《临证指南医案》中柴胡运用规律及特色分析

Application of Radix Bupleuri in A Guide to Clinical Practice

目的:研究《临证指南医案》中柴胡运用规律及特色。方法:采用自行研发的"医案查询统计分析系统",对《临证指南医案》中有关柴胡的运用从症状、病机、方药等方面,采用频次计数法挖掘整理。结果:检索出相关医案49则,涉及症状有46种,主要为脾胃病证、肝胆及其经脉循行部位的病证、妇科病证等;病机总频次为74次,主要与脾胃病证有关和肝胆病证相关;与柴胡配伍的药物有80味,主要为当归、甘草、白芍药、人参、陈皮、白术、茯苓等。结论:在《临证指南医案》中使用柴胡的特色是:柴胡可配伍芍药、当归、白术、茯苓等药物疏肝胆以调和肝脾;柴胡配升麻可升举下陷之清阳,具有升提中气之效,在案中用于便后下血,中气下陷坠肛而痛、久泻等证的治疗;柴胡可以通过疏肝解郁、补益中气而用于内伤发热的退热。并在《温热论》中在小柴胡汤和解的基础之上进行加减,创立和解凉血祛瘀、和解温里、和解行气等法治疗温热病热入血室证。

Objective： To discuss the application of Radix Bupleuri in A Guide to Clinical Practice. Methods： On the basis of self-made Analysis System of Medical Records, this paper analyses the symptom, pathogenesis, treatment and medicine related to Radix Bupleuri in A Guide to Clinical Practice to collect the information by exploiting the frequency. Results： Forty- nine cases were selected from the medical records and 46 syndromes mainly were spleen-stomach disease, liver-gallbladder, circulation of the liver meridian, and gynecological disease ; Seventy-four kinds of pathogenesis mainly related to the diseases of spleen-stomach and liver-gallbladder; eighty kinds of medicine combined with Radix Bupleuri were Radix Angelicae Sinensis, Radix Glycyrrhizae, Radix paeoniae alba, Ginseng, Pericarpium Citri Reticulatae, Rhizoma Atractylodis Macrocephalae and Poria. Conclusion： Ye Tianshi did not exclude Radix Bupleuri in A Guide to Clinical Practice. Combined with Radix paeoniae alba, Radix Angelicae Sinensis, Rhizoma Atractylodis Macrocephalae and Poria can sooth the liver and gallbladder to regulate liver and spleen; combined with Rhizoma Cimicifugae can lift the clear-yang for hematochezia, prolapse of anus and chronic diarrhea ; Radix Bupleuri can treat fever by dispersing liver to relieve dispersion and nourishing middle qi. Ye Tianshi modified ＂Xiaochaihu Decoction＂ to treat warm diseases in blood chamber by cooling blood to eliminate stasis, warming the inner and motivating qi methods.