石膏粳米汤治疗外感发热  

Gypsum and Semen Oryza Sativa Decoction on External-Contraction Fever

作　　者：黄新芳 林星辉[2] 伍波[3] 邵命海[4] HUANG Xinfang;LIN Xinghui;WU Bo;SHAO Minghai(Shanghai East Hospital Affiliated to Tongji University,Shanghai,China,200120;Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,China,200127;Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,China,200233;Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai,China,201203)

机构地区：[1]上海市东方医院,同济大学附属东方医院,上海200120 [2]上海交通大学医学院附属仁济医院,上海200127 [3]上海交通大学医学院附属第六人民医院,上海200233 [4]上海中医药大学附属曙光医院,上海201203

出　　处：《河南中医》2024年第7期1021-1025,共5页Henan Traditional Chinese Medicine

基　　金：国家中医药管理局第四批全国中医(临床、基础)优秀人才研修项目{国中医药人教发【2017】24号}。

摘　　要：石膏粳米汤出自《医学衷中参西录》,可治温病初得、脉浮而有力、身体壮热者;也可治一切感冒初得,身不恶寒而心中发热者。石膏粳米汤中生石膏清热泻火,粳米助力发汗,全方清热泻火,辛凉发汗,祛邪而不伤正,其退热机理在于清热发汗。石膏粳米汤对于治疗新型冠状病毒感染初期,确属热证的,有较好的退热效果,但临床应用时需注意以下几点:(1)石膏必须使用生石膏,避免煅石膏,用前需研细末,且剂量不能过少;(2)粳米不可或缺,粳米可以减轻石膏寒凉特性,对于脾胃虚弱的患者尤为重要,可以避免生石膏所致腹泻等不良反应;(3)要温热服下,有助于快速发汗降温;(4)高热39℃,甚至40℃以上者可结合西药治疗;(5)建议在新型冠状病毒感染高热早期使用,若是疾病中后期发热可能病已传经入里,恐生他变;(6)对于高龄、基础疾病多且伴有严重肺感甚至多脏器衰竭的重症患者,应该中西医结合治疗,以提高疗效,挽救生命。Gypsum and Semen Oryza Sativa Decoction is derived from Records of Chinese Medicine with Reference to Western Medicine and can treat warm diseases that are newly diagnosed,having a floating and powerful pulse,and excessive body heat;It can also treat all kinds of colds which are at the beginning of occurrence,and patients who do not feel aversion to cold but have heat in their hearts.Gypsum and Semen Oryza Sativa Decoction contains raw Shigao(Gypsum Fibrosum) for clearing heat and dispelling fire,and Jingmi(Semen Oryza Sativa) for helping to sweat.The whole formula clears heat and dispels fire,induces to sweat,and expels pathogens without harming the body.Its mechanism for reducing fever is to clear heat and sweat.The formula is effective for treating the initial stage of novel coronavirus infection in patients with obvious heat symptoms,but it should be noted that clinical application should pay attention to the following points:(1) Shigao should be used with raw type,avoiding calcined one.It should be ground into fine powder before use,and the dose should not be too small;(2) Jingmi is indispensable.It can relieve the cold and dry nature of Shigao,which is particularly important for patients with weak spleen and stomach.It can prevent the diarrhea and other adverse reactions caused by raw Shigao;(3) The decoction should be taken warm,which helps promote sweating and lower the temperature quickly;(4) For those with high fever above 39 ℃ or even 40 ℃,a combination of Western medicine treatment may be used;(5) It is advised to use it in the early stage of novel coronavirus infection with high fever,because if the fever occurs in the middle or later stage of the disease,it may indicate that the illness has progressed to the interior and may lead to other complications;(6) For elderly patients with multiple underlying diseases and severe pneumonia,or even multi-organ failure,a combination of Western and Chinese medicine should be used for treatment to improve efficacy and save lives.

关 键 词：石膏粳米汤 外感发热 新型冠状病毒感染 《医学衷中参西录》 张锡纯 

分 类 号：R281.9[医药卫生—中药学]