揭秘 | 常用中药药量的不传之秘，这儿都总结全了（下）
<img src="https://mmbiz.qpic.cn/mmbiz_gif/Ljib4So7yuWgtdMOatvbylZFVB9QZbZaMd1DS9icemKiarEsw0I3CoYrcytvg8eP96cNoj0QZAIgBDjZX4LwdSKMA/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;">关注医家名方，<span style="color: black;">一块</span>聊中医</strong></span><span style="color: black;"><strong style="color: blue;">！</strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">昨天探讨了部分中药剂量，今天来聊聊剩余的“不传之秘”。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><span style="color: black;">揭秘 | 常用中药药量的不传之秘，<span style="color: black;">这儿</span>都总结全了（上）</span></a></p><span style="color: black;">当归功能补血活血，适用于血虚血瘀诸证。然而<span style="color: black;">当归在复方中，小剂量应用则补血，大剂量应用则活血</span>。如当归补血汤即由黄芪30g，当归<span style="color: black;">6g</span><span style="color: black;">构成</span>；后世在应用补血的总方四物汤时，当归用量<span style="color: black;">亦</span>不超过<span style="color: black;">10g;</span></span><span style="color: black;">归脾汤、八珍汤中，当归的用量仅<span style="color: black;">3g</span>。<span style="color: black;">然则</span><span style="color: black;">拥有</span>清热解毒，活血止痛<span style="color: black;">功效</span>治疗脱疽的四妙勇安汤，当归的用量竟达<span style="color: black;">60g</span>，<span style="color: black;">重点</span>是取其活血止痛<span style="color: black;">;</span>治<span style="color: black;">女性</span>产后瘀血内阻的恶露不行，小腹<span style="color: black;">病痛</span>的生化汤，当归的用量为<span style="color: black;">24g</span>，<span style="color: black;">亦</span>取其活血止痛，祛瘀生新之效能。</span><span style="color: black;">再如治妇人胎前产后气郁血瘀诸疾的佛手散，当归用二至三两者，乃取其活血之用，使瘀去新生、血有所归。由此可见，当归用于活血，剂量宜大，可用至<span style="color: black;">15g</span>以上。前人谓其气味俱厚，行则有余，守则不足，故重用则行血之力更甚。若当归用于补血，剂量宜轻，<span style="color: black;">3</span>～<span style="color: black;">9g</span><span style="color: black;">就可</span>。血虚者每致阴虚，阴虚则生虚热。当归气味辛温而主动，重用则每致动血，切不可重用，否则适得其反，病家服后每致口干、烦躁、失眠、<span style="color: black;">头昏</span>更剧，甚则鼻衄。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中药超大剂量应用的<span style="color: black;">重视</span>事项</p><span style="color: black;">中药的超大剂量的应用属于临床中药学<span style="color: black;">科研</span>范畴的内容，这方面的<span style="color: black;">科研</span><span style="color: black;">日前</span>还只是<span style="color: black;">刚才</span>起步，许多内容还是未知数。<span style="color: black;">日前</span>尚<span style="color: black;">不可</span><span style="color: black;">知道</span>地回答每味中药在什么<span style="color: black;">要求</span>下<span style="color: black;">能够</span>超大剂量应用，剂量超出权威规定的剂量上限多少时最适宜，超大剂量应用中药<span style="color: black;">是不是</span>对机体有潜在的不良反应等问题。中药超大剂量应用的<span style="color: black;">重点</span>依据仍然是古代及现代医家的临床用药经验，而现代中药药理、毒理学<span style="color: black;">科研</span>的结论却尚未用于临床<span style="color: black;">指点</span>中药的超大剂量应用。在<span style="color: black;">日前</span>的这种<span style="color: black;">状况</span>下，对中药的超大剂量应用应持<span style="color: black;">小心</span>态度。中药超大剂量<span style="color: black;">详细</span>应用时，必须<span style="color: black;">重视</span>下列<span style="color: black;">相关</span>事项。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">01</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">适应症要准确</span></p><span style="color: black;">中药的超大剂量应用都有相应的适应症，超大剂量用药，适应症<span style="color: black;">必定</span>要准确，否则，会<span style="color: black;">显现</span>两种<span style="color: black;">结果</span>：一是药重病轻，二是药轻病重。例如，中药细辛治疗风寒表证的剂量<span style="color: black;">通常</span>用3克，最多不超过<span style="color: black;">9</span>克。而当用细辛治疗各类痛证时，用量常常超大，有时用至<span style="color: black;">30</span>克，<span style="color: black;">乃至</span>更大。显然，当风寒表证时用超大剂量的细辛，不仅于证无益，<span style="color: black;">况且</span>会<span style="color: black;">导致</span>不良反应；相反，<span style="color: black;">倘若</span>要发挥细辛的<span style="color: black;">止疼</span><span style="color: black;">功效</span>，而用常用剂量，显然是杯水车薪，于痛无济。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">02</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">剂量递增原则</span></p><span style="color: black;">剂量递增原则是有毒中药应用的重要原则，这一原则<span style="color: black;">一样</span>适用于中药的超大剂量应用。<span style="color: black;">尤其</span>是在经验不足时更应该遵循这一原则，以避免因<span style="color: black;">茫然</span>超大剂量而<span style="color: black;">导致</span>毒性及不良反应。个体之间的差异性决定了超大剂量用中药必须做到剂量递增，切忌生搬硬套，剂量大到<span style="color: black;">难以置信</span>的地步。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">03</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">严格炮制、制剂规范</span></p><span style="color: black;">许多中药在超大剂量应用时，在炮制、煎药和制剂技术上有比较严格的规定性，中药在这方面的经验比较成熟，应用时应该严格遵守。附子、乌头类中药超大剂量应用时，<span style="color: black;">尤其</span>强调先煎、久煎，以煎煮至不麻口为标准。现代药化、药理<span style="color: black;">科研</span>结果证明，<span style="color: black;">以上</span>炮制、制剂规范是非常必要和<span style="color: black;">恰当</span>的，它能够<span style="color: black;">保准</span>在不影响药效的前提下，有效地降低这类中药的毒性。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">04</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">相畏配伍，减轻毒性</span></p><span style="color: black;">从古籍和名老中医超大剂量应用中药的经验中，<span style="color: black;">咱们</span>还<span style="color: black;">能够</span><span style="color: black;">发掘</span>某些中药超大剂量应用时，常有<span style="color: black;">有些</span>比较特定的配伍关系。如半夏配生姜、甘草；马钱子配甘草等。其目的是防止和降低超大剂量用药可能<span style="color: black;">导致</span>的毒性及不良反应。临床应用时必须严格遵循。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">05</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">认识</span>中药的毒性及解救<span style="color: black;">办法</span></span></p><span style="color: black;">在超大剂量应用中药时，应对<span style="color: black;">各样</span>中药的毒性及不良反应应该有一个比较系统的<span style="color: black;">认识</span>，<span style="color: black;">尤其</span>是与剂量密切<span style="color: black;">关联</span>的毒性及不良反应。<span style="color: black;">同期</span>，还应该<span style="color: black;">熟练</span>传统的和现代的<span style="color: black;">有些</span>中毒解救<span style="color: black;">办法</span>，做到心中有数，防患于未然。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">END</strong></span></p><span style="color: black;"><span style="color: black;">这儿</span>是医小虎的二维码</span><span style="color: black;">想要在线问诊、医案讨论、进群畅聊</span><span style="color: black;"><span style="color: black;">能够</span>扫码添加小虎<span style="color: black;">微X</span></span><img src="https://mmbiz.qpic.cn/mmbiz/Ljib4So7yuWjia191DgIjV9HufhZzoXxDnuZ7SsRjywzh898KrAmMtMVMPiaibC5LRemhFx2toSRibC3pWPicQVTtIrw/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;"><strong style="color: blue;"><img src="https://mmbiz.qpic.cn/mmbiz_png/08MrO2Sw4EiaNgzdNUCIo14thia8NzSXaEAvTdbZBsL96ohuwl7I4QA4KtXgPVicibpVFiaPDvTicicwUSCtUI1CCicOew/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></strong></span><span style="color: black;">Ps：本公众号原创<span style="color: black;">文案</span>未经授权不得私自转载，转载须标注<span style="color: black;">源自</span>“医家名方大公开”及相应作者。</span><span style="color: black;">·<span style="color: black;">倘若</span><span style="color: black;">爱好</span>，右下方点个<span style="color: black;">“在看”</span>，<span style="color: black;">亦</span><span style="color: black;">能够</span><span style="color: black;">转发至<span style="color: black;">伴侣</span>圈</span>
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