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[木防己汤方证溯源及其对急重症的作用]

[Mufangji Decoction formula tracing and its effect on emergency and severe cases].

作者信息

Xiong Xing-Jiang

机构信息

Guang'anmen Hospital,China Academy of Chinese Medical Sciences Beijing 100053,China.

出版信息

Zhongguo Zhong Yao Za Zhi. 2019 Jan;44(2):388-400. doi: 10.19540/j.cnki.cjcmm.2019.0009.

Abstract

Mufangji Decoction is a famous herbal formula from Synopsis of Golden Chamber. However,it is easy to be misunderstood due to so its unique compatability. The syndromes treated by Mufangji Decoction included the following aspects:(1) in terms of modern medicine,it could be used to treat acute and chronic heart failure,heart failure aggravated by lung infection,chronic obstructive pulmonary disease acute episode,pulmonary heart disease,bilateral pleural effusion,acute attack of gout,rheumatic fever,rheumatoid arthritis,and rheumatoid arthritis;(2) in terms of symptoms,it could be used to treat asthma,chest tightness,wheeze impacting prostration and dyspnea impacting sitting posture; gastric distention; dark face,cyanotic,and mitral valvular face; edema of head and extremities; dry mouth,thirsty,unwilling to wear thick clothes,intolerance of heat,and irritable; fatigue,shortness of breath,poor appetite,constipation,less urine,yellow color,poor response to diuretics,and diuretic resistance; fast heart rate,which is hard to be controlled by Western medicine and has no response to Zhenwu Decoction; dark red tongue,dry tongue with yellow fur,rapid pulse,or deep tight pulse. In emergency and severe cases,Yang deficiency and fluid retention are normal syndromes of heart failure,while Yang deficiency,fluid retention,and heat are metamorphic syndromes of heart failure,which possessed complex mechanisms of pathophysiology; the mechanisms of Shaoyin heat-conversion syndrome is similar to Yang deficiency,fluid retention,and heat syndrome; the reason of application of gypsum in Mufangji Decoction shall be further studied; the " empty" and " real" in modified Mufangji Decoction are physical signs,rather than pathogenesis.

摘要

木防己汤是《金匮要略》中的名方。然而,因其独特的配伍,容易被误解。木防己汤所治疗的证候包括以下几个方面:(1)从现代医学角度看,可用于治疗急慢性心力衰竭、肺部感染加重的心力衰竭、慢性阻塞性肺疾病急性发作、肺源性心脏病、双侧胸腔积液、痛风急性发作、风湿热、类风湿关节炎;(2)从症状方面,可用于治疗气喘、胸闷、喘促不得卧、呼吸困难不得平卧;胃脘胀满;面色暗黑、发绀、二尖瓣面容;头面及四肢水肿;口干、口渴、不欲穿厚衣、不耐热、烦躁;乏力、气短、食欲不振、便秘、尿少色黄、对利尿剂反应差及利尿剂抵抗;心率快,西药难以控制且对真武汤无反应;舌红绛、舌干苔黄、脉数或脉沉紧。在急重症情况下,阳虚水泛是心力衰竭的常见证候,而阳虚水泛兼热是心力衰竭的变证,其病理生理机制复杂;少阴热化证的机制与阳虚水泛兼热证相似;木防己汤中应用石膏的原因有待进一步研究;加减木防己汤中的“虚”与“实”是体征,而非病机。

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