《金匮要略》呕吐证治探要

呕吐临床常见,亦是多种病证的一种临床表现。呕吐最早的记载见于《内经》,但对呕吐的脉证治疗则详见于《金匮要略》。本期《〈金匮要略〉呕吐证治探要》一文,笔者对《金匮要略》呕吐的证治进行了梳理和总结,认为仲景治疗呕吐既见呕止呕,标本兼顾;又见呕不止呕,重于治病求本;更见呕勿令止呕,法倡因势利导。此三条法则至今适用,临证当详审细辨,灵活运用。     

小议《伤寒论》治呕法

呕吐既是一个病名，又是一个症状，在《伤寒论》中则多指一种症状而言，其表现有微呕、干呕、喜呕、呕逆、呕不止、呕渴、吐利等。对于呕吐一症，张仲景在《伤寒论》中就记载有数十条经文，并且针对不同病因辅以相应的方药，足见该症在临床治疗上的普遍性及指导意义。     

基于药性组合的呕吐病机与治法分析

通过整理2005版《中华人民共和国药典》一部中具有"止呕"功效的中药及其药性的数据记载,利用关联规则方法,总结了"止呕"功效相关的常见药性组合,分析了药性组合对应的病机和治法。通过药性组合总结的呕吐病机和治法,与张仲景对于治呕方法的记载以及中医药理论的治呕原则具有一致性。结果表明,药性组合是贯穿中医临床理、法、方、药的核心,从药性组合层面阐释病机、治法,研究方剂的配伍规律,有利于将中医药理论与用药实践结合,充分发挥药性理论的核心指导作用。     

吴茱萸汤临床应用体会

吴茱萸汤为汉代张仲景方,在《伤寒论》和《金匮要略》中均有记载,本方由吴茱萸、人参、生姜、大枣四味药组成。《伤寒论》第243条:"食谷欲呕,属阳明,吴茱萸汤主之。"第309条:"少阴病,吐利,手足逆冷,     

何若苹运用半夏泻心汤加味治疗胃痛经验

<正>何若苹主任中医师系第五批全国老中医药专家学术经验继承工作指导老师,跟随国医大师何任教授多年。从医三十余载,擅长诊治内科、妇科以及各种疑难杂症等。笔者有幸跟师随诊,获益匪浅,现将其运用半夏泻心汤加味治疗胃痛经验总结如下。《伤寒论》记载:"伤寒五六日,呕而发热者,柴胡汤证具……但满而不痛者,此为痞……宜半夏泻心汤。"《金匮要略》云:"呕而肠鸣,心下痞者,半夏泻心汤主之。"按《伤寒论》所述,半夏泻心汤证由小柴胡汤证误下     

大枣生姜在经方中的配伍

<正>姜是一种广泛应用的药食两用植物,作为一种食料,早在春秋时期《论语.乡党》中就有记载:"每食不撤姜。"生姜是姜的新鲜根茎,《名医别录》云:"味辛,微温。主伤寒头痛鼻塞,咳逆上气,止呕吐。"《现代中药学大辞典》记载:"生姜味辛,性温;归肺、胃、脾经;功效为发散风寒,温中止呕,化痰解毒。"大枣     

《伤寒论》治呕方药统计

目的:探讨《伤寒论》治疗呕吐的遣方用药特点,为学习研究和临床治疗提供参考。方法:整理《伤寒论》中治疗呕吐的方剂,对"呕吐"关键词的出现频数,治呕方药使用频数、频率,以及四气五味、脏腑归经进行统计分析。结果:《伤寒论》中含"呕吐"相关字词的条文达87条,治呕方剂共31首,药味精简,最多不超过10味,除去瓜蒂散及重复的药物后,一共运用了45种药物。结论:《伤寒论》治呕善用辛甘温热之品,从脾胃论治为主,八法之中尤重和法。     

活血化瘀治关格

<正> 关格证见於祖国医学书籍记载良多:《寿世保元》中说:“溺溲不通非细故也,期朝不通,便令人呕。名曰关格。”《诸病源候论》卷十四言:“关格者,大小便不通也。”《医醇剩义》更明确指出呕吐而渐见大小便不通者就是关格证。可见关格证即是以呕吐不已,二便不通为主要表现的病证。此证临床多见胃气上逆型和脾虚痰饮型,报道多用舒肝理气、降逆止呕或健脾益气、温阳逐饮等为治疗大法。但笔者在临床     

吴茱萸止痛应用举隅

吴茱萸,其味辛苦,性热,归肝脾胃肾经。能温中散寒、疏肝下气、降逆止呕,尤擅止痛。早在《神农本草经》中就有所记载:"吴茱萸……温中下气,止痛,咳逆寒热,除温血痹。"     

《伤寒论》“呕”“吐”证的辨证论治

就《伤寒论》中的"呕""吐"两个方面,讨论了呕、吐证的辨证论治。在"呕"的辨证中,有呕逆、干呕、但呕、呕不止、微呕、欲呕、呕利、喜呕、使呕、不大便而呕、得食而呕、食谷欲呕、呕不能食、呕而发热、呕而咳、呕而汗出、呕而脉弱、呕家、呕者、不可治呕之别;在"吐"的辨证中,有吐脓血、吐血、吐逆、吐蛔、吐利、吐涎沫、欲吐不吐、气逆欲吐、食入即吐、当吐、不可吐之别。张仲景论治"呕""吐"的思维方法为后世医家所推崇,有解表法、清里法、和解法、温阳法、灸法等,丝丝入扣,总不离辨证论治。"呕""吐"虽为《伤寒论》中一证,然病因病机不同,治法上不能见呕止呕,须观其脉证,随证治之。     

从化学、药效和毒性角度比较认识正品大黄与土大黄

土大黄与药典收载的正品大黄具有某些功效的相似性,常常被用作大黄替代品应用。究竟土大黄与正品大黄能否简单的替换使用,或者说两者之间有无差异,差异在何处?对此进行研究,对于正确认识土大黄,以及临床与市场上的正确应用等都具有重要意义。该文在作者己有的工作基础上,结合相关文献报道,以大黄的主要功效"泻下"为基本点,从化学、药效及其毒性等方面进行了探讨。分析结果表明,华北大黄(土大黄)的泻下作用弱于正品大黄,其原因在于两者间结合型蒽醌类成分的含量差异,同时华北大黄的小鼠急性毒性也强于正品大黄,因此,华北大黄不宜简单的替代正品大黄使用。     

Assessment of the renal protection and hepatotoxicity of rhubarb extract in rats

Aim of the study

Rhubarb is well used to treat chronic renal failure (CRF) in China and Japan, but recent studies reported that the anthraquinone derivatives contained in rhubarb had nephrotoxicity. In this investigation an attempt was made to assess the value and toxic potential of rhubarb to treat CRF.

Materials and methods

Histopathologic and biochemical tests combined with toxicokinetic analysis were performed to investigate the nephrotoxic potential and protective effect of rhubarb extract.

Results

In normal rat groups, no death was observed and no renal lesion was found after repetitive administration of rhubarb for 3 weeks. The survival rate, pathologic conditions and biochemical indexes of CRF rats treated with rhubarb at two dosages were all improved and significant amelioration was found in the low dosage group compared to the untreated CRF group. Rhein was the mainly absorbable anthraquinone derivative into systemic circulation after oral administration and the area under curve of rhein in CRF groups was lower than that in normal groups at same dosage.

Conclusions

After 3 weeks of administration of rhubarb extract, there was evidence of protective effect to CRF rats, while incidences of hepatotoxicity with minimal to mild hyaline droplets were also observed in normal rats.     

大黄对消化性溃疡合并出血的止血作用的临床研究

本文报道了175例消化性溃疡合并出血用大黄原生药、大黄止血有效部位及单体止血,分六组进行了随机与双盲对照研究。其结果表明原生药的显效率高(68.8%),止血时间短(1.1～1.5天),但有恶心、呕吐等副作用。大黄止血有效部位与单体的疗效与西药相似,唯大黄醇提片既保留了原生药的优点又消除了它的不良反应,有推广应用价值。     

The diarrhoeogenic and antidiarrhoeal bidirectional effects of rhubarb and its potential mechanism

Aim of the study

The present study investigated the pharmacological effects of different extracts of rhubarb on intestinal function of mice, further to explore possible reasons for the adverse effects of long-term use of rhubarb as a purgative.

Materials and methods

The total extract of rhubarb (TR) was extracted with 60% ethanol and the total anthraquinones extract (TA), total tannins extract (TT) and remaining components extract (RC) of rhubarb were separated from TR using macroporous resin. The pharmacological effects of each extract on the intestinal function of mice were evaluated by defecation test and the antidiarrhoeal activity of rhubarb tannins as well as its mechanism was studied by different animal models and histopathological examination.

Results

Both TR and TA produced purgative activities, but the purgative activity of TA was stronger than that of TR. Successive administration of TT produced an antidiarrhoeal activity in a time- and dose-dependent manner. Besides, successive administration of RC showed no significant effect on the intestinal function of mice. The antidiarrhoeal activity of rhubarb tannins was confirmed directly for the first time and its mechanism was probable that rhubarb tannins generated protein-precipitating reaction to the gastrointestinal mucosa due to its protein-precipitating action.

Conclusions

The results confirmed that rhubarb had the diarrhoeogenic and antidiarrhoeal bidirectional effects due to the coexistence of anthraquinones and tannins. The bidirectional effects might be the reason or one of the reasons for the adverse effects of long-term use of rhubarb as a purgative.     

活血化瘀治疗精神病36例临床分析

中医辨证论治,在临床实践中确有深刻体会,祖国医学有其独特出色的科学理论及其治疗体系,根据五行、脏腑、经络、四诊、八纲,结合精神病的病因、病机进行辨证论治。活血化瘀是我国古代治疗精神病的基本法则之一,＂血瘀＂与精神病的关系,早在《内经》有记载,至汉代张仲景提出＂热入血室＂、＂蓄血症＂热结膀胱等症,又明确提出桃仁承气汤：桃仁12g,大黄12g等,抵挡汤：桃仁12g,水蛭8g等活血化瘀治疗精神病,至清代王清任提出用癫狂萝醒汤：香附15g,赤芍12g等治疗精神病,其中主要药物是用活血化瘀之剂。     

H NMR-based metabonomic analysis of the effect of optimized rhubarb aglycone on the plasma and urine metabolic fingerprints of focal cerebral ischemia–reperfusion rats

Ethnopharmacological relevance

The ischemia cerebrovascular disease is one of leading causes of death and long-term disability in modern society. Rhubarb is one of the common traditional Chinese medicine with many effects, and the main pharmacodynamic ingredients are aloe-emodin, rhein, emodin, chrysophanol and physcion. The five components are also known as rhubarb aglycone. Rhubarb aglycone has been confirmed to play a remarkable curative effect on cerebral ischemia, but the mechanism is not clear. In this study, ¹H NMR-based metabonomics approach has been used to investigate the protective effect of the optimized rhubarb aglycone on rats of cerebral ischemia–reperfusion.

Materials and methods

Male Wistar rats were divided into four groups: sham operation group, model group, Nimodipine group and the optimized rhubarb aglycone group. Based on ¹H-NMR spectra of plasma and urine, principal component analyses were performed to identify different metabolic markers and explore the changes of associated biochemical pathways. Behavior research and brain histopathology examinations were also performed.

Results

It was showed that the optimized rhubarb aglycone treatment improved neurological deficits, cerebral infarction and neuronal apoptosis. Principal component analysis scores plots demonstrated that the cluster of model rats was separated from those of sham operation group; rats of the optimized rhubarb aglycone group were classified from model group, but the optimized rhubarb aglycone group closed to the sham operation group. Optimized rhubarb aglycone regulated the associated amino acid, energy and lipid metabolisms disturbed in model rats.

Conclusion

Our results suggested that the optimized rhubarb aglycone had protective effect on rats of cerebral ischemia–reperfusion and explored the metabolic regulation mechanism. This work showed that the NMR-based metabonomics approach might be a promising approach to study mechanisms of traditional Chinese medicines.     

3种大黄饮片在贮存过程中5种蒽醌成分的含量变化

目的:分析生大黄、酒大黄和熟大黄3种大黄饮片在贮存中过程中5种蒽醌成分的含量变化。方法:采用超高效液相色谱仪,分别对贮存1,3,6,9和12月的生大黄、酒大黄和熟大黄中的芦荟大黄素、大黄酸、大黄素、大黄酚和大黄素甲醚含量进行检测。结果:检测的5种蒽醌成分在3种大黄饮片的贮存过程中均呈明显的下降趋势,其中以大黄酚和大黄素甲醚含量下降最为明显。3种饮片中熟大黄的蒽醌成分含量下降较小,而酒大黄的蒽醌成分含量下降最为明显。结论:大黄饮片在贮存过程中蒽醌成分下降明显。炮制工艺的不同对大黄饮片贮存中蒽醌成分含量变化有影响。     

升降散临床应用研究进展

升降散由蝉蜕、僵蚕、姜黄、大黄组成,黄酒及蜂蜜调和,作为温病名方,其组成首载于明代张鹤腾所著的《伤暑全书》中,后清代医家杨粟山将其载于《伤寒瘟疫条辩》中,列为治疗“温病郁热内伏”十五方之总方。后世医家潜心研究,将其灵活加减,广泛应用于各系统疾病的治疗中。本文将对升降散的临床应用研究进展进行分析,以为其临床应用提供参考。     

小包装和散装中药饮片对质量控制与含水量的影响研究

目的:探究小包装及散装中药饮片的优缺点,并分析不同季节与环境对其含水量与质量的影响。方法:使用快速水分测定仪检测10种小包装和散装中药饮片在不同季节、环境下含水量,并观察和记录两种中药饮片性状改变情况。结果:14个月内小包装饮片含水量未明显受环境湿度的影响,散装饮片出现明显受环境湿度改变的影响,且小包装饮片在各时间点含水量比较,差异无统计学意义(P>0.05);散装饮片中甘草、款冬花、麦冬、生大黄、酒大黄及炙甘草在各时间点含水量比较,差异有统计学意义(P<0.05)。薏苡仁、麦冬、生黄芪、生大黄及党参的散装饮片含水量波动幅度明显大于小包装饮片,差异有统计学意义(P<0.05)。14个月内,甘草、薏苡仁、炙黄芩、生黄芪、党参及炙甘草的散装及小包装饮片均出现外观性状变化,款冬花、麦冬、酒大黄及生大黄均未出现外观性状变化。结论:小包装和散装中药饮片在不同季节、环境改变下,含水量和性状均出现不同程度变化,但小包装饮片所受影响较轻。     

药味配伍对小承气汤中蒽醌类衍生物溶出率的影响

目的：研究药味配伍对小承气汤中有效成分蒽醌类衍生物溶出率的影响。方法：用薄层层析－紫外分光光度法测定了大黄及大黄与不同药物配伍组水煎液中游离蒽醌及结合型蒽醌的含量。结果：测定数据经统计检验显示,与大黄水煎液相比合煎方中结合型大黄酸及游离大黄素含量变化不显著,其余各配伍组水煎液中游离蒽醌、结合型蒽醌含量变化均极显著（Ｐ〈０．０２,Ｐ〈０．０２,Ｐ〈０．００１）。结论：各种配伍药材对不同的蒽醌类成分产生的影响不同。