现代岭南名医肺系医案收集整理及肺胀证治规律与临床观察研究

发布时间：2018-08-13 20:13

【摘要】：目的：建立现代(1949年至今)岭南名老中医肺系医案数据库,并应用数据挖掘技术对其中的肺胀病医案进行系统研究,总结岭南名医治疗肺胀病的证治规律,旨在抢救和继承名老中医学术经验,研究和发挥区域中医药资源优势和临床特色,为岭南地区名老中医学术经验的继承应用和发展创新提供理论与实践的依据。此外,利用数据挖掘所提取的肺胀病基本方对慢性阻塞性肺疾病急性加重期(AECOPD)患者进行临床观察研究,以期发挥岭南医学特色,拓展中医药治疗AECOPD的思路和方法。方法：1.通过到图书馆、文献馆实地采集,期刊文献数据库搜索下载等形式,对现代岭南名老中医治疗肺系病证现存医案进行收集整理,应用Epidata3.1数据管理软件将肺系医案归纳、总结并规范化后建立医案数据库,并综合利用SPSS17.0及IBM SPSS Modeler14.1统计软件中频数分析、因子分析、系统聚类分析及Apriori关联规则等数据挖掘方法,对肺胀病证治规律进行系统研究,结合专业知识分析岭南名医治疗肺胀病临证思路、用药规律等内涵。2.其次,对上述数据挖掘方法所提取的基本方进行临床观察研究,选择AECOPD患者共66例,随机分为对照组和治疗组两组,对照组予西医常规处理,治疗组在对照组的基础上加用健脾降气化痰方药,选用中医临床症状体征积分、白细胞计数、血气分析指标等为观察项目,评价该疗法的临床疗效。结果：1.医案收集整理结果共收集岭南名老中医77人肺系医案相关著作50册,文献112篇,其中期刊杂志106篇,学位论文3篇,论文汇编2篇,网上期刊1篇。初步整理,总计收集医案392例,有效处方743条,包括感冒111条、咳嗽166条、哮病86条、喘证74条、肺痈21条、肺痿10条、肺胀94条、肺痨38条、咳血56条、肺癌87条,初步形成岭南名老中医肺系医案数据库。2.肺胀医案数据挖掘结果对收集到的47例94诊次肺胀医案的有效诊疗信息进行分析,共出现：症状总计90种824频次,主要症状表现为咯痰、气促、咳嗽、痰白、粘稠痰、食欲减退等；舌象20种318频次,其中舌淡频数最高,占17.61%,其次为苔白、舌红、舌暗、苔腻、苔黄等；脉象16种159频次,其中脉细频数最高,占22.64%,其次为脉数、脉滑、脉弦、脉沉、脉缓等；证型21种349频次,其中,本证中肺气虚证频数最高,占23.78%,其次为脾气虚证、肾阳虚证等；标证中痰湿阻肺证频数最高,占10.89%,其次为痰瘀阻肺证、水饮泛溢证、痰热壅肺证等。94条处方中,共用中药151味,累计用药次数1049次,其中甘草、半夏、茯苓、白术、陈皮、苦杏仁、党参、五味子、苏子等35味药物出现频数较高,累积频率达72.16%,而所使用岭南道地药材中,陈皮、肉桂、化橘红、五指毛桃、广地龙、青天葵等使用频率较高。对151味药物进行功效分类,出现频率由高到底依次为补虚药、化痰止咳平喘药、清热药、解表药、利水渗湿药、理气药等,岭南地区名老中医治疗肺胀病证以扶正、祛邪为总纲,补虚多选益气、养阴、温阳之品,祛邪则根据病邪性质,分别采取降气化痰、宣肺解表、清热解毒、利水消肿、理气止咳等治法。对35味高频药物进行因子分析及聚类分析,分别得出11类及8类药物组合。它们分别从不同角度体现了肺胀病病因病机及岭南名医临证用药思维特点、组方原则等。药物关联规则分析发现生姜+白芍、枳壳+半夏等35对常用药对及干姜+半夏+细辛、莱菔子+白芥子+苏子等24组常用三味药药物组合。症状药物关联分析挖掘出15种症药联系,舌脉药物关联分析挖掘出13种症药联系,证型药物关联分析挖掘出13种证药联系,从不同方面体现岭南名医辨证论治,证药相合的治病用药特色。数据挖掘体现岭南地区肺胀病虚实夹杂、脾虚湿困、气机失调、痰瘀互结、寒热错杂等病证特点,岭南名医治疗肺胀特色则有：扶正祛邪,标本兼顾；健脾化湿,培土生金；升降出入,善调气机；化痰行气,活血化瘀；因地制宜,寒温并用；药贵道地,岭南特色。3.临床研究结果两组治疗前后疗效分析,治疗组总有效率93.55%；对照组总有效率为80.65%,两组比较有显著统计学差异(P0.05),说明治疗组总疗效优于对照组。两组在临床症状体征、白细胞计数、血气分析指标等方面均较治疗前明显改善,治疗组咳嗽、咯痰、喘息、纳呆及腹胀等症状体征及Pa02/FiO2、PaCO2较对照组改善明显,有显著统计学差异(P0.05)。两组用药均未见明显毒副作用。结论：1.数据挖掘可以归纳提炼名医证治规律及治疗法则：如利用频数分析,可得出补益、化痰止咳平喘是肺胀病应用中最集中的法则；利用因子、聚类分析可得出肺胀病病因病机以及治疗肺胀的常用药物组合体,归纳基本方药；利用关联规则分析可得出肺胀病药-药、症-药、证-药等之间的深层关系。2.数据挖掘技术不仅可以使名老中医的经验变得更直观、更易懂,同时还可以进行重复性的操作,运用数据挖掘技术分析海量的中医诊疗信息,有助于发现中医辨证施治、处方用药等环节中隐含的关键规律,有助于促进中医的传承、发展和创新,进而促进中医药现代化的进程。3.医案体现了中医诊治理法方药的综合应用,在中医学术经验传承中具有极其重要的、不可替代的学术地位,研究医案是总结、传承名中医经验的有效途径。4.以健脾降气化痰法方药治疗AECOPD兼痰湿阻肺证可缓解临床症候,改善肺血气分析,临床疗效明显,无不良反应,为健脾降气化痰法治疗岭南地区AECOPD兼痰湿阻肺证提供临床依据,并为COPD急性加重期提供新的治疗手段。总之,运用现代科技数据挖掘技术,可以科学地从多角度、多方面对名老中医医案进行分析,且能够得到客观的、实用的、对临床工作有指导意义的结论。临床研究发现：健脾降气化痰法治疗AECOPD痰湿阻肺证有着确切的疗效。
[Abstract]:OBJECTIVE: To establish a modern (1949-present) lung system medical record database of famous and old Chinese medicine in Lingnan, and apply data mining technology to systematically study the medical records of lung distension, summarize the rules of syndrome and treatment of lung distension by famous doctors in Lingnan, in order to rescue and inherit the academic experience of famous and old Chinese medicine, study and exert the advantages of regional Chinese medicine resources and clinical characteristics. In addition, the basic prescriptions of pulmonary distention extracted from data mining were used to carry out clinical observation and Study on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), in order to give full play to the characteristics of Lingnan medicine and expand the treatment of traditional Chinese medicine for AECOPD. Methods: 1. Collecting and sorting out the existing medical records of famous and old Lingnan traditional Chinese medicine treating pulmonary diseases and syndromes by means of library, on-the-spot collection in the literature library, searching and downloading the periodical literature database, and so on. By using SPSS17.0 and IBM SPSS Modeler 14.1 statistical software, data mining methods such as frequency analysis, factor analysis, system clustering analysis and Apriori association rules were used to systematically study the rule of syndrome and treatment of pulmonary distention. Combined with professional knowledge, the clinical thinking of famous doctors in Lingnan for treating pulmonary distention and the law of medication were analyzed. 2. Secondly, the above data mining was carried out. Methods Sixty-six patients with AECOPD were randomly divided into control group and treatment group. The control group was treated with routine western medicine. The treatment group was treated with Jianpi Jiangqi Fang on the basis of the control group. The clinical symptoms and signs integral, white blood cell count and blood gas analysis index were selected as the observation indexes. Results: 1. A total of 50 books and 112 papers were collected, including 106 journals, 3 dissertations, 2 papers and 1 online journal. A total of 392 medical records and 743 effective prescriptions were collected, including 111 colds. There were 166 cough, 86 asthma, 74 asthma, 21 lung carbuncle, 10 flaccidity, 94 lung distention, 38 tuberculosis, 56 hemoptysis and 87 lung cancer. The database of lung system medical records of famous old Chinese medicine in Lingnan was preliminarily formed. 2. The data mining results of lung distention medical records analyzed the effective diagnosis and treatment information of 47 cases of 94 lung distention medical records collected. The total symptoms were 90 kinds and 82 kinds. The main symptoms were phlegm expectoration, shortness of breath, cough, white phlegm, viscous phlegm, loss of appetite, etc. The frequency of tongue symptoms was 318 times of 20 kinds, of which the frequency of tongue paleness was the highest, accounting for 17.61%, followed by white fur, red tongue, dark tongue, greasy fur, yellow fur, etc. Among them, the frequency of lung-qi deficiency syndrome was the highest, accounting for 23.78%, followed by spleen-qi deficiency syndrome and kidney-yang deficiency syndrome; the frequency of phlegm-dampness obstructing lung syndrome was the highest, accounting for 10.89%, followed by phlegm-stasis obstructing lung syndrome, water-drinking overflow syndrome, phlegm-heat obstructing lung syndrome and so on. Ling, white atractylodes macrocephala, orange peel, bitter almond, Codonopsis pilosula, Schisandra chinensis, Perilla frutescens and other 35 kinds of medicines appear frequently, the cumulative frequency is 72.16%. In Lingnan genuine medicinal materials, such as orange peel, cinnamon, Huatanghong, Wuzhi peach, Guangdilong, Qingtiankui are used frequently. Phlegm antitussive and antiasthmatic drugs, antipyretic drugs, diuresis and dampness drugs, Qi-Regulating drugs and so on, famous and old traditional Chinese medicine in Lingnan area treats lung distention syndrome with strengthening the right and eliminating evil as the general principle, nourishing deficiency and selecting more qi, nourishing yin and warming Yang products, eliminating evil according to the nature of the disease, respectively adopt the treatment methods of reducing qi, expelling phlegm, clearing away heat and toxin, relieving edema, regulating qi and stopping cough. The high-frequency drugs were analyzed by factor analysis and cluster analysis, and 11 kinds and 8 kinds of drug combinations were obtained. They reflected the etiology and pathogenesis of pulmonary distention from different perspectives, the thinking characteristics and prescription principles of famous doctors in Lingnan. Twenty-four groups of commonly used triple drug combinations, such as Semen Raphani, White Mustard, Perilla Fructus, etc. According to the characteristics of lung distension in Lingnan area, such as deficiency and excess of lung distension, spleen deficiency and dampness, Qi disorder, phlegm and blood stasis, mixed cold and heat, the famous doctors in Lingnan have the following characteristics: strengthening the body and dispelling evil, giving consideration to both the specimen; strengthening the spleen and removing dampness, cultivating the earth to produce gold; ascending and descending in and out, regulating qi; resolving phlegm and promoting blood circulation and removing blood stasis; combining cold and temperature according to local conditions; The total effective rate was 93.55% in the treatment group and 80.65% in the control group. There was significant difference between the two groups (P 0.05), indicating that the total curative effect of the treatment group was better than that of the control group. The symptoms and signs of cough, expectoration, asthma, nausea, abdominal distention and Pa02/FiO2, PaCO2 in the treatment group were significantly improved compared with those in the control group (P The most centralized rule in the application of pulmonary distention is to make up for the benefit, relieve phlegm, relieve cough and relieve asthma; the etiology and pathogenesis of pulmonary distention and the combinations of commonly used drugs for the treatment of pulmonary distention can be obtained by factor and cluster analysis, and the basic prescriptions and medicines can be summarized; the deep relationship among pulmonary distention drugs, symptoms, medicines, syndromes and medicines can be obtained by association It can not only make the experience of famous and old Chinese medicine more intuitive and easier to understand, but also can carry out repetitive operation. Using data mining technology to analyze the massive information of TCM diagnosis and treatment is helpful to discover the key rules hidden in the links of TCM syndrome differentiation and treatment, prescription medication and so on. It is helpful to promote the inheritance, development and innovation of TCM, and further promote the development of TCM. 3. Medical records embody the comprehensive application of TCM diagnosis and treatment, and play an important and irreplaceable role in the inheritance of TCM academic experience. The study of medical records is an effective way to summarize and inherit famous TCM experience. 4. The treatment of AECOPD combined with phlegm dampness obstructing lung syndrome by invigorating spleen and reducing phlegm can alleviate impending clinical symptoms. Bed symptoms, improve lung blood gas analysis, clinical efficacy is obvious, no adverse reactions, for Jianpi Jiangqi phlegm method for the treatment of Lingnan AECOPD and phlegm dampness obstruction of lung syndrome provides clinical basis, and for the acute exacerbation of COPD provides a new means of treatment. Medical case analysis, and can get objective, practical and instructive conclusions for clinical work. Clinical research found that: Jianpi Jiangqi Phlegm method for the treatment of AECOPD phlegm dampness obstruction syndrome has a definite effect.
【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】：2016
【分类号】：R249;R256.14

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