《临证指南医案·卷五》药物应用规律探微

Discussion on Regularity of Medication Application in Guide to Clinical Practice with Medical Records·VolumeⅤ

[目的]利用数据挖掘方法分析《临证指南医案·卷五》(以下称外感卷)药物的应用与配伍规律,探求温病的辨治规律。[方法]对外感卷203则医案190味药物进行标准化处理,通过频次统计与分层聚类法进行分析。[结果]外感卷药物中茯苓、杏仁、滑石与连翘配伍最广,应用频次最高,体现叶氏宣达芳化、渗利祛湿配伍辛凉清解之特色。风温、温热篇以清热生津为主;暑、湿篇以清热祛湿为主,在卫以辛凉清解,气分证以白虎汤为主,夹湿治以三焦渗利;伤阴则取麦门冬、增液汤类;湿热以中焦脾胃为主,重视宣展气机,治从三焦,即宣上、畅中、渗下。叶氏清热(含清卫分热、清气分热与清营血分热)、养阴(卫分、气分至营血分)、祛湿(以气分证为主,重在中焦)的用方多为自创,或化裁伤寒方,体现出卫气营血证的层层变化。[结论]外感卷是叶氏《温热论》卫气营血辨证体系的具体体现,其中的辨治思想与方药多被《温病条辨》收录,并演绎出三焦辨证体系,对于当下辨治外感病具有极重要的参考价值。

[Objective]To analyze the application and compatibility regularity of herbs in Guide to Clinical Practice with Medical Records·VolumeⅤ(hereinafter referred to as Exogenous Diseases Volume),and explore the treatment regularity of warm febrile diseases based on syndrome differentiation.[Methods]In the Exogenous Diseases Volume,there were 203 medical cases involving 190 herbs.After standardizing,they were analyzed by frequency statistics and hierarchical clustering methods.[Results]Among all 190 herbs in the Exogenous Diseases Volume,Poria cocos,Armeniacae Semen Amarum,Talcum were usually composed with Forsythiae Fructus with the highest frequency of application,which reflected the compatibility characteristics of YE’s dispersion and aromatization,seeping and dispelling dampness cooperated with pungent cool and clear resolution.In Wind Warm and Febrile Chapters,the common treatment method was clearing heat to promote body fluid,and clearing heat and expelling dampness was the most frequently used method in Summer Heat and Dampness Chapters.In the Wei phase,it was mainly to use pungent cool for clearing resolution.The Wei phase syndrome was mainly treated by Baihu Decoction.Herbs for promoting drain dampness from tri-Jiao were used if combined with dampness;Maimendong Decoction and Zengye Decoction were used if Yin was consumed.Damp heat mainly impacted the middle-Jiao,spleen and stomach.YE put emphasis on enlivening functional activities of Qi,and treated basing on the tri-Jiao,dispersing the upper-Jiao,clearing the middle-Jiao and draining the lower-Jiao.YE’s prescriptions for clearing heat(clearing heat from the Wei,Qi,Ying and blood phases),nourishing the Yin(from the Wei phase,to Qi,Ying and blood phases),dispelling dampness(from the Qi phase,location in the middleJiao)were mostly self-created,and others were adapted from the Treatise on Exogenous Febrile Disease,which reflected the changes in the Wei,Qi,Ying and blood syndrome.[Conclusion]Exogenous Diseases Volume embodied the theory of Wei,Qi,Ying and blood differentiation which was derived from YE’s book entitled Treatise on Warm Febrile Disease.Many of the thoughts and prescriptions were included in the book Detailed Analysis of Warm Febrile Diseases,and became the sources of tri-Jiao syndrome differentiation.Those thoughts were extremely important references for the identification and treatment of exogenous diseases at present.