《伤寒杂病论》治疗腹痛用药规律分析

郑昊 翁森辉 黄嘉华

【摘 要】 目的：探讨《伤寒杂病论》治疗腹痛的遣方用药规律，为临床治疗腹痛提供一定的参考。方法：筛选《伤寒杂病论》中有关腹痛的条文，对“腹痛”相关词汇，治疗腹痛的方药，药物的四气、五味和归经进行统计分析。结果：《伤寒杂病论》涉及腹痛条文共48条，其中方剂26首，共37种药物。药物性味以辛、甘、苦、温居多，主要归脾经和胃经，重视芍药、甘草的应用。结论：《伤寒杂病论》治疗腹痛多以脾胃为中心，主要选择辛、甘、苦、温味药，侧重芍药、甘草的运用，以恢复中焦之气机，使气血运行通畅，并兼顾心、肺、肝的治疗。

【关键词】 《伤寒杂病论》;腹痛;用药规律

【中图分类号】R256.33   【文献标志码】 A    【文章编号】1007-8517（2020）10-0012-04

Abstract：Objective To explore the prescription rules of Treatise on Cold Pathogenic and Miscellas Diseases for the treatment of abdominal pain， and provide a certain reference for clinical treatment of abdominal pain. Methods Screen the articles about abdominal pain in Treatise on Cold Pathogenic and Miscellas Diseases， and analyze the vocabulary related to “abdominal pain”， prescriptions for treating Stomachache， and the four qi， five flavors and meridian of medicine. Results Treatise on Cold Pathogenic and Miscellas Diseases involves a total of 48 articles on abdominal pain， of which 26 are prescriptions and a total of 37 drugs. The medicinal flavors are mostly Xin， Gan， Bitter， and Warm， which are mainly attributed to the Spleen and Stomach Meridians， and the application of paeonia licorice and licorice is important.Conclusion The treatment of abdominal pain by Treatise on Cold Pathogenic and Miscellas Diseases is centered on the spleen and stomach. The main choices are Xin， Gan， Bitter， Warm flavor medicines， focusing on the use of peony and licorice， in order to restore the Qi engine， make the blood flow smoothly， and take care of the heart， lung， and liver.

Keywords：Treatise on Cold Pathogenic and Miscellas Diseases;Abdominal pain;Medication rules

腹痛是指胃脘以下，恥骨毛际以上之间区域发生的以疼痛为主症的病症。由于中医学古籍对胸腹部的划分是以膈为界限，膈以下即为腹部，故胃痛亦包含于腹痛之中。《伤寒杂病论》对腹痛的论述较多，遣方用药颇具特色，为后人治疗腹痛留下宝贵的经验。笔者拟对《伤寒杂病论》中有关腹痛的条文进行挖掘，分析其中的用药规律，以期为临床提供一定的参考。

1 《伤寒杂病论》中腹痛相关词统计分析

对《伤寒杂病论》条文逐条阅读，按以下标准挑选与腹痛相关的条文：①条文中直接描述为腹部疼痛者;②条文经后人[1-2]考证确为描述腹痛者;③腹部不适明显但无疼痛症状者不纳入。经过整理，本次研究共纳入与腹痛相关条文48条。条文中对腹痛的描述方式较多，根据腹部分野进行总结归纳，如将“少腹急结”归属于“少腹痛”等，最终可分为“腹中痛、心下痛、胁下痛、少腹痛、绕脐痛、小腹痛”6种。……