从六对论治谈国医大师吕仁和应用芍药经验(1)
摘要 辨证论治是中医学治疗的特色。吕仁和教授提出的“六对论治”辨证思路，包括对病论治、对病辨证论治、对病分期辨证论治、对症论治、对症辨证论治和对症辨病与辨证论治相结合，为临床辨证提供了完善的思路。芍药为吕仁和教授临床常用中药，以其应用经验为切入点，结合病案系统介绍吕仁和教授“六对论治”学术思想。介绍将四逆散化裁，赤、白芍同用以柔肝养血、活血化瘀，针对肝气郁滞证候;以“三丹汤”中牡丹皮、丹参、赤芍同用，针对肾脏病“微型癥瘕”病机;以赤、白芍大剂量生用通便泻浊对症治疗等临床用药经验。
关键词 白芍;赤芍; @ 吕仁和;六对论治;国医大师;经验传承;中医;辨证论治
Abstract Syndrome differentiation and treatment is the feature of Traditional Chinese Medicine.Professor LYU Renhe puts forward the syndrome method of “six diagnosis and treatment principles” including treatment according to the disease，treatment and differentiation according to the disease，syndrome differentiation according to the disease stage，treatment according to the symptom，syndrome differentiation according to the symptom，as well as combination of syndrome and disease differentiation according to the symptom，providing perfect ideas for clinical syndrome differentiation.Paeoniae Radix is a common Chinese medicine used by Professor LYU Renhe.Taking its application experience as the starting point，the academic thoughts of Professor LYU Renhe′s“six diagnosis and treatment principles”were introduced in conjunction with the medical record system.It mainly introduces the use of Sini Powder.Radix Paeoniae Rubra and Radix Paeoniae Alba are used to soften liver and nourish blood，promote blood circulation and remove blood stasis.Aiming at the syndrome of liver qi stagnation，in“Sandan Decoction”，Danpi，Radix Salviae Miltiorrhizae，and Radix Paeoniae Rubra are used together，aiming at the pathogenesis of kidney disease“minimal symptom”; large doses of Radix Paeoniae Rubra and Radix Paeoniae Alba laxative symptomatic treatment experience in clinics.
Keywords Debark peony root;Peony root; @ LYU Renhe; Six diagnosis and treatment principles; National Chinese medicine master; Experience inheritance; Traditional Chinese medicine; Syndrome differentiation and treatment
中圖分类号：R249.2/.7文献标识码：Bdoi：10.3969/j.issn.1673-7202.2020.21.027
国医大师吕仁和教授临床工作近60年，中西合参，学验俱丰。针对临床时常出现的“传统中医无证可辨”或者“现代西医无药可用”的情况，吕仁和教授在“辨证论治”和“整体观”的基础上，创造性提出“对病论治、对病辨证论治、对病分期辨证论治、对症论治、对症辨证论治、对症辨病与辨证论治相结合”的六对论治辨证思路，提纲挈领，驾简驭繁。吕仁和教授临床遣方用药颇为灵活，强调不仅要用好“方”，更要用好“药”，吕教授尤为擅长应用药对和药串，所谓“调百药齐，和之所宜”。学生在跟师期间发现吕教授处方喜用芍药，赤芍、白芍出现频率较高。本文结合吕仁和教授“六对论治”的辨证思路，试述吕教授临床运用芍药的经验。
1 芍药简介
1.1 历史源流 《神农本草经》[1]列芍药为中品，载：“味苦平，主邪气腹痛，除血痹，破坚积，寒热疝瘕，止痛，利小便，益气”。未区分赤芍和白芍。《伤寒论》常用芍药益阴和营、养血通脉、敛阴止汗、缓急止痛、利水、清热、和血，并分别配合桂枝、当归、黄芪、甘草、茯苓、柴胡、麻黄等使用[2]。陶弘景《本草经集注》[3]始分赤、白芍，后世渐渐认为二者由于加工炮制的不同而同源异效。《中华人民共和国药典》[4]载：“白芍为毛茛科植物芍药的根部，除去外皮置沸水中煮后晒干而成，性微寒，味苦、酸，归肝、脾经，功可平肝止痛，养血调经，敛阴止汗。赤芍为毛茛科植物芍药或川赤芍的根晒干而成，性微寒味苦，归肝经，功可清热凉血，散瘀止痛”。二者一补一泻，一收一散，相反相成，临床常常配伍使用。赤、白芍也常常以药对的形式出现在吕仁和教授的处方中。, http://www.100md.com(石晓琪 王辰光 闫璞 史银春 高梦蕉 陈宗俊 肖永华)
关键词 白芍;赤芍; @ 吕仁和;六对论治;国医大师;经验传承;中医;辨证论治
Abstract Syndrome differentiation and treatment is the feature of Traditional Chinese Medicine.Professor LYU Renhe puts forward the syndrome method of “six diagnosis and treatment principles” including treatment according to the disease，treatment and differentiation according to the disease，syndrome differentiation according to the disease stage，treatment according to the symptom，syndrome differentiation according to the symptom，as well as combination of syndrome and disease differentiation according to the symptom，providing perfect ideas for clinical syndrome differentiation.Paeoniae Radix is a common Chinese medicine used by Professor LYU Renhe.Taking its application experience as the starting point，the academic thoughts of Professor LYU Renhe′s“six diagnosis and treatment principles”were introduced in conjunction with the medical record system.It mainly introduces the use of Sini Powder.Radix Paeoniae Rubra and Radix Paeoniae Alba are used to soften liver and nourish blood，promote blood circulation and remove blood stasis.Aiming at the syndrome of liver qi stagnation，in“Sandan Decoction”，Danpi，Radix Salviae Miltiorrhizae，and Radix Paeoniae Rubra are used together，aiming at the pathogenesis of kidney disease“minimal symptom”; large doses of Radix Paeoniae Rubra and Radix Paeoniae Alba laxative symptomatic treatment experience in clinics.
Keywords Debark peony root;Peony root; @ LYU Renhe; Six diagnosis and treatment principles; National Chinese medicine master; Experience inheritance; Traditional Chinese medicine; Syndrome differentiation and treatment
中圖分类号：R249.2/.7文献标识码：Bdoi：10.3969/j.issn.1673-7202.2020.21.027
国医大师吕仁和教授临床工作近60年，中西合参，学验俱丰。针对临床时常出现的“传统中医无证可辨”或者“现代西医无药可用”的情况，吕仁和教授在“辨证论治”和“整体观”的基础上，创造性提出“对病论治、对病辨证论治、对病分期辨证论治、对症论治、对症辨证论治、对症辨病与辨证论治相结合”的六对论治辨证思路，提纲挈领，驾简驭繁。吕仁和教授临床遣方用药颇为灵活，强调不仅要用好“方”，更要用好“药”，吕教授尤为擅长应用药对和药串，所谓“调百药齐，和之所宜”。学生在跟师期间发现吕教授处方喜用芍药，赤芍、白芍出现频率较高。本文结合吕仁和教授“六对论治”的辨证思路，试述吕教授临床运用芍药的经验。
1 芍药简介
1.1 历史源流 《神农本草经》[1]列芍药为中品，载：“味苦平，主邪气腹痛，除血痹，破坚积，寒热疝瘕，止痛，利小便，益气”。未区分赤芍和白芍。《伤寒论》常用芍药益阴和营、养血通脉、敛阴止汗、缓急止痛、利水、清热、和血，并分别配合桂枝、当归、黄芪、甘草、茯苓、柴胡、麻黄等使用[2]。陶弘景《本草经集注》[3]始分赤、白芍，后世渐渐认为二者由于加工炮制的不同而同源异效。《中华人民共和国药典》[4]载：“白芍为毛茛科植物芍药的根部，除去外皮置沸水中煮后晒干而成，性微寒，味苦、酸，归肝、脾经，功可平肝止痛，养血调经，敛阴止汗。赤芍为毛茛科植物芍药或川赤芍的根晒干而成，性微寒味苦，归肝经，功可清热凉血，散瘀止痛”。二者一补一泻，一收一散，相反相成，临床常常配伍使用。赤、白芍也常常以药对的形式出现在吕仁和教授的处方中。, http://www.100md.com(石晓琪 王辰光 闫璞 史银春 高梦蕉 陈宗俊 肖永华)