【作者】 金海浩；

【导师】 孙世发；

【作者基本信息】 南京中医药大学 ， 方剂学， 2011， 博士

【摘要】 本论文的研究范围包括培土生金法、金水相生法、滋水涵木法、益火补土法等间接补法,统称为五行相生间接补法。收集用以上治法治疗的古代医案817例,主要应用粗糙集重要度分析、数据关联挖掘和因子分析等方法进行研究,结果如下。培土生金法治疗的主要症候以有痰、气短喘促、纳差、咳血咯血、便溏泄泻、乏力、咳嗽,脉虚、软、细、数为其表现,病机上包括肺脾气虚、肺胃阴虚和肺脾(胃)阳虚等方面(其中,肺脾气虚是主要方面)。用药上,茯苓、陈皮、白术、人参、黄芪、麦冬、半夏、甘草、五味子、杏仁、大枣、贝母、山药、当归、党参、白芍、生姜等药物的重要度超过0.6。药物归经上,基本以肺、脾经为主(在最主要因子f1中,肺经的载荷是0.950,脾经载荷是0.919,两经因子载荷基本接近)。本法使用时常配合辛开理气化痰之品,补而不腻,祛邪而不伤气。金水相生法治疗的症候以咳嗽、喘促、有痰、咳血咯血、舌红无苔或燥或黄、脉细数为主要表现,病机上以肺肾阴虚为主。用药上,麦冬、山药、茯苓、贝母、陈皮、熟地、甘草、五味子、生地、沙参、山茱萸、牡丹皮、杏仁、牛膝、当归等的重要度超过0.6,药物归经上,肾经载荷(0.952)高于肺经载荷(0.775)。本法应用时应注重先天之本肾,滋肾以补肺(即水生金),滋肾养肾处于核心地位。滋水涵木法：头晕和视物不清是滋水涵木法应用的最主要症状,弦、细、数脉等是最主要脉象,同时常伴有虚、软等虚损不足的脉象。使用药物上,熟地、白芍、麦冬、当归、生地、菊花、茯神、牡蛎、枸杞子、山茱萸、茯苓、牡丹皮、山药、五味子、阿胶、酸枣仁、牛膝、石斛、石决明、龟板等的重要度超过0.6。从用药归经看肾经载荷0.892,肝经载荷0.891,肾经载荷略高于肝经。益火补土法治疗的症候以泄泻、腹胀痞满、腹痛、纳差、呕吐恶心、舌淡红、苔白或腻、脉细、沉、虚、大、微为主要表现。病机上,属于脾肾阳虚或心脾阳虚或脾气(阳)虚。治疗上,以温补命门以生脾土为主,但也包括补心火以温脾土,但后者并不占主导地位。茯苓、白术、附子、肉桂、山药、人参、熟地、甘草、陈皮、山茱萸、炮姜等是其高重要度药物(重要度超过0.6)。归经上,脾经因子重要性>肾经因子重要性>心经因子重要性。在粗糙集和因子分析基础上,以五行相生法为一个整体,分析症候、药物、治法之间的支持度、作用度和双关联置信度,即分析症(?)药关联、药(?)药关联、药(?)法,深入研究五行相生法用药的内在机理。根据症(?)药的作用度大于1的原则,研究常用药物与症状之间相关性。发现与药物正相关的症状大部分是药物自身功效范围内的症状,但也有一部分正相关的症状是与药物自身功效无关的所累及的母脏或子脏的间接症状。符合药(?)药双向强关联规则的药对组合中,综合归经以肾经和脾经为主,在肾经(或脾经)药物与非肾经(或脾经)药物的配伍中,肾、脾经药物处于主导地位(处在主导地位的药物置信度低)。从症状与药对之间关联来看,与药对自身功效直接对应的高置信度症候比单味药增多,而间接对应症候减少。母病及子或子病及母出现的相关脏腑同时受损的症候表现和病机是使用五行相生间接补法的依据。多味药组的药物间强关联规则分析结果表明,肾经和脾经药物的置信度比其他药物低,处在主导地位。根据药(?)药双向强关联分析得出两个基本方,一个是补肾的基础方剂——六味地黄丸,另一个是健脾益气基本方剂——异功散。药物(?)治法的关联规则分析结果与粗糙集的重要度分析结果基本接近。从五行相生法各主要脏腑的常用剂量分布看,肾经一般在32.79g-38.02g之间,脾经一般在30.99-35.10g之间,肺经一般在20.87g-24.09g之间,心经一般在15.48g-18.81g之间,肝经一般在20.08g-23.03g之间,胃经一般在15.48g-18.81g之间,肾经和脾经用量多于其他各经。One Way ANOVA—SNK法进行各经药量的均数间比较结果,肾经和脾经药量与其他各经有显著性差异(P<0.01),而肾经和脾经两者之间并无显著性差异。主成分因子分析结果,重要性最高的因子f1中归肾经药物的载荷是0.882,高于其他归经药物的载荷；第二成分因子f2中归脾经药物的载荷是0.808,高于其他归经的药物,说明肾和脾是五行相生法补益的核心脏腑。粗糙集理论和数据关联分析方法是方剂治法中数据分析的有效方法,可以分析模糊的、边界域不清的、潜在的数据资料。因子分析研究原始变量的内部关系,简化原变量的协方差结构,分析变量中存在的复杂关系。数据挖掘和分析结果显示,应用五行相生间接补法,我们必须遵循两大原则：一是根据母病及子或子病及母的相关脏腑表现和病机来确定治法和选择用药；二是不管用哪种五行相生法,都应注重补益先天之本——肾和后天之本——脾,这也是其他补益方法应该遵循的原则。人体是五脏为中心的有机体,各个脏腑自身的功能和五脏之间的生理、病理关系是应用五行相生法的物质基础。五行理论是哲学理论,我们可以用它去阐释脏腑功能特性和相互间关系,也可以从中得到某种启发,但不可用定格化的五行生克理论去套脏腑关系。更多还原

【Abstract】 This papers studies the indirect tonifications of promotion among five elements which include the methods of reinforcing earth to strengthen metal, mutual promotion of metal and water, replenishing water to nourish wood and assisting fire to strengthen earth.817 ancient medical cases using the treatment above were analyzed with the methods of rough association rule, data mining and association and factor analysis, the following was the results.The main clinical manifestations of the method of reinforcing earth to strengthen metal include expectoration of sputum, shortness of breath, breathlessness, anorexia, hemoptysis, loose stools, diarrhea, lassitude, cough, deficient or soft or thready or rapid pulse. Spleen-lung qi deficiency, lung-stomach yin deficiency and lung (spleen)-stomach yang deficiency are the main pathomechanism. On the medication, Fu Ling, Chen Pi, Bai Zhu, Ren Shen, Huang Qi, Mai Dong, Ban Xia, Gan Cao, Wu Wei Zi, Xing Ren, Da Zao, Bei Mu, Shan Yao, Dang Gui, Dang Shen, Bai Shao and Sheng Jiang have the higher importance, which exceed 0.6, the lung meridian, spleen meridian and stomach meridian are the main meridian tropism (the ratio of their factor loading close to 1:1.). The method is often accompanied by the Chinese herbs of pungent-dispersing,qi-regulation and phlegm-resolving, achieving the purpose of "tonifying but not greasy, dispeling the pathogen but not hurting qi.’The main clinical symptoms of the method of mutual promotion of metal and water include cough, breathlessness, expectoration of sputum, hemoptysis, red tongue without coating, or dry or yellow, thready rapid pulse, the lung-kidney yin deficiency is the main pathomechanism. Tonifying the kidney to nourish the lung is the main aspects of the method of mutual promotion of metal and water, far more than nourishing the lung to tonifying the kidney. On the medication, Mai Dong, Shan Yao, Fu Ling, Bei Mu, Chen Pi, Shu Di, Gan Cao, Wu Wei Zi, Sheng Di, Sha Shen, Shan Zhu Yu, Mu Dan Pi, Xing Ren, Niu Xi and Dang Gui have the higher importance, which exceed 0.6, the factor loading of kidney meridian (0.952) is higher than that of lung meridian (0.775) on the meridian tropism. It should be attached importance to the-root-of-innateness-kidney, tonifying the kidney to nourish the lung, tonifying the kidney is the core of this method.The method of replenishing water to nourish wood:dizziness and blurred vision are the most common symptoms, wiry,thready and rapid pulse are the most common pulse, which often accompanied by some kinds of wasting less pulse. On the medication, Shu Di, Bai Shao, Mai Dong, Dang Gui Sheng Di, Ju Hua, Fu Shen, Mu Li, Gou Qi Zi, Shan Zhu Yu, Fu Ling, Mu Dan Pi, Shan Yao, Wu Wei Zi, E Jiao, Suan Zao Ren, Niu Xi, Shi Hu, Shi Jue Ming and Gui Ban have the importance of exceeding 0.6. From the meridian tropism, the factor loading of kidney meridian (0.892) is equal to that of liver meridian (0.891) basically.The main clinical manifestations of the method of assisting fire to strengthen earth include diarrhea, abdominal distension or fullness, abdominal pain, anorexia, vomiting, nausea, pink tongue, white or greasy coating, thready, deep, deficient, large or faint pulse. The main pathomechanism is spleen-kidney yang deficiency or heart-spleen yang deficiency or spleen qi (yang) deficiency.The therapeutic methods lie in mainly warming and tonifying life gate to promote spleen-earth, while the method of tonifying heart-fire to warm spleen-earth is also used, which does not occupy a dominant position. Fu Ling, Bai Zhu, Fu Zi, Rou Gui, Shan Yao, Ren Shen, Shu Di, Gan Cao, Chen Pi, Shan Zhu Yu and Pao Jiang have the higher importance (the importance exceed 0.6). On the meridian tropism, the descending order of the factor loading is: spleen meridian>kidney meridian>Heart meridian.Based on the rough set and factor analysis, the double support, confidence and lift between symptom, drug and therapy of the indirect tonifications of promotion among five elements were discussed as a whole, namely analyze the association between symptom and drug, drug and drug, drug and therapy, and study the internal mechanism of the drug compatibility of the indirect tonifications of promotion among five elements.According to the principle of lift between symptom and drug above 1, the correlation between symptom and drug of the drugs used commonly showed that most of the symptoms were associated with the effect of dugs themselves, while some symptoms were not, they belong to the organs which are involved. In the drug combination which correspond to the principle of strong association between drug and drug, the kidney meridian and spleen meridian lead primarily from the meridian tropism. The dugs whose meridians were kidney (or spleen) were dominant when they compatible with the drugs whose meridians were not kidney (or spleen) (the drugs in the dominant position have the low confidence). The high-confidence symptoms which were directly associated with the effects of drugs were more than single herbs, the symptoms indirectly associated with the drugs were less. The symptom and pathogenesis that the organs involved in the case of involvement of the child by its mother or involvement of the mother by its child damaged simultaneously are the basis of the indirect tonifications of promotion among five elements.The results of the analysis of the strong association between groups of multiherb showed that the confidence of drugs of kidney meridian and spleen meridian was lower than that of other meridian, from the results we can get Liu Wei Di Huang Wan as the basic recipe of tonifying the kidney and Yi Gong San as the basic recipe of tonifying the spleen.The results of analysis of strong association between drug and therapy were close to that of the rough set.The distribution of usual dosage of the main organs involved in the indirect tonifications of promotion among five elements showed that, the kidney meridian is 32.79g～38.02g, the spleen meridian is 30.99～35.10g, the lung meridian is 20.87g～24.09g, the heart meridian is 15.48g-18.81g, the live meridian is 20.08g～23.03g, the stomach meridian is 15.48g～18.81g, the dosage of the kidney and spleen meridians were more than that of the other. Comparing the mean of the dosage of each meridian with One Way ANOVA-SNK method, it showed that the kidney and spleen meridians are significantly different from the other organs, while there was no significant difference between kidney and spleen. The analysis of principal component factor showed that, in the fl factor the drug loading of the kidney meridian was 0.882, which was higher than that of the other meridians, in the f2 factor the drug loading of the spleen meridian was the highest in the organs, which was 0.80, this showed the kidney and spleen were the core organs in the indirect tonifications of promotion among five elements.The rough set theory and association data analysis were effective methods in the data analysis of prescription treatment, which could analyze the information and data of ambiguous, unclear boundary and potential. The results indicated that two principles must be followed when we apply the indirect tonifications of promotion among five elements:firstly, the choice of drugs and therapies should be according to the pathogenesis and performance of the organs involved in the involvement of the child by its mother and the involvement of the mother by its child; Secondly, no matter what method we use, it should be payed attention to the kidney which is the root-of-acquirement and the spleen which is the root-of-innateness, and it is also the principle of other replenishing methods.The human body is an organism with the five-zang as the center, the functions of each organ and relationship between physiology and pathology of five-zang are the material basis of the application of the indirect tonifications of promotion among five elements. The theory of the Five Elements is philosophy, it can be used to illustrate the function of the organs and the relationship among them, we can also gain some inspiration from the theory, but it is not good to explain the mechanical relationship between the organs with the theory mechanically.更多还原