结合《温病条辨》探究叶天士在《临证指南医案》湿病篇的组方及用药规律

Exploration of YE Tianshi's Prescription and Medication Rule in the Chapter of Dampness in A Guide to Clinical Practice with Medical Records Combined with Treatise on Differentiation and Treatment of Epidemic Febrile Disease

目的探究叶天士在湿病辨治方面的辨证用药规律。方法收集《临证指南医案》原书中湿病篇所有方剂建立数据库。采用SPSS Statistics 26.0及SPSS Modeler Version 18.0作为数据挖掘平台,对数据库进行用药频次、聚类分析、关联规则分析并绘制关联规则网络图,最后将《临证指南医案》与《温病条辨》中的组方用药进行对比,绘制成表。结果总数据库累计收录组方63个,包含中药112味,其中应用频率>20%的中药分别是茯苓、白术、厚朴、陈皮、生姜、滑石。主要入脾、肺、胃经;辛味中药应用最多,其次为甘、苦味中药;寒性、温性中药应用较多。寒湿数据库累计收录组方36个,包含中药74味,应用频次前6位的中药依次是茯苓、白术、陈皮、厚朴、生姜、薏苡仁。湿热数据库累计收录组方22个,包含中药78味,应用频次前6位的中药依次是滑石、杏仁、茯苓、厚朴、连翘、半夏。关联规则所得核心药对为白术-茯苓,其次分别为厚朴-陈皮、生姜-茯苓、杏仁-滑石。聚类分析得到5组有意义的药物聚类组,其功效分别为,组方1:燥湿行气、温中健脾;组方2:温中助阳,健脾益气;组方3:清湿热,祛脾胃浊毒;组方4:清热宣肺,行气燥湿;组方5:清热利湿,分消泻浊。得到《温病条辨》中对应组方31首,其中治在上焦的方剂共5首,治在中焦的方剂为22首,治在下焦的方剂共4首。结论叶天士将湿病分为寒湿和湿热治疗,亦分为上中下焦,从三焦进行辨证论治,在治疗过程中注重调脾,兼顾肺胃,用药特点为以辛甘苦寒治湿热,辛甘苦温治寒湿。叶天士在湿病治疗时常以五苓散、平胃散、杏仁滑石汤、杏仁薏苡汤、小半夏加茯苓汤为底方加减。

Objective To explore Ye Tianshi's syndrome differentiation and treatment of damp disease.Methods All prescriptions in the original book of A Guide to Clinical Practice with Medical Records were collected to establish a database.SPSS statistics 26.0 and SPSS modeler version 18.0 were used as the data mining platform to analyze the medication frequency,cluster analysis and association rules of the database,and draw the network diagram of association rules.Finally,the prescription medication in A Guide to Clinical Practice with Medical Records and Treatise on Differentiation and Treatment of Epidemic Febrile Disease were compared and drawn into a table.Results The total database included 63 prescriptions,including 112 traditional Chinese medicines,of which the application frequency>20%were Fuling(Poria),Baizhu(Atractylodis Macrocephalae Rhizoma),Houpo(Magnoliae Officinalis Cortex),Chenpi(Citri Reticulatae Pericarpium),Shengjiang(Zingiberis Rhizoma Recens),Huashi(Talcum).It mainly enters spleen,lung and stomach channels;The application of pungent herbs was the most,followed by sweet and bitter herbs;Cold and warm herbs are widely used.The cold dampness database has collected 36 prescriptions,including 74 kinds of traditional Chinese medicine.The top six Chinese medicine used frequently are:Fuling(Poria),Baizhu(Atractylodis Macrocephalae Rhizoma),Chenpi(Citri Reticulatae Pericarpium),Houpo(Magnoliae Officinalis Cortex),Shengjiang(Zingiberis Rhizoma Recens),Yiyiren(Coicis Semen).The database of dampness and heat has collected 22 prescriptions,including 78 kinds of traditional Chinese medicine.The top six Chinese medicine used frequently are Huashi(Talcum),Xingren(Armeniacae Semen Amaruma),Fuling(Poria),Houpo(Magnoliae Officinalis Cortex),Lianqiao(Forsythiae Fructus)and Banxia(Pinelliae Rhizomap).The core pair of association rules is Baizhu(Atractylodis Macrocephalae Rhizoma)-Fuling(Poria).Secondly,they are Houpo(Magnoliae Officinalis Cortex)-Chenpi(Citri Reticulatae Pericarpium),Shengjiang(Zingiberis Rhizoma Recens)-Fuling(Poria),Xingren(Armeniacae Semen Amaruma)-Huashi(Talcum).Five significant drug clusters were obtained by cluster analysis,Formula 1:dryness and dampness promoting Qi,warming and invigorating spleen;Formula 2:warming the middle to help Yang,invigorating the spleen and replenishing Qi;Formula 3:clearing dampness and heat,dispelling turbid toxin of spleen and stomach;Formula 4:clearing heat and dispersing lung,promoting Qi and drying dampness;Formula 5:clearing away heat and dampness,resolving turbid.There are 31 corresponding prescriptions in Treatise on Differentiation and Treatment of Epidemic Febrile Disease,including 5 prescriptions for upper Jiao,22 prescriptions for middle Jiao and 4 prescriptions for lower Jiao.Conclusion YE Tianshi divided the dampness into cold dampness and damp heat treatment,and also divided into upper,middle and lower Jiao.He treated the dampness according to syndrome differentiation from Sanjiao.He paid attention to regulating the spleen and lung and stomach in the treatment process.The characteristics of medication were treating dampness and heat with pungent,sweet and bitter cold,and treating cold and dampness with pungent,sweet and bitter warm.YE Tianshi often used Wuling Powder(五苓散),Pingwei Powder(平胃散),Xingren Huashi Decoction(杏仁滑石汤),Xingren Yiyi Decoction(杏仁薏苡汤),Xiaobanxia Jiafuling Decoction(小半夏加茯苓汤)as the base prescription in the treatment of damp diseases.