2010年10月20日 星期三

苦瓜治糖尿,是真是假?

苦瓜: Bitter Melon
學名:Momordica charantia
英文:Balsam pear,Bitter Melon, Bitter gourd

首先介紹中醫對苦瓜的認識。
別名:涼瓜, “君子菜” (因苦瓜雖苦,卻從不會把苦味傳給“別人”,如用苦瓜燒魚,魚塊絕不沾苦味,所以有這雅稱。)
原產亞洲熱帶地區,廣泛分佈於熱帶、亞熱帶和溫帶 印度、日本以及東南亞地區栽培歷史久遠,中國栽培歷史約600年。
苦瓜氣味苦、無毒、性寒,入心、肝、脾、肺經;具有清熱祛暑、明目解毒、利尿涼血、解勞清心、益氣壯陽之功效;主治中暑、暑熱煩渴、暑癤、痱子過多、目赤腫痛、癰腫丹毒、燒燙傷、少尿等病症。我找不到傳統中醫用苦瓜治糖尿病的文獻。
注 意事項 : 苦瓜性涼,食苦味食品不宜過量,多食易傷脾胃,過量易引起噁心、嘔吐等,所以脾胃虛弱的人更要少吃苦瓜。苦瓜仁(籽) 味苦甘,卻可“益氣壯陽”。 此處壯陽,殆指腎火積熱,房事一觸即洩,得苦瓜仁散其邪熱,性事反得平衡而復正常,故能壯陽。 若體弱虛寒的陽痿,服之益增其痿矣。
一般傳言說苦瓜含奎寧Quinine,會刺激子宮收縮,引起流產,因此孕婦慎食。但研究顯示奎寧Quinine並沒有引起流產的功效,過量只能毒傷腎臟和引致死亡 。

苦瓜在印度一向是民間用來治療2型糖尿病的。在實驗研究用的2型糖尿白老鼠,已證實苦瓜能提高2型糖尿病鼠對胰島素的敏感,減低糖尿病的病狀(如口乾多飲水,多尿和尿中有糖份),並降低空腹血糖和胰島素的水平。即是說,苦瓜能治療有2型糖尿病的白老鼠。

苦瓜如何達到這效果呢?它可能有數個機制去降血糖,但其中一個現今較清楚的是,苦瓜有四種化學物,可能有類似胰島素作用的化學物,能刺激肌肉細胞和脂肪細胞表面的「胰島素接受體」,來提升細胞裏一個蛋白 AMP-Activated Kinase(AMPK),而這AMPK會使細胞造出更多的「葡萄糖轉運體4 」Glucose Transporter-4 (GLUT-4),放置在細胞表面。顧名思義,這GLUT-4是負責讓血糖從血液中轉運(滲進)細胞,而當身體的肌肉和脂肪細胞都多些GLUT-4,則血液中糖份自然下降,從而改善了糖尿病。

那麼苦瓜對2型糖尿病病人的效果又如何呢?根據Cochrane Library的數據,在較大型的隨機、臨牀測試中,暫時苦瓜的作用與安慰劑無異,即未能證明療效,並提議需要更多觀察研究Observational Study。

對 各位2型糖尿病的患者,又希望苦瓜能幫助改善病況的,有何實用的建議呢?有,你可以多食苦瓜,天天吃也無大礙,實驗老鼠吃下大劑量的苦瓜也不見在肝腎的損 傷,正常的飲食量應該是安全的。若天天吃苦瓜,2型糖尿病會否改善?可能會,但苦瓜並不能取代你現時所吃的糖尿藥。若多食苦瓜後而經醫生檢查和抽血,發現 糖尿有改善,可能有減少用藥的空間。

不過,就算苦瓜被臨牀證實有改善2型糖尿病,也只不過是把過多的糖份從血液運到肌肉細胞中儲存,但這 「貨倉」也有飽和,甚至滿瀉的一日,到那刻糖尿又可能再惡化。而對付2型糖尿病,更重要的是戒口和做運動,因為做運動是提升AMPK和「葡萄糖轉運體4 」 GLUT-4的快捷方法,證實能改善糖尿病。而運動亦會燒耗了肌肉中的糖份,使它能源源不絕的去「吸」糖。做運動加上適當的戒口,才是治理2型糖尿病的「王道」,用藥和食療,假如有效,也只是輔助的方法而已。

"Antidiabetic Activities of Triterpenoids Isolated from Bitter Melon Associated with Activation of the AMPK Pathway". Chemistry & Biology 15 (3): 263–273.

Four cucurbitane glycosides, momordicosides Q, R, S, and T, and stereochemistry-established karaviloside XI, were isolated from the vegetable bitter melon (Momordica charantia). These compounds and their aglycones exhibited a number of biologic effects beneficial to diabetes and obesity. In both L6 myotubes and 3T3-L1 adipocytes, they stimulated GLUT4 translocation to the cell membrane—an essential step for inducible glucose entry into cells. This was associated with increased activity of AMP-activated protein kinase (AMPK), a key pathway mediating glucose uptake and fatty acid oxidation. Furthermore, momordicoside(s) enhanced fatty acid oxidation and glucose disposal during glucose tolerance tests in both insulin-sensitive and insulin-resistant mice. These findings indicate that cucurbitane triterpenoids, the characteristic constituents of M. charantia, may provide leads as a class of therapeutics for diabetes and obesity.

"Antihyperglycemic effects of three extracts from Momordica charantia" J Ethnopharmacol 88 (1): 107–11.

Momordica charantia (L.) (Cucurbitaceae) commonly known as bitter gourd or karela is a medicinal plant, used in Ayurveda for treating various diseases, one of which is diabetes mellitus. In this study, various extract powders of the fresh and dried whole fruits were prepared and their blood glucose lowering effect compared by administrating them orally to diabetic rats. The aqueous extract powder of fresh unripe whole fruits at a dose of 20 mg/kg body weight was found to reduce fasting blood glucose by 48%, an effect comparable to that of glibenclamide, a known synthetic drug. This extract was tested for nephrotoxicity, hepatotoxicity and biochemical parameters such as SGOT, SGPT and lipid profile. The extract did not show any signs of nephrotoxicity and hepatotoxicity as judged by histological and biochemical parameters. Thus the aqueous extract powder of Momordica charantia, an edible vegetable, appears to be a safe alternative to reducing blood glucose.


"Effect of bitter gourd (Momordica charantia) on glycaemic status in streptozotocin induced diabetic rats". Plant Foods Hum Nutr. 60 (3): 109–12.

Bitter gourd (Momordica charantia), a commonly consumed vegetable is used as an adjunct in the management of diabetes mellitus. A study was carried out to examine the effect of edible portion of bitter gourd at 10% level in the diet in streptozotocin induced diabetic rats. To evaluate the glycaemic control of bitter gourd during diabetes, diet intake, gain in body weight, water intake, urine sugar, urine volume, glomerular filtration rate and fasting blood glucose profiles were monitored. Water consumption, urine volume and urine sugar were significantly higher in diabetic controls compared to normal rats and bitter gourd feeding alleviated this rise during diabetes by about 30%. Renal hypertrophy was higher in diabetic controls and bitter gourd supplementation, partially, but effectively prevented it (38%) during diabetes. Increased glomerular filtration rate in diabetes was significantly reduced (27%) by bitter gourd. An amelioration of about 30% in fasting blood glucose was observed with bitter gourd feeding in diabetic rats. These results clearly provided experimental evidence that dried bitter gourd powder in the diet at 10% level improved diabetic status signifying its beneficial effect during diabetes.

"Bitter gourd (Momordica Charantia): A dietary approach to hyperglycemia". Nutr Rev. 64 (7 Pt 1): 331–7.

Bitter gourd (Momordica charantia) is a vegetable with pantropical distribution. It contains substances with antidiabetic properties such as charantin, vicine, and polypeptide-p, as well as other unspecific bioactive components such as antioxidants. Metabolic and hypoglycemic effects of bitter gourd extracts have been demonstrated in cell culture, animal, and human studies. The mechanism of action, whether it is via regulation of insulin release or altered glucose metabolism and its insulin-like effect, is still under debate. Adverse effects are also known. Nevertheless, bitter gourd has the potential to become a component of the diet or a dietary supplement for diabetic and prediabetic patients. Well-designed interdisciplinary research by nutritionists, medical doctors, and agronomists is needed before a dietary recommendation can be given and a product brought to the market.

"Hypoglycemic activity of the fruit of the Momordica charantia in type 2 diabetic mice". J Nutr Sci Vitaminol (Tokyo) 47 (5): 340–4.

The antidiabetic activity of Momordica charantia L. (Cucurbitaceae) was investigated in KK-Ay mice, an animal model with type 2 diabetes with hyperinsulinemia. The water extract of the fruit of Momordica charantia L. (MC) reduced the blood glucose of KK-Ay mice 3 weeks after oral administration (p<0.01) and also significantly lowered the serum insulin of KK-Ay mice under similar conditions (p<0.01). However, MC did not affect the blood glucose in normal mice. MC-treated KK-Ay mice blood glucose significantly decreased in an insulin tolerance test. Moreover, the muscle content of facilitative glucose transporter isoform 4 (GLUT4) protein content in the plasma membrane fraction from muscle significantly increased in the orally MC-treated mice when compared with that of the controls (p<0.01). These results suggest that the antidiabetic effect of MC is derived, at least in part, from a decrease in insulin resistance because of the increase of GLUT4 protein content in the plasma membrane of the muscle.


"Slow Acting Protein Extract from Fruit Pulp of Momordica charantia with Insulin Secretagogue and Insulinomimetic Activities." Biological & Pharmaceutical Bulletin
Vol. 29 (2006) , No. 6 1126

The protein from Thai bitter gourd (Momordica charantia) fruit pulp was extracted and studied for its hypoglycemic effect. Subcutaneous administration of the protein extract (5, 10 mg/kg) significantly and markedly decreased plasma glucose concentrations in both normal and streptozotocin-induced diabetic rats in a dose-dependent manner. The onset of the protein extract-induced antihyperglycemia/hypoglycemia was observed at 4 and 6 h in diabetic and normal rats, respectively. This protein extract also raised plasma insulin concentrations by 2 fold 4 h following subcutaneous administration. In perfused rat pancreas, the protein extract (10 μg/ml) increased insulin secretion, but not glucagon secretion. The increase in insulin secretion was apparent within 5 min of administration and was persistent during 30 min of administration. Furthermore, the protein extract enhanced glucose uptake into C2C12 myocytes and 3T3-L1 adipocytes. Time course experiments performed in rat adipocytes revealed that M. charantia protein extract significantly increased glucose uptake after 4 and 6 h of incubation. Thus, the M. charantia protein extract, a slow acting chemical, exerted both insulin secretagogue and insulinomimetic activities to lower blood glucose concentrations in vivo.

Cochrane Database Syst Rev. 2010 Feb 17;2:CD007845.
Momordica charantia for type 2 diabetes mellitus.

Abstract
BACKGROUND: Momordica charantia is not only a nutritious vegetable, but is also used in traditional medical practices­ to treat type 2 diabetes mellitus. Experimental studies with animals and humans suggested that the vegetable has a possible role in glycaemic control.
OBJECTIVES: To assess the effects of mormodica charantia for type 2 diabetes mellitus.
SEARCH STRATEGY: Several electronic databases were searched, among these The Cochrane Library (issue 4, 2009), MEDLINE, EMBASE, CINAHL, SIGLE and LILACS (all up to November 2009), combined with handsearches. No language restriction was used.
SELECTION CRITERIA: Randomized controlled trials that compared momordica charantia with a placebo or a control intervention with or without pharmacological or non-pharmacological interventions were included.
DATA COLLECTION AND ANALYSIS: Two authors independently extracted the data. Risk of bias of trials was evaluated using the parameters of randomization, allocation concealment, blinding, completeness of outcome data, selective reporting and other potential sources of bias. A meta-analysis was not performed given the quality of data and the variability of preparations of momordica charantia used in interventions (no similar preparation was tested twice).
MAIN RESULTS: Three randomised controlled trials with up to three months duration and investigating 350 participants met the inclusion criteria. Risk of bias of these trials (only one study was published as a full peer-reviewed publication) was generally high. Two RCTs compared the effect of preparations from different parts of the momordica charantia plants and placebo on the glycemic control in type 2 diabetes mellitus. There was no statistically significant difference compared to placebo. The effects of preparation from the leaves of the plant and glibenclamide were comparable in the third trial. No serious adverse effects were reported in all the trials. There were no documentations of death from any cause, morbidity, (health-related) quality of life and costs.
AUTHORS' CONCLUSIONS: There is insufficient evidence to recommend momordica charantia for type 2 diabetes mellitus. Further studies are therefore required to address the issues of standardization and the quality control of preparations. For medical nutritional therapy, further observational trials evaluating the effects of momordica charantia are needed before RCTs are established to guide any recommendations in clinical practice.
PMID: 20166099 [PubMed - indexed for MEDLINE]

2010年10月15日 星期五

肝炎

肝炎是一個很常見的病,對市民的健康有極大影響,很值得從中西角度來認識,和中西醫互相學習。

顧名思意,肝炎便是肝臟發生炎證 (Inflammation)。為何會發生呢?很多人都知道有甲型肝炎病毒和乙型肝炎病毒,它們亦是最流行的肝炎病毒,但亦只是五類肝炎病毒中的頭兩類,還有丙、丁和戊型,另外如腮腺炎病毒(Mumps)、德國的疹病毒(Rubella)、EB病毒等,均可引致肝炎。除病毒引起之肝炎外,最常見的原因便是酒精所引致的(Alcoholic Hepatitis),在西方衞生情況較好的地方,酒精是引起肝炎的主因,在衞生條件較差的地方,則是甲和乙型肝炎病毒。脂肪肝是肥胖人士發生肝炎的重要因素,其他肝炎原因有藥物(中、西藥均會)、鐵質過多(Haemochromatosis)、免疫系統出毛病(Auto Immune Hepatitis)等。

不同的肝炎病毒會有不同的傳播途徑、潛伏期、發病時間、病狀和預後。以最常見的甲型為例,甲型肝炎是糞口傳播(faecal-oral),即是食了受糞便污染的食物。乙型肝炎病毒則是與被感染的人的血和精液接觸,通過皮膚上的傷口或粘膜而進入,高危因素包括不安全性交、靜脈注射毒品、受污染的醫療器械、 帶菌母親生育時傳及親生兒等。

病毒引起的肝炎發病有急性和慢性之分。急性肝炎首先便有一般病毒發病之徵狀(如疲倦,周身酸痛,關節痛,發燒,頭痛),這些病狀一般人錯誤了解為「感 冒」。實則「感冒」是病毒性上呼吸道感染,故應還有咳、痰、鼻水、咽喉不適等。肝炎還多有腸胃之問題,如胃口差、肚瀉、嘔吐等。不久便有肝發炎之像,如小便 深色如茶(Tea color urine)、胃口極差、煙民連煙也不想吸、眼白先變黃色(Jaundice)、繼而皮膚也染上黃色等,檢查身體可見肝、脾發脹。眼白與皮膚發黃是因身體膽紅素(Bilirubin)不正常的積聚,小便茶色則是因膽紅素從小便排出。

慢性肝炎可能沒病狀,只有驗血時才發現,亦可出現急性肝炎之狀,病狀不過一般也是較輕微,但不等於不危險。慢性肝炎「拖」得夠耐,對肝影響很大,可出現肝腫脹、肝硬化(因肝有很多疤痕)、腹水脹 (Ascites) 和全人水腫(因肝不能做足夠蛋白質(Albumin)去吸住血管裏的水液)和出血傾向(因肝負責製造凝血酶)等。

從 預後來說,甲型肝炎是較好的。雖然統計每年有一千萬人染上甲型肝炎,發病和復元後是沒有慢性肝炎這後遺症,死亡率約為千分之四,兒童發病病情亦較成年人為 輕,小孩約一個月便復元,成年人則較嚴重和長久,要完全復元可能要數月時間。乙型肝炎的預後,則十分視乎受感染的時間,成年人才受感染的話,九成 以上會出現病狀,數月後大多完全復元和體內出現抗體,即以後有免疫力對付乙型肝炎病毒。有一成的成人受感染者也會有慢性肝炎和長期帶菌。可惜小孩,尤其是嬰兒,因他們的免疫系統尚未成熟,若從母體受感染,身體不識對抗乙肝病毒,因此新生兒有九成機會變成長期乙型肝炎病毒帶菌者,而這批長期帶菌者,當中接近四分一有機會死於肝硬化、肝癌等併發症。這批人有多少呢?單單在香港,長期帶菌者佔了成年人的十分之一,約五十萬, 全港每年有 肝癌新症大約1,700宗,九成 50歲以上, 若推算到中國的人口,數目大得驚人。

傳統中醫又如何理解和治療肝炎呢?可以肯定的是,以往衞生條件更差,肝炎(甲和乙型病毒肝炎)數目比現在更多,故中醫治療肝炎一定經驗豐富 ,不過也不可能分出那一型病毒或急性慢性型。 急性肝炎發病時多數有腸胃不適、全身乏力等病癥,中醫從病狀角度來看,是濕邪為患,而腸胃屬脾,故中醫對急性肝炎的分析多從濕熱和肝脾來辨證,如「濕阻脾胃」, 「肝郁氣滯」等。若肝炎發病有出現眼白變黃時,中醫便從「黃疸病」來辨證治療。早在《素問.平人氣象論篇》說「溺黃赤安卧者,黃疸……目黃者曰黃疸」,《諸病源侯論》則根據不同病況而把黃疸病分成二十八種證候,可說十分詳細。當然,肝炎只是黃疸的其中一類原因,中醫的黃疸病絕不等同肝炎。對黃疸病,教科書則分成「陽黃」(即黃色中鮮明如橘)色和「陰黃」(色黃而晦黯不鮮明),「陽黃」中再細分熱象明顯或是濕象較多。有趣 的是西醫亦觀察到不同程度的黃,例如黃色中帶檸檬色是溶血病引起,黃中帶橙色是肝病引起,黃中帶綠是膽管阻塞性引起的。

慢性肝炎病程一般是半年以上,反複出現疲倦、胃口差、腹瀉、頭暈等,中醫相信久病則虛,故以濕熱、脾虛、肝郁出發點來辨證,若病況的寒熱較明顯,則加上陰虛或陽虛等。到後期若出現肝硬化、肝癌,中醫則從「肋痛」、「臌脹」、「積聚」來辨證和治療。同樣,中醫的「肋痛」可包括肝炎引發的肝癌,但亦有轉移性肝癌、 肝發大(Hepatomegaly)等病,「臌脹」可包括肝硬化的腹水,但其他病如轉移性腹腔癌、心衰竭、腎水腫也是成因。

講到治療肝炎,西醫對急性甲、乙型肝炎其實沒有甚麼好辨法,只能提供支援治療(Supportive therapy)和癥狀治療(Symptomatic treatment),例如嘔吐勵害則止嘔,靜脈注射補充水份,提供有營養低脂食物,讓身體殺死病毒和肝臟自我復元。不幸發生重型肝炎(Fulminant Hepatitis)和急性肝衰竭(Acute Hepatic Failure) 只能換肝而已,否則死路一條。近年有研究發現,用N -乙酰半胱氨酸( N-Acetyl-Cysteine) 和 亞米加 3 (Omega 3) 可能減低肝發炎的程度,現正就各類不同肝炎作臨床測驗,有確定療效便向讀者解釋。

在這「知得多,做得少」的情況下,中醫治療肝炎的經驗便十分重要和值得研究了。但要知道,急性肝炎絕大部份都是不藥而癒,即是話不論中、西醫給與病人任何治療的藥物,可能只發揮「安慰劑」(Placebo Effect )的作用,病人除了因有藥食而感覺 好些之外,實則病情病況都是如期復元。

研究方向是,在清楚分別是那一類型的病毒肝炎之後,把不同的証型來個標準化,統一化。在這基礎之上,便能客觀比較療效,如提早痊癒、病狀減輕、病毒數量減少、肝炎指數下降等。用藥與否,要視乎療效能否被確定。那種肝炎,何種証型,那條方劑,何種藥物能再提高治療效果,這亦是要客觀比較才能知道,這樣便可一步步的提升療效,得益的便是病人。

另一個課題是中藥抗病毒研究,針對乙型肝炎的長期帶菌者,減低病毒數量,甚至完全清除是很重要的,亦有證據能減低肝炎、肝硬化和肝癌的發病。現時西醫用的抗病毒藥, 如拉米呋啶,只能阻止病毒在肝細胞裏的繁殖,讓自身的抗病毒機制去減低病毒的數量Viral Load, 但病毒很易產生抗藥性。雖有新的抗病毒藥出現,都是從舊藥中改良而已。若能在眾多中藥中提鍊出更新更強更多類別的抗病毒藥,絕對是好消息。中藥如蚤休、山豆根、虎杖、大黃、丹參、菁蒿等數十種藥物,均有抗病毒的能力,把它們抗病毒的成份提鍊和增強,弄清其抗病毒的機理,亦是一個重要科研課題。

中醫的治 病原則是「扶正袪邪」,用於慢性乙型干炎之中,袪邪便是抗病毒,扶正又是甚麼呢?要知道當肝炎發病時,炎證不是病毒直接引起,而是身體的免疫系統襲 擊帶有病毒的肝細胞造成的,故扶正可能是調節自身免疫系統,減低肝損害。中藥裏的黃芪、黨參、白朮、沙參、熟地黃、茯芩、當歸、白芍等等,均能有這功能, 如何利用這作用於乙型肝炎發作時,很值得研究。肝硬化是長期肝炎的危險後遺症,中藥如冬蟲草、丹參、鱉甲等被發現可降解纖維化,如果能利用這作用來預防肝硬化,又是中醫扶正的好例子了。

要預防甲型肝炎,小心飲食,尤其是貝殼類食物,不煮熟不食。甲型肝炎疫苗是有效的預防疫苗,估計十年保護率有九成以上。乙型肝炎的傳播途徑是與患者的體液接 觸,不安全的性行為是極危險的。共用針筒(如注射毒品),國內的非法血站是主要傳播媒體,愛滋病也是同樣的傳來傳去。要預防則要靠個人的安全意識了。乙肝疫苗是安全和有效的,一般十年以上可能要打加強劑。

對於乙型肝炎的帶菌者而言,佔香港成年人口約十分之一(自一九八八年起政府已為全港嬰兒打乙肝預防針, 故理論上二十歲以下青年是不會有帶菌者),要做的是經常驗血(肝炎及肝癌指數)。醫學界未有指引,但一般提議半年測一次和照超聲波,目的是盡早發現肝是否有發炎(因肝炎越遲發現肝損傷越多) 和肝癌(若不幸出現,最好的治療是最早 的治療)。何時用抗乙肝病毒藥物也未有一致意見,以往是等肝酵毒升高(即肝已發炎)到某程度才落藥,但亦有專科醫生 基於乙肝帶菌數目而治療。研究仍然進行,例如2010年3月中文大學醫學院發佈了一套評估慢性乙肝帶菌 者的肝癌風險 指數 ( 包括用年齡、白蛋白數量、膽紅素數量、乙肝病毒數量和有否肝硬化等數據 ),把病人分為低、中及高肝癌風險,希望能使到高風險病人得到優先治療。

2010年10月4日 星期一

猴棗散

近日見電視廣告推介猴棗散,故作了一 些研讀,向讀者介紹。

首先要了解「猴棗」是甚麼?猴棗,又名猴丹,猴子栆。為猴科動物獼猴等的肝 膽或胃之結石。性味:味苦,微咸:性寒。歸經:心,肺,肝經。功能主治:清熱鎮驚,豁痰定喘,解毒消腫。主痰 熱喘咳,咽痛喉痺,驚癇,小兒急驚,瘰癧痰核。


用現代用語來解讀,即這藥材味道是苦和微鹹,性質屬寒,病人服後會 出現「寒」的表現,如感到寒涼,小便較多和長而顏色清,大便軟,體溫下降,心跳慢等。一般性「寒」的藥是用於有「熱」象的病人,「熱」象有口苦口乾身熱,小便 赤短和大便硬等,這 便是「熱者寒之」的治療原則。歸,即歸屬,指藥物作用 的歸屬;經,即人體的臟腑經絡。 歸經,藥物作用的定位 ,即猴棗這藥對心、肺、肝的毛病有效。 清熱是清除「熱」象,鎮驚是使「驚」的表現 可以鎮靜,豁(排遣) 痰,氣喘安定下來,毒物被化解,消除腫塊。 主治 熱邪所引起的熱痰(黃綠色和粘稠)喘咳; 喉痺,痺者,閉塞不通之意,是西醫學的急、慢性咽炎; 驚癇是指小兒因為突然受刺激、被 嚇一跳、發高燒而出現抽筋的現象,即受驚而得的癇病,《小兒衛生總微論方》:“小兒驚癇者,……輕者,但身熱面赤,睡眠不安,驚惕上竄,不發搐 者,此名驚也;重者,上視身強,手足拳,發搐者,此名癇也”,表現與西醫學的發燒抽筋 Febrile Convulsion 和 腦膜炎Meningitis 接近,不過西醫認為受刺激或被 驚嚇是不會發高燒抽筋的。 驚癇又稱為小兒急驚 風。 (有急驚風,自然有慢驚風,俗稱所謂「發羊吊」,即癲癇症Epilepsy就是了);瘰癧即痰核,是發生於頸部淋巴結的慢性感染性疾病。常結塊成串,累累如貫珠。俗稱『癘子頭』,或『老鼠瘡』。現代 醫學稱之為頸部淋巴結結核。


「猴棗散」是一個驗方,最早收集於《全國中藥成藥處方集》中,但以後各生產商的藥方出入很大,功效主治亦因此有別,家長應注意,看清其成份,現舉例說明。「精制 猴棗散」的方最基本,有猴棗400g,天竺黄300g,川 貝母 200g, 沉香 100g,羚羊角100g, 硼砂(煅)100g, 麝香40g,青礞石(煅)100g, 具有清热,化痰,镇驚等功能。用於小兒驚風,痰涎壅盛,氣喘痰鳴,煩燥不寧。

另一藥「猴棗化痰散」為例,成份有猴子棗、 竹黃 精、 膽南星、 防風、 川貝母、 生甘草、法半夏、陳皮。 主治是小兒痰熱閉肺所 致之咳嗽痰多、 痰稠難咯及胸膈不舒等症。 從病狀來看,似是西醫的下呼吸道感染,如肺炎,支氣管炎等較為嚴重的病,若嬰孩有肺炎,支氣管炎等,我提議快快入醫院好了。

第三隻叫「珠珀猴棗散」,成分有茯神14%、薄荷.8%、鉤藤10%、雙花12%、防風10%、 神 粬10%、麥芽10%、竺黃8%、甘草10%、梅片1%、真 珠3%、琥珀.3%、猴棗1%,作用是治療因肺熱引致的痰多、 咳嗽、 驅風去寒、 小兒微熱、 嘔奶、 夜睡不寧等症狀。

以上三藥都叫「猴棗散」,用途有別,藥方組成分別很大,猴棗的比重也不同,從「珠珀猴棗散」的成份來看, 命名的猴棗只佔全方的1%,真珠3%, 琥珀3%,而茯神則有14%, 其他藥每味都有8%-10%,能否仍稱為珠珀「猴棗散」嗎?一般人(尤其是長者)分別得出嗎?


近日政府開始立法規管中藥,是重要的一步。很多中 成藥的成份沒有說清楚,只用了「等名貴藥材」,而每種藥材的比例也欠奉,以上各類「猴棗散」的寫法,已是較理想的。至於那藥是用作治理何病,所用的名稱很 多時仍是傳統的名稱,未能與現代人所熟悉的醫學觀念接軌。任何藥都可能有副作用,但中藥的說明書亦少有提到副作。這不理想的現況其實與中醫藥的歷史發展有 關,西醫的藥廠因有專利和版權的關係,因此肯付出昂貴的科研成本,去發展新藥,只要能成功的證實療效,和提供各類數據,便是一本萬利。但中草藥和方劑,沒 有人能把它「專利」化,亦因此沒有作科研的誘因,沒科研亦沒有進步的可能。對這困局有出路嗎?