黃海(hai)龍 廣(guang)東省(sheng)深(shen)圳市(shi)人(ren)民(min)醫院
近(jin)日貴報對“春(chun)夏養(yang)陽,秋冬養(yang)陰(yin)”的含義展開了熱烈的討(tao)論,談(tan)了不同(tong)(tong)意見,但難(nan)免(mian)有(you)偏頗之(zhi)嫌。追溯(su)古(gu)代醫家的觀(guan)點(dian),也有(you)見仁(ren)見智的不同(tong)(tong),如王(wang)冰持飲(yin)食寒溫說;張志聰根(gen)(gen)據季節特點(dian)保養(yang)陽氣、陰(yin)氣說;李時珍(zhen)治療用藥順應(ying)四(si)時陰(yin)陽變(bian)化說等。筆者認為,《素問(wen)·四(si)時調神大論》在“春(chun)夏養(yang)陽,秋冬養(yang)陰(yin)”之(zhi)后(hou)“以從其根(gen)(gen)”這句(ju)話非常重要,它提示“春(chun)夏養(yang)陽,秋冬養(yang)陰(yin)”這句(ju)話要從“陰(yin)陽互根(gen)(gen)”上去認識。
《素問(wen)(wen)·天元(yuan)紀大論(lun)(lun)》指出:“陰(yin)中(zhong)(zhong)(zhong)有陽(yang)(yang)(yang)(yang)(yang),陽(yang)(yang)(yang)(yang)(yang)中(zhong)(zhong)(zhong)有陰(yin)”。對于(yu)這個(ge)問(wen)(wen)題,張(zhang)景岳(yue)有十分精辟的(de)論(lun)(lun)述(shu):“陰(yin)根于(yu)陽(yang)(yang)(yang)(yang)(yang),陽(yang)(yang)(yang)(yang)(yang)根于(yu)陰(yin)”;“蓋陰(yin)不(bu)(bu)可(ke)(ke)以(yi)(yi)(yi)無(wu)(wu)陽(yang)(yang)(yang)(yang)(yang),非氣(qi)無(wu)(wu)以(yi)(yi)(yi)生形(xing)也(ye);陽(yang)(yang)(yang)(yang)(yang)不(bu)(bu)可(ke)(ke)以(yi)(yi)(yi)無(wu)(wu)陰(yin),非形(xing)無(wu)(wu)以(yi)(yi)(yi)載氣(qi)也(ye)。”又指出:“善補陽(yang)(yang)(yang)(yang)(yang)者,必于(yu)陰(yin)中(zhong)(zhong)(zhong)求陽(yang)(yang)(yang)(yang)(yang),則陽(yang)(yang)(yang)(yang)(yang)得陰(yin)助而(er)生化無(wu)(wu)窮;善補陰(yin)者,必于(yu)陽(yang)(yang)(yang)(yang)(yang)中(zhong)(zhong)(zhong)求陰(yin),則陰(yin)得陽(yang)(yang)(yang)(yang)(yang)升而(er)泉源不(bu)(bu)竭。”所(suo)以(yi)(yi)(yi)我們在(zai)具體運用(yong)上(shang),不(bu)(bu)能偏(pian)(pian)頗(po)。一般來說,春夏(xia)養(yang)陽(yang)(yang)(yang)(yang)(yang)是對的(de),但不(bu)(bu)能單純(chun)(chun)一味養(yang)陽(yang)(yang)(yang)(yang)(yang),而(er)是要從陰(yin)中(zhong)(zhong)(zhong)求陽(yang)(yang)(yang)(yang)(yang);秋冬養(yang)陰(yin)也(ye)是對的(de),也(ye)不(bu)(bu)能單純(chun)(chun)一味養(yang)陰(yin),必須要從陽(yang)(yang)(yang)(yang)(yang)中(zhong)(zhong)(zhong)求陰(yin)。這是因(yin)為臨床(chuang)上(shang)單純(chun)(chun)的(de)陽(yang)(yang)(yang)(yang)(yang)虛或陰(yin)虛很(hen)少,可(ke)(ke)以(yi)(yi)(yi)說是微乎其(qi)微,多見的(de)是陰(yin)陽(yang)(yang)(yang)(yang)(yang)兩虛偏(pian)(pian)于(yu)陰(yin)虛或偏(pian)(pian)于(yu)陽(yang)(yang)(yang)(yang)(yang)虛。
基于此,筆者(zhe)在上世紀70年代參加攻(gong)克(ke)“老慢支”的(de)(de)(de)臨床實(shi)踐(jian)中,遇到患者(zhe)秋末(mo)冬初(chu)病(bing)(bing)情復發或(huo)(huo)加重(zhong),遵“秋冬養(yang)(yang)陰”之(zhi)(zhi)旨(zhi),投養(yang)(yang)陰潤肺化痰止咳(ke)藥,往往療(liao)效(xiao)(xiao)差(cha),有的(de)(de)(de)反增胸悶痰多(duo)氣(qi)喘(chuan)等癥(zheng)(zheng)。究其(qi)因(yin),此類患者(zhe)多(duo)是(shi)陰陽(yang)兩虛(xu)(xu)而偏于陽(yang)虛(xu)(xu),尤其(qi)是(shi)脾(pi)腎陽(yang)虛(xu)(xu)為主,改循“夫(fu)病(bing)(bing)痰飲者(zhe),當以溫(wen)藥和之(zhi)(zhi)”,改用(yong)苓桂(gui)術(shu)甘湯(tang)或(huo)(huo)真武(wu)湯(tang)而獲效(xiao)(xiao)。但(dan)是(shi)到了(le)春夏之(zhi)(zhi)時,若再堅(jian)持溫(wen)藥和之(zhi)(zhi),看來似乎符(fu)合“春夏養(yang)(yang)陽(yang)”之(zhi)(zhi)旨(zhi),但(dan)病(bing)(bing)人往往出(chu)現(xian)咽干口燥,咳(ke)嗽加劇,心煩少氣(qi)等。即使(shi)不(bu)出(chu)現(xian)癥(zheng)(zheng)狀,我們也要(yao)給(gei)以“麥(mai)味地黃湯(tang)”或(huo)(huo)“八味腎氣(qi)丸”之(zhi)(zhi)類的(de)(de)(de)藥物以治其(qi)本(ben)。如是(shi)能夠(gou)獲得預期(qi)的(de)(de)(de)治療(liao)效(xiao)(xiao)果,至(zhi)冬不(bu)發病(bing)(bing)或(huo)(huo)發病(bing)(bing)較(jiao)輕。又(you)如有的(de)(de)(de)哮喘(chuan)病(bing)(bing)人,往往是(shi)冬月服紅參癥(zheng)(zheng)減,夏日進洋(yang)參病(bing)(bing)輕,似乎有悖于“春夏養(yang)(yang)陽(yang),秋冬養(yang)(yang)陰”之(zhi)(zhi)訓。
筆者(zhe)認為,對“春夏養陽,秋冬養陰(yin)”要辯證地對待,千(qian)萬不(bu)要忘記“以從其根”。至于(yu)具體(ti)運用,還是要辨證論治。
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