Zhao Hong-Xia, Yu Zhi-Min, Geng Ying, Li Yi, Wang Wen-Lai, Tao Xu-Guang, Guo Rong, Yang Zhen, Hu Jing-Qing
Institute of Basic Theory, China Academy of Chinese Medical Sciences Beijing 100700, China.
Beijing Tongren Hospital Affiliated to Capital Medical University Beijing 100176, China.
Zhongguo Zhong Yao Za Zhi. 2020 Mar;45(5):1209-1212. doi: 10.19540/j.cnki.cjcmm.20200103.501.
Simiao Yong'an Decoction is composed of Lonicerae Japonicae Flos, Scrophulariae Radix, Angelicae Sinensis Radix, Glycyrrhizae Radix et Rhizome, which was chosen as one of the 100 classic prescriptions in Catalogue of Ancient Classics Prescription(the first batch). Through tracing to the source, It was found that the Simiao Yong'an Decoction(but not named) originated from the Shi Shi Mi Lu, and was later cited by books such as Ancient and Modern Book Integration-Full Record of Medical Department and New Edition of Useful Prescriptions. Literature shows that this prescription was not named until first reported in the Effect of Traditional Chinese Medicine on Arterial Embolism Gangrene in 1956 by a journalist LYU Min. This article recorded that SHIJIA Baoshan, a monk from Hebei Province, used self-named "Simiao Yong'an Decoction" to treat local arterial embolic gangrene. After comparison, there was two difference between ancient books and SHIJIA Baoshan's records. Firstly, according to ancient books, the composition and dosage of Simiao Yong'an Decoction is Lonicerae Japonicae Flos 90 g, Scrophulariae Radix 90 g, Angelicae Sinensis Radix 60 g, Glycyrrhizae Radix et Rhizome 30 g", and the ratio is 3∶3∶2∶1. By SHIJIA Baoshan's record, the composition and dosage are: Lonicerae Japonicae Flos 66 g, Scrophulariae Radix 132 g, Angelicae Sinensis Radix 99 g, Glycyrrhizae Radix et Rhizome 33 g, and the ratio changed to 2∶4∶3∶1. Secondly, ancient books show that patients can be healed after taking seven or ten days of the previous prescription, however, it would take 3 or 4 months, even 7 months in SHIJIA Baoshan's records. It can be considered that the previous prescription should be used at the beginning of gangrene, while the modified Simiao Yong'an Decoction by SHIJIA Baoshan is widely used in the middle and late stages of gangrene, even the critical condition, that is the reason for longer treatment and larger dosage. Nowadays, Simiao Yong'an Decoction is not limited to the treatment of gangrene and bulla in clinic. Relevant studies have confirmed that Simiao Yong'an Decoction has the effects such as anti-inflammatory, plaque stabilization, lipid-lowering, vascular protection, improvement of hemorheology, anticoagulation, inhibition of thrombosis and fibrinolysis, etc. In the follow-up, we should carry out the analysis of the compatibility of this four medicines, and redefine the scope of its clinical application under the theory of traditional Chinese medicine.
四妙勇安汤由金银花、玄参、当归、甘草组成，被选为《古代经典名方目录》（第一批）中的100首经典方剂之一。经溯源发现，四妙勇安汤（当时未命名）源自《石室秘录》，后被《古今图书集成·医部全录》《新增万病回春》等书籍引用。文献显示，该方直到1956年吕敏记者在《中药治疗动脉栓塞性坏疽的疗效》中首次报道才被命名。该文章记载，河北和尚释家宝山用自拟的“四妙勇安汤”治疗局部动脉栓塞性坏疽。经比较，古籍记载与释家宝山的记录有两点不同。其一，古籍记载四妙勇安汤的组成及用量为金银花90g、玄参90g、当归60g、甘草30g，比例为3∶3∶2∶1；释家宝山的记录中组成及用量为金银花66g、玄参132g、当归99g、甘草33g，比例变为2∶4∶3∶1。其二，古籍记载服用前方七至十日可愈，而释家宝山的记录中则需三四个月，甚至七个月。可以认为前方适用于坏疽初期，而释家宝山改良后的四妙勇安汤多用于坏疽中晚期，甚至危急病症，这也是治疗时间更长、用药剂量更大的原因。如今，四妙勇安汤在临床中不限于治疗坏疽和疱疡。相关研究证实，四妙勇安汤具有抗炎、稳定斑块、降脂、血管保护、改善血液流变学、抗凝、抑制血栓形成及纤维蛋白溶解等作用。后续应开展这四味药的配伍分析，并在中医理论指导下重新界定其临床应用范围。
