《医宗金鉴·正骨心法要旨》中骨伤外治处方的用药规律分析

Clinical medication rules of the prescriptions for external treatment of orthopedic and traumatic diseases in Yi-zong Jinjian,Essentials of Bone Orthopedics

目的:分析《医宗金鉴·正骨心法要旨》中骨伤外治处方的用药规律。方法:收集《医宗金鉴·正骨心法要旨》中的骨伤外治处方,建立标准化方药数据库。采用Microsoft Office Excel 2019软件统计纳入处方中药物的使用频次、药性、药味、归经及功效,采用SPSS Statistics 22.0软件对其中的高频药物进行聚类分析。结果:共筛选出100首骨伤外治处方,涉及140味中药,其中20味中药无法查证,最终纳入120味中药进行分析。120味中药累计使用1218次。使用频次≥20的中药共25味,累计使用742次,其中当归(74次)、红花(55次)、没药(44次)、麝香(43次)、川芎(38次)使用频次较高;药性统计结果显示,温性药(630次)、平性药(309次)、寒性药(216次)使用频次较高;药味统计结果显示,辛味药(792次)、甘味药(588次)、苦味药(494次)使用频次较高;药物归经统计结果显示,120味中药分属12种归经,其中归肝经(711次)、心经(546次)、肾经(410次)的药物使用频次较高;药物功效统计结果显示,120味中药共涉及18种功效,其中活血化瘀药(302次)、补虚药(239次,多为补血药)、祛风湿药(121次)、清热药(117次)、温里药(70次)、解表药(69次)使用频次较高。使用频次≥20的25味中药可聚为3类,第1类仅包括乳香,第2类包括防风、当归、甘草、白芍、牡丹皮、茯苓、丁香,第3类包括麝香、没药、红花、木香、血竭、川芎、肉桂、丁香根、赤芍、苍术、透骨草、法半夏、蛇床子、五加皮、牛膝、附子、虎骨。结论:《医宗金鉴·正骨心法要旨》中骨伤外治处方以“活血化瘀止痛、祛风通络、兼顾补血”为主要治法,采用辛温之药从肝入手,辨证施治。

Objective:To analyze the clinical medication rules of the prescriptions for external treatment of orthopedic and traumatic diseases in Yizong Jinjian,Essentials of Bone Orthopedics.Methods:The prescriptions used for external treatment of orthopedic and traumatic diseases were extracted from Yizong Jinjian,Essentials of Bone Orthopedics.The extracted and normalized Chinese herbs(CHs)in the prescriptions were input into the Microsoft Office Excel 2019 software for building a database, based on which their usage frequency, medicinal property, medicinal flavor, meridian tropism and efficacy were statistically analyzed.The high-frequency CHs were then subjected to cluster analysis by using SPSS Statistics 22.0 software.Results:One hundred prescriptions(140 CHs)were searched out.After screening, 120 CHs(appeared 1218 times)were included in the final analysis, among which 25 ones(appeared 742 times)displayed a usage frequency of ≥20,and the ones with high usage frequency included Angelica Sinensis(74 times),Carthamus Tinctorius(55 times),Myrrha(44 times),Moschus(43 times)and Chuanxiong Rhizoma(38 times).The results of statistics on medicinal property showed that the most frequently used CHs were those with a warm property(630 times),followed by the ones with a neutral property(309 times)and a cold property(216 times).The results of statistics on medicinal flavor showed that the CHs with pungent, sweet and bitter flavors were more preferred, with their usage frequency of being 792,588 and 494 times respectively.The results of statistics on meridian tropism showed that the 120 CHs were categorized into 12 types by meridian tropism, and they mainly acted on the liver meridians(711 times),heart meridians(546 times)and kidney meridians(410 times).The results of statistics on efficacy showed that the 120 CHs involved 18 categories of efficacy, and the ones with high usage frequency included blood-activating and stasis-resolving herbs(302 times),deficiency-reinforcing herbs(239 times, mostly blood-tonifying herbs),wind-damp-dispelling herbs(121 times),heat-clearing herbs(117 times),interior-warming herbs( 70 times) and exterior-releasing herbs( 69 times). As revealed by the cluster analysis,the 25 CHs with a usage frequency of≥20 were clustered into 3 categories,with Frankincense alone into Category Ⅰ;Saposhnikoviae Radix,Angelica Sinensis,Glycyrrhiza uralensis,Paeoniae Radix Alba,Moutan Cortex,Poria( TCD) and Caryophylli Flos into CategoryⅡ;and Moschus,Myrrha,Carthamus Tinctorius,Aucklandiae Radix,Draconis Sanguis,Chuanxiong Rhizoma,Cinnamomi Cortex,Caryophylli Flos( root),Paeoniae Radix Rubra,Atractlodis Rhizoma,Herba Speranskiae Tuberculatae,Pinelliae Rhizoma Praeparatum,Cnidii Fructus,Acanthopanacis Cortex,Achyranthes Bidentatae Radix( TCD),Aconiti Lateralis Radix Praeparaka and Os Panthera Tigris( TCD) into CategoryⅢ. Conclusion: The prescriptions used for external treatment of orthopedic and traumatic diseases in Yizong Jinjian,Essentials of Bone Orthopedics mainly follow the principle of promoting blood-circulation to remove blood-stasis and pain,expelling wind and dredging collaterals as well as tonifying blood,and the pungent and warm CHs acting on liver meridian are often used as the start of the treatment,followed by treatment based on disease differentiation.