《临证指南医案》治疗心系病证用药规律研究

Medication Rule of the Treatment of Heart Diseases in Clinic Guideline of Medical Records

目的:分析《临证指南医案》治疗心系病证的用药规律。方法:系统整理《临证指南医案》中治疗心系病证的相关方剂,运用中医传承计算平台(V3.0)分析中药的使用频次、性味归经、关联规则、聚类等。结果:通过筛选,共纳入方剂119首,中药160味。用药频次≥10次的中药有21味,位列前10的依次为茯神、茯苓、人参、半夏、生地黄、炙甘草、白芍、酸枣仁、生姜、麦冬。四气以温、寒、平为主,五味多用甘、苦、辛,归经多以心、肺、脾为主,功效位列前3的依次为补虚类、利水渗湿类、清热类。频次位列前3的药物组合依次是茯神-人参、茯神-酸枣仁、茯苓-半夏,置信度位列前3的药物组合依次是人参,酸枣仁-茯神、枳实-半夏、酸枣仁-茯神。中药聚类分析提取到3类核心组合。结论:《临证指南医案》中叶氏治疗心系病证多以补益心脾、滋阴养血、温通阳气、化痰除湿为法,治心为主,注重五脏之间的关系,兼顾脾、肝、肺等脏,审因用药。

Objective:To analyze the medication rule of the treatment of heart diseases in Clinic Guideline of Medical Records.Methods:The related prescriptions for the treatment of heart diseases in Clinic Guideline of Medical Records were systematically collated,and the frequency of use,taste meridians,association rules and clustering of traditional Chinese medicine were analyzed by using the traditional Chinese medicine inheritance computing system(V3.O).Results:Through screening,a total of 119 prescriptions were included,involving 160 traditional Chinese medicine drugs in total.There were 21 herbs that the frequency of using were more than 10 times,and the top 10 drugs in terms of the frequency of use were Fu Shen,Poria cocos,Ginseng,Pinellia ternata,Rehmannia glutinosa,Radix Glycyrrhizae,Radix Paeoniae Alba,Semen Ziziphi Spinosae,Zingiber officinale,and Radix Ophiopogonis japonicus.Most drugs were warm,cold and neutral in nature and had a sweet,bitter and pungent taste,and most drugs entered the heart,lung and spleen meridians.The top three functions were tonic class,benefit water infiltration wet class,and heat-clearing class.The top three drug combinations in frequency were Fu Shen-Ginseng,Fu Shen-Semen Ziziphi Spinosae,Poria cocos-Pinellia ternata,and the top three drug combinations in confidence were Ginseng,Semen Ziziphi Spinosae-Fu Shen,Zhi Shi-Pinellia ternata,and Semen Ziziphi Spinosae-Fu Shen.Cluster analysis of traditional Chinese medicine extracted three types of core combinations.Conclusion:In Clinic Guideline of Medical Records,Ye's treatment of cardiac syndrome is mainly based on tonifying heart and spleen,nourishing yin and nourishing blood,warming yang qi,resolving phlegm and removing dampness,focusing on the relationship between the five viscera,taking into account the spleen,liver,lung and other viscera,and examining the cause of medication.