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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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