狂癇
★ 甘麥(mai)大棗湯(《金(jin)匱要略》)
藥(yao)物組成(cheng):甘(gan)草 小麥 大棗
臨床應用:婦人臟(zang)躁(zao),喜(xi)悲欲(yu)哭,如(ru)神(shen)靈(ling)所靈(ling),數(shu)欠(qian)身,甘麥(mai)大棗湯主(zhu)之。仲景設此方,系本著“肝苦(ku)急,急食甘以(yi)緩之”的治則(ze),以(yi)治婦科諸(zhu)郁證。
以純甘之(zhi)(zhi)(zhi)劑,以甘緩之(zhi)(zhi)(zhi),緩急迫之(zhi)(zhi)(zhi)意也。甘草、大棗(zao)皆為緩和之(zhi)(zhi)(zhi)藥,緩解肌肉拘攣(luan)、神(shen)經興(xing)奮(fen)、各種疼(teng)痛等;小麥也有鎮靜安(an)神(shen)之(zhi)(zhi)(zhi)功,尤能養心(xin),1958年第 8期(qi)《江蘇(su)中醫》有“從臨床體會(hui)談談甘麥大棗(zao)湯的應用標(biao)準”,具(ju)體談到患者(zhe)言(yan)行失常,或(huo)無故悲傷,或(huo)喜(xi)怒不(bu)節者(zhe);心(xin)煩不(bu)得眠,或(huo)恍惚多(duo)夢,或(huo)坐臥不(bu)安(an),或(huo)身(shen)如蟻(yi)走樣者(zhe);汗多(duo),口干,不(bu)思飲食(shi),大便秘結(jie),常數日不(bu)衣者(zhe);怕一切聲光(guang),怕與人交談,喜(xi)獨(du)居暗(an)室者(zhe)。
★ 大承氣湯(《傷寒論》)
藥(yao)物組成:大共同12g 厚樸15g 枳實12g 芒硝9g
臨床(chuang)應用:上藥(yao)4味(wei),用水100ml,先煎厚樸(pu)、枳實(shi),取(qu)500ml。去滓,納(na)大黃,更煮取(qu)200ml,去滓,納(na)芒硝,再上微(wei)火煎一二沸,分2次溫服。
治(zhi)癇證發狂(kuang)等屬于里(li)實熱證者。
★ 丑寶丸(《古今醫鑒·卷七》)
藥物(wu)組成:牛黃15g 琥珀 辰砂(sha)(為衣) 雄黃各3g 膽(dan)星(xing)30g 礞石15g 沉(chen)香 犀角(現已(yi)禁用)各4.5g 黃芩(炒(chao))大黃各60g 天麻15g 石菖蒲30g 僵蠶21g 蟬蛻15g 豬心2具
臨床應用:上藥15味(wei),為細末,竹瀝、豬心血和丸,如綠(lv)豆大,每服60-70丸,臨臥(wo)時(shi)用薄荷湯(tang)下。
(1)活(huo)(huo)(huo)血(xue)(xue)(xue)(xue)(xue)化(hua)(hua)閼法(fa)(fa)(fa)(fa)(fa)(fa) 此(ci)法(fa)(fa)(fa)(fa)(fa)(fa)對于(yu)(yu)(yu)(yu)顱腦外傷,或(huo)(huo)(huo)(huo)(huo)(huo)(huo)小(xiao)兒難產(chan)、顱內(nei)出(chu)血(xue)(xue)(xue)(xue)(xue)所(suo)(suo)造成的(de)(de)(de)癲(dian)(dian)癇(xian)(xian)更為適宜(yi)。癲(dian)(dian)癇(xian)(xian)發(fa)作(zuo)時(shi)(shi),人體臟腑(fu)(fu)氣(qi)血(xue)(xue)(xue)(xue)(xue)失(shi)去(qu)了平衡(heng)而(er)發(fa)生紊亂。氣(qi)機紊亂必然導致(zhi)(zhi)血(xue)(xue)(xue)(xue)(xue)流不(bu)(bu)暢,這是(shi)(shi)(shi)(shi)(shi)因為氣(qi)和(he)血(xue)(xue)(xue)(xue)(xue)有(you)(you)(you)(you)密切的(de)(de)(de)聯系。氣(qi)滯以(yi)(yi)后血(xue)(xue)(xue)(xue)(xue)流瘀(yu)阻(zu)(zu),血(xue)(xue)(xue)(xue)(xue)瘀(yu)以(yi)(yi)后氣(qi)機更加不(bu)(bu)利。所(suo)(suo)以(yi)(yi)在治療(liao)癲(dian)(dian)癇(xian)(xian)時(shi)(shi),尤其(qi)是(shi)(shi)(shi)(shi)(shi)治療(liao)外傷性(xing)癲(dian)(dian)癇(xian)(xian)時(shi)(shi),運用(yong)(yong)(yong)(yong)活(huo)(huo)(huo)血(xue)(xue)(xue)(xue)(xue)化(hua)(hua)瘀(yu)的(de)(de)(de)藥(yao)物可以(yi)(yi)提高療(liao)效(xiao)。常用(yong)(yong)(yong)(yong)活(huo)(huo)(huo)血(xue)(xue)(xue)(xue)(xue)藥(yao)時(shi)(shi)要(yao)注(zhu)意,婦女月經過多(duo)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)妊娠(shen)期間禁用(yong)(yong)(yong)(yong)。 中醫(yi)學有(you)(you)(you)(you)"久病(bing)多(duo)瘀(yu)"之(zhi)(zhi)說,對于(yu)(yu)(yu)(yu)癲(dian)(dian)癇(xian)(xian),有(you)(you)(you)(you)瘀(yu)血(xue)(xue)(xue)(xue)(xue)癥狀者(zhe),應(ying)用(yong)(yong)(yong)(yong)活(huo)(huo)(huo)血(xue)(xue)(xue)(xue)(xue)化(hua)(hua)瘀(yu)法(fa)(fa)(fa)(fa)(fa)(fa)當屬無疑。但對于(yu)(yu)(yu)(yu)部分(fen)癇(xian)(xian)證(zheng),有(you)(you)(you)(you)時(shi)(shi)瘀(yu)阻(zu)(zu)之(zhi)(zhi)象不(bu)(bu)明顯,但病(bing)久難愈,用(yong)(yong)(yong)(yong)其(qi)他治法(fa)(fa)(fa)(fa)(fa)(fa)效(xiao)不(bu)(bu)顯著(zhu)時(shi)(shi),也(ye)(ye)可配合(he)使用(yong)(yong)(yong)(yong)活(huo)(huo)(huo)血(xue)(xue)(xue)(xue)(xue)通(tong)絡(luo)治療(liao),往(wang)往(wang)可收到好療(liao)效(xiao)。 (2)醒(xing)神開(kai)(kai)(kai)(kai)(kai)竅定癇(xian)(xian)法(fa)(fa)(fa)(fa)(fa)(fa) 癲(dian)(dian)癇(xian)(xian)神昏竅閉(bi)當以(yi)(yi)開(kai)(kai)(kai)(kai)(kai)竅法(fa)(fa)(fa)(fa)(fa)(fa)救急,這是(shi)(shi)(shi)(shi)(shi)共識,但如何開(kai)(kai)(kai)(kai)(kai)竅,認識并不(bu)(bu)統一。有(you)(you)(you)(you)人主(zhu)張芳香開(kai)(kai)(kai)(kai)(kai)竅,有(you)(you)(you)(you)人主(zhu)張豁(huo)痰(tan)(tan)(tan)(tan)開(kai)(kai)(kai)(kai)(kai)竅,有(you)(you)(you)(you)人則認為勿需單(dan)用(yong)(yong)(yong)(yong)開(kai)(kai)(kai)(kai)(kai)竅藥(yao),而(er)應(ying)以(yi)(yi)活(huo)(huo)(huo)血(xue)(xue)(xue)(xue)(xue)化(hua)(hua)痰(tan)(tan)(tan)(tan)通(tong)絡(luo)為主(zhu)。我的(de)(de)(de)經驗是(shi)(shi)(shi)(shi)(shi)遇(yu)癇(xian)(xian)發(fa)急癥,要(yao)針(zhen)藥(yao)并用(yong)(yong)(yong)(yong),中西醫(yi)并舉,迅速(su)止(zhi)癇(xian)(xian),以(yi)(yi)保護(hu)腦髓(sui)神機免遭持續損害為目的(de)(de)(de)。安宮(gong)牛黃(huang)丸、蘇合(he)香丸、至(zhi)寶丹皆(jie)是(shi)(shi)(shi)(shi)(shi)常用(yong)(yong)(yong)(yong)之(zhi)(zhi)品(pin)。現在臨床(chuang)(chuang)(chuang)(chuang)腦病(bing)科常用(yong)(yong)(yong)(yong)的(de)(de)(de)中藥(yao)如醒(xing)腦靜、清開(kai)(kai)(kai)(kai)(kai)靈注(zhu)射液,皆(jie)可辯(bian)證(zheng)應(ying)用(yong)(yong)(yong)(yong)于(yu)(yu)(yu)(yu)癲(dian)(dian)癇(xian)(xian)的(de)(de)(de)臨床(chuang)(chuang)(chuang)(chuang)治療(liao),特別是(shi)(shi)(shi)(shi)(shi)發(fa)作(zuo)期的(de)(de)(de)急救。 (3)化(hua)(hua)滯通(tong)腑(fu)(fu),清熱(re)(re)止(zhi)癇(xian)(xian)法(fa)(fa)(fa)(fa)(fa)(fa) 這種方法(fa)(fa)(fa)(fa)(fa)(fa)適用(yong)(yong)(yong)(yong)于(yu)(yu)(yu)(yu)中醫(yi)所(suo)(suo)說的(de)(de)(de)"食癇(xian)(xian)"、"熱(re)(re)癇(xian)(xian)",食癇(xian)(xian)即由于(yu)(yu)(yu)(yu)飲(yin)食失(shi)節而(er)誘發(fa)的(de)(de)(de)癲(dian)(dian)癇(xian)(xian)病(bing),小(xiao)兒癇(xian)(xian)病(bing)用(yong)(yong)(yong)(yong)此(ci)法(fa)(fa)(fa)(fa)(fa)(fa)者(zhe)較多(duo)。癲(dian)(dian)癇(xian)(xian)發(fa)作(zuo)時(shi)(shi)多(duo)數伴有(you)(you)(you)(you)胃腸(chang)道的(de)(de)(de)癥狀,如打嗝,脘腹(fu)脹滿(man),納呆厭食,或(huo)(huo)(huo)(huo)(huo)(huo)(huo)反復(fu)嘔吐,或(huo)(huo)(huo)(huo)(huo)(huo)(huo)陣發(fa)性(xing)劇烈腹(fu)部疼痛。常用(yong)(yong)(yong)(yong)的(de)(de)(de)消食化(hua)(hua)滯藥(yao)物有(you)(you)(you)(you)山(shan)楂、檳榔、麥芽、雞內(nei)金、神曲、萊(lai)菔(fu)子等。這些(xie)藥(yao)物必須同(tong)(tong)祛風(feng)(feng)(feng)、化(hua)(hua)痰(tan)(tan)(tan)(tan)、鎮驚、清熱(re)(re)等方法(fa)(fa)(fa)(fa)(fa)(fa)同(tong)(tong)時(shi)(shi)應(ying)用(yong)(yong)(yong)(yong)才能取(qu)效(xiao)。 關于(yu)(yu)(yu)(yu)通(tong)腑(fu)(fu)法(fa)(fa)(fa)(fa)(fa)(fa)的(de)(de)(de)作(zuo)用(yong)(yong)(yong)(yong)范圍,不(bu)(bu)論是(shi)(shi)(shi)(shi)(shi)發(fa)作(zuo)期或(huo)(huo)(huo)(huo)(huo)(huo)(huo)休止(zhi)期都(dou)可用(yong)(yong)(yong)(yong)通(tong)下(xia)法(fa)(fa)(fa)(fa)(fa)(fa)。且下(xia)之(zhi)(zhi)宜(yi)早不(bu)(bu)宜(yi)遲。若(ruo)有(you)(you)(you)(you)腹(fu)脹、便(bian)秘(mi)、舌紅、苔黃(huang)、脈實則更是(shi)(shi)(shi)(shi)(shi)必用(yong)(yong)(yong)(yong)之(zhi)(zhi)證(zheng)。臨床(chuang)(chuang)(chuang)(chuang)上通(tong)腑(fu)(fu)至(zhi)大便(bian)瀉,腑(fu)(fu)氣(qi)通(tong)為度,不(bu)(bu)宜(yi)過量,同(tong)(tong)時(shi)(shi)還需根(gen)據正氣(qi)盛衰,病(bing)機之(zhi)(zhi)兼夾(jia),靈活(huo)(huo)(huo)配伍用(yong)(yong)(yong)(yong)化(hua)(hua)痰(tan)(tan)(tan)(tan)、平肝、活(huo)(huo)(huo)血(xue)(xue)(xue)(xue)(xue)、補益等。 (4)祛風(feng)(feng)(feng)解毒止(zhi)癇(xian)(xian)法(fa)(fa)(fa)(fa)(fa)(fa) 本(ben)法(fa)(fa)(fa)(fa)(fa)(fa)適用(yong)(yong)(yong)(yong)于(yu)(yu)(yu)(yu)因風(feng)(feng)(feng)邪(xie)(xie)而(er)引起的(de)(de)(de)癲(dian)(dian)癇(xian)(xian)。風(feng)(feng)(feng)邪(xie)(xie)有(you)(you)(you)(you)外風(feng)(feng)(feng)和(he)內(nei)風(feng)(feng)(feng)的(de)(de)(de)區別。外風(feng)(feng)(feng)多(duo)是(shi)(shi)(shi)(shi)(shi)指風(feng)(feng)(feng)寒(han)或(huo)(huo)(huo)(huo)(huo)(huo)(huo)風(feng)(feng)(feng)濕之(zhi)(zhi)邪(xie)(xie),從口鼻或(huo)(huo)(huo)(huo)(huo)(huo)(huo)皮毛而(er)入,風(feng)(feng)(feng)邪(xie)(xie)阻(zu)(zu)于(yu)(yu)(yu)(yu)經絡(luo)可以(yi)(yi)見(jian)到劇烈頭(tou)痛、肢體麻(ma)木等癥。內(nei)風(feng)(feng)(feng)則是(shi)(shi)(shi)(shi)(shi)由于(yu)(yu)(yu)(yu)肝陽上亢或(huo)(huo)(huo)(huo)(huo)(huo)(huo)陰虛內(nei)動、風(feng)(feng)(feng)挾痰(tan)(tan)(tan)(tan)濁瘀(yu)血(xue)(xue)(xue)(xue)(xue)上擾神明而(er)引起癲(dian)(dian)癇(xian)(xian)抽(chou)搐。臨床(chuang)(chuang)(chuang)(chuang)上發(fa)病(bing)迅猛,變(bian)化(hua)(hua)迅速(su),臨床(chuang)(chuang)(chuang)(chuang)表現復(fu)雜(za)多(duo)樣,或(huo)(huo)(huo)(huo)(huo)(huo)(huo)出(chu)現全(quan)身(shen)強直抽(chou)搐,搖頭(tou)動肩(jian),口眼震顫,肢體肌(ji)肉抖動,或(huo)(huo)(huo)(huo)(huo)(huo)(huo)兩眼上視或(huo)(huo)(huo)(huo)(huo)(huo)(huo)斜視,頭(tou)暈目眩(xuan)、脈弦(xian)勁有(you)(you)(you)(you)力。 (5)祛痰(tan)(tan)(tan)(tan)止(zhi)癇(xian)(xian)法(fa)(fa)(fa)(fa)(fa)(fa) 中醫(yi)認為"無痰(tan)(tan)(tan)(tan)不(bu)(bu)作(zuo)癇(xian)(xian)",也(ye)(ye)就是(shi)(shi)(shi)(shi)(shi)說痰(tan)(tan)(tan)(tan)是(shi)(shi)(shi)(shi)(shi)致(zhi)(zhi)癇(xian)(xian)之(zhi)(zhi)源,故逐痰(tan)(tan)(tan)(tan)、豁(huo)痰(tan)(tan)(tan)(tan)是(shi)(shi)(shi)(shi)(shi)治療(liao)癲(dian)(dian)癇(xian)(xian)很重要(yao)的(de)(de)(de)方法(fa)(fa)(fa)(fa)(fa)(fa)。癲(dian)(dian)癇(xian)(xian)病(bing)人或(huo)(huo)(huo)(huo)(huo)(huo)(huo)是(shi)(shi)(shi)(shi)(shi)由于(yu)(yu)(yu)(yu)形之(zhi)(zhi)痰(tan)(tan)(tan)(tan)閉(bi)阻(zu)(zu)肺絡(luo),出(chu)現喉間痰(tan)(tan)(tan)(tan)聲漉漉、口吐痰(tan)(tan)(tan)(tan)涎(xian),或(huo)(huo)(huo)(huo)(huo)(huo)(huo)者(zhe)由于(yu)(yu)(yu)(yu)無形之(zhi)(zhi)痰(tan)(tan)(tan)(tan)蒙蔽(bi)狀。這些(xie)痰(tan)(tan)(tan)(tan)證(zheng)有(you)(you)(you)(you)的(de)(de)(de)是(shi)(shi)(shi)(shi)(shi)由于(yu)(yu)(yu)(yu)脾虛運化(hua)(hua)失(shi)職,水(shui)濕所(suo)(suo)化(hua)(hua)的(de)(de)(de)痰(tan)(tan)(tan)(tan),開(kai)(kai)(kai)(kai)(kai)成熱(re)(re)痰(tan)(tan)(tan)(tan)、燥痰(tan)(tan)(tan)(tan)所(suo)(suo)致(zhi)(zhi)。驗之(zhi)(zhi)臨床(chuang)(chuang)(chuang)(chuang),當根(gen)據患者(zhe)痰(tan)(tan)(tan)(tan)邪(xie)(xie)性(xing)質不(bu)(bu)同(tong)(tong),分(fen)別選(xuan)用(yong)(yong)(yong)(yong)清熱(re)(re)化(hua)(hua)痰(tan)(tan)(tan)(tan)、燥濕化(hua)(hua)痰(tan)(tan)(tan)(tan)、理氣(qi)化(hua)(hua)痰(tan)(tan)(tan)(tan)、搜風(feng)(feng)(feng)化(hua)(hua)痰(tan)(tan)(tan)(tan)等法(fa)(fa)(fa)(fa)(fa)(fa)。 參考資(zi)料: www.sy93303.com
早在二千多年前,古代中國對癲癇病早有認識。《黃帝內經》中對癲癇二字有過確切的定義,“癲”即癲狂,表示發作時的意識障礙;“癇”即抽搐,表示發作時的痙攣狀態。中醫治療癲癇由來已久,癲癇在發作期,首先要急則治標,控制其發作,盡快解除病人昏厥和抽搐的危急狀態,宜以豁痰開竅、熄風止痙為治法,選治療效快而作用強的,采用不同的治療途徑。在休止期或緩解期,病情趨于緩和,此時則以緩則治其本的原則,認真細致地辨證,認清其病位、病性,分別予以治之,整體上以健脾化痰、補益肝腎、養心安神為治法,除其痰、風之源,以治其本,防止本病的復發。同時根據臨床綜合表現辨證論治,邪實者,以攻邪為主;有虛象者,予以扶正。攻邪常用熄風、瀉火、活血、滌痰等法,扶正多用滋肝、健脾、養心、補益等法。但有邪實而正虛,在攻邪的同時,要兼顧扶正,在正虛的同時兼有外邪,則以扶正為主,兼以祛邪,達到祛邪平癲的最終目的。中藥治療癲癇常用方法根據中醫理論常采用以下方法:
1.定癇熄風:用五癇神應丸,定癇丸,溫膽湯,風引湯,磁朱丸等。
2.豁痰開竅:如紫石英散加減,五不散,黃蕪花,牽牛子,礞石,白礬,石菖蒲等。
3.清心瀉火:如牛黃,橄欖,硼砂等。
4.活血化瘀:如黃芪赤風湯,血府逐瘀湯等。
5.育陰潛陽:如柴胡龍骨牡蠣湯加減,風引湯加減等。
6.扶(fu)正(zheng)固本:如(ru)香砂六君子湯,人參(can)養榮丸,河車大造丸等。
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