Li Jian, Yang Xue
Bupleurum chinense DC. in Shennong's Classic of Materia Medica states that it tastes bitter and flat. The main confidant has stomach stagnation and food accumulation; Cold and heat pathogens; Push Chen Zhixin ". In Materia Medica, it is said that Bupleurum chinense is "cool in nature, so it can relieve cold and heat, muscle surface hot flashes, liver and gallbladder fire inflammation, chest and hypochondriac pain, and also treat sores and ulcers, so the blood room is heated; Its nature is scattered, so it is the main cause of typhoid fever, warm disease with excessive heat, shaoyang headache and liver meridian depression. " It is pointed out in "Drug Meaning" that "Bupleurum chinense is light and clear in nature, mainly ascending and dispersing, slightly bitter in taste, mainly soothing the liver ... and can dispel and disperse the muscle surface. It is a medicine for treating cold and heat, malaria, and hot flashes ... it can lift and sink, and lift the vitality and turn left. "
In modern clinic, Bupleurum chinense can be used to treat exogenous pathogenic factors, internal injuries, regulating qi and regulating blood, and it can also be used for deficiency syndrome, which is widely used. Xiaochaihu decoction, Sini powder, Chaihu Shugan powder, etc., which take Bupleurum as the main medicine, have become the main prescriptions for regulating the liver because of their good effects of soothing the liver and regulating qi, and are commonly used by women and children at home and abroad. However, since the Qing Dynasty febrile disease scientists put forward that "Bupleurum robbed the liver yin", many doctors, especially those of the febrile disease school, put Bupleurum on the shelf and were afraid to use it in clinic. Is it true that Bupleurum can rob liver yin, or is it prudent to use Bupleurum for febrile diseases, or is there another reason? This paper will discuss the origin of "Bupleurum robbing liver yin", the application of Bupleurum in febrile diseases, the clinical application report and pharmacological research of Bupleurum.
1 the origin of "Chaihu robbing liver yin"
The theory that "Chaihu robbed the liver yin" was first seen in Zhang Sikui's book "Injury to Summer". However, whether Bupleurum robbed liver yin or not, the later doctors held different opinions.
1. 1 Those who agree that "Chaihu robs the liver yin"
Ye Tianshi, a master of epidemic febrile diseases, mentioned in "A Brief Introduction to Pediatrics and Malaria Gate" that "treating malaria generously should be divided into twelve meridians. If the young family is vulgar, but with Bupleurum chinense, or the genus of Elsholtzia and Pueraria, I don't know that Bupleurum chinense robbed the liver yin and Pueraria exhausted the stomach juice "; Wang Mengying once again emphasized in Warm Jingwei that "at the sight of fever in young families, Chai Ge is used to relieve muscles, and at the beginning, why it causes fever is not investigated.". If the exterior heat is unclear, Chai Ge will not be removed. Although the liver wind has moved and the carbuncle has taken shape, it is still careless to abuse the wind and medicine. This Ye's family is also forbidden to rob the liver yin and exhaust the stomach juice. In Zhang Wanxiang's "Zhang's Medical Instructions for Warming Summer", the treatment of malaria is "the more severe it is to take Xiaochaihu Decoction by mistake"; Wang Xie-cheng said, "When malaria misuses Bupleurum root, it will cause persistent fever or severe pain in both ears, or even make people faint, or even arouse liver wind, causing convulsions.": "Introduction to Medicine" warns that "those who are determined by vitality and sweating due to yin fire will die if they take it by mistake". "Herbal Classic Shu" says: "Patients with deficiency and rising qi should avoid it, and those with vomiting and excessive inflammation due to yin deficiency should be avoided by the same method." It is considered that the yin essence of patients with Bupleurum syndrome is deficient, but Bupleurum is pungent and scattered in nature, which can raise yang qi, and the use of Bupleurum can make the yin essence that has been deficient even more depleted.
1.2 Those who oppose "Chaihu robbing the liver yin"
Xu Dachun, a famous doctor in the south of the Yangtze River at the same time as Ye Tianshi, commented on Ye Tianshi's remark about "Chaihu robbing the liver and yin", saying that "I heard that people who used to treat malaria, banned Chaihu, and ate by ear, were said to think that it was a secret method, and they did not use it. I think this is a rumor, and this old man will never come to this point. After reading this case, no one uses Bupleurum, but I know that this statement is true. Then this old man is deviant, which is really unexpected. " For Ye Tianshi's point of view, he questioned, "Where did this come from? What is this old man's lifelong enmity with Bupleurum?" In the Qing Dynasty, Zhang Xichun pointed out in the Record of Medical Enthusiasm in the West that "Bupleurum is the main drug of malaria. If you encounter yang deficiency or heat entering the blood, you may wish to use drugs that nourish yin and cool blood; In case of dryness and heat, or heat exceeding qi, you may wish to use more drugs to moisten dryness and clear fire; It is a fool who treats malaria with reuse of rehmannia root and rehmannia root; There are those who reuse gypsum and Anemarrhena asphodeloides; Those whose qi is divided into deficiency, and those who reuse ginseng and astragalus to heal; However, there is no need for Bupleurum in the prescription. " It can be seen that those who advocate and pursue "Bupleurum robbing liver yin" are mainly febrile disease experts, so is "Bupleurum robbing liver yin" limited to febrile diseases?
Application of Bupleurum chinense in febrile diseases
Due to the proposal of "robbing the liver and yin", the application scope of Bupleurum chinense in epidemic febrile diseases has been greatly reduced, and some doctors don't even use Bupleurum chinense. Liu Bao-yi proposed Xiaochaihu decoction and other prescriptions in Wen Wen Feng Yuan that "dryness and fierceness rob yin, especially for febrile diseases". Ye Tianshi didn't use Bupleurum blindly in treating typhoid fever in Clinical Guide to Medical Records, and suggested that Artemisia annua should replace Bupleurum, thinking that "Artemisia annua is inferior to Bupleurum, and it is also the medicine for shaoyang". Nevertheless, Bupleurum chinense has its unique application range in epidemic febrile diseases. Wu Tang, a febrile disease expert in the Qing Dynasty, used Guizhi Chaihu half decoction and Wuyuzhizifenmuxiang decoction to treat "headache, body cold and heat, chest and hypochondriac pain, and even hernia pain" caused by autumn dryness, and all of them combined Guizhi because Chaihu "reached the qi of shaoyang, that is, reached the qi of liver and wood".
Evil spirits go out to the sun; In "Damp-warm Diseases", there are prescriptions with Bupleurum as the main medicine, such as Buzhong Yiqi Decoction, Xiaochaihu Decoction, Xiaochaihu Decoction with Dried Ginger and Pericarpium Citri Tangerinae, and Shengren Baidu Powder, to treat the syndrome of shaoyang malaria or summer-heat dampness causing cold and heat exchanges.
Wang Mengying [1] recorded the prescriptions of Bupleurum in Wen Re Jing Wei, including Xiaochaihu Decoction, Biejiajian Pill and Baidu Powder. It is considered that the functions of the three drugs are to work with Scutellaria baicalensis Georgi to eliminate pathogenic heat in shaoyang; Combined with Ramulus Cinnamomi to harmonize exterior and interior; "Relieve heat and clear up, assist Chuanxiong and calm the liver with blood, so as to treat headache and dizziness". It is believed that "taking Bupleurum as the main drug to treat malaria, only those who are rich in nourishing yin, or the evil of warmth and summer dampness is not very heavy, and those who feel the exterior evil of wind and cold can see the work." Ding Ganren [2], a famous physician in modern times, also used Bupleurum in the treatment of epidemic febrile diseases, and it was effective to use Bupleurum in the treatment of wind-temperature, wet-temperature, malaria, big head plague and so on.
From the medical records and works of the above physicians, it can be seen that Bupleurum chinense is mainly used in malaria and shaoyang syndrome or damp-warm disease with cold and heat exchanges as the main symptoms, and its scope is relatively limited.
Clinical application report and pharmacological study of Bupleurum chinense DC
3. 1 Report on the clinical application of Bupleurum chinense Guo Pengnian [3], a famous doctor in Fujian in the late Qing Dynasty, used Bupleurum chinense 250 g, which was decocted in water as tea frequently, to treat the epistaxis caused by Wen Guanchun, who was studying hard day and night. A doctor was shocked and said, "Bupleurum chinense is rising and robbing the liver yin. How can you use half a catty at a time?" Guo explained, "Because of the eagerness for fame and fame, the liver depression turned into fire, which disturbed the nose and orifices, resulting in epistaxis. Most of the former doctors used catharsis soup to break the fire, instead of lifting the soup to stop boiling, why not take the bottom out? " Liu Duzhou [4], a master of traditional Chinese medicine, did not stick to the theory that "Chaihu robbed the liver yin" in treating hepatobiliary diseases, and established Chaihu Jiedu Decoction with Chaihu as the main medicine to treat damp-heat syndrome; Chaihu Huoluo Decoction and Chaihu Zhitong Decoction were established to treat liver depression and qi stagnation syndrome. Chaihu Biejia Decoction was established to treat the syndrome of liver and kidney yin deficiency and toxic accumulation. Zhang Qi [5], a famous doctor, used Xiaochaihu Decoction to treat fever. All patients with clinical symptoms such as fever, aversion to cold, white tongue coating, floating pulse, nausea and vomiting used a large dose of Bupleurum (more than 20 g). Not only did they not see the disadvantages of robbing yin to help heat, but they used it repeatedly. Wang Lingtai [6], a famous doctor, treated the syndrome of liver depression and spleen deficiency combined with liver and kidney yin deficiency with soothing the liver and strengthening the spleen, nourishing the liver and kidney, and clearing away damp-heat. Bupleurum 10 g was commonly used in it.
3.2 Pharmacological study of Bupleurum chinense DC
Sun Shi et al. [7] observed the liver function and other indexes of SD rats by continuous gavage with Bupleurum root for 1 month, and found that Bupleurum root could lead to the increase of AST, ALP, ALT and other indexes in rats, and related histopathological examination also found liver injury mainly caused by fatty degeneration of hepatocytes; Guo et al. [8] observed the pathological changes of rat liver by continuously administering drugs to three groups of nonalcoholic fatty liver rat models (normal group, model group, Chaihu and Danshen compound group) for three weeks, and found that Chaihu and Danshen compound can effectively reverse the fatty degeneration and inflammatory changes of liver caused by high-fat diet by enhancing the expression of peroxisome proliferator-activated receptor γ; Gao et al. [9] proved through mouse experiments that both the separate decoction and the combined decoction of Bupleurum and Scutellaria have the function of protecting the liver, and the effect of the combined decoction is obviously better than that of the separate decoction; Wang [10] and Liu et al. [1 1] proved that the compatibility of Bupleurum chinense and Scutellaria baicalensis Georgi had the effect of resisting acute alcoholic liver injury, and pointed out that the effect was the best when Bupleurum chinense and Scutellaria baicalensis Georgi =2 1. Fu Shi [12] Through the influence experiment of Chaihu Shugan Powder on the experimental model of liver fibrosis in rats, it was found that Chaihu Shugan Powder can obviously improve liver function, and at the same time significantly reduce serum HA and LN, which confirmed that Chaihu Shugan Powder has a good preventive and therapeutic effect on CCl 4-induced liver fibrosis in rats. Cheng et al. [13] observed the effect of saikosaponin on the immune function of rat liver cancer induced by diethylnitrosamine, and found that saikosaponin D could increase the proportion of CD 4+,CD 4+/CD 8+T lymphocyte subsets in rat liver cancer and reduce the number of CD 8+. It is proved that saikosaponin D has good immune protection and anti-tumor effect. Through the clinical application report of Bupleurum chinense, we think that we should use Bupleurum chinense boldly when there are indications for the use of Bupleurum chinense in diseases and there are no contraindications for the use of Bupleurum chinense, and we should not stick to the saying that Bupleurum chinense robs liver yin. Of course, the premise of using it is accurate syndrome differentiation and proper dosage and compatibility. At the same time, it should be noted that Bupleurum is not a nourishing product, and it needs to stop the middle disease, and it should not be taken for a long time and in large doses. So what are the contraindications and side effects of Bupleurum chinense?
Contraindications of Bupleurum chinense
Regarding the contraindications of Bupleurum, there are many related discussions in China's herbal works: "Southern Yunnan Materia Medica" says "Bupleurum is used for typhoid fever and sweating, and it can be used after four days; If it is used first, yang syndrome is introduced into yin meridian, which should be contraindicated "; "Compendium of Materia Medica" states that "if fatigue has fever in the spleen and stomach, or yang sinks, Bupleurum is a necessary medicine for inducing menstruation, eliminating qi and reducing fever; Only those who work in the lungs and kidneys don't have to use Kerr "; In "Materia Medica Seeking Truth", it is said that "the real deficiency and the real heat should also be considered as appropriate"; It is said in "Medicine Signs" that "it is useless to use it if there is no syndrome of fullness in chest and hypochondrium". "Chongqing Tang Essay" said, "Bupleurum is the main medicine for typhoid fever, and it is impossible to treat damp-heat sensation; It is the main drug of shaoyang malaria; It is impossible to treat all malaria in his meridians; As a gynecological panacea, it is impossible to treat the body of yin deficiency and yang yue, and the user should judge it. " In the clinical application of Bupleurum chinense, it has been reported [14] that 30% of oral Bupleurum chinense granules cause mild fatigue; At high dose, 80% of them caused deep sleep, 17% had poor sleep and decreased appetite. It has been reported [15] that the use of Bupleurum preparation to treat colds leads to stomach cramps in patients, and the accidental use of Bupleurum injection in patients with upper respiratory tract infection leads to acute hypokalemia [16]; Hu et al. [17] reported 43 cases of adverse reactions of Bupleurum, and thought that the main adverse reactions of Bupleurum were anaphylactic shock, respiratory reaction, cardiovascular system reaction and skin reaction. In addition, Yang et al. [18] confirmed that peroxide damage is one of the important mechanisms of liver toxicity induced by Bupleurum volatile oil in rats.
Through the above-mentioned ancient herbal works and modern pharmacological research on the side effects of Bupleurum chinense, the author thinks that the contraindications of Bupleurum chinense are: (1) the syndrome differentiation is inaccurate, and those without Bupleurum chinense syndrome cannot be used; (2) Those with deficiency of middle energizer or damp heat or cold and dampness are not available; (3) Caution should be used for patients with yin-blood deficiency, solitary yang fatigue, gingival bleeding, vomiting blood due to yin deficiency, excessive liver-fire or hyperactivity of liver-yang.
5. Safe application of Bupleurum chinense
The safe application of Bupleurum chinense DC. is not only accurate in syndrome differentiation, but also mainly about controlling dosage and compatibility of drugs. The common compatibility of Bupleurum chinense in clinic is: with Scutellaria baicalensis Georgi to clear damp-heat in liver and gallbladder and regulate qi-flowing; Compounding Radix Paeoniae Alba to soothe the liver, relieve depression and relieve pain; With Cimicifuga foetida and rising yang; With tangerine peel to soothe the liver and relieve depression, regulate qi and strengthen the spleen; Cooperate with Atractylodes macrocephala to promote yang, eliminate dampness and strengthen spleen; With bitter orange to soothe the liver and regulate qi; With peucedanum praeruptorum for relieving fever, relieving cough and resolving phlegm; With chicken gizzard-membrane, soothing the liver, invigorating the spleen and promoting digestion; With ginseng, it can invigorate qi and yang, strengthen spleen and eliminate dampness. Liu Duzhou [19] thinks that the dosage of Bupleurum chinense is always the smallest for patients with liver yin deficiency, and the medicine for nourishing yin should be reused. Sweet and cold products nourish yin and clear heat simultaneously, promote blood circulation and cool blood, and have no harm to yin and righteousness. Commonly used clinical compatibility is turtle shell, Adenophora adenophora, Ophiopogon japonicus, Polygonatum odoratum and so on. This is similar to Zhang Xichun's use of Radix Bupleuri with Radix Rehmanniae and Radix Rehmanniae in treating diseases.
To sum up, the theory of "Bupleurum robbing liver yin" has its historical reasons, which can remind doctors to use drugs carefully in clinic. However, we can't stick to this, and we should use it boldly when the syndrome differentiation really conforms to its application scope. For patients with liver yin deficiency, Bupleurum chinense should be used in small doses and combined with large doses of nourishing yin. At the same time, it is necessary to pay attention to stop the middle disease and avoid taking Bupleurum in large doses for a long time.