常用治痫虫药及其在治痫方剂中的配伍应用

Commonly-Used Insect Drugs for Epilepsy and Their Compatible Application in Antiepileptic Prescriptions

虫药具有攻逐搜剔之特性,对治痫有独特的优势。常用的治痫虫药有全蝎、蜈蚣、地龙、蝉蜕、僵蚕共5味,其具有止痉、平肝熄风、走窜入络的功效特点。古今中医文献中的虫药治痫方剂中,完全由虫药组成的方剂(如二虫定痫散、止痉散)及虫药占比较高者的方剂(如全蝎散、牛黄丸)占少部分,少佐以虫药的方剂(如五痫丸、控涎丸)则较多见;近现代虫药治痫方剂较多,且常联用多味虫药。全蝎与僵蚕性平而无寒热之偏,是最常用的药对;全蝎与蜈蚣常相须为用,止痉之力倍增;僵蚕配伍蝉蜕早在唐代即用于治痫病,具有祛风除痰、解郁化滞之功效;僵蚕配伍地龙主要出现于近现代方剂中,一升一降,熄风止痉又能舒展气机,通络止痛。通过对常用治痫虫药的药性、功效特点、配伍规律等进行探讨,可为痫病的临床治疗提供参考。

Insect drugs have the actions of offensively eliminating and expelling pathogens,with unique advantage in the treatment of epilepsy.Commonly-used insect drugs for epilepsy consist of Scorpio,Scolopendra,Pheretima,Cicadae Periostracum,and Bombyx Batryticatus,which have the efficacy of ceasing spasm,calming liver wind,and activating the meridians.In the anti-epilepsy prescriptions composing of insect drugs recorded in the ancient and modern Chinese medical literature,the prescriptions only consisting of insect drugs(e.g.Erchong Dingxian Powder,Zhijing Powder)and the prescriptions consisting of high proportion of insect drugs(e.g.Quanxie Powder,Niuhuang Pills)accounted for a small proportion,while the prescriptions consisting of less insect drugs(e.g.Wuxian Pills,Kongxian Pills)were more commonly used.The prescriptions for epilepsy consisting of insect drugs were increased in modern times,and often multiple insect drugs were used in one prescription.The Scorpio and the Bombyx Batryticatus are mild in nature and have no cold or heat predominance,which were the most commonly-used drug pair.Scorpio and the Scolopendra were normally used together for reinforcement on arresting convulsion.Bombyx Batryticatus combined with Cicadae Periostracum was used early in the Tang Dynasty to treat epilepsy,and had the actions of dispelling wind and removing phlegm,relieving depression and removing stagnation.The combination of Bombyx Batryticatus and Pheretima was mainly used in the modern prescriptions,and the herbal pair had the features of one ascending and another descending,which acted on suppressing wind and ceasing spasm,and on activating qi movement,unblocking collaterals and relieving pain.The exploration of the pharmacological properties,efficacy and compatibility regularity of the commonly-used insect medicines for epilepsy will provide reference for the clinical treatment of epilepsy.