李可“肾四味”味重量轻取代重剂补肾

Doctor Li Ke's theory of tonifying kidney with four drugs

"肾四味"出自《李可老中医急危重症疑难病经验专辑》,"余常用之枸杞子,酒泡菟丝子,盐水补骨脂,仙灵脾;四药入肝肾,药性和平,温而不燥,润而不腻;益肾精,鼓肾气,温阳无桂附之弊,滋阴无熟地之弊;阴中有阳,阳中有阴,……上四味合盐巴戟肉、盐杜仲、骨碎补、川断、仙茅、沙苑子为‘肾十味’,对男女不育、骨质增生、老年前列腺退化性病变、更年期综合症等,随症选用,疗效满意"。枸杞子,菟丝子性平,补骨脂、淫羊藿性温,四味药整体微温,补骨脂、淫羊藿、菟丝子三味补肾阳,枸杞子补肾阴,阴阳双补,以阳为主,体现阴中求阳,阳中求阴,阳主阴从观念;以"润而不燥,滋而不腻"为原则精选补肾药。清吴鞠通《温病条辨》"治上焦如羽,非轻不举;治中焦如衡,非平不安;治下焦如权,非重不沉",从李老用药经验得到启发:此重是指药味重,既可是味重量重,亦可以味重量轻;以四味甚至十味补肾药配伍取代一两味重剂补肾,减轻滋肾阴药对脾胃的影响,补肾阳药的温燥之性,补充和完善"治下焦如权,非重不沉"补肾思路。减其制,杂化之,附验案五则。

The theory of tonifying kidney with four drugs comes from ＂LI Ke old doctor of traditional Chinese medicine of acute critical illness experience difficult disease album＂,I often prescribe Gouqizi,wine fried dodder,fructus psoraleae,epimedium.The four drugs＇ s Channel Tropism is the liver meridian and the kidney meridian,These medicines are quite mild,Wen Yang but not dry,nourishing but not greasy.They benefit kidney essence and tonify kidney,Wen Yang but no side effect like Cortex Cinnamomi or monkshood,nourishing Yin but no side effect like cooked rehmannia.Gouqizi and dodder are mild-natured,fructus psoraleae and epimedium are warm-natured.Overall,the four drugs are warm-natured.From the effect,Dodder fructus psoraleae and epimedium tonify kidney-yang,Gouqizi tonify kidney-yin.They tonify both yin and Yang,tonify mainly Yang.The theory reflects opinion of Reinforcing Yang from Yin,obtaining yang from yin,Being base on Yang and Yin following.Select drugs of tonifying kidney with the principle of ＂Wen Yang but not dry,nourishing but not greasy＂.Replace the one or two drugs with four drugs even ten drugs Chinese medicine of tonifying kidney,reduce the side effects of medicine of tonifying kidney.Supplement and perfect the ideas of ＂Treatment of the lower diseases like weight should use traditional Chinese medicine with rich and doses＂.Reduce the dosis and add the drugs. This theory is applied to clinical,curative effect is satisfactory.