茯苓的量效关系及其临床应用探讨
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摘要
通过搜集整理古医籍及现代医家临证经验,总结出茯苓具有以下量效特点:1)临床用量多在3～150g范围之内。2)临床运用茯苓应结合病种、证型、症状选择茯苓最佳剂量,如茯苓小剂量健脾渗湿、化痰止泻,用于治疗呼吸系统疾病(如慢性阻塞性肺疾病、慢性支气管炎、慢性咽炎等),消化系统疾病(如厌食症、泄泻等),临床用量多为3～30 g;中剂量利水行气、宁心安神,用于治疗神经系统疾病(失眠、抑郁症、癫痫等),妇科疾病(如慢性盆腔炎、输卵管阻塞性不孕等),皮肤病(如顽固性湿疹、胆碱性荨麻疹等),临床用量多为10～90 g;大剂量利水消肿、和胃止呕,用于治疗循环系统疾病(如恶性心包积液、高血压病等),内分泌及代谢疾病(如糖尿病肾病、高血脂症、类风湿关节炎等)临床用量多为10～150 g。3)为发挥茯苓最佳功效,临床常根据病种、证型及症状,配伍相应中药,如利水渗湿常配伍泽泻、白术等;宁心安神常配伍酸枣仁、知母等。
Through collecting ancient medical books and clinical experience of modern doctors, the following dosage-effect characteristics of poria cocos were summarized: 1) the clinical dosage was mostly within the range of 3-150 g. 2) According to diseases, syndromes, symptoms, we choose the best dosage of poria cocos, for example, poria cocos has the functions of invigorating spleen, eliminating dampness, resolving phlegm and relieving diarrhea in small dose. It is used for treating respiratory diseases(chronic obstructive pulmonary disease, chronic bronchitis, chronic pharyngitis, etc) and digestive system diseases(anorexia, diarrhea, etc), and the clinical dosage is generally 3-30 g.Middle dose diuresis, promoting qi circulation, calming the heart and tranquilizing the mind, it can be used for treating neurological diseases(insomnia, depression, epilepsy, etc), gynecological diseases(chronic pelvic inflammatory disease, tubal obstructive infertility, etc), and dermatoses(intractable eczema, choline urticaria, etc), with a clinical dosage of 10-90 g. Large dose diuresis for detumescence, harmonizing stomach and stopping vomiting, the clinical dosage for treating circulatory system diseases(malignant pericardial effusion, hypertension, etc), endocrine and metabolic diseases(diabetic nephropathy, hyperlipidemia, rheumatoid arthritis, etc) is generally 10-150 g. 3) To exert the best effect of poria cocos, it often combined with corresponding traditional Chinese medicines, such as Alisma orientale and Atractylodes macrocephala, according to diseases, syndromes and symptoms. It is often combined with Semen Ziziphi Spinosae and Rhizoma Anemarrhenae to soothe the nerves and relieve restlessness.
Through collecting ancient medical books and clinical experience of modern doctors, the following dosage-effect characteristics of poria cocos were summarized: 1) the clinical dosage was mostly within the range of 3-150 g. 2) According to diseases, syndromes, symptoms, we choose the best dosage of poria cocos, for example, poria cocos has the functions of invigorating spleen, eliminating dampness, resolving phlegm and relieving diarrhea in small dose. It is used for treating respiratory diseases(chronic obstructive pulmonary disease, chronic bronchitis, chronic pharyngitis, etc) and digestive system diseases(anorexia, diarrhea, etc), and the clinical dosage is generally 3-30 g.Middle dose diuresis, promoting qi circulation, calming the heart and tranquilizing the mind, it can be used for treating neurological diseases(insomnia, depression, epilepsy, etc), gynecological diseases(chronic pelvic inflammatory disease, tubal obstructive infertility, etc), and dermatoses(intractable eczema, choline urticaria, etc), with a clinical dosage of 10-90 g. Large dose diuresis for detumescence, harmonizing stomach and stopping vomiting, the clinical dosage for treating circulatory system diseases(malignant pericardial effusion, hypertension, etc), endocrine and metabolic diseases(diabetic nephropathy, hyperlipidemia, rheumatoid arthritis, etc) is generally 10-150 g. 3) To exert the best effect of poria cocos, it often combined with corresponding traditional Chinese medicines, such as Alisma orientale and Atractylodes macrocephala, according to diseases, syndromes and symptoms. It is often combined with Semen Ziziphi Spinosae and Rhizoma Anemarrhenae to soothe the nerves and relieve restlessness.
引文
[1]姬航宇.《伤寒论》本源药物剂量探索[D].北京:北京中医药大学,2009.
[2]吴嘉瑞,张冰,杨冰,等.基于关联规则和复杂系统熵聚类的颜正华教授治疗失眠用药规律研究[J].中国实验方剂学杂志,2012,18(24):1-4.
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[4]吴嘉瑞,郭位先,张冰,等.国医大师颜正华教授用药剂量规律数据挖掘研究[J].中华中医药杂志,2014,29(4):1046-1049.
[5]郑志鹏.干祖望诊治慢性咽炎的数据挖掘分析及用药规律的研究[D].广州:广州中医药大学,2016.
[6]袁媛,陈小宁.国医大师干祖望“泻离填坎”法论治耳鸣经验探析[J].时珍国医国药,2016,27(6):1500-1502.
[7]胡荣魁,谈勇.夏桂成国医大师调治子宫内膜异位症经验探赜[J].江苏中医药,2015,47(7):1-4.
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[10]彭智平.仝小林教授活用小柴胡汤辨治杂病举隅[J].吉林中医药,2012,32(1):32-33.
[11]张昆.仝小林治疗不完全性肠梗阻经验[J].中医药临床杂志,2012,24(8):712.
[12]仝小林.重剂起沉疴[M].北京:人民卫生出版社,2010.
[13]刘松涛.李赛美辨治中晚期糖尿病用药规律探析[J].广州中医药大学学报,2017,34(5):763-765.
[14]陈靖雯.李赛美柴胡类方临床运用多媒体数据库建立与研究[D].广州:广州中医药大学,2012.
[15]曹健,王耀顷,唐甲哲,等.黄煌治疗高血脂经验[J].湖北中医杂志,2015,37(1):28-29.
[16]苗婷婷,黄煌.黄煌教授经方验案三则[J].中医药学报,2016,44(1):111-112.
[17]张喜莲,马融.小儿癫痫的辨证治疗[J].中华中医药杂志,2007,22(6):376-378.
[18]马驰远,刘向哲.刘向哲教授运用苓桂术甘汤加味治疗痰浊上蒙型眩晕经验[J].中医临床研究,2018,10(12):23-25.
[19]易长莲,张晓华.桂枝茯苓丸加味治疗前列腺增生[J].湖北中医杂志,2012,34(8):61.
[20]沈利华.桂枝茯苓胶囊治疗慢性盆腔炎的疗效观察[J].实用妇科内分泌电子杂志,2015,2(11):190,192.
[21]刘刚,严余明.当归芍药散合桂枝茯苓丸加减治疗单纯性卵巢囊肿的临床研究[J].云南中医学院学报,2015,38(2):73-76.
[22]段元志,余桂枝.茵陈五苓散化裁治疗慢性乙型肝炎黄疸63例[J].江西中医药,2013,44(11):26-28.
[23]梁爱武.加用苏子降气汤、五苓散治疗慢性阻塞性肺疾病急性加重期临床观察[J].广西中医药,2003,26(2):12-14.
[24]龚文婧,郑春青,张颖,等.黄芪四君子汤加减治疗气阴两虚型妊娠糖尿病30例临床观察[J].中医药导报,2012,18(11):31-33.
[25]克修尧,黄厚章.四君子汤合黄芪建中汤治疗脾胃虚寒型慢性胃炎(附46例分析)[J].中国医药指南,2013,11(17):687-688.
[26]周君丰,胡敏霞.四君子汤配合痛泻要方治疗溃疡性结肠炎30例[J].陕西中医,2010,31(5):539-540.
[27]胡昌珍,姬水英,王东.真武汤治疗糖尿病肾病68例[J].中国老年学杂志,2012,32(24):5565-5566.
[28]赵金岭,乔新梅.木防己汤合真武汤治疗心肾阳虚型慢性心力衰竭疗效观察[J].黑龙江中医药,2018,47(1):56-57.
[29]欧阳卫权.真武汤在皮肤科的临床应用[J].中国医学文摘(皮肤科学),2017,34(2):262-266,11.
[30]黄子冬.针刺四缝穴结合参苓白术散加减治疗小儿疳积的疗效分析[J].中国医药指南,2009,7(9):132-133.
[31]罗映霞.参苓白术散联合捏脊疗法治疗小儿缺铁性贫血疗效观察[J].中医临床研究,2018,10(14):122-123,125.
[32]仝小林.方药量效关系名医汇讲[M].北京:人民卫生出版社,2014.
[33]陈昌明.浅议茯苓的功效[J].中医杂志,2010,51(S1):114-115.
[34]刘学儒,杨英.茯苓过敏一例报告[J].中国医院药学杂志,1992(8):45.
[35]朱勤厚.茯苓引起肝损害2例报告[J].中西医结合肝病杂志,1999,9(2):23.
[2]吴嘉瑞,张冰,杨冰,等.基于关联规则和复杂系统熵聚类的颜正华教授治疗失眠用药规律研究[J].中国实验方剂学杂志,2012,18(24):1-4.
[3]吴嘉瑞,郭位先,张冰,等.基于数据挖掘的国医大师颜正华教授含茯苓处方用药规律研究[J].中国中医药信息杂志,2014,21(10):39-42.
[4]吴嘉瑞,郭位先,张冰,等.国医大师颜正华教授用药剂量规律数据挖掘研究[J].中华中医药杂志,2014,29(4):1046-1049.
[5]郑志鹏.干祖望诊治慢性咽炎的数据挖掘分析及用药规律的研究[D].广州:广州中医药大学,2016.
[6]袁媛,陈小宁.国医大师干祖望“泻离填坎”法论治耳鸣经验探析[J].时珍国医国药,2016,27(6):1500-1502.
[7]胡荣魁,谈勇.夏桂成国医大师调治子宫内膜异位症经验探赜[J].江苏中医药,2015,47(7):1-4.
[8]钱菁,赵海英.夏桂成诊治子宫腺肌病痛经的临床经验[J].江苏中医药,2012,44(12):11-12.
[9]谈勇.夏桂成:调周法治不孕[N].中国中医药报,2014-12-11(004).
[10]彭智平.仝小林教授活用小柴胡汤辨治杂病举隅[J].吉林中医药,2012,32(1):32-33.
[11]张昆.仝小林治疗不完全性肠梗阻经验[J].中医药临床杂志,2012,24(8):712.
[12]仝小林.重剂起沉疴[M].北京:人民卫生出版社,2010.
[13]刘松涛.李赛美辨治中晚期糖尿病用药规律探析[J].广州中医药大学学报,2017,34(5):763-765.
[14]陈靖雯.李赛美柴胡类方临床运用多媒体数据库建立与研究[D].广州:广州中医药大学,2012.
[15]曹健,王耀顷,唐甲哲,等.黄煌治疗高血脂经验[J].湖北中医杂志,2015,37(1):28-29.
[16]苗婷婷,黄煌.黄煌教授经方验案三则[J].中医药学报,2016,44(1):111-112.
[17]张喜莲,马融.小儿癫痫的辨证治疗[J].中华中医药杂志,2007,22(6):376-378.
[18]马驰远,刘向哲.刘向哲教授运用苓桂术甘汤加味治疗痰浊上蒙型眩晕经验[J].中医临床研究,2018,10(12):23-25.
[19]易长莲,张晓华.桂枝茯苓丸加味治疗前列腺增生[J].湖北中医杂志,2012,34(8):61.
[20]沈利华.桂枝茯苓胶囊治疗慢性盆腔炎的疗效观察[J].实用妇科内分泌电子杂志,2015,2(11):190,192.
[21]刘刚,严余明.当归芍药散合桂枝茯苓丸加减治疗单纯性卵巢囊肿的临床研究[J].云南中医学院学报,2015,38(2):73-76.
[22]段元志,余桂枝.茵陈五苓散化裁治疗慢性乙型肝炎黄疸63例[J].江西中医药,2013,44(11):26-28.
[23]梁爱武.加用苏子降气汤、五苓散治疗慢性阻塞性肺疾病急性加重期临床观察[J].广西中医药,2003,26(2):12-14.
[24]龚文婧,郑春青,张颖,等.黄芪四君子汤加减治疗气阴两虚型妊娠糖尿病30例临床观察[J].中医药导报,2012,18(11):31-33.
[25]克修尧,黄厚章.四君子汤合黄芪建中汤治疗脾胃虚寒型慢性胃炎(附46例分析)[J].中国医药指南,2013,11(17):687-688.
[26]周君丰,胡敏霞.四君子汤配合痛泻要方治疗溃疡性结肠炎30例[J].陕西中医,2010,31(5):539-540.
[27]胡昌珍,姬水英,王东.真武汤治疗糖尿病肾病68例[J].中国老年学杂志,2012,32(24):5565-5566.
[28]赵金岭,乔新梅.木防己汤合真武汤治疗心肾阳虚型慢性心力衰竭疗效观察[J].黑龙江中医药,2018,47(1):56-57.
[29]欧阳卫权.真武汤在皮肤科的临床应用[J].中国医学文摘(皮肤科学),2017,34(2):262-266,11.
[30]黄子冬.针刺四缝穴结合参苓白术散加减治疗小儿疳积的疗效分析[J].中国医药指南,2009,7(9):132-133.
[31]罗映霞.参苓白术散联合捏脊疗法治疗小儿缺铁性贫血疗效观察[J].中医临床研究,2018,10(14):122-123,125.
[32]仝小林.方药量效关系名医汇讲[M].北京:人民卫生出版社,2014.
[33]陈昌明.浅议茯苓的功效[J].中医杂志,2010,51(S1):114-115.
[34]刘学儒,杨英.茯苓过敏一例报告[J].中国医院药学杂志,1992(8):45.
[35]朱勤厚.茯苓引起肝损害2例报告[J].中西医结合肝病杂志,1999,9(2):23.