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阿膠的變遷

醫案日(ri)記 2023-05-15 01:29:48

阿膠的變遷

周益新 山西省大同(tong)市新建康醫院

阿膠,出《神農本草經(jing)》,為馬科動物驢(lv)的皮(pi),經(jing)漂泡(pao)去毛后(hou)熬制(zhi)而成(cheng)的膠(jiao)(jiao)質塊,故《千金·食治》稱驢(lv)皮(pi)膠(jiao)(jiao);晉唐(tang)時(shi)期“歲常煮膠(jiao)(jiao)以(yi)貢(gong)天府”,又稱貢(gong)膠(jiao)(jiao);昔謂(wei)以(yi)山東東阿阿井之水熬制(zhi)而成(cheng),故傳統有(you)阿膠(jiao)(jiao)之名。其性味(wei)甘、平,入肺、肝、腎經(jing)。有(you)補血(xue)止血(xue)、養(yang)陰潤肺之功。但(dan)溯源歷史,阿膠(jiao)(jiao)最初并非用(yong)驢(lv)皮(pi)制(zhi)成(cheng)。

考(kao)南北朝(chao)時(shi)梁(liang)代(dai)(dai)陶弘景(jing)《名醫別錄》謂(wei)阿膠(jiao)(jiao)(jiao)(jiao)“生東(dong)平郡,煮牛(niu)(niu)皮(pi)(pi)(pi)作之。出東(dong)阿。”可(ke)見最早阿膠(jiao)(jiao)(jiao)(jiao)是用(yong)牛(niu)(niu)皮(pi)(pi)(pi)煮熬(ao)而(er)成(cheng),并(bing)非以驢皮(pi)(pi)(pi)為(wei)(wei)之。故漢晉所(suo)用(yong)之阿膠(jiao)(jiao)(jiao)(jiao)是以牛(niu)(niu)皮(pi)(pi)(pi)為(wei)(wei)原料制作的牛(niu)(niu)皮(pi)(pi)(pi)膠(jiao)(jiao)(jiao)(jiao),并(bing)非今(jin)(jin)天通常認為(wei)(wei)的驢皮(pi)(pi)(pi)膠(jiao)(jiao)(jiao)(jiao)。北魏賈思勰《齊民要(yao)術》載:“煮膠(jiao)(jiao)(jiao)(jiao)要(yao)用(yong)二(er)月(yue)(yue)(yue)、三月(yue)(yue)(yue)、九月(yue)(yue)(yue)、十月(yue)(yue)(yue),余(yu)月(yue)(yue)(yue)則(ze)不成(cheng)。娑牛(niu)(niu)皮(pi)(pi)(pi)、水牛(niu)(niu)皮(pi)(pi)(pi)、豬皮(pi)(pi)(pi)為(wei)(wei)上,驢馬駝騾皮(pi)(pi)(pi)為(wei)(wei)次。其膠(jiao)(jiao)(jiao)(jiao)勢力雖復相(xiang)似,但驢馬皮(pi)(pi)(pi)薄毛多(duo)膠(jiao)(jiao)(jiao)(jiao)少,倍費樵薪。”可(ke)見當時(shi)并(bing)不以驢皮(pi)(pi)(pi)膠(jiao)(jiao)(jiao)(jiao)為(wei)(wei)貴。到唐代(dai)(dai),陳士良《食(shi)療本草》中(zhong)首次提出以牛(niu)(niu)皮(pi)(pi)(pi)制作的膠(jiao)(jiao)(jiao)(jiao)稱(cheng)為(wei)(wei)“黃明膠(jiao)(jiao)(jiao)(jiao)”,一直沿襲至今(jin)(jin)。而(er)陳藏器《本草拾遺》、王燾《外臺秘要(yao)》等(deng)書,同時(shi)記述了(le)驢皮(pi)(pi)(pi)膠(jiao)(jiao)(jiao)(jiao)、黃明膠(jiao)(jiao)(jiao)(jiao)和阿膠(jiao)(jiao)(jiao)(jiao),作用(yong)相(xiang)近(jin),應用(yong)未加(jia)細分。

阿(a)(a)(a)(a)(a)膠(jiao)(jiao)(jiao)(jiao)作(zuo)(zuo)為(wei)通(tong)用(yong)(yong)名稱,制(zhi)作(zuo)(zuo)原(yuan)料不一,如(ru)宋代(dai)王繼先《紹興(xing)校(xiao)定經史證類備急本(ben)(ben)草》言(yan):“阿(a)(a)(a)(a)(a)膠(jiao)(jiao)(jiao)(jiao)……謂(wei)用(yong)(yong)東平(ping)阿(a)(a)(a)(a)(a)井水(shui)(shui)而(er)熬成(cheng),然(ran)皆以(yi)(yi)驢(lv)、牛皮(pi)(pi)(pi)(pi)(pi)可(ke)就。”但似以(yi)(yi)東阿(a)(a)(a)(a)(a)井水(shui)(shui)煮制(zhi)驢(lv)皮(pi)(pi)(pi)(pi)(pi)而(er)成(cheng)者為(wei)地道(dao),如(ru)宋代(dai)蘇頌《本(ben)(ben)草圖經》稱阿(a)(a)(a)(a)(a)膠(jiao)(jiao)(jiao)(jiao)“以(yi)(yi)阿(a)(a)(a)(a)(a)縣城北井水(shui)(shui)作(zuo)(zuo)煮者為(wei)真。其井官禁,真膠(jiao)(jiao)(jiao)(jiao)極難得,貨者多(duo)偽(wei)。其膠(jiao)(jiao)(jiao)(jiao)以(yi)(yi)烏驢(lv)皮(pi)(pi)(pi)(pi)(pi)得阿(a)(a)(a)(a)(a)井水(shui)(shui)煎成(cheng)乃佳爾。今(jin)時方家用(yong)(yong)黃(huang)明(ming)膠(jiao)(jiao)(jiao)(jiao),多(duo)是(shi)牛皮(pi)(pi)(pi)(pi)(pi);《本(ben)(ben)經》阿(a)(a)(a)(a)(a)膠(jiao)(jiao)(jiao)(jiao)亦是(shi)牛皮(pi)(pi)(pi)(pi)(pi),是(shi)二皮(pi)(pi)(pi)(pi)(pi)可(ke)通(tong)用(yong)(yong)。但今(jin)牛皮(pi)(pi)(pi)(pi)(pi)制(zhi)作(zuo)(zuo)不甚精,止可(ke)膠(jiao)(jiao)(jiao)(jiao)物,故不堪(kan)入藥(yao)也。”但到(dao)明(ming)代(dai),對制(zhi)膠(jiao)(jiao)(jiao)(jiao)的原(yuan)料亦未統一為(wei)驢(lv)皮(pi)(pi)(pi)(pi)(pi),李時珍《本(ben)(ben)草綱目》載:“凡造諸膠(jiao)(jiao)(jiao)(jiao),自十月(yue)至二三月(yue)間,用(yong)(yong)娑(suo)牛、水(shui)(shui)牛、驢(lv)皮(pi)(pi)(pi)(pi)(pi)者為(wei)上(shang),豬、馬(ma)、騾、駝皮(pi)(pi)(pi)(pi)(pi)者次(ci)之(zhi),其舊皮(pi)(pi)(pi)(pi)(pi)、鞋(xie)、履等(deng)物者為(wei)下。……大抵古方所用(yong)(yong)多(duo)是(shi)牛皮(pi)(pi)(pi)(pi)(pi),后世乃貴(gui)驢(lv)皮(pi)(pi)(pi)(pi)(pi)。若偽(wei)者皆雜以(yi)(yi)馬(ma)皮(pi)(pi)(pi)(pi)(pi)、舊革、鞍、靴之(zhi)類,其氣(qi)濁臭,不堪(kan)入藥(yao)。當以(yi)(yi)黃(huang)透如(ru)琥(hu)珀(po)色(se),或光黑(hei)如(ru)瑿(yi)漆者為(wei)真,真者不作(zuo)(zuo)皮(pi)(pi)(pi)(pi)(pi)臭,夏月(yue)亦不濕軟(ruan)。”直到(dao)清(qing)代(dai)以(yi)(yi)后,阿(a)(a)(a)(a)(a)膠(jiao)(jiao)(jiao)(jiao)始逐漸統一以(yi)(yi)驢(lv)皮(pi)(pi)(pi)(pi)(pi)為(wei)原(yuan)料熬制(zhi)而(er)成(cheng)。清(qing)代(dai)周巖(yan)《本(ben)(ben)草思辨錄》稱:“阿(a)(a)(a)(a)(a)膠(jiao)(jiao)(jiao)(jiao)以(yi)(yi)濟(ji)水(shui)(shui)黑(hei)驢(lv)皮(pi)(pi)(pi)(pi)(pi)煎煉而(er)成(cheng)。”

阿(a)(a)(a)(a)膠(jiao)(jiao)(jiao)(jiao)(jiao)質(zhi)地(di)的優劣(lie),功(gong)(gong)效(xiao)強弱固然與(yu)原料(liao)(liao)密(mi)切相(xiang)關(guan),但(dan)似(si)乎并(bing)不(bu)是絕對的。據周鳳梧《古今藥方縱橫》言(yan):“近年來,又試制(zhi)成功(gong)(gong)以(yi)豬皮(pi)代(dai)替驢(lv)(lv)皮(pi)熬(ao)制(zhi)的產品(pin)新阿(a)(a)(a)(a)膠(jiao)(jiao)(jiao)(jiao)(jiao),經分析和(he)鑒定,所(suo)(suo)含成分與(yu)驢(lv)(lv)皮(pi)阿(a)(a)(a)(a)膠(jiao)(jiao)(jiao)(jiao)(jiao)相(xiang)似(si),臨床功(gong)(gong)效(xiao)亦同,完全可代(dai)驢(lv)(lv)皮(pi)阿(a)(a)(a)(a)膠(jiao)(jiao)(jiao)(jiao)(jiao)使用。”(人民(min)衛生出版社(she),1987年版。)而所(suo)(suo)用水(shui)質(zhi)、輔料(liao)(liao)及加工工藝似(si)當(dang)深(shen)究,確(que)關(guan)療效(xiao)之(zhi)(zhi)(zhi)高低(di)。山東(dong)東(dong)阿(a)(a)(a)(a)之(zhi)(zhi)(zhi)阿(a)(a)(a)(a)膠(jiao)(jiao)(jiao)(jiao)(jiao),以(yi)驢(lv)(lv)皮(pi)加冰(bing)糖、黃酒、豆油等為(wei)輔料(liao)(liao),尤(you)取阿(a)(a)(a)(a)井(jing)水(shui)煉制(zhi)而正宗(zong)。阿(a)(a)(a)(a)井(jing),位于東(dong)阿(a)(a)(a)(a)鎮(zhen),舊屬山東(dong)省東(dong)阿(a)(a)(a)(a)縣,今歸(gui)山東(dong)省平陰縣。阿(a)(a)(a)(a)井(jing)之(zhi)(zhi)(zhi)水(shui)乃濟水(shui)之(zhi)(zhi)(zhi)眼,其(qi)色綠且(qie)醇,趨(qu)(qu)下(xia)域(yu)內(nei)有狼溪(xi)河,其(qi)水(shui)為(wei)憬水(shui)之(zhi)(zhi)(zhi)源(yuan),乃洪范等九泉(quan)之(zhi)(zhi)(zhi)水(shui)所(suo)(suo)會歸(gui),性(xing)屬甘溫,合(he)此水(shui)制(zhi)膠(jiao)(jiao)(jiao)(jiao)(jiao)為(wei)最善。北魏酈道元《水(shui)經注》中即言(yan):東(dong)阿(a)(a)(a)(a)縣故(gu)城“大(da)城內(nei)西側(ce)皋(gao)上有大(da)井(jing),其(qi)巨若輪(lun),深(shen)六(liu)七丈,歲(sui)常煮膠(jiao)(jiao)(jiao)(jiao)(jiao)以(yi)貢天府(fu)。本草所(suo)(suo)謂阿(a)(a)(a)(a)膠(jiao)(jiao)(jiao)(jiao)(jiao)也,故(gu)世俗有阿(a)(a)(a)(a)井(jing)之(zhi)(zhi)(zhi)名。”沈括《夢溪(xi)筆談》亦說:“阿(a)(a)(a)(a)井(jing)水(shui),性(xing)趨(qu)(qu)下(xia),清且(qie)重(zhong),取井(jing)水(shui)煮膠(jiao)(jiao)(jiao)(jiao)(jiao),謂之(zhi)(zhi)(zhi)阿(a)(a)(a)(a)膠(jiao)(jiao)(jiao)(jiao)(jiao)。”《中國(guo)藥學(xue)大(da)辭典(dian)》也記載:“狼溪(xi)河其(qi)水(shui)源(yuan)為(wei)憬水(shui)之(zhi)(zhi)(zhi)源(yuan),洪范九泉(quan)之(zhi)(zhi)(zhi)水(shui)所(suo)(suo)匯(hui)歸(gui),其(qi)性(xing)甘溫。”說明(ming)其(qi)淵源(yuan)有自(zi),其(qi)來甚古。

可見,阿膠古(gu)來所用(yong)原料不一,先用(yong)牛皮(pi)(pi)(pi),后諸皮(pi)(pi)(pi)皆用(yong),至(zhi)唐宋時牛、驢(lv)(lv)(lv)皮(pi)(pi)(pi)成兩大(da)主流,清(qing)至(zhi)今漸以(yi)(yi)驢(lv)(lv)(lv)皮(pi)(pi)(pi)熬制(zhi)(zhi),牛皮(pi)(pi)(pi)制(zhi)(zhi)作者(zhe)名黃明膠,功用(yong)近似,然從古(gu)今用(yong)藥(yao)經驗(yan)和臨床習(xi)慣來看(kan),以(yi)(yi)黑驢(lv)(lv)(lv)皮(pi)(pi)(pi)制(zhi)(zhi)之(zhi)為(wei)(wei)上,尤以(yi)(yi)東阿井(jing)水熬制(zhi)(zhi)為(wei)(wei)道地,牛皮(pi)(pi)(pi)次(ci)之(zhi),豬皮(pi)(pi)(pi)等制(zhi)(zhi)成的新阿膠更下(xia)之(zhi),且(qie)作用(yong)為(wei)(wei)弱(ruo)。

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