叶天士和薛生白治疗湿热性温病用药异同研究

Similarities and Differences in Herb Use of YE Tianshi and XUE Shengbai for Treating Warm Diseases due to Damp-heat Pathogen

  • 摘要: 目的 分析比较叶天士和薛生白在治疗湿热类温病的用药异同及各自治法特点。方法 根据叶天士、薛生白两人著作中的医案,借助中医传承辅助系统,应用关联规则及SymbolcA@检验比较二者用药异同。结果 叶、薛二家在治疗湿热类温病时,茯苓、陈皮、厚朴、杏仁、滑石、泽泻、半夏、薏苡仁、白术、苍术等10味均有较高的使用频率,其中杏仁、滑石、泽泻3味药物的使用中叶天士要多于薛生白,具有显著性差异(P<0.05)。在药物配伍方面,叶、薛二家均喜用茯苓-陈皮-厚朴;不同的是叶天士还喜用黄芩-黄连、猪苓-泽泻、滑石-竹叶-杏仁等配伍,而薛生白使用较多的是杏仁-厚朴-白豆蔻、陈皮-白术-茯苓、厚朴-茯苓-陈皮-草果等配伍。结论 叶、薛二家在治疗湿热类温病时均遵行了《内经》的治湿原则,另外叶氏的常用配伍也体现了其“总以苦辛寒治湿热”的用药特色,而薛氏的用药则体现了其“湿热病属阳明太阴者居多”的认识,治疗以中焦阳明、太阴为主。

     

    Abstract: OBJECTIVE To compare the similarities and differences of YE Tianshi and XUE Shengbai in herb use for treating warm diseases caused by damp-heat pathogen as well as their medication characteristics. METHODS Based on the medical cases written by YE Tianshi and XUE Shengbai, we analyzed the similarities and differences of their herbal usage preferences, with the application of TCM inheritance assist platform, association rules and SymbolcA@ test. RESULTS Both of them tended to use poria, tangerine peel, officinal magnolia bark, almond, talc, rhizoma alismatis, pinellia ternata, coix seed, white atractylodes rhizome and rhizoma atractylodis, these top ten herbs for warm diseases due to damp-heat accumulation. Among which, YE Tianshi applied more often of almond, talc, rhizoma alismatis than XUE Shengbai, with significant differences(P<0.05). In terms of herb compatibility, they both had the habit of using the pairs of poria-tangerine peel-officinal magnolia bark. The differences lay in that the pairs of scutellaria baicalensis-coptis, agaric-rhizoma alismatis and talc-bamboo leaf-almond were mainly seen in YE Tianshi's prescriptions, while those pairs of almond-officinal magnolia bark-white round cardamom, tangerine peel-white atractylodes rhizome-poria and officinal magnolia bark-poria-tangerine peel-amomum tsaoko were preferred by XUE Shengbai. CONCLUSION Both Ye and Xue have followed the principles of eliminating dampness set in Internal Canon of Medicine. In addition, the commonly applied compatibility of Ye embodies the characteristics of treating damp-heat pathogen with bitter, cold and spicy herbs, whereas that of Xue demonstrates that damp-heat diseases are mainly induced by the disorder of yang-ming meridian and tai-yin meridian, with the treatment focusing on the middle energizer spleen and stomach.

     

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