小建中汤方证与应用的文献研究

【作者】 黄濬承；

【导师】 王新佩；

【作者基本信息】 北京中医药大学 ， 中医临床基础， 2012， 硕士

【摘要】 小建中汤是经方中建中法的代表方剂,在《伤寒论》和《金匮要略》中,主要被用于脾胃虚弱引起的各类病症的治疗。由小建中汤演化出的黄芪建中汤和当归建中汤更是广为流传,这三个建中汤被历代医家广泛的应用于临床各科疾病的治疗中。研究目的：通过对小建中汤的古今文献进行整理分析,总结并分析其临床应用的特点、治疗疾病的种类、组方依据、药物组分等,试图发现其临床应用规律和作用起效物质基础,以期待为临床应用提供一定佐证。研究内容：临床方面综述了其临床应用的疾病种类和加减应用情况,综述了其在消化系统疾患、呼吸系统疾患、妇科、儿科病、老年病及血液系统疾患等的应用及与其他疗法结合的加减应用情况。机制研究方面综述了小建中汤治疗各个系统相关疾患的作用机制和环节,通过相关研究,揭示其起效的环节和靶点。药物组分方面,对于采用各种药理学手段进行的化学组分研究进行总结,揭示其起效的物质基础和药物化学组分之间的相互作用。通过借用统计学方法,对于临床治疗疾患种类和治疗药物使用频次进行分析总结。研究结果：1.小建中汤的应用主要集中在临床病例观察和治疗脾胃疾病等相关机制研究,也有部分文献关于组分研究的,但是相对于目前的临床报道,这部分内容相对较少。2.小建中汤除了主要应用于治疗脾胃系统疾病和呼吸系统疾病。同时还可以治疗血液系统系统疾患、妇科、儿科和老年病的相关疾患,对于肿瘤、外伤等也有一定的应用价值。其临床应用范围已经大大拓宽,不仅仅局限于腹痛的治疗。3.通过分析发现,现在临床应用小建中汤治疗疾患,除了单纯应用外,大多都结合其他方药进行加减应用,而且也不局限于单纯方药加减,还结合了针灸、按摩等其他疗法多种应用。4.小建中汤作用机制的研究方面,主要集中于调节免疫、针对消化道粘膜影响的机制的探讨,研究结果提示其调节免疫、修复消化道粘膜的作用与其促进机体特异性和非特异性免疫系统、修复胃肠道粘膜、促进胃肠排空的功能有关。5.从药物的使用频次统计结果来看,小建中汤组方中有五味药物均居于前列,其他加减药物则以健脾、益气、养阴、活血等为主。结论：1.通过古代现今文献的整理,我们发现,目前对小建中汤的运用：一是严格遵循《伤寒论》和《金匮要略》原文论述的证候要点进行运用；二是根据建中法的原则和思路,通过加减化裁灵活运用进而扩大其应用范围。2.组方规律：小建中汤的立法旨在调和气血,建顾中气,通过平衡阴阳达到中焦气机调达的作用,进而恢复脾胃功能,生化气血,滋养四旁,通过脾胃功能的恢复达到调和脏腑气机,平衡脏腑阴阳的作用。这种补益而不滋腻、调中以运四旁的制方思路和治疗思路,为后世补土学派的发展奠定了坚实的基础,同时也为其治疗开创了新的思路。3.从使用频次及临床加减应用情况上可以发现,小建中汤的组方、配伍药物相对稳定,历代应用均是在原方的基础上,进行加减化裁或者与其它治疗方案联合应用是小建中汤临床应用的基本思路,也是保证临床疗效的重要因素之一4.现代机理研究结果表明,小建中汤可促进机体特异性和非特异性免疫系统；缓解实验小鼠为黏膜炎症,减轻炎症细胞的浸润；促进模型小鼠胃排空,推进其小肠运动,促进其肠壁结构恢复；延缓胃衰老等作用。5.适合小建中汤应用的常见症状为：乏力、胃痛(腹痛)、纳差、便溏(腹泻)、畏寒肢冷、头晕、自汗、发热、心悸、咳嗽。以舌淡、苔薄白和虚弱性脉象为主要表现。而其主治范畴以虚劳和脾胃系统疾病为主。虽然历经千年,但其应用范围仍然跳不出仲景应用的范围：外感、腹痛、虚劳和黄疸。更多还原

【Abstract】 Xiao Jian Zhong Tang Decoction is under construction representative of theZhang zhongjing, prescription by prescription, in the "Shang han lun" and "Jin kui yao lue", mainly for the treatment of the spleen and stomach caused by various diseases. Astragalus Decoction and Xiao Jian Zhong Tang evolved Angelica Decoction widely circulated, three Jianzhong Tang Decoction ancient physicians widely used in the treatment of diseases of the clinical subjects.ObjectiveThis article through to the ancient and modern literature analysis of Xiao jian zhong tang Decoction, this paper summarizes and analyzes the characteristics of its clinical application, the type of disease, choice of basis, such as drug components, trying to find its clinical application rules and function effect to material foundation, to look forward to provide certain evidence for clinical application.Contents and MethodsClinical summarized the clinical application of disease types and application and their application. Summarized in the digestive system disorders, respiratory disorders, gynecological, pediatric, geriatric and blood system combined with the application and the sum of the application.Mechanism research reviewed the Xiao jian zhong tang Decoction in the treatment of mental system disease, through the related research, reveals the effect to link and targets. Prescription components, for the various means of chemical components of pharmacology study summarized, reveals the effect to the material basis of chemical composition and drug interactions.Through the use statistical methods, for the clinical treatment of disease types and treatment drug use frequency are analyzed and summarized.Results1. The document Xiao Jian Zhong Tang Decoction application focused research in the mechanisms of observation and treatment of clinical cases of stomach diseases, calm and related mechanism research, also had the part of literature research about components, but compared with the current clinical reports, this section is relatively rare.2. Xiao Jian Zhong Tang Decoction addition to the main used in the treatment of stomach diseases and respiratory diseases. Can also treat the blood system system disorders, gynecological, pediatric and geriatric disorders, tumors, trauma, with a certain value. Its clinical application has been greatly expanded, not limited to the town of abdominal pain treatment.3. Through the analysis found that, now clinical application Xiao Jian Zhong Tang Decoction treatment disease, in addition to use application Suan-Zao-Ren Decoction, most clinical are combined with other herbs to add and subtract application, and is not limited to add and subtract simple formulae, combined with acupuncture and moxibustion, massage, and other therapy many applications.4. Xiao Jian Zhong Tang Decoction mechanisms of research, mainly focused on the regulation of the immune mechanism of the influence of the gastrointestinal mucosa, the results suggest that the regulation of immune and repair of gastrointestinal mucosa and its promotion of body specificity and non-specific immune system, repairgastrointestinal mucosa, and promote to the function of the gastrointestinal emptying.5. From drug use frequency statistics result, Xiao Jian Zhong Tang Decoction five square gout drug is located in the top five, and other drug astragalus focused on fill gas, big jujube focused on blood, It may also conforms to the cube of Xiao Jian Zhong Tang Decoction intended.Conclusions1. The ancient documents from the sorting of results can be seen, and now the use of Xiao Jian Zhong Tang Decoction basically based on two ideas to launch, one is strictly according to the synopsis of "Shang Han Lun"and "Jin Kui Yao Lue" for clinical use; Two is based on Suan-Zao-Ren Decoction and the pathogenesis and formula law party, trying to expand the application range of the or add and subtract, or in combination with other different formula and treatment in order to adapt to the different disease performance.2. In the formula, Xiao Jian Zhong Tang Decoction legislation aimed at reconciling the blood, building consultants in the air, through the balance of yin and yang of the role of coke gas machine tune up, and then restore the spleen and stomach function, and biochemical blood, nourish all around through the recovery of the spleen and stomach to reach reconcile organsgas machine, the role of balance of yin and yang organs. This benefit without AIDS greasy, tune in to the system of party ideas and its treatment shipped all around, and laid a solid foundation for later the putty school development, but also for its treatment and created a new way of thinking.3. Use frequency statistics from herbs and clinical application and can be seen, the square of Xiao Jian Zhong Tang Decoction compatibility structure is relatively stable, in the original party on the basis of overall use, add flavor or in combination with other therapy is to use the basic thought of Xiao Jian Zhong Tang Decoction, clinical curative effect is to ensure that one of the important factors. 4. The modern mechanism, Xiao Jian Zhong Tang Decoction can promote the body’s specific and nonspecific immune system; ease of laboratory mice to mucosal inflammation, and reduce the infiltration of inflammatory cells; promoting model of gastric emptying, promoting its intestinal motility and promote theirintestinal structural recovery; delay stomach aging and other effects.5. Suitable for the application of Xiao Jian Zhong Tang common symptoms are:fatigue, stomach pain (abdominal pain), anorexia, loose stools (diarrhea), aversion to cold, dizziness, spontaneous sweating, fever, palpitations, cough. Pale tongue, thin white fur and weak pulse, the main performance. While attending the scope of Consumption and stomach system diseases. Although after the millennium, but its application is still impossible to escape the the Zhongjing scope of application:exogenous, abdominal pain, consumptive, and jaundice.更多还原