基于数据挖掘的当代中医治疗慢性肾炎蛋白尿证治方药规律研究
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摘要
目的应用数据挖掘技术,研究当代中医治疗慢性肾炎蛋白尿的证治方药规律。方法检索并筛选中国知网、万方医学网数据库中近20年间发表的有关当代中医治疗慢性肾炎蛋白尿的文献,提取其中的证治方药信息,建立数据库。在统计软件中运用频数统计、关联规则分析、聚类分析等方法进行数据挖掘,探求相关证治方药规律。结果①中医证型由高频至低频依次为脾肾两虚证、气阴两虚证、风邪外袭证、肝肾阴虚证、湿热壅盛证等。②按照方剂功用进行分类汇总,其中补益剂出现频率最高,为252次;其次为祛湿剂,为128次;再次为逐瘀剂,为51次。③按照方剂应用频次进行统计,排名前5位的方剂为参苓白术散(30次)、六味地黄丸(29次)、参芪地黄汤(20次)、二至丸(18次)、金匮肾气丸(18次)。④应用频次最多的中药为黄芪。⑤经中药数据聚类分析后,发现"茯苓、地黄、山茱萸、山药、泽泻、牡丹皮、黄芪、白术""党参、菟丝子、陈皮、甘草、金樱子、芡实""丹参、益母草、当归、川芎、赤芍、桃仁、红花"等5个新的药物组合。⑥慢性肾炎蛋白尿的核心中药主要为补气健脾药(黄芪、白术、茯苓),以及补肾涩精药(山茱萸、山药、地黄、芡实)。结论①当代中医认为,慢性肾炎蛋白尿的基本病机在于脾肾两虚,风邪、湿热、瘀血是其常见病理因素,临床上可以从脾肾两虚、气阴两虚、肝肾阴虚、风邪外袭、湿热壅盛、血瘀六个证型进行辨证论治。②参苓白术散、六味地黄丸及参芪地黄汤是临床使用率较高的方剂;治疗慢性肾炎蛋白尿的核心中药主要为补气健脾药(黄芪、白术、茯苓),以及补肾涩精药(山茱萸、山药、地黄、芡实)。
Objective To study the regularity of syndrome-treatment and prescription-drugs of proteinuria in chronic nephritis in contemporary Chinese medicine using data mining technology. Methods Literatures published in recent 20 years about proteinuria in chronic nephritis in contemporary Chinese medicine were retrieved and screened in the database of China National Knowledge Infrastructure( www. CNKI. net) and Wanfang Medical Network( http://med.wanfangdata.com.cn/),and the information on syndrome-treatment and prescription-drugs was extracted to establish a database.In statistical software,frequency statistics,association rules analysis,cluster analysis and other methods were used for data mining to explore the relevant regularity. Results(1)The traditional Chinese medicine( TCM) syndromes from high to low frequency were spleen and kidney deficiency,qi and yin deficiency,external attack of wind pathogen,liver and kidney yin deficiency,excessive dampness and heat,etc.(2)In terms of the function of prescriptions,tonifying recipes showed the highest frequency of occurrence,252 times; followed by dampness dispelling recipes,128 times; and stasis removing recipes,51 times.(3)In terms of the frequency of prescription application,the top five prescriptions are Shenling Baizhu Powder( 30 times),Liuwei Dihuang Pill( 29 times),Shenqi Dihuang Decoction( 20 times),Erzhi Pill( 18 times) and Jinkui Shenqi Pill( 18 times).(4)Astragalus root is the most frequently used traditional Chinese medicine.(5) After cluster analysis of data on traditional Chinese medicine,five new drug combinations were found, including"poria,rehmannia root,cornus fruit,dioscorea root,alisma tuber,tree peony bark,astragalus root and ovate atractylodes roo"t,"codonopsis root,dodder seed,aged tangerine peel,licorice root,cherokee rose fruit and euryale seed"and"salvia root,motherwort,Chinese angelica,Sichuan lovage root,red peony root,peach kernel and safflower".(6)The core Chinese medicines for proteinuria in chronic nephritis were mainly qi-tonifying and spleen-invigorating drugs( astragalus root,ovate atractylodes root and poria) and drugs supplementing the kidney and astringing essence( cornus fruit,dioscorea root,rehmannia root and euryale seed). Conclusion(1)According to TCM,the basic pathogenesis of proteinuria in chronic nephritis is spleen and kidney deficiency. Wind pathogen,dampness-heat and blood stasis are the common pathological factors. Clinically,syndrome differentiation and treatment can be carried out considering six syndromes: spleen and kidney deficiency,qi and yin deficiency,liver and kidney yin deficiency,external attack of wind pathogen,excessive dampness and heat and blood stasis.(2)Shenling Baizhu Powder,Liuwei Dihuang Pill and Shenqi Dihuang Decoction are the commonly used prescriptions clinically; the core Chinese medicines for proteinuria in chronic nephritis are mainly qi-tonifying and spleen-invigorating drugs (astragalus root,ovate atractylodes root and poria)and drugs supplementing the kidney and astringing essence(cornus fruit,dioscorea root,rehmannia root and euryale seed).
Objective To study the regularity of syndrome-treatment and prescription-drugs of proteinuria in chronic nephritis in contemporary Chinese medicine using data mining technology. Methods Literatures published in recent 20 years about proteinuria in chronic nephritis in contemporary Chinese medicine were retrieved and screened in the database of China National Knowledge Infrastructure( www. CNKI. net) and Wanfang Medical Network( http://med.wanfangdata.com.cn/),and the information on syndrome-treatment and prescription-drugs was extracted to establish a database.In statistical software,frequency statistics,association rules analysis,cluster analysis and other methods were used for data mining to explore the relevant regularity. Results(1)The traditional Chinese medicine( TCM) syndromes from high to low frequency were spleen and kidney deficiency,qi and yin deficiency,external attack of wind pathogen,liver and kidney yin deficiency,excessive dampness and heat,etc.(2)In terms of the function of prescriptions,tonifying recipes showed the highest frequency of occurrence,252 times; followed by dampness dispelling recipes,128 times; and stasis removing recipes,51 times.(3)In terms of the frequency of prescription application,the top five prescriptions are Shenling Baizhu Powder( 30 times),Liuwei Dihuang Pill( 29 times),Shenqi Dihuang Decoction( 20 times),Erzhi Pill( 18 times) and Jinkui Shenqi Pill( 18 times).(4)Astragalus root is the most frequently used traditional Chinese medicine.(5) After cluster analysis of data on traditional Chinese medicine,five new drug combinations were found, including"poria,rehmannia root,cornus fruit,dioscorea root,alisma tuber,tree peony bark,astragalus root and ovate atractylodes roo"t,"codonopsis root,dodder seed,aged tangerine peel,licorice root,cherokee rose fruit and euryale seed"and"salvia root,motherwort,Chinese angelica,Sichuan lovage root,red peony root,peach kernel and safflower".(6)The core Chinese medicines for proteinuria in chronic nephritis were mainly qi-tonifying and spleen-invigorating drugs( astragalus root,ovate atractylodes root and poria) and drugs supplementing the kidney and astringing essence( cornus fruit,dioscorea root,rehmannia root and euryale seed). Conclusion(1)According to TCM,the basic pathogenesis of proteinuria in chronic nephritis is spleen and kidney deficiency. Wind pathogen,dampness-heat and blood stasis are the common pathological factors. Clinically,syndrome differentiation and treatment can be carried out considering six syndromes: spleen and kidney deficiency,qi and yin deficiency,liver and kidney yin deficiency,external attack of wind pathogen,excessive dampness and heat and blood stasis.(2)Shenling Baizhu Powder,Liuwei Dihuang Pill and Shenqi Dihuang Decoction are the commonly used prescriptions clinically; the core Chinese medicines for proteinuria in chronic nephritis are mainly qi-tonifying and spleen-invigorating drugs (astragalus root,ovate atractylodes root and poria)and drugs supplementing the kidney and astringing essence(cornus fruit,dioscorea root,rehmannia root and euryale seed).
引文
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[10] 胡营杰,陈沙沙,王广洋,等.黄芪有效组分对大鼠肾小球系膜细胞血小板源性生长因子- BB 表达的影响[J].中华中医药杂志,2016,31(7):2797- 2799.
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[2] 周仲瑛.中医内科学[M].北京:中国中医药出版社,2007:20.
[3] 国家技术监督局.中医临床诊疗术语·证候部分:GB/T16751.2- 1997[S].北京:中国标准出版社,1997:1- 55.
[4] 国家药典委员会.中华人民共和国药典(2015版):一部[M].北京:中国医药科技出版社,2015:1- 384.
[5] 李冀.方剂学[M].北京:中国中医药出版社,2012:1- 291.
[6] 孙元莹,郭茂松,王暴魁,等.张琪治疗原发性肾小球肾病经验介绍[J].时珍国医国药,2007,18(2):509- 511.
[7] 潘清泉,杨洪涛.杨洪涛教授治疗肾性蛋白尿经验[J].中国中西医结合肾病杂志,2018,19(1):1- 2.
[8] 侯英华,王耀光.王耀光教授从脾论治慢性肾炎蛋白尿[J].吉林中医药,2011,31(10):947- 948.
[9] 杨柳,李爱平,张王宁,等.黄芪及含黄芪经方在治疗肾病方面的药理作用及临床应用研究进展[J].中草药,2018,49(17):3419- 3424.
[10] 胡营杰,陈沙沙,王广洋,等.黄芪有效组分对大鼠肾小球系膜细胞血小板源性生长因子- BB 表达的影响[J].中华中医药杂志,2016,31(7):2797- 2799.
[11] 李刘生,张煜.黄芪治“肾”新论[J].世界中西医结合杂志,2017,12(11):1612- 1615.