中医杂志

目的总结古今医案中桂枝汤的用药规律。方法收集明确使用桂枝汤的医案,对纳入医案的药味和药量信息进行规范化处理并建立数据库。采用描述性统计方法对桂枝汤原方药物、加味药物及类别、常用加味药物及剂量、合方情况进行频次分析,对桂枝汤原方用量的均值、极小值、极大值、众数进行统计,并采用关联规则对加味药物与主症进行关联分析。结果共纳入医案1035则。桂枝汤方的临床常用剂量为桂枝10 g,白芍10 g(或赤芍15 g),生姜10 g或3片(或干姜6 g,炮姜3 g),大枣10 g或5枚,甘草6 g。加味药物共计229味,2481味次,出现频次最高的前5位药物为黄芪(181)、当归(144)、防风(141)、白术(137)、党参(128);其涉及药物类别在前5位者为补虚药(743)、解表药(399)、清热药(181)、活血化瘀药(155)、安神药(146)。合方方剂共47首,90频次,合方频次在2次以上者有玉屏风散(29)、当归补血汤(5)、生脉饮(4)、四物汤(3)、麻黄附子细辛汤(3)。结论桂枝汤临床用量与原方所载无明显差异,其加味药物以补虚药最多,方中生姜、大枣、甘草是重要组成药味,不可随意删减。

Objective To summarize medication rule in Guizhi Decoction( 桂枝汤) in the ancient and modern consilias. Methods Collect consilias that explicitly use Guizhi Decoction. Then they normatively processed information about amount and dosage of herbs brought into consilias and set up a database. Used descriptive statistical method to make frequency analysis about primary herbs in Guizhi Decoction,category of modified herbs,dosage of common modified herbs,case of uniting prescription. Made statistics about average,minimum,maximum and mode of dosage of primary Guizhi Decoction and used association rules to make correlation analysis between modified herbs and primary symptom. Results There were 1035 consilias included. Clinical common dosage of each herb in Guizhi Decoction includes: Guizhi( Cassia Twig) 10 g,Baishao( Radix Paeoniae albae) 10 g [or Chishao( Radix Paeoniae rubrae) 15 g],Shengjiang( Rhizoma Zingiberis recens) 10 g or 3 pieces [or Ganjiang( Rhizoma Zingiberis)15 g,baked ginger 3 g],Dazao( Fructus Zizyphi jujubae) 5 g or 5 grains and Gancao( Radix Glycyrrhizae) 6 g.There were 229 herbs used to modify Guizhi Decoction,2481 times in total. Occurrence frequency of the top five herbs were Huangqi( Radix Astragali)( 181),Danggui( Radix Angelicae sinensis)( 144),Fangfeng( Radix Ledebouriellae)( 141),Baizhu( Rhizoma Atractylodis macrocephalae)( 137),Dangshen( Radix Codonopsis)( 128). Involved herbs category among the top five were medicines for tonifying deficiency( 743),medicines for relieving exterior syndrome( 399),medicines for heat-clearing( 181),medicines for invigorating blood circulation and eliminating stasis( 155) and medicines for tranquilization( 146). There were 47 uniting prescription used 90 times. The uniting prescription of frequency more than 2 times were Yupingfeng San( 玉屏风散,29),Danggui Buxue decoction( 当归补血汤,5),Shengmai Yin( 生脉饮,4),Siwu decoction( 四物汤,3),and Mahuang Fuzi Xixin decoction( 麻黄附子细辛汤,3). Conclusion Clinical dosage of Guizhi Decoction has no obvious difference with the primary. The most modified herb is for tonifying deficiency. In the prescription,Shengjiang( Rhizoma Zingiberis recens),Dazao( Fructus Zizyphi jujubae),Gancao( Radix Glycyrrhizae) are important component herbs that are not pruned optionally.