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Fuzi ( Lateralis Preparata/Tuber Aconiti))---(炮)附子

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fuzi-yuantai-l.jpgfuzi-yaocai-l.jpg

 It is the procesed daughter root of Aconitum carmichaeli Devx., family Ranunculaceae. It is mostly harvested and collected from the first 10 days ofJune to the first 10 days of August. The main-root, fibrous root, mud and sand are removed. The processed materials are named as Salt-Fuzi, Black-Fuzi piece and White-fuzi piece, it can be utilized as medicine.

[ Medicinal Properties ]: Pungent, sweet in flavor, extremely hot in nature; toxic; relate to heart, kidney and spleen meridians.

[ Medicinal Efficacies ]: Restore yang from collapse; reinforce fire and strengthen yang; disperse cold to alleviate pain.

[ Clinical Application ]: 1. Syndrome of yang exhaustion     It is the essential medicinal for the treatment of yang exhaustion syndroe manifesting as cold clammy limbs, indistinct and faint pulse and it is usually used in combinatin with Ganjiang, Gancao , such as in the formula Sini Decoction. in treating for sudden collapse of qi and yang, manifesting as dripping with sweat, tachypnea,dyspnea,it can be used with Renshen, such as in the  formula Shenfu Decoction.

2. Syndrome of yang deficiency     In treating for syndrome of deficiency of kidney yang, manifesting as impotence, frequent nocturia, cold uterus and leucorrhea, it can be used in combination with Rougui, Shanzhuyu and Shudihuang, such as in the forula Guifu Bawei Pill; for insufficiency of splee-yang with coldness and pain in the abdomen with loose stool, it can be used together with Renshen, Baizhu and Ganjing, such as in the formula Fuzi Lizhong Pill; for the syndrome of deficiency yang of the spleen and kidney, manifesting as dysuria, pitting edema of the limbs, it can used togtether with Baizhu and Fuling, such as in the formula Zhengwu Decociton; for deficiency yan gof heart, manifesting as palpitation, angina pectoris of chest impediment, it can be used with Renshen, Guizhi and Xiebai; for external contraction and deficiency yang, it can be used together with Mahuang, and Xixin, such as in the formula Mahuang Fuzi Xixin Decoction.

3. Cold-Bi Syndrome     It is specially used to treat pain of all the joints in the body due to the domination of cold and dampness, it is often combined with Guizhi and Baizhu such as in the formula the Gancao Fuzi Decoction.

[ Usage and Dosage ]: 3-15g is used inn decoction for oral use. It is decocted at first, for 30-60 miutes in order to reduce its toxicity. The raw form has a stronger toxicity, and is gererally used for external application.

[ Precautions ]: This medicinal is contraindicated in pregnant women. It is incompatible with Banxia, Gualou, Tianhuafen, Beimum, Bailian and Baiji.

[ Side Effects ]: The raw form of Fuzi contains aconitine, which is poisonous. When poisoning occurs, it can manifested as heart rate becoming slow, heart block, ventricular extrasystole or ventricular tachycardia event, ventricular firbrillation, the serious are convulsion, coma, even death.

附子 Fuzi为毛茛科植物乌头Aconitum carmichaeli Debx.的子根的加工品。主产于四川、湖北、湖南等地。6月下旬至8月上旬采挖,除去母根、须根及泥沙,习称“泥附子”。加工炮制为盐附子、黑附片(黑顺片)、白附片、淡附片、炮附片。

【药性】辛、甘,大热。有毒。归心、肾、脾经。        【功效】回阳救逆,补火助阳,散寒止痛。      
 
【应用】        1.亡阳证。本品能上助心阳、中温脾阳、下补肾阳,为“回阳救逆第一品药”。常与干姜、甘草同用,治吐利汗出,发热恶寒,四肢拘急,手足厥冷,或大汗、大吐、大泻所致亡阳证,如四逆汤(《伤寒论》);本品能回阳救逆,人参能大补元气,二者同用,可治亡阳兼气脱者,如参附汤(《正体类要》);若寒邪入里,直中三阴而见四肢厥冷,恶寒倦卧,吐泻腹痛,脉沉迟无力或无脉者,可与干姜、肉桂、人参同用,如回阳急救汤(《伤寒六书》)。       
 
2.阳虚证。本品辛甘温煦,有峻补元阳、益火消阴之效,凡肾、脾、心诸脏阳气衰弱者均可应用。配肉桂、山茱萸、熟地等,可治肾阳不足,命门火衰所致阳痿滑精、宫寒不孕、腰膝冷痛、夜尿频多者,如右归丸(《景岳全书》);配党参、白术、干姜等,可治脾肾阳虚、寒湿内盛所致脘腹冷痛、大便溏泻等,如附子理中汤(《和剂局方》);与茯苓、白术等同用,可治脾肾阳虚,水气内停所致小便不利、肢体浮肿者,如真武汤(《伤寒论》);若治心阳衰弱,心悸气短、胸痹心痛者,可与人参、桂枝等同用;治阳虚兼外感风寒者,常与麻黄、细辛同用,如麻黄附子细辛汤(《伤寒论》)。       
3.寒痹证。本品气雄性悍,走而不守,能温经通络,逐经络中风寒湿邪,故有较强的散寒止痛作用。凡风寒湿痹周身骨节疼痛者均可用之,尤善治寒痹痛剧者,常与桂枝、白术、甘草同用,如甘草附子汤(《伤寒论》)。       
 
【用法用量】煎服,3~15g;本品有毒,宜先煎0.5~1小时,至口尝无麻辣感为度。       
 
【使用注意】孕妇及阴虚阳亢者忌用。反半夏、瓜蒌、贝母、白蔹、白及。生品外用,内服须炮制。若内服过量,或炮制、煎煮方法不当,可引起中毒。       
 
【古籍摘要】        1.《神农本草经》:“主风寒咳逆邪气,温中,金疮,破癥坚积聚,血瘕,寒湿踒躄,拘挛膝痛,不能行步。”       
 
2.《本草汇言》:“附子,回阳气,散阴寒,逐冷痰,通关节之猛药也。诸病真阳不足,虚火上升,咽喉不利,饮食不入,服寒药愈甚者,附子乃命门主药,能入其窟穴而招之,引火归原,则浮游之火自熄矣。凡属阳虚阴极之候,肺肾无热证者,服之有起死之殊功。”       
 
 3.《本草正义》:“附子,本是辛温大热,其性善走,故为通十二经纯阳之要药,外则达皮毛而除表寒,里则达下元而温痼冷,彻内彻外,凡三焦经络,诸脏诸腑,果有真寒,无不可治。”       
 
【现代研究】        1.化学成分:本品含乌头碱,中乌头碱,次乌头碱,异飞燕草碱,新乌宁碱,乌胺及尿嘧啶等。       
 
2.药理作用:附子煎剂、水溶性部分等,对蛙、蟾蜍及温血动物心脏,不论是正常状态或处于衰竭状态均有明显的强心作用;其正丁醇提取物,乙醇提取物及水提物对氯仿所致小鼠室颤有预防作用;附子有显著的抗炎作用,能抑制蛋清、角叉菜胶、甲醛等所致大鼠足跖肿胀,抑制醋酸所致毛细血管通透性亢进,抑制肉芽肿形成及佐剂性关节炎;中乌头碱、乌头碱及次乌头碱均有镇痛作用。最近研究表明,附子能增强机体抗氧化能力,具有抗衰老作用。       
 
 3.临床研究:附子、广木香、延胡索各10g,甘草4g。共研细末,生姜汁调匀,制成药饼,敷于脐腹部疼痛最明显处。治疗胃痛100例,总有效率为90%?,脾胃虚寒型胃脘痛疗效较好(浙江中医杂志,1993,2:64);附片10~20g,白术、生姜各12~18g,茯苓15~24g,白芍10~15g。水煎服,日1剂。随症加减,治梅尼埃征,总有效率为100%?(陕西中医,1994,3:105);附子10g,白酒50g,浸泡0.5小时后,文火慢煎,煎沸3分钟后趁热用棉球蘸酒液涂于患处,每晚睡前涂擦5次,治冻疮(未溃破者)37例,痊愈20例,好转10例,(浙江中医杂志,1998,10:441)。另有用附子治疗病态窦房结综合征、心律失常、心力衰竭、休克、慢性支气炎、支气管哮喘、新生儿硬皮病、小儿长期腹泻等。       
 
4.不良反应:附子中含多种乌头碱类化合物,具有较强的毒性,尤其表现为心脏的毒性。但经水解后形成的乌头碱,毒性则大大降低。乌头碱类结构属二萜类生物碱,具有箭毒样作用,即阻断神经肌肉接头传导,还具有乌头碱样作用,表现为心律紊乱、血压下降、体温降低、呼吸抑制,肌肉麻痹和中枢神经功能紊乱等。附子大剂量粗制生物碱可导致多种动物全身性及呼吸麻痹症状,症状表现为呼吸停止先于循环紊乱。附子中毒原因主要是误食或用药不慎(如剂量过大,煎煮不当,配伍失宜等)或个体差异等,严重者可致死亡。因此必须严格炮制,按照规定的用法用量使用,才能保证用药安全。附子中毒救治的一般疗法为:早期催吐,洗胃;有呼吸麻痹症状时,及时使用呼吸兴奋剂,给氧;心跳缓慢而弱时可皮下注射阿托品;出现室性心律紊乱可用利多卡因。

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