【作者】 卫向龙；

【导师】 孙世发；

【作者基本信息】 南京中医药大学 ， 方剂学， 2010， 博士

【摘要】 金元时期的著名医家李东垣创立的脾胃学说,在中医脾胃理论的形成和发展方面产生了极为深远的影响,被后世尊称为“补土派”。其所创制的大量方剂,至今仍广泛应用于临床,疗效显著。近年来对李东垣的组方配伍反映的学术思想进行了不断的研究,但缺乏全面系统深入的整体研究。一个医家的学术思想传承,不仅仅是在其理论方面的研究,更重要的是其在理论指导下运用于临床实践中的方剂。这些方剂集中体现了其学术思想,反映出其独特的组方用药配伍规律,但所涉及的著作多,方剂数目较多,内含的信息量也巨大。在这些错综复杂的信息中隐藏着的方剂配伍规律,用传统的解读方法是不可能实现的,因此,我们通过分析众多的现代统计分析方法,采用了SQL Server 2005和SPSS两种统计分析软件中的部分功能组合,在中医传统方药理论研究思路的指导下,对李东垣著作中的方剂进行了全面和系统的研究分析,试图获得其著作中方剂配伍变化的内在规律。研究内容主要包括：李东垣六本著作,即《内外伤辨惑论》、《兰室秘藏》、《脾胃论》、《医学发明》、《东垣试效方》、《活法机要》中涉及的895首中639首方剂为研究对象,进行方剂的预处理,使中医方药的概念性描述转变为有数据特性的数据,并能进行数据运算。通过不同的方法(关联分析、因子分析等)应用,结果显示李东垣著作中方剂的组方配伍规律有如下特点：(1)在药物的四气五味归经方面,药物在四气寒温方面上基本平衡,略微偏温；在性味配伍方面注重辛、甘、苦三味的应用；归经方面多归于脾肺胃三经。说明其用药既重性味,也重归经。(2)东垣组方用药方面：常常在黄芪、人参、炙甘草温补的同时配伍黄柏或黄连、黄芩苦寒之药,体现其用温补药升阳治疗之本,同时兼标,以祛除湿热邪气。体现了其制方时谆谆告诫后人“辛甘温药者,非独用也。复有甘苦大寒之剂,亦非独用也。”的组方思想。(3)在风药的运用方面：柴胡、升麻用于中气虚弱,偏于气郁蕴热,湿邪不盛者；防风、羌活、藁本则适用于中气不足,偏于湿邪为重,或下流,或弥漫全身肌肉者。当外有湿邪,内有湿邪化热之象时,往往又多同用,这正是东垣用药富于辨证精神的体现。(4)治疗单纯湿邪方面：是采取给邪以出路,全以利水渗湿药为主,取其甘淡利湿,也是治湿不利小便,非其治也的体现。(5)在东垣运用方面：体现其以内伤脾胃为病机基础,以补中益气的组方原则,旁治各科杂病。(6)在用药剂量方面：组方上按君臣佐使来定量,主病者为君,佐君者为臣,应臣者为使；以及君药分量最多,臣药次之,使药又次之的用量法则,是随病机变化而定的。通过对李东垣著作中的方剂研究分析验证了其组方法则和用药的一些特点,对临床应用其理论组方和用药都很有意义。更多还原

【Abstract】 LiDongYuan, who lived in the Jin and Yuan dynasty created a famous theory about stomach and spleen. The theory has been of far-reaching impact, and he is called the founder of enriching the earth", In recent years, some research about LiDongYuan’s formula has been studied,but the problem is the studies are all lack of comprehensive in-depth research.A physician’s academic theory and idea, not only lives in its theory, but even more importantly, guided by the theory used in clinical practice in the prescription. The formula embodies the academic thinking, reflecting its unique compatibility Prescription drug laws, but the work involved more than the number of prescriptions more, also contains a huge amount of information. In these complex information hidden combination law interpretation of the traditional methods can not be realized, we analyzed a large number of modern statistical methods, using two tools, including SQL Server 2005 and SPSS statistical analysis software The theory of traditional Chinese traditional medicine under the guidance of research ideas on the recipe book a comprehensive and systematic analysis, attempting to acquire his works Prescription change inherent laws. The study includes six books, that is, "Clarification of Perplexities About Internal and External Damage "/’Secret Book of Orchid Chamber ", "Treatise on Spleen and Stomach", "medical inventions"," Test efficiency formula of LiDongYuan" and "Law of confidential". In these books, There are 896 formulas, and we select 639 formula as the object. We carried out pre-processing prescriptions, so that prescription medicine into the conceptual description of the characteristics of the data with data and data operations can be carried out. Through different methods (correlation analysis, factor analysis, etc.) applications, the results show the following laws in LiDongyuan’s formula:In four natures and five flavors of drugs, the medicines are balanced in four nature, and they are focus on Pungent, sweet and bitter in five flavor,and they are focused on spleen, lung and stomach. (2)He always used Licorice, Astragalus, Ginseng with goldthread, skullcap and phellodendron, reflecting its treatment with warm tonic of the Sun, at the same time and marked, in order to eliminate the heat evil.(3)In application of Wind Dispelling Drugs, he always used Bupleurum, Cimicifuga in those who felt weak and yun heat,used Wind, Notopterygium, ligustilide in those who weak and biased Dampness is heavy, or obscene, or diffuse those muscles.(4) Treatment of simple damp-pathogen:the damp-pathogen is taken for a way out, by using diuretics with actions of eliminating dampness, which is also the embodiment of diuresis.(5)In the application of the medicine used by LiDongYuan, the theory is based on improvement of the interior and promote movement of qi.(6)In the dosage of medicine,LiDongYuan measured the dosage by the relation of "monarch, minister, assistant and guide",the more important the medicine was,the larger dosage it had.In a word,by the study of the formula in LiDongYuan’s book,the compatibility rules was found,which is important in both the theory of formula compatility and clinical practice.更多还原