趙獻可(1573年(nian)~1664年(nian))。字養葵,自號醫巫閭子,鄞縣(xian)(今浙(zhe)江寧波)人。善(shan)易而精(jing)醫;好學(xue)淹(yan)貫,醫德(de)高尚,往來民間(jian),能承(cheng)父業,治病不問高低(di)貴賤,不計禮(li)酬。著有:《醫貫》、《內經鈔(chao)》、《素問鈔(chao)》、《經絡考》、《正脈論(lun)》、《二體(ti)一例(li)》,以《醫貫》流傳廣而影響大(da),系醫論(lun)著作。
中國(guo)明末醫(yi)學(xue)家。生卒年不(bu)詳,約活動于16~17世紀。字養葵,自(zi)號醫(yi)巫(wu)閭子。鄞縣(今浙江(jiang)寧波)人(ren)(ren)。趙(zhao)獻可好(hao)學(xue)博覽(lan),除醫(yi)之(zhi)外,儒(ru)、道、釋(shi)均有涉獵,曾(ceng)游歷于山西(xi)、陜西(xi)等地。在哲(zhe)學(xue)思想(xiang)上受《易經》影響較大,在醫(yi)學(xue)上又遵從李東垣、薛己,屬于溫(wen)補學(xue)派。趙(zhao)獻可提出(chu)命門為(wei)人(ren)(ren)一身(shen)之(zhi)主,而不(bu)是(shi)心,命門的水火即人(ren)(ren)的陰陽。
代表著作有(you)《醫貫》6卷,對(dui)后世影響很大。此外(wai)他還(huan)著有(you)《邯鄲遺稿(gao)》,又名《胎產遺論》,為婦科專著,另有(you)《內經鈔》、《素(su)問(wen)注》、《經絡考》、《正脈論》、《二本一例》等書(shu)皆失傳(chuan),其(qi)子趙貞(zhen)觀(guan)亦(yi)精(jing)醫學,輯有(you)《痘(dou)疹論》一書(shu)。
趙(zhao)獻可認為命(ming)(ming)(ming)(ming)(ming)門(men)(men)(men)為人(ren)(ren)(ren)(ren)(ren)身(shen)(shen)之(zhi)(zhi)大(da)主(zhu),強調(diao)了命(ming)(ming)(ming)(ming)(ming)門(men)(men)(men)在人(ren)(ren)(ren)(ren)(ren)體(ti)生命(ming)(ming)(ming)(ming)(ming)活動(dong)過(guo)程中的(de)重要作(zuo)(zuo)用(yong)。指出(chu)人(ren)(ren)(ren)(ren)(ren)的(de)發育過(guo)程,先有命(ming)(ming)(ming)(ming)(ming)門(men)(men)(men),而后生成五(wu)臟六腑,命(ming)(ming)(ming)(ming)(ming)門(men)(men)(men)為十二(er)臟腑之(zhi)(zhi)根(gen),為生命(ming)(ming)(ming)(ming)(ming)之(zhi)(zhi)原。命(ming)(ming)(ming)(ming)(ming)門(men)(men)(men)在人(ren)(ren)(ren)(ren)(ren)體(ti)生命(ming)(ming)(ming)(ming)(ming)活動(dong)過(guo)程中,起主(zhu)要作(zuo)(zuo)用(yong)者(zhe),乃命(ming)(ming)(ming)(ming)(ming)門(men)(men)(men)內(nei)具之(zhi)(zhi)相火,他把相火比(bi)喻人(ren)(ren)(ren)(ren)(ren)體(ti)的(de)命(ming)(ming)(ming)(ming)(ming)門(men)(men)(men),認為人(ren)(ren)(ren)(ren)(ren)體(ti)五(wu)臟六腑之(zhi)(zhi)所以能(neng)發揮(hui)正常作(zuo)(zuo)用(yong),同樣(yang)依賴于(yu)命(ming)(ming)(ming)(ming)(ming)門(men)(men)(men)相火的(de)作(zuo)(zuo)用(yong),充(chong)分反映出(chu)趙(zhao)氏對命(ming)(ming)(ming)(ming)(ming)門(men)(men)(men)的(de)重視,認為它是(shi)人(ren)(ren)(ren)(ren)(ren)身(shen)(shen)之(zhi)(zhi)至(zhi)寶(bao),是(shi)生命(ming)(ming)(ming)(ming)(ming)活動(dong)之(zhi)(zhi)源。這樣(yang),趙(zhao)氏將人(ren)(ren)(ren)(ren)(ren)體(ti)陽氣之(zhi)(zhi)根(gen)從心臟轉移至(zhi)命(ming)(ming)(ming)(ming)(ming)門(men)(men)(men),使腎命(ming)(ming)(ming)(ming)(ming)的(de)生理(li)功能(neng)作(zuo)(zuo)用(yong)在人(ren)(ren)(ren)(ren)(ren)體(ti)中顯得尤為重要,使中醫學術理(li)論又有了新的(de)發展。
趙(zhao)氏(shi)(shi)(shi)認為(wei),命(ming)(ming)門(men)(men)位于(yu)(yu)兩(liang)腎(shen)之(zhi)中,內具真水(shui)(shui)(shui)(shui)(shui)(shui)(shui)真火(huo)(huo),而(er)命(ming)(ming)門(men)(men)之(zhi)相火(huo)(huo)又位于(yu)(yu)兩(liang)腎(shen)水(shui)(shui)(shui)(shui)(shui)(shui)(shui)之(zhi)間,它們(men)之(zhi)間有(you)(you)著非常密切的(de)(de)(de)(de)關系。火(huo)(huo)之(zhi)有(you)(you)余(yu)是由(you)于(yu)(yu)水(shui)(shui)(shui)(shui)(shui)(shui)(shui)虧,陰不制陽(yang)(yang)(yang)(yang),而(er)見相對(dui)火(huo)(huo)旺(wang)之(zhi)象;水(shui)(shui)(shui)(shui)(shui)(shui)(shui)之(zhi)有(you)(you)余(yu),又是由(you)于(yu)(yu)火(huo)(huo)虧,陽(yang)(yang)(yang)(yang)虛(xu)(xu)相對(dui)陰盛而(er)見的(de)(de)(de)(de)表現(xian),這是陰陽(yang)(yang)(yang)(yang)對(dui)立觀所(suo)(suo)決(jue)定的(de)(de)(de)(de)。真水(shui)(shui)(shui)(shui)(shui)(shui)(shui)真火(huo)(huo)只能慮其不足(zu),不能慮其有(you)(you)余(yu),因為(wei)命(ming)(ming)門(men)(men)水(shui)(shui)(shui)(shui)(shui)(shui)(shui)火(huo)(huo)是人(ren)體生命(ming)(ming)活動能力(li)的(de)(de)(de)(de)根源,是先天(tian)之(zhi)本(ben)。所(suo)(suo)以(yi),只能慮其虛(xu)(xu)。水(shui)(shui)(shui)(shui)(shui)(shui)(shui)火(huo)(huo)之(zhi)間,水(shui)(shui)(shui)(shui)(shui)(shui)(shui)為(wei)火(huo)(huo)之(zhi)根。因此,補(bu)(bu)(bu)(bu)火(huo)(huo)當于(yu)(yu)水(shui)(shui)(shui)(shui)(shui)(shui)(shui)中求火(huo)(huo),既在(zai)陰中求陽(yang)(yang)(yang)(yang),使陰生陽(yang)(yang)(yang)(yang)長。對(dui)于(yu)(yu)命(ming)(ming)門(men)(men)水(shui)(shui)(shui)(shui)(shui)(shui)(shui)火(huo)(huo)的(de)(de)(de)(de)作用(yong),趙(zhao)氏(shi)(shi)(shi)更(geng)強調火(huo)(huo)的(de)(de)(de)(de)作用(yong),認為(wei)相火(huo)(huo)在(zai)人(ren)身(shen)中是起決(jue)定性作用(yong)的(de)(de)(de)(de),應當時刻保護(hu),不能任(ren)意(yi)戕(qiang)伐。對(dui)于(yu)(yu)命(ming)(ming)門(men)(men)先天(tian)水(shui)(shui)(shui)(shui)(shui)(shui)(shui)、火(huo)(huo)不足(zu)的(de)(de)(de)(de)治療,不是補(bu)(bu)(bu)(bu)水(shui)(shui)(shui)(shui)(shui)(shui)(shui),就是補(bu)(bu)(bu)(bu)火(huo)(huo)。趙(zhao)氏(shi)(shi)(shi)認為(wei),崔氏(shi)(shi)(shi)八味丸與錢乙(yi)所(suo)(suo)制的(de)(de)(de)(de)六味地黃丸,是補(bu)(bu)(bu)(bu)真火(huo)(huo)、真水(shui)(shui)(shui)(shui)(shui)(shui)(shui)的(de)(de)(de)(de)主方(fang)。
趙(zhao)氏創(chuang)立(li)命門理論(lun),闡發(fa)腎(shen)命水(shui)(shui)火(huo)(huo)的關(guan)系,并將(jiang)其(qi)廣泛(fan)應用(yong)于臨(lin)證(zheng)。如痰(tan)證(zheng)、血(xue)(xue)(xue)證(zheng)、咳嗽(sou)、吐血(xue)(xue)(xue)、喘證(zheng)、喉(hou)咽痛、眼目病、齒病、口瘡、耳病、消渴、中(zhong)滿、噎膈、瀉痢、大便不(bu)通、小(xiao)便不(bu)通與失(shi)禁等(deng)多種病證(zheng),不(bu)僅從(cong)其(qi)一般(ban)辨證(zheng)規律進(jin)行(xing)施治,而(er)(er)(er)且(qie)均注意到從(cong)腎(shen)命水(shui)(shui)火(huo)(huo)虧虛方面進(jin)行(xing)分析,廣泛(fan)使用(yong)六(liu)味(wei)(wei)、八味(wei)(wei)諸(zhu)方,為(wei)治療以(yi)上(shang)(shang)疾病提供(gong)了有益經驗。如其(qi)辨治血(xue)(xue)(xue)證(zheng),趙(zhao)氏提出,血(xue)(xue)(xue)不(bu)僅有其(qi)本身為(wei)血(xue)(xue)(xue)的特點,而(er)(er)(er)且(qie)屬水(shui)(shui),故而(er)(er)(er)腎(shen)中(zhong)真(zhen)水(shui)(shui)干涸(he),則真(zhen)火(huo)(huo)勢必上(shang)(shang)炎(yan),血(xue)(xue)(xue)亦(yi)隨火(huo)(huo)而(er)(er)(er)上(shang)(shang)騰(teng);反之,若腎(shen)中(zhong)真(zhen)火(huo)(huo)衰竭,則真(zhen)水(shui)(shui)反盛(sheng),血(xue)(xue)(xue)亦(yi)失(shi)所依(yi)附(fu)而(er)(er)(er)上(shang)(shang)泛(fan),這是血(xue)(xue)(xue)證(zheng)產(chan)生的兩種病機。因此,在治療時,由于陽虛而(er)(er)(er)動血(xue)(xue)(xue)上(shang)(shang)泛(fan)者(zhe)(zhe),用(yong)桂(gui)、附(fu)加于八味(wei)(wei)丸之中(zhong),使腎(shen)中(zhong)溫(wen)暖,龍雷之火(huo)(huo)潛(qian)歸于原宅,不(bu)用(yong)寒涼(liang)而(er)(er)(er)火(huo)(huo)自降,不(bu)必止血(xue)(xue)(xue)而(er)(er)(er)血(xue)(xue)(xue)亦(yi)自安。若因腎(shen)中(zhong)水(shui)(shui)涸(he)而(er)(er)(er)火(huo)(huo)炎(yan)者(zhe)(zhe),就可用(yong)六(liu)味(wei)(wei)丸以(yi)補水(shui)(shui)配火(huo)(huo),不(bu)必去火(huo)(huo),而(er)(er)(er)血(xue)(xue)(xue)亦(yi)安。
認為(wei)(wei)痰(tan)本(ben)非人身所固有,或(huo)是(shi)水(shui)(shui)泛為(wei)(wei)痰(tan),或(huo)是(shi)火(huo)(huo)(huo)煉為(wei)(wei)痰(tan)。因此(ci),辨(bian)痰(tan)證(zheng)(zheng)(zheng),當分辨(bian)有火(huo)(huo)(huo)無火(huo)(huo)(huo),由于(yu)火(huo)(huo)(huo)衰不能(neng)制水(shui)(shui),水(shui)(shui)不歸(gui)原(yuan),泛溢為(wei)(wei)痰(tan),痰(tan)如清水(shui)(shui)者,趙(zhao)氏主(zhu)張用八味(wei)丸以補(bu)命火(huo)(huo)(huo),火(huo)(huo)(huo)壯水(shui)(shui)化(hua)則(ze)痰(tan)自消。由于(yu)陰虛火(huo)(huo)(huo)動(dong),水(shui)(shui)液沸騰(teng)而(er)(er)動(dong)于(yu)腎,驟(zou)而(er)(er)成痰(tan)者,其(qi)痰(tan)重濁白沫,則(ze)應(ying)當選用六(liu)味(wei)丸以滋水(shui)(shui)配(pei)火(huo)(huo)(huo),火(huo)(huo)(huo)靜則(ze)痰(tan)自消。脾為(wei)(wei)生(sheng)痰(tan)之(zhi)(zhi)源,趙(zhao)氏治(zhi)(zhi)痰(tan),雖(sui)亦接(jie)受用四君(jun)子湯或(huo)六(liu)君(jun)子湯之(zhi)(zhi)類補(bu)脾燥濕化(hua)痰(tan)之(zhi)(zhi)法(fa),然更重視(shi)治(zhi)(zhi)腎命之(zhi)(zhi)本(ben)。其(qi)論喘(chuan)證(zheng)(zheng)(zheng),一般(ban)認為(wei)(wei)屬氣(qi)(qi)有余(yu)之(zhi)(zhi)證(zheng)(zheng)(zheng),趙(zhao)氏認為(wei)(wei),當屬火(huo)(huo)(huo)之(zhi)(zhi)有余(yu),水(shui)(shui)之(zhi)(zhi)不足。因此(ci)治(zhi)(zhi)療當用六(liu)味(wei)丸加麥(mai)門冬、五(wu)味(wei)子等,壯水(shui)(shui)之(zhi)(zhi)主(zhu),使水(shui)(shui)升火(huo)(huo)(huo)降(jiang),喘(chuan)息自定(ding)。若有由于(yu)命門真(zhen)元之(zhi)(zhi)火(huo)(huo)(huo),不能(neng)歸(gui)其(qi)下元,陰氣(qi)(qi)在下,陽(yang)氣(qi)(qi)浮越于(yu)上,亦可見呼吸氣(qi)(qi)促,其(qi)證(zheng)(zheng)(zheng)似喘(chuan)非喘(chuan),外見四肢厥逆,面(mian)赤煩躁,脈(mo)象(xiang)兩寸浮大而(er)(er)散(san),兩尺微而(er)(er)無力。治(zhi)(zhi)療主(zhu)張用八味(wei)丸等,以人參(can)生(sheng)脈(mo)散(san)煎(jian)服(fu)送下。總(zong)之(zhi)(zhi),對喘(chuan)證(zheng)(zheng)(zheng)屬虛者,從腎命水(shui)(shui)火(huo)(huo)(huo)治(zhi)(zhi)療,亦可見其(qi)重視(shi)腎命的觀(guan)點。
對于郁證的治療
認為“凡病(bing)(bing)之(zhi)(zhi)起,多由于郁(yu)(yu)(yu)(yu)。郁(yu)(yu)(yu)(yu)者,抑而(er)不(bu)通之(zhi)(zhi)義。”趙氏所論郁(yu)(yu)(yu)(yu)證(zheng)不(bu)僅包括各種雜證(zheng),還包括一切外(wai)感病(bing)(bing)。由于多因(yin)(yin)木郁(yu)(yu)(yu)(yu)導致諸郁(yu)(yu)(yu)(yu),故可(ke)“以一法(fa)代五法(fa)”。其(qi)(qi)治木郁(yu)(yu)(yu)(yu),使肝膽之(zhi)(zhi)氣舒展,則(ze)(ze)諸郁(yu)(yu)(yu)(yu)自(zi)解(jie)。逍遙散是趙氏治療木郁(yu)(yu)(yu)(yu)的主劑,并常結合(he)左金丸(wan)和六味地(di)黃(huang)丸(wan)同用。他(ta)認為,“世人(ren)因(yin)(yin)郁(yu)(yu)(yu)(yu)而(er)致血(xue)病(bing)(bing)者多。凡郁(yu)(yu)(yu)(yu)皆肝病(bing)(bing)也,木中有(you)火,郁(yu)(yu)(yu)(yu)甚則(ze)(ze)火不(bu)得舒,血(xue)不(bu)行(xing)藏(zang)而(er)妄(wang)行(xing)”。這種失血(xue),或(huo)因(yin)(yin)怒郁(yu)(yu)(yu)(yu)、憂郁(yu)(yu)(yu)(yu),或(huo)因(yin)(yin)陰(yin)(yin)虛火旺(wang)之(zhi)(zhi)人(ren)外(wai)感風(feng)寒暑濕,皮(pi)毛閉塞(sai),火不(bu)能泄(xie),以致血(xue)隨(sui)火而(er)妄(wang)行(xing),出現鼻衄、吐血(xue)等證(zheng)。其(qi)(qi)辨證(zheng)要(yao)點是:“凡系(xi)郁(yu)(yu)(yu)(yu)者,其(qi)(qi)脈(mo)必澀,其(qi)(qi)人(ren)必惡(e)風(feng)惡(e)寒……須視其(qi)(qi)面色必滯,必喜嘔(ou),或(huo)口苦,或(huo)口酸”。審(shen)有(you)如是證(zheng),則(ze)(ze)當舒散其(qi)(qi)郁(yu)(yu)(yu)(yu)為主,即“木郁(yu)(yu)(yu)(yu)達之(zhi)(zhi)”、“火郁(yu)(yu)(yu)(yu)發之(zhi)(zhi)”之(zhi)(zhi)義。其(qi)(qi)方用逍遙散加丹(dan)皮(pi)、茱、連。血(xue)止后當用六味地(di)黃(huang)丸(wan)滋陰(yin)(yin)善(shan)后,否則(ze)(ze)多復發。
趙獻(xian)可,字養(yang)葵,號醫(yi)(yi)巫閭子。約生(sheng)活于十(shi)(shi)六世(shi)紀(ji)后期與(yu)(yu)十(shi)(shi)七世(shi)紀(ji)初期,雖(sui)史料無(wu)詳細記載,但據(ju)黃宗羲《張景岳(yue)傳》說:“趙養(yang)葵,名獻(xian)可,寧波(bo)人(ren)(ren),與(yu)(yu)介賓同時(shi),未嘗相見(jian),而(er)議論往往有合者。”說明趙、張屬同時(shi)期人(ren)(ren),而(er)張景岳(yue)生(sheng)卒年(nian)代為(wei)公元1563~1640年(nian),故趙氏亦可能生(sheng)活年(nian)代與(yu)(yu)之(zhi)相近,屬明代一(yi)大(da)醫(yi)(yi)家。籍貫鄞縣,其一(yi)生(sheng)治醫(yi)(yi)學(xue),獨重視腎水命(ming)火(huo),對命(ming)門學(xue)說猶有貢(gong)獻(xian),是易水學(xue)派的學(xue)術思(si)想(xiang),又由研究后天(tian)(tian)脾胃轉向先天(tian)(tian)腎命(ming),為(wei)之(zhi)一(yi)變(bian)。著有《醫(yi)(yi)貫》一(yi)書,充分反(fan)映(ying)其學(xue)術思(si)想(xiang)。