用户名: 密码: 验证码:
桂枝汤及其加减方方证数据挖掘研究
详细信息    本馆镜像全文|  推荐本文 |  |   获取CNKI官网全文
摘要
研究目的桂枝汤是《伤寒杂病论》开篇第一方,是调和营卫、血气、阴阳的总方,虽药仅五味,而应用范围之广、演变类方之多,实非它方所能及。桂枝汤方证即桂枝汤临床应用时的适应症及其病机,历代文献对此方研究较多。本文在总结历代医家经验的基础上,从数据挖掘的角度对此方方证进行研究。目的是为了揭示桂枝汤的多效多证,揭示桂枝汤的拓展应用的规律,桂枝汤方随证变的规律。从古今桂枝汤及其加减方的应用数据中挖掘桂枝汤方证的诊断标准,从而使桂枝汤方证规范化、客观化、标准化,指导临床应用。
     研究方法本文所研究的数据来源于①有《伤寒杂病论》(桂枝汤及其类方33首,涉及62条原文)。②《方剂大辞典》(桂枝汤及其加减方剂93首)③现代临床应用报道(应用桂枝汤及其加减方临床治案421例)。④相关医学著作的内容(39种医学专著,涉及医案92例)。在研究过程中,首先,对所采集的数据信息进行了规范处理,建立病证、症状、方剂、用药等相应的数据库,分别对《伤寒杂病论》、《方剂大辞典》及现代临床报道三类文献中主治病、症状、方剂、用药情况进行了统计。其次,采用文献研究法,对桂枝汤原方方证进行研究。运用因子分析的数据挖掘方法,分别对三类文献进行症状因子分析、用药因子分析,以此来揭示桂枝汤及其加减方方证的病机、变化证型及药物配伍规律。此外,还运用双向关联规则的数据挖掘方法分别对《伤寒杂病论》、《方剂大辞典》及现代临床报道中病—方、症—方、病—桂芍比及药对之间的关联关系进行分析。以此来揭示桂枝汤及其加减方病—证—方—药之间的关系。在本文研究过程中,引入了族类方的概念,以此来形象地揭示桂枝汤与其类方之间的血缘亲疏关系。
     研究结果
     1、三类文献症状因子分析结果反映了桂枝汤及其加减方具有外感营卫不和、心阳虚、肢体痹痛、脾胃不和、气上冲等证侯特点。其中,《方剂大辞典》及现代临床应用的症状因子分析结果还反映了营卫失和、阴阳两虚的证侯特点。
     2、三类文献用药因子分析结果有交叉,基本体现了桂枝汤原方、桂枝加厚朴杏子汤、桂枝加龙骨牡蛎汤、当归四逆汤、苓桂术甘汤、桂枝加葛根汤、桂枝加附子汤、黄芪建中汤、桂枝新加汤等桂枝汤的药物加减规律。此外,《方剂大辞典》及现代临床应用还体现了柴胡桂枝汤、桂枝羌活汤、桂枝新加汤、桂枝甘草汤等方剂配伍规律。
     3、三类文献病—方关联分析结果显示桂枝汤与外感发热、精微不固类疾病密切相关,小建中汤、黄芪建中汤与虚劳类、腹痛类疾病密切相关。现代临床应用研究结果还提示桂枝汤与皮肤病、肢体痹痛类疾病密切相关。
     4、根据三类文献症—方关联分析结果相关度值的高低推论桂枝汤证的主证为脉浮缓、汗出。兼证为发热、恶风、恶寒、头痛、苔薄白、二便调。根据现代文献症状与方剂相关度表还可以推论柴胡桂枝汤、当归四逆汤、桂枝加附子汤、桂枝麻黄各半汤等桂枝汤加减方的主证及兼证。
     5、三类文献病—桂芍比关联分析结果显示《伤寒杂病论》中桂芍比1:1出现的较多,达61%。《方剂大辞典》中桂芍比1:0出现较多,达33%,而现代临床应用中,应用比例较高的依次为桂芍比1:1、1:0、1:2、5:3。桂芍比1:1多用于外感表证、肢体痹痛类病证。桂芍民1:0多用于心阳虚类及气上冲类病证。桂芍比1:2多用于腹痛类及虚劳类病证。桂芍比5:3用于气上冲类病证。
     6、三类文献药对关联分析结果提示在古代文献中原方两两配对应用情况较普遍,而现代临床应用中,由于药物加减较多,故提示的药对多为加减后两两出现的药物。
     结论通过以上研究方法的运用,本文归纳出桂枝汤原方方证、桂枝汤加减方的方证、桂枝汤加减方的构效关系规律及桂枝汤加减方的量效关系规律。
     1、桂枝汤原方方证有四(1)太阳表证;(2)脾胃不和兼表证;(3)未感外邪的营卫不和证:(4)妊娠恶阻证。桂枝汤的基本病机为营卫不调。此外,本文还归纳出桂枝汤的体质特点。
     2、桂枝汤加减方证候可分为七大类,分别为(1)外感发热类(2)肌肉痉挛类(3)肢体痹痛类(4)腹痛类(5)气上冲类(6)心阳虚类(7)精微不固类。
     3、桂枝汤及其加减方的构效关系规律:桂枝汤原方由桂枝甘草汤及芍药甘草汤两张基础方构成。根据三类文献用药因子分析结果,归纳出20张桂枝汤加减方的药物加减规律及其所主治的病证,并对其各自与桂枝汤原方的族类关系进行了分析。
     4、桂枝汤及其加减方的量效关系规律:桂芍比1:1多为桂枝汤原方,或是桂枝汤亲族、近族,解表合里,调和营卫;桂芍比1:0多为桂枝汤的远族,温通心阳、平冲降逆;桂芍比1:2多为桂枝汤的变族,温阳和络、缓急止痛;桂芍比5:3解肌通阳、平冲降逆。
     最后,本文对桂枝汤的调和作用、桂枝汤的煎服法、现代药理研究进行了讨论。分析本文所运用的数据挖掘方法的先进性及其不足之处。同时,对今后深层次的研究进行了展望。
     创新之处将双向关联规则算法及因子分析方法同时运用于经方的方证研究。并通过症状与方剂关联度结果表来推测方剂的主证及兼证,使方剂的主证、兼证标准更加客观化。运用族类关系来分析桂枝汤与其类方的关系,使之形象化、系统化。
Objective:《GUIZHI DECOCTION》is the first prescription in "Treatise on Cold Pathogenic and Miscellaneous Diseases", which is the general prescription for harmonizing yingfen and weifen, qi and blood, yin-yang. Although it only consists of five herbal medicines, no other prescription can be comparable in the aspects of wide range of application and variety of categorized formula. The prescription and syndrome of GUIZHI DECOCTION is namely its clinical indications and pathogenesis, which has been researched widely in the literatures of past dynasties. In this thesis, based on the experience of herbalist doctors of past dynasties, it uses the data mining technology to research the prescription and syndrome of GUIZHI DECOCTION, which aims to unveil the multi indications and multi functions, and the application rule of extending use, the rule of prescription modification with syndrome. Mining the diagnosis standard of GUIZHI DECOCTION from application from GUIZHI DECOCTION and its modification can make the prescription and syndrome of GUIZHI DECOCTION standardization, objective so as to guide clinic application.
     Methods:The research data in this thesis come from 1) "Treatise on Cold Pathogenic and Miscellaneous Diseases "(33 cases of GZT and its categorized formula, related to 62 items of original text); 2) "Prescription Dictionary"(93 prescriptions of GZT and its modification); 3) Modern clinical application(421 clinical cases treated by GZT and its modification);4) Relevant medical literatures (39 medical literatures, covering 92 clinical cases). In our research, the data is processed by standardization first, and the databases of symptom, prescription, treatment with medicine are built respectively, the prescription, symptom and treatment with medicine in above three types of literatures are made statistic respectively. Then, reference research method is used to research the prescription and symptom of《GUIZHI DECOCTION》,and factor analysis is used to analyze for above three types of literature, which is to reveal the pathogenesis、varied syndrome and the law of herbal synergy of GUIZHI DECOCTION and its modifying prescription. Besides, the bi-direction association rule is used to analyze the association relationship of disease -prescription、syndrome-prescription、disease-the rate of GuiZhi Shaoyao dosage in above three types of literature, which is to reveal the relationship among the disease-syndrome-prescription-herbal medicine for GUIZHI DECOCTION and its modifying prescription. In our research, the concept of the family categorized formule is introduced so as to reveal the relationship among GUIZHI DECOCTION and other categorized formula。
     Result:
     1 Factor analysis results on symptom from three kinds of literature reflect that the GUIZHI DECOCTION has following features on syndrome:exogenous disease of disharmony between nutrient qi and defensive qi, devitalization of heart yang, body pantalgia, syndrome of incoordination between spleen and stomach, syndrome of qi rushing upward, where factor analysis results of Prescription Dictionary and Modern clinical application reflect the syndrome features on disharmony between nutrient qi and defensive qi, deficiency of both yin and yang.
     2 The factor analysis results on treatment with medicine from three kinds of literature are overlapped in certain degree, which reflects the medicine modifying rules of GUIZHI DECOCTION categorized formula, such as guizhi decoction, guizhi houpu xingzi decoction, guizhi longgu muli decoction, danggui sini decoction, linggui shugan decoction, guizhi gegen decoction, guizhi fuzi decoction, huangqi jianzhong decoction,guizhi xinjia decoction. Beisdes, the factor analysis results on treatment with medicine from Prescription Dictionary and Modern clinical application also reflects the herbal synergy rules of caihu guizhi decoction, guizhi qianghuo decoction, guizhi xinjia decoction, guizhi gancao decoction etc.
     3 The association analysis on disease-prescription from three kinds of literature show the GUIZHI DECOCTION has close association with exogenous disease of fever, failure of keeping essence. Xiao jianzhong decoction, huangqi jianzhong decoction has close association with consumptive diseas and abdominal pain. The results from Modern clinical application also indicate that GUIZHI DECOCTION has close association with dermatosis and body pantalgia.
     4 Based on the association analysis on syndrome-prescription from three kinds of literature, the principal syndrome of GUIZHI DECOCTION inferred from the correlation degree is floating and moderate pulse, sweating. The complication syndrome is fever, aversion to wind, aversion to cold, headache, thin and white fur, natural stool and pee. According to the correlation degree on syndrome-prescription from modern literatures, the principal syndrome and the complication syndrome can inferred for modifying prescription of GZT, such as caihu guizhi decoction, danggui sini decoction, guizhi fuzi decoction, guizhi mahuang decoction etc.
     5 The association analysis on rate of Guizhi Shaoyao dosage reveals that the frequency of this rate with 1:1 is high in "Treatise on Cold Pathogenic and Miscellaneous Diseases" with 61%; the frequency of this rate with 1:0 is high in "Prescription Dictionary" with 33%, and for modern clinical application, the this rate with high frequency is 1:1,1:0,1:2,5:3. The rate with 1:1,1:0,1:2,5:3, is mainly used for exogenous disease of superficies syndrome and body pantalgia, devitalization of heart yang and syndrome of qi rushing upward, consumptive diseas and abdominal pain, syndrome of qi rushing upward respectively.
     6 The association analysis on couplet medicines of three kinds of literature cues us that the two herbal synergy is very popular in ancient literatures, but in modern clinical application, due to herbal modifying in prescription, the hinted couplet medicines is the two herbal after modifying.
     Conclusion:Based on above research, some rules are summed up for GUIZHI DECOCTION and its modifying prescription, such as the relationship between prescription and syndrome, effect and quantity, effect and composition. The principal prescription and syndrome of GUIZHI DECOCTION and its modifying prescription can be concluded as follows:
     1 The syndrome of GUIZHI DECOCTION original prescription has four aspects: (1) Taiyang superficies syndrome (2)syndrome of incoordination between spleen and stomach with superficies syndrome (3)disharmony between nutrient qi and defensive qi without external cause (4)hyperemesis gravidarum. The pathogenesis of GZT is disharmony between nutrient qi and defensive qi. Besides, the applicable constitution feature of GZT is also summed up.
     2 The syndrome of modifying prescription of GUIZHI DECOCTION can be grouped into 7 types, they are (1)exogenous disease of fever, (2)muscle spasm, (3) body pantalgia, (4) abdominal pain, (5) syndrome of qi rushing upward, (6) devitalization of heart yang, (7) failure of keeping essence.
     3 The rule of relationship between component and effect of GZT:The original prescription of GZT is based on the two prescription of guizhi gancao decoction and shaoyao gancao decoction. By the factor analysis results, herbal modifying rule of 20 prescriptions of GZT and their principal symptom are concluded, and their family relationship with original prescription of GZT is also analyzed.
     4 The rule of relationship between effect and quantity of GZT and its modifying prescription is as follows:the rate of Guizhi Shaoyao dosage with 1:1 is mainly from original prescription or cognation of GZT, which has the indication of expelling pathogens from both interior and superficies, harmonizing yingfen and weifen. The rate of Guizhi Shaoyao dosage with 1:0 is mostly the far family of GZT, which has the indication of warmly invigorating heart yang, activating qi for lowering adverse qi. The rate of Guizhi Shaoyao dosage with 1:2 is mostly the modifying family of GZT, which has the indication of warming yang and removing obstruction in collaterals, relieving spasm and relieving pain. The rate of Guizhi Shaoyao dosage with 5:3 has the indication of expelling pathogenic factors from muscles and warming yang, activating qi for lowering adverse qi.
     Finally, At the end, the harmonizing effect, the decoction method and modern pharmacody of GZT are discussed. Meanwhile, the advantage and disadvantage of data mining technology used in this thesis are discussed, and research in the future is prospected.
     Innovation:The bi-direction association rule and factor analysis are used to research the prescription and syndrome of classical prescription at same time. Besides, the correlation degree of syndrome and prescription is used to infer the principal syndrome and complication syndrome of prescription, which makes the standard of the principal syndrome and complication syndrome of prescription more objective. The family cluster relation is used to analyze GZT and its categorized formula so as to makes the research visualization, systematic.
引文
[1]赵国平.试论病证、方证和药证[J].中医杂志.2006(47)7:544
    [2]刘王月,谢鸣.关于“以方测证”方法的思考[J].中医杂志,2007,48(5):459
    [3]张兰凤,王阶,王永炎.方证对应研究[J].中华中医药杂志,2005,20(1):8
    [4]陈西平.复方研究的思路与方法浅析[J].中医药学刊,2003,21(11):1850
    [5](日)汤本求真.皇汉医学[M].人民卫生出版社.1956.5
    [6]刘娟等.白术类方的药证关联分析[J].成都中医药大学学报.2004,27(4):55
    [7]尚景盛等.半夏泻心汤配伍应用的数据挖掘试验[J].中日友好医院学报.2005,19(4):227
    [8]李锋刚等.数据挖掘技术在新安医学研究中的应用[J].安徽中医学院学报.2005,24(6):12
    [9]李崐等.数据挖掘技术在药对配伍规律研究中的应用[J].辽宁中医杂志.2006,33(7):773
    [10]戴永平,谢鸣.建立中医方剂数据挖掘系统的探讨[J].湖南中医药大学学报.2007,27(1):39
    [11]蒋永光等.中医脾胃方配伍规律的数据挖掘试验[J].中医药现代化.2003,5(3):33
    [12]曾怡祯.朱建贵主任医师应用经方方证的临床经验研究[D].中国中医科学院硕士论文.2007
    [13]徐姗姗等.从数据挖掘探析桂枝汤临床运用规律[J].河南中医.2007.27(7):1
    [14]徐姗姗等.从数据挖掘探析桂枝汤临床运用规律(续)[J].河南中医.2007.27(8):5
    [15]邓欣怡.桂枝汤的族类关系[J].北京中医药大学学报.2003.17(6):14
    [16]史欣德.43首桂枝汤加味方分析[J].南京中医药大学学报.2000.16(6):366
    [17]张清苓.桂枝汤类方剂临床运用的统计分析[J].北京中医药大学学报.1994.17(5):16
    [18]徐姗姗.从数据挖掘探析桂枝汤临床运用规律[J].河南中医.2007.27(7):1
    [19]郭春兰.中医“调和”思想———桂枝汤及类方中桂芍比例解析[J].中医药信息.2002.19(1):31
    [20]同利香.桂枝汤治疗自汗症44例[J].现代中医药.2005(1):8
    [21]龙涛.桂枝汤治疗慢性荨麻疹58例疗效观察[J].职业与健康.2004.20(8):98
    [22]姚梦华.桂枝汤及其类方治疗儿科疾病体会[J].2007.17(6):368
    [23]李静华等.枝汤类合方临床应用现状[J],.承德医学院学报.2005.22(2):158
    [24]郭春生.枝汤衍变方及其现代应用探析[J].光明中医.2006.21(9):18
    [25]侯新安.桂枝汤类方的双向调节作用[J].中华中医药学刊.2007.25(6):1254
    [26]张保国.桂枝汤现代药效学研究[J].中国中药杂志.2007.32(7):557
    [27]刘敏等.桂枝汤四个主要组成成分不同组合对白细胞介素1β刺激的脑微血管内皮细胞分泌前列腺素E2的影响[J].中国实验方剂学杂志.2005.11(5):61
    [28]陈辉等.体质学说与仲景桂枝汤证[J].中医药学刊.2005.23(4):675
    [29]吴红彦等.桂枝汤及其类方的源流衍化考[J].中成药.2002.24(7):544
    [30]张再良.日本医家对麻黄汤和桂枝汤类方的研究—读江布洋一郎的《经方医学》[J].上海中医药大学学报.2003.17(2):7
    [31]林齐鸣等.桂枝汤的文献分析研究[J].2006.17(5):841
    [32]江尔逊、龙治平.桂枝汤类方证应用研究[M].四川科学技术出版社,1989
    [33]李克光、杨百茀.金匮要略讲义[M].上海科学技术出版社,1985
    [34]彭怀仁,项平主编.中医方剂大辞典[M].人民卫生出版社,1999
    [35]姚乃礼.中医症状鉴别诊断学[M],北京:人民卫生出版社,2000-6-9
    [36]姚乃礼.中医症候鉴别诊断学[M],北京:人民卫生出版社》,2002
    [37]吴承玉.中医诊断学[M],北京:中国中医药出版社,2004-1-1
    [38]田德禄.中医内科学[M],北京:人民卫生出版社,2003.177
    [39]江苏新医学院编.中药大辞典[M].上海科学技术出版社.1986
    [40]李翠娟等.论《内经》的文献研究方法[J].时珍国医国药.2009,20(7):1814
    [41]王松涛,探索性因子分析与验证性因子分析比较研究[J].兰州学刊,2006,(5):152-154
    [42]苏占东,游福成,杨炳儒.关联规则的综合评价方法研究与实例验证[J].计算机应用,2004,24(10):17-20
    [43]邓欣怡.从桂枝汤的加减方变化探讨伤寒方的族类关系[D].北京中医药大学硕士论文.2006
    [44](清)柯琴.伤寒附翼[M].姑苏原版.
    [45]何兼臣.全国名医验案类编[M].福建科学技术出版社.2005
    [46]王鱼生.万友生医案选[M].上海中医药大学出版社.1997
    [47]秦伯未.谦斋医学讲稿[M].上海科学技术出版社.2009
    [48]中国中医研究院.岳美中医案集·现代著名老中医名著重刊丛书[M].人民卫生出版社.2005
    [49]吴佩衡.吴佩衡医案[M].人民军医出版社.2009
    [50](日)汤本求真.皇汉医学[M].人民卫生出版社.1956
    [51](清)潘楫.医灯续焰[M].中国中医社出版社.1999
    [52]曹颖甫.经方实验录.学苑出版社.[M].2008
    [53]夏近宜.桂枝汤治疗小儿地图舌38例[J].上海中医药杂志.1995.(3):11
    [54]刘渡舟.伤寒论十四讲[M].天津科学技术出版社.1982
    [55]姚梦华.桂枝汤及其类方治验[J].浙江中西医结合杂志.2007,17(6):368
    [56]刘少轩.对桂枝汤治疗自汗的点滴体会[J].福建中医药.1964,5:35
    [57]张启文.桂枝汤及其类方运用琐谈[J].北京针灸骨伤学院学报.1999.3(2):17
    [58]胡希恕.伤寒论通俗讲话[M].中国中医药出版社.2008
    [59]王圣德.桂枝汤治疗皮肤病[J].浙江中医杂志.1965,5:30
    [60]龙涛,杨祖丽.桂枝汤治疗慢性荨麻疹58例疗效观察[J].职业与健康.2004,20(8):98
    [61]高德.伤寒论医案选编[M].湖南科学技术出版社.1980
    [62]裴永清.伤寒论临床应用五十论[M].学苑出版社.1995
    [63]裴永清.桂枝汤治妊娠恶阻[J].新中医.1984,4:12
    [64]大塚敬节著,张金铎译.中医临床30年.哈尔滨中医[J].1960,8:71
    [65]门德纯.桂枝汤的临证应用体会.山西医药杂志.1979,1:25
    [66]尤在泾.金匮要略心典.卷下.妇人妊娠病脉证治[M].上海:科技卫生出版社,1956.47
    [67]彭怀仁 仲景所用桂枝之我见[J].南京中医学院学报1984.3:35
    [68]黄煌.中医十大类方[M].江苏科学技术出版社.1995
    [69]陈修园.伤寒论浅注[M].中国书店.1985
    [70]尤怡.金匮要略心典[M].中国中医药出版社.2009
    [71]王子接.绛雪园古方选注[M].中国中医药出版社.1993
    [72]张璐.伤寒缵论[M].清康熙6年丁未
    [73]方有执.伤寒论条辨[M].学苑出版社.2009
    [74]南京中医学院医经教研组.内经选读[M].上海科学技术出版社.1978
    [75]徐树楠,牛兵占.神农本草经[M].河北科学技术出版社.1994
    [76]邹澍.本经疏正[M].上海卫生出版社.1957
    [77]王子接.绛雪园古方选注[M].上海科学技术出版社.1982
    [78]胡久略等.从桂枝汤谈经方的双向调节作用[J].河南中医.2005.25(4):10
    [79]谢惠民.合理用药[M].人民卫生出版社..1989

© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号

地址:北京市海淀区学院路29号 邮编:100083

电话:办公室:(+86 10)66554848;文献借阅、咨询服务、科技查新:66554700