基于数据挖掘的李济仁教授治疗痹痿症—证—药相关性研究

发布时间：2018-10-19 09:00

【摘要】：目的:本课题从李济仁教授治疗痹病和痿病的临床病案着手,使用TCMISS(V2.5)对符合纳入标准的临床病案进行统计分析和数据挖掘,结合中医学理论知识,对痹病和痿病的症状-证候-治则治法-中药进行比较研究,着重探讨李济仁教授治疗痹病、痿病的用药规律,进一步探讨其“痹痿统一论”的学术思想。方法:收集2015年1月—2016年12月李济仁教授诊治的痹病、痿病患者完整病历(门诊),按照纳入、排除标准进行筛选,将入选的痹病、痿病各50例病历,包括相关患者基本情况、临床症状、辨证分型、选方用药等情况,在中医传承辅助系统中构建数据库,通过频数、关联规则、卡方检验等分析方法,得到症状、证候、治则治法、中药等方面的统计结果,比较分析痹病和痿病的用药规律。结果:研究结果发现,痹病和痿病同时出现的症状、证候、治则治法方面,大部分存在统计学差异。症状上,痹病和痿病患者在乏力、行走困难、肌肉萎缩以及腰痛等症状分布具有显著统计学差异(P0.01);证候上,痹病和痿病患者中肝肾亏虚证、寒湿阻络证、湿热阻痹证、瘀血阻络证等证候组比较存在统计学差异(P0.05),说明痹病和痿病患者在上述证候分布方面不完全相同,且痹病和痿病患者在寒湿阻络证、瘀血阻络证两组证候分布比较具有显著统计学差异(P0.01)。其中肝肾亏虚证在痹病和痿病患者证候中频次最高;痹病和痿病患者中使用活血舒筋、温补气血、温化寒湿等治则治法组存在统计学差异(P0.05),说明痹病和痿病的治则治法不完全相同,其中滋补肝肾、活血舒筋在痹病和痿病患者治则治法中频次最高。痹病和痿病中同时出现的频次较高的药物有:黄芪、全蝎、当归、千年健、鸡血藤、活血藤、狗脊、补骨脂、五加皮、牛膝、生地黄、炒白术等,四气均以温、平药物为主,温药出现频次最多;五味以苦、辛、甘为主;归经均以入肝、肾、脾、心、胃经药物为主,其中肝经和肾经药物出现频次最多;同时挖掘出痹病新方4首,痿病新方6首。结论:痹病和痿病患者均可以出现以“乏力”、“行走困难”、“肌肉萎缩”等为主要表现的症状;“肝肾亏虚证”在痹病和痿病患者证候中出现频次最高,是痹病和痿病的主要证候;“滋补肝肾”、“活血舒筋”是痹病和痿病患者出现频次最高的治则治法;治疗药物多以肝经、肾经药物为主。痹病和痿病在症状、证候、治则治法、中药方面有着相似性和联系性,为李济仁教授“痹痿统一论”和“治痿专重肝肾”思想提供了一定意义上的临床实例和参考。
[Abstract]:Objective: to start with Professor Li Jiren's clinical records of treating arthralgia and impotence, and use TCMISS (V2.5) to analyze and mine the clinical medical records according to the inclusive criteria, and combine with the theoretical knowledge of traditional Chinese medicine (TCM). This paper makes a comparative study on symptoms, syndromes, principles of treatment and traditional Chinese medicine of arthralgia and impotence, emphasizes on professor Li Jiren's treatment of arthralgia and impotence, and further probes into his academic thought of "unified theory of arthralgia and impotence". Methods: from January 2015 to December 2016, the complete medical records (outpatient) of the patients with arthralgia and impotence were collected and screened according to the inclusive and exclusion criteria. Each of the 50 cases of arthralgia and impotence was selected, including the basic information of the related patients. Clinical symptoms, syndrome differentiation and drug use, etc., to construct a database in the system of traditional Chinese medicine inheritance and assistance, through frequency, association rules, chi-square test and other analytical methods, to obtain symptoms, syndromes, and treatment methods. The statistical results of traditional Chinese medicine and other aspects, comparative analysis of arthralgia disease and impotence drug use law. Results: most of the symptoms, syndromes and treatments of arthralgia and impotence were statistically different. There were significant differences in the distribution of symptoms such as fatigue, difficulty in walking, muscular atrophy and low back pain between patients with arthralgia and arthralgia (P0.01); syndromes: deficiency of liver and kidney, cold and dampness, obstruction of collaterals, dampness and heat blocking arthralgia, syndrome of deficiency of liver and kidney, syndrome of dampness and dampness, and arthralgia of dampness and heat. There was a statistical difference between the syndrome groups of stagnation of blood and obstruction of collaterals (P0.05), which indicated that the distribution of the above syndromes was not identical in the patients with arthralgia and impotence, and the patients with arthralgia and impotence were in the syndrome of blocking collaterals with cold and dampness. There was significant difference in the distribution of syndrome between the two groups (P0.01). The syndrome of deficiency of liver and kidney is the highest in the syndrome of arthralgia and impotence. There was statistical difference between the two groups (P0.05), which indicated that the treatment principles of arthralgia and impotence were not the same, among which nourishing liver and kidney, activating blood circulation and Shujin were the highest in the treatment of arthralgia and impotence. The drugs with higher frequency in both arthralgia and impotence include astragalus, scorpion, angelica sinensis, healthy chicken, blood activating rattan, dog ridge, psoralen bone fat, Acanthopanax, Achyranthes bidentata, Rehmannia Rehmanniae, Atractylodes macrocephala, and so on. The most frequent appearance of warm drugs; the five flavors of bitter, Xin, Gan mainly; return to the liver, kidney, spleen, heart, stomach meridian drugs mainly, in which liver and kidney meridian drugs appear the most frequently; at the same time, excavated the disease of 4 new prescription, 6 new prescription of impotence. Conclusion: "fatigue", "walking difficulty" and "muscular atrophy" are the main symptoms in patients with arthralgia and impotence, and "liver-kidney deficiency syndrome" is the most frequent symptom in patients with arthralgia and impotence. It is the main syndromes of arthralgia and impotence; "nourishing liver and kidney" and "activating blood circulation and soothing muscle" are the most frequent treatment methods for patients with arthralgia and impotence; the main treatment drugs are liver meridian and kidney meridian drugs. Arthralgia and impotence have similarities and connections in symptoms, syndromes, principles of treatment and traditional Chinese medicine, which provide some clinical examples and references for Professor Li Jiren's thought of "unified theory of arthralgia and impotence" and "treating impotence with special emphasis on liver and kidney".
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R249;R255.6

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