基于总结魏子孝教授治疗糖尿病学术思想及临证经验的继承方法研究
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摘要
中医药学的发展过程,始终是中医药学术不断积累、整理、总结、提炼和升华的过程。其中重要的一个环节就是历代名老中医的学术思想传承。名老中医学术思想和临证经验是中医药学术特点、理论特质的集中体现,是鲜活而极具实用性的智慧财富。如果能将每个名老中医的学术思想都准确、系统地总结出来,名老中医的经验传承工作就会更加鲜活,不仅使广大患者受益,还使后学者学有所宗,使中医事业代有才人出。
魏子孝教授从事临床、教学、科研近40年,在中医临证过程中,提出一系列具有缜密逻辑思维和特色的思维模式,在具体临证中形成了自己独特的诊疗风格。魏师对糖尿病的认识及治疗思路,主要以中西医疗结合的方式来治疗疾病,临床收效甚好,故值得对魏子孝主任医师的学术思想内涵及其实际诊疗运用的方法,做完整的整理与深入的探析。并在总结魏师治疗糖尿病的学术思想、临证经验的基础上,探讨继承这些宝贵知识的最佳方法。
一、主要研究内容
以魏师论著及其临床病历为主要研究对象,探讨其关于糖尿病独特创新的学说理论与临证经验心得。
对魏子孝教授相关论著的研究。通过对这些论著的研究,总结出魏师对糖尿病中医理论、中医经典的新见解、新观点。如魏师在糖尿病辨证方面,将宏观辨病与微观辨证相结合,对临床中一部分无证可辨的患者,多以理化指标为一辨证依据,丰富了中医辨证的内涵。另在处方用药方面,根据论著所述用药心得,结合临床数据挖掘结果,发现魏师临证用药,颇具匠心,用药不拘一格,精于药性、药物炮制和配伍；有的取古方、经方之原旨,有的依其现代药理研究,有的以自身临证经验搭配,独具个性,临床疗效甚佳。
对临床门诊病历的研究,主要是制定电子病历,使病历信息数字化,再通过数据挖掘技术对病历进行挖掘分析。对数据挖掘结果进行整理,提炼导师治疗本病的思维模式、诊疗规则、核心处方、用药规律等内容,并将结果由导师确认、分析、指导后,形成最终经验总结报告。根据最终报告内容,提出中医药治疗本证的有效辨证思路及治疗方法、用药规律。
二、学术思想研究
糖尿病是现代医学病名,魏师在具体诊疗时,认为不能将糖尿病完全等同于古代之消渴病。糖尿病与消渴之间,在临床表现上存在一定差异。对于大部分糖尿病患者中医不能诊断为“消渴”,故诊治时亦不必套用三消分证的思路。对于糖尿病的具体中医治疗,魏师提出了一个重要思路——从“抓主症”入手的“辨病与辨证相结合”的治疗思路。魏师认为,中医在抗高血糖治疗中“抓主症”的思想,与西医重视糖代谢中诸多干扰因素的认识相一致。排除干扰因素(抓主症)并非能解决高血糖的全部问题,但对稳定血糖有重要作用,故临证时“抓主症”这一治疗思路具有重要意义。具体步骤：先“抓主症”；处理好“标本先后”；再围绕主症辨证论治,确立基础方；然后结合病情,利用传统中药学、中药的现代药理研究,对基础方进行药味加减。对治疗结果的评价,既要依据检测指标(来源于西医的疗效标准),又要依据症状(来源于主症及加减所据的症状)、证候(来源于辨证及加减所据的兼证)。
“辨病与辨证相结合”的诊疗思路还可解决很多糖尿病患者有疾却“无证可辨”的情况。魏师强调要详审舌、脉、体,不可断然“舍症取脉”。并以中医基础理论为根据,逆推其病机。认为高血糖的中医病机是水谷精微化生异常,不能化生气血津液,郁而积聚为瘀血、水湿、痰浊等有形之邪导致。从“治未病”原则考虑,此时虽未出现三多症状,仍需要治疗干预。具体思路：一方面加强受纳、运化、化生功能,治在脾、肾。另一方面维护气血畅行,行气、活血均不能偏废,以防止水谷精微积聚为邪。另从糖尿病本身的发展规律顺推其病机,在未出现并发症时,要做到“既病防变”。“既病防变”含义有二：一是防止上、中消转变为下消,采取两消甚或三消同治；二是对病程较久,虽无并发症发生,舌体脉提示有瘀滞者,多以益气活血药物,防止并发症的发生。
重视专方专药。魏师认为如果在辨证论治的基础上,选用专方、专药,治疗效果会明显提高,专方专药是对辨证论治的补充,如导师在多年的临证过程中,根据糖、脂代谢障碍机理,结合传统中医理论及个人临床体会,汲取中药药理研究的成果,拟订处方降糖消脂胶囊就是很好的例证。
以上魏师的临床诊疗思路,为中医药治疗糖尿病提出了新的有效模式。通过本部分内容研究,对于如何继承魏子孝教授治疗糖尿病学术思想,本文认为除掌握中医有关消渴及其他疾病的基本理论、糖尿病相关的现代医学知识外,更主要应从以下几方面着手：
1跟师学习
通过跟随魏师出门诊,切身体会魏师在治疗糖尿病过程时的具体思路：以西医辨病,做到对该病的轻重、缓急、治疗难易、疗效指标心中有数；以中医辨证,灵活掌握“辨病与辨证相结合”。不以中药降糖为主要目的,而是以整体调理为出发点。强调抓主症,结合舌苔脉象辨证以定基础方,特别反对仅以脉象论短长。在制定基础方时,魏师喜用传统方剂,认为传统方剂理法明晰、构成严谨,有较好疗效。对于传统方剂的使用,依理法变通,不拘泥具体用药。常使用的基础方中有对肾、肝、脾三补三泻的六味地黄汤；养血、疏肝、健脾的逍遥散；清胃热、滋肾阴、引热下行的玉女煎等。对于个别病症特殊患者,则依基础方之法,选用针对性更强的药物,而不刻板遵从原方用药及剂量,使治疗完全个体化。临证处方时,用方精炼,全方保持十余味药,在具体加减时主要从证候或症状、药理、“治未病”等三方面考虑选择合宜药物。如车前、石韦兼止咳；磁石、紫石英兼补肾；党参、白术升高血浆白蛋白；金樱子、白茅根、土茯苓、玉米须等可减少尿蛋白。
跟师学习要善于总结老师的诊疗规律、用药规律。要善于学习老师的辨证思路,要做到有闻必录,有录必思,有疑必问,将老师的用药技巧加以分析体悟,领悟和总结其规律性的东西,这样才能事半功倍。
2做好笔记
做笔记是继承老中医经验的有效途径。做笔记有两方面内容：一是对中医经典及老师指定阅读书目做笔记,一是对老师临诊医案及讲解做笔记。无论哪种笔记,都要强调“认真”二字。对经典著作、医学名著、学术理论、诊治经验做到精研细读,铭记医理。跟师笔记要从老师医案入手,医案可以反映老中医的学术思想和临床经验,整理好一份完整的医案比上几节课的收获还要大。通过整理老师临证医案,反复体会老师的辨证思想、治法、方药及随证加减用药等经验,加深对该类疾病的认识。当然,最重要者更应记录老师对病例的讲解,包括如何抓主症、辨证分析、治法、用药经验及诊疗技巧等内容。
3悉心体悟
悉心体悟与跟师学习、整理笔记密不可分。继承名老中医经验决不是治疗某个疾病的几个方、几个法的问题。“医者意也,医者技也。”学习中医更需要长期揣摩,在临床实践中不断去领悟、体会中医学的思维方法：通过跟师临诊,耳濡目染老师治病经验；通过与老师交流,得到老师精心指导；通过做跟师笔记,细心体悟老师临证思路、用药特点。这样,所学才能真正成为自己的经验知识。
总之,跟师学习、做笔记、悉心体悟是继承魏子孝教授治疗糖尿病学术思想的最佳方式。其中以熟读中医经典、掌握西医知识为基础,跟师临证、交流、学习为重点,自己体悟为关键。但这种学习方式在研究导师老中医临证经验,分析临床大量医案时就有其局限性,如人力对大量数据的处理能力,及比较主观的经验总结等。为解决这一问题,本文利用现代信息处理技术——数据挖掘系统对魏师临证治疗糖尿病的医案进一步分析、整理,挖掘潜在众多医案中的有矩可循的可视化知识。
三、数据挖掘魏子孝教授治疗糖尿病的临证经验
通过建立结构化电子病历,将收集到的188例、368诊次的魏师治疗糖尿病的门诊及病房医案进行数据化处理,依靠数据挖掘技术获取这些医案的潜在规律内容。相关挖掘结果总结如下：临床表现“三多”症并不明显,而以乏力、手足麻木、视物模糊、下肢肿胀、手足凉、瘙痒、关节痛等为主。中医证候以血瘀、气虚、肾虚、脾虚、血虚、阴虚、痰浊等证候最为常见。网络分析示,血瘀、气虚同其他联系最为密切,其次为痰湿、肾虚、脾虚等证候,提示了糖尿病“本虚标实”的病机特点。中医诊断属下消者为最多,其他根据患者主症而予不同中医诊断。本数据库中,其他中医诊断主要有水肿、郁症、汗证、瘙痒、胸痹等。中医治法以活血化瘀、益气、补肾、清热、健脾、通络、养血、滋阴、化痰降浊为主,其中活血化瘀、健脾、益气、滋阴、清热等治法与其他治法联系最为密切。具体用药以陈皮、赤芍、茯苓、苍术、白芍、川牛膝、当归、白术、生黄芪、石菖蒲、川芎、红花、丹参、郁金、鸡血藤、柴胡、丹皮、生甘草、黄连、葛根、地龙、党参、法半夏、土茯苓、远志、车前子、知母等使用频率较高。
利用数据挖掘的方法研究魏子孝教授治疗糖尿病的临证经验,具有高效、快捷、客观等优点。但因缺乏与导师的心得体会交流,在研究名老中医的学术思想方面缺乏灵动的思维。因此要全面总结魏师治疗糖尿病临证经验,就要“人-机结合”、“以人为主”对数据库挖掘出的辨证、诊断、治法、用药等结果进行确认和评价。通过本部分研究,数据挖掘是继承魏子孝教授治疗糖尿病临证经验的重要手段,是继承临证经验的方便快捷工具,是师承制学习魏子孝教授治疗糖尿病学术思想及临证经验必不可少的补充形式。
四、结论
若完整继承魏师治疗糖尿病学术思想及临证经验,单纯的师承制和数据挖掘方法,都不能完善地总结出名老中医的学术思想和临证经验。因此二者的结合,可以取长补短,是继承魏师治疗糖尿病学术思想及临证经验的最佳方案。故本文提出研读导师论著、跟师学习、撰写心得、与导师交流,利用现代信息技术分析导师临证经验的研究型学习方式,是继承导师治疗糖尿病学术思想和临证经验的的最佳途径；同时也是继承其他中老名医学术思想及临证经验的最佳途径。
The developmental process of TCM is an accumulated, systematical, summarized, and promoted process. The most important of it is to inherite the experience and academic thought of distinguished senior traditional Chinese physicians. The academic thought and clinical experience of distinguished senior traditional Chinese physicians are actively and practicality intelligence wealth. It embody the academic features and trait theory of TCM. If we could exactly and systematicly to summeried the academic thought of every prestigious traditional Chinese physicians, the work of inheritance will be more vitality. It not only benefit to the majority of patients, but also benefit to the youth TCM doctor.
Professor Wei Zixiao has been studied the theory of TCM and engaged in clinical working for more than fourty years in diabetes, and became his own critically logical thinking pattern and diagnosis-treatment style. The train thought of Prof.Wei to treatment diabetes mode is combination of TCM and western medicine, and received good curative effect. So it worth to study the academic thought and clinical experience of Prof.Wei. And in this base approached to a best way to inherit these valuable knowledge.
1. Major researches
To study the literatures and medical records of Prof.Wei, exploring his unique theory and clinical experience.
Through study the literature to summerize the new view of theory and classical about Prof. Wei treatment on diabetes. Such as the aspect of diabetes syndrome differentiation, to combine macroscopic with microscopic syndrome differentiation. Stand on physical and chemical specifications, made syndrome differentiation in those no any symdrome patients. It riched the sphere of syndrome differentiation. Aspect of prescription, combination medicine use experience with result of data mining, we find that the uinque style of Prof.Wei has to use medicine. He use herbal medecine always based on classical theory, pharmacology and his own experience, and obtained good clinical results.
Study on clinical case, build electronic medical records database, digitized the cases, and then analysis them by data mining methods. From the results abstract thinking mode, diagnosis and treatment regulations, core prescriptions, use herbal medicine habits etc.. At last, under the direction of tutor write summing-up report. According to the report, refining summary the train thought of syndrome differentiations, treatment and using heebal medecine regulations.
2. Academic Thought Study
Prof. Wei don't consider that diabetes completely equate with TCM's Xiaoke. There are some differernts between diabetes with Xiaoke. Most of diabetes patients can't be diagnosed TCM's Xiaoke. So if use TCM methods to treat diabetes it doesn't must to use Sanxiao differentiations. About concrete TCM methods to treatment diabetes, Prof.Wei come up with an immportant Combination of TCM and Western medicine treatment thought---- start form seizing the main syndromes. He deemed that the idea of TCM's seizing the main syndromes is same as the value of glucose interference factor of Modern medicine. To eliminate interference factors(seizing the main syndromes) is not all method to solve hyperglycemia, but it can stable glucose. So the thought of seizing the main syndromes play an important role in treatmenting diabetes. Concrete step:first seizing the main syndromes, then treating both principal and secondary aspects of a disease promptly or slowly, made syndrome differentiation, confirm the prescription, plus-minus herbal based on disease. Assessment of efficacy must be based on physical and chemical specifications, based on main syndromes, based on syndrome differentiation.
The thought of Combinatino of Syndrome and Disease Differentiation can solve many diabetics differentiation of syndrome unavailable situation. Prof. Wei emphasis on examining tongue, pulse, body carefully, must not option Symptom-Pulse arbitrarily. On the ground of Basic theory of TCM backstepping the pathogenesis of hyperglycemia is dysfunction metabolism of food essence, and lead blood stasis, water-wet, phlegm-turbid came into being. Consider in Prevention of Disease principle, though the patient have none typical symptom of diabetes now, it also need to treatment. Concrete thought:one hand is to strengthen the spleen and kidney function, on the other hand to preserve qi-blood transportation and prevent food-essen to form pathogenic factor. Base on the law of diabetes development, backstepping the pathogenesis. Before complicating disease occurrence, we should treat diabetes early and to prevent it deteriorate. Treat early to prevent deterioration meaning treatment sanxiao together and preventing shangxiao and zhongxiao transform xiaxiao, another meaning is to prevent complicating disease occurrence.
Make a point of specific prescriptions and medications. Prof. Wei think if make syndrome differentiation and treatment early, choose the specific prescriptions and medications, the efficacy would be improving obviously. The specific prescriptions and medications is a supplement of syndrome differentiation and treatment. For example, Jiang Tang Xiao Zhi Capsule is a research finding which based on dysmetabolism mechanism of glycolipid and derive the pharmacology research achievements of TCM, combine with theory of TCM and personal experience of tutor.
The diagnosis and treatment thought of Prof. Wei is offering an efficacy new treatment style. Through this part of study, we got an answer to how inherite the thought of Prof. Wei to treatment on diabetes. This paper argues that besides master the basic theory of Xiaoke and other disease, also master the modern diabetes knowledge. A nd even more important thing should be done from next point. (1) Learning From an Expert
By means of following teacher practise, to be keenly aware of the thought of Prof. Wei:differentiate disease with morden medicine, so as to know fairly well about the order of importance and urgency, the easy or diffculty of treatment, and the endpoint of disease. Differentiate syndrome with TCM, master combination disease differentiation with syndrome differentiation flexibility. Not out of the purpose of hypoglycemic, but from adjusting whole body. Emphasis on seizing the main syndromes, and bombine it with tough, fur and puls, so as to determine basic prescription. Object to decide everything by puls only. For prescription, Prof. Wei like to use traditional prescriptions. He believe the traditional prescriptions have distinctly and exact theory, often get good clinic effect. When use traditional prescriptions accommodating with theory, not scrupulous about specific herbal medicine. Such as Dang Gui Liu Huang Tang have reinforcing and reducing kidney, liver and spleen's function, Xiao Yao San have function of nourishing blood, soothing liver and strengthening spleen. Yu Nv Jian have function of clearing away heat and nourishing Yin. For some special patients, base the law of traditional prescriptions, choose targeted herbal, made therapy totally tailored. The whole prescription use herb no more than dozen, plus-minus herbal based on syndrome, pharmacology and prevent disease etc.facters. Such as Plantago and pyrrosia can relieving cough, magnet and fluoritum can nourishing kidney, lanceolata and atractylodes can increasing hemoglobin, Cherokee rose, cogongrass rhizome, smilax glabra and maydis stigma can reduce urinary protein.
Learning from an expert must be good at summing-up the regulation and thought of diagnosis, treatment and using herba medicine; must take notes, thinking and ask when hearing some quesetion. Analysis the medication skill of tutor, summing-up the regular pattern, so we can get twice the result with half the effort.
(2) Note Taking
The effective ways of inheriting prestigious Chinese physician is take note. There are two thing should be take attention, and should be take seriously. One is notes for books which teacher ask to read. The other one is note the teacher's explanation about clinical cases. Star at taking note, read intensive and remember the medicine classic, academic and experience. There are more benefit to finishing a complete case than have several classes. The case embody the academic thought and clinical experience of tutor. Through collation teacher's clinic case, appreciate from syndrome differentiation, treatment and plus-minus herbal experiences, better understanding of disease. Of ocourse, the most immprotant thing is to note the teacher's explanation about clinical cases, including how to seize main syndrome, how to make syndrome differentiation, how to diagnosis and treatment, and how to use herbal medicine etc..
(3) Conscientiously Understanding
Conscientiously to understand is inseparable with learning from teacher and take note. The problem of inherite experience of the prestigious Chinese physician are not the questions about how many disease and therapy methods can be done. "Medicine is beyond technique". Study TCM need try to fathom for a long time, try to understand the thinking methods while clinical practice. Follow teacher practice, imperceptibly influenced by what one constantly sees and hears. Through communicate with tutor got careful guidance; through take note got good understanding of teacher's experience. Only in this way, we can change these knowledge into ourselves'.
In a word, learning from teacher, taking note, conscientiously to understand are the best modes to inherite academic thought of Prof. Wei to treat diabetes. Among them familiar with the classic and master modern medicine knowledge are the foundations, learning from teacher, and communication with teacher are the key points. But this study way shows the limitations when dealling with mass data. For example the power of human to deal with mass data, the subjective experience summary etc.. In order to solve this problem the article take advantage of modern information processing technology——data mining system to analysis regular and visualizations knowledge of clinical cases.
3. Data Minging Clinical Experience of Prof. Wei Treat on Diabetes
By buildding electronic medical records database, digitized the 188cases 368times, clinic record. Depending on data mining skill obtain potential law of these cases. Some mining results as follows:the typical symptoms of diabetes "three many a little"(so-called "three many" means "much food, much drink, much urine", "a little" points "weight decrease") are rare to see, but hypodynamia, numbness and cold of hands and feet, blurred vision, lower limb swelling, pruritus, arthralgia etc. are common symptoms. Blood stasis, Qi deficiency, kidney deficiency, spleen deficiency, blood deficiency, Yin deficiency, turbid phlegm are the most common syndrome. Network analysis show Blood stasis and Qi deficiency have much closed relation than others, and then is turbid phlegm, kidney deficiency and spleen deficiency symptoms. It disclose the deficiency incidental excess feature of diabetic pathogenesis. For the diagnosis of TCM most were diagnosised Xiaxiao, the rest based on main symptom were diagnosised other disease. In this database the TCM diagnosises have several types, such as edema, depression, sweating disease, pruritus, chest stuffiness etc. The treatment methods of TCM mainly are promoting blood circulation for removing blood stasis, supplementing qi, invigorating kidney, clearing away heat, invigorating spleen, dredging collaterals, nourishing blood, nourishing Yin, resolving phlegm lowering chaotic etc.. Among them the promoting blood circulation for removing blood stasis, invigorating spleen, supplementing qi, nourishing Yin, clearing away heat have closed relation than others. The use of herbal medicine mainly as follow:tangerine peel, red peony root, poria, atractylodes, white peony root, medicinal cyathula root, angelica, astragalus, sweetflag, rhizoma chuanxiong, safflower, salvia, curcuma, spatholobus stem, bupleurum, moutan, glycyrrhiza, coptis, kudzu, earthworm, lanceolata, pinellia, smilax glabra, polygala, plantago, anemarrhena etc..
The method of data mining is the effective and objective method to study clinic experience of Prof. Wei to treat diabetes. But it lack communication with teacher and have little stiff in studing academic thought of prestigious Chinese physician. So if comprehensive summary clinic experience of Prof. Wei to treat diabetes, we must combination human with computer, and give first place to human. Analysis and evaluate mining results. Through this part study, we can draw a conclusion that data mining is important means and convenient tool and absolutely necessary supplementary form to inherit clinic experience of Prof. Wei treat diabetes.
4. Conclusion
If completely inherit academic thought and clinical experience of Prof. Wei treat diabetes, depending on single learning from teacher and data mining method couldn't make a completive summary. So combination of the two is the best way to inherit. At last we can say that intensive reading classic, learning from teacher, take notes, communication with teacher, take advantage of modern information technology are the best way to analysis and inherit academic thought and clinical experience of Prof. Wei and other famous specialists of TCM.
魏子孝教授从事临床、教学、科研近40年,在中医临证过程中,提出一系列具有缜密逻辑思维和特色的思维模式,在具体临证中形成了自己独特的诊疗风格。魏师对糖尿病的认识及治疗思路,主要以中西医疗结合的方式来治疗疾病,临床收效甚好,故值得对魏子孝主任医师的学术思想内涵及其实际诊疗运用的方法,做完整的整理与深入的探析。并在总结魏师治疗糖尿病的学术思想、临证经验的基础上,探讨继承这些宝贵知识的最佳方法。
一、主要研究内容
以魏师论著及其临床病历为主要研究对象,探讨其关于糖尿病独特创新的学说理论与临证经验心得。
对魏子孝教授相关论著的研究。通过对这些论著的研究,总结出魏师对糖尿病中医理论、中医经典的新见解、新观点。如魏师在糖尿病辨证方面,将宏观辨病与微观辨证相结合,对临床中一部分无证可辨的患者,多以理化指标为一辨证依据,丰富了中医辨证的内涵。另在处方用药方面,根据论著所述用药心得,结合临床数据挖掘结果,发现魏师临证用药,颇具匠心,用药不拘一格,精于药性、药物炮制和配伍；有的取古方、经方之原旨,有的依其现代药理研究,有的以自身临证经验搭配,独具个性,临床疗效甚佳。
对临床门诊病历的研究,主要是制定电子病历,使病历信息数字化,再通过数据挖掘技术对病历进行挖掘分析。对数据挖掘结果进行整理,提炼导师治疗本病的思维模式、诊疗规则、核心处方、用药规律等内容,并将结果由导师确认、分析、指导后,形成最终经验总结报告。根据最终报告内容,提出中医药治疗本证的有效辨证思路及治疗方法、用药规律。
二、学术思想研究
糖尿病是现代医学病名,魏师在具体诊疗时,认为不能将糖尿病完全等同于古代之消渴病。糖尿病与消渴之间,在临床表现上存在一定差异。对于大部分糖尿病患者中医不能诊断为“消渴”,故诊治时亦不必套用三消分证的思路。对于糖尿病的具体中医治疗,魏师提出了一个重要思路——从“抓主症”入手的“辨病与辨证相结合”的治疗思路。魏师认为,中医在抗高血糖治疗中“抓主症”的思想,与西医重视糖代谢中诸多干扰因素的认识相一致。排除干扰因素(抓主症)并非能解决高血糖的全部问题,但对稳定血糖有重要作用,故临证时“抓主症”这一治疗思路具有重要意义。具体步骤：先“抓主症”；处理好“标本先后”；再围绕主症辨证论治,确立基础方；然后结合病情,利用传统中药学、中药的现代药理研究,对基础方进行药味加减。对治疗结果的评价,既要依据检测指标(来源于西医的疗效标准),又要依据症状(来源于主症及加减所据的症状)、证候(来源于辨证及加减所据的兼证)。
“辨病与辨证相结合”的诊疗思路还可解决很多糖尿病患者有疾却“无证可辨”的情况。魏师强调要详审舌、脉、体,不可断然“舍症取脉”。并以中医基础理论为根据,逆推其病机。认为高血糖的中医病机是水谷精微化生异常,不能化生气血津液,郁而积聚为瘀血、水湿、痰浊等有形之邪导致。从“治未病”原则考虑,此时虽未出现三多症状,仍需要治疗干预。具体思路：一方面加强受纳、运化、化生功能,治在脾、肾。另一方面维护气血畅行,行气、活血均不能偏废,以防止水谷精微积聚为邪。另从糖尿病本身的发展规律顺推其病机,在未出现并发症时,要做到“既病防变”。“既病防变”含义有二：一是防止上、中消转变为下消,采取两消甚或三消同治；二是对病程较久,虽无并发症发生,舌体脉提示有瘀滞者,多以益气活血药物,防止并发症的发生。
重视专方专药。魏师认为如果在辨证论治的基础上,选用专方、专药,治疗效果会明显提高,专方专药是对辨证论治的补充,如导师在多年的临证过程中,根据糖、脂代谢障碍机理,结合传统中医理论及个人临床体会,汲取中药药理研究的成果,拟订处方降糖消脂胶囊就是很好的例证。
以上魏师的临床诊疗思路,为中医药治疗糖尿病提出了新的有效模式。通过本部分内容研究,对于如何继承魏子孝教授治疗糖尿病学术思想,本文认为除掌握中医有关消渴及其他疾病的基本理论、糖尿病相关的现代医学知识外,更主要应从以下几方面着手：
1跟师学习
通过跟随魏师出门诊,切身体会魏师在治疗糖尿病过程时的具体思路：以西医辨病,做到对该病的轻重、缓急、治疗难易、疗效指标心中有数；以中医辨证,灵活掌握“辨病与辨证相结合”。不以中药降糖为主要目的,而是以整体调理为出发点。强调抓主症,结合舌苔脉象辨证以定基础方,特别反对仅以脉象论短长。在制定基础方时,魏师喜用传统方剂,认为传统方剂理法明晰、构成严谨,有较好疗效。对于传统方剂的使用,依理法变通,不拘泥具体用药。常使用的基础方中有对肾、肝、脾三补三泻的六味地黄汤；养血、疏肝、健脾的逍遥散；清胃热、滋肾阴、引热下行的玉女煎等。对于个别病症特殊患者,则依基础方之法,选用针对性更强的药物,而不刻板遵从原方用药及剂量,使治疗完全个体化。临证处方时,用方精炼,全方保持十余味药,在具体加减时主要从证候或症状、药理、“治未病”等三方面考虑选择合宜药物。如车前、石韦兼止咳；磁石、紫石英兼补肾；党参、白术升高血浆白蛋白；金樱子、白茅根、土茯苓、玉米须等可减少尿蛋白。
跟师学习要善于总结老师的诊疗规律、用药规律。要善于学习老师的辨证思路,要做到有闻必录,有录必思,有疑必问,将老师的用药技巧加以分析体悟,领悟和总结其规律性的东西,这样才能事半功倍。
2做好笔记
做笔记是继承老中医经验的有效途径。做笔记有两方面内容：一是对中医经典及老师指定阅读书目做笔记,一是对老师临诊医案及讲解做笔记。无论哪种笔记,都要强调“认真”二字。对经典著作、医学名著、学术理论、诊治经验做到精研细读,铭记医理。跟师笔记要从老师医案入手,医案可以反映老中医的学术思想和临床经验,整理好一份完整的医案比上几节课的收获还要大。通过整理老师临证医案,反复体会老师的辨证思想、治法、方药及随证加减用药等经验,加深对该类疾病的认识。当然,最重要者更应记录老师对病例的讲解,包括如何抓主症、辨证分析、治法、用药经验及诊疗技巧等内容。
3悉心体悟
悉心体悟与跟师学习、整理笔记密不可分。继承名老中医经验决不是治疗某个疾病的几个方、几个法的问题。“医者意也,医者技也。”学习中医更需要长期揣摩,在临床实践中不断去领悟、体会中医学的思维方法：通过跟师临诊,耳濡目染老师治病经验；通过与老师交流,得到老师精心指导；通过做跟师笔记,细心体悟老师临证思路、用药特点。这样,所学才能真正成为自己的经验知识。
总之,跟师学习、做笔记、悉心体悟是继承魏子孝教授治疗糖尿病学术思想的最佳方式。其中以熟读中医经典、掌握西医知识为基础,跟师临证、交流、学习为重点,自己体悟为关键。但这种学习方式在研究导师老中医临证经验,分析临床大量医案时就有其局限性,如人力对大量数据的处理能力,及比较主观的经验总结等。为解决这一问题,本文利用现代信息处理技术——数据挖掘系统对魏师临证治疗糖尿病的医案进一步分析、整理,挖掘潜在众多医案中的有矩可循的可视化知识。
三、数据挖掘魏子孝教授治疗糖尿病的临证经验
通过建立结构化电子病历,将收集到的188例、368诊次的魏师治疗糖尿病的门诊及病房医案进行数据化处理,依靠数据挖掘技术获取这些医案的潜在规律内容。相关挖掘结果总结如下：临床表现“三多”症并不明显,而以乏力、手足麻木、视物模糊、下肢肿胀、手足凉、瘙痒、关节痛等为主。中医证候以血瘀、气虚、肾虚、脾虚、血虚、阴虚、痰浊等证候最为常见。网络分析示,血瘀、气虚同其他联系最为密切,其次为痰湿、肾虚、脾虚等证候,提示了糖尿病“本虚标实”的病机特点。中医诊断属下消者为最多,其他根据患者主症而予不同中医诊断。本数据库中,其他中医诊断主要有水肿、郁症、汗证、瘙痒、胸痹等。中医治法以活血化瘀、益气、补肾、清热、健脾、通络、养血、滋阴、化痰降浊为主,其中活血化瘀、健脾、益气、滋阴、清热等治法与其他治法联系最为密切。具体用药以陈皮、赤芍、茯苓、苍术、白芍、川牛膝、当归、白术、生黄芪、石菖蒲、川芎、红花、丹参、郁金、鸡血藤、柴胡、丹皮、生甘草、黄连、葛根、地龙、党参、法半夏、土茯苓、远志、车前子、知母等使用频率较高。
利用数据挖掘的方法研究魏子孝教授治疗糖尿病的临证经验,具有高效、快捷、客观等优点。但因缺乏与导师的心得体会交流,在研究名老中医的学术思想方面缺乏灵动的思维。因此要全面总结魏师治疗糖尿病临证经验,就要“人-机结合”、“以人为主”对数据库挖掘出的辨证、诊断、治法、用药等结果进行确认和评价。通过本部分研究,数据挖掘是继承魏子孝教授治疗糖尿病临证经验的重要手段,是继承临证经验的方便快捷工具,是师承制学习魏子孝教授治疗糖尿病学术思想及临证经验必不可少的补充形式。
四、结论
若完整继承魏师治疗糖尿病学术思想及临证经验,单纯的师承制和数据挖掘方法,都不能完善地总结出名老中医的学术思想和临证经验。因此二者的结合,可以取长补短,是继承魏师治疗糖尿病学术思想及临证经验的最佳方案。故本文提出研读导师论著、跟师学习、撰写心得、与导师交流,利用现代信息技术分析导师临证经验的研究型学习方式,是继承导师治疗糖尿病学术思想和临证经验的的最佳途径；同时也是继承其他中老名医学术思想及临证经验的最佳途径。
The developmental process of TCM is an accumulated, systematical, summarized, and promoted process. The most important of it is to inherite the experience and academic thought of distinguished senior traditional Chinese physicians. The academic thought and clinical experience of distinguished senior traditional Chinese physicians are actively and practicality intelligence wealth. It embody the academic features and trait theory of TCM. If we could exactly and systematicly to summeried the academic thought of every prestigious traditional Chinese physicians, the work of inheritance will be more vitality. It not only benefit to the majority of patients, but also benefit to the youth TCM doctor.
Professor Wei Zixiao has been studied the theory of TCM and engaged in clinical working for more than fourty years in diabetes, and became his own critically logical thinking pattern and diagnosis-treatment style. The train thought of Prof.Wei to treatment diabetes mode is combination of TCM and western medicine, and received good curative effect. So it worth to study the academic thought and clinical experience of Prof.Wei. And in this base approached to a best way to inherit these valuable knowledge.
1. Major researches
To study the literatures and medical records of Prof.Wei, exploring his unique theory and clinical experience.
Through study the literature to summerize the new view of theory and classical about Prof. Wei treatment on diabetes. Such as the aspect of diabetes syndrome differentiation, to combine macroscopic with microscopic syndrome differentiation. Stand on physical and chemical specifications, made syndrome differentiation in those no any symdrome patients. It riched the sphere of syndrome differentiation. Aspect of prescription, combination medicine use experience with result of data mining, we find that the uinque style of Prof.Wei has to use medicine. He use herbal medecine always based on classical theory, pharmacology and his own experience, and obtained good clinical results.
Study on clinical case, build electronic medical records database, digitized the cases, and then analysis them by data mining methods. From the results abstract thinking mode, diagnosis and treatment regulations, core prescriptions, use herbal medicine habits etc.. At last, under the direction of tutor write summing-up report. According to the report, refining summary the train thought of syndrome differentiations, treatment and using heebal medecine regulations.
2. Academic Thought Study
Prof. Wei don't consider that diabetes completely equate with TCM's Xiaoke. There are some differernts between diabetes with Xiaoke. Most of diabetes patients can't be diagnosed TCM's Xiaoke. So if use TCM methods to treat diabetes it doesn't must to use Sanxiao differentiations. About concrete TCM methods to treatment diabetes, Prof.Wei come up with an immportant Combination of TCM and Western medicine treatment thought---- start form seizing the main syndromes. He deemed that the idea of TCM's seizing the main syndromes is same as the value of glucose interference factor of Modern medicine. To eliminate interference factors(seizing the main syndromes) is not all method to solve hyperglycemia, but it can stable glucose. So the thought of seizing the main syndromes play an important role in treatmenting diabetes. Concrete step:first seizing the main syndromes, then treating both principal and secondary aspects of a disease promptly or slowly, made syndrome differentiation, confirm the prescription, plus-minus herbal based on disease. Assessment of efficacy must be based on physical and chemical specifications, based on main syndromes, based on syndrome differentiation.
The thought of Combinatino of Syndrome and Disease Differentiation can solve many diabetics differentiation of syndrome unavailable situation. Prof. Wei emphasis on examining tongue, pulse, body carefully, must not option Symptom-Pulse arbitrarily. On the ground of Basic theory of TCM backstepping the pathogenesis of hyperglycemia is dysfunction metabolism of food essence, and lead blood stasis, water-wet, phlegm-turbid came into being. Consider in Prevention of Disease principle, though the patient have none typical symptom of diabetes now, it also need to treatment. Concrete thought:one hand is to strengthen the spleen and kidney function, on the other hand to preserve qi-blood transportation and prevent food-essen to form pathogenic factor. Base on the law of diabetes development, backstepping the pathogenesis. Before complicating disease occurrence, we should treat diabetes early and to prevent it deteriorate. Treat early to prevent deterioration meaning treatment sanxiao together and preventing shangxiao and zhongxiao transform xiaxiao, another meaning is to prevent complicating disease occurrence.
Make a point of specific prescriptions and medications. Prof. Wei think if make syndrome differentiation and treatment early, choose the specific prescriptions and medications, the efficacy would be improving obviously. The specific prescriptions and medications is a supplement of syndrome differentiation and treatment. For example, Jiang Tang Xiao Zhi Capsule is a research finding which based on dysmetabolism mechanism of glycolipid and derive the pharmacology research achievements of TCM, combine with theory of TCM and personal experience of tutor.
The diagnosis and treatment thought of Prof. Wei is offering an efficacy new treatment style. Through this part of study, we got an answer to how inherite the thought of Prof. Wei to treatment on diabetes. This paper argues that besides master the basic theory of Xiaoke and other disease, also master the modern diabetes knowledge. A nd even more important thing should be done from next point. (1) Learning From an Expert
By means of following teacher practise, to be keenly aware of the thought of Prof. Wei:differentiate disease with morden medicine, so as to know fairly well about the order of importance and urgency, the easy or diffculty of treatment, and the endpoint of disease. Differentiate syndrome with TCM, master combination disease differentiation with syndrome differentiation flexibility. Not out of the purpose of hypoglycemic, but from adjusting whole body. Emphasis on seizing the main syndromes, and bombine it with tough, fur and puls, so as to determine basic prescription. Object to decide everything by puls only. For prescription, Prof. Wei like to use traditional prescriptions. He believe the traditional prescriptions have distinctly and exact theory, often get good clinic effect. When use traditional prescriptions accommodating with theory, not scrupulous about specific herbal medicine. Such as Dang Gui Liu Huang Tang have reinforcing and reducing kidney, liver and spleen's function, Xiao Yao San have function of nourishing blood, soothing liver and strengthening spleen. Yu Nv Jian have function of clearing away heat and nourishing Yin. For some special patients, base the law of traditional prescriptions, choose targeted herbal, made therapy totally tailored. The whole prescription use herb no more than dozen, plus-minus herbal based on syndrome, pharmacology and prevent disease etc.facters. Such as Plantago and pyrrosia can relieving cough, magnet and fluoritum can nourishing kidney, lanceolata and atractylodes can increasing hemoglobin, Cherokee rose, cogongrass rhizome, smilax glabra and maydis stigma can reduce urinary protein.
Learning from an expert must be good at summing-up the regulation and thought of diagnosis, treatment and using herba medicine; must take notes, thinking and ask when hearing some quesetion. Analysis the medication skill of tutor, summing-up the regular pattern, so we can get twice the result with half the effort.
(2) Note Taking
The effective ways of inheriting prestigious Chinese physician is take note. There are two thing should be take attention, and should be take seriously. One is notes for books which teacher ask to read. The other one is note the teacher's explanation about clinical cases. Star at taking note, read intensive and remember the medicine classic, academic and experience. There are more benefit to finishing a complete case than have several classes. The case embody the academic thought and clinical experience of tutor. Through collation teacher's clinic case, appreciate from syndrome differentiation, treatment and plus-minus herbal experiences, better understanding of disease. Of ocourse, the most immprotant thing is to note the teacher's explanation about clinical cases, including how to seize main syndrome, how to make syndrome differentiation, how to diagnosis and treatment, and how to use herbal medicine etc..
(3) Conscientiously Understanding
Conscientiously to understand is inseparable with learning from teacher and take note. The problem of inherite experience of the prestigious Chinese physician are not the questions about how many disease and therapy methods can be done. "Medicine is beyond technique". Study TCM need try to fathom for a long time, try to understand the thinking methods while clinical practice. Follow teacher practice, imperceptibly influenced by what one constantly sees and hears. Through communicate with tutor got careful guidance; through take note got good understanding of teacher's experience. Only in this way, we can change these knowledge into ourselves'.
In a word, learning from teacher, taking note, conscientiously to understand are the best modes to inherite academic thought of Prof. Wei to treat diabetes. Among them familiar with the classic and master modern medicine knowledge are the foundations, learning from teacher, and communication with teacher are the key points. But this study way shows the limitations when dealling with mass data. For example the power of human to deal with mass data, the subjective experience summary etc.. In order to solve this problem the article take advantage of modern information processing technology——data mining system to analysis regular and visualizations knowledge of clinical cases.
3. Data Minging Clinical Experience of Prof. Wei Treat on Diabetes
By buildding electronic medical records database, digitized the 188cases 368times, clinic record. Depending on data mining skill obtain potential law of these cases. Some mining results as follows:the typical symptoms of diabetes "three many a little"(so-called "three many" means "much food, much drink, much urine", "a little" points "weight decrease") are rare to see, but hypodynamia, numbness and cold of hands and feet, blurred vision, lower limb swelling, pruritus, arthralgia etc. are common symptoms. Blood stasis, Qi deficiency, kidney deficiency, spleen deficiency, blood deficiency, Yin deficiency, turbid phlegm are the most common syndrome. Network analysis show Blood stasis and Qi deficiency have much closed relation than others, and then is turbid phlegm, kidney deficiency and spleen deficiency symptoms. It disclose the deficiency incidental excess feature of diabetic pathogenesis. For the diagnosis of TCM most were diagnosised Xiaxiao, the rest based on main symptom were diagnosised other disease. In this database the TCM diagnosises have several types, such as edema, depression, sweating disease, pruritus, chest stuffiness etc. The treatment methods of TCM mainly are promoting blood circulation for removing blood stasis, supplementing qi, invigorating kidney, clearing away heat, invigorating spleen, dredging collaterals, nourishing blood, nourishing Yin, resolving phlegm lowering chaotic etc.. Among them the promoting blood circulation for removing blood stasis, invigorating spleen, supplementing qi, nourishing Yin, clearing away heat have closed relation than others. The use of herbal medicine mainly as follow:tangerine peel, red peony root, poria, atractylodes, white peony root, medicinal cyathula root, angelica, astragalus, sweetflag, rhizoma chuanxiong, safflower, salvia, curcuma, spatholobus stem, bupleurum, moutan, glycyrrhiza, coptis, kudzu, earthworm, lanceolata, pinellia, smilax glabra, polygala, plantago, anemarrhena etc..
The method of data mining is the effective and objective method to study clinic experience of Prof. Wei to treat diabetes. But it lack communication with teacher and have little stiff in studing academic thought of prestigious Chinese physician. So if comprehensive summary clinic experience of Prof. Wei to treat diabetes, we must combination human with computer, and give first place to human. Analysis and evaluate mining results. Through this part study, we can draw a conclusion that data mining is important means and convenient tool and absolutely necessary supplementary form to inherit clinic experience of Prof. Wei treat diabetes.
4. Conclusion
If completely inherit academic thought and clinical experience of Prof. Wei treat diabetes, depending on single learning from teacher and data mining method couldn't make a completive summary. So combination of the two is the best way to inherit. At last we can say that intensive reading classic, learning from teacher, take notes, communication with teacher, take advantage of modern information technology are the best way to analysis and inherit academic thought and clinical experience of Prof. Wei and other famous specialists of TCM.
引文
[1]陈明,张书河.关联规则在中医疾病证候诊断中的应用[J].中华医学丛刊,2004,4(5)：14-16.
[2]秦中广,毛宗源,邓兆智.粗糙集在中医类风湿证候诊断中的应用[J].中国生物医学工程学报,2001,20(4)：354-363.
[3]刘晋平.数据挖掘在中医脉诊研究中的应用[C].天津中医药大学硕士论文,2002.
[4]蒋永光,胡波,刘娟等.方剂配伍的数据挖掘可行性探索[J].四川中医,2004,22(8)：25-28.
[5]何前锋,崔蒙,吴朝晖等.方剂中配伍知识的发现[J].中国中医药信息杂志,2004,11(7)：655-658.
[6]姚美村,艾路,袁月梅等.消渴病复方配伍规律的关联规则分析[J].北京中医药大学学报,2002,25(6)：48-501.
[7]魏子孝.学用中医体会录[M].北京：人民卫生出版社,2010,19-20.
[8]王冰.黄帝内经·索问.北京：人民卫生出版社,1963,357.
[9]清·程国彭.医学心悟·卷三·消渴.北京：人民卫生出版社,1963.
[10]清·黄元御.素灵微蕴.见：孙洽熙主编.黄元御医学全书.北京：中国中医药出版社,1999：958.
[11]清·叶天士.临证指南医案.见：黄英志主编.叶天士医学全书.北京：中国中医药出版社,1999：176-177.
[12]魏子孝.用中医阻断神经病变.糖尿病新世界[J],2008,8：32-33.
[13]魏子孝.糖尿病性肾病的中医治疗体会[J].世界中医药,2007,2(1)：2031.
[14]明·徐春甫.古今医统人全.北京：人民卫生出版社,1991年第1版：15.
[15]明·徐春甫.古今医统人全北京：人民卫生出版社,1991年第1版：16.
[16]唐·王冰.黄帝内经·素问.北京：人民卫生出版社,1963,139-140.
[17]黄帝内经·灵枢.北京：人民卫生出版社,1993,52.
[18]宋·王怀隐.太平圣惠方.北京：人民卫生出版社出版,1958年第1版：卷53.
[19]宋·许叔微.普济本事方.上海：上海科学技术出版社,1959：83.
[20]清·陈士铎.辨证录.见：柳长华主编.陈士铎医学全书.北京：中国中医药出版社,1999年第1版：842.
[21]胡文丰,张正国.生物医学数据挖掘[J].国外医学生物医学工程分册,2003,26(1)：11-15.
[22]何前锋,崔蒙,吴朝晖等.方剂中配伍知识的发现.中国中医药信息杂志,2004,11(7)：655-658.
[23]姚美村,艾路,袁月梅等.消渴病复方配伍规律的关联规则分析.北京中医药大学学报,2002,25(6)：48-50.
[24]黎敬波,马力.中医临床常见症状术语规范[M].北京：中国医药科技出版社,2005.
[25]国家技术监督局.中华人民共和国国家标准中医临床诊疗术语证候部分[M].中国标准出版社,1997.
[26]朱文锋.证素辨证学[M].北京：人民卫生出版社,2008：162-228.
[27]国家技术监督局.中华人民共和国国家标准中医临床诊疗术语治法部分[M].中国标准出版社,1997.
[28] Hartigan J A. Direct Clustering of a Data Matrix[J]. JASA,1972,67.
[29]黎元元.糖尿病证候要素提取与应证组合规律研究[D].北京：中国中医科学院,2006.
[30]邓铁涛.邓铁涛医学文集.北京：人民卫生出版社,2001,228.
[31]戴恩来.关于中医教育模式有关问题的理性思考[J].甘肃中医,2005,18(3)：37.
[32]姚美村,袁月梅,艾路等.数据挖掘及其在中医药现代化研究中的应用[J].北京中医药大学学报,2002,25(5)：20-23.
1.陈明,张书河.关联规则在中医疾病证候诊断中的应用[J].中华医学丛刊,2004,4(5)：14-16.
2.秦中广,毛宗源,邓兆智.粗糙集在中医类风湿证候诊断中的应用[J].中国生物医学工程学报,2001,20(4)：354-363.
3.刘晋平.数据挖掘在中医脉诊研究中的应用[C].天津中医药大学硕士论文,2002.
4.蒋永光,胡波,刘娟等.方剂配伍的数据挖掘可行性探索[J].四川中医,2004,22(8)：25-28.
5.何前锋,崔蒙,吴朝晖等.方剂中配伍知识的发现[J].中国中医药信息杂志,2004,11(7)：655-658.
6.姚美村,艾路,袁月梅等.消渴病复方配伍规律的关联规则分析[J].北京中医药大学学报,2002,25(6)：48-501.
7.魏子孝.学用中医体会录[M].北京：人民卫生出版社,2010,19-20.
8.王冰.黄帝内经·素问.北京：人民卫生出版社,1963,357.
9.清·程国彭.医学心悟·卷三·消渴.北京：人民卫生出版社,1963.
10.清·黄元御.素灵微蕴.见：孙洽熙主编.黄元御医学全书.北京：中国中医药出版社,1999：958.
11.清·叶天士.临证指南医案.见：黄英志主编.叶天士医学全书.北京：中国中医药出版社,1999：176-177.
12.魏子孝.用中医阻断神经病变.糖尿病新世界[J],2008,8：32-33.
13.魏子孝.糖尿病性肾病的中医治疗体会[J].世界中医药,2007,2(1)：20-31.
14.明·徐春甫.古今医统人全.北京：人民卫生出版社,1991年第1版：15.
15.明·徐春甫.古今医统人全北京：人民卫生出版社,1991年第1版：16.
16.唐·王冰.黄帝内经·素问.北京：人民卫生出版社,1963,139-140.
17.黄帝内经·灵枢.北京：人民卫生出版社,1993,52.
18.宋·王怀隐.太平圣惠方.北京：人民卫生出版社出版,1958年第1版：卷 53.
19.宋·许叔微.普济本事方.上海：上海科学技术出版社,1959：83.
20.清·陈士铎.辨证录.见：柳长华主编.陈士铎医学全书.北京：中国中医药出版社,1999年第1版：842.
21.胡文丰,张正国.生物医学数据挖掘[J].国外医学生物医学工程分册,2003,26(1)：11-15.
22.何前锋,崔蒙,吴朝晖等.方剂中配伍知识的发现[J].中国中医药信息杂志,2004,11(7)：655-658.
23.姚美村,艾路,袁月梅等.消渴病复方配伍规律的关联规则分析[J].北京中医药大学学报,2002,25(6)：48-50.
24.黎敬波,马力.中医临床常见症状术语规范[M].北京：中国医药科技出版社,2005.
25.国家技术监督局.中华人民共和国国家标准中医临床诊疗术语证候部分[M].中国标准出版社,1997.
26.朱文锋.证素辨证学[M].北京：人民卫生出版社,2008：162-228.
27.国家技术监督局.中华人民共和国国家标准中医临床诊疗术语治法部分[M].中国标准出版社,1997.
28. Hartigan J A. Direct Clustering of a Data Matrix[J]. JASA,1972, 67.
29.黎元元.糖尿病证候要素提取与应证组合规律研究[D].北京：中国中医科学院,2006.
30.邓铁涛.邓铁涛医学文集.北京：人民卫生出版社,2001,228.
31.戴恩来.关于中医教育模式有关问题的理性思考[J].甘肃中医,2005,18(3)：37.
32.姚美村,袁月梅,艾路等.数据挖掘及其在中医药现代化研究中的应用[J].北京中医药大学学报,2002,25(5)：20-23.
[2]秦中广,毛宗源,邓兆智.粗糙集在中医类风湿证候诊断中的应用[J].中国生物医学工程学报,2001,20(4)：354-363.
[3]刘晋平.数据挖掘在中医脉诊研究中的应用[C].天津中医药大学硕士论文,2002.
[4]蒋永光,胡波,刘娟等.方剂配伍的数据挖掘可行性探索[J].四川中医,2004,22(8)：25-28.
[5]何前锋,崔蒙,吴朝晖等.方剂中配伍知识的发现[J].中国中医药信息杂志,2004,11(7)：655-658.
[6]姚美村,艾路,袁月梅等.消渴病复方配伍规律的关联规则分析[J].北京中医药大学学报,2002,25(6)：48-501.
[7]魏子孝.学用中医体会录[M].北京：人民卫生出版社,2010,19-20.
[8]王冰.黄帝内经·索问.北京：人民卫生出版社,1963,357.
[9]清·程国彭.医学心悟·卷三·消渴.北京：人民卫生出版社,1963.
[10]清·黄元御.素灵微蕴.见：孙洽熙主编.黄元御医学全书.北京：中国中医药出版社,1999：958.
[11]清·叶天士.临证指南医案.见：黄英志主编.叶天士医学全书.北京：中国中医药出版社,1999：176-177.
[12]魏子孝.用中医阻断神经病变.糖尿病新世界[J],2008,8：32-33.
[13]魏子孝.糖尿病性肾病的中医治疗体会[J].世界中医药,2007,2(1)：2031.
[14]明·徐春甫.古今医统人全.北京：人民卫生出版社,1991年第1版：15.
[15]明·徐春甫.古今医统人全北京：人民卫生出版社,1991年第1版：16.
[16]唐·王冰.黄帝内经·素问.北京：人民卫生出版社,1963,139-140.
[17]黄帝内经·灵枢.北京：人民卫生出版社,1993,52.
[18]宋·王怀隐.太平圣惠方.北京：人民卫生出版社出版,1958年第1版：卷53.
[19]宋·许叔微.普济本事方.上海：上海科学技术出版社,1959：83.
[20]清·陈士铎.辨证录.见：柳长华主编.陈士铎医学全书.北京：中国中医药出版社,1999年第1版：842.
[21]胡文丰,张正国.生物医学数据挖掘[J].国外医学生物医学工程分册,2003,26(1)：11-15.
[22]何前锋,崔蒙,吴朝晖等.方剂中配伍知识的发现.中国中医药信息杂志,2004,11(7)：655-658.
[23]姚美村,艾路,袁月梅等.消渴病复方配伍规律的关联规则分析.北京中医药大学学报,2002,25(6)：48-50.
[24]黎敬波,马力.中医临床常见症状术语规范[M].北京：中国医药科技出版社,2005.
[25]国家技术监督局.中华人民共和国国家标准中医临床诊疗术语证候部分[M].中国标准出版社,1997.
[26]朱文锋.证素辨证学[M].北京：人民卫生出版社,2008：162-228.
[27]国家技术监督局.中华人民共和国国家标准中医临床诊疗术语治法部分[M].中国标准出版社,1997.
[28] Hartigan J A. Direct Clustering of a Data Matrix[J]. JASA,1972,67.
[29]黎元元.糖尿病证候要素提取与应证组合规律研究[D].北京：中国中医科学院,2006.
[30]邓铁涛.邓铁涛医学文集.北京：人民卫生出版社,2001,228.
[31]戴恩来.关于中医教育模式有关问题的理性思考[J].甘肃中医,2005,18(3)：37.
[32]姚美村,袁月梅,艾路等.数据挖掘及其在中医药现代化研究中的应用[J].北京中医药大学学报,2002,25(5)：20-23.
1.陈明,张书河.关联规则在中医疾病证候诊断中的应用[J].中华医学丛刊,2004,4(5)：14-16.
2.秦中广,毛宗源,邓兆智.粗糙集在中医类风湿证候诊断中的应用[J].中国生物医学工程学报,2001,20(4)：354-363.
3.刘晋平.数据挖掘在中医脉诊研究中的应用[C].天津中医药大学硕士论文,2002.
4.蒋永光,胡波,刘娟等.方剂配伍的数据挖掘可行性探索[J].四川中医,2004,22(8)：25-28.
5.何前锋,崔蒙,吴朝晖等.方剂中配伍知识的发现[J].中国中医药信息杂志,2004,11(7)：655-658.
6.姚美村,艾路,袁月梅等.消渴病复方配伍规律的关联规则分析[J].北京中医药大学学报,2002,25(6)：48-501.
7.魏子孝.学用中医体会录[M].北京：人民卫生出版社,2010,19-20.
8.王冰.黄帝内经·素问.北京：人民卫生出版社,1963,357.
9.清·程国彭.医学心悟·卷三·消渴.北京：人民卫生出版社,1963.
10.清·黄元御.素灵微蕴.见：孙洽熙主编.黄元御医学全书.北京：中国中医药出版社,1999：958.
11.清·叶天士.临证指南医案.见：黄英志主编.叶天士医学全书.北京：中国中医药出版社,1999：176-177.
12.魏子孝.用中医阻断神经病变.糖尿病新世界[J],2008,8：32-33.
13.魏子孝.糖尿病性肾病的中医治疗体会[J].世界中医药,2007,2(1)：20-31.
14.明·徐春甫.古今医统人全.北京：人民卫生出版社,1991年第1版：15.
15.明·徐春甫.古今医统人全北京：人民卫生出版社,1991年第1版：16.
16.唐·王冰.黄帝内经·素问.北京：人民卫生出版社,1963,139-140.
17.黄帝内经·灵枢.北京：人民卫生出版社,1993,52.
18.宋·王怀隐.太平圣惠方.北京：人民卫生出版社出版,1958年第1版：卷 53.
19.宋·许叔微.普济本事方.上海：上海科学技术出版社,1959：83.
20.清·陈士铎.辨证录.见：柳长华主编.陈士铎医学全书.北京：中国中医药出版社,1999年第1版：842.
21.胡文丰,张正国.生物医学数据挖掘[J].国外医学生物医学工程分册,2003,26(1)：11-15.
22.何前锋,崔蒙,吴朝晖等.方剂中配伍知识的发现[J].中国中医药信息杂志,2004,11(7)：655-658.
23.姚美村,艾路,袁月梅等.消渴病复方配伍规律的关联规则分析[J].北京中医药大学学报,2002,25(6)：48-50.
24.黎敬波,马力.中医临床常见症状术语规范[M].北京：中国医药科技出版社,2005.
25.国家技术监督局.中华人民共和国国家标准中医临床诊疗术语证候部分[M].中国标准出版社,1997.
26.朱文锋.证素辨证学[M].北京：人民卫生出版社,2008：162-228.
27.国家技术监督局.中华人民共和国国家标准中医临床诊疗术语治法部分[M].中国标准出版社,1997.
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