从“汤液经法图”角度探讨《医林改错》22首活血化瘀方剂的组方配伍规律  

The Formula and Combination Rules of 22 Prescriptions for Activating Blood Circulation and Resolving Blood Stasis in Correction on Errors in Medical Works(Yi Lin Gai Cuo)from the Perspective of"Tang-ye-jing-fa map"

作　　者：刘奕呈 王亦菲 张智博 付双清 张大武[1] 马晓昌[1] LIU Yicheng;WANG Yifei;ZHANG Zhibo;FU Shuangqing;ZHANG Dawu;MA Xiaochang(Xiyuan Hospital,China Academy of Chinese Medical Sciences,National Clinical Research Center for Chinese Medicine Cardiology,Beijing 100091,China;Beijing University of Chinese Medicine)

机构地区：[1]中国中医科学院西苑医院,国家中医心血管病临床医学研究中心,北京100091 [2]北京中医药大学

出　　处：《中西医结合心脑血管病杂志》2024年第22期4044-4050,共7页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：2018重点研发计划项目课题(No.2018YFC1707401)。

摘　　要：目的:从“汤液经法图”角度探讨《医林改错》22首活血化瘀方剂的组方配伍规律,以期为临床活血化瘀法的应用提供理论依据及《医林改错》的研究提供新思路。方法:运用《辅行诀五脏用药法要》所载“汤液经法图”解析清代王清任所著《医林改错》记载的22首活血化瘀方剂,制成“22首活血化瘀方剂组方配伍分析表”,分别绘制22首活血化瘀方剂的汤液经法分析图,分析药物的配伍结构。结果:9首以补肝为主的方剂,基本以“辛-苦-甘-咸”为组方配伍原则,多以肝为主,五脏同调;7首以泻脾为主的方剂,基本以“甘-辛-苦”为组方配伍原则,多以脾为主,肝心肾同调,不涉及肺脏;4首以泻心为主的方剂,基本以“辛-甘-苦”或“苦-咸”为组方配伍原则,多以脾为主,五脏同调;2首以泻脾为主的方剂,以“辛-苦-甘”为组方配伍原则,多以脾为主,肝心肾同调,不涉及肺脏。结论:22首活血化瘀方剂整体以“辛-苦-甘”为组方配伍原则,多数涉及肝木、脾土和心火。王清任用药频次最高的活血化瘀药是桃仁,其次是红花、赤芍、当归和川芎,补气药是黄芪和甘草,行气药是柴胡和川芎,药物归经频率最高为肝经,五味以辛、甘、苦味为主,符合王清任活血化瘀为主,辅以补气行气的用药特点。王清任多使用“甘辛化苦”五味配伍转化关系,促使作用于脾的辛味药和甘味药入心泻心。王清任善用黄芪,重视活血化瘀同时补气,22首活血化瘀方中有8首使用了黄芪。王清任将活血化瘀药与引经药和不同作用的药物配伍,因势攻邪,引导活血化瘀药直接作用于不同的瘀血部位。Objective:To explore the formulae and combination rules of 22 prescriptions for activating blood circulation and resolving blood stasis in Correction on Errors in Medical Works(Yi Lin Gai Cuo)from the perspective of"Tang-ye-jing-fa map".Methods:The"Tang-ye-jing-fa map"was used to analyze the 22 prescriptions for activating blood circulation and resolving blood stasis as recorded in Correction on Errors in Medical Works(Yi Lin Gai Cuo)by Wang Qingren,the"22 prescriptions for activating blood circulation and resolving blood stasis"were used to draw a 22 prescriptions for activating blood circulation and resolving blood stasis."Tang-ye-jing-fa map"of the 22 prescriptions for activating blood circulation and resolving blood stasis was drawn to analyse the structure of the combination of the medicinal flavours.Results:The nine formulas mainly for tonifying the liver were used based on the principle of"pungent-bitter-sweet-salty",with the liver being the main organ and the five organs being in tune.The seven formulas mainly for tonifying the spleen were used based on the principle of"sweet-pungent-bitter",with the spleen being the main organ and the liver,heart and kidney being in tune,without involving the lungs.The four formulas mainly for dipping the heart were basically based on the principle of"pungent-sweet-bitter"or"bitter-salty",with the spleen being the main organ and the five organs being in tune.The two formulas mainly for purging the spleen were based on the principle of"pungent-bitter-sweet",with the spleen being the main organ and the liver,heart and kidney being in tune,without the lungs.Conclusion:Most of the formulas involved liver wood,spleen earth and heart fire.The most frequently used herbs by Wang Qingren to invigorate blood circulation and resolve blood stasis were peach kernel,followed by red flower,red peony,angelica and chuanxiong,the Qi tonifying herbs were huangqi and licorice,the Qi moving herbs were chaihu and chuanxiong,and the most frequently used herbs were for the liver meridian.The fi

关 键 词：活血化瘀方剂 《医林改错》 汤液经法图 王清任 

分 类 号：R289.1[医药卫生—方剂学]