趙獻(xian)可(1573年~1664年)。字養葵(kui),自號醫巫(wu)閭(lv)子,鄞縣(今(jin)浙江寧波)人。善易而(er)精醫;好學淹貫,醫德(de)高(gao)尚,往來民間,能承(cheng)父業,治(zhi)病不(bu)問高(gao)低貴賤,不(bu)計禮酬。著有:《醫貫》、《內(nei)經(jing)鈔(chao)(chao)》、《素問鈔(chao)(chao)》、《經(jing)絡(luo)考》、《正脈論(lun)(lun)》、《二體一例》,以《醫貫》流傳(chuan)廣(guang)而(er)影(ying)響大,系醫論(lun)(lun)著作。
中國明末醫(yi)學家。生卒(zu)年不詳,約活動于16~17世(shi)紀。字(zi)養葵,自號醫(yi)巫閭子(zi)。鄞縣(今浙江寧波)人(ren)(ren)。趙獻(xian)可好(hao)學博(bo)覽,除醫(yi)之外(wai),儒、道、釋均有涉獵(lie),曾(ceng)游歷于山(shan)西、陜西等地。在(zai)哲學思想上受(shou)《易經》影響較(jiao)大,在(zai)醫(yi)學上又遵從李東垣、薛己(ji),屬于溫補學派。趙獻(xian)可提出命門為人(ren)(ren)一身之主,而不是心,命門的水火即人(ren)(ren)的陰(yin)陽(yang)。
代表著作有《醫(yi)貫》6卷,對后(hou)世(shi)影響很大。此外他還(huan)著有《邯鄲遺稿》,又名(ming)《胎產遺論》,為(wei)婦科專著,另有《內經(jing)鈔》、《素問(wen)注(zhu)》、《經(jing)絡考》、《正(zheng)脈論》、《二本一例》等(deng)書皆失(shi)傳,其子(zi)趙(zhao)貞觀(guan)亦精醫(yi)學,輯有《痘(dou)疹論》一書。
趙(zhao)獻(xian)可認(ren)(ren)為(wei)命(ming)(ming)(ming)門(men)為(wei)人(ren)(ren)(ren)身(shen)之(zhi)大主,強(qiang)調了命(ming)(ming)(ming)門(men)在(zai)人(ren)(ren)(ren)體(ti)(ti)(ti)生(sheng)命(ming)(ming)(ming)活(huo)動(dong)過程(cheng)中的(de)重(zhong)要(yao)作(zuo)用(yong)(yong)(yong)。指(zhi)出人(ren)(ren)(ren)的(de)發(fa)育過程(cheng),先有(you)命(ming)(ming)(ming)門(men),而后生(sheng)成(cheng)五臟(zang)六(liu)腑(fu),命(ming)(ming)(ming)門(men)為(wei)十二(er)臟(zang)腑(fu)之(zhi)根,為(wei)生(sheng)命(ming)(ming)(ming)之(zhi)原。命(ming)(ming)(ming)門(men)在(zai)人(ren)(ren)(ren)體(ti)(ti)(ti)生(sheng)命(ming)(ming)(ming)活(huo)動(dong)過程(cheng)中,起主要(yao)作(zuo)用(yong)(yong)(yong)者(zhe),乃命(ming)(ming)(ming)門(men)內具之(zhi)相火,他(ta)把(ba)相火比喻(yu)人(ren)(ren)(ren)體(ti)(ti)(ti)的(de)命(ming)(ming)(ming)門(men),認(ren)(ren)為(wei)人(ren)(ren)(ren)體(ti)(ti)(ti)五臟(zang)六(liu)腑(fu)之(zhi)所以能發(fa)揮正常作(zuo)用(yong)(yong)(yong),同樣依賴于命(ming)(ming)(ming)門(men)相火的(de)作(zuo)用(yong)(yong)(yong),充分反(fan)映出趙(zhao)氏對命(ming)(ming)(ming)門(men)的(de)重(zhong)視(shi),認(ren)(ren)為(wei)它是(shi)人(ren)(ren)(ren)身(shen)之(zhi)至寶(bao),是(shi)生(sheng)命(ming)(ming)(ming)活(huo)動(dong)之(zhi)源。這(zhe)樣,趙(zhao)氏將(jiang)人(ren)(ren)(ren)體(ti)(ti)(ti)陽氣之(zhi)根從心臟(zang)轉移(yi)至命(ming)(ming)(ming)門(men),使腎(shen)命(ming)(ming)(ming)的(de)生(sheng)理(li)功能作(zuo)用(yong)(yong)(yong)在(zai)人(ren)(ren)(ren)體(ti)(ti)(ti)中顯得尤(you)為(wei)重(zhong)要(yao),使中醫學術理(li)論又有(you)了新(xin)的(de)發(fa)展。
趙氏認為(wei),命門(men)位于(yu)(yu)兩腎之(zhi)(zhi)(zhi)中(zhong)(zhong),內具真(zhen)水(shui)真(zhen)火(huo)(huo),而(er)(er)命門(men)之(zhi)(zhi)(zhi)相火(huo)(huo)又(you)位于(yu)(yu)兩腎水(shui)之(zhi)(zhi)(zhi)間(jian),它們之(zhi)(zhi)(zhi)間(jian)有著非常密切的(de)(de)(de)關(guan)系。火(huo)(huo)之(zhi)(zhi)(zhi)有余(yu)是(shi)(shi)(shi)(shi)由(you)于(yu)(yu)水(shui)虧(kui),陰(yin)(yin)不(bu)制陽(yang),而(er)(er)見相對(dui)火(huo)(huo)旺之(zhi)(zhi)(zhi)象;水(shui)之(zhi)(zhi)(zhi)有余(yu),又(you)是(shi)(shi)(shi)(shi)由(you)于(yu)(yu)火(huo)(huo)虧(kui),陽(yang)虛相對(dui)陰(yin)(yin)盛而(er)(er)見的(de)(de)(de)表現(xian),這是(shi)(shi)(shi)(shi)陰(yin)(yin)陽(yang)對(dui)立觀(guan)所決定(ding)的(de)(de)(de)。真(zhen)水(shui)真(zhen)火(huo)(huo)只(zhi)能慮其(qi)不(bu)足,不(bu)能慮其(qi)有余(yu),因為(wei)命門(men)水(shui)火(huo)(huo)是(shi)(shi)(shi)(shi)人體生命活動能力的(de)(de)(de)根源,是(shi)(shi)(shi)(shi)先(xian)天(tian)之(zhi)(zhi)(zhi)本。所以(yi),只(zhi)能慮其(qi)虛。水(shui)火(huo)(huo)之(zhi)(zhi)(zhi)間(jian),水(shui)為(wei)火(huo)(huo)之(zhi)(zhi)(zhi)根。因此,補火(huo)(huo)當(dang)于(yu)(yu)水(shui)中(zhong)(zhong)求(qiu)火(huo)(huo),既在(zai)(zai)陰(yin)(yin)中(zhong)(zhong)求(qiu)陽(yang),使陰(yin)(yin)生陽(yang)長。對(dui)于(yu)(yu)命門(men)水(shui)火(huo)(huo)的(de)(de)(de)作(zuo)(zuo)用(yong),趙氏更強調火(huo)(huo)的(de)(de)(de)作(zuo)(zuo)用(yong),認為(wei)相火(huo)(huo)在(zai)(zai)人身中(zhong)(zhong)是(shi)(shi)(shi)(shi)起決定(ding)性作(zuo)(zuo)用(yong)的(de)(de)(de),應當(dang)時刻保護,不(bu)能任(ren)意戕伐。對(dui)于(yu)(yu)命門(men)先(xian)天(tian)水(shui)、火(huo)(huo)不(bu)足的(de)(de)(de)治(zhi)療,不(bu)是(shi)(shi)(shi)(shi)補水(shui),就是(shi)(shi)(shi)(shi)補火(huo)(huo)。趙氏認為(wei),崔氏八味丸與錢乙所制的(de)(de)(de)六(liu)味地黃(huang)丸,是(shi)(shi)(shi)(shi)補真(zhen)火(huo)(huo)、真(zhen)水(shui)的(de)(de)(de)主方。
趙氏(shi)(shi)創立(li)命門理論(lun),闡(chan)發腎(shen)命水(shui)(shui)火(huo)(huo)(huo)的(de)關系,并將其(qi)廣(guang)泛應用(yong)(yong)于(yu)(yu)臨證(zheng)(zheng)。如痰證(zheng)(zheng)、血(xue)(xue)證(zheng)(zheng)、咳嗽、吐血(xue)(xue)、喘證(zheng)(zheng)、喉(hou)咽痛、眼目病(bing)、齒病(bing)、口(kou)瘡、耳病(bing)、消(xiao)渴、中(zhong)(zhong)(zhong)滿、噎膈(ge)、瀉痢、大便不(bu)通、小便不(bu)通與失(shi)禁等多種病(bing)證(zheng)(zheng),不(bu)僅從其(qi)一般辨證(zheng)(zheng)規律進(jin)行施治,而(er)(er)且(qie)均注意到(dao)從腎(shen)命水(shui)(shui)火(huo)(huo)(huo)虧虛(xu)方面進(jin)行分析,廣(guang)泛使(shi)用(yong)(yong)六(liu)味(wei)、八味(wei)諸方,為治療以(yi)上疾病(bing)提供(gong)了有益經驗。如其(qi)辨治血(xue)(xue)證(zheng)(zheng),趙氏(shi)(shi)提出,血(xue)(xue)不(bu)僅有其(qi)本身為血(xue)(xue)的(de)特點,而(er)(er)且(qie)屬水(shui)(shui),故而(er)(er)腎(shen)中(zhong)(zhong)(zhong)真水(shui)(shui)干(gan)涸,則(ze)(ze)真火(huo)(huo)(huo)勢必上炎(yan),血(xue)(xue)亦(yi)隨火(huo)(huo)(huo)而(er)(er)上騰;反之(zhi),若腎(shen)中(zhong)(zhong)(zhong)真火(huo)(huo)(huo)衰(shuai)竭,則(ze)(ze)真水(shui)(shui)反盛,血(xue)(xue)亦(yi)失(shi)所依附而(er)(er)上泛,這是血(xue)(xue)證(zheng)(zheng)產生的(de)兩種病(bing)機(ji)。因此,在治療時,由(you)于(yu)(yu)陽虛(xu)而(er)(er)動血(xue)(xue)上泛者(zhe)(zhe),用(yong)(yong)桂(gui)、附加于(yu)(yu)八味(wei)丸(wan)之(zhi)中(zhong)(zhong)(zhong),使(shi)腎(shen)中(zhong)(zhong)(zhong)溫暖(nuan),龍雷之(zhi)火(huo)(huo)(huo)潛歸于(yu)(yu)原宅,不(bu)用(yong)(yong)寒涼(liang)而(er)(er)火(huo)(huo)(huo)自(zi)降,不(bu)必止血(xue)(xue)而(er)(er)血(xue)(xue)亦(yi)自(zi)安(an)。若因腎(shen)中(zhong)(zhong)(zhong)水(shui)(shui)涸而(er)(er)火(huo)(huo)(huo)炎(yan)者(zhe)(zhe),就可用(yong)(yong)六(liu)味(wei)丸(wan)以(yi)補水(shui)(shui)配(pei)火(huo)(huo)(huo),不(bu)必去火(huo)(huo)(huo),而(er)(er)血(xue)(xue)亦(yi)安(an)。
認為(wei)痰(tan)本(ben)非人身(shen)所固有(you)(you),或是水(shui)泛(fan)為(wei)痰(tan),或是火煉為(wei)痰(tan)。因(yin)此,辨(bian)痰(tan)證,當(dang)分辨(bian)有(you)(you)火無(wu)火,由于(yu)火衰不(bu)能制(zhi)水(shui),水(shui)不(bu)歸(gui)原,泛(fan)溢(yi)為(wei)痰(tan),痰(tan)如清水(shui)者(zhe),趙(zhao)氏(shi)主(zhu)張(zhang)用八(ba)味丸(wan)以補命(ming)火,火壯水(shui)化則(ze)痰(tan)自消(xiao)。由于(yu)陰虛火動(dong),水(shui)液沸(fei)騰(teng)而(er)(er)動(dong)于(yu)腎(shen),驟(zou)而(er)(er)成痰(tan)者(zhe),其(qi)(qi)(qi)痰(tan)重(zhong)濁(zhuo)白(bai)沫,則(ze)應當(dang)選用六(liu)味丸(wan)以滋水(shui)配(pei)火,火靜則(ze)痰(tan)自消(xiao)。脾為(wei)生痰(tan)之(zhi)(zhi)(zhi)源,趙(zhao)氏(shi)治痰(tan),雖亦(yi)接(jie)受用四(si)君(jun)子湯(tang)或六(liu)君(jun)子湯(tang)之(zhi)(zhi)(zhi)類補脾燥濕(shi)化痰(tan)之(zhi)(zhi)(zhi)法,然更重(zhong)視治腎(shen)命(ming)之(zhi)(zhi)(zhi)本(ben)。其(qi)(qi)(qi)論喘(chuan)(chuan)(chuan)證,一般認為(wei)屬氣有(you)(you)余之(zhi)(zhi)(zhi)證,趙(zhao)氏(shi)認為(wei),當(dang)屬火之(zhi)(zhi)(zhi)有(you)(you)余,水(shui)之(zhi)(zhi)(zhi)不(bu)足。因(yin)此治療當(dang)用六(liu)味丸(wan)加麥門(men)(men)冬、五(wu)味子等(deng)(deng),壯水(shui)之(zhi)(zhi)(zhi)主(zhu),使(shi)水(shui)升火降,喘(chuan)(chuan)(chuan)息自定。若有(you)(you)由于(yu)命(ming)門(men)(men)真元之(zhi)(zhi)(zhi)火,不(bu)能歸(gui)其(qi)(qi)(qi)下(xia)元,陰氣在下(xia),陽氣浮(fu)越于(yu)上(shang),亦(yi)可見(jian)呼吸氣促,其(qi)(qi)(qi)證似喘(chuan)(chuan)(chuan)非喘(chuan)(chuan)(chuan),外見(jian)四(si)肢厥逆,面赤(chi)煩躁,脈象(xiang)兩寸浮(fu)大而(er)(er)散,兩尺微而(er)(er)無(wu)力。治療主(zhu)張(zhang)用八(ba)味丸(wan)等(deng)(deng),以人參生脈散煎服(fu)送下(xia)。總之(zhi)(zhi)(zhi),對喘(chuan)(chuan)(chuan)證屬虛者(zhe),從腎(shen)命(ming)水(shui)火治療,亦(yi)可見(jian)其(qi)(qi)(qi)重(zhong)視腎(shen)命(ming)的觀點。
對于郁證的治療
認為“凡(fan)病之(zhi)起,多(duo)由(you)于郁(yu)(yu)(yu)(yu)。郁(yu)(yu)(yu)(yu)者(zhe),抑而(er)不(bu)通之(zhi)義。”趙氏(shi)所論郁(yu)(yu)(yu)(yu)證不(bu)僅(jin)包括各種雜證,還包括一(yi)切(qie)外(wai)(wai)感病。由(you)于多(duo)因(yin)(yin)木(mu)郁(yu)(yu)(yu)(yu)導致(zhi)(zhi)諸郁(yu)(yu)(yu)(yu),故(gu)可“以(yi)一(yi)法(fa)代五法(fa)”。其(qi)治木(mu)郁(yu)(yu)(yu)(yu),使肝膽之(zhi)氣舒展,則諸郁(yu)(yu)(yu)(yu)自解(jie)。逍遙散(san)是(shi)趙氏(shi)治療木(mu)郁(yu)(yu)(yu)(yu)的主劑(ji),并常結合(he)左金丸(wan)(wan)(wan)和六(liu)味地(di)黃丸(wan)(wan)(wan)同用。他認為,“世人(ren)因(yin)(yin)郁(yu)(yu)(yu)(yu)而(er)致(zhi)(zhi)血病者(zhe)多(duo)。凡(fan)郁(yu)(yu)(yu)(yu)皆肝病也,木(mu)中有(you)火,郁(yu)(yu)(yu)(yu)甚則火不(bu)得舒,血不(bu)行藏(zang)而(er)妄行”。這(zhe)種失血,或(huo)(huo)因(yin)(yin)怒郁(yu)(yu)(yu)(yu)、憂郁(yu)(yu)(yu)(yu),或(huo)(huo)因(yin)(yin)陰虛火旺之(zhi)人(ren)外(wai)(wai)感風寒(han)暑濕,皮毛閉塞,火不(bu)能泄,以(yi)致(zhi)(zhi)血隨(sui)火而(er)妄行,出現鼻衄、吐(tu)血等證。其(qi)辨證要點是(shi):“凡(fan)系(xi)郁(yu)(yu)(yu)(yu)者(zhe),其(qi)脈必澀,其(qi)人(ren)必惡風惡寒(han)……須視(shi)其(qi)面色必滯,必喜嘔,或(huo)(huo)口苦,或(huo)(huo)口酸”。審有(you)如是(shi)證,則當(dang)舒散(san)其(qi)郁(yu)(yu)(yu)(yu)為主,即“木(mu)郁(yu)(yu)(yu)(yu)達之(zhi)”、“火郁(yu)(yu)(yu)(yu)發(fa)(fa)之(zhi)”之(zhi)義。其(qi)方用逍遙散(san)加丹皮、茱、連。血止后當(dang)用六(liu)味地(di)黃丸(wan)(wan)(wan)滋陰善后,否則多(duo)復發(fa)(fa)。
趙(zhao)獻可(ke),字養葵,號醫巫閭子。約生(sheng)活(huo)于十六(liu)世(shi)紀后期(qi)與(yu)十七世(shi)紀初期(qi),雖史(shi)料無詳(xiang)細記(ji)載,但據黃(huang)宗羲《張(zhang)(zhang)景岳傳》說:“趙(zhao)養葵,名獻可(ke),寧波人(ren),與(yu)介賓同時,未嘗相見,而(er)議(yi)論往往有合(he)者。”說明趙(zhao)、張(zhang)(zhang)屬(shu)同時期(qi)人(ren),而(er)張(zhang)(zhang)景岳生(sheng)卒年代為(wei)公元1563~1640年,故趙(zhao)氏亦可(ke)能生(sheng)活(huo)年代與(yu)之(zhi)相近,屬(shu)明代一大醫家。籍貫鄞縣,其(qi)一生(sheng)治醫學(xue)(xue),獨重視腎(shen)水命火,對命門學(xue)(xue)說猶有貢獻,是易水學(xue)(xue)派(pai)的學(xue)(xue)術(shu)思想,又由(you)研究后天脾胃(wei)轉向先天腎(shen)命,為(wei)之(zhi)一變。著有《醫貫》一書,充分(fen)反映其(qi)學(xue)(xue)術(shu)思想。