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張錫純:軒岐奧理存靈素, 化作甘露灑大千

荊十三 2024-03-03 10:50:30

張(zhang)錫(xi)純(1860 ~ 1933),河北(bei)鹽山人。近代(dai)中(zhong)醫藥學(xue)家,中(zhong)國中(zhong)西醫匯(hui)通學(xue)派先驅。早年習舉子業(ye),科舉不第遂轉攻中(zhong)醫藥學(xue),曾學(xue)習西醫及其他西學(xue)。1912年任軍醫正,1918年任立(li)達(da)醫院院長(chang),1924年因直奉戰爭回(hui)鄉懸壺于(yu)滄縣(xian),醫名(ming)日(ri)噪。晚年遷居天(tian)津,創辦國醫函授學(xue)校,培養(yang)中(zhong)西醫匯(hui)通人才。他長(chang)期從(cong)事(shi)臨床與研(yan)究著述(shu),其代(dai)表作? 醫學(xue)衷中(zhong)參西錄? 對中(zhong)醫界影響很大,被譽為(wei)“ 第一(yi)可法之書”。

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在學(xue)(xue)術(shu)思想上,他倡導中(zhong)(zhong)(zhong)(zhong)西(xi)醫(yi)學(xue)(xue)匯(hui)通,衷中(zhong)(zhong)(zhong)(zhong)參(can)西(xi),提出(chu)(chu)心腦共(gong)主(zhu)神明說、大(da)氣學(xue)(xue)說等。在實(shi)踐(jian)中(zhong)(zhong)(zhong)(zhong),他崇尚(shang)臨(lin)床實(shi)驗,重(zhong)視(shi)藥物研究。他充分發揮生(sheng)石膏治(zhi)療熱(re)病的(de)功效(xiao),對山萸肉、生(sheng)山藥等藥物作(zuo)了(le)系統闡發,并創(chuang)立“升(sheng)陷湯” 治(zhi)療大(da)氣下陷證。在治(zhi)療急證、防治(zhi)霍亂等方面亦頗(po)有建樹。他醫(yi)術(shu)精(jing)湛,醫(yi)德(de)高尚(shang),在繼承傳(chuan)統中(zhong)(zhong)(zhong)(zhong)醫(yi)藥學(xue)(xue)的(de)基礎上,敢(gan)于推陳出(chu)(chu)新,促(cu)進了(le)中(zhong)(zhong)(zhong)(zhong)西(xi)醫(yi)學(xue)(xue)的(de)溝通與(yu)交流(liu)。他用(yong)藥精(jing)靈,組方嚴謹,療效(xiao)卓(zhuo)著,臨(lin)床經(jing)驗多為后世效(xiao)法。近代(dai)(dai)以來,在西(xi)醫(yi)學(xue)(xue)被(bei)廣泛(fan)傳(chuan)播并逐漸成為主(zhu)流(liu)醫(yi)學(xue)(xue)的(de)時代(dai)(dai)背景下,張錫純(chun)以其衷中(zhong)(zhong)(zhong)(zhong)參(can)西(xi)的(de)胸懷(huai)、精(jing)勤實(shi)踐(jian)的(de)精(jing)神,被(bei)時人稱之為一代(dai)(dai)中(zhong)(zhong)(zhong)(zhong)醫(yi)大(da)師。

張(zhang)錫純以弘揚(yang)中醫(yi)藥學為己(ji)任(ren),勤于(yu)實踐(jian),勇于(yu)創(chuang)新,學術影響遍及大(da)江(jiang)南北(bei),被后(hou)世(shi)譽為“軒岐之(zhi)功臣,醫(yi)林(lin)之(zhi)楷模(mo)”。當(dang)時他(ta)與(yu)江(jiang)蘇陸晉笙、楊如侯,廣(guang)東(dong)劉蔚楚(chu)并(bing)稱(cheng)(cheng)“名(ming)(ming)醫(yi)四大(da)家(jia)”;又(you)與(yu)慈溪張(zhang)生甫(fu)、嘉定張(zhang)山雷并(bing)稱(cheng)(cheng)“名(ming)(ming)醫(yi)三張(zhang)”;又(you)與(yu)漢口冉(ran)雪峰并(bing)稱(cheng)(cheng)“南冉(ran)北(bei)張(zhang)”。他(ta)的(de)入門弟子有周(zhou)禹(yu)錫、陳愛棠、李慰農、高硯樵、王攻酲、張(zhang)方(fang)輿、孫玉(yu)泉(quan)、李寶和、仲曉秋(qiu)等,均為一方(fang)名(ming)(ming)醫(yi)。

張錫純的學(xue)術思想(xiang)與成就簡要介紹如下:

1.衷中參西,匯通中西醫學

1909年張(zhang)錫純在?醫學(xue)(xue)(xue)衷中參西(xi)(xi)錄? 自(zi)序中說(shuo): “今凡百事皆尚西(xi)(xi)法……吾(wu)(wu)儒生(sheng)古(gu)(gu)人(ren)之(zhi)(zhi)(zhi)后,當竟古(gu)(gu)人(ren)未竟之(zhi)(zhi)(zhi)業(ye)。而不能與古(gu)(gu)為(wei)(wei)(wei)新(xin),俾吾(wu)(wu)中華醫學(xue)(xue)(xue)大(da)放光明(ming)于(yu)全(quan)球(qiu)之(zhi)(zhi)(zhi)上(shang),是(shi)吾(wu)(wu)儒之(zhi)(zhi)(zhi)罪也。……斯(si)編(bian)(bian)于(yu)西(xi)(xi)法非僅采用(yong)其(qi)醫理,恒(heng)有(you)采其(qi)化學(xue)(xue)(xue)之(zhi)(zhi)(zhi)理,運用(yong)于(yu)方藥中者,斯(si)乃合中西(xi)(xi)而融貫(guan)為(wei)(wei)(wei)一,又非若采用(yong)其(qi)藥者,僅為(wei)(wei)(wei)記問之(zhi)(zhi)(zhi)學(xue)(xue)(xue)也。特是(shi)學(xue)(xue)(xue)問之(zhi)(zhi)(zhi)道,貴與年俱進,斯(si)編(bian)(bian)既成(cheng)(cheng)之(zhi)(zhi)(zhi)后,行將博覽(lan)西(xi)(xi)法,更采其(qi)可信之(zhi)(zhi)(zhi)說(shuo)與可用(yong)之(zhi)(zhi)(zhi)方,試之(zhi)(zhi)(zhi)確有(you)效者,作為(wei)(wei)(wei)續編(bian)(bian)。此有(you)志未逮之(zhi)(zhi)(zhi)事,或即有(you)志竟成(cheng)(cheng)之(zhi)(zhi)(zhi)事也。” 因此張(zhang)錫純參西(xi)(xi)的(de)思想與時(shi)勢有(you)關,其(qi)出發點在于(yu)與時(shi)俱進,目的(de)在于(yu)發揚中醫,使之(zhi)(zhi)(zhi)放光明(ming)于(yu)全(quan)球(qiu)。

實(shi)踐衷中(zhong)(zhong)參(can)西,匯(hui)通中(zhong)(zhong)西醫學(xue)(xue),首先(xian)在(zai)治學(xue)(xue)上(shang)需(xu)要尊古而(er)不(bu)泥古。張錫(xi)純(chun)(chun)認(ren)為(wei)(wei):“吾人生(sheng)古人之(zhi)(zhi)(zhi)(zhi)后,貴(gui)(gui)發古人所未(wei)發,不(bu)可以(yi)(yi)古人之(zhi)(zhi)(zhi)(zhi)才智囿我(wo)(wo),實(shi)貴(gui)(gui)以(yi)(yi)古人之(zhi)(zhi)(zhi)(zhi)才智啟我(wo)(wo),然(ran)后醫學(xue)(xue)有進(jin)步(bu)也。” 他以(yi)(yi)自身的經(jing)歷來說明他的觀(guan)點(dian)。張錫(xi)純(chun)(chun)兩(liang)試(shi)秋闈不(bu)第,雖在(zai)壯年,但淡于進(jin)取,遂廣求方書(shu),約共搜閱百余種, “知(zhi)?本(ben)(ben)經(jing)? 與(yu)?內(nei)經(jing)?,詒之(zhi)(zhi)(zhi)(zhi)開天辟地(di)之(zhi)(zhi)(zhi)(zhi)圣神,為(wei)(wei)醫學(xue)(xue)之(zhi)(zhi)(zhi)(zhi)鼻(bi)祖,實(shi)即為(wei)(wei)醫學(xue)(xue)之(zhi)(zhi)(zhi)(zhi)淵海也。迨漢季張仲景出(chu),著(zhu)?傷寒?、?金匱? 兩(liang)書(shu),為(wei)(wei)?本(ben)(ben)經(jing)?、?內(nei)經(jing)? 之(zhi)(zhi)(zhi)(zhi)功臣(chen)”,然(ran)而(er)“自晉、唐迄今(jin),諸(zhu)家著(zhu)述(shu),非不(bu)美備,然(ran)皆(jie)斤(jin)斤(jin)以(yi)(yi)傅(fu)舊為(wei)(wei)務,初未(wei)嘗日新月異,俾吾中(zhong)(zhong)華醫學(xue)(xue)漸有進(jin)步(bu)”,因此他認(ren)為(wei)(wei), “夫事貴(gui)(gui)師古者,非以(yi)(yi)古人之(zhi)(zhi)(zhi)(zhi)規矩(ju)、準(zhun)繩限我(wo)(wo)也,唯借以(yi)(yi)瀹我(wo)(wo)性(xing)靈(ling),益我(wo)(wo)神智。迨至(zhi)性(xing)靈(ling)神智,洋(yang)溢(yi)活(huo)潑(po),又(you)貴(gui)(gui)舉古人之(zhi)(zhi)(zhi)(zhi)規矩(ju)、準(zhun)繩而(er)擴充之(zhi)(zhi)(zhi)(zhi)、變(bian)化之(zhi)(zhi)(zhi)(zhi)、引伸觸長之(zhi)(zhi)(zhi)(zhi),使古人可作,應嘆為(wei)(wei)后生(sheng)可畏。凡天下事皆(jie)宜然(ran),而(er)醫學(xue)(xue)何獨不(bu)然(ran)哉”。可見張錫(xi)純(chun)(chun)對中(zhong)(zhong)醫的發展進(jin)行過深(shen)入的思考,在(zai)中(zhong)(zhong)醫理念上(shang)絕不(bu)泥古而(er)薄今(jin)。他主張: “讀?內(nei)經(jing)? 之(zhi)(zhi)(zhi)(zhi)法,但于其(qi)可信之(zhi)(zhi)(zhi)(zhi)處(chu)(chu)精研有得,即能開無(wu)限法門。其(qi)不(bu)可信之(zhi)(zhi)(zhi)(zhi)處(chu)(chu),或(huo)為(wei)(wei)后世(shi)偽托,付(fu)之(zhi)(zhi)(zhi)(zhi)不(bu)論可也。”

同時,張錫純對那些攻擊中醫理論的做法也表示了極大的不滿,針對“乃今之偏重西法者,不于?內經? 可信之處費心研究,但于其不可信之處極力指摘” 的情況,他不禁感慨, “夫我四萬萬同胞,皆黃帝之子(zi)孫也(ye),以祖(zu)宗嘉惠(hui)后人之典冊,不知倍加愛護,而轉欲(yu)弁毛(mao)棄之,此真令人可(ke)發(fa)浩嘆者也(ye)”。因此,他對(dui)于中醫經典,是主張繼承(cheng)發(fa)揚的(de)。

張錫純認為(wei)“中(zhong)(zhong)(zhong)醫(yi)(yi)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)理(li)(li)(li)多(duo)包括(kuo)西(xi)醫(yi)(yi)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)理(li)(li)(li),溝通(tong)中(zhong)(zhong)(zhong)西(xi)原(yuan)非(fei)難事(shi)”。他主(zhu)張“學醫(yi)(yi)工夫(fu)(fu),須先(xian)明(ming)(ming)人身(shen)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)生(sheng)理(li)(li)(li)。全身(shen)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)肢體、臟(zang)腑、經絡(luo)皆(jie)生(sheng)理(li)(li)(li)攸關也(ye)”。因此他“兼采(cai)中(zhong)(zhong)(zhong)西(xi)生(sheng)理(li)(li)(li)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)學,更(geng)參以(yi)(yi)哲學家談生(sheng)理(li)(li)(li)處,復(fu)以(yi)(yi)己意融(rong)會貫通(tong)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)。生(sheng)理(li)(li)(li)既明(ming)(ming),而(er)(er)養(yang)生(sheng)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)理(li)(li)(li)寓其中(zhong)(zhong)(zhong)矣(yi);養(yang)生(sheng)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)理(li)(li)(li)既明(ming)(ming),而(er)(er)治病之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)理(li)(li)(li)寓其中(zhong)(zhong)(zhong)矣(yi)”。他“遠采(cai)古籍所載,近參時賢之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)說”,從生(sheng)理(li)(li)(li)、病理(li)(li)(li)、藥理(li)(li)(li)各方面積極尋(xun)找中(zhong)(zhong)(zhong)醫(yi)(yi)與西(xi)醫(yi)(yi)的(de)共(gong)通(tong)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)處。通(tong)過比較,他得出結論, “中(zhong)(zhong)(zhong)西(xi)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)論藥性,凡其不同(tong)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)處,深究之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)又皆(jie)可以(yi)(yi)相通(tong)也(ye)”。由此道出了(le)他的(de)醫(yi)(yi)學主(zhu)張: “夫(fu)(fu)醫(yi)(yi)學以(yi)(yi)活(huo)人為(wei)宗旨,原(yuan)不宜有中(zhong)(zhong)(zhong)西(xi)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)界限存于胸中(zhong)(zhong)(zhong)。在(zai)中(zhong)(zhong)(zhong)醫(yi)(yi)不妨取西(xi)醫(yi)(yi)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)所長,以(yi)(yi)補中(zhong)(zhong)(zhong)醫(yi)(yi)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)所短(duan);在(zai)西(xi)醫(yi)(yi)尤當(dang)精研氣化,視中(zhong)(zhong)(zhong)醫(yi)(yi)深奧之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)理(li)(li)(li)原(yuan)為(wei)形上之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)道,而(er)(er)非(fei)空談無實際也(ye)。”

張錫純(chun)“著書以(yi)衷中(zhong)參(can)西為(wei)名,原欲(yu)采(cai)西人之(zhi)(zhi)所(suo)(suo)長(chang)以(yi)補吾人之(zhi)(zhi)所(suo)(suo)短(duan)”,在(zai)?醫(yi)(yi)(yi)學(xue)(xue)(xue)衷中(zhong)參(can)西錄? 一(yi)書中(zhong),他“于西人之(zhi)(zhi)說可(ke)采(cai)者(zhe)采(cai)之(zhi)(zhi),其說之(zhi)(zhi)可(ke)溝(gou)通(tong)者(zhe)尤(you)喜溝(gou)通(tong)之(zhi)(zhi)”,在(zai)他看來,只有“如此以(yi)精研醫(yi)(yi)(yi)學(xue)(xue)(xue),醫(yi)(yi)(yi)學(xue)(xue)(xue)庶有振(zhen)興之(zhi)(zhi)一(yi)日”。所(suo)(suo)謂“衷中(zhong)”,“衷” 者(zhe)“中(zhong)心也”、“正也”,就是以(yi)中(zhong)醫(yi)(yi)(yi)為(wei)主,立足于發(fa)揚(yang)祖國醫(yi)(yi)(yi)學(xue)(xue)(xue);所(suo)(suo)謂“參(can)西”,就是取西醫(yi)(yi)(yi)之(zhi)(zhi)長(chang)為(wei)我(wo)所(suo)(suo)用,闡發(fa)中(zhong)醫(yi)(yi)(yi)理(li)論(lun),豐富(fu)治(zhi)療(liao)手段。張錫純(chun)衷中(zhong)參(can)西,匯(hui)通(tong)中(zhong)西醫(yi)(yi)(yi)學(xue)(xue)(xue)的(de)學(xue)(xue)(xue)術思(si)想(xiang)體現了他中(zhong)醫(yi)(yi)(yi)為(wei)本,西醫(yi)(yi)(yi)為(wei)用,取彼之(zhi)(zhi)長(chang),補己之(zhi)(zhi)短(duan),以(yi)弘揚(yang)國醫(yi)(yi)(yi)的(de)理(li)念。

張(zhang)錫純認為(wei)中(zhong)西(xi)(xi)(xi)醫(yi)(yi)(yi)能(neng)夠(gou)匯(hui)通(tong)的(de)前提是(shi)“中(zhong)醫(yi)(yi)(yi)之(zhi)(zhi)理(li)多包括西(xi)(xi)(xi)醫(yi)(yi)(yi)之(zhi)(zhi)理(li)”。一(yi)方面西(xi)(xi)(xi)醫(yi)(yi)(yi)尚不(bu)能(neng)夠(gou)解釋的(de)中(zhong)醫(yi)(yi)(yi)理(li)論(lun)未必不(bu)如(ru)理(li)、不(bu)正確(que),如(ru)“答(da)陳董塵疑(yi)?內(nei)經(jing)(jing)? 十二經(jing)(jing)有名無質” 的(de)質疑(yi)中(zhong)他(ta)(ta)(ta)(ta)(ta)提出“天下(xia)之(zhi)(zhi)妙理(li)富于(yu)跡(ji)象(xiang)(xiang)之(zhi)(zhi)中(zhong),實(shi)超于(yu)跡(ji)象(xiang)(xiang)之(zhi)(zhi)外,被拘于(yu)跡(ji)象(xiang)(xiang)以索(suo)解者(zhe),縱于(yu)理(li)能(neng)窺(kui)其(qi)妙,實(shi)未能(neng)窮其(qi)極妙也(ye)”,那種(zhong)“因(yin)研究(jiu)剖解之(zhi)(zhi)學者(zhe)于(yu)十二經(jing)(jing)之(zhi)(zhi)起止莫(mo)能(neng)尋其(qi)跡(ji)象(xiang)(xiang),遂(sui)言(yan)?內(nei)經(jing)(jing)? 所(suo)言(yan)十二經(jing)(jing)無可(ke)考據(ju)” 是(shi)不(bu)正確(que)的(de)。他(ta)(ta)(ta)(ta)(ta)認為(wei), “ ?內(nei)經(jing)(jing)? 之(zhi)(zhi)?靈樞? 原名?針(zhen)經(jing)(jing)?,故欲究(jiu)十二經(jing)(jing)之(zhi)(zhi)奧妙,非精(jing)針(zhen)灸者(zhe)不(bu)能(neng)得(de)其(qi)實(shi)際”。另(ling)一(yi)方面可(ke)以借鑒西(xi)(xi)(xi)醫(yi)(yi)(yi)學說闡明(ming)一(yi)些(xie)中(zhong)醫(yi)(yi)(yi)理(li)論(lun),如(ru)對中(zhong)風(feng)癥,他(ta)(ta)(ta)(ta)(ta)認為(wei)?素問-調經(jing)(jing)淪? 之(zhi)(zhi)“血之(zhi)(zhi)與氣(qi),并走于(yu)上,則(ze)為(wei)大厥,厥則(ze)暴(bao)死,氣(qi)反(fan)則(ze)生,不(bu)反(fan)則(ze)死”,即“西(xi)(xi)(xi)人所(suo)謂腦充血也(ye)”,據(ju)此(ci)他(ta)(ta)(ta)(ta)(ta)創制(zhi)鎮肝熄風(feng)湯、建瓴湯等名方,后世應用頗(po)多,并被收入現代中(zhong)醫(yi)(yi)(yi)教材。又如(ru)“黃(huang)疸之(zhi)(zhi)證,中(zhong)說謂脾胃受濕熱,西(xi)(xi)(xi)說謂膽汁濫行,究(jiu)之(zhi)(zhi)二說原可(ke)貫(guan)通(tong)也(ye)”,這里張(zhang)錫純采用中(zhong)西(xi)(xi)(xi)醫(yi)(yi)(yi)之(zhi)(zhi)理(li)闡明(ming)膽汁阻塞型(xing)黃(huang)疸,他(ta)(ta)(ta)(ta)(ta)還用西(xi)(xi)(xi)醫(yi)(yi)(yi)血液(ye)循環理(li)論(lun)解釋中(zhong)醫(yi)(yi)(yi)脈診,以西(xi)(xi)(xi)醫(yi)(yi)(yi)神經(jing)(jing)系統功能(neng)來(lai)闡明(ming)心腦體用等,體現了(le)他(ta)(ta)(ta)(ta)(ta)在中(zhong)西(xi)(xi)(xi)醫(yi)(yi)(yi)理(li)論(lun)匯(hui)通(tong)上的(de)有益嘗試。

張錫(xi)(xi)純(chun)中(zhong)(zhong)西(xi)(xi)(xi)(xi)(xi)(xi)(xi)匯通的(de)另一個特點是主張中(zhong)(zhong)西(xi)(xi)(xi)(xi)(xi)(xi)(xi)藥(yao)(yao)(yao)并(bing)用(yong)(yong)(yong)(yong)(yong)。他著(zhu)有“論中(zhong)(zhong)西(xi)(xi)(xi)(xi)(xi)(xi)(xi)之(zhi)(zhi)(zhi)藥(yao)(yao)(yao)原宜相助(zhu)為(wei)(wei)(wei)理(li)” 專論,強(qiang)調中(zhong)(zhong)藥(yao)(yao)(yao)、西(xi)(xi)(xi)(xi)(xi)(xi)(xi)藥(yao)(yao)(yao)應(ying)相濟為(wei)(wei)(wei)用(yong)(yong)(yong)(yong)(yong),不(bu)要有“畛域之(zhi)(zhi)(zhi)見存于(yu)其(qi)間”。他本人就(jiu)是“用(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)多喜取西(xi)(xi)(xi)(xi)(xi)(xi)(xi)藥(yao)(yao)(yao)之(zhi)(zhi)(zhi)所(suo)長,以(yi)濟吾中(zhong)(zhong)藥(yao)(yao)(yao)之(zhi)(zhi)(zhi)所(suo)短”。如(ru)他首創的(de)“石膏(gao)阿(a)(a)司(si)匹(pi)(pi)林(lin)(lin)(lin)湯”,采用(yong)(yong)(yong)(yong)(yong)中(zhong)(zhong)藥(yao)(yao)(yao)石膏(gao)、西(xi)(xi)(xi)(xi)(xi)(xi)(xi)藥(yao)(yao)(yao)阿(a)(a)司(si)匹(pi)(pi)林(lin)(lin)(lin)合(he)(he)用(yong)(yong)(yong)(yong)(yong),治(zhi)療(liao)(liao)實熱(re)性(xing)關節(jie)腫痛。張錫(xi)(xi)純(chun)認為(wei)(wei)(wei)“石膏(gao)之(zhi)(zhi)(zhi)性(xing),又(you)最(zui)宜與(yu)西(xi)(xi)(xi)(xi)(xi)(xi)(xi)藥(yao)(yao)(yao)阿(a)(a)司(si)匹(pi)(pi)林(lin)(lin)(lin)并(bing)用(yong)(yong)(yong)(yong)(yong)。蓋石膏(gao)清熱(re)之(zhi)(zhi)(zhi)力雖大,而(er)發(fa)表之(zhi)(zhi)(zhi)力稍輕(qing)。阿(a)(a)司(si)匹(pi)(pi)林(lin)(lin)(lin)味(wei)酸性(xing)涼,最(zui)善達表,使內郁(yu)之(zhi)(zhi)(zhi)熱(re)由表解(jie)散(san),與(yu)石膏(gao)相助(zhu)為(wei)(wei)(wei)理(li),實有相得益彰之(zhi)(zhi)(zhi)妙也(ye)”。張錫(xi)(xi)純(chun)甚至(zhi)認為(wei)(wei)(wei)“能匯中(zhong)(zhong)西(xi)(xi)(xi)(xi)(xi)(xi)(xi)藥(yao)(yao)(yao)品,即(ji)漸(jian)能匯通中(zhong)(zhong)西(xi)(xi)(xi)(xi)(xi)(xi)(xi)病理(li)”。在臨(lin)床(chuang)上,他也(ye)常常應(ying)用(yong)(yong)(yong)(yong)(yong)西(xi)(xi)(xi)(xi)(xi)(xi)(xi)藥(yao)(yao)(yao)加復方治(zhi)療(liao)(liao)疾(ji)病。如(ru)張錫(xi)(xi)純(chun)首創用(yong)(yong)(yong)(yong)(yong)西(xi)(xi)(xi)(xi)(xi)(xi)(xi)藥(yao)(yao)(yao)阿(a)(a)司(si)匹(pi)(pi)林(lin)(lin)(lin)配合(he)(he)中(zhong)(zhong)藥(yao)(yao)(yao)治(zhi)療(liao)(liao)肺結(jie)核(he),效果(guo)頗佳。他認為(wei)(wei)(wei): “西(xi)(xi)(xi)(xi)(xi)(xi)(xi)藥(yao)(yao)(yao)阿(a)(a)司(si)匹(pi)(pi)林(lin)(lin)(lin)為(wei)(wei)(wei)治(zhi)肺結(jie)核(he)之(zhi)(zhi)(zhi)良藥(yao)(yao)(yao),而(er)發(fa)散(san)太過,恒傷肺陰。若兼(jian)用(yong)(yong)(yong)(yong)(yong)玄(xuan)參(can)、沙參(can)諸(zhu)藥(yao)(yao)(yao)以(yi)滋(zi)肺陰,則結(jie)核(he)易愈”。對(dui)于(yu)中(zhong)(zhong)西(xi)(xi)(xi)(xi)(xi)(xi)(xi)藥(yao)(yao)(yao)并(bing)用(yong)(yong)(yong)(yong)(yong)的(de)具(ju)體方法,他提出(chu)“凡西(xi)(xi)(xi)(xi)(xi)(xi)(xi)藥(yao)(yao)(yao)之(zhi)(zhi)(zhi)性(xing)近和平(ping),確(que)知其(qi)原質者,不(bu)妨(fang)與(yu)中(zhong)(zhong)藥(yao)(yao)(yao)一時并(bing)用(yong)(yong)(yong)(yong)(yong)。至(zhi)未知其(qi)原質者,慮其(qi)與(yu)中(zhong)(zhong)藥(yao)(yao)(yao)有所(suo)妨(fang)礙,正不(bu)妨(fang)中(zhong)(zhong)隔數點鐘而(er)先(xian)后用(yong)(yong)(yong)(yong)(yong)之(zhi)(zhi)(zhi)也(ye)”。中(zhong)(zhong)西(xi)(xi)(xi)(xi)(xi)(xi)(xi)藥(yao)(yao)(yao)合(he)(he)用(yong)(yong)(yong)(yong)(yong)的(de)實踐對(dui)后世(shi)中(zhong)(zhong)西(xi)(xi)(xi)(xi)(xi)(xi)(xi)醫結(jie)合(he)(he)有很(hen)大的(de)啟(qi)迪。如(ru)現代臨(lin)床(chuang)常用(yong)(yong)(yong)(yong)(yong)的(de)維C銀翹(qiao)片等中(zhong)(zhong)西(xi)(xi)(xi)(xi)(xi)(xi)(xi)藥(yao)(yao)(yao)合(he)(he)用(yong)(yong)(yong)(yong)(yong)的(de)藥(yao)(yao)(yao)品就(jiu)是以(yi)這種模式發(fa)展的(de)。

張錫純致力于衷中(zhong)參(can)西(xi),匯(hui)通中(zhong)西(xi)醫(yi)學,他(ta)中(zhong)西(xi)互參(can)的(de)(de)努力幾乎見于其書(shu)的(de)(de)每(mei)一篇(pian)章。他(ta)一方(fang)(fang)面(mian)在(zai)理論上(shang)試圖匯(hui)通中(zhong)西(xi)醫(yi);另一方(fang)(fang)面(mian)他(ta)并不空談,而(er)是崇尚實(shi)驗(yan)方(fang)(fang)法。他(ta)雖無利用儀器進行實(shi)驗(yan)室研究(jiu)的(de)(de)條件,卻有堅(jian)持不懈(xie)的(de)(de)實(shi)驗(yan)精神,突(tu)出體(ti)現在(zai)對藥物的(de)(de)切實(shi)研究(jiu)和(he)臨(lin)床的(de)(de)細致觀察上(shang),為了發(fa)古(gu)(gu)人(ren)所未(wei)發(fa),與古(gu)(gu)為新,他(ta)以大無畏的(de)(de)精神不斷地實(shi)踐古(gu)(gu)方(fang)(fang)新藥。

2.與古為(wei)新(xin),闡創(chuang)古方新(xin)藥(yao)

張錫(xi)純畢生勤(qin)于實(shi)踐(jian),堅(jian)持臨證,注重實(shi)驗(yan),言(yan)必(bi)有據,時(shi)人稱之(zhi)為一(yi)代(dai)“實(shi)驗(yan)派大師(shi)”。他認(ren)為“天下(xia)事(shi)理(li)之(zhi)賾,非一(yi)一(yi)親身經過,且時(shi)時(shi)留心,必(bi)不(bu)能確(que)切言(yan)之(zhi)”。他強調(diao)“凡事(shi)必(bi)實(shi)驗(yan)而(er)后知(zhi),不(bu)敢(gan)人云亦云”。他認(ren)為藥(yao)必(bi)親驗(yan)而(er)知(zhi)其(qi)藥(yao)性,明其(qi)用(yong)途,而(er)后才施之(zhi)于人。毒(du)如巴豆、硫磺,峻如甘遂、細辛、麻黃、花椒等,他均(jun)親口嘗驗(yan)。又曾煎(jian)服麻黃八錢(qian)(qian),以驗(yan)其(qi)發散之(zhi)力(li)。曾嚼服甘遂一(yi)二錢(qian)(qian),瀉下(xia)大量水(shui)及(ji)凝痰,始(shi)悟(wu)其(qi)有開頑痰之(zhi)功(gong)。嚼服花椒三(san)十(shi)粒,知(zhi)其(qi)確(que)有毒(du)副作(zuo)用(yong)。對代(dai)赭石(shi)的(de)應用(yong),張錫(xi)純謂其(qi)“能鎮(zhen)逆氣(qi),墜(zhui)痰涎,止(zhi)嘔(ou)吐,通(tong)燥結(jie)”,通(tong)過實(shi)踐(jian)悟(wu)出代(dai)赭石(shi)雖有重墜(zhui)之(zhi)力(li),但(dan)“降(jiang)逆氣(qi)而(er)不(bu)傷正(zheng),通(tong)燥結(jie)而(er)毫無開破”,臨床常用(yong)至(zhi)數兩。

張錫純認為“學醫工夫原有數層”,其中“就第一層工夫言之,則最在識藥性”。他指出“ ?神農本(ben)草? 為講藥(yao)(yao)(yao)性之祖(zu),勝(sheng)于(yu)后世本(ben)草”。但他本(ben)人(ren)(ren)在藥(yao)(yao)(yao)性上的諸多(duo)發明皆本(ben)于(yu)實驗(yan)(yan)與臨床效(xiao)應(ying)。如論山(shan)萸肉救脫,參(can)芪(qi)利尿,白礬化(hua)痰(tan)熱(re),三(san)七消(xiao)瘡(chuang)腫(zhong),三(san)棱、莪(e)術化(hua)瘀血(xue)等均基于(yu)個人(ren)(ren)經驗(yan)(yan)。其善(shan)于(yu)運用生石膏、生山(shan)藥(yao)(yao)(yao)的經驗(yan)(yan)更(geng)具特色。

生(sheng)石膏(gao)(gao)性微(wei)寒,涼而能散,透表解肌,善(shan)清(qing)上焦及(ji)中(zhong)焦實熱(re),張(zhang)錫純認(ren)為(wei)外感(gan)病(bing)有實熱(re)者,放膽用(yong)之直勝金(jin)丹(dan)。然醫家多誤認(ren)為(wei)其性大(da)寒而煅用(yong),是變(bian)金(jin)丹(dan)為(wei)鴆毒。張(zhang)錫純闡發此(ci)說不厭其繁,僅(jin)“石膏(gao)(gao)解” 后(hou)所附(fu)醫案即達38例,其中(zhong)多系危重癥,有痢疾、瘧(nve)疾、肺炎、產褥熱(re)、產后(hou)大(da)出血、風濕熱(re)、猩紅熱(re)等,同時伴(ban)昏迷、休克或全身衰竭者近半數(shu)(shu)。張(zhang)錫純曾說“愚(yu)臨(lin)證40 余(yu)年,重用(yong)生(sheng)石膏(gao)(gao)治愈之證當(dang)以數(shu)(shu)千(qian)計(ji)。有治一證用(yong)數(shu)(shu)斤(jin)者,有一證用(yong)至十余(yu)斤(jin)者”。1954年,石家莊組織中(zhong)醫運用(yong)張(zhang)錫純重用(yong)石膏(gao)(gao)的經驗治療流行性乙型腦炎,獲得良好(hao)的效果(guo),衛生(sheng)部門曾作(zuo)為(wei)重大(da)科技成果(guo)向全國推(tui)廣(guang)。

張錫純臨證以喜用(yong)(yong)山(shan)(shan)(shan)藥(yao)(yao)而著稱,他認為(wei)“山(shan)(shan)(shan)藥(yao)(yao)之(zhi)性,能(neng)滋(zi)陰又(you)能(neng)利濕,能(neng)滑潤又(you)能(neng)收澀(se),是以能(neng)補肺補腎兼補脾胃,在滋(zi)補藥(yao)(yao)中(zhong)誠為(wei)無(wu)上之(zhi)品”。其(qi)(qi)所創制的160余首方劑中(zhong),有48首方應用(yong)(yong)山(shan)(shan)(shan)藥(yao)(yao),其(qi)(qi)中(zhong)27首方中(zhong)山(shan)(shan)(shan)藥(yao)(yao)為(wei)君(jun)藥(yao)(yao)。他用(yong)(yong)山(shan)(shan)(shan)藥(yao)(yao)滋(zi)陰功(gong)(gong)效(xiao)(xiao)治傷寒、溫病(bing)、淋濁、消渴(ke),用(yong)(yong)其(qi)(qi)利濕功(gong)(gong)效(xiao)(xiao)治帶下、泄瀉,用(yong)(yong)其(qi)(qi)滑潤之(zhi)性治咳(ke)嗽,用(yong)(yong)其(qi)(qi)收澀(se)之(zhi)性治脫證,用(yong)(yong)其(qi)(qi)補腎功(gong)(gong)效(xiao)(xiao)治喘息(xi)、淋濁,用(yong)(yong)其(qi)(qi)補脾功(gong)(gong)效(xiao)(xiao)治久瀉、久痢,用(yong)(yong)其(qi)(qi)補肺功(gong)(gong)效(xiao)(xiao)治虛癆(lao)等。

創制大量有效新方是張錫純對中醫學的又一大貢獻。 ?醫學衷中參西錄? 全書載方189首,除古方數首外,自擬者達160余首。關于自擬方的緣由與出處,他說:“醫者以挽回人命為孜孜當盡之天職。至遇難治之證,歷試成方不效,不得不苦心經營,自擬治法。迨擬出用之有效,且屢次用之皆能隨手奏效,則其方即不忍拋棄,而詳為錄存。是此160余方,皆迫于孜孜挽回人命之熱忱,而日積月累以成卷帙者也。” 張錫純所創制的“升陷湯”、“鎮肝熄風湯”、“固沖湯”、“玉液湯” 等大都為臨床常用的有效驗方,為后世醫家所推崇。其中“升陷湯” 用于他根據?靈樞

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