基于数据挖掘方法探析半夏泻心汤临床应用规律

发布时间：2019-03-13 21:34

【摘要】：目的:泻心汤类方为中医经典方剂,其中半夏泻心汤最为代表,临床应用十分广泛。为了系统研究半夏泻心汤,采取反向挖掘方法,通过查阅临床医家报道医案文献,获得该方的临床运用信息,利用规范化的数据挖掘系统对其进行建库、挖掘和分析。通过对半夏泻心汤应用病种、临床表现、病机、方药配伍等项集进行挖掘,为临床更准确应用半夏泻心汤提供客观依据和方法学参考。方法:通过对中国知网2016年9月之前中医期刊文献库进行搜索,获取半夏泻心汤运用的医案信息,并对其进行筛选、清洗、整理。采用MedcaseV3.2数据记录挖掘系统对符合纳入标准的医案进行数据库构建、数据挖掘分析,重点挖掘医案中的病种、症状、病机、方药等内容,并分析探讨半夏泻心汤临床应用规律。结果:260诊次医案中,男性患者共143诊次,女性患者117诊次,年龄分布较广,以中年为主。临床表现方面,主症共计30余项,以纳差、胃胀、口干等为主,非脾胃系统症状表现主要涉及寐差、心烦、口腔溃疡等。舌苔方面,以舌质红,苔黄腻最为常见。症状与舌苔外关联中,胃胀、胃痛与苔黄腻支持度较高,胃痛、口腔溃疡与舌质红支持度最高。病机主要涉及寒热错杂、湿热中阻、脾胃虚弱,其中痞结不开与湿热中阻关联度最高。脉象以弦脉频率最高,其次为细脉。药物涉及广泛,高频药物主要有:半夏、黄连、黄芩、甘草、干姜、党参、大枣、茯苓、白术等,原方中人参使用频次较低,核心药对半夏-黄连。主要药物与症状外关联中,法半夏与口干、便溏关联度高,而姜半夏与胃胀、纳差关联度高。黄连与呃逆、腹痛、恶心关联度高,而与黄芩关联性高的主症有面部红斑、咽部异物感、粉刺。所有医案诊次中,西医病种涉及84个,其中以慢性胃炎、口腔溃疡、失眠、胃溃疡等为主。中医病种涉及53个,以胃痞、胃痛、口疮、不寐、腹痛为主。结论:本次研究得出临床应用半夏泻心汤涉及病种十分广泛,以慢性胃炎、口腔溃疡、失眠、胃溃疡等疾病居多,凸显中医异病同治特色。此方以改善纳差、胃胀、口干、口腔溃疡、寐差等症状为主。患者多见舌红、苔腻或黄,脉象以弦脉较常见。半夏泻心汤除主治寒热错杂证,还常用于治疗湿热中阻证。原方中半夏-黄连为核心药对,现多用党参替人参,临证精于炮制,常配合行气药、化湿药同用。识病(异病同治)-辨证-立法-处方,环环相扣,紧密相连。方从法出,法随证立,证从症出,四诊和参,中医临床诊治思维言简意赅、博大精深。
[Abstract]:Objective: Xiexin decoction is a classical prescription of traditional Chinese medicine, among which Banxia Xiexin decoction is the most representative, and its clinical application is very wide. In order to systematically study Banxia Xiexin decoction, the reverse mining method was adopted to obtain the clinical application information of Banxia Xiexin decoction by consulting the medical documents reported by clinicians, and the standardized data mining system was used to build the database, mine and analyze it. In order to provide objective basis and methodological reference for more accurate clinical application of Banxia Xiexin decoction, a collection of disease types, clinical manifestations, pathogenesis and compatibility of prescription and medicine were excavated in order to provide more accurate clinical application of Banxia Xiexin decoction. Methods: the medical records of Banxia Xiexin decoction were obtained by searching the literature database of Chinese medical journals before September 2016, and were screened, cleaned and sorted out by using Banxia Xiexin decoction. The MedcaseV3.2 data record mining system is used to construct the database of the medical records which meet the inclusion criteria, to analyze the data mining, and to mine the diseases, symptoms, pathogenesis, prescription and medicine in the medical records, especially the contents of the diseases, symptoms, pathogenesis, prescription and medicine in the medical records. The clinical application of Banxia Xiexin decoction was analyzed and discussed. Results: among 260 medical cases, 143 were male and 117 were female. The age distribution was wide, mainly middle-aged. In clinical manifestation, the main symptoms were more than 30 items, such as anorexia, gastric distension, dry mouth and so on. The symptoms of non-spleen and stomach system were mainly related to poor sleep, upset, oral ulcer and so on. In terms of tongue coating, red tongue and yellow coating are the most common. Symptoms and tongue coating external correlation, stomach distension, stomach pain and moss yellow greasy support is higher, stomach pain, oral ulcer and tongue red support degree is the highest. The pathogenesis is mainly related to the disorder of cold and heat, dampness and heat, spleen and stomach weakness, among which ruffian knots do not open and dampness-heat middle resistance has the highest correlation degree. The chordal pulse frequency is the highest, followed by the veinlets. Drugs involved in a wide range of high-frequency drugs are: Pinellia, Rhizoma Coptidis, Scutellaria baicalensis, licorice, dried ginger, Codonopsis, jujube, Poria cocos, Atractylodes, etc., the use of ginseng in the original prescription is low, the core drug to Pinellia-Coptis. Among the main drugs and symptoms, there was a high correlation between French pinellia and dry mouth, loose stool, while ginger pinellia was highly correlated with stomach distension and tolerance. Coptis has a high correlation with hiccup, abdominal pain, nausea, and Scutellaria baicalensis with a high correlation between the main symptoms are facial erythema, pharynx foreign body feeling, acne. Among all medical records, 84 types of diseases were involved, including chronic gastritis, oral ulcers, insomnia, gastric ulcers and so on. Traditional Chinese medicine diseases involving 53, to stomach ruffiti, stomach pain, sore, insomnia, abdominal pain. Conclusion: the clinical use of Banxia Xiexin decoction involves a wide range of diseases, mainly chronic gastritis, oral ulcer, insomnia, gastric ulcer and other diseases, highlighting the characteristics of different diseases and common treatment of traditional Chinese medicine. This prescription to improve anaesthesia, stomach distension, dry mouth, oral ulcer, such as poor symptoms. Patients with red tongue, greasy or yellow, pulse is more common chord pulse. Banxia Xiexin decoction in addition to the main treatment of cold-heat dislocation syndrome, but also used in the treatment of damp-heat obstruction syndrome. The original prescription of Pinellia pinelliae-Coptis as the core drug pair, now more used for ginseng, clinical syndrome is fine in processing, often combined with qi medicine, dampening drugs used together. Knowledge (different diseases are treated with each other)-syndrome differentiation-legislation-prescription, linked closely to each other. Prescription from law, law with syndrome, syndrome from syndrome, four diagnostic and reference, clinical diagnosis and treatment of traditional Chinese medicine thinking concise, broad and profound.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R289.5

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