经典名方枳实薤白桂枝汤的古代文献与现代临床应用分析

Ancient Literature Analysis and Modern Clinical Application of Famous Classical Prescription Zhishi Xiebai Guizhi Tang

枳实薤白桂枝汤出自《金匮要略》(汉·张仲景),是治疗胸痹疾病常用经典名方之一。笔者采用文献计量学的方法,搜集枳实薤白桂枝汤相关中医古籍63部,筛选出有效中医古籍36部,系统梳理枳实薤白桂枝汤的历史源流、药物组成、主治病证、剂量、炮制、制法煎法等方面进,行统计分析,发现枳实薤白桂枝汤由枳实、薤白、桂枝、厚朴、瓜蒌五味药物组成,具有通阳散结,祛痰下气的功能,主治“阳气被遏,心气郁滞,痰瘀郁生,痰之邪阻结在心胸或胸肺”所致的胸痹胸满、胸痛、喘息咳唾、短气。同时,发现枳实薤白桂枝汤现代临床应用文献共计70篇,主治系统疾病范围为循环系统(51篇),占比72.85%;内分泌系统(4篇)占比5.7%;呼吸系统(9篇)占比12.85%;消化系统(6篇)8.57%,其中以循环系统中“冠心病(中医为胸痹)”为主,其中医证型主要为痰热痰浊内阻证,痰浊痰瘀痹阻证,寒凝痰瘀气滞证,胸阳不振、痰瘀互结型等为主要临床特征。古代医籍记载应用与现代临床应用是保证经典名方复方制剂安全性和有效性的关键。因此,该文通过对经典名方枳实薤白桂枝汤古代医籍整理挖掘及现代临床应用的统计分析,旨在为其新药研发和临床应用提供文献参考依据。

Zhishi Xiebai Guizhi Tang,derived from Synopsis of the Golden Chamber(《金匮要略》,Han dynasty,ZHANG Zhongjing),is a famous classical prescription commonly used for chest impediment.By means of bibliometrics,the authors collected 63 ancient Chinese medical books related to Zhishi Xiebai Guizhi Tang and screened 36 effective books for statistical analysis of the historical origin,composition,main indications,dosage,processing,decocting method and other aspects of the prescription.The findings revealed that Zhishi Xiebai Guizhi Tang was composed of five medicinal herbs,namely,Auranti Fructus Immaturus,Alli Macrostemonis Bulbus,Cinnamomi Ramulus,Magnoliae Officinalis Cortex,and Trichosanthis Fructus,with the function of activating Yang,dissipating mass,dispelling phlegm and lowering Qi.The prescription was mainly used to treat chest impediment,chest fullness,chest pain,wheezing,coughing and shortness of breath caused by suppressed Yang Qi,stagnant heart Qi,stagnant phlegm and stasis,and phlegm evil blocking heart,chest or lungs.Additionally,it was found that there were 70 modern literature recording the clinical applications of Zhishi Xiebai Guizhi Tang,and the main system diseases treated were circulatory system(51,72.85%),endocrine system(4,5.7%),respiratory system(9,12.85%)and digestive system(6,8.57%),of which circulatory system is dominated by coronary heart disease(chest impediment in traditional Chinese medicine).The involved medical syndrome types mainly included internal obstruction of phlegm heat and turbidity,obstruction of phlegm turbidity and stasis,congealing cold,phlegm,stasis and Qi stagnation,chest Yang depression and combined phlegm and stasis.Ancient medical records and modern clinical application are the keys to ensure the safety and effectiveness of famous classical prescriptions and compound preparations.Therefore,this paper sorted and mined ancient medical books of Zhishi Xiebai Guizhi Tang and statistically analyzed its modern clinical application,aiming to provide a literature reference for the research and development of new drugs and clinical application of the prescription.