芦根这味药,用对了真是了不得

芦根这味药,用对了真是了不得

笔者发现,芦根是治疗热病疗效最好、应用最广泛的一味药。

芦根甘寒,教科书言其归肺、胃经,其实不止肺胃,心、小肠、大肠、肾、膀胱皆可治及。

说到芦根的功效,广泛的很。《别录》云其“主消渴客热”,就是清热生津,这是由其甘寒之性决定的,对热病津伤尤其是肺胃燥热很有效。因为既清又润,所以对肺胃痰热者,也是清、润、化并俱。

加之芦根体轻而中空,所以它又有宣透郁热之功,清中有透,对风热郁肺、肺气不宣尤为适宜,温病名方桑菊饮、银翘散均有此君,正缘于此。需要指出的是,桑菊饮、银翘散的主要功效是宣透风热或温热,但宣透需要充足的津液作保障,因此,除用芦根的宣透作用外,还以之甘寒生津,一补耗损,二作保障。

如此,芦根清、润、化、透兼俱,所以于肺肠热痈腐脓之证则具清热散痈、化腐透脓之功,仲师之苇茎汤中所用即其茎管耳。

因为芦根中空而为根,所以又有利尿作用,其实是其透窍之功的一种体现。《本草图经》说:“芦根清泻肺热,兼能利尿,可导热毒从小便出,故可治肺热咳嗽痰稠及肺痈咳吐脓血。”可见芦根既能宣上窍,又可透下窍,故不但对肺郁肺热、痰浊阻遏者可清宣利导,而且对三焦热郁(包括胃热津燥、热移小肠、热郁膀胱、热伤肾燥等)而气化不畅、邪浊留恋者甚合,临床验之,亦屡试不爽。

此外,芦根更有止呕之功,有人喻之为胃热呕吐之优品。余曾以之加味(如竹茹麦冬等)治疗一例胃津枯耗、虚火炎炎、食饮即吐之晚期胃癌患者,殊有良功。

芦根不仅对胃腑浊热、痰热,或胃津有伤所致胃气上逆而呕吐者,而且还对上焦肺热不肃、下焦热浊上犯所致胃气不降而呕吐者皆见佳效。由此而言,芦根又有清润化浊降逆之功。据此,余临床用于肺胃热郁津气不降或津伤不降所致肠燥便秘者,亦获好效。

因为芦根清中有透,故对郁热扰于神窍而心烦者,有清心透窍除烦之效,这是芦根轻清透窍之功的又一体现。不管对上焦心肺郁热还是中下焦热浊上冲所致者皆有良效。于清透除烦而言,芦根和石膏、豆豉可为“三剑客”,然从质气轻重言,石膏为重,豆豉为中,芦根为轻。

芦根体轻气味俱薄,虽为凉寒之品但轻清不伤正气,这一点大家可能有所共识。

芦根之用,以鲜者疗效为佳,量宜大。由于条件所限,余用鲜品经验不多。干品之用量,轻宣郁热、清透除烦,量可小,常用12g。而清热生津、化痰透脓、降逆止呕、利尿排浊等,则量宜大;根据病机轻重深浅和患者体质,余一般用36克及以上40、60克不等。

总之,芦根可直清内热,可生津润燥,可宣散风热(或郁热),可降逆止呕,可透热除烦,可利尿排浊,可化痰排脓,集“清、润、宣、降、透、利、化、排”于一身,上中下三焦兼治,普遍适合风热或温热、热毒等温病范畴各个病变过程和病理机转。故可随手而用,且其凉而不凝,润而不腻,轻清味淡,宣利不耗气阴。

由于芦根的上述功效,如再配伍一味人参(或党参或太子参),就是活脱脱一剂竹叶石膏汤之轻剂。如温热病后期气津两伤、余热尚留而有低热乏力、痰少咳逆、口渴心烦、干呕欲吐、小便少而黄、舌红而脉虚数或浮数者,余常以芦根12g、人参5g(或党参5g或太子参5g)两味开水泡茶,时时饮之,效果真不错。

芦根一味虽好,但毕竟势单力薄,于急病重病者需配入方中相须为用,方为稳妥。

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