苓桂(gui)術甘湯出自于醫圣張仲景《傷(shang)寒雜(za)病(bing)論(lun)》，由茯苓、桂(gui)枝、白術、炙(zhi)甘草(cao)分(fen)為，更具益氣活血(xue)化(hua)飲，補脾利水的(de)功效(xiao)與(yu)作用，專冶水濕之氣而致之病(bing)。

寒(han)濕腿痛(tong)(tong)系脾(pi)(pi)腎虧虛(xu)，外受寒(han)濕，致經(jing)絡阻(zu)滯，氣血虛(xu)不(bu)暢，痰(tan)(tan)瘀互結(jie)(jie)引起，其主要(yao)病機為脾(pi)(pi)腎虧虛(xu)，痰(tan)(tan)瘀互結(jie)(jie)，與苓桂術甘湯的(de)脾(pi)(pi)陽不(bu)到(dao)，痰(tan)(tan)飲內停方證(zheng)病機相關。按(an)照醫(yi)學(xue)醫(yi)生(sheng)針灸(jiu)醫(yi)生(sheng)學(xue)異病同治(zhi)思維模式，臨證(zheng)將(jiang)痰(tan)(tan)飲證(zheng)的(de)苓桂術甘湯加減用在診治(zhi)寒(han)濕腿痛(tong)(tong)，取效甚捷。盛福小編我的(de)榮(rong)幸追隨安徽醫(yi)學(xue)醫(yi)生(sheng)針灸(jiu)醫(yi)生(sheng)藥(yao)二本大(da)學(xue)所屬駐(zhu)馬店市醫(yi)學(xue)醫(yi)生(sheng)針灸(jiu)醫(yi)生(sheng)院辦公室主任醫(yi)學(xue)醫(yi)生(sheng)針灸(jiu)醫(yi)生(sheng)師劉天驥借鑒，開始反擊良多(duo)，現分享到(dao)其用苓桂術甘湯加味診治(zhi)腿痛(tong)(tong)體力。

　　胡某(mou)，男，48歲，陜西駐馬店人，2016年9月6日(ri)初診(zhen)(zhen)(zhen)。主訴腰(yao)疼(teng)(teng)腿疼(teng)(teng)一年余。一年前一次性工作汗(han)出(chu)后(hou)，突遇(yu)雨淋(lin)，程序實現(xian)感腰(yao)腹部(bu)位重著(zhu)(zhu)引(yin)發(fa)痛(tong)苦(ku)，經(jing)各地診(zhen)(zhen)(zhen)所(suo)MRI進行檢查為椎(zhui)間盤間盤突顯出(chu)癥(zheng)，經(jing)治而愈（基(ji)本制療不(bu)(bu)祥(xiang)）。隨(sui)后(hou)，每遇(yu)過(guo)勞(lao)(lao)或季節波動即使得腰(yao)疼(teng)(teng)腿疼(teng)(teng)，雖經(jing)針(zhen)灸、針(zhen)灸理療等(deng)引(yin)發(fa)痛(tong)苦(ku)減輕癥(zheng)狀，但最終不(bu)(bu)可以(yi)恢復。刻診(zhen)(zhen)(zhen)：腰(yao)腹部(bu)位冷痛(tong)，酸脹重著(zhu)(zhu)發(fa)木，延及右髖及右雙(shuang)下肢(zhi)亦引(yin)發(fa)痛(tong)苦(ku)發(fa)木，屈伸不(bu)(bu)便(bian)，很難轉側，遇(yu)勞(lao)(lao)或寒流來(lai)襲、陰陰雨天加料(liao)。舌質淡，苔白厚(hou)，脈沉(chen)緊。

　　中醫婦科臨(lin)床診斷：寒(han)濕腰疼腿疼（外(wai)感寒(han)濕，痰瘀互(hu)結）。

　　治法：健(jian)腎壯腰，補脾加濕，祛瘀止(zhi)咳化(hua)痰，溫經(jing)通絡。

　　治理：茯苓20克(ke)(ke)，桂枝15克(ke)(ke)，白術30克(ke)(ke)，炙甘草10克(ke)(ke)，鹽杜仲15克(ke)(ke)，川(chuan)(chuan)斷15克(ke)(ke)，酒烏(wu)梢蛇15克(ke)(ke)，醋延胡索15克(ke)(ke)，狗脊15克(ke)(ke)，土元6克(ke)(ke)，川(chuan)(chuan)牛膝6克(ke)(ke)。7劑，日一劑。

　　-10月14日二診：藥后(hou)隱痛減少，發木酸脹(zhang)涼感稍減。守(shou)頂(ding)部(bu)白術加至(zhi)45克(ke)，狗脊(ji)30克(ke)，7劑，服法同前。

　　9月(yue)23日三診：藥后以上(shang)所述諸癥均較(jiao)前降(jiang)低，但無(wu)知覺感減問(wen)題(ti)言，下方加黃芪30克繼服。至16月(yue)8日，共再服7周，腰腿痛(tong)苦(ku)無(wu)知覺感全消(xiao)而告愈。一整年內隨(sui)訪未再發作(zuo)。

　　按：苓桂(gui)術(shu)甘(gan)(gan)湯加味(wei)(wei)方(fang)中(zhong)(zhong)(zhong)(zhong)，茯(fu)苓既(ji)(ji)健(jian)脾(pi)(pi)(pi)養(yang)胃(wei)(wei)胃(wei)(wei)養(yang)胃(wei)(wei)又利水(shui)滲濕(shi)(shi)，使(shi)濕(shi)(shi)無(wu)所聚，痰(tan)(tan)無(wu)由生(sheng)(sheng)(sheng)，既(ji)(ji)消已聚之(zhi)(zhi)(zhi)飲(yin)(yin)，又杜(du)生(sheng)(sheng)(sheng)痰(tan)(tan)之(zhi)(zhi)(zhi)源(yuan)。《世(shi)補(bu)(bu)齋醫書》中(zhong)(zhong)(zhong)(zhong)云：“茯(fu)苓一種(zhong)(zhong)(zhong)，為(wei)(wei)治(zhi)(zhi)(zhi)(zhi)(zhi)痰(tan)(tan)主(zhu)藥(yao)(yao)(yao)。痰(tan)(tan)之(zhi)(zhi)(zhi)本(ben)，水(shui)也(ye)(ye)，茯(fu)苓會行(xing)(xing)水(shui)；痰(tan)(tan)之(zhi)(zhi)(zhi)動(dong)，濕(shi)(shi)也(ye)(ye)，茯(fu)苓會行(xing)(xing)濕(shi)(shi)。”桂(gui)枝(zhi)辛(xin)(xin)溫(wen)，助陽化(hua)(hua)(hua)氣(qi)(qi)(qi)，益氣(qi)(qi)(qi)化(hua)(hua)(hua)瘀(yu)以(yi)(yi)(yi)化(hua)(hua)(hua)飲(yin)(yin)，可五水(shui)共(gong)(gong)治(zhi)(zhi)(zhi)(zhi)(zhi)濕(shi)(shi)不化(hua)(hua)(hua)，聚為(wei)(wei)痰(tan)(tan)飲(yin)(yin)之(zhi)(zhi)(zhi)證。《武漢藥(yao)(yao)(yao)解》表明：“桂(gui)枝(zhi)，入肝(gan)家而(er)行(xing)(xing)血(xue)(xue)(xue)分，定經(jing)(jing)(jing)絡(luo)(luo)(luo)而(er)達榮郁。善(shan)(shan)解風(feng)(feng)邪(xie)，最調(diao)木氣(qi)(qi)(qi)。升(sheng)清陽之(zhi)(zhi)(zhi)脫陷，降濁(zhuo)陰(yin)之(zhi)(zhi)(zhi)沖逆，舒筋(jin)(jin)脈(mo)之(zhi)(zhi)(zhi)急(ji)(ji)攣，利骨(gu)(gu)節(jie)之(zhi)(zhi)(zhi)壅阻，入肝(gan)膽而(er)散遏(e)抑，極解痛(tong)(tong)(tong)楚，走經(jing)(jing)(jing)絡(luo)(luo)(luo)而(er)開(kai)痹(bi)(bi)澀(se)，甚抽(chou)濕(shi)(shi)寒(han)(han)(han)(han)。”脾(pi)(pi)(pi)養(yang)家糊口痰(tan)(tan)之(zhi)(zhi)(zhi)源(yuan)，脾(pi)(pi)(pi)虛(xu)水(shui)濕(shi)(shi)衰弱(ruo)，聚而(er)滋生(sheng)(sheng)(sheng)痰(tan)(tan)飲(yin)(yin)。白術(shu)補(bu)(bu)氣(qi)(qi)(qi)健(jian)脾(pi)(pi)(pi)養(yang)胃(wei)(wei)胃(wei)(wei)養(yang)胃(wei)(wei)溫(wen)其(qi)(qi)源(yuan)，燥濕(shi)(shi)利水(shui)開(kai)其(qi)(qi)流(liu)(liu)，故為(wei)(wei)治(zhi)(zhi)(zhi)(zhi)(zhi)痰(tan)(tan)喝水(shui)腫天(tian)然滋補(bu)(bu)品。黃(huang)宮繡大(da)(da)贊其(qi)(qi)為(wei)(wei)：“脾(pi)(pi)(pi)臟補(bu)(bu)氣(qi)(qi)(qi)一要藥(yao)(yao)(yao)。”炙甘(gan)(gan)草(cao)(cao)甘(gan)(gan)平，配桂(gui)枝(zhi)以(yi)(yi)(yi)辛(xin)(xin)甘(gan)(gan)化(hua)(hua)(hua)陽，助苓術(shu)祛(qu)濕(shi)(shi)祛(qu)痰(tan)(tan)。上四味(wei)(wei)為(wei)(wei)苓桂(gui)術(shu)甘(gan)(gan)湯，功(gong)(gong)(gong)(gong)較益氣(qi)(qi)(qi)化(hua)(hua)(hua)瘀(yu)化(hua)(hua)(hua)飲(yin)(yin)，健(jian)脾(pi)(pi)(pi)養(yang)胃(wei)(wei)胃(wei)(wei)養(yang)胃(wei)(wei)利水(shui)，為(wei)(wei)治(zhi)(zhi)(zhi)(zhi)(zhi)痰(tan)(tan)飲(yin)(yin)主(zhu)方(fang)，同樣(yang)是“病痰(tan)(tan)飲(yin)(yin)者，當以(yi)(yi)(yi)溫(wen)藥(yao)(yao)(yao)和之(zhi)(zhi)(zhi)。”的(de)實(shi)際上廣泛(fan)應用(yong)(yong)。腰為(wei)(wei)腎(shen)(shen)(shen)(shen)之(zhi)(zhi)(zhi)府，故治(zhi)(zhi)(zhi)(zhi)(zhi)腰必養(yang)腎(shen)(shen)(shen)(shen)。方(fang)中(zhong)(zhong)(zhong)(zhong)杜(du)仲補(bu)(bu)腎(shen)(shen)(shen)(shen)功(gong)(gong)(gong)(gong)能(neng)(neng)(neng)，強(qiang)骨(gu)(gu)筋(jin)(jin)，為(wei)(wei)治(zhi)(zhi)(zhi)(zhi)(zhi)腎(shen)(shen)(shen)(shen)功(gong)(gong)(gong)(gong)能(neng)(neng)(neng)缺乏，腰膝(xi)(xi)(xi)酸脹之(zhi)(zhi)(zhi)要藥(yao)(yao)(yao)，《神(shen)農本(ben)草(cao)(cao)經(jing)(jing)(jing)》謂(wei)其(qi)(qi)：“主(zhu)腰脊(ji)痛(tong)(tong)(tong)”。續斷甘(gan)(gan)以(yi)(yi)(yi)補(bu)(bu)虛(xu)，溫(wen)以(yi)(yi)(yi)助陽，辛(xin)(xin)以(yi)(yi)(yi)散瘀(yu)，包括(kuo)補(bu)(bu)益腎(shen)(shen)(shen)(shen)功(gong)(gong)(gong)(gong)能(neng)(neng)(neng)，強(qiang)筋(jin)(jin)壯骨(gu)(gu)，通(tong)利精(jing)血(xue)(xue)(xue)之(zhi)(zhi)(zhi)功(gong)(gong)(gong)(gong)，治(zhi)(zhi)(zhi)(zhi)(zhi)腎(shen)(shen)(shen)(shen)功(gong)(gong)(gong)(gong)能(neng)(neng)(neng)缺乏，腰膝(xi)(xi)(xi)酸脹，常與杜(du)仲相伍以(yi)(yi)(yi)提效(xiao)。狗(gou)脊(ji)既(ji)(ji)補(bu)(bu)腎(shen)(shen)(shen)(shen)功(gong)(gong)(gong)(gong)能(neng)(neng)(neng)，強(qiang)骨(gu)(gu)筋(jin)(jin)，又祛(qu)風(feng)(feng)抽(chou)濕(shi)(shi)，通(tong)痹(bi)(bi)解痛(tong)(tong)(tong)，且善(shan)(shan)堅(jian)脊(ji)骨(gu)(gu)，腰疼脊(ji)強(qiang)非此莫除。《神(shen)農本(ben)草(cao)(cao)經(jing)(jing)(jing)》云其(qi)(qi)：“主(zhu)腰背強(qiang)，行(xing)(xing)政機關緩(huan)急(ji)(ji)，周痹(bi)(bi)，寒(han)(han)(han)(han)濕(shi)(shi)，膝(xi)(xi)(xi)痛(tong)(tong)(tong)，頗(po)利老(lao)大(da)(da)爺。”牛膝(xi)(xi)(xi)補(bu)(bu)腎(shen)(shen)(shen)(shen)功(gong)(gong)(gong)(gong)能(neng)(neng)(neng)，強(qiang)腰膝(xi)(xi)(xi)，化(hua)(hua)(hua)瘀(yu)通(tong)經(jing)(jing)(jing)，利骨(gu)(gu)節(jie)，善(shan)(shan)治(zhi)(zhi)(zhi)(zhi)(zhi)下處腰膝(xi)(xi)(xi)骨(gu)(gu)節(jie)酸脹等癥。《滇南本(ben)草(cao)(cao)》表明：“止(zhi)(zhi)骨(gu)(gu)筋(jin)(jin)痛(tong)(tong)(tong)，強(qiang)筋(jin)(jin)舒筋(jin)(jin)，止(zhi)(zhi)腰膝(xi)(xi)(xi)酸麻，破瘀(yu)意外(wai)流(liu)(liu)產。”上四味(wei)(wei)均能(neng)(neng)(neng)補(bu)(bu)腎(shen)(shen)(shen)(shen)功(gong)(gong)(gong)(gong)能(neng)(neng)(neng)，強(qiang)骨(gu)(gu)筋(jin)(jin)，壯腰膝(xi)(xi)(xi)，止(zhi)(zhi)各(ge)種(zhong)(zhong)(zhong)痛(tong)(tong)(tong)感(gan)(gan)，為(wei)(wei)中(zhong)(zhong)(zhong)(zhong)藥(yao)(yao)(yao)開(kai)展(zhan)腎(shen)(shen)(shen)(shen)功(gong)(gong)(gong)(gong)能(neng)(neng)(neng)虧虛(xu)，腰膝(xi)(xi)(xi)各(ge)種(zhong)(zhong)(zhong)痛(tong)(tong)(tong)感(gan)(gan)的(de)最優樂(le)隊組合(he)。“痛(tong)(tong)(tong)則不暢，通(tong)則不疼。”中(zhong)(zhong)(zhong)(zhong)藥(yao)(yao)(yao)開(kai)展(zhan)寒(han)(han)(han)(han)濕(shi)(shi)腰腿痛(tong)(tong)(tong)，除非上述之(zhi)(zhi)(zhi)補(bu)(bu)天(tian)先性(xing)，強(qiang)大(da)(da)后(hou)天(tian)，益腎(shen)(shen)(shen)(shen)功(gong)(gong)(gong)(gong)能(neng)(neng)(neng)，祛(qu)痰(tan)(tan)濁(zhuo)認(ren)知能(neng)(neng)(neng)力，化(hua)(hua)(hua)瘀(yu)通(tong)絡(luo)(luo)(luo)解痛(tong)(tong)(tong)亦(yi)為(wei)(wei)必用(yong)(yong)之(zhi)(zhi)(zhi)藥(yao)(yao)(yao)。方(fang)中(zhong)(zhong)(zhong)(zhong)醋延(yan)胡索(suo)辛(xin)(xin)散溫(wen)通(tong)，化(hua)(hua)(hua)瘀(yu)行(xing)(xing)氣(qi)(qi)(qi)，為(wei)(wei)治(zhi)(zhi)(zhi)(zhi)(zhi)氣(qi)(qi)(qi)滯(zhi)血(xue)(xue)(xue)瘀(yu)，諸(zhu)種(zhong)(zhong)(zhong)各(ge)種(zhong)(zhong)(zhong)痛(tong)(tong)(tong)感(gan)(gan)之(zhi)(zhi)(zhi)妙品。《本(ben)草(cao)(cao)綱目(mu)》謂(wei)其(qi)(qi)：“延(yan)胡索(suo)，能(neng)(neng)(neng)行(xing)(xing)血(xue)(xue)(xue)中(zhong)(zhong)(zhong)(zhong)氣(qi)(qi)(qi)滯(zhi)，氣(qi)(qi)(qi)中(zhong)(zhong)(zhong)(zhong)血(xue)(xue)(xue)滯(zhi)，故針對(dui)這身左右(you)兩諸(zhu)痛(tong)(tong)(tong)。”土(tu)鱉(bie)蟲(chong)破血(xue)(xue)(xue)逐瘀(yu)，續筋(jin)(jin)接(jie)骨(gu)(gu)，為(wei)(wei)治(zhi)(zhi)(zhi)(zhi)(zhi)骨(gu)(gu)裂(lie)筋(jin)(jin)傷(shang)，瘀(yu)積血(xue)(xue)(xue)痛(tong)(tong)(tong)之(zhi)(zhi)(zhi)要藥(yao)(yao)(yao)。烏梢蛇祛(qu)風(feng)(feng)邪(xie)，透骨(gu)(gu)節(jie)，通(tong)經(jing)(jing)(jing)絡(luo)(luo)(luo)，止(zhi)(zhi)各(ge)種(zhong)(zhong)(zhong)痛(tong)(tong)(tong)感(gan)(gan)，為(wei)(wei)治(zhi)(zhi)(zhi)(zhi)(zhi)骨(gu)(gu)質增生(sheng)(sheng)(sheng)頑痹(bi)(bi)，盲(mang)目(mu)拘攣之(zhi)(zhi)(zhi)妙品，配土(tu)鱉(bie)蟲(chong)取其(qi)(qi)蟲(chong)藥(yao)(yao)(yao)搜剔(ti)，祛(qu)風(feng)(feng)通(tong)絡(luo)(luo)(luo)之(zhi)(zhi)(zhi)功(gong)(gong)(gong)(gong)。諸(zhu)藥(yao)(yao)(yao)配伍，共(gong)(gong)奏補(bu)(bu)腎(shen)(shen)(shen)(shen)功(gong)(gong)(gong)(gong)能(neng)(neng)(neng)，強(qiang)骨(gu)(gu)筋(jin)(jin)，祛(qu)寒(han)(han)(han)(han)邪(xie)，祛(qu)骨(gu)(gu)質增生(sheng)(sheng)(sheng)，祛(qu)痰(tan)(tan)濁(zhuo)，逐瘀(yu)血(xue)(xue)(xue)，通(tong)經(jing)(jing)(jing)絡(luo)(luo)(luo)，止(zhi)(zhi)各(ge)種(zhong)(zhong)(zhong)痛(tong)(tong)(tong)感(gan)(gan)之(zhi)(zhi)(zhi)功(gong)(gong)(gong)(gong)，牢(lao)牢(lao)把握寒(han)(han)(han)(han)濕(shi)(shi)腰腿痛(tong)(tong)(tong)之(zhi)(zhi)(zhi)病機，故較果顯著(zhu)性(xing)。（魏賀(he)峰 上海省汝南縣中(zhong)(zhong)(zhong)(zhong)醫醫生(sheng)(sheng)(sheng)院(yuan)）

　　（注(zhu)：上面的介紹(shao)中所載藥方和中藥治療做(zuo)法請在中醫師教育指(zhi)導下(xia)適用。）