基于药性理论探析全国名中医曹恩泽辨治慢性肾功能衰竭组方经验

Investigation on Cao Enze's Experience of Composition in Treating Chronic Renal Failure based on the Theory of Drug Properties

目的:分析总结曹恩泽全国名中医治疗慢性肾功能衰竭(CRF)组方药物性味归经特点。方法:收集曹恩泽治疗的CRF非透析患者病例330例,有效处方1220首,应用临床病例采集系统,录入处方所用药物的四气、五味及归经等相关数据信息,进行统计分析。结果:应用频率>90%的中药有黄芪、煅龙骨、煅牡蛎、地龙、全蝎、土茯苓、槐米、苍术、僵蚕和生大黄。药性方面,温性药应用比率占45.08%,寒性药占30.23%,平性药占19.80%,凉性药4.73%,热性药应用最少,CRF前期(CKD2-3期)温性药应用比率占39.97%、寒性药占35.60%、平性药占18.98%,后期(CKD4-5期)温性药应用比率占53.01%、寒性药占21.89%、平性药占21.07%;药味方面,甘味药应用比率占31.19%,辛味药占29.26%,苦味药占20.21%,其余药味应用比率均少于10%,其中咸味和淡味分别为8.01%和7.41%,而酸、涩味使用较少,CRF前期(CKD2-3期)甘味药应用比率占31.74%、辛味药占30.48%、苦味药占18.78%、咸味药占7.13%,后期(CKD4-5期)甘味药应用比率占30.27%、辛味药占27.18%、苦味药占22.64%,咸味药占9.50%;归经方面,归肝经药物使用比率占24.25%、归脾经药物占16.48%、归胃经药物占14.63%、归肾经药物占12.79%、归肺经药物占11.55%,其余归经药物比率均低于10%。结论:曹恩泽辨治CRF所应用药物,药性以温为主,温寒并重,药味以甘、辛、苦为多,药物多入肝、脾、胃、肾、肺经,组方药物少用大热、酸涩之品,体现其“清降”“清补”“活血”相合辨治CRF之法。

Objective:To analyze and summarize the pharmacologic characteristics of composition prescribed by Cao Enze,a national famous TCM doctor,for treating chronic renal failure.Methods:A total of 330 nondialysis cases with chronic renal failure treated by Cao Enze were collected,with 1220 valid prescriptions.The data of four qi,five flavors and channel entry associated with the drugs used in the prescriptions were input through the clinical case collection system and analyzed.Results:The application frequency of raw Astragalus membranaceus,Calcined keel,Calcined oyster,Lumbricus,Scorpion,Rhizoma smilacis glabrae,Pagoda tree flower,Atractylodes,Stiff silkworm and Raw rhubarb were more than 90%.In terms of drug properties,the pro⁃portion of drugs with warm,cold,balanced and cool nature was 45.08%,30.23%,19.80%,and 4.73%re⁃spectively,among which drugs with warm nature were the least used.The proportion of drugs with warm,cold and balanced nature was 39.97%,35.60%,and18.98%respectively in the early stage of chronic renal failure(CKD2-3).In the later stage(CKD4-5),the proportions of drugs with warm,cold,and balanced nature were 53.01%,21.89%,and 21.07%respectively.In the aspect of medicine flavor,the application rates of medicine in flavor of sweetness,acidity and bitterness accounted for 31.19%,29.26%,and 20.21%respective⁃ly,while the application rate of medicine with other flavors was less than 10%.Among them,the rates of medi⁃cine with salty flavor and bland flavor were 8.01%and 7.41%,while the medicine with acid flavor and astrin⁃gent flavor were used less.In the early stage of chronic renal failure(CKD2-3),the application rates of medicine with sweet,acrid,better and salty flavor accounted for 31.74%,30.48%,18.78%,and 7.13%respective⁃ly.In the later stage(CKD4-5),the application rates of medicine with sweet,acrid,better and salty flavor ac⁃counted for 30.27%,27.18%,22.64%,and 9.50%respectively.In terms of channel entry,the usage rate of drugs to liver channel accounted for 24.25%,to spleen channel 16.48%,to stomach channel 14.63%,to kid⁃ney channel 12.79%,to lung channel 11.55%,while other drugs to channel entry accounted for less than 10%.Conclusion:Drugs used by Cao Enze in the treatment of chronic renal failure are mainly with warm nature,while warmth and coldness pay equal attention.The medicinal flavors are mostly sweet,acrid,and bitter.Most of the drugs enter the liver,spleen,stomach,kidney,and lung channel.The prescriptions are of less hot and sour products,which reflect the combination of"clearing down","clearing tonic"and"activating blood"in the differentiation and treatment of chronic renal failure.