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大黃

2018-12-13 10:55| 發布者: admin| 查看: 5798| 評論: 44

摘要: 【功能主治】 瀉熱毒,破積滯,行瘀血。治實熱便秘,譫語發托,食積痞滿,痢疾初起,里急后重,瘀停經閉,癥瘕積聚,時行熱疫,暴眼赤痛,吐血,衄血,陽黃,水腫,淋濁,溲亦,癰瘍腫毒,疔瘡,湯火傷。

【別    名】  將軍、黃良、火參、膚如、蜀大黃、錦紋大黃、牛舌大黃、錦紋、生軍、川軍

【藥用部位】  為蓼科植物掌葉大黃、唐古特大黃或藥用大黃的根莖。

【成    份】  大黃含有蒽類衍生物、苷類化合物、鞣質類、有機酸類、揮發油類等。   1. 蒽類衍生物分為:⑴游離蒽醌衍生物,如蘆薈大黃素(aloe emodin)、土大黃素(chrysaron)、大黃酚(chrysophanol)、大黃素(emodin)、異大黃素(isoernodin)、蟲漆酸D(laccaic acid D)、大黃素甲醚(physcion)、大黃酸(rhein);⑵結合蒽醌化合物,有大黃酸、蘆薈大黃素、大黃酚的單和雙葡萄糖甙;大黃素、大黃素甲醚的單糖甙;蒽酚和蒽**合物:大黃二蒽**(rheidin)、掌葉二蒽**(palmidin)以及與糖結合的甙如番瀉甙(sennoside)A、B、C、D、E、F等。   2. 苷類化合物:土大黃甙(rhaponticin)、3,5,4’-三羥基芪烯一4’-O-β-D-(6’-O-沒食子酰)葡萄糖甙(3,5,4’-trihydroxy-stilbene-4’-O-β-D-(6’-O-gallayl)-glucoside)、3,5,4’-三羥基茋烯-4’-O-β-D-吡喃葡萄糖甙(3,5,4’-trihydroxy stilbene-4’-O-β-D-glucopyranoside)。   3. 萘衍生物:torachrysone-8-O-β-D-glucopy ranoside,torachrysone-8-(6′-oxaly)-glucoside及決明松(torachryson)。   4. 鞣質類:沒食子酰葡萄糖、d-兒茶素、沒食子酸、大黃四聚素(tetrann)等。大黃四聚苯經水解,得沒食子酸、肉桂酸及大黃明(rheosmin)。此外合有樹脂。   尚含有有機酸:蘋果酸、琥珀酸、草酸、乳酸、桂皮酸、異丁烯二酸、檸檬酸、延胡紊酸等。   大黃中還含有揮發油、脂肪酸及植物甾醇等。

【功能主治】   瀉熱毒,破積滯,行瘀血。治實熱便秘,譫語發托,食積痞滿,痢疾初起,里急后重,瘀停經閉,癥瘕積聚,時行熱疫,暴眼赤痛,吐血,衄血,陽黃,水腫,淋濁,溲亦,癰瘍腫毒,疔瘡,湯火傷。

瀉熱通腸,涼血解毒,逐瘀通經。用于實熱便秘、積滯腹痛、瀉痢不爽、濕熱黃疸。

①《本經》:"下瘀血,血閉,寒熱,破癥瘕積聚,留飲宿食,蕩滌腸胃,推陳致新,通利水谷("水谷"一作"水谷道"),調中化食,安和五臟。"

②《別錄》:"平胃,下氣,除痰實,腸間結熱,心腹脹滿,女子寒血閉脹,小腹痛,諸老血留結。"

③《藥性論》:"主寒熱,消食,煉五臟,通女子經候,利水腫,破痰實,冷熱積聚,宿食,利大小腸,貼熱毒腫,主小兒寒熱時疾,煩熱,蝕膿,破留血。"

④《日華子本草》:"通宣一切氣,調血脈,利關節,泄塑滯、水氣,四肢冷熱不調,溫瘴熱痰,利大小便,并敷-切瘡癤癰毒。"

⑤《綱目》:"主治下痢亦白,里急腹痛,小便淋瀝,實熱燥結,潮熱譫語,黃疸,諸火瘡。"

【用法與用量】 內服:煎湯(用于瀉下,不宜久煎),1~4錢;或入丸、散。外用:研末,水或醋調敷。

【臨床應用】   ①用于血小板減少癥及止血

用酒洗大黃10克,甘油5毫升,苯甲醇2毫升,制成注射液100毫升。每次2毫升,肌肉注射。對血小板減少癥每日1次,手術后止血用每日2次。亦有用生大黃9錢,石灰1兩,文火炒拌,直至石灰呈灰粉紅色時取出,加入明礬(每100克石灰加入明礬0.6克)共研細粉。將此粉16克加水至100毫升,振蕩后沉淀過濾。用時取棉球浸藥水壓迫出血處。經應用于500余人次外傷出血,證明止血效果良好,未見不良反應及副作用。此外,對晚期血吸蟲病食道靜脈破裂出血患者,用大黃炭1.6克,白芍炭1.6克,加葡萄糖粉(或細白糖)30克共研細末,小量分次干吞(于1天內吞完)。治療10例,均達到止血效果。一般平均在7~8天能起床活動.服用該藥后可見惡心消失、胃部舒適、大便逐漸恢復正常,并無迅速腹水蓄積后遺癥出現。

②治療口腔炎、口唇潰瘍及毛囊炎等

用生大黃3~8錢,煎取150~500毫升(每劑最多使用2天),供漱口、濕熱敷及洗滌用,每天4~6次。治療前先清洗局部,除凈分泌物。本法對于一般金****葡萄球菌感染的口腔炎、口唇潰瘍、皮膚毛囊炎及頭部癤腫等炎性疾患均有效,局部培養金****葡萄球菌的轉陰日數亦比較迅速。

③治療燙傷

先取陳石灰10斤除凈雜質,過篩,投入鍋內用文火炒松,再投人大****5斤,共同拌炒,俟石灰炒至帶桃紅色、大黃炒至灰黑色時,即出鍋篩去石灰;將大黃攤開冷卻后研成細粉備用。用時先以生理鹽水清洗創面,而后撒布大黃粉。如有水泡應刺破;撥開表皮,排凈泡液后再撒藥粉。如僅見局部紅腫,則可用麻油或桐油將大黃粉調成糊狀涂患處。換藥時如發現傷處潰爛,應拭去膿液、膿癡后再撒藥粉。在夏季可行暴露療法。共治療415例,均獲顯著效果,且療程短,無副作用,愈后無疤痕。

④治療臁瘡(下肢潰瘍)

用生大黃5~7錢,研成極細粉末;另取甘草捶碎,去凈纖維,取細粉約為大黃的1/5量,共研極細。先用溫開水洗凈瘡面,揩干后均勻撤布藥粉,再用"千層"(又名千張或百頁,為純黃豆制成品,以薄而韌者為良)覆蓋包好。如有滲液外流,可聽其自然,第2天再洗。每日換藥1次。輕者換藥3~6次,重者8~9次,即可新生肉芽。此時不可再洗,藥粉可少用或不用,但"千層"必需每日一換。當結痂牢固時會發生癢感,不可揭去痂蓋,隔5~7日或7日以上,癡蓋自然脫落。治療12例均愈,其中1例病程達13年,經用藥粉6日,貼"千層"20余日,便結癡而愈。

⑤治療小兒蛔蟲性腸梗阻

用大黃粉蜜合劑(生大黃粉5錢,炒至微黃的米粉3錢,蜂蜜2兩,加適量溫開水調勻),每小時服1次,每次約1湯匙,全劑分12次服完;至排出蛔蟲為止。經治6例均排出蛔蟲,癥狀解除而愈。排蟲最多者達60余條。排蟲后均無持續腹瀉現象。

⑥治療腸脹氣

用大黃1兩研成細末,加適量醋調成糊狀,敷于兩側涌泉穴上,每次二小時,必要時可敷2~3次。臨床觀察6例,一般敷藥后一小時即出現腸腔蠕動感和肛門排氣現象,自覺腹脹減輕,有腸鳴音。

【宜    忌】   凡表證未罷,血虛氣弱,脾胃虛寒,無實熱、積滯、瘀結,以及胎前、產后,均應慎服。

①《本草經集莊》:"黃芩為之使。"

②《藥性論》:"忌冷水。惡干漆。"

③《本草經疏》:"凡血閉由于血枯,而不由于熱積;寒熱由于陰虛,而不由于瘀血;癥瘕由于脾胃虛弱,而不由于積滯停留;便秘由于血少腸燥,而不由于熱結不通;心腹脹滿由于脾虛中氣不運,而不由于飲食停滯;女子少腹痛由于厥陰血虛,而不由于經阻老血瘀結;吐、衄血由于陰虛火起于下,炎爍乎上,血熱妄行,溢出上竅,而不由于血分實熱;偏墜


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