基于灰色筛选法联合多元分析法的癌性发热处方规律分析及新方发现
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摘要
癌性发热是进展期恶性肿瘤常见的症状之一,严重影响了患者的生活质量和生存期。目前中医药治疗癌性发热的临床研究较局限,缺乏从病-症-证多个维度对其用药规律进行归纳研究,癌性发热的治疗一直未取得实质性的进展。该研究通过收集中医治疗癌性发热的文献,总结出常见的证型有阴虚型、气虚型、阳虚型、血瘀型、湿热蕴结型、热毒炽盛型和肝经郁热型,并从中提取出中药处方257首,单药249味,对药物药性构成分析发现癌性发热治疗以清热药和补虚药为主,对药物进行Apriori关联分析发现二、三项关联药物主要为地黄、牡丹皮、青蒿、鳖甲、知母。灰色关联度前5位为补骨脂、柴胡、麦芽、黄芩、神曲,并演化得到7个新处方。结果表明癌性发热的治疗可从病-症-证入手,滋阴清热为辨病论治的重要大法,柴胡-黄芩配伍应用是对症治疗的体现,新处方符合中医"辨证论治"的思想,能为临床用药提供参考。基于灰色筛选法联合多元分析法分析中医治疗癌性发热的处方规律,遵循了传统中医的黑箱结构,将方剂潜在规律显性化,开阔了其中医治疗思路,弥补了传统分析方法的不足。
Cancerous fever is one of the common symptoms of advanced malignant tumors,which seriously affects the quality of life and survival of patients. At present,the clinical research on the treatment of cancerous fever by traditional Chinese medicine is limited,and there is a lack of research on the medication rules from multiple dimensions of disease-symptom-syndrome. The treatment of cancerous fever has not made substantial progress. In this study,we collected the literature on treatment of cancerous fever in Chinese medicine,and concluded that common syndrome types include Yin deficiency type,Qi deficiency type,Yang deficiency type,blood stasis type,damp-heat accumulation type,toxic heat flourishing type and liver meridian stagnated heat type. Two hundreds and fifty-seven prescriptions for Chinese medicine and 249 flavors for single medicine were extracted. The analysis of the drug composition of the drug found that the cancerous fever treatment was mainly based on heat-clearing drugs and deficiency-nourishing drugs. Apriori association analysis of the drug found that the second and third related drugs were mainly Rehmanniae Radix,Moutan Cortex,Artemisiae Annuae Herba,Trionycis Carapax and Anemarrhenae Rhizoma. The top five gray correlation degrees were Psoraleae Fructus,Bupleuri Radix,Hordei Fructus Germinatus,Scutellariae Radix and Massa Medicata Fermentata. And seven new prescriptions were evolved. The results showed that the treatment of cancerous fever can be started from the disease-symptom-syndrome,nourishing Yin and clearing heat is an important method for " disease differentiation and treatment". The combination of Bupleuri Radix and Scutellariae Radix is the embodiment of " symptom differentiation and treatment". The new prescriptions conform to the idea of " syndrome differentiation and treatment" of traditional Chinese medicine can provide reference for clinical medication. The grey screening method combined with multivariate analysis method was used to analyze the prescription rules of Chinese medicine in the treatment of cancer fever,which followed the black box structure of traditional Chinese medicine,made the potential rule of prescriptions explicit,broadened its thinking of Chinese medicine treatment,and made up for the deficiency of traditional analysis methods.
Cancerous fever is one of the common symptoms of advanced malignant tumors,which seriously affects the quality of life and survival of patients. At present,the clinical research on the treatment of cancerous fever by traditional Chinese medicine is limited,and there is a lack of research on the medication rules from multiple dimensions of disease-symptom-syndrome. The treatment of cancerous fever has not made substantial progress. In this study,we collected the literature on treatment of cancerous fever in Chinese medicine,and concluded that common syndrome types include Yin deficiency type,Qi deficiency type,Yang deficiency type,blood stasis type,damp-heat accumulation type,toxic heat flourishing type and liver meridian stagnated heat type. Two hundreds and fifty-seven prescriptions for Chinese medicine and 249 flavors for single medicine were extracted. The analysis of the drug composition of the drug found that the cancerous fever treatment was mainly based on heat-clearing drugs and deficiency-nourishing drugs. Apriori association analysis of the drug found that the second and third related drugs were mainly Rehmanniae Radix,Moutan Cortex,Artemisiae Annuae Herba,Trionycis Carapax and Anemarrhenae Rhizoma. The top five gray correlation degrees were Psoraleae Fructus,Bupleuri Radix,Hordei Fructus Germinatus,Scutellariae Radix and Massa Medicata Fermentata. And seven new prescriptions were evolved. The results showed that the treatment of cancerous fever can be started from the disease-symptom-syndrome,nourishing Yin and clearing heat is an important method for " disease differentiation and treatment". The combination of Bupleuri Radix and Scutellariae Radix is the embodiment of " symptom differentiation and treatment". The new prescriptions conform to the idea of " syndrome differentiation and treatment" of traditional Chinese medicine can provide reference for clinical medication. The grey screening method combined with multivariate analysis method was used to analyze the prescription rules of Chinese medicine in the treatment of cancer fever,which followed the black box structure of traditional Chinese medicine,made the potential rule of prescriptions explicit,broadened its thinking of Chinese medicine treatment,and made up for the deficiency of traditional analysis methods.
引文
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[24]王建婷,王上,刘松林,等.基于整合药理学平台的柴胡-黄芩药对抗抑郁的分子机制研究[J].中国中药杂志,2018,43(7):1323.
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[32]李玉娟,刘小玉,姜厚望,等.叶天士与薛生白治疗湿热痞证用药特色分析[J].中国中药杂志,2017,42(12):2391.
[2]秦英刚,花宝金.癌性发热辨治经验浅析[J].中医杂志,2013,54(9):796.
[3]秘红英,李彩云,李红蓉,等.中医医案的分析方法[J].中国实验方剂学杂志,2017,23(13):226.
[4]何彦澄,肖永华,闫璞,等.中医医案分析方法评述[J].中医杂志,2018,59(13):1106.
[5]李鑫颉,贾振华,吴以岭.数据挖掘方法在中医医案研究中的现状分析[J].中国中医基础医学杂志,2012,18(1):117.
[6]谌松霖,张利红,陈聪,等.基于灰色理论联合多元统计方法的中药研究模式的探讨[J].中草药,2016,47(1):1.
[7]邓聚龙.灰色系统基本方法[M].武汉:华中工学院出版社,1987.
[8]孙继佳,陆奕宇,苏式兵.灰色关联分析方法在中医学临床信息分析中的应用[J].数理医药学杂志,2011,24(1):12.
[9]白云静,申洪波,孟庆刚,等.基于复杂性科学的中医学发展取向与方略[J].中国中医药信息杂志,2005,12(1):2.
[10]陈振东,孙燕,王肇炎.实用肿瘤并发症诊断治疗学[M].合肥:安徽科学技术出版社,1997.
[11]中国药典.一部[S].2015.
[12]高学敏.中药学[M].北京:中国中医药出版社,2010.
[13]邱德文.中华本草[M].北京:中医古籍出版社,2006.
[14]何凤远.中文词频分布与齐夫定律的汉语适用性初探[J].现代语文:语言研究版,2010(10):110.
[15]王洵.最小努力原则与齐夫定律[J].情报科学,1981(2):32.
[16]刘瑜彬,王晖,唐晓峰,等.灰关联聚类法评价补中益气汤对大鼠气虚发热的效果[J].中国实验方剂学杂志,2010,16(18):124.
[17]陈伟清,史丽娜,吕冬妮,等.基于灰色关联聚类分析的智慧城市建设领域发展水平实证研究[J].科技管理研究,2017,37(6):59.
[18]陆宁,郭勇,阮善明.癌性发热中西医结合治疗模式探讨[J].实用中西医结合临床,2008(1):66.
[19]王巍,刘华清,陈云凤,等.青蒿鳖甲汤加减治疗癌性发热的研究概况[J].世界最新医学信息文摘,2016,16(67):177.
[20]壮雨雯,吴存恩,赵智明,等.浅议青蒿鳖甲汤在阴虚内热型癌性发热治疗中的运用[J].中华中医药杂志,2018,33(10):4666.
[21] Zhang Yu,Qian Lili,Shen Jianping,et al. Effect of Chinese medicine treatment based on pattern identification on cellular immunophenotype of myelodysplastic syndrome[J]. Chin J Integr Med,2017,23(6):469.
[22]阳国彬,刘松林,梅国强.《伤寒论》柴胡类方辨治癌性发热探析[J].中国中医基础医学杂志,2018,24(9):1332.
[23]李亚芹,瞿融.柴胡和黄芩配伍的研究进展[J].中国中医基础医学杂志,2018,24(2):282.
[24]王建婷,王上,刘松林,等.基于整合药理学平台的柴胡-黄芩药对抗抑郁的分子机制研究[J].中国中药杂志,2018,43(7):1323.
[25]姜枫,李超,李运伦.由柴芩药对解析历代医家对小柴胡汤类方的继承[J].山西中医学院学报,2015,16(3):1.
[26]陈慧慧,张敏,虞慧娟,等.柴胡和黄芩配伍解热抗炎作用研究[J].中成药,2011,33(9):1596.
[27]张介宾.景岳全书[M].北京:中国医药科技出版社,2016.
[28]韩懋.韩氏医通[M].南通:江苏科学技术出版社,1985.
[29]王士雄.四科简效方[M].北京:中医古籍出版社,1991.
[30]王青,苏聪平,张惠敏,等.从炎性反应角度探讨清热解毒药的作用机制[J].中国中药杂志,2018,43(18):3787.
[31]吴瑭.温病条辨[M].北京:人民卫生出版社,1967.
[32]李玉娟,刘小玉,姜厚望,等.叶天士与薛生白治疗湿热痞证用药特色分析[J].中国中药杂志,2017,42(12):2391.