伍炳彩应用当归芍药散的诀窍,非常宝贵的经验

伍炳彩应用当归芍药散的诀窍,非常宝贵的经验

伍炳彩男, 1940年生, 江西省吉安县人。毕业于江西中医学院, 毕业后一直留校任教。师承江西中医学院已故名誉院长姚荷生教授,从事金匮、中医内科教学与临床工作。现任江西中医学院金匮教研室主任, 教授、主任中医师、硕士研究生导师, 享受国务院特殊津贴。是第三批全国老中医药专家学术经验继承工作指导老师。现任江西省保健委员会专家组成员、江西省新药评审委员、南昌市医学会医疗事故技术鉴定专家组成员、江西中医学院中医临床基础学科负责人等。临床力倡辨证论治, 擅长中医内科杂病, 对气管炎、哮喘、心率失常、肝炎、胆囊炎、胃病、神经官能症、肾炎及疑难发热等有较好的疗效。主要著作有《解表法在肾炎中的运用》、《心律失常治法探讨》等30余篇。

当归芍药散两次见于《金匮要略》, 一见于《妇人妊娠病篇》, 一见于《妇人杂病篇》。本方由当归、芍药、川芎、泽泻、茯苓、白术组成, 具有调和肝脾、活血利湿之效。本方是肝脾同治, 但以治肝为主;亦为气血同治, 但以治血为主。关于本方的应用, 近年来报道很多, 譬如用于治疗月经不调、痛经、不孕、妊娠腹痛、先兆流产、习惯性流产、胎位不正、妊娠中毒症、子宫异常出血、妊娠水肿、产后小便难、闭经、子宫炎、附件炎、卵巢囊肿、子宫肌瘤、更年期综合征等妇科疾病, 还可用于治疗慢性胃炎、胆囊炎、慢性肝炎、泌尿系结石并感染、肠梗阻、痛风、心衰水肿、肾病水肿、脑外伤后综合症(眩晕)、梅尼埃病、脑血栓形成、舞蹈症、冠心病心绞痛、坐骨神经痛、神经炎、过敏性鼻炎、慢性荨麻疹等诸多疾病, 这大大扩大了本方的应用范围。《药鉴》谓:“病无常形, 医无常方, 药无常品, 惟在人之善学善用耳。”如何灵活地运用本方, 伍炳彩教授认为要从以下几个方面入手:

一、据原文提示用于先兆流产、痛经

《金匮要略·妇人妊娠病脉证并治》谓:“妇人怀妊, 腹中痛, 当归芍药散主之。”《妇人杂脉证并治》谓:“妇人腹中诸疾痛, 当归芍药散主之。”这两条原文虽很简单, 但一为妊娠“腹中疠痛” , 一为杂病“ 腹中诸疾痛” , 可见其着眼于“痛”字, 且痛的部位都在腹中。引起痛的原因虽很复杂, 但其总的病机, 不外虚实二端或虚实夹杂。盖实则经脉不通, 血行不畅, 即所谓“不通则痛” ;虚则脉道不充, 筋脉失养而痛;虚实夹杂则通而不畅, 养而不荣, 经脉失润而痛。所以前人有“气血以流通为贵” , 即是指痛证而言。本方重用芍药敛肝、和营、止痛, 又佐以当归、川芎以调肝和血, 更配以茯苓、白术、泽泻健脾渗湿。综观全方, 有养血疏肝、健脾利湿之力, 是寓通于补之方。凡是肝郁血虚、脾虚湿困, 以致肝脾不和、气血失调而发生的腹部疼痛, 均可以此方加减治疗。据原文, 本方常用于治疗先兆流产, 除此之外, 还可用于治疗痛经等妇科疾病。

1 .治疗妊娠腹痛

罗某, 女, 25岁, 1993年5月10日初诊。患者妊娠已2月, 近日工作繁忙, 遂出现腹部隐痛不适。证见腹部隐隐作痛, 休息稍舒, 腰酸,腹部有下坠感, 口不渴, 纳可, 食后不胀, 大便适中, 小便稍黄, 苔白, 脉弦滑。其症状正符合“妇人怀妊, 腹中疠痛”之经文, 以当归芍药散加味:当归10g , 白芍15g , 川芎3g , 云茯苓10g , 泽泻10g , 白术10g , 杜仲10g , 桑寄生10g , 黄芪15g ,党参15g 。三剂, 水煎服。

1993年5月13日二诊。药后腹部隐痛停止, 腰酸亦减, 腹部下坠感减轻, 嘱用上方再服伍剂。药后诸症消失, 足月生一男孩。

2 .治疗妊娠下血

兰某, 女, 34岁, 1972年2月初诊。患者停经60余天, 阴道出血一周, 出血量少, 色暗红,淋漓不绝, 无血块, 伴有腰胀, 少腹胀痛, 胃纳尚佳, 无呕吐泛酸, 口不干略苦, 二便正常。近半月来情绪不佳。经用黄体酮等止血之剂, 血量稍少, 但仍有阴道出血。脉弦, 舌质淡红, 苔薄白。妊娠试验阳性。此为肝脾不和, 湿滞内停。以当归芍药散加味:当归10g , 白芍15g , 川芎5g , 云茯苓10g , 泽泻10g , 白术10g , 阿胶9g , 桑寄生15g , 杜仲10g , 苎麻根10g 。共服10剂, 血止, 随诊, 足月顺产一男婴。

按:本方可用于胎动不安, 但目前临床医生多惧而不用, 常用寿胎丸。据日本中田敬吾的研究, 其对妊娠期服用本方的40例中有回音的27例孕妇及儿童进行了随访调查, 结果:27例中未发现因服本方剂对母子健康有不良影响者, 此外, 在产后母体恢复和小儿发育方面未见到任何有害作用的迹象。现代医学认为, 在受精卵分裂旺盛的妊娠初期服药, 畸形发生率高;从本方的使用来观察, 在胚胎尚未形成以前给药, 改善母体内环境, 使受精卵形成胚胎的发育过程获得良好影响, 未见有致畸性, 而且对儿童的健康起着积极的作用。伍炳彩教授每年均可遇类似病例, 用当归芍药散加味大多数均获满意疗效, 足见经方疗效之可靠。

3 .治疗痛经

陈某, 女, 30岁, 患痛经已半年, 曾用逍遥散、丹栀逍遥散加味治疗无效, 乃来诊。诊时面色萎黄, 纳佳, 经期尚对期, 行经时少腹隐痛便溏, 月经量少, 色暗红, 质较稀, 口稍黏, 苔白微厚, 舌正, 脉弦细。证属肝血不足, 脾虚有湿。拟当归芍药散加味:当归10g , 白芍15g , 川芎6g , 云茯苓10g , 泽泻10g , 白术10g , 乌药10g ,玄胡索10g , 川楝子6g 。三剂水煎服。药后腹痛止, 嘱下月行经时再用3剂以巩固疗效。

二、据肝经循行用于治疗胁腹疼痛

当归芍药散是肝脾两调之方, 而肝脾两调之中, 又以治肝为主, 因此可治肝脾不和, 以肝经为主的病变。附件炎、阑尾炎、慢性肝炎等疾病在临床上常见胁腹疼痛, 此属肝经循行部位,故可考虑用本方治疗。

1 .治疗附件炎

李某, 女, 35岁, 2002 年1月20日初诊。诉少腹胀痛, 腰骶部酸痛已半年余, 近月来感少腹胀痛加剧, 伴带下量多白稀, 经妇科检查, 诊为慢性附件炎。舌淡, 苔薄白, 脉弦。证属肝脾不和, 湿邪内停之少腹痛, 治以调肝和脾化湿,用当归芍药散加味:当归10g , 白芍15g , 川芎6g ,云茯苓10g , 泽泻10g , 白术10g , 杜仲10g ,桑寄生15g 。服5剂少腹疼痛减轻, 白带减少,连服20剂, 少腹痛除, 白带大减。

2 .治疗阑尾炎

李某, 女, 20岁, 1983年10月1日初诊。患者自觉右侧少腹隐痛不适已3日, 过去亦有类似发作史, 此次发作较剧, 至某西医院就诊,诊断为慢性阑尾炎, 建议手术治疗, 因患者害怕开刀, 乃求治于余。就诊时除右下腹持续性隐痛外, 按之不适, 纳可, 口黏, 大便偏软, 小便黄,脉弦。辨为肝脾不和, 湿邪内停, 用当归芍药散加败酱草15g , 红藤20g , 服5剂疼痛完全停止。以后曾多次碰到其父, 云多年未发。

3 .治疗慢性肝炎

黄某, 男, 32岁, 患慢性乙型肝炎多年, 经常右胁隐痛不适, 休息不好时加剧, 纳佳, 食后不胀, 口稍黏, 精神尚可, 大黄偏稀, 苔白略厚,舌质红, 脉细弦。拟当归芍药散加味:当归10g , 白芍15g , 川芎6g , 云茯苓10g , 泽泻10g ,白术10g , 姜黄10g 。服7剂后, 患者曾来诊数次, 因效果明显, 效不更方, 服35剂疼痛止, 口黏除, 苔厚转薄白, 脉稍弦, 嘱用逍遥丸继续调理。

此外还可用此方加减治疗慢性结肠炎具有少腹疼痛脉弦者、慢性前列腺炎亦有效。结石疼痛发作向输尿管放射者, 用本方亦效佳。

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