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大和中丸

中醫(yi)世(shi)家 2023-05-06 01:49:46

大和中丸(wan)

處方 : 木香(xiang)半(ban)兩(liang)(liang),沉香(xiang)半(ban)兩(liang)(liang),枳實(shi)半(ban)兩(liang)(liang),檳榔半(ban)兩(liang)(liang),蓬術半(ban)兩(liang)(liang),宿砂半(ban)兩(liang)(liang),青皮(pi)半(ban)兩(liang)(liang),陳皮(pi)半(ban)兩(liang)(liang),木通(tong)半(ban)兩(liang)(liang),當歸半(ban)兩(liang)(liang),黃(huang)(huang)芩半(ban)兩(liang)(liang),三棱半(ban)兩(liang)(liang),豬牙皂(zao)角半(ban)兩(liang)(liang),白(bai)豆蔻(kou)半(ban)兩(liang)(liang),郁李(li)仁半(ban)兩(liang)(liang),黃(huang)(huang)連半(ban)兩(liang)(liang),牽牛(頭末)1兩(liang)(liang),大(da)黃(huang)(huang)2兩(liang)(liang),黃(huang)(huang)柏1兩(liang)(liang)半(ban),香(xiang)附1兩(liang)(liang)半(ban)。

制法 : 上(shang)為末,滴水為丸(wan),如(ru)梧桐子(zi)大(da)。

功能主治 : 食傷氣滯。

用法用量 : 每(mei)服30-50丸,溫水送下。

摘錄 : 《醫(yi)方類聚(ju)》卷一(yi)○九引(yin)《新效方》

目前臨床應用的丸(wan)劑中哪些(xie)是大蜜丸(wan)、哪些(xie)是小(xiao)蜜丸(wan)?

丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)劑(ji)(ji)(ji)是(shi)藥(yao)(yao)材(cai)(cai)細(xi)粉(fen)(fen)或(huo)(huo)(huo)藥(yao)(yao)材(cai)(cai)提取物(wu)(wu)加適(shi)宜(yi)粘(zhan)(zhan)(zhan)合(he)(he)(he)劑(ji)(ji)(ji)或(huo)(huo)(huo)輔料(liao)(liao),制(zhi)成(cheng)(cheng)(cheng)(cheng)(cheng)的(de)(de)(de)球(qiu)形或(huo)(huo)(huo)類(lei)(lei)球(qiu)形的(de)(de)(de)固(gu)體(ti)(ti)制(zhi)劑(ji)(ji)(ji),是(shi)中(zhong)成(cheng)(cheng)(cheng)(cheng)(cheng)藥(yao)(yao)最(zui)古老的(de)(de)(de)劑(ji)(ji)(ji)型(xing)之一(yi)(yi)。根據(ju)粘(zhan)(zhan)(zhan)合(he)(he)(he)劑(ji)(ji)(ji)的(de)(de)(de)不(bu)同丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)劑(ji)(ji)(ji)又分(fen)(fen)(fen)為(wei)(wei)(wei)(wei)蜜(mi)(mi)(mi)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)、水(shui)(shui)(shui)蜜(mi)(mi)(mi)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)、水(shui)(shui)(shui)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)、糊(hu)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)、濃(nong)縮(suo)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)、微(wei)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)等(deng)(deng)(deng)(deng)類(lei)(lei)型(xing)。 (1)蜜(mi)(mi)(mi)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan):藥(yao)(yao)材(cai)(cai)細(xi)粉(fen)(fen)以(yi)(yi)蜂(feng)蜜(mi)(mi)(mi)為(wei)(wei)(wei)(wei)粘(zhan)(zhan)(zhan)合(he)(he)(he)劑(ji)(ji)(ji)制(zhi)成(cheng)(cheng)(cheng)(cheng)(cheng),是(shi)中(zhong)醫臨(lin)床應用(yong)(yong)(yong)最(zui)廣泛(fan)的(de)(de)(de)一(yi)(yi)種(zhong)。丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)重(zhong)(zhong)(zhong)在(zai)0.5克以(yi)(yi)上(shang)(含(han)0.5克)稱(cheng)為(wei)(wei)(wei)(wei)大蜜(mi)(mi)(mi)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan),丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)重(zhong)(zhong)(zhong)在(zai)0.5克以(yi)(yi)下為(wei)(wei)(wei)(wei)小(xiao)(xiao)蜜(mi)(mi)(mi)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)。蜂(feng)蜜(mi)(mi)(mi)富于營養,并有潤肺(fei)止(zhi)咳、潤腸通(tong)便的(de)(de)(de)功能,同時還(huan)有質地(di)柔(rou)潤、吸(xi)(xi)收緩(huan)(huan)(huan)慢(man)、作(zuo)用(yong)(yong)(yong)緩(huan)(huan)(huan)和(he)的(de)(de)(de)特點。滋補類(lei)(lei)藥(yao)(yao)物(wu)(wu)、小(xiao)(xiao)兒(er)用(yong)(yong)(yong)藥(yao)(yao)、貴(gui)重(zhong)(zhong)(zhong)及(ji)含(han)易(yi)揮發性(xing)(xing)成(cheng)(cheng)(cheng)(cheng)(cheng)分(fen)(fen)(fen)的(de)(de)(de)藥(yao)(yao)物(wu)(wu)常制(zhi)成(cheng)(cheng)(cheng)(cheng)(cheng)蜜(mi)(mi)(mi)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)。多用(yong)(yong)(yong)于治療(liao)慢(man)性(xing)(xing)病(bing)和(he)虛(xu)弱性(xing)(xing)疾病(bing),如六味地(di)黃丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)、人參鹿(lu)茸丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)等(deng)(deng)(deng)(deng)。 (2)水(shui)(shui)(shui)蜜(mi)(mi)(mi)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan):藥(yao)(yao)材(cai)(cai)細(xi)粉(fen)(fen)以(yi)(yi)水(shui)(shui)(shui)和(he)蜂(feng)蜜(mi)(mi)(mi)按適(shi)當比例混勻為(wei)(wei)(wei)(wei)粘(zhan)(zhan)(zhan)合(he)(he)(he)劑(ji)(ji)(ji)制(zhi)成(cheng)(cheng)(cheng)(cheng)(cheng)。水(shui)(shui)(shui)蜜(mi)(mi)(mi)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)的(de)(de)(de)特點與蜜(mi)(mi)(mi)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)相似,作(zuo)用(yong)(yong)(yong)緩(huan)(huan)(huan)慢(man)、持久,但因用(yong)(yong)(yong)蜜(mi)(mi)(mi)較(jiao)(jiao)蜜(mi)(mi)(mi)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)少(shao),故含(han)水(shui)(shui)(shui)量(liang)低、易(yi)保存(cun)和(he)服(fu)用(yong)(yong)(yong)。多用(yong)(yong)(yong)于補益(yi)類(lei)(lei)藥(yao)(yao)物(wu)(wu),如補中(zhong)益(yi)氣丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)等(deng)(deng)(deng)(deng)。 (3)水(shui)(shui)(shui)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan):藥(yao)(yao)材(cai)(cai)細(xi)粉(fen)(fen)以(yi)(yi)水(shui)(shui)(shui)或(huo)(huo)(huo)醋、藥(yao)(yao)汁、黃酒等(deng)(deng)(deng)(deng)為(wei)(wei)(wei)(wei)粘(zhan)(zhan)(zhan)合(he)(he)(he)劑(ji)(ji)(ji)制(zhi)成(cheng)(cheng)(cheng)(cheng)(cheng)。因特殊(shu)需要,水(shui)(shui)(shui)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)還(huan)可(ke)(ke)包衣(yi)。泛(fan)制(zhi)水(shui)(shui)(shui)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)體(ti)(ti)積(ji)小(xiao)(xiao),表面致密光滑,便于吞服(fu),不(bu)易(yi)吸(xi)(xi)潮。 (4)濃(nong)縮(suo)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan):全部藥(yao)(yao)材(cai)(cai)或(huo)(huo)(huo)部分(fen)(fen)(fen)藥(yao)(yao)材(cai)(cai)的(de)(de)(de)煎液或(huo)(huo)(huo)提取液,與適(shi)宜(yi)的(de)(de)(de)輔料(liao)(liao)或(huo)(huo)(huo)藥(yao)(yao)物(wu)(wu)細(xi)粉(fen)(fen)加適(shi)宜(yi)的(de)(de)(de)粘(zhan)(zhan)(zhan)合(he)(he)(he)劑(ji)(ji)(ji)制(zhi)成(cheng)(cheng)(cheng)(cheng)(cheng)。根據(ju)粘(zhan)(zhan)(zhan)合(he)(he)(he)劑(ji)(ji)(ji)的(de)(de)(de)不(bu)同,又分(fen)(fen)(fen)為(wei)(wei)(wei)(wei)濃(nong)縮(suo)蜜(mi)(mi)(mi)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)、濃(nong)縮(suo)水(shui)(shui)(shui)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)、濃(nong)縮(suo)水(shui)(shui)(shui)蜜(mi)(mi)(mi)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)。濃(nong)縮(suo)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)體(ti)(ti)積(ji)小(xiao)(xiao),藥(yao)(yao)物(wu)(wu)有效(xiao)成(cheng)(cheng)(cheng)(cheng)(cheng)分(fen)(fen)(fen)含(han)量(liang)高,易(yi)于服(fu)用(yong)(yong)(yong),在(zai)體(ti)(ti)內溶化(hua)吸(xi)(xi)收比較(jiao)(jiao)緩(huan)(huan)(huan)慢(man)。濃(nong)縮(suo)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)適(shi)用(yong)(yong)(yong)于慢(man)性(xing)(xing)疾病(bing)等(deng)(deng)(deng)(deng)多種(zhong)疾病(bing)。 (5)糊(hu)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan):藥(yao)(yao)材(cai)(cai)細(xi)粉(fen)(fen)以(yi)(yi)米糊(hu)或(huo)(huo)(huo)面糊(hu)為(wei)(wei)(wei)(wei)粘(zhan)(zhan)(zhan)合(he)(he)(he)劑(ji)(ji)(ji)制(zhi)成(cheng)(cheng)(cheng)(cheng)(cheng)。糊(hu)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)質地(di)堅硬,在(zai)體(ti)(ti)內崩解慢(man),內服(fu)既(ji)可(ke)(ke)延(yan)長藥(yao)(yao)效(xiao),又能減少(shao)某些毒(du)性(xing)(xing)成(cheng)(cheng)(cheng)(cheng)(cheng)分(fen)(fen)(fen)的(de)(de)(de)釋放(fang)或(huo)(huo)(huo)減緩(huan)(huan)(huan)刺(ci)(ci)(ci)(ci)激(ji)(ji)性(xing)(xing)成(cheng)(cheng)(cheng)(cheng)(cheng)分(fen)(fen)(fen)對胃(wei)腸的(de)(de)(de)刺(ci)(ci)(ci)(ci)激(ji)(ji)。刺(ci)(ci)(ci)(ci)激(ji)(ji)性(xing)(xing)較(jiao)(jiao)大或(huo)(huo)(huo)有毒(du)藥(yao)(yao)物(wu)(wu)宜(yi)制(zhi)成(cheng)(cheng)(cheng)(cheng)(cheng)糊(hu)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)。 (6)蠟丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan):藥(yao)(yao)材(cai)(cai)細(xi)粉(fen)(fen)以(yi)(yi)蜂(feng)蠟為(wei)(wei)(wei)(wei)粘(zhan)(zhan)(zhan)合(he)(he)(he)劑(ji)(ji)(ji)制(zhi)成(cheng)(cheng)(cheng)(cheng)(cheng)。蠟丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)是(shi)中(zhong)成(cheng)(cheng)(cheng)(cheng)(cheng)藥(yao)(yao)的(de)(de)(de)長效(xiao)劑(ji)(ji)(ji)型(xing)之一(yi)(yi),溶化(hua)極其(qi)緩(huan)(huan)(huan)慢(man),可(ke)(ke)延(yan)長藥(yao)(yao)效(xiao),防止(zhi)藥(yao)(yao)物(wu)(wu)中(zhong)毒(du)或(huo)(huo)(huo)對胃(wei)起強烈的(de)(de)(de)刺(ci)(ci)(ci)(ci)激(ji)(ji)作(zuo)用(yong)(yong)(yong)。處方中(zhong)含(han)較(jiao)(jiao)多的(de)(de)(de)劇毒(du)或(huo)(huo)(huo)強刺(ci)(ci)(ci)(ci)激(ji)(ji)性(xing)(xing)藥(yao)(yao)物(wu)(wu),或(huo)(huo)(huo)要求在(zai)腸道吸(xi)(xi)收的(de)(de)(de)中(zhong)成(cheng)(cheng)(cheng)(cheng)(cheng)藥(yao)(yao),都可(ke)(ke)制(zhi)成(cheng)(cheng)(cheng)(cheng)(cheng)蠟丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)。為(wei)(wei)(wei)(wei)中(zhong)成(cheng)(cheng)(cheng)(cheng)(cheng)藥(yao)(yao)傳統(tong)劑(ji)(ji)(ji)型(xing),品種(zhong)已不(bu)常見。 (7)微(wei)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan):藥(yao)(yao)材(cai)(cai)細(xi)粉(fen)(fen)以(yi)(yi)水(shui)(shui)(shui)或(huo)(huo)(huo)酒泛(fan)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan),或(huo)(huo)(huo)以(yi)(yi)百草霜(shuang)為(wei)(wei)(wei)(wei)衣(yi),采用(yong)(yong)(yong)現代技(ji)術(shu)制(zhi)成(cheng)(cheng)(cheng)(cheng)(cheng)。微(wei)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)直徑小(xiao)(xiao)于2.5毫米,體(ti)(ti)積(ji)小(xiao)(xiao),應用(yong)(yong)(yong)劑(ji)(ji)(ji)量(liang)小(xiao)(xiao),服(fu)用(yong)(yong)(yong)方便,吸(xi)(xi)收平穩。微(wei)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)適(shi)宜(yi)于刺(ci)(ci)(ci)(ci)激(ji)(ji)性(xing)(xing)藥(yao)(yao)物(wu)(wu),貴(gui)重(zhong)(zhong)(zhong)或(huo)(huo)(huo)細(xi)料(liao)(liao)藥(yao)(yao)材(cai)(cai)多制(zhi)備成(cheng)(cheng)(cheng)(cheng)(cheng)微(wei)丸(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)(wan)。

理中丸和附(fu)子理中丸

溫中祛寒劑,適用于中焦虛寒證。代表方如理中丸、小建中湯、吳茱萸湯、大建中湯等。

《傷寒論》

【組成】人參 干姜 甘草炙 白術各三兩(各9g)

【用法】上四味,搗篩,蜜和為丸,如雞子黃許大(9g)。以沸湯數合,和一丸,研碎,溫服之,日三四服,夜二服。腹中未熱,益至三四丸,然不及湯。湯法:以四物依兩數切,用水八升,煮取三升,去滓,溫服一升,日三服。服湯后,如食頃,飲熱粥一升許,微自溫,勿發揭衣被(現代用法:上藥共研細末,煉蜜為丸,重9g,每次1丸,小蜜丸則每次9g,溫開水送服,每日2~3次;亦可作湯劑,水煎服,藥后飲熱粥適量)。

【功用】溫中祛寒,補氣健脾。

【主治】1.脾胃虛寒證。脘腹疼痛,喜溫喜按,嘔吐便溏,脘痞食少,畏寒肢冷,口淡不渴,舌質淡、苔白潤,脈沉細或沉遲無力。2.陽虛失血證。便血、吐血、衄血或崩漏等,血色暗淡,質清稀,面色?白,氣短神疲,脈沉細或虛大無力。3.中陽不足,陰寒上乘之胸痹;脾氣虛寒,不能攝津之病后多涎唾;中陽虛損,土不榮木之小兒慢驚;食飲不節,損傷脾胃陽氣,清濁相干,升降失常之霍亂等。

【證治機理】本證系由脾胃虛寒所致。中陽不足,寒自內生,陽虛失溫,則畏寒肢冷;寒凝而滯,則腹痛綿綿喜溫按;脾主運化而升清,胃主受納而降濁,脾胃虛寒致脾不運化、胃不受納,升降納運失職,故見脘腹痞滿,食少倦怠,嘔吐便溏;舌淡苔白潤,口中不渴,脈沉細或沉遲無力,皆為虛寒之象。若脾胃虛寒,統攝失權,血不循經則可見便血、吐血、衄血或崩漏等,但血色暗淡,質清稀;若中陽不足,陰寒上乘而致胸陽不振,則可見胸痹心痛;若久病傷及脾陽,使津無所攝,上溢于口,則可見病后多涎唾,甚則流涎不止;若小兒先天稟賦不足,后天脾胃虛寒,生化無源,致經脈失養,土不榮木,則可見慢驚;若食飲不節,損傷脾胃陽氣,清濁相干,升降失常則致霍亂。法當溫中祛寒,益氣健脾。

【方解】方中干姜大辛大熱,溫脾暖胃,助陽祛寒為君藥。陽虛則兼氣弱,氣旺亦可助陽,故臣以甘溫之人參,益氣健脾,補虛助陽,《內經》云:“脾欲緩,急食甘以緩之。”君臣相配,溫中健脾。脾為中土,喜燥惡濕,虛則濕濁易生,反困脾胃,故佐以甘溫苦燥之白術,既健脾補虛以助陽,又燥濕運脾以助生化。甘草與諸藥等量,一與參、術以助益氣健脾,補虛助陽;二可緩急止痛;三為調和諸藥,是佐藥而兼使藥之用。四藥相伍,可溫中陽,補脾氣,助運化,故曰“理中”。

本方在《金匱要略》中作湯劑,稱“人參湯”。理中丸方后亦有“然不及湯”四字。蓋湯劑較丸劑作用強而迅速,臨床可視病情之緩急酌定劑型。(理中丸與人參湯,兩方組成、用量完全相同。前者為丸劑,治中焦虛寒之脘腹疼痛、自利不渴或病后喜唾;后者為湯劑,主治中、上二焦虛寒之胸痹,癥見心胸痞悶、氣從脅下上逆搶心。前者虛寒較輕,病勢較緩,取丸以緩治;后者虛寒較重,病勢較急,取湯以速治)

【配伍特點】辛熱甘苦合方,溫補并用,補中寓燥。

【運用】本方為治療中焦脾胃虛寒證之基礎方。以脘腹疼痛,喜溫喜按,嘔吐便溏,脘痞食少,畏寒肢冷,舌淡,苔白,脈沉細為辨證要點。本方臨證服后,當“飲熱粥”,且溫覆“勿發揭衣被”。藥后當覺腹中似有熱感,若“腹中未熱”,則應適當加量,“益至三四丸”,或易為湯劑。

【附方】

1.附子理中丸(《太平惠民和劑局方》)?

附子炮,去皮、臍? ?人參去蘆? ?干姜炮? ?甘草炙? 白術各三兩(各9g) 上為細末,煉蜜為丸,每兩作十丸。每服一丸(6g),以水一盞,化開,煎至七分,稍熱服之,空心食前。

功用:溫陽祛寒,補氣健脾。主治:脾胃虛寒較甚,或脾腎陽虛證。癥見脘腹疼痛,下利清谷,惡心嘔吐,畏寒肢冷,或霍亂吐利轉筋等。

2.桂枝人參湯(《傷寒論》)?

桂枝別切,四兩(12g) 甘草炙,四兩(9g) 白術三兩(9g) 人參三兩(9g) 干姜三兩(9g) 上五味,以水九升,先煮四味,取五升,內桂更煮,取三升,去滓,溫服一升,日再,夜一服。

功用:溫陽健脾,解表散寒。主治:脾胃虛寒,復感風寒表證。癥見惡寒發熱,頭身疼痛,腹痛,下利便溏,口不渴,舌淡苔白滑,脈浮虛者。

【鑒別】理中丸為治療中焦脾胃虛寒證之基礎方,附子理中丸、桂枝人參湯均為理中丸加味而成。附子理中丸加用大辛大熱之附子,其溫中散寒之力更強,且能溫腎,適用于脾胃虛寒之重證或脾腎虛寒者;桂枝人參湯即人參湯加桂枝,溫陽健脾,兼解表寒,表里同治,適用于脾胃虛寒而外兼風寒表證者。

【方論選錄】脾胃應土,處在中州,在五臟曰孤臟,屬三焦曰中焦,自三焦獨治在中,一有不調,此丸專治,故名曰理中丸。人參味甘溫,《內經》曰:脾欲緩,急食甘以緩之。緩中益脾,必以甘為主,是以人參為君。白術味甘溫,《內經》曰:脾惡濕,甘勝濕,溫中勝濕,必以甘為助,是以白術為臣。甘草味甘平,《內經》曰:五味所入,甘先入脾。脾不足者,以甘補之,補中助脾,必先甘劑,是以甘草為佐。干姜味辛熱,喜溫而惡寒者,胃也,胃寒則中焦不治,《內經》曰:寒淫所勝,平以辛熱。散寒溫胃,必先辛劑,是以干姜為使。(成無己《傷寒明理論》)

【醫案舉例】曹省初病傷寒,六七日,腹滿而吐,食不下,身溫,手足熱,自利,腹中痛,嘔,惡心。醫者謂之陽多,尚疑其手足熱,恐熱蓄于胃中嘔吐,或見吐利而為霍亂。請予診,其脈細而沉。質之,曰太陰證也。太陰之為病,腹滿而吐,食不下,自利益甚,時腹自痛。予止以理中丸,用仲景云“如雞子黃大”,晝夜投五六枚。繼以五積散,數日愈。(《傷寒九十論》)

【方歌】理中丸主理中鄉,甘草人參術黑姜,嘔利腹痛陰寒盛,或加附子總扶陽。

合六法,方六首。

理中丸

霍亂,頭痛發熱,身疼痛,熱多欲飲水者,五苓散主之;寒多不用水者,理中丸主之。

理中丸方(下有作湯加減法)

人參? 干姜? 甘草炙? 白術各三兩

右四味,搗篩,蜜和為丸,如雞子黃許大。以沸湯數合,和一丸,研碎,溫服之,日三四,夜二服;腹中未熱,益至三四丸。然不及湯,湯法,以四物依兩數切,用水八升,煮取三升,去滓,溫服一升,日三服。

若臍上筑者,腎氣動也,去術加桂四兩;吐多者,去術,加生姜三兩;下多者,還用術;悸者,加茯苓二兩;渴欲得水者,加術,足前成四兩半;腹中痛者,加人參,足前成四兩半;寒者,加干姜,足前成四兩半;腹滿者,去術,加附子一枚。服湯后如食頃,飲熱粥一升許,微自溫,勿發揭衣被。

理中湯

脾胃不和,中寒上沖,胸脅逆滿,心腹 痛,痰逆惡心,或時嘔吐,心下虛痞,隔塞不通,飲食減少,短氣羸困,溫中逐水,止汗去濕。又腸胃冷濕,泄瀉注下,水谷不分,腹中雷鳴,傷寒時氣,里寒外熱,霍亂吐利,手足厥冷,胸痹心痛,逆氣結氣,并皆治之。

人參? ?甘草銼,炒? ?白術? ?干姜炮,各三兩

上為粗末。每三錢,以水一盞半,煎取中盞,去滓,稍熱服,空心、食前。
附子理中圓?

治脾胃冷弱,心腹絞痛,嘔吐泄利,霍亂轉筋,體冷微汗,手足厥寒,心下逆滿,腹中雷鳴,嘔噦不止,飲食不進,及一切沉寒痼冷,并皆治之。

附子(炮,去皮、臍)? 人參(去蘆)? 干姜(炮)? 甘草(炙)? 白術各三兩

上(shang)為(wei)細(xi)末,用煉蜜和為(wei)圓(yuan)(yuan),每兩(liang)作一(yi)十(shi)圓(yuan)(yuan)。每服一(yi)圓(yuan)(yuan),以水一(yi)盞化破,煎至七(qi)分(fen),稍(shao)熱服之,空心食前。

中丸和(he)四神丸好,還是附子理中丸和(he)桂附地黃(huang)丸一起吃

附子理中丸和四神丸合用用于脾腎兩虛引起的腹瀉(五更瀉,早餐5點鐘腸鳴臍痛,瀉后痛減,大便稀薄)、脘腹冷痛,嘔吐泄瀉,手足不溫。
附(fu)(fu)子理(li)中丸和桂附(fu)(fu)地黃丸都含有附(fu)(fu)子,附(fu)(fu)子有大毒(du)(du),合用(yong)(yong)會使藥量增加,引起毒(du)(du)副作用(yong)(yong)。

?八味理中丸作用與功效,有什么副作用?

八味理中丸--《活幼口議》卷十九
【處方】人參 甘草(炙)白術 干姜 枳實(制炒)白茯苓 五味子(去梗)桑白皮(去赤皮)各等分。
【制法】藥為細末,煉蜜為丸,如小指頭大。
【功能主治】小兒心肺不和,息數脈急,上下不得升降,中膈痞滿,坐臥煩悶,神情不樂,飲食不下者。
【用法用量】每服1丸,用淡豆豉5粒,水150毫升,煎至75毫升,去豉,通口服無時。
【摘錄】《活幼口議》卷十九
八味理中丸--《醫統》卷八十五
【處方】白術1兩(炒),炙甘草7錢,人參5錢,白茯苓5錢,干姜(炒)5錢,滑石5錢,麥芽(炒)5錢,神曲(炒)5錢。
【制法】上為細末,米糊為丸,如梧桐子大。
【功能主治】壯氣補虛。主治產后氣血俱虛,汗出嘔吐。
【用法用量】每服30-40丸,食前生姜湯送下。有痰,加半夏曲。
【摘錄】《醫統》卷八十五
八味理中丸--《普濟方》卷三八七
【處方】人參、甘草(炙)、白術、干姜、枳實(治炒)、白茯苓、五味子(去梗)、桑白皮(去赤皮)各等分。
【制法】上為細末,煉蜜為丸,如小指大。
【功能主治】小兒心脾肺不和,息數脈急,上下不升降,中膈痞滿,胸臆郁抑,坐臥煩悶,精神不樂,飲食不下。
【用法用量】每次1丸,用淡豆豉5粒,水1小盞,煎至半,去豉,通口服,不拘時候。
【摘錄】《普濟方》卷三八七
八味理中丸--《百一》卷二
【處方】川姜2兩,縮砂仁2兩,麥糵2兩,神曲(炒)1兩,白茯苓1兩,人參1兩,甘草1兩半(炙),白術4兩。
【制法】上為細末,煉蜜為丸,每兩分作10丸。
【功能主治】脾胃虛弱,胸膈痞悶,心腹疼痛,腹滿身重,四肢不舉,腸鳴泄瀉,飲食不化,嘔吐痰水。
【用法用量】《普濟方》加半夏曲,入鹽點服,名「八味理中湯」。
【摘錄】《百一》卷(juan)二

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