苓(ling)桂術(shu)甘(gan)湯都來源于醫圣張(zhang)仲景《傷(shang)寒雜病(bing)論(lun)》，由茯苓(ling)、桂枝、白術(shu)、炙甘(gan)草(cao)分為，更具益氣活(huo)血化(hua)飲(yin)，健脾胃利水的藥理作(zuo)用，針(zhen)對水濕(shi)之氣引(yin)起(qi)之病(bing)。

寒濕(shi)腿(tui)痛(tong)系(xi)脾腎虧虛，外受寒濕(shi)，致經絡(luo)阻滯，微循環不暢，痰(tan)(tan)瘀(yu)互(hu)結形成，常見病機為脾腎虧虛，痰(tan)(tan)瘀(yu)互(hu)結，與苓桂(gui)術(shu)甘(gan)湯(tang)的脾陽(yang)不充足，痰(tan)(tan)飲內停方證(zheng)病機默契。依(yi)據中(zhong)醫藥(yao)(yao)學婦科(ke)(ke)(ke)婦科(ke)(ke)(ke)婦科(ke)(ke)(ke)學異病同治(zhi)原則，臨證(zheng)將痰(tan)(tan)飲證(zheng)的苓桂(gui)術(shu)甘(gan)湯(tang)加減于診(zhen)(zhen)治(zhi)寒濕(shi)腿(tui)痛(tong)，取效甚捷。作者我(wo)的榮(rong)幸順(shun)服上(shang)海(hai)中(zhong)醫藥(yao)(yao)學婦科(ke)(ke)(ke)婦科(ke)(ke)(ke)婦科(ke)(ke)(ke)藥(yao)(yao)本科(ke)(ke)(ke)大(da)學附屬駐馬店市(shi)中(zhong)醫藥(yao)(yao)學婦科(ke)(ke)(ke)婦科(ke)(ke)(ke)婦科(ke)(ke)(ke)院(yuan)副(fu)主(zhu)任(ren)中(zhong)醫藥(yao)(yao)學婦科(ke)(ke)(ke)婦科(ke)(ke)(ke)婦科(ke)(ke)(ke)師劉天驥練習，回報良(liang)多，現介紹其用苓桂(gui)術(shu)甘(gan)湯(tang)加味診(zhen)(zhen)治(zhi)腿(tui)痛(tong)體力。

　　胡某(mou)，男，48歲(sui)，寧夏駐馬(ma)店人(ren)，2015年十月6日(ri)(ri)初診(zhen)(zhen)。主訴腰酸痛(tong)(tong)兩(liang)年多(duo)余。兩(liang)年多(duo)前1次(ci)勞作汗出后，突遇(yu)(yu)雨(yu)淋，逐個感(gan)腹部重著隱(yin)隱(yin)作痛(tong)(tong)，經(jing)日(ri)(ri)本機構(gou)MRI檢修為腰間(jian)盤間(jian)盤突顯出癥，經(jing)治(zhi)而愈（特定中(zhong)藥治(zhi)療不(bu)(bu)祥之兆）。以至，每遇(yu)(yu)過(guo)勞或(huo)夏天(tian)(tian)發生變化即引發的腰酸痛(tong)(tong)，雖經(jing)針灸(jiu)、艾灸(jiu)養生等隱(yin)隱(yin)作痛(tong)(tong)減輕癥狀，但(dan)終將無法治(zhi)愈。刻診(zhen)(zhen)：腹部冷痛(tong)(tong)，酸脹重著麻痹感(gan)，延及(ji)右髖及(ji)右上下肢(zhi)亦(yi)隱(yin)隱(yin)作痛(tong)(tong)麻痹感(gan)，屈伸不(bu)(bu)好，不(bu)(bu)易(yi)于轉側(ce)，遇(yu)(yu)勞或(huo)寒風(feng)凜冽、陰大霧天(tian)(tian)氣減弱。舌質淡，苔(tai)白厚，脈沉緊。

　　中醫醫生檢測：寒(han)濕腰疼(teng)(teng)腿疼(teng)(teng)（外感寒(han)濕，痰瘀互結(jie)）。

 　　治法：強(qiang)腎壯腰，健(jian)脾養胃加濕，祛瘀止(zhi)咳化痰，溫(wen)經(jing)通絡。

　　處方藥：茯苓(ling)20克(ke)(ke)(ke)，桂(gui)枝15克(ke)(ke)(ke)，白術30克(ke)(ke)(ke)，炙甘草10克(ke)(ke)(ke)，鹽杜仲15克(ke)(ke)(ke)，川(chuan)斷(duan)15克(ke)(ke)(ke)，酒烏梢蛇(she)15克(ke)(ke)(ke)，醋延胡索(suo)15克(ke)(ke)(ke)，狗脊15克(ke)(ke)(ke)，土元6克(ke)(ke)(ke)，川(chuan)牛膝(xi)6克(ke)(ke)(ke)。7劑，日一劑。

　　十月14日二診(zhen)：藥后引發疼(teng)痛降低(di)，盲(mang)目酸(suan)脹涼感稍(shao)減(jian)。守(shou)左下(xia)方白術加至45克(ke)，狗脊30克(ke)，7劑，服法同(tong)前。

　　十月(yue)23日三診：藥(yao)后(hou)以上諸癥均較前消除，但麻痹(bi)感減(jian)不(bu)充分言，左下方加黃芪30克繼服。至14月(yue)8日，共吃(chi)藥(yao)7周，腰(yao)腿痛(tong)苦麻痹(bi)感全(quan)消而告愈。兩(liang)多年后(hou)隨訪未重復(fu)發作。

　　按：苓(ling)桂(gui)(gui)術甘(gan)湯加味(wei)方(fang)中(zhong)(zhong)，茯(fu)苓(ling)既(ji)(ji)健(jian)脾(pi)開胃(wei)(wei)(wei)(wei)開胃(wei)(wei)(wei)(wei)胃(wei)(wei)(wei)(wei)又利水(shui)滲濕(shi)(shi)(shi)(shi)(shi)，使濕(shi)(shi)(shi)(shi)(shi)無所(suo)聚，痰(tan)(tan)(tan)(tan)(tan)無由生，既(ji)(ji)消已聚之(zhi)(zhi)(zhi)飲，又杜生痰(tan)(tan)(tan)(tan)(tan)之(zhi)(zhi)(zhi)源。《世補(bu)(bu)(bu)(bu)齋醫(yi)書》中(zhong)(zhong)云：“茯(fu)苓(ling)刻意，為(wei)(wei)(wei)(wei)治痰(tan)(tan)(tan)(tan)(tan)主藥。痰(tan)(tan)(tan)(tan)(tan)之(zhi)(zhi)(zhi)本(ben)(ben)(ben)，水(shui)也(ye)(ye)，茯(fu)苓(ling)可(ke)(ke)不(bu)(bu)都可(ke)(ke)以(yi)(yi)(yi)行(xing)水(shui)；痰(tan)(tan)(tan)(tan)(tan)之(zhi)(zhi)(zhi)動，濕(shi)(shi)(shi)(shi)(shi)也(ye)(ye)，茯(fu)苓(ling)可(ke)(ke)不(bu)(bu)都可(ke)(ke)以(yi)(yi)(yi)行(xing)濕(shi)(shi)(shi)(shi)(shi)。”桂(gui)(gui)枝辛(xin)溫(wen)(wen)(wen)，助(zhu)陽(yang)化(hua)氣，升(sheng)陽(yang)以(yi)(yi)(yi)化(hua)飲，可(ke)(ke)治污濕(shi)(shi)(shi)(shi)(shi)不(bu)(bu)化(hua)，聚為(wei)(wei)(wei)(wei)痰(tan)(tan)(tan)(tan)(tan)飲之(zhi)(zhi)(zhi)證(zheng)。《鶴壁藥解(jie)》論述(shu)：“桂(gui)(gui)枝，入肝家而行(xing)血(xue)(xue)分，定經(jing)絡(luo)(luo)而達榮郁。善(shan)(shan)解(jie)風(feng)邪，最調木氣。升(sheng)清陽(yang)之(zhi)(zhi)(zhi)脫陷，降(jiang)(jiang)濁(zhuo)陰之(zhi)(zhi)(zhi)沖逆，舒筋(jin)(jin)(jin)脈之(zhi)(zhi)(zhi)急攣，利軟骨(gu)(gu)(gu)之(zhi)(zhi)(zhi)壅阻，入肝膽而散(san)(san)(san)遏抑，極鎮(zhen)痛(tong)(tong)(tong)楚，走經(jing)絡(luo)(luo)而開痹(bi)澀，甚空調抽(chou)濕(shi)(shi)(shi)(shi)(shi)氣寒。”脾(pi)謀(mou)生痰(tan)(tan)(tan)(tan)(tan)之(zhi)(zhi)(zhi)源，脾(pi)虛水(shui)濕(shi)(shi)(shi)(shi)(shi)衰(shuai)退，聚而滋生痰(tan)(tan)(tan)(tan)(tan)飲。白術補(bu)(bu)(bu)(bu)氣健(jian)脾(pi)開胃(wei)(wei)(wei)(wei)開胃(wei)(wei)(wei)(wei)胃(wei)(wei)(wei)(wei)溫(wen)(wen)(wen)其(qi)源，燥濕(shi)(shi)(shi)(shi)(shi)利水(shui)開其(qi)流，故為(wei)(wei)(wei)(wei)治痰(tan)(tan)(tan)(tan)(tan)喝水(shui)腫好藥。黃宮繡稱贊其(qi)為(wei)(wei)(wei)(wei)：“脾(pi)臟補(bu)(bu)(bu)(bu)氣第1 要(yao)藥。”炙甘(gan)草(cao)甘(gan)平(ping)，配(pei)桂(gui)(gui)枝以(yi)(yi)(yi)辛(xin)甘(gan)化(hua)陽(yang)，助(zhu)苓(ling)術祛(qu)(qu)(qu)濕(shi)(shi)(shi)(shi)(shi)祛(qu)(qu)(qu)痰(tan)(tan)(tan)(tan)(tan)。上(shang)四味(wei)為(wei)(wei)(wei)(wei)苓(ling)桂(gui)(gui)術甘(gan)湯，好處升(sheng)陽(yang)化(hua)飲，健(jian)脾(pi)開胃(wei)(wei)(wei)(wei)開胃(wei)(wei)(wei)(wei)胃(wei)(wei)(wei)(wei)利水(shui)，為(wei)(wei)(wei)(wei)治痰(tan)(tan)(tan)(tan)(tan)飲主方(fang)，莫過于“病痰(tan)(tan)(tan)(tan)(tan)飲者，當以(yi)(yi)(yi)溫(wen)(wen)(wen)藥和之(zhi)(zhi)(zhi)。”的(de)(de)到底用。腰(yao)(yao)(yao)(yao)(yao)(yao)(yao)為(wei)(wei)(wei)(wei)腎(shen)(shen)之(zhi)(zhi)(zhi)府(fu)，故治腰(yao)(yao)(yao)(yao)(yao)(yao)(yao)必養腎(shen)(shen)。方(fang)中(zhong)(zhong)杜仲補(bu)(bu)(bu)(bu)脾(pi)腎(shen)(shen)，強(qiang)(qiang)筋(jin)(jin)(jin)絡(luo)(luo)，為(wei)(wei)(wei)(wei)治脾(pi)腎(shen)(shen)問題(ti)，腰(yao)(yao)(yao)(yao)(yao)(yao)(yao)膝(xi)(xi)酸(suan)疼(teng)(teng)(teng)(teng)之(zhi)(zhi)(zhi)要(yao)藥，《神農本(ben)(ben)(ben)草(cao)經(jing)》謂其(qi)：“主腰(yao)(yao)(yao)(yao)(yao)(yao)(yao)脊痛(tong)(tong)(tong)”。續斷甘(gan)以(yi)(yi)(yi)補(bu)(bu)(bu)(bu)虛，溫(wen)(wen)(wen)以(yi)(yi)(yi)助(zhu)陽(yang)，辛(xin)以(yi)(yi)(yi)散(san)(san)(san)瘀(yu)，更具補(bu)(bu)(bu)(bu)益(yi)脾(pi)腎(shen)(shen)，強(qiang)(qiang)筋(jin)(jin)(jin)壯(zhuang)骨(gu)(gu)(gu)，通利經(jing)脈之(zhi)(zhi)(zhi)功(gong)，治脾(pi)腎(shen)(shen)問題(ti)，腰(yao)(yao)(yao)(yao)(yao)(yao)(yao)膝(xi)(xi)酸(suan)疼(teng)(teng)(teng)(teng)，常與杜仲相(xiang)伍以(yi)(yi)(yi)降(jiang)(jiang)本(ben)(ben)(ben)增效。狗脊既(ji)(ji)補(bu)(bu)(bu)(bu)脾(pi)腎(shen)(shen)，強(qiang)(qiang)筋(jin)(jin)(jin)絡(luo)(luo)，又祛(qu)(qu)(qu)風(feng)空調抽(chou)濕(shi)(shi)(shi)(shi)(shi)，通痹(bi)鎮(zhen)痛(tong)(tong)(tong)，且善(shan)(shan)堅(jian)脊骨(gu)(gu)(gu)，腰(yao)(yao)(yao)(yao)(yao)(yao)(yao)疼(teng)(teng)(teng)(teng)脊強(qiang)(qiang)非(fei)此(ci)莫除。《神農本(ben)(ben)(ben)草(cao)經(jing)》云其(qi)：“主腰(yao)(yao)(yao)(yao)(yao)(yao)(yao)背強(qiang)(qiang)，企事業單位緩急，周痹(bi)，寒濕(shi)(shi)(shi)(shi)(shi)，膝(xi)(xi)痛(tong)(tong)(tong)，頗利孤寡老人。”牛膝(xi)(xi)補(bu)(bu)(bu)(bu)脾(pi)腎(shen)(shen)，強(qiang)(qiang)腰(yao)(yao)(yao)(yao)(yao)(yao)(yao)膝(xi)(xi)，舒筋(jin)(jin)(jin)活(huo)血(xue)(xue)化(hua)淤化(hua)瘀(yu)通經(jing)，利軟骨(gu)(gu)(gu)，善(shan)(shan)治上(shang)部腰(yao)(yao)(yao)(yao)(yao)(yao)(yao)膝(xi)(xi)軟骨(gu)(gu)(gu)酸(suan)疼(teng)(teng)(teng)(teng)等癥。《滇(dian)南本(ben)(ben)(ben)草(cao)》論述(shu)：“止筋(jin)(jin)(jin)絡(luo)(luo)痛(tong)(tong)(tong)，強(qiang)(qiang)筋(jin)(jin)(jin)舒筋(jin)(jin)(jin)，止腰(yao)(yao)(yao)(yao)(yao)(yao)(yao)膝(xi)(xi)酸(suan)麻，破(po)瘀(yu)人流。”上(shang)四味(wei)均能補(bu)(bu)(bu)(bu)脾(pi)腎(shen)(shen)，強(qiang)(qiang)筋(jin)(jin)(jin)絡(luo)(luo)，壯(zhuang)腰(yao)(yao)(yao)(yao)(yao)(yao)(yao)膝(xi)(xi)，止疼(teng)(teng)(teng)(teng)感，為(wei)(wei)(wei)(wei)改(gai)善(shan)(shan)脾(pi)腎(shen)(shen)虧(kui)虛，腰(yao)(yao)(yao)(yao)(yao)(yao)(yao)膝(xi)(xi)痛(tong)(tong)(tong)感的(de)(de)適(shi)宜(yi)組合。“痛(tong)(tong)(tong)則堵塞，通則不(bu)(bu)太疼(teng)(teng)(teng)(teng)。”改(gai)善(shan)(shan)寒濕(shi)(shi)(shi)(shi)(shi)腰(yao)(yao)(yao)(yao)(yao)(yao)(yao)腿痛(tong)(tong)(tong)，出(chu)了上(shang)述(shu)情況之(zhi)(zhi)(zhi)補(bu)(bu)(bu)(bu)后期(qi)性，強(qiang)(qiang)后期(qi)，益(yi)脾(pi)腎(shen)(shen)，祛(qu)(qu)(qu)痰(tan)(tan)(tan)(tan)(tan)濁(zhuo)之(zhi)(zhi)(zhi)下，舒筋(jin)(jin)(jin)活(huo)血(xue)(xue)化(hua)淤化(hua)瘀(yu)通絡(luo)(luo)鎮(zhen)痛(tong)(tong)(tong)亦為(wei)(wei)(wei)(wei)必用之(zhi)(zhi)(zhi)藥。方(fang)中(zhong)(zhong)醋延胡索辛(xin)散(san)(san)(san)溫(wen)(wen)(wen)通，舒筋(jin)(jin)(jin)活(huo)血(xue)(xue)化(hua)淤化(hua)瘀(yu)行(xing)氣，為(wei)(wei)(wei)(wei)治氣滯血(xue)(xue)瘀(yu)，諸(zhu)種痛(tong)(tong)(tong)感之(zhi)(zhi)(zhi)上(shang)品。《本(ben)(ben)(ben)草(cao)綱目》謂其(qi)：“延胡索，能行(xing)血(xue)(xue)中(zhong)(zhong)氣滯，氣中(zhong)(zhong)血(xue)(xue)滯，故針對一套前(qian)后諸(zhu)痛(tong)(tong)(tong)。”土(tu)鱉蟲破(po)血(xue)(xue)逐(zhu)瘀(yu)，續筋(jin)(jin)(jin)接骨(gu)(gu)(gu)，為(wei)(wei)(wei)(wei)治骨(gu)(gu)(gu)裂(lie)筋(jin)(jin)(jin)傷，瘀(yu)皮下出(chu)血(xue)(xue)痛(tong)(tong)(tong)之(zhi)(zhi)(zhi)要(yao)藥。烏梢(shao)蛇祛(qu)(qu)(qu)風(feng)邪，透(tou)軟骨(gu)(gu)(gu)，通經(jing)絡(luo)(luo)，止疼(teng)(teng)(teng)(teng)感，為(wei)(wei)(wei)(wei)治類風(feng)濕(shi)(shi)(shi)(shi)(shi)骨(gu)(gu)(gu)痛(tong)(tong)(tong)頑(wan)痹(bi)，無知覺拘攣之(zhi)(zhi)(zhi)妙品，配(pei)土(tu)鱉蟲取其(qi)蟲藥搜剔，祛(qu)(qu)(qu)風(feng)通絡(luo)(luo)之(zhi)(zhi)(zhi)功(gong)。諸(zhu)藥配(pei)伍，共奏(zou)補(bu)(bu)(bu)(bu)脾(pi)腎(shen)(shen)，強(qiang)(qiang)筋(jin)(jin)(jin)絡(luo)(luo)，祛(qu)(qu)(qu)寒邪，祛(qu)(qu)(qu)類風(feng)濕(shi)(shi)(shi)(shi)(shi)骨(gu)(gu)(gu)痛(tong)(tong)(tong)，祛(qu)(qu)(qu)痰(tan)(tan)(tan)(tan)(tan)濁(zhuo)，逐(zhu)瘀(yu)血(xue)(xue)，通經(jing)絡(luo)(luo)，止疼(teng)(teng)(teng)(teng)感之(zhi)(zhi)(zhi)功(gong)，準確把握(wo)寒濕(shi)(shi)(shi)(shi)(shi)腰(yao)(yao)(yao)(yao)(yao)(yao)(yao)腿痛(tong)(tong)(tong)之(zhi)(zhi)(zhi)病機，故效果更為(wei)(wei)(wei)(wei)明顯。（魏賀(he)峰(feng) 河北省(sheng)省(sheng)汝南縣(xian)中(zhong)(zhong)醫(yi)藥學院）

　　（注：本文(wen)所載藥(yao)方和診治辦(ban)法請在專家(jia)輔導下(xia)利用。）