基于临床医案探讨芍药甘草汤证的辨治规律

Discussion of Differentiation Treatment Rules of Shaoyao Gancao Tang Syndrome Based on Clinical Medical Cases

目的:研究现代医案中芍药甘草汤证涉及的疾病范围和辨治规律,为现代临床应用提供理论依据和实践指导。方法:检索中国知网、维普期刊全文数据库及万方数据知识服务平台自建库—2021年9月关于芍药甘草汤的临床医案,对芍药甘草汤证涉及的主治病种、药物用量比值、不同剂量使用频次、用药配比及规律进行统计分析。结果:共涉及103个病种,主要集中在胃脘痛、腓肠肌痉挛、头痛、便秘、呃逆、慢性胃炎、三叉神经痛、腹痛、坐骨神经痛、痛经、支气管哮喘等疾病中。方中白芍∶甘草配伍比例前三位是2∶1、3∶1、1∶1,分别占比22.78%、18.51%、8.01%;白芍的用量最多在21~30 g,甘草的用量最多在11~20 g区间;治疗消化系统疾病白芍多用21~30 g,占比34.59%,甘草多用1~10 g,占比46.49%,以2∶1的配伍比例出现次数最多,占比21.08%;治疗运动系统疾病时,白芍多用21~30 g,占比39.68%,甘草多用11~20 g,占比49.21%,以2∶1的配伍比例出现次数最多,占比27.78%;治疗神经系统疾病时,白芍多用21~30 g,占比37.76%,甘草多用11~20 g,占比51.05%,以2∶1的配伍比例出现次数最多,占比20.28%;治疗呼吸系统疾病时,白芍多用11~20 g,占比33.33%,甘草多用1~10 g,占比54.17%,以2∶1的配伍比例出现次数最多,占比37.50%;治疗泌尿生殖系统疾病时,白芍多用多用21~30 g,占比36.36%,甘草多用1~10 g,占比65.45%,以3∶1的配伍比例出现次数最多,占比23.64%。结论:芍药甘草汤证涉及疾病种类广泛,并未拘于某一种或几种疾病的治疗,且不同系统疾病由于病机和证型证候有所区别,方药的剂量配比和发挥的作用自然不同,但均是以芍药甘草汤证为纲,“以证统病”“以法立方”,这也与仲景六经辨证的思想不谋而合,也为今后研究学者从研究方证的角度提供了新思路。

Objective:To study the disease range and differentiation treatment rules related to Shaoyao Gancao tang syndrome in clinical medical cases,so as to provide theoretical basis and practice guidance for modern clinical application.Methods:The clinical medical cases concerning Shaoyao Gancao tang were searched from China National Knowledge Infrastructure,VIP Database and Wanfang Database from their constructions to Sep 2021.The main diseases,drug dosage and ratio,frequency of different doses,drug ratio and rules involved in Shaoyao Gancao tang were counted and analyzed.Results:A total of 103 disease kinds were involved,mainly concentrated on epigastric pain,gastrocnemius spasm,headache,constipation,hiccup,chronic gastritis,trigeminal neuralgia,abdominal pain,sciatica,dysmenorrhea,bronchial asthma and other diseases.The top three compatibility ratios of Radix Paeoniae Alba and Radix et Rhizoma Glycyrrhizae were 2∶1,3∶1 and 1∶1,accounting for 22.78%,18.51%and 8.01%respectively.The maximum dosage of Radix Paeoniae Alba ranged from 21 g to 30 g,and that of Radix et Rhizoma Glycyrrhizae ranged from 11 g to 20 g.In the treatment of digestive system diseases,the dosage of Radix Paeoniae Alba was mostly 21 g to 30 g,accounting for34.59%,and that of Radix et Rhizoma Glycyrrhizae was mostly 1 g to 10 g,accounting for 46.49%;the compatibility ratio of2∶1 was applied most,accounting for 21.08%.In the treatment of motor system diseases,the dosage of Radix Paeoniae Alba was mostly 21 g to 30 g,accounting for 39.68%,and Radix et Rhizoma Glycyrrhizae was mostly 11 g to 20 g,accounting for 49.21%;the compatibility ratio of 2∶1 was applied most,accounting for 27.78%.In the treatment of nervous system diseases,the dosage of Radix Paeoniae Alba was mostly 21 g to 30 g,accounting for 37.76%,and Radix et Rhizoma Glycyrrhizae was mostly 11 g to 20 g,accounting for 51.05%;the compatibility ratio of 2:1 appeared the most,accounting for 20.28%;In the treatment of respiratory diseases,the dosage of Radix Paeoniae Alba was mostly 11 g to 20 g,accounting for 33.33%,and Radix et Rhizoma Glycyrrhizae was 1 g to 10 g,accounting for 54.17%;the compatibility ratio of2∶1 was applied most,accounting for 37.50%.In the treatment of urogenital diseases,the dosage of Radix Paeoniae Alba was mostly 21 g to 30 g,accounting for 36.36%,and Radix et Rhizoma Glycyrrhizae was mostly 1 g to 10 g,accounting for65.45%;the compatibility ratio of 3∶1 appeared the most,accounting for 23.64%.Conclusion:Shaoyao Gancao tang involves a wide range of diseases and is not confined to the treatment of one or several diseases.Due to the difference of pathogenesis,syndrome types and syndromes of different system diseases,the dose,ratio and role of prescriptions and drugs are naturally different.However,Shaoyao Gancao tang is considered as the key link to"treat diseases based on syndrome"and"apply prescriptions based on rules",which also coincides with the thought of Zhongjing’s six-channel syndrome differentiation,and provides new ideas for future researchers from the perspective of prescription and syndrome.