基于仲景血证学术思想的消化道出血经方方证文献研究
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摘要
仲景先师《伤寒杂病论》为后世创立了六经辨证的中医辨证理论体系,以六经来诠释临床疾病发展过程。本研究以仲景创立的六经辨证体系分析探讨仲景血证论治思路,相信更能接近仲景血证本意,体现仲景血证精髓。消化道出血属于中医学血证证治范畴,仲景吐血、便血两疾病的论治大致体现了仲景消化道出血的学术思想,形成了现代中医临床消化道出血证治的重要组成内容,不愧为指导消化道出血辨证施治的古今规矩之准绳。
基于仲景血证学术思想认识,消化道出血仲景论治思路探讨的基础上,本研究以仲景泻心汤、黄土汤两经方方证作为代表展开消化道出血仲景经方方证研究。
在消化道出血的仲景经方方证临床诊断研究中,经过频数分析结合中医药专业知识,我们得出了泻心汤、黄土汤两方证症状体征、舌质、舌苔、脉象从高到低的出现频次情况。针对其中部分症状体征数据差别较大,参考卡方检验结果结合专业比较分析认为,两方证一寒一热,一补一泻,是本质不同的两个方证,原因属于方证特征性症候差异因素。出血鲜红、出血暗红、呕吐、腹痛、头晕、纳呆6种共同症状参考卡方检验结果结合专业我们认为是消化道出血疾病诊断必见症和可见症,可参考作为消化道出血临床诊断标准。在吐血、便血两疾病的比较分析中我们发现,出血鲜红、呕吐和口苦多和吐血关系密切,原因和胃腑有关；出血暗红、腹痛、纳呆、目赤和便血密切关系,原因和肠道关联。通过因子分析我们得出泻心汤方证和黄土汤方证症状构成均分为四类。
在消化道出血的仲景经方方证药物研究中,我们统计出泻心汤、黄土汤二方证原方涉及药物9种,配伍药物有34种,卡方检验后有25味药物未见明显差异,9种药物具有显著或极显著差异,认为主要是二方证特征性配伍药物原因。对43种药物分类分析发现,止血类药物最多有22种,其次清热药和补虚药均为6种。还有解表药3种,收涩药2种,泻下药、温里药、理气药、活血化瘀药各1种。分析43种中药归经情况,结果发现五脏六腑均有出现,出现频次共112次,以五脏为主共80次,占71.43%,肝脏最高,占26.79%,胃腑占11.61%。
血证仲景经方古今用药比较发现,仲景古方38首,用药76种,具有理血功能中药28种,占36.84%。现今中医临床经方用药,泻心汤、黄土汤二方证原方药物9种,配伍药物34种,共43种,具有理血功能中药26种,占60.47%。其中仲景古方止血功用药物4味,现今经方临床止血作用药物22味,其它理血药仅4味,仲景古方则大多明确具有活血化瘀作用。还有仲景古方最多配伍补虚药,有10种,现今经方临床配伍补虚药仅6种,可以看出仲景古方配伍药物种类大大超出了现今临床范围。中医药发展,由于古今对疾病生理病理认识及使用药物种类的变化,用药规律正发生着深刻的变革,值得进一步深化研究。
The theory of typhoid miscellaneous diseases of zhang zhongjing created TCM (Traditional Chinese Medicine) dialectical system of syndrome differentiation of the six meridians for posterity to explain the process of clinical disease development.The study analyzes and discusses zhongjing's thought on diagnosing and treating hemorrhagic syndrome with the system of six-channel differentiation. We believe it is closer to original intention and essence of hemorrhagic syndrome.Gastrointestinal bleeding belongs to the category of hemorrhagic syndrome of traditional Chinese medicine. zhongjing's hematemesis and hemafecia two disease differentiation roughly reflected his academic thoughts of gastrointestinal bleeding,which formed an important content of the modern TCM clinical digestive tract hemorrhage cure,and deserves should be the guidance rules of gastrointestinal bleeding of ancient and modern.
On the basis of understanding zhongjing's academic thoughts on hemorrhagic syndrome and discussing zhongjing's differentiation ideas on gastrointestinal bleeding,this study begins to research the correspondence between prescription and symptom of zhongjing's jingfang about gastrointestinal bleeding with xiexin decoction and huangtu decoction as representative.
Through frequency analysis,combined with professional knowledge of Chinese medicine,we obtained the frequency of occurrence from high to low of symptoms,signs,tongue body,tongue coating,pulse condition in xiexin decoction's and huangtu decoction's Fangzheng-corresponding.There is a relatively large data gap between Some symptoms and signs,referring to the result of chi-square test and professional comparative analysis,we think that the characteristic syndrome difference factors can interpret the phenomenon,because in the2decoctions one is cold and tonic.the other is hot and catharsisal Referring to the result of chi-square test and professional knowledge,we regard6kinds of common symptoms,which is bright red bleeding,dark red bleeding,vomiting,abdominal pain, dizziness and anorexia,as essential elements for diagnosing gastrointestinal bleeding. They can be the reference for clinical diagnostic criteria of gastrointestinal bleeding. Comparing hematemesis disease with hemafecia disease,we found that bright red bleeding,vomiting and bitter taste are more closely related to hematemesis disease,which is related with stomach; dark red bleeding, abdominal pain,anorexia and hot eyes have close relation with hemafecia disease,which associated with intestinal.Through factor analysis,we concluded that xiexin decoction fangzheng and huangtu decoction fangzheng's symptoms are divided into four categories.
In the research of all the drugs in the digestive tract hemorrhage of zhongjing's jingfang,we identified in the xiexin decoction fangzheng and huangtu decoction fangzheng,their original prescriptions have9kinds of drugs,and there are34kinds of compatibility of medicines.After chi-square we found that the25kinds of drugs have not obvious difference,and there are9kinds of drugs having significant or extremely significant difference.we think the main reason attributes to the characteristic compatibility of medicines in the two prescriptions.By analyzing the43kinds of drugs classification,we found that hemostatic drugs reach up to22kinds,heat clearing drugs and tonic drugs have6kinds respectively,diaphoretic drugs have3kinds,astringent drugs have2kinds,beyond that,there are respectively1kind of cathartic drug,warm drug,qi medicine and drugs for promoting blood circulation and removing blood stasis.After analyzing the43kinds of drugs'condition which meridians they get to,we found that they can reach internal organs of the body. The total occurrence frequency is112times.Give priority to five zang-organs,they occur80times,accounted for71.43%,in which liver is highest,accounted for26.79%,and stomach inner parts accounted for11.61%.
By comparing the ancient and modern medicine in the zhongjing's jingfang treating hemorrhagic disease,we found that zhongjing's gu fang have38prescriptions,in which the drugs are76kinds,with28kinds of drugs having hemostatic function, accounting for36.84%. Nowadays in Chinese medicine clinical,the original prescriptions of xiexin decoction fangzheng and huangtu decoction fangzheng have9kinds of drugs,and there are34kinds of compatibility of medicines,In other words,it is a total of43kinds of drugs,with26kinds of Chinese medicine having blood management functions (60.47%).There are4drugs having hemostatic function in zhongjing's gu fang.In present jingfang the same function drugs are22kinds,other blood management medicine only4kinds. Zhongjing's gu fang is mostly clear with promoting blood circulation to remove blood stasis.There are10kinds of tonic drugs in zhongjing's gu fang,today only6kinds.It can be seen that the variety of Chinese medicine in Zhongjing's gu fang make rings round the scope of current clinical medicines.With the development of traditional Chinese medicine, and the variations of ancient and modern understanding of disease physiological and pathology and the variety of Chinese medicine,the law using medicine is undergoing profound changes,and it deserves to be further studied.
基于仲景血证学术思想认识,消化道出血仲景论治思路探讨的基础上,本研究以仲景泻心汤、黄土汤两经方方证作为代表展开消化道出血仲景经方方证研究。
在消化道出血的仲景经方方证临床诊断研究中,经过频数分析结合中医药专业知识,我们得出了泻心汤、黄土汤两方证症状体征、舌质、舌苔、脉象从高到低的出现频次情况。针对其中部分症状体征数据差别较大,参考卡方检验结果结合专业比较分析认为,两方证一寒一热,一补一泻,是本质不同的两个方证,原因属于方证特征性症候差异因素。出血鲜红、出血暗红、呕吐、腹痛、头晕、纳呆6种共同症状参考卡方检验结果结合专业我们认为是消化道出血疾病诊断必见症和可见症,可参考作为消化道出血临床诊断标准。在吐血、便血两疾病的比较分析中我们发现,出血鲜红、呕吐和口苦多和吐血关系密切,原因和胃腑有关；出血暗红、腹痛、纳呆、目赤和便血密切关系,原因和肠道关联。通过因子分析我们得出泻心汤方证和黄土汤方证症状构成均分为四类。
在消化道出血的仲景经方方证药物研究中,我们统计出泻心汤、黄土汤二方证原方涉及药物9种,配伍药物有34种,卡方检验后有25味药物未见明显差异,9种药物具有显著或极显著差异,认为主要是二方证特征性配伍药物原因。对43种药物分类分析发现,止血类药物最多有22种,其次清热药和补虚药均为6种。还有解表药3种,收涩药2种,泻下药、温里药、理气药、活血化瘀药各1种。分析43种中药归经情况,结果发现五脏六腑均有出现,出现频次共112次,以五脏为主共80次,占71.43%,肝脏最高,占26.79%,胃腑占11.61%。
血证仲景经方古今用药比较发现,仲景古方38首,用药76种,具有理血功能中药28种,占36.84%。现今中医临床经方用药,泻心汤、黄土汤二方证原方药物9种,配伍药物34种,共43种,具有理血功能中药26种,占60.47%。其中仲景古方止血功用药物4味,现今经方临床止血作用药物22味,其它理血药仅4味,仲景古方则大多明确具有活血化瘀作用。还有仲景古方最多配伍补虚药,有10种,现今经方临床配伍补虚药仅6种,可以看出仲景古方配伍药物种类大大超出了现今临床范围。中医药发展,由于古今对疾病生理病理认识及使用药物种类的变化,用药规律正发生着深刻的变革,值得进一步深化研究。
The theory of typhoid miscellaneous diseases of zhang zhongjing created TCM (Traditional Chinese Medicine) dialectical system of syndrome differentiation of the six meridians for posterity to explain the process of clinical disease development.The study analyzes and discusses zhongjing's thought on diagnosing and treating hemorrhagic syndrome with the system of six-channel differentiation. We believe it is closer to original intention and essence of hemorrhagic syndrome.Gastrointestinal bleeding belongs to the category of hemorrhagic syndrome of traditional Chinese medicine. zhongjing's hematemesis and hemafecia two disease differentiation roughly reflected his academic thoughts of gastrointestinal bleeding,which formed an important content of the modern TCM clinical digestive tract hemorrhage cure,and deserves should be the guidance rules of gastrointestinal bleeding of ancient and modern.
On the basis of understanding zhongjing's academic thoughts on hemorrhagic syndrome and discussing zhongjing's differentiation ideas on gastrointestinal bleeding,this study begins to research the correspondence between prescription and symptom of zhongjing's jingfang about gastrointestinal bleeding with xiexin decoction and huangtu decoction as representative.
Through frequency analysis,combined with professional knowledge of Chinese medicine,we obtained the frequency of occurrence from high to low of symptoms,signs,tongue body,tongue coating,pulse condition in xiexin decoction's and huangtu decoction's Fangzheng-corresponding.There is a relatively large data gap between Some symptoms and signs,referring to the result of chi-square test and professional comparative analysis,we think that the characteristic syndrome difference factors can interpret the phenomenon,because in the2decoctions one is cold and tonic.the other is hot and catharsisal Referring to the result of chi-square test and professional knowledge,we regard6kinds of common symptoms,which is bright red bleeding,dark red bleeding,vomiting,abdominal pain, dizziness and anorexia,as essential elements for diagnosing gastrointestinal bleeding. They can be the reference for clinical diagnostic criteria of gastrointestinal bleeding. Comparing hematemesis disease with hemafecia disease,we found that bright red bleeding,vomiting and bitter taste are more closely related to hematemesis disease,which is related with stomach; dark red bleeding, abdominal pain,anorexia and hot eyes have close relation with hemafecia disease,which associated with intestinal.Through factor analysis,we concluded that xiexin decoction fangzheng and huangtu decoction fangzheng's symptoms are divided into four categories.
In the research of all the drugs in the digestive tract hemorrhage of zhongjing's jingfang,we identified in the xiexin decoction fangzheng and huangtu decoction fangzheng,their original prescriptions have9kinds of drugs,and there are34kinds of compatibility of medicines.After chi-square we found that the25kinds of drugs have not obvious difference,and there are9kinds of drugs having significant or extremely significant difference.we think the main reason attributes to the characteristic compatibility of medicines in the two prescriptions.By analyzing the43kinds of drugs classification,we found that hemostatic drugs reach up to22kinds,heat clearing drugs and tonic drugs have6kinds respectively,diaphoretic drugs have3kinds,astringent drugs have2kinds,beyond that,there are respectively1kind of cathartic drug,warm drug,qi medicine and drugs for promoting blood circulation and removing blood stasis.After analyzing the43kinds of drugs'condition which meridians they get to,we found that they can reach internal organs of the body. The total occurrence frequency is112times.Give priority to five zang-organs,they occur80times,accounted for71.43%,in which liver is highest,accounted for26.79%,and stomach inner parts accounted for11.61%.
By comparing the ancient and modern medicine in the zhongjing's jingfang treating hemorrhagic disease,we found that zhongjing's gu fang have38prescriptions,in which the drugs are76kinds,with28kinds of drugs having hemostatic function, accounting for36.84%. Nowadays in Chinese medicine clinical,the original prescriptions of xiexin decoction fangzheng and huangtu decoction fangzheng have9kinds of drugs,and there are34kinds of compatibility of medicines,In other words,it is a total of43kinds of drugs,with26kinds of Chinese medicine having blood management functions (60.47%).There are4drugs having hemostatic function in zhongjing's gu fang.In present jingfang the same function drugs are22kinds,other blood management medicine only4kinds. Zhongjing's gu fang is mostly clear with promoting blood circulation to remove blood stasis.There are10kinds of tonic drugs in zhongjing's gu fang,today only6kinds.It can be seen that the variety of Chinese medicine in Zhongjing's gu fang make rings round the scope of current clinical medicines.With the development of traditional Chinese medicine, and the variations of ancient and modern understanding of disease physiological and pathology and the variety of Chinese medicine,the law using medicine is undergoing profound changes,and it deserves to be further studied.
引文
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[3]陈荣馨.仲景论治瘀血证的文献研究.北京中医药大学硕士研究生论文,2011.33-45.
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[5]Renzulli P,Candinas D,Seiler CA. Acute" ifficult" gastrointesti nal bleeding. Then Umsch,2006,63 (5):311-319.
[6]徐少华,汪祖春,李燕.消化道出血病因及误诊原因分析[J].湖南中医药大学学报,2012.4(32)：47-48.
[7]Raju GS, Gerson L, Das A, et al. American Gastroenterological Association(ACA)Institute medical position statement on obscure gastrointestinal bleeding. Gastroenterolog,2007,133(5):1694-1696.
[8]Boonpongmanee S, Fleiseher DE, Collier K, et al. GastrointestEndosc。2001：53(11)：AB213
[9]Cappell MS, Friedel D. Initial management of acute upper gastrointestinal bleeding:from initial evaluation up to gastrointestinal endoscopy[J]. MedClinNAm,2010,72(31):495-512.
[10]WalshDC, Prakash C, Levin M, et al. Gastrointest Endosc,2001; 53(11):AB205
[11]Lai KC, Lam SK, Chu KM, et al. Gastroenterology,2001; 120(Suppl 1):AB104
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