【作者】 曹宁；

【导师】 邓中甲；

【作者基本信息】 成都中医药大学 ， 方剂学， 2009， 博士

【摘要】 目的：研究大黄在复方中功效发挥方向的影响因素,揭示大黄在复方中发挥各功效时的基本配伍规律、常用剂量、炮制品种、最佳剂型及煎服方法等。方法：以《中华医方精选辞典》(精选本)为蓝本,收集含大黄的方剂1224首,建立数据表,使用计算机数据处理系统,利用其筛选工具,归类统计出与大黄配伍使用的高频次药物,发挥特定功效时大黄的用药剂量范围、炮制方法、剂型、煎服方法等。参考《伤寒杂病论》以后的方书；《神农本草经》以后的本草著作；历代名医方论；现代期刊杂志和大黄研究专著等,对影响大黄在复方中功效发挥方向的诸因素进行总结,并结合其相应的病机进行讨论。结果：大黄的功效可归纳为5个方面15个作用方向：1.泻下攻积(泻下热结、攻下冷积、攻下宿食、攻下虫积、攻痰逐饮)；2.泻火解毒(泻热消痞、清心泻火、清肠泻肺、清肝泻热、清热通淋、清热消痈、解毒消疮)；3.活血化瘀(活血通经、活血止痛、化瘀消癥)；4.凉血止血；5.利胆退黄。影响大黄在复方中功效发挥方向的因素有配伍环境、剂量、炮制、剂型、煎服法等。其中配伍环境是最主要的影响因素,大黄配芒硝、枳实、厚朴、槟榔、甘遂、牵牛子、胡麻仁、杏仁等长于泻下攻积；配黄连、黄芩、栀子、连翘、生石膏、川木通、滑石、龙胆草、瞿麦、牛黄、犀角、薏苡仁、冬瓜仁、煅石膏、陈石灰、白矾、白及等长于泻火解毒；配当归、川芎、桃仁、红花、乳香、没药、三棱、莪术、蛰虫、虻虫、水蛭等长于活血化瘀；配丹皮、生地、地榆、蒲黄等长于凉血止血；配茵陈、栀子等长于利胆退黄；配山楂,神曲等长于健胃消食。其它因素方面,大黄的用量因受药材品质、炮制品种、剂型、配伍环境、地域环境、病人体质、病势缓急等因素影响而有较大差异,但一般来说,其剂量规律具有两个特点：①泻热消痞、清热利湿时用量宜小；泻下攻积、凉血止血时用量宜大；活血化瘀、泻火解毒时用量中等；②表里同病时用量宜轻；表和里实时用量较重。大黄的炮制品种中生大黄长于清热泻火、泻下攻积、解毒消痈、凉血止血；酒大黄长于活血化瘀,兼可引药上行而清上焦实热；熟大黄泻下之力缓和,常用于体质虚弱而兼便秘的患者；大黄炭长于收涩止血,治疗各种出血性疾病。大黄常用的剂型有汤、丸、膏、散四种,汤剂可广泛适用于大黄各种功效的发挥；丸剂常用于泻下攻积、泻火解毒、活血化瘀等功效,较少在凉血止血、利胆退黄功效中使用；散剂主要用于泻下攻积、泻火解毒、活血化瘀、凉血止血等功效,较少在利胆退黄功效中使用：膏剂主要以外用的形式治疗各种痈疮肿毒。结论：配伍环境、剂量、剂型、炮制、煎服方法等皆能对复方中大黄功效的发挥方向产生不同程度的影响,其中尤以配伍环境为最主要的影响因素。大黄在复方中的功效发挥是上述诸因素综合作用的结果。更多还原

【Abstract】 Objective:To research the regulating factors that controlling the function of Dahuang(Radix Acanthopanax Senticosi) in formula.To reveal the basic regulation of prescription composition, dosage in most use, the best preparation, boiling and usage of Dahuang that display various effects in formula.Methods:According to the classic format Formula Dictionary of Traditional Chinese Medicine,1224 formulae including Dahuang were collected and structured data bank in Micro-Excel. To statistics the high frequency medicine compatibility with Dahuang, dosage in most use, the best preparation, decocting and usage of taking special effects. Consulting various historical documents of Traditional Chinese Medicine after Treatise on Febrile and Miscellaneous and Sheng Nong’s herbal classic, modern periodical magazine and research monograph about Dahuang. To sun up regulating factors that affecting the direction of function of Dahuang, and discussing it with relevant pathogenesis.Result:The five kinds of concluded Dahuang’s efficacy and 15 functional exertion are dispelling diarrhea and purge substantial Evil(expel Heat to loosen the bowels,purge away constipation duo to accumulation of Cold, purge away dyspepsia, detoxicate and kill parasites, expel Fluid-retention), dispel Heat and remove toxin(dispel Heat to relieve thoraxic, clear away heart-fire, clear away Lung-Heat and Intestine-Heat, purge Liver-fire, clear away Heat and promote diuresis, clear away Heat to remove carbuncle, detoxicate to remove sore), promote Blood circulation to dissipate Blood stasis (promote Blood circulation to induce menstruation, promote Blood circulation to relieve pain, promote Blood circulation to remove stagnancy), coll Blood for hemostasis, promote the function of the gallbladder to alleviate jaundice.The regulation factors that controlling functional exertion of Dahuang in formula are the circumstances of compatibility, dosage, processing of preparation, preparation,usage and boiling.The circumstances of compatibility are the most important regulating factors. When exerting function of dispelling diarrhea and purge substantial Evil, Radix Acanthopanax Senticosi is usually made up a prescription with Natrii Sulfas, Fructus Aurantii Immaturus, Cortex Magnoliae Officinalis, Semen Arecae, Radix Euphorbiae Kansuil, Semen Pharbitidis, Fructus Cannabia, Semen Armeniacae Amarum and so on. With Radix Scutellariae, Rhizoma Coptidis, Fructus Gardeniae, Fructus Forsythiae, Gypsum Fibrosum, Caulis Clematidis Armandii,Talcum, Radix GenTianae, Herba Dianthi, Calculus Bovis, Cornu Rhinoceri Asiatici, Semen Coicis, Semen Benincasae, Alumen, Rhizoma Bletillae and so on, Radix Acanthopanax Senticosi is praescribed for dispel Heat and remove toxin. With Radix Angelicae Sinensis, Rhizoma Ligustici Chuanxiong, Semen Persicae, Flos Carthami, Rhizoma Sparganii, Rhizoma Zedoariae, Tabanus, Hirudo and so on, for promote Blood circulation to dissipate Blood stasis. With Cortex Moutan Radicis, Radix Rehmanniae, Radix Sanguisorbae, Pollen Typhae, for coll Blood for hemostasis.With Herba Artemisiae Scopariae, Fructus Gardeniae, for promote the function of the gallbladder to alleviate jaundice.As for the other factors, Dahuang was more different in doseage because different medicinal materials, circumstances of compatibility, dosage, processing of preparation, region natural environment, physique of patient and so on.but generally speaking, the doseage of Dahuang have two regulation:①. It employed as dispel Heat to relieve thoraxic and clear away Heat and promote diuresis shoud be less, mostly for dispelling diarrhea and purge substantial Evil and coll Blood for hemostasis, intermediatly for promote Blood circulation to dissipate Blood stasis and dispel Heat and remove toxin.②the doseage of Dahuang employed as disease involving both Exterior and Interior should be less, mostly for Exterior harmony and Interior-Excess. Raw Dahuang was often used in the function of diarrhea and purge substantial Evil, dispel Heat to relieve thoraxic, detoxicate to remove sore, coll Blood for hemostasis;Wine Dahuang was often used in promote Blood circulation to dissipate Blood stasis and lead other medicine to Shangjiao;processed Dahuang was used in the patient with a weak constitution; Dahuang charcoal was often used in the function of hemostasis. Decoction, pill, paste and powder is four kinds of preparation of Dahuang most in use. Decoction apply to all kinds of function; pill is often used in diarrhea and purge substantial Evil, dispel Heat and remove toxin, promote Blood circulation to dissipate Blood stasis and less used in coll Blood for hemostasis and promote the function of the gallbladder to alleviate jaundice; powder is often used in diarrhea and purge substantial Evil, dispel Heat and remove toxin, promote Blood circulation to dissipate Blood stasis, coll Blood for hemostasis and less used in promote the function of the gallbladder to alleviate jaundice; paste is often used in pyogenic infection of skin.Conclusion:The compatibility is the key point of all the factors influencing the efficacy exertion of Dahuang.What’s more,other factors including compatibility, dosage, processing of preparation, preparation and so on are also influential in it. Therefore, the efficacy exertion of Dahuang in compound formulae is influenced by all the factors we mentioned above.更多还原