基于数据挖掘的周仲瑛教授哮喘辨证思路及组方用药规律研究
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摘要
[目的]以当代国医大师周仲瑛教授几十年来专研于中医学理论经验与临床实践为基础,结合现代先进的数据挖掘技术及科学的检验方法,对周仲瑛教授近二十年来辨治哮喘的临证经验与学术思想进行深入地探讨研究与传承发扬,使其独具一格、别具匠心的辨证思路与组方用药规律能够启迪思维,指导临床。
[方法]收集周仲瑛教授临证20余年来的哮喘病案,依次输入电脑,将所有数据进行归类、统计分析,并将资料转换为Word文件存档,按纳入标准、排除标准筛选,将符合标准的87例477诊次的全部临床资料,针对病案信息多维、多阶、动态的特征现象,发挥多学科、多方位、多指标综合研究的优势,建立最佳的病案数据挖掘的模型,系统诠释病、证、症和方、药的对应规律。联合运用关联规则和卡方检验增加了数据挖掘结果的可靠性,是数据挖掘运用在名老中医经验采集方面的新突破与新进展。最终通过对数据挖掘结果的分析,并结合周仲瑛教授的治疗经验探讨其辨证思路与组方用药规律。
[结果]通过分析87例447诊纳入病案,得出哮喘的病理因素有痰、热、风、瘀、寒、饮、湿、燥八种；病机主要涉及痰热瘀肺、气阴两伤、肺热内蕴、风痰伏肺、痰热内蕴、风邪上受、痰湿上干、肺胃同病、肺肾两虚等九种；症状、病机、药物之间互相存在直接与间接的对应关系,尤其着重于证-药及症-药两个方面,如痰热瘀肺证与南沙参、北沙参、黄芩、知母四药相组合,其余各证亦多有得出相关组合药物；再如黏痰可用知母、葶苈子的药对等等。可见周仲瑛教授既注重临证的随机加减变化,又重视基本药物和组方的运用。
[结论]通过研究发现周仲瑛教授在辨证中注重病理因素的作用,体现在哮喘中主要是痰、热、瘀和风四者。周仲瑛教授在哮喘症状、病机、药物三者之间强调“审证求因”、“审机论治”,对中医学的理论与临床都有着十分重要的地位与深远的意义。其在辨治哮喘时提出了多种辨证思路与方法,如注重脏腑间相互关系的影响、强调活血药在治疗哮喘中的运用、明确具体两证型间存在的易转化倾向等；其在组方用药时,严谨又灵活多变,药随证转,其常用特色药物有苍耳草、露蜂房、丹参、桃仁、南北沙参等。此外,对比数据挖掘结果和分析,与周仲瑛教授临床处方甚相近,肯定了数据挖掘在名老中医经验分析中的可实践性。
[Objective] Based on the TCM theory and clinical practice specialized by Professor Zhou Zhongying who is one of the topmost masters of TCM,combined with modern advanced data mining technology and scientific testing methods,we study、heritage and develop the clinical experience and academic ideas accumulated by Professror Zhou Zhongying treating asthma in the past two decades,in order to enlighten our thinking and guide clinical with his unique syndrome differentiation style and the law of prescription drugs.
[Methods] We collect the clinical asthma cases of professor Zhou Zhongying over the past 20 years and input them into the computer. All data are classified、counted、analised、changed into Word document and archived.According to inclusion criteria, exclusion criteria to screen, we get 477 cases of 87 patients and establish a database mining platform for professor Zhou Zhongying treating asthma.According to the multidimensional,multi-stage,dynamic characteristics of medical record information,we take advantagesof a multi-disciplinary,multi-directional,multi-index comprehensive study to establish the best data mining model for medical record and make a systemic interpretation of the corresponding laws of disease,syndrome,symptoms and prescription and drugs.The joint use of association rules and chi-square test increase the reliability of the results of data mining and is the new breakthroughs and development of data mining used in the collecting old Chinese experience.Finally we explore the syndrome differentiation thinking and law of prescription drugs which is based on the analysis of the data mining results and combined with clinical experience of Professor Zhou Zhongying.
[Results] Through the analysis of 447 cases of 87 patients,we come to some conclusions. Pathological factors of asthma include sputum, heat, wind, stasis, cold, drink, dampness and dry.Pathogenesis is mainly related to retention of phlegm-heat in the lung,both deficiency of Qi and Yin,accumulation of lung-heat,wind-phlegm attracting the lung,accumulation of phlegm-heat,wind pathogen invading the upwards,phlegm-dampness invading the upwards,disease of the lung and stomach and both deficiency of the lung and kidney.There is corresponding direct and indirect correlations with symptoms、pathogenesis and drugs, particularly with syndrome-drugs and symptoms-drugs,such as retention of phlegm-heat in the lung syndrome combination with nanshashen,beishashe,huangqin,zhimu.The remaining cards are also found to have similar combination of drugs,such as both zhimu and tinglizi are usesd to treat phlegm.We find that Professor Zhou Zhongying not only focus on the random change in clinical, but also on the essential drugs and prescription
[Conclusion] Through the study we find that Professor Zhou Zhongying stress the function of pathological factors in the syndrome differentiation.sputurm、feve、blood stasis and wind are embodied in asthma.Professor Zhou Zhongying emphasis on the view of "infering the cause and judge the syndrome"and"judging the pathogenesis and designing the therapeutic trial principle" among syptoms、pathogenesis and drugs in asthma,which has a important and far-reaching meaning in TCM theory and clinical.He proposes several syndrome differentiation ideas and methods,such as focusing on the impact of the interrelationship of the Zangfu-organs,stressing the use of promoting blood circulation drugs in the treatment of asthma,specificing the existence of the tendence of changing between syndrome.Prescripting drugs are rigorous,flexible and changeable, cangercao,lufengfan,danshen,taoren,nanshashen and beishashen are commonly used and characteristics, the comparative results. of data mining and analysis are similar with Professor Zhou Zhongying's linical prescription,which certain the ablility of analysing the old Chinese medicine experience with the data mining.
[方法]收集周仲瑛教授临证20余年来的哮喘病案,依次输入电脑,将所有数据进行归类、统计分析,并将资料转换为Word文件存档,按纳入标准、排除标准筛选,将符合标准的87例477诊次的全部临床资料,针对病案信息多维、多阶、动态的特征现象,发挥多学科、多方位、多指标综合研究的优势,建立最佳的病案数据挖掘的模型,系统诠释病、证、症和方、药的对应规律。联合运用关联规则和卡方检验增加了数据挖掘结果的可靠性,是数据挖掘运用在名老中医经验采集方面的新突破与新进展。最终通过对数据挖掘结果的分析,并结合周仲瑛教授的治疗经验探讨其辨证思路与组方用药规律。
[结果]通过分析87例447诊纳入病案,得出哮喘的病理因素有痰、热、风、瘀、寒、饮、湿、燥八种；病机主要涉及痰热瘀肺、气阴两伤、肺热内蕴、风痰伏肺、痰热内蕴、风邪上受、痰湿上干、肺胃同病、肺肾两虚等九种；症状、病机、药物之间互相存在直接与间接的对应关系,尤其着重于证-药及症-药两个方面,如痰热瘀肺证与南沙参、北沙参、黄芩、知母四药相组合,其余各证亦多有得出相关组合药物；再如黏痰可用知母、葶苈子的药对等等。可见周仲瑛教授既注重临证的随机加减变化,又重视基本药物和组方的运用。
[结论]通过研究发现周仲瑛教授在辨证中注重病理因素的作用,体现在哮喘中主要是痰、热、瘀和风四者。周仲瑛教授在哮喘症状、病机、药物三者之间强调“审证求因”、“审机论治”,对中医学的理论与临床都有着十分重要的地位与深远的意义。其在辨治哮喘时提出了多种辨证思路与方法,如注重脏腑间相互关系的影响、强调活血药在治疗哮喘中的运用、明确具体两证型间存在的易转化倾向等；其在组方用药时,严谨又灵活多变,药随证转,其常用特色药物有苍耳草、露蜂房、丹参、桃仁、南北沙参等。此外,对比数据挖掘结果和分析,与周仲瑛教授临床处方甚相近,肯定了数据挖掘在名老中医经验分析中的可实践性。
[Objective] Based on the TCM theory and clinical practice specialized by Professor Zhou Zhongying who is one of the topmost masters of TCM,combined with modern advanced data mining technology and scientific testing methods,we study、heritage and develop the clinical experience and academic ideas accumulated by Professror Zhou Zhongying treating asthma in the past two decades,in order to enlighten our thinking and guide clinical with his unique syndrome differentiation style and the law of prescription drugs.
[Methods] We collect the clinical asthma cases of professor Zhou Zhongying over the past 20 years and input them into the computer. All data are classified、counted、analised、changed into Word document and archived.According to inclusion criteria, exclusion criteria to screen, we get 477 cases of 87 patients and establish a database mining platform for professor Zhou Zhongying treating asthma.According to the multidimensional,multi-stage,dynamic characteristics of medical record information,we take advantagesof a multi-disciplinary,multi-directional,multi-index comprehensive study to establish the best data mining model for medical record and make a systemic interpretation of the corresponding laws of disease,syndrome,symptoms and prescription and drugs.The joint use of association rules and chi-square test increase the reliability of the results of data mining and is the new breakthroughs and development of data mining used in the collecting old Chinese experience.Finally we explore the syndrome differentiation thinking and law of prescription drugs which is based on the analysis of the data mining results and combined with clinical experience of Professor Zhou Zhongying.
[Results] Through the analysis of 447 cases of 87 patients,we come to some conclusions. Pathological factors of asthma include sputum, heat, wind, stasis, cold, drink, dampness and dry.Pathogenesis is mainly related to retention of phlegm-heat in the lung,both deficiency of Qi and Yin,accumulation of lung-heat,wind-phlegm attracting the lung,accumulation of phlegm-heat,wind pathogen invading the upwards,phlegm-dampness invading the upwards,disease of the lung and stomach and both deficiency of the lung and kidney.There is corresponding direct and indirect correlations with symptoms、pathogenesis and drugs, particularly with syndrome-drugs and symptoms-drugs,such as retention of phlegm-heat in the lung syndrome combination with nanshashen,beishashe,huangqin,zhimu.The remaining cards are also found to have similar combination of drugs,such as both zhimu and tinglizi are usesd to treat phlegm.We find that Professor Zhou Zhongying not only focus on the random change in clinical, but also on the essential drugs and prescription
[Conclusion] Through the study we find that Professor Zhou Zhongying stress the function of pathological factors in the syndrome differentiation.sputurm、feve、blood stasis and wind are embodied in asthma.Professor Zhou Zhongying emphasis on the view of "infering the cause and judge the syndrome"and"judging the pathogenesis and designing the therapeutic trial principle" among syptoms、pathogenesis and drugs in asthma,which has a important and far-reaching meaning in TCM theory and clinical.He proposes several syndrome differentiation ideas and methods,such as focusing on the impact of the interrelationship of the Zangfu-organs,stressing the use of promoting blood circulation drugs in the treatment of asthma,specificing the existence of the tendence of changing between syndrome.Prescripting drugs are rigorous,flexible and changeable, cangercao,lufengfan,danshen,taoren,nanshashen and beishashen are commonly used and characteristics, the comparative results. of data mining and analysis are similar with Professor Zhou Zhongying's linical prescription,which certain the ablility of analysing the old Chinese medicine experience with the data mining.
引文
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[3]王建民,金仁炎,楼兰花.论哮喘证宿根[J].浙江中医学院学报,1996,20(6)：4.
[4]任辉.寒哮夙根是客邪[J].新中医,1991,23(2)：11.
[5]刘自力,张庆荣,吴兆利.论脾虚为哮喘宿根[J].中医药学刊,2006,24(2)：294-295.
[6]裘生梁,徐俪颖,鲁建锋.论脾虚为支气管哮喘之“宿根”[J].中华中医药学刊,2009,27(9)：1971-1973.
[7]宋康,石亚杰,夏永良.支气管哮喘与肾虚本质相关性的理论探讨[J].中医药学刊,2005,23(7)：1183-1184.
[8]邵长荣,傅继勋,唐忆星.支气管哮喘缓解期补虚后气道反应性测验[J].上海中医药杂志,1988.(10)：23-24.
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