《名医类案》与《续名医类案》泄泻案的用药、组方及证治特点研究
|
摘要
目的：泄泻,为临床多发病、常见病之一。针对该病发生及诊疗的研究,对于提高人民生活质量,促进人民身心健康等方面,均有实用价值与积极意义。而《名医类案》与《续名医类案》为中医医案之杰出代表,开“以证类案”之肇端。其内之泄泻医案,沉淀着中医理、法、方、药之精华,从这些散在的、庞杂的、宝贵的经验与方药中,寻找出泄泻之辨证、立法、遣方、用药等规律,具有重要的临床指导意义和应用价值。
方法：整理、研究《名医类案》与《续名医类案》中有关泄泻的医案,利用统计分析及分类、比较等研究方法,梳理、分析、探讨泄泻之辨证、立法、遣方、用药等规律。
结果：
《名医类案》收录泄泻医案43则,《续名医类案》收录一般泄泻医案68则,妇科妊娠泄泻医案6则、妇科产后泄泻医案6则,儿科泄泻医案18则、儿科痘疮泄泻医案31则,合计172则医案。此中可用于统计之内科治疗的有效医案共计148则。有明确医家的医案132则。
两部《名医类案》中所记载之治疗泄泻方剂共计91首,共计使用频次为177次。使用次数较多的方剂依次是：六君子汤、补中益气汤、四君子汤、参苓白术散、八味丸、四神丸、异功散、五苓散、无忧散、木香散。
两部《名医类案》中所记载的治疗泄泻的药物共计177味,使用频次为1535次。其中白术(114次)、甘草(107次)、人参(95次)、茯苓(85次)、陈皮(71次)、白芍(45次)、当归(42次)、黄连(41次)、木香(35次)、肉豆蔻(33次)、泽泻(30次)、黄芪(29次)、半夏(28次)、升麻(27次)、柴胡(24次)15味药使用频率最高。
结论：
一、通过内服方剂的统计发现：治疗泄泻以健脾、益气、祛湿、补肾等类功效方剂为主。
二、通过对药物统计发现：治疗泄泻主要以补益、祛湿、升清、柔肝、理气、清热、收涩等类药物为主。
三、从病名探讨入手,以病名学角度认识泄泻,为厘清其与相关病证提供了依据,对泄泻病名的标准化认识提供了借鉴,为其分类治疗提供了参考。
四、《名医类案》、《续名医类案》之泄泻案体现了众多医家不同的泄泻治法,本文以文献分析为基础,全面总结和分析了所涉医家对泄泻病证的认识、诊疗及用药特点等。全文对诸医家学术思想提要钩玄,指出其发展之处,对于临床泄泻病证之治疗具有一定指导价值。
五、《名医类案》泄泻案对《医宗必读》之“治泻九法”影响深远,李中梓总结之“治泻九法”颇受《名医类案》泄泻案之启迪。
六、《名医类案》、《续名医类案》泄泻案对临床诊疗泄泻有多种启示与贡献：1、提升学术理论,培养临证思维；2、集百家经验于一处,易于较析,知常达变；3、充实脉症之学,为泄泻诊疗拓增信息；4、改进泄泻治法,丰富临床手段；5、革新方药理论,扩展临证及科研思路；6、以前车之鉴启示后学,以识病演进之过程昭示后学。
Objective:Diarrhea, one of the common clinical frequently-occurring diseases. Study based on the occurrence and treatment of this disease has practical value and significance in improving the quality of people's life, and promoting people's physical and mental health. The Cases of "Well-know Physicians" and "Continued Cases of Well-know Physicians", as the outstanding representative of Chinese medicine cases, were the "beginning of classifying cases by syndromes", in which the case of diarrhea was the essence of Chinese medicine theory, prescription, therapy, and Chinese herbs, from the scattered, complex, valuable experience and medicine prescriptions, to find out the law of the syndrome differentiation of diarrhea, its treating method, prescription, and herbs selection, and it has important clinical significance and application value.
Methods:Classifying and studying the cases related to diarrhea, in "Cases of Well-know Physicians" and "Continued Cases of Well-know Physicians", by using methods of statistical analysis and classification, comparison, analysis, sorting the law of the syndrome differentiation of diarrhea, its treating method, prescription, and herbs selection.
Results:The "Cases of Well-know Physicians" included43diarrhea cases, and the "Continued Cases of Well-know Physicians" included68general diarrhea cases,6gynecological pregnancy diarrhea,6gynecologic postpartum diarrhea cases and pediatric cases,18cases of pediatric diarrhea,31smallpox, with a total of172cases. This can be used for effective medical statistics, with a total of148, Department of internal medicine treatment. Have a clear medical record of132.
The cases of the two "Well-know Physicians" in the treatment of diarrhea totaled91, with a total of177times using frequency. The frequency of prescription used ranked as follows:Liujunzi Decoction, Buzhongyiqi Decoction, Sijunzi Decoction, Shen ling Baizhu Powder, Bawei Pill, Si shen Pill, Yigong San, Wuling Powder, Wuyou Powder, Muxiang Powder.
Diarrhea treatment herbs recorded in the two "Cases of Well-know Physicians" amounted to a total of177, and the using frequency is1535times. The white atractylodes (114times), licorice (107times), ginseng(95times), Poria (85times), dried tangerine peel (71times), Radix Paeoniae Alba(45times), Radix Angelicae Sinensis (42times), Rhizoma Coptidis (41times), Radix Aucklandiae (35times), nutmeg (33times), Alisma orientale (30times), Huangqi (29times), Pinellia ternata (28times), Cimicifuga (27times), bupleurum (24times),these15herbs were used with the highest frequency.
Conclusions:
Firstly, through the statistics of orally taken prescriptions, the following findings were discovered:the treatment of diarrhea with prescription for tonifying spleen, benefiting Qi, dispelling dampness, and nourishing kidney.
Secondly, through the statistics of herbs, the following findings were discovered:main herbs for treatment of diarrhea are replenishing, dispelling dampness, ascending clear, softening liver, regulating vital energy, clearing heat, astringent drugs.
Thirdly, from the names of the diseases, understanding from the perspective of the names diarrhea disease, to clarify and provide basis for related diseases, to provide a reference of standardization of the diarrhea disease names, and to provide reference for its classified treatment.
Fourthly, the diarrhea cases in "Cases of Well-know Physicians" and "Continued Cases of Well-know Physicians" displayed the various therapies adopted by different physicians for treating diarrhea. This thesis is based on the literature analysis, to summarize and analyze the diagnosis, medication characteristics and the medicine for diarrhea. The thesis searched into an abstruse subject and indicated the importance of the academic thoughts of different schools, with the aim to illustrate that their development had certain guiding value for the clinical treatment of diarrhea.
Fifthly, Diarrhea cases in the "Cases of Well-know Physicians" had far-reaching influence on the case of the "Nine Methods of Treating Diarrhea". The "Nine Methods of Treating Diarrhea" summed up by Li Zhongzi was greatly enlightened by the diarrhea cases in the "Cases of Well-know Physicians".
Sixthly, the diarrhea cases in "Cases of Well-know Physicians" and "Continued Cases of Well-know Physicians" have a variety of implications and contributions to clinical diagnosis and treatment of diarrhea:1, improving the academic theory, cultivating clinical thoughts;2, gathering experience from all schools, making it easier for more analysis and comparison, knowing the ordinary and being flexible;3, enriching the pulse syndromes, supplementing new information of diarrhea diagnosis and treatment;4, improving diarrhea treatment, enriching clinical means;5, reforming medicine theory, extending clinical and scientific ideas;6, providing future enlightenments, implying continuous study through evolution knowledge of the disease.
方法：整理、研究《名医类案》与《续名医类案》中有关泄泻的医案,利用统计分析及分类、比较等研究方法,梳理、分析、探讨泄泻之辨证、立法、遣方、用药等规律。
结果：
《名医类案》收录泄泻医案43则,《续名医类案》收录一般泄泻医案68则,妇科妊娠泄泻医案6则、妇科产后泄泻医案6则,儿科泄泻医案18则、儿科痘疮泄泻医案31则,合计172则医案。此中可用于统计之内科治疗的有效医案共计148则。有明确医家的医案132则。
两部《名医类案》中所记载之治疗泄泻方剂共计91首,共计使用频次为177次。使用次数较多的方剂依次是：六君子汤、补中益气汤、四君子汤、参苓白术散、八味丸、四神丸、异功散、五苓散、无忧散、木香散。
两部《名医类案》中所记载的治疗泄泻的药物共计177味,使用频次为1535次。其中白术(114次)、甘草(107次)、人参(95次)、茯苓(85次)、陈皮(71次)、白芍(45次)、当归(42次)、黄连(41次)、木香(35次)、肉豆蔻(33次)、泽泻(30次)、黄芪(29次)、半夏(28次)、升麻(27次)、柴胡(24次)15味药使用频率最高。
结论：
一、通过内服方剂的统计发现：治疗泄泻以健脾、益气、祛湿、补肾等类功效方剂为主。
二、通过对药物统计发现：治疗泄泻主要以补益、祛湿、升清、柔肝、理气、清热、收涩等类药物为主。
三、从病名探讨入手,以病名学角度认识泄泻,为厘清其与相关病证提供了依据,对泄泻病名的标准化认识提供了借鉴,为其分类治疗提供了参考。
四、《名医类案》、《续名医类案》之泄泻案体现了众多医家不同的泄泻治法,本文以文献分析为基础,全面总结和分析了所涉医家对泄泻病证的认识、诊疗及用药特点等。全文对诸医家学术思想提要钩玄,指出其发展之处,对于临床泄泻病证之治疗具有一定指导价值。
五、《名医类案》泄泻案对《医宗必读》之“治泻九法”影响深远,李中梓总结之“治泻九法”颇受《名医类案》泄泻案之启迪。
六、《名医类案》、《续名医类案》泄泻案对临床诊疗泄泻有多种启示与贡献：1、提升学术理论,培养临证思维；2、集百家经验于一处,易于较析,知常达变；3、充实脉症之学,为泄泻诊疗拓增信息；4、改进泄泻治法,丰富临床手段；5、革新方药理论,扩展临证及科研思路；6、以前车之鉴启示后学,以识病演进之过程昭示后学。
Objective:Diarrhea, one of the common clinical frequently-occurring diseases. Study based on the occurrence and treatment of this disease has practical value and significance in improving the quality of people's life, and promoting people's physical and mental health. The Cases of "Well-know Physicians" and "Continued Cases of Well-know Physicians", as the outstanding representative of Chinese medicine cases, were the "beginning of classifying cases by syndromes", in which the case of diarrhea was the essence of Chinese medicine theory, prescription, therapy, and Chinese herbs, from the scattered, complex, valuable experience and medicine prescriptions, to find out the law of the syndrome differentiation of diarrhea, its treating method, prescription, and herbs selection, and it has important clinical significance and application value.
Methods:Classifying and studying the cases related to diarrhea, in "Cases of Well-know Physicians" and "Continued Cases of Well-know Physicians", by using methods of statistical analysis and classification, comparison, analysis, sorting the law of the syndrome differentiation of diarrhea, its treating method, prescription, and herbs selection.
Results:The "Cases of Well-know Physicians" included43diarrhea cases, and the "Continued Cases of Well-know Physicians" included68general diarrhea cases,6gynecological pregnancy diarrhea,6gynecologic postpartum diarrhea cases and pediatric cases,18cases of pediatric diarrhea,31smallpox, with a total of172cases. This can be used for effective medical statistics, with a total of148, Department of internal medicine treatment. Have a clear medical record of132.
The cases of the two "Well-know Physicians" in the treatment of diarrhea totaled91, with a total of177times using frequency. The frequency of prescription used ranked as follows:Liujunzi Decoction, Buzhongyiqi Decoction, Sijunzi Decoction, Shen ling Baizhu Powder, Bawei Pill, Si shen Pill, Yigong San, Wuling Powder, Wuyou Powder, Muxiang Powder.
Diarrhea treatment herbs recorded in the two "Cases of Well-know Physicians" amounted to a total of177, and the using frequency is1535times. The white atractylodes (114times), licorice (107times), ginseng(95times), Poria (85times), dried tangerine peel (71times), Radix Paeoniae Alba(45times), Radix Angelicae Sinensis (42times), Rhizoma Coptidis (41times), Radix Aucklandiae (35times), nutmeg (33times), Alisma orientale (30times), Huangqi (29times), Pinellia ternata (28times), Cimicifuga (27times), bupleurum (24times),these15herbs were used with the highest frequency.
Conclusions:
Firstly, through the statistics of orally taken prescriptions, the following findings were discovered:the treatment of diarrhea with prescription for tonifying spleen, benefiting Qi, dispelling dampness, and nourishing kidney.
Secondly, through the statistics of herbs, the following findings were discovered:main herbs for treatment of diarrhea are replenishing, dispelling dampness, ascending clear, softening liver, regulating vital energy, clearing heat, astringent drugs.
Thirdly, from the names of the diseases, understanding from the perspective of the names diarrhea disease, to clarify and provide basis for related diseases, to provide a reference of standardization of the diarrhea disease names, and to provide reference for its classified treatment.
Fourthly, the diarrhea cases in "Cases of Well-know Physicians" and "Continued Cases of Well-know Physicians" displayed the various therapies adopted by different physicians for treating diarrhea. This thesis is based on the literature analysis, to summarize and analyze the diagnosis, medication characteristics and the medicine for diarrhea. The thesis searched into an abstruse subject and indicated the importance of the academic thoughts of different schools, with the aim to illustrate that their development had certain guiding value for the clinical treatment of diarrhea.
Fifthly, Diarrhea cases in the "Cases of Well-know Physicians" had far-reaching influence on the case of the "Nine Methods of Treating Diarrhea". The "Nine Methods of Treating Diarrhea" summed up by Li Zhongzi was greatly enlightened by the diarrhea cases in the "Cases of Well-know Physicians".
Sixthly, the diarrhea cases in "Cases of Well-know Physicians" and "Continued Cases of Well-know Physicians" have a variety of implications and contributions to clinical diagnosis and treatment of diarrhea:1, improving the academic theory, cultivating clinical thoughts;2, gathering experience from all schools, making it easier for more analysis and comparison, knowing the ordinary and being flexible;3, enriching the pulse syndromes, supplementing new information of diarrhea diagnosis and treatment;4, improving diarrhea treatment, enriching clinical means;5, reforming medicine theory, extending clinical and scientific ideas;6, providing future enlightenments, implying continuous study through evolution knowledge of the disease.
引文
[1]廖湘伊.藿苓双术汤治疗小儿泄泻63例临床研究.中药材,2003,7(7)26：32
[2]黄云春.加味香连丸治疗泄泻25例.湖北中医杂志,2003,(9)25：18
[3]孙昭东.健脾燥湿法治疗慢性泄泻.中华实用中西医杂志,2003,9(16)3：25
[4]李监督.健脾止泻汤治疗慢性泄泻150例.河南中医,2005,10(25)3：34
[5]王爱蓉.理中丸加味治疗小儿泄泻50例.湖南中医杂志,2002,3(18)2：49
[6]陆美琼.自拟健脾止泻汤治疗小儿泄泻75例.中国实用乡村医生杂志,2005,12(8)： 43
[7]郭明娃,周凯.调气温肠止泻汤治疗顽固性泄泻50例.河南中医,2005,3(25)3： 46
[8]宋金凯.柴胡桂枝干姜汤加减治疗胆囊术后泄泻54例.江苏中医药,2004,(25)2： 23
[9]庞学丰.徐富业教授治疗慢性泄泻经验.湖北中医杂志.2004,(26)7：16
[10]刘美林,刘长生.藿朴饮治疗暑湿泄泻66例.中国中医药信息杂志,2003,2(10) 2：55
[11]余德钊.泻痢合剂治疗小儿泄泻40例疗效观察.新中医,2004,6(36)6：14
[12]施海优,施海婕.白拟芩愧汤治疗小儿湿热泄泻106例.广西中医药,2004,2(27) 1：12
[13]彭林,陈海泉,等.中医宏观辩证结合微观辩证治疗湿热型慢性结肠炎40例.四川中医,2005,(23)7：54
[14]王相才.温肾健脾汤治疗肾阳虚泄泻153例.吉林中医药,2004,5(5)24：25
[15]王洪歧,杨志华,等.温肾固元汤加减治疗慢性泄泻146例疗效观察.河北中医,2004,3(26)3：182
[16]刘冰华,李希斌.温阳活血法治疗小儿脾肾阳虚型泄泻100例.河北中医,2004,7(26) 7：509
[17]谷文芳,薜世昌.温阳解毒法治疗五更泄泻15例.陕西中医,2004,(25)12：1115
[18]石冬辉.温阳止泻汤治疗慢性泄泻87例临床体会.中国民族民间医药杂志,2003,(60)：27
[19]张古清.升阳汤治疗慢性泄泻.四川中医,2003(21)3：49
[20]李启允.升阳益土汤治疗慢性泄泻89例疗效观察.云南中医药杂志.2002(23)3：11
[21]冯俊志.浅议风药在慢性泄泻中的运用.四川中医.2003,(21)1：27
[22]史世军.祛风解表药治疗慢性泄泻.河南中医.2004,7(24)7：7 1
[23]丛丽,郑鸿雁.饥饿疗法在儿科脾虚泄泻中的应用.吉林中医药,2004,9(24)9： 53
[24]任子风,李华,等.安徽中医临床杂志。2003,2(15)1：50
[25]王晓燕.隔药饼灸对虚寒胃痛和脾虚泄泻患者免疫功能的影响.中国针灸与按摩,2004,11(24)11：756
[26]邓兰亭,焦英霞,等.穴位注射法治疗泄泻46例.针灸临床杂志,2004,(20)5：37
[27]杨风玲.轻刺重灸治疗慢性泄泻24例.陕西中医,2003,.(24)1：60
[28]黄映君,刁本恕.温灸合穴位贴敷法治疗脾虚泄泻证60例,2004,11(23)11：27
[29]陈丽华,袁海燕,等.穴位拔罐治疗飞行员泄泻45例疗效观察,航空军医,2004,8 (32) 4：175
[30]李春阳.推拿治疗经行泄泻96例.中国民间疗法,2005,8(13)8：21
[31]焦平,王艳君,等.推拿治疗伤食型婴幼儿泄泻60例.中国针灸与按摩,2003,4(23) 14：52
[32]苏海荣,王金爱,等.外贴内服法治疗小儿泄泻84例.吉林中医药,2005,4(25)4：32
[33]陈宏涛,陆景芳.针灸配合中药治疗婴幼儿泄泻.中国乡村医药杂志,2004,2(11)2：49
[34]董湘玉 中医心理学[M] 北京：人民卫生出版社,2007：7
[2]黄云春.加味香连丸治疗泄泻25例.湖北中医杂志,2003,(9)25：18
[3]孙昭东.健脾燥湿法治疗慢性泄泻.中华实用中西医杂志,2003,9(16)3：25
[4]李监督.健脾止泻汤治疗慢性泄泻150例.河南中医,2005,10(25)3：34
[5]王爱蓉.理中丸加味治疗小儿泄泻50例.湖南中医杂志,2002,3(18)2：49
[6]陆美琼.自拟健脾止泻汤治疗小儿泄泻75例.中国实用乡村医生杂志,2005,12(8)： 43
[7]郭明娃,周凯.调气温肠止泻汤治疗顽固性泄泻50例.河南中医,2005,3(25)3： 46
[8]宋金凯.柴胡桂枝干姜汤加减治疗胆囊术后泄泻54例.江苏中医药,2004,(25)2： 23
[9]庞学丰.徐富业教授治疗慢性泄泻经验.湖北中医杂志.2004,(26)7：16
[10]刘美林,刘长生.藿朴饮治疗暑湿泄泻66例.中国中医药信息杂志,2003,2(10) 2：55
[11]余德钊.泻痢合剂治疗小儿泄泻40例疗效观察.新中医,2004,6(36)6：14
[12]施海优,施海婕.白拟芩愧汤治疗小儿湿热泄泻106例.广西中医药,2004,2(27) 1：12
[13]彭林,陈海泉,等.中医宏观辩证结合微观辩证治疗湿热型慢性结肠炎40例.四川中医,2005,(23)7：54
[14]王相才.温肾健脾汤治疗肾阳虚泄泻153例.吉林中医药,2004,5(5)24：25
[15]王洪歧,杨志华,等.温肾固元汤加减治疗慢性泄泻146例疗效观察.河北中医,2004,3(26)3：182
[16]刘冰华,李希斌.温阳活血法治疗小儿脾肾阳虚型泄泻100例.河北中医,2004,7(26) 7：509
[17]谷文芳,薜世昌.温阳解毒法治疗五更泄泻15例.陕西中医,2004,(25)12：1115
[18]石冬辉.温阳止泻汤治疗慢性泄泻87例临床体会.中国民族民间医药杂志,2003,(60)：27
[19]张古清.升阳汤治疗慢性泄泻.四川中医,2003(21)3：49
[20]李启允.升阳益土汤治疗慢性泄泻89例疗效观察.云南中医药杂志.2002(23)3：11
[21]冯俊志.浅议风药在慢性泄泻中的运用.四川中医.2003,(21)1：27
[22]史世军.祛风解表药治疗慢性泄泻.河南中医.2004,7(24)7：7 1
[23]丛丽,郑鸿雁.饥饿疗法在儿科脾虚泄泻中的应用.吉林中医药,2004,9(24)9： 53
[24]任子风,李华,等.安徽中医临床杂志。2003,2(15)1：50
[25]王晓燕.隔药饼灸对虚寒胃痛和脾虚泄泻患者免疫功能的影响.中国针灸与按摩,2004,11(24)11：756
[26]邓兰亭,焦英霞,等.穴位注射法治疗泄泻46例.针灸临床杂志,2004,(20)5：37
[27]杨风玲.轻刺重灸治疗慢性泄泻24例.陕西中医,2003,.(24)1：60
[28]黄映君,刁本恕.温灸合穴位贴敷法治疗脾虚泄泻证60例,2004,11(23)11：27
[29]陈丽华,袁海燕,等.穴位拔罐治疗飞行员泄泻45例疗效观察,航空军医,2004,8 (32) 4：175
[30]李春阳.推拿治疗经行泄泻96例.中国民间疗法,2005,8(13)8：21
[31]焦平,王艳君,等.推拿治疗伤食型婴幼儿泄泻60例.中国针灸与按摩,2003,4(23) 14：52
[32]苏海荣,王金爱,等.外贴内服法治疗小儿泄泻84例.吉林中医药,2005,4(25)4：32
[33]陈宏涛,陆景芳.针灸配合中药治疗婴幼儿泄泻.中国乡村医药杂志,2004,2(11)2：49
[34]董湘玉 中医心理学[M] 北京：人民卫生出版社,2007：7