---------------------------------------------------------------最新资料推荐------------------------------------------------------ 黄煌教授讲座笔记----06肝病黄煌教授讲座笔记----06 肝病肝病全身倦怠、慢性肝炎、急性肝炎肝硬化(觸之如額) . 等等目前沒有較佳療法，中藥只能緩解症狀，沒有治本之法。

民間療法：壁虎+蟾蜍+斑毛蟲等等以毒攻毒 (效用無) 一、茵陳蒿湯【傷寒 260：身黃如橘子色，小便不利(多、少、頻、短、無皆是) ，腹微滿者】原方：茵陳蒿 6 兩山梔子 14 枚大黃 2 兩黃煌：茵陳蒿 10~30g 山梔子 10~15g 制大黃 6~12g (茵陳蒿退黃專藥) 1. 本方適用於急性病毒性肝炎，重症肝炎膽道感染見黃疸，色鮮明(陽黃有光澤：三黃瀉心湯、黃連解毒湯) ，小變色黃短少，腹滿，舌紅苔黃膩 (如甲肝大流行即可用) 2. 患者體質：身目黃染色鮮明，黃紅隱隱，兼有身熱便結，口乾燥煩，舌紅脈數 (陰黃：晦暗如煙薰非本方証) 3. 可治妊娠期肝內膽汁淤積證(ICP) 新生兒黃疸紅素血症(量要少，如：茵陳 8g、梔子 4g、大黃 3g，水煎 40ml，每次服10ml，一日四次) 4. 本方治黃疸多與大小柴胡湯合用矢數道明曰：1 / 10「與小柴胡湯合用，治療熱毒鬱肝，症見黃疸、腹脹」與大柴胡湯合用，治療膽道感染、膽囊炎 5. 本方證不必見便秘(大黃於此方中不必後下，用量不必太大) ，大黃主退黃、除腹滿6. 本方劑型可用灌腸二、小柴胡湯(天然之干擾素，所有病毒感染均可用) 黃煌方：柴胡 5~10g 黃芩 5~10g 薑制半夏 5~10g 黨參 6~12g 生甘草3~6g 乾薑 3~6g 紅棗 3~10g (小柴胡湯治療肝炎藥量要小) 1. 小柴胡湯主治慢性肝炎(濕熱內蘊) ，症見寒熱往來(往來即指纏綿難癒、節律不定肝指數變動) 、胸脇苦滿(右上腹肝區隱痛、胸悶)、默默不欲飲食(精神抑鬱、社會壓力) 2. 小劑量，長期服用(因為此藥亦須由肝處理)，兩個月檢查肝指數一次，沒有改善或肝功能反異常即停 3. 體質：青年人多，膚色黃暗、偏瘦，舌脈無明顯異常，肝功能基本正常(GOT/GPT 高可) ，易食慾不振，睡眠障礙，常與五苓散、茯苓、豬苓合用 (便稀, 口渴無津) (不辨體質曾有間質性肺炎之後遺症) 4. 脂肪肝病人數上升 (酒肉油炸. . ) 中醫可治調代謝補虛三、小建中湯經方：桂枝 3 兩芍藥 6 兩甘草 2 兩生薑 3 兩大棗 12 枚飴糖(麥芽糖) 1 升黃煌方：桂枝 10~20g/肉桂 5~10g 白芍 10~20g(倍於桂枝) 炙甘草3~6g 生薑 3~6 片/乾薑 5~10g 紅棗 15~30g 糖 15~30g(可用蜂蜜代替，亦可用麥芽糖代替) 1. 本方為強壯性保肝藥，治療---------------------------------------------------------------最新资料推荐------------------------------------------------------慢性肝炎、肝硬化體型：多瘦、膽紅素不高、膚白而細膩、皮膚濕潤、喜甜食、大便多乾結、小腿抽筋、易疲勞、出汗、易腰酸背痛、易肢體酸痛、舌苔薄白、舌質嫩紅 2. 芍藥當重用，赤芍為佳(膽紅素高時尤有效！茵陳無效時可試) (黃疸越深，預後越差) 原發性膽汁淤積性肝硬化渾身發癢如蟲咬，大便乾結如栗，右側腰部肌肉酸痛芍藥乾草湯(小建中湯主要組合) 、白芍 30g、赤芍 30g、炙甘草 10g (需合用西藥熊去氧膽酸優思弗，效果才出來) 3. 按照中醫養肝柔肝學說加減 (龍骨、牡蠣、山藥、枸杞、鱉甲、北沙參) 飴糖一般不用，以生麥芽取代 4. 糖尿病足可用四味健步湯 (芍藥牛膝石斛丹蔘) 四、茵陳五苓散(治濕熱) (五苓散可解酒毒、味精吃多) 原方：茵陳蒿 10 分五苓散 5 分黃煌方：茵陳蒿 10~20g 豬苓 10~20g 澤瀉 15~30g 白朮 10~20g 茯苓10~20g 桂枝6~12g/肉桂 5~10g 1. 本方治慢性肝炎、肝硬化，見輕度黃疸(膽紅素偏高) ，兼下肢浮腫、大便不成型者若有腹水者加懷牛膝 20~40g、赤芍 20~60g 若無黃疸者去茵陳蒿 2. 本方可治【脂肪肝(主要是因為有五苓散) ，即濕、水、瀆身困重】酗酒者，或伴有腹瀉者可加葛根 30~60g (比較葛根芩連湯、半夏瀉心湯) 3. 如血清白蛋白低下、浮腫時，白朮可重用至 60g 白朮天然白蛋白 (蘇州某名老、南中醫孟景春等善重用白朮保肝)3 / 104. 五苓散服法：上五味，搗為糊，以白飲(米湯) 和服，方寸匕(量器單位) ，日三服，多飲暖水，汗出癒期間多飲溫熱水，忌生冷 5. 建議使用散劑(五苓散) 療效較好、易服、便宜五、真武湯原方：茯苓 3 兩芍藥 3 兩生薑 3 兩白朮 2 兩附子 1 枚黃煌方：茯苓 10~20g 白芍或赤芍 10~60g 乾薑 5~10g 白朮 10~20g 制附子 10~20g (傷寒 82：太陽病，發汗，汗出不解，心下悸，頭眩，身瞤動，振振欲僻地者) ㄖㄨㄣˊ 1. 本方為傳統溫陽利水劑，陽虛有水，陰寒體質陽虛脈沉細無力，畏寒肢冷，精神萎靡(大病重症) 有水浮腫(檢查小腿腓腸肌) ，小便不利，舌胖大苔滑2. 本方多用於肝硬化失代償期，即低蛋白血症(易腹水) 腹水難消醫案：真武湯合五苓散、牛膝 (附子量可加至 30g，要先煎 30 分，赤白芍各30g) 3. 比較OOOOOOPPPP PPPPPPP PPPPPQQDDDDDDDDDDDDDDDDE EEEEEEEEEEEE EEEFFFFFFFFFFFFFFFFGGGGG GGG888888887 777777777777777666666666 666666655555 555555555iiiihhhhhhhhhhh hhhhh ggggggg gggggggggfffffffffffffff eeeetttttttt---------------------------------------------------------------最新资料推荐------------------------------------------------------ ttttttttssssssssssssssss rrrrr rrrrrrr rrrrqqqqqqDDDDDDDDDDDDCC CCCCCC CCCCCC CBBBBBBBBBBBBBBBBAAAAAAA AAAAAP PPPPPP POOOOOOOOOOOOOOOONNNNNNN NNNNNN NNMMMM MMMMMMMMMMMZZZZYYYYYYYYY YYYYYY XXXXXX XXXXXXXXXXW W WWWWWWWWWWWW WWVV- ------- --------) ) )) ) ) ) ) ) ) ) ) ) ) ) ) ((((( ((((((( ((((******a a aaaaaaaaaaa9 999999999999 999888 88888888888887777 7777bccccccc cccccccccddddddddddddddd eeeeeeeeeeee eeeefffff000000000000000 111111111111 111122222222222222233333 3########### ##!!! !!!! !!!! !!! !$$$$$$$ $$$$$$$$$%%% %%%%%OOOOOOOOOOOO PPPPPPP PPPPPPP PPQQQ QQQQQQQQQQQQRRRRRRRRREEE EEEEEEE FFFFF FFFFFFFFFFGGGGGGGGGGGGGG GGHHHHHHHHHH Huuuuuuuvvvvvvvvvvvvvvvv wwwwwww wwwww wwwwxxxxxxxxxxxxiiiiiiii jjjjjjjjjjjj jjjkkkkkkkkkkkkkkkklllll lllllll88888 89999999999999999aaaaaaa aaaaaa aaabbb bbbbbbbbbbDDDDCCCCCCCCCC CCCCCB BBBBBB BBBBBBBBBAAAAAAAAAAAAAAA NNNMMMMMMMMMMMMMMMMLLLL L LLLLLLLLLLL KKKKKKK KKKKK KKKZZZZZYYYY Y YYYYYYYYYYX XXXXXXX XXXXX XXXWWWWWWWWW W WWWW++++--- ------- -----5 / 10-) ) ) ) ) ) ) ) ) )) ) ) ) ) ) ( (((((((((((((99998888888 888888888777 777777777777666666666666 666lllllkkkk kkkkkkkkkkkkjjjjjjjjjjjj jjjjiiiiiiii iiiivvvvvvuuuuuuuuuuuuuu uutttttttttt tttttsssssssssYYZZZZZZZZ ZZZZZZ ZZ#### ############!!! !!! !!!! !! ! !!$$$$$$$$$ $$$$$$$%%%%%%%%%% %%%%%% *******SSSSSSSSSSSSTTT TTTTTT TTTTTT UUUUUUUUUUU U UUUUVVVVVVVV VVVVV VVVWWWW WWWWWWWWWWW W XXXXXXXXXXXX XXXYY YYYYYYY YYYYYYYZZZZ Z ZZZZZZZZZZZ# ##### ##LLLLL LLLLLLLMMMM M MMMMMMMMMMNN NNNNN NNNNNNN NNOOOOOOOOO O OOOOOOPPPPPP PPPPP PPPPQQQ QQQQQQ QQQQQQQRRRRRRRRRR RRRRRRSSSSSS SSSSSSSSSTTTTTTTGGGGGGGG GGGGHH HHHHHH HHHHHHHIIIIIIIIIIIIIIIIJ JJJJJJJ JJJJJ JJJKKKKKKKKKKKKKKKKLLLLL LLLLLLLLLLMM MMMMMMMMMMMMMMNNNNNNNNNN NNNNNNO OOOOB BBBBBBBBBBBBCCCCCCCCCCCC CCCCDDD DDDDD DDDDDD(((((((((((() ) ) ) ) ) ) ) ) ) ) ) )) ) ) -- --------------++++++++++ +++++0000000 000000000111 111111111111 122222222222 222222222221111111111111 111000000000 000000+++ccccccccccccccc cbEEEE EDDDDD DDDDDDDDDDDCCCCCCCCRRRRR RRRRRR RQQQQQ QQQQQQQQQQQPPPPPbbbbbbbb bbcccccccccc---------------------------------------------------------------最新资料推荐------------------------------------------------------ ccccccddddddddddddddddee eeeeeeeeeeeeeeffJJJJJJJ K KKKKKKKKKKK KKKKLLL LLLLL LLLLLLLMMMMM M MMMMMMMMMMN NNN555555566 666666666666 667777777777 777778888888 888888888999 (( (********* ******* % %% %%%%%%%%%% %%$$$$$$yyyy xxxxxxxxxxxx xx xwwwwwwwww wwwwwwwv vvvv vvvvvvvvvvvu uu XXXXWWWWWW WWWWWWWWWVVV VVVVVVVVVVVV VU UUUUUUUUUU UUUUzzzk kkkk kkkkkkllllll llllllllllmm mmmmmmmm mmmm mnnnnnaaaaa* * *********** ((((((( ((((( (((() ) ) ) ) ) ) ) )) ) ) ) ) ) -UUVVVVGGGG GGGGGGG GGGGGHHHHHHHHHHHHHHHIIII IIIIIIIIIvvv vvviijjjjjjjjjjjjjjjjkkk kkkkk kkkkkkk klllllllllllttttGGGGFFFF FFFFF FFFFFFF EEEEEEEEEEEEEEEEDDDDDDDD DDSS* ******* **%%%%%% %%%%% %%%%$$$ $$$$kkkkkkkkkkkkkkkkjjjj jjjjjjjjjjjj iiiiiiiiiiiiiiiKKKKKKKJJ JJJJJJ JJJJJJ JJIIIIIIIIIIIIIIIHHHHHHH Hwwwww wxxxxx xxxxxxxxxxyyyyyyyyyyyyyy yyzzzzzzzz77 777777777777788888888888 888899999999 9999999TTTTTTUUUUUUUUUUU UUUUUV VVVVVV VVVVVVVVVWWWWWWuuuuuuuuu uuuuuu uvvvvv vvvvvvvvvvvwwwwwwwwwwwvv vvvvv vuuuuuu uuuuuu7 / 10uuuuttttttttttttt tttsssVVVUUU UUUUUUUUUUUUUTTTTTTTTTTT TTTTTSSSSSSS aaaaaaaaaaaaaaa999999999 999999988888 888888AAAAAAAAAAAzzzzzzz zzzzzzzzzyyy yyyyyyyyyyyIIIIIIIIIIIII JJJJJJJJJJJJ JJJJKKKKKKKKKKKKiiiiiiii iiijjjjjjjjj jjjjjjkkkkkkkkkkkkkk$$$$ $$$$$%% %%%%% %%%%%%%% ) ) ) ) (((((((( ((((((((**** * ********** nnnm mmmmm mmmmmmmmmmll llllllllllll lkkkkkN NMMMM MMMMMMMMMMMMLLLLLLLLLLLL LLLLKK KK3322 222222222222221111111111 111111000055 555556666666666666666777 77777777777P PPPPPPPPQQQQQQQQQQQQQQQR RRRRRRRRRRRRppppppppppq q qqqqqqqqqqq qqrrrrrr rrrr rr++++++++++ + 00000000000 000001111111 11########## Z ZZZZZZZZZZZ ZZZZYYYYYYYY YY11111ggggg ggffffffffff ffffffeeeeee eeGGGGGGGGGG G GGGFFFFFFFF FFFFFFFF EEEE E %%%%%%% %%%%%%%% %$$$ bbbbbbbbbbcc cccccccccccc ccdddddddddV VVVVVVVVVVVV W WWWWWWWWWWW WWWWXXX XXuvv vvvvvvvvvvvv v vwwwwwwwwww wwwwwwx 44444 455555555555 555566666666 66666VV VVVVV UUUUUUUUUUUU U UUTTTTTTTTT TTTbbbbbbbbb bbaaaaaaaaaa a aaaaa999999 zzzzzzzzzzzz zzyyyyyyyyyy yyyyyyxxx### #ZZZZZZ ZZZZZ ZZZZZYYYYYYY Y YYYYY ggggggggggggg gggh hhhhhhhhhhhh hh iZZZZZZ### ######### ###---------------------------------------------------------------最新资料推荐------------------------------------------------------#!!! !!!! !!!z zzzzzzzzzzzA AAAAAAAAA AAA AAABBBB88899 999999999999 9aaaaaaaa aaa aaaRRRRRRQQQ QQ QQQQQQQQQQ QPPPPPPPP P55 555555555444 444 444444444 43333wwwv vvv vvvvvvvvvvvv uuuuuuuuuuuu WWWWWWWWWWVV VVVVVVVVVVVV VVU UUUUjjjjjjjjkkkkk kkkkkkk kkkklllllll%%%%%%%%%%%%% %% CCCCCCCCDDDDDDDDDDD DDDDEE EEEEEc cccccccccccccccddddddddd dddddM MMMLLL LLLLLLLLLLLLKKKKKKKKKKK2 222222222221 11111111111111000ttttsss ssssssssssss srrrrrrrrrTTTTTTTTTTTTTS SSSSSSSSSSSS SSSmmmmmmmmmmmmmnnnnnnnn nnnnn nnn**** ***(((((((( ( (((((() ) ) ) ) ) ) FFFFF FFFFFF FFFFFGGGGGGGGGGGGGtggggg gghhhh hhhhhh hhhhhiiiiiJJJJJJJJJJJJJJ JIIIIIIIIIII II000000000+++++++++++++ +++-- -edddqq qqqqqqqqqqqqqpppppppppCC CCCCCC CCRRRR QQQQQQQQQQQQQQDDDDDDDDDD DEEEEEEEEEpp pppppp ) ) ) ) ) )) ) ) -------- ------- -++VW WWWWWWJJJJJJJJJJJKKKKKKK Kvvvvv vvvvvv vwwwwwwwwwjjjjjjvvvvuuuu uuuuuu uuuuuu ttttGGGVVVVVVVVVVVVVVVUU UUUUUU UUUUaa aaaaaaa99999999999999998 8BBBBBAAAAAA AAAAAAAAAzzzzzzzEEEEEEEF FFFFFFF FFFFF9 / 10FFGGGGdddeeeeeeeeeeeeeee effffff fXXXX XXXXXXXXXXXYYYYYYYYYYYww wwwwwwwwwwxx xxxxxxxxxxxxuuuuuttttttt tttttttttsss s。