论灵活配伍乌头治诸痛

On Flexible Application of Aconite for Various Pains with Compatibility

[目的]探析乌头止痛功效与其峻烈药性之间的辩证关系,总结乌头的不同配伍在痛证治疗方面的应用,为临床灵活运用乌头拓展思路。[方法]通过查阅历代文献医籍,搜集部分医家的学术观点及相关用药经验,从痛证的不同病因病机探讨乌头的配伍应用,并结合现代药理学研究,总结一般规律。[结果]在风、寒、湿、瘀等以实邪结聚,阻滞经络为主要病机的痛证中,多取用乌头辛热发散之药性祛除病因,同时消除湿浊、瘀血、痰饮等病理产物来达到止痛目的;热痛虽为邪实疼痛,但其病机与乌头大辛大热之性不相适宜,治疗应配伍石膏、知母、白芍等与之药性相反的药物,起到"去性存用"的效果;虚痛的治疗应以标本兼治为原则,在补虚扶正的基础上保留或增强乌头的止痛作用",减毒增效"成为其应用的关键;在外伤、麻醉、癌痛等各类杂痛中,重视对乌头药理活性成分及其抗炎镇痛效应的现代研究,并结合历代医家方药,侧重于发挥乌头"对症治疗"的作用。[结论]乌头为止痛之要药,通过准确辨证,合理配伍,各类痛证均可大胆用之。

[Objective]To analyze the dialectical relationship between aconitum’s analgesic effect and its severe medicine property,and to summarize the application of aconitum’s different compatibility in the treatment of pain syndrome,so as to expand the thought for clinical flexible application of aconitum.Through consulting the medical records of the past dynasties,collecting some medical scholars’academic viewpoint and related drug-using experience,discussing the compatibility and application of aconitum from different etiology and pathogenesis of pain syndrome,and summarizing the general law by combining modern pharmacology research.[Results]In the pain syndromes of wind,cold,damp and blood stasis,which are mainly caused by the accumulation of excess pathogenic factors and the blocking of meridians and collaterals,the medicine property of aconitum heat dispersing is often used to eliminate the cause of the disease,and the pathological products such as damp-turbidity,blood stasis and phlegm-fluid are eliminated to achieve the purpose of pain relief.Although the heat pain is caused by excess pathogenic factors,its pathogenesis is not suitable for the nature of aconitum heat,so gypsum,anemarrhena and white peony should be used in the treatment to play the effect of"property-removed and action-reserved".The treatment of asthenia pain should be based on the principle of"treating disease both from manifestation and root cause",and"toxicity reducing and efficacy enhancing"has become the key to its application.In all kinds of miscellaneous pain,such as trauma,anesthesia,cancer pain and so on,attention should be paid to the modern research on the pharmacological active ingredients of aconitum and its anti-inflammatory and analgesic effects,and combine with the doctors’prescriptions of all ages,focusing on the"symptomatic treatment"of aconitum.Aconitum is an important drug for relieving pain.It can be used boldly in all kinds of pain syndrome through accurate syndrome differentiation and reasonable compatibility.