基于最优尺度分析的四逆散临床应用关键因素研究  

Research on critical factors concerning the clinical application of Sini powder based on optimal scaling analysis

作　　者：韩新 方枫琪 张琳[1] 刘雅倩 张妙芬 江宇宁 余洁英[1] HAN Xin;FANG Fengqi;ZHANG Lin(School of Chinese Medicine,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学中医药学院

出　　处：《环球中医药》2019年第5期686-690,共5页Global Traditional Chinese Medicine

基　　金：广东省自然科学基金博士启动项目(2015A030310357);广东新南方中医研究院基金(201801)

摘　　要：目的本文选取2007~2017十年间四逆散运用的有效医案作为研究对象,运用统计学方法探讨病因病机、脉象、症状、药物四个因素的关系,从而判断四逆散现代临床运用规律。方法最优尺度分析法里的非线性典型相关分析分析医案中"病因病机-脉象-症状-加减药物"的关联关系,并绘制出质心图。结果 数据统计四逆散临床主要病因病机排前五位(下同)的依次是肝郁气滞、肝郁脾虚、肝胃不和、气滞血瘀、肝火炽盛;主要症状表现依次为心烦、乏力、胁痛、失眠、手足心热;主要脉象依次为脉弦、脉细、脉沉、脉滑、脉数;主要用药依次为茯苓、郁金、当归、半夏、黄芩。质心图整理后得出以肝胃不和、肝郁脾虚、肝火炽盛、气滞血瘀、肝郁气滞为中心的五组关系。结论四逆散现代临床运用上已经跳出了《伤寒论》六经辨证的思维模式,多采用脏腑辨证,病位以肝、胆、脾胃为多。病机则围绕因肝失疏泄,肝气郁结而引发一系列其他症状的治疗,尤其是关于脾胃疾病的治疗效果十分显著。Objective To determine the law of modern clinical application of Sini powder,effective medical cases using Sini power in the ten years from 2007 to 2017 were selected as the research object.Using statistical methods,the relationships among the four factors concerning etiology and pathogenesis,pulse manifestation,symptoms,and medicine were explored.Methods Using the nonlinear canonical correlation analysis in the optimal scaling analysis method,the "etiology and pathogenesis-pulse manifestation-symptoms-adding and subtracting medicine" relationship was analyzed,and the center of mass diagram was drawn out.Results According to the statistics,the top 5 kinds of main clinical etiology and pathogenesis of using Sini powder (the same as below) were liver constraint and qi stagnation,liver constraint and spleen deficiency,liver-stomach disharmony,qi stagnation and blood stasis,as well as intense liver fire,successively.The main symptoms are vexation,lack of strength,hypochondriac pain,insomnia,as well as feverish feeling in palms and soles,successively.The main pulse manifestations are wiry pulse,thready pulse,deep pulse,slippery pulse and rapid pulse.The main medicals were Poria,Radix Curcumae,Radix Angelicae Sinensis,Rhizoma Pinelliae and Radix Scutellariae.After the completion of the center of mass diagram,5 groups of relations were found to be centered on liver-stomach disharmony,liver constraint and spleen deficiency,intense liver fire,qi stagnation and blood stasis,as well as liver constraint and qi stagnation.Conclusion Sini powder in the modern clinical application has already jumped out of the thinking mode of six-channel pattern differentiation in Treatise on Cold-indused and Miscellaneous diseases,where zang-fu pattern differentiation is frequently used and the disease locations are mostly liver,gallbladder,spleen and stomach.The pathogenesis is related to the treatment of a series of other symptoms due to the liver failing to govern the free flow of qi and binding constraint of liver qi.Especially,the therap

关 键 词：四逆散 病因病机 临床应用 最优尺度分析法 

分 类 号：R289[医药卫生—方剂学]