牟允方老中医运用大黄治验急症医案5则

Five cases of veteran doctors of traditional Chinese medicine Mou Yunfang's application of Rhubarb in treating acute diseases

大黄味苦、性寒,功能泻下攻积、清热解毒、凉血泻火、止血活血、逐瘀通经。牟允方老中医认为,大黄的使用属中医八法之“下”法,但绝非单纯通便之用,实为逐邪之举,泄热、浊、瘀、毒、痰之邪由肠腑魄门而去,临床运用得法,能救厄于顷刻。现选取脓毒症、骨折疼痛、胆石症、妊娠肠痈、外感发热等5则验案,分析其运用大黄的临床体会和经验,如内科——脓毒症取大黄凉血泄热之效;伤科——骨折取其行瘀活血止痛之功;外科——胆石症虽治胆,但借大黄攻下腑积、利湿退黄之用而取效;妇科——妊娠肠痈虽忌攻下峻烈,仍投大黄泻肠间湿热、祛肠中瘀血,可知“有故无损”法则;儿科——外感发热,风寒内湿夹滞,在散寒燥湿之时,少佐大黄泻下化积,使邪有出路,表里同解。师公认为临床上大黄适应证广泛,如急腹症、慢性阻塞性肺疾病、肝硬化、脑卒中、心肌梗死、狂犬病、破伤风、毒蛇咬伤等许多疑难杂症,但仍须遵辨证论治原则,紧抓“胃家实”,即里实热证之病机,才能效如桴鼓,若为虚证则应忌用。

Rhubarb has a bitter taste and a cold nature.It is known for its functions of clearing heat and detoxifying,cooling blood and purging fire,stopping bleeding and promoting blood circulation,eliminating blood stasis,and dredging the channel.Mou Yunfang believed that the use of Rhubarb belongs to the"purgative"method of the 8 traditional Chinese medicine(TCM)methods,but it was not simply used for defecation.In fact,it was an act of expelling evil spirits.The evil spirits of heat release,turbidity,blood stasis,toxin,and phlegm are eliminated from the intestinal and visceral gates.With proper clinical application,it can save the suffering in an instant.And 5 proven cases of sepsis,fracture pain,cholelithiasis,pregnancy with intestinal abscess and exogenous fever were selected to analyze his clinical experience in using Rhubarb.The effect of using Rhubarb to cool blood and relieve heat in sepsis of internal medicine.Traumatology fractures have the function of promoting blood stasis,promoting blood circulation,and relieving pain.Although surgical cholelithiasis treats the gallbladder,it is effective through the use of Rhubarb to attack the accumulation of organs,promote dampness and reduce jaundice.Although gynecological pregnancy with intestinal abscess should not be attacked severely,Rhubarb should still be used to relieve dampness and heat in the intestines and remove blood stasis in the intestines,which is known as the"combat severe disease with drastic medicines"principle;pediatric fever caused by external factors,wind cold and internal dampness entrapment.When dispelling cold and dampness,a small amount of Rhubarb should be used to relieve constipation,providing a way out for evil and resolving both the exterior and interior.Grandmaster believes that the clinical use of Rhubarb has a wide range of indications,such as acute abdomen,chronic obstructive pulmonary disease,liver cirrhosis,stroke,myocardial infarction,rabies,tetanus,venomous snake bites,and many other difficult and miscellaneous diseases.However,the principle of differentiation and treatment still needs to be followed,and the pathogenesis of"stomach excess",that is,the heat syndrome of the internal excess,should be closely grasped in order to be effective.If it is a deficiency syndrome,it should be avoided.