大黄的临床应用规律综述

A review on the clinical application of Rhubarb

大黄,别名将军、黄良、火参等,为蓼科植物药用大黄、唐古特大黄、掌叶大黄的干燥根和根茎,味苦,性寒,归大肠、胃、脾、心包经。大黄在临床应用的范围广泛、方法多样,针对不同的配伍、剂量和炮制方法可发挥泻下攻积、清热泻火、凉血解毒、止血、逐瘀通经、利湿退黄等功效,用于治疗因腑气不通、食积、热邪、痰湿、瘀血、肝郁所引起的多种疾病,均取得较好疗效。然大黄药力峻猛,掌握确切用法极为关键,否则有碍其发挥疗效。基于大黄的临床常用配伍,文章总结出以下运用规律:大黄在治疗腑气不通、食积时常配伍行气消食药、扶正温阳药;治疗热邪、痰湿时常配伍清热凉血药、化痰健脾药;治疗瘀血时常配伍活血化瘀药、行气止痛药;治疗肝郁时,常配伍疏肝柔肝药、健脾开窍药。运用大黄时,不同剂量、炮制方法及煎煮时间对应的功效各异。小剂量健胃,中剂量解毒,大剂量攻逐。生大黄峻泻,熟大黄缓泻,酒大黄升散走窜,大黄炭收敛止血,醋大黄活血化瘀。大黄生用,泻下功著。若取其清扬之气,薄其重浊之味,开水渍之须臾即可。文章从临床常用药物配伍和注意要点两大方面对大黄的研究现状进行汇总,提炼配伍规律及要点,以期为大黄的临床应用提供参考。

Dahuang(Radix et Rhizoma Rhei),also known as Jiangjun(将军),Huangliang(黄良),Huoshen(火参),etc.,is the dried root and rhizome of Rheum officinale Baill,Rheum tanguticum Maxim.ex Regel and Rheum palmatum L in Polygonaceae.It is bitter in taste and cold in medicinal properties.The channel tropism of Rhubarb includes the large intestine meridian,stomach meridian,spleen meridian and pericardium meridian.Rhubarb has a wide range of clinical applications.And its clinical application methods are also diversified.According to different compatibility,dosage and processing methods,the role it plays also varies,such as removing accumulation with purgation,eliminating heat and purging fire,removing pattogenic heat from the blood and toxic material from the body,stopping bleeding,removing blood stasis and dredging meridians,promoting diuresis and removing jaundice,which are used to treat various diseases caused by obstruction of fu-organ Qi(腑气),food retention,pathogenic heat,phlegm-dampness,blood stasis and liver stagnation,which has achieved good results.However,the efficacy of Rhubarb is too strong,making it a doubleedged sword.When used properly,the curative effect of Rhubarb is rapid and significant.In the same way,improper use of the drug is likely to cause certain toxicity to people.Based on the compatibility of Rhubarb,which is commonly used in the general clinical practice,this paper summarizes the following application rules:In the treatment of fu-organ Qi obstruction and food retention,whose symptoms are abdominal distension,abdominal fullness,constipation,etc.,Rhubarb is often combined with Qi-promoting and digestion-promoting drugs,it can also be combined with strengthening the body resistance and warming Yang(阳)drugs.When it comes to the treatment of pathogenic heat and phlegm-dampness,Rhubarb is often combined with heat-clearing and blood-cooling drugs,it is also advisable to be combined with phlegm-resolving and spleen-invigorating drugs.In the treatment of diseases caused by blood stasis,Rhubarb is often combined with blood-activating and stasis-resolving drugs,it is also combined with Qi-promoting and pain-relieving drugs.In the treatment of liver stagnation,Rhubarb is often combined with liver-soothing and liver-softening drugs,it may have a better result if it is combined with spleen invigorating and resuscitation drug.Many factors will affect the efficacy of Rhubarb,such as the dosage of Rhubarb,the processing method or the time of decocting traditional Chinese medicinal.Even one of the factors makes subtle change,the effects of Rhubarb probably change correspondingly.To be more specific,the small dose of the medicinal can invigorate the stomach,while the medium dose can detoxify.In the clinical use of Rhubarb,attention should be paid to the reasonable selection of processed products.The raw Rhubarb makes people diarrhea at a high rate of speed.Compared with the raw Rhubarb,the cooked one has a rather mild impact on the evacuation of feces.The wine-processed Rhubarb ascends and disperses,and the Rhubarb charcoal astringes and stops bleeding as well as cooling blood,so it is advisable to treat bleeding caused by blood heat burning collateral.What's more,the vinegar-processed Rhubarb promotes blood circulation and removes blood stasis.In addition to the factors discussed above,the time of decocting is also worthy of attention.For instance,the raw Rhubarb is used for purgation,when its light and clear flavor is wanted but its heavy and turbid taste is avoided in the meantime,it can be soaked in boiling water for a moment.This paper summarizes the research status of Rhubarb from two aspects of clinical compatibility of commonly used drugs and key points of attention,and the compatibility rules and key points are extracted in order to provide a reference for the clinical application of Rhubarb,which is of great significance.