聊聊张锡纯医案

聊聊张锡纯医案

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174 Episodes
著名中医诊断学博士罗大伦,从中药材的角度出发,用轻松的话语,带您细细研读民国著名中医张锡纯的代表著作《医学衷中参西录》里的经典医案。
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Episodes
174 Episodes

张锡纯(1860~1933)中国医学家。中西汇通派代表人物之一。字寿甫。河北盐山人。出身于书香之家,自幼读经书,习举子业,两次乡试未中,遵父命改学医学,上自《黄帝内经》、《伤寒论》,下至历代各家之说,无不披览。同时读了西医的一些著作。1911年曾应德州驻军统领之邀,任军医正,以后任过立达医院院长、直鲁联军军医处处长等职,1893年第二次参加秋试再次落弟后,张锡纯开始接触西医及其他西学。1904年,中国废科举,兴学校,张锡纯成为盐山县唯一可教代数和几何学的教员。此时张氏开始接触西医及其它西学。受时代思潮的影响,张氏萌发了衷中参西的思想,遂潜心于医学。1900年前后十余年的读书、应诊过程,使他的学术思想趋于成熟。1909年,完成《医学衷中参西录》前三期初稿,此时他年近50,医名渐著于国内。1912年,德州驻军统领聘张氏为军医正,从此他开始了专业行医的生涯。1916年,奉天设近代中国第一家中医院——立达医院,聘张氏为院长。1928年定居天津,创办国医函授学校。由于他有高明的医术和特殊的地位,医名显赫。 张锡纯治学虽多创论,然措词婉转,鲜直斥前人之非,与同道多友善,不好贬人贵己,不好大言傲人。中西医论争势若冰炭时,仍本其夙志,撰文论...

医案:友人毛仙阁之哲嗣印棠,年二十余。于孟冬得伤寒证,调治十余日,表里皆解。忽遍身发热,顿饭顷,汗出淋漓热顿解,须臾球又热又汗,若是两昼夜,势近垂危。仓猝迎愚诊治,及至见汗出,浑身如洗,目上窜不露黑睛,左脉微细模糊,按之即无,此肝胆虚极,而元气欲脱也。盖肝胆虚者,其病象为寒热往来,此证之忽热忽汗,亦即寒热往来之意。急用净萸肉二两煎服,热与汗均愈其半,遂为疏方用净萸肉二两,生龙骨、生牡蛎各一两,生杭芍六钱,野台参四钱,炙甘草二钱(此方载三期一卷,名来复汤),连服两剂病若失。

医案:邻村李子勋,年五旬,偶相值,求为诊脉,言前月有病服药已愈,近觉身体清爽,未知脉象何如。诊之,其脉尺部无根,寸部摇摇有将脱之势,因其自谓病愈,若遽悚以危语,彼必不信,姑以脉象平和答之。遂秘谓其侄曰:“令叔之脉甚危险,当服补敛之药,以防元气之暴脱。”其侄向彼述之,果不相信。后二日,忽遣人迎愚,言其骤然眩晕不起,求为诊治。既至见其周身颤动,头上汗出,言语错乱,自言心怔忡不能支持,其脉上盛下虚之象较前益甚,急投以净萸肉两半,生龙骨、生牡蛎、野台参、生赭石各五钱,一剂即愈。继将萸肉改用一两,加生山药八钱,连服数剂,脉亦复常。按:此方赭石之分量,宜稍重于台参。

医案(1): 邻村黄龙井庄周某,年三十许。当大怒之后,渐觉腿疼,日甚一日,两月之后,卧床不能转侧。医者因其得之恼怒之余,皆用舒肝理气之药,病转加剧。诊其脉左部微弱异常,自言凡疼甚之处皆热。——恍悟《内经》谓“过怒则伤肝”,所谓伤肝者,乃伤肝经之气血,非必郁肝经之气血也。气血伤则虚弱随之,故其脉象如是也。其所以腿疼且觉热者,因肝主疏泄,中藏相火,肝虚不能疏泄,相火即不能逍遥流行于周身,以致郁于经络之间,与气血凝滞而作热作疼,所以热剧之处疼亦剧也。投以净萸肉一两,知母六钱,当归、丹参、乳香、没药各三钱(方载三期四卷名曲直汤)。连服十剂,热消疼止,步履如常。 医案(2):一媪,年近七旬。陡然腿疼,不能行动,夜间疼不能寐。其家人迎愚调治,谓脉象有力,当是火郁作疼。及诊其脉,大而且弦,问其心中亦无热意。愚曰:此脉非有火之象,其大也,乃脾胃过虚,真气外泄也。其弦也,乃肝胆失和,木盛侮土也。治以振中汤,加人参、白芍、山萸肉(去净核)各数钱,补脾胃之虚,即以抑肝胆之盛,数剂而愈。

医案:沧州友人张寿田,曾治一少年,素患心疼,发时昼夜号呼。医者屡用药开通,致大便滑泻,虚气连连下泄,汗出如洗,目睛上泛,心神惊悸,周身眴动,须人手按而心疼如故。延医数人,皆不敢疏方。寿田投以前方,将萸肉倍作二两,连进两剂,诸病皆愈,心疼竟从此除根。

医案(1):曾治沧州路家庄马氏少妇,咳血三年,百药不效,即有愈时,旋复如故。后愚为诊视,其夜间多汗。遂用净萸肉、生龙骨、生牡蛎各一两,俾煎服,拟先止其汗,果一剂汗止;又服一剂,咳血亦愈。按:从前之咳血久不愈者,因其肺中之络或胃中血管有破裂处,萸肉与龙骨、牡蛎同用,以涩之、敛之,故咳血亦随之愈也。 医案(2):又治本村表弟张权,年三十许,或旬日,或浃辰之间,必吐血数口,浸至每日必吐,亦屡治无效。其脉近和平,微有芤象。亦治以此方,三剂痊愈。后又将此方加三七细末三钱,煎药汤送服,以治咳血吐血之久不愈者,约皆随手奏效。因将其方登于三期二卷,名“补络补管汤”,若遇吐血之甚者,宜再加赭石五六钱,与前三味同煎汤,送服三七细末更效。

医案:奉天大东关于氏女,年近三旬,出嫁而孀,依于娘门。其人善英文,英商在奉者,延以教其眷属。因病还家,夜中忽不能言,并不能息。其同院住者王子岗系愚门生,急来院叩门求为挽救。因向曾为诊脉,方知其气分甚弱,故此次直断为胸中大气下陷,不能司肺脏呼吸,是以气息将停而言不能出也。急为疏方,用生箭芪30克,当归12克,升麻6克,煎服,须臾即能言语。翌晨,舁至院中,诊其脉沉迟微弱,其呼吸仍觉气短,遂用原方减升麻3克,又加山药、知母各9克,柴胡、桔梗各4.5克,连服数剂痊愈。

医案:一人,年二十。卧病两月不愈,精神昏聩,肢体酸懒,也不知有所苦。屡次延医诊视,莫审病情,用药也无效。一日忽然不能喘息,张口呼吸外出,而气不能上达,其气蓄极之时,肛门突出,约二十呼吸之顷,气息方通。一昼夜之间,如此者8、9次。诊其脉,关前微弱不起,知其大气下陷,不能司其肺脏呼吸之枢机也。遂投以人参一两,柴胡三钱,知母二钱,一剂而呼吸顺。又将柴胡改用二钱,知母改用四钱,再服数剂,宿病亦愈。 (人参、黄耆皆补气兼能升气,然人参补气之力胜于黄耆,黄耆升气之力胜于人参。故大气陷而气分之根柢犹未伤者当用黄耆,大气陷而气分根柢兼伤损者当用人参。此证因卧病数月而气分亏损太甚,故以人参代黄耆。)

医案:一人,年二十四。胸中满闷,昼夜咳嗽,其咳嗽时,胁下疼甚。诊其脉象和平,重按微弦无力。因其胁疼,又兼胸满,疑其气分不舒,少投以理气之药。为其脉稍弱,又以黄 佐之,而咳嗽与满闷益甚,又兼言语声颤动。乃细问病因,知其素勤稼穑,因感冒懒食,犹枵腹力作,以致如此。据此病因,且又服理气之药不受,其为大气下陷无疑。遂投以升陷汤,四剂,其病脱然。 按:此证之形状,似甚难辨,因初次未细诘问,致用药少有差错,犹幸迷途未远,即能醒悟,而病亦旋愈。由斯观之,临证者,甚勿自矜明察,而不屑琐琐细问也。

医案:一人,年四十许。失音半载,渐觉咽喉发紧,且常溃烂,畏风恶寒,冬日所着衣服,至孟夏犹未换。饮食减少,浸成虚劳。多方治疗,病转增剧。诊其脉,两寸微弱,毫无轩起之象,知其胸中大气下陷也。投以升陷汤,加玄参四钱,两剂咽喉即不发紧。遂减去升麻,又连服十余剂,诸病皆愈。

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