基于数据挖掘方法总结周乃玉教授治疗类风湿关节炎用药规律研究

发布时间：2018-12-16 00:02

【摘要】：1.研究背景类风湿关节炎是一种以慢性、侵蚀性多关节炎为主要表现的自身免疫病,属中医“痹病”范畴。本病目前尚无根治的方法,西医治疗的主要目的是改善症状,减少和防止关节骨的破坏。中医学在痹病的治疗方面积累了丰富的诊疗经验,中医治疗应用个体化的辨证论治,多层次、多靶点地作用于机体,在缓解症状、防止复发及安全性等方面具有一定的优势。周乃玉教授是国家级名老中医,为全国第三、四、五批中医药专家学术经验继承带教指导老师,对类风湿关节炎等疾病积累了丰富的临证经验、见解独到,其经验值得不断总结与进一步挖掘。2.研究目的系统梳理周乃玉教授治疗类风湿关节炎的病案,总结名老中医经验,初步归纳其诊治该病的学术思想,为提高中医药治疗类风湿关节炎的临床疗效提供借鉴和参考。3.研究方法3.1按照病例纳入及排除标准,收集周乃玉教授门诊治疗类风湿关节炎的病案。将病案中患者信息(一般情况、症状、病位、证候分型、药物)录入Excel表格,后进行标准化处理,建立病案数据库。3.2运用“中医传承辅助平台系统”对数据库中的数据进行描述性分析、药物频次统计及关联规则、复杂系统熵聚类分析,对周乃玉教授治疗类风湿关节炎的用药特点及规律进行总结,并结合中医的辨证分型进行研究,探索周乃玉教授治疗该病的用药特色。4.结果研究发现,周乃玉教授治疗类风湿关节炎的常用药物有甘草、黄芪、白芍、桂枝、白芥子、穿山甲、片姜黄、防风、熟地黄、防己、全蝎、当归、补骨脂、丹参、白术、骨碎补、柴胡、白鲜皮、威灵仙、附子。所用药物从“四气五味”分析,以甘、温类药应用最多。从药物“归经”分析,入肝经药物最多,其次分别为入脾经、肺经、胃经、肾经。证候分析中寒湿痹阻证所占比例最高,其次分别为湿热痹阻证、痰瘀痹阻证。按药物功效分类,以补虚药应用最多,其次为活血化瘀药、解表药、祛风湿药、清热药等。周乃玉教授常用的药物组合有甘草、白芍;黄芪、甘草、白芍;穿山甲、白芥子;黄芪、桂枝;黄芪、当归等。这些药对组合以益气健脾、益气养阴、益气养血、活血化痰为主要功效,符合周乃玉教授治疗类风湿关节炎注重扶正固本的思想。5.结论周乃玉教授认为类风湿关节炎发病的内因是脾肾阳虚、气血不足,外因中寒湿之邪为主要的致病因素,同时十分重视痰浊瘀血、肝气郁结在类风湿关节炎发病中的作用,因此在类风湿关节炎的中医治疗中强调扶正固本,以调补气血为先、重视温补脾肾,治疗时将化痰逐瘀贯穿始终,辅以疏肝理气。常用黄芪桂枝五物汤益气温经、和血通痹,善用柴胡剂疏肝理气,虫类药物搜剔通络止痛。
[Abstract]:1. Background Rheumatoid arthritis is an autoimmune disease characterized by chronic and erosive polyarthritis, which belongs to the category of arthralgia. There is no cure for the disease. The main purpose of western medicine is to improve the symptoms and reduce and prevent the destruction of joint bone. Traditional Chinese medicine (TCM) has accumulated rich experience in diagnosis and treatment of arthralgia. Chinese medicine has some advantages in relieving symptoms, preventing recurrence and safety by applying individualized syndrome differentiation and multi-level, multi-target action on the body. Professor Zhou Naiyu is a famous old Chinese medicine doctor at the national level. He inherits the academic experience of the third, fourth, and fifth groups of TCM experts in the country and has accumulated rich clinical experience and unique opinions on rheumatoid arthritis and other diseases. Its experience is worth continuously summing up and further excavating. 2. Objective to study the history of Professor Zhou Naiyu's treatment of rheumatoid arthritis, summarize the experience of famous Chinese medicine, and preliminarily sum up his academic thoughts on the diagnosis and treatment of rheumatoid arthritis. In order to improve the treatment of rheumatoid arthritis with traditional Chinese medicine, the clinical efficacy of reference and reference. 3. Methods 3.1 according to the criteria of inclusion and exclusion, Professor Zhou Naiyu's outpatient treatment of rheumatoid arthritis was collected. The patient information (general condition, symptom, disease position, syndrome type, drug) in the medical record was entered into the Excel form, and then standardized treatment was carried out. 3.2 descriptive analysis of data in the database, statistics of drug frequency and association rules, entropy cluster analysis of complex systems, This paper summarizes the characteristics and laws of professor Zhou Naiyu's treatment of rheumatoid arthritis, studies the syndrome differentiation of traditional Chinese medicine, and explores the characteristics of professor Zhou Naiyu's treatment of rheumatoid arthritis. 4. Results the common drugs used by Professor Zhou Naiyu to treat rheumatoid arthritis were liquorice, astragalus, Radix Paeoniae Alba, Guizhi, White mustard, pangolin, turmeric, Fangfeng, cooked Rehmannia, Fangji, Scorpio, Angelica sinensis, Psoralen, Salvia miltiorrhiza, Atractylodes macrocephala. Broken bone, Bupleurum, white fresh skin, Weiling Xian, aconite. The use of drugs from the "four-gas five-flavor" analysis, Gan, the most used warm drugs. According to the analysis of medicine, the drugs into the liver channel were the most, followed by the spleen meridian, the lung meridian, the stomach meridian and the kidney meridian. In syndrome analysis, the proportion of cold and dampness arthralgia syndrome was the highest, followed by damp-heat arthralgia syndrome and phlegm stasis arthralgia syndrome. According to the classification of drug efficacy, tonifying medicine is the most used, followed by activating blood circulation and removing blood stasis, antitabular drugs, antirheumatic drugs, heat-clearing drugs and so on. Professor Zhou Naiyu commonly used combination of liquorice, Radix Paeoniae Alba, Radix Astragali, Radix Glycyrrhizae, Radix Paeoniae Alba, Pangolin, White mustard seed, Astragalus, Guizhi, Astragalus, Angelica and so on. These medicines to invigorate qi and invigorate spleen, invigorate qi and nourish yin, invigorate qi and nourish blood, and promote blood circulation and dissipate phlegm as the main efficacy, in line with professor Zhou Naiyu's thoughts of treating rheumatoid arthritis and paying attention to strengthening and strengthening the root of rheumatoid arthritis. 5. Conclusion Professor Zhou Naiyu thinks that the internal cause of rheumatoid arthritis is deficiency of spleen and kidney yang, deficiency of qi and blood, and external pathogenic factor of cold and dampness. At the same time, he attaches great importance to the role of phlegm and turbid blood stasis and stagnation of liver qi in the pathogenesis of rheumatoid arthritis. Therefore, in the treatment of rheumatoid arthritis, emphasis is placed on strengthening and strengthening the essence of rheumatoid arthritis, focusing on warming and tonifying spleen and kidney by regulating qi and blood, and dispelling phlegm and removing blood stasis throughout the treatment, supplemented by soothing the liver and regulating qi. Commonly used Astragalus Cinnamomum decoction, and blood-free, make good use of Bupleurum decoction to soothe the liver and qi, insect drugs search tick Tongluo pain.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R249;R259

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