节点文献
中药七情的文献研究
【作者】 姜开运；
【导师】 范颖；
【作者基本信息】 辽宁中医药大学 ， 方剂学， 2009， 博士
【摘要】 方剂配伍规律研究既是方剂研究的关键问题,又是难点问题。因方剂成分复杂,很难从现代医学、药学角度解释清楚。但药对是最简单的配伍,亦是复方的基础和核心,“七情”理论是反映药对配伍相互作用最为典型的规律,因此选择“七情”理论作为研究方剂配伍规律的突破口。近些年来对“七情”配伍的研究颇多,但在理论上没有大的突破,对“七情”涵义的认识也出现了一些分歧。本课题以历代本草、方书及医家论述中有关“七情”配伍及所载“七情药例”为研究对象,通过系统整理、归纳、分析古今相关文献资料,旨在从“七情”理论起源与沿革探讨“七情”的变化规律;整理、分析“七情药例”的文献记载及存在问题;从历代医家对“七情”的阐述,参照“七情药例”的内容,给“七情”做出更为合理的、科学的定义;并利用“七情”理论分析、确定临床遣药组方的原则。通过深入地研究,对某些争议较大的问题作了必要的解释,并提出自己的见解,其结果如下:1.从中药“七情”理论的发展脉络上看,其理论核心是《神农本草经》;有所贡献的医家有:张仲景、陶弘景、陈家谟、李时珍,其中影响最大的当属陶弘景和李时珍。陶弘景例示“七情”及李时珍对“七情”涵义的经典论述成为我们研究“七情”理论的重要理论依据。近、现代研究成果可作为有益的补充。2.“七情药例”的核心内容来源于《集注》残卷;《唐本草》与《集注》残卷在收载药物和药物分类上略有差别,可作为《集注》残卷的校订和补充;《证类本草》引述《嘉佑本草》内容,总结了宋以前配伍用药的经验,尤为重要的是明确提出了新增内容的出处,为求本溯源提供文献依据;《本草纲目》集明以前配伍用药经验之大成。通过分析主流本草中“七情药例”以利于探讨“七情”的涵义。但“七情药例”中有精华,亦有糟粕,因此我们要正确对待“七情药例”,并不断发展“七情药例”以利于现代的临床实践。3.“七情”涵义单行的涵义有二:其一是单用一味药治疗疾病,一般只有少数针对性强的药物治疗病情单一的疾病;其二是药物的配合应用,二药分别针对不同的病机,彼此间互不影响药性、功效、治疗效应和毒副作用,各行其是。相须是配伍二药在某方面具有特殊协同增效作用,彼此间不可分离。包括同类相须和异类相须。同类相须是配伍二药具有相似的药性、功效,由于协同作用,配伍后疗效大大超过单味药疗效的总和,其功效增加的强度大于简单叠加;异类相须是配伍二药没有相似的药性和功效,但二药相互需求,相互激发,产生新的治疗作用,配伍二药具有不可替代的配伍关系。相使用以强调配伍二药的主辅关系,其中以一药为主,另一药为辅,辅药可以增强主药某方面治疗效应的配伍关系。但二者不具有特殊协同作用。一般说来,在增强疗效的配伍关系中,不属于相须者,即为相使。相杀是二药合用,一药能削弱或消除另一药毒性的配伍关系。此处的“毒”是指狭义的毒性,二药中至少有一味是有毒的药物。相畏是二药合用,一药的毒副作用被另一味药物削弱或消除的配伍关系。既包括有毒的药物对机体的损害性,又包括平和无毒之品所产生的副作用。相恶是二药配伍后,一药或两药的某方面或某几方面的治疗效应削弱的配伍关系,而非全部功效的消失,药物与治疗无关的功效有可能不变、甚至增强。相反是二药合用后,二药原有治疗效应完全消失,或是增强毒副作用,甚至产生了新的毒副作用的配伍关系。4.根据“七情”配伍理论确定临床遣药组方的原则是:病情单一,可用疗效突出、针对性强的单味药治疗;病机复杂,则必须将药物配伍应用。若配伍药物各自针对不同病机,单独发挥治疗效应,各行其是,属于单行的另一种情况;若需要提高药物的治疗效应,应首先使用具有相须配伍关系的药对;其次根据病情,使用相使配伍关系的药对;当使用有毒的药物时应使用相杀、相畏的配伍关系以削弱药物的毒性;即便针对平和无毒之品,也要考虑可能会产生的副作用,而使用相畏配伍;尽量避免使用相恶与相反的配伍关系。但二者不是绝对的配伍禁忌,在具体病证下,相恶可以转化为相使、相畏的配伍,相反配伍在治疗痼疾、险证时可能会取得特殊的治疗效果。
【Abstract】 Research on law of prescription compatibility is both the key problem and the difficult problem for prescription study. Because of the complexity of prescription ingredient, it is hard to explain it on basis of modern medicine. But medicament is the easiest compatibility and the foundation and core of compound as well. Seven Relations Theory is the most typical law to reflect the interaction between medicament and compatibility. Thus, choosing the Seven Relations Theory as the breakthrough to study the law of prescription compatibility. In recent years, there are so many researches on the compatibility of Seven Relations. But they all have not the important breakthrough on theory and represent the bifurcatons on the cognition of Seven Relations meaning.This topic research object is the Book on Chinese medicine , the theory work of monographs on Prescription and ancient and modern references, pass sorting and inducing, analyzing the related literary data, aim at discussing the changing law of Seven Relations based on the origin and evolution of it, reorganization, analysis "the seven emotions medicine example" literature record and existence question, to make the rational and scientific definition of Seven Relations based on the medical scientists representations of all ages and the contents of medicine examples of Seven Relations, to confirm the principles of clinical dispensing and prescription based on the analysis of Seven Relations Theory.Through studies thoroughly, has made the essential explanation to the certain dispute major problem, proposed that own opinion, its result is as follows:1. Seven Relations Theory in the theory development vein looked from the traditional Chinese medicine that its theory core is "Shen Nong Book on Chinese medicine "; Has the contribution medicine to have: Zhang Zhongjing, Tao Hongjing, Chen Jiamo, Li Shi Zhen, affects in a big way, when is Tao Hongjing and Li Shi Zhen. Tao Hongjing the illustration Seven Relations Theory, Li Shi Zhen is right Seven Relations Theory the implication classics to elaborate into us to study "seven sentiments" the theory important theory basis. Near, the modern research results may take the beneficial supplement.2. "the seven emotions medicine example" the central content originates in "The book on Chinese medicine after collects " the remnant volume, "Tang Book on Chinese medicine" and "The book on Chinese medicine after collects " the remnant volume in gathers on the medicine slightly to have the difference, may take "Collects" remnant volume checking against the authoritative text and supplemented; "Card Class Book on Chinese medicine" quotes "Fine Blesses Book on Chinese medicine" the content, summarized Song before blends the medication the experience, proposed explicitly especially more importantly the additional content’s source, to strive for this tracing to provide the literature basis; "Native Chinese Plants" collection bright before blends accomplishment of the medication experience. Through analyzes in the mainstream book on Chinese medicine "the seven emotions medicine example" to be possible to obtain all previous dynasties medication rule, favors the discussion "the seven emotions" implication. but "the seven emotions medicine example" has the essence, also has the dregs, therefore we must treat "the seven emotions medicine example" correctly, and must develop "the seven emotions medicine example" to favor modern unceasingly the clinical practice.3. Uniline is a kind of treatment to cure the illness of single condition with single medicine or refers to watertight compatibility relations on therapeutic effect and toxic and side effect. That means the different medicine has the different effect to the specific illness.Mutual promotion between two drugs refers to the special synergy in some aspects. Congeneric mutual promotion makes the therapeutic effect of two drugs greater than the easy summation. Inhomogeneous mutual promotion produces the new therapeutical effect with the irreplaeable compatibility relations between the two drugs.Mutual detoxicity emphasizes two drugs’ main and aid relations. The aid medicine can strengthen the main medicine’ s therapeutic effect. But the two drugs have not the synergy. In general, either mutual promotion or mutualdetoxicity can strengthen the curative effect.Mutual detoxication refers to the compatibility relations in which one canweaken or eliminate the toxicity of the other. Herein the toxicity is narrowsense because there must be one medicine that is toxic.Mutual restraint refers to the compatibility relations in which one canweaken or eliminate the toxic and side effect of the other. It includes boththe medicine’ s harm and the medicine’ s side effect.Mutual inhibition means the compatibility relations in which one drug ortwo drugs can weaken each other in one or some aspects. It is not the abolitionof all efficacy, even the other therapeutical effects can be strengthened onthe contrary.Reverse refers to the compatibility relations in which the two drugstherapeutic effect abolishes absolutely or strengthens or produces the new toxicand side effect.4. Blends the theory according to "seven Relations" to determine thatclinical dispatches the medicine group side the principle is: The condition is unitary, available curative effect prominent, pointed strong simple treatment; The pathogenesis is complex, then must blend the medicine the application. If blends the medicine to aim at the different pathogenesis respectively, displays the treatment effect alone, each does what he thinks is right, belongs to specific another kind of situation; If needs to enhance the medicine the treatment effect, should first use has must blend relational the medicine to be right; Next according to the condition, the use causes to blend relational the medicine to be right; When uses the virulent medicine should use kills, the fear to blend the relations to weaken the medicine the toxicity; Even if in view of gentle non-toxic, must consider possibly will produce side effect, but will use the fear Lo blend; Avoids using as far as possible wicked and opposite blends the relations, but the two are not the absolute incompatibilities. Under the concrete sickness card, wicked may transform for causes, fear blending, possibly on the contrary will blend when will treat chronic disease, the dangerous card willobtain the special treatment result.