《伤寒论》误治证素分布及救误用药规律研究  

Study on syndrome elements distribution and prescription regularity in treatment of deteriorated syndromes caused by erroneous therapy of Treatise on Cold Pathogenic Diseases

作　　者：李芊芊 付兴 杨凤 侯鉴宸 陶晓华[1] LI Qianqian;FU Xing;YANG Feng;HOU Jianchen;TAO Xiaohua(College of Traditional Chinese Medicine,Beijing University of Traditional Chinese Medicine,Beijing 102488,China;College of Traditional Chinese Medicine,Hainan Medical College,Haikou 571199,China)

机构地区：[1]北京中医药大学中医文献研究院,北京102488 [2]海南医学院中医学院,海口571199

出　　处：《新疆医科大学学报》2022年第12期1460-1466,共7页Journal of Xinjiang Medical University

基　　金：国家重点研发计划项目(2019YFC1709200);国家重点研发计划课题(2019YFC1709201)。

摘　　要：目的 分析《伤寒论》中误用汗法、误用下法及汗下乱投后所致变证的中医证素分布及仲景救误治疗用药规律。方法 借助中医古籍“病脉证并治”知识元标引系统抽取《伤寒论》误治相关条文中误治类型、证候、中药等数据并提取证素信息建立数据库,利用SPSS Modeler、MATLAB、Graph Pad Prism等软件及Hiplot平台,采用频数分析、聚类分析及关联规则的Apriori算法与灰色关联度分析等方法,对相关证候、证素、中药以及其间关系进行挖掘分析并可视化展示。结果 误治后出现证候频数最高为发热(5.43%)、腹泻(5.14%)、脘痞胀(4.83%)等。误用汗法最易出现汗出(6.54%)、谵语(5.61%),病位多在肝、表、心神、胃,病性以热、阴虚、气滞、闭、动血为主,且表→血热、热(支持度44%,置信度63.64%)间关联较强;误用下法最易出现腹泻(7.51%)、发热(6.93%),病位在脾、胃、肝、小肠、大肠,病性主要为气滞、气虚、湿、阴虚、阳虚,且胃→气虚、气滞(支持度58.33%,置信度80.95%)间关联较强;汗下乱投最易出现烦躁(9.43%)、脘痞胀(7.55%),病位多在肝、胃、心神、半表半里,病性以气滞、阴虚、血虚、热为主,且肝→阴虚、热(支持度58.33%,置信度100%)间关联较强;治疗所用高频中药包括甘草(13.17%)、生姜(7.19%)、大枣(7.19%)、桂枝(6.59%)、人参(5.09%)等;误用汗法后桂枝→表+外风(支持度32.00%,置信度75.00%)、误用下法后甘草→肾+阳虚(支持度38.89%,置信度92.86%)、汗下乱投后甘草→膀胱+饮(支持度41.67%,置信度66.67%)等关联较强。结论 不同类型误治后的证素分布与用药规律有所不同,本研究结果有助于加深对仲景误治理论的理解,总结经验教训,加强对误诊误治的警觉性,提高临床辨治水平。Objective To explore the syndrome elements distribution and the prescription regularity in treatment of deteriorated syndromes caused by erroneous therapy by analyzing the contents of erroneous therapy of Treatise on Cold Pathogenic Diseases from perspective of syndrome element differentiation. Methods The data of syndromes, TCM prescriptions and types of erroneous therapy in Treatise on Cold Pathogenic Diseases were extracted from the indexing system, and the weights of syndrome elements were recorded form the database. SPSS Modeler,MATLAB, GraphPad Prismetc software and Hiplot were used for statistical analysis of the syndrome elements and the prescription information. Clustering analysis, association rules, grey correlation analysis, and etc were used in data mining. Results The highest frequency of syndromes after the mistreatment was fever( 5. 43%), diarrhea(5. 14%), abdominal distension(4. 83%), etc. Sweating(6. 54%) and delirium(5. 61%) were most likely to occur when the sweat method was misused. The disease location was mainly in the liver, exterior, mind, and stomach. The disease nature was mainly heat, yin deficiency, qi stagnation, closure, and blood movement. The correlation between exterior, blood heat, and heat(44% support, 63. 64% confidence) was strong;When the lower method was misused, diarrhea(7. 51%) and fever(6. 93%) were most likely to occur. The disease was located in the spleen, stomach, liver, small intestine, and large intestine. The disease nature was mainly qi stagnation, qi deficiency, dampness, yin deficiency, and yang deficiency. There was a strong correlation between stomach→qi deficiency, and qi stagnation(58. 33% support, 80. 95% confidence);Disorderly investment under sweating was most likely to lead to restlessness(9. 43%) and distension(7. 55%). The disease location was mostly in the liver, stomach, mind, half exterior and half interior. The disease nature was mainly qi stagnation, yin deficiency, blood deficiency and heat, and the correlation between liver→yin deficiency a

关 键 词：伤寒论 误治 证素 数据挖掘 灰色关联度分析 

分 类 号：R22[医药卫生—中医基础理论]