桂枝茯苓丸古今运用考探

【作者】 艾丽丝；

【导师】 谢鸣；

【作者基本信息】 北京中医药大学 ， 方剂学， 2006， 硕士

【摘要】 方剂学的研究方法可分为实验研究、临床研究和文献研究三个方面。近十多年来,方剂学的研究一直以古方在临床运用经验的总结和方剂学实验研究的开展较为多见。然而从目前来看,方剂学文献研究越来越受到重视,其研究内容也更加广泛,并取得了丰硕的成果。目前中医药古籍文献数字化工作较少见。所以通过计算机的使用,深入发掘古代医籍所蕴含信息,是现代中医药工作者所面临的一项重大任务。本文采用文献研究与数据库统计结果分析相结合的方法,对桂枝茯苓丸古今运用进行考探。目前在临床研究中,桂枝茯苓丸在妇科疾病的运用中已远远超过了原方的使用范围,并且在内、外等各科疾病中也被广泛运用。实验研究认为本方具有降低血液粘度、抗脑缺血,调节机体的免疫功能、抗肿瘤作用、抑制前列腺组织增生、调节性激素、防治肝纤维化、镇痛、镇静、抗炎等作用。本文根据中医学术发展经验和方剂学知识,调查了古今方剂学及其相关文献,从67部古代医籍与342篇现代文献中搜集到古代和现代有关桂枝茯苓丸运用的信息607条,应用计算机技术,借助现代化数据工具,建立了有关桂枝茯苓丸的相关数据库;将文献资料转化为数字信息,并从多个角度对信息进行处理、对结果进行归纳分析,总结出古代和现代桂枝茯苓丸的运用范围、治证病机、加减化裁、合方应用、用法及其剂型变化、副作用,禁忌及其方名的演变过程等特点。结果发现:古代桂枝茯苓丸在运用中出现的病名共有28种。现代文献显示,桂枝茯苓丸的临床使用范围较古代更加广泛。桂枝茯苓丸在妇科的使用中所涉及中医病名出现频率较高的是癥瘕,产后恶露不绝,崩漏,不孕,乳癖。其中,月经病常见于崩漏、痛经、闭经;妊娠疾病常见于坠胎、胎动不安、胎死腹中;产后疾病多为产后恶露不绝;还可用于带下病和乳房病类。桂枝茯苓丸在妇科的使用中所涉及西医病名出现频率较高的为子宫肌瘤,盆腔炎,卵巢囊肿,痛经。可以看出,在古代,桂枝茯苓丸主要用于妊娠疾病中的妊娠下血、胎动不安、堕胎以及催生,而现代妇科中使用本方主要用于增生性(子宫肌瘤、囊肿包块、内膜异位)、炎性(盆腔炎、输卵管炎、子宫内膜炎、附件炎)及出血性(人产术后子宫出血、功能性子宫出血)疾病。妊娠下血、胎动不安、堕胎以及催生在现代很少使用桂枝茯苓丸治疗,说明在临床使用中本方某些重要功效未得到很好利用,值得现代临床重视。非妇科疾病中的中医病名常见的有癃闭、头痛、腹痛和心悸怔忡等。其西医病名,主要为慢性前列腺炎,慢性阑尾炎、局限性肠粘连、冠心病、胸膜炎。古代文献中记载桂枝茯苓丸运用所涉症状主要有,妊娠下血不止,胎动不安,爪甲淡紫,发热恶寒,冷汗自出,心胸闷绝等。现代文献所涉及的症状有少腹疼痛、经色紫暗或夹块、神疲乏力、腰骶胀痛等。桂枝茯苓丸在《金匮要略》中没有提到具体的舌脉。现代文献对本方使用中更多还原

【Abstract】 Research on formulas is divided into clinical research, experimental research and literature studies. During the last fifteen years, reports of the experience of the use of ancient formulas in clinical practice and the development of experimental research of formulas are seen most. Recently, literature studies are becoming more and more important, the content is becoming more substantial and achieving successful results.This thesis tried, through the collection and arrangement of a large amount of texts of ancient and modern times and through the use of the computer, with the help of statistics, to dig out the information of Guizhi Fuling Pills hidden in ancient classical works and modern reports. It results in a summing up and summarizing of the characteristics of the range of diseases that can be treated by the pills, the symptoms, its pathogenesis, additions to the original compositions, combination with other formulas, its application and change in the form of the prescription、its side-effects, contra-indications and finally changes in the name of the prescription during ancient times.Nowadays, we can see that in clinical practice, Guizhi Fuling Pills already far exceeded the range of gynecological diseases used for in ancient times. Even more, the prescription is now widely used in internal medicine, urology, ophthalmology and other departments. The development of experimental research probes into the mechanisms that are the base for clinical treatment in many ways. From experimental research, we can see that the prescription can decrease the viscosity of the blood, decrease the effect on cerebral ischemia, regulates immunity functions, inhibits prostatic hyperplasie, regulates sexual hormone levels, prevents liver fibrosis, relieves inflammation and also has a anti-tumorous, sedative and anti-algesic effect.Results and discussion: In ancient times, Guizhi Fuling Pills were used to treat 28 different kinds of diseases. Nowadays, the use of Guizhi Fuling Pills is used for the treatment of a much wider range. In gynecology, the formula is used for abdominal lumps, post-partum lochiorrhea, infertility, metrorrhagia and metrostasis, etc. used in menopathy, diseases associated with pregnancy, post-partum diseases, leukorrhea and mastopathia. Results showed that recently, the formula is mainly used to treat hyperplasia, inflammatory and hemorrhagic diseases and that the diseases where it was used for in ancient times, like vaginal bleeding during pregnancy, fetal movement and abortion, are not treated that much anymore. This shows us that some important effects of the formula deserve more attention in clinical practice nowadays. Beside of gynecological diseases, retention of urine, headache, pain in abdomen and palpitation更多还原