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从"汤液经法图"角度探讨《医林改错》22首活血化瘀方剂的组方配伍规律

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目的:从"汤液经法图"角度探讨《医林改错》22首活血化瘀方剂的组方配伍规律,以期为临床活血化瘀法的应用提供理论依据及《医林改错》的研究提供新思路。方法:运用《辅行诀五脏用药法要》所载"汤液经法图"解析清代王清任所著《医林改错》记载的22首活血化瘀方剂,制成"22首活血化瘀方剂组方配伍分析表",分别绘制22首活血化瘀方剂的汤液经法分析图,分析药物的配伍结构。结果:9首以补肝为主的方剂,基本以"辛-苦-甘-咸"为组方配伍原则,多以肝为主,五脏同调;7首以泻脾为主的方剂,基本以"甘-辛-苦"为组方配伍原则,多以脾为主,肝心肾同调,不涉及肺脏;4首以泻心为主的方剂,基本以"辛-甘-苦"或"苦-咸"为组方配伍原则,多以脾为主,五脏同调;2首以泻脾为主的方剂,以"辛-苦-甘"为组方配伍原则,多以脾为主,肝心肾同调,不涉及肺脏。结论:22首活血化瘀方剂整体以"辛-苦-甘"为组方配伍原则,多数涉及肝木、脾土和心火。王清任用药频次最高的活血化瘀药是桃仁,其次是红花、赤芍、当归和川芎,补气药是黄芪和甘草,行气药是柴胡和川芎,药物归经频率最高为肝经,五味以辛、甘、苦味为主,符合王清任活血化瘀为主,辅以补气行气的用药特点。王清任多使用"甘辛化苦"五味配伍转化关系,促使作用于脾的辛味药和甘味药入心泻心。王清任善用黄芪,重视活血化瘀同时补气,22首活血化瘀方中有8首使用了黄芪。王清任将活血化瘀药与引经药和不同作用的药物配伍,因势攻邪,引导活血化瘀药直接作用于不同的瘀血部位。
The Formula and Combination Rules of 22 Prescriptions for Activating Blood Circulation and Resolving Blood Stasis in Correction on Errors in Medical Works (Yi Lin Gai Cuo ) from the Perspective of "Tang-ye-jing-fa map"
Objective:To explore the formulae and combination rules of 22 prescriptions for activating blood circulation and resolving blood stasis in Correction on Errors in Medical Works (Yi Lin Gai Cuo ) from the perspective of "Tang-ye-jing-fa map".Methods:The "Tang-ye-jing-fa map" was used to analyze the 22 prescriptions for activating blood circulation and resolving blood stasis as recorded in Correction on Errors in Medical Works (Yi Lin Gai Cuo ) by Wang Qingren,the "22 prescriptions for activating blood circulation and resolving blood stasis" were used to draw a 22 prescriptions for activating blood circulation and resolving blood stasis."Tang-ye-jing-fa map" of the 22 prescriptions for activating blood circulation and resolving blood stasis was drawn to analyse the structure of the combination of the medicinal flavours.Results:The nine formulas mainly for tonifying the liver were used based on the principle of "pungent-bitter-sweet-salty",with the liver being the main organ and the five organs being in tune.The seven formulas mainly for tonifying the spleen were used based on the principle of "sweet-pungent-bitter",with the spleen being the main organ and the liver,heart and kidney being in tune,without involving the lungs.The four formulas mainly for dipping the heart were basically based on the principle of "pungent-sweet-bitter" or "bitter-salty",with the spleen being the main organ and the five organs being in tune.The two formulas mainly for purging the spleen were based on the principle of"pungent-bitter-sweet",with the spleen being the main organ and the liver,heart and kidney being in tune,without the lungs.Conclusion:Most of the formulas involved liver wood,spleen earth and heart fire.The most frequently used herbs by Wang Qingren to invigorate blood circulation and resolve blood stasis were peach kernel,followed by red flower,red peony,angelica and chuanxiong,the Qi tonifying herbs were huangqi and licorice,the Qi moving herbs were chaihu and chuanxiong,and the most frequently used herbs were for the liver meridian.The five flavours were mainly pungent,sweet and bitter,which were in line with Wang Qingren's characteristic use of the medicine to invigorate blood circulation and remove blood stasis,supplemented by tonifying and promoting Qi.Wang Qingren's used of the five flavours was combination to transform the five flavours into bitterness,and to promote the use of pungent and sweet herbs that acted on the spleen to enter the heart and exorcise the heart.Wang Qingren used of huangqi,which was used in eight of his 22 prescriptions to invigorate blood circulation and remove blood stasis,without forgetting to tonify Qi.Wang Qingren's combined of blood-stasis invigorating herbs with meridian inducing herbs and herbs with different trends of action,directs the blood-stasis invigorating herbs to act directly on different areas of blood stasis.

prescriptions for promoting blood circulation and removing blood stasisCorrectionon Errorsin Medical Works(Yi Lin Gai Cuo )Tang-ye-jing-fa mapWang Qingren

刘奕呈、王亦菲、张智博、付双清、张大武、马晓昌

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中国中医科学院西苑医院,国家中医心血管病临床医学研究中心 北京 100091

北京中医药大学

活血化瘀方剂 《医林改错》 汤液经法图 王清任

2024

中西医结合心脑血管病杂志
中国中西医结合学会 山西医科大学第一医院

中西医结合心脑血管病杂志

CSTPCD
影响因子:1.463
ISSN:1672-1349
年,卷(期):2024.22(22)