基于数据挖掘法探讨白兆芝教授治疗慢性萎缩性胃炎并癌前病变的用药经验

发布时间：2018-05-06 16:41

本文选题：CAG并癌前病变 + 脾胃气滞　；参考：《山西中医学院》2016年硕士论文

【摘要】：目的1.整理和继承我国名老中医白兆芝教授治疗慢性萎缩性胃炎并癌前病变的临床经验。2.运用数据挖掘方法对白兆芝教授的治疗经验进行有效的总结和传承。方法选取符合纳入标准的慢性萎缩性胃炎并癌前病变患者110例;将病历资料规范化,并将其基本信息、主诉、症状、体征、舌脉、诊断、治法、药物进行录入,形成病历资料数据库;运用EXCEL软件制作频数分布表,对患者性别、年龄构成,证候分布、药物等进行描述,运用Statistica8.0软件(Data Mining)模块为挖掘工具,运用weka3.4数据挖掘软件对临床常见症状与常用药物以及药物对应配伍关系进行关联规则分析;初步总结白兆芝教授治疗慢性萎缩性胃炎并癌前病变的临证经验;形成可直接分析的多维临床数据。结果慢性萎缩性胃炎并癌前病变可为肝胃气滞、肝胃郁热、脾胃湿热、脾胃气虚、脾胃虚寒、胃阴不足、胃络瘀血七个证型[1],研究结果表明,本病临床以脾胃气虚为主,临床症状以脘痞、纳呆、乏力、畏冷,大便溏薄,舌暗淡边齿痕苔薄白,脉沉弦为主,治则以“益气健脾、活血解毒”为基础,常用黄芪、太子参、白术、茯苓加丹参、莪术、白屈菜等;病程日久可见胃阴不足,临床症状主要表现为脘中灼热、嘈杂或隐痛,舌红少津或有裂纹,脉沉细或数,治则为“益气养阴、活血解毒”,用太子参、麦冬、百合、乌药加丹参、莪术、白屈菜等;因“木克土”,故在临床中肝胃不和的证型也较常见,可见胃胀、可牵及胁肋不适,嗳气,心烦易怒,情绪不佳时表现益甚,舌暗苔白,脉沉弦,多采用疏肝和胃、化瘀解毒法,常用柴胡、白芍、枳实、陈皮加丹参、莪术、白花蛇舌草等,此外,因个人体质及饮食习惯等差异,疾病早期也可见湿热内蕴证型,临床常见脘痞、纳呆、口干苦,恶心,舌红苔厚腻,脉沉弦或弦滑,常用清化湿热、化瘀解毒法,用黄芩、生薏仁、白蔻仁加丹参、莪术、白屈菜等。结论白兆芝教授治疗CAG并癌前病变的临床经验突出了中医整体观念,注重把握病机转化规律,认为脾胃虚弱是CAG发病的基础,其关键因素是胃气阻滞,胃络瘀阻则贯穿疾病发展始终;辩证以虚实、寒热、气血、阴阳为主,但更注重虚实夹杂、寒热失调、气血同病的复合证候;治疗主张缓调,以和为要,以“益气健脾,化瘀通络”为基本原则,根据临床症状灵活变化,做到局部和整体综合调治[2];用药配伍注重刚柔相济、升降相宜、气血相合等多方面,开辟了治疗本病的新领域。以“人机结合,以人为主”的数据挖掘方式进行整理名老中医临床经验,探讨诊疗规律是切实可行的,跟师出诊学习,收集足量有价值的临床资料为基础,运用数据挖掘方法,在大量而复杂的个体化病例资料中总结出科学有效的经验[3],将之归纳成可随时参考、进行实践的有价值的知识,是对中医最好的继承和发扬。
[Abstract]:Objective 1. Collate and inherit the clinical experience of Professor Bai Zhaozhi in the treatment of chronic atrophic gastritis with precancerous lesion. The data mining method is used to summarize and inherit Professor Bai Zhaozhi's treatment experience. Methods 110 patients with chronic atrophic gastritis complicated with precancerous lesion were selected and their basic information, complaints, symptoms, signs, tongue veins, diagnosis, treatment methods and drugs were recorded. Form the database of medical record data, use EXCEL software to make frequency distribution table, describe patient's sex, age composition, syndrome distribution, drug, etc., use Statistica8.0 software / data mining module as mining tool, Weka3.4 data mining software was used to analyze the association rules between common clinical symptoms and common drugs and their corresponding compatibility, and the clinical experience of Professor Bai Zhaozhi in treating chronic atrophic gastritis with precancerous lesions was summarized preliminarily. To form multidimensional clinical data that can be directly analyzed. Results chronic atrophic gastritis combined with precancerous lesion could be divided into seven types: liver and stomach qi stagnation, liver and stomach stagnation heat, spleen and stomach dampness and heat, spleen and stomach qi deficiency, spleen and stomach deficiency cold, stomach yin deficiency and gastric collateral blood stasis. The results showed that the main clinical pattern of the disease was spleen and stomach qi deficiency. The clinical symptoms were epigastric distension, incapacity, fatigue, dread of cold, thin stool, thin fur of tongue, thin white tongue, weak vein, and the treatment was based on "invigorating qi and strengthening spleen, promoting blood circulation and detoxification". Astragalus membranaceus, Radix princeliae, Atractylodes macrocephala, Poria cocos plus Salvia miltiorrhiza, Curcuma were commonly used. The main clinical symptoms were burning heat, noise or pain, red tongue or crack, fine or number of veins, treatment for "nourishing qi and yin, promoting blood circulation and detoxification", using Radix Pseudostellariae, Radix Ophiopogonis, Lilium, etc. Wuyao plus Salvia miltiorrhiza, Curcuma curcumae, etc., because of "Mu Ke Tu", the syndrome type of disharmony between liver and stomach is also more common in clinical practice. It can be seen that stomach distension, discomfort of pulling and hypochondria, belching, irritability, bad mood and white tongue coating. The blood vessel sinks the string, uses the soothing liver and the stomach, detoxifies the blood stasis method, commonly used chaihu, white peony, Aurantii, Chen Pei + Danshen, Curcuma, the white flower snake tongue grass and so on. In addition, because of the individual physique and the diet habit and so on difference, the disease early may also see the damp heat internal accumulation syndrome type, Clinical common epigastric bullies, dry bitter mouth, nausea, tongue red fur thick and greasy, pulse sink string or string smooth, commonly used to remove dampness and heat, detoxification method, with Scutellaria baicalin, Shengyi, Baikourenjia Danshen, Curcuma, Baiqu dish, etc. Conclusion Professor Bai Zhaozhi's clinical experience in the treatment of CAG with precancerous lesions highlights the whole concept of traditional Chinese medicine, pays attention to the law of pathogenesis and transformation, and holds that the deficiency of spleen and stomach is the basis of the pathogenesis of CAG, and the key factor is gastric qi block. The stagnation of stomach collaterals runs through the development of the disease all the time; dialectical is based on deficiency and reality, cold and heat, qi and blood, yin and yang, but pays more attention to the complex syndromes of deficiency and deficiency, imbalance of cold and heat, Qi and blood with disease; treatment advocates slow adjustment, takes harmony as the main purpose, and "invigorates qi and invigorates spleen", Huayu Tongluo "is the basic principle, according to the clinical symptom nimble change, achieves the partial and the whole synthesis adjusts the treatment [2]; the medicine compatibility pays attention to the rigid and soft to be mixed, rises and falls suitable, and so on many aspects and so on unifies, opens up the new domain which treats this disease. Based on the data mining method of "man-machine combination, people-oriented", to sort out the clinical experience of famous Chinese medicine, to discuss the rule of diagnosis and treatment, to study with the teacher, to collect enough valuable clinical data, and to use the method of data mining. It is the best inheritance and development of traditional Chinese medicine to sum up scientific and effective experience in a large number of complicated individual case data and to generalize it into valuable knowledge which can be referred to and practiced at any time.
【学位授予单位】：山西中医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R249;R259

【参考文献】