从量效关系探讨《伤寒论》桂枝用药规律

Discussion on Medication Rules of Cinnamomi Ramulus in Shang Han Lun from Dose-Response Relationship

目的分析《伤寒论》中桂枝的量效关系及配伍用药规律,为临床应用提供借鉴。方法系统整理《伤寒论》中含有桂枝的条文,采用SPSS20.0统计软件单因素逻辑回归分析及二元相关性分析桂枝剂量与相关因素之间关系。结果经筛选,共纳入含桂枝方剂40首,占《伤寒论》全部方剂的35.40%。桂枝单次用量与药味数、用水量密切相关(P=0.000,P=0.004),而与剩余水量、单次服用水量和服用次数无明显相关性(P>0.05)。单因素逻辑回归分析显示,桂枝是否为主药与桂枝单次用量和服用次数关系密切(P=0.008,P=0.043)。桂枝与炙甘草配伍,与桂枝为非主药时比较,桂枝为主药时的桂枝单次用量明显偏高(P=0.046)、药味数明显偏低(P=0.043),差异均有统计学意义。桂枝与芍药或麻黄配伍,与桂枝为非主药时比较,桂枝为主药时的桂枝单次用量和药味数差异无统计学意义(P>0.05)。桂枝为主药时未发现其与茯苓或柴胡配伍使用。结论从量效关系可发现《伤寒论》桂枝的使用及配伍严格而又灵活多变,剂量规律可为临床应用提供依据。

Objective To provide references for clinical medication through the analysis on the dose-response relationship and compatibility medication rules of Cinnamomi Ramulus. Methods It systematically arranged the provisions containing Cinnamomi Ramulus in Shang Han Lun. Relationship between the dose of Cinnamomi Ramulus and the related factors were analyzed by single factor logistic regression analysis and binary correlation analysis by SPSS20.0 statistical software. Results After screening, 40 prescriptions including Cinnamomi Ramulus were selected, accounting for 35.40% in the total prescriptions of Shang Han Lun. The taken dose of every time of Cinnamomi Ramulus had a close relationship with the number of medicine and water consumption, with statistical significance （P=0.000, P=0.004）. However, it had no relationship with residual water, water consumption per time and use frequency, without statistical significance （P〉0.05）. Single factor logistic regression analysis showed whether Cinnamomi Ramulus as a mainmedicine had the close relationship with the taken dose of every time of Cinnamomi Ramulus and use frequency （P=0.008, P=0.043）. When Cinnamomi Ramulus and Glycyrrhizae Radix et Rhizoma Praeparata cum Mella were in compatibility, compared with when Cinnamomi Ramulus was not the main medicine, the taken dose of every time of Cinnamomi Ramulus as the main medicine in the group was more frequently used, with statistical significance （P=0.046）; however, the number of medicine was statistically lower than when Cinnamomi Ramulus was not main medicine （P=0.043）. When Cinnamomi Ramulus and Ephedrae Herba were in compatibility, there was no statistical difference in the taken dose of every time of Cinnamomi Ramulus or the number of medicine （P〉0.05）. When Cinnamomi Ramulus was the main medicine, it was not in compatibility with Poria or Bupleuri Radix. Conclusion From the dose-response relationship, it can be found that the use and compatibility of Cinnamomi Ramulus in Shang Han Lun are strict and flexible, and dose law can provide a basis for clinical application.