《临证指南医案》黄芪运用的研究
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摘要
研究目的
本课提以《临证指南医案》为基础,搜集其中处方黄芪的医案,以计算机处理搜集出有关医案的内容及处方黄芪的种类,分析叶天士在上述医案中对运用黄芪的方法,从而为现代中医临床用药提供理论依据,从而对病患者的治疗能发挥更好的疗效。
研究方法
以《临证指南医案》为基础,搜查其中收录有关处方黄芪及含有黄芪组成方药的医案,井收集有关医案所针对的主证、病种、症状、脉象与其它药物的配伍并录入数据库。采用EPI data数据库,整理有关数据,再应用SPSS 15.0统计软件包进行研究分析。其后,再挑出频数大于6的病种进行讨论。
结果
一.运用黄芪最多的主证
在《临证指南医案》记载有关黄芪的处方中,属气虚总证和阳虚总证为最多。
二.运用黄芪最多的病种
在《临证指南医案》记载有关黄芪的处方中,根据病种出现的频数从大至小,依次序为吐血、痹(包括肩臂背痛)、咳嗽、虚劳、中风和汗等。
三.运用黄芪最多的脉象
在《临证指南医案》记载有关黄芪的处方中,有记录脉象的不多,根据脉象出现的频数从大至小,依次序为脉弱、脉虚和脉弦等,都是主属虚证。
四.配伍黄芪最多的药物
在《临证指南医案》记载有关黄芪的处方中,根据配伍药物出现的频数从大至小,依次序为人参、当归、南枣、白术、炙黑甘草和桂枝等。
五.不同种类黄芪的运用
在《临证指南医案》记载处方中有炙黄芪、生黄芪、炙黄芪皮和生黄芪皮四种,其中以炙黄芪占绝大多数。炙黄芪多配伍人参、白术、当归、陈皮、青皮、泽泻、茯苓、苡仁、神曲、川芎、远志、枣仁、茯神等补益气血、健脾安神、鼓振脾气,使气血化生有源,又多配以升麻、柴胡、木香等升阳举陷、行气药物,防止气虚下陷、气血壅滞。生黄芪多用于气虚血滞导致的痹证、中风、肩臂背痛等,多配伍防风、天麻、片姜黄、羌活、桑枝、海桐皮等通经活络、祛风湿、行气血药物,又多配以菊花、牡蛎、枸杞等滋肝阴、潜肝阳药物,以补益肝肾。炙黄芪皮与生黄芪皮多用于热伤元气之疮疡病、劳乏致伤之咳嗽病、胃气虚和脏阴损伤之吐血病等,可知,二药有收敛功效,多配伍北沙参、麦冬等滋阴药物,以抑制阳热。
六、运用黄芪频数最高的六个病种的用药特点在《临证指南医案》记载有关黄芪出现最多的六个病种,其运用特点如下:
1.吐血:对治疗气虚血溢型的吐血,多以炙黄芪配人参、南枣和炙黑甘草等;对治疗肝火犯胃型的吐血,多以生黄芪配人参、南枣和炙黑甘草等,再辅以北沙参和麦冬等。
2.痹(包括肩臂背痛):对治疗气虚血亏型的痹,多以黄芪配伍当归和白术等,并多佐以防风等。
3.咳嗽:多以黄芪配伍南枣等,并常用黄芪建中汤加减以作治疗。
4.虚劳:多以黄芪配伍人参和南枣等,并常用黄芪建中汤加减以作治疗。
5.中风:多以黄芪配伍白术等作治疗。
6.汗:对治疗肺卫不固型和营卫不和型的汗,多以黄芪配伍炙黑甘草等,并多佐以桂枝和煨姜等。
Purpose
This thesis concentrates in the usage of Astragalus Membranaceus as included in the "Guide to Clinical Medical Records",searching and recording all the related descriptions about the Astragalus Membranaceus through computer, analyzing the thinking method of the author of the book - Mr.Ye Tianshi, in order that to set up the possible theorical base for the modern clinical threatment as well as to have better curative effect for patients.
Method
To search all the medical case related to Astragalus Membranaceus which was included in the "Guide to Clinical Medical Records",collecting and inputing the necessary data including Diseases,Syndromes,Performances,Pulses and the formulation of different Chinese Medicines into the data bank,selecting EPI data as the data bank for data decoration,operating the professional statistical software - SPSS 15.0 to analyse all the input data and obtain the result.
Result
1.Major Syndromes as related to Astragalus Membranaceus in the "Guide to Clinical Medical Records"
In the "Guide to Clinical Medical Records",according to the Chinese Medical Theory of Yi-Yang-Qi-Blood,those Syndromes like Qi deficiency and Yang deficiency are found more frequent used with the Astragalus Membranaceus.
2.Major Diseases as related to Astragalus Membranaceus in the "Guide to Clinical Medical Records"
In the "Guide to Clinical Medical Records",according to the number of appearance of Astragalus Membranaceus in the Diseases,as from more to less are Hematemesis,Numbness(including Pain over Shoulder＆Pain in the Back), Cough,Tiredness,Stroke and Sweat etc.
3.Major Pulse as related to Astragalus Membranaceus in the "Guide to Clinical Medical Records"
In the "Guide to Clinical Medical Records",even though,the Pulse was not recorded in every medical case of the book,but the more frequent appeared pulses are Weak,Deficiency and String,all are belonged to the Syndrome of Deficiency.
4.Major Chinese Medicines as related to Astragalus Membranaceus in the "Guide to Clinical Medical Records"
In the "Guide to Clinical Medical Records",the Astragalus Membranaceus are found very often to formulate with some other Chinese Medicines which are Ginseng,Angelica,Ziziphus,Atractylodes Macrocephala,Honey-roasted Glycyrrhgiza and Guizhi etc.
5.The characteristics of using different types of Astragalus Membranaceus as recorded in the "Guide to Clinical Medical Records"
In the "Guide to Clinical Medical Records",there is four(4) types of Astragalus Membranaceus were appeared in the concerned medical cases.They are Honey-roasted Astragalus Membranaceus,Raw Astragalus Membranaceus,Honey-roasted Astragalus Membranaceus Skin and Raw Astragalus Membranaceus Skin.The Honey-roasted Astragalus Membranaceus is the most popular used in the medical cases.
According to the Clustering Analysis,Honey-roasted Astragalus Membranaceus is always formulated with Ginseng,Atractylodes Macrocephala,Angelica,Citrus Reticulata,Alisma Orientalis,Poria Cocos,Massa Medicata Fermentata,Chuanxiong,Polygala Tenuifolia and Ziziphus etc.to promote the borning of Qi＆Blood in order to replenish Qi and Blood,invigorating the Spleen and calm(soothe) the Nerves,excite Spleen Qi and with Cimicifuga Heracleifolia,Bupleurum,Aucklandia for promoting Yang、lifting the sinking and promoting circulation of Qi,avoiding collapse from Qi deficiency and Qi＆Blood stasis.The raw Astragalus Membranaceus is very often used in the type of Blood stasis from Qi deficiency in Numbness,Stroke,Pain over the Shoulder＆Pain in the Back,is always formulating with Saposhnikovia Divaricata,Gastrodia Elata,Curcuma Longa,Notopterygium Incisum,Morus Alba and Eryththrina Variegata for smoothing venation、expelling Wind and removing Dampness and promoting Qi and Blood,with Chrysanthemum,Ostrea and Lycium Bararum for repressing hyperactive Liver Yang and Nourishing Liver and Kidney. The Honey-roasted Astragalus Membranaceus Skin and the Raw Astragalus Membranaceus Skin have the function of constringency and are always used in the sore of Heat weakening in the vitality type,Cough of weary type,Hematemesis of Stomach Qi deficiency and Zang Yin damages type,are usually formulated with Glehnia and Ophiopogon for Nourishing Yin in order to inhibiting YangRe.
6.The way of using Astragalus Membranaceus in different Diseases in the "Guide to Clinical Medical Records"
In the "Guide to Clinical Medical Records".there is top six(6) Diseases usually formulated with Astragalus Membranaceus being recorded,their characteristics are as follows:
a.Hematemesis:The Honey-roasted Astragalus Membranaceus is found very often to formulate with Ginseng,Ziziphus,and Honey-roasted Glycyrrhgiza etc.to cure the Hematemesis in the type of Blood overflowing due to Qi deficiency.The raw Astragalus Membranaceus is found very often to formulate with Ginseng,Ziziphus,Honey-roasted Glycyrrhgiza,Glehnia and Ophiopogon etc.to cure the Hematemesis in the type of invasion of stomach by Liver Fire.
b.Numbness(including Pain over the Shoulder＆Pain in the Back):The Astragalus Membranaceus is found very often to formulate with Angelica, Atractylodes Macrocephala and Saposhnikovia etc.to cure the Numbness in the type of Qi and Blood deficiency.
c.Cough:The Astragalus Membranaceus is found very often to formulate with Ziziphus etc.and is always to use the famous formula of Huangqi Jianzhong Tang for plus＆minus to cure the Cough in the type of cough due to internal injury.
d.Tiredness:The Astragalus Membranaceus is found very often to formulate with Ginseng,Ziziphus and is always use the famous formula of Huangqi Jianzhong Tang for plus＆minus to cure the Tiredness.
e.Stroke:The Astragalus Membranaceus is found very often to formulate with Astractylodes Macrocephala to cure the Stroke.
f.Sweat:The Astragalus Membranaceus is found very often to formulate with Honey-roasted Glycyrrhgiza,Guizhi and Zingiber etc.to cure the Sweat.
本课提以《临证指南医案》为基础,搜集其中处方黄芪的医案,以计算机处理搜集出有关医案的内容及处方黄芪的种类,分析叶天士在上述医案中对运用黄芪的方法,从而为现代中医临床用药提供理论依据,从而对病患者的治疗能发挥更好的疗效。
研究方法
以《临证指南医案》为基础,搜查其中收录有关处方黄芪及含有黄芪组成方药的医案,井收集有关医案所针对的主证、病种、症状、脉象与其它药物的配伍并录入数据库。采用EPI data数据库,整理有关数据,再应用SPSS 15.0统计软件包进行研究分析。其后,再挑出频数大于6的病种进行讨论。
结果
一.运用黄芪最多的主证
在《临证指南医案》记载有关黄芪的处方中,属气虚总证和阳虚总证为最多。
二.运用黄芪最多的病种
在《临证指南医案》记载有关黄芪的处方中,根据病种出现的频数从大至小,依次序为吐血、痹(包括肩臂背痛)、咳嗽、虚劳、中风和汗等。
三.运用黄芪最多的脉象
在《临证指南医案》记载有关黄芪的处方中,有记录脉象的不多,根据脉象出现的频数从大至小,依次序为脉弱、脉虚和脉弦等,都是主属虚证。
四.配伍黄芪最多的药物
在《临证指南医案》记载有关黄芪的处方中,根据配伍药物出现的频数从大至小,依次序为人参、当归、南枣、白术、炙黑甘草和桂枝等。
五.不同种类黄芪的运用
在《临证指南医案》记载处方中有炙黄芪、生黄芪、炙黄芪皮和生黄芪皮四种,其中以炙黄芪占绝大多数。炙黄芪多配伍人参、白术、当归、陈皮、青皮、泽泻、茯苓、苡仁、神曲、川芎、远志、枣仁、茯神等补益气血、健脾安神、鼓振脾气,使气血化生有源,又多配以升麻、柴胡、木香等升阳举陷、行气药物,防止气虚下陷、气血壅滞。生黄芪多用于气虚血滞导致的痹证、中风、肩臂背痛等,多配伍防风、天麻、片姜黄、羌活、桑枝、海桐皮等通经活络、祛风湿、行气血药物,又多配以菊花、牡蛎、枸杞等滋肝阴、潜肝阳药物,以补益肝肾。炙黄芪皮与生黄芪皮多用于热伤元气之疮疡病、劳乏致伤之咳嗽病、胃气虚和脏阴损伤之吐血病等,可知,二药有收敛功效,多配伍北沙参、麦冬等滋阴药物,以抑制阳热。
六、运用黄芪频数最高的六个病种的用药特点在《临证指南医案》记载有关黄芪出现最多的六个病种,其运用特点如下:
1.吐血:对治疗气虚血溢型的吐血,多以炙黄芪配人参、南枣和炙黑甘草等;对治疗肝火犯胃型的吐血,多以生黄芪配人参、南枣和炙黑甘草等,再辅以北沙参和麦冬等。
2.痹(包括肩臂背痛):对治疗气虚血亏型的痹,多以黄芪配伍当归和白术等,并多佐以防风等。
3.咳嗽:多以黄芪配伍南枣等,并常用黄芪建中汤加减以作治疗。
4.虚劳:多以黄芪配伍人参和南枣等,并常用黄芪建中汤加减以作治疗。
5.中风:多以黄芪配伍白术等作治疗。
6.汗:对治疗肺卫不固型和营卫不和型的汗,多以黄芪配伍炙黑甘草等,并多佐以桂枝和煨姜等。
Purpose
This thesis concentrates in the usage of Astragalus Membranaceus as included in the "Guide to Clinical Medical Records",searching and recording all the related descriptions about the Astragalus Membranaceus through computer, analyzing the thinking method of the author of the book - Mr.Ye Tianshi, in order that to set up the possible theorical base for the modern clinical threatment as well as to have better curative effect for patients.
Method
To search all the medical case related to Astragalus Membranaceus which was included in the "Guide to Clinical Medical Records",collecting and inputing the necessary data including Diseases,Syndromes,Performances,Pulses and the formulation of different Chinese Medicines into the data bank,selecting EPI data as the data bank for data decoration,operating the professional statistical software - SPSS 15.0 to analyse all the input data and obtain the result.
Result
1.Major Syndromes as related to Astragalus Membranaceus in the "Guide to Clinical Medical Records"
In the "Guide to Clinical Medical Records",according to the Chinese Medical Theory of Yi-Yang-Qi-Blood,those Syndromes like Qi deficiency and Yang deficiency are found more frequent used with the Astragalus Membranaceus.
2.Major Diseases as related to Astragalus Membranaceus in the "Guide to Clinical Medical Records"
In the "Guide to Clinical Medical Records",according to the number of appearance of Astragalus Membranaceus in the Diseases,as from more to less are Hematemesis,Numbness(including Pain over Shoulder＆Pain in the Back), Cough,Tiredness,Stroke and Sweat etc.
3.Major Pulse as related to Astragalus Membranaceus in the "Guide to Clinical Medical Records"
In the "Guide to Clinical Medical Records",even though,the Pulse was not recorded in every medical case of the book,but the more frequent appeared pulses are Weak,Deficiency and String,all are belonged to the Syndrome of Deficiency.
4.Major Chinese Medicines as related to Astragalus Membranaceus in the "Guide to Clinical Medical Records"
In the "Guide to Clinical Medical Records",the Astragalus Membranaceus are found very often to formulate with some other Chinese Medicines which are Ginseng,Angelica,Ziziphus,Atractylodes Macrocephala,Honey-roasted Glycyrrhgiza and Guizhi etc.
5.The characteristics of using different types of Astragalus Membranaceus as recorded in the "Guide to Clinical Medical Records"
In the "Guide to Clinical Medical Records",there is four(4) types of Astragalus Membranaceus were appeared in the concerned medical cases.They are Honey-roasted Astragalus Membranaceus,Raw Astragalus Membranaceus,Honey-roasted Astragalus Membranaceus Skin and Raw Astragalus Membranaceus Skin.The Honey-roasted Astragalus Membranaceus is the most popular used in the medical cases.
According to the Clustering Analysis,Honey-roasted Astragalus Membranaceus is always formulated with Ginseng,Atractylodes Macrocephala,Angelica,Citrus Reticulata,Alisma Orientalis,Poria Cocos,Massa Medicata Fermentata,Chuanxiong,Polygala Tenuifolia and Ziziphus etc.to promote the borning of Qi＆Blood in order to replenish Qi and Blood,invigorating the Spleen and calm(soothe) the Nerves,excite Spleen Qi and with Cimicifuga Heracleifolia,Bupleurum,Aucklandia for promoting Yang、lifting the sinking and promoting circulation of Qi,avoiding collapse from Qi deficiency and Qi＆Blood stasis.The raw Astragalus Membranaceus is very often used in the type of Blood stasis from Qi deficiency in Numbness,Stroke,Pain over the Shoulder＆Pain in the Back,is always formulating with Saposhnikovia Divaricata,Gastrodia Elata,Curcuma Longa,Notopterygium Incisum,Morus Alba and Eryththrina Variegata for smoothing venation、expelling Wind and removing Dampness and promoting Qi and Blood,with Chrysanthemum,Ostrea and Lycium Bararum for repressing hyperactive Liver Yang and Nourishing Liver and Kidney. The Honey-roasted Astragalus Membranaceus Skin and the Raw Astragalus Membranaceus Skin have the function of constringency and are always used in the sore of Heat weakening in the vitality type,Cough of weary type,Hematemesis of Stomach Qi deficiency and Zang Yin damages type,are usually formulated with Glehnia and Ophiopogon for Nourishing Yin in order to inhibiting YangRe.
6.The way of using Astragalus Membranaceus in different Diseases in the "Guide to Clinical Medical Records"
In the "Guide to Clinical Medical Records".there is top six(6) Diseases usually formulated with Astragalus Membranaceus being recorded,their characteristics are as follows:
a.Hematemesis:The Honey-roasted Astragalus Membranaceus is found very often to formulate with Ginseng,Ziziphus,and Honey-roasted Glycyrrhgiza etc.to cure the Hematemesis in the type of Blood overflowing due to Qi deficiency.The raw Astragalus Membranaceus is found very often to formulate with Ginseng,Ziziphus,Honey-roasted Glycyrrhgiza,Glehnia and Ophiopogon etc.to cure the Hematemesis in the type of invasion of stomach by Liver Fire.
b.Numbness(including Pain over the Shoulder＆Pain in the Back):The Astragalus Membranaceus is found very often to formulate with Angelica, Atractylodes Macrocephala and Saposhnikovia etc.to cure the Numbness in the type of Qi and Blood deficiency.
c.Cough:The Astragalus Membranaceus is found very often to formulate with Ziziphus etc.and is always to use the famous formula of Huangqi Jianzhong Tang for plus＆minus to cure the Cough in the type of cough due to internal injury.
d.Tiredness:The Astragalus Membranaceus is found very often to formulate with Ginseng,Ziziphus and is always use the famous formula of Huangqi Jianzhong Tang for plus＆minus to cure the Tiredness.
e.Stroke:The Astragalus Membranaceus is found very often to formulate with Astractylodes Macrocephala to cure the Stroke.
f.Sweat:The Astragalus Membranaceus is found very often to formulate with Honey-roasted Glycyrrhgiza,Guizhi and Zingiber etc.to cure the Sweat.
引文
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