经方硝类药物考辨及应用规律研究

【作者】 田甜；

【导师】 肖相如；

【作者基本信息】 北京中医药大学 ， 中医临床基础， 2010， 博士

【摘要】 本课题所研究的硝类药物包括芒硝族的多种药物和硝石。其中芒硝族药物包括朴硝、芒硝、马牙硝、风化硝、玄明粉、西瓜霜等,其基原为硫酸钠；硝石的基原为硝酸钾。研究重点为经方所用到的芒硝、硝石和朴硝。张仲景在《伤寒论》和《金匮要略》中提到的硝类药物名称有芒硝、赤硝、硝石和朴硝四种,总共13方50次。本文对其进行了本草学考辨,以及应用规律的探讨,主要有以下几个方面的内容：第一：名实考辨对于硝类药物来说,名实之辨一直是历代本草文献记载的重点。本课题研究发现,虽然古代硝类药物名实混淆问题严重,但大部分本草的名实与现代还是基本相符的,单从成分看,朴硝为粗制的十水硫酸钠；芒硝即马牙硝,为精制的十水硫酸钠；风化硝为芒硝风化失去结晶水而成的无水硫酸钠；玄明粉为芒硝煅制而成的无水硫酸钠;硝石为硝酸钾。但在《神农本草经》时代,“朴消”主要成分为硝酸钾,并含有较多的杂质；“消石”为十水硫酸钠。唐代“芒消”与“消石”为一物,但当时存在着两种“芒消”,一种就是十水硫酸钠,烧之成为无水硫酸钠,以当“消石”用,实际也是玄明粉的前身。另一种是二次结晶后析出的七水硫酸镁,又名“苦消”。宋代以后,硝类药物的名实就基本稳定了下来,一直沿用至今。值得一提的是,从古至今道家所言的硝石一直都是硝酸钾。在经方所用的硝类药物当中,张仲景总共提到过四个名称：芒硝、硝石、朴硝、赤硝。其中芒硝为精制的十水硫酸钠,朴硝为硫酸钠的粗制品,硝石与赤硝皆为为硝酸钾。第二：功效总结历代文献记载的硝类药物性味功效多有穿插混淆之处,这主要表现在硝石和芒硝的混淆上。在对其进行正名之后,结合经方及历代用法总结诸硝性味功效如下：芒硝：性寒,味咸略苦。泄热通便,润燥软坚,清火消肿,祛痰饮宿食,破血祛瘀。主五脏积热,治天行热疾疫疠,疗伤寒发狂,五心潮热,烦躁不眠,阳强,头痛,为心火炽盛有实热者之要药,凡百实热,悉可泻除；能通利二便,破五淋,治腹胀,胃闭,停痰痞满,涤去蓄结饮食,荡涤三焦肠胃实热,推陈致新,除邪气；破留血,通经脉,疗女子月候不通,主堕胎；外用化水点眼,或煎汤熏洗,能明目消翳,愈目疾红肿；傅漆疮,下瘰疬,润毛发。用于实热便秘,积滞腹胀,停痰积聚,肠痈肿痛,妇人瘀血腹痛；外治乳痈、回乳,目赤障翳,咽喉肿痛,口疮,丹毒痈肿,痔疮,疮疡等证；解可溶性钡盐中毒。与大黄相须,与三棱相反,以石苇为使,畏麦句姜。伐下焦真阴,脾胃虚寒及孕妇忌服。芒硝族的药物还包括芒硝、马牙硝、朴硝、风化硝、玄明粉和西瓜霜。基原与芒硝一致,因炮制方法不同而有不同的名称,故功效大部分与芒硝相通,但同时具有各自的特点。马牙硝与芒硝相同,古代常用于点眼；朴硝药性较烈,多用于峻下宿结；风化硝其性轻浮,多用于祛除上焦顽痰；玄明粉经过火煅,性较温和,常用于体虚缓下,及外用点眼吹喉；西瓜霜多用于喉科疾病。硝石：辛苦微咸,温,有小毒。散血消瘀,化滞散结,开闭除疫。其性属火而上升,阴中之阳,能破积散坚,治诸寒热交错之病；升散三焦火郁,调和脏腑虚寒。性与朴硝相近,其寒凉之力逊于朴硝,而消化之力胜于朴硝。主百病,除寒热邪气,暴伤寒,腹中大热,心腹痛,头痛,治伏暑伤冷,霍乱吐利；逐六府积聚,结固留癖,能化七十二种石,与皂矾同用,善治内伤黄胆,消胆中结石,膀胱中结石及钩虫病。主要治疗偏寒的疾病,及疫疠邪气、气闭痰厥、瘀血症瘕等证。治痧胀,心腹疼痛,吐泻,癥积,黄疸,淋病。火为之使,恶苦参、苦菜、曾青,畏女菀、杏仁、竹叶、粥。体弱及孕妇均忌服。第三：炮制方法硝类药物的炮制与其功效及命名休戚相关。炮制之后的硝类药物一般比较纯净,性味相对缓和,有些加入辅料共制的方法,还使其带有了辅料药物的一些性质,成为一个小的“复方”。朴硝的炮制方法历来比较统一,即原材料溶解取汁,煎干而得,未经再炼,故名日“朴”。当然,随原材料的不同,朴硝的成分会有所差别,而且,这种炮制方法也决定了朴硝的成分不会纯净,当是多种物质的混合物。芒硝最初的炮制方法只是溶解过滤、降温结晶的提净过程。到宋代提出了“英硝”、“马牙硝”的名称,并已经明确二者与芒硝成分相同。芒硝炮制中加入萝卜为辅料是从明代开始的,并且作为标准炮制方法一直沿用到现在。传统的玄明粉炮制方法有朴硝提纯、加入辅料、煅制和去火毒四个步骤,其与风化硝所不同的地方在于风化硝为芒硝直接风化所得,而玄明粉是经煅制所得。由于炮制方法的不同,两者药效也有所差别,临床最好不要混用。古代硝石的炮制方法可分为水制和火制两种。水制法一般为：取原材料溶解过滤取汁,直接煎干,或降温结晶。前者比较粗糙,杂质较多,后者所得硝酸钾结晶将比较纯净,但产量肯定要低。火制法即道家所谓“伏火”,可以简单的概括为与辅料共同加热的制法。现代硝石的炮制方法并不统一,据以上文献记载,有净制、火制、加辅料水制等。现在一般药店芒硝、朴硝、马牙硝,皆为芒硝,即十水硫酸钠；风化硝、玄明粉同为无水硫酸钠；硝石则极少有售。诸药均未经任何炮制。第四：应用规律不论是经方,还是其他历代医家的记载,硝石的应用范围都要比芒硝族药物小得多。就二者的应用历史发展看,芒硝族药物中逐渐发展衍生出了玄明粉等多种炮制方法的产物,而硝石则几乎没有大的发展变化,并且现在有萎缩趋势。经方中的硝类药物可分为两类：第一类为芒硝族药物芒硝与朴硝,基原皆为Na2SO4·10H2O;第二类为硝石族药物硝石与赤硝,成分相同,皆为KNO3。从仲景的用法看,芒硝主要用其咸寒之性,泄热通便,润燥软坚,祛痰逐饮,破血祛瘀。凡病情涉及阳明,有燥结、宿食、热证、瘀血结滞等表现者,皆可加减应用；硝石主要用其辛苦之性,消瘀,散血,祛湿,散结,主要用于湿热瘀血之黄疸,及癥瘕瘀滞之疟母；朴硝咸寒,破积通便,由于药性过于峻烈,仅用于攻下宿食暴结。仲景以后芒硝族药物又出现了马牙硝、风化硝、玄明粉、西瓜霜等。其中芒硝除了继承和发展了经方的用法以外,还更多的记载了一系列外用的方法,包括眼科、口腔、皮科等多个方面,应用非常广泛；马牙硝与芒硝一致,由于其质洁净,多用于眼科用药；风化硝其质轻浮,多用于清化上焦顽痰；玄明粉性质纯净和缓,多用于缓下热结,及外用点眼、吹喉等；西瓜霜多用于喉科。硝石的应用历代记载比较混乱,很多文献中所言之“硝石”实指芒硝。真正的硝石由于其性属温,辛散升腾,历代多用于治疗偏寒的疾病,及疫疠邪气、气闭痰厥、瘀血症瘕等证。对于芒硝和硝石两药的功效特点,二者的相同点在于皆有消积祛滞之功；区别在于,第一,芒硝味咸而硝石味辛,芒硝之“消”在于润燥软坚,有通破之力,善消有形之积滞,如宿食、燥屎、痰饮、留血等；而硝石之“消”在于辛散化瘀,具消散之功,能消弥漫之郁结,如湿热黄疸、疟母癥瘕等；第二,芒硝之性纯寒泻热,其性下走；而硝石带有升散之气,其性当属温。硝石寒凉之力逊于芒硝,而消化之力较胜。更多还原

【Abstract】 In this work, different medicines of the family of Mirabilite and Niter were studied. The medicine of the family of Mirabilite include Impure mirabilite、Mirabilite、Maya-Mirabilit、Weathered mirabilite、Matrii Sulfas Exiccatus and Watermelon frost. The basic composition of mirabilite medicin is sodium sulfate while that of the Niter is potassium nitrate. This work emphasized on the Mirabilite、Niter and Impure mirabilite which are usually used in the classical prescription.Mirabilite medicine referred by Zhang Zhong-Jing in the "Shang Han Lun" and " Chin-Kuei Theories " include Mirabilite、Red-Niter、Niter and Impure mirabilite. They are referred for 50 times and used in 13 different prescriptions. In this work, the research based on the herbal lore and the discussion of the application of these medicines is proposed as follows.First:Distinguish between the name and the entityFor nitrate drugs, the distinguish between the name and the entity has been always the focus of the herbal literatures through the ages. The research project found that although the confusion of ancient nitrate drugs were a serious problem, most herbs were actually consistent with the modern. Viewed from the composition, Impure mirabilite is the crude decahydrate sodium sulfate; Mirabilite is Maya-Mirabilite, which is the refined decahydrate sodium sulfate; Weathered mirabilite is Mirabilite which loses its crystal water and formed anhydrous sodium sulfate; Matrii Sulfas Exsiccatus is calcined Mirabilite; Niter is potassium nitrate. But in the record from "The Shen Nong Ben Cao Jing", " Impure mirabilite" means potassium nitrate with a lot of impurities; "Niter" means decahydrate sodium sulfate. Then in the Tang dynasty, "Mirabilite" and "Niter" were the same thing. But at that time, there were two "Mirabilite" One is decahydrate sodium sulfate, which can be burned into anhydrous sodium sulfate and used as "Niter". Actually, it is the predecessor of Matrii Sulfas Exiccatus. The other one is Magnesium Sulphate(Hepta) made from the Secondary recrystallization, which is also known as "Bitter Nitrite". After the Song Dynasty, the name of real nitrate drugs was basically stabilized until now. It is worth to be mentioned that the "Niter" referred by the ancient Taoist always means potassium nitrate.Four different names of the nitrate drugs which are used by classical prescriptions are referred by Zhang Zhong-Jing:Mirabilite, Niter, Impure mirabilite and Red-Niter. Here, Mirabilite is the purficication of the decahydrate sodium sulfate; Impure mirabilite is the crude sodium sulfate; Niter and Red-Niter are potassium nitrate.Second:Efficacy SummaryThe records of properties and action of nitrate drugs are confused in the literatures of different ages. It is mainly manifested in the confusion of the Niter and the Mirabilite. After the rectification of the names, the properties and action of nitrate drugs is summarized as follows.Mirabilite:cold-natured,salty flavor and slightly bitter.Clearing heat Relaxing the bowels, Moisturizing dryness Softening hard mass, Discharging fire Ddetumescence, Reduce phlegm, Relieving dyspepsia, Activating blood circulation to dissipate blood stasis.Niter:warm-natured, pungent and bitter flavor and slightly salty, slightly poisonous. Scatter blood circulation to dissipate blood stasis, Scatter stasis Eliminating stagnation, Therapy for waking up a patient from unconsciousness.Third:the processing methodThe name and action of the nitrate drugs are closely related to the processing method. After the processing, the nitrate drugs are usually relatively pure, and the action is relatively eased. There are also some accessories may be added during the processing, which will make the drugs have some properties from the accessories and act like a small "compound".The processing method of Impure mirabilite is always unified. The raw material is dissolved in water, removing all the insoluble impurities, and then the solution is fried into the final product. No further refining process is included in this method, so the product of this method is "Impure" mirabilite. Of course, for different raw materials, the composition of the Impure mirabilite is quite different. Furthermore, the product made by this method is not very pure, which is a mixture of various substances.At the beginning, the processing of Mirabilite only includes processes as dissolving, filtering and cooling crystallization. In the Song Dynasty, the names of "Ying-Mirabilite" and "Maya-Mirabilite" were proposed, and they have the same component as Mirabilite. From the Ming Dynasty, radish was added as an accessory in the processing of Mirabilite, and this method has been adopted as a standard to the present.The traditional processing method of Matrii Sulfas Exsiccatus includes four steps:purification of Impure mirabilite, adding accessories, calcining and remove the irritating. It is different from the Weathered mirabilite which is made by weathering the Mirabilite; the Matrii Sulfas Exsiccatus is obtained by calcined system. Because of the differences in processing methods, the medical actions of the two drugs are different and should not be mixed in clinical use.Ancient processing methods of Niter can be divided into two types:water preparing and fire preparing. Generally, water preparing means dissolving the raw materials, filtering and selecting the solution, then drying the solution or obtain product by cooling crystallization. Product by the former method is crude with a lot of impurities, and the latter is more pure but with lower yield. Fire preparing is also known as the "Fu-Huo" in Taoist system. It can be simply summarized as heating together with the accessories. Modern processing methods of Niter are not uniform. Different methods such as cleansing, fire preparing, and water preparing with accessories are used based on different literatures.The Mirabilite, Impure mirabilite, and Maya-Mirabilite sold in modern pharmacies are generally Mirabilite, that means, decahydrate sodium sulfate. Weathered mirabilite and Matrii Sulfas Exsiccatus are anhydrous sodium sulfate. Niter is rarely available for sale. All of them are not processed.Fourth:The Law of applicationAccording to both the classical prescriptions and the records of ancient physicians, the application of Niter is much less than the drugs of Mirabilite’ s family. It can be found from the development of both applications that different products, such as Matrii Sulfas Exsiccatus, are derived from different processing methods, while no obvious development and changes can be found in the application of Niter, even a trend of shrinking can be observed now.Nitrate drugs used in classical prescriptions can be divided into two categories. The first group is drugs of Mirabilite’s family, including Mirabilite and Impure mirabilite, and both of them have the same main component, Na2SO4·10H2O. The second group is drugs of Niter’s family, including Niter and Red-Niter, and both of them have the same composition, KN03.From the usage of these drugs by Zhang Zhongjing, usually, the cold and salty nature of Mirabilite is used to relieve constipation by purgation, moisten and soften dry and hard things, expectorant and expel blood stasis stagnation. The Mirabilite can be used in all conditions where the disease is related to Yangming and the symptom shows dryness, dyspepsia, heat syndrome or blood stasis stagnation, etc. The properties of Niter usually used its pungent flavor and bitter taste. It can be applied to silt, scatter blood, and remove dampness. For example, Niter can be used in Dampness and heat icterus and malarial nodule. Impure mirabilite is salty and cold, which can be used to relieve constipation. However, as the Crude niter is too furious, it can only used for relieving chest and abdominal distention. After the time of Zhang Zhongjing, some new drugs in the Mirabilite’s family appeared, such as Maya-Mirabilite, Weathered mirabilite, Matrii Sulfas Exsiccatus and Watermelon frost and so on. Besides the traditional usage in classical prescription, more external application of Mirabilite has been developed, including ophthalmology, department of stomatology, dermatological department and some other areas. Maya-Mirabilite is similar to Mirabilite and for it is more pure, it is much more widely used as ophthalmic drugs. Weathered mirabilite is usually used to facilitate expectoration resulted from disease of upper energizer for it is very light. Matrii Sulfas Exsiccatus is more pure and soothing, so it is usually used to release the lower hot and used externally in eyes and throats. Watermelon frost is usually used in the throat.The records of the application of Niter are quite disordered. Sometimes, Niter referred by some literatures is Mirabilite in fact. The real Niter is warm, pungent and ascending, so it is usually used for the treatment of some cold diseases and malignant malaria、syncope by phlegm、Stagnation of blood mass and so on.The same point of the effect of Mirabilite and Niter is both of them can remove stagnation. And the differences are as follows. Firstly, Mirabilite taste salty while Niter taste pungent. As a result, Mirabilite is powerful to break or remove material stagnant, such as putrefaction and blood, while Niter is useful to diffuse disperse stagnant, such as Dampness and heat icterus、malarial nodule and so on. Secondly, Mirabilite is pure cold with the property to descend, while Niter has the potential to ascend and is a little warm. In another word, Niter is more powerful in digestion but not as cold as Mirabilite.更多还原