张锡纯《医学衷中参西录》治疗血瘀证原创处方用药规律分析

Law of Original Prescriptions for Blood Stasis Syndrome in Records of Traditional Chinese and Western Medicine in Combination by Zhang Xichun

目的 总结《医学衷中参西录》中张锡纯治疗血瘀证原创处方的用药规律和中医思想。方法 收集《医学衷中参西录》张锡纯治疗血瘀证的原创处方,采用中医传承计算平台V 3.0建立数据库分析组方用药规律。结果 纳入处方346首,涉及中药179味,频次前4味为没药、当归、乳香、黄芪,用药主要为温、寒、平性,苦、甘、辛味,归肝、脾、心经,功效以补虚类、活血化瘀类、清热类为主;高频药物组合50组,关联规则11条,得到“没药-乳香”“三棱-莪术”“牡蛎-龙骨”3种高频次、高置信度且各自独立的药物组合;K-means聚类将处方根据配伍大致聚为“活血化瘀”“补虚化瘀”“解毒化瘀”3类,提取出3首核心处方。结论 《医学衷中参西录》中张锡纯治疗血瘀证有“活血化瘀”“补虚化瘀”“解毒化瘀”3种治法,体现了张氏在使用活血化瘀方药的同时重视扶正祛邪的中医思想。

Objective To summarize the law of original prescriptions for blood stasis syndrome and the traditional Chinese medicine(TCM)thought in Records of Traditional Chinese and Western Medicine in Combination by Zhang Xichun.Methods The original prescriptions for blood stasis syndrome in the book were collected,and the Traditional Chinese Medicine Inheritance Support System V3.0 was utilized to establish a database for analyzing the law of these prescriptions.Results A total of 346 prescriptions were included,involving 179 Chinese medicinal herbs.The four most frequently used herbs were Myrrh,Radix Angelicae Sinensis,Frankincense,and Radix Astragali.The herbs were primarily warm,cold,and moderate in nature,and bitter,sweet,and pungent in flavor,targeting the liver,spleen,and heart meridians.The primary effects were tonifying deficiency,promoting blood circulation and resolving stasis,and clearing heat.Fifty high-frequency herb combinations were identified,along with 11 association rules,which revealed three independent combinations with high frequency and high confidence level:Myrrh-Frankincense,Rhizoma Sparganii-Rhizoma Curcumae,and Concha Ostreae-Ossa Draconis.K-means clustering grouped the prescriptions into three categories based on their compatibility:promoting blood circulation and resolving blood stasis,tonifying deficiency and resolving blood stasis,and removing toxin and resolving blood stasis,from which three core prescriptions were extracted.Conclusion In the Records of Traditional Chinese and Western Medicine in Combination by Zhang Xichun,there were three treatment principles for blood stasis syndrome:promoting blood circulation and resolving blood stasis,tonifying deficiency and resolving blood stasis,and removing toxin and resolving blood stasis.This demonstrated Zhang emphasized the TCM philosophy of supporting the healthy qi and dispelling pathogenic factors while utilizing prescriptions that promote blood circulation and resolve blood stasis.