国医大师严世芸教授治疗胸痹合并郁证的用药规律分析

Analysis of the Medication Rules for Treating Chest Bi Combined with Depression Syndrome by Renowned Traditional Chinese Medicine Master Professor YAN Shi-yun

目的探析国医大师严世芸教授治疗胸痹合并郁证的用药规律。方法收集严世芸教授于2016年5月至2023年7月在上海中医药大学附属曙光医院门诊治疗的胸痹合并郁证患者医案,录入处方。运用中医传承计算平台进行分析,同时对患者中成药的使用情况进行统计。结果整理纳入109首处方。通过平台分析发现涉及中药177味,中药四气统计依次为温、平、寒、热、凉;五味统计依次为甘、苦、辛、酸、咸;归经统计前5位为肝、脾、肺、心、肾;中药分类统计前5位活血化瘀药类、补气药类、安神药类、补阳药类、补血药类;用药频次统计前5位的中药分别为人参、川芎、桃仁、酸枣仁、桂枝;常用的药物组合包括川芎和人参、川芎和桃仁、川芎和酸枣仁、桃仁和酸枣仁等;常用的方剂依次为酸枣仁汤、强心饮、血府逐瘀汤、补阳还五汤、柴胡桂枝龙骨牡蛎汤、瓜蒌薤白半夏汤、失笑散;中成药使用率最高的3种分别为天王补心丸、逍遥丸、归脾丸。结论严世芸教授治疗胸痹合并郁证的用药特色以寒温并用;从肝而治,又兼顾五脏;擅用人参,补益心气;活血化瘀兼以虫类药破瘀;补益与活血化瘀并用,攻补兼施,使攻不伤正,补不助邪;时方和经方灵活组方,创制强心饮为治疗胸痹之良方;以中成药配合汤药治疗。通过展现严世芸教授辨治胸痹合并郁证的用药规律及临床经验,为治疗该病提供参考。

Objective We aim to analysis the medication rules of renowned Traditional Chinese Medicine(TCM)master Professor YAN Shi-yun in the treatment of chest Bi combined with depression syndrome.Methods We collect the medical records of patients with chest Bi combined with depression syndrome treated by Professor YAN Shi-yun in the outpatient department of Shuguang Hospital affiliated to Shanghai University of TCM from May 2016 to July 2023.The prescriptions from these cases were recorded.Subsequently,we conducted an analysis using TCM Inheritance Support Platform and performed statistical analysis on the usage of traditional Chinese patent medicines among the patients.Results In this study,a total of 109 prescriptions were included.Through analysis using the platform,it was found that 177 different Chinese herbs were involved,with their thermal properties categorized as warm,neutral,cold,hot,and cool.The taste attributes were recorded in the order of sweet,bitter,spicy,sour,and salty.In terms of the top 5 meridian affinity,including liver,spleen,lung,heart,and kidney.Furthermore,the top 5 categories in the TCM classification statistics are blood-activating and stasis-resolving herbs,qi-tonifying herbs,calming the spirit herbs,yang-tonifying herbs,and blood-nourishing herbs.The top 5 individual herbs in medication frequency are Renshen(Ginseng),Chuanxiong(Ligusticum),Taoren(Peach Kernel),Suanzaoren(Sour Jujube Seed),and Guizhi(Cinnamon Twig).The most common herbal combinations included Chuanxiong(Ligusticum)with Renshen(Ginseng),Chuanxiong(Ligusticum)with Taoren(Peach Kernel),Chuanxiong(Ligusticum)with Suanzaoren(Sour Jujube Seed),and Taoren(Peach Kernel)with Suanzaoren(Sour Jujube Seed).The frequently prescribed formulas were Suanzaoren Tang,Qiangxin Yin,Xuefu Zhuyu Tang,Buyang Huanwu Tang,Chaihu Guizhi Longgu Muli Tang,Gualou Xiebai Banxia Tang,and Shixiao San.Regarding Chinese patent medicines,the top three in terms of usage were Tianwang Buxin Wan,Xiaoyao Wan,and Guipi Wan.Conclusion Professor YAN Shi-yun's medication approach for treating chest Bi combined with depression syndrome includes the simultaneous use of cold and warm Chinese herbs,focusing on treating the liver while considering the other organs.He is skilled in using Renshen(Ginseng)to nourish the heart qi,and adeptly employs blood-activating herbs in combination with insect-based medicines to disperse stasis without harming the body.He combines tonifying and blood-activating herbs,employing both attacking and tonifying methods to ensure the attack does not damage the body and the tonification does not assist pathogenic factors.He flexibly formulates prescriptions using modified classic formulas,and he created the effective Qiangxin Yin for treating chest Bi.Chinese patent medicines are also used in combination with decoctions for treatment.By presenting Professor YAN Shi-yun's medication patterns and clinical experience in diagnosing and treating chest Bi combined with depression syndrome,this provides reference for the treatment of this condition.