yong)(yong)(yong)(yong)量(liang)大(da)小亦有(you)(you)考究(jiu)。張錫(xi)(xi)純(chun)(chun)(chun)運用(yong)(yong)(yong)(yong)(yong)平(ping)(ping)(ping)(ping)和之(zhi)(zhi)(zhi)藥(yao)(yao)(yao)(yao)，劑量(liang)大(da)小之(zhi)(zhi)(zhi)間，頗有(you)(you)創意(yi)。甘(gan)草(cao)(cao)，醫(yi)者(zhe)(zhe)(zhe)用(yong)(yong)(yong)(yong)(yong)之(zhi)(zhi)(zhi)最(zui)多，張錫(xi)(xi)純(chun)(chun)(chun)平(ping)(ping)(ping)(ping)常(chang)用(yong)(yong)(yong)(yong)(yong)之(zhi)(zhi)(zhi)，多為1～2錢(qian)(qian)，而(er)用(yong)(yong)(yong)(yong)(yong)治(zhi)(zhi)肺癰之(zhi)(zhi)(zhi)清(qing)金華蓋飲，甘(gan)草(cao)(cao)用(yong)(yong)(yong)(yong)(yong)量(liang)6錢(qian)(qian)。以(yi)甘(gan)草(cao)(cao)既能(neng)(neng)清(qing)火解毒，又能(neng)(neng)培(pei)土生(sheng)(sheng)金，故論(lun)有(you)(you)單用(yong)(yong)(yong)(yong)(yong)生(sheng)(sheng)甘(gan)草(cao)(cao)粉4兩(liang)煎水頓服以(yi)治(zhi)(zhi)肺癰。白茅根(gen)(gen)(gen)性味甘(gan)寒，功能(neng)(neng)涼血止血、清(qing)熱利(li)尿(niao)，常(chang)用(yong)(yong)(yong)(yong)(yong)干品量(liang)5錢(qian)(qian)～1兩(liang)，鮮(xian)者(zhe)(zhe)(zhe)倍之(zhi)(zhi)(zhi)。張錫(xi)(xi)純(chun)(chun)(chun)常(chang)用(yong)(yong)(yong)(yong)(yong)茅根(gen)(gen)(gen)鮮(xian)品，制白茅根(gen)(gen)(gen)湯(tang)治(zhi)(zhi)陽虛水腫，用(yong)(yong)(yong)(yong)(yong)量(liang)達1斤之(zhi)(zhi)(zhi)多，而(er)制滋(zi)陰清(qing)胃湯(tang)治(zhi)(zhi)產(chan)后溫病，白茅根(gen)(gen)(gen)僅(jin)用(yong)(yong)(yong)(yong)(yong)2錢(qian)(qian)，用(yong)(yong)(yong)(yong)(yong)量(liang)大(da)小相差80倍。補(bu)(bu)(bu)虛張錫(xi)(xi)純(chun)(chun)(chun)喜用(yong)(yong)(yong)(yong)(yong)生(sheng)(sheng)山藥(yao)(yao)(yao)(yao)，常(chang)用(yong)(yong)(yong)(yong)(yong)量(liang)4錢(qian)(qian)～1兩(liang)，對虛甚者(zhe)(zhe)(zhe)，每(mei)用(yong)(yong)(yong)(yong)(yong)2～6兩(liang)。然治(zhi)(zhi)一(yi)人年(nian)40余，滑瀉，喘息(xi)迫促(cu)，勢(shi)將欲脫，2日(ri)共用(yong)(yong)(yong)(yong)(yong)生(sheng)(sheng)山藥(yao)(yao)(yao)(yao)18兩(liang)。茯(fu)苓(ling)(ling)甘(gan)淡，能(neng)(neng)利(li)水滲濕，健脾(pi)安神。雖藥(yao)(yao)(yao)(yao)性平(ping)(ping)(ping)(ping)和，張錫(xi)(xi)純(chun)(chun)(chun)常(chang)用(yong)(yong)(yong)(yong)(yong)量(liang)多為2錢(qian)(qian)。而(er)案載有(you)(you)用(yong)(yong)(yong)(yong)(yong)茯(fu)苓(ling)(ling)4、5兩(liang)治(zhi)(zhi)愈產(chan)后熱病汗出(chu)不(bu)止。山藥(yao)(yao)(yao)(yao)、茯(fu)苓(ling)(ling)皆(jie)平(ping)(ping)(ping)(ping)和之(zhi)(zhi)(zhi)藥(yao)(yao)(yao)(yao)，大(da)劑能(neng)(neng)力挽狂瀾，是平(ping)(ping)(ping)(ping)常(chang)藥(yao)(yao)(yao)(yao)非(fei)平(ping)(ping)(ping)(ping)常(chang)之(zhi)(zhi)(zhi)用(yong)(yong)(yong)(yong)(yong)而(er)為功也。山茱萸能(neng)(neng)補(bu)(bu)(bu)肝腎，收斂固澀(se)，張錫(xi)(xi)純(chun)(chun)(chun)投補(bu)(bu)(bu)常(chang)用(yong)(yong)(yong)(yong)(yong)之(zhi)(zhi)(zhi)。且謂山茱萸得木氣(qi)最(zui)全，功雖收斂而(er)只斂正氣(qi)不(bu)斂邪氣(qi)，收斂之(zhi)(zhi)(zhi)中更具開(kai)通條暢(chang)之(zhi)(zhi)(zhi)性。
大劑山(shan)(shan)茱(zhu)萸(yu)2～4兩(liang)用治(zhi)(zhi)(zhi)脫(tuo)證(zheng)，功(gong)效卓著。張(zhang)錫(xi)純(chun)(chun)謂“山(shan)(shan)萸(yu)肉救脫(tuo)之(zhi)力，十倍(bei)于參(can)(can)、芪”。張(zhang)錫(xi)純(chun)(chun)雖喜用山(shan)(shan)茱(zhu)萸(yu)，但把(ba)握(wo)有度，如治(zhi)(zhi)(zhi)一20余歲(sui)青年，大氣(qi)下陷之(zhi)證(zheng)，方用生黃芪1兩(liang)，柴胡、升麻、山(shan)(shan)茱(zhu)萸(yu)各2錢(qian)(qian)。制加(jia)味理中湯治(zhi)(zhi)(zhi)中焦虛寒，山(shan)(shan)茱(zhu)萸(yu)只用1錢(qian)(qian)，此為(wei)善用山(shan)(shan)茱(zhu)萸(yu)者。白芍藥(yao)養血斂陰，柔肝緩急(ji)，張(zhang)錫(xi)純(chun)(chun)常用劑量為(wei)2～3錢(qian)(qian)，而(er)重(zhong)癥則逾兩(liang)。如治(zhi)(zhi)(zhi)鄰(lin)村周某(mou)溫病變證(zheng)，用小(xiao)劑白虎湯加(jia)生白芍藥(yao)1.5兩(liang)；治(zhi)(zhi)(zhi)一少年溫病后期，怔忡，小(xiao)便(bian)(bian)不(bu)利，大便(bian)(bian)滑泄，投芍藥(yao)甘草湯，生白芍藥(yao)2兩(liang)，炙(zhi)甘草1.5兩(liang)。張(zhang)錫(xi)純(chun)(chun)謂芍藥(yao)、甘草合用，味近人參(can)(can)，功(gong)近人參(can)(can)。更有案載用生白芍藥(yao)6兩(liang)，阿膠2兩(liang)治(zhi)(zhi)(zhi)陰虛小(xiao)便(bian)(bian)不(bu)利，水腫甚劇，大便(bian)(bian)秘結而(er)效。雞(ji)內(nei)金(jin)性(xing)味甘平，乃(nai)消食化積、澀精止遺之(zhi)品，且能活血通(tong)經(jing)。張(zhang)錫(xi)純(chun)(chun)對(dui)婦女(nv)經(jing)閉，習以雞(ji)內(nei)金(jin)通(tong)之(zhi)。
關于雞內金之用(yong)量，大(da)者(zhe)用(yong)5錢(qian)(qian)，如制(zhi)雞月至茅根(gen)湯治水(shui)臌、氣(qi)臌。更有用(yong)雞內金1兩，生(sheng)酒曲(qu)5錢(qian)(qian)治龔某胃脘堵塞。小者(zhe)只取2、3分(fen)至1錢(qian)(qian)，以助(zhu)運化。張錫純治結胸(xiong)證，每以瓜蔞(lou)(lou)仁2～4兩替(ti)代陷胸(xiong)湯，謂(wei)瓜蔞(lou)(lou)力雖稍弱(ruo)，重用(yong)則轉弱(ruo)為強。其他如用(yong)人參、三(san)七止血，重者(zhe)用(yong)至1兩，輕(qing)者(zhe)2～3錢(qian)(qian)；以大(da)劑熟地黃治一室女溫病(bing)欲(yu)脫(tuo)，1日之中單(dan)用(yong)熟地黃12兩而險疾竟愈(yu)。張錫純使用(yong)平藥亦非一味用(yong)重，如治八秩(zhi)章(zhang)氏老婦，氣(qi)如游絲，大(da)氣(qi)下陷之重證，方(fang)用(yong)生(sheng)黃芪1.5錢(qian)(qian)，知母8分(fen)，山(shan)茱萸1錢(qian)(qian)，柴(chai)胡(hu)4分(fen)，升麻3分(fen)，漸次平復，是虛極不耐重藥峻補(bu)，以防藥病(bing)相激相反而歧變(bian)。此(ci)皆(jie)平常之藥，超常用(yong)之而建超常之功.
5 小結(jie)
張(zhang)(zhang)錫(xi)(xi)純，是近代名醫(yi)(yi)(yi)，溫(wen)病(bing)大家。受現代醫(yi)(yi)(yi)學影響，張(zhang)(zhang)錫(xi)(xi)純對疾病(bing)的認識和中(zhong)藥(yao)(yao)(yao)的功效，藥(yao)(yao)(yao)物的配(pei)伍及用量都有很多創(chuang)新，如(ru)首(shou)開中(zhong)西藥(yao)(yao)(yao)結合之(zhi)先河，創(chuang)臟器療法等。張(zhang)(zhang)錫(xi)(xi)純一(yi)生所(suo)遇重病(bing)怪疾、沉疴頑癥(zheng)頗(po)多，他不落俗套，敢于(yu)探索求(qiu)新，為后(hou)人樹立(li)了(le)榜樣。疾病(bing)有常(chang)有變(bian)，治(zhi)法方(fang)藥(yao)(yao)(yao)亦有常(chang)當變(bian)，張(zhang)(zhang)錫(xi)(xi)純理(li)法方(fang)藥(yao)(yao)(yao)雖出神(shen)入化，但其大旨(zhi)總是以勝病(bing)為主，正如(ru)張(zhang)(zhang)錫(xi)(xi)純所(suo)云：“用藥(yao)(yao)(yao)之(zhi)道(dao)，貴因時、因地(di)、因人活(huo)潑斟(zhen)酌，以勝病(bing)為主，不必拘(ju)于(yu)成(cheng)見也。”本文所(suo)述，僅揭示了(le)張(zhang)(zhang)錫(xi)(xi)純醫(yi)(yi)(yi)道(dao)之(zhi)一(yi)斑，為后(hou)學者探索求(qiu)新之(zhi)例范。
文源:醫品閣
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