The good generals in troubled times in traditional Chinese medicine can kill people if used improperly

　　Rhubarb has no merit in saving lives, and ginseng has no fault in saving lives. The world of traditional Chinese medicine is also complicated. Many Chinese medicines have good reputations, but some Chinese medicines are shackles of " ", which makes many doctors shun them. It is said that this " " is also the "good general in troubled times" in Chinese medicine. Proper use can bring life, improper use can kill people! The key lies in how you use it! Today let's listen to how the old Chinese medicine doctor in the article uses it!

　　The toxicity of traditional Chinese medicine is one of the cores of the theory of traditional Chinese medicine. Doctors of all ages have attached great importance to the study of the toxicity of traditional Chinese medicine. Professor Chen Guigui believes that the poisonousness and non-toxicity of traditional Chinese medicine and the degree of toxicity are relative. Poisonous products can cure diseases when used rationally; non-toxic products can also cause trouble if used improperly. Therefore, the indications and contraindications should be strictly controlled, which is an issue that clinicians must pay attention to. "Medicine Yuantong: Disadvantages of Medication" says: "When you are sick, you should take aconite and aconite, which are the best medicines; when you are sick, you should not take ginseng, stilbene, deer antler, and wolfberry." ”The medicine of the king and the medicine of the mean can certainly "replenish deficiency and disease" and "lighten the body and replenish qi", and are commonly used in clinical syndromes. However, poisonous medicines and severe agents are also necessary to "break accumulation" and "remove cold evil". If its properties can be mastered and properly combined with other drugs, and does not violate the spirit of syndrome differentiation and treatment, in clinical work, it will not only be effective in treating common diseases, but also treat most difficult and severe syndromes and stubborn chronic diseases. The following introduces several toxic Chinese medicinal materials commonly used by Professor Chen in clinical diagnosis.

　　1. Pinellia ternata

　　It is a perennial herbaceous plant of the Araceae family, and its nature is pungent and warm. Raw Pinellia ternata is poisonous and was first recorded in "Shen Nong's Materia Medica". Later generations of doctors also agreed that because of its poisonous nature, it was often prepared and used clinically. The toxic components of Pinellia ternata irritate the skin, especially when taken orally, it can easily cause respiratory paralysis. Poisoning is manifested by itching and numbness of the mouth, tongue, and throat, hoarseness, salivation, loss of taste, nausea, vomiting, chest tightness, abdominal pain, diarrhea, and even laryngeal spasm, dyspnea, limb paralysis, drop in blood pressure, damage to liver and kidney function, etc., and finally death due to paralysis of the respiratory center. According to different processing methods, it can be divided into French pinellia, ginger pinellia and clear water pinellia. Tao Hongjing said: "For Pinellia ternata, before using it, wash it with soup for ten times, so that the slipperiness is gone and it does not harm the throat. ”This book still records the relevant discussion in "Lei Gong Pao Zhi Lun": "Purify four liang of Pinellia ternata, pound 3 liang of white powder, add 6 liang of first vinegar, stir the second taste to make it turbid, put the Pinellia ternata in it and wash it three times. If the saliva is not washed thoroughly, the qi will be reversed and the liver qi will be full of anger. ”This processing method is French Pinellia. It is also boiled with ginger alum, or pickled, or steamed, or stir-fried with ginger. The prepared pinellia is called ginger pinellia. The pinellia ternata soaked, boiled or pickled in alum is water. Modern pharmacological research believes that the main ingredients of this product are p-glutinol, choline, mannitol, various amino acids, alkaloids, various fatty acids and other substances. Decoction of Pinellia ternata with alcohol precipitate and intramuscular injection into hungry mice can inhibit gastric juice secretion and pepsin activity, reduce gastric juice total acidity and free acidity, and protect and promote repair of acute mucosal injury.

　　Professor Chen Guoguo likes to use Pinellia ternata in clinical prescriptions. Pinellia ternata enters the three meridians of the lungs, spleen and stomach. It has the functions of drying dampness and reducing phlegm, reducing qi and stopping vomiting, eliminating pimples and dispersing stagnation. It is said that when water and dampness are removed, the spleen will be strong and phlegm and saliva will disappear. If the adverse qi is reduced, the stomach will be harmonious and fullness will be relieved, and vomiting will stop. Therefore, Pinellia ternata is a good medicine for drying dampness and reducing phlegm, lowering qi and stopping vomiting, and eliminating phlegm and stagnation. It is often used to treat spleen, stomach and lung diseases. Professor Chen believes that nine out of ten people with stomach problems also suffer from pharyngitis. Pinellia ternata is the most suitable medicine because it has multiple effects. Many prescriptions in ancient books, such as Wendan Decoction, Erchen Decoction, Banxia Houpu Decoction, etc., contain this medicine. The dosage and compatibility of Pinellia ternata are very particular. For example, among the 43 prescriptions for compatibility of Pinellia ternata by Zhong Jing, those with larger dosages, such as the Da Banxia decoction for treating nausea "vomiting after eating in the morning and vomiting after eating in the evening", use Pinellia ternata. Two liters, combined with Poria cocos, can strengthen the spleen and lower the nihilus, treat cold phlegm in the diaphragm of typhoid fever; for those with a small dose, such as Bupleurum Guizhi Decoction for treating "micro-vomiting", use two and a half of Pinellia ternata, combined with ginger to strengthen the spleen and stomach, lower the phlegm and stop vomiting. According to the weights and measures of the Han Dynasty and the dosage of Zhang Zhongjing's prescription, half a liter of Pinellia ternata is 60g.

　　Professor Chen Guogui believes that the dosage of Pinellia ternata is determined by the therapeutic effect of Pinellia ternata. Pinellia ternata returns to the spleen meridian, which can dry dampness and resolve phlegm, lower qi and relieve vomiting. The dosage is generally 10-15g. The dosage can be used in conjunction with a variety of drugs according to the patient's symptoms. For those with cough and excessive phlegm, use tangerine peel, poria, and fritillary; for those with cold phlegm and vomiting, add ginger and dried ginger; for those with hot phlegm, add scutellaria baicalensis, coptis, and trichosanthes. In addition, Pinellia ternata can also eliminate pimples and dissipate stagnation. The dosage should be large, usually around 30g, especially for the stubborn symptoms of heart fullness and vomiting. The medicine is effective. Heavy doses of Pinellia ternata can also treat insomnia caused by disharmony between Yin and Yang and disharmony between the spleen and stomach. The idea is derived from the "Pinellia Pinellia Rice Soup" in the "Huangdi Neijing". Professor Chen Baoguo said: “Using large doses of Pinellia ternata requires long-term decoction, and the disease will stop immediately. ”Although Pinellia ternata is poisonous, it can generally be used with confidence after being prepared, and attention should be paid to compatibility with other medicines to reduce its toxicity.

　　2. Asarum

　　It is a perennial herbaceous plant of the Aristolochiaceae family. "Shen Nong's Materia Medica" records: "It tastes pungent and warm, and is mainly used for cough, headache, cerebral palsy, spasm of joints, rheumatic arthralgia, and dead muscles." Taking it for a long time can improve eyesight, benefit the nine orifices, and lighten the body for many years. ”"Syndrome Dialectical Record·Volume 2" discusses its use in headaches: "Ligusticum chuanxiong can relieve headaches best, but it cannot go straight to the top of the head without using asarum. ”Because this product is slightly toxic, some ancient books on herbal medicine say that "asarum is not worth the money". For example, "Compendium of Materia Medica" says: "Asarum, if used alone at the end of the day, it cannot be used as a dagger. If it is used too much, the Qi will be stuffy and blocked, and the person who is blocked will die." ”"New Compilation of Materia Medica": "Asarum, Zhi can be used less, but not more, and Zhi can be used together, but not alone. If used multiple times, the energy will be depleted and pain will increase; if used alone, the energy will be exhausted and life will be lost. ”However, "Famous Doctors" says: "Asarum is non-toxic. ”In addition, "Materia Medica Mengquan", "Materia Medica Chengya Bangao" and "Materia Medica Chongyuan" all record that asarum is non-toxic. Professor Chen Guoguo believes that the saying "Asarum is not worth the money" does have some truth, but this "but the money" means that when Asarum is used as powder, it cannot be worth the money. If used as a decoction, the whole Asarum plant can be used to make the money. The toxicity of asarum mainly comes from the roots. It can be taken with confidence after decoction and decoction for an effective period. Modern pharmacological research believes that asarum contains volatile oil, the main component of which is sassafras, which is also the main source of toxic effects. By adding decoction and decoction, the volatile oil will evaporate and the toxicity can be greatly reduced (the usual decoction time is 20 minutes).

　　Professor Chen Guoguo’s clinical use of asarum is usually 3 to 10g, and up to 15g can be used without any adverse reactions. People who use Asarum to spend money have been around since ancient times. For example, in Zhang Zhongjing's Treatise on Febrile Diseases in the Han Dynasty, there are as many as 19 prescriptions using asarum with excessive amounts of money. Among them, 14 are used as decoctions. The minimum dosage is one liang, and the average dosage is three liang. For example, Xiao Qinglong Decoction is used to treat typhoid fever and water drinking. Three liangs of asarum are used in the prescription, which has the effect of warming the lungs, dispelling cold, warming the lungs, resolving phlegm and purifying the drink. Another example is in the chapter on Shaoyang Disease, "For Shaoyang disease, when it is first diagnosed, it will cause fever and a heavy pulse." Use Aconite Asarum Decoction. Use two liang of Asarum and one Aconite to warm the meridians and support the yang, connect the inside and outside, and help relieve the exterior. The three medicines are used together to relieve both the exterior and interior.

　　The toxicity of asarum mainly inhibits breathing, and severe cases can lead to death. Caution should be used in clinical use. But becoming a good doctor requires mastery of medical skills. Great doctors have always been good at using it and dared to use it because they strictly controlled the dosage, understood the properties of the medicine, made reasonable compatibility, strictly prepared it, and instructed patients to decoct it effectively, thus ensuring stable clinical efficacy. Professor Chen Guogui’s experience: Asarum, about 0.5g is used to relieve cough in children, 3g is used to relieve cough, and 10g is needed to relieve pain to have the exact effect. For those with cough and asthma, use asarum and boil it first. In addition, asarum can also be used externally to treat mouth and tongue sores. Mix asarum powder with water and apply it to the navel, and apply coptis juice to the affected area.

　　3. Aconite

　　It is a representative medicine that warms the interior. This type of medicine has pungent taste and warm nature. It can dispel cold evil, circulate qi and blood, promote the circulation of internal organs, warm the interior and dispel cold, warm the menstruation and relieve pain. It is the main medicine for treating interior cold syndrome. Doctors and herbal books of the past dynasties have all said that Aconite is "poisonous" and "very poisonous", mainly referring to its strong effects and improper use, which can easily lead to serious toxic and side effects. "Famous Doctors" regards Aconite as "the best of a hundred medicines". "Treatise on Febrile Diseases" written by Zhang Zhongjing contains 115 prescriptions, including 54 prescriptions and a total of 14 flavors. Among them, Aconite is used most frequently, reaching 19 prescriptions. Li Ke, a clinical master, calls "Aconite the most powerful medicine". He is good at using Aconite to rescue critically ill patients with heart failure.

　　Aconite can strengthen the heart yang at the upper level to unblock the meridians, nourish the kidney yang at the lower level to replenish the fire, and save the lost yang. It is the "first-class medicine for restoring yang and relieving adverse events." The processed aconite commonly used in modern clinical practice include salt aconite, black aconite, white aconite, etc. Professor Chen Baoguo believes that although Aconite has strong medicinal properties, if properly combined with other drugs, it can indeed invigorate Yang Qi, strengthen the body, eliminate evil, and improve body functions.

　　For example, aconite root can warm the kidneys and subdue yang, so that yin and yang can be calmed down; used with drugs for relieving external symptoms, it can help yang and relieve symptoms, strengthen the body and eliminate evil; used with drugs for strengthening the spleen and warming the kidneys, it can warm the kidneys and strengthen the spleen, and nourish both the spleen and kidneys; used with drugs for clearing away heat, it can warm yang and clear away heat, and can go hand in hand; used with drugs for clearing turbidity and clearing away heat, it can go hand in hand. When used together with laxatives, it can strengthen the body and relieve turbidity, and relieve constipation; when used together with dampness-removing drugs, it can warm yang and remove dampness; when used together with liver-soothing and qi-regulating drugs, it can strengthen and regulate qi, and regulate emotions; when used together with blood-tonifying and yin-nourishing drugs, it can nourish yin and submerge yang, and nourish both yin and yang; when used together with astringent-consolidating drugs, it can warm and nourish kidney yang and consolidate astringent stools. The dosage of Aconite has always been a hot issue in TCM clinical and academic circles. Although the "Chinese Pharmacopoeia" clearly stipulates that the dosage of Aconite is 3 to 15g (a daily dose in decoction), it is far from the actual clinical application. Professor Chen Guoguo usually uses 10 to 15g in clinical practice. If necessary, it can be increased to 20g or 25g, or even 30g. When using it, it must be handled according to the degree of Yang deficiency and Yin evil, and the urgency of the condition. Generally speaking, those whose yang deficiency is not severe, yin evil is not strong, and whose condition is mild, can start with a small dose, and then gradually increase the dosage according to the reaction after taking the medicine. The dosage needs to be determined according to the patient's constitution and specific condition, and cannot be generalized. For example, residents in Yunnan and Sichuan use a large amount of aconite stew daily in winter and have greater tolerance to aconite. When applying Aconite to clinical symptoms, in addition to paying attention to the patient's facial expression, we should also pay more attention to the "pulse".

　　Professor Chen Guoguo’s experience: If the Qi and Yang are insufficient and the pulse is weak, the pulse will be weak and weak, which is an indication for the application of Aconite. Professor Chen Guogui believes that clinical medication should not avoid toxic or powerful drugs, but should "turn poison into medicine" through reasonable and correct use. Because of its fast and violent nature and its special effect, it has the power to kill generals and seize obstacles. If its advantages can be used and its disadvantages can be avoided, it is no different from the sharp sword of a military strategist, which can indeed defeat the enemy and cause serious illness. It’s just that most doctors are afraid of poisonous drugs and fail to figure out the appropriate dosage, so they often adopt an avoidant attitude and seldom or not use them in clinical practice. As time goes by, many types that could be used clinically are becoming less and less. This vicious cycle is very detrimental to the development of traditional Chinese medicine and traditional Chinese medicine.

　　Beginners need to pay special attention to the following items. First of all, it is recommended to use it with caution. Beginners have little clinical experience and insufficient understanding of the drug, so they should not be used unless it is absolutely necessary. Secondly, it is advocated to process it strictly to slow down its poison, such as making kansui with vinegar, removing oil from croton and making cream, etc. Third, we must follow the ancient method, start with a small dose, and increase gradually if it is not effective, until it is effective. We must not take the first measure as enough and lead to an excessive attack. Fourth, it should be used at intervals and interspersed with correction. Do not use medicine continuously to attack the disease, as this may cause the old disease to persist but new disease to appear again, or the body may become extremely weak and unable to take medicine.