基于六经辨证的《伤寒杂病论》治痹用药规律探讨

Discussion on the medication law of treating the bi syndrome in Shanghan Zabing Lun based on the syndrome differentiation of six channels theory

目的基于六经辨证分析《伤寒杂病论》治疗痹证的方剂,探讨张仲景治疗痹证的用药特色及用药规律,为临床用经方治疗痹证提供理论依据。方法选取符合筛选标准的方剂并记录其药物组成,利用Excel 2013、BMI SPSS Modeler 18.0、SPSS 25.0建立数据库并进行数据统计与分析。结果根据筛选标准,共收集经方38首,涉及中药49味。高频使用药物有炙甘草、桂枝、生姜等;药物功效使用频率最高为补气药;关联分析得到24对关联药物,其中“生姜-大枣”关联最强;聚类分析得到4个可供参考的聚类组合。结论《伤寒杂病论》治疗痹证的核心方剂为桂枝汤;仲景治痹法则为补养气血、祛风除湿、温阳通络;痹证各经皆有,仲景治痹不拘于专病专方,而是随证治之。

Objective To explore the medication characteristics and regularities in Zhang Zhongjing’s treatment of the bi syndrome by analyzing the prescriptions of Shanghan Zabing Lun(Treatise on Cold Pathogenic and Miscellaneous Diseases)based on the syndrome diff erentiation of six channels theory,and to provide a theoretical basis for the clinical use of classical prescriptions for the treatment of a bi syndrome.Methods The prescriptions meeting the screening criteria were selected and their drug compositions were recorded.Excel 2013,BMI SPSS Modeler 18.0 and SPSS 25.0 were used to establish a database and the relevant data were statistically analyzed.Results According to the screening criteria,a total of 38 classical prescriptions were collected,involving 49 traditional Chinese medicines,among which frequently used drugs included roasted liquorice root,cassia twig,fresh ginger,etc.The highest frequency of drug efficacy was replenishing qi.A total of 24 couple medicines were obtained by the association analysis,among which fresh ginger-Chinese date was the most strongly associated one.Four cluster combinations for a possible reference were obtained by the cluster analysis.Conclusion Guizhi Decoction is the core prescription for treating the bi syndrome in Shanghan Zabing Lun.Zhang Zhongjing’s principles in treating the bi syndrome are replenishing qi and nourishing blood,expelling wind and removing dampness,warming yang and dredging collaterals.A bi syndrome can occur in each meridian.Zhang Zhongjing’s bi syndrome treatment is not confi ned to a specifi c disease or prescription,but varies in accordance with the syndrome.