《临证指南医案》呕吐辨治规律探析

目的:通过对《临证指南医案》中呕吐医案的统计整理,总结叶天士辨治呕吐的经验,为现代临床辨治呕吐提供借鉴和参考,也为古代医籍研究及名医经验总结提供思路和方法。方法:选取《临证指南医案》呕吐医案57例,将医案相关信息录入Excel表格,采用SPSS 20.0和Clementine 12.0统计软件对证候、症状、药物进行频数分析、关联规则分析、聚类分析和因子分析,最后运用中医理论对统计结果进行分析总结。结果:①在57例呕吐病案初诊记录中,共涉及证候11种;症状56个,频次≥3的高频症状13个;药物73味,频次≥3的高频药物27味,《中药学》教材收录的常用药物69味。②得到有意义的症状因子组3组,药物聚类组6组,症状聚类组5组,药-药二阶关联8组,三阶关联24组,四阶关联5组。结论:叶天士辨证呕吐重视肝胃关系,从木乘土辨证呕吐是其特色。治疗呕吐以和胃降逆为基本治则,用药注重辛开苦降,调气止呕。

Law of Pattern Differentiation and Treatment of Vomiting in Case Records as a Guide to Clinical Practice

Objective:Through the statistical analysis of vomiting case in Case Records as a Guide to Clinical Practice,the experience by YE Tianshi on treating vomiting was summarized,not only to provide references for modern clinical treatment of vomiting,also to provide ideas and methods for the study of ancient Chinese medical books and experience of distinguished doctors in the ancient time. Methods:Fifty seven cases of vomiting in the Case Records as a Guide to Clinical Practice were selected,the relevant information in the case records were input into the Excel tables,SPSS 20.0 and Clementine 12.0 were applied to perform the frequency analysis,association analysis,clustering analysis and factor analysis for the pattern,symptoms and medicinals,and finally traditional Chinese medicine(TCM) theory was applied to analyze the statistical results. Results:①There were 57 cases of vomiting,and in the first record,there were 11 patterns,56 symptoms(13 symptoms with frequency ≥3) and 73 medicinals(27 medicinals with frequency ≥3) in which 69 medicinals were recorded in the Chinese Materia Medica. ②There were 3 groups of symptom factors combination,6 groups of medicinal cluster,5 groups of symptoms clustering,8 groups of double medicinals combination,24 groups of triple medicinals combination and 5 groups of quadruple medicinals combination. Conclusion:In the treatment for vomiting,YE Tianshi emphasized the relation between liver and stomach,and held that the pattern differentiation should be based on wood over-restricting earth. The major principles for the treatment of vomiting should be harmonizing the stomach and directing counterflow downward. Acridity opens and bitterness discharges and regulating qi and stop vomiting are the medication characteristics.