经典名方白术散的古代文献分析和考证

Analysis of Classical Prescription Baizhusan Based on Ancient Literature

白术散出自宋代钱乙的《小儿药证直诀》,是一首历来为医家所推崇并广泛运用于临床的经典名方,被收录于2022国家中医药管理局发布了的《古代经典名方目录(第二批儿科部分)》中。采用文献学的研究方法,搜集白术散的相关古代文献,分析和考证方剂源流与组成、药物基原与炮制、剂量与煎服法、功能主治等。共获取白术散古代文献数据211条,涉及中医古籍116部。结果发现古代以白术散命名的方剂较多,但以人参、茯苓、白术、藿香、木香、甘草、葛根7味药物组成的白术散首先见于《小儿药证直诀》,现一般称之为“七味白术散”。白术散的方剂组成、方义历代较为统一;其药物基原与炮制基本清晰,但白术与甘草的炮制存在争议,建议选用土炒白术和甘草生品;其功能为健脾益气,和胃生津,主治病证较多,如泄泻、消渴、不食等,古今文献一致,但需注意脾虚津亏的基本病机。此外,发现白术散文献中关于药物剂量与煎煮法的争议较大,而“武英殿聚珍本”《小儿药证直诀》所载白术散药物配伍比例为历代主流用药规范。

Baizhusan,derived from Key to Medicines and Patterns of Children's Diseases(《小儿药证直决》)by QIAN Yi in Song dynasty,is a classical prescription that has been highly praised by doctors and widely used in clinical practice.It was included in the Catalogue of Ancient Classical Prescriptions(the second batch of Pediatrics)released by the National Administration of Traditional Chinese Medicine(TCM)in 2022.In this paper,the ancient documents related to Baizhusan were collected by bibliographical research,and the source,composition,herb origin and processing,dosage,decocting method,administration method,functions and indications of the prescription were analyzed and verified.A total of 21l ancient documents on Baizhusan were obtained,involving 116 ancient TCM books.It was found that there were many prescriptions named Baizhusan in ancient times,but the prescription named Baizhusan and composed of Ginseng Radix et Rhizoma,Poria,Atractylodis Macrocephalae Rhizoma,Pogostemonis Herba,Aucklandiae Radix,Glycyrrhizae Radix et Rhizoma,and Puerariae Lobatae Radix was first seen in Key to Medicines and Patterns of Children's Diseases,and is now generally known as Qiweibaizhusan.The composition and functions of Baizhusan were unified in past dynasties,and its herb origin and processing were basically clear.However,there was a dispute on the processing of Atractylodis Macrocephalae Rhizoma and Glycyrrhizae Radix et Rhizoma,which was solved by recommended use of soil-fried Atractylodis Macrocephalae Rhizoma and raw Glycyrrhizae Radix et Rhizoma.Boasting the functions of tonifying spleen,replenishing Qi,harmonizing stomach and promoting fluid production,Baizhusan treated a variety of symptoms such as diarrhea,consumptive thirst and loss of appetite,which were consistent in ancient and modern literature,but attention should be attached to the basic pathogenesis of spleen deficiency and fluid inadequacy.In addition,considerable disagreements were also observed about the dosage and decocting method of Baizhusan in the documents,and the combination ratio of Baizhusan in another version of Key to Medicines and Patterns of Children's Diseases of Wuyingdian Zhenben was the dominant standard for drug use in past dynasties.