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张锡纯:蜈蚣经验之一,“定风丹”,附蜈蚣治斜视、顽固咳嗽经验-
张锡纯:蜈蚣经验之一,“定风丹”,附蜈蚣治斜视、顽固咳嗽经验

张锡纯:蜈蚣经验之一,“定风丹”,附蜈蚣治斜视、顽固咳嗽经验

 

蜈蚣味辛微咸,性微温,气微腥,入肝经,具熄风止痉之功,临床多用于治疗中风半身不遂和口眼歪斜、痉挛抽搐、手足麻木、癫痫、惊风等肝风内动证。张锡纯非常善于运用蜈蚣,不仅用本品熄风止痉,更侧重发挥其搜逐外风、开瘀散结、通络除痹、止痛镇痛、解毒疗疮等作用。

临证效用发挥

张锡纯:蜈蚣经验之一,“定风丹”,附蜈蚣治斜视、顽固咳嗽经验

1.“内治肝风萌动”用于眼神经病变、百日咳

蜈蚣擅长熄风止痉,多用于治疗类中风、小儿急慢惊风、癫痫等肝风内动疾病。无论虚证还是实证,张锡纯都主张应用蜈蚣,认为“其性尤善搜风,内治肝风萌动,癫痫眩晕,抽掣瘛疭,小儿脐风”。

张锡纯治疗小儿慢惊风和急惊风创制【定风丹】,组成:

生明乳香3钱、生明没药3钱、朱砂1钱、全蜈蚣大者1条、全蝎1钱。

上药共为细末,每小儿哺乳时,用药分许,置其口中,乳汁送下,每日约服药5次。

  • 气虚者,可配伍生黄芪、当归、党参;
  • 脾虚者可配伍生山药、生白术、鸡内金;
  • 肝肾亏虚者可配伍熟地黄、山茱萸、枸杞子、酸枣仁;
  • 脾肾阳虚者,可配伍丁香、肉桂、川椒、补骨脂、干姜、炮附子;
  • 肝胆火盛者可配伍羚羊角、钩藤、薄荷、柴胡、龙胆草、青黛;
  • 阳明火热盛者,可配伍生石膏;
  • 痰盛者可配伍清半夏、胆南星、僵蚕、茯神、代赭石、铁锈水。

张锡纯认为“此方以治小儿绵风或惊风,大抵皆效。而能因证制宜,再煮汤剂以送服此丹,则尤效。宗弟相臣,青县之名医也。喜用此丹以治小儿惊风。又恒随证之凉热虚实,作汤剂以送服此丹。其所用之汤药方,颇有可采”。

张锡纯:蜈蚣经验之一,“定风丹”,附蜈蚣治斜视、顽固咳嗽经验

根据张锡纯蜈蚣“内治肝风萌动”说,笔者父亲张运增老中医将蜈蚣用于眼神经病变取得良好效果。例如:

某女,12岁,于数月前无明显诱因(排除外伤史),双目出现复视现象,且视物时眼球左斜,而头部不自主右倾。曾往省市多家医院就诊(诊断为复视、神经性斜视,排除眼底及脑部病变),多方治疗无效。

患儿就诊时舌质黯红、边尖有瘀点、苔薄白,脉沉弦。

诊为肝郁气滞血瘀、筋脉失荣生风,予血府逐瘀汤加减:

当归10g、川芎6g、桃仁10g、红花6g、柴胡10g、赤芍10g、牛膝15g、葛根15g、菊花10g。

患儿服药50余剂后斜视减轻,头稍正,复视好转。

思蜈蚣善熄内风,故上方改为:

当归10g、桃仁10g、红花8g、大蜈蚣1条、百合10g、桑叶12g、菊花12g、白蒺藜15g、钩藤12g、谷精草15g、枸杞子15g。

续服12剂后基本痊愈。上方蜈蚣改为2条,10剂后复视和斜视均消失,视物完全正常。

根据张锡纯蜈蚣“内治肝风萌动”说和古代医家用本品治疗小儿百日咳的经验,笔者临证将蜈蚣移治各种顽固性咳嗽亦取良好效果。无论是感冒失治或误治、外邪伏肺,或是饮食不节、脾失运化、痰饮阻肺,还是肝气郁结或肝郁化火犯肺,最终都会导致肺系经络筋脉痉挛拘急。

但医生往往多着眼于解表散寒、健脾化痰、疏肝解郁、清肝泻火、镇咳止咳,而忽视熄风止痉。蜈蚣擅长熄风止痉,不但擅长熄肝风内动,也擅长熄肺风内动,因此可以用于治疗顽固性咳嗽。

张锡纯:蜈蚣经验之一,“定风丹”,附蜈蚣治斜视、顽固咳嗽经验

笔者临床治疗顽固性咳嗽,在辨证论治的基础上多选用蜈蚣、僵蚕、蝉蜕、地龙、全蝎、水蛭、土鳖虫、钩藤、夜交藤、海风藤、络石藤、石楠藤、威灵仙、桑枝、丝瓜络、伸筋草等药物配伍使用,取得较好疗效。

下期:张锡纯:蜈蚣经验之二,“逐风汤”,附吞服蜈蚣等治疗经验

冯瑞雪,张紫微,张再康

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