CN104352641B - 治疗高热擦浴退温外用中药制剂及其制备方法 - Google Patents
治疗高热擦浴退温外用中药制剂及其制备方法 Download PDFInfo
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Abstract
本发明公开了一种疗效更好的治疗高热擦浴退温外用中药制剂及其制备方法。本发明药物冰片、薄荷、荆芥、防风、紫苏、蝉蜕、桑叶、僵蚕、颠茄叶、白曼陀罗、桂枝、麻黄、细辛、菊花、辛夷、香薷、羌活、川穹进行组合制成的，将这些药物组合使得各药物功效产生协同作用，从而有效地共同促进血液循环、加速血流体表，挥发带走热量之效。本发明药物既符合祖国医学辨证论治的原则，又有现代药理研究支持，故疗效显著；且无毒副作用，远期疗效稳定，使用方便，值得推广应用。
Description
技术领域
本发明属于中医中药技术领域，具体涉及一种治疗高热擦浴退温外用中药制剂及其制备方法。
背景技术
高热病在临床上属于危重症范畴。以体温在39℃以上，伴有心烦口干，尿赤便秘，舌红苔黄、脉数为主症的多种急性发热疾病，持续高热会加重人体各器官的负担，使代谢加快，耗氧量增加，发生自身蛋白质的破坏而致消瘦；脂肪代谢发生紊乱而致酮血症；脑皮质兴奋、抑制功能失调，消化液分泌减少，消化酶活力降低，胃肠功能紊乱等，最终导致人体防御能力下降，各器官功能衰竭；高热可诱发小儿惊厥，体温升高39℃时发生的惊厥，主要表现为突然发生的全身或局部肌群的强直性或阵挛性抽搐，双眼球凝视、斜视、发直或上翻，伴意识丧失。
高热病在临床中除用药物进行降温外，物理降温为最有效、最直接的降温方法。临床上常单用酒精擦浴、温水擦浴、冷敷等方法降温，但是效果仍不明显，降温效果不持久，容易出现寒战、冻伤等副作用，易反复发作。而中药制剂在高热降温方面具有非常独特的优势，多种中药组合使得各药物功效产生协同作用，不仅降温快，还能消除高热带来的头痛、全身肌肉关节痛等，降温持久，作用温和、安全，能降低不良反应的产生。因此，寻找一种安全有效、应用方便、降温持久、迅速的中药制剂成为高热患者的迫切需要。
发明内容
本发明的目的在于提供一种标本兼治、副作用小，降温持久、迅速，复发率低，能够更为有效进行物理降温的治疗高热擦浴退温外用中药制剂及其制备方法。
本发明药物组成份的用量是发明人经过长期大量摸索总结得来的，各组份用量在下述重量份都具有较好的疗效：
冰片10～15份、薄荷15～30份、荆芥15～30份、防风15～30份、紫苏15～30份、蝉蜕15～30份、桑叶15～30份、僵蚕30～45份、颠茄叶15～30份、白曼陀罗10～15份、桂枝15～30份、麻黄15～30份、细辛5～10份、菊花15～30份、辛夷15～30份、香薷15～30份、羌活30～50份、川穹15～30份。
本发明药物选择冰片、薄荷、荆芥、防风、紫苏、蝉蜕、桑叶、僵蚕、颠茄叶、白曼陀罗、桂枝、麻黄、细辛、菊花、辛夷、香薷、羌活、川穹进行组合，将这些药物组合使得各药物功效产生协同作用，从而有效地共同促进血液循环、加速血流体表，挥发带走热量之效。
祖国医学对“发热”的认识：有壮热、潮热之分。壮热指高热（体温在39℃以上）持续不退，不恶寒只恶热的症状。常兼面赤、口渴、大汗出、脉洪大等症。中医临床分五种类型：①多因风热内传，或风寒入里化热，正邪相搏，阳热炽盛，蒸达于外所致。②多见于伤寒阳明经证和温病气分阶段，属里实热证；③潮热指按时发热，或按时热势加重，如潮汐之有定时的症状。④胃肠燥热内结，阳明经气旺于申时，正邪斗争剧烈，故在此时热势加重。⑤或见于瘀血积久，郁而化热者。
中医治疗采用辛凉、辛温解表之法：冰片透达；荆芥、防风蝉蜕、细辛、辛夷、香薷、僵蚕辛温散寒，疏风解表，透热外出；柴胡、薄荷疏表退热；川芎活血散风；羌活、独活祛风散寒；麻黄，桂枝祛寒解表；银花、连翘辛凉透表，清热解毒；桑叶、菊花清利头目；紫苏具有刺激皮肤汗腺分泌又具有挥发性，挥发时可带走机体内大量热量。颠茄叶、白曼陀罗扩张外周血管，改善血液循环，增加外周血流量，带走更多的热量。
本发明药物既符合祖国医学辨证论治的原则，又有现代药理研究支持，故疗效显著；且无毒副作用，远期疗效稳定，使用方便，值得推广应用。
具体实施方式
本发明所述治疗高热擦浴退温外用中药制剂中各组分的重量份配比在下述范围内都具有较好的疗效：冰片10～15份、薄荷15～30份、荆芥15～30份、防风15～30份、紫苏15～30份、蝉蜕15～30份、桑叶15～30份、僵蚕30～45份、颠茄叶15～30份、白曼陀罗10～15份、桂枝15～30份、麻黄15～30份、细辛5～10份、菊花15～30份、辛夷15～30份、香薷15～30份、羌活30～50份、川穹15～30份。
实施例1：本发明是由下列重量份的原药制成的：冰片10份、薄荷15份、荆芥15份、防风15份、紫苏15份、蝉蜕15份、桑叶15份、僵蚕30份、颠茄叶15份、白曼陀罗10份、桂枝15份、麻黄15份、细辛5份、菊花15份、辛夷15份、香薷15份、羌活30份、川穹15份。
实施例2：本发明是由下列重量份的原药制成的：冰片15份、薄荷30份、荆芥30份、防风30份、紫苏30份、蝉蜕30份、桑叶30份、僵蚕45份、颠茄叶30份、白曼陀罗15份、桂枝30份、麻黄30份、细辛10份、菊花30份、辛夷30份、香薷30份、羌活50份、川穹30份。
实施例3：本发明是由下列重量份的原药制成的：冰片13份、薄荷23份、荆芥23份、防风23份、紫苏23份、蝉蜕23份、桑叶23份、僵蚕38份、颠茄叶23份、白曼陀罗13份、桂枝23份、麻黄23份、细辛8份、菊花23份、辛夷23份、香薷23份、羌活40份、川穹23份。
为得到上述治疗高热擦浴退温外用中药制剂，其制备方法如下：取置容器，将上述重量份的中药薄荷、荆芥、防风、紫苏、蝉蜕、桑叶、僵蚕、颠茄叶、白曼陀罗、桂枝、麻黄、细辛、菊花、辛夷、香薷、羌活、川穹洗净晾干、混合，放入容器内，再往容器内倒入50%酒精2000ml，上述酒精的量以浸没上述药物为准，侵泡七天后捞出上述药物弃之，将上述重量份的冰片粉碎倒入容器中摇匀即得所述外用中药制剂。
使用方法：取该中药制剂200ml,加入50℃温水100ml混匀。将小毛巾浸入中药制剂中，拧至半干，缠于手上成手套状，以离心的方向擦拭患者皮肤，边擦边按摩。擦浴顺序依次为颈部外侧、上肢、腋下、侧胸、背部、腹股沟、臀部、下肢。禁擦后项、胸前区、腹部和足底。在颈部两侧、腋窝、肘窝、手心、腹股沟、腘窝等血管丰富处适当延长擦浴时间，以促进散热。擦浴时间共计20分钟。
临床观察资料
（一）本发明药物主要功能与治疗范围
1、主要功能：
清凉、解毒、疏风、散热
2、治疗范围：
适用于感染性和非感染性发热，体温在39～41℃。感冒、中暑、脑血管意外、病毒性脑炎、结核性脑病等。
本发明药物的临床观察资料
1、一般资料
收治住院高热（体温T：39～41℃）患者103例，随机将患者分为两组，治疗组52例，给予本发明物理降温，对照组51例，给予采用医用酒精擦浴；其中年龄最小2岁，最大75岁，病程最短30分钟，最长20天，临床治疗观察，最短10分钟，最长两天。两组患者在平均年龄、病程、病情无显著差异。
2、诊断标准
全部病例体温都在39℃以上。
3、疗效评定标准
痊愈：体温下降至37.5℃以下，且不再复热；
显效：体温下降至37.5℃以下；再次发热
有效：体温37.5℃～38.5℃；
无效：体温39℃以上；
4、治疗方法
治疗方法是在患者或家属自愿前提下，随机将患者分为两组，治疗组52例，使用本发明中药制剂擦浴；对照组51例，使用医用酒精物理降温。
5.统计结果
治疗组52例中，痊愈38例，占73.07％；显效10例，占19.23％；有效3例，占5.76％；无效1例，占1.92％；总有效率98.07％。对照组51例中痊愈31例，占60.78％；显效16例，占31.37％；有效3例，占5.88％；无效2例，占3.92％；总有效率96.07％。两组总有效率比较P＜0.01
表1两种方法物理降温前后对比
| 分组 | 例数 | 痊愈 | 显效 | 进步 | 无效 | 总有效率 | |
| 1 | 酒精组 | 51 | 31 | 16 | 3 | 2 | 96.07% |
| 2 | 本发明组 | 52 | 38 | 10 | 3 | 1 | 98.07% |
表2
| 病种 | 降温前体温 | 降温后体温 | t值 | P值 |
| 脑血管意外 | 39.5±0.41 | 37.3±0.12 | 2.467 | ＜0.05 |
| 病毒性脑炎 | 40.2±0.78 | 37.1±0.11 | 3.421 | ＜0.05 |
| 结核性脑病 | 40.1±0.46 | 37.2±0.23 | 2.67 | ＜0.05 |
两组总有效率比较P＜0.01，有显著差异。
从表1中可以看出治疗组疗效明显优于对照组（p＜0.01）。
典型病例
病例1：
张某，男，47岁。因开会时生气，随出现左侧肢体偏瘫，昏迷2h，由急诊收入病房。入院后经脑CT检查: 基底节区脑出血: 41mL。入院第3天体温升高，渐至40.1℃以上，在39.5～40.1℃之间，伴见面红目赤，身热气粗，口噤口臭，无汗，腹胀便闭，舌红，苔黄，脉滑数。查体：神昏，颈强，双侧瞳孔等大等圆，对光反射存在，心率102 次/min，律齐，肝、肺无异常。神经系统检查:右侧肢体生理反射减低，病理反射未引出。左侧肢体检查正常。中医辨证为阳明腑实证。给予本发明物理降温上午8时使用，下午1时体温开始下降，半小时后测体温38.5℃，至下午3时体温降至37.5℃。
病例2：
李某，17岁，男，学生。2010年1月9日入院。近2个月来不明原因发热，热型不规则：最高体温41℃，但无相应热病面容，面色如常，四肢肤冷，额头略有热感，退烧时亦无大汗出，仅额头少许液，发热时伴头痛隐隐 恶心欲吐，尿频尿急尿痛，退后以上症状消失。患者发热特点及伴随症状同前，口干而苦，素来大便干结，夜寐尚可，纳谷一般，舌红，苔或黄或白厚腻，脉弦滑。服用中药拟祛风解表，清热解毒，养阴润肠通便一付。再给予本发明物理降温，上午10时使用，下午16时体温开始下降，半小时后测体温39℃，至下午19时体温降至37.7℃。
病例3：
李某，男性，45岁。主诉“反复高热3周余”，2011年9月13日15：00初诊。患者自诉2011年8月21日以来无明显诱因出现发热，查：39.5℃，血常规未见明显异常。C反应蛋白28mg／L，病毒(一)，衣原体(一)，布什菌(一)。予西药(具体不详）治疗无效。2011年8月31 日复查血常规：白细胞5*109/L，淋巴细胞0.62，中性细胞O.29。自服退热药后汗出，体温略有下降。但转而又发热，自觉每晚7：00～8：00热起，晚10：00左右体温最高达40℃。刻诊：T：39℃，夜间加重，伴恶寒，头痛，手足凉，身痛，咳嗽，无恶心，无咽痛，无汗出，纳可，睡眠一般，二便尚调。查浅表淋巴结无肿大，舌胖色暗红，苔薄白腻，脉浮细濡数。西医诊断：发热原因待查。中医诊断：高热，证属外感寒邪、内有湿阻、郁而发热。治法：解表散寒、祛湿除热。方用麻黄加术汤：生麻黄10g，炒杏仁10g，桂枝10g，甘草10g，麸炒苍术15g。3剂内服。配合给予本发明物理降温1次/1小时，患者服后觉周身汗出，发热已退，疼痛大减，偶有咳嗽，疲乏，舌红，苔薄白，脉转为缓象。继予人参败毒散善后调理。1周后随访，热退、咳减、疲乏消失，宛若常人。
Claims (2)
1.一种治疗高热擦浴退温外用中药制剂，其特征在于所述治疗高热擦浴退温外用中药制剂是由下列重量份的原药制成的：冰片10～15份、薄荷15～30份、荆芥15～30份、防风15～30份、紫苏15～30份、蝉蜕15～30份、桑叶15～30份、僵蚕30～45份、颠茄叶15～30份、白曼陀罗10～15份、桂枝15～30份、麻黄15～30份、细辛5～10份、菊花15～30份、辛夷15～30份、香薷15～30份、羌活30～50份、川穹15～30份。
2.一种如权利要求1所述治疗高热擦浴退温外用中药制剂的制备方法，其特征在于该制备方法如下：取置容器，将上述重量份的中药薄荷、荆芥、防风、紫苏、蝉蜕、桑叶、僵蚕、颠茄叶、白曼陀罗、桂枝、麻黄、细辛、菊花、辛夷、香薷、羌活、川穹洗净晾干、混合，放入容器内，再往容器内倒入50%酒精2000ml，上述酒精的量以浸没上述药物为准，浸 泡七天后捞出上述药物弃之，将上述重量份的冰片粉碎倒入容器中摇匀即得所述治疗高热擦浴退温外用中药制剂。
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