基于证素辨证探讨柴胡汤类方症-证规律

Rules of Symptom-syndrome of Chaihu Decoction and Its Associated Prescriptions Based on Syndrome Elements Differentiation

目的挖掘柴胡汤类方中医症状及证素分布规律,为证素辨证应用于类方鉴别提供依据。方法对52本《伤寒论》相关书籍中柴胡汤类方医案进行整理,提取症状、舌象、脉象、诊断以及治疗方剂名称,建立数据库,按照证素辨证原理进行症状规范化处理及证素诊断,运用频数法对数据进行分析。结果521条规范化柴胡汤类方共同症状为口苦、纳呆恶食、胸闷、脉弦,共同证素为肝、胆、气滞、湿、热、阴虚。不同柴胡汤类方证素比较,小柴胡汤为半表半里、气虚、痰、胃,大柴胡汤为胃、半表半里、痰、脾,柴胡加芒硝汤为半表半里、气虚、脾、胃,柴胡加龙骨牡蛎汤为痰、心神、气虚、阳亢,柴胡桂枝汤为气虚、阳虚、表、半表半里,柴胡桂枝干姜汤为气虚、阳虚、脾、半表半里。结论运用证素辨证原理可以客观地反映柴胡汤类方症-证规律在症状、证素的差异,为柴胡汤类方研究提供新的思路。

Objective:To explore the distribution laws of traditional Chinese medicine symptoms and syndrome elements of Chaihu decoction and its associated prescriptions,and to provide evidence for the application of syndrome elements differentiation to the differentiation of associated prescriptions.Methods:The medical records of Chaihu decoction and its associated prescriptions were sort out from 52 books related to Treatise on Febrile Diseases.The fields of book title,author,ISBN number,publication date,gender and age of patients,time of clinical visiting,symptoms,tongue image,pulse image,diagnosis and prescription name were extracted from the medical records and the database was established.The principle of syndrome elements differentiation was applied to symptoms standardization and syndrome elements diagnosis,and the frequency analysis was applied to data processing.Results:The common symptoms of 521 standardized Chaihu decoction and its associated prescriptions were bitter taste,poor appetite,chest tightness and wiry pulse,and the common syndrome elements were liver,Qi stagnation,dampness,heat,Yin deficiency and gallbladder.Comparison of the syndrome elements of different kinds of Chaihu decoction and its associated prescriptions,the syndrome elements of Xiaochaihu decoction were half-superficies and half-interior,Qi deficiency,phlegm and stomach;the syndrome elements of Dachaihu decoction were stomach,half-superficies and half-interior,phlegm and spleen;the syndrome elements of Chaihu Jia Mangxiao decoction were half-superficies and half-interior,Qi deficiency,spleen and stomach;the syndrome elements of Chaihu Jia Longgu Muli decoction were phlegm,heart spirit,Qi deficiency and Yang hyperactivity;the syndrome elements of Chaihu Guizhi decoction were Qi deficiency,Yang deficiency,superficies and half-superficies and half-interior;the syndrome elements of Chaihu Guizhi Ganjiang decoction were Qi deficiency,Yang deficiency,spleen and half-superficies and half-interior.Conclusion:The principle of syndrome differentiation is applied to objectively reflect the differences of symptoms and syndrome elements in Chaihu decoction and its associated prescriptions,providing new insights for the study of Chaihu decoction and its associated prescriptions.