第12章 — 整体草药医学模型 (第3/4页)
模型和案例研究的应用
模型应用 Applying the Model
Summary: When selecting herbs for a patient, the practitioner follows a structured seven-step process:
list signs and symptoms, interpret underlying processes, find herbs by primary and secondary actions,
identify system tonics, consider biochemistry,
integrate into a prescription, and address lifestyle factors.
This becomes intuitive with practice, though it requires years of experience to master fully.
草药选择的 7 个步骤
在为患者选择草药时，许多草药可能是选择，问题是：哪种草药会产生反应 all the needs 对患者最佳？过程从:
- 经过处理 diagnostic procedure 适当的，明确过程 physiological 需要处理
- 选择 appropriate actions 用于管理生理和病理生理过程
- 选择 relevant herbs 从主要和次要作用，以适应患者
最好的方法是遵循 steps 以下 — 刚开始可能会觉得长，但随着经验的积累会变得正常:
| 步骤 | Description |
|---|---|
| 1 | 清单 signs and symptoms 每个问题的 |
| 2 | 解释 processes 了解症状和病理生理学，然后确定合适的草药功效 |
| 3 | 使用参考列表，搜索可能有助于 primary and secondary actions |
| 4 | 注明 body systems 所需 tonic herbs 然后选择相关的滋补草药 |
| 5 | 检查 biochemical considerations — 阳性指标或 contraindications |
| 6 | Integrate 总结结果并开发处方 |
| 7 | 注明 other healing modalities and lifestyle issues 以增强草药效力 |
主要和次要作用(Primary & Secondary Actions)
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Secondary actions 是伴随植物主要生理效应的额外功效。然而，当试图进行分析时出现问题 logical, reductionist 全部
主要药草的功效究竟是什么？有些情况很明显（例如 senna 是一种泻药，但在某些情况下，这取决于观点——有些人可能会说 chamomile 主要 relaxing nervine 而其他人可能称其为 carminative, anti-inflammatory herb
次级功效 subjective 有些人效果明显，有些人则没有。这就是为什么草药治疗既是 art 和 science
เราเรียนรู้รายละเอียดได้ แต่ต้องใช้เวลาหลายปีเพื่อเป็นนักสมุนไพรที่แท้จริง! (นักสมุนไพรที่ยิ่งใหญ่ที่สุดที่ผมเคยพบอายุเกิน 70 ปี ไม่รู้จักแยกซาโปนินกับจานดาวเทียม แต่เป็นผู้รักษาที่น่าทึ่ง)
滋养系统药物(Identifying Relevant Tonics)
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某些草药显示 affinity 与器官、身体系统或特定组织一起发挥作用 tonics 或者 nutrients 适用于相关部分，可自由使用
生物化学考虑 (Biochemical Considerations)
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从药理学的角度 biochemical 可能识别 positive indications 仅适用于某些植物或 contraindications 清晰的
需要熟悉 phytochemistry 和 pharmacology 在一定程度上，但存在局限性 — 效果 materia medica 大部分草药尚不清楚，因为缺乏研究或生物化学已知尚未阐明作用机制
生活方式因素(Lifestyle Factors)
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健康和活力无法仅通过一种治疗方法来管理，无论是草药还是西药 acupuncture 或其他
- Nutrition — 通常是健康的关键，检查患者的饮食：食物种类、烹饪方法、食用方式，不一定需要补充食物
- Structural issues — 必须以适当的方式处理，例如 osteopathy 或整骨疗法，草药不能替代 manipulation 评估运动和活动也很重要——在森林徒步或在海滩上跑步既能锻炼身体，又能提供 nature
- Psychological issues — 情绪问题需要 conscious and compassionate processing 不是 "神奇药丸" 无论草药还是西药
案例研究：选择合适的草药 Selecting Relevant Herbs
Summary: Two case studies illustrate the selection process.
Example 1: A patient with cystitis and irritable bowel syndrome (IBS) — comparing primary actions reveals overlapping needs for anti-inflammatory, astringent, and antispasmodic herbs.
Example 2: A complex of uterine fibroids, PMS, hypertension, and constipation — demonstrating how to create multiple prescriptions addressing both symptoms and root causes.
示例 1：膀胱炎 + 肠易激综合征 Cystitis & IBS
第一步是比较 primary actions 每个患者问题所必需的:
必要的关键药效 — Cystitis vs IBS
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| 功效 | Cystitis | IBS |
|---|---|---|
| Antimicrobial | ✓ 帮助免疫系统控制细菌感染，特别是富含挥发性油的植物利尿 | — |
| Anti-inflammatory | ✓ 缓解疼痛和不适 | ✓ 减少局部粘膜反应 |
| Astringent | ✓ 有助于 hematuria | ✓ 停止腹泻 |
| Diuretic | ✓ 清洁泌尿道（应选择抗菌型） | — |
| Antispasmodic | ✓ 如果疼痛剧烈，可能需要 | ✓ 如果出现严重的抽筋 |
| Bitters | — | ✓ 调节肠道功能 |
| Carminative | — | ✓ 帮助缓解腹胀和胃部不适 |
| Nervine | — | ✓ 缓解根本性压力 |
在两个清单中出现的功效尤为重要: anti-inflammatory, astringent, antispasmodic — 是选择同时具有主要和次要功效的药草的基础
交叉功效表 — 抗炎草药、抗菌草药、缓解痉挛
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以下表格(Tables 12.2–12.4 （在药典中）显示具有主要作用的一种草药，以及增强的次要作用:
Anti-inflammatory Herbs & 辅助作用(Table 12.2)
| 辅助作用 | 草药（学名） |
|---|---|
| Antimicrobial | Achillea, Calendula, Hydrastis, Hypericum, Matricaria, Mentha, Populus, Salvia, Solidago |
| Antispasmodic | Angelica, Apium, Cimicifuga, Dioscorea, Glycyrrhiza, Hypericum, Lavandula, Matricaria, Mentha, Sambucus, Tilia, Viburnum |
| Astringent | Achillea, Aesculus, Agrimonia, Calendula, Geranium, Hydrastis, Plantago, Populus, Salvia, Solidago, Symphytum, Tilia |
| Bitter | Achillea, Agrimonia, Hydrastis, Matricaria, Menyanthes |
| Carminative | Achillea, Angelica, Apium, Glycyrrhiza, Lavandula, Matricaria, Mentha, Salvia, Solidago, Tilia |
| Diuretic | Achillea, Agrimonia, Apium, Galium, Menyanthes, Plantago, Sambucus, Solidago, Tilia, Zea |
| Nervine | Apium, Cimicifuga, Hypericum, Lavandula, Matricaria, Mentha, Tilia, Viburnum |
Antimicrobial Herbs & 辅助作用(Table 12.3)
| 辅助作用 | 草药 |
|---|---|
| Anti-inflammatory | Artemisia absinthium, Calendula, Hypericum, Mentha, Plantago |
| Antispasmodic | Allium, Carum, Hypericum, Mentha, Pimpinella, Rosmarinus, Salvia, Thymus |
| Astringent | Achillea, Arctostaphylos, Carum, Plantago, Rosmarinus, Salvia, Thymus |
| Bitter | Achillea, Artemisia absinthium, Gentiana, Hydrastis, Ruta |
| Carminative | Artemisia, Capsicum, Carum, Juniperus, Mentha, Pimpinella, Rosmarinus, Salvia, Thymus |
| Diuretic | Achillea, Arctostaphylos, Juniperus, Plantago |
| Nervine | Hypericum, Mentha, Rosmarinus |
Antispasmodic Herbs & 辅助作用(Table 12.4)
| 辅助作用 | 草药 |
|---|---|
| Anti-inflammatory | Angelica, Apium, Dioscorea, Glycyrrhiza, Hypericum, Lavandula, Matricaria, Melissa, Mentha, Salvia, Sambucus, Tilia |
| Antimicrobial | Carum, Drosera, Humulus, Hypericum, Lavandula, Matricaria, Mentha, Pimpinella, Rosmarinus, Thymus |
| Astringent | Humulus, Hypericum, Lycopus, Prunus, Rosmarinus, Salvia, Tilia, Viburnum |
| Bitter | Artemisia vulgaris, Humulus, Matricaria |
| Carminative | Angelica, Anethum, Artemisia, Carum, Foeniculum, Humulus, Lavandula, Leonurus, Matricaria, Melissa, Mentha, Petroselinum, Pimpinella, Rosmarinus, Thymus, Valeriana, Zingiber |
| Diuretic | Angelica, Daucus, Lycopus, Petroselinum, Sambucus, Tilia |
| Nervine | Cimicifuga, Eschscholzia, Humulus, Hypericum, Lavandula, Leonurus, Matricaria, Melissa, Mentha, Passiflora, Scutellaria, Tilia, Valeriana, Viburnum |
交叉功效表 — 涩敛药草，苦味，驱风，利尿
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Astringent Herbs & 辅助作用(Table 12.5)
| 辅助作用 | 草药 |
|---|---|
| Anti-inflammatory | Agrimonia, Euphrasia, Filipendula, Geranium, Plantago, Polygonum, Quercus, Solidago |
| Antimicrobial | Achillea, Arctostaphylos, Inula, Quercus, Rosmarinus, Salvia, Solidago |
| Antispasmodic | Lycopus, Prunus, Rosmarinus, Salvia |
| Bitter | Achillea, Agrimonia, Prunus |
| Diuretic | Achillea, Agrimonia, Arctostaphylos, Lycopus, Plantago, Solidago, Verbascum |
| Nervine | Prunus, Rosmarinus |
Bitter Herbs & 辅助作用(Table 12.6)
| 辅助作用 | 草药 |
|---|---|
| Anti-inflammatory | Achillea, Agrimonia, Artemisia absinthium, Hydrastis, Matricaria |
| Antimicrobial | Achillea, Artemisia absinthium, A. vulgaris, Hydrastis, Matricaria |
| Antispasmodic | Marrubium, Matricaria, Ruta |
| Astringent | Achillea, Agrimonia, Hydrastis |
| Carminative | Artemisia absinthium, Matricaria |
| Diuretic | Achillea, Agrimonia |
| Nervine | Artemisia vulgaris, Matricaria |
Carminative Herbs & 辅助作用(Table 12.7)
| 辅助作用 | 草药 |
|---|---|
| Anti-inflammatory | Angelica, Apium, Artemisia absinthium, Matricaria, Melissa, Mentha |
| Antimicrobial | Allium, Artemisia, Humulus, Juniperus, Matricaria, Mentha, Pimpinella, Salvia, Thymus |
| Antispasmodic | Allium, Anethum, Angelica, Artemisia, Carum, Leonurus, Matricaria, Melissa, Mentha, Pimpinella, Salvia, Thymus, Valeriana |
| Astringent | Carum, Humulus, Salvia, Thymus |
| Bitter | Artemisia absinthium, Humulus, Matricaria |
| Diuretic | Angelica, Apium, Juniperus, Petroselinum |
| Nervine | Apium, Humulus, Leonurus, Matricaria, Melissa, Mentha, Valeriana |
Diuretic Herbs & 辅助作用(Table 12.8)
| 辅助作用 | 草药 |
|---|---|
| Anti-inflammatory | Agrimonia, Apium, Eupatorium purpureum, Galium, Iris |
| Antimicrobial | Achillea, Agathosma, Arctostaphylos, Juniperus |
| Astringent | Achillea, Agrimonia, Arctostaphylos, Cytisus, Galium, Lycopus |
| Bitter | Agrimonia, Arctium |
| Nervine | Apium, Lycopus, Tilia |
处方 Cystitis + IBS
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在许多表格中反复出现的草药特别合适。对于这个假设患者的选项:
- Agrimonia eupatoria (agrimony)
- Angelica archangelica (angelica)
- Arctostaphylos uva-ursi (bearberry)
- Humulus lupulus (hops)
- Hydrastis canadensis (goldenseal)
- Matricaria recutita (chamomile)
- Melissa officinalis (lemon balm)
- Viburnum opulus (cramp bark)
处方
| 草药 | 部分(parts) |
|---|---|
| Arctostaphylos uva-ursi | 2 |
| Viburnum opulus | 1 |
| Agrimonia eupatoria | 2 |
| Angelica archangelica | 1 |
| Humulus lupulus | 1 |
| Hydrastis canadensis | 1 |
Dosage: 酊剂至5 ml 每日3次
建议饮用 infusion 的 Matricaria recutita (chamomile) 或者 Melissa officinalis (lemon balm) 经常全天
处方药的功效（Table 12.9)
| 功效 | 草药处方 |
|---|---|
| Diuretic | Agrimonia, Angelica, Arctostaphylos |
| Antimicrobial | Arctostaphylos, Humulus, Hydrastis |
| Astringent | Agrimonia, Hydrastis, Viburnum |
| Bitter | Agrimonia, Humulus, Hydrastis, Matricaria |
| Anti-inflammatory | Agrimonia, Angelica, Hydrastis, Matricaria, Melissa |
| Carminative | Angelica, Humulus, Matricaria, Melissa |
| Antispasmodic | Angelica, Humulus, Matricaria, Melissa, Viburnum |
| Nervine | Humulus, Matricaria, Melissa, Viburnum |
调整处方:
- 强调泌尿系统 — 增加比例 Arctostaphylos 或增加 Agathosma betulina (buchu) + 草药 demulcent 例如 Zea mays (cornsilk) 或者 Althaea (marshmallow)
- 侧重肠易激综合征 — 增加草药 bitter carminative 例如 Artemisia vulgaris (mugwort) 或者 astringent 例如 Filipendula (meadowsweet)
- 强调焦虑 — 添加镇静剂如 Valeriana officinalis (valerian)
例子 2：复杂综合征 A Complex of Conditions
这个假设患者有 uterine fibroids, PMS, hypertension 和 constipation
每种症状所需的功效（Table 12.10)
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| 症状 | 信号/症状 | 所需功效 |
|---|---|---|
| Uterine fibroids | Dysmenorrhea | Antispasmodic, uterine tonic, hormonal normalizer |
| Menorrhagia (可能患有贫血) | Astringent, uterine tonic, hormonal normalizer | |
| 腹腔积液 | Diuretic, uterine tonic, hormonal normalizer, lymphatic, circulatory stimulant, peripheral vasodilator | |
| PMS | 心理症状（易怒、烦躁、疲劳、抑郁、心悸） | Nervine relaxant, hormonal normalizer |
| 神经系统症状（头痛、眩晕） | Nervine relaxant, hormonal normalizer | |
| Edema | Diuretic, hormonal normalizer | |
| 皮肤问题 | Alterative, hormonal normalizer | |
| Hypertension | 常无症状 | Hypotensive |
| Constipation | 排便困难或不频繁 | Laxative |
功效分类：缓解症状 vs 基础治疗(Table 12.11)
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| 主要缓解症状 | 基本治疗作用 |
|---|---|
| Antispasmodic | Uterine tonic |
| Astringent | Hormonal normalizer |
| Nervine relaxant | Alterative |
| Diuretic | Lymphatic |
| Hypotensive | Circulatory stimulant |
| Laxative | Peripheral vasodilator |
第一类草药（缓解症状）取决于患者的病症表现——第二类（基础治疗）对治疗过程更重要
草药选择和禁忌（Table 12.12)
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| 功效 | 选定的草药 |
|---|---|
| Antispasmodic | Dioscorea villosa, Cimicifuga racemosa, Viburnum prunifolium |
| Astringent | Vinca major, Geranium maculatum, Achillea millefolium |
| Nervine relaxant | Scutellaria spp., Tilia platyphyllos, Leonurus cardiaca |
| Diuretic | Taraxacum officinale, Galium aparine, Achillea millefolium |
| Hypotensive | Crataegus spp., Tilia spp., Achillea millefolium |
| Laxative | Rumex crispus |
| Uterine tonic | Mitchella repens, Caulophyllum thalictroides |
| Hormonal normalizer | Vitex agnus-castus |
| Alterative / Lymphatic | Cimicifuga racemosa, Galium aparine, Rumex crispus |
| Circulatory stimulant | Zanthoxylum americanum |
重要的禁忌: 泻药类 anthraquinone 例如 senna — 过度刺激腹部肌肉会导致子宫痉挛加重
需要系统的身体 tonic support:
- Reproductive
- Nervous
- Cardiovascular
- Digestive
用于复杂综合征的处方
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处方1: Fibroids + Hypertension + Constipation
| 草药 | 部分(parts) |
|---|---|
| Vinca major | 2 |
| Dioscorea villosa | 2 |
| Caulophyllum thalictroides | 1 |
| Vitex agnus-castus | 1 |
| Rumex crispus | 1 |
| Crataegus spp. | 1 |
| Galium aparine | 1 |
| Tilia spp. | 1 |
| Viburnum opulus | 1 |
Dosage: 酊剂 5 ml 每日3次
处方2: PMS
| 草药 | 部分(parts) |
|---|---|
| Scutellaria lateriflora | 2 |
| Cimicifuga racemosa | 1 |
Dosage: 酊剂5–15 ml 根据症状需要 PMS
来自两个处方的功效Table 12.13)
| 功效 | 草药 |
|---|---|
| Uterine tonic | Caulophyllum, Cimicifuga |
| Uterine astringent | Vinca |
| Alterative | Galium, Cimicifuga, Caulophyllum |
| Antispasmodic | Cimicifuga, Scutellaria, Tilia, Viburnum |
| Lymphatic | Galium |
| Nervine | Scutellaria, Tilia, Cimicifuga |
| Diuretic | Galium, Crataegus, Tilia |
| Hormonal normalizer | Vitex |
| Hypotensive | Crataegus, Tilia, Viburnum |
最终步骤是确定 other healing modalities and lifestyle changes 以支持草药的功效