重用黄芪之经方联用治疗疑难重症举隅

Combined Application of Classical Prescription of Astragalus Membranaceus with Large Dose in the Treatment of Difficult and Severe Diseases

[目的]介绍重用黄芪之经方联用治疗四则疑难重症的体会。[方法]通过整理、分析临床治疗心包积液、不明原因单侧上肢肿胀疼痛、湿疹重症、黄汗重症四则验案,总结联合运用经方且重用黄芪,发挥其利水之功效治疗疑难重症的经验。[结果]黄芪具有益气固表、利水消肿的功效,临床上黄芪用量达80~100 g可发挥其利水之功。结合患者整体临床表现,验案一选用防己黄芪汤、枳实薤白桂枝汤等以温振心阳、化气利水;验案二选用黄芪桂枝五物汤、防己地黄汤等以活血通阳、利水燥湿;验案三选用桂枝加黄芪汤、麻黄连轺赤小豆汤等以祛风散邪、清利湿热;验案四选用芪芍桂酒汤、防己茯苓汤等以通调气血、行水利湿,治疗后临床效果显著。[结论]临床上遵循“观其脉证,知犯何逆,随证治之”的原则联合应用经方,以疾病症状体征为导向,谨守病因病机遣方用药,能治疗多种疑难重症。

[Objective] To introduce the experience of applying classical prescriptions together with high dose of Astragalus membranaceus in the treatment of four cases of difficult and severe diseases. [Methods] Through the collation and analysis of four clinical cases in the treatment of pericardial effusion, unexplained unilateral upper limb swelling and pain, severe eczema, and severe yellow sweat, the experience in the treatment of difficult and severe cases was summarized by the combined use of classical prescription and large dose of Astragalus membranaceus to play its drainage effect. [Results] Astragalus membranaceus can invigorate Qi for consolidating superficies and induce diuresis for removing edema. According to the clinical practice, the dose of Astragalus membranaceus up to 80~100 g can have diuretic effect. According to the overall clinical manifestations of patients, in the first case, Fangji Huangqi Decoction and Zhishi Xiebai Guizhi Decoction were used to warm and invigorate Yang, transform Qi and induce diuresis;in case two, Huangqi Guizhi Wuwu Decoction and Fangji Dihuang Decoction were used to promote blood circulation and activate Yang, induce diuresis and remove dampness;in the third case, Guizhi plus Huangqi Decoction and Mahuang Lianyao Chixiaodou Decoction were used to dispel wind and disperse evil, clear away dampness-heat;in the fourth case, Qishao Guijiu Decoction and Fangji Fuling Decoction were used to regulate Qi and blood, induce diuresis. The above four cases had remarkable effect after treatment. [Conclusion] According to the principle of “observe the pulse and syndrome, know what is wrong, and treat it according to the syndrome”, the combination of classical prescriptions, guided by the symptoms and signs of the disease, and fully following the etiology and pathogenesis of the disease, can treat a variety of difficult and severe diseases in clinic.