叶天士《临证指南医案》中鲜药应用的规律及特色探讨

Discussions on the Application Rules and Characteristics of Fresh Medicines in Ye Tianshi’s Clinic Guidline of Medical Records

目的通过对叶天士《临证指南医案》中使用鲜药的规律和特点进行分析,为临床引进及使用鲜药提供学术参考,也为吴门医派鲜药研究提供方法学借鉴。方法采用Excel软件录入使用鲜药的医案处方,对药物的使用频数、性味、归经等信息进行统计分析,用SPSSClementine12.0软件进行病证与药物的关联分析。结果医案中使用鲜药的病证共79类,以温热病、疫病为主,使用鲜药品种75种,使用频次718次。鲜药性味以甘、寒为主,主入胃、肺经。药物与疾病之间存在一定的关联,如疟证常用生姜、姜汁,吐血用鲜荷叶汁等。鲜药联用以姜汁-竹沥、甜梨汁-甘蔗浆较多。结论《临证指南医案》记载鲜药多为地产清轻之品,清热养阴生津之效更胜,在温病治疗中占重要地位,高频常用药物及药对可为临床用药提供参考依据。

OBJECTIVE To analyze the regularity and characteristics of fresh medicines used in Ye Tianshi’s Clinic Guidline of Medical Records, to provide academic reference for clinical introduction and use of fresh medicines, also provide methodological reference for the study of fresh medicines of Wumen Medical School. METHODS Excel software was used to input the prescriptions of fresh medicines, and analyzed the information of frequency, property, taste and meridian tropism of drugs. Used SPSS Clementine 12.0 software to analyze the correlation between disease and medicines. RESULTS In all medical records, there were 79 kinds of diseases using fresh medicines, mainly were febrile diseases and epidemic disease. There were 75 kinds of fresh medicines, the total frequency of drug usage was 718. Property and taste of fresh medicines were mainly sweet and cold, and meridian tropism were mainly into the stomach and lung meridians. There was a certain correlation between drugs and diseases, such as ginger and ginger juice commonly used in malaria syndrome, fresh lotus leaf juice used in hematemesis, etc. Fresh medicine pairs, like ginger juice-bamboo juice, pear juice-sugarcane pulp were combined used. CONCLUSION Fresh medicines in Clinic Guidline of Medical Records are mostly native herbs, the effect of clearing away heat and nourishing Yin and promoting body fluid are better than dry, which play an important role in the treatment of febrile diseases. The commonly used medicines and medicine pairs can provide reference for the clinical medication.