| 1 | |
| 00:00:00,168 --> 00:00:8,242 | |
| 第六点呢跟大家汇报一点我的自己的感悟就是说沥肝气补肝阳调营卫何寤寐 | |
| 2 | |
| 00:00:8,694 --> 00:00:15,918 | |
| 这个是用桂枝桂枝汤的一个基本的一个想法跟思路不一定对仅供大家参考 | |
| 3 | |
| 00:00:15,918 --> 00:00:19,215 | |
| 第一个桂枝汤为什么立肝气补肝牙 | |
| 4 | |
| 00:00:19,215 --> 00:00:22,601 | |
| 我们讲甘的情况之下经常只讲到了什么 | |
| 5 | |
| 00:00:22,601 --> 00:00:25,10 | |
| 只讲到了肝血虚 | |
| 6 | |
| 00:00:25,10 --> 00:00:26,151 | |
| 肝阴虚 | |
| 7 | |
| 00:00:26,151 --> 00:00:31,527 | |
| 啊甚至今天我门诊的时候也有患者问我说我医生我是不是肝阴虚 | |
| 8 | |
| 00:00:31,527 --> 00:00:33,755 | |
| 但是很少提到是肝 | |
| 9 | |
| 00:00:33,755 --> 00:00:37,148 | |
| 阳虚其实阴阳气血 | |
| 10 | |
| 00:00:37,148 --> 00:00:40,241 | |
| 它是相互对立的它一定是存在的 | |
| 11 | |
| 00:00:40,241 --> 00:00:43,574 | |
| 比如说本草纲目说贵利肝肺气 | |
| 12 | |
| 00:00:43,574 --> 00:00:47,888 | |
| 留周老也讲到说桂枝细辛通阳疏肝以上寒 | |
| 13 | |
| 00:00:48,36 --> 00:00:49,28 | |
| 爸 | |
| 14 | |
| 00:00:49,28 --> 00:00:54,99 | |
| 找云博警官实验录理中说桂枝汤的功能疏肝补脾者也 | |
| 15 | |
| 00:00:54,166 --> 00:00:57,975 | |
| 被桂枝汤它其实有疏肝有补脾的这么一种 | |
| 16 | |
| 00:00:57,975 --> 00:00:59,931 | |
| 那为什么说他补肝阳呢 | |
| 17 | |
| 00:00:59,931 --> 00:01:03,703 | |
| 他首先讲的疏肝 | |
| 18 | |
| 00:01:03,703 --> 00:01:05,559 | |
| 也是跟这个桂枝跟 | |
| 19 | |
| 00:01:05,559 --> 00:01:08,50 | |
| 跟这个柴胡跟细心有什么区别呢 | |
| 20 | |
| 00:01:08,50 --> 00:01:15,07 | |
| 我说简单地理解就是一个是凉风来治疗气滞一个热风来治疗寒滞 | |
| 21 | |
| 00:01:15,07 --> 00:01:16,68 | |
| 都是质 | |
| 22 | |
| 00:01:16,68 --> 00:01:18,32 | |
| 但是寒症属性不一样 | |
| 23 | |
| 00:01:18,591 --> 00:01:22,783 | |
| 肝胆组疏泄疏泄诗书就有太过根不足 | |
| 24 | |
| 00:01:22,783 --> 00:01:24,273 | |
| 太过实证 | |
| 25 | |
| 00:01:24,273 --> 00:01:26,720 | |
| 肝气郁结玉油矿物肝阳妄动 | |
| 26 | |
| 00:01:26,720 --> 00:01:30,127 | |
| 先郁郁寡欢然后暴躁最后登高 | |
| 27 | |
| 00:01:30,127 --> 00:01:31,711 | |
| 歌弃医而走 | |
| 28 | |
| 00:01:31,711 --> 00:01:33,758 | |
| 这就是肝气气的三个 | |
| 29 | |
| 00:01:33,758 --> 00:01:35,88 | |
| 实证的三个 | |
| 30 | |
| 00:01:35,88 --> 00:01:39,536 | |
| 不同的层次虚症必然也涉及到阴阳气血 | |
| 31 | |
| 00:01:39,536 --> 00:01:43,465 | |
| 而这个肝阳尤其容易被我们所忽视的 | |
| 32 | |
| 00:01:43,465 --> 00:01:47,484 | |
| 至今为止讲到甘阳虚的文献仍然非常少 | |
| 33 | |
| 00:01:47,484 --> 00:01:49,794 | |
| 但是肝者为八级之本 | |
| 34 | |
| 00:01:50,65 --> 00:01:54,934 | |
| 骂急资本它就跟疲劳没有力不能只要有明显的关系 | |
| 35 | |
| 00:01:54,934 --> 00:01:57,733 | |
| 甘为尽管为将军之官但 | |
| 36 | |
| 00:01:57,733 --> 00:02:04,104 | |
| 历史上出现女无能的将军其实也是屡见不鲜的对不对 | |
| 37 | |
| 00:02:04,104 --> 00:02:07,92 | |
| 肝阳不足它有什么样的表现呢 | |
| 38 | |
| 00:02:07,276 --> 00:02:08,810 | |
| 不能谋虑了 | |
| 39 | |
| 00:02:08,810 --> 00:02:10,797 | |
| 优柔寡断的是不是 | |
| 40 | |
| 00:02:10,797 --> 00:02:12,139 | |
| 然后 | |
| 41 | |
| 00:02:12,139 --> 00:02:15,306 | |
| 肝主筋它的筋腱失于温煦呢 | |
| 42 | |
| 00:02:15,306 --> 00:02:17,321 | |
| 谎种不收 | |
| 43 | |
| 00:02:17,321 --> 00:02:18,154 | |
| 所以 | |
| 44 | |
| 00:02:18,154 --> 00:02:19,35 | |
| 能 | |
| 45 | |
| 00:02:19,35 --> 00:02:21,779 | |
| 能躺着不坐着能坐着不站着 | |
| 46 | |
| 00:02:21,779 --> 00:02:25,376 | |
| 在这种情况那么有些时候我们就会 | |
| 47 | |
| 00:02:25,376 --> 00:02:32,802 | |
| 跟这个脾气去做健脾虚去做鉴面但脾气脾胃的问题在胃肠道的反应会更多一点 | |
| 48 | |
| 00:02:32,802 --> 00:02:36,259 | |
| 水在这种情况之下调和营卫补干健脾 | |
| 49 | |
| 00:02:36,259 --> 00:02:40,645 | |
| 理中内经讲的摔着补之损则温值 | |
| 50 | |
| 00:02:40,645 --> 00:02:41,465 | |
| 喝 | |
| 51 | |
| 00:02:41,465 --> 00:02:43,912 | |
| 这个行不足者 | |
| 52 | |
| 00:02:43,912 --> 00:02:52,521 | |
| 温之以气以及甘苦及急食甘以缓之所以我们在桂枝汤的基础之上加上其竹 | |
| 53 | |
| 00:02:52,521 --> 00:02:53,476 | |
| 弃医 | |
| 54 | |
| 00:02:53,476 --> 00:02:56,731 | |
| 首乌鹿茸等等像这样去 | |
| 55 | |
| 00:02:56,731 --> 00:02:58,69 | |
| 补他的肝 | |
| 56 | |
| 00:02:59,576 --> 00:03:01,221 | |
| 那么这个 | |
| 57 | |
| 00:03:01,221 --> 00:03:03,85 | |
| 桂枝当具调和营卫 | |
| 58 | |
| 00:03:03,85 --> 00:03:05,597 | |
| 治疗营卫不和不是说只有桂枝汤 | |
| 59 | |
| 00:03:05,597 --> 00:03:07,633 | |
| 俺用桂枝当句调和营卫 | |
| 60 | |
| 00:03:07,633 --> 00:03:08,535 | |
| 那么他 | |
| 61 | |
| 00:03:08,535 --> 00:03:22,917 | |
| 还需要有很多的加减的方法比如说肝阳虚肝阳虚七实我们是不主张你直接用理中或者附子理 | |
| 中去治疗的因为在这种情况之下就跟当归势利汤一样的甘维将军之官 | |
| 62 | |
| 00:03:22,917 --> 00:03:25,990 | |
| 将军之官你是不能硬碰硬的 | |
| 63 | |
| 00:03:25,990 --> 00:03:29,231 | |
| 要柔肝养肝气温润与肝 | |
| 64 | |
| 00:03:29,231 --> 00:03:30,662 | |
| 温润以肝 | |
| 65 | |
| 00:03:31,473 --> 00:03:34,685 | |
| 在里面尤其要提到的一个药就是黄芪 | |
| 66 | |
| 00:03:35,277 --> 00:03:37,477 | |
| 搬起甘温益气健脾 | |
| 67 | |
| 00:03:37,477 --> 00:03:39,111 | |
| 还其性 | |
| 68 | |
| 00:03:39,111 --> 00:03:41,81 | |
| 温上升不易干扰 | |
| 69 | |
| 00:03:41,81 --> 00:03:47,650 | |
| 最张锡纯在医学中山西渡里面就说肝属木儿应春生提气温而性条达 | |
| 70 | |
| 00:03:47,650 --> 00:04:03,450 | |
| 黄芪性温的上升以致补肝原有铜气相求之妙友与之林阵以来防御肝气细虚弱不能调达用一切 | |
| 补干之药皆不效又重用黄芪为主少佐气之饼扶之付被而减效应 | |
| 71 | |
| 00:04:03,450 --> 00:04:04,545 | |
| 所以 | |
| 72 | |
| 00:04:04,545 --> 00:04:07,431 | |
| 张锡纯就特喜欢用什么用 | |
| 73 | |
| 00:04:07,431 --> 00:04:09,35 | |
| 这这段话 | |
| 74 | |
| 00:04:09,522 --> 00:04:12,828 | |
| 自动化回答两个问题第一个 | |
| 75 | |
| 00:04:12,828 --> 00:04:17,145 | |
| 肝气虚弱不能调达用这个什么来补肝阳 | |
| 76 | |
| 00:04:17,145 --> 00:04:24,157 | |
| 用黄芪以铸肝胆之阳气作以桂直之新温更有开通之利 | |
| 77 | |
| 00:04:24,157 --> 00:04:28,623 | |
| 这我们是后来在查文献的时候才发现原来 | |
| 78 | |
| 00:04:28,623 --> 00:04:29,510 | |
| 大家有 | |
| 79 | |
| 00:04:29,510 --> 00:04:36,945 | |
| 这个异曲同工之妙都是在桂枝汤的基础之上加黄芪或者桂枝加黄芪来相配来去治疗 | |
| 80 | |
| 00:04:36,945 --> 00:04:38,83 | |
| 肝阳不足 | |
| 81 | |
| 00:04:38,83 --> 00:04:38,951 | |
| 情况 | |
| 82 | |
| 00:04:39,18 --> 00:04:40,143 | |
| 那么 | |
| 83 | |
| 00:04:40,525 --> 00:04:44,57 | |
| 安龙庄在血证录里面也说肝经气虚 | |
| 84 | |
| 00:04:44,57 --> 00:04:46,691 | |
| 藏含魂阙精神好善 | |
| 85 | |
| 00:04:46,691 --> 00:04:57,814 | |
| 所以大家看到肝阳虚其实在精神类的疾病在心理障碍性的疾病它非常重要的位置的只是说我 | |
| 们现在还没那么对它认可还没那么 | |
| 86 | |
| 00:04:57,814 --> 00:05:00,288 | |
| 这个深刻但是 | |
| 87 | |
| 00:05:00,288 --> 00:05:02,647 | |
| 这个我们一直都是这么提的 | |