中(zhong)(zhong)藥(yao)(yao)藥(yao)(yao)性指中(zhong)(zhong)藥(yao)(yao)臨床(chuang)應用過(guo)程中(zhong)(zhong)與(yu)治療(liao)作用相關的(de)(de)性能。由于中(zhong)(zhong)藥(yao)(yao)大都來源(yuan)天然,其所含(han)的(de)(de)化學成(cheng)分具有(you)“多種性”,不同(tong)劑量、不同(tong)配伍時,以及(ji)炮制(zhi)前(qian)后(hou),中(zhong)(zhong)藥(yao)(yao)的(de)(de)臨床(chuang)作用是不同(tong)的(de)(de),也就(jiu)是說(shuo)中(zhong)(zhong)藥(yao)(yao)具有(you)“多效性”,同(tong)時各醫學流派對藥(yao)(yao)性的(de)(de)見(jian)解也不盡相同(tong),所以正確認識和運(yun)用藥(yao)(yao)性至關重要。
現就中(zhong)藥(yao)的一藥(yao)“多味”與一藥(yao)“二性(xing)”或“多性(xing)”,淺議如下:
一藥“多味”
一藥“多(duo)味(wei)(wei)(wei)(wei)(wei)(wei)”是指(zhi)一味(wei)(wei)(wei)(wei)(wei)(wei)中(zhong)(zhong)藥有(you)二種或(huo)多(duo)種味(wei)(wei)(wei)(wei)(wei)(wei)。這(zhe)里所(suo)說的(de)(de)(de)(de)一藥,是指(zhi)中(zhong)(zhong)藥處方所(suo)用的(de)(de)(de)(de)某(mou)(mou)一味(wei)(wei)(wei)(wei)(wei)(wei)藥,而(er)不是指(zhi)經過炮(pao)制(zhi)后(hou)有(you)多(duo)種味(wei)(wei)(wei)(wei)(wei)(wei)的(de)(de)(de)(de)某(mou)(mou)一種藥,因為(wei)現今(jin)《中(zhong)(zhong)國(guo)藥典》已將一種藥的(de)(de)(de)(de)不同部位,以(yi)及(ji)炮(pao)制(zhi)品(pin)作為(wei)了(le)不同的(de)(de)(de)(de)藥味(wei)(wei)(wei)(wei)(wei)(wei)。一藥多(duo)味(wei)(wei)(wei)(wei)(wei)(wei)在《中(zhong)(zhong)國(guo)藥典》或(huo)教材(cai)《中(zhong)(zhong)藥學》中(zhong)(zhong)較(jiao)為(wei)普遍(bian)。如(ru)決(jue)明子有(you)甘(gan)、苦(ku)、咸(xian)三味(wei)(wei)(wei)(wei)(wei)(wei)。《本草求真》曰(yue):“決(jue)明子,除風(feng)散熱。凡人目淚不收,眼痛不止,多(duo)屬風(feng)熱內淫(yin),以(yi)致血不上行,治當即為(wei)驅逐(zhu);按此苦(ku)能(neng)泄熱,咸(xian)能(neng)軟堅,甘(gan)能(neng)補血,力薄氣(qi)浮,又能(neng)升(sheng)散風(feng)邪,故(gu)為(wei)治目收淚止痛要藥。并(bing)可作枕以(yi)治頭風(feng)。”再如(ru)香附有(you)辛(xin)、微(wei)(wei)苦(ku)、微(wei)(wei)甘(gan)三味(wei)(wei)(wei)(wei)(wei)(wei)。《本草綱目》曰(yue):“香附之(zhi)氣(qi)平而(er)不寒(han),香而(er)能(neng)竄。其味(wei)(wei)(wei)(wei)(wei)(wei)多(duo)辛(xin)能(neng)散,微(wei)(wei)苦(ku)能(neng)降(jiang),微(wei)(wei)甘(gan)能(neng)和(he)。散時(shi)氣(qi)寒(han)疫,利三焦,解六郁,消飲食積聚,痰飲痞滿”。一藥多(duo)味(wei)(wei)(wei)(wei)(wei)(wei)主(zhu)要是解決(jue)中(zhong)(zhong)藥的(de)(de)(de)(de)“多(duo)效”問題。
一藥“多性”
一般(ban)認(ren)為,藥(yao)(yao)味可(ke)(ke)相兼,然而(er)一藥(yao)(yao)二(er)氣(qi)(性)或(huo)(huo)多性,則有(you)了爭(zheng)議。比如酒有(you)“性熱(re)(re)(re)(re)質(zhi)寒(han)(han)(han)”說,少(shao)量(liang)飲用(yong)為熱(re)(re)(re)(re),大量(liang)長期飲用(yong)為寒(han)(han)(han)。關于(yu)“一藥(yao)(yao)二(er)氣(qi)”的明確提法(fa),首見王好(hao)古。其言:“有(you)一藥(yao)(yao)一氣(qi),或(huo)(huo)二(er)氣(qi)者。熱(re)(re)(re)(re)者多,寒(han)(han)(han)者少(shao),寒(han)(han)(han)不(bu)為之(zhi)(zhi)寒(han)(han)(han);寒(han)(han)(han)者多,熱(re)(re)(re)(re)者少(shao),熱(re)(re)(re)(re)不(bu)為之(zhi)(zhi)熱(re)(re)(re)(re)。或(huo)(huo)寒(han)(han)(han)熱(re)(re)(re)(re)各半而(er)成溫(wen),或(huo)(huo)溫(wen)多而(er)成熱(re)(re)(re)(re),或(huo)(huo)涼多而(er)成寒(han)(han)(han),不(bu)可(ke)(ke)一途而(er)取(qu)也。又(you)或(huo)(huo)寒(han)(han)(han)熱(re)(re)(re)(re)各半,晝服之(zhi)(zhi),則從熱(re)(re)(re)(re)之(zhi)(zhi)屬(shu)而(er)升;夜服之(zhi)(zhi),則從寒(han)(han)(han)之(zhi)(zhi)屬(shu)而(er)降。至(zhi)于(yu)晴日(ri)則從熱(re)(re)(re)(re),陰雨(yu)則從寒(han)(han)(han),所(suo)從求類,變化猶(you)不(bu)一也。”
臨床研究表明,藥(yao)(yao)物的寒熱屬(shu)性與(yu)配伍(wu)、用(yong)藥(yao)(yao)劑量、給藥(yao)(yao)途徑以及(ji)機(ji)體(ti)狀態等(deng)有關,并在(zai)一定的條件下發生變(bian)化。比(bi)如中藥(yao)(yao)普遍存在(zai)雙向調節作用(yong),這就說明,中藥(yao)(yao)客觀具有“二(er)氣(性)”或“多性”。
一藥之二性或多性與配伍
在(zai)佐制(zhi)配伍中(zhong)(zhong)(zhong),由于藥物的(de)(de)寒(han)(han)熱(re)偏(pian)性可隨配伍后(hou)其用(yong)量比例(li)(li)及所(suo)治(zhi)病證的(de)(de)不(bu)(bu)同而(er)發生(sheng)變(bian)化。如交(jiao)泰丸中(zhong)(zhong)(zhong)黃(huang)連與(yu)(yu)肉桂的(de)(de)比例(li)(li)是(shi)10∶1時,左金丸中(zhong)(zhong)(zhong)黃(huang)連與(yu)(yu)吳(wu)茱萸(yu)用(yong)量比例(li)(li)是(shi)6∶1時,兩(liang)個處方(fang)(fang)(fang)(fang)均呈寒(han)(han)涼(liang)之性,而(er)肉桂與(yu)(yu)吳(wu)茱萸(yu)的(de)(de)溫(wen)(wen)熱(re)之性則不(bu)(bu)顯。眾所(suo)周(zhou)知的(de)(de)麻黃(huang)杏仁(ren)石(shi)(shi)膏甘草湯治(zhi)療肺熱(re)實喘,大(da)黃(huang)附子湯治(zhi)療寒(han)(han)積便(bian)秘(mi),前(qian)方(fang)(fang)(fang)(fang)中(zhong)(zhong)(zhong)寒(han)(han)性的(de)(de)石(shi)(shi)膏制(zhi)約麻黃(huang)的(de)(de)溫(wen)(wen)性,而(er)使(shi)處方(fang)(fang)(fang)(fang)偏(pian)寒(han)(han)涼(liang);后(hou)方(fang)(fang)(fang)(fang)中(zhong)(zhong)(zhong)大(da)黃(huang)的(de)(de)寒(han)(han)性則被附子、麻黃(huang)的(de)(de)溫(wen)(wen)性抑(yi)制(zhi),而(er)使(shi)大(da)黃(huang)單存瀉下之效(xiao),即所(suo)謂“去(qu)性存用(yong)”。
一藥之二性或多性與給藥劑量
在一定劑量(常用量)下,中藥主要的“偏性”顯示,次要或相反的偏性被掩蓋而不顯現。隨著劑量增加而逐漸達到“有效濃度”,中藥就表現出新偏性或相反的功效。正如《神農本草經》載丹參性(xing)(xing)“微寒”,即指在治(zhi)療劑量(liang)(liang)下(xia),其發揮清(qing)心涼血的(de)(de)作用(yong),治(zhi)療熱病擾心之心神不寧等(deng)熱證;而陶(tao)弘景言其:“時人服多眼赤,故(gu)應性(xing)(xing)熱。”提示兩者觀察丹參藥性(xing)(xing)的(de)(de)角度(du)不同(tong),亦反映出同(tong)一藥物用(yong)量(liang)(liang)多少不一,其“氣(qi)”可發生(sheng)變化。再如柴(chai)胡,劑量(liang)(liang)較小時,其寒性(xing)(xing)并不明顯,臨床用(yong)以升陽舉陷(xian)、疏肝解郁(yu);若劑量(liang)(liang)增大,則解表退熱,顯現出寒性(xing)(xing)。可見(jian)同(tong)一藥物,因用(yong)量(liang)(liang)不同(tong),其藥性(xing)(xing)會發生(sheng)變化。
一藥之二性或多性與給藥途徑、煎藥方法
目前,隨(sui)著(zhu)劑型的(de)多(duo)樣化(hua),給(gei)(gei)藥(yao)(yao)途徑更加復雜,給(gei)(gei)藥(yao)(yao)途徑不(bu)同(tong),藥(yao)(yao)性(xing)寒熱(re)(re)也可(ke)能呈現(xian)差異。如(ru)冰片外用,對五官和皮膚熱(re)(re)證之(zhi)(zhi)紅腫癢(yang)痛(tong),有良(liang)好(hao)的(de)清熱(re)(re)消(xiao)腫、止癢(yang)止痛(tong)作用,由(you)此(ci)觀之(zhi)(zhi),當有寒涼之(zhi)(zhi)性(xing);其(qi)內(nei)(nei)服開竅醒神、緩(huan)解(jie)冠(guan)心(xin)病及外傷疼(teng)痛(tong),偏于溫通走(zou)竄,其(qi)性(xing)又(you)當偏溫。如(ru)枳實內(nei)(nei)服,用以行氣化(hua)痰、除痞散結,其(qi)寒熱(re)(re)效應很不(bu)明顯(xian)。因(yin)承氣諸方用之(zhi)(zhi),古本草謂其(qi)微寒;但改(gai)用靜脈給(gei)(gei)藥(yao)(yao),則(ze)強心(xin)升(sheng)壓(ya),表現(xian)出溫性(xing)的(de)治療效應。煎藥(yao)(yao)方法對藥(yao)(yao)物性(xing)能的(de)影響,最典型的(de)就是(shi)大黃,后下瀉下,久煎可(ke)致便秘。
一藥之二性或多性與機體的狀態
藥物(wu)的(de)作用是以(yi)機(ji)體(ti)的(de)狀態(tai)為(wei)(wei)基礎的(de),機(ji)體(ti)的(de)狀態(tai)不(bu)(bu)同(tong)(tong),藥物(wu)的(de)作用不(bu)(bu)同(tong)(tong),這(zhe)是因為(wei)(wei)藥物(wu)具有(you)多(duo)種效應(ying),不(bu)(bu)同(tong)(tong)的(de)功(gong)用,可(ke)糾正不(bu)(bu)同(tong)(tong)的(de)病理狀態(tai),而(er)呈現不(bu)(bu)同(tong)(tong)的(de)治(zhi)療效應(ying),其(qi)(qi)表(biao)現出來的(de)寒熱(re)藥性也(ye)不(bu)(bu)同(tong)(tong)。即徐靈胎所言:“藥之(zhi)功(gong)用非此(ci)一(yi)端。”如丹參用于熱(re)病邪入(ru)營血,瘡癰紅腫疼(teng)痛,因其(qi)(qi)清熱(re)涼血之(zhi)功(gong)而(er)被確定為(wei)(wei)寒性(至少是微(wei)(wei)寒);而(er)其(qi)(qi)活血止痛、化瘀生新(xin)之(zhi)功(gong),對寒凝(ning)瘀滯之(zhi)證亦療效可(ke)靠,且無明顯寒涼之(zhi)偏(pian)性。根(gen)據其(qi)(qi)不(bu)(bu)同(tong)(tong)功(gong)用相應(ying)的(de)寒熱(re)治(zhi)療效應(ying),藥性可(ke)以(yi)微(wei)(wei)寒,可(ke)以(yi)微(wei)(wei)溫,也(ye)可(ke)以(yi)為(wei)(wei)平(ping)性,即表(biao)現為(wei)(wei)一(yi)物(wu)三“性”。
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