从防风剂量变化探讨“泻黄散”病机及其在儿科的临床应用  

Discussion on Clinical Application of Xiehuang San in Pediatrics Based on Modern Medical Records

作　　者：王天君 刘晓鹰 张雪荣 WANG Tianjun;LIU Xiaoying;ZHANG Xuerong(Hubei University of Traditional Chinese Medicine,Wuhan 430065,China;Hubei Provincial Hospital of Traditional Chinese Medicine,Wuhan 430061,China)

机构地区：[1]湖北中医药大学中医临床学院,湖北武汉430065 [2]湖北中医药大学/湖北中医药大学附属医院/湖北省中医院/湖北时珍实验室,湖北武汉430061

出　　处：《云南中医药大学学报》2024年第6期36-41,45,共7页Journal of Yunnan University of Chinese Medicine

基　　金：湖北省中医药重点学科建设项目(P-20230316-1137);湖北中医药大学“十四五”优秀学科团队(100702020803)。

摘　　要：目的通过对泻黄散现代医案的整理分析,从防风的剂量变化探讨泻黄散之病机及其在儿科的临床应用规律。方法从中国知网、万方数据库、维普网中以泻黄散为关键词进行检索,选取其中临床资料完整且有明确疗效的医案,对其中的诊断、症状、中医证型、药物等进行规范后构建数据库;运用SPSS 23.0软件进行统计及数据分析。结果有效医案89则,西医疾病31种,中医症状41种,中医体征11种;处方118个,药物205种,用药总频次1400次,除泻黄散主方药物外,常加药物频次≥20次的依次为牡丹皮、蝉蜕、黄连、生地黄、赤芍;除2个散剂外,将汤剂中泻黄散各药物的剂量频次进行统计,结果频次最多的剂量为藿香10 g,防风10 g,栀子10 g,石膏15 g,甘草5 g;剂量比例以石膏最大,均值占比36.04%,防风、藿香、栀子均值占比相当,甘草最小,分别为防风18.71%,藿香17.87%,栀子17.21%,甘草10.17%。结论1.临床应用"泻黄散"由重用防风,变为重用石膏,佐用防风,轻用甘草,并常加入清热滋阴凉血的药物;剂型由散剂改为汤剂使用。2.泻黄散病机以脾胃气机升降失常,郁而化火为核心,可累及心火、肺热、肝风内动等证,以热证、实证为主,病因为热、火兼夹湿,病位主要涉及脾、胃、心、肺、肝,其临床表现可总结为:大便干结难下、小便调、纳差、口腔溃疡、口唇干渴、喜饮、咳嗽咳痰、咽充血,舌红,苔黄或苔黄腻,脉数或脉滑数。Objective To explore the clinical application rule of Xiehuang San in pediatrics through sorting out modern medical cases and data mining.Methods Searching Xiehuang San as a keyword in CNKI,Wanfang and VIP databases.Selecting complete clinical dates and definite curative medical records to build a database.Using SPSS 23.0 to analysis the date.Results There are 89 valid medical cases,31 types of Western medicine diseases,41 types of TCM symptoms,11 types of TCM signs and 14 types of TCM pathogenesis,118 prescriptions,205 kinds of drugs,and the total frequency of medication was 1400 times.Except Xiehuang San,Peony bark,Cicada slough,Coptis chinensis,Rehmannia glutinosa and Radix Paeoniae Rubra were often added,which frequency more than 20 times;statistics were made on the frequency of each drug in Xiehuang San,the results showed that the most frequent were Huoxiang 10 g,Fangfeng 10 g,Gardenia 10 g,Gypsum 15 g and Glycyrhiza 5 g.The largest was gypsum with an average of 36.04%,the Fangfeng(18.71%)Huoxiang(17.87%)and Gardenia(17.21%)was similar,and the dose of Glycyrrhiza(10.17%)was the smallest.Conclusion 1.In the clinical application of Xiehuang San,the use of powder was changed to decoction,and the drug dosage was changed from reuse of parsnip and licorice to gypsum,supplemented with parsnip and light licorice,and often added with drugs to clear heat and nourish Yin.2.Xiehuang San's syndrome is mainly characterized by heat syndrome and empirical evidence.The disease is caused by heat,fire or dampness,mainly relates to spleen and stomach,heart,lungs,its clinical manifestations can be summarized as:stool stem node under the hard,urinate and poor appetite,oral ulcer,oral thirst,like drinking,cough and expectoration,pharyngeal hyperemia,red tongue,yellow moss or moss yellow greasy,pulse number.

关 键 词：泻黄散 病因病机 药物剂量分析 防风 石膏 

分 类 号：R272[医药卫生—中医儿科学] R289.1[医药卫生—中医学]