《景岳全书》治疗内科杂病补益方剂配伍规律的研究
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摘要
张景岳(1563-1640),又名张介宾,字会卿,别号为通一子,明朝末期浙江绍兴人。是温补学派的重要代表人物之一,明代杰出的医学家。因其临证善于运用熟地,又有“张熟地”之美名。在晚年,景岳完成了记述他一生学术研究成果和临床实践经验的《景岳全书》,该书共六十四卷,载有临床各科理法方药。书中用了很大的篇幅,来重点论述景岳的补益思想以及内科杂证的症因脉治。书中论述中肯全面,其中景岳的很多学术思想和他对临床疾病的独到见解以及自创方剂,都备受后世所推崇。
本课题以《景岳全书》书中卷九至卷三十七“杂证谟”中所涉及的补益方剂142首为研究对象,借助数据挖掘软件Clementine,对所研究方剂中的药物频次、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《景岳全书·内科杂病》补益方剂的用药特点及配伍规律。142首方剂分属补气剂、补血剂、补阴剂等7大类。123种药物分属补气药、理气药、安神药、补血药等19大类,共使用998次,平均每方使用药物8.1味。
从药物使用种类及频次来看,《景岳全书·内科杂病》补益方剂以补气药使用最多,为278次,占药物使用总次数的27.86%；其次为补血药。补气之品以人参、黄芪、茯苓、白术为主；补血之品以熟地黄、当归、白芍为主。从气血阴阳分类来看,景岳治疗内科杂病时,首重补气。他推崇“行医不识气,治病从何据”的说法,认为“旨哉斯言,是实治身治病第一大纲”。
从药物性味上讲,《景岳全书·内科杂病》补益方剂的用药以甘温、甘平为主,而少用、慎用苦、寒、凉之品。性温者使用了456次,平性药物使用了345次,分居药物四气使用频次的前两位。在药味方面,味甘者使用了775次,居第一位。景岳强调阳气对人身的重要性,提倡“阳非有余”之说,在治疗疾病时注重对于阳气的顾护,认为苦寒的药物容易使人体阳气受到损伤,故在临证时应当谨慎使用。而“甘能滋阴”,“补必兼温”,甘温、甘平之品既能够滋养阴液精血,而又无伤阳伐正之弊。所以用药主甘温、甘平,而远寒凉。
从药物归经上讲,景岳重视先天后天,而二者之中又以后天为重。对全部药物进行统计,入脾经者最多,共49味,使用569次,占总使用频次的57.01%。而将脾胃二经用药频次相加更是如此。他在“论东垣《脾胃论》”篇中,赞成李氏的观点：“元气之充足,皆由脾胃之气无所伤,而后能滋养元气。若胃气之本弱……而元气亦不能充,此诸病之所由生也。”
对熟地与当归、人参与熟地、附子与肉桂、白术与黄芪等有代表性药对配伍药组配伍进行理论分析,以探求《景岳全书·内科杂病》补益方剂的组方配伍规律。1.补气剂中常配伍：①健脾利湿药。脾虚失运,最易生湿。健脾则生化有权,利湿则脾气得以健运。②行气药,使之补而不滞。③升举清阳药。主要是针对气虚下陷的病证,依“下者举之”的治则,于补气剂中配伍升举清阳之品,从而提高补气升阳的力量。2.补血剂常配伍：①活血化瘀药。一方面,血虚之证,血液运行往往不能畅达,易于凝聚成瘀。另一方面,瘀血不去,新血不生。所以,加入活血祛瘀的药物,既有生新血的作用,又有防瘀祛瘀的效用。②补气药,以补气生血。3.补阴剂中常配伍：①补阳药。对于阴虚者,若仅仅单纯养阴,则无以化生阳气,已经亏损的阴液也难以得益,而且过用阴凝的药物还容易使阳气受损。故张氏根据“阴阳互根”的理论,在补阴剂中配伍补阳的药物,以助阴之化生,即所谓“阴中求阳”之法。②清热药。阴虚则阳亢,而疾病易从热化,因此补阴方剂宜加入适量的清热药共同使用。4.补阳剂中常配伍：①补阴药,即景岳：“阴中求阳”之法,肾为水火之脏,其内存真阴真阳,由于阴阳互根互用,因此补阳的方剂若配伍补阴药,则可使阳有所依,从而收到补阳之功。②收涩药,主要是针对肾虚封藏失固的不同兼证,以期达到标本兼顾的目的。
另外,景岳重视补益脾胃；用药慎用攻伐,喜用平和之品,药物过偏、过猛易伤正气；提倡温补,提出“阳非有余”的观点；“治贵精一”论,立法处方,力求做到方证相对应,精一而不乱；用补之法,贵在先轻后重,务必使之成功。
Jingyue Zhang (1563to1640), also known as Zhang Jie-bin, the late Ming Dynasty Shaoxing, Zhejiang. Warming important representatives of the school of one of the Ming Dynasty Outstanding physician. He was good at the use of cultivated land, has "Zhang Rehmannia" reputation. In his later years, Jing Yue complete "Jing Yue Quan Shu", which account of his life, academic research and clinical practice experience. This book has64chapters, containing knowledge of clinical subjects. The book focuses on his academic ideas. The book discusses pertinent and comprehensive, many of his academic thinking and his insights as well as create their own prescription of clinical disease, are highly respected by the future generations.
The topics to miscellaneous cards mo Spleen Deficiency142as the object of the study. With the help of data mining software Clementine. With data mining software Clementine, to study all the relevant prescriptions. Using data mining technology, combined with traditional Chinese medicine theory analysis to explore the tonic prescription medication Features and Compatibility Law. The142prescriptions belonging to qi agents, blood agents, yin, etc.7categories.123drugs belonging to qi medicine, qi drugs, sedative drugs, Hematinic19categories. The use of traditional Chinese medicine,998. Per square drug use8.1flavor.
"Jing Yue Quan Shu-Internal Medicine Miscellaneous Diseases " tonic prescription qi drug use up to278times, accounting for27.86%of the total number of drug use. Followed Hematinic."Jing Yue Quan Shu-Internal Medicine Miscellaneous Diseases "the replenishing prescription medication sweet warm, gamping use less caution and bitter cold, cool products. And warm to use456times,345times the level of drug use, drug Separated gas use the frequency of the first two. Taste sweet drug used775times, ranking first. Jing Yue yang stressed the importance of the personal and the promotion of "positive non-surplus" theory. Focus on nursing care for the yang in the treatment of diseases. That the bitter cold of the drug is easy to make the human body yang damage, should be used with caution in Clinical. So the medication the main sweet warm, gamping away the cold.
From the drugs Meridian sense, Jing Yue emphasis on innate and acquired, and the two days after heavy. Statistics of all drugs, the Rupi up to a total of49taste, and used569times, accounting for57.01%of the frequency. Stomach by the frequency of drug use, especially by adding.
Theoretical analysis was then conducted on some representative ingredients such as Rehmannia and Angelica, Ginseng and Rehmannia, Aconite and cinnamon, Atractylodes and Astragalus to investigate the underlying principles of how ingredients were used in combination. First, The qi agents often compatibility:①Spleen dampness drugs. The spleen biochemical entitled, dampness able to temper health movement.②Gas line drugs,so that complement rather than stagnation.③Lifting Qing Yang drug. Qi subsidence syndromes, according to the rule is "give the" qi agent compatibility lift clear yang products, thereby enhancing the power of qi Sun. Second, blood agents often compatibility:①Traditional medicine, The one hand, the deficiency of the permit, the blood runs are often not accessible, easy to condense into stasis. On the other hand, not stasis, new blood is not life. Stasis drugs, both students and the role of new blood, but also the effectiveness of anti-stasis stasis.②Qi medicine, qi and blood. Third, Compatibility the yin agent often:①Yang drugs. For Yin deficiency, just simply Yangyin, no to metaplasia yang, Yin Ye loss is difficult to benefit, You and Guo Yin-coagulation drugs are also easy to make yang damage.②Antipyretic. The Yin Yang Kang disease easily from the heat of the yin prescription should be adding an appropriate amount antipyretic common.For the last, Yin tonic, Scenery Yue:"yin and yang" of the law, the kidney is the dirty water and fire, its memory really overcast true positive, yin and yang mutual root interoperability, yang prescription compatibility yin tonic, will enable the Yang reliance, which received the power of the yang.②Astringent drug. Loss of solid sealing possession for kidney different syndrome, in order to achieve the purpose of both specimens.
In addition, the the Jingyue emphasis on replenishing spleen; Medication with caution Gongfa like to use something mild, the drugs too biased, too fast easily hurt righteousness; To promote the warming,"Yang more than non-" point of view; Governance expensive Seiichi "On the legislative prescription, and strive to achieve party certificate corresponding, Seiichi without the chaos; Complement the law, the earlier light after, be sure to make it a success.
本课题以《景岳全书》书中卷九至卷三十七“杂证谟”中所涉及的补益方剂142首为研究对象,借助数据挖掘软件Clementine,对所研究方剂中的药物频次、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《景岳全书·内科杂病》补益方剂的用药特点及配伍规律。142首方剂分属补气剂、补血剂、补阴剂等7大类。123种药物分属补气药、理气药、安神药、补血药等19大类,共使用998次,平均每方使用药物8.1味。
从药物使用种类及频次来看,《景岳全书·内科杂病》补益方剂以补气药使用最多,为278次,占药物使用总次数的27.86%；其次为补血药。补气之品以人参、黄芪、茯苓、白术为主；补血之品以熟地黄、当归、白芍为主。从气血阴阳分类来看,景岳治疗内科杂病时,首重补气。他推崇“行医不识气,治病从何据”的说法,认为“旨哉斯言,是实治身治病第一大纲”。
从药物性味上讲,《景岳全书·内科杂病》补益方剂的用药以甘温、甘平为主,而少用、慎用苦、寒、凉之品。性温者使用了456次,平性药物使用了345次,分居药物四气使用频次的前两位。在药味方面,味甘者使用了775次,居第一位。景岳强调阳气对人身的重要性,提倡“阳非有余”之说,在治疗疾病时注重对于阳气的顾护,认为苦寒的药物容易使人体阳气受到损伤,故在临证时应当谨慎使用。而“甘能滋阴”,“补必兼温”,甘温、甘平之品既能够滋养阴液精血,而又无伤阳伐正之弊。所以用药主甘温、甘平,而远寒凉。
从药物归经上讲,景岳重视先天后天,而二者之中又以后天为重。对全部药物进行统计,入脾经者最多,共49味,使用569次,占总使用频次的57.01%。而将脾胃二经用药频次相加更是如此。他在“论东垣《脾胃论》”篇中,赞成李氏的观点：“元气之充足,皆由脾胃之气无所伤,而后能滋养元气。若胃气之本弱……而元气亦不能充,此诸病之所由生也。”
对熟地与当归、人参与熟地、附子与肉桂、白术与黄芪等有代表性药对配伍药组配伍进行理论分析,以探求《景岳全书·内科杂病》补益方剂的组方配伍规律。1.补气剂中常配伍：①健脾利湿药。脾虚失运,最易生湿。健脾则生化有权,利湿则脾气得以健运。②行气药,使之补而不滞。③升举清阳药。主要是针对气虚下陷的病证,依“下者举之”的治则,于补气剂中配伍升举清阳之品,从而提高补气升阳的力量。2.补血剂常配伍：①活血化瘀药。一方面,血虚之证,血液运行往往不能畅达,易于凝聚成瘀。另一方面,瘀血不去,新血不生。所以,加入活血祛瘀的药物,既有生新血的作用,又有防瘀祛瘀的效用。②补气药,以补气生血。3.补阴剂中常配伍：①补阳药。对于阴虚者,若仅仅单纯养阴,则无以化生阳气,已经亏损的阴液也难以得益,而且过用阴凝的药物还容易使阳气受损。故张氏根据“阴阳互根”的理论,在补阴剂中配伍补阳的药物,以助阴之化生,即所谓“阴中求阳”之法。②清热药。阴虚则阳亢,而疾病易从热化,因此补阴方剂宜加入适量的清热药共同使用。4.补阳剂中常配伍：①补阴药,即景岳：“阴中求阳”之法,肾为水火之脏,其内存真阴真阳,由于阴阳互根互用,因此补阳的方剂若配伍补阴药,则可使阳有所依,从而收到补阳之功。②收涩药,主要是针对肾虚封藏失固的不同兼证,以期达到标本兼顾的目的。
另外,景岳重视补益脾胃；用药慎用攻伐,喜用平和之品,药物过偏、过猛易伤正气；提倡温补,提出“阳非有余”的观点；“治贵精一”论,立法处方,力求做到方证相对应,精一而不乱；用补之法,贵在先轻后重,务必使之成功。
Jingyue Zhang (1563to1640), also known as Zhang Jie-bin, the late Ming Dynasty Shaoxing, Zhejiang. Warming important representatives of the school of one of the Ming Dynasty Outstanding physician. He was good at the use of cultivated land, has "Zhang Rehmannia" reputation. In his later years, Jing Yue complete "Jing Yue Quan Shu", which account of his life, academic research and clinical practice experience. This book has64chapters, containing knowledge of clinical subjects. The book focuses on his academic ideas. The book discusses pertinent and comprehensive, many of his academic thinking and his insights as well as create their own prescription of clinical disease, are highly respected by the future generations.
The topics to miscellaneous cards mo Spleen Deficiency142as the object of the study. With the help of data mining software Clementine. With data mining software Clementine, to study all the relevant prescriptions. Using data mining technology, combined with traditional Chinese medicine theory analysis to explore the tonic prescription medication Features and Compatibility Law. The142prescriptions belonging to qi agents, blood agents, yin, etc.7categories.123drugs belonging to qi medicine, qi drugs, sedative drugs, Hematinic19categories. The use of traditional Chinese medicine,998. Per square drug use8.1flavor.
"Jing Yue Quan Shu-Internal Medicine Miscellaneous Diseases " tonic prescription qi drug use up to278times, accounting for27.86%of the total number of drug use. Followed Hematinic."Jing Yue Quan Shu-Internal Medicine Miscellaneous Diseases "the replenishing prescription medication sweet warm, gamping use less caution and bitter cold, cool products. And warm to use456times,345times the level of drug use, drug Separated gas use the frequency of the first two. Taste sweet drug used775times, ranking first. Jing Yue yang stressed the importance of the personal and the promotion of "positive non-surplus" theory. Focus on nursing care for the yang in the treatment of diseases. That the bitter cold of the drug is easy to make the human body yang damage, should be used with caution in Clinical. So the medication the main sweet warm, gamping away the cold.
From the drugs Meridian sense, Jing Yue emphasis on innate and acquired, and the two days after heavy. Statistics of all drugs, the Rupi up to a total of49taste, and used569times, accounting for57.01%of the frequency. Stomach by the frequency of drug use, especially by adding.
Theoretical analysis was then conducted on some representative ingredients such as Rehmannia and Angelica, Ginseng and Rehmannia, Aconite and cinnamon, Atractylodes and Astragalus to investigate the underlying principles of how ingredients were used in combination. First, The qi agents often compatibility:①Spleen dampness drugs. The spleen biochemical entitled, dampness able to temper health movement.②Gas line drugs,so that complement rather than stagnation.③Lifting Qing Yang drug. Qi subsidence syndromes, according to the rule is "give the" qi agent compatibility lift clear yang products, thereby enhancing the power of qi Sun. Second, blood agents often compatibility:①Traditional medicine, The one hand, the deficiency of the permit, the blood runs are often not accessible, easy to condense into stasis. On the other hand, not stasis, new blood is not life. Stasis drugs, both students and the role of new blood, but also the effectiveness of anti-stasis stasis.②Qi medicine, qi and blood. Third, Compatibility the yin agent often:①Yang drugs. For Yin deficiency, just simply Yangyin, no to metaplasia yang, Yin Ye loss is difficult to benefit, You and Guo Yin-coagulation drugs are also easy to make yang damage.②Antipyretic. The Yin Yang Kang disease easily from the heat of the yin prescription should be adding an appropriate amount antipyretic common.For the last, Yin tonic, Scenery Yue:"yin and yang" of the law, the kidney is the dirty water and fire, its memory really overcast true positive, yin and yang mutual root interoperability, yang prescription compatibility yin tonic, will enable the Yang reliance, which received the power of the yang.②Astringent drug. Loss of solid sealing possession for kidney different syndrome, in order to achieve the purpose of both specimens.
In addition, the the Jingyue emphasis on replenishing spleen; Medication with caution Gongfa like to use something mild, the drugs too biased, too fast easily hurt righteousness; To promote the warming,"Yang more than non-" point of view; Governance expensive Seiichi "On the legislative prescription, and strive to achieve party certificate corresponding, Seiichi without the chaos; Complement the law, the earlier light after, be sure to make it a success.
引文
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