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Shudihuang (Prepared Rehmannia Root)---熟地黄(powder100g/bottle)

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This medicinal is the  prepared root tuber of Rehmannia glutinosa Libosch.(fam. Scrophulariaceae). After mixture with wine, Sharen and Chenpi, the crude root is processed with a series of steaming and drying by natural sunlight repeatedly until the whole root becomes black with a soft, sticky and greasy property. Then it is sliced or baked into charcoal for use.

[ Medicinal Properties ]: Sweet, slightly warm; relate to liver and kidney meridians.

[ Medicinal Efficacies ]: Nourish yin and tonify blood, replenish essence and marrow.

[ Clinical Applications]: 1. Blood deficiency syndrome    It treats blood deficiency syndrome manifested as sallow complexion, dizziness,palpitations, insomnia, irregular menstruation, metrorrhagia and metrostaxis, in combination with Danggui, Baishao and Chuanxiong, as in Siwu Decoction. For palpations, fearful throbbings due to heart blood deficiency, it is combined with Yuanzhi and Suanzaoren; for metrorrhagia and metrostaxis, with Ejiao and Aiye.

2. Deficiency syndrome of liver-kidney yin     It treats limpness of knees and lumbus, spermatorrha, night sweating, tinnitus, deafness and Xiaoke(diabetes), due to deficiency of liver-kidney yin, in combination with Shanyao and Shanzhuyu, as in the Liuwei Dihuang Pill. For yin deficiency with bone-steaming tidal fever, it is combined with Zhimu and Huangbo. In the case of early graying of hair due to insufficiency of essence and blood, it is used with Heshouwu and Niuxi.

In addition, cardbonized Shudihuang has the function of stop bleeding, so it is able to treat hemorrhage due to blood deficiency, such as metrorrhagia and metrostaxis.

[ Usage and Dosage ]: 10-30g.

[ Precautions ]: This medicinal is more sticky and greasy than Shengdihuang and may cause dyspepsia. Therefore, it is contraindicated in patients with qi stagnation, profuse phlegm, gastric and abdominal fullness, anorexia and loose stool. When used in large dosage for a long time, it should be used in comination with Chenpi and Sharen to avoid dyspepsia.

[ Medicinal Comparison ]: Clinically, Dihuang is categorized as fresh, crude and prepared Dihuang. Both have the function of nourishing yin and promoting body fluid and are indicated for deficiency syndrome of yin and fluid. Fresh Dihuang, sweet, bitter and extremely cold, is weak in nourishing yin, but good at clearing heat, cooling blood, purging fire to relieve dysphoria and indicated for syndrome of exuberance of pathogenic heat and yin deficiency with fluid inadequacy. Crude Dihuang, cool and moisty, has a mild action of cooling blood. It is good at nourishing yin of heart-kidney and appropriate for blood heat damaging yin or fever due to blood deficiency. Prepared Dihuang, sweet and warm, relates to the liver and kidney meridians. It has strong action of nourishing yin, tonifying blood and replenishing essence and marrow and is indicated for insufficiency of true yin, essence and marrow.

Similarities: Both Danggui and Shudihuang have similar actions of tonifying blood and treat blood deficiency syndrome.

Differences: Dangui also has the efficacy of activating blood, regulating menstruation, relieving pains and moistening intestines and is indicated for blood deficiency with stagnation, pain due to deficiency-cold, arthralgia due to wind-dampness, traumatic injuries, carbuncles, ulcers and sores, constipation due to intestinal dryness. Shudihuang , which is good at nourishing yin and replenishing essence and marrow, is indicated for limpness of knees and loins, spermatorrhea, night sweating, tinnitus, deafness, due to deficiency of liver-kidney yin, Xiaoke(diabets)and early graying of hair due to deficiency of essence and blood.

熟地黄为玄参科植物地黄Rehmannia glutinosa(Gdertn) Iibosch.的块根,经加工炮制而成。通常以酒、砂仁、陈皮为辅料经反复蒸晒,至内外色黑油润,质地柔软粘腻。切片用,或炒炭用。

       【药性】甘,微温。归肝、肾经。        【功效】补血养阴,填精益髓。       
 
【应用】        1.血虚诸证。本品甘温质润,补阴益精以生血,为养血补虚之要药。常与当归、白芍、川芎同用,治疗血虚萎黄,眩晕,心悸,失眠及月经不调、崩中漏下等,如四物汤(《和剂局方》);若心血虚心悸怔忡,可与远志、酸枣仁等安神药同用;若崩漏下血而致血虚血寒、少腹冷痛者,可与阿胶、艾叶等补血止血、温经散寒药同用,如胶艾汤(《金匮要略》)。       
 
 2.肝肾阴虚诸证。本品质润入肾,善滋补肾阴,填精益髓,为补肾阴之要药。古人谓之“大补五脏真阴”,“大补真水”。常与山药、山茱萸等同用,治疗肝肾阴虚,腰膝酸软、遗精、盗汗、耳鸣、耳聋及消渴等,可补肝肾,益精髓,如六味地黄丸(《小儿药证直诀》);亦可与知母、黄柏、龟甲等同用治疗阴虚骨蒸潮热,如大补阴丸(《丹溪心法》)。本品益精血、乌须发,常与何首乌、牛膝、菟丝子等配伍,治精血亏虚须发早白,如七宝美髯丹(《医方集解》);本品补精益髓、强筋壮骨,也可配龟甲、锁阳、狗脊等,治疗肝肾不足,五迟五软,如虎潜丸(《医方集解》)。       
 
此外,熟地黄炭能止血,可用于崩漏等血虚出血证。       
 
【用法用量】煎服,10~30g。       
 
【鉴别用药】地黄始见于《神农本草经》,现临床使用有鲜、生、熟三种。均有养阴生津之功,而治阴虚津亏诸证。鲜地黄甘苦大寒,滋阴之力虽弱,但长于清热凉血,泻火除烦,多用于血热邪盛,阴虚津亏证;生(干)地黄甘寒质润凉血之力稍逊但长于养心肾之阴,故血热阴伤及阴虚发热者宜之;熟地黄性味甘温,入肝肾而功专养血滋阴,填精益髓,凡真阴不足,精髓亏虚者,皆可用之。       
 
【使用注意】本品性质粘腻,较生地黄更甚,有碍消化,凡气滞痰多、脘腹胀痛、食少便溏者忌服。重用久服宜与陈皮、炒仁等同用,防止粘腻碍胃。       
 
【古籍摘要】        1.《医学启源》;“熟地黄……补血虚不足,虚损血衰之人须用,善黑须发。”       
 
2.《本草纲目》:“填骨髓,长肌肉,生精血,补五脏内伤不足,通血脉,利耳目,黑须发,男子五劳七伤,女子伤中胞漏,经候不调,胎产百病。”       
 
3.《药品化义》:“熟地,藉酒蒸熟,味苦化甘,性凉变温,专人肝脏补血。因肝苦急,用甘缓之,兼主温胆,能益心血,更补肾水。凡内伤不足,苦志劳神,忧患伤血,纵欲耗精,调经胎产,皆宜用此。安五脏,和血脉,润肌肤,养心神,宁魂魄,滋补真阴,封填骨髓,为圣药也。”       
 
 【现代研究】        1.化学成分:本品含梓醇、地黄素、甘露醇、维生素A类物质、糖类及氨基酸等。       
 
2.药理作用:地黄能对抗连续服用地塞米松后血浆皮质酮浓度的下降,并能防止肾上腺皮质萎缩。地黄煎剂灌胃能显著降低大白鼠肾上腺维生素C的含量。可见地黄具有对抗地塞米松对垂体-肾上腺皮质系统的抑制作用,并能促进肾上腺皮质激素的合成。六味地黄汤对大鼠实验性肾性高血压有明显的降血压、改善肾功能、降低病死亡率的作用。六味地黄汤明显对抗N-亚硝基氨酸乙脂诱发小鼠前胃鳞状上皮细胞癌的作用。       
 
3.临床研究:熟地黄煎剂治疗高血压,血压、血清胆固醇和甘油三酯均有下降,且脑血流图和心电图也有所改善(熟地黄炮制加酒与否科研成果鉴定书,1980.6)。用复方五子地黄口服液治疗男性不育症总有效率为84%。(中国中西医结合杂志,1995,15,(4):209)。

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