临床資料
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11例中男9人,女两人,年龄在45岁以上者9人,42到44者各1人。口眼喎斜兼肢体麻木不仁,神识尚清者9人;有中风不语兼麻木不仁,神识不清者1人;单纯头昏痛,兼肢体麻木不仁屈伸不利者1人。病程1个月内来治者4人,两到三个月后来治疗者5人,年余以上而后来治疗者1人,不详者1人。经治疗在1个月内健康恢复者4人,两个月内健康两人,三到四个月内恢复者各2人,六到八个月恢复健康者3人。
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方药
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煆石决明30克,龙胆草9克,伸筋草15克,鸡血藤15克,活血藤12克,白姜蚕9克,青陈皮各3克,青木香6克,槟榔3克,京菖蒲1.5克,桑枝30克,白茅根9克,炒乌葯4.5克,远志肉3克,蝉衣1.5克
加减:有神识不清,属肝阳上亢,中风闭症者,先服安宫牛*丸,待神识清醒后,方用本方;属肝阳上亢,热甚鸱张者,加勾藤、菊花、生石膏、寒水石;属痰火内闭者,加姜竹茹、天竺*;大便不通者,加全瓜蒌、火麻仁、黑山栀;四肢有顫抖或瘈瘲者,加嫩白薇。
病案举例
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例1郑xx,男,72岁,年3月10号来院就诊。患者以板车拖来,据陪诊人述,因数日前与家中人闹气,以致突然昏糊不清,两腿不能动,左手不能举,大便数日未解,小便色*,苔*膩,脉弦滑。观患者满面紅赤,此因恼怒激动肝阳,痰火上扰而然,以偏枯再生汤加减,合安宮牛*丸治之。
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煆石决明30克,龙胆草9克,远志肉3克,白僵蚕9克,化橘紅3克,青陈皮各3克,黑山梔6克,枳实6克,全瓜蒌9克,青木香6克,炒乌葯4.5克,天竺黃6克,竹茹9克,吞服安宮牛*丸一粒。
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二诊:神识略清,语言仍不出,面色由红转*,原方服到7剂(三剂后,安宮牛*丸就停用),神识已清,语言已出,惟左半身麻木不能活动,原方加入伸筋草、桑枝、鸡血藤、活血藤,服到27剂,腿已能行,左手已活动,至56剂时,身体麻木已减,手足活动接近正常。直至7月为止,计3个月零27天,两月后追访,手足活动良好,可做轻微工作。
例2夏xx,男,42岁年7月8号初诊。头昏、左半身及面部麻木不仁,口喎向右,舌麻,已半个多月,曾在针灸科治疗过三次,效果不显著。现在大便梢干,小便如常,苔*微腻,脉象弦滑,治以鎮肝、祛风、化痰为法,以偏枯再生汤加减:
煆石决明30克,炒乌葯6克,姜蚕9克,青皮6克,宣木瓜6克,化橘红3克,京菖蒲1.5克,勾藤9克,菊花9克,竹茹9克,枳实6克,龙胆草9克。
二诊:加入天竺*、远志肉,三诊加伸筋草、活血藤。服到16剂时,口喎已正,舌已不麻,伸缩如常,惟笑时不如平常自然。原方加减服到27剂,诸症消失十分之九,一切活动接近正常。带葯回家调治,经30天治愈,追访患者现在已参加工作,一切活动良好。
《内经》谓“诸风掉眩,皆属于肝”,肝血郁滞,风阳暗动,在上则眩晕巔疾,在四肢则瘈瘲筋痿,着于半身则为偏枯,在肝厥昏迷之时,势必镇肝、清脑,畅其血流,俾脉絡通利、瘀滞尽化,则偏枯自已。观先生处方立意,在乎清泄肝热,调气通络,按证加减,悉有法度,如方中石决明、龙胆草以镇肝清脑,辅僵蚕、蝉衣以祛风;鸡血藤、活血藤、伸筋草、桑枝、青木香、白茅根以活血通络;佐菖蒲、远志以开心气而去痰,青陈皮、乌药以调气有相得益彰之妙,无偏盛燥化冷滞之弊。在临床上多次试用,确获疗效。至于慢性虚证,肝肾阴血不足者,又当以柔滋肾,养血通络治之,相机应变,要在医者善于掌握而已。
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