85例柴胡桂枝干姜汤病例资料回顾性分析

Retrospective Analysis of 85 Cases of Chaihu Guizhi Ganjiang Decoction

目的:通过对病例资料的回顾性分析探讨柴胡桂枝干姜汤的证治规律。方法:对2018年1月至2020年10月间就诊于北京大学第三医院中医科门诊的85例柴胡桂枝干姜汤病例资料所记录的舌象、脉象、症状以及病位证素、病性证素分别进行频数和聚类分析。结果:频数排前10位的症状分别是夜寐不安、畏寒、口干、喜热食、大便溏薄但头汗出、胸胁胀满、脘痞、入睡难和疲乏,症状聚类分析显示喜热食但头汗出、大便溏薄之间的关联性最强,其次为夜寐不安、口干和畏寒;弦脉出现频率最高占70.6%,舌淡白、苔薄白为最常见的复合舌象占35.3%;病位与病性证素聚类分析显示脾胃与阳虚的关联性及胆与热的关联性较强,多兼有痰湿、停饮而阴虚少见。结论:寒热错杂、虚实相兼以阳(气)虚为主是本方证的病机特点,胆热脾寒是本方最常见的病机形式,常兼有痰湿、停饮。

Objective:Through the retrospective analysis of case data,this paper discusses the law of syndrome differentiation and treatment of Chaihu Guizhi Ganjiang decoction.Methods:The frequency and cluster analysis were carried out on the tongue,pulse,symptoms,syndrome elements of disease location and syndrome elements of disease nature recorded in the case data of 85 cases of Chaihu Guizhi Ganjiang decoction in the outpatient department of traditional Chinese medicine of Peking University Third Hospital from January 2018 to October 2020.Results:The top 10 symptoms were restless sleep,aversion to cold,dry mouth,liking hot-food,feces rarefaction,sweating only on the head,fullness in chest and hypochondrium,stomach distension,difficulty in falling asleep and fatigue.Cluster analysis of symptoms showed there was the strongest correlation between liking hot-food,sweating only on the head and feces rarefaction,followed by restless sleep,dry mouth and aversion to cold.The frequency of string-like pulse was the highest,accounting for 70.6%.The most common compound tongue image was pale tongue with thin and white moss,accounting for 35.3%.Cluster analysis of syndrome elements of disease location and syndrome elements of disease nature showed there was a strong correlation between spleen,stomach and Yang deficiency,and between gallbladder and heat.Most of cases had phlegm-dampness and fluid-retention,while Yin deficiency was rare.Conclusion:The pathogenesis of this syndrome is characterized by cold-heat complex,deficiency-excess mixing,and deficiency of Yang(Qi)is the main pathogenesis of this syndrome.Gallbladder heat with spleen cold is the most common form of pathogenesis.Phlegm-dampness and fluid-retention are common pathological products.