關鍵詞(ci)：《章次公醫案》蟲類中藥(yao) 痹癥 頭(tou)風痛 腫脹 小兒驚(jing)風

章成之(zhi)先(xian)生(sheng)(sheng)(1903～1959年)，字次(ci)公。江蘇鎮江人。早年攻讀(du)于上海(hai)中(zhong)(zhong)(zhong)(zhong)醫(yi)(yi)專(zhuan)門學(xue)(xue)校，親炙于丁(ding)甘仁、曹穎甫(fu)諸先(xian)生(sheng)(sheng)。在滬從事(shi)診(zhen)(zhen)務(wu)，先(xian)后在上海(hai)中(zhong)(zhong)(zhong)(zhong)醫(yi)(yi)專(zhuan)門學(xue)(xue)校、中(zhong)(zhong)(zhong)(zhong)國醫(yi)(yi)學(xue)(xue)院(yuan)、新中(zhong)(zhong)(zhong)(zhong)國醫(yi)(yi)學(xue)(xue)院(yuan)、蘇州國醫(yi)(yi)學(xue)(xue)校等處(chu)任教，對培養中(zhong)(zhong)(zhong)(zhong)醫(yi)(yi)藥(yao)人才作出貢獻。建國后，曾在上海(hai)市衛生(sheng)(sheng)局直屬中(zhong)(zhong)(zhong)(zhong)醫(yi)(yi)門診(zhen)(zhen)所應診(zhen)(zhen)，其后應聘(pin)出任中(zhong)(zhong)(zhong)(zhong)華人民共和國衛生(sheng)(sheng)部中(zhong)(zhong)(zhong)(zhong)醫(yi)(yi)顧(gu)問、中(zhong)(zhong)(zhong)(zhong)國醫(yi)(yi)學(xue)(xue)科(ke)學(xue)(xue)院(yuan)院(yuan)務(wu)委(wei)員、北京醫(yi)(yi)院(yuan)中(zhong)(zhong)(zhong)(zhong)醫(yi)(yi)科(ke)主(zhu)任，并當(dang)選為(wei)第(di)三(san)屆全(quan)國政協委(wei)員、中(zhong)(zhong)(zhong)(zhong)國亞洲團結(jie)委(wei)員會委(wei)員。先(xian)生(sheng)(sheng)曾編著《藥(yao)物學(xue)(xue)》四卷、《診(zhen)(zhen)余(yu)抄》一(yi)集及(ji)醫(yi)(yi)學(xue)(xue)論著數十(shi)篇(pian)，發表于多種醫(yi)(yi)學(xue)(xue)雜志。《章次(ci)公醫(yi)(yi)案》一(yi)書，由其學(xue)(xue)生(sheng)(sheng)整理而(er)成。

《章次公(gong)醫(yi)案》共收(shou)集醫(yi)案723則(ze)，包括內科(ke)(如(ru)(ru)(ru)感冒、春溫、暑溫、頭(tou)痛、中(zhong)(zhong)(zhong)風、泄(xie)瀉等29種(zhong)病(bing)證(zheng))、婦科(ke)(如(ru)(ru)(ru)月(yue)經(jing)不調(diao)、痛經(jing)、胎前、產后(hou)等7種(zhong)病(bing)證(zheng))、兒科(ke)(如(ru)(ru)(ru)驚厥、咳嗽(sou)、傷食、蟲(chong)積等12種(zhong)病(bing)證(zheng))、外(wai)科(ke)(如(ru)(ru)(ru)瘰疬(li)、流注(zhu)、濕疹等8種(zhong)病(bing)證(zheng))等臨(lin)(lin)床常見多發病(bing)及疑難(nan)病(bing)證(zheng)，其中(zhong)(zhong)(zhong)多數是1940年前后(hou)的醫(yi)案。章氏師古(gu)(gu)不泥古(gu)(gu)，善于(yu)吸取各家學(xue)驗(yan)之長，樂(le)用古(gu)(gu)代和(he)(he)現代醫(yi)學(xue)之理論(lun)和(he)(he)經(jing)驗(yan)。他對(dui)熱性病(bing)和(he)(he)慢性雜病(bing)及婦科(ke)調(diao)經(jing)方面都(dou)有獨特的治(zhi)療(liao)經(jing)驗(yan)。臨(lin)(lin)證(zheng)中(zhong)(zhong)(zhong)擅長應用蟲(chong)類(lei)(lei)藥(yao)，療(liao)效十分顯著(zhu)。現將此(ci)書載述(shu)之蟲(chong)類(lei)(lei)藥(yao)物在臨(lin)(lin)床中(zhong)(zhong)(zhong)應用選介于(yu)下。

痹證

痹(bi)證(zheng)(zheng)是由(you)于人體肌表(biao)經(jing)絡遭受風(feng)(feng)(feng)、寒(han)、濕(shi)(shi)(shi)(shi)邪侵襲后，使氣(qi)血(xue)運(yun)行(xing)(xing)(xing)不暢，引起筋(jin)骨(gu)、肌肉、關(guan)節(jie)酸痛(tong)(tong)(tong)、麻木，關(guan)節(jie)腫(zhong)(zhong)大(da)等癥。其(qi)發病原因，正(zheng)如《類(lei)證(zheng)(zheng)治(zhi)(zhi)(zhi)裁》所說：“諸痹(bi)……良(liang)由(you)營衛(wei)先虛，腠理不密，風(feng)(feng)(feng)寒(han)濕(shi)(shi)(shi)(shi)乘虛內(nei)襲，正(zheng)氣(qi)為邪所阻，不能(neng)(neng)宣行(xing)(xing)(xing)，因而留滯，氣(qi)血(xue)凝滯，久而成痹(bi)。”痹(bi)證(zheng)(zheng)治(zhi)(zhi)(zhi)宜祛(qu)(qu)風(feng)(feng)(feng)，散寒(han)，利(li)濕(shi)(shi)(shi)(shi)，參(can)以治(zhi)(zhi)(zhi)血(xue)。章(zhang)先生方(fang)治(zhi)(zhi)(zhi)用(yong)藥(yao)(yao)，常取(qu)蜈(wu)蚣(gong)、全(quan)蝎、地(di)鱉蟲、蘄(qi)蛇(she)等蟲類(lei)藥(yao)(yao)以助療效。如治(zhi)(zhi)(zhi)痹(bi)證(zheng)(zheng)病案(an)中(zhong)載(zai)述：宋某(男)。背(bei)部(bu)(bu)疼痛(tong)(tong)(tong)，右髖關(guan)節(jie)強直已有(you)七(qi)年。精(jing)神倦怠，四(si)肢(zhi)無力，踝關(guan)節(jie)浮腫(zhong)(zhong)，梅季更甚。西(xi)醫診斷(duan)為風(feng)(feng)(feng)濕(shi)(shi)(shi)(shi)樣脊椎炎、髖關(guan)節(jie)炎。初診服用(yong)大(da)活絡丹，亦(yi)(yi)無顯效。二診藥(yao)(yao)用(yong)：蘄(qi)蛇(she)、露蜂房、大(da)蜈(wu)蚣(gong)、全(quan)蝎、三(san)七(qi)、仙茅、全(quan)當歸(gui)、桑(sang)(sang)寄(ji)生、生白術、甘草(cao)。上藥(yao)(yao)共研，為丸。方(fang)中(zhong)蘄(qi)蛇(she)祛(qu)(qu)風(feng)(feng)(feng)通絡，透骨(gu)搜風(feng)(feng)(feng)，可(ke)(ke)治(zhi)(zhi)(zhi)風(feng)(feng)(feng)濕(shi)(shi)(shi)(shi)痹(bi)痛(tong)(tong)(tong)等癥。據章(zhang)先生臨床經(jing)驗，蘄(qi)蛇(she)治(zhi)(zhi)(zhi)風(feng)(feng)(feng)濕(shi)(shi)(shi)(shi)痛(tong)(tong)(tong)在腰部(bu)(bu)者最佳。蜈(wu)蚣(gong)、全(quan)蝎走(zou)竄以祛(qu)(qu)風(feng)(feng)(feng)通絡，其(qi)中(zhong)全(quan)蝎有(you)良(liang)好(hao)的止(zhi)痛(tong)(tong)(tong)功能(neng)(neng)，治(zhi)(zhi)(zhi)風(feng)(feng)(feng)濕(shi)(shi)(shi)(shi)病療效卓著。露蜂房具(ju)有(you)祛(qu)(qu)風(feng)(feng)(feng)攻毒，散腫(zhong)(zhong)止(zhi)痛(tong)(tong)(tong)之功。方(fang)中(zhong)4味蟲類(lei)藥(yao)(yao)以祛(qu)(qu)風(feng)(feng)(feng)通絡，散腫(zhong)(zhong)止(zhi)痛(tong)(tong)(tong)。此外(wai)，當歸(gui)甘溫而潤，活血(xue)止(zhi)痛(tong)(tong)(tong)，辛香善于行(xing)(xing)(xing)走(zou)，與祛(qu)(qu)風(feng)(feng)(feng)濕(shi)(shi)(shi)(shi)藥(yao)(yao)配伍，可(ke)(ke)治(zhi)(zhi)(zhi)風(feng)(feng)(feng)濕(shi)(shi)(shi)(shi)痹(bi)痛(tong)(tong)(tong)。白術燥濕(shi)(shi)(shi)(shi)，《醫學啟(qi)源(yuan)》認為有(you)“除濕(shi)(shi)(shi)(shi)益燥，和(he)(he)中(zhong)益氣(qi)……”之效能(neng)(neng)。三(san)七(qi)活血(xue)行(xing)(xing)(xing)瘀，尤長于止(zhi)痛(tong)(tong)(tong)。仙茅一(yi)藥(yao)(yao)，《本草(cao)正(zheng)義》認為：“乃補(bu)陽(yang)溫腎之專(zhuan)藥(yao)(yao)，故亦(yi)(yi)兼能(neng)(neng)祛(qu)(qu)除寒(han)濕(shi)(shi)(shi)(shi)……。”而桑(sang)(sang)寄(ji)生具(ju)有(you)補(bu)肝腎，除風(feng)(feng)(feng)濕(shi)(shi)(shi)(shi)，強筋(jin)骨(gu)功效。甘草(cao)甘以緩急，緩和(he)(he)藥(yao)(yao)性(xing)。患者藥(yao)(yao)后背(bei)痛(tong)(tong)(tong)、踝腫(zhong)(zhong)大(da)為減退。原方(fang)續服。從(cong)上可(ke)(ke)見(jian)《章(zhang)次公醫案(an)》治(zhi)(zhi)(zhi)療痹(bi)證(zheng)(zheng)之用(yong)藥(yao)(yao)特色(se)。

頭風痛

頭(tou)(tou)(tou)(tou)(tou)位于(yu)人(ren)體最高部位，臟腑清陽(yang)(yang)(yang)之(zhi)(zhi)(zhi)氣(qi)上(shang)(shang)(shang)注于(yu)頭(tou)(tou)(tou)(tou)(tou)，手足三陽(yang)(yang)(yang)經和主一(yi)身(shen)之(zhi)(zhi)(zhi)陽(yang)(yang)(yang)的(de)督脈亦均上(shang)(shang)(shang)至(zhi)頭(tou)(tou)(tou)(tou)(tou)部，所謂“頭(tou)(tou)(tou)(tou)(tou)為(wei)(wei)諸陽(yang)(yang)(yang)之(zhi)(zhi)(zhi)會”。對于(yu)頭(tou)(tou)(tou)(tou)(tou)痛(tong)(tong)(tong)(tong)看法，諸家不一(yi)。《素問·風(feng)(feng)(feng)(feng)論(lun)》曰：“風(feng)(feng)(feng)(feng)氣(qi)循風(feng)(feng)(feng)(feng)府(fu)而(er)上(shang)(shang)(shang)，則(ze)(ze)為(wei)(wei)腦風(feng)(feng)(feng)(feng)。”李東(dong)垣認(ren)為(wei)(wei)：“巔頂之(zhi)(zhi)(zhi)上(shang)(shang)(shang)，惟風(feng)(feng)(feng)(feng)可(ke)(ke)到。”丹溪(xi)認(ren)為(wei)(wei)：“頭(tou)(tou)(tou)(tou)(tou)痛(tong)(tong)(tong)(tong)多(duo)(duo)(duo)主于(yu)痰(tan)，痛(tong)(tong)(tong)(tong)甚者(zhe)(zhe)火(huo)多(duo)(duo)(duo)，有(you)(you)(you)(you)(you)可(ke)(ke)吐者(zhe)(zhe)，亦有(you)(you)(you)(you)(you)可(ke)(ke)下者(zhe)(zhe)。”朱(zhu)肱認(ren)為(wei)(wei)：“三陽(yang)(yang)(yang)有(you)(you)(you)(you)(you)頭(tou)(tou)(tou)(tou)(tou)痛(tong)(tong)(tong)(tong)，三陰則(ze)(ze)無。”而(er)《雜病(bing)證治(zhi)(zhi)(zhi)準(zhun)繩》說：“醫(yi)(yi)(yi)書(shu)多(duo)(duo)(duo)分(fen)頭(tou)(tou)(tou)(tou)(tou)痛(tong)(tong)(tong)(tong)、頭(tou)(tou)(tou)(tou)(tou)風(feng)(feng)(feng)(feng)為(wei)(wei)二門，然(ran)一(yi)病(bing)也，但(dan)(dan)有(you)(you)(you)(you)(you)新久去留(liu)之(zhi)(zhi)(zhi)分(fen)耳。淺而(er)近者(zhe)(zhe)名(ming)頭(tou)(tou)(tou)(tou)(tou)痛(tong)(tong)(tong)(tong)……，深而(er)遠者(zhe)(zhe)為(wei)(wei)頭(tou)(tou)(tou)(tou)(tou)風(feng)(feng)(feng)(feng)……。”在(zai)(zai)臨(lin)床上(shang)(shang)(shang)一(yi)般分(fen)為(wei)(wei)外(wai)(wai)感頭(tou)(tou)(tou)(tou)(tou)痛(tong)(tong)(tong)(tong)(多(duo)(duo)(duo)為(wei)(wei)風(feng)(feng)(feng)(feng)寒(han)、風(feng)(feng)(feng)(feng)熱、濕邪所致(zhi))、內(nei)傷頭(tou)(tou)(tou)(tou)(tou)痛(tong)(tong)(tong)(tong)(分(fen)為(wei)(wei)氣(qi)虛、血(xue)虛、肝火(huo)、寒(han)厥、痰(tan)濁等)。前(qian)人(ren)認(ren)為(wei)(wei)頭(tou)(tou)(tou)(tou)(tou)風(feng)(feng)(feng)(feng)痛(tong)(tong)(tong)(tong)由外(wai)(wai)邪從(cong)風(feng)(feng)(feng)(feng)府(fu)入(ru)(ru)腦，郁而(er)為(wei)(wei)痛(tong)(tong)(tong)(tong)，或風(feng)(feng)(feng)(feng)淫火(huo)郁。正如葉天(tian)士《臨(lin)證指南醫(yi)(yi)(yi)案》中(zhong)徐靈(ling)胎評為(wei)(wei)：“頭(tou)(tou)(tou)(tou)(tou)風(feng)(feng)(feng)(feng)之(zhi)(zhi)(zhi)疾(ji)，輕者(zhe)(zhe)易愈，其重者(zhe)(zhe)風(feng)(feng)(feng)(feng)毒上(shang)(shang)(shang)攻(gong)，絡(luo)(luo)血(xue)橫逆，重則(ze)(ze)厥冒，久則(ze)(ze)傷目，必(bi)重劑(ji)并外(wai)(wai)治(zhi)(zhi)(zhi)諸法，方(fang)能有(you)(you)(you)(you)(you)效。”在(zai)(zai)案中(zhong)葉氏采用(yong)(yong)(yong)(yong)蟲(chong)(chong)蟻一(yi)類藥(yao)(yao)(yao)入(ru)(ru)血(xue)中(zhong)搜逐，攻(gong)通(tong)(tong)(tong)(tong)邪結。章(zhang)次(ci)(ci)公繼承發揚了(le)葉天(tian)士等善用(yong)(yong)(yong)(yong)蟲(chong)(chong)類藥(yao)(yao)(yao)的(de)寶貴經驗。按(an)照辨證論(lun)治(zhi)(zhi)(zhi)的(de)原則(ze)(ze)，選用(yong)(yong)(yong)(yong)大劑(ji)量蟲(chong)(chong)類藥(yao)(yao)(yao)治(zhi)(zhi)(zhi)療頭(tou)(tou)(tou)(tou)(tou)風(feng)(feng)(feng)(feng)痛(tong)(tong)(tong)(tong)。如治(zhi)(zhi)(zhi)頭(tou)(tou)(tou)(tou)(tou)痛(tong)(tong)(tong)(tong)案例中(zhong)，王某(女(nv))。頭(tou)(tou)(tou)(tou)(tou)痛(tong)(tong)(tong)(tong)達(da)十年之(zhi)(zhi)(zhi)久，作輟無常，痛(tong)(tong)(tong)(tong)劇則(ze)(ze)嘔吐頻作，徹夜(ye)不寐，痛(tong)(tong)(tong)(tong)苦不可(ke)(ke)名(ming)狀。在(zai)(zai)治(zhi)(zhi)(zhi)則(ze)(ze)上(shang)(shang)(shang)，章(zhang)先(xian)生認(ren)為(wei)(wei)治(zhi)(zhi)(zhi)風(feng)(feng)(feng)(feng)當先(xian)治(zhi)(zhi)(zhi)血(xue)，血(xue)行風(feng)(feng)(feng)(feng)自滅(mie)，古有(you)(you)(you)(you)(you)明(ming)訓(xun)，但(dan)(dan)追風(feng)(feng)(feng)(feng)通(tong)(tong)(tong)(tong)絡(luo)(luo)之(zhi)(zhi)(zhi)品，仍不可(ke)(ke)少。藥(yao)(yao)(yao)用(yong)(yong)(yong)(yong)炮附塊、全(quan)當歸、大川芎、甘枸杞、明(ming)天(tian)麻、藁(gao)本(ben)、大蜈蚣、炙全(quan)蝎(xie)、制半(ban)夏、綿黃(huang)(huang)芪(qi)、炒棗(zao)仁(ren)、茯(fu)(fu)苓、生白術。上(shang)(shang)(shang)藥(yao)(yao)(yao)共研細末，1日3次(ci)(ci)，每次(ci)(ci)3克，飯后(hou)服。此方(fang)服兩料，即告痊愈。據上(shang)(shang)(shang)案分(fen)析，病(bing)人(ren)頭(tou)(tou)(tou)(tou)(tou)痛(tong)(tong)(tong)(tong)已久，氣(qi)滯血(xue)瘀(yu)、絡(luo)(luo)脈受阻，故(gu)治(zhi)(zhi)(zhi)宜活(huo)血(xue)化(hua)瘀(yu)，佐以通(tong)(tong)(tong)(tong)絡(luo)(luo)止痛(tong)(tong)(tong)(tong)。方(fang)中(zhong)附子溫(wen)熱，其性善走，能祛(qu)除寒(han)濕而(er)止痛(tong)(tong)(tong)(tong)。當歸、川芎活(huo)血(xue)、祛(qu)脈絡(luo)(luo)之(zhi)(zhi)(zhi)瘀(yu)閉(bi)，蜈蚣祛(qu)風(feng)(feng)(feng)(feng)通(tong)(tong)(tong)(tong)絡(luo)(luo)，息肝風(feng)(feng)(feng)(feng)。全(quan)蝎(xie)祛(qu)風(feng)(feng)(feng)(feng)通(tong)(tong)(tong)(tong)絡(luo)(luo)，鎮痙止痛(tong)(tong)(tong)(tong)，二味(wei)蟲(chong)(chong)類藥(yao)(yao)(yao)均有(you)(you)(you)(you)(you)較強的(de)搜風(feng)(feng)(feng)(feng)剔(ti)邪作用(yong)(yong)(yong)(yong)。黃(huang)(huang)芪(qi)、白術益氣(qi)補脾以升陽(yang)(yang)(yang)，藁(gao)本(ben)升散(san)，善達(da)巔頂，功能祛(qu)風(feng)(feng)(feng)(feng)散(san)寒(han)止痛(tong)(tong)(tong)(tong)。棗(zao)仁(ren)、枸杞滋養心肝，天(tian)麻息風(feng)(feng)(feng)(feng)通(tong)(tong)(tong)(tong)絡(luo)(luo)止痛(tong)(tong)(tong)(tong)，佐半(ban)夏、茯(fu)(fu)苓以化(hua)痰(tan)濕。從(cong)該書(shu)治(zhi)(zhi)(zhi)頭(tou)(tou)(tou)(tou)(tou)痛(tong)(tong)(tong)(tong)病(bing)案中(zhong)可(ke)(ke)見(jian)，凡屬于(yu)氣(qi)滯血(xue)瘀(yu)型頭(tou)(tou)(tou)(tou)(tou)痛(tong)(tong)(tong)(tong)，章(zhang)先(xian)生在(zai)(zai)方(fang)中(zhong)必(bi)選用(yong)(yong)(yong)(yong)蟲(chong)(chong)藥(yao)(yao)(yao)，最常用(yong)(yong)(yong)(yong)的(de)蟲(chong)(chong)類藥(yao)(yao)(yao)為(wei)(wei)蜈蚣、全(quan)蝎(xie)、僵(jiang)蠶(can)。在(zai)(zai)《章(zhang)次(ci)(ci)公醫(yi)(yi)(yi)案》中(zhong)，治(zhi)(zhi)(zhi)療頭(tou)(tou)(tou)(tou)(tou)痛(tong)(tong)(tong)(tong)用(yong)(yong)(yong)(yong)蟲(chong)(chong)類藥(yao)(yao)(yao)為(wei)(wei)主的(de)方(fang)劑(ji)，占33%。

腫脹

先(xian)生(sheng)(sheng)繼承發揚了仲景、楊(yang)？、葉天士等醫家(jia)應用(yong)蟲(chong)(chong)(chong)類(lei)(lei)藥治(zhi)病(bing)(bing)的經(jing)驗。根據患者病(bing)(bing)證(zheng)(zheng)，結(jie)合個人臨(lin)床心(xin)得(de)，立(li)(li)方遣藥。他往往選用(yong)以(yi)蟲(chong)(chong)(chong)類(lei)(lei)藥為(wei)主，配(pei)伍其他藥物，治(zhi)療腹部水(shui)(shui)脹病(bing)(bing)證(zheng)(zheng)。如在腫脹案例中，先(xian)生(sheng)(sheng)治(zhi)邵(shao)某女患者。在南京診斷(duan)為(wei)慢性肝(gan)炎。求診時以(yi)腹部脹滿，肝(gan)區隱隱作痛為(wei)苦(ku)，胃納(na)尚佳，但大便不(bu)暢(chang)，小溲(sou)短(duan)少，而經(jing)常頭暈欲仆，舌淡，脈(mo)弦細。先(xian)生(sheng)(sheng)針對正虛邪實(shi)，采(cai)用(yong)攻(gong)補(bu)兼施(shi)之法。立(li)(li)法為(wei)消(xiao)腫通絡，補(bu)益肝(gan)腎(shen)。方用(yong)地(di)(di)鱉(bie)(bie)蟲(chong)(chong)(chong)、蜣(qiang)螂攻(gong)堅(jian)散(san)結(jie)。螻蛄、將軍(jun)干(即蟋蟀(shuai))行(xing)水(shui)(shui)通便。配(pei)合五(wu)靈脂(zhi)、廣郁金、姜黃、三七、當歸、山甲祛瘀(yu)止(zhi)(zhi)痛，黑丑瀉水(shui)(shui)消(xiao)腫。地(di)(di)龍咸寒降泄，又善走竄，可清熱通絡利尿。再用(yong)黃芪、枸杞、五(wu)味(wei)(wei)、鱉(bie)(bie)甲等益氣、補(bu)肝(gan)腎(shen)、軟(ruan)堅(jian)。全方共奏祛瘀(yu)散(san)結(jie)，行(xing)水(shui)(shui)止(zhi)(zhi)痛，補(bu)益肝(gan)腎(shen)之效。全方20味(wei)(wei)藥，其中蟲(chong)(chong)(chong)類(lei)(lei)藥占(zhan)有(you)5味(wei)(wei)，先(xian)生(sheng)(sheng)治(zhi)療這類(lei)(lei)病(bing)(bing)證(zheng)(zheng)，一般常用(yong)蟲(chong)(chong)(chong)藥有(you)地(di)(di)鱉(bie)(bie)蟲(chong)(chong)(chong)、地(di)(di)龍、蜣(qiang)螂蟲(chong)(chong)(chong)、螻蛄、將軍(jun)干、干蟾皮等。

小兒驚風

小(xiao)(xiao)兒(er)驚(jing)(jing)(jing)厥，為(wei)(wei)兒(er)科(ke)常見癥狀(zhuang)，中(zhong)醫(yi)(yi)稱為(wei)(wei)驚(jing)(jing)(jing)風(feng)(feng)。臨(lin)床以(yi)四(si)肢抽搐或(huo)意識不(bu)(bu)清為(wei)(wei)主要特征。分為(wei)(wei)急驚(jing)(jing)(jing)風(feng)(feng)與(yu)慢驚(jing)(jing)(jing)風(feng)(feng)。急性熱病，如小(xiao)(xiao)兒(er)肺炎(yan)、乙型腦(nao)炎(yan)，或(huo)持續高熱不(bu)(bu)退等均可(ke)出現驚(jing)(jing)(jing)風(feng)(feng)。一般以(yi)急驚(jing)(jing)(jing)風(feng)(feng)為(wei)(wei)多(duo)見，即劉完素所謂“熱甚而風(feng)(feng)生(sheng)”。章(zhang)先(xian)(xian)生(sheng)選擇(ze)蟲(chong)類藥為(wei)(wei)主治小(xiao)(xiao)兒(er)驚(jing)(jing)(jing)風(feng)(feng)頗具(ju)特色。如案(an)例中(zhong)，陳某(幼)，驚(jing)(jing)(jing)厥，頭向后(hou)傾，右腿(tui)屈伸不(bu)(bu)利，兩(liang)手(shou)時時抽搐，瞳孔反應(ying)消(xiao)失。西醫(yi)(yi)診為(wei)(wei)結核(he)性腦(nao)膜炎(yan)，注射鏈(lian)霉素五十瓶無效，預后(hou)堪(kan)慮。先(xian)(xian)生(sheng)用(yong)(yong)炮附塊、黨參、白術、云苓、僵蠶、蝎(xie)(xie)尾、天麻、遠志、清炙(zhi)草。此案(an)用(yong)(yong)蟲(chong)藥僵蠶，既(ji)能平(ping)息(xi)內風(feng)(feng)以(yi)解痙(jing)，又能祛除(chu)外風(feng)(feng)以(yi)散風(feng)(feng)熱，具(ju)有化痰散結效能，配蝎(xie)(xie)尾、天麻以(yi)平(ping)肝(gan)息(xi)風(feng)(feng)而止抽搐。蝎(xie)(xie)尾息(xi)風(feng)(feng)力強(qiang)，有顯著鎮痙(jing)功效，《中(zhong)藥大辭典(dian)》認(ren)為(wei)(wei)“觀古方多(duo)用(yong)(yong)蝎(xie)(xie)尾，蓋(gai)以(yi)此蟲(chong)之力，全(quan)在于尾……”，且有較強(qiang)解毒作用(yong)(yong)。方中(zhong)用(yong)(yong)附塊配伍黨參、白術、清炙(zhi)草，功能益氣(qi)溫(wen)脾，茯(fu)苓、遠志養心(xin)安神。章(zhang)先(xian)(xian)生(sheng)治療小(xiao)(xiao)兒(er)驚(jing)(jing)(jing)風(feng)(feng)，常用(yong)(yong)蟲(chong)藥為(wei)(wei)地龍、僵蠶、蝎(xie)(xie)尾。這(zhe)對當今治療小(xiao)(xiao)兒(er)驚(jing)(jing)(jing)風(feng)(feng)，有一定啟迪作用(yong)(yong)。

總之，《章次公醫案》中較廣(guang)泛地應用(yong)蟲類藥治(zhi)(zhi)(zhi)療多種病(bing)證，如治(zhi)(zhi)(zhi)中風(feng)，用(yong)僵(jiang)蠶、蝎尾息(xi)風(feng)通絡；治(zhi)(zhi)(zhi)咳嗽(sou)，用(yong)地龍清熱解(jie)痙；治(zhi)(zhi)(zhi)胃脘痛(tong)，用(yong)九(jiu)香蟲理氣止(zhi)痛(tong)；治(zhi)(zhi)(zhi)痿證，用(yong)蜘蛛、地鱉蟲、地龍活(huo)血祛瘀止(zhi)痛(tong)；治(zhi)(zhi)(zhi)腫脹，用(yong)蟋蟀、螻蛄(gu)通便利水(shui)。治(zhi)(zhi)(zhi)痛(tong)經(jing)，用(yong)全蝎止(zhi)痛(tong)。治(zhi)(zhi)(zhi)月經(jing)不(bu)調，用(yong)地鱉蟲、虻(meng)蟲消瘀散結，或用(yong)大黃蟲丸等等。

綜上(shang)所述，章(zhang)次公先(xian)生在蟲(chong)類藥(yao)應用(yong)(yong)上(shang)，繼承和發展(zhan)了前賢的(de)(de)寶(bao)貴經驗，如仲景用(yong)(yong)大黃蟲(chong)丸治(zhi)干血；孫思邈《千金要(yao)方》用(yong)(yong)蟲(chong)、虻(meng)蟲(chong)、水(shui)蛭治(zhi)療(liao)跌打損作，腹中(zhong)瘀血；楊(yang)(yang)？《楊(yang)(yang)氏(shi)家藏方》用(yong)(yong)全蝎(xie)治(zhi)泄瀉，地龍治(zhi)風(feng)濕，用(yong)(yong)白花(hua)蛇頭(tou)、烏蛇頭(tou)、蜈蚣、僵蠶、全蝎(xie)治(zhi)中(zhong)風(feng)等，并結合個人的(de)(de)診(zhen)治(zhi)心得，故療(liao)效(xiao)卓著。先(xian)生應用(yong)(yong)蟲(chong)類藥(yao)治(zhi)病的(de)(de)經驗，有重要(yao)的(de)(de)借鑒和參(can)考價值。

中國中醫研(yan)究院中國醫史(shi)文獻研(yan)究所(北京，100700)王亞芬 李琴

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