基于病机证素新说的周仲瑛教授哮喘病案回顾性研究
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摘要
[目的]以当代国家级名老中医、国医大师周仲瑛教授长期累积治疗哮喘的有效验案为基础,以现代数据挖掘技术为手段,以周仲瑛教授提出的病机证素新说为理论指导,开展对周仲瑛教授治疗哮喘的中医辨治规律进行探讨,以期进一步提高中医哮喘临床疗效,使其源于临床,高于临床,又能回归、指导临床。
[方法]通过跟随周仲瑛教授临证抄方学习,以及提取周仲瑛教授诊疗系统管理数据软件的内容,对周仲瑛教授近20年来积累的所有哮喘病案进行全面收集、整理,将符合标准的87例病案共447诊次的全部临床数据,基于多尺度分析及自我调整理论构建神经模糊推理系统,运用频数分布、聚类分析、关联规则、卡方检验等,着重挖掘、分析其中的病机、病机证素、症状、处方之间的关联性或相关性,并结合病例数据对挖掘结果进行分析、归纳、总结。
[结果]87例患者,年龄最大82岁,年龄最小2岁,平均年龄23.40岁。447诊中病机证素频率>20%,依序分别为“痰”、“热”、“虚”、“瘀”、“风”；复合病机证素以“痰热”出现频数最高。病机方面,出现频数以“痰热瘀肺”最多,为121次,频率27.07%；其次依序为气阴两伤、肺热内蕴、风痰伏肺、风邪上受、痰热内蕴、痰湿上干、肺肾两虚、肺胃同病等,频率皆>5%。用药方面,周仲瑛教授灵活运用近300种药物,范围广泛,但强调药随证转,一药多能。
[结论]通过研究发现,哮喘的基本病机为“脏腑阴阳失调”,导致肺、脾、肾对津液的运化失常,液凝聚而成“痰”,伏藏于肺,成为发病的潜在病理因素。哮喘的主要病机证素为“风”、“寒”、“痰”、“瘀”、“湿”、“饮”、“热”等,共七项,其临床贯穿哮喘病终始的证候类型主要包括痰热瘀肺,气阴两伤,肺热内蕴,风痰伏肺等。用药方面,周仲瑛教授善用一些具有特色的化痰药物,如泽漆等。
[Objective] This dissertation explores Professor Zhou Zhong Ying's disease etiology and principles of asthma treatment. This study is based on Professor Zhou's years of asthma treatment cases, and it uses a modern data seeking technique. Also, it applies Professor Zhou's new syndromic etiology theory as a guideline. The study is hoped to improve the asthma clinical treatment and expand TCM knowledge.
[Methods] This study accumulates Professor Zhou Zhong Ying's asthma-related cases over the past twenty years by closely following his long term clinical practice and collecting the data from his diagnostic database. The selected results are 87 cases with 447 clinical followups, based on analysis on multiple scale and muti-level-self-adjust-reasoning system, the data are organized in order to get frequency distribution, cluster analysis, associated condition and clinical examination factors. This study put emphasis on defining and analyzing the connection between syndromic etiology, pathogenesis and prescription, aiming to sum up the result and draw a conclusion.
[Result] The 87 patients range from 82 years old to 2 years old, and the average age is 23.40 years old. Of the 447 clinical followups, the syndromic etiology frequency is over 20%, and they are phlegm, heat, deficiency, stagnation and wind. Among the combination of syndromic etiologies, the phlegm-heat has the highest frequency. As for etiology, phlegm-heat-stagnated-lung has the highest frequency, which appeared 121 times with the frequency of 27.07%; it is followed up by "deficiency of both qi and yin," "internal lung-heat stagnation," "wind-phlegm attacked lung," "wind pathogen invade upper jao," "internal phlegm-heat stagnation," "phlegm-damped upper body," "deficiency of both lung and kidney" and "lung and stomach both ill." Each of the above has the frequency over 5%. Professor Zhou Zhong Ying used nearly 300 herbs to treat asthma. Despite the variety of the herbs, Professor Zhou emphasized that the herbs should be used according to one's syndromes, and one herb may have multiple functions.
[Conclusion] This study has found that the basic etiology of asthma is imbalance of zhang-fu and yin-yang, which causes the dysfunction of body fluid transport in lung, spleen and kidney, resulting in accumulation of phlegm in the lung and then becomes the main symptom of the disease. The 7 main etiologies of asthma are "wind," "cold," "phlegm," "stagnation," "dampness," "watery" and "heat." The clinical syndrome of asthma includes "phlegm-heat-stagnated-lung," "deficiency of both qi and yin," internal lung-heat stagnation," and "wind-phlegm attacked lung." As for prescription, Professor Zhou Zhong Ying is good at using certain specific herbs that dissolve phlegm, such as Zeqi.
[方法]通过跟随周仲瑛教授临证抄方学习,以及提取周仲瑛教授诊疗系统管理数据软件的内容,对周仲瑛教授近20年来积累的所有哮喘病案进行全面收集、整理,将符合标准的87例病案共447诊次的全部临床数据,基于多尺度分析及自我调整理论构建神经模糊推理系统,运用频数分布、聚类分析、关联规则、卡方检验等,着重挖掘、分析其中的病机、病机证素、症状、处方之间的关联性或相关性,并结合病例数据对挖掘结果进行分析、归纳、总结。
[结果]87例患者,年龄最大82岁,年龄最小2岁,平均年龄23.40岁。447诊中病机证素频率>20%,依序分别为“痰”、“热”、“虚”、“瘀”、“风”；复合病机证素以“痰热”出现频数最高。病机方面,出现频数以“痰热瘀肺”最多,为121次,频率27.07%；其次依序为气阴两伤、肺热内蕴、风痰伏肺、风邪上受、痰热内蕴、痰湿上干、肺肾两虚、肺胃同病等,频率皆>5%。用药方面,周仲瑛教授灵活运用近300种药物,范围广泛,但强调药随证转,一药多能。
[结论]通过研究发现,哮喘的基本病机为“脏腑阴阳失调”,导致肺、脾、肾对津液的运化失常,液凝聚而成“痰”,伏藏于肺,成为发病的潜在病理因素。哮喘的主要病机证素为“风”、“寒”、“痰”、“瘀”、“湿”、“饮”、“热”等,共七项,其临床贯穿哮喘病终始的证候类型主要包括痰热瘀肺,气阴两伤,肺热内蕴,风痰伏肺等。用药方面,周仲瑛教授善用一些具有特色的化痰药物,如泽漆等。
[Objective] This dissertation explores Professor Zhou Zhong Ying's disease etiology and principles of asthma treatment. This study is based on Professor Zhou's years of asthma treatment cases, and it uses a modern data seeking technique. Also, it applies Professor Zhou's new syndromic etiology theory as a guideline. The study is hoped to improve the asthma clinical treatment and expand TCM knowledge.
[Methods] This study accumulates Professor Zhou Zhong Ying's asthma-related cases over the past twenty years by closely following his long term clinical practice and collecting the data from his diagnostic database. The selected results are 87 cases with 447 clinical followups, based on analysis on multiple scale and muti-level-self-adjust-reasoning system, the data are organized in order to get frequency distribution, cluster analysis, associated condition and clinical examination factors. This study put emphasis on defining and analyzing the connection between syndromic etiology, pathogenesis and prescription, aiming to sum up the result and draw a conclusion.
[Result] The 87 patients range from 82 years old to 2 years old, and the average age is 23.40 years old. Of the 447 clinical followups, the syndromic etiology frequency is over 20%, and they are phlegm, heat, deficiency, stagnation and wind. Among the combination of syndromic etiologies, the phlegm-heat has the highest frequency. As for etiology, phlegm-heat-stagnated-lung has the highest frequency, which appeared 121 times with the frequency of 27.07%; it is followed up by "deficiency of both qi and yin," "internal lung-heat stagnation," "wind-phlegm attacked lung," "wind pathogen invade upper jao," "internal phlegm-heat stagnation," "phlegm-damped upper body," "deficiency of both lung and kidney" and "lung and stomach both ill." Each of the above has the frequency over 5%. Professor Zhou Zhong Ying used nearly 300 herbs to treat asthma. Despite the variety of the herbs, Professor Zhou emphasized that the herbs should be used according to one's syndromes, and one herb may have multiple functions.
[Conclusion] This study has found that the basic etiology of asthma is imbalance of zhang-fu and yin-yang, which causes the dysfunction of body fluid transport in lung, spleen and kidney, resulting in accumulation of phlegm in the lung and then becomes the main symptom of the disease. The 7 main etiologies of asthma are "wind," "cold," "phlegm," "stagnation," "dampness," "watery" and "heat." The clinical syndrome of asthma includes "phlegm-heat-stagnated-lung," "deficiency of both qi and yin," internal lung-heat stagnation," and "wind-phlegm attacked lung." As for prescription, Professor Zhou Zhong Ying is good at using certain specific herbs that dissolve phlegm, such as Zeqi.
引文
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[6]刘小凡.郭蓉晓.孟晓露.等.哮宁口服液治疗小儿哮喘的临床与实验[J].辽宁中医杂志,2005,32(2)：89
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[10]毛玉燕.钱育寿治疗小儿哮喘的经验[J].河北中医,2000,22(3)：1-2
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[12]陈黎明,张俐.从瘀血论治哮喘机理探讨[J].国医论坛,1999,14(2)：17
[13]杨华萃,许尤佳.中西医结合治疗小儿哮喘的远期疗效观察[J].湖北中医杂志,2000,22(8)：17-18
[14]周仲瑛.哮喘杂谈[J].江苏中医,2000,21(18)：15
[15]王兴娟.沈自尹治喘经验[J].中医杂志,1999,40(3)：139
[16]廖世才.小儿哮喘活血化瘀法治疗体会[J].江西中医药,1997,28(6)：33-34
[17]张天嵩,吴红梅.温阳法分期治疗哮喘学术特色探析[J].中医函授通,1999,18(6)：3-5
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