基于数据挖掘的周仲瑛教授糖尿病病机证治规律的研究
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摘要
目的：从整理、研究、提炼周仲瑛教授治疗糖尿病的临床经验及学术思想入手,借助于计算机数据挖掘技术,以周仲瑛教授2003年至2010年来较完整的糖尿病病案为研究对象,着重深度挖掘糖尿病病理因素的演变、组合规律和周老独到的辨证与治疗经验,从名老中医临床经验传承方面,深化中医对糖尿病的理论认识,进一步提高糖尿病的中医临床疗效,造福广大患者。
方法：借由周仲瑛门诊病案系统,把周仲瑛教授2003年至2010年的门诊病例数据全部录入。目前收集符合入选标准患者共计有104例,共167诊次。通过病案数据挖掘平台,运用描述性统计方法及聚类分析、关联规则挖掘方法分析总结周仲瑛教授治疗糖尿病的核心用药、核心病机,以及根据症状变化加减用药的经验。
结果：通过分析纳入病案的104例167诊次,得出糖尿病的主要症状是四肢麻木、口干、尿不畅。舌苔主要为苔薄黄腻、质暗红、脉细滑。病机主要表现为肝肾阴虚。药物主要为地骨皮、知母、鬼箭羽、玄参、制僵蚕大生地等。
结论：
1.病理因素主要涉及虚、热、瘀、湿热、痰、风、郁。
2.病机以肝肾阴虚、气阴两伤为主。
3.主要症状以四肢麻木、口干、尿不畅、尿频、大便干、四肢肿胀易汗、大便偏烂、视糊、胸闷心慌、善饥等多见,舌脉以苔薄黄腻、质暗红、脉细滑为多见。
4.用药主要涉及清肺润燥药、清热燥湿药、凉血活血化瘀药、益气养阴药、生津止渴药、利水通络药、化湿健脾药。
[Objective] By using computer Dada Mining and modern epidemiology statistical methods, we analyzed Professor Zhou Zhongying's recent years clinical rcords of the pathogenesis and etiology of Diabetes Mellitus. Differentiation of symptoms and signs, academic perspectives on the treatment to deepen the research of Traditional Chinese Medicine on Diabetes Mellitus, further improve the clinical efficacy as to bring greater benefits to patients.
[Methods] From the last century, professor Zhou Zhongying has left tens of thousands of out-patient medical records which have the rich clinical first-hand information and reliable sources such as the integrity of four diagnostic data and herbal prescriptions. We collect a total of 104 cases met the criteria who have 167 clinical visits, use association rules, cluster analysis, chi-square test and the core side of the classification, multi-data ect. to increase the reliability of the results of data mining to have a breakthrough on objectively collecting TCM experts' experience, finally find the Professor Zhou Zhongying's experience about the pathogenesis and herbal prescriptions of Diabetes Mellitus.
[Result] Through the research, we found that the Diabetes Mellitus's main symptoms are 4 extremities numbness, dry mouth, unsmootth urination. The tongue is dark red with thin yellow greasy coating and the pulse is thin slippery. The pathogenesis of Diabetes Mellitus is liver-kidney deficiency. The herbal medicine used are difupi, zhimu, guijianyu, xuanshen, zhijiangcan.
[Conclusion] From the above analysis, we can clearly understand pathogenesis and etiologies of Diabetes Mellitus as the following:
1. Pathogenesis of Diabetes Mellitus is liver-kidney deficiency and Qi-Yin deficiency..
2. Main symptoms of Diabetes Mellitus are extremities numbness, dry mouth, unsmooth urination, frequent urination, dry stool, extremities swollen, easy sweat, diarrhea, blurred vision, chest congestion and easy hunger. The tongue diagnostic is dark red tongue body with thin yellow greasy coating. The pulse diagnostic is mainly thin slippery.
3. The herbal medicines used are as following:clear lung and moist dryness herbs, clear heat and dry dumpness herbs, cool blood and clear stagnation herbs, tonify Qi and nourish Yin herbs, stop thirst herbs, drain water and clear channel herbs, clear dumpness and tonify spleen herbs.
方法：借由周仲瑛门诊病案系统,把周仲瑛教授2003年至2010年的门诊病例数据全部录入。目前收集符合入选标准患者共计有104例,共167诊次。通过病案数据挖掘平台,运用描述性统计方法及聚类分析、关联规则挖掘方法分析总结周仲瑛教授治疗糖尿病的核心用药、核心病机,以及根据症状变化加减用药的经验。
结果：通过分析纳入病案的104例167诊次,得出糖尿病的主要症状是四肢麻木、口干、尿不畅。舌苔主要为苔薄黄腻、质暗红、脉细滑。病机主要表现为肝肾阴虚。药物主要为地骨皮、知母、鬼箭羽、玄参、制僵蚕大生地等。
结论：
1.病理因素主要涉及虚、热、瘀、湿热、痰、风、郁。
2.病机以肝肾阴虚、气阴两伤为主。
3.主要症状以四肢麻木、口干、尿不畅、尿频、大便干、四肢肿胀易汗、大便偏烂、视糊、胸闷心慌、善饥等多见,舌脉以苔薄黄腻、质暗红、脉细滑为多见。
4.用药主要涉及清肺润燥药、清热燥湿药、凉血活血化瘀药、益气养阴药、生津止渴药、利水通络药、化湿健脾药。
[Objective] By using computer Dada Mining and modern epidemiology statistical methods, we analyzed Professor Zhou Zhongying's recent years clinical rcords of the pathogenesis and etiology of Diabetes Mellitus. Differentiation of symptoms and signs, academic perspectives on the treatment to deepen the research of Traditional Chinese Medicine on Diabetes Mellitus, further improve the clinical efficacy as to bring greater benefits to patients.
[Methods] From the last century, professor Zhou Zhongying has left tens of thousands of out-patient medical records which have the rich clinical first-hand information and reliable sources such as the integrity of four diagnostic data and herbal prescriptions. We collect a total of 104 cases met the criteria who have 167 clinical visits, use association rules, cluster analysis, chi-square test and the core side of the classification, multi-data ect. to increase the reliability of the results of data mining to have a breakthrough on objectively collecting TCM experts' experience, finally find the Professor Zhou Zhongying's experience about the pathogenesis and herbal prescriptions of Diabetes Mellitus.
[Result] Through the research, we found that the Diabetes Mellitus's main symptoms are 4 extremities numbness, dry mouth, unsmootth urination. The tongue is dark red with thin yellow greasy coating and the pulse is thin slippery. The pathogenesis of Diabetes Mellitus is liver-kidney deficiency. The herbal medicine used are difupi, zhimu, guijianyu, xuanshen, zhijiangcan.
[Conclusion] From the above analysis, we can clearly understand pathogenesis and etiologies of Diabetes Mellitus as the following:
1. Pathogenesis of Diabetes Mellitus is liver-kidney deficiency and Qi-Yin deficiency..
2. Main symptoms of Diabetes Mellitus are extremities numbness, dry mouth, unsmooth urination, frequent urination, dry stool, extremities swollen, easy sweat, diarrhea, blurred vision, chest congestion and easy hunger. The tongue diagnostic is dark red tongue body with thin yellow greasy coating. The pulse diagnostic is mainly thin slippery.
3. The herbal medicines used are as following:clear lung and moist dryness herbs, clear heat and dry dumpness herbs, cool blood and clear stagnation herbs, tonify Qi and nourish Yin herbs, stop thirst herbs, drain water and clear channel herbs, clear dumpness and tonify spleen herbs.
引文
[1]宋宝珍.几丁质、几丁聚糖与人体健康[J].精细与专用化学品,1999(21)。
[2]李三鲁.阿卡波糖联合黄连素治疗糖尿病64例疗效观察[J].中国医药指南,2010(35),164.
[3]白雪琴等.L-阿拉伯糖干预高血糖患者的临床研究[M].北京中医药大学,2010。
[4]徐秋焕等.降纤酶联合低分子右旋糖酐治疗糖尿病并进展性脑梗死临床观察[J].中国实用神经疾病杂志,,2011(18),022.
[5]赵存杰,韩丽芳,刘美兰,等.中医药治疗早期糖尿病肾病疗效观察[J].现代中西医结合杂志,2010：19(1),38-39.
[6]李花民,穆培坤,李宗辉,等.补肾健脾法治疗糖尿病疗效观察[J].现代中西医结合杂志,2010：19(1),62-63.
[7]蓝柳贵,彭万年,赵玲,等.糖尿病心肾并病中医药诊治探析[J].辽宁中医药大学学报,2010：12(1).
[8]粱成.补肾润燥方治疗糖尿病便秘68例[J].陕西中医,2009：30(1),28-29.
[9]莫娜,乔小燕.中医药治疗2型糖尿病胰岛素提抗用药分析[J].陕西中医,2009：30(1),88-89.
[10]李亚文,杨焱,陈凤娇,等.益气活血汤加虫类药治疗糖尿病周围神经病变35例疗效观察[J].中国现代药物应用,2009：3(1),120-121.
[11]佟晓哲,瘳威.健脾化痰清热方药对湿热困脾证2型糖尿病病患者血清C反应蛋白和白细胞介素6的影响[J].中华中医药学刊,2009：27(1),221-222.
[12]袁爱红,刘志诚,魏群利,等.针灸治疗肥胖2型糖尿病35例[J].安徽中医学院学报,2009：28(1),28-29.
[13]周东海,王海峰,杜长海,等.怀柔区217例糖尿病患者中医辨证分型与相关因素探讨[J].北京中医药,2009：28(1),39-40.
[14]周仲瑛主编.医论选[M].北京：人民卫生出版社,2008.138.
[2]李三鲁.阿卡波糖联合黄连素治疗糖尿病64例疗效观察[J].中国医药指南,2010(35),164.
[3]白雪琴等.L-阿拉伯糖干预高血糖患者的临床研究[M].北京中医药大学,2010。
[4]徐秋焕等.降纤酶联合低分子右旋糖酐治疗糖尿病并进展性脑梗死临床观察[J].中国实用神经疾病杂志,,2011(18),022.
[5]赵存杰,韩丽芳,刘美兰,等.中医药治疗早期糖尿病肾病疗效观察[J].现代中西医结合杂志,2010：19(1),38-39.
[6]李花民,穆培坤,李宗辉,等.补肾健脾法治疗糖尿病疗效观察[J].现代中西医结合杂志,2010：19(1),62-63.
[7]蓝柳贵,彭万年,赵玲,等.糖尿病心肾并病中医药诊治探析[J].辽宁中医药大学学报,2010：12(1).
[8]粱成.补肾润燥方治疗糖尿病便秘68例[J].陕西中医,2009：30(1),28-29.
[9]莫娜,乔小燕.中医药治疗2型糖尿病胰岛素提抗用药分析[J].陕西中医,2009：30(1),88-89.
[10]李亚文,杨焱,陈凤娇,等.益气活血汤加虫类药治疗糖尿病周围神经病变35例疗效观察[J].中国现代药物应用,2009：3(1),120-121.
[11]佟晓哲,瘳威.健脾化痰清热方药对湿热困脾证2型糖尿病病患者血清C反应蛋白和白细胞介素6的影响[J].中华中医药学刊,2009：27(1),221-222.
[12]袁爱红,刘志诚,魏群利,等.针灸治疗肥胖2型糖尿病35例[J].安徽中医学院学报,2009：28(1),28-29.
[13]周东海,王海峰,杜长海,等.怀柔区217例糖尿病患者中医辨证分型与相关因素探讨[J].北京中医药,2009：28(1),39-40.
[14]周仲瑛主编.医论选[M].北京：人民卫生出版社,2008.138.