古代医籍泄泻医案用药规律的发掘研究

Research on medication rule of diarrhea in ancient medical books and medical cases

目的:挖掘整理古代医籍中治疗泄泻的医案,探析其用药规律,为临床治疗泄泻类疾病提供借鉴。方法:查阅清末(1911年)以前历代医家有代表性的泄泻医案著作,选取以'泄泻'相关症状为主症的医案。通过中医传承辅助系统V2.5建立处方数据库,寻找高频药物、药性、归经、药对等,对软件统计结果进行分析。结果:收入医案处方604首,涉及中药277味,用药总频数5 312次。频次前5味药物为茯苓、白术、甘草、陈皮、人参;高频药物按功效分类主要为补虚药、利水渗湿药、温里药、化湿药、解表药、理气药、消食药、清热药、收涩药等;药性温为主,其次平和寒;药味甘为主,继之辛和苦;药物归经前5种是脾、胃、肺、肾、心;药对以白术-茯苓最为常见。结论:古代医籍中泄泻医案的治疗用药有一定规律性,与现代中医诊治泄泻基本病机与治法较相符合,用药特色对启迪现代中医诊治泄泻思路有借鉴作用。

Objective:To excavate and sort out the medical records of treating diarrhea in ancient medical books and analyze the medication rule,in order to provide references for diagnosis and treatment of diarrhea diseases in clinical practice.Methods:Representative medical works of diarrhea cases written by medical experts of the past dynasties prior to the late Qing Dynasty(1911)were reviewed and medical records with diarrhea as the main symptoms were selected.Establishing a data bank of prescriptions of diarrhea through Chinese Medicine inheritance Assistant system Software(V2.5)to find high-frequency drugs,drugs properties,channel tropism,couplet medicines,then analyze the statistical results.Results:A total of 604 prescriptions were collected,involving 277 kinds of traditional Chinese medicine,with a total frequency of 5 312 times.The top five frequently used drug were Poria cocos,Rhizoma Atractylodis Macrocephalae,Radix Glycyrrhizae,Pericarpium Citri Reticulatae and Radix Ginseng respectively;The high frequency drugs were classified according to their efficacy into tonifying deficiency medicine,diuresis and diffusing dampness medicine,warming interior medicine,eliminating dampness medicine,superficies-relieving medicine,regulating qi-flowing medicine,digestive medicine,clearing heat medicine and astringent medicine.The main property of drug was warming,followed by peaceful and cold.The medicinal flavor was mostly sweet,followed by pungent and bitter.The top five channel tropism of drugs were spleen,stomach,lung,kidney and heart respectively.The most common couplet medicine was of Rhizoma Atractylodis Macrocephalae-Poria cocos.Conclusion:There is a certain regularity in the medicine of diarrhea treatment in ancient medical records,which is in line with the basic pathogenesis and treatment methods of modern Chinese medicine.The characteristics of medication have a reference role in enlightening treating diarrhea by modern Chinese medicine.