金元四大家治疗头痛处方用药规律分析

Prescription and medication rules of the four great medical schools in Jin and Yuan Dynasties in treatment of headache

目的:整理并总结金元四大家(刘完素、李东垣、张子和、朱丹溪)治疗头痛的用药规律,以期为完善和分析金元四大家学术体系及用药配伍提供客观数据支持。方法:收集金元四大家医学著作中与头痛相关的中药方剂,对符合纳入标准的中药方剂进行数据统计,利用Excel软件建立中药信息数据库,分别应用IBM SPSS Modeler 18.0、IBM SPSS 20.0统计软件对信息库中的高频药物进行数据挖掘分析,并采用Gephi 0.9.2软件绘制药物网络图。结果:本研究共获得治疗头痛的中药方剂89首,其中甘草使用频率最高(49.44%),其次为川芎(46.07%)、黄芩(38.20%)、防风(34.83%)、羌活(28.09%)、细辛(23.60%)等;药物功效以解表、补虚、清热、活血化瘀及化痰为主;药性方面,以温性药使用最多,其次为平性、寒性;药味方面,以辛味药使用最多,其次为甘味、苦味;共挖掘出17对高频药对(如甘草-川芎、黄芩-川芎、黄芩-甘草等),12组高频药组(如川芎-甘草-防风、川芎-甘草-黄芩等),4组核心药物组方。结论:金元四大家治疗头痛主要从肝、肺、心三脏论治,治疗上以攻邪、补中、清热及理气化痰法为主,多用解表、补虚、清热、活血化瘀和化痰药,并根据“六经头痛”特点分经治之,可治疗外感、气虚、瘀血、痰浊头痛等,常用方剂有川芎石膏汤、羌活汤及清上泻火汤等。

Objective:To investigate the medication rule of the four great medical schools in Jin and Yuan Dynasties(Liu Wansu,Li Dongyuan,Zhang Zihe,and Zhu Danxi)in the treatment of headache,and to provide ob-jective data for perfecting and analyzing the academic system and medication compatibility of the four great medical schools.Methods:The traditional Chinese medicine(TCM)prescriptions associated with headache were collected from the medical works of the four great medical schools,and a statistical analysis was performed for the TCM pre-scriptions meeting the inclusion criteria.Excel software was used to establish a TCM information database,and IBM SPSS Modeler 18.0 and IBM SPSS 20.0 were used to perform data mining of high-frequency drugs in the data-base.Gephi 0.9.2 was used to plot a drug network diagram.Results:A total of 89 TCM prescriptions were obtained for the treatment of headache,among which Radix Glycyrrhizae had the highest frequency of use(49.44%),followed by Rhizoma Chuanxiong(46.07%),Scutellaria baicalensis(38.20%),Radix Saposhnikoviae(34.83%),Rhizoma et Radix Notopterygii(28.09%),and asarum(23.60%).The drugs had the main functions of relieving exterior syndrome,tonifying deficiency,clearing heat,activating blood and resolving stasis,and resolving phlegm;as for drug nature,the drugs with a warm nature had the highest frequency of use,followed by those with a neutral or cold nature;as for drug taste,the drugs with a pungent taste had the highest frequency of use,followed by those with a sweet or bitter taste.Data mining obtained 17 high-frequency drug pairs(including Radix Glycyrrhizae-Rhizoma Chuanxiong,Scutellaria baicalensis-Rhizoma Chuanxiong,and Scutellaria baicalensis-Radix Glycyrrhi-zae),12 high-frequency drug combination(including Rhizoma Chuanxiong-Radix Glycyrrhizae-Radix Saposhnik-oviae and Rhizoma Chuanxiong-Radix Glycyrrhizae-Scutellaria baicalensis),and 4 core drug prescriptions.Conclusion:The four great medical schools in Jin and Yuan Dynasties mainly treated headache from the liver,the lung,and the heart and used the methods of attacking pathogen,tonifying middle-Jiao,clearing heat,regulating Qi,and resolving phlegm.They often used the drugs with the functions of relieving exterior syndrome,ton-ifying deficiency,clearing heat,activating blood and resolving stasis,and resolving phlegm and treated the disease based on the features of“headache involving the six meridians”,which can be used for the treatment of headache due to exogenous disease,Qi deficiency,blood stasis,and turbid phlegm.Commonly used prescriptions include Chuanxiong Shigao decoction,Qianghuo decoction,and Qingshang Xiehuo decoction.