李東垣脾胃病用藥配伍的數(shù)據(jù)分析

王貴民（甘肅會(huì)寧縣人民醫(yī)院中醫(yī)綜合科，會(huì)寧　730700）

李東垣脾胃病用藥配伍的數(shù)據(jù)分析

王貴民
（甘肅會(huì)寧縣人民醫(yī)院中醫(yī)綜合科，會(huì)寧730700）

目的 研究金代名醫(yī)李東垣中藥復(fù)方治療脾胃病的藥對(duì)配伍規(guī)律，為臨床選藥組方提供科學(xué)的理論指導(dǎo)。方法 將金代名醫(yī)李東垣《脾胃論》中治療脾胃病的中醫(yī)復(fù)方錄入計(jì)算機(jī)，使用Microoft Office Excel2003軟件建立中藥復(fù)方數(shù)據(jù)庫(kù)，運(yùn)用統(tǒng)計(jì)學(xué)方法進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析藥對(duì)配伍規(guī)律。結(jié)果 整理治療脾胃病中藥復(fù)方61首，涉及中藥93種，篩選出甘草、陳皮、人參、白術(shù)、升麻、當(dāng)歸等前20味高頻核心藥物，統(tǒng)計(jì)得到藥對(duì)1107對(duì)，而關(guān)聯(lián)頻度大于10次的33個(gè)。結(jié)論 通過(guò)對(duì)高頻藥對(duì)的功效進(jìn)行統(tǒng)計(jì)，得到治療脾胃病的藥對(duì)配伍特色:補(bǔ)虛藥中的補(bǔ)氣藥、補(bǔ)血藥與解表藥中的發(fā)散風(fēng)熱藥配伍；補(bǔ)虛藥中的補(bǔ)氣藥、補(bǔ)血藥與補(bǔ)虛藥中的補(bǔ)氣藥配伍；理氣藥與補(bǔ)虛藥中的補(bǔ)氣藥、補(bǔ)血藥配伍；解表藥與理氣藥、補(bǔ)虛藥與清熱藥相須配伍；止咳化痰平喘藥與理氣藥、補(bǔ)虛藥配伍；化濕藥與理氣藥、解表藥、補(bǔ)虛藥配伍。總結(jié)配伍的代表藥對(duì)，為臨床辨證脾胃病處方用藥提供科學(xué)的理論依據(jù)。

李東垣；脾胃病；數(shù)據(jù)分析；配伍規(guī)律

《脾胃論》［1］是金代名醫(yī)李東垣在1249年為辨治脾胃病所撰的臨床內(nèi)科專(zhuān)著。共列出中藥復(fù)方61首，使用中藥93味，用藥總次數(shù)達(dá)532次［2］。依據(jù)《中藥學(xué)》［3］和《中藥大辭典》［4］分類(lèi)標(biāo)準(zhǔn)對(duì)藥物藥性進(jìn)行統(tǒng)計(jì)，運(yùn)用統(tǒng)計(jì)學(xué)方法：藥物使用頻率=藥物使用頻次/藥物使用總頻次×100%；藥對(duì)使用頻率=關(guān)聯(lián)頻度/總復(fù)方數(shù)×100%；平均頻次=配伍頻次/藥對(duì)數(shù)，反映藥對(duì)使用的集中度。通過(guò)數(shù)據(jù)挖掘分析其藥對(duì)功效，為臨床治療脾胃病總結(jié)出有效的用藥組方配伍規(guī)律體系。

1　復(fù)方中使用單味高頻藥物頻數(shù)頻率分析

通過(guò)對(duì)61首復(fù)方涉及用藥總次數(shù)達(dá)532次的93味中藥運(yùn)用數(shù)據(jù)挖掘分析，篩選出前20味中藥，其分布情況見(jiàn)表1。

表1　李東垣治療脾胃病高頻藥物統(tǒng)計(jì)一覽表　　［例（%）］

由表1可知：61首中藥復(fù)方中，甘草使用頻率最高為7.52%，14種藥物（15.05%）使用頻率大于2.00%，說(shuō)明常用藥以補(bǔ)虛藥甘草、人參、白術(shù)、當(dāng)歸、黃芪，解表藥升麻、柴胡和理氣藥陳皮等為主。因此可認(rèn)為前20味藥是金代名醫(yī)李東垣加減治療脾胃病的高頻次藥物。

2　復(fù)方中使用高頻藥對(duì)頻數(shù)頻率分析

對(duì)61首復(fù)方中篩選出的前20味高頻藥物兩藥相互進(jìn)行組合，其組成藥對(duì)共1107對(duì)，而關(guān)聯(lián)頻度大于10 次33個(gè)藥對(duì)的分布情況見(jiàn)表2。

表2　李東垣治療脾胃病藥對(duì)頻數(shù)頻率統(tǒng)計(jì)一覽表　　［例（%）］

由表2可知：對(duì)從61首復(fù)方中篩選出的前20味高頻藥物進(jìn)行藥物組合，藥對(duì)配伍關(guān)聯(lián)頻度大于10的藥對(duì)共33對(duì)。首先，陳皮+甘草配伍使用頻率最高為37.70%；其次，為人參+甘草、升麻+甘草和人參+陳皮，頻率分別為36.07%、34.43%和32.79%；再次，為柴胡+甘草，頻率為31.15%等。而其他藥對(duì)的應(yīng)用，體現(xiàn)了臨證根據(jù)病情靈活加減運(yùn)用。說(shuō)明篩選出的陳皮、甘草、人參、升麻、柴胡等理氣補(bǔ)虛，發(fā)散醒脾的高頻藥物組合藥對(duì)是李東垣治療脾胃病的處方特點(diǎn)。

3　復(fù)方中使用高頻藥對(duì)功效配伍特點(diǎn)分析

通過(guò)對(duì)61首復(fù)方中前20味高頻藥物兩藥相互組合進(jìn)行統(tǒng)計(jì)，藥對(duì)組合較多，其中高頻藥對(duì)代表治療脾胃病用藥起關(guān)鍵治療作用，因而對(duì)藥物功效進(jìn)行細(xì)分，能準(zhǔn)確分析出藥物功效的配伍特點(diǎn)，更能總結(jié)出藥對(duì)配伍規(guī)律，分析情況見(jiàn)表3。

表3　李東垣治療脾胃病藥對(duì)配伍功效統(tǒng)計(jì)一覽表　［例（%）］

由表3可知：①解表藥與補(bǔ)虛藥配伍：在9對(duì)高頻藥對(duì)配伍中，有7對(duì)是發(fā)散風(fēng)熱藥與補(bǔ)氣藥相配伍，突現(xiàn)了臨證治療脾胃病時(shí)注重益氣醒脾的治療思路，藥對(duì)配伍以發(fā)散風(fēng)熱藥柴胡、升麻與補(bǔ)氣藥甘草、人參、黃芪相互配伍為代表。②補(bǔ)虛藥與補(bǔ)虛藥配伍：在8對(duì)高頻藥對(duì)配伍中，有5對(duì)是補(bǔ)氣藥與補(bǔ)氣藥相配伍，體現(xiàn)了治療脾胃病時(shí)重視健脾益氣，藥對(duì)配伍以補(bǔ)氣藥甘草、人參、黃芪、白術(shù)相互配伍為代表。③補(bǔ)虛藥與理氣藥配伍：在5對(duì)高頻藥對(duì)配伍中，有4對(duì)是補(bǔ)氣藥與理氣藥相配伍，說(shuō)明了治療時(shí)選用行氣健脾，藥對(duì)配伍以補(bǔ)氣藥甘草、人參、黃芪、白術(shù)與理氣藥陳皮相互配伍為代表。④理氣藥陳皮與解表藥、化濕藥蒼術(shù)、止咳化痰平喘藥半夏的相互配伍為代表作為輔助治療。

4　結(jié)論

金代名醫(yī)李東垣在1249年所撰《脾胃論》是治療脾胃病的專(zhuān)著。由醫(yī)論38篇，方論63篇組成，列方61首。書(shū)中依據(jù)臨床實(shí)踐，結(jié)合醫(yī)學(xué)理論，提出“內(nèi)傷脾胃，百病由生”、脾胃勝衰論、脾胃虛實(shí)傳變論等脾胃學(xué)說(shuō)的主要觀點(diǎn)。為了進(jìn)一步挖掘金代名醫(yī)李東垣臨證辨治脾胃病的處方配伍結(jié)構(gòu)，利用數(shù)據(jù)挖掘方法對(duì)其篩選的高頻藥物相互組合形成的藥對(duì)進(jìn)行研究分析可知：①高頻核心藥為甘草、陳皮、人參、白術(shù)、升麻、當(dāng)歸、黃芪、柴胡等。②高頻藥對(duì)主要為陳皮+甘草、人參+甘草、升麻+甘草、人參+陳皮、柴胡+甘草等。③功效配伍主要是解表藥與補(bǔ)虛藥、補(bǔ)虛藥與補(bǔ)虛藥、補(bǔ)虛藥與理氣藥相互配伍。

總之，方劑療效的基礎(chǔ)不是單味中藥功效的相加，而是藥物之間的配伍作用，藥對(duì)由兩味藥組成為達(dá)到某種療效而組合使用的最小單位。研究?jī)晌端幣湮榈臋C(jī)理、作用及臨床功用是中醫(yī)臨床處方用藥的經(jīng)驗(yàn)總結(jié)，明確藥對(duì)之配伍理論，掌握在組方中的藥物配伍應(yīng)用規(guī)律，能吸取金代醫(yī)家李東垣治療脾胃病的用藥配伍精華，對(duì)探討臨證治療脾胃病藥物配伍規(guī)律具有重要意義。

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Data Analysis on Compatibility Regularity of Li Dongyuan in Treating the Spleen and Stomach Disease

WANG Guimin
（TCM General Department，Huining People's Hospital，Gansu Province，Huining 730700，China）

Objective To study the compatibility regularity of Li Dongyuan of Jin Dynasty in treating the spleen and stomach disease with Chinese medicine compound formula，and to provide a scientific theoretical guidance for clinical selected medicine formula. Methods The compound Chinese medicine formula in Treatise on Spleen and Stomach of famous doctor Li Dongyuan in Jin Dynasty was input to the computer，Microoft office Excel 2003 software was used to establish the database of the Chinese medicine compound formula，and statistical methods for statistical data analysis of drug compatibility regularity was used.Results There were of 61 kinds of Chinese medicine compound formula in the treatment of spleen and stomach disease，involving 93 kinds of Chinese medicine，licorice root，dried orange peel，ginseng，white atractylodes rhizome，Cimicifuga rhizome，Chinese angelica，etc.of 20 kinds of highfrequency core drugs were screened，and there were 1107 couplet medicines，and associated frequency greater than 10 times were 33 couplet medicines.Conclusion Through the conclusion of high-frequency drugs on the efficacy of statistics，the combinations features were as follows:tonic medicine of tonifying qi，blood drug had compatibility with hot wind divergence of relieving exterior syndrome medicine，tonic medicine of tonifying qi and blood medicine had compatibility with tonic medicine of tonifying qi medicine，tonic medicine of tonifying qi and blood compatibility of medicines，drug and qi regulating drugs，tonifying qi and blood medicine in tonic deficiency drugs and regulating qi drug had compatibility，relieving exterior syndrome medicine，regulating qi medicine，tonic deficiency drugs and clearing heat medicine had compatibility each other，antitussive expectorant and antiasthmatic drugs had compatibility with regulating qi medicine and tonic deficiency drugs，resolving dampness medicine had compatibility with regulating qi medicine，relieving exterior syndrome medicine and tonic deficiency drugs.The representative couplet medicines were summarized，which provided a scientific basis for clinical syndrome differentiation of spleen and stomach disease.

Li Dongyuan；spleen and stomach disease；data analysis；compatibility regularity

10.3969/j.issn.1672-2779.2016.16.024

1672-2779（2016）-16-0061-03

??張文娟 本文校對(duì)：吳宗智

2016-04-14）