基于现代临床文献的经典名方吴茱萸汤主治病症及用药规律分析

Analysis on Indications and Medication Regularities of Famous Classical Formula Wuzhuyu Tang Based on Modern Clinical Literature

吴茱萸汤出自东汉张仲景所著《伤寒论》,收录于《古代经典名方目录(第一批)》,全方由吴茱萸、人参、生姜、大枣4味药组成,具有温中补虚、散寒降逆之功。该文通过数据挖掘,分析归纳吴茱萸汤现代临床研究文献,为明确吴茱萸汤的"病-症-方-药"内在关系及其现代临床适应症、临床参考用量提供依据。全文以"吴茱萸汤"为关键词,搜集了2000~2020年中国知网、维普、万方数据库中出现的253例完整病例,涉及中药处方292首。利用Microsoft Excel 2019建立病案数据库,对其现代临床应用主证范围进行了统计分析,并对其辨证特点、发病规律、用药规律等进行总结。结果发现,吴茱萸汤现代临床应用范围广泛,主要治疗头痛、眩晕、呕吐、泄泻、痛经、恶阻等病证;症状以"虚、寒、逆"为主,主要表现为恶心呕吐、头痛、神疲乏力、手足厥冷、纳差、面色晦暗、眩晕、恶风寒、腹痛、大便溏泄、腹胀、寐差及舌淡苔白、脉沉弦细等;发病主要集中在女性及中年人群;用药大多随症加减,原方药物剂量以吴茱萸6~15 g,生姜10~15 g,党参10~15 g或人参9~12 g,大枣4~6枚为常见,加味按频次高低依次为半夏、白术、茯苓、甘草、川芎等。

Wuzhuyu Tang(WZYT),a classical traditional Chinese medicine(TCM)formula,was first recorded in Treatise on Cold Damage by the prestigious physician ZHANG Zhong-jing in the Eastern Han Dynasty,and included in Catalogue of Ancient Classical Formulas(First Batch).WZYT is composed of four medcinals:Euodiae Fructus,Ginseng Radix et Rhizoma,Zingiberis Rhizoma Recens,and Jujubae Fructus,which has the effects of warming the middle and tonifying deficiency,dissipating cold and descending adverse qi.Based on data mining,this paper analyzes the modern clinical research literature on WZYT,which is expected to lay a basis for clarifying the"disease-symptom-prescription-medicinal"relationship of WZYT,as well as its modern clinical indications and clinical dosage.With the search term"Wuzhuyu Tang",253 complete medical records were retrieved from CNKI,VIP,and Wanfang(2000-2020),involving 292 TCM prescriptions.Microsoft Excel 2019 was employed to establish the medical record database and the main clinical indications were statistically analyzed.Moreover,the syndromes,incidence law,and medication regularity were summed up.The result indicates WZYT has a wide range of modern clinical applications,mainly including the treatment of headache,dizziness,vomiting,diarrhea,dysmenorrhea,morning sickness,and other diseases,and the"deficiency,cold,and reversal"symptoms,mainly manifested as nausea and vomiting,headache,fatigue and lack of strength,reversal cold of hands and feet,poor appetite,gloomy complexion,dizziness,aversion to wind and cold,abdominal pain,sloppy diarrhea,abdominal distension,poor sleep,pale tongue,white coating,and deep thread wiry pulse.These diseases and symptoms mainly occur in women and middle-aged people.In most cases,medicinals are added or subtracted according to the symptoms,and the common doses of Euodiae Fructus,Zingiberis Rhizoma Recens,Codonopsis Radix or Ginseng Radix et Rhizoma,and Jujubae Fructus in the original prescription are 6-15 g,10-15 g,10-15 g or 9-12 g,and 4-6,respectively.The added medicinals are in the descending order of Pinelliae Rhizoma,Atractylodis Macrocephalae Rhizoma,Poria,Glycyrrhize Radix et Rhizoma,and Chuanxiong Rhizoma according to the frequency.