基于古今医案数据分析的偏头痛病证治规律研究

发布时间：2018-01-02 13:22

本文关键词：基于古今医案数据分析的偏头痛病证治规律研究　出处：《广州中医药大学》2017年博士论文　论文类型：学位论文

【摘要】：目的:通过收集和整理古今偏头痛病医案文献资料,探析偏头痛病的源流,并运用数理统计方法及数据挖掘技术分析医案数据中隐含的规律,探求偏头痛病的证治规律及其演变。从而为中医的医案研究提供思路与方法学上的借鉴,为偏头痛病的临床辨治和实验研究提供新的思路和线索。方法:1.全面收集和整理历代偏头痛病的医案、医话等文献资料,掌握其历史分布情况,对偏头痛病的病名、病因病机、治则治法进行全面整理和分析,实现对偏头痛病的发展规律的全面、系统的认识。2.对梳理后的医案进行数据汇总,建立数据库,进行标准化处理后构建出明清时期数据库、近现代时期数据库和综合数据库库,然后采用spss statistics 20进行统计分析,对数据进行频数和因子的分析,并采用spss modeler 18进行关联规则的分析。3.从各分析结果中挖掘出症状与症状、药物和药物、疼痛部位和药物间存在的规律,归纳不同时期偏头痛病证治演变规律,从而实现对偏头痛病的病位、病因病机、症候类型、治则治法的系统整理和总结。结果:1.通过对偏头痛病诱因的频数统计发现,高频诱因包括情绪因素、劳累因素、月经因素。2.通过对不同历史时期和综合数据库的频数分析得出,偏头痛病临床上常见的症状有不寐、呕吐、恶心、便秘、烦躁、口苦、目痛、口干、疲倦、头晕、耳鸣、心悸等。通过各时期症状频数分析、高频药物的因子分析、关联规则分析等得出偏头痛病病机类型包括:肝阳上亢、肝动化风、风邪外袭、肝火上炎、胆郁痰扰、痰浊内蕴、肝热夹痰、血虚、气虚、气血两虚、阴虚、阳虚、肾精不足、瘀血阻络、肝郁气滞。3.通过对明清时期、近现代时期和综合数据库医案的高频药物进行归类分析,得出治疗偏头痛病的常用药物的类型有解表药、平肝息风药、清热药、补虚药、化痰药、祛风药、活血药、温里药、理气药、和解药。4.通过对不同历史时期和综合数据库高频药物归类分析,得出临床上偏头痛病的治则包括平肝潜阳法、平肝息风法、疏风解表法、清肝泻火法、清热化痰法、补血养血法、补益气血法、活血化瘀法、和解少阳法。5.通过对数据库中所使用的高频药物进行关联规则发现药对16对,包括细辛+川芎、川芎+羌活、川芎+白芷、川芎+当归、川芎+赤芍、钩藤+僵蚕、黄连+黄芩、柴胡+黄芩、柴胡+黄连、竹茹+半夏、桂枝+白芍、熟地+白芍、香附+柴胡、川芎+香附、香附+白芍、枳壳+柴胡。6.通过对数据库中所使用的高频药物进行关联规则分析,得出治疗偏头痛病的代表方剂有:天麻钩藤饮、羚角钩藤汤、川芎茶调散、芎芷石膏汤、半夏白术天麻汤、二陈汤、四物汤、四君子汤、异功散、小柴胡汤、四逆散、柴胡疏肝散。7.通过对不同时期偏头痛病的疼痛部位频次进行分析得出:(1)各个时期的或左或右型偏头痛病出现频次最高,而偏左型偏头痛病和偏右型偏头痛病出现频次无明显差别;(2)明清时期或左或右型偏头痛病出现频次的比例高于近现代时期,而偏左型偏头痛病和偏右型偏头痛病出现频次比例低于近现代时期。8.通过对不同历史时期和综合数据库药物和疼痛部位的关联规则分析得出(1)明清时期右偏头痛病中多属肝风内动、肝阳上亢的证型;近现代时期右偏头痛病多属于肝风内动、瘀血阻络、胆郁痰扰的证型。(2)近现代时期左偏头痛病多属于阴虚、外感风邪的证型。(3)近现代时期或左或右偏头痛病多属于肝阳上亢、阴虚、血虚、胆郁痰扰、肝风内动的证型。结论:(1)梳理了偏头痛病的源流,掌握了偏头痛病的的证治规律在明清、近现代两个历史时期的演变,为文献研究奠定了基础。(2)通过统计结果分析,整理出明清时期和近现代时期医家在偏头痛病的治法上的各自特点:①明清时期医家侧重以解表法、清热法的治疗偏头痛病②近现代时期由于偏头痛病的虚证多于实证,医家用药以补虚药、平肝息风药为多。(3)关联规则分析总库医案中使用的高频药物,筛选出了 16对常用药对。其中有一部分药对属于首次挖掘,进一步反映出治疗偏头痛病过程中药对应用的特点,这提示研究者应重视经验方中药对的归纳总结和相关的实验研究。(4)多角度,深层次挖掘偏头痛病的证治规律,归纳发现了偏头痛病的15个证候类型,9个治则治法,12个常用方剂。(5)通过数据分析,挖掘出偏头痛病发生部位与不同病因病机间存在一定联系,其用药也有差别,为医家临床治疗偏头痛病提供了新方向(6)突出展现了偏头痛病的治疗中应用升降法的重要意义,在一定程度上实现了对目前教材偏头痛病治疗理论补充,丰富了偏头痛病的治疗思路。
[Abstract]:Objective: through the collection and collation of ancient and modern literature of migraine disease cases, analysis of the origin of migraine disease, and using the mathematical statistics method and data mining technology to analyze the hidden rules in medical data, explore the migraine disease treatment regulation and evolution. So as to provide reference ideas and methodology for the case study of Chinese medicine, to provide a new the clue for clinical treatment and experimental study of migraine disease. Methods: 1. comprehensive collection and collation of migraine disease medical records, medical words of literature, grasp the historical distribution of migraine disease, etiology and pathogenesis, therapeutic principle and method to conduct a comprehensive collation and analysis, the development regularity of migraine disease of a comprehensive, systematic understanding of.2. data collection, after carding the medical records database, after the standardized treatment was constructed during the Ming and Qing Dynasties database, database of modern times And comprehensive database, and then use SPSS statistics 20 for statistical analysis, analysis of frequency and factor of the data, and dig out the symptoms and symptoms from the analysis results by the analysis of.3. SPSS modeler 18 association rules, drugs and drugs, pain and drugs between the law, summarized the different period of migraine disease treatment of evolution, thus realizing the migraine disease, etiology and pathogenesis, syndrome type, therapeutic principle of the system is summarized. Results: 1. through the frequency statistics of migraine disease causes that high-frequency incentives include emotional factors, factors of fatigue, menstrual factors of.2. by frequency in different historical periods and comprehensive database the analysis shows that migraine disease common clinical symptoms of insomnia, nausea, vomiting, constipation, irritability, mouth pain, dry mouth, eye pain, fatigue, dizziness, tinnitus, palpitation and other symptoms in each period by. The frequency analysis, factor analysis of high frequency drugs, association rules analysis that migraine disease types include: hyperactivity of liver Yang, liver dynamic wind, pathogenic factors are wind, liver inflammation, bile stagnation and phlegm disturbance, phlegm heat, liver blood deficiency, phlegm, Qi deficiency, Qi Yin deficiency, two. Yang deficiency, kidney essence deficiency, blood stasis, liver qi stagnation.3. through to the Ming and Qing Dynasties, classified analysis of modern high-frequency drugs and integrated database of medical record, the types of commonly used drugs for the treatment of migraine disease has diaphoretic, Pinggan Xifeng drugs, antipyretic, tonic, apophlegmatisant, Qufeng medicine, blood medicine, warm in medicine, Qi medicine and cure.4. through different historical periods and comprehensive database of high frequency of drug classification analysis, concluded that treatment of migraine disease clinically includes calming the liver Yang, calming liver wind, dispelling wind and diaphoresis, liver Xiehuo, phlegm method. Nourishing blood, tonifying qi and blood method , Huoxuehuayu, Shaoyang reconciliationlaw.5. by high frequency of drug used in the database of the association rules of 16 drugs, including Asarum + Rhizoma Chuanxiong Rhizoma Chuanxiong Angelica + +, + +, Chuanxiong angelica, Chuanxiong radix paeoniae rubra, Uncaria + silkworm, Coptis + skullcap, bupleurum + skullcap, bupleurum + Coptis. Zhuru + + Banxia Guizhi, Radix Paeoniae Alba, Radix Rehmanniae and Radix Paeoniae Alba, Rhizoma Cyperi Rhizoma Chuanxiong + + bupleurum, Cyperus rotundus, Fructus aurantii + Radix Paeoniae Alba, Radix Bupleuri.6. + through association rules analysis of the high frequency of drug used in the database, the representative prescription for treating migraine disease are: Tianmagoutengyin, Lingjiao Gouteng decoction, Chuanxiong chatiao San, Xiongzhi Shigao decoction, banxiabaizhutianma decoction, Siwu Decoction, two Chen Tang, Four Gentlemen Decoction, Yi Gong powder, Xiaochaihu Decoction, four inverse scattered, CHSGS.7. through the pain of migraine frequency disease in different period were analyzed by: (1) each period or the left or right of migraine disease Most frequently, and the left and right disease migraine migraine disease frequency has no obvious difference; (2) during the Ming and Qing dynasties or the left or right migraine disease frequency is higher than the proportion of the modern period, and left and right disease migraine migraine disease frequency than cases were lower than those in modern times.8. through the association rules in different historical periods and comprehensive database of drugs and pain analysis (1) endogenous mostly during the Ming and Qing Dynasties right migraine disease, liver yang hyperactivity syndrome; modern right migraine disease belongs to endogenous, blood stasis syndrome, bile stagnation sputum interference. (2) the modern period left migraine disease belongs to Yin deficiency, syndrome of exogenous pathogenic wind. (3) the modern period or the left or right of migraine disease belongs to hyperactivity of liver Yang, yin deficiency, blood deficiency, phlegm stagnation syndrome type biliary disturbance, the liver wind. Conclusion: (1) reviews the origin of migraine disease, The migraine disease treatment of the law in the Ming and Qing Dynasties, the evolution of modern two historical periods, which laid the foundation for the research of literature. (2) through statistical analysis, sorting out the respective characteristics of physicians in migraine disease treatment on the Ming and Qing Dynasties and modern times: Mingqing period to physicians focus on solution table method. The heat treatment of migraine disease in modern times because of the deficiency of migraine disease more than empirical, physicians of the drug to fill empty medicine, Pinggan Xifeng drugs for more. (3) the association rules analysis of the high frequency of drug use in the medical records database, we selected 16 of the commonly used medicines. Some medicine for mining to belong, to further reflect the characteristics of traditional Chinese medicine in the treatment of migraine disease process of application, this suggests that researchers should pay more attention to study summarizes the experience of traditional Chinese medicine on the party and relevant. (4) multi angle, deep mining law migraine disease treatment, Concludes that 15 syndrome types of migraine disease, 9 therapeutic methods, 12 prescriptions (5). Through data analysis, to find out some contact parts with different etiology and pathogenesis between migraine disease, the drug also have the difference, for the physicians for treatment of migraine disease provides a new direction (6) highlighted to show the significance of the application of lifting method in the treatment of migraine disease, to a certain extent in the current textbooks on migraine disease treatment theory supplement, enrich the treatment of migraine attack.

【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R249;R277.7

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