基于数据挖掘探讨严夏治疗冠心病的用药规律  

Exploration of YAN Xia’s Medication Rules for Coronary Heart Disease Based on Data Mining

作　　者：黄兰琳 贺亚星 江贤明 吴科锐[2] 王远平[1] 严夏[2] HUANG Lan-Lin;HE Ya-Xing;JIANG Xian-Ming;WU Ke-Rui;WANG Yuan-Ping;YAN Xia(The Second Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Dept.of Cardiovascular Diseases,Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510120 Guangdong,China)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510405 [2]广东省中医院心血管科,广东广州510120

出　　处：《广州中医药大学学报》2022年第11期2673-2681,共9页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广东省中医药局科研项目(编号:20184015)。

摘　　要：【目的】运用数据挖掘技术对严夏主任医师治疗冠心病的临床用药规律进行分析。【方法】从广东省中医院门诊系统中收集严夏主任医师在门诊诊治的冠心病患者的有效病例的医案处方资料,运用古今医案云平台的频数统计分析、关联规则分析及聚类分析对处方用药规律进行挖掘。【结果】共纳入处方671首,涉及中药191味,中医证型主要分为8类。痰浊闭阻型常用药有茯苓、陈皮、石菖蒲、法半夏等9味,药性偏温,多为甘味药,主要入脾、胃经;心血瘀阻型常用药有川芎、赤芍、郁金、丹参等9味,无明显药性偏向,多为苦味药,主要入肝经;气滞心胸型常用药为川芎、陈皮、枳壳等5味,药性偏温,多为辛味药,主要入肝、脾经;寒凝心脉型常用药为细辛、桂枝、熟附子3味,药性温热,药味无明显偏向,多入心经;气阴两虚型常用药为五指毛桃、白术、党参等6味,多为平性药,药味多甘味,主要入肺、脾经;心肾阴虚型常用药为白芍、山茱萸肉、金樱子、麦冬等6味,药性偏寒凉,药味无明显偏向,主要入肝、肾经;心肾阳虚型常用药为淫羊藿、杜仲、菟丝子、熟附子4味,无明显药性药味偏向,主要入肝、肾经;肝阳化风型常用药有全蝎、蔓荆子、钩藤3味,无明显药性药味偏向,主要入肝经。关联规则分析结果显示,强关联药对有9对,如“法半夏-陈皮”“法半夏-石菖蒲”“枳壳-赤芍”“法半夏-赤芍”“石菖蒲-五指毛桃”“陈皮-川芎”等。高频药物的聚类分析结果显示可聚为4类。【结论】严夏主任医师治疗冠心病基于通脉活血、调和气血的平衡气血治则,运用补脾助运、疏肝养血、温阳运气、活血祛瘀、燥湿化浊等治疗方法进行辨证选药,符合冠心病“阳微阴弦”的致病机制,体现了中医学平衡阴阳以防治疾病的思路。Objective To analyze the medication rules of YAN Xia for the treatment of coronary heart disease through data mining technology.Methods The prescription data of effective cases of coronary heart disease patients treated by chief physician YAN Xia in the outpatient clinic of Guangdong Provincial Hospital of Traditional Chinese Medicine were collected.And then the frequency statistical analysis,association rule analysis and cluster analysis of the Ancient and Modern Medical Case Cloud Platform were used to mine the prescription medication pattern.Results A total of 671 prescriptions were included,involving 191 Chinese herbal medicines.The traditional Chinese medicine(TCM)syndrome types were mainly classified into 8 categories.The 9 commonly-used herbs for the syndrome type of turbid phlegm obstruction such as Poria,Pericarpium Citri Reticulatae,Rhizoma Acori Tatarinowii,and Rhizoma Pinelliae Preparata,were warm in the nature and mostly sweet in the taste,and mainly had the meridian tropism of the spleen and stomach meridians.For the heart-blood stagnation type,there were9 commonly-used herbs of Rhizoma Chuanxiong,Radix Paeoniae Rubra,Radix Curcumae,Radix Salviae,etc.,which had no obvious tropism of the nature and were mostly bitter in the taste,and mainly had the meridian tropism of the liver meridian.The 5 commonly-used herbs for the syndrome type of qi stagnation in the heart and chest were Rhizoma Chuanxiong,Pericarpium Citri Reticulatae,Fructus Aurantii,etc.,which had the predominant nature of being warm and mostly were pungent in taste,and mainly had the meridian tropism of the liver and spleen meridian.For the syndrome type of cold accumulation in heart vessel,there were 3 commonlyused herbs of Herba Asari,Ramulus Cinnamomi,and Radix Aconiti Lateralis Preparata,which were warm and hot in the nature and had no predominant flavor,and most of the herbs had the meridian tropism of the heart meridian.The 6 commonly-used herbs for qi-yin deficiency type such as Radix Fici Hirtae,Rhizoma Atractylodis Macrocephalae,a

关 键 词：冠心病 通脉活血 调和气血 平衡阴阳 用药规律 古今医案云平台 严夏 

分 类 号：R256.2[医药卫生—中医内科学]