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第105章 细辛过钱触律例(1 / 1)

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第105章 细辛过钱触律例

杭城的深秋,仁济堂的银杏叶开始泛黄,诊室里飘着淡淡的陈皮香。苏怀瑾刚给一位慢性胃炎患者开完药方,社区卫生服务中心的王医生就领着位面色蜡黄的患者推门进来:“苏医生,这位大叔肝功异常,说一直在用偏方治鼻炎,您给瞧瞧。”

患者刘建国搓着粗糙的手掌,眼神躲闪:“我在网上看的,细辛粉治鼻炎特效,每天3g冲水喝,喝了两周就这样了……”苏怀瑾抬头,见他巩膜微微发黄,舌苔白腻中透着青灰,脉细数而涩——典型的中药肝损伤脉象。急诊生化单上,ALT 120U/L、AST 85U/L的数字格外刺眼。

“细辛是好药,但您这是‘过钱’了。”苏怀瑾调出2020版《中国药典》,“宋代《和剂局方》就有‘细辛不过钱’的说法,一钱相当于3g,散剂每日不能超过1g,您这剂量超了三倍。”她转向实习生小张,“去药房取点细辛饮片,给患者看看炮制前后的区别。”

药房里,苏怀瑾举起两种饮片:“这是未炮制的细辛,挥发油含量高,有毒成分甲基丁香酚超标;这是蜜炙细辛,挥发油减少40%,安全系数更高。”她翻开2018年北京中医药大学的研究报告,“每天摄入甲基丁香酚超过2mg/kg,就可能导致肝损伤,您体重60kg,每天3g细辛粉,相当于摄入6mg,远超安全线。”

刘建国听得直冒冷汗:“那现在怎么办?会不会治不好了?”苏怀瑾递过温毛巾:“立即停用细辛,我们用柴胡疏肝散加减:柴胡10g疏肝理气,茵陈15g利胆退黄,垂盆草20g清热解毒,再配合西药甘草酸二铵护肝。”她特意在处方上注明“细辛中毒性肝损伤”,启动医院的毒性药材不良反应上报流程。

下午的药事管理会议上,苏怀瑾播放了一段监控录像:“上周有患者自行网购细辛饮片,在家打粉后开出处方,我们的智能审方系统及时拦截了12g细辛的超量处方。”她敲了敲投影仪,“《本草纲目》早有警示,‘细辛,若单用末,不可过一钱’,现在我们有责任让老百姓知道,‘是药三分毒’不是空话。”

药剂科张主任点头:“确实,最近偏方导致的中毒案例增多,建议门诊增设用药咨询窗口。”苏怀瑾补充:“使用细辛必须双签名,散剂统一由制剂室制备,还要告知患者‘药证不符即有毒’——比如您是风寒鼻炎,细辛对症;但风热鼻炎用细辛,就是毒药。”

下班后,苏怀瑾整理刘建国的病历,想起祖父当年的教诲:“细辛虽能通窍,但走窜之力强,就像个急性子的将军,用好了冲锋陷阵,用错了伤己伤人。”她望着窗外的中药百草园,细辛的幼苗在风中摇曳,忽然意识到,现代中医的责任,就是给这些“个性鲜明”的药材套上“缰绳”,让它们在安全的轨道上治病救人。

第二天查房,刘建国的黄疸退了不少,肝功能指标开始下降。他拉着苏怀瑾的手不放:“再也不敢乱信偏方了,原来中药的‘过钱’不是省钱,是保命啊!”苏怀瑾笑了:“老祖宗说‘细辛不过钱’,是用无数经验换来的教训,现在我们有了更精准的检测手段,但这份敬畏心不能丢。”

正要离开,胃肠外科的李主任匆匆赶来:“苏医生,有个肠梗阻患者需要会诊,家属拒绝灌肠,点名要您用中药……”苏怀瑾心头一动,想起昨天的大黄后下病例,说不定这次又要和“将军药”打交道了。告别刘建国时,她瞥见病历夹里露出一角,正是自己昨天标注的“半夏反附子需久煎”——下一场关于中药配伍禁忌的硬仗,似乎已经在等着她。

暮色中的仁济堂,药香混着银杏叶的清苦。苏怀瑾站在“毒药专柜”前,看着标签上的细辛、附子、乌头,忽然明白,中医的神奇从来不是靠“以毒攻毒”的玄乎,而是藏在“不过钱”的谨慎里,藏在双签名的规范中,藏在每一次煎煮时对火候的较真中。这些看似束缚的“律例”,正是中医药传承千年的密码,也是现代中医在科学浪潮中站稳脚跟的根基。

这一晚,苏怀瑾在诊疗日记里写道:“细辛过钱,触的不是旧律,是对生命的轻视。当偏方遇上规范,当经验撞上科学,医者手中的笔,从来都该是守护生命的盾。”合上笔记本时,窗外飘起细雨,打在“细辛不过钱”的警示牌上,那三个红漆大字,在夜色中格外醒目。

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