趙獻(xian)可(1573年(nian)~1664年(nian))。字養葵,自號醫(yi)巫閭(lv)子,鄞(yin)縣(xian)(今浙(zhe)江(jiang)寧波(bo))人(ren)。善易而精(jing)醫(yi);好學淹貫,醫(yi)德高尚(shang),往(wang)來民間(jian),能承父業,治病不問(wen)(wen)高低貴賤,不計禮酬。著有:《醫(yi)貫》、《內經(jing)鈔》、《素(su)問(wen)(wen)鈔》、《經(jing)絡考》、《正脈(mo)論》、《二(er)體(ti)一例》,以《醫(yi)貫》流傳(chuan)廣而影響(xiang)大,系醫(yi)論著作。
中國明末(mo)醫學家。生卒年(nian)不(bu)詳,約活動于16~17世紀。字(zi)養葵,自號醫巫(wu)閭子。鄞(yin)縣(今浙江寧波)人(ren)。趙(zhao)獻可好學博覽,除(chu)醫之(zhi)外,儒、道(dao)、釋均有涉獵,曾游歷于山西(xi)(xi)、陜西(xi)(xi)等地(di)。在(zai)哲學思想上受(shou)《易經》影響較大,在(zai)醫學上又遵從李東垣(yuan)、薛(xue)己,屬于溫(wen)補學派。趙(zhao)獻可提(ti)出命門為人(ren)一(yi)身之(zhi)主,而(er)不(bu)是心,命門的(de)水火即人(ren)的(de)陰陽。
代(dai)表著(zhu)(zhu)作(zuo)有(you)(you)《醫貫》6卷,對(dui)后世影(ying)響很大。此外他還著(zhu)(zhu)有(you)(you)《邯鄲(dan)遺稿》,又名《胎產遺論》,為(wei)婦科(ke)專著(zhu)(zhu),另有(you)(you)《內經鈔(chao)》、《素問注》、《經絡考》、《正脈論》、《二(er)本一例》等書皆失(shi)傳,其子趙貞(zhen)觀亦精醫學,輯有(you)(you)《痘疹論》一書。
趙獻可(ke)認(ren)為(wei)命(ming)(ming)(ming)(ming)(ming)(ming)門(men)(men)(men)為(wei)人(ren)(ren)身之(zhi)(zhi)(zhi)大主,強調了命(ming)(ming)(ming)(ming)(ming)(ming)門(men)(men)(men)在人(ren)(ren)體生(sheng)(sheng)命(ming)(ming)(ming)(ming)(ming)(ming)活動(dong)過(guo)程中的(de)(de)重(zhong)要作用(yong)(yong)。指出人(ren)(ren)的(de)(de)發(fa)育過(guo)程,先(xian)有命(ming)(ming)(ming)(ming)(ming)(ming)門(men)(men)(men),而(er)后(hou)生(sheng)(sheng)成五臟(zang)六(liu)腑,命(ming)(ming)(ming)(ming)(ming)(ming)門(men)(men)(men)為(wei)十二臟(zang)腑之(zhi)(zhi)(zhi)根,為(wei)生(sheng)(sheng)命(ming)(ming)(ming)(ming)(ming)(ming)之(zhi)(zhi)(zhi)原。命(ming)(ming)(ming)(ming)(ming)(ming)門(men)(men)(men)在人(ren)(ren)體生(sheng)(sheng)命(ming)(ming)(ming)(ming)(ming)(ming)活動(dong)過(guo)程中,起主要作用(yong)(yong)者,乃(nai)命(ming)(ming)(ming)(ming)(ming)(ming)門(men)(men)(men)內具之(zhi)(zhi)(zhi)相火(huo),他把(ba)相火(huo)比喻(yu)人(ren)(ren)體的(de)(de)命(ming)(ming)(ming)(ming)(ming)(ming)門(men)(men)(men),認(ren)為(wei)人(ren)(ren)體五臟(zang)六(liu)腑之(zhi)(zhi)(zhi)所(suo)以(yi)能發(fa)揮正(zheng)常作用(yong)(yong),同樣依(yi)賴于命(ming)(ming)(ming)(ming)(ming)(ming)門(men)(men)(men)相火(huo)的(de)(de)作用(yong)(yong),充分反映出趙氏對命(ming)(ming)(ming)(ming)(ming)(ming)門(men)(men)(men)的(de)(de)重(zhong)視,認(ren)為(wei)它是(shi)人(ren)(ren)身之(zhi)(zhi)(zhi)至寶,是(shi)生(sheng)(sheng)命(ming)(ming)(ming)(ming)(ming)(ming)活動(dong)之(zhi)(zhi)(zhi)源。這樣,趙氏將人(ren)(ren)體陽氣之(zhi)(zhi)(zhi)根從心臟(zang)轉移(yi)至命(ming)(ming)(ming)(ming)(ming)(ming)門(men)(men)(men),使腎命(ming)(ming)(ming)(ming)(ming)(ming)的(de)(de)生(sheng)(sheng)理功能作用(yong)(yong)在人(ren)(ren)體中顯得尤為(wei)重(zhong)要,使中醫(yi)學術理論又有了新的(de)(de)發(fa)展。
趙氏認為(wei)(wei)(wei),命(ming)門位(wei)于兩腎之(zhi)中(zhong),內(nei)具(ju)真(zhen)水(shui)(shui)(shui)(shui)真(zhen)火(huo)(huo)(huo),而命(ming)門之(zhi)相(xiang)火(huo)(huo)(huo)又(you)位(wei)于兩腎水(shui)(shui)(shui)(shui)之(zhi)間,它們之(zhi)間有(you)(you)著(zhu)非常密切的(de)(de)(de)關系。火(huo)(huo)(huo)之(zhi)有(you)(you)余(yu)是(shi)(shi)由于水(shui)(shui)(shui)(shui)虧,陰不(bu)制陽(yang),而見相(xiang)對火(huo)(huo)(huo)旺之(zhi)象;水(shui)(shui)(shui)(shui)之(zhi)有(you)(you)余(yu),又(you)是(shi)(shi)由于火(huo)(huo)(huo)虧,陽(yang)虛(xu)相(xiang)對陰盛而見的(de)(de)(de)表現,這是(shi)(shi)陰陽(yang)對立觀所決(jue)定的(de)(de)(de)。真(zhen)水(shui)(shui)(shui)(shui)真(zhen)火(huo)(huo)(huo)只能慮(lv)其(qi)不(bu)足(zu),不(bu)能慮(lv)其(qi)有(you)(you)余(yu),因為(wei)(wei)(wei)命(ming)門水(shui)(shui)(shui)(shui)火(huo)(huo)(huo)是(shi)(shi)人體生命(ming)活動(dong)能力(li)的(de)(de)(de)根(gen)源,是(shi)(shi)先(xian)天(tian)(tian)之(zhi)本。所以,只能慮(lv)其(qi)虛(xu)。水(shui)(shui)(shui)(shui)火(huo)(huo)(huo)之(zhi)間,水(shui)(shui)(shui)(shui)為(wei)(wei)(wei)火(huo)(huo)(huo)之(zhi)根(gen)。因此,補火(huo)(huo)(huo)當(dang)于水(shui)(shui)(shui)(shui)中(zhong)求火(huo)(huo)(huo),既在陰中(zhong)求陽(yang),使(shi)陰生陽(yang)長。對于命(ming)門水(shui)(shui)(shui)(shui)火(huo)(huo)(huo)的(de)(de)(de)作(zuo)用,趙氏更強調火(huo)(huo)(huo)的(de)(de)(de)作(zuo)用,認為(wei)(wei)(wei)相(xiang)火(huo)(huo)(huo)在人身中(zhong)是(shi)(shi)起決(jue)定性作(zuo)用的(de)(de)(de),應當(dang)時刻保護(hu),不(bu)能任意(yi)戕伐。對于命(ming)門先(xian)天(tian)(tian)水(shui)(shui)(shui)(shui)、火(huo)(huo)(huo)不(bu)足(zu)的(de)(de)(de)治療,不(bu)是(shi)(shi)補水(shui)(shui)(shui)(shui),就(jiu)是(shi)(shi)補火(huo)(huo)(huo)。趙氏認為(wei)(wei)(wei),崔氏八味丸與錢乙(yi)所制的(de)(de)(de)六味地(di)黃丸,是(shi)(shi)補真(zhen)火(huo)(huo)(huo)、真(zhen)水(shui)(shui)(shui)(shui)的(de)(de)(de)主方。
趙氏(shi)(shi)創立命(ming)(ming)門理論,闡發腎命(ming)(ming)水(shui)火(huo)(huo)的(de)關系,并(bing)將(jiang)其廣泛應用于(yu)臨證(zheng)。如痰證(zheng)、血(xue)(xue)(xue)證(zheng)、咳(ke)嗽、吐血(xue)(xue)(xue)、喘(chuan)證(zheng)、喉咽痛、眼目病(bing)、齒病(bing)、口瘡(chuang)、耳病(bing)、消渴、中(zhong)滿、噎膈、瀉痢(li)、大便不通(tong)、小便不通(tong)與失禁(jin)等多種病(bing)證(zheng),不僅從其一般辨證(zheng)規(gui)律進行施治(zhi),而(er)(er)且均注(zhu)意(yi)到從腎命(ming)(ming)水(shui)火(huo)(huo)虧虛(xu)方(fang)面進行分(fen)析,廣泛使(shi)用六味(wei)(wei)、八(ba)味(wei)(wei)諸方(fang),為(wei)治(zhi)療以上(shang)疾病(bing)提(ti)供了有益(yi)經(jing)驗(yan)。如其辨治(zhi)血(xue)(xue)(xue)證(zheng),趙氏(shi)(shi)提(ti)出,血(xue)(xue)(xue)不僅有其本身為(wei)血(xue)(xue)(xue)的(de)特點,而(er)(er)且屬水(shui),故而(er)(er)腎中(zhong)真水(shui)干涸,則真火(huo)(huo)勢必(bi)上(shang)炎,血(xue)(xue)(xue)亦隨火(huo)(huo)而(er)(er)上(shang)騰;反之(zhi),若腎中(zhong)真火(huo)(huo)衰竭(jie),則真水(shui)反盛(sheng),血(xue)(xue)(xue)亦失所依附而(er)(er)上(shang)泛,這是血(xue)(xue)(xue)證(zheng)產生(sheng)的(de)兩(liang)種病(bing)機。因(yin)此,在(zai)治(zhi)療時,由(you)于(yu)陽虛(xu)而(er)(er)動血(xue)(xue)(xue)上(shang)泛者,用桂、附加于(yu)八(ba)味(wei)(wei)丸之(zhi)中(zhong),使(shi)腎中(zhong)溫暖,龍雷之(zhi)火(huo)(huo)潛歸于(yu)原宅,不用寒涼(liang)而(er)(er)火(huo)(huo)自(zi)降,不必(bi)止血(xue)(xue)(xue)而(er)(er)血(xue)(xue)(xue)亦自(zi)安。若因(yin)腎中(zhong)水(shui)涸而(er)(er)火(huo)(huo)炎者,就可用六味(wei)(wei)丸以補水(shui)配火(huo)(huo),不必(bi)去火(huo)(huo),而(er)(er)血(xue)(xue)(xue)亦安。
認(ren)為(wei)(wei)痰本非人身所(suo)固有(you)(you),或(huo)是水(shui)(shui)泛(fan)(fan)為(wei)(wei)痰,或(huo)是火(huo)(huo)(huo)煉為(wei)(wei)痰。因此,辨痰證(zheng)(zheng),當(dang)分辨有(you)(you)火(huo)(huo)(huo)無火(huo)(huo)(huo),由于(yu)火(huo)(huo)(huo)衰不(bu)能(neng)制水(shui)(shui),水(shui)(shui)不(bu)歸(gui)原,泛(fan)(fan)溢為(wei)(wei)痰,痰如清水(shui)(shui)者(zhe),趙(zhao)氏主(zhu)(zhu)張用八味(wei)(wei)丸以補(bu)命(ming)火(huo)(huo)(huo),火(huo)(huo)(huo)壯水(shui)(shui)化(hua)則痰自消。由于(yu)陰虛(xu)火(huo)(huo)(huo)動,水(shui)(shui)液沸騰而(er)(er)(er)動于(yu)腎,驟而(er)(er)(er)成痰者(zhe),其(qi)(qi)痰重(zhong)濁白(bai)沫,則應當(dang)選用六(liu)(liu)味(wei)(wei)丸以滋水(shui)(shui)配(pei)火(huo)(huo)(huo),火(huo)(huo)(huo)靜則痰自消。脾為(wei)(wei)生痰之(zhi)(zhi)源,趙(zhao)氏治(zhi)痰,雖亦(yi)接受用四君子(zi)(zi)(zi)湯(tang)或(huo)六(liu)(liu)君子(zi)(zi)(zi)湯(tang)之(zhi)(zhi)類(lei)補(bu)脾燥濕化(hua)痰之(zhi)(zhi)法,然更重(zhong)視(shi)治(zhi)腎命(ming)之(zhi)(zhi)本。其(qi)(qi)論喘(chuan)證(zheng)(zheng),一般(ban)認(ren)為(wei)(wei)屬氣有(you)(you)余之(zhi)(zhi)證(zheng)(zheng),趙(zhao)氏認(ren)為(wei)(wei),當(dang)屬火(huo)(huo)(huo)之(zhi)(zhi)有(you)(you)余,水(shui)(shui)之(zhi)(zhi)不(bu)足(zu)。因此治(zhi)療(liao)當(dang)用六(liu)(liu)味(wei)(wei)丸加麥門冬(dong)、五味(wei)(wei)子(zi)(zi)(zi)等,壯水(shui)(shui)之(zhi)(zhi)主(zhu)(zhu),使(shi)水(shui)(shui)升火(huo)(huo)(huo)降,喘(chuan)息自定。若有(you)(you)由于(yu)命(ming)門真(zhen)元之(zhi)(zhi)火(huo)(huo)(huo),不(bu)能(neng)歸(gui)其(qi)(qi)下元,陰氣在下,陽氣浮越(yue)于(yu)上,亦(yi)可見呼吸氣促,其(qi)(qi)證(zheng)(zheng)似喘(chuan)非喘(chuan),外見四肢厥逆,面赤(chi)煩躁(zao),脈(mo)象兩寸浮大(da)而(er)(er)(er)散,兩尺微而(er)(er)(er)無力。治(zhi)療(liao)主(zhu)(zhu)張用八味(wei)(wei)丸等,以人參生脈(mo)散煎服(fu)送下。總之(zhi)(zhi),對喘(chuan)證(zheng)(zheng)屬虛(xu)者(zhe),從腎命(ming)水(shui)(shui)火(huo)(huo)(huo)治(zhi)療(liao),亦(yi)可見其(qi)(qi)重(zhong)視(shi)腎命(ming)的觀點。
對于郁證的治療
認(ren)為“凡(fan)病之(zhi)起(qi),多(duo)由(you)于(yu)郁(yu)(yu)(yu)(yu)。郁(yu)(yu)(yu)(yu)者(zhe)(zhe),抑而(er)(er)不(bu)通之(zhi)義。”趙氏所(suo)論郁(yu)(yu)(yu)(yu)證(zheng)不(bu)僅包括(kuo)各種雜證(zheng),還包括(kuo)一(yi)切外感病。由(you)于(yu)多(duo)因(yin)木郁(yu)(yu)(yu)(yu)導致(zhi)諸(zhu)郁(yu)(yu)(yu)(yu),故可(ke)“以一(yi)法代五(wu)法”。其治木郁(yu)(yu)(yu)(yu),使肝(gan)膽之(zhi)氣舒展,則諸(zhu)郁(yu)(yu)(yu)(yu)自解。逍遙散是(shi)趙氏治療木郁(yu)(yu)(yu)(yu)的主劑,并常結(jie)合(he)左(zuo)金丸(wan)和六(liu)味(wei)地黃丸(wan)同用(yong)(yong)。他認(ren)為,“世(shi)人(ren)因(yin)郁(yu)(yu)(yu)(yu)而(er)(er)致(zhi)血(xue)病者(zhe)(zhe)多(duo)。凡(fan)郁(yu)(yu)(yu)(yu)皆肝(gan)病也(ye),木中有(you)火(huo)(huo),郁(yu)(yu)(yu)(yu)甚則火(huo)(huo)不(bu)得(de)舒,血(xue)不(bu)行藏而(er)(er)妄行”。這種失血(xue),或因(yin)怒郁(yu)(yu)(yu)(yu)、憂(you)郁(yu)(yu)(yu)(yu),或因(yin)陰虛火(huo)(huo)旺之(zhi)人(ren)外感風寒暑濕,皮(pi)毛閉塞,火(huo)(huo)不(bu)能泄(xie),以致(zhi)血(xue)隨火(huo)(huo)而(er)(er)妄行,出現鼻衄、吐血(xue)等(deng)證(zheng)。其辨(bian)證(zheng)要點(dian)是(shi):“凡(fan)系(xi)郁(yu)(yu)(yu)(yu)者(zhe)(zhe),其脈(mo)必(bi)(bi)澀,其人(ren)必(bi)(bi)惡(e)風惡(e)寒……須視(shi)其面色(se)必(bi)(bi)滯,必(bi)(bi)喜嘔,或口苦,或口酸”。審有(you)如(ru)是(shi)證(zheng),則當(dang)舒散其郁(yu)(yu)(yu)(yu)為主,即“木郁(yu)(yu)(yu)(yu)達之(zhi)”、“火(huo)(huo)郁(yu)(yu)(yu)(yu)發之(zhi)”之(zhi)義。其方(fang)用(yong)(yong)逍遙散加丹皮(pi)、茱、連。血(xue)止后(hou)當(dang)用(yong)(yong)六(liu)味(wei)地黃丸(wan)滋陰善后(hou),否(fou)則多(duo)復發。
趙獻可,字養葵(kui),號(hao)醫(yi)(yi)巫閭(lv)子。約生(sheng)(sheng)活于(yu)十六世紀(ji)(ji)后期與十七(qi)世紀(ji)(ji)初(chu)期,雖史料無詳(xiang)細記載(zai),但據黃(huang)宗羲《張景(jing)岳傳》說:“趙養葵(kui),名獻可,寧波人(ren)(ren),與介賓同(tong)時,未(wei)嘗相見,而(er)議(yi)論往(wang)往(wang)有(you)合者(zhe)。”說明(ming)(ming)趙、張屬同(tong)時期人(ren)(ren),而(er)張景(jing)岳生(sheng)(sheng)卒年代(dai)為公元1563~1640年,故趙氏亦可能(neng)生(sheng)(sheng)活年代(dai)與之相近(jin),屬明(ming)(ming)代(dai)一(yi)(yi)(yi)大(da)醫(yi)(yi)家。籍貫鄞縣,其一(yi)(yi)(yi)生(sheng)(sheng)治醫(yi)(yi)學(xue),獨重視腎(shen)水(shui)(shui)命(ming)火,對命(ming)門(men)學(xue)說猶有(you)貢獻,是易水(shui)(shui)學(xue)派的學(xue)術思(si)想(xiang),又(you)由研究(jiu)后天(tian)脾胃轉向先天(tian)腎(shen)命(ming),為之一(yi)(yi)(yi)變。著有(you)《醫(yi)(yi)貫》一(yi)(yi)(yi)書(shu),充(chong)分反(fan)映其學(xue)術思(si)想(xiang)。