名老中医赵振昌教授治疗慢性肾功能衰竭经验的数据挖掘研究

发布时间：2018-11-06 13:34

【摘要】：目的:通过对赵振昌教授治疗慢性肾功能衰竭的病案收集、整理与数据分析,总结出名老中医赵振昌教授治疗慢性肾功能衰竭的临床经验及用药规律,传承其学术思想。方法:收集赵振昌教授2014年1月-2015年12月门诊医案,应用当代名老中医医案分析挖掘系统(北京科技大学—北京金灵兰信息技术有限责任公司)软件,通过关联分析、用药分析、组方分析、群体分析等数据分析路径,挖掘对象处方中药物使用的规律,分析赵振昌教授治疗慢性肾功能衰竭的用药经验,整理学术思想、探讨用药规律。结果:分析筛选出的500首处方,计算每味中药的出现频次,挖掘各味中药之间的关联规则,使用频次最高的前15位中药依次是熟地黄,生地黄,山萸肉,黄芪,党参,白术,茯苓,山药,土茯苓,白茅根,鳖甲,杜仲,蝉蜕,僵蚕,萆參。所用药物归肾、肝、脾经为主,所用药物的性味以温、甘、酸、平为主。其次为辛、凉之品,药物组合出现频次最高的前5位依次是生地黄-熟地黄;熟地黄-山萸肉;生地黄-山萸肉;党参-白术;黄芪-白术;并挖掘出个5核心组合和4首新处方。结论:赵振昌教授临床上将慢性肾功能衰竭分以下几型:(1)脾肾气虚:治以益气补肾健脾,方选四君子汤合济生肾气丸加减,药用太子参、黄芪、生地黄、白术、茯苓、泽泻、山茱萸、山药、车前子、牛膝、甘草;(2)脾肾气阴两虚:治以益气养阴,补肾健脾,方选六味地黄汤合太子参、黄芪加减,药用太子参、黄芪、生地、泽泻、茯苓、山茱萸、山药、丹参、大黄;(3)肝肾阴虚:治以滋肝养肾,方选六味地黄丸合一贯煎加减,药用山茱萸、生地、茯苓、枸杞、山药、车前子、泽泻、沙参、当归、川楝子、怀牛膝、鳖甲;(4)阴阳两虚,治以补养气血,阴阳双补,方选麦味地黄丸合黄芪、当归加减,药用生地、熟地、麦冬、茯苓、山药、山茱萸、黄芪、当归、肉苁蓉。赵振昌教授在多年临证中发现,本病以正虚为本,浊邪为标,多兼夹瘀毒,故在临床上喜用补肾健脾之药味,诸如生地黄、熟地黄、白术、茯苓、黄芪、山药等;当机体以邪实为主要表现时,赵振昌教授则酌情加以祛湿泄浊之药味,诸如猪苓、泽泻、车前子、大黄、郁李仁等;久病入络,经络气滞血瘀,故赵振昌教授喜用活血化瘀中药以使瘀血得以运行,经络气血通达,临床常用丹参、地龙、赤芍、当归、三七等活血之品。通过本研究发现论文赵振昌教授治疗慢性肾功能衰竭经验丰富,多用补肾健脾泄浊之品,喜配伍活血化瘀药。通过频数分析及聚类分析等统计学方法对药物进行统计分析,数据挖掘得出慢性功能衰竭是脾肾亏虚为本,湿、热、毒、瘀等邪气瘀阻为标,当以补肾填精益髓,健脾益气养血,清热化湿解毒、活血化瘀通络等为其治疗大法,为我们继承和发扬名老中医治疗慢性肾衰理论和治疗方法提供了参考。
[Abstract]:Objective: to collect, arrange and analyze the medical records of Professor Zhao Zhenchang in treating chronic renal failure (CRF), sum up the clinical experience and medication law of Professor Zhao Zhenchang in the treatment of chronic renal failure (CRF), and pass on his academic thoughts. Methods: professor Zhao Zhenchang's outpatient medical records were collected from January 2014 to December 2015, and the software was used to analyze and excavate the medical records of famous traditional Chinese medicine (Beijing University of Science and Technology-Beijing Jinlinglan Information Technology Co., Ltd.). The data of drug use analysis, group analysis and so on are analyzed, the rule of drug use in prescription is excavated, the experience of professor Zhao Zhenchang in the treatment of chronic renal failure is analyzed, the academic thought is sorted out, and the law of drug use is discussed. Results: 500 prescriptions were analyzed, the occurrence frequency of each Chinese medicine was calculated, and the association rules between different Chinese medicines were excavated. The top 15 Chinese medicines with the highest frequency of use were Rehmannia glutinosa, Radix Corni, Radix Astragali, Codonopsis pilosula, Atractylodes macrocephalae. Poria cocos, yam, Poria cocos, Maomaogan, Biejia, Eucommia, cicada slough, silkworm, Bishen. The drugs used are mainly kidney, liver and spleen, and the properties of the drugs are warm, sweet, sour and flat. Followed by Xin, cool products, the drug combination of the highest frequency of the first five places are Rehmannia glutinosa; cooked Rehmannia officinalis; Codonopsis macrocephala; Astragalus macrocephala; And dig out a 5-core combination and 4 new prescriptions. Conclusion: professor Zhao Zhenchang clinically divided chronic renal failure into the following types: (1) deficiency of spleen and kidney qi: treating spleen with supplementing qi and tonifying kidney and invigorating spleen, adding and subtracting decoction of Fangxuan Sijunzi decoction combined with Jisheng Shenqi pills, Radix Pseudostellariae, Astragalus, Radix Rehmanniae, Atractylodes macrocephala, Poria cocos; Alisma, Cornus officinalis, yam, plantain, Achyranthes bidentata, licorice; (2) deficiency of spleen and kidney qi and yin: treat with supplementing qi and nourishing yin, tonifying kidney and invigorating spleen, selecting Liuwei Dihuang decoction with Radix Pseudostellariae, adding and subtracting Radix Astragali, Radix Pseudostellariae, Radix Astragali, Radix Alismatis, Poria cocos, Cornus officinalis, Chinese yam, Salvia miltiorrhiza and Rh (3) liver and kidney yin deficiency: to treat liver and kidney nourishing kidney, the prescription chooses Liuwei Dihuang pill to add and subtract consistently, medicinal dogwood, raw land, Poria cocos, Lycium barbarum, yam, plantain seed, Alismatis, Sachshen, Angelica sinensis, Chuanelianzi, Achyranthes bidentata, Biejia; (4) deficiency of yin and yang, cure by nourishing qi and blood, nourishing both yin and yang, combining Huangqi with Radix Rehmanniae pills and Radix angelicae Sinensis, adding and subtracting Radix angelicae Sinensis, medicinal land, ripe land, Ophiopogon japonicus, Poria cocos, Chinese yam, Cornus officinalis, Astragalus membranaceus, Angelica sinensis, Cistanche deserticola. Professor Zhao Zhenchang in many years of clinical syndrome found that this disease is based on the deficiency, turbid evil as the standard, more and more blood stasis poison, so in the clinic like to use the medicine flavor of tonifying kidney and spleen, such as Rehmannia, Atractylodes macrocephala, Poria cocos, Astragalus, Chinese yam and so on. When the body is the main performance of evil, Professor Zhao Zhenchang as appropriate to remove the smell of dampness and turbidity, such as Polyporus, alisma, plantain, rhubarb, Yu Li Ren and so on; Long illness into the collaterals, meridian Qi stagnation and blood stasis, so Professor Zhao Zhenchang likes to use blood stasis Chinese medicine to make blood stasis to run, meridian Qi and blood access, clinical commonly used salvia miltiorrhiza, Dilong, Radix Paeoniae Alba, angelica sinensis, Panax notoginseng and so on. It is found that Professor Zhao Zhenchang has rich experience in the treatment of chronic renal failure. By means of statistical methods such as frequency analysis and cluster analysis, the data mining shows that chronic functional failure is based on deficiency of spleen and kidney, dampness, heat, poison, stasis and other evil qi stagnation should be used as standard, and the essence and marrow of kidney should be filled with tonifying kidney. Invigorating spleen and invigorating qi and nourishing blood, clearing heat and removing dampness and detoxifying, activating blood circulation and removing blood stasis and dredging collaterals, etc., provide reference for the treatment of chronic renal failure by inheriting and carrying forward the famous traditional Chinese medicine in treating chronic renal failure.
【学位授予单位】：长春中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R249;R277.5

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