高天舒教授治疗气阴两虚兼痰瘀型糖尿病肾病的用药规律

发布时间：2018-10-10 10:03

【摘要】：目的：运用数据挖掘技术研究高天舒教授治疗糖尿病肾病的用药规律,探析高天舒教授辨证及用药经验。材料与方法：收集高天舒教授治疗糖尿病肾病病例,记录患者一般资料及处方用药等信息,使用WPS-Excel 2016建立病例信息及处方数据库,采用频数、相关性及聚类等分析方法进行处方分析。结果：1.172名患者中,平均年龄59.41±12.10岁,男性占64.53%;女性占35.47%。女性与男性的比例为1：1.82;BMI在24.0~27.9kg/m2(超重)者最多,占47.09%;合并高血压最多,占70.35%。2.以纳入及排除标准筛选处方共191则,涉及中药179味,使用总频次为2463次。其中使用频率超过10%的中药共有39味,排在前十位的药物依次为黄芪、山茱萸、泽泻、生地、茯苓、乌梅、益母草、菟丝子、桑椹和丹皮。3.179味中药中寒性药居多,温性药其次,分别占36.88%和31.28%;药味以甘、苦、辛居多;药物归经顺序依次为肝、肾、肺、脾、心经,其中归肝经的药物使用频次为1339次,占54.36%,归肾经药物使用频次为1224次,占49.70%。4.涉及16类药物,补虚药、清热药、利水渗湿药位于前列,使用频率依次为27.49%、17.30%、11.21%。其中补虚药以补阴药(45.20%)、补气药(35.01%)居多,清热药以清热凉血药(52.37%)为首。5.结合跟师经验,相关性分析得出6个常用药对,聚类分析得出4个聚类方。结论：1.高天舒教授认为气阴两虚,痰瘀阻络,是糖尿病肾病病机;“肾络微型ve瘕”是糖尿病肾病的病理关键环节。治疗上高天舒教授主张益气养阴,活血化瘀,软坚散结。2.黄芪、山茱萸、泽泻、生地、茯苓、乌梅、益母草、菟丝子、桑椹和丹皮是高天舒教授治疗糖尿病肾病的核心用药。3.用药以寒性药稍多,温性药其次,药味以甘、苦、辛为主,主归肝经,其次为肾、肺、脾、心经。4.补虚药、清热药、利水渗湿药、活血化瘀药是高天舒教授常用的药物类别,体现高天舒教授补气养阴、活血消ve的治疗主张。同时高天舒教授重视软坚散结中药如海藻、昆布在糖尿病肾病中的应用。
[Abstract]:Objective: to study the rule of drug use of Professor Gao Tianshu in the treatment of diabetic nephropathy by using data mining technology, and to explore professor Gao Tianshu's syndrome differentiation and drug use experience. Materials and methods: professor Gao Tianshu for the treatment of diabetic nephropathy cases, records the general information of patients and prescription medication information, using WPS-Excel 2016 to establish case information and prescription database, using frequency, Correlation and cluster analysis methods were used for prescription analysis. Results among 1.172 patients, the average age was 59.41 卤12.10 years old, male was 64.53 and female was 35.477.The average age was 59.41 卤12.10 years old. The female-male ratio of 1: 1.82 was the highest in 24.0~27.9kg/m2 (47.09), and the highest in hypertension (70.35.2.). A total of 191 prescriptions were screened by inclusion and exclusion criteria, involving 179 kinds of traditional Chinese medicine, with a total frequency of 2463 times. Among them, 39 herbs were used more than 10% frequently. The top ten drugs were astragalus, Cornus officinalis, alisma, Rhizoma alisma, Poria cocos, Wumei, Leonurus, semen Cuscuta, Mulberry and Danpi. 3.179 herbs were mostly cold drugs, followed by warm drugs. 36.88% and 31.28%, respectively, the medicine taste was sweet, bitter and Xin, and the order of drug meridian was liver, kidney, lung, spleen and heart meridian, in which the frequency of drug use was 1339 times, accounting for 54.36 times, and the frequency of drug use for kidney meridian was 1224 times, accounting for 49.70 times. Involving 16 kinds of drugs, tonifying deficiency medicine, clearing heat medicine, promoting water and permeating wet medicine in the front row, the frequency of use is 27.49, 17.30 and 11.21. The drugs of tonifying deficiency were tonifying yin (45.20%), invigorating qi (35.01%), and clearing away heat and cooling blood (52.37%). According to the experience of teachers, 6 common drug pairs were obtained by correlation analysis, and 4 clusters were obtained by cluster analysis. Conclusion 1. Professor Gao Tianshu thinks that deficiency of qi and yin, phlegm and stasis are the pathogenesis of diabetic nephropathy, and "kidney mini ve" is the key link of diabetic nephropathy. On the treatment of Professor Gao Tianshu advocated invigorating qi and yin, promoting blood circulation and removing blood stasis, soft strong scattered knot. 2. Astragalus membranaceus, Cornus officinalis, alisma, Rhizoma Astragali, Poria cocos, Wupai, Motherwort, Cuscuta, Mulberry and Dannan are the core drugs used by Professor Gao Tianshu in the treatment of diabetic nephropathy. Cold medicine is used a little more, warm medicine is next, medicinal taste is sweet, bitter, Xin mainly, main return liver classics, next is kidney, lung, spleen, heart Jing. 4. The medicine of tonifying deficiency, clearing away heat, promoting water and infiltrating dampness, activating blood circulation and removing blood stasis are commonly used by professor Gao Tianshu, which embodies professor Gao Tianshu's treatment proposition of nourishing qi and nourishing yin and activating blood circulation and eliminating ve. At the same time, Professor Gao Tianshu attaches importance to the application of Chinese medicine such as seaweed and kelp in diabetic nephropathy.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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