基于数据挖掘研究王旭教授临床运用桃红四物汤治疗内分泌疾病的经验

发布时间：2018-07-18 10:56

【摘要】：[目的]整理本人跟诊时所搜集到的导师临床运用桃红四物汤的医案,借助于数据挖掘技术,系统性地总结导师临床运用桃红四物汤治疗内分泌疾病的经验,便于今后在临床上更好地运用桃红四物汤,充分体现其临床价值。[方法]通过温习和查阅相关文献,深入了解桃红四物汤来源、组成、功效、临床运用及实验室研究进展等方面的相关知识,收集、整理导师王旭教授2015年9月至2016年12月间运用桃红四物汤的医案,再根据纳入标准和排除标准进行筛选,共获得符合要求的155诊次医案。将所有医案数据录入MedcaseV3.2数据记录挖掘系统中,构建本次研究的数据专库。先对医案数据进行全面清洗,再用相关数据挖掘方法(包括频数统计和关联规则等)进行挖掘分析。将挖掘得到的临床症状、舌苔、脉象、处方用药及其中的关联性等内容分析、归纳并总结。[结果]本次研究共118例患者,其中男性5例,女性113例,分别占4.24%、95.76%,男女比例1:22.6。患者中年龄最大的76岁,最小的16岁,平均为35岁。中医诊断方面,以月经不调、黧黑斑、瘿病为主,频率分别为33.55%、26.45%、14.84%。西医诊断方面,以月经病、黄褐斑为主,频率分别为30.97%、26.45%。临床表现方面,共有148个临床症状,频率较高的临床表现有月经色暗、有血块、神疲乏力、月经量少、经前乳胀、月经后期、面部色素沉着、怕冷、寐差、面色无华、脱发、经行腰酸,频率分别为49.03%、47.10%、45.81%、42.58%、31.61%、30.32%、29.03%、27.74%、23.87%、23.23%、21.94%、21.29%;舌象方面,较高频的有质淡紫(43.23%)、苔薄(38.71%)、质红(27.10%)、苔薄白(23.23%)、有瘀点(21.29%)、有紫气(17.42%)、质紫黯(14.84%)、边有齿痕(13.55%)。脉象方面,频率大于20%的脉象有:涩脉、细脉、弦脉,频率分别为92.90%、72.29%、23.23%,以涩脉、细脉为主。用药方面,高频药物有9味,分别为:桃仁、红花、川芎、当归、白芍、甘草、熟地、山药、山茱萸,频率分别为:100.00%、100.00%、97.42%、95.48%、92.26%、87.10%、85.81%、68.39%、67.10%。[结论]王旭教授临证时常体现其异病同治的思维。导师临床运用桃红四物汤治疗多种内分泌疾病,尤其在女性月经不调、黄褐斑、甲状腺相关疾病中最为多见。虽然所治疗的疾病种类不一,但这些疾病均在其发展变化中出现了血虚血瘀之证。当这些临床表现、舌苔、脉象均与血虚血瘀证相符合时,可选用桃红四物汤。导师常根据归经理论指导用药。"经脉所过,主治所及",桃红四物汤主入肝经,王旭教授临床运用桃红四物汤时,常用其治疗肝经循行所过之处的疾患,诸如黄褐斑、月经不调和甲状腺相关疾病等。王旭教授临证时常从肝肾论治,因肝肾同源,肾精与肝血互生互用,同盛同衰,故王旭教授临床运用桃红四物汤时常配伍使用六味地黄丸中"三补"(熟地、山药、山茱萸),肝肾同调。并在调理女子月经时,考虑到月经的产生与调节与肾脏、肝脏、脾脏关系紧密,故临床处方用药时注意调养肝肾,且常常肝脾肾三脏同调。
[Abstract]:[objective] to sort out the medical records of clinical application of Taohong Siwu decoction, and systematically summarize the experience of using Taohong Siwu decoction in the treatment of endocrine diseases, with the help of data mining technology. It is convenient to use Taohong Siwu decoction better in clinic in the future and fully reflect its clinical value. [methods] by reviewing and consulting the relevant literature, we can deeply understand the source, composition, efficacy, clinical application and laboratory research progress of Taohong Siwu decoction. From September 2015 to December 2016, professor Wang Xu used Taohong Siwu Tang medical records and screened them according to the inclusion criteria and exclusion criteria. A total of 155 medical records were obtained. All medical records were input into Medcase V3.2 data mining system, and the data database of this study was constructed. Firstly, the data of medical records are cleaned completely, and then the related data mining methods (including frequency statistics and association rules) are used for mining and analysis. The clinical symptoms, tongue coating, pulse, prescription medication and its relevance were analyzed and summarized. [results] there were 118 patients in this study, including 5 males and 113 females, accounting for 4. 24% and 95. 76% respectively, the ratio of male to female was 1: 22. 6. The oldest and youngest were 76 and 16, with an average age of 35. In the diagnosis of traditional Chinese medicine, menstrual disorder, blackish spot and gall disease were the main ones with the frequency of 33.555.26.45 and 14.8445, respectively. Western medicine diagnosis, menstrual disease, chloasma, the frequency of 30.97, 26.45. In terms of clinical manifestations, there were 148 clinical symptoms with high frequency, including dark menstrual color, blood clot, fatigue, less menstrual volume, premenstrual distension, late menstrual period, pigmentation on the face, fear of cold, poor sleep, no color, hair loss, The frequencies were 49.03, 47.101and 45.81, respectively. The frequencies were 42.58 and 31.61and 30.323.32 and 29.320.32, respectively. They were: 27.747.23.8723.2323.2321.9421.292.The higher frequency of light purple (43.23%), thin coating (38.71%), red (27.10%), thin white (23.23%), bruising point (21.29%), purple qi (17.42%), dark purple (14.84%), and teeth marks (13.55%) were found in the tongue picture, and there were bruises (21.29%), purple qi (17.42%), dark purple (14.84%) and teeth marks (13.55%). In terms of pulse, the frequency of more than 20% pulse is: astringent vein, thin vein, chord pulse, frequency is 92.90, 72.29 and 23.23, mainly astringent vein and thin vein. In medicine, there are 9 kinds of high frequency drugs: peach kernel, safflower, Chuanxiong, angelica, Radix Paeoniae Alba, Glycyrrhiza, ripe ground, Chinese yam, Cornus officinalis, the frequency of which is 100.000. 000.97. 42Con 92.269.2697.100.85.81and 67.107.10. [conclusion] Professor Wang Xu's clinical symptoms often reflect his thinking of treating different diseases with the same treatment. Tutor clinical use of Taohong Siwu decoction to treat a variety of endocrine diseases, especially in women menstrual disorders, chloasma, thyroid-related diseases are most common. Although the kinds of diseases treated are different, these diseases have the syndrome of blood deficiency and blood stasis in their development. When these clinical manifestations, tongue coating and pulse are consistent with blood deficiency and blood stasis syndrome, Taohong Siwu decoction can be selected. Mentors often guide the use of drugs according to the theory of return to the Classics. " When Professor Wang Xu uses Taohong Siwu decoction clinically, it is commonly used to treat diseases along the meridian of the liver, such as chloasma, menstrual disorder and thyroid related diseases. Professor Wang Xu often treats the liver and kidney from the liver and kidney, because the liver and kidney are homologous, the kidney essence and the liver and blood are used mutually, the same prosperity is the same as the aging, so Professor Wang Xu often uses Taohong Siwu decoction in clinical use in combination with Liuwei Dihuang pills "three tonics" (cooked land, Chinese yam, Chinese yam). Cornus officinalis), liver and kidney are the same. When regulating the menstruation of women, it is considered that the production and regulation of menstruation are closely related to the kidney, liver and spleen, so the clinical prescriptions should pay attention to nourishing the liver and kidney, and the three viscera of liver, spleen and kidney are often in the same tune.
【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】：R249;R259

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