基于数据挖掘的中医治疗脊髓型颈椎病证治方药规律研究  

Data mining based research on rules of syndrome-treatment-prescription-medicine for traditional Chinese medicine treatment of cervical spondylotic myelopathy

作　　者：张成波 童正一[1] 许金海[1] 乔娇娇 陈波平 周晓宁 叶洁[1] 莫文[1,2,3] 施杞 ZHANG Chengbo;TONG Zhengyi;XU Jinhai;QIAO Jiaojiao;CHEN Boping;ZHOU Xiaoning;YE Jie;MO Wen;SHI Qi(Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Spine Research Institute,Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Shanghai Shi Qi Famous Chinese Medicine Doctor Workroom,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院,上海200032 [2]上海中医药大学脊柱病研究所,上海200032 [3]上海市施杞名中医工作室,上海200032

出　　处：《上海中医药杂志》2021年第4期15-20,共6页Shanghai Journal of Traditional Chinese Medicine

基　　金：国家中医药管理局国家重大疑难疾病中西医临床协作试点项目(2018);国家中医药管理局中医药传承创新平台建设项目(2020);上海市科委科研项目(18401903200,17401934400,19401901100);上海市卫计委进一步加快中医药事业发展三年行动计划项目(ZY[2018-2020]-FWTX-2006)。

摘　　要：目的总结分析中医治疗脊髓型颈椎病的证治方药规律,为临床实践提供参考。方法通过检索中国知网数据库、万方医学网数据库、维普中文科技期刊数据库,收集并整理1990年1月1日至2019年12月31日期间有关中药内服治疗脊髓型颈椎病的文献,运用Excel 2010软件计算证型、证候要素与方药的频数、频率,运用SPSS 21.0软件对数据库中的高频药物进行聚类分析,运用SPSS Modeler 18.0软件对高频药物进行关联规则分析。结果 (1)最终筛选出符合条件的文献59篇,归类后得出本病的中医证型有34个,其中肝肾亏虚证、气滞血瘀证、经络瘀阻证、气血不足证为常见证型,占58.82%。(2)实性病性要素为6个,主要为血瘀、气滞、湿阻;虚性病性要素为4个,主要为气虚、血虚、督脉亏虚。脏腑病位主要涉及肾、肝。(3)治疗本病的中药方剂共有84首,其中成方46首,成方运用较多的是补阳还五汤、地黄饮子、圣愈汤等;对常用成方功能进行归类,发现补益剂与理血剂的使用频率最高,占78.26%。(4)治疗本病的中药共165味,高频中药依次为当归、黄芪、川芎、红花等;补虚药、活血化瘀药是治疗脊髓型颈椎病的常用药物类别,其中补虚药最多、占34.60%。(5)聚类分析可知本病高频使用的中药可分三类,对于肝肾亏虚兼风寒湿阻型可选药物组合为牛膝、党参、山茱萸等;对于气虚血瘀型可选的药物组合为当归、黄芪与川芎;对于经络瘀阻型可选的药物组合为白芍、地龙、赤芍等。(6)关联规则分析得到7味核心中药、14条核心药物组合,其中得到一组角药(黄芪、当归、川芎),并发现核心药物组合主要为补虚药(黄芪、当归、白芍)、活血化瘀药(川芎、桃仁、红花)以及平肝熄风药(地龙)。结论采用数据挖掘分析中医治疗脊髓型颈椎病证治方药规律的方法可行,其结果可为临床实践提供一定有价值的参考。Objective This paper analyzed and summarized the rules of syndrome-treatment-prescription-medicine for traditional Chinese medicine(TCM) treatment of cervical spondylotic myelopathy(CSM) to provide reference for clinical practice. Methods Literatures about the treatment of cervical spondylotic myelopathy with oral administration of traditional Chinese medicine were collected and sorted out by searching China National Knowledge Infrastructure(CNKI) database, Wanfang Medical Network database and Chinese Sci & Tech Journals(VIP) database from January 1, 1990 to December 31, 2019. Excel 2010 software was used to calculate the frequency of syndromes, syndrome elements,prescriptions and traditional Chinese herbal medicines( TCHMs),SPSS21.0 software was used to cluster the high-frequency herbal medicines in the database,and SPSS Modeler 18.0 software was used to analyze the association rules of high-frequency TCHMs. Results(1)Fifty-nine qualified literatures were finally screened out,and 34 TCM syndromes of CSM were obtained after classification,of which liver and kidney deficiency syndrome,qi stagnation and blood stasis syndrome,channel-collateral stasis and obstruction syndrome and qi and blood deficiency syndrome were common syndromes,accounting for 58. 82%.(2)There were 6 elements manifesting excess disease nature,mainly blood stasis,qi stagnation and dampness obstruction and 4 elements manifesting deficiency disease nature,mainly qi deficiency,blood deficiency and governor channel deficiency. Zang-fu organs involved were mainly kidney and liver.(3)There were 84 TCM prescriptions for the treatment of CSM,of which 46 were set prescriptions. The mostly used ones were Buyang Huanwu Decoction,Dihuang Yinzi Decoction,and Shengyu Decoction,etc. According to the classification based on the effects of commonly used prescriptions,it is found that tonifying prescriptions and blood-regulating prescriptions were the most frequently used,accounting for78.26%.(4)There were 165 kinds of TCHMs for the treatment of CSM. The high-fre

关 键 词：脊髓型颈椎病 中药内服 中医证候 中医治法 数据挖掘 

分 类 号：R274.9[医药卫生—中西医结合]