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                  評審醫藥師職稱論文中藥炭藥應用管理技巧

                  職稱驛站所屬分類:藥學論文發布時間:2016-11-28 14:05:36瀏覽:1

                  正確認識什么是重要炭藥,對與這類藥物的應用管理方式主要表現在那些方面,醫藥的建設發展有什么制度等等。文章從這些方面做了介紹。本文選自:《中藥藥理與臨床》,《中藥藥理與臨床》藥學期刊論文發表,為雙月刊,每期16開48頁,是由中國藥理學會主辦的國內外唯一一家中藥藥理的專門學術刊物,1985年創刊。辟有治法研究、名方研究、實驗研究、臨床研究、思路與方法學探討、學術爭鳴、綜述等欄目。

                     正確認識什么是重要炭藥,對與這類藥物的應用管理方式主要表現在那些方面,醫藥的建設發展有什么制度等等。文章從這些方面做了介紹。本文選自:《中藥藥理與臨床》,《中藥藥理與臨床》藥學期刊論文發表,為雙月刊,每期16開48頁,是由中國藥理學會主辦的國內外唯一一家中藥藥理的專門學術刊物,1985年創刊。辟有治法研究、名方研究、實驗研究、臨床研究、思路與方法學探討、學術爭鳴、綜述等欄目。

                  中藥藥理與臨床雜志投稿論文

                    摘要:從炭藥的應用發展看,起始制炭并非都用于止血,還有其他作用。歷代品種亦有增減,有些已證明炒炭不如生用的如貝母、犀角等,早已棄炭生用。只是在元代以后,炭藥止血才逐漸占重要地位。可見炭藥品種的增加,顯然受到元代“血見黑則止”的理論影響。

                    關鍵詞:中藥,炭藥,醫藥論文

                    1 歷史沿革

                    中藥制炭已有兩千多年的歷史,因其有特殊的治療作用,至今仍廣泛用于臨床。對中藥制炭的原理,作用機制和炮制工藝等依照傳統制藥技術和中醫藥理論,運用現代科學知識和技術設備進行理論研究。闡明炮制原理,搞清作用機制、改革工藝、制定質量標準,提高制炭質量,是中藥炮制研究工作的一項重要任務。以下談幾點粗淺的看法,供同道參考。

                    中藥制炭應用始于漢代。張仲景《金匱要略》中有亂發燒炭,王不留行、桑根白皮燒炭存性,治療產后腹痛,小便不利的記載。自晉至唐制炭入藥又增加了20余種,其中有大黃、槐角、石榴皮、桑葉等。宋代又增加了厚樸、荊芥等60余種。自唐代以來,始見有些炭藥用于止血。如《千金方》中用大黃燒炭治尿血,羚羊燒炭治產后下血,燒亂發、槐角治崩中、漏下、赤白不止等。宋代除有刺猬皮燒末治鼻血等止血作用的記載外。更多的是桅子炭治霍亂,干姜炭治痢,干漆炒炭是為了去其刺激性等多方面作用的記載,用于止血僅是其中的一部分。

                    元代是炭藥止血理論及制炭用于止血的發展時期。葛可久的《十藥神書》在總結前人經驗的基礎上最早提出了“大抵血熱則行,血冷則凝,血見黑則止……”的理論。并用“十灰散”治療嘔、吐、咯、嗽血。從此以后,在“血見黑則止”及“炭藥止血”的理論指導下,大凡止血藥物多以制炭入藥。

                    明、清以來又增加了炭藥60余種。直到目前,沿用的尚有70余種。清代有一些不同意使用炭藥的意見,如《杏草從新》認為熟地,枸杞炭是將“甘潤滋陰”之器,變為苦燥傷陰之物,非待益,而又害之矣。《本草正義》認為子炭“炒黑力微,徒有其名。”《婦科要旨》則更進一步認為“一切炭藥……皆為無氣無味之類”。不主張制炭用。

                    2 炭藥的作用

                    2.1 治療各種出血 在“血見黑則止”的理論指導下,大量的炭藥用于治療各種出血癥。但炭藥止血在臨床應用時也必須辯證選擇用藥。如痔瘡出血用槐角炭:內有瘀積,便中有血用大黃炭;下焦血熱而致的血痢、崩漏等用地榆炭:濕熱腹瀉腸風下血用黃芩炭等。在應用“血見黑則止”理論時,更需兼顧藥物原有功效。

                    2.2 用于收斂止瀉 中藥制炭后增加了澀腸止瀉的作用。如烏梅本具酸澀之性,制炭后收澀之性更強,用治赤白痢疾及腸風下血。鱉頭燒炭存性,治脫肛有效。棗樹皮制炭治腹瀉。

                    2.3 緩和藥性或除去腥臊氣味 炮姜炭溫熱之性未減,辛散之性降低;枳殼、枳實炒炭后可消其辛燥之性,有助于消導化積:干漆“燒令煙盡”以除去刺激性物質;有些動物的爪甲、骨、鱗毛等常燒炭存性,以除其腥臊氣味,使之更適合臨床應用。

                    2.4 其他 杜仲炒炭后療效提高,是因有效成分易于煎出。檳榔炭能治蛇蛟傷,蜂房炭治牙痛,烏龜頭制炭能治療結核,蛇蛻炭治惡瘡,皂角炭治下部生瘡等。

                    3 炭藥的現代研究

                    目前,炭藥的研究在藥理、化學、臨床及炮制工藝方面都作了很多工作。如在止血機制方面,實驗證明,活性炭可使凝血時間由20秒縮短至13秒,但棕炭作用更好,可由19秒縮短至9秒。荊芥炭在一定范圍內,低濃度作用好,濃度加大反而使凝血時間延長。側柏葉能明顯縮短凝血時間,但生用效果較好,制炭后止血作用反而下降。生槐米中桷槲皮素含量僅為炒炭后的十分之一,其止血作用也比生品增強。地榆生品中鞣質含量為6.9%左右,制炭后僅含1.24%。照理,地榆治燙傷應以生品為好,但中醫臨床上卻用地榆炭而不用生品。實驗治療也觀察到,地榆炭治療燙傷創面不化膿,滲出物少,恢復快,死亡少,而地榆鞣質治療效果明顯不如地榆炭。新陳棕皮水煎劑均無止血作用,而棕皮炭的煎劑和混懸劑則有明顯作用。同是棕櫚,僅因藥用部位差別及新陳程度不同,止血作用也有明顯差別,棕皮炭明顯優于棕板炭且陳者明顯優于新者。同時還觀察到,活性炭及煅炭后的棕櫚樣品混懸劑凝血效果較好,這似與炭素有關,但體內試驗活性炭并無止血作用。可見藥物制炭后發生了內在變化,這種變化的實質及其與臨床的關系有待進一步研究。對荊芥炭的研究也有新的進展。據報導,荊芥炒炭后揮發油含量明顯下降,而且揮發油中的成分也發生了質的變化。其中有8種成分炒炭后未能檢出,而在揮發油中檢出了9種新成分。實驗發現,炒炭所致揮發油成分變化,對藥理作用有較為明顯的影響。并提出不揮發油并非荊芥唯一止血活性成分,而還有其他活性物質存在。這些活性物質究竟屬何類成分及其與揮發油之間的關系和作用方式等,尚不明確。

                    藥理方面曾有人做了30種中藥炒炭前后止血作用的比較。炒炭后與生藥相比,止血時間有的明顯縮短,有的無明顯差異,但也有的反見延長。說明并不是任何一種中藥炒炭后都有止血作用。是否有止血作用是隨藥材品種而異,也說明“血見黑則止”這一理論并不能解釋所有炭藥的止血機理。

                    炭藥止血作用以外的研究較少。有人發現連翹、槐角、山桅、地榆等炒炭后對痢疾桿菌的抑制作用明顯優于生品。⑥刺猬皮功能固精縮尿,收澀止血,民間都用刺猬皮制炭研未沖服,治產后乳汁不下,下乳快,服藥時間短,療效確實。

                    炭藥炮制工藝較復雜,操作技術難度大。制作方法有炒炭法和煅炭法,選用何法為宜,視藥材質地和炮制目的而定。各法使用得當及火候掌握適中與否,直接影響炭藥的質量。《本草蒙筌》謂“制藥貴在適中,不及則功效難求,太過則氣味反失”。中藥制炭既不是完全炭化,更不是灰化,而是要“存性”。這就需要不斷改革炮制工藝。如杜仲制炭多用炒制法,加熱時間長,外部炭化已過,部分甚至灰化,但內部仍不到斷絲標準,而且損耗率高,一般在35%~38%之間。筆者用砂燙法制炭,便溫度保持在180~200℃之間,外表顏色黑,斷絲完全,能存性,其損耗率只有18%左右。僅此一項小的改革,若能推廣應用,不但提高了杜仲炭的質量,而且節省大量藥材。

                  《評審醫藥師職稱論文中藥炭藥應用管理技巧》
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