《杏林探宝——认知中药》是由上海中医药大学推出的一门关于中药学的慕课课程，由上海中医药大学杨柏灿教授主讲。 上海中医药大学（Shanghai University of Traditional Chinese Medicine）的前身是上海中医学院，创建于1956年，是新中国诞生后国家首批建立的四所中医药高等院校之一，也是上海市属高校中唯一的一所医科类重点特色院校。 中药学根植于中华文化，是中医药学的重要组成部分，也凝聚着中华文明的精髓。其悠久的历史，卓越的防病治病效果，较少的毒副作用，成为中华民族防病治病不可或缺的选择。同时，中药的作用也日益引起国际社会的关注和重视。但不可否认，对中药的认识和应用存在着一些不容忽视的误区与盲区，非常有必要采取一定的方式，通过合适的平台传播、普及中药知识，使人们对中药有一个更为全面准确的认识，并能合理应用，让中药为人类的健康保健发挥更大的作用。
5-2 部分有毒药物的介绍
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杏林探宝——认知中药
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安全合理应用中药
用药安全性概念及影响因素。以具体实例从组方配伍、用量用法、病证禁忌等方面，强调医患配合在确保中药既有效又安全上的重要性。提出如何应用一定的方法确保一些有毒药物在疾病治疗中的作用与安全，使之由毒物变宝物。
介绍中药：马钱子、朱砂、砒石等。
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杨柏灿教授，博士生导师
上海中医药大学中药学教研室
In the last class,
I've introduced
some basic concepts of Chinese herbs,
coupled with
examples.
Now I'd like to
introduce some
herbs we mentioned
in examples.
First, I'd like to talk about Ma Qian Zi (Semen Strychni).
Generally, you don't have access
to this herb
in hospital
because
it is a highly toxic herb
and strictly regulated by the government.
However, it's contained in
many patent Chinese medicine,
such as Yunnan Bai Yao,
which contains Duan Chang Cao (also toxic),
Ma Qian Zi
and other ingredients.
Let's take a look at
Ma Qian Zi.
It is bitter in flavor, cold in property and highly toxic.
I'd like to mention
it's still controversial about
whether Ma Qian Zi
is cold or warm in property.
It's now generally believed that
Ma Qian Zi is bitter, cold
and highly toxic.
Its main function is to
unblock collaterals.
I call it unblocking collaterals and resolving hard nodules.
So, first, Ma Qian Zi
has very good effect
in unblocking collaterals and relieving pain.
Therefore, it's mainly
used for
intractable rheumatic joint pain,
often accompanied by
joint deformity.
Since it unblocks collaterals,
Zhang Xichun once said
Ma Qian Zi is superior to any other herbs
in unblocking meridians and benefiting joints.
This indicates that it has noticeable
effect in alleviating pain.
And that's why it can be used
to treat intractable rheumatic joint pain
coupled with joint deformity.
It can also be used to treat
limb numbness
and paralysis due to obstructions of muscles or tendons.
Actually it's very effective
for many conditions,
for example, it's effective for facial palsy
even if used
externally.
This is its first function.
The second function
is also related to the first one.
Since it unblocks collaterals, alleviates pain,
and resovles swelling,
Ma Qian Zi can be used for traumatic injuries
and very effective for
pain due to bone fracture.
Today,
it's more often
used to
treat intractable pain,
such as vascular headache,
trigeminal neuralgia,
rheumatic joint pain,
especially intractable rheumatic joint pain,
with remarkable effects.
The problem is
that we do not
have the access.
In addition, it cannot be used in decoction,
but in solid pills or powders.
Even if you have the access,
you can only get a very small dose,
0.3g-0.6g
on a daily basis.
Then how do we use it
externally?
We've prepared a major pain-killing
component of Ma Qian Zi...
brucine
with nanotechnology.
Then it's prepared
into a spray
to apply to the affected area.
What about the effect?
(1)
Immediate pain relief:
the pain can get immediate relief
at least within 20 minutes
of spray.
It has immediate pain-relief effect.
(2)
Strong pain-relief effect:
Many kinds of pain
such as tennis elbow,
neck pain,
joint pain,
muscle injury, etc.
Can all be substantially
relieved.
(3)
Longer pain-relief effect.
So external use of
an ingredient of Ma Qian Zi
brucine
can get
amazing pain-relief effect,
better effect than other
medicine.
So much
for Ma Qian Zi.
Next
I'd like to talk about Zhu Sha (Cinnabaris).
Last year pediatric medicien in Beijing Tong Ren Tang
was detected to contain excessive mercury.
Mercury is also the major component
of Zhu Sha.
Zhu Sha
is often
used in our daily life.
As a medicine,
Zhu Sha has the following characteristics.
First,
it is indeed toxic.
It is sweet in flavor and cold in property;
and
it is very heavy.
It is cold, heavy
and enters
the heart meridian.
We all know that
the heart dominates mental activities.
Based on the fact that it enters the heart meridian,
又是寒性的
and heavy,
we know
Zhu Sha
has good effect in tranquilizing mind.
This mind-tranquilizing effect
focuses on two aspects.
First, it is
very heavy
and can strongly traquilize mind,
which
means an immediate and strong sedative effect.
As a result, it can be used for restlessness due to multiple reasons,
such as
restless, insomnia,
dementia, depression and mania.
Secondly,
since it is cold
and enters the heart meridian,
Zhu Sha can clear the heart and calm the mind.
With this function,
it can be used to treat
hyperactivity of heart fire, i.e.,
restless and insomnia due to
heart fire disturbing the mind,
and mouth or tongue ulcerations.
So clinically Zhu Sha is often used
for heart-mind disturbance.
There is a famous formula
called Zi Zhu Wan (Magnetite and Cinnabar Pill)
containing
Zhu Sha and Ci Shi (Magnetitum).
This is the first aspect.
The second aspect:
it can clear heat and remove toxins
and can often be used
for toxic-heat ENT problems
such as mouth or tongue ulcerations
and sore swollen throat.
For mouth/tongue ulcerations and sore swollen throat,
we know there is a
patent Chinese medicine
called
Bing Peng San ( Borneol and borax powder),
which is a spray
for
mouth ulceration
and sore swollen throat.
Zhu Sha is toxic
and its main ingredient is mercury.
We have be clear about:
(1)
Zhu Sha cannot be calcined with fire,
because the mercury comes out in certain temperature.
(2)
The dosage needs to be strictly controlled:
0.1g-0.5g
per day.
(3) it is not for decoction
but for pills or powders.
In summary,
we all know these products are toxic,
so did ancient people.
The ancient people also knew
under certain conditions
they can be more toxic.
So as for the preparation,
they were extremely cautious
about the temperature
and the container.
Why are we still using it?
Because we want its efficacy
and
avoid its toxicity,
which is possible.
After these two Chinese medicine,
we come to the most toxic one
Pi Shi (Arsenicum)
including red and white arsenic.
We'll introduce them together.
It is very hot,
and highly toxic.
How highly?
Even a very small dose
can be fatal.
Actually it has always been
highly poisonous since ancient times;
at the same time, it has extraordinary effect
for intractable,
difficult diseases.
There is no point
talking about its specific functions.
Because it is used externally
to treat intractable
skin ulcers,
scrofula and stubborn dermatitis.
It has good effects for above conditions
because of its function in removing rotten tissues and killing insects
when used externally.
A patent Chinese medicine
called Zi Jin Dan (Purple Gold Elixir)
contains Pi Shi.
Today,
it's very difficult to
get approval by using
Pi Shi in external preparation
and is therfore rarely used.
Here I'd also like to talk about its effect
when administered orally,
of course,
not in decoction
but in pills or powders.
It is more often
used for
intractable asthma.
We describe its functions as
'robbing' phlegm and relieving asthma.
It can be used to treat asthma due to cold phlegm.
We all know
asthma is very difficult to treat.
Why?
Because of its
hidden phlegm
inside the body,
which can be triggered by inducing factors.
These factors include
weather changes,
diet,
fatigue or emotions.
That's why
asthma is so
It is
difficult to treat.
To cure asthma,
you need to strenghten the body constitution,
you also need medicine.
We often hope
that
asthma in children can be cured
through his development,
along with
a stronger body constitution.
Other than this,
asthma is very difficult to eradicate.
To eradicate asthma,
you need to remove hidden phlegm.
How?
Pi Shi has such effect.
I've witnessed
an asthma patients in his forties
had been using steroid aerosols
all year round.
One day he was treated with spine-scraping method
while I was present.
I saw
one of the components for spine-scraping is arsenic.
At that time the patient was in his forties.
He almost never experienced asthma ever since
the spine-scraping was done more than 10 years ago.
This also indicates
Pi Shi
can help to eradicate asthma.
Why?
It can remove hidden phlegm inside the body
the cold phlegm, or
asthma due to cold phlegm.
Finally,
Pi Shi
can also be used to treat malaria.
Likewise,
we do not have
access to Pi Shi.
I use these three examples
to explain that
they are related to recent events,
Ma Qian Zi and Yunnan Bai Yao,
Zhu Sha and pediatric medicine in Beijing Tong Ren Tang,
Ci Shi and Xiong Huang (Realgar) for anti-tumor.
With three representative Chinese medicine,
I'd like you to know that
(1) they are not atoxic but toxic,
and some of them are highly toxic
and can even be
fatal.
This is one aspect.
Another aspect,
we should not discard it just because
it is toxic;
instead, we should transfrom toxicity into efficacy.
Toxicity of Chinese medicine
involves many factors.
I'm going to introduce
these factors
in next class.
So much for this class.
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