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1、淺談名老中醫(yī)李堪印運用黃芪的臨證思路* [摘要]名老中醫(yī)李堪印以黃芪為君藥治療痹癥的特色是運用中西醫(yī)結(jié)合的思路:1.辨證辨病結(jié)合,2.中西藥理結(jié)合,具體是通過西醫(yī)辨病,中醫(yī)辯證,用中藥合理配伍起到補氣健脾,利水消腫等功效,也體現(xiàn)了擴管降壓利尿,雙向調(diào)節(jié)免疫等現(xiàn)代藥理學作用。并列舉膝骨性關(guān)節(jié)炎繼發(fā)滑膜炎和強直性脊柱炎并發(fā)汗證的醫(yī)案以佐證。[關(guān)鍵詞]黃芪;思路;中西醫(yī)結(jié)合;痹癥;李堪印Brieftalkabouttheclinicalthoughtofrenownedolddoctorof
2、TCMLiKan-yinusingastragalus*YuanPu-wei,YangWei,KangWu-lin,ZhangXiao-liang,ChenBin(TheaffiliatedhospitalofShaanxiUniversityoftraditionalChineseMedicine,ShaanxiUniversityoftraditionalChineseMedicine,Xianyang,Shaanxi712000,China)Abstract:Thecharacterist
3、icthatLiKan-yin,thewell-knownolddoctoroftraditionalChinesemedicine(TCM),treatthearthralgiasyndromeusingastragalusasthemonarchdrugiswiththethoughtofthecombinationofTCMandWesternmedicine:1.Thediseasecombinedwithsyndromedifferentiation,2.Pharmacological
4、combinationofChineseandwestern.Inparticular,variousdiseasesarediagnosedbythewesternmedicineanddifferentsyndromearedifferentiatedbytheTCM.WithreasonablecompatibilityofChinesemedicine,astragalusnotonlycantonifyqi,invigoratethespleen,diuresisdetumescenc
5、eandsoon,butalsoreflectstheexpansionpipeantihypertensivediuretic,two-wayregulatingimmuneandothermodernpharmacologicaleffects.Andtocitethemedicalrecordsofakneeosteoarthritissecondarysynovitisandankylosingspondylitiswithsweatingsyndromeasevidence.Keywo
6、rds:astragalus;thethought;thecombinationofTCMandWesternmedicine;thearthralgiasyndrome;LiKan-yin 李堪印教授是陜西省名老中醫(yī)、陜西省中醫(yī)藥學會第四屆骨傷科專業(yè)委員會主任委員、全國老中醫(yī)藥專家學術(shù)經(jīng)驗繼承指導老師。李老從事臨床及教學50余載,臨證經(jīng)驗頗豐,為人極為謙和,于醫(yī)患中享有美譽,筆者有幸隨師待診,深感老先生用藥得心應手,用方靈活多變,尤以黃芪組方治療痹癥見長。黃芪乃補氣之司令,建脾之統(tǒng)帥,補血之
7、精華,從古至今,在藥用上都有深入研究探討的價值[1]。一、黃芪的概述1.1黃芪的中醫(yī)藥學功效黃芪(Astraglusmongholicus,AM),原名黃耆,又名膜莢黃芪,為“黃色的頭”(“yellowleader”),意指其藥材根的黃顏色和至要的補藥,始載《神農(nóng)本草經(jīng)》,列為上品[2]。其性味功用大致是:味甘性溫無毒,入脾肺二經(jīng),炙則溫中,生則瀉火,為補氣固表之圣藥。祖國醫(yī)學中記載,黃芪具有以下四種作用:溫肌肉而實腠理;益元氣而補三焦;內(nèi)托陰證之瘡瘍;固表虛之盜汗;簡言之,補中益氣、養(yǎng)血活血、
8、托膿生肌和利水消腫等功效,臨床用于:脾肺氣虛或中氣下陷之癥;衛(wèi)氣虛所致表虛自汗;氣血不足所致癰疽不潰或潰久不斂以及浮腫尿少和氣虛血滯導致的肢體麻木,關(guān)節(jié)痹痛等[3]。1.2黃芪的現(xiàn)代藥理學功效 現(xiàn)代藥理學研究表明黃芪的藥用成分主要含有多糖、皂苷、黃酮、氨基酸、蛋白質(zhì)、核黃、葉酸、維生素B、尼克酸、亞油酸等[4-5]。黃芪多糖是重要的天然有效成分,是黃芪藥理作用中起決定性因素的一類大分子化合物[4]。黃芪多糖在對心、腎臟及血管內(nèi)皮功能的保護,血糖的雙向調(diào)節(jié),抑病毒,抑瘤,提高免疫功能,促進骨髓造