邹旭教授治疗老龄心悸的用药规律分析
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摘要
目的基于中医传承辅助系统(V2.5)探讨邹旭教授治疗老龄心悸的中医用药经验及组方规律。方法收集邹旭教授在广东省中医院2016年6月至2018年6月门诊接诊的老龄心悸病例资料,提取处方,建立数据库,采用该软件集成的规则分析、改进互信息法、复杂系统熵聚类及无监督的熵层次聚类等数据挖掘方法,挖掘分析用药经验。结果纳入患者254例,并录入处方254个,使用中药共297味。确定处方中药物的使用频次和药物之间的关联规则,其中使用频次高于120的中药共28味,使用频次最高的前5味药依次为人参(197)、黄芪(175)、当归(171)、丹参(171)、熟地黄(170),5味药所对应的常用剂量分别为10、30、15、10、120 g;支持度为125,置信度为0.82时,共有药物组合25组,使用频次最高药物组合为麦冬-五味子(141)、人参-五味子(141),设置相关度为8,惩罚度为6,演化出14个药物核心组合及7首新方。结论邹旭教授临证以"补虚泄实"为根本,强调气阴亏虚是老龄心悸发生的根本因素,而痰、湿、瘀是发病的直接因素,临证主张养气阴、祛痰湿、活血通络,并注重协调五脏,尤以调脾护心为重。
Objective: To analyze the experience and herbal prescription rules of professor Zou Xu′s in treating aging palpitation by using the traditional Chinese medicine(TCM) inheritance system(V2.5) software. Methods:The prescriptions used for aging palpitation cases at Professor Zou's clinic in the Guangdong Provincial Hospital of Chinese Medicine from June 2016 to June 2017 were collected,and screened to establish a formula database.Based on association rules,revised mutual information,complex system entropy cluster,unsupervised hierarchical clustering and other data mining methods,the principle experience and rules were analyzed and summarized. Results: 254 cases were included,with 254 prescriptions and 297 herbs. The frequency of each herb and association rules of the herbs included in the database were identified. 28 herbs had a frequency of more than 120,and top 5 herbs with high using frequency were Ginseng(197),Astragalus membranaceus(175),Angelica sinensis(171),Salvia miltiorrhiza(171),and Radix rehmanniae(170),whose common clinical dosage was 10,30,15,10,and 20 g,respectively. There were 25 combinations of related herbs with degree of support level of 125 and the confidence level of 0.82. Top 2 herb combinations of high using frequency were Radix ophiopogonis-Schisandra chinensis(141) and Ginseng-Schisandra chinensis(141). With association degree of 8 and punishment degree of6,14 groups of core herbs combinations and 7 new prescriptions were developed. Conclusion: Professor Zou Xu believes the deficiency of Qi and Yin is the primary cause of aging palpitation,and phlegm,dampness and blood stasis are the predisposing factors. He advocates tonifying Qi and Yin,eliminating phlegm-dampness,activating blood circulation and underlined harmony of the five internal organs with a particular emphasis at coordinating spleen to protect heart.
Objective: To analyze the experience and herbal prescription rules of professor Zou Xu′s in treating aging palpitation by using the traditional Chinese medicine(TCM) inheritance system(V2.5) software. Methods:The prescriptions used for aging palpitation cases at Professor Zou's clinic in the Guangdong Provincial Hospital of Chinese Medicine from June 2016 to June 2017 were collected,and screened to establish a formula database.Based on association rules,revised mutual information,complex system entropy cluster,unsupervised hierarchical clustering and other data mining methods,the principle experience and rules were analyzed and summarized. Results: 254 cases were included,with 254 prescriptions and 297 herbs. The frequency of each herb and association rules of the herbs included in the database were identified. 28 herbs had a frequency of more than 120,and top 5 herbs with high using frequency were Ginseng(197),Astragalus membranaceus(175),Angelica sinensis(171),Salvia miltiorrhiza(171),and Radix rehmanniae(170),whose common clinical dosage was 10,30,15,10,and 20 g,respectively. There were 25 combinations of related herbs with degree of support level of 125 and the confidence level of 0.82. Top 2 herb combinations of high using frequency were Radix ophiopogonis-Schisandra chinensis(141) and Ginseng-Schisandra chinensis(141). With association degree of 8 and punishment degree of6,14 groups of core herbs combinations and 7 new prescriptions were developed. Conclusion: Professor Zou Xu believes the deficiency of Qi and Yin is the primary cause of aging palpitation,and phlegm,dampness and blood stasis are the predisposing factors. He advocates tonifying Qi and Yin,eliminating phlegm-dampness,activating blood circulation and underlined harmony of the five internal organs with a particular emphasis at coordinating spleen to protect heart.
引文
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[9]王天成,张宏艳.人参皂甙抗心律失常作用研究进展[J].中国心脏起搏与心电生理杂志,2004,18(4):309-310.
[10]陈兰英,陈奇,刘荣华,等.炙甘草汤中麦冬总皂甙及其配伍对心肌生理特性的影响[J].中国实验方剂学杂志,2000,6(4):30-32.
[11]徐晓平,彭成,卞寒敏,等.中药药理学[M].北京:中国中医药出版社,2010:63,169,307.
[12]姚耿圳,潘光明.邹旭治疗频发室性期前收缩的经验[J].江苏中医药,2010,42(6):11-12.
[13]梁蕴瑜,钟言.邹旭教授从“五脏相关”论治缓慢型心律失常经验介绍[J].新中医,2016,48(7):233-234.
[14]安宜沛,邹旭.邹旭教授治疗快速性心律失常经验总结[C].中国中医药研究促进会仲景医学分会2016年学术年会:76-78.
[15]汪如镜.“一味丹参散,功同四物汤”之我见[J].中医临床研究,2017,9(7):39-40.
[2]申珂,郭娜娜,邓健,等.中国近40年慢性病疾病谱变化情况[J].山西医药杂志,2017,46(8):903-905.
[3]Stec S,Sikorska A,Zaborska B,et al.Benign symptomatic premature ventricular complexes:short-and long-termefficacy of antiarrhythmic drugs and radiofrequency ablation[J].KardiolPol,2012,70(4):351.
[4]Krittayaphong R,Bhuripanyo K,Punlee K,et al.Effect of atenolol on symptomatic ventricul ararrhythmia without structural heart disease:arandomized placebo-controlled study[J].Am Heart J,2002,144(6):e10.
[5]Echt DS,Liebson PR,Mitchell LB,et al.Mortality and morbidity in patients receiving encainide,flecainide,orplacebo.The Cardiac Arrhythmia Suppression Trial[J].N Engl J Med,1991,324(12):781.
[6]Zou JG,Zhang J,Jia ZH,et al.Evaluation of the traditional Chinese medicine Shen song yang xin capsule on treating premature ventricular contractions:arandomized,double-blind,controlledmulticentertrial[J].Chin Med J(Engl),2011,124(1):76.
[7]李国虎,袁明道,周汉槎,等.生脉饮对体外心内直视手术心肌保护作用[J].湖南医科大学学报,1994,19(5):413.
[8]袁昌辉.美托洛尔合生脉饮注射液治疗顽固性心力衰竭31例[J].中西医结合杂志,1998,7(4):544.
[9]王天成,张宏艳.人参皂甙抗心律失常作用研究进展[J].中国心脏起搏与心电生理杂志,2004,18(4):309-310.
[10]陈兰英,陈奇,刘荣华,等.炙甘草汤中麦冬总皂甙及其配伍对心肌生理特性的影响[J].中国实验方剂学杂志,2000,6(4):30-32.
[11]徐晓平,彭成,卞寒敏,等.中药药理学[M].北京:中国中医药出版社,2010:63,169,307.
[12]姚耿圳,潘光明.邹旭治疗频发室性期前收缩的经验[J].江苏中医药,2010,42(6):11-12.
[13]梁蕴瑜,钟言.邹旭教授从“五脏相关”论治缓慢型心律失常经验介绍[J].新中医,2016,48(7):233-234.
[14]安宜沛,邹旭.邹旭教授治疗快速性心律失常经验总结[C].中国中医药研究促进会仲景医学分会2016年学术年会:76-78.
[15]汪如镜.“一味丹参散,功同四物汤”之我见[J].中医临床研究,2017,9(7):39-40.