柴胡桂枝干姜汤方证特点及配伍规律分析

Analysis on characteristics and compatibility of Chaihu Guizhi Ganjiang decoction

目的基于验案分析探讨柴胡桂枝干姜汤的方证特点与配伍规律。方法检索瀚堂典藏中医药文献数据库和中国生物医学文献服务系统(SinoMed)中使用柴胡桂枝干姜汤的古今验案,用频次法计数文献中各验案的主要症状及用药情况,用因子分析和层次聚类分析其方证特点和用药配伍规律。结果共纳入236篇文献,获得古代验案9个、现代文献验案227个。常见症状变量的因子分析显示,柴胡桂枝干姜汤验案症状可以分为少阳胆郁气滞症状、脾虚消化道症状、津液代谢失常湿盛和全身阳气不足症状4类;分层聚类分析显示,少阳郁滞、胆胃失和挟湿以及少阳郁滞、肝脾不调是其汤证的主要病机,兼见阳气不足表现。从用药情况来看,柴胡桂枝干姜汤原方药物的使用频次最高,同时多配伍健脾、和胃、养血、安神之品;药物变量分层聚类分析显示,柴胡桂枝干姜汤原方药物在用药中占绝对优势,聚为独立的一类;陈皮、党参和半夏聚为一类,发挥补虚和胃降逆化饮除湿作用;茯苓、泽泻、白术、白芍、当归和龙骨聚为一类,发挥益气养血、健脾利湿之功。结论柴胡桂枝干姜汤主证以少阳郁滞、脾胃失调、津气不化为特征,临床又有少阳兼胃气不和与少阳兼太阴不足的细微差别,用药上应灵活加减变化。

Objective To explore the characteristics and compatibility of Chaihu Guizhi Ganjiang decoction based on case analyses.Methods The ancient and modern cases of Chaihu Guizhi Ganjiang decoction were searched in Hantang traditional Chinese medicine literature database and SinoMed.The main symptoms and drug use of each case in the literatures were counted by frequency,and the characteristics of prescriptions and syndromes and the law of drug compatibility were analyzed by factor analysis and hierarchical clustering.Results A total of 236 cases were collected,including 9 ancient cases and 227 modern cases.Factor analysis of common symptom variables showed that the symptoms of Chaihu Guizhi Ganjiang decoction could be divided into 4 categories:gallbladder depression and Qi stagnation symptoms,symptoms of spleen deficiency and digestive tract,abnormal body fluid metabolism and Yang deficiency symptoms.The results of hierarchical clustering showed that the main pathogenesis of decoction syndrome was Shaoyang stagnation,bile and stomach loss and dampness,Shaoyang stagnation and disorder between liver and spleen,with Yang Qi deficiency.In terms of drug use,the original prescription of Chaihu Guizhi Ganjiang decoction had the highest frequency of use.At the same time,it was more compatible with drugs for strengthening the spleen,harmonizing the stomach,nourishing blood and calming the nerves.The results of hierarchical clustering of drug variables showed that the original drugs of Chaihu Guizhi Ganjiang decoction had an absolute advantage in drug use and were grouped into an independent category.Tangerine peel,Codonopsis pilosula and Pinellia ternata were grouped together to play the role of invigorating deficiency,reducing stomach and eliminating dampness.Poria cocos,Alisma orientalis,Atractylodes macrocephala,Radix Paeoniae Alba,Angelica sinensis and keel were grouped together to supplement Qi and nourish blood,and strengthen spleen and dampness.Conclusion The main syndromes of Chaihu Guizhi Ganjiang decoction are characterized by stagnation of Shaoyang,imbalance of spleen and stomach and immobility of body fluid and Qi.Clinically,there are subtle differences between Shaoyang and disharmony of stomach Qi and Shaoyang and deficiency of Taiyin,so the medication should be adjusted flexibly.