茵陈的临床应用及其用量探究
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摘要
本文通过整理古代医籍及现代医家临证经验,总结出茵陈的临床应用具有以下特点:1)茵陈临床常用剂量为6～60 g,最大可用至120 g。2)结合具体疾病、证型及相关症状确定茵陈的最佳剂量范围,如茵陈发挥利胆退黄功效时,可治疗急性肝炎、慢性肝病、慢性肝病、胆囊炎、胆石症及肝硬化等见黄疸症状者,常用剂量为6～45 g;发挥保肝的功效时,常用剂量为15～30 g;解热祛湿治疗外感时,常用剂量为6～9 g。3)应根据疾病、证型及症状的不同特点配伍相应的中药,如茵陈在清热利湿退黄时,若是黄疸初起,热重于湿,常配伍大黄、栀子等;湿重于热,常配伍泽泻;治疗阴黄,寒湿为主时,则配伍附子、干姜等;治疗外感暑湿、高热,常配伍藿香、青蒿、黄芩、白豆蔻。
This article summarizes the clinical application and dosage administration of a Chinese herb,Yinchen through the clinical experience of ancient and contemporary traditional Chinese medicine physicians.To sum up,the clinical application of Yinchen has the following characteristics:First,the clinical dosage of Yinchen is usually 6-60 g,and the maximum dose can be up to 120 g.Second,the most appropriate dosage range of Yinchen should be defined on the basis of specific diseases,syndromes and relevant symptoms.For example,when Yinchen is used for the treatment of jaundice from acute hepatitis,chronic liver diseases,cholecystitis,cholelithiasis and cirrhosis,we often use 6-45 g to normalize gallbladder.In improving liver function,Yinchen is usually used 15-30 g.In relieving heat and dampness,Yinchen is usually used 6-9 g.Third,Specific characteristics of diseases,syndromes and symptoms should be considered when Yinchen is compatible with different Chinese herbs.For example,when Yinchen is used for the early stage of jaundice,the syndrome is heat predominating over dampness,Dahuang and Zhizi is usually added.If the syndrome is dampness predominating over heat,Zexie is usually added.When Yinchen is used for yin jaundice,the syndrome is cold-dampness,we often add Fuzi and Ganjiang.When Yinchen is used for high fever and exogenous heat dampness,Huoxiang,Qinghao,Huangqin and Baidoukou is often added.
This article summarizes the clinical application and dosage administration of a Chinese herb,Yinchen through the clinical experience of ancient and contemporary traditional Chinese medicine physicians.To sum up,the clinical application of Yinchen has the following characteristics:First,the clinical dosage of Yinchen is usually 6-60 g,and the maximum dose can be up to 120 g.Second,the most appropriate dosage range of Yinchen should be defined on the basis of specific diseases,syndromes and relevant symptoms.For example,when Yinchen is used for the treatment of jaundice from acute hepatitis,chronic liver diseases,cholecystitis,cholelithiasis and cirrhosis,we often use 6-45 g to normalize gallbladder.In improving liver function,Yinchen is usually used 15-30 g.In relieving heat and dampness,Yinchen is usually used 6-9 g.Third,Specific characteristics of diseases,syndromes and symptoms should be considered when Yinchen is compatible with different Chinese herbs.For example,when Yinchen is used for the early stage of jaundice,the syndrome is heat predominating over dampness,Dahuang and Zhizi is usually added.If the syndrome is dampness predominating over heat,Zexie is usually added.When Yinchen is used for yin jaundice,the syndrome is cold-dampness,we often add Fuzi and Ganjiang.When Yinchen is used for high fever and exogenous heat dampness,Huoxiang,Qinghao,Huangqin and Baidoukou is often added.
引文
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[41]于永红,胡昌兴,孟卫星,等.茵陈、赤芍、三棱、淫羊藿对家兔实验性动脉粥样硬化病灶的消退作用及原癌基因C-myc、C-fos、V-sis表达的影响[J].湖北民族学院学报(医学版),2001,18(2):4-7.
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[2]冯瑞雪,张紫微,张再康.李士懋教授清透滋三法治疗里热实证的经验[J].北京中医药大学学报,2016,39(10):864-868.
[3]吕淑静,王四平,吴中秋,等.李士懋教授应用甘露消毒丹经验[J].四川中医,2010,28(8):5-6.
[4]刘明坤,张婷婷,吕文良,等.姚乃礼治疗慢性肝病常用对药经验浅析[J].北京中医,2015,33(1):21-24.
[5]王庆其,李孝刚,邹纯朴,等.国医大师裘沛然肝硬化诊疗方案[J].南京中医药大学学报,2017,33(3):217-220.
[6]高尚社.国医大师裘沛然教授治疗肝硬化验案赏析[J].中国中医药现代远程教育,2012,10(24):8-11.
[7]周兴,刘朝圣,李点,等.熊继柏教授辨治黄疸经验[J].中华中医药杂志,2014(8):2538-2540.
[8]姚欣艳,李点,何清湖,等.熊继柏教授辨治胁痛经验[J].中华中医药杂志,2015,30(3):790-792.
[9]戴克敏.姜春华运用茵陈蒿汤的经验[J].山西中医,2012,28(4):4-5.
[10]王振兴,潘怡,张秀,等.邓中甲治疗肝系病证常用药组选析[J].辽宁中医杂志,2017,44(7):1377-1379.
[11]周滢,周梅,江玉,等.邓中甲临床药对的配伍选析[J].中国实验方剂学杂志,2010,16(7):204-205.
[12]何莉莎,顾成娟,崔亚珊,等.仝小林教授从“土壅木郁”辨治代谢综合征经验[J].世界中医药,2015,10(12):1914-1917.
[13]朱葛馨,周强.仝小林运用大黄经验[J].辽宁中医杂志,2013,40(10):1988-1989.
[14]张宸,周强.仝小林教授运用大柴胡汤经验[J].世界中西医结合杂志,2013,8(3):221-223.
[15]仝小林,沈仕伟,刘文科,等.论肝胆系疾病辨治[N].中国中医药报,2016-03-30(04).
[16]郭艳青,刘文科,武胜平,等.仝小林教授治疗原发性胆汁淤积性肝硬化验案分析[J].时珍国医国药,2013,24(8):2029-2031.
[17]蒋俊民.池晓玲教授治疗肝病经验介绍[J].新中医,2008,40(5):15-17.
[18]萧焕明,蔡高术,谢玉宝.池晓玲运用经方治疗黄疸验案举隅[J].江苏中医药,2010,42(2):46-48.
[19]赵凯声,常峥,张炳厚,等.张炳厚诊治“肝脾(胃)合病”的经验[J].北京中医药,2006,25(6):336-339.
[20]张炳厚.辨证治疗急重病二则[J].新中医,1983,15(5):21-23.
[21]王付.茵陈蒿汤方证探索与实践[J].中华中医药杂志,2015,29(4):1126-1128.
[22]张卓文,李如辉,王静波,等.连建伟教授运用茵陈合剂论治黄疸经验[J].浙江中医药大学学报,2015,38(9):680-682.
[23]彭辉,刘名扬,陈赛赛,等.于庆生治疗胆石症经验[J].安徽中医药大学学报,2018,37(1):31-33.
[24]刘明波,李欣旭,程西子.张压西灵活运用大黄的临床经验总结[J].湖北中医杂志,2015,37(10):28-30.
[25]王宪波,李斌,刘慧敏.解毒凉血、健脾化湿法治疗乙型肝炎慢加急性肝功能衰竭体会[J].中医杂志,2012,53(20):1772-1776.
[26]刘永刚,宋春荣,常占杰.常占杰教授益脾养肝法治疗药物性肝损伤经验[J].中医学报,2017,32(11):2111-2114.
[27]常春阳,舒琦瑾.舒琦瑾治疗肝癌常用对药[J].浙江中医杂志,2017,52(9):693-694.
[28]慕永平,王磊,刘平.谨守病机权衡邪正主次燮理脏腑重视处方配伍--刘平教授治疗肝硬化经验浅析[J].上海中医药大学学报,2004,18(3):29-32.
[29]李勇华.赵国荣治疗慢性病毒性肝炎经验[J].中医杂志,2008,49(10):879-880.
[30]周玉麟.谢昌仁老中医辨治肝炎经验[J].中西医结合肝病杂志,2010,20(4):237-238.
[31]张美英,李春生.陈宝贵教授临床运用对药经验[J].内蒙古中医药,2017,36(14):144-145.
[32]郭海涛,乔俭.乔振纲老中医治疗肝内胆管结石经验介绍[J].光明中医,2015(12):2649-2651.
[33]赵诚.奚九一临床应用附子经验采撷[J].中医杂志,2011,52(增刊):50-52.
[34]刘援,刘国庆.附子临证应用经验[J].江西中医药,2006,37(10):41-42.
[35]乐永红,雷云霞,马燕,等.乐德行从气化论治鼓胀经验[J].中国中医基础医学杂志,2017,28(2):283-284.
[36]王俊槐.李培生诊治湿热发黄的经验[J].中医杂志,1992,33(10):14-15.
[37]邵利洁,唐方.唐方教授治疗小儿外感发热经验[J].长春中医药大学学报,2012,28(3):426-427.
[38]郑红花,罗德生,李映红.茵陈煎剂保肝作用机理的实验研究[J].湖北科技学院学报(医学版),2003,17(2):106-108.
[39]赫长胜,李源渊,岳洪义,等.茵陈多糖对梗阻性黄疸幼鼠肝脏纤维化的保护作用研究[J].中国医药导报,2012,9(8):25-27.
[40]王小英,潘竞锵,肖柳英,等.茵陈蒿提取物对高脂诱导大鼠增强胰岛素敏感性及抗脂肪肝作用的研究[J].中国药房,2007,18(21):1603-1606.
[41]于永红,胡昌兴,孟卫星,等.茵陈、赤芍、三棱、淫羊藿对家兔实验性动脉粥样硬化病灶的消退作用及原癌基因C-myc、C-fos、V-sis表达的影响[J].湖北民族学院学报(医学版),2001,18(2):4-7.
[42]范丽梅,胡春玲,谢琼,等.茵陈多糖对妊娠胆汁淤积大鼠Th1/Th2细胞免疫平衡的影响[J].中国热带医学,2013,13(3):267-269.
[43]齐善厚.茵陈黄酮的抗氧化及镇痛作用研究[J].现代食品科技,2013(3):501-504.
[44]陈少华,洪振丰,罗仁夏,等.茵陈蒿拮抗AFB_1诱发基因突变和小鼠骨髓细胞遗传损伤的实验研究[J].癌变.畸变:突变,1998(1):35-38.
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