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治疗疼痛的中医良方:桂枝加葛根汤与葛根汤-
治疗疼痛的中医良方:桂枝加葛根汤与葛根汤

治疗疼痛的中医良方:桂枝加葛根汤与葛根汤

目前,疼痛类疾病越来越多,严重地困扰着我们的身体健康,影响生活质量,因此世界卫生组织非常重视对疼痛疾病的防治。疼痛,对于我们每个人来讲都发生过,比如头痛,是我们在感冒情况下经常罹患的;腹痛,是我们患消化系统疾病时经常碰到的;肩背痛,是颈椎病的主要症状;其他如风湿疾病的关节疼痛、妇科疾病的小腹痛、腰痛、肝胆病的胁痛,以及各种癌肿疼痛等。临床上,每天都要接诊有疼痛的患者,而中医药对疼痛的治疗有独特疗效。

中医治疗疼痛类疾病有很多方剂,像人们常用的桂枝汤,它可以治疗风寒头痛,如果经过加减后,可以治疗多种疼痛。如桂枝加葛根汤、葛根汤治疗项背疼痛;桂枝新加汤治疗周身疼痛;桂枝加芍药汤、桂枝加大黄汤、小建中汤治疗腹痛等等。综观《伤寒论》及临床实践,桂枝汤类方剂主要用于头项、背部疼痛及腹痛,现主要谈谈桂枝加葛根汤和葛根汤。

两方的药物组成及主治

《伤寒论》说:“太阳病,项背强几几,反汗出恶风者,桂枝加葛根汤主之。”“太阳病,项背强几几,无汗恶风者,葛根汤主之。”《金匮要略》中也有对此病的描述,前者叫“柔痉”,后者称作“刚痉”。

桂枝汤加上葛根就叫桂枝加葛根汤,如果再加上麻黄就是葛根汤,这两个方子都是用于感受风寒引起的项背拘急不舒、疼痛。

项,是后脖子,头与后脖子、背部、甚至腰部连在一起痛,在现今的许多病中都能见到,如颈椎病、肩周炎、颈肩综合症、腰椎病、落枕、痉挛性斜颈、僵人综合症等,桂枝加葛根汤、葛根汤都是常用方剂。

一剧团男演员,盛夏外出演出,汗出触冒山间风寒,晨起项背拘急疼痛,脖子歪向左侧如落枕状,恰逢我在当地有学术交流活动,患者前来就诊。平素该病人容易出汗,一活动或吃饭时汗出较多,经常感冒。这种情况属于风寒侵袭太阳经脉,营卫不和,经脉拘急,属于柔痉。我予桂枝加葛根汤加片姜黄、僵蚕,后来病人电话告知,上方服一周而愈。

有汗无汗是两方应用的区别

葛根汤由七味药物组成:葛根、麻黄、桂枝、芍药、生姜、大枣、炙甘草,后五味是桂枝汤,所以葛根汤等于是桂枝汤加上葛根、麻黄。前面我们已说过,桂枝汤是调理太阳经营卫之气的,能够调畅太阳经脉的气血运行。葛根是这个方子里的主要药物,用量也最大,它的主要作用有三:

一是能发散太阳经的风寒之邪,邪气去则经脉自安;二是具有显著的缓急解痉作用,尤其能够缓解太阳经脉的拘急状态,是治疗背痛、头项痛、肩周痛的良药;三是具有养阴生津的作用,使太阳经脉更加柔顺、疏通。至于麻黄,在本方中主要是散寒止痛,对于无汗的筋脉拘急比较适用。如果项背痛有明显出汗的症状,则宜去掉麻黄,成为《伤寒论》的另外一个方子——桂枝加葛根汤。所以葛根汤与桂枝加葛根汤治疗的主证相同,只是无汗和有汗的区别,两个方子的区别在于伴有汗出的用桂枝加葛根汤,不出汗的用葛根汤。

葛根汤是缓解无汗拘急良方

葛根汤有良好的缓急解痉作用,对于无汗筋脉拘挛病症,葛根汤当为首选使用。一壮年男子,感冒后遗留口噤难以张开,医院诊断为下颌关节炎,建议手术治疗,病人家属不同意,改请中医治疗。病人家属诉其感冒半月,发热已退,但遗留脸部发紧,张不开嘴,吃饭时因难以张大口,必须把馒头掐成小块用手指送入口中,否则下巴连及脸颊疼痛。背部也发紧不舒。问到出汗的情况,病人诉平常不易出汗。此属刚痉范围,虽然没有病在项背,但发病的机理一样,都是病在筋脉拘急,因此开葛根汤治疗。原方没有加减,葛根用到45 克,生麻黄用10 克,服5 剂,周身微微汗出而愈。

可以看出,葛根汤的缓急解痉作用特别好,现在的颈椎病、颈肩综合症引起的背痛、头痛、头晕、手麻病症;肩周炎引起的肩背痛、上臂不能屈伸旋转的病症;风寒引起的头痛、面部肌肉痉挛、口噤不开;甚至是气管痉挛导致的咳嗽、气喘,喉头痉挛导致的失音,眼部肌肉痉挛导致的眨眼不止或眼皮跳动不止等,葛根汤都有很好疗效。曾有一个眼皮跳动的女生,眼皮不自主的跳动了半个月,跳动剧烈时右脸颊的肌肉也随之痉挛,怕风寒,用葛根汤加大葛根用量,4 剂就解决了问题。像一些面神经麻痹的病人,尤其是早期,使用葛根汤治疗确可收立竿见影之效。但对于长期眼部、脸部肌肉跳动的慢性病患者,短期解决不了问题的,注意守方使用,连续服用一段时间。

葛根汤的其他运用

皮癣:2005 年,我曾在瑞士的苏黎世讲过一段学,学员都是瑞士和德国的西医大夫、学者。在讲到葛根汤时,我对他们说:使用这个方子掌握住两个关键点,一个是头项连及背部发紧、发硬,或拘急疼痛;另外一个就是不爱出汗,或背部有点怕冷。过了一段时间,一次下课休息时,瑞士的一个学员走上讲台告诉我,她用葛根汤治好一个多年的皮癣病,一边说一边还竖起大拇指直夸张仲景的方子好。

事情是这样的,这个学员有自己的诊所,一个皮癣患者经常到她这里就诊,但治疗效果不理想。一次就诊时,这个患者无意中说他的背部经常的发紧,发紧时脖子也转动不利,该学员立即想到了葛根汤的主证,就问病人是否爱出汗,病人述说特别不爱出汗,并感觉出汗后项背紧就会舒服些。于是她就开了葛根汤以调治病人的这些症状,可没想到一周后病人再复诊时,告诉她随着项背紧的症状逐渐好转,皮癣也痊愈了很多,大赞大夫的医术高明,终于治好了他的病。后来接着吃下去,皮癣竟得痊愈。谈话间,见该学员眉色飞舞,为能治愈一顽疾而显得异常高兴。但接下来问我,葛根汤为什么能治愈皮癣,因为张仲景在《伤寒论》里并没有记载葛根汤能治皮癣。我告诉她,这正是抓主证的结果,葛根汤证的主证就是项背发紧、不爱出汗,发病的原因是太阳经里有风寒之邪,因为太阳经走头项、后背到腰部,所以风寒邪气不去,就会在其经脉运行的一些地方出现发紧、发硬或疼痛。因为太阳经主表,我们说就像人的篱笆门一样,所以,当太阳经内有邪气,使气血运行不利的时候,也会导致一些皮表疾病的发生,皮癣、皮疹、过敏性疾病等都可见到,所以中医治疗皮肤病,很多情况下都需要用发汗解表的药方。此皮癣病人见到葛根汤证的主证,说明他所患的皮癣属于风寒郁闭太阳经所致,你用了葛根汤,把太阳经的邪气赶走了,当然皮癣也会随之而愈。所以,我们要知道,风寒在太阳经导致的疾病会很多,张仲景不可能都一一写上,只能把最主要的、最具代表性的、最能反映主要病机的症状写出来,供后人使用时参考。

鼻炎、鼻窦炎:鼻炎、鼻窦炎属于风寒型的。见喷嚏不止,流清涕,鼻塞不闻香臭者,可加上川芎、苍耳子等。

肠胃型感冒:有些人一感冒就腹泻,叫做肠胃型感冒,中医认为这是由于素体肠胃功能低下,感冒时人体的气血特别是肠胃气血趋于表以抗邪,其内就相对不足,肠胃功能呆滞,使得风寒之邪得以直犯肠胃,这时用葛根汤就最好。因为葛根汤不但能发散风寒,而且葛根还可以升脾胃的阳气而止泻。这种通过解表散邪而达到止泻目的的方法,明代喻嘉言称为“逆流挽舟”法。一男子,一患感冒即发腹泻,所下清稀带有泡沫,恶寒发热无汗,腹泻后感冒不减,用葛根汤原方三剂而愈。后再感冒腹泻未发。其实,之所以发生肠胃型感冒,从《伤寒论》的观点来看,是由于表实无汗造成的,也算是人体自我排邪的表现。因为风寒束于皮表,汗孔不能打开以排汗,那么邪气就会随着津液从肠胃而出,造成腹泻的发生。既然邪气由表陷里,就让它还从里达表,由表而去,用葛根汤发散邪气,逆其腹泻之“流”而挽表邪之“舟”,称为“逆流挽舟”。

颈肩综合征:葛根汤临床主要用于以项背疼痛为主的疾病的治疗,结合我们目前的这类多发病,简单谈谈颈肩综合征。

颈肩综合征是以颈椎、胸椎关节失稳及其周围肌肉韧带劳损所造成的颈后、肩背部疼痛不适甚至颈部活动受限等一系列症候群的疾患。颈肩病的发展是一个很漫长的过程,常和身体素质、职业、生活习惯、寒冷有明显关系。生活不规律、长期紧张工作、思想高度集中者,是颈椎病的高发人群,如财务人员、电脑人员、驾驶员、教师、办公室工作人员、缝纫工等等。颈肩病本是中老年人的多发病、常见病,但是随着工作节奏的加快、复杂程度的提高,使颈椎病发病有年轻化的趋势。

颈肩综合征的早期,症状较轻,只是在长时间紧张工作后,有头晕、颈肩部劳累的表现,此时可以不用药物治疗,注意适当的体育活动和放松,情绪乐观,或可做短暂的外部治疗,一般很快便可恢复原有的轻松。若上述症状没被注意,使病变进入中期,就会出现颈肩部肌肉群痉挛、颈部发僵、两上肢酸麻胀痛等症状。此时颈椎多已发生退行性改变,但仍在可逆阶段,认真的治疗可避免退行性病变的进展。如果中期治疗不及时,或放弃中期治疗,使病变进入后期,骨质增生密度增高、椎间盘突出、椎管变狭窄,将使治疗难度增加。因此一旦出现颈肩不适,应早期治疗。

对于颈肩综合征,可用葛根汤加味治疗。处方:葛根30 克,生麻黄6~10 克,桂枝10 克,白芍15~30 克,生姜6 克,大枣6 克,炙甘草6 克,姜黄10 克,羌活10 克,独活10 克。

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    content together. I once again find myself personally spending a significant amount of time both reading and posting comments.
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  128. Howdy! This blog post could not be written much better! Reading through this post reminds me of my previous roommate!
    He continually kept preaching about this. I
    am going to send this article to him. Pretty sure he’ll have a very good read.
    I appreciate you for sharing!

  129. Have you ever considered about adding a little bit more than just your articles?
    I mean, what you say is valuable and all. However imagine if you added some great visuals or video clips to give your posts
    more, “pop”! Your content is excellent but with pics
    and videos, this blog could undeniably be one of the best in its field.
    Awesome blog!

  130. I know this if off topic but I’m looking into starting my own weblog and was curious what all is needed to get setup?

    I’m assuming having a blog like yours would cost a pretty penny?
    I’m not very web smart so I’m not 100% positive. Any suggestions or advice would be greatly
    appreciated. Kudos

  131. Hey! I know this is kind of off topic but I was wondering if you knew
    where I could get a captcha plugin for my comment form?
    I’m using the same blog platform as yours and I’m having trouble finding one?
    Thanks a lot!

  132. We absolutely love your blog and find many of your
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  133. After exploring a handful of the blog posts on your
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