《吴鞠通医案》辨治温疫用药规律分析  

Analysis on the Medication Rules in the Differentiation and Treatment of Pestilence in the WU Jutong's Collection of Case Histories

作　　者：沈云博 严博煜 刘枫 兰向宇 张笑雪 李鑫[1] 周玲羚 刘伟[2] SHEN Yunbo;YAN Boyu;LIU Feng;LAN Xiangyu;ZHANG Xiaoxue;LI Xin;ZHOU Lingling;LIU Wei(Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China;The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300250,China)

机构地区：[1]天津中医药大学,天津301617 [2]天津中医药大学第二附属医院,天津300250

出　　处：《中医药导报》2023年第9期111-115,128,共6页Guiding Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金项目(81603447);天津市中医药重点领域科研项目(2022010);天津市高等学校创新团队建设规划项目(TD13-5051);十二五特色学科中医内科学(20200402)。

摘　　要：目的:基于数据挖掘探讨吴鞠通治疗温疫用药规律,以期为临床治疗温热类疫病提供更多理论依据及用药参考。方法:通过收集并整理《吴鞠通医案》卷一“温疫篇”所载处方,建立数据库,运用SPSS Modeler 18.0、SPSS Statistics 25.0及中医传承计算平台软件(V3.0),分析药物频数、性味归经、功效、高频药物组合,并通过关联规则、聚类分析及因子分析探讨用药规律。结果:共筛选处方113份,涉及中药81味,使用频数≥10的药物有27味,排名前5的中药分别为麦冬、生地黄、甘草、牡丹皮、连翘;四气以寒为主;五味以苦、甘为主;归经以入肺、胃、心经为主;药物以清热药最多,其次为补虚药、解表药;得出高频药物组合41组,药物关联规则9条,4个聚类方,8个公因子。结论:吴鞠通治疗温疫用药以甘寒、苦寒为主,以清热、养阴、透邪为治疗原则,根据温疫热毒所处上、中、下三焦病位不同及卫、气、营、血层次不同以辨证论治,邪在上焦者治以辛凉芳香甘寒法,邪在中焦者治以清热泻火法,邪在下焦者治以甘寒、苦寒合化阴气法。Objective:To explore the medication rules of WU Jutong in the treatment of pestilence based on data mining,in order to provide more theoretical basis and medication reference for clinical treatment of the febrile disease of pestilence.Method:By collecting and organizing the prescriptions in Volume 1"Febrile Disease of Pestilence Chapter"of WU Jutong's Collection of Case Histories,a database was established.SPSS Modeler 18.0,SPSS Statistics 25.0,and the Traditional Chinese Medicine Inheritance Calculation Platform software(V3.0)were used to analyze the frequency,drug properties,taste,meridian distribution,efficacy,and high-frequency drug combinations.The medication rules were explored through association rules,cluster analysis,and factor analysis.Results:A total of 113 prescriptions were screened,involving 81 medicines,among which 27 were used with a frequency≥10,and the top 5 medicines were Maidong(Ophiopogonis Radix),Shengdihuang(Rehmanniae Radix Exsiccata seu Recens),Gancao(Glycyrrhizae Radix),Mudanpi(Moutan Cortex),and Lianqiao(Forsythiae Fructus).The four Qi were mainly cold and the five flavors were mainly bitter and sweet.The meridian were mainly directed towards the lungs,stomach,and heart meridians.The most common drugs were heat-clearing medicines,followed by tonifying medicines and relieving exterior syndrome medicines.There were 41 groups of high frequency drug combinations,9 drug association rules,4 clustering methods and 8 common factors.Conclusion:WU Jutong's medication for pestilence was mainly sweet-cold and bitter-cold,with the principles of clearing heat,nourishing Yin,and removing pathogenic factors.According to the different locations of the upper,middle and lower in Sanjiao and the different levels of Wei,Qi,Ying,and Blood,the pestilence should be treated according to syndrome differentiation.For the evil in the upper,use the method of spicy,cool,aromatic,sweet and cold,for the evil in the middle,use the method of clearing heat and purging fire,and for the evil in the lower,use the method o

关 键 词：温疫 吴鞠通 《吴鞠通医案》 用药规律 三焦辨证 数据挖掘 

分 类 号：R254.3[医药卫生—中医内科学]