【作者】 马明越；

【导师】 于文明；

【作者基本信息】 南京中医药大学 ， 中医医史文献， 2013， 博士

【摘要】 本文主要研究《伤寒杂病论》小柴胡类方的方证运用规律,研究对象包括小柴胡汤、大柴胡汤、柴胡桂枝汤、柴胡桂枝干姜汤和柴胡加龙骨牡蛎汤等。研究者在探讨《伤寒杂病论》原文涵义的基础上,收集了大量有关小柴胡类方的医案,并分别制订了适合本研究的古代医案和现代医案的纳入标准。其中对于现代医案,还引入了循证医学的思想和方法,拟定了医案证据分级的标准,进一步筛选出证据级别相对较高的现代医案,增加了研究结果的可靠性。经过对所选医案的证候、病名及药物名称进行规范化之后,分别建立古代和现代医案数据库。然后运用统计学方法及数据挖掘的手段,如频数分析、聚类分析、因子分子、关联分析等一系列方法对两个数据库中医案的症状、药物等内容进行分析、研究。挖掘、分析和探讨小柴胡类方剂的证候和用药规律,最后尝试通过各个方证的研究结果推导少阳病的实质。结果显示：1.古今医案中应用小柴胡类方时常会进行药物加味,其目的可以归纳为增强疗效和扩大主治范围两个方面。2.小柴胡类方应用范围较广,可以治疗临床各科多种疾病：小柴胡汤主治外感病、咳嗽、胃脘痛、头晕、头痛、妇科等疾病；大柴胡汤在急腹症、黄疸、胆胀等疾病应用机会较多；柴胡桂枝汤较多地用于治疗身体疼痛、自汗、肩背痛及癫痫、小儿抽搐等疾病；柴胡桂枝干姜汤临床上更多地用于治疗慢性肠炎、慢性肝炎等消化系统疾病；柴胡加龙骨牡蛎汤多用于治疗癫狂、抑郁症、焦虑症、失眠、更年期综合征等多种神经精神疾病。3.小柴胡汤的主证大体包括三项：口苦、咽干；往来寒热；胸满、胁痛。只要具备一项或一项以上主证者,就可以应用小柴胡汤；大柴胡汤的主证是在小柴胡汤主证的基础上加上便干、舌红等症状；柴胡桂枝汤主证是在小柴胡汤主证基础上加上体痛、自汗等症状；柴胡桂枝干姜汤主证是在小柴胡汤主证基础上加上腹泻、腹胀等症状；柴胡加龙骨牡蛎汤主证是在小柴胡汤主证基础上加上心悸、失眠、烦躁、抑郁、焦虑等症状。4.少阳病乃至六经的实质很宽泛,是一个包含脏腑、经络、气化、病机、病位、八纲、症候群等内容,可以从不同角度,不同层次认识的综合概念。更多还原

【Abstract】 This study researches the law of the use of Xiao Chai Hu Prescription paties. The research objects including Xiao Chai Hu Tang, Da Chai Hu Tang,Chai Hu Gui Zhi Tang,Chai Hu Gui Zhi Gan Jiang Tang and Chai Hu Jia Long Gu Mu Li Tang. On the basis of exploring the original meaning of the "Febrile Diseases", The researchers collected ancient and modern medical cases. With the ideas and methods of evidence-based medicine, Associated databases are established, by using statistical methods and data mining tools, such as frequency analysis, cluster analysis, factor molecules, correlation analysis, a series of ancient and modern two databases medical case symptoms, drug content analysis research. The researchers analysised and explored the Bupleurum class Formula syndromes and drug law, and ultimately by the findings of each square card deduced the substance of Shao yang disease.The results show:1.In ancient and modern medical cases, the application Chai Hu Prescription paties flavored drugs are designed to adapt to the needs of the disease. Its purpose can be summarized as enhance the efficacy and expand attending the scope;2.The Chai Hu Prescription paties have a wider range of application and can treat a variety of diseases. Xiao Chai Hu Tang can treat cold, cough, epigastric pain, dizziness, headache, gynecological and other diseases; Da Chai Hu Tang can treat diseases such as acute abdomen, jaundice, gall bladder swelling;Chai Hu G ui Zhi Tang is used to treat body aches, spontaneous, shoulder pain and other disease and epilepsy, infantile convulsions; treatment of bloating, chronic hepatitis, Chai Hu Gui Zhi Gan Jiang Tang can treat diarrhea and other digestive diseases; Chai Hu Jia Long Gu Mu Li Tang can treat mania, depression, anxiety, insomnia, menopausal syndrome and other neuropsychiatric diseases.3. Xiao Chai Hu Tang master card generally includes three groups:bitter mouth, throat; chills and fever; chest full hypochondriac. Along with at least one group or more one group of symptoms is the best standard of Xiao Chai Hu Tang; Da Chai Hu Tang master card is on the basis of the main card of Xiao Chai Hu Tang plus they dry, red tongue symptoms; Chai Hu Gui Zhi Tang master card is on the basis of the main card of Xiao Chai Hu Tang plus body pain, spontaneous symptoms; Chai Hu Gui Zhi Gan Jiang Tang master card is on the basis of the main card of Xiao Chai Hu Tang plus diarrhea, bloating symptoms; Chai Hu Jia Long Gu Mu Li Tang master card is on the basis of the main card of Xiao Chai Hu Tang plus heart palpitations, insomnia, irritability, depression, anxiety symptoms symptoms.4. The substance of Shaoyang disease even liu Jing, contained organs, meridians, gasification, disease, disease location, eight principal symptoms, is a comprehensive concept.更多还原