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090115 漢方

『補してシャす』

鍼灸のself medicationは、楽!


●防風通聖散
脂肪代謝を促進、下剤、食欲低下
「ダイエッターズハイ に入りやすい」

●防巳黄耆湯
余分な水を排泄促進、基礎代謝上げる

・保健指導
半年は食事・運動・ストレスのみで医療行為をしてはいけない。その後、スタチンなどいれてよい

●便秘

必ず 実

…(間でれず)

2) 柴胡カリュウコツボレイトウ
 肝気うっ滞

 柴胡  疎肝理気
 人参  益気健脾臓
 ハンゲ  理気止嘔 
 オウゴン 清熱
 
  (ここまでは小柴胡湯)
 ケイシ 暖めて他のクスリを助ける
 ブクリョウ 引薬下行
 大黄  (ツムラには入っていない)
 タイソウ、生姜 …調整に入っている

3)虚証

1.気虚
 気は推動作用 → 機能障害

特徴: でるはでるけれどすっきり出ない。残便感
   便柱が細い
   軟便(吸収が悪いから) なのにあんまりでない
 舌 淡、ハン大、苔薄、歯痕
  痩せてるか、脂肪太り

・脾気虚
脾の作用: 水穀の運化
 → 衰えれば消化吸収悪くなり、下痢

大腸の作用: ソウハク(糟粕)の作用
  → 衰えれば便秘に
 胃(受納、腐熟)の影響を受けている
 脾:
 腎(二便を司る)
 肺(表裏)

⇒ 六君子湯
 + 大黄甘草湯 (六君子湯のみではたりない)

 ●注意
   大黄は耐性ができやすい 長く使わないようにする
   大黄は標治剤で、根治薬ではない

   体質・証を治すことが大切


2.陽虚
気の温ク作用が衰えたもの
 腎(体の総元締め)虚を伴う

⇒ 八味地黄丸
 (大黄甘草湯をはじめ加えてもいい)

腹痛を伴えば
⇒桂枝加芍薬湯


3.血虚、陰虚
   物質的な不足が血虚

便が硬い、乾燥する
口渇あり、舌裂紋、苔少
爪が割れやすい

⇒麻子仁丸
麻子仁: 油分を含んでいて、腸を潤す(潤燥)
杏仁: 気を下に開く
 (cf 麻黄湯:麻黄(気を上に開く)・桂枝・杏仁(気を下に開く)・甘草)
芍薬: 補血
キ実・厚朴: 理気 …ただ、乾燥させる作用もある…
大黄

…ただ、乾燥させすぎてしまうこともある。大黄も長く使いたくない

本治のためには
⇒四物湯 + 理気剤(半夏厚朴湯など)

地黄: 補血(腎に入る)
白芍: 補血(肝に入る) 例:芍薬甘草湯(肝血が不足すると痙攣する)
当帰:  活血+補血
川キュウ: 活血 + 理気

半夏: 理気
厚朴: 理気
蘇葉: 理気
茯苓: 引薬下行
生姜:
 〜 吐き気止めで、腸まで引く力はない
 → 半夏をキ実に変更するのも手


●久病必オ

活血に主眼をおいた便秘薬
トウカクジョウキトウ 強烈だから
『乙字湯』

柴胡 : 升提作用(補中益気湯の要! 落ち込んだ気を持ち上げる)
升麻 : 升提作用 
黄ゴン: 清熱 (熱の痛みをとる)
大黄 : 清熱 シャ下
当帰 : 補血 活血 (痔は留まり)
甘草 : 潤燥

⇒痔核を伴う便秘
(下に脱出する気を持ち上げる)

 人参・黄耆を入れると、さらに持ち上がる


症例:
1)77歳男性、COPD。肺炎後、便秘悪化
⇒ カマ+ 三黄シャ心湯


2)39歳女性、父親は怒鳴り、母親は過干渉。3人姉妹で妹たちは結婚して他県にいる。男性との交際も親の反対でだめになる。ニキビと便秘に悩んでいる
⇒ サイコカリュウコツボレイトウ


3)37歳女性、乳癌術後、放射線治療後。倦怠感、四肢の冷えが主訴。ジュウゼンタイホトウ、補中益気湯、人参養栄湯、など人参だされると具合が悪くなる。顔色悪い、疲れやすい割りにぺらぺらしゃべる。痩せ型、舌暗赤、舌下静脈怒張

気血両虚、オ血、冷えあり
人参を入れないようにすると…
⇒ キュウキチョウケツヒン
もともと気にしていなかった便秘が治った。また、大黄は清熱作用が強いので冷やしすぎちゃう

4)69歳女性、高血圧、高脂血症、腰痛。下半身の冷えと頻尿あり。色白、肥満、舌淡、ハン大、舌苔薄白

⇒ 八味地黄丸
冷えよくなった。頻尿かわらない、それ以上に便通がよくなった!

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