【作者】 张亮亮；

【导师】 黄煌；

【作者基本信息】 南京中医药大学 ， 临床中药学， 2009， 博士

【摘要】 目的:通过对桂枝茯苓丸历代文献的收集整理,揭示桂枝茯苓丸的应用规律,并对其现代方证作出归纳和提炼。方法:在充分占有资料的基础上,对相关资料文献进行归类,分为方剂类文献、方论类文献、药理及实验研究类文献、医案类文献及临床观察类文献,根据不同的文献类型和特点选取不同方法提取相关信息。其中前三类文献采用传统的文义解读,对比分析法,后两类文献采用数据统计的方法。分别对古代,国内,日本及黄煌教授应用桂枝茯苓丸的经验从疾病谱-适应人群体质特征-典型指征三方面进行归纳。通过以上结论的横向对比,进行补充和取舍,归纳出更为完善,临床指导意义更明确及表述更规范的桂枝茯苓丸方证。结果:1)通过文献统计与分析,对不同时代的桂枝茯苓丸方证进行了归纳;2)结合时代背景、学术背景对上述方证的形成原因和决定因素进行了分析;3)通过历代方证之间的对比与综合,归纳出完善而规范的桂枝茯苓丸方证;4)对桂枝茯苓丸临床使用的相关问题,如方证鉴别,药物基原、剂量、剂型和使用禁忌等进行了探讨。结论:1.对桂枝茯苓丸方证从典型指征、患者体质状态和疾病谱三方面做如下表述,1)典型指征为“气上冲、少腹急结、肌肤甲错”,气上冲包括一系列望诊可见的面部表现及患者自觉地精神神经系统表现,望诊可见面部脸红、面部潮红:或脸色发暗:或面部或鼻翼毛细血管扩张,面部皮肤粗糙,或见脱发、痤疮;精神神经系统表现如烦躁、焦虑、失眠、头痛、头晕、心悸、肩颈拘急、口渴不欲饮等;少腹急结包括患者自觉的下腹各种疼痛,如隐痛、冷痛、刺痛、胀痛、经期腹痛等;也包括医生临床诊察所得腹肌抵抗、肿块、硬结、压痛等,按照日本医家经验,压痛或抵抗出现于左侧时,诊断意义更大;肌肤甲错包括皮肤色暗、干燥、瘙痒、脱屑、静脉曲张、青筋浮露;或小腿易抽筋;或膝盖以下发凉,易生冻疮等。2)桂桂枝茯苓丸体质:女性以育龄期及更年期为主,男性以60岁以上老年男性多见,体型中等或壮实,肌肉坚紧,脸色红、暗红或潮红,或面部毛细血管扩张、面部色斑,痤疮,口唇暗红;情绪不稳定,易于焦虑烦躁,常伴见头痛、眩晕、失眠、健忘等精神神经系统表现;或自觉面部发热感,胸痛、胸闷、心悸、腰酸、腰痛、小腹坠胀疼痛等躯体症状;皮肤干燥或起鳞屑,尤其以下肢为明显,下肢常冰冷,易生冻疮、易抽筋。女性常有月经不调,痛经,经期推迟、闭经、或月经量少、经色紫暗、夹血块;腹部充实,腹壁较紧张,下腹部按之多有抵抗、压痛,以左下腹更为常见,大便多秘结。3)主治疾病谱:对桂枝茯苓丸的主治疾病谱进行分析,从病理生理学角度归纳,主要用于以下几类疾病,产科及妇产科术后疾病、妇产科疾病、增生性包块疾病、闭合腔炎症性疾病、循环及血管性疾病、内分泌及代谢疾病、植物神经功能紊症候群、眼科疾病和皮肤科的某些疾病。2.相关问题:桂枝茯苓丸中“桂”以肉桂为佳,芍药以“赤芍”为佳;剂型上,推荐使用蜜丸剂,可根据实际情况进行适当调整。一般使用中等剂量,作为体质调理可小量常服。在习惯性流产、先兆流产、稽留流产等情况不推荐使用,或在医生指导下服用,在产科及妇产术后可对病用药,但中病即止,不可长服。更多还原

【Abstract】 Objective: Assemble and sort literature on Guizhi-Fuling Pill in successive dynasties so as to reveal its regular application pattern and to induce and extract its contemporary indications and symptoms.Methods: Take thoroughly possession of relevant documents, which could be classified into five types such as prescription, discussion on prescription, pharmacological and empirical study, medical record and clinical observation and draw out information accordingly. Pairing method was adopted to analyze the first three types of documents while statistical method to the others. The experience of using Guizhi-Fuling Pill in ancient times was summed up in three ways, namely spectrum of disease, constitution of patients in point and typical indication. So did the domestic experience, experience in Japan and the individual experience from the clinical practice of Professor Huang Huang respectively.Results: 1. The indications and symptoms of Guizhi-Fuling Pill both in ancient times and up to date were concluded by document statistics and analysis. 2. Considering epoch and academic background, the reasons of coming into being and determinative factors of the indications and symptoms mentioned above were analyzed. 3. Consummate and systematic indications and symptoms of Guizhi-Fuling Pill were induced through contrasting and synthesizing the indications and symptoms in past dynasties. 4. Discussions were made on clinical use of Guizhi-Fuling Pill, for instance, symptom diccrimination, herb gesus, dosage, form and taboo.Conclusions: 1. main spectrum of disease: pathophysiologically, Guzhi-Fulin pill could be primarily used for the following diseases, including diseases in obstetrics, post-operation diseases in gynecology, hyperplasia lump, inflammation in close cavity, circular and vascular disease, endocrine and metabolic disease, abnormal syndrome of autonomic nerve, ophthalmological disease and some certain diseases in dermatology. 2. Constitutions: child-bearing and climacteric period mainly for female, above 60 years old for male. The patients are usually moderate size, have firm and tight muscle, red or dark red face. Rubeosis angiotelectasis or colored spot can be seen on the face. Patients are self conscious of heat sensation, having dark red oral lips; instable emotion and liable of dysphoria and agitated, often in company with headache, vertigo, insomnia, morbid forgetfulness and other symptoms in psychological and nervous system; or having pectoralgia, chest distress, palpitation, sore waist, lumbago, lower abdomen pain and other symptoms of body; asteatosis cutis, scaling, especially on the lower limbs, feeling frosty in the lower limbs. women patients usually have irregular menstruation, algomenorrhea, menstruation delay, amenorrhea or low menstrual blood volume, dark violet menstruation, blood clot; repletion, tense abdominal wall, counteract when palpated, tenderness, especially common in left lower quadrant, dry and hard stool. 3. Typical indications: face indications, abdomen indications and leg indications. Face indications include a series of face, head and psychological and nervous symptoms, such as blush, rubeosis, or dark face, angiotelectasis on the face or wings of nose, coarse facial skin, or alopecie, acne; or accompanied by agitation, dysphoria, insomnia, headache, dizzy, palpitation, contracture in shoulder and neck, thirsty but not wanting to drink and so on. Abdomen indications include self-conscious pain in the lower abdomen, such as vague pain, crymodynia, pricking pain, gas pain, menstruation pain and so on. They also include symptoms that can be observed by doctors, such as counteract, lump, induration, tenderness and etc. According to experience of Japanese doctors, tenderness and counteract appearing on the left have more significance when diagnosing. Leg indications include dark skin on the lower limbs, dry skin, pruritus, desquamation, varication, floating and exposed bluish tendon; liable to leg convulsion, feeling chilly below knees or frostbit and so on.更多还原