Talking about the Usage of Xiaoxuming Decoction to Treat Stroke and Hypertension-谈小续命汤治疗中风、高血压的用法

【source】

The earliest record of Xiaoxunming Decoction can be found in Xiaopinfang by Chen Yanzhi, a famous physician in the Han, Wei and Jin Dynasties. Because of the remarkable effect of this prescription in treating stroke, it was regarded as the “most important of all soups” by the doctors at that time. Later, Sun Simiao received the “Prescriptions for Emergency Prepared Thousands of Money”, and determined that its functions are: strengthening the body and dispelling wind, attending to the skewed eyes of the external stroke, acute muscles and veins, hemiplegia and other diseases. The prescription for the treatment of apoplexy was quite extensive before the Tang and Song dynasties, and its importance is unquestionable. For example, “Preparation for Emergency Thousands of Funds and Prescriptions · All Winds” put Xiaoxuanming Decoction at the top of the wind treatment agents, and there are continuations. There are a number of prescriptions like Mingtang, and Wang Tao’s “Secrets of the Outside Taiwan” is also arranged in this way. It shows the important position of Xiaoxuming Decoction in the treatment of apoplexy before the Tang and Song Dynasties.

【composition】

Licorice, ephedra, fangji, ginseng, cassia twig, scutellaria, chuanxiong, almonds, peony, one or two each, one and two and a half fangfeng, five liang of ginger, and one cannon for aconite

【usage】

Top ten things, take nine liters of water and cook three liters. Divided into three servings, very good. It is better to take three or four doses if it is not bad. Sweat is as light or heavy as the person is. Some people have weak feet to take this prescription, to six or seven doses are poor. There are rubella family, and the Tianyin Festival changes to take it to prevent febrile disease.

【effect】

Warming the meridian through the yang, expelling wind and strengthening the body.

【Indications】

In the treatment of stroke, the wind is dying, the body is in a state of urgency, the speech is not correct, the tongue is too strong to speak, dying, mentally confused, all wind suits are tested, and it is not empty.

【Fangjie】

In the prescription, ephedra, cassia twig, fangfeng, anti-self, expelling wind and dampness are used to open the surface; if the evil is stuck outside, the qi inside will not be announced, so depression will turn heat, and almonds should be used to benefit, and Huangqin should be used to clear it; and evil The qi must be weak, so ginseng and licorice are used to replenish qi; white peony root and chuanxiong can protect the camp and blood; use aconite can not only tonic the power of medicine, but also help ephedra to perform its performance; ginger and jujube are used Introduced to reconcile the camp and the guard.

【Summary of Clinical Application】

“Lingshu·Five Changes”: “If the flesh is not firm, if the body is weak, it will be good for the wind.” The body’s righteousness is weak, and the wind is caused by the external attack of the cold. Due to the lack of righteousness, the body is loose, and the evil of wind and cold will drive straight in. Direct access to the meridian is a true stroke. Xiaoxunming Decoction has the function of warming the meridian and promoting yang, strengthening the body and dispelling wind, and can be used in western medicine for cerebral hemorrhage, cerebral thrombosis, cerebral embolism, subarachnoid hemorrhage, hypertensive encephalopathy, etc.

Clinical symptoms: wind evil middle meridian, fast muscles and pulse, hemiplegia, crooked mouth and eyes, astringent language, strong headache, or confusion, etc. The tongue is light and the fur is thin and greasy, and the tongue is hard or shortened and trembling. The pulse floats back or floats slowly.

【Clinical application】

Case 1. Cerebral thrombosis (Li Ke medical case)

Sun Mou, male, 60 years old. First visit on January 22, 2007. Thirty years ago, he was diagnosed with essential hypertension (high low pressure, continuous at 100-110 mmHg) and cerebral arteriosclerosis. One night 20 years ago, I was awakened suddenly. When I woke up, I found that the upper and lower limbs of my right body were shaking constantly. After shaking for about a dozen times, I stopped, shaking again after half a minute. This was repeated 3 times. The right body was paralyzed and he was diagnosed with cerebral thrombosis. After treatment with Chinese and Western medicine, he recovered but his right half of the body is still inconvenient. Since the beginning of winter, the dizziness has worsened, the fingers are numb, the knees are soft, the tongue is slightly dark, the fur is white and slippery, and the pulse is astringent and weak. The syndrome is fatigue, internal injuries, various weaknesses, long-lasting stroke, poor atmosphere, Yuanyang difficult to compress, phlegm dampness and turbidity blocking the triple burn. The head and face and the Yintang are so dark that it is not a good omen, to prevent sudden changes and try to save the decline.

Imitation Xiaoxunming Decoction Method: 250g Beiqi, 10g Ephedra, 45~200g Heifu Tablets (10g on a daily basis), Angelica sinensis, Guizhi each 45g, Liao Xixin 45g, Chuanxiong, dried ginger each 90g, red ginseng (Separate stew), 30g each of Lingzhi, 10g each of Taohong, 10g of stiff silkworm, 45g of Earthworm, 10g of Shengnanxing, 45g of raw Pinellia, 45g of ginger, 6 each of Qingquan scorpion, and 1 small white flower snake ( Yanchongfu), 30g black beans, 25 jujubes, 45g black fungus, and 10g white mustard seeds. Add 6 kg of water, simmer for 2 hours, remove the slag, decoct and concentrate to 500ml, and serve 3 times.

Second visit: After taking 1 dose, 20 minutes after the medicine, the affected limb appears itch and numbness, such as electric shock, and even sudden muscle jumps. After 3 doses, the foul-smelling and loose stools are relieved, and it feels more relaxed. After 15 doses, the walking posture has improved. For example, it turned out that the right leg must be pushed back every time he takes a step, but now there is no such action. When the aconite is increased to 165g, there is numbness in the whole body, so 10g is subtracted, and the defender continues to take it.

Third diagnosis: After 1 month, the sole of the right foot can be strode vigorously, and the effect is not better. Continue to take 1 month.

Case 2. Stroke (medical case of Yan Qianlin)

Bao Moumou, male, 62 years old. First visit on April 7, 2009. The patient has a history of hypertension for more than ten years and a history of stroke. Head MRI showed that there were multiple ischemic infarcts in both frontal and parietal lobes, lateral ventricles, basal ganglia and brainstem. Current symptoms: weakness of the left lower limb, but can be slightly elevated, can turn over when lying flat, decreased movement of the left hand, paralysis of the right hand and foot, poor stool, difficulty sleeping at night, slow pulse, red tongue, thin white coating. The syndrome is qi deficiency and blood stasis. The treatment is to replenish qi and promote blood circulation, remove blood stasis and dredge collaterals. Fang adds flavor with Xiaoxuanming Decoction.

Medicinal use: raw ephedra 6g, cassia twig 5g, asarum 3g, parsnip 10g, fangji 10g, almond 9g, scutellaria 6g, codonopsis 9g, cooked aconite 6g, chuanxiong 9g, antler 10g, cistanche 15g, dodder 10g, red peony 15g, 15g of Radix Paeoniae Alba, 10g of Angelica, 10g of Magnolia officinalis, 5g of Roasted Licorice.

Second visit: Nearly 1 month after taking the upper part, the left lower limb has been able to move, the right lower limb has also recovered, the appetite is normal, the stool is still not smooth, the dry mouth is not obvious, the phlegm is less, the tongue is red, the coating is thin and yellow, and the pulse is small. That is, use the original recipe to remove Angelica sinensis, add 15g of roasted astragalus, and 10g of turtle shell glue. After nearly 3 months of treatment, the symptoms of fatigue in both lower limbs have been significantly improved compared with before, the left lower limb can start, the right hand and foot can also move slightly, the stool is unobstructed, and other symptoms Also reduce successively.

Original note: The patient is over 60 years old, righteousness day is weak, wind evil takes advantage of the deficiency to invade the veins, blood veins and meridians are blocked, blood gradually stagnates and stasis, blocking the veins, “blood stasis does not go away, new blood does not grow”, cannot Tongrong’s limbs and muscles are painful when the limbs are dragged; after a stroke, the upper and lower levels are deficient, the deficient yang is hyperactive, the phase fire cannot be reset, the kidney-yang is deficient in the lower, and the intestines cannot be moisturized. It is often supplemented with products that warm the kidney-yang. In order to tune up and down, smooth the air machine. Therefore, the teacher used Xiaoxunming Decoction to dispel wind, promote blood circulation and dredge the collaterals, and at the same time add antlers, Cistanche cistanche and Cuscuta seeds for warming yang and nourishing the kidney, warming the kidney and nourishing essence, warming the waist and intestines. Then add roasted astragalus and tortoise shell glue to replenish qi and nourish yin, consolidate the source and clear the source.

Case 3. Essential hypertension (Peng Peichu’s medical case)

XX, male, 68 years old, was admitted to the hospital on March 3, 1999 due to dizziness and swelling for 5 years and worsening for 1 week. Check: blood pressure 165/105mmHg. Fundus examination: arteriosclerosis grade 2. The chest radiograph showed enlarged left ventricle, triglyceride 2.0mmol/L, pale red tongue, teeth marks on the sides, thin white coating, and heavy pulse. Diagnosis: essential hypertension. Stop taking western medicine and switch to Xiaoxunming Decoction: 9g each of Qianghuo and Duhuo 9g, 9g Cassia twig, 9g Ephedra, 9g Red Peony, 12g Fangfeng, 12g Fangji, 9g Aconite, 9g Gardenia, 9g Atractylodes macrocephala, 9g Chuanxiong, 12g Poria cocos , Scutellaria baicalensis Georgi 9g, Zedoary Turmeric 12g, Leech 9g, Plantago Seed 12g. After 2 doses, the symptoms gradually relieved, the headache disappeared, the blood pressure was 120/70mmHg, and he was hospitalized for 25 days, and the blood pressure was stable and discharged.

Original note: Essential hypertension belongs to the category of headwind and dizziness in Chinese medicine. Its pathogenesis can be summarized in four aspects: wind, fire, phlegm, and deficiency. Among them, wind is the first, so Xiaoxuanming Decoction is used to treat it. Fang Zhongqianghuo, Duhuo, wind-defense, self-defense and rheumatism, clear meridian; ephedra and cassia twigs to disperse the lungs and disperse pathogens, cold Sheng with aconite, heat Sheng with Scutellaria baicalensis; Chuanxiong, red peony nourishes blood and invigorates blood; Atractylodes, Poria cocos invigorates the spleen Wet; three-lens, turmeric, leech to remove blood stasis and dredge collaterals. According to clinical observations, this prescription has better antihypertensive effect.

This article is excerpted from “The Forgotten Ancient Recipe”, published by China Traditional Chinese Medicine Press. Author/Zhong Xianggen.

【来源】

小续命汤最早记载见于汉魏两晋时期著名医家陈延之的《小品方》。因该方治疗中风效果显著,被当时众医奉为“诸汤之最要”。后由孙思邈收入《备急千金要方》,并确定其功用为:扶正祛风,主治外中风之口眼歪斜,筋脉拘急,半身不遂等症。该方治疗中风病在唐宋以前颇为广泛,其重要性也是勿庸置疑的,如《备急千金要方・诸风》就把小续命汤放在治风剂之首,并列有续命汤类方数首,王焘《外台秘要》亦如此排列。显示出小续命汤在唐宋以前治疗中风病的重要地位。

【组成】

甘草、麻黄、防己、人参、桂枝、黄芩、川芎、杏仁、芍药各一两、防风一两半、生姜五两、附子大者一枚炮

【用法】

上十ー物,以水九升,煮取三升。分三服,甚良。不差更服三四剂必佳。取汗随人风轻重虚实也。有人脚弱服此方,至六七剂得差。有风疹家,天阴节变辄服之,以防瘖癔也。

【功效】

温经通阳,祛风扶正。

【主治】

治卒中风欲死,身体缓急,口目不正,舌强不能语,奄奄惚惚,精神闷乱,诸风服之皆验,不令人虚方。

【方解】

方中用麻黄、桂枝、防风、防己祛风逐湿,以开其表;又邪壅于外,则里气不宣,故郁而化热,当以杏仁利之,黄芩清之;而邪之所凑,其气必虚,故以人参、甘草益气而调中;白芍、川芎护营和血;用附子既可补药之力,又能济麻黄以行其表;姜、枣为引者,以调和营卫。

【临床应用提要】

《灵枢・五变篇》:“肉不坚,腠理疏,则善病风。”人体正气衰弱,风邪挟寒外袭所致,由于正气不足,腠理疏松,风寒之邪长驱直入,直达经络,属真中风。小续命汤功能温经通阳,扶正祛风,可用于西医脑出血、脑血栓形成、脑栓塞、蛛网膜下腔出血、高血压脑病等。

临床见症:风邪中经,筋脉拘急,半身不遂,口眼歪斜,语言蹇涩,头痛项强,或神志闷乱等。舌淡苔薄腻,舌体强硬或短缩、颤动。脉浮退或浮缓。

【临床应用】

案1、脑血栓(李可医案)

孙某,男,60岁。2007年1月22日初诊。30年前诊为原发性高血压(低压偏高,持续在100~110 mmHg)、脑动脉硬化。20年前的一天夜里,突然被惊醒,醒时就发现自己右半身的上下肢在不停地抖动,大约抖动了十几下就停下来,间隔半分钟又抖动,如此反复了3次,随后右半身瘫痪,确诊为脑血栓形成。经过中西医治疗,有所恢复但右半身仍行动不便,入冬以来,眩晕加重,手指麻木,膝软,舌质略暗,苔白滑,脉涩无力。证属劳倦内伤,诸虚百损,中风久延,大气不运,元阳难于敷布,痰湿瘀浊阻塞三焦。头面、印堂灰暗,殊非佳兆,为防突变,力挽颓势。

拟小续命汤法衍变方:北芪250g、麻黄10g、制黑附片45~200g(逐日叠加10g)、当归、桂枝各45g、辽细辛45g、川芎、干姜各90g、红参(另炖)、灵脂各30g、桃红各10g、僵蚕10g、地龙45g、生南星10g、生半夏45g、生姜45g、清全蝎、大蜈蚣各6条、小白花蛇1条(研冲服)、黑小豆30g、大枣25枚、黑木耳45g、白芥子炒研10g。加水6斤,文火煮2小时,去渣,再煎浓缩至500ml,3次分服。

二诊:服1剂,药后20分钟,患侧肢体出现痒麻如触电,甚则肌肉突突跳动。3剂后,泻下恶臭稀便,倍感轻松。15剂后,走路姿势已有好转,如原来右腿每迈步时必有后撅,而今已无此动作了。附子加至165g时,周身有麻木触电感,故减去10g,守方续服。

三诊:服1个月后,右脚掌已能用力迈步了,效不更方,继服1个月。

案2、中风(颜乾麟医案)

包某某,男,62岁。2009年4月7日初诊。病人既往有高血压病史十余年,曾有中风史。头颅MRI提示:双侧额顶叶、侧脑室旁、基底节及脑干多发缺血梗塞灶。现症见:左下肢乏力,但略可抬高,平卧时也能翻身,左手活动功能下降,右侧手足瘫痪,大便不畅,入夜难寐,脉细缓,舌红苔薄白。证属气虚血瘀。治以益气活血,化瘀通络。方以小续命汤加味。

药用:生麻黄6g、桂枝5g、细辛3g、防风10g、防己10g、杏仁9g、黄芩6g、党参9g、熟附子6g、川芎9g、鹿角10g、肉苁蓉15g、菟丝子10g、赤芍15g、白芍15g、当归10g、厚朴10g、炙甘草5g。

二诊:服上方近1月后,左下肢已能活动,右下肢也有所恢复,胃纳一般,大便仍不畅,口干不明显,痰少,舌红苔薄黄,脉小弦。即以原方去当归,加炙黄芪15g,龟板胶10g,治疗近3个月后两下肢乏力症状较前明显改善,左下肢己能起步,右侧手足亦能稍微活动,大便通畅,其他症状也递次减轻。

原按:该病人年过六旬,正气日虚,风邪趁虚侵袭脉道,血脉经络受阻,血液日渐滞行成瘀,阻塞脉道,“瘀血不去,新血不生”,不能通荣四肢肌肉,则肢体牵掣疼痛;中风之后上盛下虚,虚阳上亢,相火不能复位,肾阳亏虚于下,不能温润肠道,常辅以温助肾阳之品,以期上下同调,顺畅气机。故尊师用小续命汤祛风活血通络的同时酌加温阳益肾的鹿角、肉苁蓉、菟丝子,温肾益精,暖腰润肠。后加炙黄芪、龟板胶以取益气滋阴,固本清源收效。

案3、原发性高血压(彭培初医案)

某某,男,68岁,1999年3月3日因头昏重胀时发5年,加重1周入院。检查:血压165/105mmHg。眼底检査:动脉硬化2级。胸片示左心室扩大,甘油三酯2.0mmol/L,舌质淡红,边有齿痕,苔薄白,脉沉弦。诊断:原发性高血压。停服西药,改用小续命汤加减:羌活、独活各9g,桂枝9g,麻黄9g,赤芍9g,防风12g,防己12g,附子9g,栀子9g,白术9g,川芎9g,茯苓12g,黄芩9g,莪术12g,水蛭9g,车前子12g。2剂后症状即逐渐减轻,头痛消失,血压120/70mmHg,住院25天,血压稳定出院。

原按:原发性高血压属中医学头风、眩晕范畴,其病机归纳起来不外风、火、痰、虚四个方面,其中以风为先,故以小续命汤治之。方中羌活、独活、防风、防己祛风湿,通经络;麻黄、桂枝宣肺散邪,寒盛佐以附子,热盛佐以黄芩;川芎、赤芍养血活血;白术、茯苓健脾化湿;三棱、莪术、水蛭祛瘀通络。临床观察,本方的降压效果较好。

本文摘自《被遗忘的古方》,中国中医药出版社出版。作者/钟相根。

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