周仲瑛教授从“痰瘀”辨治高脂血症的临床经验及学术思想研究

发布时间：2018-06-10 09:11

本文选题：周仲瑛 + 高脂血症　；参考：《南京中医药大学》2017年博士论文

【摘要】：目的:本文以国医大师周仲瑛教授近三十年来所积累高脂血症病案为研究对象,运用现代计算机数据挖掘技术,以"痰瘀"为切入点,从症状、舌脉、病机、药物等角度,归纳周老对高脂血症病因病机的认识,以及临证辨证要领和用药经验,探讨其从痰瘀辨治高脂血症的学术思想体系,为临床辨治高脂血症提供新思路。方法:运用MedcaseV3.2仓公诊籍病案数据记录及分析系统,运用强化FPGrowth算法构建加强关联规则数据挖掘模型,使用Xminer Operation Tool运算工具对研究数据进行挖掘处理和逻辑分析,对计量性趋势数据运用Medcase Chart进行解构分析与图形表达。结合数据分析结果,以周仲瑛教授临证辨治思路为模型,运用中医基本理论,重点从病机认识、辨治思路、临床用药等多方位、多角度进行经验探讨与总结。结果:病案数据共861诊次(285人次),其中男性156例,女性129例。发病年龄最低8岁,最高86岁,平均年龄54.65岁,60-69岁之间发病人群最广;症状分布前10的症状分别是头晕、口干、肢体麻木、肢体疼痛、便溏、乏力、胸闷、肢体酸软、失眠、肢体肿;舌象多以暗红(53%)暗紫(30%)舌、苔黄薄腻(51%)为主;临床多见滑、细、弦、涩四种脉象,分别占64%,62%,28%,19%;病机概要多肝肾亏虚(27%)、痰瘀阻络(24%);脏腑涉及肝、脾、肾、肺、心、胃、胆、血脉等,以肝(55%)、肾(47%)、脾(10%)三脏为主,重视络(28%)的损伤;病理因素痰、瘀分别占了 40%和39%;其次是湿、热,占25%,27%,风、火,浊、毒,分别占22%,3%,3%,1%;病理因素的兼夹以痰瘀(32.5%)、瘀热(25.2%)、湿热(22.3%)最为常见;治疗药物频次前30分别是丹参、炙僵蚕、山楂肉、泽泻、桑寄生、制首乌、天麻、枸杞子、夏枯草、地黄、白蒺藜、川芎、决明子、鬼箭羽、葛根、石斛、泽兰、郁金、海藻、法半夏、玄参、茵陈、制黄精、麦冬、地骨皮、赤芍、炒苍术、黄连、鸡血藤、柴胡。症状内关联中头晕→头痛→视糊→耳鸣→胸闷之间的关联紧密(置信度0.4-0.8),舌象中舌质暗(红)→苔黄薄腻关联紧密;病机中肝肾亏虚→痰瘀阻络的支持度最高(0.1206),脉象内关联中置信度为1.0的有沉→细、数,弦→滑、数,小→滑,病机中肝肾亏虚→痰瘀阻络的支持度最高,药物内关联中制首乌→桑寄生→炙僵蚕→丹参→山楂肉→泽泻之间的关联度最大。运用聚类法聚类出三类核心方:(1)制首乌、桑寄生、鬼箭羽、丹参、炙僵蚕、泽兰、制黄精、海藻、泽泻、山楂肉;(2)天麻、白蒺藜、决明子、夏枯草、泽泻、制首乌、枸杞子、炙僵蚕、丹参;(3)玄参、茵陈、炒苍术、黄柏、泽泻、炙僵蚕、鬼箭羽、荷叶、炙水蛭、虎杖。结论:1.本病临床证候复杂多端,涉及多脏腑多系统病变,常见头晕头痛、心胸疼痛、胸闷、肢体麻木疼痛、胁痛、腹胀、视力模糊等,多见暗红(紫)舌、苔黄薄腻;多见滑、细、弦、涩四种脉象。2.本病本虚标实,病变脏腑主要在肝、肾、脾,与心、脑相关,久病及络。病理因素以痰、瘀、湿、热、风、火,浊、毒为主,痰、瘀最为常见并贯穿整个病理过程,是高脂血症进展的关键因素。核心病机为肝肾亏虚、痰瘀阻络,常见有肝郁脾虚,痰凝瘀阻;肝肾亏虚,痰瘀阻络;痰瘀阻络、湿热内蕴;痰浊瘀阻、内风扰动;痰瘀阻络、心营不畅;痰瘀阻络、气血(阴)两虚六个证型。3.周仲瑛教授治疗本病多从痰瘀立论,多采用化痰逐瘀、驱邪通脉之法,配合疏导气机,注重调补脏腑,从本缓治,临床当辨别痰瘀的属性、部位、兼夹及先后等不同而治疗各异。4.临证用药多以化痰行瘀为主,配合滋补肝肾药、清热利湿药、祛风通络药、益气养阴药等,特色用药如天南星、海藻、僵蚕、姜黄、山楂、荷叶、玄参、水蛭、鬼箭羽、泽泻等。
[Abstract]:Objective: This article, based on the modern computer data mining technology and using the modern computer data mining technology and using the "phlegm and blood stasis" as the breakthrough point, summed up the understanding of Zhou Lao on hyperlipidemic disease pathogenesis, as well as the key points of syndrome differentiation and the experience of drug use by using modern computer data mining technology and using the modern computer data mining technology and using the modern computer data mining technology and the "phlegm and blood stasis" as the breakthrough point. To discuss the academic thought system of hyperlipidemia from phlegm and blood stasis, and to provide new ideas for clinical diagnosis and treatment of hyperlipidemia. Method: using the data recording and analysis system of MedcaseV3.2 Cang medical records, using the enhanced FPGrowth algorithm to build the data mining model of the association rules, and using the Xminer Operation Tool operation tool to carry out the research data. Mining processing and logical analysis, and using Medcase Chart for deconstruction analysis and graphic expression on the measurement trend data. Combined with the results of data analysis, this paper takes professor Zhou Zhongying's syndrome differentiation and treatment thought as model, and uses the basic theory of traditional Chinese medicine, focusing on the understanding of the pathogenesis, the idea of differentiation and treatment, clinical medication and other aspects. Results: the medical record data were 861 times (285 times), of which 156 were male and 129 in women. The age of onset was 8, the highest was 86 years, the average age was 54.65 years, and the most widespread among the 60-69 years old. The first 10 symptoms were dizziness, dry mouth, numbness of limbs, limb pain, loose stools, weakness, chest tightness, sleeplessness, swollen limbs, swollen limbs. With dark red (53%) dark purple (30%) tongue and thin and greasy fur (51%), four pulse images, including 64%, 62%, 28%, 19%, were seen in clinic, including 64%, 62%, 28%, 19%, and the pathogenesis of the liver, spleen, kidney, lung, heart, stomach, gallbladder, blood and so on, the liver (55%), the kidney (47%), the spleen (10%) and the blood vessels, and the injury of the collaterals and the pathological factors. Phlegm and blood stasis accounted for 40% and 39% respectively, followed by damp, heat, 25%, 27%, wind, fire, turbid, and poison, respectively 22%, 3%, 3%, 1%, and the most common pathological factors were phlegm and stasis (32.5%), blood stasis heat (25.2%), and damp heat (22.3%), respectively. Before the frequency of treatment, 30 were respectively Dan Shen, broiled silkworm, hawthorn, Alisma Alisi, mulberry parasite, Radix Polygoni multiflorum, Rhizoma prunicae, radix rehmanniae, white Tribulus terrestris, Ligusticum chuanxiong, cassia seed, kudzu root, Dendrobium, Dendrobium, tulips, tulips, seaweed, French pinellia, Radix sargyata, Yellowstone, Radix Ophiopogon, Radix Paeoniae, Radix Paeoniae, Rhizoma Coptis, Coptis chinensis, bupleurum. The association between dizziness, headache, pasta, tinnitus and chest tightness (confidence degree 0.4-0.8), the dark (red) tongue in the tongue and thin greasy tongue in the tongue The support of liver and kidney deficiency, phlegm and stasis obstructing collaterals in the pathogenesis is the highest (0.1206), and the median confidence of 1 in the pulse image is sink, fine, number, string, slip, number, and slippery, and the support of the liver and kidney deficiency and phlegm and stasis obstructing collaterals in the pathogenesis is the highest. In the drug association, it is used to make the interrelation of the drug between the Radix Polygoni Multiflori, the silkworm silkworm, the salvia miltiorrhiza, the haw meat to the Alisma orientalis. Three core parties are clustered with clustering method: (1) the system of Radix Polygoni Multiflori, mulberry parasitic, ghosts and arrow feathers, Salvia miltiorrhiza, broiled silkworm, salvia, Rhizoma Alisma, hawthorn meat; (2) Tianma, Tribulus terrestris, cassia seed, rhizome, Rhizoma Alisma, Salvia miltiorrhiza, Salvia miltiorrhiza, Rhizoma corydalis, Rhizoma phellodendron, Rhizoma Alisma, roasted silkworm, roasted silkworm, ghosts arrow feathers, and lotus leaves, Conclusion: the clinical syndromes of the 1. diseases are complex and multiterminal, involving multiple viscera and multi system lesions, common dizziness and headache, pain in the chest, chest pain, numbness and pain, hypochondriac pain, abdominal distension, and blurred vision, and many dark red (purple) tongues and four kinds of.2. diseases, which are slippery, fine, chord and astringent, and the disease is mainly in the liver, kidney and spleen. The main pathological factors are phlegm, stasis, damp, heat, wind, fire, turbidity, poison, phlegm and stasis, which are the most common and throughout the whole pathological process. The key pathogenesis is liver and kidney deficiency, phlegm stasis, phlegm stasis, phlegm stasis, phlegm stasis, damp heat, phlegm and stasis, phlegm and stasis, phlegm and stasis, phlegm, phlegm, phlegm, phlegm and phlegm. Turbid stasis, internal wind disturbance, phlegm and stasis obstructing collaterals, obstruction of heart camp, phlegm and blood stasis, Qi and blood (Yin) and two deficiency of the six syndrome type.3. treatment of the disease mostly from Phlegm Stasis Theory, the use of phlegm and stasis, exorcism through the way, with the dredging air machine, pay attention to the adjustment of the viscera, from this slow treatment, clinical when identifying phlegm and stasis attributes, parts, pinch and successively different, and so on. The treatment of different.4. is mainly treated with phlegm and blood stasis, combined with nourishing liver and kidney medicine, clearing heat and dampness medicine, removing wind and dredging collaterals, supplementing qi and nourishing Yin medicine, such as Rhizoma planus, seaweed, silkworm, turmeric, hawthorn, lotus leaf, Radix sage, leech, ghosts, arrows feathers, Alisma and so on.
【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R249;R259

【相似文献】