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衛(wèi)考在線|學(xué)習(xí)心得|考試動態(tài)

中藥學(xué)考試指導(dǎo)-止血藥    







第十四單元 止血藥V'Eg I-2zvAg"kpdvnASn|v_I

 h%4f`d 6i~oj4oaDz


(一)基本要求_P=wE~#D l8DI:G;HEUy2

1.性能主治xhU2thLlk5BH8h- ;bN`,"%K2hi

(1)止血藥的性能功效x&OQnFa76e yv4vt

(2)止血藥的適應(yīng)范圍UHYlT
h1%Y5|22MCw@UQpoV

2.止血藥的分類!X% hv;xI"KAIESAn%U1

止血藥的分類及各類的性能特點e7O vM%T4Qn#F&FEws#

3.配伍與使用注意w|sW1C%oD7rx^QY4uNft7E

(1)止血藥的配伍方法7Aqr@q
~Vn dXwuF3d

(2)止血藥的使用注意3/ykiAcYx_ C%rG9WH|La

(二)常用中藥 87H,IYN@J2W l3eE_
sHC1|pod

1.大薊小薊地榆白茅根、白及三七、茜草蒲黃、艾葉m npY2LF6 y0k_!e

(1)各藥的藥性、性能特點x6y@00N4Xc_
jX

(2)各藥的功效、主治病證/xnQHBDtmET#_%A w~L

`
Y

(3)各藥的用法、使用注意#HXmjOGJ#vnB75!Ww

(4)與各章功效相似藥物的藥性、功效及主治病證的異同3a ^TeyLiuI!1Ni9

(5)三七、蒲黃的主要藥理作用2Y % yK
VI#y%`KN^mTJsTtCPT

(6)蒲黃配五靈脂、白及配烏賊骨、艾葉配阿膠的意義2-8BuW`%Sd;1Fi0:z_f6Ye0FA/

2.槐花、側(cè)柏葉、苧麻根、仙鶴草、炮姜l_Kkep^ x/yal`K4p'u-/3s3

(1)各藥的藥性#XMw^,O~k
V-=JceAu44
L6

(2)各藥的功效、主治病證IAqqi:r%G I&;;lok1&061L",##

(3)各藥的用法。使用注意i
^AzAig:E"6X2#;v#

(4)與各章功效相似藥物的藥性、功效及主治病證的異同XXGa^e%izQhxfrOxDRfhB

3.棕櫚炭、紫珠、藕節(jié)U3c;n7lDxaIVpmmLA--

(1)各藥的藥性%nF ;C
k_;n
Ge!B2

(2)各藥的功效9A;cYbjcfUS_mWLi

(3)各藥的用法、使用注意WYA NGGv^Za NAyZ|eQn"

(4)與各章功效相似藥物的藥性及功效的異同TCD1`K@u4XOErezO88G zb

GJeTWN,Jl 9v,4lnpuq=CCMf

 UbTNvb-l~&mPV 2D8%aU l|

 |dbaaTD,f"'n-a !~I_sL

一、止血藥的基本要求ei pgi,yde;L'B POn^s

 zc0t_DwRT'T;-@ZXEG6KSYj

1.含義 v/8Y_H2xU_5ma, L0=

凡以制止體內(nèi)外出血,治療各種出血病證為主的藥物稱止血藥。@P_Dd 9"yLj~X_szLTl

 
OKYGG#kR5c"UV#"&DnQDO

~k15FRbeEsj":lAAcGU9lv8`





 so%yWCeYaR'`#C'uSy;2zG#

 CV7~\x`u4LC%DFn/GY"biT

 Uv:PEK:n^Ws/Y,5#Eu

2.功效與適應(yīng)病證`5K#3wt'cQr&!I@a

(1)功效 止血,兼能清熱涼血、化瘀、收澀及溫經(jīng)散寒等。Lgzzf 2OtzP6b9xUw3'5Q

(2)適應(yīng)病證 咯血、咳血、衄血、吐血、便血、尿血、崩漏、紫癜以及外傷出血等各種體內(nèi)外出血病證。gq3NDjDd7QC'5nEsS

3.性能特點及分類7/BuO_UcA:YtdmNcYq!V
XjJX

(1)性能特點 藥性有寒、溫、散、斂之異,主歸心、肝、脾經(jīng)。5#jD;gAL5H-:_rA UThwO

(2)分類 根據(jù)功效與主治及性能特點,止血藥分為涼血止血藥、化瘀止血藥、收斂止血藥、溫經(jīng)止血藥。RG_4 bYP79LS 7Xl,QGF

4.配伍應(yīng)用Zjmf _x%YOD` eF1YG"fL;a!X

(1)根據(jù)出血的病因與病情,選擇相應(yīng)的止血藥,并進(jìn)行必要的配伍。cR9d`~4cGe2A" FYmxIe~

(2)血熱妄行者,配清熱涼血藥;陰虛陽亢者,配滋陰潛陽藥;瘀血阻滯而出血不止者,配活血行氣藥;虛寒性出血者,根據(jù)證情宜配溫陽、益氣、健脾等藥物。NCr :_ezwx#7ojEU^5edeX

5.使用注意Li1M;pL0bJcR _8SaV jO

(1)因證選藥。e"o;fMAkJmMgMbDta9&e`M5O

(2)出血兼有瘀滯者不宜單獨使用止血藥,以免止血留瘀之弊。AlqoX8";DBc2 XNeEDUa

(3)出血過多,氣隨血脫者,當(dāng)峻補元氣以救氣脫危候。m, I y|%_4yfbz0d!^2:

(4)根據(jù)具體藥物特性,視情況炒炭應(yīng)用。sXN|0hLE@MU@8`8KQU^
Gf1

二、涼血止血藥 I'!#t9Yfsj/

本類藥物味或苦或甘而性均寒涼,能清血分之熱而止血,主治血熱妄行之出血證,過量濫用有留瘀之弊(表14-1)。jA&D -8Bwg;
tp

 PuU"2mgXJ6 8&
IYKGn0

表14-1 涼血止血藥t30ayx:y@6!5HBt@!

 Jub"qoP
XJ' @8% uP


   
       
           
           
           
           
           
       
       
           
           
           
           
           
       
       
           
           
           
           
           
       
       
           
           
           
           
           
       
       
           
           
           
           
           
       
   

           
藥名QW pX@cPGIUBVtLCm-0M&pB

           

           
 性味歸經(jīng)HU;tNZeiJ`JVxIAv9GF9

           

           
    功 效
:aohs%GIpAXCY'jZs8D '3Uc6

           

           
    主 治D^_` S'bkxDtq'FkJKlrC

           

           
    藥理作用特點!%im XggV
/lftUl,xms 2

           

           
大薊#^8VKjN,13Sw6dC

           
 LH|:tS&/q814WK-h;1l

           
 KCsaBE^pdiw8q@p7:P40u&v

           

           
甘、苦,涼。歸boC| 331057CX:"as  Fgtew

           
心、肝經(jīng)#@,!gIFvm6 %3,b

           
 sSV;v!m~O!PGiY_iq0
un

           

           
①涼血止血`I`jC"Yg|s6Dc1;
!aVN~

           
②散瘀消癰kVO9;cUC~R|#
47V
U

           
 %@
UC
S LQHc'^3,

           

           
①血熱出血證。常用于吐血、咯T=Zh3rCdBs U-p4|^;

           
 血及崩漏下血7@UDwj~n9YkGyZcCXuZ

           
②熱毒癰腫J;% A`KJo wkt9U Vnk

           

           
 8
~i3; !6zQ,%KJn

           

           
小薊E!X mC/
| UcoBC

           
 1Wa#6s
04q:D
30, m

           
 HiItOwOE25p&L'K/Nmj: 7

           

           
辛、微苦,涼。zgtS5Lh=6k Xw 

           
歸心、肝經(jīng)Q~Rt4hn8nU|Cv NcJe!&%y5;

           
 r~xt6Si|q m:KEX'9KNr6

           

           
①涼血止血MLaz=g:JY` P6Ie: QJL:G

           
②散瘀消癰Vs50` r x%cjS Z"

           
 c"@KwIxp plA~L"Snu"
k8LW

           

           
①血熱出血證。兼能利尿通淋, J:0;/uD=zh O9"kh%7

           
 尤善治尿血、血淋8W!P_,j71d|h #orFx-xCTU

           
②熱毒癰腫D=y_JpD"GKUty
z /-JDOV4

           

           
 vx~/t8uf/g63RSZ:JvS

           

           
地榆10EziMqJ A_BwD2_#j

           
 G#6xttz^FgX

           
 '
1BiGn98:p"9"%X!-lu~

           
 yqE;3RQxXfbfdrize"V

           

           
苦、酸,微寒。gNu:,#Pt e;ub'Cbu_V

           
歸肝、胃、大腸^fUthli|g#Lt~UB

           
經(jīng)=
A b,~3dk xhz

           
 RoL:P'=pUlz;~p3m"1Nh63t

           

           
①涼血止血Oa m=j
BBcP'"0'vM9

           
 yJ |o ~/3mYUvV9I6U ,mz

           
 !!`!q&#D9goB &@yAX=b0

           
②解毒斂瘡GNah5nu:2#lzPwsE

           

           
①血熱出血證。兼能收斂止血。9#c^:l,CvhV'cU2rIl!Ka

           
 尤宜于下焦之便血、痔血、崩ikb;HLsTaomdJu0Vo,v~Eu

           
 漏下血#6V'-IPY3IP4/7= e4QGrd,

           
②燙傷,濕疹,瘡瘍癰腫J=^RV'p~
yY#jVlQPj1XCaK=uoR|L

           

           
為水火燙傷之要藥gg7uueV VgPl# JDOd
GF


           
 wi0h2 V'G`Wnq!_`FWyD|

           
 t`Mf1@Q 9k1-"iIw_0b`m@"l_

           
 cCG T# XBsvv/#=;Qy

           

           
白茅根SDqeE@cqJ
pf:~0D|D4,nsi

           
 gr!9lGm!/m`
Grus5  R!B

           
 Oz`J P!6nZ"K5z0

           
 "~yjz9|qHYqs" JBky 

           
 -;^Q"L^N~#t'&yFeQd

           

           
甘,寒。歸肺、I
7e 4a x 1Y&b iv^5k08rf

           
胃、膀胱經(jīng)kFY0uC~NU-xlQ=SW
5e5

           
 1-U5
Ka1k^PL4BUEk"I

           
 Fy2e =Acm3 ,~ f

           
 j^lUnB&5h_M~hPmPpwT8st

           

           
①涼血止血FSIA=&F
i03^o/PpPop

           
 /k`9ly#e
#1 =56
@2j8_D||0bC~

           
 7HS4O=@Um:Bnfct_At l#

           
②清熱利尿|8x6`pDnz'Zr=Ie6|S

           
③清熱生津S-PK 7u8CTaSGY@HMfXW

           

           
①血熱出血證。本品不僅善治上hI8hkdYLE^WEqW0w9P,=

           
 部火熱之出血證,也善治膀胱aey,64V|YY8TX|~jlP=^1

           
 濕熱之尿血、血淋oa#idhd -Zt',oDamv%`I

           
②水腫,血淋,熱淋,濕熱黃疸uk#;hbk;1r Z~R;|Dy3drc


           
③熱病煩渴胃熱嘔吐、肺熱咳喘m
AFU4BxmrL
pH4cpCw!H

           

           
 Rs3;6^r Re7A2H0
-0gg

           

 Xfvp3y9`I3io NALoL"sQ

aN0;- 3M:SmVgzHxYJV
UXO|





 :BVtwkR1iL`Lk8o4o 

 poFm Zx-&Q5-=UfFSO

續(xù)表DmGXgHg1p=0E#Z1=1=ih 6Sg JH`

 n4=vupyR
b5RSV


   
       
           
           
           
           
           
       
       
           
           
           
           
           
       
       
           
           
           
           
           
       
       
           
           
           
           
           
       
   

           
藥名Z^Dl^ ~%t
2yf#/6X

           

           
 性味歸經(jīng)kXre09tebUnjQBy
g|

           

           
    功 效5/095gA u'U"
F=Dc^K

           

           
    主 治R5|g:"4jWo=Wh5I^29==r

           

           
    藥理作用特點axh x21 /A #0U4T

           

           
槐花;
mCMR5FDngivdTL52z

           
 TD7xdZr8 XKn;;:/H

           
 dhMCAl @3' sT&C O96r80

           

           
藥性微寒2 iLXx:9gfRza_`i~"

           
 O;Qsm'kZv;5V2iUENtZ:

           
 _JcrsiZ 5FxL#Zij5rzk09F

           

           
①涼血止血;"'vd3W,HU;QD&:SiwFOt

           
 SCm T|r9l@/tOZ=w6-4

           
②清肝瀉火2!fOq67
Ai-_4d `i1'&

           

           
①血熱出血證。尤善治痔血、J wL#=7;!D9b_F4NphlzI|

           
 便血~ ehMu8%bSB
we-  /J

           
②肝火上炎之目赤,頭痛1@/s^r#G^885^!
a

           

           
 /2N D@cV
a/h

           

           
側(cè)柏葉xO F7C|_QQnRA@P@`wwW N
hBzp

           
 
xrK@rzQ&&|V^T
DUBX
RV-"

           
 uU,t!m
'xjK`=^9V8tnWVv

           
 s!D&x&c9jGFh |vf0&Pu1

           

           
藥性微寒7s1idxN h
gg;dDAhae/ #tM2

           
 |mqij8Y~"I 24F4dY/dC9/` 

           
 ac=#rwwCgIK-KRv_Qvx

           
 mEVtl~nF3x"IoyRTit&SYq

           

           
①涼血止血E5B`iagW!y8!`9l,,

           
 SqIv"=V,zvC:nz=sd

           
②祛痰止咳gdNXF  zZAjyWy@k^Y94
g

           
 /sUNOv
gnU1%uuq#gJ

           

           
①血熱出血證。兼能收斂止血,U!DoIMU0_L:UaE_rV
c;

           
 為治各種出血病證之要藥7Mr!pvizRne#@XKgMK|PO"S

           
②肺熱咳嗽痰多。還可外用治燙lWmT0vCfNZKtF@bykj6,

           
 傷及脫發(fā)k/VF&i_SR
/#aL"FaRe09HI&ZiZT3_

           

           
 DFjT;~o%cc4nSoA9K@

           

           
苧麻根bARgE"z Rs;~@ luF!=Vq

           
 DE4B=5XT!qQ,~||p

           
 It;aKOFYL& "us:/

           
 "45EvP41g`^0R,4wnC u&/

           

           
藥性寒-/@aSkOMx@Yy5U3h_

           
 ;W
G~
ubas 1#
IZ3XG-W

           
 -`z
nOz6h3@ xk2KD;P1

           
 uTlf'OR50siuUwQB
og5nV

           

           
①涼血止血o=#s2Lwq|'GS#N4jadM2

           
②清熱安胎AN0 =Oj9 z%5=r|@1
vA:zFD

           
③利尿、解毒kx`75%Fq4L K!Wi/-2T2

           
 K^qX:Z5DFB&Z&9tC
w

           

           
①血熱出血證6:Bf3!Z%
&9df

           
②胎動不安,胎漏下血et8AXP@!PTMdZ7n
U

           
③濕熱淋痛,熱毒瘡腫,蛇蟲#gc DCB=th~&%c:

           
 咬傷
i:`=Jfuy3rxp%"QqW13&

           

           
 N2d
X5V7"1T-VK& 4

           

 mH-MUS;jQ0=KI,Be1

、化瘀止血藥H10b,I9lVI w'44I|vcP

 RoyC3!Joqwn9jj!1"6I

   本類藥性味雖各異卻能消散瘀血而止血,主治瘀血內(nèi)阻,血不循經(jīng)之出血證,有止血不留瘀之長,為治出血之佳品(表14-2)。Qx"|R~;P CheL

 kldJtCx5
BJ8"V
7OElx

表14-2 化瘀止血藥S~P6xqVI|NKxzQ

 `/^VGp_8"7YBy! 87

`


   
       
           
           
           
           
           
       
       
           
           
           
           
           
       
       
           
           
           
           
           
       
       
           
           
           
           
           
       
   

           
藥名;-&qbsv4|NA4g2eQBdmcG

           

           
 性味歸經(jīng)9G=jzse
0,RhSEUmU@2X`4V

           

           
 功 效"Mjv9f/R 2DAKd0xT"!Fr81d59

           

           
        GLGEYfrcZ`o y5xDG^e&;S,#Q

           

           
    藥理作用特點36VQu gI_%
2 V!,4

           

           
三七RfYaF7_9o uZJ~G hYz 

           
 ,OHSLB
A'YKG`NFA9uS&KuTv

           
 NEUv sQu`23 xKxSKt'eq&8

           
 hxx"CVVS9ctuNADvB F@HP

           
 'ipOUM5!34^#zu_Jy| IJ=

           
 ^"wpt"_f|TCEs
my~_n

           
 XWe;jr%`GMm -KS;ZU~
GpJh

           

           
甘、微苦,溫。P/`5x VnDnrqf#&fKAvpU

           
歸肝、胃經(jīng)ZQW=bO UNCaL"e0rl:xGE

           
 K/%3DBACybE,N 'NJ`U

           
 x !w/ 8m#cYol/fi ~

           
 6
t=`"vJr
2wF9!x

           
 MZezFppl735XS-u plY42

           
 9U"_/NG1;@sfkA 8VGDcs

           

           
①化瘀止血
VQJt 2X670FOOy&8Ge2XyYo~

           
 w1Z|YcP#3EeJZlC!

           
②活血定痛8L_M8S Mb'
DK P c3Te llhJ

           
 3308y4C3Bm"BqkIo

           
 Bc6Oep3!T^fU !5QQS4hp4

           
 fwucZ xU7M: sDP KI
'

           
 ss0Y 9Z# ci cV!xG5B Q -5

           

           
①體內(nèi)外各種出血證。尤宜于#SQXlw
q4~5o NRVUS9Vtk|f

           
 出血兼瘀滯者Oue,Z8o_mupf
KKHE24

           
②跌打損傷,瘀血腫痛。也治ZrFiMY
'Ze4KLz

           
 胸腹刺痛`qN8UNDv
W3CO`37HT|

           
 xa1MbiG!sjtXEYSdHv

           
  %jRXn6Hh0I/@AsS 9_

           
  `/yc/hvOmlVc70jl87z53

           

           
為傷科之要藥。oFGsr5~j&itYs:o~y
~

           
止血、抗血栓、擴(kuò)張血管、降Gh&:waAumFn^ZQmhQS

           
血壓、抗心肌缺血、抗腦缺NSOthZUFXf
4n
O9K#cP

           
血、抗心律失常、抗炎、鎮(zhèn):G6CEs~V#%=r4jk
vKoWa&`

           
痛、鎮(zhèn)靜、增強腎上腺皮質(zhì)功JaSEB,
aZMm;HV",ES"U

           
能、調(diào)節(jié)糖代謝、保肝、抗衰VPyVbOLn8mGNJ!3oWwl

           
老、抗輻射、抗菌、抗腫瘤等`dbRf,i A-@@Ko|1


           

           
茜草1 S 8pzq6;V QC!FVm'"

           
 w0j#Ag^ePmk Lv HtG#@

           
 7@~D"^d'@j9|=H_jly,jT=_

           

           
苦,寒。歸肝經(jīng)7=MJV!A-Of1- g,ZPdH1"U:

           
 =@gjQ /aDNRc j68:tHrBi
P

           
 
Bw6|'p'B^z5wDi'

           

           
①涼血止血bRWu-o-@=3nG_ X:ixYt`

           
②活血祛瘀8K X0cilgd Bg!%R4
6S 7

           
 W'zdLYiugH^Ch;CP
hf2g

           

           
①吐血、衄血、尿血、便血等L,:ct!uEFj#l9PDTvIW

           
②經(jīng)閉,痛經(jīng),跌打腫痛,痹YfY
Q~wfg6
eps;Gb3jd1

           
 癥關(guān)節(jié)腫痛/jgxt
-7OW uaWxz
w#cl^V

           

           
 T3VIBtL#IYYyFiM&lf^l"

           

           
蒲黃HYd&:Bv
|
J0y6^`%

           
 -Ik hag
;
mg_i_V-i

           
 or9C7-gKJS3n05_Icxv `q

           
 Y,5 5!y!pN|!hmJzP;3'cb XzzS^R

           
 d-zl87qg,EbBDKX:oam

           

           
甘、平。歸肝、p D 48mgshHpLIcYB`p6vH y

           
心包經(jīng)&a`J77@|AQOE1^ 1^USH

           
 s ;30@Rs;hcSF6B 3sLy=8yQ

           
 wz
HwF-";
 e3zNP|iT#L

           
 j2
wcv8 ! k:y ymQix

           

           
①收斂止血@g|&pF 447v;M%5

           
 &DplTln to#R/_:JFfS=Z7D

           
②活血祛瘀m;pJu,M Sqp|x'd_

           
 N4EAGV@^;@fQ;HRD&3E~G6

           
 `CE:eTzj-yyhEaUoh7tP@

           

           
①吐血、咯血、衄血、尿血、3K|W""N"OA6H6bRzN54

           
 便血、崩漏、外傷出血W@IBL M Vllaw9AAmjB

           
②血瘀心腹疼痛、痛經(jīng)、產(chǎn)后;XMbLXuPb-2t1@f h~F;Vh@-z

           
 瘀阻腹痛等,常與五靈脂 r4VOI o%A _T@HJ6

           
 合用OP# _KGv9^Nt8!rn Tp,Lfw= Kb&

           

           
促進(jìn)血凝、止血、抗血小板聚VR:alt/Ij 8| fM1`

           
集、擴(kuò)張血管、降壓、抗動脈F'`ikg@R5O6XHSdjmb

           
粥樣硬化、改善微循環(huán)、興奮GBA,z45;gxeD;DNQgP FZG

           
子宮、利尿、平喘、抗炎、鎮(zhèn)UaahmNn9W O_sIO59g

           
痛、抗缺血再灌注損傷等D
kK3#|cFq;/W5

           

 &fs,2t0J2JMerY_ NyYXqMq%5W

四、收斂止血藥TW"E
3q/X#kn NXPf|

本類藥味多澀,或為炭類、或質(zhì)黏性多平,或涼而不寒雖善收澀止血但有留瘀戀mUux;GD;ds/QKye8

  II6Q~"%vabpdMvRg'_EQ

6z'Fo@2
5Nay9eLe/!C_p2#b





 @ TpMjr;^ye0XLwo^/S

 Uc^^y640j|nd8ebL@B

 Edo~5YfcQKh!1Y|"bO/dVz` =&

邪之弊,主治出血而無瘀滯者,若有瘀血或邪實者慎用(表14-3)。dD56Tc#Opy0=0Da%G

表14-3 收斂止血藥kSyASB` 53 wz40

 %e"5aVfgI4Pf
3`cvjk=


   
       
           
           
           
           
           
       
       
           
           
           
           
           
       
       
           
           
           
           
           
       
       
           
           
           
           
           
       
       
           
           
           
           
           
       
       
           
           
           
           
           
       
   

           
藥名C
5Q5 WdSB%9,"~Y4b

           

           
 性味歸經(jīng)yal/q;&vuPrZE- PK1/

           

           
    功 效rsp9bmiN EWW/'W:MDQRoa

           

           
   主 治75 TRv~D4Yl J-9

           

           
    藥理作用特點cEOZ@QNZtB8Ysy/4B4"!

           

           
白及~:'vYC`vNQ|k^7:^

           
 XV^"EsiNHEZa:dGs`Tw`

           
 n
%e&X M%Ce|`r31

           
 WKO h6r,EfZDa%

           
 CzSZSmR
3f61R
@RdQ;V6

           

           
、。:6ut =n@g
G&#VBr m8vl%Ei%

           
歸肺、胃、肝經(jīng)aceI&Kr%Z9Rrf p0Nv'

           
 II4D^Z5Scl#:z %/Tv

           
 7azZ#5T`4JG5HShgb9&W

           
 zbo=OC- Q&SP-sx
_%Efh

           

           
①收斂止血Xh!Q^Ajs #H 8/dE%"

           
 CoGY|JVXxsc=jPDr_#=U~

           
②消腫生肌r@C^
mzCNIsy,
6N on

           
 , ew1  va@3u LE

           
 I'w'9
3@N'`-'VI3"

           

           
①咯血、咳血、衄血、吐血、外34=!Ag=gvZ
!kVr

           
 傷出血等。多治肺胃出血證i hvuy/| tj0wPv!Bk9Lf

           
②癰腫瘡瘍,手足皸裂,水火燙u:@`! ,0Io K_uM2:

           
 傷,肛裂及肺癰咳吐腥痰膿血sy9Chwr
`NFTRD1K7PJX^

           
 日漸減少者 rOzESGZM3qfM^lF/7yLzbE f

           

           
為收斂止血之要藥Gtcd4RgKJ%GI
&T&ut,^

           
 `jrj,4g=
D8G-
5_ @NE-

           
 SGADS2ySF#_M&|NfQvOYIb-

           
 oRf -%2&p
a45
|W=lzp_^

           
 p 3:LHktz4b~_JT^TD-N!B

           

           
仙鶴草HYrl,^l4/Su& '"6 J_ls

           
 WBG`=_!qc"BRjwNH!tl,b

           
 l
SanEiDmf9gbgJu2h

           
 M&_mXh08!B!2t@qnlCu=8@,

           
  Emi IN s03rp2O~lkx0CWhM6

           
 /;2TCgWZXCQe#^%yAj 3

           
 C UP jD^6P&ChSOhA
0J-

           

           
藥性平-5pK tg=6H^!015FL9ppO

           
 nKMl-J2Ll 6L:,uXit#`z N

           
 
nFTxw,N_wXmLMPLN
A9 

           
 re
=ErL;2
ByJ"J2 XX

           
 ! KB_2R2DpsB/#bJZav n5h

           
 /p~M/2O-CY=N-^tPkQ4%

           
 &F1jAy/x^
n pLy=P1,^h

           

           
①收斂止血azM
q3P5;2"wk0V4tLp xP1`L

           
 z-F`U=A=`XN@uU Qs%d

           
②止痢= Gm%EJbchW %eknC 1&a'H

           
 WOw_@o=_6 fGu#R/;
/ 1SNg

           
③截瘧:,%3jom
L~Hccl-f!x""q

           
④解毒殺蟲OajAldV_OFIVyHlmN8
/Z

           
 v
KL%JA P=8VwHz7@ 9

           

           
①咯血、咳血、衄血、吐血、尿
4_jAo~ya3ePrN

           
 血、便血、崩漏等8
8hXeh&M^  :U3m/#PgwQ@y

           
②腹瀉、痢疾。多用于血痢及久zp!1c IJr7rA^V8 S,q`1~1z

           
 病瀉痢者!L:g`wok,ml`M,CbY

           
③瘧疾寒熱lw-OsC'BN_tN
!Xaa@J=

           
④瘡癤癰腫及滴蟲性陰道炎所致7d3r&#,g- o#
,"8y,nM:K!V

           
 陰癢帶下。可治脫力勞傷e#akxO3
xGZ=6:AI

           

           
各種出血,無論寒熱n
'K!D2Bs9~M--HiS,U
I
S

           
虛實皆宜p9X=bL4UcI`CK85R63VVfM

           
 b5NMS
D!`qIuWWR%oaZby~9

           
 #uf7xF #kItG WGUudKwyg~

           
 1_1MK:KbTr`vxS;1JH

           
 AG%JB_'YIXGM^c^646@Ca

           
 gKl2sM#8gqG`
,&w;g/rfu

           

           
紫珠|wh
DiVBvZHH-g79o/"lo

           
 G
Ms1u9Y'~n1~gY&mHT;k^x

           

           
藥性涼K2wOebZ8!kV13 26wtHBgFtcMu0

           
 QQ^y3
_`juDP
t_Me!_`

           

           
收斂止血,清熱KSz~m=`/lX^f,~RHQL^k

           
解毒F4O
h:sPcK15UaH'eGwD

           

           
 HciRuMWg1thXOH-pA =

           

           
 yQ^4WE!,=!9Rif4SGKV

           

           
棕櫚炭rV Zl5;^VVPPRr 5z

           

           
藥性平UN
6cDKmh~^Ty|1xkK

           

           
收斂止血,W6rnE
zOP`pM9%QD//%

           

           
 AOlG1R4kE|Fnx '@ O
"X

           

           
 4JLg&v NCo&Qxlnp|jb d`

           

           
藕節(jié)Hg@2~!s ev1efpdV7A^Q-

           

           
藥性平cxB8-f Cz3ozJ&'!K
T_F

           

           
收斂止血@c yNka3~RV,Gy'2hu

           

           
 pK7Lwg
%6Kqxbx9%PQ/

           

           
 l2I-e=R"FQ"N sVL9&qa5E

           

 01%AFZyONmvQ
tmS
q

五、溫經(jīng)止血藥VI3cKFd`!Re'iXK&!M

 -@
x
1h8S5,;Jg
L;p

本類藥性溫?zé)?span style="letter-spacing: -2.85pt;">,能溫脾陽、固沖脈而統(tǒng)攝血液功善溫經(jīng)止血,主治脾不統(tǒng)血沖脈失固之虛寒性出血(表14-4)。;662TA Du4`W#e

 !s^T%% ~Cfo9j9G^Aaz


表14-4 溫經(jīng)止血藥zaPyw! eOEXP ME;QA9U

 B
uSOR%KC@a' V2gtU&b


   
       
           
           
           
           
           
       
       
           
           
           
           
           
       
       
           
           
           
           
           
       
   

           
藥名klnWg/6|Xu&~sgw^ wKn^Y

           

           
 性味歸經(jīng) =u`=M,4HDHZKVOyIa9|

           

           
 功 效Ii
=mYLt~3"
vD:wgGRc:

           

           
    主 治S@HQ-b ibl- RdHN2a h

           

           
    藥理作用特點w =%KYe63_AH iX ^c~N
=J,@A

           

           
艾葉@4jl dAz8m%n-96%6 7d S

           
 R1y50g"PhB;8:F 2n

           
 d_5d7uZ_UKbQGTjaCY"=

           
 PDTD&B5&-m
6!cDa1pT

           
 z|CbocOi&Ek~nvmRV fR

           

           
辛、苦,溫。歸GnlLH-b0KyC vovNO

           
肝、脾、腎經(jīng)Q8Cr
\Q#
JcP,"hwsgoUoae&C

           
 daD
d "%87zElB~~

           
 U9#1sZR:zICrXFWjG ubPWXU

           
 wvi8O@w pdjIz;L#L r

           

           
①溫經(jīng)止血Zq4TL#pS#6 ;QYx
kH

           
 :RAP8y
a kFC90Pb5J -

           
②散寒止痛eZ@FXVd 6=Y ~QN7|

           
 uPzTWTk Ur6U`Kk^CxvU
D
W

           
 #^^tiSb`n/9SQAj_;4XencwK

           

           
①虛寒性崩漏下血、胎漏。尤宜于/DQ5fr79x
QgfU=Af j0q`T

           
 崩漏;&T3 X/o5q=MtM4A

           
②經(jīng)寒痛經(jīng)、月經(jīng)不調(diào),帶下清稀,C@_0-SIQ|L#|Y md"r 

           
 宮冷不孕;脘腹冷痛;外用治濕疹Ov@S^LguhvlgpempX=#RUd@T2Y

           
 瘙癢。并用于溫灸z0oF&z2H|AyQ^IcUL`Xj3 ykE

           

           
為溫經(jīng)止血之要藥J6J_Id2
My
D'1H!Sa

           
 b-n8a
'axwMG!N2

           
 sr-jQlpG'e!s37:" 

           
 0dZQPTsAa8=  ='Jb

           
 #`-k@Tf BW-1n9e0a

           

           
炮姜SgJjBt!9x
j6Qv/b4

           
 : p~ UTiH0xO7UKk
78 

           

           
藥性溫!lT2g r Q "O A3fZ38O

           
 ~G!U3|HUq-dWUh2:BC
k'4

           

           
①溫經(jīng)止血ObHm@n'I O^6S=L/B8WU:X/

           
②溫中止痛^iON!ptXoPlF hji/-

           

           
①虛寒性吐血、便血、崩漏等證uCr0A|
_wf,GvaF=a~&

           
②脾胃虛寒腹痛、吐瀉等uJya9ph #q``Tu'u

           

           
 ' m; &G6M`|`B5TE5G&,RG

           

 ^y4A
yK sl=hUTZ--MnkP

D
2b=g1zshz-jL;GFW


一、考試難點zH=oGp&;NDwmwk&=LRE"D

1.止血藥相關(guān)藥對的配伍意義KXh s l3MFL!AG

(1)蒲黃配五靈脂 均能活血止痛,化瘀止血,相須為用,以治血瘀胸脅心腹諸痛及血瘀出血。'b Q 8w1 Zr25zKRgU#l0


(2)白及配烏賊骨 均能收斂止血,烏賊骨又可制酸止痛兩藥合用,不但止血力強,且能促進(jìn)潰瘍愈合,以治胃、十二指腸潰瘍之吐血、便血。ku!UQ oP21bF|0WTZ36

(3)白及配三七 行止并施止血力增強而不留瘀,以治各種出血,內(nèi)服外用皆可u1EN-SFA@NiC;yD1wO

(4)艾葉配阿膠 既養(yǎng)血止血,又散寒暖宮調(diào)經(jīng)以治下元虛冷,沖任不固所致的崩漏下血等。"Dbveo=

xYz:ayd_gwhzm9E

(5)地榆與槐花 性皆下行,均能涼血止血,以治血熱妄行之新舊痔血。Fn18k
r`Lq/n 2 zZksF4Cu

(6)三七與蒲黃 均能化瘀止血,以治瘀血內(nèi)阻之出血證。MN5xRpmidh^!lIZ|dPa^_2

2.安全性及用法方面值得關(guān)注的要點w-K9 Ajq
MVg#J% dxVr

(1)安全性 本單元中,地榆含有鞣質(zhì),燒傷面積大者外用易引起中毒性肝炎;白及不宜與烏頭類藥材同用側(cè)柏葉多服久服可導(dǎo)致頭、惡心等不良反應(yīng)不宜過服或久服。#~gxLIyGl8w^T X6prL

(2)用法 白及、三七止血宜研末吞服;槐花止血宜炒炭用清熱瀉火宜生用;側(cè)柏葉止血多炒炭用化痰止咳多生用;茜草止血宜炒炭用活血祛瘀多生用或酒炒用;蒲黃入湯劑宜包煎化瘀利尿多生用;艾葉溫經(jīng)止血宜炒炭用,散寒止痛宜生用。藕節(jié)對于血熱出血夾瘀者宜生用;虛寒性出血者宜炒炭用。"HCFGO_ p6L6
H|
z^6G'Z

(3)使用注意 地榆涼血止血兼能收斂止血凡虛寒性出血及出血有瘀者慎用;槐花有傷陽生寒之弊脾胃虛寒者慎用。三七性溫活血孕婦慎用,血熱及陰虛有火者不宜單用;生蒲黃有收縮子宮作用,孕婦忌服;艾葉辛香溫燥,不可過量或久服陰虛火旺者忌服;炮姜苦辛溫散,血熱及陰虛火旺之出血者忌用;棕櫚炭收澀力強,出血兼瘀者慎用。aAd&O`pum=== @:~V

二、考試易混淆知識點W_ppGs-
QcA7hj t1JEm B,P!q

 9XsnK3&N1~fk4_^BU4bKu~

1.涼血止血藥rNFq~aP ITR#b'qqQ/kC;o^

均為寒涼之品,有涼血止血功效,主治血熱妄行所致的各種出血病證。0l!hem6r=mKzPM eLyeZ#d

(1)涼血止血,散瘀消癰藥——大薊、小薊0Pb~m043mw4HU4 2,

二者都能涼血止血,散瘀解毒消癰用治血熱出血諸證及熱毒瘡瘍。大薊散瘀消癰力,止血作用廣泛,尤以治療吐血咯血及崩漏下血最為適宜;小薊兼能利尿通淋,故以治血尿、血淋為佳。_Y&=Lcj1~_Cz& jJ/N~r_

(2)涼血止血,清熱利尿藥——白茅根、苧麻根

        
二者均能涼血止血,治血熱出血證;又能清熱利尿,治水腫,小便不利,血淋等證。白茅根善清膀胱之熱而利尿力強;苧麻根則入心、肝經(jīng)而止血力強。此外,白茅根還有清肺胃之熱而生津、止嘔;苧麻根還能清熱安胎、解毒。Q1Nan q0v"Hzw-y Wy%V

u 3lx^1YDXU:P`

(3)清熱生津、止嘔、利尿藥——白茅根、蘆根3'Qz`vE r'F!6m`&-z`7k

二者均能清熱生津止嘔、治熱病煩渴胃熱嘔噦、肺熱咳嗽、熱淋血淋及水腫等證;且不傷胃、不膩膈。白茅根長于清降涼血而止血蘆根則長于清透氣分之熱,且能排膿。此外,白茅根還治濕熱黃疸,蘆根還治風(fēng)熱咳嗽。NYiHWtIhFBOgmUeGiF_,n

(4)清熱安胎、涼血止血藥——苧麻根、黃芩u !_ P!I~IN;@J 6-slUu
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二者均能清熱安胎涼血止血,治胎熱胎動不安胎漏下血及血熱妄行之各種出血;又均能清熱解毒治癰腫瘡毒、熱淋、血淋等。苧麻根味甘,藥力較弱,長于涼血,兼能利尿。黃芩則味苦,清熱解毒瀉火力強瘡腫火熱毒盛者多用;并具較強的燥濕之功,治濕熱黃疸、瀉痢濕溫、濕瘡;且長于清肺熱,治肺熱咳喘;還常與柴胡同用,治少陽往來寒熱。wGfmcQ14Vc7XkVdl

2.化瘀止血藥fzjo"4f= `^C5O3MaS

本類藥止血、化瘀,有止血而不留瘀的特點,適用于瘀血內(nèi)阻,血不循經(jīng)之出血病證?;龆寡?/span>——三七、蒲黃、茜草@w=iXjQhF~Ls#&j

三者都可化瘀止血,用治瘀血內(nèi)阻之出血證三七化瘀止血力強,有化瘀而不傷正的特點。無論有無瘀滯的出血均可用,尤以有瘀滯者為宜又能消腫定痛,為傷科之要藥。蒲黃性平,生用炒用均能止血生用活血化瘀止血,并兼利尿瘀血出血無論寒熱均宜,尤善治尿血血淋;炒炭則收斂止血,略兼化瘀,出血無瘀或瘀滯不明顯者宜之茜草性,化瘀止血多炒炭用,瘀阻出血兼熱者用之為宜;生用則涼血活血通經(jīng),瘀血夾熱者宜用,又治關(guān)節(jié)痹痛。um`gJ49y3xL=OQ9`e gr6rly6e5

3.收斂止血藥4,tr#m
RNs_=Dp7 

本類藥收斂,有留瘀戀邪之弊以出血無明顯邪氣和血瘀者為宜對于出血有瘀或出血初期邪實者,當(dāng)慎用之。Yn=D7&p YciCGYS:EB~@nXs

收斂止肺胃出血的藥物——白及、紫珠IBBcTn
HlzN@yKd_o7DAN5 Hp

二者均為寒涼之品,能收斂止血,用治多種出血癥。又歸肺胃二經(jīng),多用于肺胃出白及還能消腫生肌,對于瘡瘍無論未潰或已潰均可應(yīng)用。能促進(jìn)手足皸裂之裂口愈合;促進(jìn)水火燙傷創(chuàng)面生肌結(jié)痂。紫珠清熱解毒,可用于燒燙傷、熱毒瘡瘍等證。B_`kF-f'B:,Iz|#`YP9fHJn

4.溫經(jīng)止血藥Hp@f:wXstvIIgi
aayF

本類藥皆為溫?zé)嶂?span style="letter-spacing: -1.3pt;">,能溫經(jīng)止血,適用于脾不統(tǒng)血,沖脈失固之虛寒性出血病證熱盛火旺之出血證忌用。~K =p -&Hy
:3z%M4-

溫經(jīng)止血藥——炮姜、艾葉;V1p%8 G
T V@KL%'!|

二者均能溫經(jīng)止血,治虛寒出血諸證。炮姜味苦辛性熱入脾兼入肝,善溫脾陽、中寒,炒炭專于溫經(jīng)止血,治脾陽虛失于統(tǒng)攝之吐血、便血崩漏多用;生用長于散寒溫中止痛,治虛寒腹痛、泄瀉及產(chǎn)后血虛寒凝之小腹痛多用。艾葉味苦辛性溫,入肝脾腎經(jīng),善暖中下二焦治虛寒出血多炒炭用;且暖宮尤宜治虛寒崩漏;還能散寒止痛經(jīng)寒痛經(jīng)月經(jīng)不調(diào)、宮冷不孕帶下及脘腹冷痛等;此外煎湯外洗可治濕疹瘙癢,用于溫灸能溫煦氣血、透達(dá)經(jīng)絡(luò)。e`zt5N@%ahmCv/0

 8iKd4Zr#N3Oh/JOoc/

 
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