目的:通过分析《临证指南医案》治疗痹证的用药规律,探讨温病学派代表人物叶天士治疗痹证的用药特色。方法:选取《临证指南医案》治疗痹证的医案复方,建立数据表,对药物的使用频数、功效、性味、归经、科属等特征进行统计。结果:在治疗痹证的80首汤剂复方中,药物120味,用药次数是560总频次,平均每方用药7味,方简力专。其中防己、桂枝、茯苓、白术、当归等17味药累积使用频次占总频次的52.2%,是高频常用药物。另外,蚕沙配防己、石膏配防己、独活配白术、独活配茯苓等药对也是高频常用药对。120味药物按功效划分,使用频率较高依次为:补虚药25.4%,祛风湿药16.4%,利水渗湿药12.9%;按药性划分,使用频率较高依次为:温性药46.44%,寒性药28.04%,平性药19.64%;按药味划分,使用频次较高依次为:甘味药39.51%,苦味药28.72%,辛味药18.12%;按归经划分,使用频次较高依次为:肺经17.52%,脾经17.36%,肝经15.84%,肾经12.49%;120味中药分属59种科属,使用频次较高的依次为:伞形科10.2%,豆科9.8%,多孔菌科6.1%。结论:叶天士治疗痹证用药特色寒温并用,补泻同施,气血同治,重用甘味补益气血、缓急止痛,辛开苦降宣通三焦脏腑气机,促进肢体关节经络气血流通而痹痛除。高频常用药物及药对是特色用药,为临床医生用药提供参考依据。
Objective:To investigate features of YE Tian-shi in applying traditional Chinese medicine(TCM) in treatment of bi disease by analyzing the regularity of applying TCM in treatment of bi disease in A Guide to Clinical Practice with Medical Record.Methods:The compound prescriptions for bi disease recorded in A Guide to Clinical Practice with Medical Record were selected,and the data sheet was established,in order to analyze the frequency of drug usage,functions,nature and flavor,channel tropism,family and genus of drugs.Results:Eighty compound prescriptions for bi disease were selected including120 drugs with 7 drugs in every prescription.The total frequency of drug usage was 560.The accumulated usage frequency of17 commonly used traditional Chinese medicines such as fangchi root,cassia twig,Indian bread,largehead atractylodes rhizome,Chinese angelica accounted for 52.2%.The commonly used medicine suits were silkworm droppings combined with fangchi root,gypsum combined with fangchi root,doubleteeth pubescent angelica root combined with largehead atractylodes rhizome,and doubleteeth pubescent angelica root combined with Indian bread.The categories of drugs used commonly were,in order,drugs for restoring vital energy(25.4%),drugs for rheumatism(16.4%),and drugs for removing dampness and promoting dieresis(12.9%).The four natures of drugs used commonly were,in order,warm drugs(46.44%),cold drugs(28.04%),and calm drugs(19.64%).The five flavours of drugs used commonly were,in order,sweet drugs(39.51%),bitter drugs(28.72%),and pungent drugs(18.12%).The channel tropism of drugs used commonly were,in order,lung channel(17.52%),spleen channel(17.36%),liver channel(15.84%),and kidney channel(12.49%).The 120 traditional Chinese medicines belonged to 59 family and genus,which used commonly were,in order,umbeliferae(10.2%),leguminosae(9.8%),and polyporeceae(6.1%).Conclusion:The features of YE Tian-shi in treating bi disease were cooling and warming in co