Xiong Xing-Jiang
Guang'anmen Hospital, China Academy of Chinese Medical Sciences Beijing 100053, China.
Zhongguo Zhong Yao Za Zhi. 2023 May;48(10):2583-2594. doi: 10.19540/j.cnki.cjcmm.20230219.501.
Huangtu Decoction, first recorded in Essentials from the Golden Cabinet(Jin Kui Yao Lue) from ZHANG Zhong-jing in Han dynasty, is used to treat distal bleeding. It is mainly treated for the syndrome of failing to control blood with spleen-yang deficiency. The connotation of distal bleeding is more extensive, including not only upper gastrointestinal bleeding in the traditional sense such as peptic ulcer bleeding, gastrointestinal tumors, gastric mucosal lesions, vascular dysplasia, esophagogastric variceal bleeding, and pancreatic and biliary tract injury, but also other anorectal diseases such as part colon and rectal cancer swelling or polyps, hemorrhoids, and anal fissure and other parts of bleeding such as epistaxis, thrombocytopenia, functional uterine bleeding, threatened abortion, and unexplained hematuria. Distal bleeding also involves syndromes of failing to keep part deficient and cold fluids in interior, such as nocturia, enuresis, clear nose, sweating, cold tears, and leucorrhea, and excessive gastrointestinal bleeding caused by anti-plate and anticoagulant drugs, unexplained positive in the fecal occult blood test, and other modern clinical new problems. The indications of Huangtu Decoction include not only lower blood, defecation before blood, distant blood, hematemesis, epistaxis, and other diseases in traditional Chinese medicine, but also three types of clinical manifestations including bleeding, deficiency syndrome, and stagnant heat syndrome. In the clinic, Huangtu Decoction can be used to treat acute upper gastrointestinal bleeding, acute coronary syndrome complicated with acute upper gastrointestinal bleeding, bleeding events caused by excessive antiplatelet and anticoagulant drugs, unexplained positive in the fecal occult blood test, gastrointestinal tumor with bleeding, thrombocytopenia, and other acute and critical diseases. The dosage of Cooking Stove Earthkey, Rehmanniae Radix, and Asini Corii Colla in Huangtu Decoction is the key to hemostasis.
黄土汤首载于汉代张仲景所著《金匮要略》，用于治疗远血。主要治疗脾阳虚不能统血之证。远血的内涵较为广泛，不仅包括传统意义上的上消化道出血，如消化性溃疡出血、胃肠道肿瘤、胃黏膜病变、血管发育异常、食管胃静脉曲张破裂出血以及胰胆损伤等，还包括其他肛肠疾病，如部分结肠癌、直肠癌肿物或息肉、痔疮、肛裂等部位的出血，以及鼻出血、血小板减少、功能性子宫出血、先兆流产、不明原因血尿等其他部位的出血。远血还涉及体内阴液亏虚、寒饮内停之证，如夜尿、遗尿、清涕、出汗、冷泪、白带等，以及抗血小板和抗凝药物所致的胃肠道出血过多、粪便潜血试验不明原因阳性等现代临床新问题。黄土汤的适应证不仅包括中医传统的下血、先便后血、远血、吐血、鼻出血等病症，还包括出血、虚证、郁热证三种临床表现类型。临床中，黄土汤可用于治疗急性上消化道出血、急性冠脉综合征合并急性上消化道出血、抗血小板和抗凝药物过量所致出血事件、粪便潜血试验不明原因阳性、伴有出血的胃肠道肿瘤、血小板减少等急危重症。黄土汤中灶心土、生地黄、阿胶的用量是止血的关键。
