经典名方当归四逆汤的文献考证及临床应用分析

Literature research and clinical application analysis of famous classical formula Danggui Sini Decoction

当归四逆汤出自《伤寒论》,通过系统整理古籍与现代文献,对经典名方当归四逆汤的处方来源、组成、药物基原、剂量、炮制、煎服法、功效主治等关键信息及现代临床应用进行考证分析。共获取当归四逆汤相关条目1146条,涉及古籍文献152部。基于古籍考证结果,研究建议方中桂枝基原为樟科植物肉桂Cinnamomum cassia的干燥嫩枝,细辛为马兜铃科植物北细辛Asarum heterotropoides的干燥根及根茎,白芍为毛茛科植物芍药Paeonia lactiflora的干燥根,通草为木通科植物木通Akebia quinata的干燥藤茎,当归、甘草、大枣基原与《中国药典》2020年版一致。炮制方面,建议甘草宜炙炒,余药用生品即可。经古今剂量换算,建议以水525 mL煎煮当归9 g、桂枝9 g、细辛3 g、甘草6 g、木通6 g、白芍9 g、大枣25g,煮取280 mL,每次温服100 mL,每日3次。古籍记载该方治疗以手足厥寒、脉细欲绝为表现的血虚寒厥证,经后世医家临证灵活应用,常用于治疗糖尿病周围神经病变、肩关节周围炎、冻疮等疾病,为当归四逆汤后期研发提供了依据。

Danggui Sini Decoction(当归四逆汤,DSD)is derived from Treatise on Cold Damage.Through a systematic collation of ancient books and modern literature,key information regarding the classic prescription DSD,including its source,composition,herbal base,dosage,processing,decocting and medication,efficacy and indications,as well as its modern clinical application were thoroughly examined.A total of 1146 items related to the DSD were obtained including 152 ancient books and literature.Based on the findings from ancient literature research,it is suggested that Guizhi(Cinnamomi Ramulus)refers to the dried shoots of Cinnamomum cassia,while Xixin(Asari Radix et Rhizoma)corresponds to the dried roots and rhizome of Asarum heterotropoides.Baishao(Paeoniae Radix Alba)represents the dried root of Paeonia lactiflora in Ranunculaceae family,and Tongcao(Tetrapanacis Medulla)denotes the dried vine stem of Akebia quinata in Lardizabalaceae family.The origins of Danggui(Angelicae Sinensis Radix),Gancao(Glycyrrhizae Radix et Rhizoma)and Dazao(Jujubae Fructus)are consistent with which were specified in Chinese Pharmacopeia(2020 edition).In terms of processing,it is suggested that Glycyrrhizae Radix et Rhizoma should be fried,while the remained raw herbs should be utilized as raw materials.According to the conversion of ancient to modern dosages,9 g Angelicae Sinensis Radix,9 g Cinnamomi Ramulus,3 g Asari Radix et Rhizoma,6 g Glycyrrhizae Radix et Rhizoma,6 g Akebiae Caulis,9 g Paeoniae Radix Alba and 25 g Jujubae Fructus are advised to decocte with 525 mL of water to 280 mL.Ancient books recorded that this recipe effectively treated the syndrome of blood deficiency and cold syncope manifested as cold syncope of hands and feet and lack of pulse.Subsequently it is applied by later physicians for clinical treatment flexibly,treating diseases such as diabetic peripheral neuropathy,scapulohumeral periarthritis,chilblains among other ailments,which has laid a foundation for further research and development of DSD.