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1、痹者闭也，又有不得自如之义。内经云：风寒湿三气杂 至合而为痹。而风寒湿三气之侵于人也，又因各气之多寡轻 重之不同，又分而为三。（二）寒气胜，则为痛痹。其痛有定处，如四肢、肩臂、腰 膝等各关节之疼痛，肿或不肿。脉多浮迟，或沉涩，五积散 主之。内经又有五痹，五脏痹，肠痹，胞痹，周痹，众痹；金匮有 湿痹，风痹，血痹，胸痹，黄汗历节。在各方书中，又有痛 风，白虎风，鹤膝风，及四肢肩臂腰膝等。各关节疼痛，均 系由于风寒湿三气之侵所致。内经痹论篇云，其入脏者死。 故将五脏痹，及不常见之痹症，暂为省略，兹将临床常见之 痹症，分列于后，以作参考。金匮云：“太阳病一身关节疼痛而烦，脉沉而细者，此名湿痹， 此症可
2、发汗。惟须取微似汗，不宜大发汗。若汗大出者，但 风去湿气在，故不能愈也。若治风湿者，发其汗只微微似出 者，风湿俱去也。麻黄加术汤主之。”风湿有由外感所引起者，如坐卧卑湿，过河涉水，猝受雨露， 或当风取凉。亦有内伤者，如正气虚亏，湿邪凑之，久而始 觉。其症头胀痛，发热，恶寒，身重疼痛，胸闷不知饥渴。其脉濡缓舌苔白，面色黄，汗出恶风者，防己黄芪汤主之。若无汗，日晡热甚者，麻黄杏仁薏苡甘草汤主之。胸痹金匮云：胸之病，喘息欬唾，胸背俱痛，气短。扣脉沉而迟， 关上小紧数者，栝蒌韭白白酒汤或栝蒌韭白半夏汤并主之。若心中痞气，气结在胸，胸满胁下逆抢心者，枳实韭白桂枝 汤主之，人参汤亦主之。痛风行走各肢节，经
3、称贼风，即被贼风所侵袭。其新受邪者， 脉浮紧，头痛，恶寒，发热，五积散主之。若外邪少而体虚 弱者，驱风行血四物汤主之。白虎风，有名为白虎历节风，有方书以痛风名为白虎风，本 节以白虎风与痛风症，在症治上略有不同，故另列之。白虎 风，其痛如虎咬故名。其症昼伏夜出（此与痛风不同者），有抽掣者多寒，有肿者多湿，有汗者多风，以虎骨秦艽汤依 症加减治之。胫腿枯细而膝头肿大，此系风寒湿三气，着于膝关节而成， 形同鹤膝，故名，初起头痛，发热，表症者重者五积散主之， 若痢后病变鹤膝风者，亦主之。其久病体虚渐变此症者，宜 十全大补酌加附子、牛膝、杜仲、羌活、防风等品温通之。 若痛甚者，赶痛散主之。东垣云：“经气虚
4、则风寒湿三气之邪客之， 痛病生矣。其腰痛 有不能俯仰转侧，与转摇运动者。盖腰痛多有肾虚所起，但 不仅只是风寒湿之痹症”，而本节只就痹症论之，以下臂痛肩 背痛等亦同此。臂痛臂为风寒湿三气所侵袭， 或内蕴风湿等邪，因提重物所引起， 以致臂痛不能举，有肿有不肿者。茯苓丸主之。肩背感受风寒湿而疼痛，不能回顾者，蠲痹汤主之。可酌加 桂枝、桑枝、薄荷等品颇效。内经云：“风寒湿气客于外分肉之间，迫切而为沫得寒则聚， 聚则排分肉而分裂，分裂则痛也。”本节所论痹症疼痛之原因，似专指行痹之风寒湿三气集聚在 肌肉者，其在关节者，亦系三气集聚在筋膜间者也。其所谓 沫者，即水蒸气（湿气）之意，水蒸气遇冷则凝为水，水蒸
5、气，若在分肉或筋膜之间，其两面之神精被压迫即感疼痛， 或因运动则神精被压更甚，故其疼痛亦必更剧也。关于痹症虽如上述，至所列各症之处方，均系由金匮要略及 各方书中所摘录，不敢言某方有效无效，有待同仁共同加以 研究，验证于临床。临床上对于行痹或腰腿疼痛等症，试用较为有效的经验方为 仙灵木瓜汤，桂枝地龙汤二方，录列于后以备试用。又以方 书中，关于治疗风寒湿症及腰背肩臂四肢关节疼痛等症集方 一百个，统计其用药次数，并将其祛风，除湿，调气，活血， 止痛，引经，和中等药，附以符号，录列于后，以备选用， 希同仁试用之。羌活二钱防风二钱葛根二钱秦艽三钱桂枝三钱黄苓二钱生姜三片血余炭、贯众各等份为末，面糊为丸，
6、每服二钱至三钱，黄酒送下。苍术八钱麻黄五钱陈皮五钱枳壳五钱干姜四钱 各味共研末，每服三四钱，用生姜三片葱白三根水煎去渣送服，重者日服二次，此方适于初患新邪者。苍术三钱 白术三钱泽泻二钱羌活二钱陈皮二钱 神效黄芪汤甘草一钱麻黄三钱桂枝二钱杏仁炒研三钱 炙甘草二钱 白术五钱麻黄杏仁薏苡甘草汤水煎服分三次，有微汗避风。炙甘草二钱 炮附子三钱 白术三钱 桂枝四钱，栝蒌韭白白酒汤加水煎分三次服。枳实三钱厚朴三钱韭白三钱桂枝一钱全栝蒌一两驱风行血四物汤炙甘草二钱虎骨秦艽汤骨碎补二钱广木香一钱赶痛散各等份为末，每服三钱，黄酒送下。桂枝白芍知母汤白术五钱 知母四钱防风四钱炮附子二钱白术（或苍术）四钱云苓四钱干
7、姜二钱炙甘草二钱白术二两 赤苓二两山药一两白芍三两肉桂二两法夏一两 黄芪三两生地一两蠲痹汤片姜黄二钱仙灵脾四钱 木瓜三钱 牛膝四钱 马钱子二个（制净） 秦艽三钱 甘草梢二钱桂枝地龙汤（验方）制附子三钱 杜仲三钱 炙甘草三钱 秦艽三钱 千年健 钱半水煎分三次服。 此方对于有心脏病之风湿关节疼痛，较为 适应。治遊风疹方（即荨麻疹俗称鬼风疙瘩）芥穗二钱 防风二钱 当归三钱 蝉蜕钱半 银花三钱 生石膏五钱 水煎服。关于痹症集方一百个统计其用药次数如下药性<td width="66" valign="top" style="width:49.35p
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18、lt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">调气<td width="72" valign="top" style="width:54.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-
19、border-top-alt:solidwindowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">人参<td width="48" valign="top" style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid wind
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23、pt;height:31.5pt">柴胡<td width="48" valign="top" style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solidwindowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-bord
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26、;mso-border-bottom-alt:solidwindowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:31.5pt">肉桂<td width="48" valign="top" style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:s
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32、 windowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">止痛<td width="60" valign="top" style="width:45.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-t
33、op-alt:solidwindowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">没药<td width="48" valign="top" style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1
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36、owtext1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solidwindowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">芍药<td width="48" valign="top" style="width:36.0pt;borde
37、r-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solidwindowtext 1.0pt;mso-border-top-alt:solidwindowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">24<td width="48" v
38、align="top" style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solidwindowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;h
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40、lt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">泽泻<td width="48" valign="top" style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solidwindowtext .5pt;m
41、so-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">13<td width="48" valign="top" style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windo
42、wtext 1.0pt;mso-border-top-alt:solidwindowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">驱寒<td width="60" valign="top" style="width:45.0pt;border-top:none;border-left:none;border-b
43、ottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solidwindowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">川乌<td width="48" valign="top" style="w
44、idth:36.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solidwindowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">10<td widt
45、h="54" valign="top" style="width:40.65pt;border:solid windowtext 1.0pt;border-top:none;mso-border-top-alt:solidwindowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:31.5pt">调气<td width="66" valign="top" style=&
46、quot;width:49.35pt;border-top:none;border-left:none;border-bottom:solid windowtext1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solidwindowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">陈皮<t
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48、ing:0cm 5.4pt0cm 5.4pt;height:31.5pt">19<td width="48" valign="top" style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solidwindowtext .5pt;mso-border-left-alt:solid wind
49、owtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">除湿<td width="72" valign="top" style="width:54.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-al
50、t:solidwindowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">茯苓<td width="48" valign="top" style="width:36.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;
51、border-right:solid windowtext 1.0pt;mso-border-top-alt:solidwindowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">13<td width="48" valign="top" style="width:36.0pt;border-top:none;b
52、order-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solidwindowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt0cm 5.4pt;height:31.5pt">驱寒<td width="60" valign="top" style="width:45.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top-alt:solidwindowtext .5pt;mso-border-left-alt:solid windowtext .5pt;ms