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病人用补中益气汤10剂仍未痊愈,父亲动了二味药,效果立竿见影-
病人用补中益气汤10剂仍未痊愈,父亲动了二味药,效果立竿见影

病人用补中益气汤10剂仍未痊愈,父亲动了二味药,效果立竿见影

1979年5月,余诊治一女性患者。患者述其精神不振,倦怠乏力,肢体软弱,食欲不振,大便溏薄,日2~3次,少腹胀闷不适。舌淡苔白,脉虚弱。

诊为中气不足。立方以补中益气汤加减:党参15克,焦白术15克,升麻6克,柴胡12克,炙黄芪15克,当归15克,陈皮6克,炒山药18克,炒薏仁12克,炙甘草5克。水煎服,每日1剂。

病人用补中益气汤10剂仍未痊愈,父亲动了二味药,效果立竿见影

患者此方连服10剂,病情时有好转,但总不能痊愈。余欲改方另用,即与家父商讨。家父观方刻许,提笔作处方修改:只动二味药剂量,即改升麻2克,柴胡3克,嘱患者连续服用3~5剂。患者服药后,精神大有好转,病情已向痊愈。

余不解,向父请教。父云:补中益气汤为治疗劳倦伤脾,中气下陷而用,有升阳举陷之功,其组方之妙,在于用升麻、柴胡为引。李东垣称“升麻发散阳明风邪,升胃中清气,又引甘温之药上升,以补卫气之散,而实其表,故元气不足者,用此于阴中升阳。”《本草备要》中云柴胡“味薄气升为阳,主阳气下陷,能引清气上行”。故临床中,许多医家都言:“胃中清气沉,用升麻、柴胡,气之轻而味厚者,引胃气以上腾,复其平位,使能升浮以行生长之气矣。补中之剂,得发表之品而中自安。益气之剂,赖清气之品而气益倍,此用药有相须之妙也。”家父进一步指出,原方升柴只用二或三分,其药量之少,意在取轻薄之性,举下陷之清气,以归脾胃。升柴若用二三钱,能去散肌表。若少用二三分,能升提下陷。补中益气汤升柴少量,可提元气,升达参芪以补中气。故本案减柴胡、升麻用量,而能升举阳气,是为引经之妙用也,重用柴胡、升麻,则反无功矣。

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