《临证指南医案》癥瘕积聚用药规律分析

Analysis of Medication Rules for Abdominal Mass Recorded in Medical Records as a Guide to Clinical Practice

目的探讨《临证指南医案》治疗癥瘕积聚遣方用药规律,为临床治疗癥瘕积聚提供借鉴。方法统计《临证指南医案》中治疗癥瘕积聚的方剂,对治疗癥瘕积聚的方药使用频数、频率,以及药物四气五味、脏腑归经进行统计分析。结果《临证指南医案》中治癥瘕积聚方剂共43首,累计使用378种药物,总使用频次275次。药物使用频次≥5次的药物共有21味,排名前5味的药物依次为茯苓、当归、小茴香、香附、川楝子;用药以辛味最多,占32.76%(152次),其次为苦味占27.80%(129次);在药性上以温性药使用频次最多,占49.09%(135次);在药物归经上以脾经药物最多,占20.57%(166次),其次为肝经,占18.09%(146次)。结论叶天士治癥瘕积聚多从肝脾调治,以辛开、温散,辅以苦降为主,调畅脏腑气机升降;佐以健脾、和血,攻中有补,攻补结合。

Objective To explore the rule of prescription and medication for the treatment of abdominal mass recorded in Medical Records as a Guide to Clinical Practice,and to provide reference for the clinical treatment of abdominal mass.Methods The prescriptions for the treatment of abdominal mass recorded in Medical Records as a Guide to Clinical Practice were collected,and then the frequency and relative frequency of the prescriptions and the herbs for the treatment of abdominal mass,as well as the four natures,five flavors and meridian tropism of viscera of the herbs were statistically analyzed.Results There were 43 prescriptions for the treatment of abdominal mass recorded in Medical Records as a Guide to Clinical Practice,involving 378 drugs and with a total frequency of 275 times.A total of 21 drugs had the medication frequency≥5,and the 5 leading herbs were Poria,Radix Angelicae Sinensis,Fructus Foeniculi,Rhizoma Cyperi,and Fructus Toosendan.The flavors of the herbs were characterized by being pungent(152 times,accounting for 32.76%),and then followed by being bitter(129 times,accounting for 27.80%).The properties of the herbs were characterized by being were warm(135 times,accounting for 49.09%),and the herbs were characterized by the meridian tropism of spleen(166 times,accounting for 20.57%)and liver(146 times,accounting for 18.09%).Conclusion Practitioner YE Tian-shi stressed the treatment of abdominal mass from the perspective of regulating the liver and spleen,and mainly adopted the pungent and warm herbs for dispersing and the bitter herbs for descending.The therapeutic methods for the abdominal mass are to regulate the qi movement of zang-and fu-organs,assisted by strengthening the spleen and harmonizing the blood,which embodies the principles of simultaneous application of purging and tonifying methods.