《伤寒论》太阳病篇证治规律研究

Syndrome differentiation and treatment of Taiyang disease in Shanghan Lun

目的:探讨《伤寒论》太阳病篇证候规律及方剂、药物的应用规律。方法:用频次法计数太阳病篇主要症状、方剂和中药出现的百分率,用层次聚类法分析主要症状的分布规律和中药使用规律。结果:从症状分析来看,太阳病本证以发热、恶寒为主症,常伴有头痛、无汗、项强、脉浮紧和身痛等表现,兼变证可以分为以汗出、气喘为主的肺系病证,以脘痞、腹泻为主的脾虚病证和以便秘、呕吐为主的胃家证候;从方剂和中药使用来看,桂枝汤是太阳病的主方,麻黄配杏仁,大黄配芒硝,白术配茯苓,附子配干姜以及柴胡、黄芩配半夏、人参为太阳病兼变证的常见配伍,分别用于治疗肺系、胃家、脾虚、肾虚和少阳病证。结论:《伤寒论》太阳病篇以表证为主要见证,桂枝汤为其主治。症状、药物的使用揭示了外感病上、中、下三焦的大致传变规律,方剂的使用则反映了外感病由卫分深入气分的发展规律。

Objective： To explore the laws in syndrome differentiation of Taiyang disease and the prescriptions and herbs used in its treatment in Shanghan Lun （Treatise on Febrile Diseases）. Methods： The occurrence rates of main syndromes of Taiyang disease, and the usage frequency of the prescriptions and herbs in its treatment were calculated, and the laws in syndrome differentiation and herbal medication were analyzed by hierarchical clustering analysis. Results： Fever and aversion to cold were found to be the main symptoms of Taiyang disease and usually accompanied with headache, absent sweating, neck stiff, floating and tight pulse, and body ache. The accompanying or aggravated symptoms could be classified into lung system syndrome with the manifestations of sweating and asthma, spleen-deficiency syndrome with the manifestations of gastric fullness and diarrhea, stomach syndrome with vomit and constipation. Guizhi decoction was the main prescription used in the treatment of Taiyang disease. Mahuang （Herba Ephedrae） matching Xingren （Semen Armeniacae）, Dahuang （ Radix et Rhizoma Rhei） matching Mangxiao （ Natrii Sulfas）, Baizhu （ Rhizoma Atractylodis Macrocephalae） matching Fuling （ Poria ）, Fuzi （ Radix Aconiti Lateralis） matching Ganjiang （ Rhizoma Zingiberis）, Chaihu （ Radix Bupleuri） matching Huangqin （ Radix Scutellariae）, Banxia （ Rhizoma Pinelliae）, and Renshen （ Radix Ginseng） as the main compatibilities were used in treating lung diseases, stomach diseases, spleen- deficiency diseases, kidney-deficiency diseases and Shaoyang diseases respectively. Conclusion： Exterior syndrome, as a common syndrome in Taiyang disease, is usually treated with Guizhi decoction. The change in syndromes from upper-energizer to lower-energizer in exterior disease can be found from the change of symptoms and the use of herbs. And the development from defending stage to qi stage in exterior disease can be found in the use of prescriptions in Shanghan Lun.