03-08 Arrangement of Herba Ephedrae Drug Pairs (2) Compatibility

There are hundreds of records in Shennong Materia Medica, which contain ephedra. Ephedra "can penetrate deep into skin pores, but also can penetrate deep into phlegm to stop bleeding, and whatever medicine can't, it can be done."

The results showed that there were 32 prescriptions containing ephedra in Treatise on Febrile Diseases, accounting for 65,438 02.40% of all prescriptions. Among them, 30 tablets can be dose-converted. The results of correlation analysis showed that the single dose of Herba Ephedrae was significantly correlated with the number of drugs, water consumption, water consumption and taking times, and had no correlation with the remaining water, which was basically consistent with the calculation results of single dose of Herba Ephedrae.

At the same time, the results of single factor logistic regression analysis showed that ephedra had no correlation with the above factors.

Therefore, the application of Herba Ephedrae fully embodies its idea of syndrome differentiation and treatment according to the severity of syndromes, the deficiency and excess of disease bodies and the combination of pathogenic factors.

In addition, according to the distribution of six meridians, it is consistent with the understanding in Treatise on Febrile Diseases that Mahuang Decoction is not only for the sun, but also for ephedra, that is, Mahuang Decoction is a Zhongjing Dafa. Therefore, the compatibility characteristics of ephedra and its dose-effect relationship have important clinical reference value.

Compatibility of Ephedra and Almond

Mahuang decoction is mainly composed of ephedra, and the dosage of ephedra is 3 taels and almond is 70 taels (1.65 taels). The non-main drug is Ephedra Forsythia Red Bean Decoction, and the dosage is Ephedra 2 Liang and Almond 40 Liang (0.94 Liang).

Dose analysis showed that only the difference of residual water between the main drug ephedra and the non-main drug ephedra was statistically significant, indicating that there was no effective relationship between ephedra and almond. On the one hand, when the external pathogen is prominent or the internal pathogen is not serious, Ephedra needs to take the maximum dose in the prescription to eliminate the pathogen. On the other hand, when the dosage of the compatible drugs is greater than that of Ephedra, it will not affect its sweating and relieving exterior syndrome. In clinical use, if the prescription is 6 herbs twice a day, the dosage of Ephedra is 10.29 g(≈ 10 g) if it is the main herb, and it is 7.43 g(≈7 g) if it is not the main herb, there is no difference between them.

Compatibility of ephedra with cassia twig and peony.

Mahuang Aso Decoction takes Mahuang as the main medicine, including Mahuang 2.5 Liang, Paeonia lactiflora 0.25 Liang and Guizhi 0.25 Liang. It is used to treat "people with typhoid fever on June 7th, after heavy diarrhea, the middle pulse in the inch is delayed, the hands and feet are syncope, the inferior pulse is insufficient, the larynx and pharynx are unfavorable, pus and blood are vomited, and urination is not smooth".

The non-main medicine is pueraria decoction, which contains 3 liang of ephedra, 2 liang of white peony root and 2 liang of cassia twig, and the prescription is mostly 4 liang of pueraria, which is different from Guizhi plus pueraria decoction. When there is no sweat, ephedra should be used to relieve exterior syndrome by sweating.

Dose analysis showed that compared with ephedra, there was a significant difference only in the number of drugs. It can be seen that when Herba Ephedrae is mixed with Ramulus Cinnamomi and Radix Paeoniae, its main function is still sweating and relieving exterior syndrome. If there is no exogenous pathogen, it can be used as the main drug by adjusting the compatibility and dosage, just like Ephedra in Shennong's Herbal Classic, "Cough against qi, gentle lifting can disperse lung evil." Evil eliminates cold and heat, and disperses honor and defense. The function of "dispersing" is manifested in breaking diseases and accumulating hard materials, and dispersing internal knots in viscera. In clinical use, if the prescription is 6 kinds of drugs, twice a day, the dosage of the main drug Ephedra is 2.96g(≈3 g) and the dosage of the non-main drug is 5.62 g(≈6 g), and there is no difference between them.

Compatibility of Herba Ephedrae and Radix Aconiti lateralis Preparata

The main drug of Ephedra is Ephedra Fuzi Gancao Decoction, including 2 tablets of Ephedra and 0.76 tablets of Fuzi/KLOC-0.

When it is not the main medicine, Guizhi Shaoyao plus Mahuang Asarum Fuzi Decoction is the representative, including 2 pieces of Mahuang and 0.76 pieces of Fuzi 1 piece.

Professor Hu Xishu thinks that the sun syndrome and the shaoyin syndrome in the system of six meridians and eight classes are the yang syndrome and the yin syndrome of exterior syndrome respectively, so it is necessary to add aconite on the basis of Glycyrrhiza Mahuang decoction syndrome.

Dose analysis showed that there was no significant difference in factors between the main drug ephedra and the non-main drug ephedra. It can be seen that the compatibility of Herba Ephedrae and Radix Aconiti Lateralis can also alleviate exterior syndrome. Increasing the dosage of Herba Ephedrae to form Ephedrae Fuzi Decoction will increase sweating power. If the cold syndrome is obvious, it will increase the heat of Asari and slow down the removal of licorice, thus forming Ephedrae Asari Fuzi Decoction, which warms the yang and makes people sweat.

Although in clinical application, the prescription is six drugs twice a day. For example, the main drug dosage of Ephedra sinica is 15.24g(≈ 15g), which is obviously higher than its non-main drug dosage of 4.5 1g(≈5g). This is because there are 7 kinds of drugs in Guizhi Qushaoyao plus Mahuang Asarum Fuzi Decoction, so it should be used according to it.

Compatibility of ephedra with gypsum

Ephedra is a non-main medicine, represented by Bai Yue Decoction, including 6 ephedra and 8 gypsum, which are the most widely used prescriptions in Treatise on Febrile Diseases. It shows that the compatibility of Herba Ephedrae and gypsum is simple, mainly used for exterior pathogen and internal heat, and the degree is heavy, in which the function of Herba Ephedrae is sweating and relieving exterior syndrome.

In addition, ephedra and gypsum should be used as non-main drugs, and the best ratio of them is 3∶4.

In clinical use, if the prescription is 6 herbs twice a day, the dosage of Herba Ephedrae is 27.60g(≈28g).

Compatibility of Herba Ephedrae and Rhizoma Pinelliae

According to the equivalence of Banxia Mahuang Pills, this prescription takes Ephedra as the main medicine, while Mahuang in Houpu Mahuang Decoction and Shegan Mahuang Decoction is the non-main medicine, of which Ephedra is 4 Liang (55.2g) and Banxia is 0.5 L (64g).

Professor Hu Xishu thinks that this prescription can be used to treat hypochondriac palpitation caused by stagnant water and drinking, which shows that ephedra has the function of dispelling dampness.

However, both Houpu Mahuang Decoction and Shegan Mahuang Decoction are used to treat cough, and the effect of Herba Ephedrae is still "sweating and relieving exterior symptoms".

If the prescription is 6 herbs twice a day, the dosage of Herba Ephedrae is 6. 13 g(≈6g).

In Treatise on Febrile Diseases, Herba Ephedrae is only used for exterior syndrome, and its main function lies in sweating and relieving exterior syndrome. Only Mahuang Aso Decoction and Banxia Mahuang Pill use their "dispersing" function.

Moreover, Ephedra has no obvious cold and heat properties, and can be used to treat complex clinical symptoms by compatibility with other drugs when syndromes appear.

The study of dose-effect relationship shows that the compatibility of ephedra with other drugs is not dose-related, and it is often used in combination with almond, cassia twig, peony, aconite, gypsum and Pinellia ternata.

In addition, Ephedra sinica is not used with Shaoyang Bupleurum, Yangming rhubarb and mirabilite, and it is forbidden to use it with "combined hair" or "purgation" when sweating. Therefore, only by strictly observing the compatibility law of ephedra and "dialectical medication" can we master its usage flexibly.

1 Exogenous fever

Zhongjing treated exogenous fever with ephedra. For exterior syndrome of taiyang typhoid, the dosage is mostly increased or decreased according to the degree of stagnation of exogenous pathogens, and it is mostly combined with Guizhi. Representative prescriptions include Mahuang Decoction, Guizhi Mahuang Decoction, Guizhi Ermahuang Decoction, Gegen Decoction, Gegen Plus Banxia Decoction, Xiaoqinglong Decoction, etc.

Article 35 of Treatise on Febrile Diseases stipulates: "Mahuang Decoction is the main treatment for sunstroke, headache, fever, body pain, lumbago and joint pain, and bad wind, asthma and no sweat." This is the syndrome of exterior cold, stagnation of Wei Yu, stagnation of camp and Wei, and "no sweat" means that you can't sweat, indicating that the cold pathogen on the muscle surface is heavier. Zhongjing is treated with Mahuang Decoction, with Mahuang Sanliang to relieve depression in Wei Qi, and with Guizhi Erliang to penetrate Wei Wen Meridian. The two are combined into one, and the effect of sweating and relieving exterior syndrome is doubled.

There is a sentence in every half soup of Guizhi Mahuang: "Fever and aversion to cold, more heat and less cold ... those with hot complexion do not seek relief", which reflects the state that cold pathogens are depressed in the exterior and want to be relieved but cannot be relieved. It is a kind of superficial depression and light syndrome. Zhongjing takes Mahuang Decoction and Guizhi Decoction 65,438+0/3 each, Ephedra is reduced by one or two, Guizhi is one or two hundred and sixteen baht, and slight sweat relieves exterior cold.

After the syndrome of Guizhi Erhuang Decoction was treated by sweating, it was said that "sweating will relieve exterior symptoms" and that depression in exterior and interior was mild, so Ephedra only used sixteen baht and Guizhi 127 baht to relieve exterior and interior symptoms.

Zhongjing also used ephedra to treat fever caused by cold pathogen blocking exterior and stagnation of heat. It is often combined with gypsum, and the representative prescriptions are Daqinglong Decoction, Guizhi Yuemainv Decoction and Yuemai Decoction. The syndrome of Daqinglong Decoction is exogenous cold and pathogenic stagnation of muscle abscess, and weiyang stagnation turns into heat. Symptoms are "tight pulse, fever, aversion to cold, body pain, irritability and no sweating". Zhongjing used ephedra to relieve qi, dispel cold and evil, and gypsum to clear away heat. Because gypsum hindered the sweating effect of ephedra, he used ephedra 62. Guizhi gave Yi Tang in February that "less cold" means slight aversion to cold, indicating that exogenous pathogenic factors have decreased, while "heat" means that yang stagnation and heat are not solved, and the exterior pathogenic heat here is light, so a small amount of 18 baht ephedra and 24 baht gypsum are used to remove slight pathogenic factors.

In addition, Zhongjing used ephedra to treat fever caused by exogenous yin and yang deficiency, and the dosage was small, and it was mostly compatible with aconite, such as ephedra asarum aconite decoction and ephedra aconite licorice decoction. Treatise on Febrile Diseases (30 1): "Shaoyin disease begins with fever and deep pulse, and Mahuangxixin Fuzi decoction is the main one." This is due to the lack of yang and exogenous cold. Therefore, a small amount of Herba Ephedrae is used to relieve exterior syndrome and dispel cold, prevent sweating and consume yang, and it is combined with Radix Aconiti Lateralis to warm meridians and support yang and help Herba Ephedrae to eliminate evil.

Cough and asthma

Zhongjing often uses ephedra to treat cough and asthma caused by external cold and internal drinking, and the dosage is generally three to four liang. It is often combined with asarum, Pinellia ternata and dried ginger, such as Xiaoqinglong Decoction and Shegan Mahuang Decoction. If you drink it in cold for a long time, it will be compatible with gypsum, such as Xiaoqinglong plus gypsum soup, Houpu Mahuang soup, Yuemecca Banxia soup and so on.

Article 40 of Treatise on Febrile Diseases: "The exterior and interior of typhoid fever are puzzled, and there is dampness under the heart ... fever and cough ... Xiaoqinglong decoction is the main one." This is the syndrome of exogenous wind-cold and internal stagnation of cold drinks. Therefore, Herba Ephedrae has the functions of dispersing cold, dispersing lung and relieving asthma. It is used together with dried ginger, asarum and Pinellia ternata to warm lung and dispel cold, resolve phlegm and clear drink.

Compared with Xiaoqinglong decoction syndrome, Xiaoqinglong decoction syndrome has a longer course of disease, and the internal heat turns to heat due to prolonged depression, leading to "irritability and asthma", so gypsum is used to clear fire.

Zhongjing also uses ephedra to treat cough and asthma caused by exogenous pathogenic factors, which is often combined with gypsum, such as ephedra almond licorice gypsum soup. Ephedra almond licorice paste soup is used to treat "sweating and asthma". When the external cold depresses the lungs and the pathogenic heat rushes up, it will "gasp"; If you go out in the heat and steam, you will "sweat". In the prescription, Herba Ephedrae uses four drugs to relieve exterior syndrome, dispel pathogenic factors, disperse lung and relieve asthma, and it is used together with gypsum to clear lung and calm exterior syndrome. The combination of warm and cold ingredients makes ephedra disperse lung heat and relieve asthma without helping heat, while gypsum is not cold but clears lung heat.

3 body yellow

Zhongjing also used ephedra to treat yellow body, using a small amount of sweating, or compatibility with red bean, or using ephedra alone, such as ephedra forsythia red bean soup, "Qianjin" ephedra alcohol wine soup and so on. Yellow body caused by exterior and interior sweating of typhoid fever and damp-heat stagnation is treated with Herba Ephedrae, Fructus Forsythiae and Semen Phaseoli Decoction.

The Book of Classics Shuzheng says: "Ephedra is not a special treatment for exterior syndrome, but can be used by all patients with internal diseases." The red bean in the square can clear the damp heat and make it come out from the bottom. Herba Ephedrae uses two ingredients to remove dampness, so that dampness can seep from the skin, separate from adzuki bean, and eliminate damp heat.

Qianjin Mahuangchun Decoction is used to treat Huang Zhi's syndrome, which is caused by cold and dampness stagnation on the muscle surface. Only Mahuang Powder is bright for sweating, and sake is used to help yang and yellow.

4 edema

Zhongjing uses ephedra to treat edema, and the dosage is large, and it is mostly compatible with Atractylodes macrocephala, Gypsum Fibrosum and Radix Aconiti Lateralis, such as Yuemai Jiashu Decoction, Yuemai Decoction, Daqinglong Decoction, Xiaoqinglong Decoction, Glycyrrhiza Ephedra Decoction and Ephedra Fuzi Decoction.

Article 5 of Synopsis of the Golden Chamber: "Those who enter the water have yellow swollen face, heavy pulse and unfavorable urination, which makes them sick. If you let urine benefit you, it will kill body fluids, so it will make you thirsty. The more you go, the more you can help the soup. " This article is edema caused by skin water belt heat. The lung is blocked, the spleen does not transport, and the water stays in the body and transports the bladder downward, so the pulse is heavy and urination is unfavorable. When water is wet, it can't go up and down, and it turns into heat and overflows on the muscle surface, so the whole body is yellow and swollen. In the prescription, ephedra is repeatedly used to steam the water, dredge the waterway, and Atractylodes macrocephala is used to strengthen the spleen and eliminate dampness, so that the dampness is from bottom to top. The combination of the two can disperse the water inside and outside, which embodies the purpose of "opening the door of hell and cleaning the house" Ephedra combined with gypsum can dissipate heat from exterior to interior.

For the edema caused by heat in geomantic omen, Zhongjing used Mahuang 62 to open the door of hell and clear away heat with plaster, such as Yuemai Decoction to treat "bad geomantic omen, bad wind and edema all over the body" and Daqinglong Decoction to treat "overflowing disease".

For edema caused by yang deficiency in common cold, Ephedra Fuzi Decoction is used, in which Ephedra is reduced to three ounces of aconite, which warms the meridians and helps yang, sweating and promoting diuresis.

5 limb pain

Zhongjing used Ephedra to treat joint pain, and the dosage was small. It was often combined with Radix Aconiti Lateralis Preparata, Radix Astragali, Coicis Semen and Atractylodis Macrocephalae. The representative prescriptions were Fuzi Decoction, Guizhi Shaoyao Mu Zhi Decoction, Qianjin Sanhuang Decoction, Maxing Yigan Decoction and Mahuang Jia Zhu Decoction.

Zhongjing used Aconitum Soup to treat "the patient's medical record is dull and painful". According to the prescription, the pathogenesis is that pathogenic wind, cold and dampness enter the joints and block the meridians. The symptoms are mainly joint pain, aggravated by cold, and unfavorable flexion and extension. Therefore, ephedra sanliang is used to dispel wind and sweat, promote yang and relieve arthralgia, dispel cold and dampness, and cooperate with aconite to dispel wind and remove dampness, warm meridians and dispel cold and relieve pain.

Guizhi Shaoyao Mu Zhi Decoction is used to treat joint swelling and pain caused by cold and dampness for a long time, and the symptoms are "sore limbs, sore body and swollen feet". In the prescription, ephedra, aconite root and aconite root are used for removing arthralgia, expelling wind and removing dampness, warming channels and dispelling cold, and Anemarrhena rhizome is used for nourishing yin and clearing heat.

"Qianjin" Sanhuang Decoction is used to treat exogenous deficiency, rheumatism blocking exterior and interior, and summer heat stagnation. The symptoms are "pain in all joints, restlessness, aversion to cold, and aversion to eating and drinking after menstruation". Herba Ephedrae with Asari, Radix Angelicae Pubescentis for expelling wind and removing dampness, dredging collaterals and relieving pain, Radix Astragali for invigorating qi and consolidating exterior, calming wind and removing dampness, and Radix Scutellariae for clearing heat and relieving vexation.

Zhongjing's prescription for treating "body trouble and body pain" caused by cold-dampness obstruction is Mahuang Jiazhu Decoction. Mahuang Sanliang is used to relieve exterior symptoms, dispel cold and remove dampness, and it can also be used together with Atractylodes macrocephala to remove the dampness of stool and stop Mahuang from sweating. Maxing Yigan Decoction is lighter in exterior syndrome than the former. It can be used for treating wind-cold-dampness blocking meridians, relieving exterior syndrome and eliminating dampness. It is used with Coix seed to clear heat and remove arthralgia.

6 others

In addition, Zhongjing also used ephedra combined with Cimicifuga rhizome, dried ginger and Scutellaria baicalensis to treat throat obstruction caused by upper heat and lower cold, such as ephedra Cimicifuga decoction; Ephedra and Banxia Toarey Yang Juanyin (such as Banxia Mahuang Pill) are used to treat palpitation of yang hyperactivity; Herba Ephedrae is compatible with Ginseng and Angelica, which can dispel wind and cold, replenish qi and nourish blood, and treat stagnation caused by both deficiency of both qi and blood and wind, such as Xu Ming Decoction in ancient and modern records and proven cases; Treat malaria with ephedra and oysters, such as oyster soup; Herba Ephedrae combined with Ramulus Cinnamomi, Radix Aconiti Lateralis Preparata and Rhizoma Zingiberis Recens can warm yang to dispel cold, promote qi circulation and promote diuresis, and treat cold drinks fullness caused by yang deficiency and qi stagnation, such as Guizhi Shaoyao Mahuangxixin Fuzi Decoction.

Most doctors have always said that Ephedra is pungent in taste and sweaty, and they are afraid of it, especially those who are afraid of it, which leads to this delicious medicine being shelved. Zhang Cigong also mentioned that "in modern times, ephedra was feared as a tiger". By combing the prescriptions of ephedra in Treatise on Febrile Diseases, it is found that Zhongjing uses ephedra to treat various diseases, and flexibly chooses the dosage and compatibility of ephedra according to different pathogenesis, which provides guidance for our better clinical application of ephedra.

The theory of "correspondence between prescriptions and syndromes" originated from article 3 17 of Treatise on Febrile Diseases written by Zhang Zhongjing at the end of the Eastern Han Dynasty: "All diseases correspond to prescriptions, but we should obey them", and expounded the internal correspondence between prescriptions and syndromes. With the development of the times, through the long-term clinical practice of doctors in past dynasties, the correspondence between prescriptions and syndromes has gradually developed into the theory of "correspondence between prescriptions and syndromes" This theory integrates "principle-method-prescription-medicine", takes the principle of "taking the evidence as the prescription and treating the syndrome with the prescription", and is characterized by "treating the syndrome under the disease, treating the syndrome under the prescription and treating the syndrome under the syndrome", emphasizing the pertinence of prescription and medicine to the treatment of syndrome, and has gradually become the medication criterion for clinical treatment of physicians in past dynasties.

1 ephedra plus cassia twig

Ephedra is bitter and pungent, warm in nature, dispersing lung qi and relieving asthma, and can open and close depressed lung qi and disperse exterior cold, so it is the first medicine for typhoid fever. The combination of ephedra and cassia twig has two meanings: first, it can relax tendons and activate collaterals, and warm meridians and activate collaterals. As emphasized in Materia Medica Justice, Ramulus Cinnamomi can not only help Herba Ephedrae relieve exterior syndrome, enhance sweating ability, but also help relieve cough. Second, warming meridians to relieve pain can nourish yin to relieve pain.

From the table 1, it can be concluded that Ma Gui in Treatise on Febrile Diseases is a common combination of Zhongjing's warm heart and sweating. Through comparison, it is found that the common ratio of 1) Ma Guixin to sweating is 3:2, which can be used for all kinds of exogenous wind-cold exterior syndrome, sweating to relieve exterior syndrome, so as to vent the sun and exterior evil; 2) For patients with severe aversion to cold and fever who need to sweat urgently, such as Daqinglong decoction syndrome, the dosage of Herba Ephedrae should be increased to six taels, in order to make hemp and Guangxi grow together and sweat to relieve exterior symptoms; 3) If it is used for patients who are troubled by small pathogenic factors, the dosage of Herba Ephedrae is small, so as to reduce sweating and reduce heat, and it is compatible with Guizhi to form xiaohan decoction, such as Guizhi Erhuang decoction and Guizhi Mahuang decoction. 4) If it is used for phlegm caused by deficiency of body yang and retention of water and dampness, it should be taken warm. Therefore, using Magui to dispel cold and increasing the dosage of Ramulus Cinnamomi to the same amount as that of Herba Ephedrae can not only help Herba Ephedrae to perspire and relieve exterior symptoms, but also warm cold drinks and treat both exterior and interior symptoms.

2 ephedra and Cimicifuga foetida

There is a special prescription in Treatise on Febrile Diseases-Mahuangshengma Decoction. This prescription is the most widely used prescription in Treatise on Febrile Diseases, and its dosage is also very small. Ephedra and Cimicifuga are monarch drugs. Among them, Cimicifuga is slightly cold, and its performance is mixed. Cimicifuga in ancient times is like rhinoceros horn today. It has the function of clearing away heat and toxic materials, and is good at propaganda. Using Mahuang to dispel cold and relieve exterior syndrome, first, it can raise stomach and body fluid, induce warm drugs to go up to the throat and reach the throat, so as to consolidate exterior syndrome and spread lung; Second, it can raise and disperse Yangming, clear yang, lower Jue yin and cultivate vitality. This compatibility in the mixed environment of cold and heat, the combination of cold and heat, often will produce hair and eliminate evil, the more yang is, the more depression. Combined with the whole prescription, it can be used to treat cold and heat, purulent blood and vomiting.

3 ephedra and gypsum

Gypsum tastes sweet and cold, and is good at clearing away heat and purging fire, relaxing muscles and tendons and reducing fever. It is an important drug for clearing lung and stomach qi and separating excess heat. After compatibility with Herba Ephedrae, it mainly acts on lung meridian, and has the functions of dispersing lung qi, relieving asthma, clearing away heat and relieving annoyance. According to Treatise on Febrile Diseases, gypsum is the most used in Maxing Shigan Decoction, which is the most representative in the compatible application of ephedra and gypsum, as shown in Table 2. The dosage of gypsum in this prescription reaches half a catty, which is twice that of ephedra. In this prescription, ephedra and gypsum are combined into one, and ephedra's gypsum makes the whole prescription not too warm and can not help heat, and has the function of dispersing lung and relieving asthma. Ephedra sinica, which is obtained from gypsum, has the function of clearing lung heat instead of excessive chill, and the two complement each other to treat cough and asthma caused by lung heat. Tai Yang apoplexy syndrome of Daqinglong decoction is accompanied by dysphoria, and stagnation of defensive qi leads to fever and dysphoria, indicating that muscle carbuncle is heat, so it is necessary to mix appropriate amount of gypsum to clear away heat and disperse exterior syndrome, which can treat exterior syndrome of wind-cold. The other two prescriptions in Table 2 are all caused by excessive internal heat due to exterior depression, and the treatment should focus on sweating and relieving exterior syndrome, clearing heat and relieving exterior syndrome. Therefore, the application of gypsum combined with ephedra to relieve exterior depression, clear yang and depress heat embodies Zhongjing's idea of distinguishing primary from secondary and treating both symptoms and root causes.

Herba Ephedrae with Radix Aconiti Lateralis and Herba Asari.

In Treatise on Febrile Diseases, only Mahuangxixin Fuzi Decoction and Mahuangfuzi Decoction are used to treat shaoyin typhoid syndrome.

It can be seen from Table 3 that the dosage ratio of Herba Ephedrae to Radix Aconiti Lateralis is 3:2. Herba Ephedrae and Radix Aconiti Lateralis can disperse exterior cold and warm yang of lower energizer, while Radix Aconiti Lateralis combined with Herba Ephedrae can warm and solidify lower energizer and lower energizer, activate yin and yang, and disperse exterior evil of upper energizer. The compatibility of the two medicines complements each other, nourishing the vital fire with less yin inside and dispersing the cold of the sun outside, so as to achieve the functions of exorcising evil spirits without damaging righteousness and restoring yang without leaving the cold.

Asarum powder has a strong ability of pungent and hot. Can walk without following ephedra, enhance sweating ability. For example, Mahuang Asarum Fuzi Decoction can be combined with Radix Aconiti Lateralis to dispel cold in the interior, and can also help Mahuang dispel cold, giving consideration to both exterior and interior, and attacking and defending simultaneously; Xiaoqinglong decoction can dispel phlegm in cold water inside and outside, and asarum can help Magui dispel cold and warm, and benefit water.

The pathogenesis of Mahuang Fuzi Gancao Decoction is Shaoyin disease, with a long course of disease and yang deficiency. It needs Radix Aconiti Lateralis Preparata and Radix Glycyrrhizae Preparata to help warm yang, and a little Herba Ephedrae to help sweating.

5 ephedra almond

Almond tastes bitter and diarrhea, which is an important drug for treating cough and asthma. There is a saying in Zhou Yan in Qing Dynasty: "Almond, so it is the arm of ephedra." Ephedra gets almonds, and almonds spread lung qi, so as not to spread lung qi too much. Almonds get ephedra, which lowers lung qi, but not too much. It is a pair of classic combinations commonly used by Zhongjing to treat lung disease. Through research, it is found that Mahuang Decoction is the most widely used in Zhongjing's prescriptions of ephedra and almond, with 70 tablets, equivalent to 23g today. They are both like lungs. Followed by dried soup of Maxingshi, as shown in Table 4. Ephedra and almond in the prescription should be used together, which can not only spread the lung and eliminate evil spirits, but also lower the lung and relieve asthma. Together with gypsum, it can clear lung heat, relieve cough and asthma. In Daqinglong Decoction, the main symptom is "irritability due to not sweating", and the key point is sweating, so the dosage of ephedra is doubled, and almonds are less used to relieve exterior syndrome. The other two prescriptions use a small amount of almonds with ephedra to treat superficial evils with slight sweat.

6 Herba Ephedrae with Radix Paeoniae Alba

Radix Paeoniae Alba tastes sour, astringing liver yin and nourishing blood, nourishing blood and softening liver to relieve pain. It is often combined with Cinnamomum cassia twig to harmonize ying and Wei, as shown in Table 5. There are two functions in the compatibility formula of cassia twig and cassia twig. First, it can use the nature of acid harvest to limit cassia twig to prevent excessive sweating from harming body fluid and yin blood; Second, according to Chen's research, the compatibility of Paeonia lactiflora and Cinnamomum cassia can slow down the elimination speed of paeoniflorin, the effective component of Paeonia lactiflora, and prolong the retention time, which is beneficial to the lasting effect of paeoniflorin in the body. Paeonia lactiflora plays a role in nourishing body fluid and eliminating yin in Gegen decoction and Gegen plus Banxia decoction, so Paeonia lactiflora is an adjuvant in Mahuang prescription. In terms of dosage, the dosage of Paeonia lactiflora used in Zhongjing is similar to that of Ephedra sinica, generally one to three. If there are pain symptoms due to internal cold, it is necessary to increase the dose of Paeonia lactiflora to relieve the pain.

7 ephedra with licorice

Glycyrrhiza uralensis Fisch is sweet in taste and flat in nature, and has many functions such as harmonizing various medicines, clearing away heat and toxic materials, and relieving pain. Known as "China's old medicine", each prescription regulates a variety of drugs, and Zhongjing is commonly used in compatibility. See Table 6. In Treatise on Febrile Diseases, there are three main functions of Herba Ephedrae combined with Radix Glycyrrhizae: First, relieving exterior syndrome and strengthening spleen and strengthening body resistance. Glycyrrhiza uralensis Fisch, as a medicine in Mahuang Decoction and Daqinglong Decoction, can not only relieve the health of Hemp and Cinnamomum cassia, avoid excessive sweating, but also replenish middle energizer and help sweat source, so that healthy qi can be restored and pathogenic factors can be eliminated. Glycyrrhiza uralensis Fisch in Maxing Gypsum Decoction can invigorate qi, regulate cold and heat, and avoid stomach injury due to cold. The compatibility of hemp and grass in Xiaoqinglong Decoction not only has expectorant and antitussive effects, but also can prevent excessive pungent powder, consuming yin and activating collaterals and damaging healthy qi. The second is sweating and relieving exterior syndrome. Glycyrrhiza uralensis Fisch in Ephedra Fuzi Glycyrrhiza Decoction can not only help Ephedra sweating and relieve exterior syndrome, but also be combined with Fuzi to warm yang. The third is to relieve pain. Glycyrrhiza uralensis Fisch and Radix Paeoniae Alba are used together in Radix Puerariae decoction and Radix Puerariae plus Rhizoma Pinelliae decoction to relieve the urgent need of tendons and collaterals. In Zhongjing, the dosage of Herba Ephedrae and Radix Glycyrrhizae is usually between one and three, and the ratio of Herba Ephedrae: Ramulus Cinnamomi: Radix Glycyrrhizae is generally 3: 2: 1, which can be adjusted according to the dosage of Herba Ephedrae.

According to the theory of "prescription-syndrome correspondence", this paper preliminarily analyzes the compatibility law of ephedra in treating different syndrome types: ephedra can be used to treat exogenous wind-cold exterior syndrome, and it can be compatible with cassia twig at a ratio of 3:2 to open yang and relieve exterior syndrome; Treating cold-heat syndrome can be combined with a little Cimicifuga to reveal yang depression; The treatment of lung-heat cough and asthma syndrome can be combined with appropriate amount of gypsum to disperse lung and clear heat, and ephedra to relieve exterior syndrome and depression; To treat shaoyin typhoid fever, it is necessary to combine Radix Aconiti Lateralis and Asari to replenish internal fire and dispel external cold. The treatment of lung-inverse cough and asthma syndrome should be properly combined with almond and ephedra, which can disperse lung and eliminate evil, lower lung and relieve asthma; The compatibility of Radix Paeoniae Alba and Ramulus Cinnamomi can adjust the balance between health and nutrition, and Radix Glycyrrhizae can relieve the medicinal properties. Therefore, a small amount of Radix Paeoniae Alba and Radix Glycyrrhizae are often used as adjuvant drugs in the compatibility of Ma and Gui, and Ephedra is used together with the whole prescription to strengthen the body resistance, eliminate evil spirits, reconcile yin and yang, and avoid excessive sweating and damage to the body.

Application taboo

People with weak constitution should use ephedra with caution. Ephedra is strong in sweating, so it should be used with caution by the general elderly, children and the weak. If the clinical symptoms are exogenous wind and cold, but sweating is more, ephedra should also be used with caution.

People with exogenous qi deficiency should use ephedra with caution. Ephedra sinica is generally suitable for empirical research. Ephedra sinica should be used with caution in patients with exogenous wind-cold symptoms due to qi deficiency, such as aversion to wind-cold, shortness of breath, fatigue, spontaneous sweating during exercise, pale tongue and weak pulse.

People with yin deficiency and blood deficiency and bleeding tendency should use ephedra with caution. Ephedra is pungent and warm, strong in dryness, and easy to injure yin and promote blood circulation. People with yin deficiency and blood deficiency, fear of cold and wind, dry mouth and thirst, no sweat or less sweat, less red tongue coating, and thready pulse should use ephedra with caution, even if they have chest tightness and cough. Yin deficiency of liver and kidney, hyperactivity of liver yang, dizziness, headache, night sweats, red tongue with yellow fur and strong pulse should not be used with ephedra.

Ephedra is not suitable for patients with insufficient heart blood, uneasy heart, palpitation, chest tightness and asthma, edema of lower limbs, dysuria, pale tongue with white fur and rapid pulse. People with yin deficiency and blood heat, such as hemoptysis, hematemesis, hematuria, hematochezia, epistaxis, subcutaneous purpura or menorrhagia, should avoid using ephedra although the symptoms are exogenous cold, cough and chest tightness. Ephedra should be careful with itchy skin spots and red and burning colors.

Pharmacological research shows that ephedra can excite the central nervous system and raise blood pressure, so it should be used with caution for those with irritability, palpitation, insomnia and hypertension.

Ephedrine can excite bladder sphincter. Excessive or long-term use of Herba Ephedrae can reduce urine volume, even urinary retention or urinary closure. Therefore, it should be used with caution for those with dysuria and oliguria.

The dosage of ephedra should not be too large. According to People's Republic of China (PRC) Pharmacopoeia, the daily dose of adult decoction is 3-9g, and the general poisoning dose is 30~ 50g. Excessive dosage may lead to palpitation, shortness of breath, tremor and angina pectoris. Severe poisoning can lead to blurred vision, dilated pupils, coma, dyspnea and convulsions. Even lead to respiratory failure and ventricular fibrillation.

Ephedra sinica should not be combined with digitalis cardiac glycoside to avoid ventricular arrhythmia.