民国时期温病医案证候要素与应证组合规律研究
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摘要
本文在全面整理民国时期温病医案的基础上,对673则温病医案进行分析,建立民国时期温病医案数据库。以证候要素与应证组合为切入点,运用频数统计、Logistic回归法、因子分析、关联规则分析、典型相关分析等数据挖掘的方法,利用SAS9.1.3统计软件,对温病医案进行系统研究。探讨温病的发病原因、症状特点,挖掘温病证候要素及证候要素应证组合规律。研究结果证实:1.疠气与六淫是温病发生的决定性因素,体质与饮食影响着温病的发展变化。2.民国时期温病医案集中体现热、毒、湿、痰、气逆、瘀血、阴虚、气乱、风、燥结、气滞、阳虚、寒、积滞、燥、风阳、暑、气虚、血虚等19个证候要素,这些证候要素反映了民国时期温病证候的总体特征。3.温病的核心证候要素为热、毒、湿、虚,可能在温病证候要素辨证中具有重要意义。4.由于感受邪气性质及及程度的不同,加之患者体质的不同,证候要素作用的靶位具有一定规律性。邪气在表,可见短暂的卫分证或上焦证。感受温热病邪,化燥伤阴趋势明显,其证候要素靶位主要集中在肺、胃、气分、营分及阳明,若热毒内陷心包或引动肝风则证候要素靶位主要在心、肝。而湿邪偏重的温病,其主要证候要素靶位集中在脾、胃、大肠、中焦。5.以证候要素挖掘为切入点,掌握证候要素的应证组合规律,是提高中医药治疗温病临床疗效的关键。
The 673 cases of Warm disease of the period of the Republic of China were analyzed and the database was established. Data were analyzed by frequency analysis, factor analysis, typical correlation analysis, Logistic regression, Correlation analysis with SAS software. The etiology and symptom features were probed and the syndrome elements were abstracted, so that the rule of interrelation between Warm disease and syndrome elements was researched. The conclusions were as followed: 1. Warm disease is caused by many factors. Epidemic pathogenic factors and six exogenous pathogenic factors belong to the external cause, which are decisive factors. Physique and diet belong to the internal cause,which affect the development and change of Warm disease.. 2 It is found that heat, toxicity, dampness, phlegm, reversed flow of qi, blood stasis, yin deficiency, disorder of qi, wind, dry stagnation, qi stagnation, yang deficiency, cold, dyspepsia, dryness, wind-yang, summer-heat, qi deficiency and blood deficiency are the major syndrome elements. They completely reflect the syndrome characteristics of Warm disease in the period of the Republic of China.3 The core syndrome elements of Warm disease are heal, toxicity, dampness and deficiency, which can be regarded as creeds of syndrome differentiation of warm disease.4 When suffered the evil of warm, the trend of becoming dryness and injuring yin would be more obvious, and the syndrome elements target mainly concentrated in the lung, stomach, qifen, yingfen and Yangming. If the heat and toxic invaded the pericardium or caused liver wind, the syndrome elements target will be on the heart and liver. On the wetness warm disease, the main syndrome elements target will be on the spleen, stomach, large intestine and the middle jiao.5 The syndrome differentiation of Warm disease doesn't follow the rule of wei, qi, ying, and xue and triple warmer transmission. Searching the syndrome common features of the warm disease, namely syndrome elements, which act as the entry point, and the law of interrelation between Warm disease and syndrome elements was been as the focal point, in order that we can enrich the treatment system based on syndrome differentiation of warm disease in this study.
The 673 cases of Warm disease of the period of the Republic of China were analyzed and the database was established. Data were analyzed by frequency analysis, factor analysis, typical correlation analysis, Logistic regression, Correlation analysis with SAS software. The etiology and symptom features were probed and the syndrome elements were abstracted, so that the rule of interrelation between Warm disease and syndrome elements was researched. The conclusions were as followed: 1. Warm disease is caused by many factors. Epidemic pathogenic factors and six exogenous pathogenic factors belong to the external cause, which are decisive factors. Physique and diet belong to the internal cause,which affect the development and change of Warm disease.. 2 It is found that heat, toxicity, dampness, phlegm, reversed flow of qi, blood stasis, yin deficiency, disorder of qi, wind, dry stagnation, qi stagnation, yang deficiency, cold, dyspepsia, dryness, wind-yang, summer-heat, qi deficiency and blood deficiency are the major syndrome elements. They completely reflect the syndrome characteristics of Warm disease in the period of the Republic of China.3 The core syndrome elements of Warm disease are heal, toxicity, dampness and deficiency, which can be regarded as creeds of syndrome differentiation of warm disease.4 When suffered the evil of warm, the trend of becoming dryness and injuring yin would be more obvious, and the syndrome elements target mainly concentrated in the lung, stomach, qifen, yingfen and Yangming. If the heat and toxic invaded the pericardium or caused liver wind, the syndrome elements target will be on the heart and liver. On the wetness warm disease, the main syndrome elements target will be on the spleen, stomach, large intestine and the middle jiao.5 The syndrome differentiation of Warm disease doesn't follow the rule of wei, qi, ying, and xue and triple warmer transmission. Searching the syndrome common features of the warm disease, namely syndrome elements, which act as the entry point, and the law of interrelation between Warm disease and syndrome elements was been as the focal point, in order that we can enrich the treatment system based on syndrome differentiation of warm disease in this study.
引文
[1]刘景源.中医疫病学与温病学的历史沿革——先秦至隋唐时期.中国中医药现代远程教育,2003,7,32—35
[2]姜素椿.我国传染病的现状与思考.中华内科杂志,2004,43,(7) 481—483
[3]刘建平,张柯欣.数据挖掘技术在中医药领域中的应用.辽宁中医药大学学报,2007,9,(6)324—325
[4]毕雪华.森干数据挖掘技术在医学领域中的应用.电脑知识与技术.2007,17,1366-1367
[5]邹石,周莺,吴丽丽.古代心悸医案信息284例数理分析.江西中医学院学报.2007,19(5):91-92
[6]黎元元.糖尿病证候要素提取与应证组合规律研究.中国中医科学院博士学位论文,2006,4
[7]张志斌,王永炎.辨证办法新体系的建立.北京中医药大学学报,2005,28(1):1—3
[8]张志斌,王永炎,王志国.辨识证候要素在突发性公共卫生事件中的作用.北京中医药大学学报,2005,28(26) 4—7
[9]王永炎,张启明,张志斌.证候要素及其靶位的提取.山东中医药大学学报,2006,30(1):6～7
[10]张启明,王永炎,张志斌,等.外感病因中证候要素的提取.山东中医药大学学报,2005,29(5):339—341
[11]曹洪欣主编.SARS-瘟疫研究.中医古籍出版社,北京:2005,11
[12]王阶,李军,姚魁武,等.冠心病心绞痛证候要素与应证组合研究.中医杂志,2007,48(10):920—922
[13]邢雁伟.采用聚类分析和对应相关方法研究1069例冠心病心绞痛证候应证组合规律.中华中医药杂志,2007,22(11):747—750
[14]李文波.中国传染病史料.北京:化学工业出版社,2004,60,145
[15]马登潮,周峰林.世纪罪行--侵华日军对浙细菌战述略.档案与历史,2003,12,34—37
[16]郝先中.民国时期争取中医教育合法化运动始末.中华医史杂志,2005,35(4) 220—224
[17]赵少卡.基于大型数据库的数据挖掘.福建电脑,2007,12,115—116
[18]文小燕,杜海若.数据挖掘的发展和应用综述.电脑知识与技术,2007,18,1486
[19]胡冬裴.中医心藏象理论规律研究.上海中医药大学学报,2007,21(4):16—19
[20]罗和古,韩哲,李军祥,等.胃癌前期病变的中医证候规律研究.中华中医药杂志,2007,22(6) 399—401
[21]朱玉全,杨鹤标,孙蕾,著.数据挖掘技术.东南大学出版社,2006,11
[22]毛国君,段立娟,王实.数据挖掘原理与算法.中国水利水电出版社,2005,64-108
[23]孙振球.医学统计学.北京:人民卫生出版社,2002,330-331,
[24]林亭秀,朱明.论伏气.新疆医科大学学报,2007,30(5):522—523
[25]杨钦河,彭胜权.伏气温病学说初探.南京中医药大学学报,1998,14(3):132—134
[26]李洪涛.温病病因再辨.安徽中医学院学报,2002,21(1):1-3
[27]印会河,张伯讷主编.《中医基础理论》.北京:人民卫生出版社,1989,
[28]王琦主编.《中医体质学》.北京:人民卫生出版社,2005,
[29]陈任枚.温病学讲义(线装铅印本).广州:广州中医药专门学校.1929.2
[30]杜松,当代当代瘟疫诊疗实践对温病理论的继承与创新研究.中国中医科学院博士学位论文,2007,4
[31]张启明,王永炎,等.外感病因中证候要素的提取.山东中医药大学学报,2005,29(5):339—341
[32]健康报评论员.运用中医治温病原则治乙型脑炎(《健康报》463期).中医杂志,1956,(10):505
[33]蒲辅周,沈仲圭,等.流行性“乙型”脑炎中辨证施治的一股规律.中医杂志,1957,(9):446—447
[2]姜素椿.我国传染病的现状与思考.中华内科杂志,2004,43,(7) 481—483
[3]刘建平,张柯欣.数据挖掘技术在中医药领域中的应用.辽宁中医药大学学报,2007,9,(6)324—325
[4]毕雪华.森干数据挖掘技术在医学领域中的应用.电脑知识与技术.2007,17,1366-1367
[5]邹石,周莺,吴丽丽.古代心悸医案信息284例数理分析.江西中医学院学报.2007,19(5):91-92
[6]黎元元.糖尿病证候要素提取与应证组合规律研究.中国中医科学院博士学位论文,2006,4
[7]张志斌,王永炎.辨证办法新体系的建立.北京中医药大学学报,2005,28(1):1—3
[8]张志斌,王永炎,王志国.辨识证候要素在突发性公共卫生事件中的作用.北京中医药大学学报,2005,28(26) 4—7
[9]王永炎,张启明,张志斌.证候要素及其靶位的提取.山东中医药大学学报,2006,30(1):6～7
[10]张启明,王永炎,张志斌,等.外感病因中证候要素的提取.山东中医药大学学报,2005,29(5):339—341
[11]曹洪欣主编.SARS-瘟疫研究.中医古籍出版社,北京:2005,11
[12]王阶,李军,姚魁武,等.冠心病心绞痛证候要素与应证组合研究.中医杂志,2007,48(10):920—922
[13]邢雁伟.采用聚类分析和对应相关方法研究1069例冠心病心绞痛证候应证组合规律.中华中医药杂志,2007,22(11):747—750
[14]李文波.中国传染病史料.北京:化学工业出版社,2004,60,145
[15]马登潮,周峰林.世纪罪行--侵华日军对浙细菌战述略.档案与历史,2003,12,34—37
[16]郝先中.民国时期争取中医教育合法化运动始末.中华医史杂志,2005,35(4) 220—224
[17]赵少卡.基于大型数据库的数据挖掘.福建电脑,2007,12,115—116
[18]文小燕,杜海若.数据挖掘的发展和应用综述.电脑知识与技术,2007,18,1486
[19]胡冬裴.中医心藏象理论规律研究.上海中医药大学学报,2007,21(4):16—19
[20]罗和古,韩哲,李军祥,等.胃癌前期病变的中医证候规律研究.中华中医药杂志,2007,22(6) 399—401
[21]朱玉全,杨鹤标,孙蕾,著.数据挖掘技术.东南大学出版社,2006,11
[22]毛国君,段立娟,王实.数据挖掘原理与算法.中国水利水电出版社,2005,64-108
[23]孙振球.医学统计学.北京:人民卫生出版社,2002,330-331,
[24]林亭秀,朱明.论伏气.新疆医科大学学报,2007,30(5):522—523
[25]杨钦河,彭胜权.伏气温病学说初探.南京中医药大学学报,1998,14(3):132—134
[26]李洪涛.温病病因再辨.安徽中医学院学报,2002,21(1):1-3
[27]印会河,张伯讷主编.《中医基础理论》.北京:人民卫生出版社,1989,
[28]王琦主编.《中医体质学》.北京:人民卫生出版社,2005,
[29]陈任枚.温病学讲义(线装铅印本).广州:广州中医药专门学校.1929.2
[30]杜松,当代当代瘟疫诊疗实践对温病理论的继承与创新研究.中国中医科学院博士学位论文,2007,4
[31]张启明,王永炎,等.外感病因中证候要素的提取.山东中医药大学学报,2005,29(5):339—341
[32]健康报评论员.运用中医治温病原则治乙型脑炎(《健康报》463期).中医杂志,1956,(10):505
[33]蒲辅周,沈仲圭,等.流行性“乙型”脑炎中辨证施治的一股规律.中医杂志,1957,(9):446—447