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【本篇是：彭博士讲《黄帝内经》系列-精华篇-之五百零三。（更多精彩内容持续更新中……）】
“青，脈之至也。長而左右彈。有積氣在心下，肢胠。名曰肝痹。得之寒濕，與疝同法。腰痛足清頭痛。”——《黃帝內經·五藏生成篇》
听众朋友们大家好，我是中医彭鑫博士，今天我们继续讲解《黄帝内经·素问·五脏生成篇第十》，我们先来看原文∶“青，脉之至也。长而左右弹。有积气在心下，肢胠。名曰肝痹。得之寒湿，与疝同法。腰痛足清头痛。”这段话从字面上的意思来理解并不是很难。
我们先看“青，脉之至也”，也就是外面气色见到青色。“脉之至”就是脉来的时候长而左右弹，就是脉来颇长，而且左右弹指，把上脉之后，左边、右边，两侧都会弹指。这种情况就是病情积聚在心下。（今日头条@中医彭鑫博士）“胠”指的就是腋下到腰这个位置，就是我们老百姓所说的两肋这个地方。这个地方特别胀满，叫做肢胠。这种病名叫做肝痹。怎么得的呢？叫做“得之寒湿，与疝同法”，致病因素主要是受了寒湿，病理跟疝气相通。有什么症状呢？有腰痛、足冷、头痛这三个症状。清指的就是清冷，就是脚凉的意思。这些病组在一起，病名就叫做肝痹，就是肝气闭塞不通，肝气不能宣达这样一个病名和病机。
在这里我再带着大家的从头到尾把一些关键的地方带大家捋一遍，尤其是古代医家的注解。第一个叫做“长而左右弹”，弹指的是脉应指搏击，如弹人手。弹的意思就是脉摸上去之后，脉给你的反作用力就好像脉搏在弹你的手一样。《类经》里边注解∶“言两手俱长而弦强也”，张景岳认为脉象的表现就是两个手的脉都特别弦长，而且按上去像琴弦，非常强硬这种脉象。皇甫谧写的《针灸甲乙经》可以参考，皇甫谧有很多内容是从《素问》《灵枢经》当中直接抄录下来的。在这个地方《甲乙经》底下有一个字就是弦，也就是说长而左右弹弦，有一个弦字，也可以参考，指的脉不仅长，而且有特别弦。
“胠”，一个月字边，一个来去的去，本意指腋下的意思，《说文解字》里边注解∶“胠，腋下也”。《广雅·示亲》里边解释说：“胠，胁也”。胁指的也是腋下到腰这个位置。我们之前也学过《素问·咳论》里边讲的叫做“甚则不可以转，转则两胠下满”，如果是严重不可以转侧，转侧胁肋就会胀满，这就是“胠”字的含义。
大家可以这么理解，“胠”指的就是腋下胁下这个位置，其实就是肝经所过的位置。所以张介宾在《类经》里边注解∶“肝邪有余，故气积心下，及于肢胠，因成肝痹”。邪气要是有余就会积累在心下的位置，因此就成了肝痹。“得之寒湿”，与寒湿这种外邪有关系。“与疝同法”什么意思？疝就疝气的疝。张介宾在《类经》里边讲∶“得之寒湿而积于心下肢胠者，则为肝痹。积于小腹前阴者，则为疝气。总属厥阴之寒邪，故云与疝同法”。张介宾是博闻强记，他把《伤寒论》里边一些内容也记住了，要是积于小腹前阴就是疝气，用什么药治呢？用当归四逆加吴茱萸生姜汤就治这种病，或直接用当归四逆汤也治。
如果“得之寒食，而气积心下肢胠者，则为肝痹”，也就是单纯在人体上半部，也就是在腰以上部位积聚，就是肝痹，那疏肝解郁就行了。我们在临床可能会用到四逆散，也可能用到四逆散合当归四逆汤。总而言之，把足厥阴肝经的寒湿郁给解了就好了。如果积于小腹前阴，这个位置也是中医所说的足厥阴肝经所经过的部位，这个地方如果是积聚就会出现疝气，这个时候就用当归四逆加吴茱萸生姜汤或者当归四逆汤或者是吴茱萸生姜汤，都能根据临床症状都可以得到很好的解决。因此张介宾说∶“总属厥阴之寒邪，故云与疝同法”。他认为其实《黄帝内经》这段话虽然讲的是肝痹，但是这个病跟疝气也特别像，而且是同样一个经络所得的病，因此用同样的方法来治就可以。（未完待续）
本篇是：彭博士讲《黄帝内经》系列-精华篇-之五百零三。（更多精彩内容持续更新中……）
免责声明：本文为健康知识分享。文中所涉及的药物、药方、针灸以及其他各种治疗和养生方法，请在专业医师指导下应用，切勿自行应用。如因不当使用所产生的问题，概不负责。
版权声明：本文作者彭鑫，本文为原创文章，未经许可，不得转载或引用。
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“基础”可能不指知识，“栋梁”也许出自土木建筑
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近日，一段“妻子用头绳带失明丈夫跑步”的短视频打动了许多网友，携手相伴30年，这段“爱情长跑”跑过了四季风雨，跑过了岁时变迁，跑过了生活起落。 很多人说，真正的爱情无需多言，陪伴就…
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【咨询】：核酸检测时，打开郑好办中的亮码检测显示与我姓名不符，请问可以修改吗？ 【回复】：可以。登录郑好办APP—核酸检测一键通或核酸检测信息登记—报名登记查询，点击编辑进行修改。…
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不知道是享受惯了科技带来的福利还是怎样，但凡能用软件解决的事，我都不乐意动手，一是图省事儿，二是觉得何必呢？费那个劲…… 就拿语音转文字这件事儿来说，自己听一遍再转写出来不也行吗，…
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那些汇满蜜意的夜晚 查看详情 城南郊外出土了一座千年古墓，然后，我火了。 只因我长得，与那画像上古墓的女主人一模一样。 紧接着，我的生活中开始不断出现一连串离奇事件。 我总是见到一…
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作者：萧建壮 欣读李振环仁兄妙文《读“韦编三绝”有感》一文，倍感欣喜，因该文文精情茂，法理森然，布局章法极其巧妙也！令人拍案叫绝，拍手称奇不已也！余及余之兄、余之姐，无不为李兄大才…
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“法官，我在法院没有官司，但我微信账号里的钱被你们冻结了，微信钱包已经无法正常使用，能否解除我微信账号内资金的冻结呢？” 随着网络支付的普及， 微信、支付宝等电子钱包 已成为我们日…
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