从桂枝汤药物规律性组合与其证机相关性探讨证概念内涵

【作者】 郭文娟；

【导师】 烟建华；

【作者基本信息】 北京中医药大学 ， 中医基础理论， 2009， 博士

【摘要】 当前,中医基础理论研究的首要任务,是通过内涵建设,促进中医基础理论总体学术水平的提高。证概念内涵则是中医理论研究的重点之一。证以中医基础理论特别是藏象理论为基础,又指导着中医临床中药(主要是复方)的应用,因此中医证的研究,与中医藏象理论和中药复方作用机理的研究紧密相关,是关系到中医理论发展的关键问题。其中证本质研究又是最主要的攻关对象。自20世纪50年代以来,证本质的研究多途径、多方法进行,但研究结果显示指标的特异性变成了普遍性。问题的暴露,说明这方面有太多的经验教训,更说明证本质的研究首先必须明了证概念的内涵。我们对证概念内涵和证本质的研究进行综述发现,在这两方面虽取得一些进展,但还存在不少问题,尤其是对证概念内涵的认识仍有很大分歧。随着证本质研究的深入,各种问题也接踵而来,概括有:指标的非特异性和缺少相关性;动物模型的局限性;病例对照组设置不合理;病种选择少等。证本质的研究在思路上主要还是运用实体论的还原分析的线性方法,通过实验手段、技术分离和抽象思维对事物系统加以控制,将现象层面芜杂交错的联系剪断,只在现实或思维中留下认识主体所关注的少量事物要素之间的联系,对之加以研究。这种思路和方法对探索宏观层面的概念与整体综合义涵的证,显然是力不从心,难明其理。上述问题的暴露,说明只有正确认识证概念内涵,并在科研思路和技术路线上给予足够的重视,才能更好地认识证本质,并作为研究的突破口,促进中医药学的发展。近来从方证关联研究的角度是值得探讨的方法。我们对方证研究综述发现,现代方证领域的研究主要还是定位在对方或对证的探索上,较少考虑到方与证之间的内在联系。对方剂配伍规律的综述发现,各种方法的研究均在不同程度上作出了贡献,但方剂配伍规律大多局限于单一具体方剂的研究。与过去简单的一方对应一证不同,我们认为经方组方对应证机严密,而证就是病机的诊断用语,关乎病的本质。经方是法因证立,方因法出,药因方配伍加减。其中法即组方思路是方剂学调和关系的体现,是与病机密切相关的,药物经过组合和系统整体的整合形成方剂,对应的是复杂的病机,而病机是人体功能关系失调的综合表现,由此说明方药组合体现纠正功能关系失调。说明对证概念内涵的研究,通过经方药物规律性组合与其证机的相关性研究可当此任。与西医学所用的还原分析的线性方法不同,由于历史条件所限,中医学主要运用的是取象比类的意象思维方法,注重人体内外各部整体的功能关系的联系性,乃是中医学的立论之本。我们提出了注重功能关系探索证内涵研究新思路的认识。桂枝汤为《伤寒杂病论》的“群方之冠”,桂枝汤药物规律性组合与其证机相关的确定性,药物组合应用广泛,是研究的较为理想的对象,所以我们以桂枝汤药物规律性组合与其证机相关性探讨证概念内涵。桂枝汤中含有规律性的药物组合,比如桂枝芍药组合、桂枝甘草组合、芍药甘草组合、桂枝芍药甘草组合、生姜大枣甘草组合等等,这些组合可以用在桂枝汤类方中和由此构成的其他方剂中,基本的药物组合与基本的功能关系失调是对应的,同时由于药物组合之间的剂量比例不同,对应的病机也不同,即量效关系还受到该组合与其他药物整合关系的影响,使得对应复杂的病机,即复杂的功能关系失调。从桂枝汤药物规律性组合与其证机相关性的横向、纵向研究中,我们得出如下结论:1.病机的功能关系失调论决定了组方思路的变化和药物组合的应用,包括药物组合的比例和药味配伍变化。经方是因证论效的。2.病机是功能关系失调单元的动态变化和有机整合,当病机比较复杂,组方思路多元化,通过药物组合的量变和药味配伍变化,发生整合作用产生协同功效或新功效,来调节人体复杂的整体功能关系失调。3.病机的变化,经方组方思路及药物组合的灵动性和演变,体现了方剂调节不同时空状态时人整体功能关系的失调。通过以上研究我们更加清晰地认识到病机的功能关系失调决定了方剂的原理就是调和关系,通过组方思路和药物组合的量变和药味变化发生相互联系达到整体综合作用,最终调节人体整体功能关系失调的,是与证相适应的,是因证论效的,而且体现出随证动态化裁的灵活性。应用这样的方法我们可以举一反三,看到其它经方与其证机的关联性,说明复杂的证是多种功能关系失调的整合,由此旁及证概念的内涵。我们的结论是:证概念内涵具有功能关系性、整体关联性、动态时空性、模型性、多维意象性。概括来说,证概念内涵是人在一定时空状态时多种因素相互作用后,反映出来的人体整体功能关系失调的多维意象动态模型。我们的研究方法、内容与结论,具有较大的应用范围和指导意义:可以端正证本质研究的思路;对方剂配伍规律研究和方证相关研究、药物剂型革新和新产品开发亦具指导意义;同时可以直接指导临床用药。更多还原

【Abstract】 At present,the first and foremost task of the basic theories of Chinese medicine is through the meaning of the construction of basic theories of Chinese medicine to promote the overall improvement of academic standards.Connotation of the concept of Syndrome is the focus of the study of Chinese medicine theory.The concept of Syndrome is based on the theroy of Tcm,especialy on the five zang organs picture theroy and ories Of Chinese medicine and guide the applications of clinical medicine(mainly compound).Therefore,the study of the theroy of sysdrome is related to the study of the five zang organs picture theory and the mechanism of Tcm closely and it is related to the development of chinese medicine theroy of the key issues.The nature of research evidence is the most important research objects.Since the 50’s of the 20th century,study on the sydrome essence is carried out by sub—channels and multi—method.However,results showed that the specificity of indicators into a universal.Exposed of the problem that there are too many lessons,further illustrated the study on the sydrome essence must be definite evidence of the meaning of the concept of sydrome.We reviewed the study on the intension of syndrome conception and sydrome essence and found that researchers benevolent see benevolence,the wise see wisdom,from many different perspectives to discuss the intension of syndrome conception,evidences of the meaning of the concept is of all kinds,dose not suit to facilitate exchanges and to master it.A variety of issues following with the further study on sydrome,summrized:non-specific indicators and the lack of relevance;the limitations of animal models;case-control group sets up unreasonably;kinds of diseases have been chosen few,etc,ldea of the study on sydrome essence is used of the reducible and analytical linear methods.Through this method,system of things is controled by experimental means,separation,and abstract thinking.It shears break the complex staggered relation of phenomena and leaves the link between things of a small number elements in the attention of subjict in the real or thinking,which as its research subjects.This idea and method is insufficient and unequal to the task,because sydrome is a concept of macroscopic and viewing the situation as a whole.These questions show that only the correct understanding of the connotation of the concept of Syndrome and giving enough attention to scientific ideas and technology in line,We can understand the essence of sydrome better and service for its study and the overall level of Chinese medicine.It is worth to be discussed a method from the study relation between formula and syndrome recently.We reviewed the study on the relation between formula and syndrome and found that modern researchs in the field to the compound or sydrome mainly,and taking less account into the filed of the intrinsic link between formula and syndrome.we reviewed the law of compatibility of medicines in prescriptions and found that they had different contribution in a variety of methods to varying degrees,but mostly confined to a single study of a specific prescription.We think that classical prescription is rigorous with sydrome and sydrome is the diagnostic parlance of pathogenesis and it related to disease’s essence.Therapeutic methods set up with the sydrome and the classical prescription composed with the therapeutic methods,chinese medicine plusminus with the classical prescription compatibility. Therapeutic methods is the essence of the Chinese formulae which harmonic the relationship between person and sydrome,and it is based on pathogenesis.Chinese medicine through combination and system holistic integration form prescription,corresponding complexPathogenesis,the pathogenesis is the functional relationship between the imbalance in the body of the integrated performance.This note that compound and chinese medicine combination correct functional relationship between the disorders.That is according to the study on the classical prescription can completed this task of connotation of the concept of sydrome.Different to the reducible and analytical linear methods of morden medicine,due to historical conditions,chinese medicine used the image thinking methods of analogy by classification mainly,it pays attention to the relationship resistance of human internal and external whole function.We have proposed that it is a new idea of study on sydrome connotation to pay attention to functional relationship and it is the base of chinese medicine. The differences between types of associated prescriptions are come into being with the different sydrome,so the study on associated prescriptions is used to explain connotation of sydrome.Cinnamon twig decoction can be applied to a wide range of diseases by plusminus flexibly as long as clinically consistent with the pathogenesis.Therfore,we use regularity drugs combination of cinnamon twig decoction and it’s associated prescriptions posses as a starting point,and combinate of disease theory to study the intension of syndrome conception.After a study found that regularity drugs combination of cinnamon twig decoction such as cassia twig and peony combination,cassia twig and glycyrrhiza combination,peony and glycyrrhiza combination,Cassia twig and peony,glycyrrhiza combination,ginger and jujube, glycyrrhiza combination,etc.these combination can be used in guizhitang and it,s associated prescriptions and other Prescription composed by these combinations.Basic drugs combination corresponds to the basic functional unit of imbalance.Of course,it may be corresponds to the different pathogenesis as a result of the ratio between the different dose between the drug combinations.That is,Dose-effect relationship is affected by the relationship of integration between the combination with other drugs,which makes it to correspond the complexity of the pathogenesis,that is,complexity of relationship of dysfunction.We make such conclusions from the study of the correlation between regularity drugs combination of cinnamon twig decoction and the sydrome mechanism: (1)Pathological mechanism decide the use of regularity drugs combination of cinnamon twig decoction including its quantitative change and medicinal ingredients.The combination’s forms are suit for pathological mechanism.The effect is discussed by sydrome.(2)Several regularity drugs combinations through the combination’s forms to adapt the complicated pathological mechanism and emerge the coordination effect to adjust the relationship of function imbalance of human body in generally.(3)The regularity drugs combinations of cinnamon twig decoction evolute many prescriptions by its quantitative chang and medicinal ingredients through the complicated pathological mechanism,which adjust the different function imbalance of human body in different time and space.Through the above-mentioned study,we recognized more clearly that prescription’s principle is to reconcile the relationship of human body,the effect is discussed by sydrome,tanken integraly,dynamic changed.Further said that it is for pathogenesis,achieved an integrated whole effection through the drug combinations and re-integration process,then regulate the relationship of function imbalance of human body.It is adapt to sydrome and embodied the flexibility of changes with sydrome.We can learn by analogy by application of this method that we can understand the relevance between other classical prescriptions and sydrome and pathogenesis,which evidence that the complex sydrome is the integration of multi-functional disorders.Thus we can concern the connotation of sydrome concept.Our conclusion is that the connotation of sydrome concept has the overall and relatively,function,and dynamics of space-time,model, and multi-dimensional image.In general,"sydrome" is a multi-dimensional dynamic model of imagery under a certain space-time interaction of many factors reflected in the overall functional relationship between the imbalance in the body.Our research methods,content and conclusion have greater application scope and significance:which can correctitude the thought of the study on the essence of sydrome;can guide the study on the law of compatibility of prescription and the correlation of prescription and sydrome,innovative of medicine formulations and new product development;at the same time can guide clinical medication.更多还原