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第146章 青蒿绞汁截疟疾(1 / 2)

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(立夏·输入性疟)

立夏清晨的急诊室像个蒸笼,空调外机嗡嗡作响却驱不散湿热。从非洲回国的陈建国裹着三条毛毯蜷缩在病床上,牙齿打颤的声音盖过了监护仪的滴答声。“半小时前还烧到39.5℃,现在又冷得像掉进冰窟窿……”他的妻子攥着皱巴巴的机票,眼眶通红,“在那边确诊脑型疟疾,可他对青蒿素过敏,西医说只能试试看……”

苏怀瑾掀开被子,触到患者滚烫的额头时,对方突然抽搐起来。血涂片镜检结果让她心头一紧——恶性疟原虫环状体在视野里蠕动,典型的周期性寒热往来,符合《伤寒论》“往来寒热,胸胁苦满”的少阳证。但更棘手的是,患者对西药青蒿素哌喹片过敏,手背的红疹还未消退。

“快取鲜青蒿!”她抓起电话通知药房,“慈溪产的头茬青蒿,要带露水的!”转身时撞见患者家属捧着个塑料药瓶,标签上“速效青蒿丸”的字样在晨光下格外刺眼,“在非洲买的,吃了三天没见效……”苏怀瑾接过摇晃,药丸碰撞声空洞,倒出几粒放在显微镜下——赫然是青蒿杆粉碎后压制的伪品,毫无青蒿素结晶。

脉诊时,陈建国的手腕像根绷紧的琴弦,弦数中带着涩象,仿佛有瘀血堵在经络里。舌质红、苔薄黄腻,巩膜泛着淡淡黄疸,脾脏肿大平脐,Kernig征阳性——邪伏少阳,兼夹湿热瘀血,正是《肘后备急方》中“疟疾寒热”的重症。

“他在非洲工地喝生水,湿热毒邪趁机入侵,”苏怀瑾边记录边解释,“现在寒热往来如拉锯战,得用青蒿绞汁截断病势。”家属递来的体温单上,体温曲线像过山车,每12小时准时飙升,“西医说这是恶性疟,咱们中医两千年前就有办法。”

抢救室里,苏怀瑾翻开泛黄的《肘后备急方》影印本,“青蒿一握,水二升,绞取汁”的记载旁,贴着屠呦呦团队的研究摘要:“鲜青蒿的乙醚提取物对疟原虫杀灭率95%,关键在冷提取避免高温破坏青蒿素。”对比患者带来的伪药丸,HPLC图谱上毫无青蒿素的特征峰,反而检出过期氯喹的残留。

“他们用青蒿杆充数,”她指着显微镜下的纤维组织,“真正的青蒿素藏在新鲜叶片的分泌细胞里,晒干或高温加工就失效。”想起屠呦呦实验室的冷浸法,她果断决定:“按古籍绞汁,加5ml白酒送服,借酒性引药入血,比水煎剂强三倍。”

药房送来的鲜青蒿还带着泥土气息,200g叶片在绞汁机里打成翠绿色糊状物,滤液静置后析出淡黄色油状物——那是青蒿素的标志。“每4小时1次,连服三天,”苏怀瑾亲自喂服,“当年屠教授就是从这小小的汁液里找到抗疟密码。”西医同步准备氯喹静脉滴注,过敏试验结果出来前,鲜汁就是唯一的希望。

小柴胡汤加减方里,青蒿后下保留挥发油,黄芩清少阳郁热,半夏降逆止呕。“寒热往来是正邪相争,”她解释道,“青蒿透邪外出,柴胡疏利气机,就像给交战的两军打开通道,让热毒有出路。”青蒿茎叶煮水擦浴时,患者滚烫的皮肤渐渐降温,大椎穴的药气渗透,仿佛给高热的身体打开一扇散热的窗。

护士每2小时记录寒热发作时间,体温单上的曲线终于在24小时后趋于平缓。血常规显示血小板计数回升,疟原虫密度下降,陈建国的意识逐渐清醒,“感觉有凉气从骨头缝里冒出来……”

炮制要点:三时三用的青蒿密码

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