《临证指南医案》痉厥辨治规律分析
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R249;R256.44

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中央级公益性科研院所基本科研业务费专项资金资助(ZZ13-YQ-129);中国中医科学院基本科研业务费自主选题(ZC201902,ZZ130306, ZZ140314)


Analysis of Treatment Rules of Convulsive Syncope Based on Syndrome Differentiation in Linzheng Zhinan Yi'an
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    摘要:

    目的:通过对《临证指南医案》痉厥医案的整理和分析,归纳叶天士治疗痉厥的经验,为现代医学临证诊疗提供参考和借鉴。方法:选取《临证指南医案·卷七》中的68 则痉厥医案,对治疗痉厥使用药物的药性、药味、功效及归经进行统计分析,运用中医学理论对结果进行分析总结。结果:68 则医案,涉及证候19 种,中药118 味,其中高频药物(使用频次≥6 次) 共27 味;使用频次≥4 次的药物功效类别共12 类,使用频次由多到少排序:补虚药>清热药>利水渗湿药>理气药。常用药物的药性以寒、温、平为主,其中寒性药物最多。药味主要为甘味、苦味、辛味,以甘味药最多。归经包括心经、肾经、肺经、肝经、脾经等,使用频次由多到少排序:心经>肾经>肺经>肝经、脾经。关联分析得到14 组药对,并将使用频次≥6 次的26 味高频药物进行聚类,得到5 类有意义的药组。结论:叶天士治疗痉厥的治法主要有清热养阴法、祛风通络法、清润滋补法、通闭开窍法、滋阴潜阳法等。根据不同病机随证变法,其所用的经典药物和辨证选方的思想为现代临床医生遣方用药提供了重要的参考依据。

    Abstract:

    Abstract:Objective:To provide a reference for clinical diagnosis and treatment of modern medicine by arrangement and analysis of medical cases of convulsive syncope in Linzheng Zhinan Yi'an, and summarization of experience of YE Tianshi treating convulsive syncope. Methods: A total of 68 medical cases of convulsive syncope in Volume 7 of Linzheng Zhinan Yi'an. were selected. Medicine nature, medicine flavor, efficacy, and meridian entry in treatment of convulsive syncope were counted and analyzed,and Chinese medicine theory was used to analyze and summarize the results. Results:Among 68 medical cases, 19 syndromes and 118 Chinese medicines were involved. Among 118 Chinese medicines, there were 27 high-frequency Chinese medicines(the frequency equal to or more than six times);there were 13 categories of efficacy in Chinese medicines with frequency equal to or more than four times, and the frequency from high to low was as follows: deficiency- supplementing medicine, heat- clearing medicine, urination- promoting and dampness- percolating medicine, and qi-rectifying medicine. The nature of commonly-used medicines mainly was cold,warm,and neutral,and the Chinese medicine with cold nature had the largest proportion. The medicine nature mainly was sweet, bitter, and acrid, and the Chinese medicine with sweet nature had the largest proportion. In terms of meridian entry,prescriptions were mainly from the heart,the kidney,the lung,the liver,and the spleen;the frequency from high to low was as follows:the heart,the kidney,the lung,the liver,and the spleen meridians. According to association analysis,there were 14 couplet medicines. Clustering analysis of 26 high-frequency medicines with frequency equal to or more than six times was carried out,and five categories of significant couplet medicines were obtained. Conclusion:The treatment methods of convulsive syncope by YE Tianshi mainly included heat- clearing and yin- nourishing method, wind- dispelling and collaterals- unblocking method, clearing-moistening and enriching-nourishing method,unblocking and orifice-opening method,and yin-enriching and yang subduing method. The treatment methods based on differentiation of syndrome and pathogenesis, the classic medicines, and the thought of prescriptions selected based on syndrome differentiation provide important references for clinical prescriptions and medication by clinicians in modern society.

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胡雪原,李鸿涛,赵阳,张晓丽,李兵.《临证指南医案》痉厥辨治规律分析[J].新中医,2021,53(18):19-24

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  • 在线发布日期: 2021-09-24
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