大剂量黄芪的中医临床应用综述

A Review of the Clinical Application of High-Dose Astragalus in Traditional Chinese Medicine

摘要: 黄芪为豆科植物蒙古黄芪的干燥根，是中医临床常用的补气要药，首载于《神农本草经》，被列为“上品”，谓其“味甘，微温。主痈疽，久败疮，排脓止痛，大风癞疾，五痔，鼠瘘。补虚，小儿百病”。黄芪味甘、性微温，归脾、肺经，核心功效为补气升阳、固表止汗、利水消肿、生津养血、行滞通痹、托毒排脓、敛疮生肌。在中医临床实践中，黄芪的用量差异较大，小剂量(10~30 g)多用于日常补气调理，而大剂量(≥50 g，甚至可达100~300 g)则在治疗疑难重症中展现出独特疗效。本文结合中医理论与现代临床研究，对大剂量黄芪的应用理论基础、临床应用规律、适应症、配伍特点及注意事项进行系统综述，以期为临床合理用药提供参考。

Abstract: Astragalus membranaceus, the dried root of the plant Astragalus membranaceus var. mongholicus, is a commonly used tonic herb in traditional Chinese medicine (TCM) for invigorating qi. It was first recorded in the “Shen Nong’s Materia Medica” and classified as a “superior grade” herb. It is described as having a sweet taste and a slightly warm nature, and is used to treat abscesses, chronic sores, expelling pus and relieving pain, severe skin diseases, hemorrhoids, and scrofula. It also helps to tonify qi, and is effective for various pediatric diseases. Astragalus is sweet in taste and slightly warm in nature, and it belongs to the spleen and lung meridians. Its core functions include invigorating qi and raising yang, consolidating the exterior and stopping sweating, promoting diuresis and reducing edema, generating body fluids and nourishing blood, promoting the circulation of qi and blood and relieving pain, promoting the discharge of toxins and pus, and promoting wound healing and tissue regeneration. In TCM clinical practice, the dosage of Astragalus varies greatly. Small doses (10~30 g) are often used for daily qi tonification and conditioning, while large doses (≥50 g, and even up to 100~300 g) have shown unique therapeutic effects in treating difficult and severe conditions. This article systematically reviews the theoretical basis, clinical application patterns, indications, compatibility characteristics, and precautions of large-dose Astragalus, combining TCM theory with modern clinical research, with the aim of providing a reference for rational clinical use.