“半蒌贝蔹及攻乌”同方配伍规律研究
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摘要
“十八反”是中药配伍禁忌的核心内容,对中医临床安全用药起着重要的指导作用。历代均有一定数量含反药配伍的方剂,临床亦有反药配伍治病的事实。“半蒌贝蔹及攻乌”是中药“十八反”的重要组成部分,本论文通过对“半萎贝蔹及攻乌”同方配伍方剂的配伍特征和主治病症特点的探讨,为“半蒌贝蔹及攻乌”同方配伍方剂能否在临床安全、合理应用提供参考。
论文主要分两部分,第一部分是关于历代“半蒌贝蔹及攻乌”同方配伍规律的研究。收集整理了中国中医药数据库中从汉代至建国初期的方剂,共84464首,对其中“半蒌贝蔹及攻乌”同方配伍的1297首方剂,运用数据挖掘方法进行处理分析,探讨了“半蒌贝蔹及攻乌”同方配伍方剂的配伍特征和主治病症特点。结果表明：
1.“半蒌贝蔹及攻乌”是“十八反”配伍方剂中数量最多的一组。附子的使用频率远多于川乌、草乌。附子半夏是“半萎贝蔹及攻乌”中最常见的配伍。
2.在乌头类药物与半夏同方配伍的方剂中,附子半夏同用方剂配伍的药物类别主要有补虚药、温里药、化痰药,常用药物有生姜、肉桂、人参、甘草、茯苓、白术等。主治病症性质为阳虚寒盛,兼有痰、湿或气滞,多用于脾胃病、肺系病,还涉及到心肝肾以及气血津液及肢体经络病症。常见食欲不振、畏寒、腹冷、疲乏、胸闷等症状。关联关系中较密切的有甘草-生姜、甘草-人参、腹冷-畏寒、人参-食欲不振。川乌半夏同用方剂配伍的药物类别主要有祛风湿药、活血化瘀药、补虚药、解表药。常用药物有天南星、川乌、白芷、当归、防风、细辛等。主治病症的性质为风寒痰瘀阻滞经络。多用于治疗肢体经络病及气血津液病,症状方面,前者以头痛、口眼歪斜、关节疼痛常见,后者以腹中痞块、瘰疬、痰核流注常见。关联关系中较密切的有没药-乳香、独活-羌活、草乌-无名肿毒、草乌-跌打损伤。草乌半夏配伍方剂与除外阳子的乌头类药物半夏配伍方剂,在配伍特征和主治病症特点两方面与川乌半夏配伍方剂相近。
在乌头类与瓜蒌类药物同方配伍的方剂中,以附子天花粉配伍者居多。附子天花粉同用方剂配伍的药物类别主要有补虚药、温里药、清热药,常用药物有白术、人参、防风、茯苓、肉桂、甘草等。主治病症的性质为阳气虚弱,津液上呈不足,郁热生毒。多用于治疗气血津液病和外科病。常见症状有疮、瘰疬、痈、疽、肩背痈肿等。关联关系较密切的有防风-细辛、肉桂-细辛、肉桂-畏寒。草乌天花粉同用方剂配伍的药物类别主要有清热药、解表药、祛风湿药,常用药物有白芷、防风、(?)柏、当归、羌活、乳香、大黄等。主治病症的性质为毒瘀郁结,多用于外科病,常见症状有疮、无名肿毒、痈、疽、跌打损伤、肩背痈肿等。关联关系较密切的有没药.乳香、当归-防风、蓖麻子-无名肿毒、蓖麻子-疮。川乌天花粉同用方剂与草乌天花粉同用方剂的配伍规律相近。附子瓜萎同用方剂配伍的药物类别主要有清热药、解表药、祛风湿药、活血化瘀药等。常用的药物有白芷、防风、当归、羌活、草乌等。主治病症的性质为毒瘀郁结,多用于外科病,常见症状有疮、无名肿毒、痈、跌打损伤、腹中痞块等。关联关系较密切的有天花粉-草乌、当归-防风、木鳖子-疮、蓖麻子-疮。除外附子的乌头类药物与瓜蒌类药物同用方剂配伍的药物类别主要有清热药、祛风湿药、补虚药、解表药等,常用药物有防风、细辛、肉桂、白芷、当归等。主治病症的性质为毒瘀郁结。多用于外科病及肢体经络病,前者以疮、无名肿毒、痈常见,后者以关节疼痛、头痛常见。关联关系较密切的有没药-乳香、大黄-黄柏、疽-痈、没药-痈、黄连-痈。
在乌头类与贝母类药物同方配伍的方剂中,以川乌浙贝母配伍者居多,川乌浙贝母同用方剂配伍的药物类别主要有解表药、祛风湿药、化痰药、补虚药,常用药物有没药、大黄、当归、穿山甲、乳香等。主治病症的性质为痰瘀互结。多用于气血津液病和外科病,前者以腹中痞块、癥瘕常见,后者以痈、疽常见。关联关系较密切的有穿山甲-大黄、穿山甲.当归、腹痛-寒热往来、苍术-腹痛、青皮-腹痛。除外附子的乌头类药物与贝母类药物同用方剂配伍的药物类别主要有清热药、解表药、活血化瘀药、祛风湿药等,常用药物有当归、白芷、大黄、肉桂、甘草等。主治病症的性质为风寒痰瘀阻滞经络,多用于外科病及气血津液病,前者以无名肿毒、疮、痈常见,后者以腹中痞块、癥瘕常见。关联关系较密切的有独活-羌活、没药-乳香、赤芍-无名肿毒、柳枝-无名肿毒。
在乌头类与白蔹同方配伍的方剂中,以附子白蔹同方配伍方剂居多。附子白蔹同用方剂配伍的药物类别主要有补虚药、温里药、清热药、活血化瘀药,常用药物有肉桂、当归、川芎、防风、甘草、细辛、白芷等。主治病症的性质为阳气虚弱,毒瘀郁结。多用于外科病及肢体经络病,前者以疮、跌打损伤、痈、疽常见,后者以关节疼痛、四肢麻木常见。关联关系较密切的有白芷-木香、川芎-当归、当归-跌打损伤、川芎-跌打损伤。川乌白蔹同用方剂配伍的药物类别主要有清热药、祛风湿药、活血化瘀药,常用的药物有当归、白芷、白及、肉桂、没药等。主治病症的性质为风寒湿毒瘀郁结。多用于外科病及肢体经络病,前者以疮、跌打损伤、无名肿毒常见,后者以关节疼痛、四肢拘急常见。关联关系较密切的有没药-乳香、草乌-大黄、疮-无名肿毒、牛膝-关节疼痛、大黄-疮。草乌白蔹同用方剂与除外附子的乌头类药物白蔹同用方剂,二者配伍特征和主治病症特点与川乌白蔹同用方剂相近。
在乌头类药物与白及同方配伍的方剂中,以附子白及同方配伍方剂居多。附子白及同用方剂配伍的药物类别主要有温里药、活血化瘀药、清热药、补虚药,常用药物有当归、肉桂、白芷、白蔹、川芎等。主治病症的性质为阳虚寒凝,毒瘀郁结。多用外科病,常见症状有疮、跌打损伤、疽、痈、肩背痈肿等。关联关系较密切的有当归-肉桂、白芷-当归、黄芪-痈、防风-疮。川乌白及同用方剂配伍的药物类别主要有祛风湿药、清热药、活血化瘀药、解表药,常用药物有草乌、当归、、白蔹、白芷、大黄、没药等。主治病症的性质为风寒湿毒瘀郁结,多用于外科病,常见症状有无名肿毒、跌打损伤、痈、疽等。关联关系较密切的有乳香-没药、防风-疮、穿山甲-疮。草乌白及同用方剂与除外附子的乌头类药物白及同用方剂,二者配伍特征和主治病症特点与川乌白及同用方剂相近。
第二部分为中药“十八反”基层医院应用现状调查及分析。方法是实地收集处方,并结合走访、座谈等。收集了河北省围场县中医院及9所乡镇卫生院近3年处方共78238首,其中含“十八反”的处方共255首,含“半蒌贝蔹及攻乌”处方198首。对处方配伍特征和主治病症特点的研究分析方法同第一部分。结果表明：
1.“半蒌贝蔹及攻乌”是“十八反”配伍处方中数量最多的一组。附子的应用频率远多于川乌、草乌。附子半夏是“半萎贝蔹及攻乌”中最常见的配伍。反药配伍处方临床多用于常见病、多发病。医生开具反药处方的数量随着年龄和从业年限的增长而增加。
2.附子半夏配伍处方的药物类别以补气药为主,常用药物有茯苓、甘草、白术、丹参、黄芪、陈皮等。主治病症的性质为阳虚寒盛。多用于心系病、肺系病、脾胃病、肾系病,常见症状有畏寒、心悸、呕吐、心下痞、水肿等。关联关系较密切的有白术-茯苓、丹参.黄芪、山茱萸-腰疫、熟地黄.腰疫。川乌草乌半夏配伍处方的药物类别以祛风湿药为主,常用药物有甘草、地龙、黄芪、川芎、天麻等。主治病症的性质为外感风寒湿邪。多用于肢体经络病,常见症状有关节疼痛、头痛、肩痛等。关联关系较密切的有甘草-黄芪杜仲-关节疼痛。
附子瓜蒌配伍处方的药物类别以补气药为主,常用药物有丹参、黄芪、桂枝、甘草、川芎、茯苓等。主治病症的性质为为阳虚寒凝,痰浊阻滞。多用于心系病、脾胃病,常见症状有心悸、胸痛、胸闷、呃逆、心下痞等。关联关系较密切的有川芎-郁金、丹参-酸枣仁、丹参-心悸、川芎-心悸。
附子川贝母配伍处方的药物类别以化痰药为主,常用药物有茯苓、黄芪、白术、白芍、甘草等。主治病症的性质为心肾阳虚,水饮凌心射肺。多用于肺系病、心系病,常见症状有咳嗽、心悸、水肿等。关联关系较密切的有白芍-茯苓、丹参-茯苓、鳖甲-腹中痞块、山慈茹-腹中痞块。附子浙贝母同用处方配伍药物的类别以补气药为主,常用药物有白芍、延胡索、甘草、白术、炮姜等。主治病症的性质为脾肾阳虚。多用于脾胃病、肺系病,常见症状有胃脘痛、呃逆、心下痞、咳嗽等。关联关系较密切的有白芍-甘草、白芍-延胡索、旋覆花-呃逆、代赭石-呃逆。川乌浙贝母同用处方配伍药物的类别以祛风湿药为主,常用药物有牛膝、草乌、乳香、没药等。主治病症的性质为风寒湿痰瘀邪痹阻经络。多用于肢体经络病为主,常见症状有关节疼痛、腰痛等。关联关系较密切的有没药-乳香、没药-牛膝、狗脊-腰痛、熟地黄-腰痛。草乌浙贝母同用处方与川乌浙贝母同用处方的配伍特征和主治病症特点,无明显差别。
附子白及同用处方配伍药物的类别以理气药为主,常用药物有陈皮、川楝子、姜黄、砂仁、白术、甘草等。主治病症的性质为脾肾阳虚,多用于脾胃病,常见症状有畏寒、腹满、腹痛、心下痞等。关联关系较密切的有陈皮-姜黄、陈皮-川楝子、荔枝核-腹痛、莱菔子-腹满。
海藻甘草同用处方配伍药物的类别主要有补虚药、化痰药、清热药,常用药物有浙贝母、柴胡、牡蛎、昆布、玄参等。主治病症的性质为痰瘀互结,气机郁滞,多用于气血津液病,常见症状有积聚、经前乳胀、瘰疬、胁痛、腹中痞块等。关联关系较密切的有牡蛎.浙贝母、浙贝母.柴胡、玄参.经前乳胀、玄参.积聚。
As everyone knows, eighteen clashes are regarded as the key content of incompatibility of drugs in a prescription, and play an important role in guiding the clinically safe administration of traditional Chinese medicine.'Do not use the prescriptions with Aconite in combination with Pinellia, Snakegourd Fruit, Fritillary, Ampelopsis Japonica Makino or Rhizoma Bletillae'was an important element of eighteen clashes. In this paper, we compared and analyzed compositions, effects, the main indications and compatibilities of these prescriptions, extracted the characteristic association relationship, and explored the disease features in practice, which might provide references for clinically safe and reasonable administration of these prescriptions.
This article mainly included two parts, and the first part was about compounding rules of the prescriptions with Aconite in combination with Pinellia, Snakegourd Fruit, Fritillary, Ampelopsis Japonica Makino and Rhizoma Bletillae in different dynasties. We retrieved84464prescriptions in traditional Chinese prescription of traditional Chinese medicine database (TCMDB) from the Han Dynasty to the initial stage of new China. There were1297prescriptions touching on application of Aconite in combination with Pinellia, Snakegourd Fruit, Fritillary, Ampelopsis Japonica Makino and Rhizoma Bletillae. By means of data mining, the compatibility features, major symptoms and diseases were studied. The results were showed as follows.
1. The prescriptions relative to Aconite in combination with Pinellia, Snakegourd Fruit, Fritillary, Ampelopsis Japonica Makino and Rhizoma Bletillae were more than any other prescriptions toughing on concerted application of eighteen clashes. Radix Aconiti Lateralis Preparata was more frequently applied than Radix Aconiti and Radix Aconiti Kusnezoffii. Radix Aconiti Lateralis Preparata was the most frequently compounded with Pinellia of all incompatibilities of drugs in a prescription.
2. The prescriptions of Radix Aconiti Lateralis Preparata compounded with Pinellia were the most common of all prescriptions of Aconite compounded with Pinellia. Main drug classes included tonic drugs, interior-warming drugs, and phlegm-resolving drugs, and that specific drugs included Rhizoma Zingiberis Recens, Cortex Cinnamomi, Radix Ginseng, Radix Glycyrrhizae, Poria and Rhizoma Atractylodis Macrocephalae. Major pathogenesis was Yang deficiency and cold manifestation, as well as phlegm, dampness and Qi stagnation. These prescriptions were commonly used to treat spleen-stomach diseases and lung diseases, and some prescriptions were related to heart diseases, liver diseases, kidney diseases, Qi-blood-fluid diseases and limb-meridian diseases. Common symptoms include inappetence, fear of cold, cold in abdomen, fatigue and oppression in chest. There were relatively close association relationships in Radix Glycyrrhizae and Rhizoma Zingiberis Recens, Radix Glycyrrhizae and Radix Ginseng, cold in abdomen and fear of cold, Rhizoma Zingiberis Recens and inappetence, Radix Ginseng and inappetence. Main drug classes in the prescriptions of Radix Aconiti compounded with Rhizoma Pinelliae included antirheumatic drugs, blood-activating&stasis-removing drugs, tonic drugs and superficies-resolving drugs. Frequently-used drugs included Rhizoma Arisaematis, Radix Aconiti, Radix Angelicae Dahuricae, Radix Angelicae Sinensis, Radix Saposhnikoviae and Herba Asari. Major pathogenesis was that pathogenic wind, cold, phlegm and blood stasis blocked the meridians. These prescriptions were mainly used for limb-meridian diseases and Qi-blood-fluid diseases. The former symptoms mainly included headache, facial paralysis and arthralgia, the latter symptoms primarily included mass in abdomen, scrofula and phlegm nuclear lingers. There were relative close association relationships in Myrrha and Olibanum, Radix Angelicae Pubescentis and Rhizoma et Radix Notopterygii, bloody purulent stool and tenesmus, diarrhea and tenesmus, Radix Aconiti Kusnezoffii and phlegmon, Radix Aconiti Kusnezoffii and traumatic injuries. Compounding rules of Radix Aconiti Kusnezoffii combined with Pinellia were similar to those of Radix Aconiti combined with Pinellia.
Radix Trichosanthis was the most frequent drug of all the prescription of Aconite compounded with Melon Trichosanthis drugs. Main drug classes included tonic drugs, interior-warming drugs and heat-clearing drugs, and that frequently-used drugs included Rhizoma Atractylodis Macrocephalae, Radix Ginseng, Radix Saposhnikoviae, Poria, Cortex Cinnamomi and Radix Glycyrrhizae. Main pathogenesis was Yang deficiency, lack of body fluid and heat-toxin. The prescriptions were mainly used to treat Qi-blood-fluid diseases and surgical diseases. Main symptoms included sores, scrofula, carbuncle, deep-rooted carbuncle, carbuncle in shoulder and back. There were relatively close association relationships in Radix Saposhnikoviae and Herba Asari, Cortex Cinnamomi and Herba Asari, shoulder-back carbuncle and carbuncle, Cortex Cinnamomi and fear of cold, Radix Saposhnikoviae and fatigue. Main drug classes in the prescriptions of Radix Aconiti Kusnezoffii compounded with Radix Trichosanthis included heat-clearing drugs, superficies-resolving drugs and antirheumatic drugs, and that frequently-used drugs included Radix Angelicae Dahuricae, Radix Saposhnikoviae, Cortex Phellodendri, Radix Angelicae Sinensis, Rhizoma et Radix Notopterygii, Olibanum and Radix et Rhizoma Rhei. Main pathogenesis was toxin stagnation and blood stasis. The prescriptions were primarily used to treat surgical diseases, and that common symptoms included sores, phlegmona, carbuncle, deep-rooted carbuncle, traumatic injuries, and shoulder-back carbuncle. There were relatively close association relationships in Myrrha and Olibanum, Radix Angelicae Sinensis and Radix Saposhnikoviae, mass in abdomen and lumbago, carbuncle and deep-rooted carbuncle, Semen Ricini and phelgmona, Semen Ricini and sores. Compounding rules of Radix Aconiti concerted with Radix Trichosanthis were similar to those of Radix Aconiti Kusnezoffii concerted with Radix Trichosanthis. Main drug classes in the prescriptions of Radix Aconiti Lateralis Preparata compounded with Snakegourd Fruit included heat-clearing drugs, superficies-resolving drugs, antirheumatic drugs, and drugs for-promoting blood circulation and removing blood stasis. Frequently-used drugs included Radix Angelicae Dahuricae, Radix Saposhnikoviae, Radix Angelicae Sinensis, Rhizoma et Radix Notopterygii and Radix Aconiti Kusnezoffii. Main pathogenesis was toxin stagnation and blood stasis, and that these prescriptions were mainly used to treat surgical diseases. Common symptoms included sores, phelgmona, carbuncle, traumatic injuries and mass in abdomen. There were relatively close association relationships in Radix Trichosanthis and Radix Aconiti Kusnezoffii, Radix Angelicae Sinensis and Radix Saposhnikoviae, arthralgia and lumbago, mass in abdomen and arthralgia, Semen Momordicae and sores, Semen Ricini and sores. Main drug classes of Aconitine (exclusive of Radix Aconiti Lateralis Preparata) compounded with Snakegourd Fruit included heat-clearing drugs, antirheumatic drugs, tonic drugs and superficies-resolving drugs. Frequently-used drugs included Radix Saposhnikoviae and Herba Asari, Cortex Cinnamomi, Radix Angelicae Dahuricae and Radix Angelicae Sinensis. Main pathogenesis was toxin stagnation and blood stasis. These prescriptions were mainly used to treat surgical diseases and limb-meridian diseases. The former mainly included sores, phelgmona and carbuncle, the latter primarily included arthralgia and headache. There were relatively close association relationships in Myrrha and Olibanum, Radix et Rhizoma Rhei and Cortex Phellodendri, carbuncle and deep-rooted carbuncle, Myrrha and carbuncle, Rhizoma Coptidis and carbuncle.
Bulbus Fritillariae Thunbergii was the most frequently compounded with Radix Aconiti in the prescriptions of Aconite concerted with Fritillary. Main drug classes in the prescriptions of Radix Aconiti compounded with Bulbus Fritillariae Thunbergii included superficies-resolving drugs, antirheumatic drugs, phlegm-resolving drugs and tonic drugs, and that frequently-used drugs included Myrrha, Radix et Rhizoma Rhei, Radix Angelicae Sinensis, Squama Manis and Olibanum. Main pathogenesis was intermingled phlegm and blood stasis, and that the prescriptions were primarily applied to treat Qi-blood-fluid diseases and surgical diseases. The former mainly included mass in abdomen in symptom, the latter primarily included carbuncle and deep-rooted carbuncle in symptom. There were close association relationships in Squama Manis and Radix et Rhizoma Rhei, Squama Manis and Radix Angelicae Sinensis, bellyache and alternate attacks of chill and fever, Rhizoma Atractylodis and bellyache, Pericarpium Citri Reticulatae Viride and bellyache. Main drug classes in the prescriptions of Aconitine (exclusive of Radix Aconiti Lateralis Preparata) compounded with Fritillary heat-clearing drugs, superficies-resolving drugs, drugs for promoting blood circulation and removing blood stasis and antirheumatic drugs. Frequently-used drugs included Radix Angelicae Sinensis, Radix Angelicae Dahuricae, Radix et Rhizoma Rhei, Cortex Cinnamomi and Radix Glycyrrhizae. Main pathogenesis was that pathogenic wind, cold, phlegm and blood stasis blocked meridians. The prescriptions were mainly used to treat surgical diseases and Qi-blood-fluid diseases. The former mainly included phlegmona, sores and carbuncles in symptom, the latter primarily included mass in abdomen in symptom. There were close association relationships in Radix Angelicae Pubescentis and Rhizoma et Radix Notopterygii, Myrrha and Olibanum, Radix Paeoniae Rubra and phlegmona, Branch Willow and phlegmona.
Radix Aconiti Lateralis Preparata was most frequently compounded with Ampelopsis Japonica Makino in the prescriptions of Aconite concerted with Ampelopsis Japonica Makino, and that main drug classes included tonic drugs, interior-warming drugs, heat-clearing drugs and drugs for promoting blood circulation and removing blood stasis. Frequently-used drugs included Cortex Cinnamomi, Radix Angelicae Sinensis, Rhizoma Ligustici Chuanxiong, Radix Saposhnikoviae, Radix Glycyrrhizae, Herba Asari and Radix Angelicae Dahuricae. Main pathogenesis was Yang deficiency, toxin stagnation and blood stasis. The prescriptions were mainly applied to treat surgical diseases and limb-meridian diseases. The former mainly included sores, traumatic injuries, carbuncles and deep-rooted carbuncles in symptom, the latter primarily included arthralgia and limb numbness. There were relatively close association relationships in Radix Angelicae Dahuricae and Radix Aucklandiae, Rhizoma Ligustici Chuanxiong and Radix Angelicae Sinensis, carbuncle and deep-rooted carbuncle, Radix Angelicae Sinensis and traumatic injuries, Rhizoma Ligustici Chuanxiong and traumatic injuries.
Main drug classes in the prescriptions of Radix Aconiti compounded with Ampelopsis Japonica Makino included heat-clearing drugs, antirheumatic drugs and drugs for promoting blood circulation and removing blood stasis, and that frequently-used drugs included Radix Angelicae Sinensis, Radix Angelicae Dahuricae, Rhizoma Bletillae, Cortex Cinnamomi and Myrrha. Main pathogenesis was pathogenic wind, cold, dampness, toxin stagnation and blood stasis. The prescriptions were mainly applied to treat surgical diseases and limb-meridian diseases. The former mainly included sores, traumatic injuries and phlegmona, the latter primarily included arthralgia and spasm of limbs. There were relatively close association relationships in Myrrha and Olibanum, Radix Aconiti Kusnezoffii and Radix et Rhizoma Rhei, sores and phlegmona, carbuncles and deep-rooted carbuncles, Radix Achyranthis Bidentatae and arthralgia, Radix et Rhizoma Rhei and sores. Compounding rules of Radix Aconiti Kusnezoffii concerted with Ampelopsis Japonica Makino were similar to those of Aconitine (exclusive of Radix Aconiti Lateralis Preparata) concerted with Ampelopsis Japonica Makino.
Radix Aconiti Lateralis Preparata was usually compounded with Rhizoma Bletillae in the prescriptions of Aconite conbined with Rhizoma Bletillae, and that main drug classes included interior-warming drugs, drugs for promoting blood circulation and removing blood stasis, heat-clearing drugs and tonic drugs. Frequently-used drugs included Radix Angelicae Sinensis, Cortex Cinnamomi, Radix Angelicae Dahuricae, Ampelopsis Japonica Makino and Rhizoma Ligustici Chuanxiong. Main pathogenesis was Yang deficiency, toxin stagnation and blood stasis. The prescriptions were mainly applied to surgical diseases, and that common symptoms included sores, traumatic injuries, deep-rooted carbuncles, carbuncles and carbuncles in shoulder and back. There were relatively close association relationships in Radix Angelicae Sinensis and Cortex Cinnamomi, Radix Angelicae Dahuricae and Radix Angelicae Sinensis, deep-rooted carbuncles and carbuncles, carbuncles in shoulder and back and deep-rooted carbuncles, Radix Astragali seu Hedysari and carbuncles, Radix Saposhnikoviae and sores. Main drug classes in the prescriptions of Radix Aconiti compounded with Rhizoma Bletillae included antirheumatic drugs, heat-clearing drugs, drugs for promoting blood circulation and removing blood stasis and superficies-resolving drugs, and that frequently-used drugs included Radix Aconiti Kusnezoffii, Radix Angelicae Sinensis, Ampelopsis Japonica Makino, Radix Angelicae Dahuricae, Radix et Rhizoma Rhei and Myrrha. Major pathogenesis was pathogenic wind, cold, dampness, toxin stagnation and blood stasis, and that the prescriptions were primarily applied to treat surgical diseases. Common symptoms included phlegmona, traumatic injuries, carbuncles and deep-rooted carbuncles. There were close association relationships in Olibanum and Myrrha, cough and asthma, deep-rooted carbuncles and carbuncles, Radix Saposhnikoviae and sores, Squama Manis and sores. Compounding rules of Radix Aconiti Kusnezoffii concerted with Rhizoma Bletillae were similar to those of Aconitine (exclusive of Radix Aconiti Lateralis Preparata) cocerted with Rhizoma Bletillae.
The second part was mainly application status and analysis of eighteen clashes in grassroots hospitals. We collected78238prescriptions from nine health clinics in towns and townships as well as Chinese Medicine Hospital of Wei-Chang County in He-Bei Province in the last3years. There were255prescriptions touching on eighteen clashes, and there were198prescriptions of Aconite in combination with Pinellia, Snakegourd Fruit, Fritillary, Ampelopsis Japonica Makino or Rhizoma Bletillae. The same research methods as the first part were used to analyze the compounding rules. The findings were shown as follows.
1. The ratio of prescriptions of Aconite in combination with Pinellia, Snakegourd Fruit, Fritillary, Ampelopsis Japonica Makino or Rhizoma Bletillae had the highest application frequency, and reached77.65%in all prescriptions toughing on eighteen clashes. Radix Aconiti Lateralis Preparata had the higher application frequency than Radix Aconiti and Radix Aconiti Kusnezoffii. Radix Aconiti Lateralis Preparata was more frequently compounded with Pinellia of all incompatibilities of drugs in a prescription. The prescriptions with eighteen clashes were generally applied for common diseases and frequently-occurring diseases. The amount of prescriptions with eighteen clashes was in proportion to the ages of doctors.
2. Main drug classes in the prescriptions of Radix Aconiti Lateralis Preparata compounded with Pinellia was Qi-tonifying drugs, and that frequently-used drugs included Poria, Radix Glycyrrhizae, Rhizoma Atractylodis Macrocephalae, Radix Salviae Miltiorrhizae, Radix Astragali seu Hedysari and Pericarpium Citri Reticulatae. The prescriptions were commonly used for heart diseases, lung diseases, spleen-stomach diseases and kidney diseases. Main symptoms included fear of cold, palpitation, vomiting, epigastric oppression and edema. The were relatively close association relationships in Rhizoma Atractylodis Macrocephalae and Poria, Radix Salviae Miltiorrhizae and Radix Astragali seu Hedysari, Fructus Corni and soreness of loins, Radix Rehmanniae Preparata and soreness of loins. Drug class in the prescriptions of Radix Aconiti and Radix Aconiti Kusnezoffii in combination with Pinellia was antirheumatic drugs, and that frequently-used drugs included Radix Glycyrrhizae, Lumbricus, Radix Astragali seu Hedysari, Rhizoma Ligustici Chuanxiong and Rhizoma Gastrodiae. Main pathogenesis was affected by exterior wind, cold and dampness. There were close association relationships in Lumbricus and Radix Glycyrrhizae, Radix Glycyrrhizae and Radix Astragali seu Hedysari, Radix Glycyrrhizae and fear of cold, Cortex Eucommiae and arthralgia.
Main drug classes in the prescriptions of Radix Aconiti Lateralis Preparata compounded with Snakegourd Fruit was Qi-tonifying drugs, and that frequently-used drugs were Radix Salviae Miltiorrhizae, Radix Astragali seu Hedysari, Ramulus Cinnamomi, Radix Glycyrrhizae, Rhizoma Ligustici Chuanxiong and Poria. Main pathogenesis was Yang deficiency, coagulated cold and phlegmatic blockage. The prescriptions were commonly used for heart diseases and spleen-stomach diseases. Main symptoms included palpitation, chest pain, oppression in chest, hiccough and epigastric oppression. There were close association relationships in Rhizoma Ligustici Chuanxiong and Radix Curcumae, Radix Salviae Miltiorrhizae and Semen Ziziphi Spinosae, Radix Salviae Miltiorrhizae and palpitation, Rhizoma Ligustici Chuanxiong and palpitation.
Main drug classes in the prescriptions of Radix Aconiti Lateralis Preparata compounded with Bulbus Fritillariae Cirrhosae was phlegm-resolving drugs, and that frequently-used drugs included Poria, Radix Astragali seu Hedysari, Rhizoma Atractylodis Macrocephalae, Radix Paeoniae Alba and Radix Glycyrrhizae. Main pathogenesis was Yang deficiency of heart and kidney, and fluid retention. The prescriptions were commonly used for lung diseases and heart diseases. Main symptoms included cough, palpitation and edema. There were relatively close association relationships in Radix Paeoniae Alba and Poria, Radix Salviae Miltiorrhizae and Poria, Carapax Trionycis and mass in abdomen, Pseudobulbus Cremastrae seu Pleiones and mass in abdomen. Main drug classes in the prescriptions of Radix Aconiti Lateralis Preparata compounded with Bulbus Fritillariae Thunbergii was Qi-tonifying drugs, and that frequently-used drugs were Radix Paeoniae Alba, Rhizoma Corydalis, Radix Glycyrrhizae, Rhizoma Atractylodis Macrocephalae and baked ginger. Main pathogenesis was Yang deficiency of spleen and kidney. The prescriptions were commonly used for spleen-stomach diseases and lung diseases. Main symptoms included stomachache, hiccough, epigastric oppression and cough. There were relatively close association relationships in Radix Paeoniae Alba and Radix Glycyrrhizae, Radix Paeoniae Alba and Rhizoma Corydalis, inula flower and hiccough, ruddle and hiccough. Main drug class in the prescriptions of Bulbus Fritillariae Cirrhosae in combination with Bulbus Fritillariae Thunbergii was antirheumatic drugs, and main drugs included Radix Achyranthis Bidentatae, Radix Aconiti Kusnezoffii, Olibanum and Myrrha. Major pathogenesis was that pathogenic wind, cold, dampness, phlegm and blood stasis blocked meridians. The prescriptions were primarily used for limb-meridian diseases, and that common symptoms included arthralgia and lumbago. There were relatively close association relationships in Olibanum and Myrrha, Myrrha and Radix Achyranthis Bidentatae, Rhizoma Cibotii and lumbago, Radix Rehmanniae Preparata and lumbago. There were no markedly difference in compounding rules when Bulbus Fritillariae Thunbergii was in combination with Radix Aconiti or Radix Aconiti Kusnezoffii.
Main drug class in the prescriptions of Radix Aconiti Lateralis Preparata compounded with Rhizoma Bletillae was Qi-regulating drugs, and that frequently-used drugs included Pericarpium Citri Reticulatae, Fructus Meliae Toosendan, Rhizoma Curcumae Longae, Fructus Amomi Villosi, Rhizoma Atractylodis Macrocephalae and Radix Glycyrrhizae. Main pathogenesis was Yang deficiency of spleen and kidney, and that the prescriptions were commonly used for spleen-stomach diseases. Main symptoms included fear of cold, abdominal distention, bellyache and epigastric oppression. There were relatively close association relationships in Pericarpium Citri Reticulatae and Rhizoma Curcumae Longae, Pericarpium Citri Reticulatae and Fructus Meliae Toosendan, Semen Litchi and bellyache, Semen Raphani and bellyache.
Main drug classes in the prescriptions of Sargassum in combination with Radix Glycyrrhizae were tonic drugs, phlegm-resolving drugs and heat-clearing drugs, and that frequently-used drugs included Bulbus Fritillariae Thunbergii, Radix Bupleuri, Concha Ostreae, Thallus Eckloniae and Radix Scrophulariae. Main pathogenesis was intermingled phlegm and blood stasis and stagnation of Qi. The prescriptions were primarily applied for Qi-blood-fluid diseases, and that common symptoms included abdominal mass, distending pain of breasts during menstruation, scrofula and hypochondriac pain. There were close association relationships in Concha Ostreae and Bulbus Fritillariae Thunbergii, Bulbus Fritillariae Thunbergii and Radix Bupleuri, Radix Scrophulariae and distending pain of breasts during menstruation, Radix Scrophulariae and abdominal mass.
论文主要分两部分,第一部分是关于历代“半蒌贝蔹及攻乌”同方配伍规律的研究。收集整理了中国中医药数据库中从汉代至建国初期的方剂,共84464首,对其中“半蒌贝蔹及攻乌”同方配伍的1297首方剂,运用数据挖掘方法进行处理分析,探讨了“半蒌贝蔹及攻乌”同方配伍方剂的配伍特征和主治病症特点。结果表明：
1.“半蒌贝蔹及攻乌”是“十八反”配伍方剂中数量最多的一组。附子的使用频率远多于川乌、草乌。附子半夏是“半萎贝蔹及攻乌”中最常见的配伍。
2.在乌头类药物与半夏同方配伍的方剂中,附子半夏同用方剂配伍的药物类别主要有补虚药、温里药、化痰药,常用药物有生姜、肉桂、人参、甘草、茯苓、白术等。主治病症性质为阳虚寒盛,兼有痰、湿或气滞,多用于脾胃病、肺系病,还涉及到心肝肾以及气血津液及肢体经络病症。常见食欲不振、畏寒、腹冷、疲乏、胸闷等症状。关联关系中较密切的有甘草-生姜、甘草-人参、腹冷-畏寒、人参-食欲不振。川乌半夏同用方剂配伍的药物类别主要有祛风湿药、活血化瘀药、补虚药、解表药。常用药物有天南星、川乌、白芷、当归、防风、细辛等。主治病症的性质为风寒痰瘀阻滞经络。多用于治疗肢体经络病及气血津液病,症状方面,前者以头痛、口眼歪斜、关节疼痛常见,后者以腹中痞块、瘰疬、痰核流注常见。关联关系中较密切的有没药-乳香、独活-羌活、草乌-无名肿毒、草乌-跌打损伤。草乌半夏配伍方剂与除外阳子的乌头类药物半夏配伍方剂,在配伍特征和主治病症特点两方面与川乌半夏配伍方剂相近。
在乌头类与瓜蒌类药物同方配伍的方剂中,以附子天花粉配伍者居多。附子天花粉同用方剂配伍的药物类别主要有补虚药、温里药、清热药,常用药物有白术、人参、防风、茯苓、肉桂、甘草等。主治病症的性质为阳气虚弱,津液上呈不足,郁热生毒。多用于治疗气血津液病和外科病。常见症状有疮、瘰疬、痈、疽、肩背痈肿等。关联关系较密切的有防风-细辛、肉桂-细辛、肉桂-畏寒。草乌天花粉同用方剂配伍的药物类别主要有清热药、解表药、祛风湿药,常用药物有白芷、防风、(?)柏、当归、羌活、乳香、大黄等。主治病症的性质为毒瘀郁结,多用于外科病,常见症状有疮、无名肿毒、痈、疽、跌打损伤、肩背痈肿等。关联关系较密切的有没药.乳香、当归-防风、蓖麻子-无名肿毒、蓖麻子-疮。川乌天花粉同用方剂与草乌天花粉同用方剂的配伍规律相近。附子瓜萎同用方剂配伍的药物类别主要有清热药、解表药、祛风湿药、活血化瘀药等。常用的药物有白芷、防风、当归、羌活、草乌等。主治病症的性质为毒瘀郁结,多用于外科病,常见症状有疮、无名肿毒、痈、跌打损伤、腹中痞块等。关联关系较密切的有天花粉-草乌、当归-防风、木鳖子-疮、蓖麻子-疮。除外附子的乌头类药物与瓜蒌类药物同用方剂配伍的药物类别主要有清热药、祛风湿药、补虚药、解表药等,常用药物有防风、细辛、肉桂、白芷、当归等。主治病症的性质为毒瘀郁结。多用于外科病及肢体经络病,前者以疮、无名肿毒、痈常见,后者以关节疼痛、头痛常见。关联关系较密切的有没药-乳香、大黄-黄柏、疽-痈、没药-痈、黄连-痈。
在乌头类与贝母类药物同方配伍的方剂中,以川乌浙贝母配伍者居多,川乌浙贝母同用方剂配伍的药物类别主要有解表药、祛风湿药、化痰药、补虚药,常用药物有没药、大黄、当归、穿山甲、乳香等。主治病症的性质为痰瘀互结。多用于气血津液病和外科病,前者以腹中痞块、癥瘕常见,后者以痈、疽常见。关联关系较密切的有穿山甲-大黄、穿山甲.当归、腹痛-寒热往来、苍术-腹痛、青皮-腹痛。除外附子的乌头类药物与贝母类药物同用方剂配伍的药物类别主要有清热药、解表药、活血化瘀药、祛风湿药等,常用药物有当归、白芷、大黄、肉桂、甘草等。主治病症的性质为风寒痰瘀阻滞经络,多用于外科病及气血津液病,前者以无名肿毒、疮、痈常见,后者以腹中痞块、癥瘕常见。关联关系较密切的有独活-羌活、没药-乳香、赤芍-无名肿毒、柳枝-无名肿毒。
在乌头类与白蔹同方配伍的方剂中,以附子白蔹同方配伍方剂居多。附子白蔹同用方剂配伍的药物类别主要有补虚药、温里药、清热药、活血化瘀药,常用药物有肉桂、当归、川芎、防风、甘草、细辛、白芷等。主治病症的性质为阳气虚弱,毒瘀郁结。多用于外科病及肢体经络病,前者以疮、跌打损伤、痈、疽常见,后者以关节疼痛、四肢麻木常见。关联关系较密切的有白芷-木香、川芎-当归、当归-跌打损伤、川芎-跌打损伤。川乌白蔹同用方剂配伍的药物类别主要有清热药、祛风湿药、活血化瘀药,常用的药物有当归、白芷、白及、肉桂、没药等。主治病症的性质为风寒湿毒瘀郁结。多用于外科病及肢体经络病,前者以疮、跌打损伤、无名肿毒常见,后者以关节疼痛、四肢拘急常见。关联关系较密切的有没药-乳香、草乌-大黄、疮-无名肿毒、牛膝-关节疼痛、大黄-疮。草乌白蔹同用方剂与除外附子的乌头类药物白蔹同用方剂,二者配伍特征和主治病症特点与川乌白蔹同用方剂相近。
在乌头类药物与白及同方配伍的方剂中,以附子白及同方配伍方剂居多。附子白及同用方剂配伍的药物类别主要有温里药、活血化瘀药、清热药、补虚药,常用药物有当归、肉桂、白芷、白蔹、川芎等。主治病症的性质为阳虚寒凝,毒瘀郁结。多用外科病,常见症状有疮、跌打损伤、疽、痈、肩背痈肿等。关联关系较密切的有当归-肉桂、白芷-当归、黄芪-痈、防风-疮。川乌白及同用方剂配伍的药物类别主要有祛风湿药、清热药、活血化瘀药、解表药,常用药物有草乌、当归、、白蔹、白芷、大黄、没药等。主治病症的性质为风寒湿毒瘀郁结,多用于外科病,常见症状有无名肿毒、跌打损伤、痈、疽等。关联关系较密切的有乳香-没药、防风-疮、穿山甲-疮。草乌白及同用方剂与除外附子的乌头类药物白及同用方剂,二者配伍特征和主治病症特点与川乌白及同用方剂相近。
第二部分为中药“十八反”基层医院应用现状调查及分析。方法是实地收集处方,并结合走访、座谈等。收集了河北省围场县中医院及9所乡镇卫生院近3年处方共78238首,其中含“十八反”的处方共255首,含“半蒌贝蔹及攻乌”处方198首。对处方配伍特征和主治病症特点的研究分析方法同第一部分。结果表明：
1.“半蒌贝蔹及攻乌”是“十八反”配伍处方中数量最多的一组。附子的应用频率远多于川乌、草乌。附子半夏是“半萎贝蔹及攻乌”中最常见的配伍。反药配伍处方临床多用于常见病、多发病。医生开具反药处方的数量随着年龄和从业年限的增长而增加。
2.附子半夏配伍处方的药物类别以补气药为主,常用药物有茯苓、甘草、白术、丹参、黄芪、陈皮等。主治病症的性质为阳虚寒盛。多用于心系病、肺系病、脾胃病、肾系病,常见症状有畏寒、心悸、呕吐、心下痞、水肿等。关联关系较密切的有白术-茯苓、丹参.黄芪、山茱萸-腰疫、熟地黄.腰疫。川乌草乌半夏配伍处方的药物类别以祛风湿药为主,常用药物有甘草、地龙、黄芪、川芎、天麻等。主治病症的性质为外感风寒湿邪。多用于肢体经络病,常见症状有关节疼痛、头痛、肩痛等。关联关系较密切的有甘草-黄芪杜仲-关节疼痛。
附子瓜蒌配伍处方的药物类别以补气药为主,常用药物有丹参、黄芪、桂枝、甘草、川芎、茯苓等。主治病症的性质为为阳虚寒凝,痰浊阻滞。多用于心系病、脾胃病,常见症状有心悸、胸痛、胸闷、呃逆、心下痞等。关联关系较密切的有川芎-郁金、丹参-酸枣仁、丹参-心悸、川芎-心悸。
附子川贝母配伍处方的药物类别以化痰药为主,常用药物有茯苓、黄芪、白术、白芍、甘草等。主治病症的性质为心肾阳虚,水饮凌心射肺。多用于肺系病、心系病,常见症状有咳嗽、心悸、水肿等。关联关系较密切的有白芍-茯苓、丹参-茯苓、鳖甲-腹中痞块、山慈茹-腹中痞块。附子浙贝母同用处方配伍药物的类别以补气药为主,常用药物有白芍、延胡索、甘草、白术、炮姜等。主治病症的性质为脾肾阳虚。多用于脾胃病、肺系病,常见症状有胃脘痛、呃逆、心下痞、咳嗽等。关联关系较密切的有白芍-甘草、白芍-延胡索、旋覆花-呃逆、代赭石-呃逆。川乌浙贝母同用处方配伍药物的类别以祛风湿药为主,常用药物有牛膝、草乌、乳香、没药等。主治病症的性质为风寒湿痰瘀邪痹阻经络。多用于肢体经络病为主,常见症状有关节疼痛、腰痛等。关联关系较密切的有没药-乳香、没药-牛膝、狗脊-腰痛、熟地黄-腰痛。草乌浙贝母同用处方与川乌浙贝母同用处方的配伍特征和主治病症特点,无明显差别。
附子白及同用处方配伍药物的类别以理气药为主,常用药物有陈皮、川楝子、姜黄、砂仁、白术、甘草等。主治病症的性质为脾肾阳虚,多用于脾胃病,常见症状有畏寒、腹满、腹痛、心下痞等。关联关系较密切的有陈皮-姜黄、陈皮-川楝子、荔枝核-腹痛、莱菔子-腹满。
海藻甘草同用处方配伍药物的类别主要有补虚药、化痰药、清热药,常用药物有浙贝母、柴胡、牡蛎、昆布、玄参等。主治病症的性质为痰瘀互结,气机郁滞,多用于气血津液病,常见症状有积聚、经前乳胀、瘰疬、胁痛、腹中痞块等。关联关系较密切的有牡蛎.浙贝母、浙贝母.柴胡、玄参.经前乳胀、玄参.积聚。
As everyone knows, eighteen clashes are regarded as the key content of incompatibility of drugs in a prescription, and play an important role in guiding the clinically safe administration of traditional Chinese medicine.'Do not use the prescriptions with Aconite in combination with Pinellia, Snakegourd Fruit, Fritillary, Ampelopsis Japonica Makino or Rhizoma Bletillae'was an important element of eighteen clashes. In this paper, we compared and analyzed compositions, effects, the main indications and compatibilities of these prescriptions, extracted the characteristic association relationship, and explored the disease features in practice, which might provide references for clinically safe and reasonable administration of these prescriptions.
This article mainly included two parts, and the first part was about compounding rules of the prescriptions with Aconite in combination with Pinellia, Snakegourd Fruit, Fritillary, Ampelopsis Japonica Makino and Rhizoma Bletillae in different dynasties. We retrieved84464prescriptions in traditional Chinese prescription of traditional Chinese medicine database (TCMDB) from the Han Dynasty to the initial stage of new China. There were1297prescriptions touching on application of Aconite in combination with Pinellia, Snakegourd Fruit, Fritillary, Ampelopsis Japonica Makino and Rhizoma Bletillae. By means of data mining, the compatibility features, major symptoms and diseases were studied. The results were showed as follows.
1. The prescriptions relative to Aconite in combination with Pinellia, Snakegourd Fruit, Fritillary, Ampelopsis Japonica Makino and Rhizoma Bletillae were more than any other prescriptions toughing on concerted application of eighteen clashes. Radix Aconiti Lateralis Preparata was more frequently applied than Radix Aconiti and Radix Aconiti Kusnezoffii. Radix Aconiti Lateralis Preparata was the most frequently compounded with Pinellia of all incompatibilities of drugs in a prescription.
2. The prescriptions of Radix Aconiti Lateralis Preparata compounded with Pinellia were the most common of all prescriptions of Aconite compounded with Pinellia. Main drug classes included tonic drugs, interior-warming drugs, and phlegm-resolving drugs, and that specific drugs included Rhizoma Zingiberis Recens, Cortex Cinnamomi, Radix Ginseng, Radix Glycyrrhizae, Poria and Rhizoma Atractylodis Macrocephalae. Major pathogenesis was Yang deficiency and cold manifestation, as well as phlegm, dampness and Qi stagnation. These prescriptions were commonly used to treat spleen-stomach diseases and lung diseases, and some prescriptions were related to heart diseases, liver diseases, kidney diseases, Qi-blood-fluid diseases and limb-meridian diseases. Common symptoms include inappetence, fear of cold, cold in abdomen, fatigue and oppression in chest. There were relatively close association relationships in Radix Glycyrrhizae and Rhizoma Zingiberis Recens, Radix Glycyrrhizae and Radix Ginseng, cold in abdomen and fear of cold, Rhizoma Zingiberis Recens and inappetence, Radix Ginseng and inappetence. Main drug classes in the prescriptions of Radix Aconiti compounded with Rhizoma Pinelliae included antirheumatic drugs, blood-activating&stasis-removing drugs, tonic drugs and superficies-resolving drugs. Frequently-used drugs included Rhizoma Arisaematis, Radix Aconiti, Radix Angelicae Dahuricae, Radix Angelicae Sinensis, Radix Saposhnikoviae and Herba Asari. Major pathogenesis was that pathogenic wind, cold, phlegm and blood stasis blocked the meridians. These prescriptions were mainly used for limb-meridian diseases and Qi-blood-fluid diseases. The former symptoms mainly included headache, facial paralysis and arthralgia, the latter symptoms primarily included mass in abdomen, scrofula and phlegm nuclear lingers. There were relative close association relationships in Myrrha and Olibanum, Radix Angelicae Pubescentis and Rhizoma et Radix Notopterygii, bloody purulent stool and tenesmus, diarrhea and tenesmus, Radix Aconiti Kusnezoffii and phlegmon, Radix Aconiti Kusnezoffii and traumatic injuries. Compounding rules of Radix Aconiti Kusnezoffii combined with Pinellia were similar to those of Radix Aconiti combined with Pinellia.
Radix Trichosanthis was the most frequent drug of all the prescription of Aconite compounded with Melon Trichosanthis drugs. Main drug classes included tonic drugs, interior-warming drugs and heat-clearing drugs, and that frequently-used drugs included Rhizoma Atractylodis Macrocephalae, Radix Ginseng, Radix Saposhnikoviae, Poria, Cortex Cinnamomi and Radix Glycyrrhizae. Main pathogenesis was Yang deficiency, lack of body fluid and heat-toxin. The prescriptions were mainly used to treat Qi-blood-fluid diseases and surgical diseases. Main symptoms included sores, scrofula, carbuncle, deep-rooted carbuncle, carbuncle in shoulder and back. There were relatively close association relationships in Radix Saposhnikoviae and Herba Asari, Cortex Cinnamomi and Herba Asari, shoulder-back carbuncle and carbuncle, Cortex Cinnamomi and fear of cold, Radix Saposhnikoviae and fatigue. Main drug classes in the prescriptions of Radix Aconiti Kusnezoffii compounded with Radix Trichosanthis included heat-clearing drugs, superficies-resolving drugs and antirheumatic drugs, and that frequently-used drugs included Radix Angelicae Dahuricae, Radix Saposhnikoviae, Cortex Phellodendri, Radix Angelicae Sinensis, Rhizoma et Radix Notopterygii, Olibanum and Radix et Rhizoma Rhei. Main pathogenesis was toxin stagnation and blood stasis. The prescriptions were primarily used to treat surgical diseases, and that common symptoms included sores, phlegmona, carbuncle, deep-rooted carbuncle, traumatic injuries, and shoulder-back carbuncle. There were relatively close association relationships in Myrrha and Olibanum, Radix Angelicae Sinensis and Radix Saposhnikoviae, mass in abdomen and lumbago, carbuncle and deep-rooted carbuncle, Semen Ricini and phelgmona, Semen Ricini and sores. Compounding rules of Radix Aconiti concerted with Radix Trichosanthis were similar to those of Radix Aconiti Kusnezoffii concerted with Radix Trichosanthis. Main drug classes in the prescriptions of Radix Aconiti Lateralis Preparata compounded with Snakegourd Fruit included heat-clearing drugs, superficies-resolving drugs, antirheumatic drugs, and drugs for-promoting blood circulation and removing blood stasis. Frequently-used drugs included Radix Angelicae Dahuricae, Radix Saposhnikoviae, Radix Angelicae Sinensis, Rhizoma et Radix Notopterygii and Radix Aconiti Kusnezoffii. Main pathogenesis was toxin stagnation and blood stasis, and that these prescriptions were mainly used to treat surgical diseases. Common symptoms included sores, phelgmona, carbuncle, traumatic injuries and mass in abdomen. There were relatively close association relationships in Radix Trichosanthis and Radix Aconiti Kusnezoffii, Radix Angelicae Sinensis and Radix Saposhnikoviae, arthralgia and lumbago, mass in abdomen and arthralgia, Semen Momordicae and sores, Semen Ricini and sores. Main drug classes of Aconitine (exclusive of Radix Aconiti Lateralis Preparata) compounded with Snakegourd Fruit included heat-clearing drugs, antirheumatic drugs, tonic drugs and superficies-resolving drugs. Frequently-used drugs included Radix Saposhnikoviae and Herba Asari, Cortex Cinnamomi, Radix Angelicae Dahuricae and Radix Angelicae Sinensis. Main pathogenesis was toxin stagnation and blood stasis. These prescriptions were mainly used to treat surgical diseases and limb-meridian diseases. The former mainly included sores, phelgmona and carbuncle, the latter primarily included arthralgia and headache. There were relatively close association relationships in Myrrha and Olibanum, Radix et Rhizoma Rhei and Cortex Phellodendri, carbuncle and deep-rooted carbuncle, Myrrha and carbuncle, Rhizoma Coptidis and carbuncle.
Bulbus Fritillariae Thunbergii was the most frequently compounded with Radix Aconiti in the prescriptions of Aconite concerted with Fritillary. Main drug classes in the prescriptions of Radix Aconiti compounded with Bulbus Fritillariae Thunbergii included superficies-resolving drugs, antirheumatic drugs, phlegm-resolving drugs and tonic drugs, and that frequently-used drugs included Myrrha, Radix et Rhizoma Rhei, Radix Angelicae Sinensis, Squama Manis and Olibanum. Main pathogenesis was intermingled phlegm and blood stasis, and that the prescriptions were primarily applied to treat Qi-blood-fluid diseases and surgical diseases. The former mainly included mass in abdomen in symptom, the latter primarily included carbuncle and deep-rooted carbuncle in symptom. There were close association relationships in Squama Manis and Radix et Rhizoma Rhei, Squama Manis and Radix Angelicae Sinensis, bellyache and alternate attacks of chill and fever, Rhizoma Atractylodis and bellyache, Pericarpium Citri Reticulatae Viride and bellyache. Main drug classes in the prescriptions of Aconitine (exclusive of Radix Aconiti Lateralis Preparata) compounded with Fritillary heat-clearing drugs, superficies-resolving drugs, drugs for promoting blood circulation and removing blood stasis and antirheumatic drugs. Frequently-used drugs included Radix Angelicae Sinensis, Radix Angelicae Dahuricae, Radix et Rhizoma Rhei, Cortex Cinnamomi and Radix Glycyrrhizae. Main pathogenesis was that pathogenic wind, cold, phlegm and blood stasis blocked meridians. The prescriptions were mainly used to treat surgical diseases and Qi-blood-fluid diseases. The former mainly included phlegmona, sores and carbuncles in symptom, the latter primarily included mass in abdomen in symptom. There were close association relationships in Radix Angelicae Pubescentis and Rhizoma et Radix Notopterygii, Myrrha and Olibanum, Radix Paeoniae Rubra and phlegmona, Branch Willow and phlegmona.
Radix Aconiti Lateralis Preparata was most frequently compounded with Ampelopsis Japonica Makino in the prescriptions of Aconite concerted with Ampelopsis Japonica Makino, and that main drug classes included tonic drugs, interior-warming drugs, heat-clearing drugs and drugs for promoting blood circulation and removing blood stasis. Frequently-used drugs included Cortex Cinnamomi, Radix Angelicae Sinensis, Rhizoma Ligustici Chuanxiong, Radix Saposhnikoviae, Radix Glycyrrhizae, Herba Asari and Radix Angelicae Dahuricae. Main pathogenesis was Yang deficiency, toxin stagnation and blood stasis. The prescriptions were mainly applied to treat surgical diseases and limb-meridian diseases. The former mainly included sores, traumatic injuries, carbuncles and deep-rooted carbuncles in symptom, the latter primarily included arthralgia and limb numbness. There were relatively close association relationships in Radix Angelicae Dahuricae and Radix Aucklandiae, Rhizoma Ligustici Chuanxiong and Radix Angelicae Sinensis, carbuncle and deep-rooted carbuncle, Radix Angelicae Sinensis and traumatic injuries, Rhizoma Ligustici Chuanxiong and traumatic injuries.
Main drug classes in the prescriptions of Radix Aconiti compounded with Ampelopsis Japonica Makino included heat-clearing drugs, antirheumatic drugs and drugs for promoting blood circulation and removing blood stasis, and that frequently-used drugs included Radix Angelicae Sinensis, Radix Angelicae Dahuricae, Rhizoma Bletillae, Cortex Cinnamomi and Myrrha. Main pathogenesis was pathogenic wind, cold, dampness, toxin stagnation and blood stasis. The prescriptions were mainly applied to treat surgical diseases and limb-meridian diseases. The former mainly included sores, traumatic injuries and phlegmona, the latter primarily included arthralgia and spasm of limbs. There were relatively close association relationships in Myrrha and Olibanum, Radix Aconiti Kusnezoffii and Radix et Rhizoma Rhei, sores and phlegmona, carbuncles and deep-rooted carbuncles, Radix Achyranthis Bidentatae and arthralgia, Radix et Rhizoma Rhei and sores. Compounding rules of Radix Aconiti Kusnezoffii concerted with Ampelopsis Japonica Makino were similar to those of Aconitine (exclusive of Radix Aconiti Lateralis Preparata) concerted with Ampelopsis Japonica Makino.
Radix Aconiti Lateralis Preparata was usually compounded with Rhizoma Bletillae in the prescriptions of Aconite conbined with Rhizoma Bletillae, and that main drug classes included interior-warming drugs, drugs for promoting blood circulation and removing blood stasis, heat-clearing drugs and tonic drugs. Frequently-used drugs included Radix Angelicae Sinensis, Cortex Cinnamomi, Radix Angelicae Dahuricae, Ampelopsis Japonica Makino and Rhizoma Ligustici Chuanxiong. Main pathogenesis was Yang deficiency, toxin stagnation and blood stasis. The prescriptions were mainly applied to surgical diseases, and that common symptoms included sores, traumatic injuries, deep-rooted carbuncles, carbuncles and carbuncles in shoulder and back. There were relatively close association relationships in Radix Angelicae Sinensis and Cortex Cinnamomi, Radix Angelicae Dahuricae and Radix Angelicae Sinensis, deep-rooted carbuncles and carbuncles, carbuncles in shoulder and back and deep-rooted carbuncles, Radix Astragali seu Hedysari and carbuncles, Radix Saposhnikoviae and sores. Main drug classes in the prescriptions of Radix Aconiti compounded with Rhizoma Bletillae included antirheumatic drugs, heat-clearing drugs, drugs for promoting blood circulation and removing blood stasis and superficies-resolving drugs, and that frequently-used drugs included Radix Aconiti Kusnezoffii, Radix Angelicae Sinensis, Ampelopsis Japonica Makino, Radix Angelicae Dahuricae, Radix et Rhizoma Rhei and Myrrha. Major pathogenesis was pathogenic wind, cold, dampness, toxin stagnation and blood stasis, and that the prescriptions were primarily applied to treat surgical diseases. Common symptoms included phlegmona, traumatic injuries, carbuncles and deep-rooted carbuncles. There were close association relationships in Olibanum and Myrrha, cough and asthma, deep-rooted carbuncles and carbuncles, Radix Saposhnikoviae and sores, Squama Manis and sores. Compounding rules of Radix Aconiti Kusnezoffii concerted with Rhizoma Bletillae were similar to those of Aconitine (exclusive of Radix Aconiti Lateralis Preparata) cocerted with Rhizoma Bletillae.
The second part was mainly application status and analysis of eighteen clashes in grassroots hospitals. We collected78238prescriptions from nine health clinics in towns and townships as well as Chinese Medicine Hospital of Wei-Chang County in He-Bei Province in the last3years. There were255prescriptions touching on eighteen clashes, and there were198prescriptions of Aconite in combination with Pinellia, Snakegourd Fruit, Fritillary, Ampelopsis Japonica Makino or Rhizoma Bletillae. The same research methods as the first part were used to analyze the compounding rules. The findings were shown as follows.
1. The ratio of prescriptions of Aconite in combination with Pinellia, Snakegourd Fruit, Fritillary, Ampelopsis Japonica Makino or Rhizoma Bletillae had the highest application frequency, and reached77.65%in all prescriptions toughing on eighteen clashes. Radix Aconiti Lateralis Preparata had the higher application frequency than Radix Aconiti and Radix Aconiti Kusnezoffii. Radix Aconiti Lateralis Preparata was more frequently compounded with Pinellia of all incompatibilities of drugs in a prescription. The prescriptions with eighteen clashes were generally applied for common diseases and frequently-occurring diseases. The amount of prescriptions with eighteen clashes was in proportion to the ages of doctors.
2. Main drug classes in the prescriptions of Radix Aconiti Lateralis Preparata compounded with Pinellia was Qi-tonifying drugs, and that frequently-used drugs included Poria, Radix Glycyrrhizae, Rhizoma Atractylodis Macrocephalae, Radix Salviae Miltiorrhizae, Radix Astragali seu Hedysari and Pericarpium Citri Reticulatae. The prescriptions were commonly used for heart diseases, lung diseases, spleen-stomach diseases and kidney diseases. Main symptoms included fear of cold, palpitation, vomiting, epigastric oppression and edema. The were relatively close association relationships in Rhizoma Atractylodis Macrocephalae and Poria, Radix Salviae Miltiorrhizae and Radix Astragali seu Hedysari, Fructus Corni and soreness of loins, Radix Rehmanniae Preparata and soreness of loins. Drug class in the prescriptions of Radix Aconiti and Radix Aconiti Kusnezoffii in combination with Pinellia was antirheumatic drugs, and that frequently-used drugs included Radix Glycyrrhizae, Lumbricus, Radix Astragali seu Hedysari, Rhizoma Ligustici Chuanxiong and Rhizoma Gastrodiae. Main pathogenesis was affected by exterior wind, cold and dampness. There were close association relationships in Lumbricus and Radix Glycyrrhizae, Radix Glycyrrhizae and Radix Astragali seu Hedysari, Radix Glycyrrhizae and fear of cold, Cortex Eucommiae and arthralgia.
Main drug classes in the prescriptions of Radix Aconiti Lateralis Preparata compounded with Snakegourd Fruit was Qi-tonifying drugs, and that frequently-used drugs were Radix Salviae Miltiorrhizae, Radix Astragali seu Hedysari, Ramulus Cinnamomi, Radix Glycyrrhizae, Rhizoma Ligustici Chuanxiong and Poria. Main pathogenesis was Yang deficiency, coagulated cold and phlegmatic blockage. The prescriptions were commonly used for heart diseases and spleen-stomach diseases. Main symptoms included palpitation, chest pain, oppression in chest, hiccough and epigastric oppression. There were close association relationships in Rhizoma Ligustici Chuanxiong and Radix Curcumae, Radix Salviae Miltiorrhizae and Semen Ziziphi Spinosae, Radix Salviae Miltiorrhizae and palpitation, Rhizoma Ligustici Chuanxiong and palpitation.
Main drug classes in the prescriptions of Radix Aconiti Lateralis Preparata compounded with Bulbus Fritillariae Cirrhosae was phlegm-resolving drugs, and that frequently-used drugs included Poria, Radix Astragali seu Hedysari, Rhizoma Atractylodis Macrocephalae, Radix Paeoniae Alba and Radix Glycyrrhizae. Main pathogenesis was Yang deficiency of heart and kidney, and fluid retention. The prescriptions were commonly used for lung diseases and heart diseases. Main symptoms included cough, palpitation and edema. There were relatively close association relationships in Radix Paeoniae Alba and Poria, Radix Salviae Miltiorrhizae and Poria, Carapax Trionycis and mass in abdomen, Pseudobulbus Cremastrae seu Pleiones and mass in abdomen. Main drug classes in the prescriptions of Radix Aconiti Lateralis Preparata compounded with Bulbus Fritillariae Thunbergii was Qi-tonifying drugs, and that frequently-used drugs were Radix Paeoniae Alba, Rhizoma Corydalis, Radix Glycyrrhizae, Rhizoma Atractylodis Macrocephalae and baked ginger. Main pathogenesis was Yang deficiency of spleen and kidney. The prescriptions were commonly used for spleen-stomach diseases and lung diseases. Main symptoms included stomachache, hiccough, epigastric oppression and cough. There were relatively close association relationships in Radix Paeoniae Alba and Radix Glycyrrhizae, Radix Paeoniae Alba and Rhizoma Corydalis, inula flower and hiccough, ruddle and hiccough. Main drug class in the prescriptions of Bulbus Fritillariae Cirrhosae in combination with Bulbus Fritillariae Thunbergii was antirheumatic drugs, and main drugs included Radix Achyranthis Bidentatae, Radix Aconiti Kusnezoffii, Olibanum and Myrrha. Major pathogenesis was that pathogenic wind, cold, dampness, phlegm and blood stasis blocked meridians. The prescriptions were primarily used for limb-meridian diseases, and that common symptoms included arthralgia and lumbago. There were relatively close association relationships in Olibanum and Myrrha, Myrrha and Radix Achyranthis Bidentatae, Rhizoma Cibotii and lumbago, Radix Rehmanniae Preparata and lumbago. There were no markedly difference in compounding rules when Bulbus Fritillariae Thunbergii was in combination with Radix Aconiti or Radix Aconiti Kusnezoffii.
Main drug class in the prescriptions of Radix Aconiti Lateralis Preparata compounded with Rhizoma Bletillae was Qi-regulating drugs, and that frequently-used drugs included Pericarpium Citri Reticulatae, Fructus Meliae Toosendan, Rhizoma Curcumae Longae, Fructus Amomi Villosi, Rhizoma Atractylodis Macrocephalae and Radix Glycyrrhizae. Main pathogenesis was Yang deficiency of spleen and kidney, and that the prescriptions were commonly used for spleen-stomach diseases. Main symptoms included fear of cold, abdominal distention, bellyache and epigastric oppression. There were relatively close association relationships in Pericarpium Citri Reticulatae and Rhizoma Curcumae Longae, Pericarpium Citri Reticulatae and Fructus Meliae Toosendan, Semen Litchi and bellyache, Semen Raphani and bellyache.
Main drug classes in the prescriptions of Sargassum in combination with Radix Glycyrrhizae were tonic drugs, phlegm-resolving drugs and heat-clearing drugs, and that frequently-used drugs included Bulbus Fritillariae Thunbergii, Radix Bupleuri, Concha Ostreae, Thallus Eckloniae and Radix Scrophulariae. Main pathogenesis was intermingled phlegm and blood stasis and stagnation of Qi. The prescriptions were primarily applied for Qi-blood-fluid diseases, and that common symptoms included abdominal mass, distending pain of breasts during menstruation, scrofula and hypochondriac pain. There were close association relationships in Concha Ostreae and Bulbus Fritillariae Thunbergii, Bulbus Fritillariae Thunbergii and Radix Bupleuri, Radix Scrophulariae and distending pain of breasts during menstruation, Radix Scrophulariae and abdominal mass.
引文
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