生(sheng)脈(mo)(mo)(mo)(mo)(mo)(mo)散(san)(san)出自李東(dong)垣《內外傷(shang)(shang)群感論》。考其(qi)(qi)源(yuan),歷代(dai)(dai)醫家皆(jie)認為(wei)(wei)(wei)(wei),此(ci)方脫(tuo)胎于《傷(shang)(shang)寒(han)雜病(bing)論》之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)復(fu)(fu)脈(mo)(mo)(mo)(mo)(mo)(mo)湯(tang)(tang)(炙甘(gan)草(cao)湯(tang)(tang))。因為(wei)(wei)(wei)(wei):一、從方名來看,復(fu)(fu)脈(mo)(mo)(mo)(mo)(mo)(mo)與(yu)生(sheng)脈(mo)(mo)(mo)(mo)(mo)(mo),其(qi)(qi)意相同,都是為(wei)(wei)(wei)(wei)了使虛弱(ruo)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)脈(mo)(mo)(mo)(mo)(mo)(mo)得(de)以(yi)復(fu)(fu)常(chang)。二、從配方及意義來看,復(fu)(fu)脈(mo)(mo)(mo)(mo)(mo)(mo)湯(tang)(tang)由多甘(gan)草(cao)、桂枝(zhi)、生(sheng)姜、人參(can)、麥(mai)冬(dong)、生(sheng)地(di)、阿膠(jiao)、麻(ma)仁(ren)、大棗、酒等(deng)組成。方中(zhong)(zhong)炙甘(gan)草(cao)、桂枝(zhi)、生(sheng)姜補(bu)(bu)心(xin)(xin)(xin)(xin)(xin)陽;生(sheng)地(di)、阿膠(jiao)、大麻(ma)仁(ren)滋(zi)養心(xin)(xin)(xin)(xin)(xin)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)陰(yin)血;人參(can)、麥(mai)冬(dong)補(bu)(bu)心(xin)(xin)(xin)(xin)(xin)氣(qi),益(yi)(yi)心(xin)(xin)(xin)(xin)(xin)液(ye),大棗和脾,酒助心(xin)(xin)(xin)(xin)(xin)陽通脈(mo)(mo)(mo)(mo)(mo)(mo)。故(gu)此(ci)方為(wei)(wei)(wei)(wei)振奮心(xin)(xin)(xin)(xin)(xin)陽,滋(zi)養心(xin)(xin)(xin)(xin)(xin)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)陰(yin)血之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)劑。生(sheng)脈(mo)(mo)(mo)(mo)(mo)(mo)散(san)(san)由人參(can)、麥(mai)冬(dong)、五(wu)味(wei)子組成。方中(zhong)(zhong)參(can)、麥(mai)冬(dong)補(bu)(bu)心(xin)(xin)(xin)(xin)(xin)氣(qi),益(yi)(yi)心(xin)(xin)(xin)(xin)(xin)液(ye),五(wu)味(wei)子斂氣(qi)生(sheng)津(jin),故(gu)為(wei)(wei)(wei)(wei)補(bu)(bu)益(yi)(yi)心(xin)(xin)(xin)(xin)(xin)臟(zang)氣(qi)液(ye)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)方。三、從主(zhu)治來看,復(fu)(fu)脈(mo)(mo)(mo)(mo)(mo)(mo)湯(tang)(tang)為(wei)(wei)(wei)(wei)心(xin)(xin)(xin)(xin)(xin)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)陰(yin)陽受傷(shang)(shang)所(suo)致之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)“脈(mo)(mo)(mo)(mo)(mo)(mo)結代(dai)(dai),心(xin)(xin)(xin)(xin)(xin)動(dong)悸(ji)”而設;生(sheng)脈(mo)(mo)(mo)(mo)(mo)(mo)散(san)(san)系為(wei)(wei)(wei)(wei)心(xin)(xin)(xin)(xin)(xin)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)氣(qi)液(ye)虛損所(suo)致之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)汗多體倦,口干舌(she)燥,短(duan)氣(qi)口渴,脈(mo)(mo)(mo)(mo)(mo)(mo)虛弱(ruo)或虛數而立(li)。四(si)、復(fu)(fu)脈(mo)(mo)(mo)(mo)(mo)(mo)湯(tang)(tang)是側(ce)重(zhong)補(bu)(bu)心(xin)(xin)(xin)(xin)(xin)陽,養心(xin)(xin)(xin)(xin)(xin)陰(yin);生(sheng)脈(mo)(mo)(mo)(mo)(mo)(mo)散(san)(san)是側(ce)重(zhong)益(yi)(yi)心(xin)(xin)(xin)(xin)(xin)氣(qi),增心(xin)(xin)(xin)(xin)(xin)液(ye)。追溯其(qi)(qi)因,由于導致心(xin)(xin)(xin)(xin)(xin)病(bing)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)因不同。“脈(mo)(mo)(mo)(mo)(mo)(mo)結代(dai)(dai),心(xin)(xin)(xin)(xin)(xin)動(dong)悸(ji)”,為(wei)(wei)(wei)(wei)傷(shang)(shang)寒(han)引(yin)起(qi)。寒(han)則傷(shang)(shang)陽,故(gu)復(fu)(fu)脈(mo)(mo)(mo)(mo)(mo)(mo)湯(tang)(tang)中(zhong)(zhong)有(you)溫補(bu)(bu)心(xin)(xin)(xin)(xin)(xin)陽之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)品;損陽及陰(yin),故(gu)方中(zhong)(zhong)又有(you)滋(zi)養陰(yin)血之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)藥。生(sheng)脈(mo)(mo)(mo)(mo)(mo)(mo)散(san)(san)所(suo)治之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)證,乃由暑熱耗氣(qi)傷(shang)(shang)津(jin)所(suo)致,故(gu)李東(dong)垣僅(jin)用(yong)復(fu)(fu)脈(mo)(mo)(mo)(mo)(mo)(mo)湯(tang)(tang)中(zhong)(zhong)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)人參(can)、麥(mai)冬(dong),并加五(wu)味(wei)子以(yi)治之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)。此(ci)方所(suo)以(yi)不用(yong)復(fu)(fu)脈(mo)(mo)(mo)(mo)(mo)(mo)湯(tang)(tang)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)其(qi)(qi)余(yu)諸藥者,以(yi)其(qi)(qi)不對證也。總之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi),脈(mo)(mo)(mo)(mo)(mo)(mo)者,血之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)府也。心(xin)(xin)(xin)(xin)(xin)主(zhu)血脈(mo)(mo)(mo)(mo)(mo)(mo),故(gu)復(fu)(fu)脈(mo)(mo)(mo)(mo)(mo)(mo)必須治心(xin)(xin)(xin)(xin)(xin)。上兩方皆(jie)為(wei)(wei)(wei)(wei)治心(xin)(xin)(xin)(xin)(xin)之(zhi)(zhi)(zhi)(zhi)(zhi)(zhi)劑。兩方有(you)先有(you)后,所(suo)以(yi)推測生(sheng)脈(mo)(mo)(mo)(mo)(mo)(mo)散(san)(san)是脫(tuo)胎于復(fu)(fu)脈(mo)(mo)(mo)(mo)(mo)(mo)湯(tang)(tang)。
生(sheng)(sheng)脈(mo)(mo)(mo)散(san)(san)(san)雖(sui)然脫(tuo)(tuo)胎于(yu)復脈(mo)(mo)(mo)湯(tang),但是(shi)也借鑒了張(zhang)仲景的白(bai)虎(hu)(hu)加(jia)(jia)(jia)入參(can)(can)(can)湯(tang)。葉天士首將(jiang)上方化(hua)裁為(wei)(wei)生(sheng)(sheng)脈(mo)(mo)(mo)散(san)(san)(san),并用(yong)于(yu)溫病(bing)(bing)(bing)津傷氣(qi)(qi)(qi)脫(tuo)(tuo)之(zhi)(zhi)(zhi)(zhi)證(zheng)(zheng)。薛生(sheng)(sheng)白(bai)《濕病(bing)(bing)(bing)條辨》又將(jiang)生(sheng)(sheng)脈(mo)(mo)(mo)散(san)(san)(san)用(yong)于(yu)“暑月熱(re)傷元氣(qi)(qi)(qi)”。吳鞠通將(jiang)白(bai)虎(hu)(hu)加(jia)(jia)(jia)人(ren)參(can)(can)(can)演變(bian)為(wei)(wei)生(sheng)(sheng)脈(mo)(mo)(mo)散(san)(san)(san)之(zhi)(zhi)(zhi)(zhi)過程,說得(de)非常具體(ti)。如《溫病(bing)(bing)(bing)條辨》說:“太陰(yin)濕病(bing)(bing)(bing),脈(mo)(mo)(mo)浮(fu)大(da)(da)(da)(da)(da)而(er)(er)芤,汗(han)大(da)(da)(da)(da)(da)出(chu),微喘,甚至鼻孔(kong)扇(shan)者(zhe)(zhe),白(bai)虎(hu)(hu)加(jia)(jia)(jia)人(ren)參(can)(can)(can)湯(tang)主(zhu)之(zhi)(zhi)(zhi)(zhi);脈(mo)(mo)(mo)若(ruo)散(san)(san)(san)大(da)(da)(da)(da)(da)者(zhe)(zhe),急用(yong)之(zhi)(zhi)(zhi)(zhi)倍人(ren)參(can)(can)(can)”,“手太陰(yin)暑溫,或已(yi)經(jing)發汗(han),或未發汗(han),而(er)(er)汗(han)出(chu)不止,煩渴而(er)(er)喘,脈(mo)(mo)(mo)洪大(da)(da)(da)(da)(da)有(you)力者(zhe)(zhe),白(bai)虎(hu)(hu)湯(tang)主(zhu)之(zhi)(zhi)(zhi)(zhi);脈(mo)(mo)(mo)洪大(da)(da)(da)(da)(da)而(er)(er)芤者(zhe)(zhe),白(bai)虎(hu)(hu)加(jia)(jia)(jia)人(ren)參(can)(can)(can)場主(zhu)之(zhi)(zhi)(zhi)(zhi)。……汗(han)多,脈(mo)(mo)(mo)散(san)(san)(san)大(da)(da)(da)(da)(da),喘而(er)(er)欲脫(tuo)(tuo)者(zhe)(zhe),生(sheng)(sheng)脈(mo)(mo)(mo)散(san)(san)(san)主(zhu)之(zhi)(zhi)(zhi)(zhi)。”汗(han)出(chu)惡寒,是(shi)津傷氣(qi)(qi)(qi)脫(tuo)(tuo)之(zhi)(zhi)(zhi)(zhi)先(xian)兆;脈(mo)(mo)(mo)浮(fu)大(da)(da)(da)(da)(da)而(er)(er)芤,汗(han)大(da)(da)(da)(da)(da)出(chu),微喘,為(wei)(wei)邪熱(re)傷及肺中津氣(qi)(qi)(qi)之(zhi)(zhi)(zhi)(zhi)表現;脈(mo)(mo)(mo)散(san)(san)(san)大(da)(da)(da)(da)(da),為(wei)(wei)邪熱(re)重(zhong)傷元氣(qi)(qi)(qi)之(zhi)(zhi)(zhi)(zhi)證(zheng)(zheng);汗(han)出(chu),脈(mo)(mo)(mo)散(san)(san)(san)大(da)(da)(da)(da)(da),喘而(er)(er)欲脫(tuo)(tuo),為(wei)(wei)津傷氣(qi)(qi)(qi)脫(tuo)(tuo),化(hua)源(yuan)欲絕之(zhi)(zhi)(zhi)(zhi)象。其病(bing)(bing)(bing)由(you)輕而(er)(er)重(zhong),由(you)虛實兼來,進而(er)(er)發展(zhan)為(wei)(wei)純虛之(zhi)(zhi)(zhi)(zhi)喉,這是(shi)符(fu)合熱(re)病(bing)(bing)(bing)變(bian)化(hua)規律的。由(you)于(yu)生(sheng)(sheng)脈(mo)(mo)(mo)散(san)(san)(san)證(zheng)(zheng)是(shi)由(you)白(bai)虎(hu)(hu)加(jia)(jia)(jia)人(ren)參(can)(can)(can)湯(tang)證(zheng)(zheng)逐漸發展(zhan)而(er)(er)成,所以,生(sheng)(sheng)脈(mo)(mo)(mo)散(san)(san)(san)之(zhi)(zhi)(zhi)(zhi)創制,要借鑒白(bai)虎(hu)(hu)加(jia)(jia)(jia)人(ren)參(can)(can)(can)湯(tang)。
總之,生脈散(san)之出,既與復脈湯有關,也借(jie)鑒了白虎加(jia)人參湯。
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