中藥怎麼來?

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1990 / 3月

文‧唐鎔 圖‧黃麗梨


在傳統中國人的生活中,中藥鋪、草藥店一直是柴米油鹽醬醋茶之外,人們常光臨的地方。儘管現在西醫發達,情況有了改變,但仍有不少人愛吃中藥,「西藥太利,中藥較溫和」是中藥擁護者的理由。

除了藥效讓人有所偏好,其實中藥還提供了視覺的美感,而藥材的製作也是一門學問,你知道它是怎麼做出來的嗎?


每屆歲末,到迪化街採辦年貨,是台北人一個愉快的購物經驗。走在這南北貨齊全的老街上,眼睛總是滴溜溜地轉個不停,深怕遺漏了什麼。

經過老中藥店,一股醇厚的藥香味傳來,它不像圓環西藥房那麼「冷冽」,也沒有萬華青草店嗆鼻的生鮮草味,自有沉穩香甘的餘韻。

放眼一看,各種稀奇古怪的藥材如穿山甲、馬結石、海狗鞭、龍骨及黃連、使君子、當歸等安穩地放在櫃台後的木質小抽屜堙A大小磁罐則另外裝著各式膏丹丸散,有的則由陶甕裝盛,還是古董級的呢!講究一點的老闆,則在烏沉沉的櫃台供著一盤清幽的水仙,讓自己和客人賞心悅目,來這兒抓藥果真是比上西藥房有趣多了。

但是,要想站在這櫃台後為客人抓藥,可不簡單喔!用「多年媳婦熬成婆」形容這行倒也真貼切。

百年老店,才學得多

人說,名師出高徒,像「乾元行」這種百年老店就是學徒們心所嚮往的地方之一。

原因很簡單,這堣j嘛!

「乾元行」的曹明憲表示,現在人工很貴,小藥房為求利潤,多半只做銷路好和高貴藥材,才划算,其他較冷門的藥就來乾元行這類大行號批發。「我的爸爸、祖先就是什麼藥都賣,我也就這麼做下來囉!」老闆陳鳳揚理所當然地說。因此來這媟篿ヴ{的,因為什麼藥材都得處理,一旦出師,自然也變成「見多識廣」了。

乾元行的黃木欽有點今非昔比的感覺:「以前學徒來學還要拿香拜師呢,現在可沒這規矩了。」新來的人多做些雜事如掃地、裝藥,和切一些便宜的草藥。黃木欽回憶道,當年常清晨起來背「本草備要」,十分用功,經過半年多,對藥有了基本認識,才開始學炮製。老師傅在顯身手時,小徒弟就站在旁邊學習;只要伶俐勤快點,老師傅就多透露些看家本事。

「炮製」是處理中藥很重要的過程,學藝精不精,就看這門功夫了。

就像食物必須經過烹調才能合於人類的脾胃一樣,成為中藥材的動、植、礦物,也必須經過一些祖先流傳下來的處理方法,才能成為治病救人的藥物,而這過程,就叫做「炮製」。

每種藥材製法不一

根據中國歷代有關炮製書籍的記載,炮製的方法可大分為水製、火製及水火共製三大類。但每種藥料藥性不一,因此炮製程序也不一樣,必須「因材施教」。

所謂水製,就是用水漂洗或浸潤藥物,為的是減低它的毒性和不好的氣味,使它潔淨、柔軟,便於切片和加工。迪化街乾元行的曹明憲舉例說,像附子,如果生吃會使人變成啞巴,必須浸在加了明礬的水中廿多天,才能去除它的毒性。但芳香性及含油的藥材如肉桂,只需用水濕潤即可,不宜浸泡,否則藥效大減。

至於火製法呢,就如中國菜的煎煮炒炸,它也分為——炒、炙、●、煨、焙等五法。同仁堂的張家馴醫師表示,炒法中的乾炒,通常不加其他輔料,依據時間、溫度的不同有炒黃、炒焦(焦褐色)、炒炭(炭黑色)之分,它們不但顏色有別,藥效也不一樣,以蒲黃為例,炒黃的蒲黃可使血液順暢,炒炭的蒲黃則可止血,由此可見炮製時分寸拿捏的重要。

而穿山甲、虎骨等動物藥材就得用砂炒,首先將洗淨的河砂炒熱,再放入藥物,直至它酥鬆、呈深黃色為止。

「拌炒」就是加輔料一起炒,如醋炒柴胡、酒炒當歸、鹽水炒黃柏等,醋、酒等輔料可幫助藥性快速達到生病的臟腑經絡,收到療效。至於麩炒、米炒,顧名思義就是用麩皮、米粒與藥材一起炒,可除去雜質、臭味等。

黃木欽表示,「炒藥」是所有炮製法中最累人的,必須常常翻動,而且有些藥味不好聞,如杜仲嗆鼻子、蒲黃則會使人涕淚縱流,令人坐立難安。就因為這些工作粗重又辛苦,所以自古以來藥行少見女學徒。

至於「炙法」有蜜炙、酒炙、薑汁炙等,是將藥材與液體輔料共同加熱,使輔料炙入藥物內部,至其表面微黃、乾爽不黏手、色澤鮮明為止。像延胡索內有「延胡索鹹」,用醋炙後才能溶於水,以達到增強療效的目的。

而將藥物放在火上的鐵篾上或砂鍋媬N,叫做「●法」。主要是為了讓藥材容易壓碎,以便於製成藥劑,如磁石、自然銅就是用這種方式處理。

「煨法」就是用濕潤的麵粉包裹藥材,然後在炒熱的滑石粉鍋內煨至外皮焦黃為止;或用紙張層層包裹、加熱,以除去藥材的油質,讓藥效發出來,如煨木香、煨肉豆蔻。

水蛭、虻蟲等看來很嚇人的藥材,就直接放入鍋內,隔紙用微火焙製,待表面微黃、內部乾燥為止,即為「焙法」。

炮製可減毒性增療效

蒸法、煮法、燀法及淬法,是經由水火共同加熱炮製,所以稱為「水火共製蒸法」。有清蒸的或加醋、酒、薑汁等一起蒸。而附子等毒性高的藥物泡水後,還須水煮去毒。曹先生表示,煮法往往須加其他配料,分量的多少,就是炮製的工夫所在,「但很多學徒疏忽這點。」而「燀法」,就是先將適量水煮沸,再將藥物投入沸水中翻動片刻,至表皮脫落為止,再漂清水、曬乾,如杏仁、桃仁就是這種作法。

「淬法」,以治療下瀉、止血的禹●石為例,先洗淨稍打碎,置於無煙炭火上●至紅透,迅速倒入醋中淬酥,才能使用。這個方法多用於金石類及貝殼類等較堅硬藥物,可使之酥鬆及氣味改變。

這些從漢代流傳,不斷增益、改善的炮製法,大多仍為傳統的中藥房所遵行,作法或有小異,但總不脫離古法。古人的經驗告訴後人,如何減少藥物的毒性、副作用,不但可增強它的療效,並且便於貯藏。

學會了炮製,接下來就學切片,「切貴重的藥如人參,要有經驗才切得好!」黃木欽強調必須能力夠了,膏丹丸散這些中藥的成藥,才可以開始做。

膏丸散丹,作法各異

膏劑常用蜂蜜加藥物煎熬而成,多是滋補之用,因為它能迅速溶化、易吸收,像滋補肝腎的「桑椹蜜」,潤肺止咳的「枇杷膏」等都是。

一位師傅表示,這種含較多黏液汁或營養豐富的植物,最適宜做成膏劑。

至於丹劑大致分二種,一種如道家的煉丹,用重金屬化合物製成,如「三仙丹」;一種是用植物製成的丹。「現在大概只有我們這家會做丹了」,曹先生說,因為煉丹非常麻煩。像紫雪丹、紫金錠,就是這家店的心血結晶。

丸劑在體內的作用緩慢而持久,藥力可維持較長時間。因蜂蜜易黏著,故多做成蜜丸服用,「糖尿病的人得吃水丸,水沒有黏性,所以最看得出工夫深淺了。」黃師傅說,製水丸時要特別注意「揉工」,否則藥會散開。

散劑就是將藥磨成細末混合而成,它不易變壞,在體內的吸收速度較湯藥、藥酒慢,相對而言便能維持較長的藥性。但散劑因接觸面積大,收效極速,適合外服。

酒劑就是藥酒,多用性較純烈的高粱、黃酒等浸泡藥材,老年人喝酒,喜歡喝藥酒,他們請藥房炮製為了是滋補健身。而露劑就是用蒸餾法提煉藥物的液體,大多是解熱的清涼藥,量少質精效力大,如地骨皮露等。

煎藥有學問

古人針對藥性、病情發展出這麼多種劑型,真令對中藥不了解的人驚訝,因為一般人的觀念中,中藥就是「煎藥」的代名詞。

煎劑的應用這麼普遍,也是其來有自。因為它是水溶液,易吞嚥、易吸收,治急病最有效,缺點就是入口較苦澀,小孩子常受不了。其次中醫講究因人、因病對症下藥,而煎劑在抓藥時可隨時因應狀況增減,不像藥丸成分已固定,比較沒有彈性「空間」。

「可是,一般人都不懂得如何煎藥」,曹明憲解釋:每種藥材的熔點不一,照理要稍加分類,不要一次全部放下,才能「藥盡其用」。如龍骨、石膏應先放,過一段時間再放其他藥。有揮發性的如茵陳、薄荷等,用沖的就可以了,不能煎,否則效果就差了。

煎藥的溫度,是能不能從中藥提取有效成分的關鍵。煎藥時如果一開始用大火,藥中的蛋白質會凝固,因而阻礙其他成分溶於水。所以最好在煎藥前先用冷水浸十五分鐘,使蛋白質先溶解,再用小火煎,藥性即可慢慢釋出。

在製藥房做二年,資質不差的大概就可以坐上櫃台了。每天接觸的客人不同,又可看許多的藥方,自然比做藥有趣多了。「看藥方,就可以知道是老中醫、書呆子或自己翻書開的藥」,研究中藥十餘年的曹先生提供秘訣,最簡單的檢查是看藥單是否按「君臣佐使」排列。如果主藥副藥跳來跳去,表示此人是翻書而來,並沒有底子;此外寒病用熱藥治,寒熱、虛實不分,那一定是剛出道的。

看藥方知病情

人說「久病成良醫」,這些藥店的師傅病人、藥方看多了也多會看些病,下處方。江仁福就頗得意他在當兵時,朋友扭傷、感冒、內傷等都是他醫好的。曹明憲也有類似的經驗,他在服役出操時常以指壓穴道,急救了不少人。「中醫實在很好用」是這些藥行師傅共同的信仰。但是,這些可不能隨便下手,真要有點底子才行。

目前台灣除了一些大藥房自己做藥外,有不少藥店是向藥廠批發。藥廠良莠不齊,有的為了利潤,會用較低劣的藥材,炮製過程也較隨便,如熟地要反覆蒸九次,藥廠通常只把它蒸黑而已。此外藥材用低溫乾燥對藥性保存較好,他們為了省時自然用高溫。甚至有人送藥去研磨,若屬高貴藥材,還會偷換。藥粉尤其容易魚目混珠,就曾有人用黃柏粉來替代黃連粉,在這種情形下,藥效自然打了折扣。

不肖藥商,魚目混珠

現今台灣用藥,多是從大陸進口的,每家都號稱是「地道藥材」,且不管是否地道,倘若製藥過程輕忽,以致藥效不彰,甚或殘留毒素,受害的可就是消費者了。

「很多中醫只會開藥方,不會看藥材好壞」,黃木欽師傅說。看來,只有內行的老師傅才能辨別炮製的好壞了。因此,慎選中藥行,比較保險。

不過,當你對藥的製作有了較多了解後,下次去中藥房若提出深入的問題,掌櫃的除了對你刮目相看外,抓藥時,也就不敢掉以輕心了。

〔圖片說明〕

P.96

要想上櫃台抓藥,得先學會怎麼做藥。

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一盆炭火上面扣著一只大菜鍋,上面烤著附子的切片,這種傳統的炮製過程,現已不多見。

P.98

到藥店常可以看見各種稀奇古怪的藥材,海馬也是其中之一。(王煒昶攝)

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很多生藥必須煮過,才能去除毒性。

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藥材炮製後,必須保持乾燥才能維持藥性。

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做藥丸用機器代勞,可省了不少氣力。

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生元行的這位老師傅,切藥已切了五十年。

P.102

現代人生活忙碌,所以中藥店有代客煎藥的貼心服務。

相關文章

近期文章

EN

The Roots of Chinese Medicine

Tang Jung /photos courtesy of Huang Li-li /tr. by Phil Newell and Peter Eberly

In the life of traditional Chinese people, Chinese medicine stores were much visited places. Even though they've changed with the development of Western medicine, many people still like to take Chinese medicine. The reason is that Western medicine is too sharp, and Chinese medicine is more moderate, says a proponent of Chinese medicine. Besides people preferring its effectiveness, Chinese medicine is also aesthetically beautiful. The manufacture of its ingredients is an art as well as a science.


Just as food must be cooked to suit people's stomachs, the animals, vegetables, and minerals that go into Chinese medicine also must go through processes passed down from the ancestors. These processes are called, in general, p'ao-chih ("concocting").

According to ancient Chinese texts on p'ao-chih, there are three types of concocting: water, fire, and water and fire together. Each type of medicinal ingredient is different in nature so the procedures also differ.

Water concoction involves washing and soaking the ingredients in order to decrease their toxicity and odor, and to make them clean and soft and easy to chop up and process. As for fire concoctions, this is similar to frying or cooking ordinary food. There are five methods: stir frying, direct exposure to flame, drying over a fire, smoking, and "crisping" (heating until brittle, specially used for minerals). But it becomes still more complex. Chang Chia-hsun, a doctor, says that, taking "dry frying" for example, this is further divided into submethods, according to different times and temperatures (yellowing, browning, cooking to a deep black) to affect the medicinal properties of the ingredients.

Making medicine by frying, according to Huang Mu-ch'in, is the most tiring method. You've got to keep turning the ingredients. Because some have a bad odor, it makes your eyes water and nose run. Because the work is laborious, young women apprentices have been rarely seen since ancient times.

Steaming, boiling, and two ways of dunking hot ingredients in cool water (one after boiling, one after heating), are the p'ao-chih which combine both fire and water. Ingredients can be steamed in water alone or together with vinegar, alcohol, or ginger juice. Even after steaming highly toxic ingredients in water, it is necessary to boil them to remove all the poison. Mr. Ts'ao indicates that one often needs to add other ingredients with the boiling method. The amount that is added is where the skill comes in to p'ao-chih, "but many novices overlook this."

Most of these concoction methods, which have been handed down since the Han dynasty and constantly elaborated on and expanded, are still followed in traditional Chinese medicine shops. Despite slight variations, there is never great deviation from the original methods. These time-tested ways have reduced the toxicity and side-effects of medicinal ingredients, not only increasing their effectiveness, but also making storage more convenient.

After learning concoction, then you learn ch'ieh-p'ien (literally "cutting into strips"). "If you cut up expensive medicines like ginseng, you've got to have experience to do it right," says Hwang Mu-ch'in.

After you've worked making the medicine for two years, if your qualifications are good enough, then you can move out to the counter. There you'll meet all kinds of customers and see all kinds of prescriptions, which is of course much more interesting than making medicine. "By looking at the prescriptions, you can tell if it was written by a learned old doctor, or somebody who just flipped through the books on his own," says Mr. Ts'ao, who has studied Chinese medicine for more than ten years.

He offers a little tip: The simplest way to tell is to see whether the prescription is properly laid out. If it jumps back and forth between main and secondary ingredients, that means the person was just flipping through the books, and has no foundation. In addition, if "cold" diseases are treated with "hot" medicines, or there's no distinction between "hot" and "cold," then it must have been by someone just getting started.

Masters of the medicine shop, having seen many patients and prescriptions, mostly can diagnose and write prescriptions themselves.

However, a person can't just go about it casually; you've got to have a firm foundation. On Taiwan at present, besides large pharmacies that make medicine themselves, quite a few buy wholesale from medicine factories. These factories are of mixed quality. Some will use rather poor quality ingredients and casual p'ao-chih to boost profits. Some even go so far as to steal more valuable medicines sent to them for grinding and stealthily replace them with inferiors.

In present day Taiwan, most of the Chinese medicine used is imported from the mainland. Every store claims that its medicinal ingredients are the "real thing." Even if they are genuine, if the manufacturing process is taken lightly, the effectiveness will be discounted. There may even be toxins left behind, and the consumer will be the victim.

"Many Chinese doctors of Chinese medicine can only write prescriptions; they can't tell if the medicine is good or bad," says Huang Mu-ch'in. It seems that only old masters in the field can distinguish whether concocted medicines are useful or not. So it is best to carefully select a Chinese medicine shop.

However, after you have a deeper understanding of the medicine-making process, if you ask penetrating questions the next time you're in a Chinese medicine shop, the guy behind the counter-besides being impressed-will not dare to carelessly take the first medicine that comes to hand.

[Picture Caption]

If you want to get to the counter, you've got to learn how to make the medicine first.

A large pot on top of a coal fire; on top are aconites being treated. This kind of traditional p'ao-chih (concocting) is not much seen these days.

One can see a variety of rare and unusual ingredients at a Chinese pharmacy, seahorses among them. (photo by Wang Wei-chang)

A lot of raw medicines must be "cooked" first to eliminate toxicity.

Using machines instead of people to make medicine capsules saves a lot of hassle.

After the ingredients are concocted, it is necessary to protect them ina dry place so that they don't lose their medicinal value.

This old master at the Sheng-yuan Shop has been cutting medicines for 50 years.

The life of moderns is hectic, so many Chinese medicine shops offer to prepare your medicines for you.

 

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