【作者】 许爱华；

【导师】 樊巧玲；

【作者基本信息】 南京中医药大学 ， 方剂学， 2009， 博士

【摘要】 枳实与枳壳是中医临床十分常用的二味理气药,它们之间渊源颇深。枳实为芸香科植物酸橙及其栽培变种或甜橙的干燥幼果。枳壳为芸香科植物酸橙及其栽培变种接近成熟的果实。在魏晋之前枳壳以枳实之名存在,在此之后逐渐从枳实中独立出来,并逐渐发展,南北朝开始有了枳壳之名的记载,唐之后收集到的含枳壳方剂开始超过枳实。但在现代研究的资料中出现了一种怪现象:枳壳在临床常用,但枳实在成分、药理、配伍规律等方面的研究较多,比如说与枳实不常用的配伍槐花、木莲、木瓜等都有资料记载,而与枳壳配伍十分常用的人参、当归、大黄等,有关它们配伍的各种研究却很少。为了能正确认识枳实与枳壳之间有何异同,有必要对枳实和枳壳进行系统的比较研究,以矫正对枳实和枳壳的错误认识,使理论研究能适应临床的需要。本文的研究以《中医方剂大辞典》为依据,收集含有枳实或者枳壳的方剂。根据选方标准,对收集的方剂进行筛选,用Access建立原始数据库,利用Access的查询功能,采用归类统计的方法进行数据统计分析,从历史时期的分布、剂型、用法、配伍药类和配伍药物等几个方面,对含枳实或枳壳的历代有方名的方剂进行了研究,总结分析枳实和枳壳的配伍应用规律,比较枳实与枳壳的配伍规律异同。《中医方剂大辞典》收录的方剂有96592首,其中含有枳实或者枳壳的方剂共计6724首,占全书方剂总数的6.96%,足见二药方剂配伍应用之广泛。通过对收集资料的研究分析,可以看出枳实与枳壳在配伍应用上有很多相似之处,也存在着不少差异。从枳实和枳壳在各个历史时期的分布来看,有关枳壳的方剂记载,在唐代才有少量出现。这一结论进一步证明“在魏晋之前,枳壳以枳实之名存在,在此之后才慢慢有了枳壳之名并逐渐发展,唐之后被医家大量使用并记载下来。对于枳实和枳壳在配伍,从药物类别上讲,与枳实或者枳壳配伍的药物类别几乎没有差别,但是不同的药物类别与枳实或枳壳的配伍侧重点不同。从药物种类上讲也是一样,只是有少量药物只偏向于与枳实和枳壳中的一种配伍应用。通过对各类药物的引用频率进行比较可知,理气药、温理药、泻下药(攻下药)、利水渗湿药(利水消肿药)、消食药和化湿药与枳实配伍比与枳壳配伍常用。活血化瘀药(活血止痛药)和驱虫药与枳壳配伍比与枳实配伍常用。化痰止咳平喘药中只有清化热痰药和温化寒痰药常与枳实或枳壳配伍应用,且与枳实配伍要比与枳壳配伍常用;对于枳实的配伍,温化寒痰药要比清化热痰药常用,但是枳壳则刚好相反。清热药中,清热燥湿药是使用最多的配伍,且与枳实配伍应用比与枳壳配伍常用;但清热凉血药只偏向于与枳壳配伍,清热泻火药只偏向于与枳实配伍。在解表药中,与枳实配伍的只有发散风热药,发散风寒药和发散风热药都与枳壳有配伍应用,且发散风寒药比发散风热药常用,无论从哪方面讲,解表药都偏向于与枳壳配伍应用。补虚药中的补气药和补血药是与枳实和枳壳最常用的配伍,其中补气药偏向于与枳实配伍应用,补血药却偏向于与枳壳配伍。根据药物的引用频率,对与枳实或枳壳配伍的药物进行比较可知,肉桂与枳实和枳壳的配伍没有偏向。陈皮、茯苓、半夏、白术、大黄、人参、厚朴、黄芩、白芍药、黄连与枳实配伍比与枳壳配伍常用。木香、当归、槟榔、桔梗、柴胡、川芎、前胡与枳壳配伍比与枳实配伍常用。栀子、青皮、山楂只偏向于与枳实配伍,防风、羌活、赤芍、黄芪只偏向于与枳壳配伍应用。从这些配伍中可以发现有些配伍值得进一步研究,比如说槟榔与枳实或枳壳的配伍。与枳壳配伍的驱虫药有6种,槟榔出现的频率高达94.83%,与枳实配伍的驱虫药有5种,槟榔出现的频率高达89.19%,槟榔在驱虫药中独树一帜,并且在所有的配伍药物中与枳实配伍居第14位,与枳壳配伍居第7位,可以推测其配伍必有重要意义。类似的配伍还有大黄与枳实或枳壳的配伍,厚朴与枳实的配伍,茯苓与枳实或枳壳配伍等等。更多还原

【Abstract】 Zhishi and Zhiqiao are two traditional Chinese medicine which are used widely in clinic. Zhishi is the immature fruit of Citrus aurantium L. and its cultivated varieties or Citrus sinensis Osbeck, family Rutaceae. The fallen fruits are collected between May and June. Zhiqiao is the dried immature fruit of Citrus aruantium L. and its cultivated varieties,with pulp removed. The raw or stir-baked with bran can be used for medication. Before Wei -Jin Dynasties,the name of Zhiqiao did not exist. After Wei-Jin Dynasties,Zhiqiao developed gradually. After Tang Dynasty,the number of Zhiqiao was more than Zhishi. The strange phenomenon cames. Zhiqiao is in common use in clinic,but the research of Zhishi in composition and formulating rules should be delt with more.For example,we can find the information of Zhishi,but we can not find that of Zhiqiao. It must find the diffirence of Zhishi and Zhiqiao.The formulas containing Zhishi or Zhiqiao were collected according to《Formula Dictionary of Traditional Chinese Medicine》.Set up data base with ACCESS,use filtrated tools in it,and adopt statistic methods of classfication to sum up the factors that influence the oriented exertions of Zhishi and Zhiqiao in complex prescriptions.There are 96592 piece of formulas in《Formula Dictionary of Traditional Chinese Medicine》.6724 pieces of formulae that all respectively contain Zhishi or Zhiqiao,and the percent of it is 6.96%. We can find that they are used widely and differently from the number.There are tonics、cough and dyspnea-relieving medicinal、heat-clearing medicinal and qi-regulating medicinal which are used with Zhishi widely according to adding frequency> 50%.Qi Tonics,one sort of tonics,is the most important;cold phlegm-resolving medicinal,one sort of cough and dyspnea-relieving medicinal,is the most important;heat-clearing and dampness-drying medicinal,the sort of heat-clearing medicinal,is the most important; There are tonics、superficies-releasing medicinal、cough and dyspnea-relieving medicinal、heat-clearing medicinal and which are used with Zhiqiao widely according to adding frequency) 50%.Qi Tonics,one sort of tonics,is the most important;cold phlegm-resolving medicinal,one sort of cough and dyspnea-relieving medicinal,is the most important;heat-clearing and dampness-drying medicinal,the sort of heat-clearing medicinal,is the most important;with-cold-dispersing medicinal,the sort of superficied-releasing medicinal,is the most important.The traditional Chinese medicines which are used with Zhishi are Chenpi、Filling、Banxia、 Dahuang、Renshen、Houpu、Huangqin、Muxiang、Rougui that site the former ten. The traditional Chinese medicines which are used with Zhiqiao are Fuling、Danggui、Chenpi、Renshen、Muxiang、Dahuang、Binlang、Baizhu、Rougui、Chuanxiong that site the former ten.更多还原