基于临床重症病例的麻黄附子细辛汤方证特征及其治疗脓毒症、多脏器功能衰竭、气管插管术后高热不退、急性心梗合并糖尿病末梢神经病变剧烈疼痛研究

Exploration of Mahuang Fuzi Xixin Decoction formula syndromes based on severe cases of critical care and its application for nosocomial infection in critical care medicine including hyperpyrexia after tracheotomy and severe pain accompanied by acute myocar

麻黄附子细辛汤出自《伤寒论》,可以温经解表,主治素体阳虚,感受风寒证。麻黄附子细辛汤方证指征包括:在现代医学的疾病方面,除常见的缓慢型心律失常、窦性心动过缓、病态窦房结综合症、老年人外感、虚人感冒、鼻炎、支气管哮喘、视神经炎、视神经萎缩、暴盲、暴喑、喉痹、偏头痛、关节痛、腰腿痛、失眠之外,还可见于休克、心衰、肾衰等急危重症合并发热,或者院内感染,气管插管术后高热不退等。在症状和体征方面,可以概括为虚寒证、痛证,以及发热。即面色晦暗或黄肿,恶寒,肢冷,精神萎靡,倦怠乏力,人困无神,欲寐而不能寐,口淡不渴,喜热饮,四肢或周身微肿,舌淡胖,苔白润或白腻,脉沉或微细;头身疼痛,关节痛,腰腿痛,以冷痛为主,得温则缓;伴或不伴发热。笔者在心血管重症监护病房(CCU)中运用该方治疗急危重症,发现该方为治疗少阴病合并发热、痛证;气管插管术是人为造成的麻黄证;气管插管术后高热不退需要区分阴证与阳证,但基本以阴证为主;阴证以麻黄附子细辛汤为主;针对气管插管术后高热不退,运用扶阳法多能取效,而运用清热药后很快病情步入厥阴重证;即使合并重症感染等邪热蕴肺的阳证指征,可以附子配生石膏以寒热并用,但绝不可肆意苦寒清热,直折阳气;麻黄附子细辛汤治疗病态窦房结综合征、二度二型房室传导阻滞、三度房室传导阻滞等缓慢型心律失常有效,能显著改善症状,短期之内提升心率,改善心律,但停药1年后往往病情还会反复,提示可能并不能改善缓慢型心律失常的远期预后;笔者常将本方运用于急危重症患者临终前出现的发热或院内感染,且大多以中等度热(38.0~38.9℃)、高热(39.0~40.9℃)以及超高热(41.0℃以上)为主;在危重症昏迷伴高热不退患者的治疗过程中,笔者用麻黄附子细辛汤浓煎鼻饲,从胃管中持续泵入以回阳退热。

Mahuang Fuzi Xixin Decoction recorded in Treatise on Febrile Diseases by Zhang Zhongjing in the Han Dynasty have been widely used in treating Yang deficiency and exogenous wind-cold syndrome by traditional Chinese medicine physicians for thousands of years.The indications of Mahuang Fuzi Xixin Decoction include bradyarrhythmia,sinus bradycardia,sick sinus node syndrome,senile exogenous,asthmatic cold,rhinitis,bronchial asthma,optic neuritis,optic atrophy,sudden blindness,sudden onset of cough,laryngeal obstruction,migraine,joint pain,low back pain,insomnia,shock,heart failure,renal failure,accompanied by fever or nosocomial infection,and hyperpyrexia after tracheotomy;dark complexion,chills,cold limbs,listlessness,fatigue,insomnia,lack of thirst,liking hot drinks,slightly swollen limbs or whole body,pale fat tongue,greasy fur,and deep pulse.Mahuang Fuzi Xixin Decoction is a potential drug for Shaoyin disease complicated with fever and pain.Tracheal intubation is an artificial ephedrine syndrome.It is necessary to distinguish Yin and Yang syndrome in treating hyperpyrexia after tracheotomy.However,it belongs to Yin syndrome,which could be treated by Mahuang Fuzi Xixin Decoction.Mahuang Fuzi Xixin Decoction is effective in the treatment of sick sinus syndrome,second degree atrioventricular block and third degree atrioventricular block.It can significantly alleviate symptoms,improve heart rate,and heart rhythm in a short period of time.However,after one year of drug withdrawal,the diseases may recur,indicating that Mahuang Fuzi Xixin Decoction may not improve the long-term prognosis of slow arrhythmia.Mahuang Fuzi Xixin Decoction is often used for fever or nosocomial infection in critical care medicine.In the treatment of critical care medicine complicated with high fever,Mahuang Fuzi Xixin Decoction is often taken continuously by stomach tube.