基于《内科摘要》探讨薛己临证药味规律与五运六气的关联性研究OA

This study analyzes 173 medical case records(involving 2 652 instances of herbal use)documented in XUE Ji's Ming Dynasty medical treatise Nei Ke Zhai Yao(《内科摘要》).By integrating the five flavors'tonification and purgation theory from Fu Xing Jue(《辅行诀》)with the five movements and six Qi(气)theory,it explores the relationship between XUE Ji's clinical herbal prescription patterns and the climatic conditions of his era.The study first standardized the names and properties of medicinal substances before conducting frequency statistical analysis.Results indicate that XUE primarily employed sweet,bitter,and pungent flavors,which collectively account for 85.64％of his prescriptions.This distribution closely aligns with the"sweet-bitter-pungent"core structure of CHEN Yan's Shenping Tang(审平汤),formulated during the Southern Song Dynasty to address the pathogenic mechanism of"Yangming dry metal governing the heaven,Shaoyin monarch fire in the earth"(characteristic of Mao-You years).Analysis of medicinal properties also revealed a predominance of warm-natured herbs,consistent with Shenping Tang's"warm-cold-neutral"distribution pattern.Among high-frequency herbs,core components of Shenping Tang such as Baizhu(Rhizoma Atractylodis Macrocephalae)and Zhigancao(Radix Glycyrrhizae Praeparata)ranked within XUE's top 20 most-used herbs,reflecting his therapeutic approach's continuity with the formula's principles.Further analysis indicates that during the 71st Jiazi cycle(1504-1563),a period dominated by dry-heat pathogens,XUE Ji did not rigidly adhere to established formulas.Instead,he dynamically adjusted herbal proportions based on specific composite pathomechanisms emerging during different phases of the Six Qi's interplay(e.g.,Taiyin damp-earth overlaying Jueyin wind-wood,Shaoyang ministerial fire overlaying Shaoyin monarch fire).Six representative medical case studies were selected to reveal how XUE Ji flexibly addressed complex pathomechanisms like"dampness-fire"and"cold-heat"arising from the"dry-fire interaction",embodying the clinical philosophy of"following the principles without rigidly adhering to formulas".From the perspective of herbal analysis,this study provides empirical evidence for the relationship between XUE Ji's academic thought and the theory of climate and energy.It reveals his core therapeutic strategies:using sweet flavors to tonify earth and generate metal,bitter flavors to drain fire and preserve metal,and pungent flavors to support wood and disperse stagnation.This offers a new perspective grounded in climate and energy theory for understanding the characteristics of his warming-tonifying school,while also providing a methodological reference for modern medical scholars to analyze climate and energy principles through the properties and flavors of herbs.