摘要
清代名医程国彭,字钟龄,原字山龄,号恒阳子,法号普明子。天都人(今安徽省歙县),生活于康熙、雍正年间(1662———1735年)。为了教学门人,程氏根据三十年行医心得体会著成《医学心悟》一书,全书共六卷,涉及医学论文、《伤寒论》的研究、内科杂病、五官、外科和妇科常见病的证治。此书理论与临床紧密结合,论述全面中肯,语言朴实,治法方药切于实用。
本课题以《医学心悟》书中卷三、卷四、卷五所涉及的内科、妇科205首方剂为研究对象,借助数据挖掘软件Clementine,对所研究方剂中的高频次药物,常用性味、归经、药对、药组、药物类型及主治病证等进行挖掘性研究。利用数据挖掘技术,结合中医药学理论分析,探讨《医学心悟》的用药特点及配伍规律。205首方剂分属清热剂、理气剂、安神剂、解表剂等18大类,使用443次。290种药物分属清热药、理气药、安神药、解表药等21大类,使用1663次,平均每方使用药物8.1味。补虚药使用次数最多,为454次,占药物使用总次数的27.30%;补益剂用了169次,占方剂总次数的38.15%;对频次≥4次(使用频次前109位,总频次1371次,占总数的82.39%)的药物进行统计,入脾经的药最多,共48味使用773次,占56.38%;涉及的90个主治病证条目中,有73个病证使用了补益剂,占总病证数的81.11%。使用频次4次以上的药对199对,三味药组242组,四味药组163组,五味药组41组。
对白术和陈皮、浙贝母和桔梗、陈皮和半夏、人参和当归等29个有代表性配伍进行理论分析,以探求《医学心悟》的组方配伍规律。①补气剂配伍行气药。气虚之人大多伴有脾胃虚弱,补气容易壅滞气机,所以在补气时配伍行气之药,通畅气机,使补而不滞。②补气剂配伍利湿药。原因有二:一方面脾为阴土,喜燥恶湿,脾失健运则不能运化水湿,易致湿邪内生,湿困脾气。另一方面,补气药中配伍渗利湿浊之药,可以防补气而壅滞中焦气机,使方药补中寓泻,补而不壅。③补血剂配伍补气药。血的生成有赖于脾气的运化,周流全身依靠心气的推动和肺气的治节。④补血剂配活血化瘀药。血虚常因血不能畅达而易停滞为瘀。⑤补血剂配伍理气药。滋阴补血方中佐入少量行气和胃醒脾之品,调畅气机,使之补而不滞,滋而不腻。⑥祛风剂配以益气养血药。气血旺盛,正气充足助祛风药祛邪外出。⑦祛风剂配伍活血药。活血药大多辛温,能散能走,可以活血通经止痛,能使机体血行畅达,所感风邪可随血之运行而消散。⑧消食剂配伍行气药。行气药能解因食积停滞于胃脘引起的脘腹痞闷胀满等症,通畅气机有利于运化。⑨消食剂配伍健脾益气药。食积可因脾胃虚弱难以运化水谷而致,积滞日久也可致使脾胃虚弱。故积滞而见脾虚者,要兼以补脾益气。⑩祛痰剂配以行气药。痰乃津液凝聚所化,气行则津液流畅,气滞则津液聚而生痰。反之,痰成之后又会阻碍气机,使气滞进一步加重。故行气有助于祛痰。11祛痰剂配伍健脾利湿药。脾主运化水湿,输布津液,脾虚不能运化,则水湿内停聚而痰。健脾利湿能杜生痰之源,且使痰湿有所出。12祛痰剂配伍清热药。痰由湿生,湿郁化热能煎熬成痰。13补阴剂配补阳药。补阴方剂中配以补阳药,有“阳中求阴”之效。14理血剂配伍行气药。气为血之帅,气是血周流全身的动力,行气有助于活瘀滞之血。15利湿剂配伍健脾益气药。津液代谢主要与肺、脾、肾、三焦有关,与脾的运化最为紧密。脾在津液代谢相当于中枢作用。通过脾气升达输布、胃气和降,方使津液周流滋润全身,糟粕下输膀胱形成尿液排出。所以利水渗湿时常配伍健脾益气药。
程氏临证重视补益,如果正气不足,则难以祛邪治病。他认为通过调理脾胃化生气血,有补五脏六腑之效;健运脾胃有助于祛邪;攻邪要忌伤脾胃之气;病后注重调养脾胃。程氏慎用攻伐之品,喜用中正平和,于平凡处见奇效。
Guopeng Cheng, also known as Zhong Ling, or Shan Ling or Heng Yang Zi or Pu Ming Zi, lived between1662and1735in Tian Du (now She Xian in Anhui Province). He published a book based on his30-year experience in medicine entitled "Insights of Medicine" as a textbook for his students. This book had six volumes, covering a wide range of topics such as theories of medicine, research on "Treatise on Exogenous Febrile Disease' diagnosis and treatment in internal medicine, otolaryngology, surgical medicine, and common disease in gynecology. This book was rich in both theory and clinical practice and written in a comprehensive and objective way. The language in the book was easy to understand and the treatment documented in the book had great practical value.
The current study focused on205prescriptions in internal medicine and gynecology in Volume3-5. Using data mining software Clemetine, this study examined the characteristics, drug group, drug type, and main medical treatment card of the most frequently used ingredients in these sections of the book. Based on the combination of comparison of Chinese medicine theories, statistical analysis and data mining results, this current study aims to explore the characteristics of the prescription. The total205prescriptions can be divided into18categories, including heat agent, the qi agent, tranquilizers, relieving agent and etc, and were used443times. There were209ingredients belonging to21categories including the antipyretic, qi drugs, sedative drugs, relieving drugs and etc, and were used1663times. The average number of ingredients per prescription was81. Tonic drug was most frequently used and was used for454times, accounting for27.30%of total time used of all ingredients. Tonic prescription was used169times, accounting for38.15%of all prescriptions. Among the ingredients used for more than4times (the top109most frequently used ingredients, the total time used were1371times, accounting for82.39%of total time used of all ingredients), ingredients of the Rupi Sutra category accounted for the most, which had48different ingredients used773times, accounting for56.38%. Among the treatment for90symptoms, tonic prescription was used for73of them, accounting for81.11%. There were199pairs of ingredients that were used for more than4times,242groups that consisted of3ingredients,163groups that consisted of4ingredients, and41groups that consisted of5ingredients.
Theoretical analysis was then conducted on29representative ingredients such as atractylodes macrocephala and dried tangerine peel, Fritillaria and Campanulaceae, tangerine peel and Pinellia, ginseng and Angelica to investigate the underlying principles of how ingredients were used in combination.①The prescriptions to increase Qi included ingredients that assist in the flow of Qi. Patients who lacked Qi often had weak spleen and stomach, who might suffer from blocked Qi when using drugs to increase Qi. The use of ingredients which were able to help the flow of Qi in the prescriptions to increase Qi could avoid the blockage of Qi.②The prescription to increase Qi included ingredients that decrease dampness. There were two reasons:first, spleen is the soil for Yin which functions better in a dry environment than a damp one. A malfunction spleen cannot clear dampness hence may result in a harmful dampness and trap the Qi of spleen. Second, the inclusion of these ingredients can avoid the blockage of Qi in the process of increasing Qi, so that the prescription had a good combination of tonic ingredients and purgative ingredients to be tonic but not obstructing.③The prescription to increase blood included ingredients that increases Qi. The production of bleed depends on the flow of Qi from the spleen, the circulation of blood depends on the pushing force of Qi from the heart and control force of the Qi from the lung.④The prescription to increase blood included ingredients that promote blood circulation. The lack of blood is often caused by the malfunction of circulation which is prone to result in blockage.⑤The prescription to increase blood included ingredients that adjust Qi. With a small amount of ingredients that adjust Qi and harmonize environment in stomach and spleen, the prescription which aims to promote Yin and increase blood can yield good adjustment of Qi, being tonic without blockage or too much.⑥The prescription to increase Feng included ingredients that increases Qi and blood. These ingredients can help hence cure Fengxie.⑦The prescription to increase Feng included ingredients that promote blood circulation. These ingredients are often mild and can help remove the blockage in the blood and meridians, stop the pain, achieve a better blood circulation, and hence cure Fengxie.⑧The prescription to help digestion included ingredients that assist the flow of Qi. These ingredients can help with the symptoms such as bloating that caused by the undigested food in the stomach because the good flow of Qi is good for digestion.⑨The prescription to help digestion included ingredients to improve the function of spleen. The undigested food cannot be removed if the spleen is too weak to carry water. On the other hand, poor digestion can weaken the spleen in the long run.⑩The prescription to remove sputum included ingredients that assist the flow of Qi. The sputum is caused by the blocked fluid. The good flow of fluid depends on a good flow of Qi. On the other hand, sputum will hinder the flow the Qi, which becomes a vicious circle and results in a worse flow of Qi. Therefore, the ingredients that enable a good flow of Qi will help removing sputum.(11) The prescription to remove sputum included ingredients that improve the spleen and decrease dampness. The main function of the spleen is to carry fluid and dampness. A weak spleen cannot fulfill this function and dampness will accumulate to form sputum. To improve the function of the spleen to carry the dampness is to cure the underlying cause for sputum as well as provide an outlet for sputum.(12) The prescription to remove sputum included ingredients that decrease heat. The sputum is a result from too much dampness with heat.(13) The prescription to increase Yin included ingredients that increase Yang. By doing so, it has the effect of inducing Yin from Yang.(14) The prescription to adjust blood circulation included ingredients that help the flow of Qi. As a master of blood, Qi provides the force for blood circulation. A good flow of Qi can help dredge the blockage of blood.(15) The prescription to decrease dampness included ingredients that improve the function of spleen and the flow of Qi. The metabolic of body fluid depends on the function of the lung, spleen and kidney, especially the carrying force from the spleen. The spleen is central in the metabolic of body fluid. It is circulation of the Qi from the spleen and the harmonization by the Qi from the stomach that promotes the circulation of body fluid. The waste is then urinated by the bladder. Therefore, the prescription to increase the excretion of body fluid to decrease the dampness often included ingredients that can improve the function of spleen and the flow of Qi.
The author emphasized on tonic. It is difficult to remove Xie and cure the disease when there is a lack of Zheng Qi. He suggested that all the organs can benefit from the improvement of the spleen and stomach which produce Qi and blood. A healthy spleen and stomach can help in removing Xie. The spleen and stomach should not be injured when removing Xie. It is also important to improve the function of the spleen and stomach in the recovery stage. In conclusion, the author seldom used aggressive ingredients. Instead, he had an inclination to use ingredients that were mild and tonic to produce a good curing effect.
引文
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